araag2/TREC_Precision-Medicine huggingface dataset:
Patient case: 73-year-old female with Pancreatic ductal adenocarcinoma. Genetic variant: ERBB3. Other conditions: Whipple, FNA.

Clinical trial: PAncreatic Adenocarcinoma in Hospital

Summary: Few data are currently available in the literature on pancreatic adenocarcinoma in France. About 8,000 new cases each year in France. The 5-year survival for all stages combined is <5%. This is the only digestive cancer in which mortality / incidence ratio is 98%.
  Epidemiological characteristics at diagnosis, the impact on the survival of recent advances related to surgery, adjuvant chemotherapy and new standard forms of adjuvant chemotherapy (FOLFIRINOX) are mispriced in real life.
  The development of new drugs and the development of Phase II and III require a better understanding of the state of this disease in the country.
  The main objective is to describe the characteristics of the pancreatic adenocarcinoma at diagnosis in France and make an inventory of diagnostic practices and support.


Eligibility: Inclusion Criteria:
  -  Living in France
  -  Pancreatic adenocarcinoma histologically or cytologically proven
  -  primary diagnosis
  -  Agreed to participate
  Exclusion Criteria:
  -  Suspected pancreatic adenocarcinoma histologically or cytologically unproven
  -  Refused to participate

Relevance to patient case: not relevant
Patient case: 73-year-old female with Pancreatic ductal adenocarcinoma. Genetic variant: ERBB3. Other conditions: Whipple, FNA.

Clinical trial: Simple Technique to Improve Diagnostic Yield in EUS-FNA

Summary: Endoscopic ultrasound and fine needle aspiration are useful tools for the diagnosis and staging of pancreatic cancer. One potential limitation is contamination when needle traverses the gastrointestinal tract under continuous negative pressure. Gastrointestinal tract contamination can lead to misinterpretation of FNA specimens. We propose a technique to eliminate any remaining negative pressure during EUS-FNA and therefore decrease gastrointestinal tract contamination. Our hypothesis is that briefly untwisting the syringe from the biopsy channel after a specimen is obtained eliminates any remaining negative pressure in the FNA needle and therefore reduces GI tract contamination of EUS-FNA specimens, and will lead to improved diagnostic accuracy of this important clinical technique.

Detailed description: Endoscopic ultrasound (EUS) has evolved into a minimally invasive diagnostic and staging method. The addition of fine needle aspiration (FNA) increases the accuracy of EUS in the diagnosis and staging of pancreatic malignancies. An ultrasound probe attached to the end of the endoscope allows real-time direct visualization by means of ultrasound transmission. During the FNA process a needle is advanced through the biopsy channel of the endoscope and into the target lesion. In order to obtain a tissue specimen of a suspicious pancreatic lesion, an FNA needle must traverse either the stomach or duodenum to access the pancreatic mass. Once the needle has entered the target lesion a syringe is exchanged for the needle stylet and negative pressure is applied allowing acquisition of a cytology specimen. Negative pressure is released from the syringe and the stop cock is closed to the syringe. However, due to the relatively long length of the needle there is is significant remaining negative pressure at the needle tip. This leads to aspiration of surrounding material including GI mucosal contamination into the needle while removing it from the target lesion.
  Contamination of the FNA specimen from gastric or duodenal epithelium can occur with continued negative pressure at the needle tip upon withdrawal of the needle out of the target lesion. While EUS-FNA has a high specificity (96%), sensitivity (87%), and accuracy (94%), gastrointestinal tract contamination can lead to misinterpretation of FNA specimens. Based on clinical experience, we propose a technique to eliminate any remaining negative pressure during EUS-FNA and therefore decreasing gastrointestinal tract contamination.

Eligibility: Inclusion Criteria:
  -  Age > 18
  -  Not pregnant
  -  Can give consent
  -  Patients with suspicious GI lesions in need of tissue diagnosis by means of EUS/FNA
  Exclusion Criteria:
  -  Pregnant
  -  Age < 18
  -  Cannot give consent
  -  EUS not technically possible

Relevance to patient case: not relevant
Patient case: 73-year-old female with Pancreatic ductal adenocarcinoma. Genetic variant: ERBB3. Other conditions: Whipple, FNA.

