bluuebunny/crossref_metadata_2025 huggingface dataset:
Failure rates of mutation-based ctDNA assays in lung cancer treatment monitoring.
Authors: Phallen Jillian , Medina Jamie E. , Trivedi Niti U. , Rinaldi Lorenzo , Velculescu Victor E. , Bach Peter Brian , Leal Alessandro
Published: June 2023

e18752

Background: Despite the wide adoption of noninvasive liquid biopsy approaches for cancer genotyping, little is known about the longitudinal performance of these assays for monitoring therapeutic responses in patients with advanced disease. Here, we report results of a pooled analysis that collects existing evidence regarding the failure rates of circulating tumor DNA (ctDNA) assays designed for therapeutic monitoring in patients with advanced or metastatic lung cancer. Methods: We searched PubMed for original studies published between February 2012 and January 2022, following these inclusion criteria: (1) Adults older than 18 years old with advanced or metastatic lung cancer treated with chemotherapy, targeted therapy, or immunotherapy; (2) Tumor-informed or plasma-only circulating tumor DNA assays based on droplet digital PCR (ddPCR) or targeted deep sequencing technologies for the detection of tumor-specific allele fractions; (3) Measurement of circulating tumor DNA levels at sequential timepoints. We defined failures as a lack of detectable mutant allele fraction (MAF) in patients with metastatic lung cancer in samples collected before treatment initiation. Two reviewers independently screened studies, extracted data, assessed the risk of bias, and evaluated the quality of evidence. Divergences were resolved by a third independent reviewer reaching a consensus. Study quality assessment covered: (1) representativeness of patient population, (2) risk of funding bias, (3) description of ctDNA analysis and outcomes, and (4) statistical quality and interpretation. Results: From 142 studies retrieved by an automated PubMed query, we extracted data from 42 studies which fulfilled the eligibility criteria - 11 registered trials, 31 prospective/retrospective cohorts. MAF levels in the circulation were measured using PCR-based assays (23/42, 55%); the remainder used NGS-based approaches (19/42, 45%). The median number of targeted genes was 1 (range 1-6) vs 73 (range 36-214), respectively. The median number of samples analyzed per study was 79 (range 3-334). On average, 31% of samples collected before treatment did not have a detectable MAF in any of the target genes analyzed, despite the high disease burden typically experienced in patients with metastatic lung cancer. Only 57% of PCR-based and 78% NGS-based studies succeeded in providing molecular response assessment metrics. We identified 10/42 studies with critical quality assessment concerns and 18 studies had funding provided by a company with investments in the commercial cfDNA assay. Conclusions: Available liquid biopsy assays that report tumor-specific mutations have a high rate of failure for measuring disease burden and response outcomes during therapy. Approaches that could be reliably used for monitoring patients with advanced cancers undergoing treatment are needed to improve patient care.
Clinician-patient insights and alignment on urothelial carcinoma care.
Authors: Ackbarali Tariqa , Chisolm Stephanie , Tagawa Scott T. , Shore Neal D.
Published: June 2023

e18755

Background: The expansion of the treatment landscape for urothelial carcinoma (UC) including immune checkpoint inhibitors and antibody-drug conjugates (ADCs) hold the promise of improving long-term survival in patients with more advanced disease. A tethered (patient-clinician) educational initiative was designed for patients/caregivers to stay up-to-date with new therapies and for clinicians to facilitate integration of new therapies into clinical practice. Methods: Two, 1-hour online, interactive, video-based programs were designed for patients and clinicians. The patient/caregiver program was hosted on CancerCoachLive in January, 2022 and the clinician program on UroCareLive and OMedLive in December, 2022. The initiative was conducted in collaboration with LUGPA, Large Urology Group Practice Association and BCAN, Bladder Cancer Advocacy Network. Behavioral assessment of preferences and attitudes toward managing patients were examined throughout the CME series and patient/caregiver program. A planned analysis of the data from these questions determined patient and clinical impact. Outcomes from the patient program were analyzed and presented during the CME series followed by expert-identified strategies to improve clinical practice. Results: A total of 1,071 participants have engaged across both educational programs. The majority of the patient participants were in remission or had recurrent UC. Patients provided insight on what mattered most at the point of decision-making (48%), the symptoms that led to a diagnosis – hematuria (85%), and their greatest quality-of-life challenge – urinary functioning concerns (52%). Of those who have been treated previously, 83% were treated with an immunotherapy and 9% with an antibody drug-conjugate. Pre- to post-activity comparisons demonstrate a greater likelihood of participation in clinical trials. When asked about the challenges patients with UC face, the top 3 challenges identified by patients were not aligned with those identified by clinicians. Clinicians additionally identified themselves as lacking confidence (58%) in their understanding of patient’s concerns or challenges. Following the activity, clinicians were very motivated to address these concerns (88%). Clinicians identified enfortumab vedotin (44%) as the ADC with the greatest potential to improve patient outcomes and a lack of knowledge on evidence-based strategies as the primary barrier to implementing changes in practice (34%). Qualitative data from both the patient and clinician activities were captured representing write-in examples of behavioral impact which will be shared. Conclusions: The initiative contributed to the provision of valuable patient insights, patient-clinician misalignment, and clinician confidence addressing patient concerns. Increasing this awareness fostered practical strategies and discussion to improve patient-centered care.
Qualitative analysis of barriers to precision oncology within the VHA.
Authors: Becker Daniel Jacob , Barbaro Alexander Michael , Csehak Kenneth , Diasti Kevin , Roman Stefanie D. , Makarov Danil V. , Sherman Scott , Squires Allison P.
Published: June 2023

