Telotristat ethyl in carcinoid syndrome: safety and efficacy in the TELECAST phase 3 trial

Telotristat ethyl, a tryptophan hydroxylase inhibitor, was efficacious and well tolerated in the phase 3 TELESTAR study in patients with carcinoid syndrome (CS) experiencing ≥4 bowel movements per day (BMs/day) while on somatostatin analogs (SSAs). TELECAST, a phase 3 companion study, assessed the safety and efficacy of telotristat ethyl in patients with CS (diarrhea, flushing, abdominal pain, nausea or elevated urinary 5-hydroxyindoleacetic acid (u5-HIAA)) with <4 BMs/day on SSAs (or ≥1 symptom or ≥4 BMs/day if not on SSAs) during a 12-week double-blind treatment period followed by a 36-week open-label extension (OLE). The primary safety and efficacy endpoints were incidence of treatment-emergent adverse events (TEAEs) and percent change from baseline in 24-h u5-HIAA at week 12. Patients (N = 76) were randomly assigned (1:1:1) to receive placebo or telotristat ethyl 250 mg or 500 mg 3 times per day (tid); 67 continued receiving telotristat ethyl 500 mg tid during the OLE. Through week 12, TEAEs were generally mild to moderate in severity; 5 (placebo), 1 (telotristat ethyl 250 mg) and 3 (telotristat ethyl 500 mg) patients experienced serious events, and the rate of TEAEs in the OLE was comparable. At week 12, significant reductions in u5-HIAA from baseline were observed, with Hodges–Lehmann estimators of median treatment differences from placebo of −54.0% (95% confidence limits, −85.0%, −25.1%, P < 0.001) and −89.7% (95% confidence limits, −113.1%, −63.9%, P < 0.001) for telotristat ethyl 250 mg and 500 mg. These results support the safety and efficacy of telotristat ethyl when added to SSAs in patients with CS diarrhea (ClinicalTrials.gov identifier: Nbib2063659)

pyam: Analysis and visualisation of integrated assessment and macro-energy scenarios [version 2; peer review: 3 approved]

The open-source Python package pyam provides a suite of features and methods for the analysis, validation and visualization of reference data and scenario results generated by integrated assessment models, macro-energy tools and other frameworks in the domain of energy transition, climate change mitigation and sustainable development. It bridges the gap between scenario processing and visualisation solutions that are "hard-wired" to specific modelling frameworks and generic data analysis or plotting packages. The package aims to facilitate reproducibility and reliability of scenario processing, validation and analysis by providing well-tested and documented methods for working with timeseries data in the context of climate policy and energy systems. It supports various data formats, including sub-annual resolution using continuous time representation and "representative timeslices". The pyam package can be useful for modelers generating scenario results using their own tools as well as researchers and analysts working with existing scenario ensembles such as those supporting the IPCC reports or produced in research projects. It is structured in a way that it can be applied irrespective of a user's domain expertise or level of Python knowledge, supporting experts as well as novice users. The code base is implemented following best practices of collaborative scientific-software development. This manuscript describes the design principles of the package and the types of data which can be handled. The usefulness of pyam is illustrated by highlighting several recent applications

From the development of an open-source energy modelling tool to its application and the creation of communities of practice: The example of OSeMOSYS

In the last decades, energy modelling has supported energy planning by offering insights into the dynamics between energy access, resource use, and sustainable development. Especially in recent years, there has been an attempt to strengthen the science-policy interface and increase the involvement of society in energy planning processes. This has, both in the EU and worldwide, led to the development of open-source and transparent energy modelling practices. This paper describes the role of an open-source energy modelling tool in the energy planning process and highlights its importance for society. Specifically, it describes the existence and characteristics of the relationship between developing an open-source, freely available tool and its application, dissemination and use for policy making. Using the example of the Open Source energy Modelling System (OSeMOSYS), this work focuses on practices that were established within the community and that made the framework's development and application both relevant and scientifically grounded

The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours

Peptide receptor radionuclide therapy (PRRNT) is a molecularly targeted radiation therapy involving the systemic administration of a radiolabelled peptide designed to target with high affinity and specificity receptors overexpressed on tumours. PRRNT employing the radiotagged somatostatin receptor agonists (90)Y-DOTATOC ([(90)Y-DOTA(0),Tyr(3)]-octreotide) or (177)Lu-DOTATATE ([(177)Lu-DOTA(0),Tyr(3),Thr(8)]-octreotide or [(177)Lu-DOTA(0),Tyr(3)]-octreotate) have been successfully used for the past 15 years to target metastatic or inoperable neuroendocrine tumours expressing the somatostatin receptor subtype 2. Accumulated evidence from clinical experience indicates that these tumours can be subjected to a high absorbed dose which leads to partial or complete objective responses in up to 30 % of treated patients. Survival analyses indicate that patients presenting with high tumour receptor expression at study entry and receiving (177)Lu-DOTATATE or (90)Y-DOTATOC treatment show significantly higher objective responses, leading to longer survival and improved quality of life. Side effects of PRRNT are typically seen in the kidneys and bone marrow. These, however, are usually mild provided adequate protective measures are undertaken. Despite the large body of evidence regarding efficacy and clinical safety, PRRNT is still considered an investigational treatment and its implementation must comply with national legislation, and ethical guidelines concerning human therapeutic investigations. This guidance was formulated based on recent literature and leading experts’ opinions. It covers the rationale, indications and contraindications for PRRNT, assessment of treatment response and patient follow-up. This document is aimed at guiding nuclear medicine specialists in selecting likely candidates to receive PRRNT and to deliver the treatment in a safe and effective manner. This document is largely based on the book published through a joint international effort under the auspices of the Nuclear Medicine Section of the International Atomic Energy Agency