Clinical trial: Clinical Evaluation of EUS-FNA on Diagnosis of Pancreatic Cystic Lesions

Summary: It is still controversial about the necessity of endoscopy ultrasound guide fine needle aspiration (EUS-FNA) on diagnosis of pancreatic cystic lesions(PCL).The aim of this study is to find the influence of EUS-FNA on diagnosis and suggestions of EUS specialists.

Detailed description: First, the investigators will send only EUS images of patients with PCL to diagnosis committee that is consisted with 8 EUS specialists from different countries.The diagnosis will be collected. Then the investigators send the results of EUS-FNA. The diagnosis and suggestions will be collected again. The investigators will calculate how much diagnosis has been changed because of results of EUS-FNA. The investigators will also follow up these patients for 5 years at least to find if these patients benefit from EUS-FNA and complications such as needle tract seeding metastases.

Eligibility: Inclusion Criteria:
  1. Adults with ages from 18-80 years old.
  2. The patients with pancreatic cystic lesions, which diameter of cystic lesion more than 2cm.
  3. Sign the informed consent voluntarily. -
  Exclusion Criteria:
  1. The patient can't accept the endoscopic procedure.
  2. The patient has blood coagulation dysfunction.
  3. The patient has mental disorders.
  4. The patient has mild or severe cardiorespiratory insufficiency.
  5. The patient has hypertension and can't be controlled to safe level.
  6. Patients with alcohol dependence.
  7. Pregnant and lactating women.
  8. The patients the investigators don't think suitable for this study.

Relevance to patient case: not relevant
Patient case: 73-year-old female with Pancreatic ductal adenocarcinoma. Genetic variant: ERBB3. Other conditions: Whipple, FNA.

Clinical trial: Plasma Biomarkers P-DAC, V1

Summary: This is an exploratory, translational, non-interventional and multi-centre clinical study. The aim of the study is to identify predictive plasma biomarkers of response to chemotherapy in PDAC.

Detailed description: This study will involve two cohort groups, all patients involved will have PDAC.
  Cohort A: Target is 80 resectable PDAC patients who will receive standard treatment of chemotherapy +/- radiotherapy
  Cohort B:
  -  Cohort B1 = Target is 80 unresectable locally advanced PDAC patients who will receive standard treatment of chemotherapy +/- radiotherapy.
  -  Cohort B2 = Target is metastatic PDAC patients who will receive standard treatment of chemotherapy +/- radiotherapy.
  Control patients: Target is 50, with acute pancreatitis admitted to hospital for observation/treatment.
  Blood samples will be taken at the following time points:
  -  prior to resection, whenever feasible for cohort A
  -  prior to CT, for both cohort A and B
  -  during CT, for both cohort A and B
  -  follow-up, approximately every 3 to 6 months for two years for cohort A

Eligibility: Inclusion Criteria:
  -  Age ≥ 18 years of age
  -  Ability to give written informed consent
  -  Histologically or cytologically-confirmed PDAC
  -  Patients who will receive standard treatment of CT +/- radiotherapy and present with:
  Cohort A: resectable cancer OR Cohort B.1: unresectable locally advanced cancer OR Cohort B.2: metastatic cancer
  -  Eastern Cooperative Oncology Group (ECOG) Performance status 0 - 2
  Exclusion Criteria:
  -  Presence of medical or psychiatric conditions, which, in the opinion of the investigator, would potentially pose a risk to the patient in participating in this study

Relevance to patient case: not relevant
Patient case: 73-year-old female with Pancreatic ductal adenocarcinoma. Genetic variant: ERBB3. Other conditions: Whipple, FNA.

Clinical trial: Detection of Circulating Tumor Cells for the Diagnostic of Pancreatic Adenocarcinoma.

Summary: Histological proof is a crucial and necessary step for appropriate care in oncology. In the case of pancreatic cancer, histological proof from pathological analysis of the surgical specimen is very rare due to the limited number (15-20 %) of localized tumor accessible to surgical resection. In most cases, invasive endoscopic explorations are necessary for histological diagnosis before deciding of the most appropriate treatment (palliative chemotherapy or radiochemotherapy). The endoscopic ultrasound with fine needle aspiration (EUS-FNA) is currently considered as the first-line endoscopic procedure for the cytological diagnosis of solid pancreatic tumors. The technique is performed under general anesthesia with sensitivity for the diagnosis of adenocarcinoma of 80% in case of a single procedure and 92% in situations where three different procedures are required. EUS-FNA has to be performed by a physician properly trained for this type of interventional endoscopy. Some severe complications may occur but are relatively rare in expert centers (bleeding, perforation, complications of general anesthesia ...).
  Diagnostic alternative approach is biological with research in the peripheral blood of markers of tumor disease. It is possible to detect indirect markers which are molecules produced by tumor tissue (eg CA19.9) and direct markers which reflect the presence of tumor biological material (circulating tumor cells (CTCs) or circulating tumor DNA).
  The value of detection of CTCs is not determined for the diagnostic and therapeutic management of pancreatic cancer. Indeed, no study has evaluated the diagnosis performance of circulating markers with EUS-FNA, the reference method for the diagnosis of unresectable forms.


