Эффективность и безопасность комбинации ленватиниба и эверолимуса у больных диссеминированным раком почки, прогрессирующим на фоне антиангиогенной таргетной терапии: второй анализ данных российского многоцентрового наблюдательного исследования

Objective. The primary endpoint was progression-free survival; secondary endpoints included overall survival, objective response rate and duration, tumor control rate and duration, as well as safety profile of lenvatinib with everolimus in consecutive patients with advanced renal cell carcinoma who had disease progression after targeted antiangiogenic therapy.Materials and methods. This observational study included 129 consecutive patients with metastatic renal cell carcinoma resistant to targeted antiangiogenic therapy. The median age was 60 years; a male to female ratio was 3.1:1. Twenty-seven patients (20.9 %) had ECOG performance status of 2—4. The majority of study participants (n = 127; 98.4 %) had multiple metastases. Tumor lesions were located in >1 organ in 104 cases (80.6 %). The primary tumor was removed in 110 (85.3 %), including 39 (30.2 %) patients undergone cytoreductive surgery. Seventy patients (54.2 %) had earlier received more than one line of therapy. Upon enrollment, there were 13 IMDC favourable-risk patients (10.1 %), 86 IMDC intermediate-risk patients (66.6 %), and 29 IMDC poor-risk patients (22.5 %). In one patient (0.8 %), the IMDC risk was not estimated. All patients received lenvatinib at a dose of 18 mg/day and everolimus at a dose of 5 mg/day. The median follow-up was 10.5 (1—30) months.Results. Median progression-free survival was 14.9 (11.9—17.9) months; overall survival was 19.9 (15.2—24.6) months. The objective response rate was 17.0 % (median duration 9.7 (2.8—16.5) months); tumor control rate was 72.9 % (median duration 10.0 (2.5—17.5) months). Adverse events were observed in 112patients (86.8 %) with grade III—IVadverse events registered in 27participants (20.9 %). Five participants (3.9 %) needed inpatient treatment of adverse events; one patient (0.8 %) died due to adverse events. Adverse events required treatment discontinuation in 4 patients (3.1 %), treatment interruption in 35 patients (27.1 %), and dose reduction in 33 patients (25.6 %).Conclusion. The results of the secondary analysis in the ROSLERCM observational study confirmed the results obtained earlier on the efficacy and safety of the lenvatinib plus everolimus combination in the second- and subsequent-line therapy for advanced renal cell carcinoma resistant to targeted antiangiogenic therapy in consecutive Russian patients.Цель. Первичной конечной точкой являлась беспрогрессивная выживаемость, вторичными — общая выживаемость, частота и длительность ответа на лечение и контроля над опухолью, а также профиль безопасности комбинации ленватиниба и эверолимуса у неотобранных пациентов с распространенным почечно-клеточным раком, прогрессирующим после антиангиогенной таргетной терапии.Материалы и методы. В наблюдательное исследование последовательно включены 129 больных диссеминированным почечноклеточным раком, резистентным к антиангиогенной таргетной терапии. Медиана возраста — 60 лет, соотношение мужчин и женщин — 3,1:1. Соматический статус расценен как ECOG 2—4у 27 (20,9 %) больных. У127 (98,4 %) пациентов имелись множественные метастазы. Опухолевые очаги локализовались в >1 органе в 104 (80,6 %) случаях. Первичная опухоль удалена у 110 (85,3 %) больных, в 39 (30,2%) наблюдениях — с циторедуктивной целью. Ранее >1 линии предшествующей терапии получали 70 (54,2 %) больных. На момент включения в исследование к группе благоприятного прогноза по шкале IMDC относились 13 (10,1 %), промежуточного — 86 (66,6 %), неблагоприятного — 29 (22,5 %) больных; группа прогноза не определена у 1 (0,8 %) пациента. Всем больным назначали ленватиниб 18мг/сут с эверолимусом 5мг/сут. Медиана наблюдения за всеми пациентами составила 10,5 (1—30) мес. Результаты. Медиана беспрогрессивной выживаемости достигла 14,9(11,9—17,9) мес, общей выживаемости — 19,9(15,2—24,6) мес. Частота объективного ответа составила 17,0 % (медиана длительности — 9,7(2,8—16,5) мес), частота контроля над опухолью — 72,9 % (медиана длительности — 10,0 (2,5—17,5) мес). Нежелательные явления зарегистрированы у 112 (86,8 %), в том числе, III—IV степеней тяжести — у 27 (20,9 %) больных. Госпитализация для коррекции нежелательных явлений потребовалась в 5 (3,9 %) случаях, 1 (0,8 %) пациент умер из-за нежелательных явлений. Нежелательные явления послужили причиной отмены терапии в 4 (3,1 %), перерыва в лечении — в 35 (27,1 %), редукции дозы — в 33 (25,6 %) случаях.Заключение. Результаты второго анализа наблюдательного исследования ROSLERCM подтвердили ранее полученные результаты применения комбинации ленватиниба с эверолимусом во 2-й и последующих линиях терапии распространенного почечно-клеточного рака, рефрактерного к антиангиогенному лечению, у неотобранных российских больных

