Phase I/II study of the LAG-3 inhibitor ieramilimab (LAG525) ± anti-PD-1 spartalizumab (PDR001) in patients with advanced malignancies

Combination; Drug therapy; ImmunotherapyCombinació; Teràpia farmacològica; ImmunoteràpiaCombinación; Terapia farmacológica; InmunoterapiaBackground Lymphocyte-activation gene 3 (LAG-3) is an inhibitory immunoreceptor that negatively regulates T-cell activation. This paper presents preclinical characterization of the LAG-3 inhibitor, ieramilimab (LAG525), and phase I data for the treatment of patients with advanced/metastatic solid tumors with ieramilimab ±the anti-programmed cell death-1 antibody, spartalizumab. Methods Eligible patients had advanced/metastatic solid tumors and progressed after, or were unsuitable for, standard-of-care therapy, including checkpoint inhibitors in some cases. Patients received ieramilimab ±spartalizumab across various dose-escalation schedules. The primary objective was to assess the maximum tolerated dose (MTD) or recommended phase II dose (RP2D). Results In total, 255 patients were allocated to single-agent ieramilimab (n=134) and combination (n=121) treatment arms. The majority (98%) had received prior antineoplastic therapy (median, 3). Four patients experienced dose-limiting toxicities in each treatment arm across various dosing cohorts. No MTD was reached. The RP2D on a 3-week schedule was declared as 400 mg ieramilimab plus 300 mg spartalizumab and, on a 4-week schedule (once every 4 weeks; Q4W), as 800 mg ieramilimab plus 400 mg spartalizumab; tumor target (LAG-3) suppression with 600 mg ieramilimab Q4W was predicted to be similar to the Q4W, RP2D schedule. Treatment-related adverse events (TRAEs) occurred in 75 (56%) and 84 (69%) patients in the single-agent and combination arms, respectively. Most common TRAEs were fatigue, gastrointestinal, and skin disorders, and were of mild severity; seven patients experienced at least one treatment-related serious adverse event in the single-agent (5%) and combination group (5.8%). Antitumor activity was observed in the combination arm, with 3 (2%) complete responses and 10 (8%) partial responses in a mixed population of tumor types. In the combination arm, eight patients (6.6%) experienced stable disease for 6 months or longer versus six patients (4.5%) in the single-agent arm. Responding patients trended towards having higher levels of immune gene expression, including CD8 and LAG3, in tumor tissue at baseline. Conclusions Ieramilimab was well tolerated as monotherapy and in combination with spartalizumab. The toxicity profile of ieramilimab in combination with spartalizumab was comparable to that of spartalizumab alone. Modest antitumor activity was seen with combination treatment.This study was sponsored by Novartis Pharmaceuticals Corporation and preliminary results were previously presented at ASCO 2018

Clinical outcomes and toxicity of proton beam radiation therapy for re-irradiation of locally recurrent breast cancer

Purpose: Repeat radiation therapy (RT) using photons/X-rays for locally recurrent breast cancer results in increased short and long-term toxicity. Proton beam RT (PBRT) can minimize dose to surrounding organs, thereby potentially reducing toxicity. Here, we report the toxicity and clinical outcomes for women who underwent re-irradiation to the chest wall for locally recurrent breast cancer using PBRT. Materials and methods: This was a retrospective study analyzing 16 consecutive patients between 2013 and 2018 with locally recurrent breast cancer who underwent re-irradiation to the chest wall with PBRT. For the recurrent disease, patients underwent maximal safe resection, including salvage mastectomy, wide local excision, or biopsy only per surgeons recommendations. Systemic therapy was used per the recommendation of the medical oncologist. Patients were treated with median dose of 50.4 Cobalt Gray Equivalent (CGyE) in 28 fractions at the time of re-irradiation. Follow-up was calculated from the start of second RT course. Acute toxicities were defined as those occurring during treatment or up to 8 weeks after treatment. Late toxicities were defined as those occurring more than 8 weeks after the completion of therapy. Toxicities were based on CTCAE 4.0. Results: The median age at original diagnosis and at recurrence was 49.8 years and 60.2 years, respectively. The median time between the two RT courses was 10.2 (0.7-20.2) years. The median follow-up time was 18.7 (2.5-35.2) months. No local failures were observed after re-irradiation. One patient developed distant metastasis and ultimately died. Grade 3-4 acute skin toxicity was observed in 5 (31.2%) patients. Four (25%) patients developed chest wall infections during or shortly (2 weeks) after re-irradiation. Late grade 3-4 fibrosis was observed in only 3 (18.8%) patients. Grade 5 toxicities were not observed. Hyperpigmentation was seen in 12 (75%) patients. Pneumonitis, telangiectasia, rib fracture, and lymphedema occurred in 2 (12.5%), 4 (25%), 1 (6.3%), and 1 (6.3%) patients, respectively. Conclusions: Re-irradiation with PBRT for recurrent breast cancer has acceptable toxicities. There was a high incidence of acute grade 3-4 skin toxicity and infections, which resolved, however, with skin care and antibiotics. Longer follow-up is needed to determine long-term clinical outcomes

