Valutazione economica in base allo studio NAVoTRIAL01 con riferimento al contesto sanitario italiano: Vinorelbine orale e Cisplatino o Pemetrexed e Cisplatino seguiti da mantenimento rispettivamente con Vinorelbine orale e Pemetrexed nel trattamento del Carcinoma Polmonare Non a Piccole Cellule Non Squamoso (NS-NSCLC) in stadio avanzato

Background Vinorelbine and Cisplatin is a standard treatment in non small cell lung cancer; oral Vinorelbine is registered in 45 countries. Pemetrexed and Cisplatin are recommended in front-line chemotherapy of non-squamous non small cell lung cancer (NS-NSCLC). An economic evaluation of oral Vinorelbine plus Cisplatin and Pemetrexed plus Cisplatin was implemented in NS-NSCLC patients, adopting specific costs and clinical settings reflecting the Italian practice

The 2010 Maule, Chile earthquake: Downdip rupture limit revealed by space geodesy

Radar interferometry from the ALOS satellite captured the coseismic ground deformation associated with the 2010 Mw 8.8 Maule, Chile earthquake. The ALOS interferograms reveal a sharp transition in fringe pattern at ~150 km from the trench axis that is diagnostic of the downdip rupture limit of the Maule earthquake. An elastic dislocation model based on ascending and descending ALOS interferograms and 13 near-field 3-component GPS measurements reveals that the coseismic slip decreases more or less linearly from a maximum of 17 m (along-strike average of 6.5 m) at 18 km depth to near zero at 43–48 km depth, quantitatively indicating the downdip limit of the seismogenic zone. The depth at which slip drops to near zero appears to be at the intersection of the subducting plate with the continental Moho. Our model also suggests that the depth where coseismic slip vanishes is nearly uniform along the strike direction for a rupture length of ~600 km. The average coseismic slip vector and the interseismic velocity vector are not parallel, which can be interpreted as a deficit in strike-slip moment release

Bone metastases and immunotherapy in patients with advanced non-small-cell lung cancer

Background Bone metastases (BoM) are a negative prognostic factor in non-small-cell lung cancer (NSCLC). Beyond its supportive role, bone is a hematopoietic organ actively regulating immune system. We hypothesized that BoM may influence sensitivity to immunotherapy. Methods Pretreated non-squamous (cohort A) and squamous (cohort B) NSCLCs included in the Italian Expanded Access Program were evaluated for nivolumab efficacy according to BoM. Results Cohort A accounted for 1588 patients with non-squamous NSCLC, including 626 (39%) with (BoM+) and 962 (61%) without BoM (BoM-). Cohort B accounted for 371 patients with squamous histology including 120 BoM+ (32%) and 251 (68%) BoM- cases. BoM+ had lower overall response rate (ORR; Cohort A: 12% versus 23%, p < 0.0001; Cohort B: 13% versus 22%, p = 0.04), shorter progression free survival (PFS; Cohort A: 3.0 versus 4.0 months, p < 0.0001; Cohort B: 2.7 versus 5.2 months, p < 0.0001) and overall survival (OS; Cohort A: 7.4 versus 15.3 months, p < 0.0001; Cohort B: 5.0 versus 10.9 months, p < 0.0001). Moreover, BoM negatively affected outcome irrespective of performance status (PS; OS in both cohorts: p < 0.0001) and liver metastases (OS cohort A: p < 0.0001; OS Cohort B: p = 0.48). At multivariate analysis, BoM independently associated with higher risk of death (cohort A: HR 1.50; cohort B: HR 1.78). Conclusions BoM impairs immunotherapy efficacy. Accurate bone staging should be included in clinical trials with immunotherapy

The prognostic role of nephrectomy in patients (pts) with metastatic renal cell carcinoma (mRCC) treated with immunotherapy according to the novel prognostic Meet-URO score: Subanalysis of the Meet-URO 15 study

