ADJUVANT-CTONG1104 (ClinicalTrials.gov identifier: NCT01405079), a randomized phase III trial, showed that adjuvant gefitinib treatment significantly improved disease-free survival (DFS) versus ...vinorelbine plus cisplatin (VP) in patients with epidermal growth factor receptor (
) mutation-positive resected stage II-IIIA (N1-N2) non-small-cell lung cancer (NSCLC). Here, we report the final overall survival (OS) results.
From September 2011 to April 2014, 222 patients from 27 sites were randomly assigned 1:1 to adjuvant gefitinib (n = 111) or VP (n = 111). Patients with resected stage II-IIIA (N1-N2) NSCLC and
-activating mutation were enrolled, receiving gefitinib for 24 months or VP every 3 weeks for four cycles. The primary end point was DFS (intention-to-treat ITT population). Secondary end points included OS, 3-, 5-year (y) DFS rates, and 5-year OS rate. Post hoc analysis was conducted for subsequent therapy data.
Median follow-up was 80.0 months. Median OS (ITT) was 75.5 and 62.8 months with gefitinib and VP, respectively (hazard ratio HR, 0.92; 95% CI, 0.62 to 1.36;
= .674); respective 5-year OS rates were 53.2% and 51.2% (
= .784). Subsequent therapy was administered upon progression in 68.4% and 73.6% of patients receiving gefitinib and VP, respectively. Subsequent targeted therapy contributed most to OS (HR, 0.23; 95% CI, 0.14 to 0.38) compared with no subsequent therapy. Updated 3y DFS rates were 39.6% and 32. 5% with gefitinib and VP (
= .316) and 5y DFS rates were 22. 6% and 23.2% (
= .928), respectively.
Adjuvant therapy with gefitinib in patients with early-stage NSCLC and
mutation demonstrated improved DFS over standard of care chemotherapy. Although this DFS advantage did not translate to a significant OS difference, OS with adjuvant gefitinib was one of the longest observed in this patient group compared with historic data.
Cisplatin-based adjuvant chemotherapy is the standard of care for patients with resected stage II–IIIA non-small-cell lung cancer (NSCLC). RADIANT and SELECT trial data suggest patients with ...EGFR-mutant stage IB–IIIA resected NSCLC could benefit from adjuvant EGFR tyrosine kinase inhibitor treatment. We aimed to compare the efficacy of adjuvant gefitinib versus vinorelbine plus cisplatin in patients with completely resected EGFR-mutant stage II–IIIA (N1–N2) NSCLC.
We did a randomised, open-label, phase 3 trial at 27 centres in China. We enrolled patients aged 18–75 years with completely resected (R0), stage II–IIIA (N1–N2), EGFR-mutant (exon 19 deletion or exon 21 Leu858Arg) NSCLC. Patients were stratified by N stage and EGFR mutation status and randomised (1:1) by Pocock and Simon minimisation with a random element to either gefitinib (250 mg once daily) for 24 months or intravenous vinorelbine (25 mg/m2 on days 1 and 8) plus intravenous cisplatin (75 mg/m2 on day 1) every 3 weeks for four cycles. The primary endpoint was disease-free survival in the intention-to-treat population, which comprised all randomised patients; the safety population included all randomised patients who received at least one dose of study medication. Enrolment to the study is closed but survival follow-up is ongoing. The study is registered with ClinicalTrials.gov, number NCT01405079.
Between Sept 19, 2011, and April 24, 2014, 483 patients were screened and 222 patients were randomised, 111 to gefitinib and 111 to vinorelbine plus cisplatin. Median follow-up was 36·5 months (IQR 23·8–44·8). Median disease-free survival was significantly longer with gefitinib (28·7 months 95% CI 24·9–32·5) than with vinorelbine plus cisplatin (18·0 months 13·6–22·3; hazard ratio HR 0·60, 95% CI 0·42–0·87; p=0·0054). In the safety population, the most commonly reported grade 3 or worse adverse events in the gefitinib group (n=106) were raised alanine aminotransferase and asparate aminotransferase (two 2% patients with each event vs none with vinorelbine plus cisplatin). In the vinorelbine plus cisplatin group (n=87), the most frequently reported grade 3 or worse adverse events were neutropenia (30 34% patients vs none with gefitinib), leucopenia (14 16% vs none), and vomiting (eight 9% vs none). Serious adverse events were reported for seven (7%) patients who received gefitinib and 20 (23%) patients who received vinorelbine plus cisplatin. No interstitial lung disease was noted with gefitinib. No deaths were treatment related.