e18760

Background: Rapidly expanding knowledge of molecular drivers of cancer helps facilitate effective, targeted cancer therapy (i.e. precision oncology), but research suggests that precision oncology is underused. We conducted a qualitative study of barriers and facilitators of precision oncology use within the Veterans Health Administration (VHA). Methods: We conducted a pragmatic qualitative study involving semi-structured interviews with both patients and providers at VA medical centers with low, medium, and high guideline concordant molecular testing. The interview guide was constructed by a multidisciplinary team of oncologists, qualitative health researchers and patient representatives using modified grounded theory (MGT) and the Theoretical Domains Framework (TDF). Summative and directed content analyses were conducted. Codes for the directed content analysis came from the framework and others evolved iteratively. Consensus-based approaches finalized the codebook. Results: Thirty-three interviews were conducted (17 patient and 16 provider interviews). A total of 1889 unique phrases were identified and categorized into 255 meaningful statement codes. The codes were mapped to 10 TDF domains. The most frequently cited determinants, representing 59% (1110 of 1889 statements) of all coded data, included the domains environmental context and resources, knowledge, and goals. Both patients and providers shared similar goals of improved outcomes and quality of care, but systems barriers were frequently cited impediments to precision oncology use. An additional 27% of codes (510 of 1889) represented the TDF domains of emotions (predominantly patient “fear of genetics” and confidence in providers), memory/attention (task priority in clinic visits), and interpersonal skills (both patient-provider, and interdisciplinary provider-provider). Additional frequently cited determinants, each comprising 6% of coded statements, included social influences (for both providers and patients) and reinforcement (perceived consequences). Conclusions: We identified determinants of precision oncology use at the patient, provider, and system level. Attempts to improve implementation of precision oncology will need to address systems barriers to care, as well as knowledge and patient-provider interactions, but can build on a foundation of shared goals.
Disparities in fertility preservation in rural adolescent and young adult patients with hematologic malignancies.
Authors: Thomas Ryan , Searles Sienna , Hitt Juvena , Kennedy Amanda , Jasra Sakshi
Published: June 2023

e18764

Background: As survival of patients with hematologic malignancies improves, quality of life (QOL) measures have gained importance. Cancer therapies can have a deleterious impact on fertility in patients of childbearing age. Previous studies have highlighted disparities in access to oncology care in rural patients, with negative effects on health outcomes and QOL. This study aims to explore the impact of rurality on fertility preservation in adult young adult (AYA) population. Methods: The study examined patients with a new diagnosis of acute leukemia or lymphoma, ages 15-39, between 2017-2022 at the University of Vermont Medical Center. These included Acute lymphoblastic leukemia (ALL), Acute myeloid leukemia (AML), Hodgkin’s lymphoma, and Non-Hodgkin’s lymphoma. We identified 145 patients and collected data on demographics, insurance, zip codes, cancer diagnoses and whether referral to fertility preservation was requested. Rurality was determined using United States census data, with Rural-Urban Commuting Area (RUCA) codes 1-3 considered urban, and codes 4-10 being considered rural. Results: Of the 145 patients, majority resided in rural (N = 81 or 56%) as compared to urban areas (N = 64 or 44%). Majority of patient did not receive a referral for discussion of fertility preservation (N = 77 or 53%). Of the patients that were referred, more urban patients received referrals (N = 38 or 56%), compared to rural cancer patients (N = 30 or 44%), and this difference was statistically significant (OR = 2.5, 95% CI 1.2-5.14, p = 0.0074). The type of insurance the patient had impacted referral rates. Patients with private insurances were more likely to receive a referral compared to those who had no insurance or had Medicare/Medicaid, (N = 41 or 60% vs. N = 27 or 40%) and this difference was also statistically significant (OR = 2.13, 95% CI 1.04-4.38, p = 0.0243). Conclusions: We find that rural AYA patients with hematologic malignancies were less likely to receive referral for fertility preservation, compared to their urban counterparts. Patients with private insurances had the highest rates of referrals, while patients with Medicare/Medicaid or no insurance were less likely to be referred. This study highlights disparities in access to fertility preservation in rural cancer patients, with significant potential impact on quality of life.
Peripheral T-cell lymphoma-not otherwise specified, angioimmunoblastic T-cell lymphoma and anaplastic large cell lymphoma: Are the outcomes any different in Hispanics?
Authors: Velez Carolina , Toro-Vélez Esteban , Liu Qianqian , Michalek Joel , Diaz Duque Adolfo Enrique
Published: June 2023

