SUSTAINABLE CONSUMPTION IN TOURISM: AN APPROACH TO ITS STATE OF KNOWLEDGE

Artículo de revisiónLas investigaciones sobre prácticas ambientales han recibido una atención creciente en el área de turismo. Sin embargo, hace falta una revisión bibliográfica que explore las prácticas de consumo sustentable en el sector. Con ese fin, a partir del uso del software ATLAS.ti 9, se realizó un análisis temático de 128 artículos cuyo objetivo principal es examinar los propósitos del consumo sustentable –buenas prácticas; hábitos del consumidor; políticas públicas, y regulaciones ambientales–, sus ámbitos de aplicación –por tipo de empresa– y su relación con la innovación (por ejemplo, con el uso de ecotecnologías). En los resultados, el análisis indica que las buenas prácticas tienen una asociación positiva con la innovación (0.72), lo que demuestra que la relación está bien establecid

Implementing Standard Diagnosis and Treatment for Locally Advanced Breast Cancer Through Global Research in Latin America: Results From a Multicountry Pragmatic Trial

PURPOSEBreast cancer mortality rates in Latin America (LA) are higher than those in the United States, possibly because of advanced disease presentation, health care disparities, or unfavorable molecular subtypes. The Latin American Cancer Research Network was established to address these challenges and to promote collaborative clinical research. The Molecular Profiling of Breast Cancer Study (MPBCS) aimed to evaluate the clinical characteristics and treatment outcomes of LA participants with locally advanced breast cancer (LABC).PATIENTS AND METHODSThe MPBCS enrolled 1,449 participants from Argentina, Brazil, Chile, Mexico, and Uruguay. Through harmonized procedures and quality assurance measures, this study evaluated clinicopathologic characteristics, neoadjuvant chemotherapy response, and survival outcomes according to residual cancer burden (RCB) and the type of surgery.RESULTSOverall, 711 and 480 participants in the primary surgery and neoadjuvant arms, respectively, completed the 5-year follow-up period. Overall survival was independently associated with RCB (worse survival for RCBIII-adjusted hazard ratio, 8.19, P < .001, and RCBII [adjusted hazard ratio, 3.69, P < .008] compared with RCB0 [pathologic complete response or pCR]) and type of surgery (worse survival in mastectomy than in breast-conserving surgery [BCS], adjusted hazard ratio, 2.97, P = .001). The hormone receptor–negative-human epidermal growth factor receptor 2–positive group had the highest proportion of pCR (48.9%). The analysis of the ASCO Quality Oncology Practice Initiative breast module revealed high compliance with pathologic standards but lower adherence to treatment administration standards. Notably, compliance with trastuzumab administration varied widely among countries (33.3%-88.7%).CONCLUSIONIn LABC, we demonstrated the survival benefit of BCS and the prognostic effect of the response to available neoadjuvant treatments despite an important variability in access to key treatments. The MPBCS represents a significant step forward in understanding the real-world implementation of oncologic procedures in LA

Lenvatinib plus pembrolizumab versus lenvatinib plus placebo for advanced hepatocellular carcinoma (LEAP-002): a randomised, double-blind, phase 3 trial

