Nivolumab plus cabozantinib versus sunitinib for first-line treatment of advanced renal cell carcinoma: extended follow-up from the phase III randomised CheckMate 9ER trial

BACKGROUND

Nivolumab plus cabozantinib (NIVO + CABO) was approved for first-line treatment of advanced renal cell carcinoma (aRCC) based on superiority versus sunitinib (SUN) in the phase III CheckMate 9ER trial (18.1 months median survival follow-up per database lock date); efficacy benefit was maintained with an extended 32.9 months of median survival follow-up. We report updated efficacy and safety after 44.0 months of median survival follow-up in intent-to-treat (ITT) patients and additional subgroup analyses, including outcomes by International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic risk score.

PATIENTS AND METHODS

Patients with treatment-naïve aRCC received NIVO 240 mg every 2 weeks plus CABO 40 mg once daily or SUN 50 mg for 4 weeks (6-week cycles), until disease progression/unacceptable toxicity (maximum NIVO treatment, 2 years). Primary endpoint was progression-free survival (PFS) per blinded independent central review (BICR). Secondary endpoints were overall survival (OS), objective response rate (ORR) per BICR, and safety and tolerability.

RESULTS

Overall, 323 patients were randomised to NIVO + CABO and 328 to SUN. Median PFS was improved with NIVO + CABO versus SUN [16.6 versus 8.4 months; hazard ratio (HR) 0.59; 95% confidence interval (CI) 0.49-0.71]; median OS favoured NIVO + CABO versus SUN (49.5 versus 35.5 months; HR 0.70; 95% CI 0.56-0.87). ORR (95% CI) was higher with NIVO + CABO versus SUN [56% (50% to 62%) versus 28% (23% to 33%)]; 13% versus 5% of patients achieved complete response, and median duration of response was 22.1 months versus 16.1 months, respectively. PFS and OS favoured NIVO + CABO over SUN across intermediate, poor and intermediate/poor IMDC risk subgroups; higher ORR and complete response rates were seen with NIVO + CABO versus SUN regardless of IMDC risk subgroup. Any-grade (grade ≥3) treatment-related adverse events occurred in 97% (67%) versus 93% (55%) of patients treated with NIVO + CABO versus SUN.

CONCLUSIONS

After extended follow-up, NIVO + CABO maintained survival and response benefits; safety remained consistent with previous follow-ups. These results continue to support NIVO + CABO as a first-line treatment for aRCC.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03141177.

350 mJ electro-optically Q-switched 2.79 µm Cr:Er:YSGG MOPA

We report on developing three flashlamp-pumped electro-optically Q-switched Cr:Er:YSGG lasers with the Q-switch based on a La3Ga5SiO14 crystal. The "short" laser cavity was optimized for high peak power applications. In this cavity, 300 mJ output energy in 15 ns pulses at a 3 Hz repetition rate was demonstrated with pump energy below 52 J. However, several applications, such as Fe:ZnSe pumping in a gain-switched regime, require longer (∼ 100 ns) pump pulse duration. We developed a 2.9 m long laser cavity that delivers 190 mJ of output energy in 85 ns pulses for these applications. We also demonstrated the Cr:Er:YSGG MOPA system producing 350 mJ output energy at 90 ns pulse duration and 47.5 J of pumping, corresponding to an amplification factor of 3.

POS0498 RELATIONSHIP BETWEEN IMPAIRED MELATONIN SECRETION AND DURATION, RADIOLOGICAL STAGE AND PHYSICAL ACTIVITY OF RHEUMATOID ARTHRITIS

Background:

There is a close relationship between the development of severe autoimmune diseases and disorders of the neuroendocrine immune regulation of the body [1]. The role of melatonin as the main mediator of neuroendocrinoimmune interactions in rheumatoid arthritis (RA) remains poorly understood [2].

Objectives:

The aim of the study was to determine the daily serum melatonin profile of RA patients with different duration of the disease, radiological stage and physical activity.

