Assessment of NETest Clinical Utility in a U.S. Registry-Based Study.

BACKGROUND: The clinical relevance of molecular biomarkers in oncology management has been recognized in breast and lung cancers. We evaluated a blood-based multigene assay for management of neuroendocrine tumors (NETs) in a real-world study (U.S. registry NCT02270567). Diagnostic accuracy and relationship to clinical disease status in two cohorts (treated and watch-and-wait) were evaluated. MATERIALS AND METHODS: Patients with NETs (n = 100) were followed for 6-12 months. Patients' primary tumors were gastroenteropancreatic (68%), lung 20%, and of unknown origin (12%). Characteristics included well-differentiated, low-grade tumors (97%), stage IV disease (96%); treatment with surgery (70%); and drug treatment (56%). NETest was measured at each visit and disease status determined by RECIST. Scores categorized as low (NETest 14%-40%) or high (≥80%) defined disease as stable or progressive. Multivariate analyses determined the strength of the association with progression-free survival (PFS). RESULTS: NETest diagnostic accuracy was 96% and concordant (95%) with image-demonstrable disease. Scores were reproducible (97%) and concordant with clinical status (98%). The NETest was the only feature linked to PFS (odds ratio, 6.1; p < .0001). High NETest correlated with progressive disease (81%; median PFS, 6 months), and low NETest correlated with stable disease (87%; median PFS, not reached). In the watch-and-wait cohort, low NETest was concordant with stable disease in 100% of patients, and high NETest was associated with management changes in 83% of patients. In the treated cohort, all low NETest patients (100%) remained stable. A high NETest was linked to intervention and treatment stabilization (100%). Use of NETest was associated with reduced imaging (biannual to annual) in 36%-38% of patients. CONCLUSION: Blood NETest is an accurate diagnostic and can be of use in monitoring disease status and facilitating management change in both watch-and-wait and treatment cohorts. IMPLICATIONS FOR PRACTICE: A circulating multigene molecular biomarker to guide neuroendocrine tumor (NET) management has been developed because current biomarkers have limited clinical utility. NETest is diagnostic (96%) and in real time defines the disease status (>95%) as stable or progressive. It is >90% effective in guiding treatment decisions in conjunction with diagnostic imaging. Monitoring was effective in watch-and-wait or treatment groups. Low levels supported no management change and reduced the need for imaging. High levels indicated the need for management intervention. Real-time liquid biopsy assessment of NETs has clinical utility and can contribute additional value to patient management strategies and outcomes.

Electrochemistry of La(0.3)Sr(0.7)Fe(0.7)Cr(0.3)O(3-δ) as an oxygen and fuel electrode for RSOFCs.

The use of a single porous mixed ion-electron conducting (MIEC) material as both the oxygen and fuel electrodes in reversible solid oxide cells is of increasing interest, primarily due to the resulting simplified cell design and lower manufacturing costs. In this work, La(0.3)Sr(0.7)Fe(0.7)Cr(0.3)O(3-δ) (LSFCr-3) was studied in a 3-electrode half-cell configuration in air, pure CO2 and in a 1 : 1 CO2 : CO mixture, over a temperature range of 650-800 °C. A detailed analysis of the impedance (EIS) data, under both open circuit and polarized conditions, as well as the cyclic voltammetry response of LSFCr-3 has shown that it is very active in all of these environments, but with oxygen evolution being somewhat more facile that oxygen reduction, and CO2 reduction more active than CO oxidation. Evidence for a chemical capacitance, associated with the Fe(3+/4+) redox process in LSFCr-3, was also obtained from the EIS and CV data in all gas environments.

Activation of H(2) oxidation at sulphur-exposed Ni surfaces under low temperature SOFC conditions.

Ni-YSZ (yttria-stabilized zirconia) cermets are known to be very good anodes in solid oxide fuel cells (SOFCs), which are typically operated at 700-1000 °C. However, they are expected to be increasingly degraded as the operating temperature is lowered in the presence of H2S (5-10 ppm) in the H2 fuel stream. However, at 500 to 600 °C, a temperature range rarely examined for sulphur poisoning, but of great interest for next generation SOFCs, we report that H2S-exposed Ni-YSZ anodes are catalytic towards the H2 oxidation reaction, rather than poisoned. By analogy with bulk Ni3S2/YSZ anodes, shown previously to enhance H2 oxidation kinetics, it is proposed that a thin layer of Ni sulphide, akin to Ni3S2, is forming, at least at the triple point boundary (TPB) region under our conditions. To explain why Ni3S2/YSZ is so active, it is shown from density functional theory (DFT) calculations that the O(2-) anions at the Ni3S2/YSZ TPB are more reactive towards hydrogen oxidation than is O(2-) at the Ni/YSZ TPB. This is accounted for primarily by structural transformations of Ni3S2 during H2 oxidation, rather than by the electronic properties of this interface. To understand why a thin layer of Ni3S2 could form when a single monolayer of sulphur on the Ni surface is the predicted surface phase under our conditions, it is possible that the reaction of H2 with O(2-), forming water, prevents sulphur from re-equilibrating to H2S. This may then promote Ni sulphide formation, at least in the TPB region.