Ruthenium p-cymene iminophosphonamide complexes: Activation under basic conditions and transfer hydrogenation catalysis

International audienceComplex [(η6-Cym)RuCl(NPN)] Cym = p-cymene; NPN = (pTolN)2PPh2 (1) yields a thermally sensitive hydride derivative [(η6-Cym)RuH(NPN)] (2) by reaction with iPrOH in the presence of a strong base, via an observable isopropoxide intermediate [(η6-Cym)Ru(OiPr)(NPN)] (3), or with NaBHEt3 in toluene. Partial conversion also occurs in iPrOH in the absence of base. 2 is stabilized by dihydrogen bonding with isopropyl alcohol, but attempts to isolate it induce isomerization by hydride migration to a ring CH position to yield a 16-electron cyclohexadienyl derivative [η5-p-C6H5(Me)(iPr)Ru(NPN)], which has been crystallographically characterized as a disordered mixture of two regioisomers (4/4′). Complex 2 is able to release H2 upon treatment with medium strength proton donors (fluorinated alcohols), but also slowly with iPrOH. 2 is an active catalyst for the transfer hydrogenation of acetophenone to phenylethanol in isopropyl alcohol. The catalytic transformation is first order in acetophenone and first order in catalyst, with k = 117 ± 10 m–1 h–1 at 40 °C. The temperature dependence of the rate constant (25–80 °C) gave the activation parameters ΔH‡ = 9.6 ± 1.3 kcal mol–1 and ΔS‡ = –31 ± 4 cal mol–1 K–1. DFT calculations have validated the slow isomerization of 2 to 4/4′ (high energy TS), the preference of the cyclohexadienyl system for 4/4′ relative to the other isomers 4Me and 4iPr, where the hydride has migrated to the CMe or CiPr position, and suggest that the hydrogen transfer mechanism involves outer sphere hydride transfer to the ketone substrate with H-bonding assistance of isopropyl alcohol to yield a σ complex intermediate [(η6-Cym)Ru+(NPN)H-C(Me)(Ph)O–]

Determination of digestible isoleucine: lysine ratio in diets for laying hens aged 42-58 weeks

Two hundred and fifty-two Hy-Line W36 laying hens were allotted in a completely randomized design with 6 treatments, 7 replicates and 6 hens per experimental unit in order to determine the ideal ratio of isoleucine (Ile) in relation to lysine (Lys) to laying hens aged 42-58 weeks. Experimental diets contained digestible Ile at different levels, resulting in different Ile:Lys ratios (0.73:1; 0.78:1; 0.83:1; 0.88:1; 0.93:1 and 0.98:1). A basal diet was formulated to provide Isoleucine in levels below recommendations. This diet was supplemented with L-isoleucine to make up the 6 diets. Each diet was made isonitrogenous by varying the dietary contents of glutamic acid and isocaloric by adjusting the contents of cornstarch. All essential amino acids were provided proportionally to lysine. Egg production, egg weight, egg mass, feed conversion ratio, albumen, yolk and eggshell contents were recorded and compiled at every 28-day period. No differences were observed in the performance over a wide range of dietary isoleucine concentrations from 5.76 to 7.73 g/kg corresponding to 0.73:1 to 0.98:1 Ile:Lys ratios. The lowest Ile:Lys ratio (0.73:1) was sufficient to ensure satisfactory performance of birds, corresponding to the consumption of 534 mg of isoleucine and 731 mg of lysine/day