Guidelines recommend that women with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (mBC) initiate hormonal therapy before chemotherapy. This study compared outcomes of women with mBC who received chemotherapy first versus hormonal therapy.
A retrospective cohort study of women with mBC was conducted using a large US commercial health plan database between 1/1/2008-4/30/2013. Subjects had evidence of a HR+/HER2- tumor subtype in a cancer registry and use of chemotherapy or hormonal therapy in claims. Subjects were continuously enrolled for ≥6 months after metastasis and assigned to cohorts for receiving chemotherapy only or hormonal therapy only during first-line (CT-1L vs HT-1L). Adjusted incidence rates of clinically significant events were compared using a negative binomial model, and adjusted health care costs were compared using a generalized linear model.
324 women with HR+/HER2- mBC met the selection criteria; 179 (55%) received CT-1L and 145 (45%) received HT-1L. Mortality rates did not differ between cohorts [unadjusted incidence rate ratio (IRR): 1.67, 95% CI: 0.82-3.46; adjusted IRR: 0.64, 95% CI: 0.32-1.27). Adjusted average total all-cause health care costs were $11,090 for women with CT-1L and $6,743 for women with HT-1L (cost ratio: 1.64, 95% CI: 1.36-1.99).
Observed use of first-line chemotherapy (>50%) was higher than expected given the HR+ molecular profile of the tumors. Chemotherapy use during first-line did not appear to be associated with a survival benefit but was associated with significantly higher costs compared with the use of hormonal therapy during first-line; however, this comparison is limited by demographic and baseline characteristic differences between the 2 cohorts. This study contributes to understanding real-world treatment patterns and the associated clinical and economic outcomes of using chemotherapy versus hormonal therapy as a first-line treatment option for the HR+/HER2- mBC population.

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The discovery and optimisation of novel, potent and selective small molecule inhibitors of the α-isoform of type III phosphatidylinositol-4-kinase (PI4Kα) are described. Lead compounds show cellular activity consistent with their PI4Kα potency inhibiting the accumulation of IP1 after PDGF stimulation and reducing cellular PIP, PIP2 and PIP3 levels. Hence, these compounds are useful in vitro tools to delineate the complex biological pathways involved in signalling through PI4Kα.
Copyright © 2015 Elsevier Ltd. All rights reserved.

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Ligands from the B7 family bind to receptors of the CD28 family, which regulate early T cell activation in lymphoid organs and control inflammation and autoimmunity in peripheral tissues. Programmed death-1 (PD-1), a member of the CD28 family, is an inhibitory receptor on T cells and is responsible for their dysfunction in infectious diseases and cancers. The complex mechanisms controlling the expression and signaling of PD-1 and programmed death ligand 1 (PD-L1) are emerging. Recently completed and ongoing clinical trials that target these molecules have shown remarkable success by generating durable clinical responses in some cancer patients. In chronic viral infections, preclinical data reveal that targeting PD-1 and its ligands can improve T cell responses and virus clearance. There is also promise in stimulating this pathway for the treatment of autoimmune and inflammatory disorders.
Copyright © 2015 Elsevier Ltd. All rights reserved.

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On April 14, 2016 AstraZeneca and its global biologics research and development arm, MedImmune, will present 57 abstracts,
deliver five oral presentations and two lectures as well as participating in a round-table session on PD-L1 diagnostic harmonisation at the American Association for Cancer Research (AACR) (Free AACR Whitepaper) Annual Meeting in New Orleans this week (Press release, AstraZeneca, APR 14, 2016, View Source [SID:1234510764]).

