Treatment Efficacy Score-continuous residual cancer burden-based metric to compare neoadjuvant chemotherapy efficacy between randomized trial arms in breast cancer trials.

BACKGROUND: Difference in pathologic complete response (pCR) rate after neoadjuvant chemotherapy does not capture the impact of treatment on downstaging of residual cancer in the experimental arm. We developed a method to compare the entire distribution of residual cancer burden (RCB) values between clinical trial arms to better quantify the differences in cytotoxic efficacy of treatments. PATIENTS AND METHODS: The Treatment Efficacy Score (TES) reflects the area between the weighted cumulative distribution functions of RCB values from two trial arms. TES is based on a modified Kolmogorov-Smirnov test with added weight function to capture the importance of high RCB values and uses the area under the difference between two distribution functions as a statistical metric. The higher the TES the greater the shift to lower RCB values in the experimental arm. We developed TES from the durvalumab + olaparib arm (n = 72) and corresponding controls (n = 282) of the I-SPY2 trial. The 11 other experimental arms and control cohorts (n = 947) were used as validation sets to assess the performance of TES. We compared TES to Kolmogorov-Smirnov, Mann-Whitney, and Fisher's exact tests to identify trial arms with higher cytotoxic efficacy and assessed associations with trial arm level survival differences. Significance was assessed with a permutation test. RESULTS: In the validation set, TES identified arms with a higher pCR rate but was more accurate to identify regimens as less effective if treatment did not reduce the frequency of high RCB values, even if the pCR rate improved. The correlation between TES and survival was higher than the correlation between the pCR rate difference and survival. CONCLUSIONS: TES quantifies the difference between the entire distribution of pathologic responses observed in trial arms and could serve as a better early surrogate to predict trial arm level survival differences than pCR rate difference alone.

Circulating tumor DNA in neoadjuvant-treated breast cancer reflects response and survival.

BACKGROUND: Pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) is strongly associated with favorable outcome. We examined the utility of serial circulating tumor DNA (ctDNA) testing for predicting pCR and risk of metastatic recurrence. PATIENTS AND METHODS: Cell-free DNA (cfDNA) was isolated from 291 plasma samples of 84 high-risk early breast cancer patients treated in the neoadjuvant I-SPY 2 TRIAL with standard NAC alone or combined with MK-2206 (AKT inhibitor) treatment. Blood was collected at pretreatment (T0), 3 weeks after initiation of paclitaxel (T1), between paclitaxel and anthracycline regimens (T2), or prior to surgery (T3). A personalized ctDNA test was designed to detect up to 16 patient-specific mutations (from whole-exome sequencing of pretreatment tumor) in cfDNA by ultra-deep sequencing. The median follow-up time for survival analysis was 4.8 years. RESULTS: At T0, 61 of 84 (73%) patients were ctDNA positive, which decreased over time (T1: 35%; T2: 14%; and T3: 9%). Patients who remained ctDNA positive at T1 were significantly more likely to have residual disease after NAC (83% non-pCR) compared with those who cleared ctDNA (52% non-pCR; odds ratio 4.33, P = 0.012). After NAC, all patients who achieved pCR were ctDNA negative (n = 17, 100%). For those who did not achieve pCR (n = 43), ctDNA-positive patients (14%) had a significantly increased risk of metastatic recurrence [hazard ratio (HR) 10.4; 95% confidence interval (CI) 2.3-46.6]; interestingly, patients who did not achieve pCR but were ctDNA negative (86%) had excellent outcome, similar to those who achieved pCR (HR 1.4; 95% CI 0.15-13.5). CONCLUSIONS: Lack of ctDNA clearance was a significant predictor of poor response and metastatic recurrence, while clearance was associated with improved survival even in patients who did not achieve pCR. Personalized monitoring of ctDNA during NAC of high-risk early breast cancer may aid in real-time assessment of treatment response and help fine-tune pCR as a surrogate endpoint of survival.

Correction to: In vivo digestibility of six selected fodder species by goats in northern Ghana.

The article "In vivo digestibility of six selected fodder species by goats in northern Ghana," written by F. K. Avornyo et al., was originally published electronically on the publisher's internet portal (currently SpringerLink) on 13 July 2019 without open access.

