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This study examines private entry strategies and internationalization patterns in the cruise terminal industry. The focus is on the second biggest cruise region in the world, the Mediterranean and its adjoining seas. A database detailing the ownership structures observed in cruise terminals in 18 different countries forms the backbone of the empirical analysis. This dataset details the entry strategies and implementation options of cruise terminal operators, their corporate features and strategies, and the emerging partnership dynamics. Methodologically, our analysis is based on earlier constructs used to conceptualize entry forms and strategic management in container terminals and port governance systems. The findings suggest that cruise terminals are subject to an initial phase of privatization and internationalization. The outcomes point to the emergence of international cruise terminal operators and the active presence of cruise lines and other types of entities (including port and shipping companies, shipping agents, and Chambers of Commerce). While the cruise terminal development path shows some similarities with what happened in container ports a few decades ago, an array of differences also emerge.

Background: Older people represent the majority of cancer patients but their specific needs are often ignored in the development of health-related quality of life (HRQOL) instruments. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-ELD15 was developed to supplement the EORTC’s core questionnaire, the QLQ-C30, for measuring HRQOL in patients aged >70 years in oncology studies. Methods: Patients ( n =518) from 10 countries completed the QLQ-C30, QLQ-ELD15 and a debriefing interview. Eighty two clinically stable patients repeated the questionnaires 1 week later (test–retest analysis) and 107 others, with an expected change in clinical status, repeated the questionnaires 3 months later (response to change analysis, RCA). Results: Information from the debriefing interview, factor analysis and item response theory analysis resulted in the removal of one item (QLQ-ELD15→QLQ-ELD14) and revision of the proposed scale structure to five scales (mobility, worries about others, future worries, maintaining purpose and illness burden) and two single items (joint stiffness and family support). Convergent validity was good. In known-group comparisons, the QLQ-ELD14 differentiated between patients with different disease stage, treatment intention, number of comorbidities, performance status and geriatric screening scores. Test–retest and RCA analyses were equivocal. Conclusion: The QLQ-ELD14 is a validated HRQOL questionnaire for cancer patients aged ⩾70 years. Changes in elderly patients’ self-reported HRQOL may be related to both cancer evolution and non-clinical events.

PurposeThe primary objective of this multicentric dose allocation and dose expansion study was to determine the MTD and the DLTs of the lucitanib (a tyrosine kinase inhibitor of the FGFR/VEGFR/PDFGR pathways)/fulvestrant combination.MethodsPostmenopausal women with ER+/HER2− mBC, who have relapsed during or after treatment with fulvestrant, were eligible. The study had a dose allocation part to assess the tolerability of the combination followed by a dose expansion part.ResultsEighteen patients with ER+, mBC were enrolled; median age was 66 years, 50% had a PS: 0 and all had received previous endocrine treatment. The study was prematurely terminated after 18 patients (15 in part 1 and 3 in part 2) based on preclinical experiments that failed to confirm the hypothesis that addition of lucitanib would reverse sensitivity to endocrine treatments. Based on data of global lucitanib development, it was decided to stop the dose allocation at 12.5 mg and to start the dose expansion part at 10 mg/day. The most common grade ≥ 3 toxicities (> 10% of patients) were hypertension (78%) and asthenia (22%). All patients required at ≥ 1 interruption, 13 patients (72%) required ≥ 1 dose reduction. Three patients (72%) withdrew from the study for AEs (at 10 mg). Three patients achieved a confirmed PR (10 mg n = 1; 12.5 mg n = 2).ConclusionAlthough the combination is feasible it requires close monitoring of the patients for the management of adverse events. Further investigation is required to better understand the potential role of FGFR inhibition in reversing resistance to endocrine treatment.