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DNA Damage Response: an industry-leading portfolio

Three oral presentations will provide insight into AstraZeneca’s industry-leading DNA Damage Response (DDR) pipeline of potential medicines as both monotherapy and in combination:

Phase I data evaluating the combination of first-in-class PARP inhibitor Lynparza (olaparib) and AKT inhibitor AZD5363 in germline BRCA and non-BRCA mutant advanced cancer patients (Abstract #CT1010)

Early safety and efficacy data from a Phase Ib study of novel potential medicine AZD1775, a small molecule designed to inhibit the Wee1 kinase, which plays a critical role in the DNA damage repair that enables cell division (Abstract #CT013)

Pre-clinical pharmacology of AZD0156, an ATM kinase inhibitor that detects DNA double strand breaks to enable downstream DNA repair and cell survival (Sunday 17 Apr – 14:15-16:15)

Andrew Mortlock, Vice President, Global Projects and Alliances, Oncology iMed at AstraZeneca said: "The data we will present at AACR (Free AACR Whitepaper) underscore the scientific promise shown by our industry-leading DDR portfolio as well as the clinical potential of this pioneering approach to targeting tumour cells. With three new molecules now in the clinic and one on the market, we are following the science and exploring their potential in both monotherapy and in combination with other therapies."

Immuno-Oncology: biomarkers, next-generation Immunotherapies, and combinations

AstraZeneca’s Immuno-Oncology research will feature prominently at AACR (Free AACR Whitepaper), including with new data from a comparative study of commonly used PD-L1 diagnostic tests in approximately 500 tumour biopsies (Abstract #LB-094; also included in the AACR (Free AACR Whitepaper) media programme). AstraZeneca will also take part in a roundtable discussing the value of PD-L1 diagnostic testing – "The Blueprint Project: Harmonizing Companion Diagnostics across a Class of Targeted Therapies", scheduled for Tuesday 19 April, 13.00 – 15.00 EST (Room 283, Morial Convention Center).

AstraZeneca will also provide updates on its exploration of biological targets beyond PD-L1 and CTLA-4, including MEDI1873, an agonist of the GITR receptor (Abstract #561) and MEDI9197, a TLR7/8 agonist (Abstract #1475), as well as the combination strategy of PD-L1/PD1 axis inhibition with several complementary mechanisms of action targeting NKG2A, OX40 and immTACs.

In addition, researchers at the congress will present the latest results from a Phase I/II trial of tremelimumab plus tumour ablation in patients with advanced hepatocellular carcinoma (HCC) (Abstract #2653).

David Berman, Senior Vice President, Head of Oncology Innovative Medicines, at MedImmune, said: "At AACR (Free AACR Whitepaper), we will present pre-clinical data and mechanistic characterisation that support our ongoing clinical trials exploring next-generation immuno-oncology targets and their combination with durvalumab. We will present a comparison of the different PD-L1 diagnostic assays to help advance the science for the field of PD1/L1 blockade. In addition, the activity of tremelimumab, a CTLA4 inhibitor, will be further evidenced."

Tumour drivers and resistance: A key area of expertise

AstraZeneca will also present data on Tagrisso (osimertinib), exploring the utilisation of non-small cell lung cancer (NSCLC) xenograft models from patients on Tagrisso to refine therapeutic strategies (Abstract #5192). Tagrisso recently received accelerated approval as the first indicated treatment for patients with EGFR T790M mutation-positive metastatic NSCLC in the US, EU and Japan.

The company will also showcase its continued progress in therapies targeting the genetic drivers of cancer with breaking data on an early-stage mTOR inhibitor that has shown pre-clinical activity in prostate cancer. Specific posters include:

Anti-tumour activity of mTOR inhibitor AZD2014 in a prostate cancer mouse model (Abstract #2147)

Overcoming mTOR resistance mutations with a next-generation mTOR inhibitor (Abstract #389)

NOTES TO EDITORS

AstraZeneca/MedImmune key presentations at AACR (Free AACR Whitepaper)

DNA Damage Response

Thomason AG
Discovery and pre-clinical pharmacology of AZD0156: A
first-in-class potent and selective inhibitor of Ataxia telangiectasia mutated (ATM) kinase
Oral
New Drugs on the Horizon
Sunday 17 Apr 14:15-16:15
New Orleans Theater C, Morial Convention Center
Webcast Available

