The impact of rare cancer and early-line treatments on the benefit of comprehensive genome profiling-based precision oncology.

BACKGROUND: Comprehensive genome profiling (CGP) serves as a guide for suitable genomically matched therapies for patients with cancer. However, little is known about the impact of the timing and types of cancer on the therapeutic benefit of CGP. MATERIALS AND METHODS: A single hospital-based pan-cancer prospective study (TOP-GEAR; UMIN000011141) was conducted to examine the benefit of CGP with respect to the timing and types of cancer. Patients with advanced solid tumors (>30 types) who either progressed with or without standard treatments were genotyped using a single CGP test. The subjects were followed up for a median duration of 590 days to examine therapeutic response, using progression-free survival (PFS), PFS ratio, and factors associated with therapeutic response. RESULTS: Among the 507 patients, 62 (12.2%) received matched therapies with an overall response rate (ORR) of 32.3%. The PFS ratios (≥1.3) were observed in 46.3% (19/41) of the evaluated patients. The proportion of subjects receiving such therapies in the rare cancer cohort was lower than that in the non-rare cancer cohort (9.6% and 17.4%, respectively; P = 0.010). However, ORR of the rare cancer patients was higher than that in the non-rare cancer cohort (43.8% and 20.0%, respectively; P = 0.046). Moreover, ORR of matched therapies in the first or second line after receiving the CGP test was higher than that in the third or later lines (62.5% and 21.7%, respectively; P = 0.003). Rare cancer and early-line treatment were significantly and independently associated with ORR of matched therapies in multivariable analysis (P = 0.017 and 0.004, respectively). CONCLUSION: Patients with rare cancer preferentially benefited from tumor mutation profiling by increasing the chances of therapeutic response to matched therapies. Early-line treatments after profiling increase the therapeutic benefit, irrespective of tumor types.

Specific and chemoselective multi-alpha-arylation reaction of benzoylformic acid with or without decarbonylation in P(2)O(5)-MsOH and related acidic media

In P(2)O(5)-MsOH, or related acidic media, benzoylformic acid (1) undergoes three types of di- or mono-alpha-arylation reactions with or without decarbonylation ((1) decarbonylative alpha, alpha-diarylation, yielding triarylmethanols 6, (2) decarbonylative alpha-monoarylation, giving benzophenone derivatives 7, and (3) alpha,alpha-diarylation without decarbonylation, affording diarylated carboxylic acids 5) and one simple decarbonylation, without arylation, to form benzoic acid (8), instead of the conventional Friedel-Crafts acylation type reaction. The product ratios are governed by the capability of the acidic medium to form mixed anhydrides with carboxylic acids and the ability of the arenes to accept electrophiles.