Background: Most of mRCC pts with favorable and intermediate prognosis, according to the IMDC classification, are offered a nephrectomy. However, in the immunotherapy era, the role of nephrectomy is still unclear. In the Meet-URO 15 study we reported the higher prognostic accuracy of the Meet-URO score compared to the IMDC score, by the addition of the neutrophil-to-lymphocyte ratio (NLR) and the presence of bone metastases to the IMDC score, identifying five categories with progressively worse prognosis. For this reason, we aimed to explore the prognostic impact of the previous nephrectomy (PN) on mRCC pts receiving immunotherapy and according to the Meet-URO score groups. Methods: The Meet-URO 15 study was a multicentric retrospective analysis on 571 pretreated mRCC pts receiving nivolumab. Univariable analysis of the correlation between PN and overall survival (OS) and multivariate analysis adjusted for IMDC score, therapy line, NLR and metastatic sites were performed. The interaction of PN with the Meet-URO prognostic groups was then evaluated. Results: 503/571 pts (88%) underwent PN. A reduced risk of death (HR = 0.44; 95% CI: 0.32-0.60; p< 0.001) and higher mOS and OS rate were observed in pts with PN than without (mOS: 36 vs 13 monhts; 1-year-OS 72% vs 52% and 2-year-OS 57% vs 24%, respectively). The reduced risk of death for pts who underwent PN was confirmed at the multivariate analysis (HR = 0.69; 95% CI: 0.49-0.97; p= 0.032). The percentage of pts receiving PN progressively reduced through the five Meet-URO prognostic groups (PN: group 1: 98%, group 2: 95%, group 3: 84%, group 4: 79%, group 5: 59%). No significant interaction was observed between the PN and Meet-URO score when all the five groups were considered (p= 0.17). A significant interaction was observed when the Meet-URO groups 1,2 and 3 were taken together (HR = 0.40; 95% CI: 0.25-0.63; p< 0.001), highlighting the significant protective role of the PN on OS for these three groups. For the Meet-URO groups 4 and 5, the interaction was indeed not significant (HR = 0.81; 95% CI: 0.51-1.30; p= 0.39). Conclusions: PN has a favourable prognostic impact on pretreated mRCC pts receiving immunotherapy. This benefit may be limited to mRCC pts with more favorable diseases as belonging to Meet-URO prognostic groups 1, 2 and 3. Further analysis of the type of PN (i.e., radical vs cytoreductive) is ongoing and confirmatory prospective evaluations are warranted

The prognostic value of the previous nephrectomy in pretreated metastatic renal cell carcinoma receiving immunotherapy: a sub-analysis of the Meet-URO 15 study

Nephrectomy is considered the backbone of managing patients with localized and selected metastatic renal cell carcinoma (mRCC). The prognostic role of nephrectomy has been widely investigated with cytokines and targeted therapy, but it is still unclear in the immunotherapy era

La Imagen y la Narrativa como Herramientas para el Abordaje Psicosocial en Escenarios de Violencia, Municipios de Covarachia, Soata, Socotá Departamento de Boyacá y Municipio de Ibagué Departamento de Tolima