In vivo digestibility of six selected fodder species by goats in northern Ghana.

An in vivo digestibility trial was conducted to evaluate the digestibility of six forages. These were selected indigenous browse species and groundnut haulms in Lawra and Jirapa Districts of the Upper West Region of Ghana. Groundnut haulms served as a control due to its known good digestibility in small ruminants. Thirty West African Dwarf (WAD) young castrated billy goats with a mean age of 8 months were used. The average live body weight was 8.9 ± 0.1 kg. The animals were randomly assigned to the six treatments and replicated five times in a completely randomized design. They were confined in metabolism cages. The adaptation period was 3 weeks after which data was taken for 10 days. The treatments were the leaves and tiny twigs of T1 Annona senegalensis, T2 Ficus gnaphalocarpa, T3 Pericopsis laxiflora, T4 Pterocarpus erinaceus, T5 Afzelia africana, and T6 (control) Arachis hypogaea. Feed intake, faecal matter and urine output were measured. The results indicated that dry matter (DM) contents of the feedstuffs were less than 50% but crude protein (CP) contents were higher than the minimum required for sustaining ruminants. Neutral and acid detergent fibre contents were high, and F. gnaphalocarpa, in particular, contained a higher level of phosphorus (P). The amounts of feed intakes were typical of most fodder species with the exception of P. laxiflora and P. erinaceus, which were lower (P < 0.05). The apparent digestibility values were also typical of most fodder species but the digestibility of A. africana fibre appeared to be lower. Nitrogen retention was positive for all test species with the exception of P. laxiflora, which was negative. Mortality was recorded in animals on P. laxiflora, and the rate was high. Pericopsis laxiflora leaves, even though morphologically similar to the leaves of P. erinaceus, were not a suitable fodder. Ficus gnaphalocarpa appeared to be the overall best fodder species in terms of nutrient uptake.

Longitudinal studies of a B cell-derived signature of tolerance in renal transplant recipients.

Biomarkers of transplant tolerance would enhance the safety and feasibility of clinical tolerance trials and potentially facilitate management of patients receiving immunosuppression. To this end, we examined blood from spontaneously tolerant renal transplant recipients and patients enrolled in two interventional tolerance trials using flow cytometry and gene expression profiling. Using a previously reported tolerant cohort as well as newly identified tolerant patients, we confirmed our previous finding that tolerance was associated with increased expression of B cell-associated genes relative to immunosuppressed patients. This was not accounted for merely by an increase in total B cell numbers, but was associated with the increased frequencies of transitional and naïve B cells. Moreover, serial measurements of gene expression demonstrated that this pattern persisted over several years, although patients receiving immunosuppression also displayed an increase in the two most dominant tolerance-related B cell genes, IGKV1D-13 and IGLL-1, over time. Importantly, patients rendered tolerant via induction of transient mixed chimerism, and those weaned to minimal immunosuppression, showed similar increases in IGKV1D-13 as did spontaneously tolerant individuals. Collectively, these findings support the notion that alterations in B cells may be a common theme for tolerant kidney transplant recipients, and that it is a useful monitoring tool in prospective trials.

Macroporosity and manure influence on atrazine transport through soil.

The influence of soil macro-porosity and manure on atrazine (6-chloro-N-ethyl-N'-(1-methylethyl)-1,3,5-triazine-2,4-diamine) transport was investigated under laboratory conditions using disturbed and undisturbed soil columns. The macro-porosity in the soil column was obtained with CT scanning technique. Liquid manure was applied at the surface of soil column, 19 cm long and 8 cm in diameter, at a rate of 60 m3/ha. Experimental results revealed that atrazine moves faster through the soils in the presence of manure compared to soil without application of manure. The average time for elusion and the relative peak concentration in the disturbed soil column without manure was 14.5 h and 3.1%, respectively compared to 11.0 h and 6.9% in the presence of manure, respectively. Similar behavior was observed in the case of disturbed soil columns. Soil macro-porosity has shown large impact on atrazine transport, especially in the presence of manure.