50 research outputs found

    Blood serum amyloid A as potential biomarker of pembrolizumab efficacy for patients affected by advanced non-small cell lung cancer overexpressing PD-L1: results of the exploratory "FoRECATT" study

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    Background: Identifying the patients who may benefit the most from immune checkpoints inhibitors remains a great challenge for clinicians. Here we investigate on blood serum amyloid A (SAA) as biomarker of response to upfront pembrolizumab in patients with advanced non-small-cell lung cancer (NSCLC). Methods: Patients with PD-L1 ≥ 50% receiving upfront pembrolizumab (P cohort) and with PD-L1 0-49% treated with chemotherapy (CT cohort) were evaluated for blood SAA and radiological response at baseline and every 9 weeks. Endpoints were response rate (RR) according to RECIST1.1, progression-free (PFS) and overall survival (OS). The most accurate SAA cut-off to predict response was established with ROC analysis in the P cohort. Results: In the P Cohort (n = 42), the overall RR was 38%. After a median follow-up of 18.5 months (mo), baseline SAA ≤ the ROC-derived cut-off (29.9 mg/L; n = 28/42.67%) was significantly associated with higher RR (53.6 versus 7.1%; OR15, 95% CI 1.72-130.7, p = 0.009), longer PFS (17.4 versus 2.1 mo; p < 0.0001) and OS (not reached versus 7.2mo; p < 0.0001) compared with SAA > 29.9 mg/L. In multivariate analysis, low SAA positively affects PFS (p = 0.001) and OS (p = 0.048) irrespective of ECOG PS, number of metastatic sites and pleural effusion. SAA monitoring (n = 40) was also significantly associated with survival endpoints: median PFS 17.4 versus 2.1 mo and median OS not reached versus 7.2 mo when SAA remained low (n = 14) and high (n = 12), respectively. In the CT Cohort (n = 30), RR was not affected by SAA level (p > 0.05) while low SAA at baseline (n = 17) was associated with better PFS (HR 0.38, 95% CI 0.16-0.90, p = 0.006) and OS (HR 0.25, 95% CI 0.09-0.67, p < 0.001). Conclusion: Low SAA predicts good survival outcomes irrespective of treatment for advanced NSCLC patients and higher likelihood of response to upfront pembrolizumab only. The strong prognostic value might be exploited to easily identify patients most likely to benefit from immunotherapy. A further study (FoRECATT-2) is ongoing to confirm results in a larger sample size and to investigate the effect of SAA on immune response in vitro assays

    PTEN Loss as a Predictor of Tumor Heterogeneity and Poor Prognosis in Patients With EGFR-mutant Advanced Non-small-cell Lung Cancer Receiving Tyrosine Kinase Inhibitors

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    Background: Rapid disease progression of patients with advanced epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC) has been recently associated with tumor heterogeneity, which may be mirrored by coexisting concomitant alterations. The aim of this analysis was to investigate the correlation between loss of function of PTEN and the efficacy of tyrosine kinase inhibitors in this population. Materials and Methods: Archival tumor blocks from patients with EGFR-mutant NSCLC who were administered upfront tyrosine kinase inhibitors were retrospectively collected. The status of 4 genes (PTEN, TP53, c-MET, IGFR) was evaluated by immunohistochemistry, and it was correlated with overall response rate, overall survival (OS), and progression-free survival (PFS). Results: Fifty-one patients were included. In multivariate analysis, PTEN loss (hazard ratio [HR], 3.46; 95% confidence interval [CI], 1.56-7.66; P = .002), IGFR overexpression (HR, 2.22; 95% CI, 1.03-4.77; P = .04), liver metastases (HR, 3.55; 95% CI, 1.46-8.65; P = .005), and Eastern Cooperative Oncology Group performance status (ECOG PS) > 1 (HR, 2.57; 95% CI, 1.04-6.34; P = .04) were significantly associated with shorter PFS. Patients with PTEN loss had a median PFS of 6 months (2-year PFS, 11.6%), whereas patients without PTEN loss had a median PFS of 18 months (2-year PFS, 43.6%) (log-rank P < .005). In the multivariate analysis, PTEN loss (HR, 5.92; 95% CI, 2.37-14.81; P < .005), liver metastases (HR, 2.63; 95% CI, 1.06-6.51; P = .037), and ECOG PS > 1 (HR, 2.80; 95% CI, 1.15-6.81; P = .024) were significantly associated with shorter OS. Patients with PTEN loss had a median OS of 6 months (2-year OS, 12.2%), whereas in patients without PTEN loss, OS was not reached (2-year OS, 63.9%) (log-rank P < .0005).Conclusions: A low-cost and reproducible immunohistochemistry assay for PTEN loss analysis represents a potential tool for identifying tumor heterogeneity in patients with advanced EGFR-mutant NSCLC

    Smoking status during first-line immunotherapy and chemotherapy in NSCLC patients: A case–control matched analysis from a large multicenter study