Bauer TM
A Phase Ib, open-label, multi-center study to assess the safety, tolerability, pharmacokinetics, and anti-tumor activity of AZD1775 monotherapy in patients with advanced solid tumors: Initial findings
Oral
Clinical Trials Plenary Session 2
Early Clinical Trials of Agents Targeting DNA or the Epigenome
Sunday 17 Apr 16:15-18:15
Room 291, Morial Convention Center
Abstract #CT013

Michalarea V
Phase I trial combining the PARP inhibitor Olaparib (Ola) and AKT inhibitor AZD5363 (AZD) in germline (g)BRCA and non-BRCA mutant (m) advanced cancer patients (pts) incorporating non-invasive monitoring of cancer mutations
Oral
Clinical Trials Plenary Session 2
Early Clinical Trials of Agents Targeting DNA or the Epigenome
Sunday 17 Apr 16:15-18:15
Room 291, Morial Convention Center
Abstract #CT010

Laing N
Genetic analysis of tumors from a Phase II trial evaluating AZD1775, carboplatin and paclitaxel in patients with TP53-mutant ovarian cancer
Poster
Experimental and Molecular Therapeutics
Novel Antitumor Agents
Sunday 17 Apr 13:00–17:00
Convention Center, Halls G-J, Poster Section 14
Poster Board #18, Abstract #337

Durant S
Blood-brain barrier penetrating ATM inhibitor (AZ32) radiosensitises intracranial gliomas in mice
Poster
Experimental and Molecular Therapeutics
Preclinical Radiotherapeutics
Tuesday 19 Apr 08:00–12:00
Convention Center, Halls G-J, Poster Section 18
Poster Board #1, Abstract #3041

Oplustil O’Connor L
A camptothecin-containing nanoparticle-drug conjugate combination with DDR agents provides a novel approach to increasing therapeutic index
Poster
Experimental and Molecular Therapeutics
Cell Death Pathways and DNA Repair
Tuesday 19 Apr 13:00–17:00
Convention Center, Halls G-J, Poster Section 14
Poster Board #19, Abstract #3721

Perez-Lopez R
Diffusion-weighted imaging of bone metastases as treatment response biomarker in prostate cancer
Poster
Clinical Research
Novel Molecular Diagnostics and Imaging
Tuesday 19 Apr 13:00–17:00
Convention Center, Halls G-J, Poster Section 24
Poster Board #3, Abstract #3973

Williams L
Continuous, low intensity systemic dosing maximizes the therapeutic margin of Eg5/KSP inhibition in a model of urothelial cell carcinoma
Poster
Experimental and Molecular Therapeutics
Novel Antitumour DNA-Reactive Agents
Tuesday 19 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 15
Poster Board #16, Abstract #3769

Cidado J
AZ5576, a novel potent and selective CDK9 inhibitor, induces rapid cell death and achieves efficacy in multiple preclinical hematological models
Poster
Molecular and Cellular Biology/Genetics
Cell Death 3
Tuesday 19 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 4
Poster Board #22, Abstract #3572

Pike K
Identifying high quality, potent and selective inhibitors of ATM kinase: Discovery of AZD0156
Poster
Cancer Chemistry
Drug Design
Wednesday 20 Apr 08:00–12:00
Convention Center, Halls G-J, Poster Section 21
Poster Board #24, Abstract #4859

Cuneo KC
A dose escalation trial of the Wee1 inhibitor AZD1775, gemcitabine and concurrent radiation in locally advanced pancreatic cancer
Poster
Phase I Clinical Trials in Progress
Monday 18 Apr 08:00–12:00
Convention Center, Halls G-J, Poster Section 13
Poster Board #16, Abstract #CT035

Min A
Androgen receptor inhibitor enhances the anti-tumor effect of PARP inhibitor in breast cancer cells via modulation of DNA damage response
Poster
Late-Breaking Research: Experimental and Molecular Therapeutics 1
Monday 18 Apr 8:00 AM – 12:00
Convention Center, Halls G-J, Poster Section 11
Abstract #LB-107

