Three vs. Four Cycles of Neoadjuvant Chemotherapy for Localized Muscle Invasive Bladder Cancer Undergoing Radical Cystectomy: A Retrospective Multi-Institutional Analysis

Three or four cycles of cisplatin-based chemotherapy is the standard neoadjuvant treatment prior to cystectomy in patients with muscle-invasive bladder cancer. Although NCCN guidelines recommend 4 cycles of cisplatin-gemcitabine, three cycles are also commonly administered in clinical practice. In this multicenter retrospective study, we assessed a large and homogenous cohort of patients with urothelial bladder cancer (UBC) treated with three or four cycles of neoadjuvant cisplatin-gemcitabine followed by radical cystectomy, in order to explore whether three vs. four cycles were associated with different outcomes

Phase 1/2 study of valproic acid and short-course radiotherapy plus capecitabine as preoperative treatment in low-moderate risk rectal cancer-V-shoRT-R3 (Valproic acid--short Radiotherapy--rectum 3rd trial).

BACKGROUND: Locally advanced rectal cancer (LARC) is a heterogeneous group of tumors where a risk-adapted therapeutic strategy is needed. Short-course radiotherapy (SCRT) is a more convenient option for LARC patients than preoperative long-course RT plus capecitabine. Histone-deacetylase inhibitors (HDACi) have shown activity in combination with RT and chemotherapy in the treatment of solid tumors. Valproic acid (VPA) is an anti-epileptic drug with HDACi and anticancer activity. In preclinical studies, our group showed that the addition of HDACi, including VPA, to capecitabine produces synergistic antitumour effects by up-regulating thymidine phosphorylase (TP), the key enzyme converting capecitabine to 5-FU, and by downregulating thymidylate synthase (TS), the 5-FU target. METHODS/DESIGN: Two parallel phase-1 studies will assess the safety of preoperative SCRT (5 fractions each of 5 Gy, on days 1 to 5) combined with (a) capecitabine alone (increasing dose levels: 500-825 mg/m2/bid), on days 1-21, or (b) capecitabine as above plus VPA (oral daily day -14 to 21, with an intra-patient titration for a target serum level of 50-100 microg/ml) followed by surgery 8 weeks after the end of SCRT, in low-moderate risk RC patients. Also, a randomized phase-2 study will be performed to explore whether the addition of VPA and/or capecitabine to preoperative SCRT might increase pathologic complete tumor regression (TRG1) rate. A sample size of 86 patients (21-22/arm) was calculated under the hypothesis that the addition of capecitabine or VPA to SCRT can improve the TRG1 rate from 5% to 20%, with one-sided alpha = 0.10 and 80% power.Several biomarkers will be evaluated comparing normal mucosa with tumor (TP, TS, VEGF, RAD51, XRCC1, Histones/proteins acetylation, HDAC isoforms) and on blood samples (polymorphisms of DPD, TS, XRCC1, GSTP1, RAD51 and XRCC3, circulating endothelial and progenitors cells; PBMCs-Histones/proteins acetylation). Tumor metabolism will be measured by 18FDG-PET at baseline and 15 days after the beginning of SCRT. DISCUSSION: This project aims to improve the efficacy of preoperative treatment of LARC and to decrease the inconvenience and the cost of standard long-course RT. Correlative studies could identify both prognostic and predictive biomarkers and could add new insight in the mechanism of interaction between VPA, capecitabine and RT.EudraCT Number: 2012-002831-28. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT01898104

Critical role of bevacizumab scheduling in combination with pre-surgical chemo-radiotherapy in MRI-defined high-risk locally advanced rectal cancer: Results of the BRANCH trial.