e18773

Background: Peripheral T cell lymphoma – not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL) and anaplastic large cell lymphoma (ALCL) are unusual non-Hodgkin lymphomas with miscellaneous clinical characteristics which share the same treatment regimen (Blood PMID28115372 Cancer Treat ResPMID30596215 Blood PMID28115369). Gene expression profiling has facilitated their diagnosis; but much remains to be learned about risk factors, biological and clinical implications (Oncologist PMID16880242). This is the first national population-based analysis evaluating ethnic differences for Hispanics (HI) diagnosed with PTCL-NOS, AITL and ALCLin the US. Methods: Data were analyzed on PTCL-NOS, AITL and ALCL patients in the US reported to the Surveillance, Epidemiology, and End Results (SEER) database between 2000-2018. Demographic, clinical and survival patterns were analyzed. Kaplan-Meier and Cox regression analyses were used when appropriate. Multivariate analysis and propensity score matching were performed with adjustment for age, stage and B-symptoms. Results: 12,749 patients were diagnosed with PTCL-NOS, AITL and ALCL (1,666 cases were HI = 798 PTCL-NOS, 316 AITL and 552 ALCL). Male predominated for HI and Non-HI (NH) in the 3 malignancies. HI were diagnosed at a younger median age than NH, PTCL-NOS 60 years(y) vs 65y, AITL 65y vs 69y, and ALCL 45y vs 55y, respectively [p <0.001]. White race predominated for both. When diagnosed with PTCL-NOS or AITL, HI were more likely diagnosed from 2015-2018 but those with ALCL were identified from 2000-2004. For the 3 malignancies limited information regarding B symptoms was available. Most of the cases of HI and NH were diagnosed at advanced stages in all subtypes. Overall, for both the tendency was towards not receiving radiation. HI vs NH diagnosed with PTLC-NOS had median survival of 1.2 vs 1.3y; AITL was 2.2 vs 1.7y and ALCL 6.0 vs 9.3y. Survival probability for 2, 5 and 10y were comparable among HI and NH for all malignancies and no difference in OS was noted. On multivariate analysis, patients who were older than 80y and between 60-80 y, had worse OS compared to those <60y. For all subtypes, those who were diagnosed at stage III/IV had worse OS than those at early stage I/II. Conclusions: Similar OS for HI and NH diagnosed with PTCL-NOS, AITL and ALCL. Nonetheless, diagnosis at younger age and early stage play a significant role to better survival. Although HI were more subjected to early age at diagnosis and less likely to be at a stage I/II, no impact in survival was evidenced, which suggests that unique responses may counteract within this race. It is captivating that no gradual increase in diagnosis was noted despite the continuous development of genetic testing and improved diagnostic tools, which highlights that socioeconomical variables may have been influencing its access.
Prognostic stratification and outcome of metastatic NSCLC based on activating mutation profile and PD-L1 status.
Authors: Chan Kok Hoe , Sridhar Arthi , Lin Ji Zheng , Jafri Syed Hasan Raza
Published: June 2023

e18776

Background: The development of mutation-directed therapy and immunotherapy has revolutionized the treatment of NSCLC. We investigated outcomes of patients with or without actionable mutations (AM) in relation to their PDL-1 status. Methods: This was a retrospective analysis of patients with stage IV NSCLC from 01/2014 to 06/2022 at our institution. Four groups were identified: P0M0 (PDL-1 <1% and no AM), P0M1 (PDL-1 <1% with AM), P1M0 (PDL-1 ≥1% and no AM), and P1M1 (PDL-1 ≥1% with AM). X2 and Wilcoxon rank-rum test were used to assess categorical and continuous data, respectively. Progression-free survival (PFS) and overall survival (OS) were compared between groups using the Cox proportional-hazards model. Results: A total of 117 patients were included. Median age was 65 years, and 63 (54%) were male. The most common histology was adenocarcinoma (79%), followed by squamous cell cancer (14%) and large cell carcinoma (4%). The most common AM was KRAS (22%), followed by EGFR (21%), MET (4%), and HER2 (4%). The median PFS and OS of the entire group were 11.8 and 33.5 months, respectively. Adenocarcinomas had a higher incidence of harboring an AM (62%, p<0.0001). When comparing the PFS and OS with regard to PDL-1 and an actionable mutation, 4 prognostic groups were identified (Table). The P0M0 subgroup (n=24) had the worst median PFS and OS (8.5 and 20.6 months). The P1M1 subgroup (n=41) had the best OS at 44.5 months. Patients in the P0M1 subgroup had a longer PFS than those in the P1M1 subgroup (25.2 vs. 13.1 months), likely due to the presence of more EGFR mutations (57% vs. 32%, p=0.05). However, this did not translate into improved OS (P0M1: 33.5 months, P1M1: 44.5 months, log-rank p=0.98), perhaps because of the durable long-term response to immunotherapy in patients with PDL-1 ≥1%. The results were not significant, likely due to the small sample size in each category. Conclusions: Patients with PDL-1 <1% and no AM had the worst prognosis (median OS, 20 months). Patients with AM and PDL-1 ≥1% had the best OS, 44.5 months. This use of real-world data is an important addition to the existing information to predict survival outcomes of patients with stage IV NSCLC based on the current treatment paradigm. It provides important clinical information and should be corroborated in a larger study. [Table: see text]
Risk factors for in-hospital mortality in cancer patients hospitalized for COVID-19.
Authors: Abuhelwa Ziad , Abuhelwa Ahmad Y , Safi Mohammad , Spencer Caleb , Elsamaloty Mazzin Haitham , Skeel Roland T , Khuder Sadik
Published: June 2023

