Combination of Lenvatinib and Pembrolizumab Is an Effective Treatment Option for Anaplastic and Poorly Differentiated Thyroid Carcinoma

Background: Anaplastic thyroid carcinoma (ATC) and metastatic poorly differentiated thyroid carcinomas (PDTCs) are rare aggressive malignancies with poor overall survival (OS) despite extensive multimodal therapy. These tumors are highly proliferative, with frequently increased tumor mutational burden (TMB) compared with differentiated thyroid carcinomas, and elevated programmed death ligand 1 (PD-L1) levels. These tumor properties implicate responsiveness to antiangiogenic and antiproliferative multikinase inhibitors such as lenvatinib, and immune checkpoint inhibitors such as pembrolizumab. Patients and Methods: In a retrospective study, we analyzed six patients with metastatic ATC and two patients with PDTC, who received a combination therapy of lenvatinib and pembrolizumab. Lenvatinib was started at 14-24 mg daily and combined with pembrolizumab at a fixed dose of 200 mg every three weeks. Maximum treatment duration with this combination was 40 months, and 3 of 6 ATC patients are still on therapy. Patient tumors were characterized by whole-exome sequencing and PD-L1 expression levels (tumor proportion score [TPS] 1-90%). Results: Best overall response (BOR) within ATCs was 66% complete remissions (4/6 CR), 16% stable disease (1/6 SD), and 16% progressive disease (1/6 PD). BOR within PDTCs was partial remission (PR 2/2). The median progression-free survival was 17.75 months for all patients, and 16.5 months for ATCs, with treatment durations ranging from 1 to 40 months (1, 4, 11, 15, 19, 25, 27, and 40 months). Grade III/IV toxicities developed in 4 of 8 patients, requiring dose reduction/discontinuation of lenvatinib. The median OS was 18.5 months, with three ATC patients being still alive without relapse (40, 27, and 19 months) despite metastatic disease at the time of treatment initiation (UICC and stage IVC). All patients with long-term (>2 years) or complete responses (CRs) had either increased TMB or a PD-L1 TPS >50%. Conclusions: Our results implicate that the combination of lenvatinib and pembrolizumab might be safe and effective in patients with ATC/PDTC and can result in complete and long-term remissions. The combination treatment is now being systematically examined in a phase II clinical trial (Anaplastic Thyroid Carcinoma Lenvatinib Pembrolizumab [ATLEP]) in ATC/PDTC patients.

P5257Prediction of 12-month cardiovascular event-free survival with regadenoson perfusion cardiovascular magnetic resonance

Background

To identify and stratify coronary artery disease (CAD) non-invasively, cardiovascular magnetic resonance (CMR) derived perfusion imaging holds a class Ia recommendation.

As Gold standard, hyperemia is induced by an intravenous application of adenosine in a body weight adapted dosage over a constant time. However, adenosin has two disadvantages: 1.) efficacy of adenosine to induce maximal hyperemia via peripheral line is imperfect and 2.) additional adenosine specific effects exclude patients having comorbidities (e.g. AV-blocks and obstructive lung disease). Fortunately, regadenoson as aselective A2A-receptor agonist has the main advantages of being easier to handle (bolus application) and to be not restricted to patients without specific comorbidities. However, there is a lack of comprehensive data on the prognostic value of regadenoson perfusion CMR to predict clinical endpoints. To assess the predictive value of regadenoson perfusion CMR, our hypothesis was, that a “negative” ischemia test result by regadenoson-CMR predicted freedom from MACE at 12 month.

Methods

676 patients, with known or suspected CAD with intermediate risk were retrospectively analyzed from May 2015 till December 2016. Cardiovascular risk factors (CVRF) like age, sex, arterial hypertension, dis-/hyperlipidemia, cigarette smoking status and diabetes were documented. All included patients received perfusion CMR (Philips 1.5 Tesla) with regadenoson (0.4 mg) and a positive ischemia test was defined as perfusion defects in ≥1,5 cardiac segments (using the 17-segment model). Major cardiovascular events (MACE) were defined as cardiovascular death, rehospitalisation due to myocardial infarction and rehospitalisation due to revascularization. The follow-up time was 12 month.