Adjuvant gefitinib led to significantly longer disease-free survival compared with that for vinorelbine plus cisplatin in patients with completely resected stage II–IIIA (N1–N2) EGFR-mutant NSCLC. Based on the superior disease-free survival, reduced toxicity, and improved quality of life, adjuvant gefitinib could be a potential treatment option compared with adjuvant chemotherapy in these patients. However, the duration of benefit with gefitinib after 24 months might be limited and overall survival data are not yet mature.
Guangdong Provincial Key Laboratory of Lung Cancer Translational Medicine; National Health and Family Planning Commission of People's Republic of China; Guangzhou Science and Technology Bureau; AstraZeneca China.
The sudden increase in COVID-19 cases is putting high pressure on healthcare services worldwide. At this stage, fast, accurate and early clinical assessment of the disease severity is vital. To ...support decision making and logistical planning in healthcare systems, this study leverages a database of blood samples from 485 infected patients in the region of Wuhan, China, to identify crucial predictive biomarkers of disease mortality. For this purpose, machine learning tools selected three biomarkers that predict the mortality of individual patients more than 10 days in advance with more than 90% accuracy: lactic dehydrogenase (LDH), lymphocyte and high-sensitivity C-reactive protein (hs-CRP). In particular, relatively high levels of LDH alone seem to play a crucial role in distinguishing the vast majority of cases that require immediate medical attention. This finding is consistent with current medical knowledge that high LDH levels are associated with tissue breakdown occurring in various diseases, including pulmonary disorders such as pneumonia. Overall, this Article suggests a simple and operable decision rule to quickly predict patients at the highest risk, allowing them to be prioritized and potentially reducing the mortality rate.Early and accurate clinical assessment of disease severity in COVID-19 patients is essential for planning the allocation of scarce hospital resources. An explainable machine learning tool trained on blood sample data from 485 patients from Wuhan selected three biomarkers for predicting mortality of individual patients with high accuracy.
Herein, an electrochemical oxidative cross‐coupling reaction between terminal alkynes and sulfonylhydrazides has been developed. Tetrabutylammonium iodide is used as the electrolyte and redox medium. ...The significant advantages of this method are high atom efficiency, functional group tolerance, and transition metal‐ and oxidant‐free conditions. Most of the compounds exhibit good inhibitory activity on tumor cell lines, and one of the compounds can inhibit cell migration and induce apoptosis in HeLa cells.
Heterogeneous, metal, single‐site catalysts often exhibit higher catalytic performance than other catalysts because of their maximized atom efficiency of 100 %. Reported herein is a ...precoordination/solvothermal polymerization strategy to fabricate a stable mononuclear Pd‐metalized porous organic polymer catalyst (Pd@POP). Pd@POP was easy to use in regioselective organic reactions because the internal structure of this Pd@POP can be easily modified. The catalyst was used to solve the intractable regioselectivity problems of Heck reactions. Pd@POP‐9 can efficiently activate the ends of olefins, thereby leading to high selectivity for substitution at the external position. To understand the reason underlying the high selectivity and activity of the catalyst, the systemic characterization of Pd@POP‐9 and density‐functional theory calculations were conducted. This Heck reaction is the first to be catalyzed by a recyclable mononuclear metal catalyst with unprecedented catalytic activity and regioselectivity.
Pop around: Reported herein is a precoordination/solvothermal polymerization strategy to fabricate a stable atomically dispersed mononuclear Pd‐metalized N‐heterocyclic carbene doped porous organic polymer catalyst (Pd@POP). This Heck reaction of electronically unbiased alkenes is the first to be catalyzed by a recyclable catalyst (Pd@POP‐9) with unprecedented catalytic activity and regioselectivity.
Exploring the mechanism of hysteresis dynamics may facilitate the analysis and controller design to alleviate detrimental effects. Conventional models, such as the Bouc-Wen and Preisach models ...consist of complicated nonlinear structures, limiting the applications of hysteresis systems for high-speed and high-precision positioning, detection, execution, and other operations. In this article, a Bayesian Koopman (B-Koopman) learning algorithm is therefore developed to characterize hysteresis dynamics. Essentially, the proposed scheme establishes a simplified linear representation with time delay for hysteresis dynamics, where the properties of the original nonlinear system are preserved. Furthermore, model parameters are optimized via sparse Bayesian learning together with an iterative strategy, which simplifies the identification procedure and reduces modeling errors. Extensive experimental results on piezoelectric positioning are elaborated to substantiate the effectiveness and superiority of the proposed B-Koopman algorithm for learning hysteresis dynamics.
