bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review of practice patterns of primary granulocyte-colony stimulating factor prophylaxis and impact on febrile neutropenia rate and chemotherapy delivery in patients with early breast cancer treated with modern adjuvant chemotherapy.
Authors: Mates Mihaela , Hopman Wilma , Altwairgi Abdullah Khalaf 
Published: March 2020

e19541 Background: Febrile neutropenia (FN) is a major complication of chemotherapy and is associated with substantial morbidity and mortality. Primary prophylaxis with granulocyte colony-stimulating factors (PP-G-CSF) is recommended for regimens with FN risk above 20%. We undertook a review of practice patterns of PP-G-CSF and impact on febrile neutropenia rate and chemotherapy delivery in patients with early breast cancer (EBC) treated with modern adjuvant chemotherapy (ACT) at the Cancer Centre of Southeastern Ontario. Methods: Women with EBC receiving at least one cycle of modern ACT (taxane containing regimens with or without anthracyclines) between January 2009 and December 2011 were included in our review. We collected demographic, disease-related, treatment-related, and outcome variables for each patient. Results: 239 women were treated with modern ACT during the specified period and were included in our analysis. Median age was 55 (32-80); 197 (82%) were <65 years and 148 (62%) were postmenopausal. 212 (89%) patients were treated with an anthracycline-taxane (A-T) regimen and 27 (11%) with a taxane (T) regimen. 145 patients (61%) received PP-G-CSF: 47 (32%) with filgrastim (F) and 98 (68%) with pegfilgrastim (PF). Of all patients 50 (21%) developed at least one FN episode. PP-G-CSF led to lower FN rate (15% vs 31%; p=0.002), reduced dose delay (17% vs 27%; p=0.060) and dose reduction (19% vs 25%; p=0.28) of planned ACT. In women receiving PP-G-CSF higher rate of FN was associated with age ≥ 65 years (27% vs 12% if < 65 years; OR 2.8, p=0.053); T regimen (30% vs 12% for A-T; OR 3.1, p=0.041) and F use (28% [n=13] vs 8% [n=8] with PF; OR 4.3, p=0.003). Conclusions: In this single-centre retrospective cohort study patients with EBC treated with modern ACT had a high rate of FN (31%) without PP-G-CSF. More than half (61%) of the patients received PP-G-CSF which led to fewer FN episodes and increased delivery of planned ACT; however, the risk of FN remained high at 15%. Factors linked to higher rate of FN despite PP-G-CSF were older age, taxane-based chemotherapy and use of filgrastim.
Treatment patterns and outcomes of acneiform skin eruptions from anti-epidermal growth factor receptor (EGFR) therapies for metastatic colorectal cancer (mCRC).
Authors: Dascalu Bogdan , Kennecke Hagen F. , Lim Howard John , Cheung Winson Y. 
Published: March 2020

e19547 Background: Use of anti-EGFR therapies, such as cetuximab (Cmab) and panitumumab (Pmab), is associated with acneiform eruptions. Because research suggests a correlation between rash severity and outcomes in unselected patients, concerns remain that prophylactic treatment of rash may interfere with anti-tumor activities of these drugs. Our aims were to 1) characterize the treatment patterns for rash due to Cmab and Pmab and 2) evaluate if a prophylactic vs reactive approach to rash management modifies outcomes. Methods: All patients diagnosed with wild-type K-ras mCRC from July 2009 to June 2011 in British Columbia, Canada and prescribed either Cmab or Pmab were reviewed to describe patterns of prophylactic (before rash) and reactive (after rash) use of antibiotics and steroid creams. Using Cox regression, the relationship between rash management and overall survival was characterized. Results: In total, 119 patients were analyzed: median age at diagnosis was 63 years, 61% were men, 34% received Cmab and 66% Pmab, and median number of anti-EGFR treatment was 9 cycles. Rash occurred in over 90% of patients. Among them, reactive was favored over prophylactic treatment (66 vs 34%). Older patients (60+ years) and those with ECOG 0/1 were more likely to receive prophylactic creams (44 vs 20%, p=0.01) and antibiotics (62 vs 12%, p=0.01), respectively. There were no further differences in rash management based on other patient or tumor characteristics (all p>0.05). Median OS was 7.0 months. The number of treatment cycles and overall survival were similar in both prophylactic and reactive groups (both p>0.05). In Cox regression, ECOG 2+ correlated with worse survival than ECOG 0/1 (HR for death 5.25 95% CI 2.01- 9.23, p<0.01). However, survival outcomes were statistically similar between patients prescribed antibiotics prophylactically vs. reactively (HR=1.10, 95% CI 0.43-2.80, p=0.85) and between patients given steroid creams prophylactically vs. reactively (HR=2.00, 95% CI 0.58-6.92, p=0.27). Conclusions: Prophylactic treatment of anti-EGFR related rash is associated with similar outcomes as compared to reactive rash treatment in mCRC patients.
Variations in serum vitamin D status during cancer chemotherapy.
Authors: Koczwara Bogda , Woodman Richard John , Teleni Laisa Vicki , Kimlin Michael , Walpole Euan Thomas , Jain Kunal , Karapetis Christos Stelios , Smith Emma-Louise , Davidson Wendy Louise , Ferguson Maree , Sukumaran Shawgi , Kichenadasse Ganessan , Isenring Elizabeth 
Published: March 2020

