ПЕРСПЕКТИВИ ПОВІТРЯНО-КОСМІЧНОЇ ОБОРОНИ СУЧАСНОЇ УКРАЇНИ

The article deals with the aerospace defense tasks, the development trends of aerospace defense means in the world developed countries were considered. The embracement necessity of the aerospace defense doctrine in Ukraine was grounded. The technical propositions about creating own aerospace defense technical means were developed. The low-budget project of the space-rocket complex with the multipurpose unmanned orbital vehicle was offered. The technical capabilities of the multipurpose unmanned orbital vehicle in terms of aerospace defense tasks performance by it were analyzed.Environmentally friendly liquid rocket engines were designed for multipurpose unmanned orbital vehicle. The control system uses data from the global positioning systems without using an inertial board system, includes stellar and solar sensors, airborne side-looking radar to guide it on the map of the earth's surface.Ukraine has the scientific and technical basis for the production of multipurpose unmanned orbital device, has its own system of space control and can control Ukrainian orbiter in the interests of the state and developing the Ukrainian business in the missile and space activity.В статье проанализированы задачи воздушно-космической обороны, рассмотрены тенденции развития средств воздушно-космической обороны в развитых государствах мира. Обоснована необходимость принятия в Украине доктрины воздушно-космической обороны. Разработаны технические предложения по созданию собственных технических средств воздушно-космической обороны. Предложен малобюджетный проект ракетно-космического комплекса с беспилотным орбитальным многоцелевым аппаратом. Проанализированы технические возможности беспилотного орбитального многоцелевого аппарата с точки зрения выполнения им задач воздушно-космической обороны.У статті проаналізовані задачі повітряно-космічної оборони, розглянуто тенденції розвитку засобів повітряно-космічної оборони в розвинутих державах світу. Обґрунтовано необхідність прийняття в Україні доктрини повітряно-космічної оборони. Розроблено технічні пропозиції по створенню власних технічних засобів повітряно-космічної оборони. Запропоновано не обтяжливий для бюджету проект ракетно-космічного комплексу з безпілотним орбітальним багатоцільовим апаратом. Проаналізовано технічні можливості безпілотного орбітального багатоцільового апарату з точки зору виконання ним завдань повітряно-космічної оборони

Perioperative Pembrolizumab for Early-Stage Non-Small-Cell Lung Cancer

BACKGROUND Among patients with resectable early-stage non-small-cell lung cancer (NSCLC), a perioperative approach that includes both neoadjuvant and adjuvant immune checkpoint inhibition may provide benefit beyond either approach alone.METHODS We conducted a randomized, double-blind, phase 3 trial to evaluate perioperative pembrolizumab in patients with early-stage NSCLC. Participants with resectable stage II, IIIA, or IIIB (N2 stage) NSCLC were assigned in a 1:1 ratio to receive neoadjuvant pembrolizumab (200 mg) or placebo once every 3 weeks, each of which was given with cisplatin-based chemotherapy for 4 cycles, followed by surgery and adjuvant pembrolizumab (200 mg) or placebo once every 3 weeks for up to 13 cycles. The dual primary end points were event-free survival (the time from randomization to the first occurrence of local progression that precluded the planned surgery, unresectable tumor, progression or recurrence, or death) and overall survival. Secondary end points included major pathological response, pathological complete response, and safety.RESULTS A total of 397 participants were assigned to the pembrolizumab group, and 400 to the placebo group. At the prespecified first interim analysis, the median follow-up was 25.2 months. Event-free survival at 24 months was 62.4% in the pembrolizumab group and 40.6% in the placebo group (hazard ratio for progression, recurrence, or death, 0.58; 95% confidence interval [CI], 0.46 to 0.72; P<0.001). The estimated 24-month overall survival was 80.9% in the pembrolizumab group and 77.6% in the placebo group (P = 0.02, which did not meet the significance criterion). A major pathological response occurred in 30.2% of the participants in the pembrolizumab group and in 11.0% of those in the placebo group (difference, 19.2 percentage points; 95% CI, 13.9 to 24.7; P<0.0001; threshold, P = 0.0001), and a pathological complete response occurred in 18.1% and 4.0%, respectively (difference, 14.2 percentage points; 95% CI, 10.1 to 18.7; P<0.0001; threshold, P = 0.0001). Across all treatment phases, 44.9% of the participants in the pembrolizumab group and 37.3% of those in the placebo group had treatment-related adverse events of grade 3 or higher, including 1.0% and 0.8%, respectively, who had grade 5 events.CONCLUSIONS Among patients with resectable, early-stage NSCLC, neoadjuvant pembrolizumab plus chemotherapy followed by resection and adjuvant pembrolizumab significantly improved event-free survival, major pathological response, and pathological complete response as compared with neoadjuvant chemotherapy alone followed by surgery. Overall survival did not differ significantly between the groups in this analysis