First-Line afatinib versus chemotherapy in patients with non–small cell lung cancer and common epidermal growth factor receptor gene mutations and brain metastases

Introduction Metastatic spread to the brain is common in patients with non–small cell lung cancer (NSCLC), but these patients are generally excluded from prospective clinical trials. The studies, phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations (LUX-Lung 3) and a randomized, open-label, phase III study of BIBW 2992 versus chemotherapy as first-line treatment for patients with stage IIIB or IV adenocarcinoma of the lung harbouring an EGFR activating mutation (LUX-Lung 6) investigated first-line afatinib versus platinum-based chemotherapy in epidermal growth factor receptor gene (EGFR) mutation-positive patients with NSCLC and included patients with brain metastases; prespecified subgroup analyses are assessed in this article. Methods For both LUX-Lung 3 and LUX-Lung 6, prespecified subgroup analyses of progression-free survival (PFS), overall survival, and objective response rate were undertaken in patients with asymptomatic brain metastases at baseline (n = 35 and n = 46, respectively). Post hoc analyses of clinical outcomes was undertaken in the combined data set (n = 81). Results In both studies, there was a trend toward improved PFS with afatinib versus chemotherapy in patients with brain metastases (LUX-Lung 3: 11.1 versus 5.4 months, hazard ratio [HR] = 0.54, p = 0.1378; LUX-Lung 6: 8.2 versus 4.7 months, HR = 0.47, p = 0.1060). The magnitude of PFS improvement with afatinib was similar to that observed in patients without brain metastases. In combined analysis, PFS was significantly improved with afatinib versus with chemotherapy in patients with brain metastases (8.2 versus 5.4 months; HR, 0.50; p = 0.0297). Afatinib significantly improved the objective response rate versus chemotherapy in patients with brain metastases. Safety findings were consistent with previous reports. Conclusions These findings lend support to the clinical activity of afatinib in EGFR mutation–positive patients with NSCLC and asymptomatic brain metastases.

Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials

Background We aimed to assess the effect of afatinib on overall survival of patients with EGFR mutation-positive lung adenocarcinoma through an analysis of data from two open-label, randomised, phase 3 trials. Methods Previously untreated patients with EGFR mutation-positive stage IIIB or IV lung adenocarcinoma were enrolled in LUX-Lung 3 (n=345) and LUX-Lung 6 (n=364). These patients were randomly assigned in a 2:1 ratio to receive afatinib or chemotherapy (pemetrexed-cisplatin [LUX-Lung 3] or gemcitabine-cisplatin [LUX-Lung 6]), stratified by EGFR mutation (exon 19 deletion [del19], Leu858Arg, or other) and ethnic origin (LUX-Lung 3 only). We planned analyses of mature overall survival data in the intention-to-treat population after 209 (LUX-Lung 3) and 237 (LUX-Lung 6) deaths. These ongoing studies are registered with ClinicalTrials.gov, numbers NCT00949650 and NCT01121393. Findings Median follow-up in LUX-Lung 3 was 41 months (IQR 35–44); 213 (62%) of 345 patients had died. Median follow-up in LUX-Lung 6 was 33 months (IQR 31–37); 246 (68%) of 364 patients had died. In LUX-Lung 3, median overall survival was 28·2 months (95% CI 24·6–33·6) in the afatinib group and 28·2 months (20·7–33·2) in the pemetrexed-cisplatin group (HR 0·88, 95% CI 0·66–1·17, p=0·39). In LUX-Lung 6, median overall survival was 23·1 months (95% CI 20·4–27·3) in the afatinib group and 23·5 months (18·0–25·6) in the gemcitabine-cisplatin group (HR 0·93, 95% CI 0·72–1·22, p=0·61). However, in preplanned analyses, overall survival was significantly longer for patients with del19-positive tumours in the afatinib group than in the chemotherapy group in both trials: in LUX-Lung 3, median overall survival was 33·3 months (95% CI 26·8–41·5) in the afatinib group versus 21·1 months (16·3–30·7) in the chemotherapy group (HR 0·54, 95% CI 0·36–0·79, p=0·0015); in LUX-Lung 6, it was 31·4 months (95% CI 24·2–35·3) versus 18·4 months (14·6–25·6), respectively (HR 0·64, 95% CI 0·44–0·94, p=0·023). By contrast, there were no significant differences by treatment group for patients with EGFR Leu858Arg-positive tumours in either trial: in LUX-Lung 3, median overall survival was 27·6 months (19·8–41·7) in the afatinib group versus 40·3 months (24·3–not estimable) in the chemotherapy group (HR 1·30, 95% CI 0·80–2·11, p=0·29); in LUX-Lung 6, it was 19·6 months (95% CI 17·0–22·1) versus 24·3 months (19·0–27·0), respectively (HR 1·22, 95% CI 0·81–1·83, p=0·34). In both trials, the most common afatinib-related grade 3–4 adverse events were rash or acne (37 [16%] of 229 patients in LUX-Lung 3 and 35 [15%] of 239 patients in LUX-Lung 6), diarrhoea (33 [14%] and 13 [5%]), paronychia (26 [11%] in LUX-Lung 3 only), and stomatitis or mucositis (13 [5%] in LUX-Lung 6 only). In LUX-Lung 3, neutropenia (20 [18%] of 111 patients), fatigue (14 [13%]) and leucopenia (nine [8%]) were the most common chemotherapy-related grade 3–4 adverse events, while in LUX-Lung 6, the most common chemotherapy-related grade 3–4 adverse events were neutropenia (30 [27%] of 113 patients), vomiting (22 [19%]), and leucopenia (17 [15%]). Interpretation Although afatinib did not improve overall survival in the whole population of either trial, overall survival was improved with the drug for patients with del19 EGFR mutations. The absence of an effect in patients with Leu858Arg EGFR mutations suggests that EGFR del19-positive disease might be distinct from Leu858Arg-positive disease and that these subgroups should be analysed separately in future trials.