Results

80,3% (n=543) of all analyzed patients showed negative ischemia testing in CMR and were thus followed up for 12 month. From these patients, 284 (52,3%) had a pre-existing coronary artery disease. The mean age regarding only the patients with negative ischemia was 66 years (65% male and 35% female) with 1,35±1,03 CVRF. The primary endpoint (MACE) occurred in 6 patients (1,1%): 3 (0,6%) died due to cardiovascular events, 1 (0,2%) suffered from a myocardial infarction and 2 (0,4%) received coronary revascularization. Consequently, an event-free survival was correctly predicted in 98,9% of all patients. No undesirable adverse reactions have appeared.

Conclusion

Regadenoson-CMR predicts a very low MACE-rate and an event-free survival in 98,9% in over 500 patients. In our study, Regadenoson was well tolerated and no side effects were reported.

Effect of Concentration on the Interfacial and Bulk Structure of Ionic Liquids in Aqueous Solution

Bio and aqueous applications of ionic liquids (IL) such as catalysis in micelles formed in aqueous IL solutions or extraction of chemicals from biologic materials rely on surface-active and self-assembly properties of ILs. Here, we discuss qualitative relations of the interfacial and bulk structuring of a water-soluble surface-active IL ([C₈MIm][Cl]) on chemically controlled surfaces over a wide range of water concentrations using both force probe and X-ray scattering experiments. Our data indicate that IL structuring evolves from surfactant-like surface adsorption at low IL concentrations, to micellar bulk structure adsorption above the critical micelle concentration, to planar bilayer formation in ILs with <1 wt % of water and at high charging of the surface. Interfacial structuring is controlled by mesoscopic bulk structuring at high water concentrations. Surface chemistry and surface charges decisively steer interfacial ordering of ions if the water concentration is low and/or the surface charge is high. We also demonstrate that controlling the interfacial forces by using self-assembled monolayer chemistry allows tuning of interfacial structures. Both the ratio of the head group size to the hydrophobic tail volume as well as the surface charging trigger the bulk structure and offer a tool for predicting interfacial structures. Based on the applied techniques and analyses, a qualitative prediction of molecular layering of ILs in aqueous systems is possible.

Abstract P6-15-10: Withdrawn

This abstract was withdrawn by the authors.

[Single incision laparoscopy : Current status]

BACKGROUND

Since the introduction of single incision laparoscopy (SIL), there has been disagreement among professional societies regarding a general recommendation for the use of this minimally invasive method.

OBJECTIVES

Determination of evidence-based advantages of SIL compared to multiport laparoscopy (MPL).

MATERIALS AND METHODS

Description of recent technical developments and evaluation of prospective randomized clinical trials and valid meta-analyses with regard to organ-specific procedures. In addition, an expert opinion is provided based on 4209 SIL interventions.

RESULTS

SIL is nowadays applied in all fields of general and visceral surgery. Due to the initial enthusiasm, methodologically weak studies were often published in the literature. Any beneficial effect of SIL on reduced perioperative morbidity is not clearly confirmed, yet. A better cosmetic outcome is either obvious (in SIL liver resections) or nearly unverifiable (in SIL cholecystectomies).

CONCLUSION

SIL has proven feasible and safe after getting through the learning curve. Scientific evidence is currently insufficient to justify SIL without reservation in particular without the individual technical experience of the surgeon.

ECSPECT prospective multicentre registry for single-port laparoscopic colorectal procedures

BACKGROUND

The international multicentre registry ECSPECT (European Consensus of Single Port Expertise in Colorectal Treatment) was established to evaluate the general feasibility and safety of single-port colorectal surgery with regard to preoperative risk assessment.

METHODS

Consecutive patients undergoing single-port colorectal surgery were enrolled from 11 European centres between March 2010 and March 2014. Data were analysed to assess patient-, technique- and procedure-dependent parameters. A validated sex-adjusted risk chart was developed for prediction of single-port colorectal surgery-related conversion and complications.