A Preliminary Habitat Suitability Model for Devil Rays in the Western Indian Ocean

The European tropical tuna purse seine fishery incidentally captures three highly migratory and endangered species of devil rays, spinetail devil ray Mobula mobular, sicklefin devil ray M. tarapacana, and bentfin devil ray M. thurstoni in the Indian Ocean. Due to their global decreasing populations, understanding the factors of their spatial and temporal distributions and the associated environmental conditions are fundamental for their management and conservation. Yet, the spatial and temporal distribution of devil rays in the Indian Ocean is poorly understood. Here we developed a habitat suitability model for devil rays in the Western Indian Ocean depicting the seasonal and interannual changes in their spatial distributions and underlying environmental conditions. We used bycatch data collected between the period 2010-2020 by the EU tropical tuna purse seine observer programs to determine which environmental variables influence the occurrence of devil rays using generalized additive models. A separate modelling was done for the spinetail devil ray, and for the three species of devil rays combined, since many individuals are only recorded at the genus level. The environmental variables associated with the presence of devil rays were chlorophyll, sea surface height and sea surface temperature fronts. When modelling the habitat suitability for spinetail devil ray, the most influential environmental variables were net primary production of phytoplankton and sea surface temperature fronts. Both the interannual and seasonal variability in habitat suitability of devil rays were explained by these environmental variables. We also showed that devil rays are associated to permanent hotspots in the Mascarene Plateau and Central Indian Ridge, and to seasonal hotspots in the Western Arabian Sea and Equatorial regions where there is a high occurrence of devil rays during winter monsoon. We found that setting on large tuna schools decreases the chances of devil ray bycatch. Both models predicted a higher probability of incidental catch of devil rays in fishing sets on free swimming schools of tunas than in sets on fish aggregating devices. The identified hotspots and associated environmental characteristics provide information about the habitat use and ecology of the devil rays in the Western Indian Ocean. Furthermore, the habitat suitability models, and biological hotspots identified in this study could also to be used to inform the development of future spatial management measures, including time-area closures, to minimize the interaction of pelagic fisheries with these vulnerable species

A preliminary habitat suitability model for oceanic whitetip shark in the western Indian Ocean

Understanding the temporal, spatial and environmental factors influencing species distributions is essential to minimize the interactions of vulnerable species with fisheries and can be used to identify areas of high bycatch rates and their environmental conditions. Classified as critically endangered by the International Union for the Conservation of Nature, the oceanic whitetip shark (Carcharhinus longimanus) is the second main shark species incidentally caught by the tropical tuna purse seine fishery in the western Indian Ocean. In this study, we used the European Union purse seine fishery observer data (2010-2020) and generalized additive models to develop a habitat suitability model for juvenile oceanic whitetip shark in the western Indian Ocean. Sea surface temperature was the main environmental driver suggesting a higher probability of occurrence of this shark with decreasing temperatures. The type of fishing operation also was an important predictor explaining its occurrence, suggesting a higher probability of incidentally catching this species when using fish aggregating devices as set type. Moreover, predictive maps of habitat suitability suggested the area offshore of Kenya and Somalia are an important hotspot with higher probabilities of incidentally catching this species during the summer monsoon (June to September) when upwelling takes place. The habitat suitability models developed here could be used to inform the design and testing of potential time-area closures in the Kenya-Somalia basin with the objective of minimizing the bycatch of this critically endangered species with the least possible impact on fishing operations and fishery yields of target tuna

Lymphovascular space invasion and lack of downstaging after neoadjuvant chemotherapy are strong predictors of adverse outcome in young women with locally advanced breast cancer