Summary Background Systemic therapies have improved the management of hepatocellular carcinoma, but there is still a need to further enhance overall survival in first-line advanced stages. This study aimed to evaluate the addition of pembrolizumab to lenvatinib versus lenvatinib plus placebo in the first-line setting for unresectable hepatocellular carcinoma. Methods In this global, randomised, double-blind, phase 3 study (LEAP-002), patients aged 18 years or older with unresectable hepatocellular carcinoma, Child Pugh class A liver disease, an Eastern Cooperative Oncology Group performance status of 0 or 1, and no previous systemic treatment were enrolled at 172 global sites. Patients were randomly assigned (1:1) with a central interactive voice-response system (block size of 4) to receive lenvatinib (bodyweight <60 kg, 8 mg/day; bodyweight ≥60 kg, 12 mg/day) plus pembrolizumab (200 mg every 3 weeks) or lenvatinib plus placebo. Randomisation was stratified by geographical region, macrovascular portal vein invasion or extrahepatic spread or both, α-fetoprotein concentration, and Eastern Cooperative Oncology Group performance status. Dual primary endpoints were overall survival (superiority threshold at final overall survival analysis, one-sided p=0·019; final analysis to occur after 532 events) and progression-free survival (superiority threshold one-sided p=0·002; final analysis to occur after 571 events) in the intention-to-treat population. Results from the final analysis are reported. This study is registered with ClinicalTrials.gov, NCT03713593, and is active but not recruiting. Findings Between Jan 17, 2019, and April 28, 2020, of 1309 patients assessed, 794 were randomly assigned to lenvatinib plus pembrolizumab (n=395) or lenvatinib plus placebo (n=399). Median age was 66·0 years (IQR 57·0–72·0), 644 (81%) of 794 were male, 150 (19%) were female, 345 (43%) were Asian, 345 (43%) were White, 22 (3%) were multiple races, 21 (3%) were American Indian or Alaska Native, 21 (3%) were Native Hawaiian or other Pacific Islander, 13 (2%) were Black or African American, and 46 (6%) did not have available race data. Median follow up as of data cutoff for the final analysis (June 21, 2022) was 32·1 months (IQR 29·4–35·3). Median overall survival was 21·2 months (95% CI 19·0–23·6; 252 [64%] of 395 died) with lenvatinib plus pembrolizumab versus 19·0 months (17·2–21·7; 282 [71%] of 399 died) with lenvatinib plus placebo (hazard ratio [HR] 0·84; 95% CI 0·71–1·00; stratified log-rank p=0·023). As of data cutoff for the progression-free survival final analysis (April 5, 2021), median progression-free survival was 8·2 months (95% CI 6·4–8·4; 270 events occurred [42 deaths; 228 progressions]) with lenvatinib plus pembrolizumab versus 8·0 months (6·3–8·2; 301 events occurred [36 deaths; 265 progressions]) with lenvatinib plus placebo (HR 0·87; 95% CI 0·73–1·02; stratified log-rank p=0·047). The most common treatment-related grade 3–4 adverse events were hypertension (69 [17%] of 395 patients in the lenvatinib plus pembrolizumab group vs 68 [17%] of 395 patients) in the lenvatinib plus placebo group), increased aspartate aminotransferase (27 [7%] vs 17 [4%]), and diarrhoea (25 [6%] vs 15 [4%]). Treatment-related deaths occurred in four (1%) patients in the lenvatinib plus pembrolizumab group (due to gastrointestinal haemorrhage and hepatorenal syndrome [n=1 each] and hepatic encephalopathy [n=2]) and in three (1%) patients in the lenvatinib plus placebo group (due to gastrointestinal haemorrhage, hepatorenal syndrome, and cerebrovascular accident [n=1 each]). Interpretation In earlier studies, the addition of pembrolizumab to lenvatinib as first-line therapy for advanced hepatocellular carcinoma has shown promising clinical activity; however, lenvatinib plus pembrolizumab did not meet prespecified significance for improved overall survival and progression-free survival versus lenvatinib plus placebo. Our findings do not support a change in clinical practice. Funding Eisai US, and Merck Sharp & Dohme, a subsidiary of Merck

Lenvatinib plus pembrolizumab versus lenvatinib plus placebo for advanced hepatocellular carcinoma (LEAP-002): a randomised, double-blind, phase 3 trial