The ADJUVANT study reported the comparative superiority of adjuvant gefitinib over chemotherapy in disease-free survival of resected EGFR-mutant stage II-IIIA non-small cell lung cancer (NSCLC). ...However, not all patients experienced favorable clinical outcomes with tyrosine kinase inhibitors (TKI), raising the necessity for further biomarker assessment. In this work, by comprehensive genomic profiling of 171 tumor tissues from the ADJUVANT trial, five predictive biomarkers are identified (TP53 exon4/5 mutations, RB1 alterations, and copy number gains of NKX2-1, CDK4, and MYC). Then we integrate them into the Multiple-gene INdex to Evaluate the Relative benefit of Various Adjuvant therapies (MINERVA) score, which categorizes patients into three subgroups with relative disease-free survival and overall survival benefits from either adjuvant gefitinib or chemotherapy (Highly TKI-Preferable, TKI-Preferable, and Chemotherapy-Preferable groups). This study demonstrates that predictive genomic signatures could potentially stratify resected EGFR-mutant NSCLC patients and provide precise guidance towards future personalized adjuvant therapy.
An efficient strategy for the synthesis of benzofuro2,3-bpyrazines was developed. These tricyclic scaffolds were formed through a multistep cascade sequence, which includes double insertion of ...isonitriles and chemoselective bicyclization. In this reaction, a nanopalladium was used as a recyclable catalyst. Product 3w exhibited excellent anticancer activity toward T-24 (IC50 = 12.5 ± 0.9 μM) and HeLa (IC50 = 14.7 ± 1.6 μM) cells. We also explored the action mechanism of 3w on T-24 cells.
This study uses PVDF, PAN, and coaxial electrospinning technique to build a core‐sheath structure for TiO2@PVDF/PAN electrospun membranes. The resulting electrospun membranes are compared with ...traditional electrospun membranes in terms of photocatalysis and oil‐water separation, which examines the influences of electrospinning fibrous structure. The test results show that the core‐sheath structure provides TiO2@PVDF/PAN electrospun membranes with a large diameter, high strength, a rough surface, a high photocatalysis, and good oil‐water separation. With PVDF as the sheath and PAN as the core, TiO2@PVDF/PAN electrospun membranes have a maximum strength of 8.96 MPa and exhibit 97% of rhodamine B pollutant after the exposure to the UV light. Moreover, the oil‐water separation rate is 99% and an oil flux is 40 163.79 L·m2·h−1, and the membrane maintains a high flux after 10 cycles, which makes TiO2@PVDF/PAN electrospun membranes an important candidate for treating wastewater produced in industry and daily life.
White-light emissive materials with stable photophysical properties are of great importance for their potential applications in information display, fluorescent sensors, and optical-recording ...systems. Herein, an amphiphilic tetraphenylpyrazine (TPP)-based cage compound (TPP-Cage) was facilely synthesized by reaction of propeller-like TPP with aggregation-induced emission characteristics and triglycol monomethyl ether-substituted triazine. By immobilizing the twisted conformation of TPP, TPP-Cage showed obvious helical chirality in the solution and aggregated state. TPP-Cage emits strong deep blue fluorescence in solution due to the restriction of intramolecular rotation of the TPP unit. Its amphiphilic nature enables it to serve as an excellent light-harvesting platform to encapsulate diketopyrrolopyrrole (DPP) with aggregation-caused quenching effect in its hydrophobic cavity in aqueous medium, forming the DPP@TPP-Cage complex. Such inclusion prevents π–π stacking of DPP enabling it to emit strong yellow-light emission in the aggregated state. Due to the complementary emission colors of TPP-Cage and DPP, DPP@TPP-Cage exhibited stable white-light emission in the aggregated state and poly(ethylene glycol) film. This work not only introduces a promising strategy for development of chiral compounds through immobilization of propeller-like achiral molecules but also provides a prospective pathway for white-light emission based on supramolecular assembly.
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