e18778

Background: COVID-19 pandemic has had a devastating impact on global health, causing significant mortality and morbidity. Cancer patients are particularly vulnerable to the virus, with increased risks of adverse outcomes. In an effort to understand the factors that contribute to these outcomes, our study analyzed the predictors of mortality in cancer patients who were hospitalized for COVID-19 in the United States. Methods: In this retrospective cohort study, we used the National Inpatient Sample database 2020, the largest inpatient database in the United States, to analyze adult patients (≥18 years) who were hospitalized for COVID-19 and had a cancer diagnosis, as determined by ICD-10-CM codes. The primary outcome was in-hospital mortality. Secondary outcomes included acute respiratory failure (ARF), the need for mechanical ventilation (MV), length of stay (LOS), and total charges (TC). To identify predictors of in-hospital mortality, we performed a multivariable logistic regression analysis. A sensitivity analysis was also conducted based on the type of cancer. Results were considered statistically significant if the p-value < 0.05. Statistical analysis was conducted using STATA 17.0. Results: A total of 28,300 adult patients with cancer who were hospitalized for COVID-19 were included. The mean age was 71 years, with 56.8% being male and 63.6% being White. The most prevalent comorbidities were hypertension (70.1%), hyperlipidemia (44.5%), and diabetes mellitus (34.5%). The overall in-hospital mortality rate was 17.4%. About 56.9% of the patients experienced ARF and 10.1% required MV. The mean LOS and TC were 8.1 ± 8.7 days and $82,731 ± 152,297, respectively. Multivariable logistic regression analysis revealed that predictors of in-hospital mortality were age (odds ratio [OR] 1.04, 95%CI 1.03-1.05, p-value < 0.001), male gender (OR 1.18, 95%CI 1.01-1.37, p-value 0.03), congestive heart failure (OR 1.35, 95%CI 1.12-1.63, p-value < 0.001), chronic kidney disease (OR 1.46, 95%CI 1.21-1.76, p-value < 0.001), liver disease (OR 2.41, 95%CI 1.8-3.24, p-value < 0.001), and diabetes mellitus (OR 1.22, 95%CI 1.04-1.43, p-value 0.01). No racial or socioeconomic disparities were found to be associated with in-hospital mortality. Sensitivity analysis according to cancer type showed that patients with lung cancer had the highest in-hospital mortality rate (OR 1.89, 95%CI 1.22-2.92, p-value 0.004). Conclusions: The results of our study indicate that age, male gender, and the presence of certain comorbidities such as congestive heart failure, chronic kidney disease, liver disease, and diabetes mellitus significantly impact in-hospital mortality among cancer patients hospitalized for COVID-19. Notably, lung cancer patients experienced the worst outcomes. These findings provide valuable insights for clinical decision making and future research on COVID-19 in cancer patients.
Awareness and perceptions of clinical trials in patients with cancer and their families in Turkey.
Authors: Kubilay Pinar , Erol Cihan , Kahraman Seda , Tacar Seher Yildiz , Özcan Erkan , Basal Fatma Bugdayci , Köse Fatih , Sendur Mehmet Ali Nahit , Tural Deniz , Cicin Irfan , Oksuzoglu Berna , Ürün Yüksel ,   ASCO Pinar Group
Published: June 2023

e18780

Background: Patient preference plays an important role in enrolling in clinical trials. We conducted this study to understand the perceptions knowledge and willingness of cancer patients or their families about clinical trials. Methods: A questionnaire in Turkish language was conducted including the sociodemographic characteristics of the participants and the factors that may affect their decision to participate in clinical trials. The study was carried out in 5 tertiary health care institutions with clinical research centers in Turkey. Adult patients diagnosed with solid tumors or their family members who agreed to participate were surveyed by medical doctors. Participants were interviewed between January 2020 and April 2021. Comparisons between groups were carried out using chi-square test χ2 for the categorical variables. IBM SPSS25 was used in analyses and p<0.05 was accepted as the level of significance. Results: A total of 978 patients whose age ranged 18 and 82 (Mean= 51.43, SD=14.41) participated in the study. %50.3 was male, %40.7 was female. Willingness to participate a clinical trial was positively corelated with participants self reported health condition is excellent or good (p=0.206), well knowledge about clinical trials (p<0.001), high school or higher education level (p<0.001), household income above poverty level (p=0.003), previously received systemic cancer treatment of himself or family member or friend (p=0.03). %73.7 stated they are more willing to participate if their oncology specialist conducting the clinical trial. %84.3 want to get information about the clinical trial from their oncology specialist. %72.5 stated that positive experiences of a previous clinical trial participant will affect their decision making. Top corcerns about clinical trials are possible treatment side effects (%56.7), being treated as a test subject (%29), risk of placebo (%20.1). Top motivations are accessing best doctors (%45.8), accessing newest and best treatment options (%40.7), getting more information about their health condition (%68.9), helping science adventions (%82.6). Conclusions: Even when patients are eligible for a clinical trial physicians may somehow not discuss the clinical trial option. For patients oncology specialists are a highly trusted source of information and can play an important role in raising awareness and encouraging participation. [Table: see text] [Table: see text]
Nutrition and head-neck cancer: A prospective observational study in patients with head neck cancer receiving adjuvant/definitive radiotherapy/chemoradiotherapy.
Authors: Deshmukh Dr Chetan Dilip , Chaudhary Dr Mukesh , Kulkarni Padmaj Sudhakar , Hingmire Sachin Sharadchandra
Published: June 2023