Background Systemic therapies have improved the management of hepatocellular carcinoma, but there is still a need to further enhance overall survival in first-line advanced stages. This study aimed to evaluate the addition of pembrolizumab to lenvatinib versus lenvatinib plus placebo in the first-line setting for unresectable hepatocellular carcinoma.Methods In this global, randomised, double-blind, phase 3 study (LEAP-002), patients aged 18 years or older with unresectable hepatocellular carcinoma, Child Pugh class A liver disease, an Eastern Cooperative Oncology Group performance status of 0 or 1, and no previous systemic treatment were enrolled at 172 global sites. Patients were randomly assigned (1:1) with a central interactive voice-response system (block size of 4) to receive lenvatinib (bodyweight &lt;60 kg, 8 mg/day; bodyweight &gt;= 60 kg, 12 mg/day) plus pembrolizumab (200 mg every 3 weeks) or lenvatinib plus placebo. Randomisation was stratified by geographical region, macrovascular portal vein invasion or extrahepatic spread or both, alpha-fetoprotein concentration, and Eastern Cooperative Oncology Group performance status. Dual primary endpoints were overall survival (superiority threshold at final overall survival analysis, one-sided p=0019; final analysis to occur after 532 events) and progression-free survival (superiority threshold one-sided p=0002; final analysis to occur after 571 events) in the intention-to-treat population. Results from the final analysis are reported. This study is registered with ClinicalTrials.gov, NCT03713593, and is active but not recruiting.Findings Between Jan 17, 2019, and April 28, 2020, of 1309 patients assessed, 794 were randomly assigned to lenvatinib plus pembrolizumab (n=395) or lenvatinib plus placebo (n=399). Median age was 660 years (IQR 570-720), 644 (81%) of 794 were male, 150 (19%) were female, 345 (43%) were Asian, 345 (43%) were White, 22 (3%) were multiple races, 21 (3%) were American Indian or Alaska Native, 21 (3%) were Native Hawaiian or other Pacific Islander, 13 (2%) were Black or African American, and 46 (6%) did not have available race data. Median follow up as of data cutoff for the final analysis (June 21, 2022) was 321 months (IQR 294-353). Median overall survival was 212 months (95% CI 190-236; 252 [64%] of 395 died) with lenvatinib plus pembrolizumab versus 190 months (172-217; 282 [71%] of 399 died) with lenvatinib plus placebo (hazard ratio [HR] 084; 95% CI 071-100; stratified log-rank p=0023). As of data cutoff for the progression-free survival final analysis (April 5, 2021), median progression-free survival was 82 months (95% CI 64-84; 270 events occurred [42 deaths; 228 progressions]) with lenvatinib plus pembrolizumab versus 80 months (63-82; 301 events occurred [36 deaths; 265 progressions]) with lenvatinib plus placebo (HR 087; 95% CI 073-102; stratified log-rank p=0047). The most common treatment-related grade 3-4 adverse events were hypertension (69 [17%] of 395 patients in the lenvatinib plus pembrolizumab group vs 68 [17%] of 395 patients) in the lenvatinib plus placebo group), increased aspartate aminotransferase (27 [7%] vs 17 [4%]), and diarrhoea (25 [6%] vs 15 [4%]).Treatment-related deaths occurred in four (1%) patients in the lenvatinib plus pembrolizumab group (due to gastrointestinal haemorrhage and hepatorenal syndrome [n=1 each] and hepatic encephalopathy [n=2]) and in three (1%) patients in the lenvatinib plus placebo group (due to gastrointestinal haemorrhage, hepatorenal syndrome, and cerebrovascular accident [n=1 each]).Interpretation In earlier studies, the addition of pembrolizumab to lenvatinib as first-line therapy for advanced hepatocellular carcinoma has shown promising clinical activity; however, lenvatinib plus pembrolizumab did not meet prespecified significance for improved overall survival and progression-free survival versus lenvatinib plus placebo. Our findings do not support a change in clinical practice

