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Lessons Learned: Non-small-cell lung cancer (NSCLC) represents 85% of lung cancer in elderly patients.In the present study performed in the 36 elderly subjects with epidermal growth factor receptor (EGFR) T790M mutation-positive NSCLC, osimertinib 80 mg demonstrated statistically significant improvement in the objective response rate, which was comparable to those in the nonelderly population.Osimertinib appears to be an effective and safe treatment option in elderly patients with advanced NSCLC with EGFR mutation; further research in larger scale is warranted., Background: Previous findings suggest the possibility of relatively safe use of osimertinib for patients with T790M-positive non-small-cell lung cancer (NSCLC), with few serious adverse events for the elderly in comparison with conventional endothelial growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), and with an antitumor effect., Methods: This phase II study was performed to prospectively investigate the efficacy and safety of osimertinib for elderly patients aged ≥75 years with ineffective prior EGFR TKI treatment or with recurrence in T790M EGFR TKI resistance mutation-positive NSCLC., Results: A total of 36 patients were included in the analyses. Among the 36 subjects, 63.9% were female, with mean age of 79.9 years. The objective response rate (ORR) was 58.3% (95% confidence interval [CI], 42.2%-72.9%), demonstrating statistically significant efficacy of osimertinib ( p = .0017). The median duration of response (DOR) was 27.9 weeks (95% CI, 21.1-82.0). Complete response (CR) and partial response (PR) were 2.8% and 55.6%, respectively. Disease control rate (DCR) was 97.2%. A waterfall plot revealed that 33 (91.6%) subjects exhibited tumor shrinkage during treatment, including 12 of 14 subjects who had stable disease (SD). All adverse events were not reason for discontinuation of the study drug., Conclusion: Osimertinib may be an effective and safe treatment option in elderly patients with advanced NSCLC with EGFR mutation., (© AlphaMed Press; the data published online to support this summary are the property of the authors.)

Background: Diagnosis of malaria relies on parasite detection by microscopy or antigen detection; both fail to detect low-density infections. New tests providing rapid, sensitive diagnosis with minimal need for training would enhance both malaria diagnosis and malaria control activities. We determined the diagnostic accuracy of a new loop-mediated amplification (LAMP) kit in febrile returned travelers., Methods: The kit was evaluated in sequential blood samples from returned travelers sent for pathogen testing to a specialist parasitology laboratory. Microscopy was performed, and then malaria LAMP was performed using Plasmodium genus and Plasmodium falciparum-specific tests in parallel. Nested polymerase chain reaction (PCR) was performed on all samples as the reference standard. Primary outcome measures for diagnostic accuracy were sensitivity and specificity of LAMP results, compared with those of nested PCR., Results: A total of 705 samples were tested in the primary analysis. Sensitivity and specificity were 98.4% and 98.1%, respectively, for the LAMP P. falciparum primers and 97.0% and 99.2%, respectively, for the Plasmodium genus primers. Post hoc repeat PCR analysis of all 15 tests with discrepant results resolved 4 results in favor of LAMP, suggesting that the primary analysis had underestimated diagnostic accuracy., Conclusions: Malaria LAMP had a diagnostic accuracy similar to that of nested PCR, with a greatly reduced time to result, and was superior to expert microscopy.

With an aim to synthesize 4'-substituted cordycepins, the 4'-phenylthio precursor 4 was prepared from adenosine through an electrophilic addition to the 3',4'-unsaturated derivative 2 by using NIS/PhSH system. Nucleophilic substitution of 4 with a series of alcohols in the presence of NBS gave the respective 4'-alpha-alkoxy cordycepins 6 as the major stereoisomer. Use of DAST, in stead of alcohol in this reaction, gave the 4'-fluoro analogue 7. The 4'-sulfone derivative 8 obtained by m-CPBA oxidation of 4 was employed for the reaction with organoaluminum reagents. These reactions furnished various types of the 4'-carbon-substituted cordycepins 9.

Synthesis of 4'-substituted analogues of cordycepin was carried out. Electrophilic addition of N-iodosuccinimide/benzoic acid to 2',5'-bis-O-(tert-butyldimethyl-silyl)-3',4'-unsaturated adenosine (5) enabled the introduction of a leaving group to the 4'-position. The resulting product 7 was converted to 4'-(benzoyloxy) cordycepin (8) upon removal of the 3'-iodine atom. Compound 8 serves as a common precursor for the synthesis of the title compounds through nucleophilic substitution using organoaluminum and organosilicon reagents.

Epoxidation of 2',5'-bis-O-silyl-protected N6-pivaloyl-3',4'-unsaturated adenine nucleosides (1, 2 and 3) with dimethyldioxirane uniformly proceeded face-selectively to give the respective 3',4'-beta-epoxides (4, 5 and 6). Ring cleavage of these epoxides examined with Me3Al in CH2Cl2 showed that the TBDMS (4) or TES (5) protected epoxide gave the desired 4'-alpha-methylated product (8 or 10) as the major stereoisomer, while use of the TBDPS protected epoxide (6) resulted in reverse stereoselectivity. Reactions of 4 with other organoaluminum reagents were also carried out.

Dimethyldioxirane-mediated epoxidation of 3',5'-O-(di-t-butylsilylene)-1',2'-dehydro uridine (6) proceeded face-selectively to give 1',2'-alpha-epoxyuracil nucleoside (7). When 7 was treated with Me3Al, an anomeric mixture of the target 1'-C-alpha-methyluridine derivative 8 and its epimer 9 (86%, 8/9 = 5/1) was obtained. On the other hand, N3-protection improved the stereoselectivity in the ring-opening reaction. Thus, N3-benzyloxymethyl (BOM)-1',2'-epoxy nucleoside 11 obtained from 10 gave the target 12 as the sole product.