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    Background: Improved outcome in tobacco smoking patients with non-small cell lung cancer (NSCLC) following immunotherapy has previously been reported. However, little is known regarding this association during first-line immunotherapy in patients with high PD-L1 expression. In this study we compared clinical outcomes according to the smoking status of two large multicenter cohorts. Methods: We compared clinical outcomes according to the smoking status (never smokers vs. current/former smokers) of two retrospective multicenter cohorts of metastatic NSCLC patients, treated with first-line pembrolizumab and platinum-based chemotherapy. Results: A total of 962 NSCLC patients with PD-L1 expression ≥50% who received first-line pembrolizumab and 462 NSCLC patients who received first-line platinum-based chemotherapy were included in the study. Never smokers were confirmed to have a significantly higher risk of disease progression (hazard ratio [HR] = 1.49 [95% CI: 1.15–1.92], p = 0.0022) and death (HR = 1.38 [95% CI: 1.02–1.87], p = 0.0348) within the pembrolizumab cohort. On the contrary, a nonsignificant trend towards a reduced risk of disease progression (HR = 0.74 [95% CI: 0.52–1.05], p = 0.1003) and death (HR = 0.67 [95% CI: 0.45–1.01], p = 0.0593) were reported for never smokers within the chemotherapy cohort. After a random case–control matching, 424 patients from both cohorts were paired. Within the matched pembrolizumab cohort, never smokers had a significantly shorter progression-free survival (PFS) (HR = 1.68 [95% CI: 1.17–2.40], p = 0.0045) and a nonsignificant trend towards a shortened overall survival (OS) (HR = 1.32 [95% CI: 0.84–2.07], p = 0.2205). On the contrary, never smokers had a significantly longer PFS (HR = 0.68 [95% CI: 0.49–0.95], p = 0.0255) and OS (HR = 0.66 [95% CI: 0.45–0.97], p = 0,0356) compared to current/former smoker patients within the matched chemotherapy cohort. On pooled multivariable analysis, the interaction term between smoking status and treatment modality was concordantly statistically significant with respect to ORR (p = 0.0074), PFS (p = 0.0001) and OS (p = 0.0020), confirming the significantly different impact of smoking status across the two cohorts. Conclusions: Among metastatic NSCLC patients with PD-L1 expression ≥50% receiving first-line pembrolizumab, current/former smokers experienced improved PFS and OS. On the contrary, worse outcomes were reported among current/former smokers receiving first-line chemotherapy

    Reproducibility of Multi-Objective Reinforcement Learning Recommendation: Interplay between Effectiveness and Beyond-Accuracy Perspectives

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    Providing effective suggestions is of predominant importance for successful Recommender Systems (RSs). Nonetheless, the need of accounting for additional multiple objectives has become prominent, from both the final users’ and the item providers’ points of view. This need has led to a new class of RSs, called Multi-Objective Recommender Systems (MORSs). These systems are designed to provide suggestions by considering multiple (conflicting) objectives simultaneously, such as diverse, novel, and fairness-aware recommendations. In this work, we reproduce a state-of-the-art study on MORSs that exploits a reinforcement learning agent to satisfy three objectives, i.e., accuracy, diversity, and novelty of recommendations. The selected study is one of the few MORSs where the source code and datasets are released to ensure the reproducibility of the proposed approach. Interestingly, we find that some challenges arise when replicating the results of the original work, due to the nature of multiple-objective problems. We also extend the evaluation of the approach to analyze the impact of improving user-centered objectives of recommendations (i.e., diversity and novelty) in terms of algorithmic bias. To this end, we take into consideration both popularity and category of the items. We discover some interesting trends in the recommendation performance according to different evaluation metrics. In addition, we see that the multi-objective reinforcement learning approach is responsible for increasing the bias disparity in the output of the recommendation algorithm for those items belonging to positively/negatively biased categories. We publicly release datasets and codes in the following GitHub repository: https://github.com/sisinflab/MORS_reproducibility

    A Hybrid Energy Storage Sizing for a Vertical Take-off and Landing Electric Aircraft

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    The energy storage sizing procedure for an all-electric aircraft, characterised by vertical take-off and landing (VTOL), is presented in the paper. In order to define the energy consumption, the propulsion system model has been developed and simulated, referring to a specific configuration of VOLT obtained by the transformation of a very light twin-propeller aircraft named Tecnam P2012 T. Specifically, a flight mission-oriented to air city taxing has been considered. The simulation results highlight the presence of significant peak power during take-off and landing. At the aim of optimising the weight and the volume of the energy storage systems (ESSs), considered a critical issue in all-electric aircraft (AEA), the sizing of electrochemical and Supercapacitors (SCs) hybrid ESS configurations have been investigated. In particular, the use of SCs is devoted to the smooth peak power demand of VTOL-AEA. A comparison between the simulation results of an electrochemical battery and hybrid ESSs, designed on the test mission of Tecnam P2012 T power demand, has been developed and presented

    A PV plant simulator for testing MPPT techniques

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    This paper introduces a versatile and reliable photovoltaic systems simulator. It includes the main components of a photovoltaic plant: a PV string and a PWM controlled boost chooper. The key feature of this simulator is the ability to consider different and non-uniform irradiation and temperature conditions (partial shading and partial heating of the strings). All the different I-V and P-V or P-I characteristics can then be determined in such non-uniform irradiation and temperature conditions, with the aim to try different MPPT algorithms. The simulator also allows to verify an enhanced version of the Incremental Conductance algorithm (IncCond) where, in order to reach the real absolute maximum power condition, the reference control current of the boost chopper are periodically reset to a given percentage of the short circuit current at standard conditions. After this perturbation, the steady state power values are registered and compared to establish the final value of reference current that allows the IncCond algorithm to reach a steady state at the real abolute maximum power transfer. © 2013 IEEE
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