Probing the nature of the χc1(3872)\chi_{c1}(3872) state using radiative decays

International audienceThe radiative decays $\chi_{c1}(3872)\rightarrow\psi(2S)\gamma$ and $\chi_{c1}(3872)\rightarrow J/\psi\gamma$ are used to probe the~nature of the~$\chi_{c1}(3872)$ state using proton-proton collision data collected with the LHCb detector, corresponding to an~integrated luminosity of~9fb$^{-1}$. Using the~$B^+\rightarrow \chi_{c1}(3872)K^+$decay, the $\chi_{c1}(3872)\rightarrow \psi(2S)\gamma$ process is observed for the first time and the ratio of its partial width to that of the $\chi_{c1}(3872)\rightarrow J/\psi\gamma$ decay is measured to be $$\frac{\Gamma_{\chi_{c1}(3872)\rightarrow \psi(2S)\gamma}} {\Gamma_{\chi_{c1}(3872)\rightarrow J/\psi\gamma}} = 1.67 \pm 0.21 \pm 0.12 \pm0.04 ,$$ where the first uncertainty is statistical, the second systematic and the third is due to the uncertainties on the branching fractions of the $\psi(2S)$ and $J/\psi$ mesons. The measured ratio makes the interpretation of the $\chi_{c1}(3872)$ state as a~pure $D^0\bar{D}^{*0}+\bar{D}^0D^{*0}$ molecule questionable and strongly indicates a sizeable compact charmonium or tetraquark component within the $\chi_{c1}(3872)$ state

Amplitude analysis of B+→ψ(2S)K+π+π−B^+ \to \psi(2S) K^+ \pi^+ \pi^- decays

International audienceThe first full amplitude analysis of $B^+ \to \psi(2S) K^+ \pi^+ \pi^-$ decays is performed using proton-proton collision data corresponding to an integrated luminosity of $9\,\text{fb}^{-1}$ recorded with the LHCb detector. The rich $K^+ \pi^+ \pi^-$ spectrum is studied and the branching fractions of the resonant substructure associated with the prominent $K_1(1270)^+$ contribution are measured. The data cannot be described by conventional strange and charmonium resonances only. An amplitude model with 53 components is developed comprising 11 hidden-charm exotic hadrons. New production mechanisms for charged charmonium-like states are observed. Significant resonant activity with spin-parity $J^P = 1^+$ in the $\psi(2S) \pi^+$ system is confirmed and a multi-pole structure is demonstrated. The spectral decomposition of the $\psi(2S) \pi^+ \pi^-$ invariant-mass structure, dominated by $X^0 \to \psi(2S) \rho(770)^0$ decays, broadly resembles the $J/\psi \phi$ spectrum observed in $B^+ \to J/\psi \phi K^+$ decays. Exotic $\psi(2S) K^+ \pi^-$ resonances are observed for the first time

Study of the rare decay J ⁣/ψ→μ+μ−μ+μ−J\mskip -3mu/\mskip -2mu\psi \to \mu^+\mu^-\mu^+\mu^-

The rare electromagnetic $J\mskip -3mu/\mskip -2mu\psi \to \mu^+\mu^-\mu^+\mu^-$ decay is observed with a significance greatly exceeding the discovery threshold, using proton-proton collision data collected by the LHCb experiment during 2016--2018 at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of $5.4\,\text{fb}^{-1}$. The rate of this decay is measured relative to that of the $J\mskip -3mu/\mskip -2mu\psi \to \mu^+\mu^-$ mode. Using the QED model for the four-muon decay in the efficiency estimation, its branching fraction is determined to be \begin{equation*} {\mathcal{B}}(J\mskip -3mu/\mskip -2mu\psi \to \mu^+\mu^-\mu^+\mu^-) = (1.13\pm0.10\pm0.05\pm0.01)\times 10^{-6}, \end{equation*} where the uncertainties are statistical, systematic and due to the uncertainty on the branching fraction of the $J\mskip -3mu/\mskip -2mu\psi \to \mu^+\mu^-$ decay.The rare electromagnetic $J/\psi \to \mu^+\mu^-\mu^+\mu^-$ decay is observed with a significance greatly exceeding the discovery threshold, using proton-proton collision data collected by the LHCb experiment during 2016-2018 at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of $5.4\,\text{fb}^{-1}$. The rate of this decay is measured relative to that of the $J/\psi \to \mu^+\mu^-$ mode. Using the QED model for the four-muon decay in the efficiency estimation, its branching fraction is determined to be \begin{equation*} {\mathcal{B}}(J/\psi \to \mu^+\mu^-\mu^+\mu^-) = (1.13\pm0.10\pm0.05\pm0.01)\times 10^{-6}, \end{equation*} where the uncertainties are statistical, systematic and due to the uncertainty on the branching fraction of the $J/\psi \to \mu^+\mu^-$ decay