Cabozantinib plus atezolizumab in previously untreated advanced hepatocellular carcinoma and previously treated gastric cancer and gastroesophageal junction adenocarcinoma: results from two expansion cohorts of a multicentre, open-label, phase 1b trial (COSMIC-021).

Background: Cabozantinib is approved for previously treated advanced hepatocellular carcinoma (aHCC) and has been investigated in gastric cancer (GC) and gastroesophageal junction adenocarcinoma (GEJ). Atezolizumab plus bevacizumab is approved for unresectable or metastatic HCC untreated with prior systemic therapy. We evaluated efficacy and safety of cabozantinib plus atezolizumab in aHCC previously untreated with systemic anticancer therapy or previously treated GC/GEJ. Methods: COSMIC-021 (ClinicalTrials.gov, NCT03170960) is an open-label, phase 1b study in solid tumours with a dose-escalation stage followed by tumour-specific expansion cohorts, including aHCC (cohort 14) and GC/GEJ (cohort 15). Eligible patients were aged ≥18 years with measurable locally advanced, metastatic, or recurrent disease per RECIST version 1.1. Patients received oral cabozantinib 40 mg daily and intravenous atezolizumab 1200 mg once every 3 weeks until progressive disease or unacceptable toxicity. The primary endpoint was investigator-assessed objective response rate per RECIST version 1.1. Findings: Patients were screened between February 14, 2019, and May 7, 2020, and 61 (30 aHCC, 31 GC/GEJ) were enrolled and received at least one dose of study treatment. Median duration of follow-up was 31.2 months (IQR 28.5-32.7) for aHCC and 30.4 months (28.7-31.9) for GC/GEJ. Objective response rate was 13% (4/30, 95% CI 4-31) for aHCC and 0% (95% CI 0-11) for GC/GEJ. Six (20%) aHCC patients and three (10%) GC/GEJ patients had treatment-related adverse events resulting in discontinuation of either study drug. Interpretation: Cabozantinib plus atezolizumab had clinical activity with a manageable safety profile in aHCC previously untreated with systemic anticancer therapy. Clinical activity of cabozantinib plus atezolizumab was minimal in previously treated GC/GEJ. Funding: Exelixis, Inc., Alameda, CA, USA.

Clinical outcomes by Child-Pugh Class in patients with advanced hepatocellular carcinoma in a community oncology setting.

Aim: Many pivotal trials in advanced hepatocellular carcinoma (HCC) require participants to have Child-Pugh A disease. However, many patients in real-world practice are Child-Pugh B or C. This study examined treatment patterns and clinical outcomes in patients with advanced HCC treated with first-line systemic therapy. Materials & methods: In this retrospective study, patients with HCC treated with first-line systemic therapy (2010-2017) were identified from US Oncology Network records. Outcomes included overall survival and progression-free survival, by Child-Pugh Class and prior liver-directed therapy. Results: Of 352 patients, 78.7% were Child-Pugh A or B, 96.6% received first-line sorafenib, and 33.8% received first-line-prior liver-directed therapy. Survival outcomes were similar for Child-Pugh A or B, and longer after first-line prior liver-directed therapy. Conclusion: First-line systemic therapy is beneficial in patients with Child-Pugh A or B, and after first-line prior liver-directed therapy. These findings may help position systemic therapy in the community setting.

Monitoring and Surveillance of Patients with Gastroenteropancreatic Neuroendocrine Tumors Undergoing Radioligand Therapy.

Radioligand therapy (RLT) with [177Lu]Lu-DOTA-TATE is a standard of care for adult patients with somatostatin-receptor (SSTR)-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Taking advantage of this precision nuclear medicine approach requires diligent monitoring and surveillance, from the use of diagnostic SSTR-targeted radioligand imaging for the selection of patients through treatment and assessments of response. Published evidence-based guidelines assist the multidisciplinary healthcare team by providing acceptable approaches to care; however, the sheer heterogeneity of GEP-NETs can make these frameworks difficult to apply in individual clinical circumstances. There are also contradictions in the literature regarding the utility of novel approaches in monitoring and surveilling patients with GEP-NETs receiving RLT. This article discusses the emerging evidence on imaging, clinical biochemistry, and tumor assessment criteria in the management of patients receiving RLT for GEP-NETs; additionally, it documents our own best practices. This allows us to offer practical guidance on how to effectively implement monitoring and surveillance measures to aid patient-tailored clinical decision-making.

