Bladder cancer is the 7th cause of death from cancer in men and 10th in women. Metastatic patients have a poor prognosis with a median overall survival of 14 months. Until recently, vinflunine was the only second-line chemotherapy available for patients who relapse. Deregulation of the PI3K/AKT/mTOR pathway was observed in more than 40% of bladder tumors and suggested the use of mTOR as a target for the treatment of urothelial cancers. This trial assessed the efficacy of temsirolimus in a homogenous cohort of patients with recurrent or metastatic bladder cancer following first-line chemotherapy. Efficacy was measured in terms of non-progression at two months according to the RECIST v1.1 criteria. Based on a two-stage optimal Simon’s design, 15 non-progressions out of 51 evaluable patients were required to claim efficacy. Patients were treated at a weekly dose of 25 mg IV until progression, unacceptable toxicities or withdrawal. Among the 54 patients enrolled in the study between November 2009 and July 2014, 45 were assessable for the primary efficacy endpoint. A total of 22 (48.9%) non-progressions were observed at 2 months with 3 partial responses and 19 stable diseases. Remarkably, 4 patients were treated for more than 30 weeks. Fifty patients experienced at least a related grade1/2 (94%) and twenty-eight patients (52.8%) a related grade 3/4 adverse event. Eleven patients had to stop treatment for toxicity. This led to recruitment being halted by an independent data monitoring committee with regard to the risk-benefit balance and the fact that the primary objective was already met. While the positivity of this trial indicates a potential benefit of temsirolimus for a subset of bladder cancer patients who are refractory to first line platinum-based chemotherapy, the risk of adverse events associated with the use of this mTOR inhibitor would need to be considered when such an option is envisaged in this frail population of patients. It also remains to identify patients who will benefit the most from this targeted therapy. ClinicalTrials.gov Identifier: NCT01827943 (trial registration date: October 29, 2012); Retrospectively registered.

This paper uses a quasi-experimental approach to test the effect of the French LEADER programme on rural development. Its main contribution is to investigate the impact of the LEADER programme on the attractiveness of treated municipalities and empirically address the role of governance design on the effectiveness of rural development policies. While the results suggest that the LEADER programme succeeds in playing the role of project activator by fostering the local dynamics and cooperation among local actors, the LEADER programme has no additional effect when it is led in parallel to granted rural development projects.

The pancreas is an unusual location for metastases from other primary cancers. Rarely, pancreatic metastases from kidney or colorectal cancers have been reported. However, a variety of other cancers may also spread to the pancreas. We report an exceptional case of pancreatic metastasis from prostate cancer. Differences in management between primary and secondary pancreatic tumors make recognition of metastases to the pancreas an objective of first importance. Knowledge of unusual locations for metastatic spread will reduce diagnostic delay and lead to a timely delivery of an appropriate treatment.

This paper analyzes the relationships between the degree of decentralization of a public policy and the emergence of horizontal strategic interactions. The Structural Fund allocation process is investigated by determining how the governance structure of the Cohesion Policy affects the development of strategic spatial interactions between regional governments. A political agency model was developed. The main proposition is that the appearance of spatial interactions increases with the degree of policy decentralization. From the empirical analysis, this theoretical proposition is confirmed by showing that spatial interactions are more intense when the policy governance is decentralized.

We use the Bosnian Living Standards Measurement Study (LSMS) survey to show that conflict-induced displacement of agricultural households dramatically affects the adoption of new technologies in agriculture. We exploit the heterogeneity in the level of violence in the pre-war location to account for selection bias. This natural experiment seems to be a source of exogenous variation in our case because violence aims at ethnic cleansing, without economic consideration. We find that the displaced are less likely than stayers to adopt fertiliser and pesticide.

The agricultural detrimental effects on the environment are a source of concern. Public mea-sures, such as agri-environmental schemes (AES), have been designed to incentivize farmers to adopt more sound environmental practices on the farm. In this study, we examine the effects of past initial economic and environmental performances on AES adoption by focusing on crop farms. Using Firth's logistic regression to address small sample bias with French FADN data from 1997 to 2007, we mainly find that technical efficiency has heterogeneous effects on AES adoption, depending on environmental indexes. This result suggests the presence of windfall effects. We also show complex interactions (antagonism or synergy) between economic and environmental performances in adoption decisions, and heterogeneous effects depending on the type of farming. The agricultural detrimental effects on the environment are a source of concern. Public mea-sures, such as agri-environmental schemes (AES), have been designed to incentivize farmers to adopt more sound environmental practices on the farm. In this study, we examine the effects of past initial economic and environmental performances on AES adoption by focusing on crop farms. Using Firth's logistic regression to address small sample bias with French FADN data from 1997 to 2007, we mainly find that technical efficiency has heterogeneous effects on AES adoption, depending on environmental indexes. This result suggests the presence of windfall effects. We also show complex interactions (antagonism or synergy) between economic and environmental performances in adoption decisions, and heterogeneous effects depending on the type of farming.