Probing the nature of the χc1(3872)\chi_{c1}(3872) state using radiative decays

International audienceThe radiative decays $\chi_{c1}(3872)\rightarrow\psi(2S)\gamma$ and $\chi_{c1}(3872)\rightarrow J/\psi\gamma$ are used to probe the~nature of the~$\chi_{c1}(3872)$ state using proton-proton collision data collected with the LHCb detector, corresponding to an~integrated luminosity of~9fb$^{-1}$. Using the~$B^+\rightarrow \chi_{c1}(3872)K^+$decay, the $\chi_{c1}(3872)\rightarrow \psi(2S)\gamma$ process is observed for the first time and the ratio of its partial width to that of the $\chi_{c1}(3872)\rightarrow J/\psi\gamma$ decay is measured to be $$\frac{\Gamma_{\chi_{c1}(3872)\rightarrow \psi(2S)\gamma}} {\Gamma_{\chi_{c1}(3872)\rightarrow J/\psi\gamma}} = 1.67 \pm 0.21 \pm 0.12 \pm0.04 ,$$ where the first uncertainty is statistical, the second systematic and the third is due to the uncertainties on the branching fractions of the $\psi(2S)$ and $J/\psi$ mesons. The measured ratio makes the interpretation of the $\chi_{c1}(3872)$ state as a~pure $D^0\bar{D}^{*0}+\bar{D}^0D^{*0}$ molecule questionable and strongly indicates a sizeable compact charmonium or tetraquark component within the $\chi_{c1}(3872)$ state

Amplitude analysis of B+→ψ(2S)K+π+π−B^+ \to \psi(2S) K^+ \pi^+ \pi^- decays

International audienceThe first full amplitude analysis of $B^+ \to \psi(2S) K^+ \pi^+ \pi^-$ decays is performed using proton-proton collision data corresponding to an integrated luminosity of $9\,\text{fb}^{-1}$ recorded with the LHCb detector. The rich $K^+ \pi^+ \pi^-$ spectrum is studied and the branching fractions of the resonant substructure associated with the prominent $K_1(1270)^+$ contribution are measured. The data cannot be described by conventional strange and charmonium resonances only. An amplitude model with 53 components is developed comprising 11 hidden-charm exotic hadrons. New production mechanisms for charged charmonium-like states are observed. Significant resonant activity with spin-parity $J^P = 1^+$ in the $\psi(2S) \pi^+$ system is confirmed and a multi-pole structure is demonstrated. The spectral decomposition of the $\psi(2S) \pi^+ \pi^-$ invariant-mass structure, dominated by $X^0 \to \psi(2S) \rho(770)^0$ decays, broadly resembles the $J/\psi \phi$ spectrum observed in $B^+ \to J/\psi \phi K^+$ decays. Exotic $\psi(2S) K^+ \pi^-$ resonances are observed for the first time

Study of the rare decay J/ψ→μ+μ−μ+μ−J/\psi \to \mu^+\mu^-\mu^+\mu^-

International audienceThe rare electromagnetic $J/\psi \to \mu^+\mu^-\mu^+\mu^-$ decay is observed with a significance greatly exceeding the discovery threshold, using proton-proton collision data collected by the LHCb experiment during 2016-2018 at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of $5.4\,\text{fb}^{-1}$. The rate of this decay is measured relative to that of the $J/\psi \to \mu^+\mu^-$ mode. Using the QED model for the four-muon decay in the efficiency estimation, its branching fraction is determined to be \begin{equation*} {\mathcal{B}}(J/\psi \to \mu^+\mu^-\mu^+\mu^-) = (1.13\pm0.10\pm0.05\pm0.01)\times 10^{-6}, \end{equation*} where the uncertainties are statistical, systematic and due to the uncertainty on the branching fraction of the $J/\psi \to \mu^+\mu^-$ decay