BACKGROUND: We have previously shown that an intensified preoperative regimen including oxaliplatin plus raltitrexed and 5-fluorouracil/folinic acid (OXATOM/FUFA) during preoperative pelvic radiotherapy produced promising results in locally advanced rectal cancer (LARC). Preclinical evidence suggests that the scheduling of bevacizumab may be crucial to optimize its combination with chemo-radiotherapy. PATIENTS AND METHODS: This non-randomized, non-comparative, phase II study was conducted in MRI-defined high-risk LARC. Patients received three biweekly cycles of OXATOM/FUFA during RT. Bevacizumab was given 2 weeks before the start of chemo-radiotherapy, and on the same day of chemotherapy for 3 cycles (concomitant-schedule A) or 4 days prior to the first and second cycle of chemotherapy (sequential-schedule B). Primary end point was pathological complete tumor regression (TRG1) rate. RESULTS: The accrual for the concomitant-schedule was early terminated because the number of TRG1 (2 out of 16 patients) was statistically inconsistent with the hypothesis of activity (30%) to be tested. Conversely, the endpoint was reached with the sequential-schedule and the final TRG1 rate among 46 enrolled patients was 50% (95% CI 35%-65%). Neutropenia was the most common grade ≥ 3 toxicity with both schedules, but it was less pronounced with the sequential than concomitant-schedule (30% vs. 44%). Postoperative complications occurred in 8/15 (53%) and 13/46 (28%) patients in schedule A and B, respectively. At 5 year follow-up the probability of PFS and OS was 80% (95%CI, 66%-89%) and 85% (95%CI, 69%-93%), respectively, for the sequential-schedule. CONCLUSIONS: These results highlights the relevance of bevacizumab scheduling to optimize its combination with preoperative chemo-radiotherapy in the management of LARC.The study was a no-profit trial partially supported by research grants from the Italian Ministry of Health to A. Avallone (RF-2009-1539464) and to A. Budillon (RF- 2011-02346914)

Machine learning meets volcano plots: Computational discovery of cross-coupling catalysts

The application of modern machine learning to challenges in atomistic simulation is gaining attraction. We present new machine learning models that can predict the energy of the oxidative addition process between a transition metal complex and a substrate for C-C cross-coupling reactions. In turn, this quantity can be used as a descriptor to estimate the activity of homogeneous catalysts using molecular volcano plots. The versatility of this approach is illustrated for vast libraries of organometallic catalysts based on Pt, Pd, Ni, Cu, Ag, and Au combined with 91 ligands. Out-of-sample machine learning predictions were made on a total of 18 062 compounds leading to 557 catalyst candidates falling into the ideal thermodynamic window. This number was further refined by searching for candidates with an estimated price lower than 10 US$ per mmol. The 37 catalyst finalists are dominated by palladium phosphine ligand combinations but also include the earth abundant transition metal (Cu) with less common ligands. Our results indicate that modern statistical learning techniques can be applied to the computational discovery of readily available and promising catalyst candidates

Valutazione della scuscettibilità e degli scenari di pericolosità e di rischio da frana in aree di interesse socio-economico (Calabria Settentrionale)

Scuola di Dottorato" Archimede" in Scienze, Comunicazione e Tecnologie, Indirizzo: Scienze e Tecnologie dei Sistemi Complessi, Ciclo XXVIII, a.a. 2015-2016Landslides are natural geologic processes that play a key role in landscape evolution, but represent also one of the most widespread natural hazard in Italian territory. In particular, many areas of the Calabria region (southern Italy) have been affected historically by mass movements, due to the combination of its peculiar geological, morphological, seismic and climatic features and frequently to regionally unsustainable land management. Landslides are responsible for direct and indirect damages, may cause loss of life and property, damages to natural resources and hamper infrastructure projects, by generating strong social and economic impacts. This resulting in millions of Euro per year in damages and restoration as well. Therefore, spatial identification of potentially unstable slopes and landslide risk evaluation are very important in order to get mitigation measures and for land planning. The aim of this study is landslide susceptibility and risk assessment in areas of socio-economic interest in Northern Calabria. Study areas were a section of the A3 highway and a part of Amendolara town. The identification and selection of study areas took into account topography, geology and urban development conditions for which the landsliding is potentially a problem. Landslide risk assessment in the section of A3 highway was performed in a qualitative way by overlapping the highway on the landslide susceptibility map; this had lead to the zonation of spatial risk which allowed an evaluation of the involvement of the highway in the different susceptibility areas. In the Amendolara territory risk assessment was carried out in a quantitative way according to the formula: Risk = Hazard × Vulnerability × Economic value of elements at risk (buildings and roads). Hazard was computed in a probabilistic way by means the product between spatial probability (probability that any given region will be affected by landslides), temporal probability (probability of occurrence of landslide events during time t) and probability of landslide size (probability that a landslide will have a certain size). Physical vulnerability was evaluated considering elements at risk features and landslide size. Finally, landslide risk was computed on the basis of economic value of elements at risk, pointing to the probability of money that can be lost at the occurrence of a landslide in a given area, in a certain interval of time and with a certain area. This study provides two case example for the qualitative and quantitative risk assessment which can be useful to planners and decision makers to identify areas where more damages are expected and that should receive priority in the use of limited resources directed to preventive plans to reduce the impact of the landslides.Università della Calabri