RESULTS

Some 1769 patients were enrolled, 937 with benign and 832 with malignant conditions. Procedures were completed without additional trocars in 1628 patients (92·0 per cent). Conversion to open surgery was required in 75 patients (4·2 per cent) and was related to male sex and ASA fitness grade exceeding I. Conversions were more frequent in pelvic procedures involving the rectum compared with abdominal procedures (8·1 versus 3·2 per cent; odds ratio 2·69, P < 0·001). Postoperative complications were observed in a total of 224 patients (12·7 per cent). Independent predictors of complications included male sex (P < 0·001), higher ASA grade (P = 0·006) and rectal procedures (P = 0·002). The overall 30-day mortality rate was 0·5 per cent (8 of 1769 patients); three deaths (0·2 per cent; 1 blood loss, 2 leaks) were attributable to surgical causes.

CONCLUSION

The feasibility and safety, conversion and complication profile demonstrated here provides guidance for patient selection.

The incidence of psychoses in diverse settings, INTREPID (2): a feasibility study in India, Nigeria, and Trinidad

BACKGROUND

There are striking global inequities in our knowledge of the incidence, aetiology, and outcome of psychotic disorders. For example, only around 10% of research on incidence of psychotic disorders originates in low- and middle-income countries. We established INTREPID I to develop, implement, and evaluate, in sites in India (Chengalpet), Nigeria (Ibadan), and Trinidad (Tunapuna-Piarco), methods for identifying and recruiting untreated cases of psychosis, as a basis for investigating incidence and, subsequently, risk factors, phenomenology, and outcome. In this paper, we compare case characteristics and incidence rates across the sites.

METHOD

In each site, to identify untreated cases of psychoses in defined catchment areas, we established case detection systems comprising mental health services, traditional and spiritual healers, and key informants.

RESULTS

Rates of all untreated psychoses were 45.9 (per 1 00 000 person-years) in Chengalpet, 31.2 in Ibadan, and 36.9 in Tunapuna-Piarco. Duration of psychosis prior to detection was substantially longer in Chengalpet (median 232 weeks) than in Ibadan (median 13 weeks) and Tunapuna-Piarco (median 38 weeks). When analyses were restricted to cases with a short duration (i.e. onset within preceding 2 years) only, rates were 15.5 in Chengalpet, 29.1 in Ibadan, and 26.5 in Tunapuna-Piarco. Further, there was evidence of age and sex differences across sites, with an older average age of onset in Chengalpet and higher rates among women in Ibadan.

CONCLUSION

Our findings suggest there may be differences in rates of psychoses and in the clinical and demographic profiles of cases across economically and socially distinct settings.

Duplex sonography of the mesenteric vessels--a critical evaluation of inter-observer variability

INTRODUCTION

The number of publications concerning mesenteric Doppler sonography (mesDS) is immense and does not correlate with the frequency of its use in clinical practice. This is astonishing since it provides real time blood flow (perfusion) information without side effects. Despite uncontrollable parameters like the technical limitations in some situations the optimization of (possibly) controllable parameters like standardization, production of normal values and reduction of the investigator variability by evaluating stable parameters could change the situation.

PATIENTS AND METHODS

10 investigators experienced in abdominal sonography ("DEGUM-Seminarleiter") performed mesenteric Doppler sonography in 5 healthy subjects with 5 different machines.

RESULTS

The portal vein at the confluence and the common hepatic artery provide a significant portion of investigations with intromission angles of more than 60°. Values of diameter, resistance index and pulsatility index of the celiac trunc could be obtained with inter-observer variability values below 25 %. The proper and the common hepatic artery show no differences in inter-observer variability values, whereas the intrahepatic measure point of the portal vein showed a higher reproducibility.

DISCUSSION

We define frame conditions for future mesenteric Doppler studies: the portal vein should be investigated at the intrahepatic measure point. Pathophysiological studies should refrain from velocity parameters except in the case of larger vessels running in a straight course towards the probe.