Eligibility: Inclusion Criteria:
  -  Patient is male or female, and > 18 years of age
  -  Patient has a nonmetastatic solid pancreatic tumor (proved by CT thoraco-abdomino-pelvic) without histological evidence
  -  Patient is referred for surgical treatment or biliopancreatic endoscopic ultrasound with fine needle aspiration (EUS-FNA) of a pancreatic mass
  -  Patient has agree to participate by giving written informed consent
  Exclusion Criteria:
  -  metastatic pancreatic tumor
  -  cancer or other hematologic malignancy during treatment or in remission for less than 5 years.
  -  minor patient under 18 years
  -  contraindication to surgical treatment or contraindication to the biliopancreatic EUS-FNA
  -  patient under guardianship
  -  Pregnant or lactating women

Relevance to patient case: not relevant
Patient case: 73-year-old female with Pancreatic ductal adenocarcinoma. Genetic variant: ERBB3. Other conditions: Whipple, FNA.

Clinical trial: Comparison of Two Needles (19G Flex Versus 22G Standard) for Pancreatic Solid Tumors Diagnosis

Summary: The purpose of this study is to compare the diagnostic gain between 22G standard needle vs 19G Flex needles transduodenal punctures of masses of the pancreatic head.

Detailed description: The negative predictive value of fine needle aspiration under ultrasound endoscopy (EUS-FNA) for the diagnosis of solid pancreatic masses is about 70 - 80 % with the 22G standard needle. Pancreatic adenocarcinoma is known to have a severe prognosis and a low rate of survival even after curative surgery. The study of pancreatic solid tumors is one the main diagnostic problem present in the investigators daily practice. In most of non operated patients, EUS-FNA is the sole possibility to confirm the diagnosis of malignancy which is required to initiate chemotherapy and/or radiotherapy. To improve the performances of the EUS-FNA, new needles are now disposable either with a cutting window design (EchoTip ProCore-COOK Medical) or flexible 19G needle (19G Expect Flex - Boston-Scientific). The goal is to obtain more tissue material with the possibility of a histologic study without increasing the risk of the puncture which is very low (complications rate < 1%). The problem concerns the lesion of the head of the pancreas requiring a trans-duodenal access for the puncture . In this position, the needle is very difficult to push out the operator channel and, in some cases, the puncture is quite impossible with stiff needles as "ProCore" or standard 19G. Thus, the interest of flexible 19G needle is to be used in difficult technical cases as transduodenal access for head pancreatic tumors, with a good safety and more efficacy than 22G needles.

Eligibility: Inclusion Criteria:
  solid tumor of pancreas to receive a biopsy under endoscopic ultrasound (EUS) patient understands the study procedures, risks and voluntarily agrees to participate by giving written informed consent
  Exclusion Criteria:
  patient participates in an other study patient mentally or legally incapacitated contraindications to the achievement of upper gastrointestinal endoscopy haemorrhagic disease, disorder of hemostasis and coagulation (TP<60%, TCA>40sec and platelets <60000/mm3) patient with anticoagulant or antiaggregating treatment that could not be stopped for the endoscopic procedure pancreatic cystic mass (fluid quota valued at more than 50% of the mass lesion on imaging) pregnant or lactating women

Relevance to patient case: not relevant
Patient case: 73-year-old female with Pancreatic ductal adenocarcinoma. Genetic variant: ERBB3. Other conditions: Whipple, FNA.

Clinical trial: Fully Covered Self-expandable Metal Stents (FCMS) in Benign Biliary Strictures

Summary: Endoscopic treatment of benign biliary strictures can be challenging. Balloon dilation and/or plastic stent placement are currently the most popular techniques. Partially covered self-expandable metallic stents have also shown to be effective but can be difficult to remove. A novel fully covered metallic stent has recently been developed.
  The aim of this study was to prospectively evaluate the placement of fully covered self-expandable metallic stents (FCSEMS) in this setting.

