ABSTRACT
Background: We investigated the efficacy and health-related quality of life (HRQoL) in patients receiving either ribociclib plus endocrine therapy (ET) or chemotherapy with/without bevacizumab as first-line treatment of metastatic hormone receptor (HR)-positive, HER2-negative breast cancer (BC). Patients and Methods: In this randomized, phase III study (RIBBIT), 38 patients diagnosed with metastatic HR-positive, HER2-negative BC with presence of visceral metastases recruited between May 2018 and December 2020 were randomly assigned in a 1:1 ratio to either arm A (ribociclib + ET) or arm B (chemotherapy with/without bevacizumab) at 12 sites in Germany. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall response rate (ORR), overall survival (OS), patient-reported HRQoL, and frequency and type of adverse events. During study conduction, the recruitment rate was persistently and considerably lower than originally expected. Therefore, the recruitment was ended prematurely. The study was initially designed to enroll and randomize 158 patients. Results: Median [95% CI] PFS was 27.3 months [19.1 - NA, parameter not estimable] in arm A and 15.8 months [8.2 - NA] in arm B. Complete responses were achieved only in arm A (n = 2, 10.5%). The ORR [95% CI] between arm A (57.9% [33.5-79.7]) and arm B (52.6% [28.9-75.6]) was comparable. Median OS [95% CI] was not reached in arm A, while in arm B median OS was 28.4 months [25.0 - NA]. Patients in arm A reported less burden by side-effects. No new safety signals emerged. Conclusion: Treatment of patients with visceral metastatic HR-positive, HER2-negative BC with ribociclib in combination with ET showed a tendency toward a more favorable clinical outcome. Despite small numbers of patients and sites, this head-to-head comparison with chemotherapy supports the use of ribociclib with ET in patients with visceral metastasis at risk of fast disease progression.
ABSTRACT
In functional magnetic resonance imaging (fMRI), functional connectivity is conventionally characterized by correlations between fMRI time series, which are intrinsically undirected measures of connectivity. Yet, some information about the directionality of network connections can nevertheless be extracted from the matrix of pairwise temporal correlations between all considered time series, when expressed in the frequency-domain as a cross-spectral density matrix. Using a sparsity prior, it then becomes possible to determine a unique directed network topology that best explains the observed undirected correlations, without having to rely on temporal precedence relationships that may not be valid in fMRI. Applying this method on simulated data with 100 nodes yielded excellent retrieval of the underlying directed networks under a wide variety of conditions. Importantly, the method did not depend on temporal precedence to establish directionality, thus reducing susceptibility to hemodynamic variability. The computational efficiency of the algorithm was sufficient to enable whole-brain estimations, thus circumventing the problem of missing nodes that otherwise occurs in partial-brain analyses. Applying the method to real resting-state fMRI data acquired with a high temporal resolution, the inferred networks showed good consistency with structural connectivity obtained from diffusion tractography in the same subjects. Interestingly, this agreement could also be seen when considering high-frequency rather than low-frequency connectivity (average correlation: r = 0.26 for f < 0.3 Hz, r = 0.43 for 0.3 < f < 5 Hz). Moreover, this concordance was significantly better (p < 0.05) than for networks obtained with conventional functional connectivity based on correlations (average correlation r = 0.18). The presented methodology thus appears to be well-suited for fMRI, particularly given its lack of explicit dependence on temporal lag structure, and is readily applicable to whole-brain effective connectivity estimation.
ABSTRACT
Knowing brain connectivity is of great importance both in basic research and for clinical applications. We are proposing a method to infer directed connectivity from zero-lag covariances of neuronal activity recorded at multiple sites. This allows us to identify causal relations that are reflected in neuronal population activity. To derive our strategy, we assume a generic linear model of interacting continuous variables, the components of which represent the activity of local neuronal populations. The suggested method for inferring connectivity from recorded signals exploits the fact that the covariance matrix derived from the observed activity contains information about the existence, the direction and the sign of connections. Assuming a sparsely coupled network, we disambiguate the underlying causal structure via L1-minimization, which is known to prefer sparse solutions. In general, this method is suited to infer effective connectivity from resting state data of various types. We show that our method is applicable over a broad range of structural parameters regarding network size and connection probability of the network. We also explored parameters affecting its activity dynamics, like the eigenvalue spectrum. Also, based on the simulation of suitable Ornstein-Uhlenbeck processes to model BOLD dynamics, we show that with our method it is possible to estimate directed connectivity from zero-lag covariances derived from such signals. In this study, we consider measurement noise and unobserved nodes as additional confounding factors. Furthermore, we investigate the amount of data required for a reliable estimate. Additionally, we apply the proposed method on full-brain resting-state fast fMRI datasets. The resulting network exhibits a tendency for close-by areas being connected as well as inter-hemispheric connections between corresponding areas. In addition, we found that a surprisingly large fraction of more than one third of all identified connections were of inhibitory nature.