Immuno-Oncology

Uppala A
Tremelimumab plus tumor ablation for patients with hepatocellular carcinoma: Clinical results, Immunomonitoring analysis of peripheral T cells and tumor biopsies
Oral
Immunology
Session Title TBD
Monday 18 Apr 15:00-17:00
New Orleans Theater B, Morial Convention Center
Abstract #2653
Press Programme

Messenheimer DJ
Timing of PD-1 blockade is critical to successful synergy with OX40 costimulation in preclinical mammary tumor models.
Oral
Immunology
Potentiating Immunotherapy Responses with Generation Agents and Combinatorial Partners
Tuesday 19 Apr 15:00-17:00
New Orleans Theater B, Morial Convention Center
Abstract #4361

Stewart R
Generation and Characterisation of MEDI1873 A Novel Hexameric GITRL Fusion Protein and Potent Agonist of the GITR Receptor
Poster
Immunology
Immune Modulating Agents 1
Sunday 17 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 26
Poster Board #22, Abstract #561

Mullins S
Local immune activation resulting in tumor growth inhibition with MEDI9197 – an intratumorally administered TLR7/8 agonist
Poster
Immunology
Immune Modulation Agents and Therapeutic Antibodies
Monday 18 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 25
Poster Board #6, Abstract #1475

Ghadially H
Analysis of expression MHC class I chain-related gene A and B (MICA/B) in normal and tumour tissue
Poster
Immunology
Immune Microenvironment and Antitumor Immunity
Monday 18 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 24
Poster Board #12, Abstract #1451

Ratcliffe M
A comparative study of PD-L1 diagnostic assays and the classification of patients as PD-L1 positive and PD-L1 negative
Poster
Late-Breaking Research: Immunology
Monday 18 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 10
Poster Board #18, Abstract #LB-094

Sola C
NKG2A immune checkpoint blockade enhances the antitumor efficacy of PD1/PD-L1 inhibitors in a preclinical model
Poster
Immunology
Immune Checkpoints 1
Monday 18 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 26
Poster Board #26, Abstract #2342

Odate S
Inhibition of STAT3 with oligonucleotide antisense molecule, AZD9150 increases the chemosensitivity and decreases tumorigenicity of neuroblastoma
Poster
Tumor Biology
Pediatric Cancer Molecular Pathways
Monday 18 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 31
Poster Board #2, Abstract #2439

Harper J
Exploring the oncolytic potential of Newcastle Disease virus
Poster
Clinical Research
Adoptive Cell Therapy, Immune Checkpoints, and Vaccines
Monday 18 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 21
Poster Board #26, Abstract #2234

Jiang L
PD-L1 expression and its relationship with other driver genes in non-small cell lung cancer (NSCLC
Poster
Tumor Biology
Immunomodulation and Immunotherapy
Wednesday 20 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 31
Poster Board #26, Abstract #5140

Leyland R
A Mouse GITRL Fusion Protein Drives T-Cell Activation and Antitumor Activity in Preclinical Mouse Models of Cancer
Poster
Immunology
Immune Response Monitoring: Preclinical
Wednesday 20 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 23
Poster Board #13, Abstract #4902

Bossi, G
ImmTACs in combination with anti-CTLA-4 and anti-PD-L1 antibodies can re-direct the immune system more efficiently to eradicate cancer
Poster
Immunology
Immune Modulation Agents 2
Wednesday 20 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 22
Poster Board #14, Abstract #4873

Huff CA
Clinical cancer stem cell targeting in multiple myeloma: An early phase trial of the anti-CD19 monoclonal antibody, MEDI-551, in combination with lenalidomide and dexamethasone
Poster
Phase II, III, and Special Population Clinical Trials
Tuesday 19 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 13
Poster Board #2, Abstract #CT102