Detailed description: After inclusion, an endoscopic procedure (ERCP) was performed in all patients in order to place a FCMS across the benign biliary stricture. The FCMS was left in place for 6 months and then extracted during a second ERCP procedure. An opacification was performed to assess the efficacy of stenting. Patients were followed up during one year after FCMS extraction.

Eligibility: Inclusion Criteria:
  -  a history of liver transplantation, chronic pancreatitis or biliary surgery
  -  impairment of liver function tests such as elevated liver enzymes and/or cholestasis
  -  a biliary stricture associated with ductal dilation detected by US, CT or MRI, with a minimum distance of 2cm between the upper stricture's edge and the lower limit of the main biliary confluence or liver hilum .
  Exclusion Criteria:
  -  an uncertainty about the benign nature of the stricture
  -  an intra-hepatic cholangitis and/ or a stricture extending beyond the hilum

Relevance to patient case: not relevant
Patient case: 73-year-old female with Pancreatic ductal adenocarcinoma. Genetic variant: ERBB3. Other conditions: Whipple, FNA.

Clinical trial: Study Of PF-03084014 In Combination With Gemcitabine And Nab-Paclitaxel In Patients With Metastatic Pancreatic Adenocarcinoma Not Previously Treated With Anticancer Therapies

Summary: This study consists of a Phase 1b portion aimed to determine the maximum tolerated dose and the safety profile of PF-03084014 in combination with gemcitabine and nab-paclitaxel followed by a Phase 2 portion to evaluate the efficacy of the triple combination in terms of overall survival in patients with metastatic pancreatic ductal adenocarcinoma not previously treated with anticancer therapies.


Eligibility: Inclusion Criteria:
  -  Histologically or cytologically diagnosis of metastatic ductal adenocarcinoma of the pancreas.
  -  No prior radiotherapy, surgery chemotherapy or investigational therapy for metastatic disease. Prior adjuvant therapy with 5-FU or gemcitabine (± gemcitabine post radiation) administered as radiosensitizer allowed, provided at least 6 months have elapsed between the last dose and study registration
  -  Tumor tissue available (Archival 6 months old or de novo biopsy)
  -  Measurable disease as per RECIST 1.1
  -  Performance Status (ECOG) 0 or 1
  Exclusion Criteria:
  -  Symptomatic brain metastases requiring steroids
  -  Prior therapy with gamma secretase inhibitors or other Notch pathway inhibitor
  -  Major surgery within 4 weeks of registration in the current study
  -  Known hypersensitivity to gemcitabine or nab-paclitaxel or any of the excipients
  -  Current or anticipated need for food or drugs that are strong/moderate CYP3A4 inhibitors or inducers
  -  Diagnosis of any second malignancy within 3 years prior to registration

Relevance to patient case: not relevant
Patient case: 73-year-old female with Pancreatic ductal adenocarcinoma. Genetic variant: ERBB3. Other conditions: Whipple, FNA.

Clinical trial: Nab-paclitaxel Plus S-1 in Patients With Advanced Pancreatic Cancer

Summary: The purpose of this study is to determine the efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) plus S-1 as first-line treatment in Chinese patients with advanced pancreatic ductal adenocarcinoma (PDA).

Detailed description: Advanced PDA is a lethal disease with a approximately 6 months of median survival. Gemcitabine is always the only approved single agent. The recent results of the phase III trial MPACT (Metastatic Pancreatic Adenocarcinoma Clinical Trial) demonstrated an improvement in overall response rate (ORR), progression free survival (PFS) and overall survival (OS) for the combination of nab-paclitaxel plus gemcitabine compared to gemcitabine alone. Thus, the combination of nab-paclitaxel with gemcitabine became one of a standard treatment in metastatic PDA. S-1 is an oral fluoropyrimidine, and shown to be non-inferior to gemcitabine on OS for unresectable pancreatic cancer, and also demonstrated non-inferior, and even superior to gemcitabine as adjuvant chemotherapy. This single-arm study is to explore the efficacy and safety of nab-paclitaxel plus S-1 as first-line treatment in Chinese patients with local advanced or metastatic pancreatic ductal adenocarcinoma.