El presente trabajo es el producto del desempeño elaborado en el estudio de escenarios de violencia en ampliación y guarnición de forma Psicosocial de las circunstancias en las vehemencias, acaparando en modo de apoyo hacia la perspectiva Narrativa, que por lo tanto busca dar importancia a la manifestación de equilibrios e intersubjetividades como instrumento valiosa para ofrecer una ayuda a las victimas obteniendo efectos producido en ellas, y aborde a ser representado como destrezas establecidas en los argumentos en que se proporcionaron y a partir de allí adquieran también una autonomía narrativa que los empodere para procesar de una circunstancia cambiante de víctima a supervivientes y de igual forma reformar su autoestima, su equivalencia, sus existencias y sus anhelos. Tomamos como instrumentos, el concepto y la narrativa hacia la observación y colisión psicosocial de textos de violencia a partir de otras crónicas, además se dio contestación a las preguntas orientadoras que facilitaran la formación de un moderno entendimiento y comprender el conflicto a partir de una contemplación perceptiva de esa situación que día a día vive el pueblo colombiano. Después, de abatir de la discusión grupal se eligió el relato de (Ana Ligia), hacia el correspondiente abordaje psicosocial y de esta manera suministrar desarrollo y especulación semejante, inmediatamente se realiza una documentación de exposición final, de igual forma se procrea el irreal de un encuentro con la intérprete de la narración, con la intención de enunciar interrogantes correspondientes; por lo tanto los integrantes de la actividad colaborativa fabricaran unos ejemplo, que están conformados en tres métodos los cuales son, estratégico, circulares y reflexivas, con su correspondiente justificación, con la conclusión de determinar la aptitud frente a una aproximación psicosocial y proactivo en el avance a las situaciones de perjudicarían a las víctimas de la guerra. De esta manera, el grupo colaborativo creó un análisis de caso de la Comunidad Cacarica, especulando y detallando operaciones en base a los actos sucedidos, para formar tres maniobras de resistencia que sobrelleve a las personas intérpretes a potencializar sus bienes y ejercer uso de fundamentos que les admita incorporarse al ambiente ostentado. Para concluir, se anexa el informe ordenado y reflexivo elaborado en el paso tres de la experiencia desarrollada en la foto voz como fundamento al progreso del diplomado de profundización y acompañamiento. Palabras Claves: abordaje psicosocial, Subjetividad, Violencia, Comunidad, Resiliencia, DesplazamientoThe present working is the product of a performance elaborated in the study of scenarios of violence in expansion and garrison of psychosocial form of circumstances in vehemences, gaining support for the Narrative perspective, which therefore seeks to give importance to the manifestation of balances and intersubjectivities as a valuable instrument to offer help to victims by obtaining effects produced in them, and try to be represented as established skills in the arguments in which they were provided and from there also acquire a narrative autonomy that empowers them to process from a changing circumstance of victim to survivors and likewise reform their self-esteem, their equivalence, their stocks and their desires. We take instruments, the concept and the narrative towards the observation and psychosocial collision of texts of violence from other chronicles, answers were also given to the guiding questions that would facilitate the formation of a modern understanding and understand the conflict from a perceptive contemplation of the situation that the Colombian people live day by day. After the group discussion, the story of (Ana Ligia) was chosen, towards the corresponding psychosocial approach and in this way to provide similar development and speculation, there is immediately a documentation of final exposition, likewise the unreal encounter with the interpreter of the narration is procreated, with the intention of enunciating corresponding interrogations; therefore the members of the collaborative activity will produce an example, which are composed of three methods which are strategic, circular and reflective, with their corresponding justification, with the conclusion of determining the suitability for a psycho-social and proactive approach in progressing to situations of harm to war victims. In this way, the collaborative group created a case analysis of the Cacarica Community, speculating and detailing operations on the basis of the acts that have taken place, to form three resistance manoeuvres that will lead the interpreters to enhance their assets and to use foundations that will allow them to enter the atmosphere. In conclusion, the ordered and reflective report elaborated in step three of the experience developed in the photo voice is attached as a foundation to the progress of the diploma of deepening and accompaniment. Keywords: psychosocial approach Subjectivity, Violence, Community, Resilience, Displacemen

Metronomic oral vinorelbine in patients with advanced non-small cell lung cancer progressing after nivolumab immunotherapy: a retrospective analysis

The availability of immune checkpoint inhibitors has deeply changed the therapeutic scenario of patients with advanced non-small cell lung cancer (NSCLC). Up until now, chemotherapy still represents the first-line treatment for patients with advanced NSCLC not harbouring genetic mutations or lacking high expression of programmed death ligand even if the addition of immunotherapy to first-line chemotherapy has recently been shown to improve clinical outcome. We carried out a multi-institutional retrospective analysis on third-line chemotherapy with metronomic oral vinorelbine (VNR) in a series of patients with metastatic NSCLC pre-treated with first-line chemotherapy and second-line immunotherapy