Hemostatic effects of two desogestrel-containing combined oral contraceptive regimens: a multinational, multicenter, randomized, open-label study

PURPOSE OF INVESTIGATION

To compare the effects of desogestrel (DSG) 150 mcg/ethinyl estradiol (EE) 20 mcg for 21 days followed by either seven days of EE ten mcg (21/7-active) or no treatment (DSG/EE+no Tx) on hemostatic markers.

MATERIALS AND METHODS

This was a randomized, multicenter, open-label study that enrolled healthy premenopausal women. Non-inferiority of 21/7-active to DSG/EE+no Tx was determined if the upper limit of the two-sided 95% CI of the mean treatment difference in prothrombin fragment 1+2 (F1+2) over 24 weeks between groups was < 130 pmol/L.

RESULTS

246 subjects (n = 125, 21/7-active; n = 121, DSG/EE+no Tx) comprised the primary analysis. Mean F1+2 levels increased in both 21/7-active and DSG/EE+no Tx regimens (least square [LS] mean changes +45 pmol/L and +56.8 pmol/L, respectively). LS mean treatment difference was -11.8 pmol/L (95% CI: -54.8, 31.2).

CONCLUSION

The effect of adding EE ten mcg to the seven-day hormone-free interval of DSG/EE on F1+2 levels was non-inferior to traditional DSG/EE.

Sexual risk behavior, alcohol use, and social media use among secondary school students in informal settlements in Cape Town and Port Elizabeth, South Africa

South Africa's HIV prevalence among young people remains among the highest in the world. A cross-sectional study was carried out in 2012 to estimate prevalences of sexual risk behavior and hazardous alcohol use (HAU) (via the Alcohol Use Disorder Identification Test) as well as to investigate potential associations between these outcomes and social media use. In all, 4485 students (mean age 15.66 years, SD 1.39) at 46 secondary schools in informal settlements in Cape Town and Port Elizabeth completed mobile-phone-assisted, self-administered baseline questionnaires within a cluster-randomized trial. In all, 312 females (12.5 %) and 468 males (23.5 %) screened positive for HAU (AOR = 1.98, 95 % CI 1.69-2.34). 730 males (39.9 %) and 268 females (11.8 %) reported having had two or more partners in the last year (AOR = 3.46, 95 % CI 2.87-4.16). Among females, having a Facebook account was associated with reported multiple partnerships in the last year (AOR = 1.81, 95 % CI 1.19-2.74), age-disparate sex in the last year (AOR = 1.96, 95 % CI 1.16-3.32) and HAU (AOR = 1.97, 95 % CI 1.41-2.74). Using Mxit-a popular mobile instant messaging application-was associated with higher odds of reported multiple partnerships in the last year among both males (AOR = 1.70, 95 % CI 1.35-2.14) and females (AOR = 1.45, 95 % CI 1.07-1.96) and with HAU among both males (AOR = 1.47, 95 % CI 1.14-1.90) and females (AOR = 1.50, 95 % CI 1.18-1.90). Further longitudinal and qualitative research should explore in more depth the observed links between social media and risk behavior.

Über die galvanomagnetischen Eigenschaften von InSb-Einkristallen mit Te-Dotierung

An InSb-Einkristallen mit einem Te-Gehalt größer 2·1016/cm3 wurde die Änderung des elektrischen Widerstandes im Magnetfeld in Abhängigkeit von Dotierung, magnetischer Induktion und Winkel zwischen Strom und magnetischer Induktion bei Zimmertemperatur, 78°K und 4,2°K gemessen. Es ergab sich eine scheinbare Anisotropie derart, daß die Werte der transversalen Widerstandsänderung mit Probenstrom parallel zur Wachstumsrichtung [111] immer größer waren, als wenn der Strom senkrecht zur Wachstumsrichtung floß. Die Unterschiede betrugen bis zu 2 Größenordnungen. Aus den Messungen des planaren HALL-Effektes folgt, daß in n-leitendem InSb bei Zimmertemperatur die Widerstandsänderung fast ausschließlich durch die gemischte Leitung verursacht wird. Dieser überlagert sich eine durch die Präparation bedingte Anisotropie.