This study focuses on the automation of terminal equipment used to handle containers. A dataset was compiled, which includes 63 fully and semi-automated container terminals in operation around the world, their organizational features, technical dimensions, and the maritime and urban markets they serve. The data analysis focuses on where, when, under which conditions, and to what extent container terminals were automated, and who is responsible for implementing terminal automation. Only 3% of the world’s container terminals were found to be either fully or semi-automated. A survey-based analysis of global terminal operators identifies how they implement their automation and the time necessary for terminal operators to start realizing a return on their investment. The results systematically map global automated terminal characteristics. Acknowledging that not all container terminals are candidates for automation of terminal equipment, this paper contributes to extant literature by presenting a systematic review of all global automated terminals in order to substantiate or refute any perceptions that might exist on their characteristics, for example, in terms of minimum cargo volumes needed for automation. The findings can provide some guidance to market actors considering investments in automation and public and private port authority decision makers that might also commit resources to automation.

Non-small-cell lung cancer (NSCLC) remains by far the major cause of cancer-related death in the Western world in both men and women. The majority of patients will be diagnosed with metastatic disease, and chemotherapy doublets remain the cornerstone of treatment for these patients. However, chemotherapy has a minimal impact on long-term survival and prognosis remains poor for these patients. Further improvement in treatment is likely to require incorporation of novel targeted therapies. Among these agents, inhibitors of the epidermal growth factor receptor (EGFR) have demonstrated significant activity in the first-, second- or third-line treatment of NSCLC. The purpose of current paper is to present the evidence for using several proposed molecular biomarkers as a tool for selection of NSCLC patients for anti-EGFR treatment. According to current data, EGFR mutation status appears to be the strongest predictor for the selection of NSCLC patients to first-line treatment with EGFR tyrosine kinase inhibitors vs chemotherapy. Use of other biomarkers remains investigational.

This study examines the concept of transparency as practiced (or not) in ports. It explores the availability of information to the general public and port stakeholders through the ports' most public face-its website, studying public ports in North America, Europe, and Latin America and the Caribbean. This exploratory research centred on identifying the parameters that would be useful for the general public to have sufficient information to monitor, review and in many cases, participate in the decision-making processes carried out by the port authority, irrespective of whether or not laws mandate such disclosure. Fifty-one items were identified for the examination of each port's website, focusing primarily on four major categories: decision-making governance, port communications and accessibility, transparency in reporting and in port operational activities. Using nine items as proxies for the 51, the research reveals uneven levels of port transparency both regionally and by governance model. The study reveals a need for increasing and differentiating the existing levels and standards of transparency in the governance of the port industry, and for greater consistency between ports within and across regions. The study concludes with a research agenda for future research.

Background: To investigate the clinical relevance of CK-19mRNA-positive circulating tumour cells (CTCs) detected before the initiation of front-line treatment in patients with metastatic breast cancer (MBC). Methods: The presence of CTCs was detected in 298 patients with MBC using a real-time PCR (RT-PCR assay. In 44 patients, the detection of CTCs was evaluated by both the CellSearch and the RT-PCR assay. Interaction with known prognostic factors and association of CTCs with clinical outcome were investigated. Results: There was a strong correlation between the detection of CTCs by both assays. CK-19mRNA-positive CTCs were detected in 201 (67%) patients and their detection was independent of various patients’ clinico-pathological characteristics. The median progression-free survival (PFS; 9.2 vs 11.9 months (mo), P =0.003) and the overall survival (OS; 29.7 vs 38.9 mo, P =0.016) were significantly shorter in patients with detectable CK-19mRNA-positive CTCs compared with patients without detectable CTCs. Multivariate analysis demonstrated that oestrogen receptor status, performance status and detection of CTCs were emerged as independent prognostic factors associated with decreased PFS and OS. Conclusion: The detection of CK-19mRNA-positive CTCs in patients with MBC before front-line therapy could define a subgroup of patients with dismal clinical outcome.

