324,461 research outputs found
Will the new stability and growth pact succeed? An economic and political perspective
No full textWhile the Maastricht Treaty establishes the entry conditions for Member States to join the single currency, the Stability and Growth Pact (SGP) aims to make budgetary discipline a permanent feature of EMU. Consequently, the Pact is commonly interpreted as a major building block of EMU's architecture: the SGP ‘must rank as one of the most remarkable pieces of policy coordination in world history. The purpose of this paper is to offer an initial evaluation of the SGP reform. Section Two reviews the main fiscal policy developments in the early years of EMU which were at the basis of the crisis of the SGP ‘mark I'. Section Three describes the reformed SGP and an assessment of its main features. Section Four presents some reflections on the political economy of the EU rules, comparing the new SGP with the Maastricht Treaty and the SGP ‘mark I'. The final section concludes.Stability and Growth Pact, Economic Monetary Union (EMU), Maastricht Treaty, Buti
Revisiting the Stability and Growth Pact: grand design or internal adjustment?
No full textThe Stability and Growth Pact is under fire. Problems have appeared in sticking to the rules. Proposals to reform the Pact or ditch it altogether abound. But is the Pact a flawed fiscal rule? Against established criteria for an ideal fiscal rule, its design and compliance mechanisms fare reasonably well. Where weaknesses are found, they tend to reflect trade-offs typical of supra-national arrangements. In the end, only a higher degree of fiscal integration would remove the inflexibility inherent in the recourse to predefined budgetary rules. This does not mean that the EU fiscal rules cannot be improved. However, given the existing degree of political integration in EMU, internal adjustment rather than attempting to re-design the rules from scratch appears a more suitable way to bring about progress. Redefining the medium term budgetary target, improving transparency, tackling the pro-cyclical fiscal bias in good times, moving towards non-partisan application of the rules and improving transparency in the data can achieve both stronger discipline and higher flexibility.sgp, stability and growth pact, Buti, Eijffinger, Franco
The role of central fiscal capacity in connecting the EU’s domestic and global agendas
No full textThe EU’s domestic and international agendas are usually discussed in different fora and follow separate tracks. Given the fallout from the Covid crisis and the dramatic consequences of the Russian invasion of Ukraine, this paper argues that these agendas should eventually merge. A central fiscal capacity is a key element for reconciling the EU’s domestic and international goals. Domestically, it would help to achieve a balanced policy mix and ensure an adequate supply of European public goods, and globally it would give credibility to the geo-economic role of the EU.https://voxeu.org/article/reconciling-eu-s-domestic-and-global-agendasA shorter version of this paper was published in VoxEU (Buti and Messori 2022)
Spotlight on cabozantinib for previously untreated advanced renal cell carcinoma: evidence to date
No full textMelissa Bersanelli, Francesco Leonardi, Sebastiano Buti University Hospital of Parma, Medical Oncology Unit, Parma, Italy Background: In the past few years, new drugs made their appearance in the first-line setting of treatment for metastatic renal cell carcinoma (mRCC), and cabozantinib is one among them. The present systematic review aims to point out any evidence published to date about first-line treatment with cabozantinib for mRCC patients, describing their outcome in all end points explored by the literature. Methods: PRISMA guidelines were followed. A systematic assessment of literature and peer-reviewed presentations was performed by searching PubMed and major oncology meeting resources, from the database inception until June 25, 2018. The following keywords were used: “cabozantinib or cabozantinib-s-malate or XL184” and “renal cell carcinoma or kidney cancer or clear cell renal carcinoma or renal cancer” and “first-line or untreated or treatment-naïve or primary treatment”. All types of original clinical studies were included, evaluating either cabozantinib monotherapy or any systemic drug combination containing cabozantinib for previously untreated patients with mRCC. Results: From potential 75 titles and abstracts, seven publications were selected. One was the main report of a randomized clinical trial (the CABOSUN study); four papers reported updated results, secondary or subgroup analyses from the same study population; and further two reports consisted of network meta-analyses. From the additional search for ongoing clinical trials, six studies currently in progress were reported. Conclusion: According to the reported evidence, cabozantinib may be a viable first-line option in mRCC patients with intermediate or poor risk according to International Metastatic Renal Cell Carcinoma Database Consortium model. It offers an undoubtful advantage in terms of progression-free survival, despite quite high rates of G3–4 toxicity, modest objective response rate, and no survival advantage. Nevertheless, given the availability of an immunotherapy combination that significantly improved overall survival for the same population in a Phase III trial and the indisputable efficacy of cabozantinib as second-line treatment, this drug may be devoted as a rescue option in patients progressive to primary therapy. Keywords: cabozantinib, renal cell carcinoma, first-line treatment, CABOSU