e18784

Background: Head-Neck cancers are at higher risk of malnutrition due to their disease or its treatment which can cause structural changes to the oral cavity and prevent effective nutrition. Malnutrition is assessed by anthropometric measurements. Skeletal muscle strength is also a marker of nutrition. The present study aimed to study the correlation between nutrition, muscle strength and acute toxicities in patients with head and neck squamous carcinoma receiving concurrent chemoradiotherapy or radiotherapy alone. Methods: A prospective observational study was conducted at Deenanath Mangeshkar Hospital, Pune, India in patients with nonmetastatic head neck squamous cancers planned for definitive or adjuvant chemo-radiotherapy. Nutritional status was assessed at baseline, end of treatment and after 3months of treatment by mid-arm circumference, weight, height and body mass index. Muscle strength was assessed by Jamar’s handgrip dynamometer. Results: A total of 103 patients (85 males and 18 females) participated in the study between February 2020 and February 2021. Four patients had to be withdrawn before initiating treatment, 99 patients completed the planned course of treatment. Mean age was 54.4 years. Postoperative chemoradiotherapy was give to 37 patients, 22 received definitive chemoradiotherapy, 33 received postoperative radiotherapy alone and 7 patients received definitive radiotherapy. A statistically significant reduction in all nutritional parameters during treatment and at 3 months after completion of treatment was seen. Mucositis and odynophagia were the commonest toxicities. Nasogastric or percutaneous gastrostomy tube was inserted in 25 patients. Seven patients required hospitalisation for toxicities. There were no treatment related deaths. Conclusions: Head and neck cancer patients undergoing concurrent chemoradiation or radiation are at significantly higher risk of malnutrition. Loss of muscle strength correlates with treatment related acute toxicity. [Table: see text]
Real world data on immunotherapeutic outcomes in solid tumours.
Authors: Srinivasalu Vijay Kumar , Patnaik Ravi Sekhar , bin Raden Mas Ismail Raden Mas Jeffri , Bin Haji Mohamad Haji Zulkhairi , Lu Dr. Shir Kiong , Sukumaran Dato Seri Laila Jasa Dr. Babu
Published: June 2023

e18785

Background: Defined as “the new kid on the blocks” in the field of medical oncology, Immunotherapy has paved the way in the armamentarium of cancer therapeutics literally in every cancer subtype. There are various biomarkers approved for considering immunotherapy, but none have been reliable. We aim to assess the response rate, PFS, OS, and clinical characteristics of patients who received immunotherapy for treatment in advanced or metastatic solid tumours. Methods: A retrospective study of all patients who were treated with immunotherapy at The Brunei Cancer Center, PJSC between December 2019 – February 2022 was included with a median follow-up of 6 months from the last dose of immunotherapy. Results: A total of 212 patients were included with Pembrolizumab 66% (n = 140), Nivolumab 24% (n = 51), Atezolizumab 8.4% (n = 18), Durvalumab 0.9% (n = 2), and Ipilimumab + Nivolumab 0.4% (n = 1). The median age was 46 years (range 31-78 years) with a female preponderance of 62%. The median number of cycles were 4.5 per patient (range 0-41). Lung cancer 29.7% (n = 63, adenoca-40, squamous-10, adenosquamous-2, SCLC-11), GI tumours 19.3 (n = 41, HCC-17, Stomach-15, MCRC-7, Pancreas-2), GU tumours 12.7% (n = 27, RCC-19, Bladder-7, Penis-1) and Head and neck tumours 9.9% (n = 21, HNSCC-13, NPC-8). On biomarker analysis for initiation of immunotherapy, PDL-1 + on IHC (either by CPS or TPS) was noted in 88 patients, TMB > 10 in 22, and MSI-H in 4 patients. The ORR in this study was 35.3% (CR-10, PR-29, and SD-36). Sixty patients received less than 3 cycles and were not included in the analysis. Disease progression (27), worsening ECOG performance status (14), and IRAEs (19) were the common reasons for discontinuation of these drugs. On ITT analysis, the ORR was 51.3%. The median duration of response is 12.5 months in responders (range 6-31 months). The Median PFS was 4.9 months (95% CI: 1.78-8.21) and the median OS was 7.1 months (95% CI: 8.14-17.85). On univariate analysis for determinants of better PFS, pretreatment NLR > 4 was associated with improved survival (p = 0.001) and presence of co-mutations, low TMB < 5 and younger age < 45 was associated with inferior survival. Conclusions: Pretreatment NLR > 4 can be used as an indicator of response to immunotherapy in the clinics. Benefits of immunotherapy are not universal, best responses were noted in NSCLC, Bladder, and RCC. Identification of novel predictive biomarkers would improve clinical outcomes in solid tumours.
Experience of a stem cell transplant in multiple myeloma: The patient and care partner perspective.
Authors: Hansen Doris K. , Bixby Todd , Fixler Karen , Shea Lisa , Brittle Christine , Brunisholz Kimberly , Liu Yi-Hsuan , Huo Jinhai
Published: June 2023