Methods:

The daily serum melatonin profile of patients with active RA (n=105, mean age 49.8±12.6 years, 75.5% of women) was compared with that of healthy subjects from the general population (n=30). In addition, we investigated daily serum melatonin secretion in relation to duration of the disease, radiological progression and physical activity (HAQ). Patients were divided into 4 groups depending on the RA duration (mean 8.4±6.6 years): 1st group - up to 2 years (n=12), 2nd group - 2-5 years (n=37), 3rd group - 6-10 years (n=26), 4th group - more than 10 years (n=30). Depending on the radiological progression, patients were divided into stages: 1st stage (n=16), 2nd stage (n=64), 3d stage (n=25). Melatonin serum levels was determined by the enzyme immunoassay at 8 and 20 o`clock. For statistical analysis were used the Man - Whitney test and the Spearman rank correlation method.

Results:

The melatonin serum levels in RA patients were in 2 and 3 times higher in the morning and evening time than those of healthy individuals in the control group (p=0.001). We noticed significant correlations between melatonin level and disease duration (rS =-0.5, p <0.01). Significant differences in melatonin levels were revealed in RA patients in 1st and 3rd groups (p=0.049), in 1st and 4th groups (p = 0.012), in 2nd and 3rd groups (p=0.001), in 2nd and 4th groups (p=0.001). Also we determined significant differences in melatonin levels between 1st and 2nd radiological stages (p =0,001) of RA patients. However, melatonin levels were not related to physical activity (HAQ).

Conclusion:

We found a close relationship between serum melatonin levels, duration of the disease and radiological progression in RA patients. The most significant changes in melatonin metabolism occur in patients with the duration of the disease up to 5 years and with lower radiological stages. Our data indicate the important role of neurotransmitter in the pathogenesis of RA, especially at the initial stage of the disease.

References:

[1]Sternberg EM. Neuroendocrine regulation of autoimmune/inflammatory disease. J Endocrinol. 2001 Jun;169(3):429-35. doi: 10.1677/joe.0.1690429. PMID: 11375112.

[2]Mańka S, Majewska E. Immunoregulatory action of melatonin. The mechanism of action and the effect on inflammatory cells. Postepy Hig Med Dosw (Online). 2016 Oct 4;70(0):1059-1067. doi: 10.5604/17322693.1221001. PMID: 27708210.

Disclosure of Interests:

None declared

Empirical study of the group delay dispersion achievable with multilayer mirrors

With the help of the most advanced algorithms we obtained many dozens of multilayer dispersive mirror designs to empirically find limits for the maximum achievable negative value of the group delay dispersion (GDD). This value depends on the total thickness of coatings and layer material combination. Nb(2)O(5)/SiO(2) and Ta(2)O(50/SiO(2) combinations are studied in detail, for combinations HfO(2)/SiO(2) and TiO(2)/SiO(2) we obtained estimations for two bandwidths. We also show that reasonable values of third-order dispersion have no significant impact on the obtained results. Current state-of-the-art technology allows to produce designs with total physical thicknesses slightly higher than 10 µm and to achieve maximum negative GDD values corresponding to this total design thickness. Designs with total physical thickness of 15 µm and 20 µm are not realized yet due to high sensitivity to deposition errors.

Multistage designs for vaccine safety studies

In a placebo-controlled vaccine safety trial, the primary interest is to demonstrate that the vaccine is sufficiently safe, rejecting the null hypothesis that the relative risk of an adverse event attributable to the vaccine is above a prespecified value, greater than one. We develop sequential as well as multistage designs for such trials where the interim analyses are conducted not after a given number of subjects but rather after a given number of events observed. We show that these designs achieve significant improvement over single-stage conditional test in terms of both the required number of events to be observed and the required number of subjects to be enrolled.

Pancreatic head cancer: accuracy of CT in determination of resectability

BACKGROUND

Pancreatic cancer is a devastating disease whose early detection remains difficult. There is no 100% reliable imaging test to diagnose and stage pancreatic cancer. We assessed the surgical value of contrast-enhanced spiral computed tomography (CT) in predicting the resectability and survival rates of patients who had pancreatic head cancer.