Younger age diagnosis of breast cancer is a predictor of adverse outcome. Here, we evaluate prognostic factors in young women with locally advanced breast cancer (LABC). We present a retrospective review of 104 patients younger than 40 years with LABC treated with surgery, radiotherapy (RT), and chemotherapy from 2003 to 2014. Patient‐, tumor‐, and treatment‐related factors important for overall survival (OS), local/regional recurrence (LRR), distant metastasis (DM), and recurrence‐free survival (RFS) were evaluated. Mean age at diagnosis was 34 years (23–39 years) with a median follow‐up of 47 months (8–138 months). Breast‐conserving surgery was performed in 27%. Axillary lymph node dissection was performed in 85%. Sixty percent of patients received neoadjuvant chemotherapy with 19% achieving pathologic complete response (pCR), and 61% downstaged. Lymph node positivity was present in 91% and lymphovascular space invasion (LVSI) in 35%. Thirty‐two percent of patients had triple negative tumors (TN, ER‐/PR‐/HER2 nonamplified). Four‐year OS and RFS was 84% and 71%, respectively. Factors associated with worse OS on multivariate analysis include TN status, LVSI, and number of positive lymph nodes. LVSI was also associated with DM and LRR, as well as worse RFS. Downstaging was associated with improved 4 year RFS in patients receiving neoadjuvant chemotherapy (74% vs. 38%, P = 0.002). With high risks of recurrence and inferior OS compared to older women, breast cancer in young women can be difficult to treat. Among additional factors, presence of LVSI and lack of downstaging portends a particularly worse prognosis

Stunting is preceded by intestinal mucosal damage and microbiome changes and Is associated with systemic inflammation in a cohort of Peruvian infants

Stunting, defined as height-for-ag

Shoot iron status and auxin are involved in iron deficiency-induced phytosiderophores release in wheat

Background: The release of phytosiderephores (PS) to the rhizosphere is the main root response to iron (Fe) deficiency in graminaceous plants. We have investigated the role of the Fe status in the shoot as well as of the signaling pathways controlled by three relevant phytoregulators-indolacetic acid (IAA), ethylene and nitric oxide (NO) - in the regulation of this root response in Fe-starved wheat plants. To this end, the PS accumulation in the nutrient solution and the root expression of the genes encoding the nicotianamine aminotransferase (TaNAAT) and ferritin (TaFER) have been evaluated in plants subjected to different treatments. Results: The application of Fe to leaves of Fe-deficient plants prevented the increase in both PS root release and TaNAAT gene expression thus showing the relevant role of the shoot to root communication in the regulation of PS root release and some steps of PS biosynthesis. Experiments with specific hormone inhibitors showed that while ethylene and NO did not positively regulate Fe deficiency induced PS root release, auxin plays an essential role in the regulation of this process. Moreover, the application of IM to Fe-sufficient plants promoted both PS root release and TaNAAT gene expression thus indicating that auxin might be involved in the shoot to root signaling network regulating Fe-deficiency root responses in wheat Conclusions: These results therefore indicate that PS root release in Fe-deficient wheat plants is directly modulated by the shoot Fe status through signaling pathways involving, among other possible effectors, auxin

Bose-Einstein Correlations of Three Charged Pions in Hadronic Z^0 Decays

Bose-Einstein Correlations (BEC) of three identical charged pions were studied in 4 x 10^6 hadronic Z^0 decays recorded with the OPAL detector at LEP. The genuine three-pion correlations, corrected for the Coulomb effect, were separated from the known two-pion correlations by a new subtraction procedure. A significant genuine three-pion BEC enhancement near threshold was observed having an emitter source radius of r_3 = 0.580 +/- 0.004 (stat.) +/- 0.029 (syst.) fm and a strength of \lambda_3 = 0.504 +/- 0.010 (stat.) +/- 0.041 (syst.). The Coulomb correction was found to increase the \lambda_3 value by \~9% and to reduce r_3 by ~6%. The measured \lambda_3 corresponds to a value of 0.707 +/- 0.014 (stat.) +/- 0.078 (syst.) when one takes into account the three-pion sample purity. A relation between the two-pion and the three-pion source parameters is discussed.Comment: 19 pages, LaTeX, 5 eps figures included, accepted by Eur. Phys. J.