Eligibility: Inclusion Criteria:
  1. Signed informed-consent form.
  2. Age no less than 18 years.
  3. Histologically confirmed locally advanced or metastatic pancreatic ductal adenocarcinoma, with RECIST measurable lesions.
  4. Eastern Cooperative Oncology Group (ECOG) 0-1 with life expectation of no less than 12 weeks.
  5. Patients must have received no previous chemotherapy or investigational therapy for the treatment of metastatic disease. Prior treatment with 5-fluorouracil or gemcitabine administered as a radiation sensitizer in the adjuvant setting is allowed, provided at least 6 months have elapsed since completion of the last dose and no lingering toxicities are present.
  6. Adequate liver/bone marrow function.
  7. Human Chorionic Gonadotropin (HCG) test negative for female with contraception measure until 3 months after study end.
  8. Compliant, and can be followed up regularly.
  Exclusion Criteria:
  1. Pregnant or breast-feeding female, or not willing to take contraception measures during study.
  2. Serious infection requiring antibiotics intervention during recruitment.
  3. Allergic to study drug.
  4. More than grade 1 neuropathy.
  5. Uncontrolled brain metastasis or mental illness.
  6. Congestive heart failure, uncontrolled cardiac arrhythmia, etc.
  7. Other malignancy within 5 years.
  8. Can't be followed up or obey protocol.
  9. Ineligible by the discretion of the investigator.

Relevance to patient case: not relevant
Patient case: 73-year-old female with Pancreatic ductal adenocarcinoma. Genetic variant: ERBB3. Other conditions: Whipple, FNA.

Clinical trial: Nab-paclitaxel Plus Gemcitabine in Chinese Patients With Advanced Pancreatic Cancer

Summary: The purpose of this study is to determine the efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) plus gemcitabine as first-line treatment in Chinese patients with advanced pancreatic ductal adenocarcinoma.

Detailed description: Advanced pancreatic ductal adenocarcinoma is a fatal disease with about 6 months of median overall survival (OS). Gemcitabine is the only approved single agent. Gemcitabine-based chemotherapy did not show benefit in OS during the past decade. The recent phase III trial MPACT (Metastatic Pancreatic Adenocarcinoma Clinical Trial) demonstrated an improvement in overall response rate (ORR), progression free survival (PFS) and OS, with nab-paclitaxel (125 mg/m2 on day 1, 8 and 15 every 28 days) plus gemcitabine (1000 mg/m2 on day 1, 8 and 15 every 28 days) compared to gemcitabine alone. Accordingly the combination of nab-paclitaxel with gemcitabine became one of standard treatments in metastatic pancreatic cancer. A Chinese phase II trial showed the modified dosage of nab-paclitaxel (120 mg/m2 on day 1 and 8 every 21 days) plus gemcitabine (1000 mg/m2 on day 1 and 8 every 21 days) is more suitable for Chinese patients. This study aims to explore the efficacy and safety of the tentative dosage of nab-paclitaxel (125 mg/m2 on day 1 and 8, every 21 days) and gemcitabine (1000 mg/m2 on day 1 and 8, every 21 days) for Chinese patients.

Eligibility: Inclusion Criteria:
  1. Signed informed-consent form.
  2. Age no less than 18 years.
  3. Histologically confirmed locally advanced or metastatic pancreatic ductal adenocarcinoma, with RECIST measurable lesions.
  4. Eastern Cooperative Oncology Group (ECOG) 0-1 with life expectation of no less than 12 weeks.
  5. Patients must have received no previous chemotherapy or investigational therapy for the treatment of metastatic disease. Prior treatment with 5-fluorouracil or gemcitabine administered as a radiation sensitizer in the adjuvant setting is allowed, provided at least 6 months have elapsed since completion of the last dose and no lingering toxicities are present.
  6. Adequate liver/bone marrow function.
  7. Human Chorionic Gonadotropin (HCG) test negative for female with contraception measure until 3 months after study end.
  8. Compliant, and can be followed up regularly.
  Exclusion Criteria:
  1. Pregnant or breast-feeding female, or not willing to take contraception measures during study.
  2. Serious infection requiring antibiotics intervention during recruitment.
  3. Allergic to study drug.
  4. More than grade 1 neuropathy.
  5. Uncontrolled brain metastasis or mental illness.
  6. Congestive heart failure, uncontrolled cardiac arrhythmia, etc.
  7. Other malignancy within 5 years.
  8. Can't be followed up or obey protocol.
  9. Ineligible by the discretion of the investigator.

Relevance to patient case: not relevant