The Predictive and Prognostic Nature of Programmed Death-Ligand 1 in Malignant Pleural Mesothelioma: A Systematic Literature Review.

Introduction: Given the emergence of combination of programmed cell death protein-1 and CTLA4 pathway blockade as effective treatment options in malignant pleural mesothelioma (MPM), there is interest in the extent to which programmed death-ligand 1 (PD-L1) expression may be prognostic of clinical outcomes and predictive of response to anti-programmed death (ligand) 1 (PD-[L]1) therapies. Methods: MEDLINE and EMBASE electronic databases were searched until November 4, 2020. English-language randomized trials and observational studies that reported clinical outcomes and PD-L1 expression in adult patients (>18 or >20 y) with MPM were included. Forest plots were used to descriptively summarize clinical outcome data across studies. Results: A total of 29 publications were identified providing data on the research question. Among the studies in which anti-PD-(L)1 therapies were not specified to have been used, 63% (10 of 16) found patients with tumors expressing PD-L1 (typically >1%) to have poorer survival than those with tumors expressing lower levels of PD-L1. Among the studies in which anti-PD-(L)1 therapies were used, 83% (five of six) did not reveal an association between survival and PD-L1 tumor expression. The single study directly comparing outcomes between those treated and untreated with anti-PD-(L)1 therapies across different PD-L1 cutoffs did not identify any differences between the groups. Conclusions: The quality and consistency of the existing evidence base are currently insufficient to draw conclusions regarding a prognostic or predictive role of PD-L1 in MPM. Furthermore, high-quality studies on this topic are required to support the use of PD-L1 as a biomarker in MPM.

First-line nivolumab plus ipilimumab versus chemotherapy for the treatment of unresectable malignant pleural mesothelioma: patient-reported outcomes in CheckMate 743.

OBJECTIVE: In CheckMate 743 (NCT02899299), nivolumab + ipilimumab significantly prolonged overall survival in patients with unresectable malignant pleural mesothelioma (MPM). We present patient-reported outcomes (PROs). MATERIALS AND METHODS: Patients (N = 605) were randomized to nivolumab + ipilimumab or chemotherapy. Changes in disease-related symptom burden and health-related quality of life (HRQoL) were evaluated descriptively using the Lung Cancer Symptom Scale (LCSS)-Mesothelioma (Meso) average symptom burden index (ASBI), LCSS-Meso 3-item global index (3-IGI), 3-level EuroQol 5-dimensional (EQ-5D-3L) visual analog score (VAS), and EQ-5D-3L utility index. PROs were assessed at baseline and every 2 (nivolumab + ipilimumab) or 3 weeks (chemotherapy) through 12 weeks, every 6 weeks through 12 months, every 12 weeks thereafter, and at specified follow-ups. Mixed-effect model repeated measures (MMRM) and time to deterioration analyses were conducted. RESULTS: Completion rates were generally >80%. LCSS-Meso ASBI mean changes from baseline trended to improve over time with nivolumab + ipilimumab and deteriorate with chemotherapy, but did not meet clinically important difference thresholds [±10 score change]. EQ-5D-3L VAS mean scores improved over time with nivolumab + ipilimumab; by week 60, patients had scores consistent with United Kingdom normal population values. MMRM analyses favored nivolumab + ipilimumab for all individual symptoms except cough. Nivolumab + ipilimumab delayed time to definitive deterioration in HRQoL (hazard ratio 0.52 [95% confidence interval 0.36-0.74]) and showed a trend in symptom delay versus chemotherapy. CONCLUSIONS: Nivolumab + ipilimumab decreased the risk of deterioration in disease-related symptoms and HRQoL versus chemotherapy and maintained QoL in patients with unresectable MPM.

Real-world treatment patterns in resectable (stages I-III) non-small-cell lung cancer: a systematic literature review.

Aim: The aim of this systematic literature review was to describe treatment patterns in nonmetastatic non-small-cell lung cancer. Methods: A search was conducted in MEDLINE and EMBASE. Eligible studies were multicentered (>50 patients) and conducted after 2000 in North America, Europe and Asia. Results: Twenty studies met the eligibility criteria. Based on US and Canadian studies in the resectable population, the proportion of patients who received neoadjuvant chemotherapy/chemoradiotherapy and adjuvant chemotherapy/chemoradiotherapy increased with increasing stage (i.e., from <3% in stage I to about 40% in stage III and from 15% in stage I to 30% in stage III, respectively). Within the resectable population, the breakdown between bimodal and trimodal therapy was variable, suggesting that clinical practice is not uniform. Conclusion: Overall, studies were heterogeneous, precluding data extrapolation across regions. Despite heterogeneity and limited evidence, this review suggested an increase in neoadjuvant and adjuvant chemotherapy with increasing stage, generally in line with treatment guidelines.