Im Gegensatz zur Widerstandsänderung ist die Elektronenbeweglichkeit isotrop. Der HALL-Koeffizient ist im Bereich zwischen 100 Gauß und 10 kGauß innerhalb der Fehlergrenze von einigen Promillen konstant.

Die elektrischen Eigenschaften von Indiumarsenid II

Es werden Messungen der spez. Leitfähigkeit und des Hall-Koeffizienten der halbleitenden Verbindung InAs mitgeteilt und diskutiert. Für die Breite der verbotenen Zone am absoluten Nullpunkt der Temperatur ergibt sich der Wert 0,47 ± 0,02 eV. Ihre Temperaturabhängigkeit ist angenähert —4,5·10-4 eV/°K. Die Elektronenbeweglichkeit hat bei Zimmertemperatur einen Maximalwert von etwa 30000 cm2/Vsec, die Löcherbeweglichkeit von etwa 200 cm2/Vsec.

Die elektrischen Eigenschaften von Indiumantimonid II

Es werden Messungen der spez. Leitfähigkeit und des Hall-Koeffizienten der halbleitenden Verbindung InSb mitgeteilt und diskutiert. Für die Breite der verbotenen Zone ergibt sich der Wert ΔE = 0,27-3·10-4T(eV). Die Elektronenbeweglichkeit ist etwa 65 000 (T/300)-1,66 cm2/Vsec. Die Löcherbeweglichkeit ist wesentlich kleiner und besitzt eine stärkere Temperaturabhängigkeit. Infolge des großen Beweglichkeitsverhältnisses muß bereits bei relativ kleinen Temperaturen die Entartung berücksichtigt werden.

Bestimmung der effektiven Massen in InSb und InAs aus Messungen der differentiellen Thermospannung

Es wurde die differentielle Thermospannung an 3 p- und 5 n-leitenden Präparaten aus InAs und an 2 p-Proben aus InSb bis 800° K gemessen. Daraus ergeben sich für die effektiven Massen in InAs zwischen 500 und 800° K folgende Werte:

mn = 0,064 m0; mp = 0,33 m0 .

In InSb erhält man bei 333° K

mn=0,037 m0; mp = 0,18 m0.

Die effektive Elektronenmasse in InSb wächst mit zunehmender Temperatur und erreicht schließlich 0,05 m0 kurz unterhalb des Schmelzpunktes.

Über die elektrischen Eigenschaften von Mischkristallen der Form In(Asy P1-y)

Bei Mischkristallen der Form In (Asy P1-y) nimmt nach elektrischen Messungen die Breite der verbotenen Zone am absoluten Nullpunkt proportional zum Phosphorgehalt zu, während gleichzeitig Elektronen- und Löcherbeweglichkeit unter Wahrung eines großen Beweglichkeitsverhältnisses kleiner werden. Die Mischkristalle lassen sich wie die einzelnen Verbindungen zur p- und n-Leitung dotieren.

Volatile organic compounds effective diffusion coefficients and fluxes estimation through two types of construction material

Accumulation of volatile organic compounds (VOCs) that migrate inside buildings from underlying contaminated soils and groundwater poses human health risks. VOCs intrusion into buildings driven only by diffusion was reproduced by a laboratory-scale experiment. Effective diffusion coefficients and fluxes of a group of selected chlorinated solvents and BTEX through two types of isolation material - that is, concrete (anhydrite screed) and geo-membrane - were estimated. The laboratory experiment indicated that the diffusive transfer of pollutants through sediments into indoor air of buildings cannot be prevented by building sealing material, but it could be attenuated to a certain degree by concrete and up to non-detectable levels by the geo-membrane. Effective diffusion coefficients through concrete and geo-membrane ranged from 3.17 × 10(-2) to 5.90 × 10(-5) cm(2) /s and from 5.47 × 10(-6) to 5.50 × 10(-8) cm(2) /s, respectively.

