Survival extrapolation in cancer immunotherapy: a validation-based case study

Background: Immune-checkpoint inhibitors may provide long-term survival benefits via a cured proportion, yet data are usually insufficient to prove this upon submission to health technology assessment bodies. Objective: We revisited the National Institute for Health and Care Excellence assessment of ipilimumab in melanoma (TA319). We used updated data from the pivotal trial to assess the accuracy of the extrapolation methods used and compared these to previously unused techniques to establish whether an alternative extrapolation may have provided more accurate survival projections. Methods: We compared projections from the piecewise survival model used in TA319 and those produced by alternative models (fit to trial data with minimum follow-up of 3 years) to a longer-term data cut (5-year follow-up). We also compared projections to external data to help assess validity. Alternative approaches considered were parametric, spline-based, mixture, and mixture-cure models. Results: Only the survival model used in TA319 and a mixture-cure model provided 5-year survival predictions close to those observed in the 5-year follow-up data set. Standard parametric, spline, and non–curative-mixture models substantially underestimated 5-year survival. Survival estimates from the TA319 model and the mixture-cure model diverge considerably after 5 years and remain unvalidated. Conclusions: In our case study, only models that incorporated an element of external information (through a cure fraction combined with background mortality rates or using registry data) provided accurate estimates of 5-year survival. Flexible models that were able to capture the complex hazard functions observed during the trial, but which did not incorporate external information, extrapolated poorly

Water chemistry and endangered white-clawed crayfish: A literature review and field study of water chemistry association in Austropotamobius pallipes

Populations of the endangered white-clawed crayfish (Austropotamobius pallipes) have rapidly declined in distribution and density in recent decades as a result of invasive crayfish, disease and habitat degradation. The species is thought to be particularly sensitive to water chemistry, and has been proposed as a bio-indicator of water quality. Here we detail the results of a systematic review of the literature regarding the chemistry of waterbodies inhabited by white-clawed crayfish, along with a wide-scale field study of the chemistry of crayfish-inhabited waterbodies in the UK. We use these data to examine potentially significant variables influencing crayfish distribution. Several variables appear to have thresholds that affect crayfish distribution; crayfish presence was associated with high dissolved oxygen, low conductivity, ammonium, sodium, and phosphate, and to a lesser extent low sulphate, nitrate, and total suspended solids. Some variables (magnesium, potassium, sodium, sulphate, nitrate, and total suspended solids) may be tolerated at moderate to high concentrations in isolation (indicated by the presence of some populations in high levels of these variables), but suites of chemical conditions may act synergistically in situ and must be considered together. Recent efforts to conserve white-clawed crayfish have included relocations to Ark Sites; novel protected habitats with reduced risk of the introduction of disease, invasive crayfish and habitat degradation. We use our findings to propose the first detailed guidelines for common water chemistry variables of potential Ark Sites for the conservation of the species throughout its European range

Clinical trial of lamivudine in children with chronic hepatitis B.

N Engl J Med. 2002 May 30;346(22):1706-13. Clinical trial of lamivudine in children with chronic hepatitis B. Jonas MM, Mizerski J, Badia IB, Areias JA, Schwarz KB, Little NR, Greensmith MJ, Gardner SD, Bell MS, Sokal EM; International Pediatric Lamivudine Investigator Group. of Gastroenterology, Children's Hospital, Boston, MA 02115, USA. Erratum in: N Engl J Med 2002 Sep 19;347(12):955. Kelley, Deirdre [corrected to Kelly, Deirdre]. Comment in: J Hepatol. 2003 May;38(5):698-9. N Engl J Med. 2002 May 30;346(22):1682-3. Abstract BACKGROUND: Lamivudine therapy is effective for chronic hepatitis B infection in adults. We evaluated the efficacy and tolerability of lamivudine as a treatment for chronic infection with hepatitis B virus (HBV) in children. METHODS: Children with chronic hepatitis B were randomly assigned in a 2:1 ratio to receive either oral lamivudine (3 mg per kilogram of body weight; maximum, 100 mg) or placebo once daily for 52 weeks. The primary end point was virologic response (defined by the absence of serum hepatitis B e antigen and serum HBV DNA) at week 52 of treatment. RESULTS: Of the 403 children screened, 191 were randomly assigned to receive lamivudine and 97 to receive placebo. The rate of virologic response at week 52 was higher among children who received lamivudine than among those who received placebo (23 percent vs. 13 percent, P=0.04). Lamivudine therapy was well tolerated and was also associated with higher rates of seroconversion from hepatitis B e antigen to hepatitis B e antibody, normalization of alanine aminotransferase levels, and suppression of HBV DNA. CONCLUSIONS: In children with chronic hepatitis B, 52 weeks of treatment with lamivudine was associated with a significantly higher rate of virologic response than was placebo. PMID: 12037150 [PubMed - indexed for MEDLINE