Tumour Drivers & Resistance

Noble R
Evaluating the consequences of MCT1 inhibition in Burkitt lymphoma following treatment with AZD3965
Poster
Experimental and Molecular Therapeutics
Novel Antitumor Agents
Sunday 17 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 17
Poster Board #6, Abstract #325

Avivar-Valderas A
Functional significance of co-occurring mutations in PIK3CA and MAP3K1 in breast cancer
Poster
Experimental and Molecular Therapeutics
Cellular Processes and Responses to Therapy
Sunday 17 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 14
Poster Board #6, Abstract #240

Sandi C
Dual mTOR inhibitor, AZD2014, and castration induce immunogenic effects and anti-tumour activity in prostate cancer mouse model
Poster
Experimental and Molecular Therapeutics
PI3K/AKT Inhibitors
Sunday 17 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 19
Poster Board #20, Abstract #389

Feng S
AZD4547 and AZD5363 synergistically inhibit prostate cancer progression by modulating MAPK and AKT activation
Poster
Molecular and Cellular Biology/Genetics
Oncogenes and Tumor Suppressor Genes and Pathways
Monday 18 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 9
Poster Board #24, Abstract #1174

Barry E
Targeting MET Exon 14 mutations with the selective small molecule inhibitor Savolitinib
Poster
Molecular and Cellular Biology/Genetics
Oncogene Function, Regulation and Targeting
Monday 18 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 8
Poster Board #30, Abstract #1150

Diallo B
The MEK1/2 inhibitor selumetinib appears as an efficient targeted therapy when used in an adjuvant setting in Patient-Derived Xenografts of Uveal Melanoma
Poster
Experimental and Molecular Therapeutics
Experimental Therapeutics
Monday 18 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 16
Poster Board #8, Abstract #2087

Rodrik-Outmezguine VS
Overcoming mTOR Resistance Mutations with a new generation mTOR inhibitor
Poster
Experimental and Molecular Therapeutics
New Drugs, Therapeutic Targets, and Treatment Approaches
Monday 18 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 18
Poster Board #17, Abstract #2147

Yang Z
Anti-tumor activities of AZD3759, a novel EGFR inhibitor with excellent penetration cross central nervous system (CNS), in pre-clinical animal models
Poster
Session Category TBD
Late-Breaking Research: Experimental and Molecular Therapeutics 2
Monday 18 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 12
Poster Board #24, Abstract #LB-217

Searle EJ
Treatment with the novel Akt inhibitor AZD5363 following radiotherapy improves tumor control in mouse models of head and neck cancer
Poster
Experimental and Molecular Therapeutics
Preclinical Radiotherapeutics
Tuesday 19 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 18
Poster Board #2, Abstract #3042

Greenawalt D
Your targeted population might not be what you predict: Changes in tumor genetic landscapes post standard of care
Poster
Clinical Research
Molecular Classification and Genomic Applications
Tuesday 19 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 23
Poster Board #5, Abstract #3168

Greer Y
MEDI3039, a novel highly potent tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) receptor agonist, induces apoptotic cell death in breast cancer cells
Poster
Molecular and Cellular Biology/Genetics
Cell Death 1
Tuesday 19 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 2
Poster Board #4, Abstract #3494

De Velasco MA
The Jak1/2 inhibitor AZD1480 suppresses tumor growth and metastasis in genetically engineered mouse models of PTEN-deficient prostate cancer
Poster
Experimental and Molecular Therapeutics
Targeting Protein Kinases, Death Pathways, and the Tumor Microenvironment
Tuesday 19 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 19
Poster Board #26, Abstract #3864

Deng J
Pre-clinical study using KRAS mutant mouse models for lung cancer immunotherapy
Poster
Tumor Biology
Mechanisms of Tumorigenesis in Animal Models of Cancer 2
Tuesday 19 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 32
Poster Board #22, Abstract #4184

McEachern K
Predicting response to Mcl-1 targeting agents in NSCLC and Multiple Myeloma
Poster
Molecular and Cellular Biology/Genetics
Cell Death 3
Tuesday 19 Apr 13:00-17:00
Convention Center, Halls G-J, Poster Section 4
Poster Board #8, Abstract #3558