This literature review aimed to describe the treatment patterns in nonmetastatic non-small-cell lung cancer. This review was performed according to the highest methodological standards and searched published and unpublished records of stages I­III non-small-cell lung cancer treatment in North America, Europe and Asia. A limited number of studies were identified showing that in North America treatment with neoadjuvant and adjuvant chemotherapy (with or without radiotherapy) increased with stage. Identified studies in all regions showed that the treatment received, such as bimodal with surgery and chemotherapy compared with trimodal with surgery, chemotherapy and radiotherapy, was quite variable and that practice was not uniform. Overall, the studies were heterogeneous and data could not be extrapolated to practice across all regions. However, the studies suggested an increase in neoadjuvant and adjuvant usage with increasing stage, which is generally in line with treatment guidelines.

Predicting in situ nanoparticle behavior using multiple particle tracking and artificial neural networks.

Predictive models of nanoparticle transport can drive design of nanotherapeutic platforms to overcome biological barriers and achieve localized delivery. In this paper, we demonstrate the ability of artificial neural networks to predict both nanoparticle properties, such as size and protein adsorption, and aspects of the brain microenvironment, such as cell internalization, viscosity, and brain region by using large (>100 000) trajectory datasets collected via multiple particle tracking in in vitro gel models of the brain and cultured organotypic brain slices. Our neural network achieved a 0.75 recall score when predicting gel viscosity based on trajectory datasets, compared to 0.49 using an obstruction scaling model. When predicting in situ nanoparticle size based on trajectory datasets, neural networks achieved a 0.90 recall score compared to 0.83 using an optimized Stokes-Einstein predictor. To distinguish between nanoparticles of different sizes in more complex nanoparticle mixtures, our neural network achieved up to a recall score of 0.85. Even in cases of more nuanced output variables where mathematical models are not available, such as protein adhesion, neural networks retained the ability to distinguish between particle populations (recall score of 0.89). These findings demonstrate how trajectory datasets in combination with machine learning techniques can be used to characterize the particle-microenvironment interaction space.

Tacrolimus versus cyclosporin in renal transplantation in Italy: cost-minimisation and cost-effectiveness analyses.

BACKGROUND: The economic impact of therapies has increasingly become part of the clinical decision-making process. Costs associated with kidney transplantation are substantial and economic evaluations are useful in identifying immunosuppressive regimens that yield optimal clinical and economic benefits. METHODS: Utilisation of health care resources during the first 6-months after renal transplantation was examined in 557 kidney transplant recipients participating in a European, multicentre, randomised, parallel group study that compared the efficacy and safety of a tacrolimus-based regimen versus a cyclosporin-microemulsion-based regimen. Cost-minimisation and cost-effectiveness analyses were conducted from an Italian hospital perspective, including direct medical costs only (e.g. medication, hospitalisation). RESULTS: The incidence of acute rejection was significantly lower in the tacrolimus group than in the cyclosporin microemulsion (ME) group (32.5% versus 51.3%; p<0.001). Patient and graft survival were similar in both treatment groups. Renal transplant recipients receiving tacrolimus-based immunosuppression had lower utilisation of health care resources and lower total costs per patient than cyclosporin-ME treated patients. When surviving patients with a rejection-free graft were analysed, tacrolimus therapy was cost-saving, since it was both more effective (18.8% difference in the incidence of acute rejection; 95%CI 10.7%-26.8%; p<0.001) and less costly than cyclosporin-ME based therapy (cost difference euro9918). The costs per patient with a functioning graft were euro2305, the costs per surviving patient were euro1892 lower in tacrolimus treated patients. Sensitivity analyses using the key cost-drivers (hospitalisation, study drug, and concomitant medication) found the cost advantage of tacrolimus was maintained. CONCLUSION: In the first 6 months after renal transplantation, tacrolimus-based therapy was less costly than cyclosporin-ME based therapy. When surviving patients with a rejection-free graft were considered, tacrolimus was the dominant therapy.