e18790

Background: Understanding patient experiences of their multiple myeloma (MM) disease journey, particularly related to the burden of autologous stem cell transplant (ASCT) and treatment recovery process, helps characterize unmet needs and quality of life of patients and their caregivers. A qualitative study of the experience of patients with MM who received ASCT and perspectives of caregivers was conducted. Methods: Recruited participants with MM were ≥18 years of age and received ASCT within the past 5 years or caregivers of patients who met these criteria. Two virtual focus group interviews were conducted, in which patients and caregivers were asked separately to narrate their disease journey starting with first symptoms and diagnosis, then focusing on the ASCT and recovery period. Results: A total of 16 participants, including 12 MM patients and 4 caregivers, were included. Nine participants (56.25%) were less than 60 years old, and eleven (68.75%) participants were female. Study participants were diverse in race/ethnicity; one-third of participants were Black and one-third comprised other minorities (Hispanic, Native Hawaiian, Asian, and Multiracial). Pain, weakness, and fractured bones (femur, hip, or spinal fractures) were common first symptoms. Other common patient-reported symptoms included high blood pressure, blurred vision, more frequent illnesses, unsteady gait, and anemia. The patients in the study were first diagnosed with MM in a variety of ways, mostly by a primary care physician and some in urgent care settings. The diagnosis process could take up to six months for some patients and commonly a community oncologist referred patients to a bone marrow transplant specialist, who was the primary driver in making ASCT decisions. Eight patients received their ASCT in an inpatient setting and four patients in an outpatient setting, with three eventually being hospitalized due to complications. Only one patient stayed in an outpatient setting the entire time. Initial recovery time after ASCT ranged from 2 weeks to 4 months; complete recovery took from 30 days to “never.” The most patient-reported difficulties during recovery time included nausea, loss of appetite, weakness, fatigue, and pain. Caregivers played an important role in the recovery process and often with negative financial impact related to missing work and travel expenses. Conclusions: Patients with MM who received ASCT and their caregivers perceived various unmet needs throughout their transplant journey. Post–stem cell transplant symptoms had a substantial impact on patients’ quality of life, especially with lengthy and challenging recovery. Innovative therapies are needed for newly diagnosed MM to reduce the burden of disease and enhance the quality of life for both patients and their caregivers.
Clinicopathological features and treatment patterns of patients with cancer of unknown primary site (CUP): Mayo Clinic experience.
Authors: Algarin Perneth Sandra , Suleiman Riham , Duran Mayra , Loor Torres Ricardo , Soto Jacome Cristian , Gile Jennifer , Leon-Ferre Roberto Antonio , Villasboas Jose Caetano , Graham Rondell P. , Thome Stephan , Halfdanarson Thorvardur Ragnar , Fuentes Bayne Harry E
Published: June 2023

e18803

Background: CUPs are a heterogeneous group of metastatic cancers for which a standardized diagnostic work-up fails to identify the site of origin at the time of diagnosis. CUP accounts for 3%-5% of all cancer diagnoses worldwide, and the natural history of patient with CUP differs from that of patients (pts) with cancer with known primary tumor. Here we report and summarize the clinical features of patients with CUP treated at Mayo Clinic. Methods: Retrospective study of patients treated at Mayo Clinic Rochester MN from 2010 to 2021. Patient demographics, tumor-related variables, treatment-related variables, and clinical data were extracted. Descriptive statistics were used, and all data were analyzed by the SPSS version 22.0 software (SPSS, Chicago, IL, United States). Results: From a total of 214 pts, 207 pts were included, as primary tumor site was identified in 7 patients after initial evaluation. The pts in this study were predominantly white (87%) of female (50.2%) gender with a mean age of 63 (SD: 13) without history of smoking (51%) and either private or public insurance (82.6%). The predominant histology was adenocarcinoma (30%), followed by neuroendocrine neoplasms (27%), and carcinoma NOS (not otherwise specified) (25%). The most prevalent grade in this cohort was grade III with poorly differentiated tumor cells. All pts had diagnostic imaging and the most used imaging modalities included CT (81.2%), and PET-CT (43.5%). In our cohort, the 3 most common sites of metastases included lymph nodes (57.5%), liver (37.8%), lung (34.3%), and bone (23.7%); and in 64% of pts, there was a specific presentation pattern including liver-predominant (24.6%), lymph node-predominant (24.6%), bone-predominant (7.7%), and peritoneal carcinomatosis (7.7%). The majority of pts received systemic therapy (69%) as first line of therapy and the most frequent first line regimens included platinum-doublet (26.5%), gemcitabine-based regimen (20.7%), 5FU-based regimens (18%) and somatostatin analogs (16.7%); whereas salvage radiation and ablation were offered to 11% of pts and surgery to 17%. The median follow-up time was 22 months (IQR: 45) with a median survival time of 23 months and the 3-year cumulative survival rate was 30%. Conclusions: The heterogenous nature of CUPs and lack of specific immunohistochemical signature prevents primary tissue of origin diagnoses in CUP pts. Without the identification of a primary origin site, treatment is restricted to generic chemotherapy with limited benefit as demonstrated in this cohort.
Characteristics of SARSCOV2 infection in vaccinated patients with cancer in one Latin American country: Real world evidence from ACHOCC19-VAC study.
Authors: Ospina Serrano Aylen Vanessa , Bruges Maya Ricardo Elias , Munevar Isabel , Jimenez Paola , Mantilla William Armando , Ramos Pedro , Rivas Tafurt Giovanna Patricia , Caicedo Mirian , Aruachan Sandra , Avendaño Ana Cristina , Manneh Kopp Ray , Triana Ivan , Barrero Angela
Published: June 2023