PurposeContainer liner shipping companies started expanding their business by investing in container port terminals in the late 1990s. This market entry results in an extensive presence of vertically integrated liners and terminals. This study aims to explore the competition effects of this vertical integration trend based on a regional (European) analysis. In particular, it extracts lessons from the European Commission (EC) cases on the competition effects of vertical integration. The critical analysis of the cases examined at the institutional level intends to reach conclusions on whether liner–terminal vertical integration harmed or advanced competition in the relevant markets and/or the extent that there is a need to revise the current policy practices.Design/methodology/approachThis study critically assesses the EC’s decisional practices in port container terminal vertical mergers in the last 25 years (1997–2021). Based on a literature review comparing maritime and competition economists' perspectives, it reviews the types of mergers examined, the methodology followed for relevant market definition and calculation of market shares and the estimated competition effects. The Hamburg–Le Havre area is the port range used as a case study for comparing the decisional practice with actual market developments. These container ports serve the greatest consuming market of final and intermediate goods in Europe and are gateways to Central and Eastern Europe.FindingsThe assessment identifies a need for expanding the investigation as a precondition for reaching conclusions on both the anti- and pro-competitive effects. First, only a limited number of transactions have been notified to the EC. Second, the empirical research identified a gap in this process, as there were no decisions (phase I) on vertical mergers between 2008 and 2016. Third, the exante assessment has not applied a phase II in-depth analysis to any case due to the absence of competition concerns. Finally, due to the absence of complaints, there is a lack of any ex post assessment of the effects of vertical integration.Research limitations/implicationsThis assessment is important for understanding the current and emerging features of intra-port and inter-port competition and the potential effects that the continuation and expansion of liner companies' vertical integration strategies will have along maritime supply chains. It also contributes to the broader discussion on liner companies' strategies, such as the research and policy-making efforts around the globe to understand the impact of both vertical and horizontal integration.Practical implicationsThese discussions are critical for a diversity of businesses that use liner shipping services or provide facilities and services to container shipping lines or ports. They are important for the interests of customers and consumers as they could inform any needed re-visiting of competition policy to protect from the dominance of any market developments that would lead to conditions limiting competition. Expanding analysis on the competition effects of non-notified mergers would help a better understanding of market changes.Social implicationsEnhancing competition and limiting monopolies is valuable from a consumer's perspective. This is more so in the case of maritime trade that serves the needs of societies. The study contributes by generating a better understanding of how decision-makers have worked towards that direction and what realignments are worthy.Originality/valueThere are no previous comprehensive reviews and analyses of the ways that policy-makers at the regional level have addressed the competition effects of vertical integration strategies of liner shipping companies when enhancing competition is valuable from a consumer perspective. Comparing maritime economists and competition, the study, via its literature review, also offers a comparison of maritime and competition perspectives on these competition effects, allowing positioning of how effective decisional-making practices have been.

‘Classical’ mutations in the EGFR tyrosine kinase domain (exons 18, 19 and 21) have been associated with sensitivity to tyrosine kinase inhibitors (TKIs) in patients with NSCLC. The aim of the current study was to evaluate whether other than the classical G719X, DEL19 and L858R mutations of EGFR confer sensitivity to TKIs. Genomic DNA was extracted from microdissected formalin-fixed paraffin-embedded tumour tissue from 86 patients treated with gefitinib. Exons 18, 19 and 21 were amplified and subjected to direct sequencing. Eleven (13%) patients harboured the classical exon's 18, 19 and 21 mutations, while 14 (16%) had ‘other’ variants. There was a significantly higher percentage of ‘never-smoker’ patients with ‘classical’ EGFR mutations ( P =0.002). Among patients with ‘classical’ mutations 3 patients achieved PR and 7 SD, while in the ‘other’ mutations group 10 patients had SD as best response. In the wild-type group, there were 3 patients with PR and 25 with SD. Median TTP was 16, 64 ( P =0.002) and 21 weeks and median survival was 36, 78 and 67 weeks for patients with wild-type, ‘classical’ and ‘other’ EGFR mutations, respectively. The clinical relevance of ‘other’ EGFR mutation variants remains uncertain and requires further assessment in a prospective study.

In this paper, we describe the capabilities and strategies required for obtaining a concession to operate a terminal in a seaport. The extent to which concession procedures create entry barriers and lower the contestability of the market is assessed. Recent studies and policy initiatives have stressed the importance of lowering economic, institutional, and locational entry barriers in seaports. Concession procedures have an effect on market entry. Tenders may lower entry barriers by ensuring transparency, restricting discrimination and exclusivity, and limiting concessions to certain periods. However, tender procedures may also introduce entry barriers in a number of ways, including the requirement of capabilities and track records to win a tender. This paper examines relevant empirical material of recently completed or intended concessions in major European ports to evaluate these issues.