Systemic adjuvant therapies in renal cell carcinoma
No full textRenal cell carcinoma (RCC) is one of the ten most frequent solid tumors worldwide. Recent innovations in the treatment of metastatic disease have led to new therapeutic approaches being investigated in the adjuvant setting. Observation is the only current standard of care after radical nephrectomy, although there is evidence of efficacy of adjuvant use of vaccine among all the strategies used. This article aims to collect published experiences with systemic adjuvant approaches in RCC and to describe the results of past and ongoing phase III clinical trials in this field. We explored all the systemic treatments, including chemotherapy, immunotherapy and targeted drugs while alternative approaches have also been described. Appropriate selection of patients who would benefit from adjuvant therapies remains a crucial dilemma. Although the international guidelines do not actually recommend any adjuvant treatment after radical surgery for RCC, no conclusions have yet been drawn pending the results of the promising ongoing clinical trials with the target therapies. The significant changes that these new drugs have made on advanced disease outcome could represent the key to innovation in terms of preventing recurrence, delaying relapse and prolonging survival after radical surgery for RCC. © Copyright S. Buti et al., 2012
The Stability pact Pains: A Forward-Looking Assessment of the Reform Debate
No full textThe Stability and Growth Pact has been under fire ever since it was born.But is the Pact a flawed fiscal rule?Against established criteria for an ideal fiscal rule, its design and compliance mechanisms show strengths and weaknesses. The latter tend to reflect tradeoffs typical of supra-national arrangements.In the end, only a higher degree of fiscal integration would remove the inflexibility inherent in the recourse to predefined budgetary rules.No alternative solution put forward in the literature appears clearly superior.This does not mean that the original Pact of 1997 could not be improved.The debate on the SGP has shown that any reform should aim at overcoming the excessive uniformity of the rules, improving their transparency, correcting pro-cyclicality and strengthening enforcement.The reform of the Pact agreed in 2005 moves in this direction but leaves open a number of issues.EMS;fiscal policy;fiscal rules;Economic and Monetary Union;Stability and Growth Pact
Clinical use of lenvatinib in combination with everolimus for the treatment of advanced renal cell carcinoma
No full textAlessandro Leonetti, Francesco Leonardi, Melissa Bersanelli, Sebastiano Buti Medical Oncology Unit, University Hospital of Parma, Parma, Italy Introduction: Renal cell carcinoma (RCC) represents 2%–3% of all cancers in adults, and its pathogenesis is mainly related to altered cellular response to hypoxia. Lenvatinib, a novel multitarget tyrosine kinase inhibitor (TKI), represents a therapeutic option, in combination with mammalian target of rapamycin (mTOR) inhibitor everolimus, for the treatment of metastatic RCC (mRCC).Aim: The objective of this article is to review the evidence about the treatment of mRCC with combination of lenvatinib plus everolimus.Evidence review: Phase I studies supported clinical activity of lenvatinib in mRCC. A randomized, Phase II, open-label, multicenter trial demonstrated the clinical efficacy of combination treatment with lenvatinib plus everolimus in patients with progressive mRCC after prior therapy with TKI. Median progression-free survival was improved by 9 months with the combination therapy compared to the single-agent everolimus, with an overall response rate of 43% for the experimental regimen. Lenvatinib plus everolimus appeared to be slightly less toxic than single-agent lenvatinib and more toxic than single-agent everolimus; grade 3–4 adverse events occurred in 71% of patients. Currently, lenvatinib plus everolimus has US Food and Drug Administration approval for its use in mRCC after failure of previous treatment with TKI.Conclusion: The combination therapy with lenvatinib plus everolimus might be a promising choice for second-line treatment of mRCC patients. Based on the results of the Phase II trial, it is possible to speculate that the combination therapy could be appropriate for patients with high disease burden or strongly symptomatic patients. Keywords: lenvatinib, everolimus, evidence-based review, renal cell carcinoma, RC
Does the cetuximab plus paclitaxel combination deserve to be studied in a phase III trial?
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