PRACTICAL IMPLICATIONS

The vapor intrusion of volatile organic compounds (VOCs) into buildings has special relevance in human health risk assessment. Prediction of indoor air VOCs concentration by applying numerical or analytical models eventually fails due to the lack of input parameters, such as the VOCs effective diffusion coefficient through building material used as foundation or isolation material. Passive migration of VOCs from contaminated sites into indoor air through construction and isolation materials has not been extensively investigated. Our findings showed that the mass flux through building material is not negligible, but it could be reduced partly, and to a minimum, with the utilization of concrete and geo-membranes, respectively. As a result of our investigation, effective diffusion coefficients of BTEX and chlorinated solvents, as well as the correlation between specific compounds’ parameters and the estimated effective diffusion coefficient, are provided.

Predictors of outcome in patients with common mental disorders receiving a brief psychological treatment: an exploratory analysis of a randomized controlled trial from Goa, India

OBJECTIVE

A randomized placebo-controlled trial of treatment for common mental disorders in Goa, India found that psychological treatment (problem-solving) was no more effective than placebo. The study aimed to identify factors predicting outcome amongst participants receiving the psychological treatment, as measured by score on the Revised Clinical Interview Schedule (CISR).

METHOD

The CISR scores at 2 months, 6 months and 12 months were modelled using multiple linear regression with a random effect for patients. Two types of variables were examined. Patient variables were age; sex; religion; education; marital status; severity of psychiatric morbidity at recruitment; and severity of social and life problems faced by the subject. Treatment variables were number of sessions attended and the hospital site.

RESULTS

About half the participants had a depressive disorder; most of the remainder had mixed anxiety-depression. Overall adherence with the intervention was low; more than a third of patients attended only one session. Attending a greater number of sessions and facing a severe life problem were significantly associated with a worse outcome (p<0.005).

CONCLUSION

The severe nature of life problems faced by some patients with common mental disorders may limit the efficacy of clinic-based psychological treatments in low income countries.

A comparison of nine scales to detect depression in Parkinson disease: which scale to use?

OBJECTIVE

The Methods of Optimal Depression Detection in Parkinson's Disease (MOOD-PD) study compared the psychometric properties of 9 depression scales to provide guidance on scale selection in Parkinson disease (PD).

METHODS

Patients with PD (n = 229) from community-based neurology practices completed 6 self-report scales (Beck Depression Inventory [BDI]-II, Center for Epidemiologic Studies Depression Rating Scale-Revised [CESD-R], 30-item Geriatric Depression Scale [GDS-30], Inventory of Depressive Symptoms-Patient [IDS-SR], Patient Health Questionnaire-9 [PHQ-9], and Unified Parkinson's Disease Rating Scale [UPDRS]-Part I) and were administered 3 clinician-rated scales (17-item Hamilton Depression Rating Scale [HAM-D-17], Inventory of Depressive Symptoms-Clinician [IDS-C], and Montgomery-Åsberg Depression Rating Scale [MADRS] and a psychiatric interview. DSM-IV-TR diagnoses were established by an expert panel blinded to the self-reported rating scale data. Receiver operating characteristic curves were used to estimate the area under the curve (AUC) of each scale.

RESULTS

All scales performed better than chance (AUC 0.75-0.85). Sensitivity ranged from 0.66 to 0.85 and specificity ranged from 0.60 to 0.88. The UPDRS Depression item had a smaller AUC than the BDI-II, HAM-D-17, IDS-C, and MADRS. The CESD-R also had a smaller AUC than the MADRS. The remaining AUCs were statistically similar.

CONCLUSIONS

The GDS-30 may be the most efficient depression screening scale to use in PD because of its brevity, favorable psychometric properties, and lack of copyright protection. However, all scales studied, except for the UPDRS Depression, are valid screening tools when PD-specific cutoff scores are used.