e18806

Background: According to results of previous ACHOC-C19 study, mortality in patients with cancer and COVID 19 infection in Colombia is 26%. The impact of vaccination was not evaluated prior to the implementation of this strategy worldwide in patients with cancer. We aimed to characterize SARSCOV 2 infection in a local cohort of vaccinated oncologic patients. Methods: The ACHOCC-19 VAC registry is a national multi-center observational cohort study. Data were collected between April 2021 and March 2022. Inclusion criteria were: age more than 18 years, confirmed diagnosis of cancer (solid tumors), be receiving treatment or being followed-up and have received at least one dose of COVID-19 vaccine. 11 oncologists from 10 health institutions participated. The primary outcome was 30 days mortality due to COVID 19 infection. Secondary outcome was to describe adverse effects related to vaccination. A descriptive univariate and inferential analysis were performed. Results: 720 patients were included, average age was 60 years, 91% lived in urban areas, 12% had low income. 73% (525) were women. The most frequent diagnosis were: breast cancer 47% (338), prostate cancer 7% (50) and lung cancer 4.6% (36). ECOG 0-1 and 2 in 91.7% and 6.1% of population respectively. 41.40% had no comorbidities and 59.4% had 1 or more comorbidity. 29.1% presented metastatic cancer, 59.3% were receiving oncological treatment of which, 32.7% were neoadjuvant or adjuvant and 28.6% palliative. 31.66% were being followed up without treatment. 32.6% had stable disease and 5.9% had cancer in progression. Administered vaccines were CoronaVac (40%), BNT162b2 (35%) others 25%, in accordance with initial availability of vaccines for oncologic population in Colombia. 93.9% of population received 2 doses. COVID19 infection was acquired by 35.9% of the population, 30 days mortality due to infection was 3%. Table 1. Frequency of adverse effects with first and second dose were 14.8% and 12.2%, mild intensity in 93% and 100% respectively, being myalgias (5%), arthralgias (2-3%) and fever (3.5%) the most frequent. Conclusions: In our population, the efficacy of the vaccine against COVID 19 is consistent with available reports in the scientific literature. The incidence of 30 days mortality due to SARCOV 2 infection is very low. Vaccine-related adverse effects had frequency of less than 15% and mild intensity. These findings reinforce the need to promote and intensify vaccination in the oncologic patients. [Table: see text] [Table: see text]
The incidence and risk factors predictive of bone metastases at initial diagnosis of malignancy.
Authors: Knapp Brendan , Flanagan Mary Ellen , Grandhi Nikhil , Ganesh Bharath , Cittolin Santos Giordano Fabricio , Gao Feng , Samson Pamela P. , Govindan Ramaswamy , Morgensztern Daniel
Published: June 2023

e18816

Background: Bone metastases are associated with increased morbidity and decreased quality of life in patients with solid tumors. We report here the incidence and predictive factors for bone metastases at initial diagnosis in a large population-based dataset. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients 18 years-old or older and with solid cancers of all stages diagnosed from 2010 to 2019. We calculated the incidence and predictive factors for bone metastases according to demographic and tumor characteristics. Results: Among the 1,132,154 patients identified, 1,075,069 (94.96%) had known bone metastasis status and were eligible for the study. Bone metastases were detected in 55,903 (4.9%) patients. Among patients with bone metastases, the most common primary tumors were lung (44.4%), prostate (19.3%), breast (12.4%), kidney (4.0%), colorectal (2.24%) and pancreas (2.23%). The percentage of bone metastases in patients with non-small cell lung cancer (NSCLC), prostate adenocarcinoma, infiltrating ductal carcinoma of the breast (IDC), and colorectal adenocarcinoma (CRC) was 18.04% (18,123 out of 100,447), 5.92% (9,071 out of 153,325), 2.9% (4,490 out of 154,626), and 1.17% (1,043 out of 89,510) respectively. In addition to T and N stage, independent risk factors by multivariable analysis for bone metastases included female sex and non-squamous histology in NSCLC, black race, hormonal and HER2 status in breast cancer, Gleason score and PSA in prostate cancer, male sex, black race, rectal location, liver metastases and lung metastases in CRC. In univariate analysis, the strongest predictors for bone metastases were N2/3 (28.3%) and T3/4 (24.9%) in NSCLC, T3/4 (15.8%), N2/3 (10.6%), N1 (5.9%) and HER2 positive (4.9%) in IDC, N1 (38.1%), Gleason score 9/10 (22.8%), PSA 98 or higher (19.5%) and PSA 20-97 (16.8%) in prostate cancer, and rectal or rectosigmoid location (1.43% vs 1.05% in colon cancer, p < 0.001) in CRC. Conclusions: Approximately 5% of patients with solid tumors have bone metastases at presentation. In addition to T and N stage, there are several risk factors for bone metastases according to the primary tumor site.
Outcomes of venous thromboembolism among cancer patients admitted with COVID-19: A nationwide inpatient sample analysis.
Authors: Ibrahim Muhammad Bilal , Litvin Rafaella , Noor Hiba , Khan Ali Husnain , Shah Mihir , Kanemo Philip Onyekaoso , Cuartas Mesa Maria Cristina , Turk Ekrem , Olafimihan Ayobami Gbenga , Vakil Jay , Deenadayalan Vaishali , Batra Kunnal
Published: June 2023