Assessing the long-term effectiveness of cladribine vs. placebo in the relapsing-remitting multiple sclerosis CLARITY randomized controlled trial and CLARITY extension using treatment switching adjustment methods

Objectives: Treatment switching adjustment methods are often used to adjust for switching in oncology randomized controlled trials (RCTs). In this exploratory analysis, we apply these methods to adjust for treatment changes in the setting of an RCT followed by an extension study in relapsing-remitting multiple sclerosis. Methods: The CLARITY trial evaluated cladribine tablets versus placebo over 96 weeks. In the 96-week CLARITY Extension, patients who received placebo in CLARITY received cladribine tablets; patients who received cladribine tablets in CLARITY were re-randomized to placebo or cladribine tablets. Endpoints were time to first qualifying relapse (FQR) and time to 3- and 6-month confirmed disability progression (3mCDP, 6mCDP). We aimed to compare the effectiveness of cladribine tablets to placebo over CLARITY and the extension. The rank preserving structural failure time model (RPSFTM) and Iterative Parameter Estimation (IPE) were used to estimate what would have happened if patients had received placebo in CLARITY and the extension, versus patients that received cladribine tablets and switched to placebo. To gauge whether treatment effect waned after the 96 weeks of CLARITY, we compared hazard ratios (HRs) from the adjustment analysis with HRs from CLARITY. Results: The RPSFTM resulted in a HR of 0.48 (95% confidence interval [CI] 0.36-0.62) for FQR, 0.62 (95% CI 0.46-0.84) for 3mCDP, and 0.62 (95% CI 0.44-0.88) for 6mCDP. IPE algorithm results were similar. CLARITY HRs were 0.44 (95% CI 0.34-0.58), 0.60 (95% CI 0.41-0.87) and 0.58 (95% CI 0.40-0.83) for FQR, 3mCDP and 6mCDP respectively. Conclusions: Treatment switching adjustment methods are applicable in non-oncology settings. Adjusted CLARITY plus CLARITY Extension HRs were similar to the CLARITY HRs, demonstrating significant treatment benefits associated with cladribine tablets versus placebo

Proximity and Josephson effects in superconductor - antiferromagnetic Nb / \gamma-Fe50Mn50 heterostructures

We study the proximity effect in superconductor (S), antiferromagnetic (AF) bilayers, and report the fabrication and measurement of the first trilayer S/AF/S Josephson junctions. The disordered f.c.c. alloy \gamma-Fe50Mn50 was used as the AF, and the S is Nb. Micron and sub-micron scale junctions were measured, and the scaling of $J_C (d_AF)$ gives a coherence length in the AF of 2.4 nm, which correlates with the coherence length due to suppression of $T_C$ in the bilayer samples. The diffusion constant for FeMn was found to be 1.7 \times 10$^{-4}$ m$^2$ s$^-1$, and the density of states at the Fermi level was also obtained. An exchange biased FeMn/Co bilayer confirms the AF nature of the FeMn in this thickness regime.Comment: 6 pages, 5 figures, accepted for Phys. Rev.

Defects and glassy dynamics in solid He-4: Perspectives and current status

We review the anomalous behavior of solid He-4 at low temperatures with particular attention to the role of structural defects present in solid. The discussion centers around the possible role of two level systems and structural glassy components for inducing the observed anomalies. We propose that the origin of glassy behavior is due to the dynamics of defects like dislocations formed in He-4. Within the developed framework of glassy components in a solid, we give a summary of the results and predictions for the effects that cover the mechanical, thermodynamic, viscoelastic, and electro-elastic contributions of the glassy response of solid He-4. Our proposed glass model for solid He-4 has several implications: (1) The anomalous properties of He-4 can be accounted for by allowing defects to freeze out at lowest temperatures. The dynamics of solid He-4 is governed by glasslike (glassy) relaxation processes and the distribution of relaxation times varies significantly between different torsional oscillator, shear modulus, and dielectric function experiments. (2) Any defect freeze-out will be accompanied by thermodynamic signatures consistent with entropy contributions from defects. It follows that such entropy contribution is much smaller than the required superfluid fraction, yet it is sufficient to account for excess entropy at lowest temperatures. (3) We predict a Cole-Cole type relation between the real and imaginary part of the response functions for rotational and planar shear that is occurring due to the dynamics of defects. Similar results apply for other response functions. (4) Using the framework of glassy dynamics, we predict low-frequency yet to be measured electro-elastic features in defect rich He-4 crystals. These predictions allow one to directly test the ideas and very presence of glassy contributions in He-4.Comment: 33 pages, 13 figure

