Gemcitabine and Paclitaxel Versus Gemcitabine Alone After 5-Fluorouracil, Oxaliplatin, and Irinotecan in Metastatic Pancreatic Adenocarcinoma: A Randomized Phase III PRODIGE 65-UCGI 36-GEMPAX UNICANCER Study.

PURPOSE: GEMPAX was an open-label, randomized phase III clinical trial designed to assess the efficacy and tolerability of gemcitabine plus paclitaxel versus gemcitabine alone as second-line treatment for patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) who previously received 5-fluorouracil, oxaliplatin, and irinotecan. METHODS: Patients with histologically or cytologically confirmed mPDAC were randomly assigned (2:1) to receive GEMPAX (paclitaxel 80 mg/m2 + gemcitabine 1,000 mg/m2; IV; once at day (D) 1, D8, and D15/arm A) or gemcitabine (arm B) alone once at D1, D8, and D15 every 28 days until progression, toxicity, or patient's decision. The primary end point was overall survival (OS). Secondary end points included progression-free survival (PFS), objective response rate (ORR), quality of life, and safety. RESULTS: Overall, 211 patients (median age, 64 [30-86] years; 62% male) were included. After a median study follow-up for alive patients of 13.4 versus 13.8 months in arm A versus arm B, the median OS (95% CI) was 6.4 (5.2 to 7.4) versus 5.9 months (4.6 to 6.9; hazard ratio [HR], 0.87 [0.63 to 1.20]; P = 0.4095), the median PFS was 3.1 (2.2 to 4.3) versus 2.0 months (1.9 to 2.3; HR, 0.64 [0.47 to 0.89]; P = 0.0067), and the ORR was 17.1% (11.3 to 24.4) versus 4.2% (0.9 to 11.9; P = 0.008) in arm A versus arm B, respectively. Overall, 16.7% of patients in arm A and 2.9% in arm B discontinued their treatment because of adverse events (AEs). One grade 5 AE associated with both gemcitabine and paclitaxel was reported in arm A (acute respiratory distress), and 58.0% versus 27.1% of patients experienced grade ≥3 treatment-related AEs in arm A versus arm B, among which 15.2% versus 4.3% had anemia, 15.9% versus 15.7% had neutropenia, 19.6% versus 4.3% had thrombocytopenia, 10.1% versus 2.9% had asthenia and 12.3% versus 0.0% had neuropathy. CONCLUSION: While GEMPAX did not meet the primary end point of OS versus gemcitabine alone in patients with mPDAC in the second-line setting, both PFS and ORR were significantly improved.

Fate, subcellular distribution and biological effects of rare earth elements in a freshwater bivalve under complex exposure.

Rare earth elements (REE) are emerging contaminants due to their increased use in diverse applications including cutting-edge and green-technologies. Their environmental concerns and contradicting results concerning their biological effects require an extensive understanding of REE ecotoxicology. Thus, we have studied the fate, bioaccumulation and biological effects of three representative REE, neodymium (Nd), gadolinium (Gd) and ytterbium (Yb), individually and in mixture, using the freshwater bivalve Corbicula fluminea. The organisms were exposed for 96 h at 1 mg L-1 REE in the absence and presence of dissolved organic matter (DOM) reproducing an environmental contamination. Combined analysis of the fate, distribution and effects of REE at tissue and subcellular levels allowed a comprehensive understanding of their behaviour, which would help improving their environmental risk assessment. The bivalves accumulated significant concentrations of Nd, Gd and Yb, which were decreased in the presence of DOM likely due to the formation of REE-DOM complexes that reduced REE bioavailability. The accumulation of Nd, Gd and Yb differed between tissues, with gills > digestive gland ≥ rest of soft tissues > hemolymph. In the gills and in the digestive gland, Nd, Gd and Yb were mostly (>90 %) distributed among metal sensitive organelles, cellular debris and detoxified metal-rich granules. Gadolinium, Yb and especially Nd decreased lysosome size in the digestive gland and disturbed osmo- and iono-regulation of C. fluminea by decreasing Na concentrations in the hemolymph and Ca2+ ATPase activity in the gills. Individual and mixed Nd, Gd and Yb exhibited numerous similarities and some differences in terms of fate, accumulation and biological effects, possibly because they have common abiotic and biotic ligands but different affinities for the latter. In most cases, individual and mixed effects of Nd, Gd, Yb were similar suggesting that additivity approach is suitable for the environmental risk assessment of REE mixtures.

Implications of speciation on rare earth element toxicity: A focus on organic matter influence in Daphnia magna standard test.

Rare earth elements (REE) have become essential in high- and green-technologies. Their increasing use lead to the release of anthropogenic REE into the environment including aquatic systems. The limited data available on the aquatic ecotoxicology of REE indicate their biological effects are highly dependent on their speciation, posing challenges for a reliable environmental risk assessment (ERA). The current study assessed the influence of speciation on the toxicity of neodymium (Nd), gadolinium (Gd) and ytterbium (Yb) in the Daphnia magna mobility inhibition test (ISO 6341:2012). REE toxicity was assessed individually and in ternary mixture, in the absence and presence of dissolved organic matter (DOM). Speciation was predicted by modeling and REE bioaccumulation by D. magna was measured to better understand the relationship between REE speciation and toxicity. DOM decreased significantly the toxicity of Nd, Gd and the mixture towards this freshwater crustacean. This was explained by a lower REE bioaccumulation in the presence of DOM due to REE-DOM complexation, which reduced REE bioavailability. DOM effects on Yb toxicity and bioaccumulation were limited because of Yb precipitation. We show that the way of expressing EC50 values (based on nominal, measured or predicted REE concentrations in solution) drastically changed REE toxicity assessment and that these changes were influenced by REE speciation. This study demonstrates for the first time that REE speciation, and especially REE-DOM complexation, significantly influences REE bioaccumulation and toxicity towards D. magna. Our results have implications for the subsequent ERA of REE.