e18823

Background: Cancer patients are at a higher risk of venous thromboembolism and fatal pulmonary embolism due to inflammatory cytokines, reduced coagulation inhibitors, microparticles, and other molecular mechanisms. COVID-19 leads to endothelial inflammation and microthrombi formation, further aggravating the baseline profound risk among cancer patients, with subsequent worsened mortality and morbidity. We sought to explore the outcomes of COVID-19-associated VTE in cancer patients. Methods: National Inpatient Sample 2020 was used to identify hospitalizations of cancer patients with COVID-19 with a secondary diagnosis of venous thromboembolism. All cancer patients with COVID-19 were stratified into two cohorts based on the presence of venous thromboembolism. The primary outcomes examined were In-patient mortality, the average length of stay (LOS), and total hospital charge (THC). Multivariate analysis was performed to obtain the odds ratio. All weighted analysis was conducted through STATA 17. Results: Using NIS 2020, 36,285 hospitalizations were identified with cancer and a primary diagnosis of COVID-19. Among cancer patients with COVID-19, the presence of any type of venous thromboembolism was associated with increased mortality(aOR: 1.7 CI: 1.36- 2.11),length of stay(11.62 vs. 7.73 days p < 0.01) and total charges($141,049 vs. $79,238 p < 0.01). Pulmonary embolism was similarly associated with increased mortality (aOR: 1.42 CI: 1.08- 1.88), LOS(9.27 vs. 7.92 days p = 0.015), and total charges($107,111 vs. $82,180 p < 0.01). Venous thromboembolism other than PE was associated with increased mortality at a higher adjusted odds ratio (aOR: 2.12 CI: 1.52- 2.96), as well as longer LOS(15.71 vs. 7.79 days p < 0.01) and higher total charges($200,999 vs. $80,406 p < 0.01). Conclusions: This study shows that venous thromboembolism among cancer patients with COVID-19 leads is associated with increased mortality and economic costs. VTE other than PE appears to be associated with less favorable odds than PE. Physicians should maintain a higher degree of suspicion for venous thromboembolism when treating cancer patients with COVID-19. Optimum thrombotic prophylaxis, timely diagnosis, and treatment of venous thromboembolism are critical to reducing the deleterious outcomes. [Table: see text]
Real-world treatment patterns of triple-class refractory (TCR) multiple myeloma (MM) across the United States (US), Canada, and western Europe: A retrospective chart study.
Authors: Guillaume Xavier , Horchi Dahbia , Gomez Jorge , Hlavacek Patrick , Ren Jinma , Schepart Alex , Aydin Didem , DiBonaventura Marco
Published: June 2023

e18826

Background: Many patients with MM relapse or become refractory to various therapeutic approaches and typically cycle through many lines of treatment. The present study sought to understand how patients with TCR MM (ie, refractory to ≥1 PI, ≥1 IMiD, and ≥1 anti-CD38 therapy) are managed across various countries. Methods: A non-interventional, retrospective chart review study was conducted across the US, Canada (CA), the UK, France (FR), Germany (DE), Italy (IT), and Spain (ES). Oncologists/hematologists were recruited to abstract medical chart information into an electronic case report form from eligible MM patients (eg, refractory to ≥1 IMiD, ≥1 PI, and ≥1 anti-CD38 antibody treatment, ECOG≤2, and initiated their first therapy after their TCR status [ie, their index therapy] between 1/1/2018 and 12/31/2020 to ensure at least 1 year of follow-up). Abstractions were performed from January through April 2022. Demographics, clinical characteristics, and treatment patterns were descriptively analyzed and reported here. Results: N = 314 patients with TCR MM were included (56.7% male; median age = 70). Clinical characteristics were similar to other TCR MM studies (eg, 26.1% had an ECOG score of 2, 25.8% had high cytogenetic risk (ie, t(4:14), t(14:16), and/or del(17p), and 10.2% had extramedullary disease). Patients received a median of 3 treatment lines prior to their index therapy, with 70 unique treatment regimens reported as part of their index therapy line (Table 1). The most common regimens (> 10%) were Pd and Kd. Conclusions: This global chart review across the US, Canada, and Western Europe highlights the consistent lack of a standard of care for the management of MM among patients who are refractory to the three main classes of therapies. [Table: see text]
Real-world data of early-onset colorectal cancer (EOCRC) in private health system in Brazil.
Authors: Mathias Maria Cecilia , Gil Mariana , Passarini Thais , Canedo Jorge Alexandre , Moraes Eduardo Dias de , Pereira Sabrina , Amorim Larissa Costa , Prolla Gabriel , Freitas Laura , Costa e Silva Matheus , Ferreira Carlos Gil , Ferrari Bruno Lemos , Garicochea Bernardo , Dienstmann Rodrigo , Gil Roberto Almeida , Peixoto Renata D'Alpino , Jácome Alexandre A.
Published: June 2023

e18830

Background: Incidence of EOCRC has been sharply rising in the past decades in the US and present distinct clinical features when compared to late-onset CRC (LOCRC). Data from other countries are scarce. We compared clinical characteristics and treatment outcomes between patients ≤45y (EOCRC) and ≥60y (LOCRC). Methods: Retrospective study evaluating 510 patients with metastatic CRC treated at 5 Oncoclinicas centers in Brazil from January 2011 to December 2019. Demographic and clinical data were retrieved from electronic medical records. The median OS was calculated by Kaplan-Meier method and prognostic factors were evaluated via multivariate Cox Regression. Results: After excluding patients with ages between 46 and 59, 326 patients were identified. EOCRC was represented by 72 (22%) patients (median age 39) and LOCRC by 254 patients (median age 69). Median follow-up was 39.5m, with 231 deaths (71%). Median OS was 33.2m and 40.9m (p = 0.971), respectively. Likewise, stage IV at presentation was similar between the groups (68% vs 58%, p = 0.215), as well as the rate of dMMR status (4% vs 6%, p = 0.655). Clinical and treatment characteristics that were statistically different between the groups are described in Table 1. In multivariate analysis, presence of RAS mutations (HR:1.83), and undergoing triplet chemotherapy (HR:3.24), primary tumor resection (HR:0.40), and metastasectomy (HR:0.45) were the variables with prognostic effect on OS. Conclusions: In this real-world analysis of mCRC, EOCRC patients presented similar clinical presentation and OS, but they were more aggressively treated compared to the older patients. There is no evidence that more intensive treatments translate into superior clinical outcomes in young patients. Real-world data have been progressively adopted in clinical practice and should be considered before clinical decision making in order to offer treatments with minimal toxicity burden to the patients. Future studies with larger population are needed and may bring additional data. [Table: see text]