Search for displaced vertices arising from decays of new heavy particles in 7 TeV pp collisions at ATLAS

We present the results of a search for new, heavy particles that decay at a significant distance from their production point into a final state containing charged hadrons in association with a high-momentum muon. The search is conducted in a pp-collision data sample with a center-of-mass energy of 7 TeV and an integrated luminosity of 33 pb^-1 collected in 2010 by the ATLAS detector operating at the Large Hadron Collider. Production of such particles is expected in various scenarios of physics beyond the standard model. We observe no signal and place limits on the production cross-section of supersymmetric particles in an R-parity-violating scenario as a function of the neutralino lifetime. Limits are presented for different squark and neutralino masses, enabling extension of the limits to a variety of other models.Comment: 8 pages plus author list (20 pages total), 8 figures, 1 table, final version to appear in Physics Letters

Measurement of the polarisation of W bosons produced with large transverse momentum in pp collisions at sqrt(s) = 7 TeV with the ATLAS experiment

This paper describes an analysis of the angular distribution of W->enu and W->munu decays, using data from pp collisions at sqrt(s) = 7 TeV recorded with the ATLAS detector at the LHC in 2010, corresponding to an integrated luminosity of about 35 pb^-1. Using the decay lepton transverse momentum and the missing transverse energy, the W decay angular distribution projected onto the transverse plane is obtained and analysed in terms of helicity fractions f0, fL and fR over two ranges of W transverse momentum (ptw): 35 < ptw < 50 GeV and ptw > 50 GeV. Good agreement is found with theoretical predictions. For ptw > 50 GeV, the values of f0 and fL-fR, averaged over charge and lepton flavour, are measured to be : f0 = 0.127 +/- 0.030 +/- 0.108 and fL-fR = 0.252 +/- 0.017 +/- 0.030, where the first uncertainties are statistical, and the second include all systematic effects.Comment: 19 pages plus author list (34 pages total), 9 figures, 11 tables, revised author list, matches European Journal of Physics C versio

Observation of a new chi_b state in radiative transitions to Upsilon(1S) and Upsilon(2S) at ATLAS

The chi_b(nP) quarkonium states are produced in proton-proton collisions at the Large Hadron Collider (LHC) at sqrt(s) = 7 TeV and recorded by the ATLAS detector. Using a data sample corresponding to an integrated luminosity of 4.4 fb^-1, these states are reconstructed through their radiative decays to Upsilon(1S,2S) with Upsilon->mu+mu-. In addition to the mass peaks corresponding to the decay modes chi_b(1P,2P)->Upsilon(1S)gamma, a new structure centered at a mass of 10.530+/-0.005 (stat.)+/-0.009 (syst.) GeV is also observed, in both the Upsilon(1S)gamma and Upsilon(2S)gamma decay modes. This is interpreted as the chi_b(3P) system.Comment: 5 pages plus author list (18 pages total), 2 figures, 1 table, corrected author list, matches final version in Physical Review Letter

Measurement of the inclusive isolated prompt photon cross-section in pp collisions at sqrt(s)= 7 TeV using 35 pb-1 of ATLAS data

A measurement of the differential cross-section for the inclusive production of isolated prompt photons in pp collisions at a center-of-mass energy sqrt(s) = 7 TeV is presented. The measurement covers the pseudorapidity ranges |eta|<1.37 and 1.52<=|eta|<2.37 in the transverse energy range 45<=E_T<400GeV. The results are based on an integrated luminosity of 35 pb-1, collected with the ATLAS detector at the LHC. The yields of the signal photons are measured using a data-driven technique, based on the observed distribution of the hadronic energy in a narrow cone around the photon candidate and the photon selection criteria. The results are compared with next-to-leading order perturbative QCD calculations and found to be in good agreement over four orders of magnitude in cross-section.Comment: 7 pages plus author list (18 pages total), 2 figures, 4 tables, final version published in Physics Letters