Early esophageal neuroendocrine tumor.

Esophageal neuroendocrine tumors are rare and often found incidentally on endoscopy. We present a unique case of an esophageal neuroendocrine tumor found in the setting of dysplasia associated with Barrett's esophagus. The tumor was removed endoscopically. This case highlights the incidence, prognosis, and management of esophageal neuroendocrine tumors.

Lanreotide Depot to Treat Gastroenteropancreatic Neuroendocrine Tumors in a US Community Oncology Setting: A Prospective, Observational Study.

INTRODUCTION: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) can result in symptoms such as diarrhea, flushing, abdominal pain, and fatigue and are often associated with a significant disease burden and poor prognosis. This non-interventional, prospective, observational study evaluated the real-world safety and effectiveness of lanreotide depot, a somatostatin analog (SSA) used to treat GEP-NETs, in a community setting. METHODS: In this prospective, non-interventional study (NCT02730104), adult patients with locally advanced (inoperable), metastatic GEP-NETs treated with lanreotide depot were evaluated by their physician every 6 months from enrollment for 24 months. Clinically defined time to disease progression (TTDP) and overall survival (OS) were estimated for the total population and by primary tumor type (gastrointestinal [GI], pancreatic, unknown origin), and an exploratory analysis determined the rate of progression-free survival (PFS) at 12 and 24 months. Patient satisfaction was evaluated via the Treatment Satisfaction Questionnaire for Medication (TSQM-9), and safety information was recorded. RESULTS: Of 99 patients, the 24-month PFS rate was 73.7% (95% confidence interval [CI] 63.1-81.7) and 24-month OS rate was 84.2% (95% CI 74.0-90.7). Median TTDP was not reached because few patients experienced disease progression during the study period. The majority of responding patients expressed satisfaction with treatment on each domain of the TSQM-9. Treatment-related adverse events (AEs) occurred in 19.2% of patients, while no serious AEs (SAEs) were related to the study drug. CONCLUSIONS: Lanreotide depot is an effective and well-tolerated treatment for GEP-NETs in the real-world community setting. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT02730104.

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare tumors that develop in the gut or pancreas. GEP-NETs may lead to a reduced lifespan, and people with GEP-NETs may have symptoms such as fatigue, muscle weakness, diarrhea, stomach pain/cramping, and skin reactions. One approved treatment for patients whose tumor cannot be removed with surgery is lanreotide depot. Clinical trials have found lanreotide depot to be effective at prolonging survival and managing symptoms in people with GEP-NETs. However, clinical trials take place under very strict conditions and often do not represent all people with a certain disease in the 'real world'. It is important to determine whether treatments are still effective when used outside of clinical trials. This study was conducted in the real world and followed 99 people with GEP-NETs whose physicians were treating them with lanreotide depot. Each person was monitored for 24 months and assessed during check-ups by their physician every 6 months. After 24 months, 73.7% of people did not have progression (worsening) of disease. The percentage of people who had not died by the end of the study was 84.2%. Most patients (91.6%) said they were satisfied with their treatment. Only 19.2% of patients experienced side effects, none of which were serious.

Neuroendocrine carcinoma of the prostate gland.

Small cell prostate carcinoma (SCPC) has a clinical course and prognosis that is markedly different from that of common adenocarcinoma of the prostate. The patient in this case presented with fever of unknown origin, dyspnea, and near spinal cord compression. He was subsequently found to have widely metastatic high-grade neuroendocrine carcinoma of prostatic origin. This case emphasizes that despite the commonality of prostate cancer, there are rare presentations of this common disease.

Synthesis of peapods using substrate-grown SWNTs and DWNTs: an enabling step toward peapod devices.

We report the successful synthesis of nanoscale peapods from single-walled and double-walled nanotubes grown by chemical vapor deposition (CVD) on substrates with windows etched into free-standing silicon nitride membranes. CVD-grown nanotubes were oxidized in air, then filled with C(60) molecules from the vapor phase. Observed variation in nanotube oxidation and C(60) packing with nanotube diameter agreed with theoretical expectations. Windowed samples provide several important advantages for property measurements of peapods and other nanomaterials. Individual nanostructures can be followed through processing steps, and a single nanostructure can be inspected by high-resolution TEM and subsequently contacted with nanoscale electrodes using electron beam lithography.