METHODS

Eighty-nine patients who had pancreatic head cancer were investigated with spiral CT. Based on the preoperative CT results, we assigned patients to one of three CT groups based on resectability.

RESULTS

A correlation between classification of CT resectability and intraoperative finding was found in 83% of patients. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of spiral CT in identifying predictive unresectability were 79%, 82%, 91%, 62%, and 81%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT in diagnosis of vascular invasion were 94%, 84.2%, 94%, 84%, and 91.3%, respectively.

CONCLUSION

The use of CT in the evaluation of pancreatic tumors provides valuable preoperative assessment of surgical resectability and should be performed for clinical examination. Classifying patients by tumor resectability on CT helps to estimate more precisely the tumor stage and to prognosticate survival rates of these patients.

Multiwavelength mid-IR spatially-dispersive CW laser based on polycrystalline Cr2+:ZnSe

For the first time we demonstrate a multiwavelength, ultrabroadband, continuous-wave, tunable, polycrystalline Cr2+:ZnSe spatially-dispersive laser, operating in the near IR spectral region. We show a dual-wavelength operation of the laser, tunable over a 600 nm spectral range (2200-2800 nm), an ultrabroadband operation of the laser, producing a continuous 135 nm wide spectrum centered at 2500 nm, and show a 200 nm wide (2400-2600 nm) multiline, tunable output spectra, consisting of up to 40 spectral lines. We also show simultaneous tuning of a 20-lines ultrabroadband spectrum over a spectral range of 2200-2800 nm.

Estimation of the combined response to treatment in multicenter trials

Analyses of multicenter trials consider the estimated treatment effect differences of the individual centers and combine them into an estimate of the overall treatment effect. There has been much debate in the literature concerning the best way to combine these treatment effect differences. We emphasize that first of all one should define the combined response to treatment (CRT), the object that has to be estimated from the results of a multicenter clinical trial. It is shown that the choice of CRT determines not only the best estimator, but also the allocation of patients among the centers that minimizes the mean squared error. A new estimator of the CRT is proposed that is based on a preliminary clustering of the centers and the use of a weighted average of the Type I estimators obtained from within each cluster. The clustering aims to minimize the bias of the combined estimator. We show via a simulation study that the simple clustering procedure provides a reasonably improved estimator. The clustering can be done on blinded data, as long as the numbers of patients on each treatment arm in each center are known. The methodology is illustrated by analyzing a multicountry, multicenter trial to compare an active treatment with placebo for the treatment of a psychiatric disorder.

Isolation and characterization of a hantavirus from Lemmus sibiricus: evidence for host switch during hantavirus evolution

A novel hantavirus, first detected in Siberian lemmings (Lemmus sibiricus) collected near the Topografov River in the Taymyr Peninsula, Siberia (A. Plyusnin et al., Lancet 347:1835-1836, 1996), was isolated in Vero E6 cells and in laboratory-bred Norwegian lemmings (Lemmus lemmus). The virus, named Topografov virus (TOP), was most closely related to Khabarovsk virus (KBR) and Puumala viruses (PUU). In a cross focus reduction neutralization test, anti-TOP Lemmus antisera showed titers at least fourfold higher with TOP than with other hantaviruses; however, a rabbit anti-KBR antiserum neutralized TOP and KBR at the same titer. The TOP M segment showed 77% nucleotide and 88% amino acid identity with KBR and 76% nucleotide and 82% amino acid identity with PUU. However, the homology between TOP and the KBR S segment was disproportionately higher: 88% at the nucleotide level and 96% at the amino acid level. The 3' noncoding regions of KBR and the TOP S and M segments were alignable except for 113- and 58-nucleotide deletions in KBR. The phylogenetic relationships of TOP, KBR, and PUU and their respective rodent carriers suggest that an exceptional host switch took place during the evolution of these viruses; while TOP and KBR are monophyletic, the respective rodent host species are only distantly related.