Palakurthi S
Utilizing NSCLC PDXs derived from patients on osimertinib (AZD9291) clinical trials to further refine therapeutic strategies
Poster
Tumor Biology
Therapeutic Studies in Patient-derived Xenografts
Wednesday 20 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 33
Poster Board #18, Abstract #5192

Nilsson M
Beta blockers abrogate EGFR TKI resistance induced by adrenergic receptor-mediated upregulation of IL-6 and modulation of the LKB1/AMPK/mTOR axis
Poster
Experimental and Molecular Therapeutics
Combination Therapies and Approaches to Sensitizing Cancer Cells to Drugs
Wednesday 20 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 15
Poster Board #3, Abstract #4662

Chen H
Therapeutic activity of bivalent BRD4 inhibitor AZD5153 in haematological cancers
Poster
Experimental and Molecular Therapeutics
Epigenetic Agents
Wednesday 20 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 16
Poster Board #16, Abstract #4705

Capasso A
A phase IB study of the combination of AZD6244 hydrogen sulfate (selumetinib) and cyclosporin A (CsA) in patients with advanced solid tumors with an expansion cohort in metastatic colorectal cancer
Poster
Phase I Clinical trials 2
Wednesday 20 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 13
Abstract # CT146

Cortes J
Phase I studies of AZD1208, a PIM kinase inhibitor, in patients with recurrent or refractory acute myelogenous leukemia or advanced solid tumors
Poster
Phase I Clinical Trials 2
Wednesday 20 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 13
Poster Board #8, Abstract #CT147
Antibody Drug Conjugates

Li J
MEDI4276, a HER2-targeting antibody tubulysin conjugate, displays potent in vitro and in vivo activity in preclinical studies
Poster
Experimental and Molecular Therapeutics
Monoclonal Antibodies and Antibody-Drug Conjugates
Tuesday 19 Apr 08:00-12:00
Convention Center, Halls G-J, Poster Section 15
Poster Board #16, Abstract #2970

About AstraZeneca in Oncology

AstraZeneca has a deep-rooted heritage in Oncology and offers a quickly growing portfolio of new medicines that has the potential to transform patients’ lives and the Company’s future. With at least 6 new medicines to be launched between 2014 and 2020 and a broad pipeline of small molecules and biologics in development, we are committed to advance New Oncology as one of AstraZeneca’s six Growth Platforms focused on lung, ovarian, breast and blood cancers. In addition to our core capabilities, we actively pursue innovative partnerships and investments that accelerate the delivery of our strategy, as illustrated by our investment in Acerta Pharma in haematology.

By harnessing the power of four scientific platforms — immuno-oncology, the genetic drivers of cancer and resistance, DNA damage response and antibody drug conjugates — and by championing the development of personalised combinations, AstraZeneca has the vision to redefine cancer treatment and one day eliminate cancer as a cause of death.

The field of HIV prevention research has recently experienced some mixed results in efficacy trials of pre-exposure prophylaxis, vaginal microbicides, and HIV vaccines. While there have been positive trial results in some studies, in the near term, no single method will be sufficient to quell the epidemic. Improved HIV prevention methods, choices among methods, and coverage for all at-risk populations will be needed. The emergence of partially effective prevention methods that are not uniformly available raises complex ethical and scientific questions regarding the design of ongoing prevention trials.
We present here an ethical analysis regarding inclusion of pre-exposure prophylaxis in an ongoing phase IIb vaccine efficacy trial, HVTN 505. This is the first large vaccine efficacy trial to address the issue of pre-exposure prophylaxis, and the decisions made by the protocol team were informed by extensive stakeholder consultations. The key ethical concerns are analyzed here, and the process of stakeholder engagement and decision-making described.
This discussion and analysis will be useful as current and future research teams grapple with ethical and scientific study design questions emerging with the rapidly expanding evidence base for HIV prevention.
© The Author(s) 2015.

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