What's the hype about CDK5RAP2?

Cyclin dependent kinase 5 regulatory subunit-associated protein 2 (CDK5RAP2) has gained attention in the last years following the discovery, in 2005, that recessive mutations cause primary autosomal recessive microcephaly. This disease is seen as an isolated developmental defect of the brain, particularly of the cerebral cortex, and was thus historically also referred to as microcephalia vera. Unraveling the pathomechanisms leading to this human disease is fascinating scientists because it can convey insight into basic mechanisms of physiologic brain development (particularly of cortex formation). It also finds itself in the spotlight because of its implication in trends in mammalian evolution with a massive increase in the size of the cerebral cortex in primates. Here, we provide a timely overview of the current knowledge on the function of CDK5RAP2 and mechanisms that might lead to disease in humans when the function of this protein is disturbed.

Estado actual del bosque de galería de la parte alta del rio Santa Elena, sector norte de la Universidad Nacional Agraria, Managua

~vii~ RESUMEN La presente investigación se realizó en el bosque de galería de la parte alta del río Santa Elena, de la Universidad Nacional Agraria, donde se identificó el estado actual y la estructura horizontal y vertical, la composición florística en el estrato arbóreo del río, además, se determinó la diversidad a través del índice ecológico de Shannon-Weiner, por lo cual se realizó un inventario al cien por ciento (100 %). En cuanto a la estructura horizontal, se encontró el mayor número de individuos correspondiendo a la categoría 10 a 19.9 cm, la que presento menores cantidades de árboles fue la categoría mayor de 90cm, la dominancia más alta fue para Ficus trigonata (Chilamate). En cuanto al índice de valor de importancia (IVI), los valores más altos, le corresponden a las especies, Ficus trigonata (Chilamate), seguido por Guazuma ulmifolia (Guácimo de ternero) y Pithecellobium dulce (Espino de playa), con respecto a la abundancia específica, Ficus trigonata (Chilamate) y Guazuma ulmifolia (Guácimo de ternero), son las más abundantes, obteniéndose el mayor valor en la ribera 4, similares resultados para la ribera 2, ribera 3, y los que presentaron menor diversidad fueron ribera 1 e Isla, existiendo las mayores abundancias para la ribera 4 y la ribera 2, sobresaliendo las especies de: Ficus trigonata (Chilamate), Inga vera (Guavillo) y Terminalia catappa (Almendra), las cuales se encuentran en todas las riberas, y otras presentes en tres y dos riberas, no obstante, las actividades que se realizan en el área y los en sayos de agricultura han permitido que disminuya la cobertura vegetal y dando espacio a nuevas especies arvense que se desarrollen llegando incluso a las orillas del río, por esta razón se proponen soluciones para conservar el recurso bosque de galería.

Impossibilità di pensare Dio non esistente : il Proslogion di Anselmo d'Aosta come applicazione implicita dei moderni procedimenti di logica aletica

Resumen: La vera intenzione teologica di Anselmo d’Aosta nello scrivere il Proslogion e il vero significato del suo celebre unum argumentum vanno visti nella funzione che la ragione svolge necessariamente all’interno della vita di fede del cristiano. Anselmo, come Tommaso d’Aquino, non sostiene che l’esistenza di Dio sia un “articulus fidei” ma piuttosto uno dei “praeambula fidei”. La ragione naturale ha la certezza che Dio esiste, ancora prima della dimostrazione metafisica, e questo non fa che confermare l’assurdità di pensare che non esista il fondamento reale di tutte le cose esistenti.

Un estatuto especial para las microempresas trabajo-trabajo también reduciría la informalidad en el sector de la construcción

El sector de la construcción es un importante generador de oportunidades laborales, en particular para las personas con menor formación y que viven en condiciones de pobreza. A pesar de contar desde mucho tiempo atrás con un régimen laboral especial que pretende atender las particularidades de la actividad, en los hechos la elevada informalidad existente lleva a que el sistema de protección opere como un dispositivo de selección adversa que otorga cobertura a muy pocos trabajadores. La construcción se vería especialmente beneficiada con un Estatuto Especial para microempresas como el que se propusiera en el informe “Empleo y Desarrollo Social” Nro. 25 (abril de 2010)

O impacto das eleições municipais na representação da Câmara dos Deputados : deputados federais candidatos às eleições para as prefeituras dos municípios

Caracteriza o impacto das eleições municipais na representação da Câmara dos Deputados, tomando como ponto de partida as candidaturas dos deputados federais que concorreram às eleições para as prefeituras municipais a partir da Constituição de 1988.