e19550 Background: Low serum vitamin D in cancer patients has been associated with inferior cancer outcomes and bone loss. The impact of chemotherapy on vitamin D levels is not known. We examined serum vitamin D levels during chemotherapy to identify magnitude and predictors of change. Methods: A prospective study of chemotherapy naïve patients commencing chemotherapy in two different sun exposure areas. Vitamin D (25(OH)D) deficiency was defined as ≤25 nmol/L and insufficiency 26-50 nmol/L. Demographic data, nutrition, sun exposure, season and biochemical parameters were collected at baseline 6 weeks (6W) and 12 weeks (12W) since commencement of treatment. The effects were assessed using a multivariate multilevel linear regression model that also included age, gender and BMI. Results: 82 Caucasian and 3 indigenous patients were enrolled. Median age was 57 (21-85) years. Forty-nine (58%) were female; 54 (65%) were treated with curative intent. Tumours included 29 (34%) breast,12 (14%) colorectal, 9 (11%) lymphomas, 7 (8%) leukemias, 7 (8%) lung, 5 (6%) ovarian, 3 (4%) testis, 3 (4%) unknown primary and 10 (11%) others. Median weight was 75 kg (50-151) and median BMI was 26.9 kg/m2 (17.7- 44.5). Seventy-six (89%) and 55 (65%) patients were receiving chemotherapy treatment at 6W and 12W respectively. Mean (±SD) serum 25(OH)D at baseline was 49.2±22.3 nmol/L. Ten (12%) patients were vitamin D deficient at baseline and a further 33 (41%) had insufficient levels. Mean serum 25(OH)D status was higher in higher sun exposure locations (61.9±22.1 nmol/L vs 42.2±19.2 nmol/L, p<0.001), varied according to season (spring=46.9±20.3 nmol/L, summer=50.8±18.2 nmol/L, fall=76.4±25.2 nmol/L, winter=36.5±15.7 nmol/L, p<0.001) and changed with treatment period (baseline=49.2±22.3 nmol/L, 6W=40.9±19.0 nmol/L, 12W=45.9±19.7 nmol/L, p=0.002). There was no association between 25(OH)D status and age, gender, BMI or nutritional status. Conclusions: Chemotherapy is associated with a fall in serum 25(OH)D. Further research is needed to determine the underlying mechanism, the impact of low serum 25(OH)D on patient outcomes and the potential role for screening and vitamin D supplementation in this group.
Thromboembolic events and bleeding in patients with metastatic carcinoma treated with chemotherapy and bevacizumab.
Authors: Ferrer Ana Isabel , Sanchez Jose Luis , Rodriguez Maria Carmen , Soriano Carmen , Aliaga Luis Alberto , Garcia Nieto Sandra , Alonso Maria Carmen , Fernandez Antonio 
Published: March 2020

e19576 Background: An increased risk of thromboembolic events (TE) and bleeding (Bl) has been observed in some trials among cancer patients (CP) treated with bevacizumab (B) and chemotherapy (QT). Our aim is to assess specific risk of TE and Bl in unselected CP treated with QT and B in general clinical practice. Methods: Retrospectively, we collected data of all metastatic CP treated with QT and B in our 3rd level hospital, since April 2007 to December 2011. Clinical histories were review to collect any TE or bleeding occurred during or immediately after the treatment. We compare risk of TE/bleeding with 94 control CP treated with QT during the same period. Results: A total of 143 CP were treated with B and QT. Of them, 105 patients (73,4%) due to metastatic colorectal cancer, 19 patients (13,3%) due to metastatic breast cancer and 12 patients (8,4%) due to metastatic non-small cell lung cancer. Median duration of B treatment was 175 days (range 18-1079). During the treatment, 9 patients (6,3%)had a venous TE, 1 patient (0,7%) had and artherial TE, and 5 patients (3,5%) had severe bleeding. Among the 94 control patients, 8 had a venous TE (8,5%), 2 had an artherial TE (2,1%) and 1 had a severe bleeding (1,1%) Risk of TE was not statistically different between groups, (OR 1.58, IC 95% 0.63-3.96) Neither for venous TE (OR 1.38, IC95% 0.51-3.72) nor for artherial events (OR 3.08, IC95% 0.27-34.5) No differences in bleeding risk was found (OR 0,29, IC 95% 0.03-2.58). Conclusions: B added to QT treatment does not appear to increase risk of TE or bleeding in general metastasic population. Although a larger number of patients would evaluate better this risk, we could assess that if patients are selected by other clinical risk factors, bevacizumab does not confer an increased risk of TE or haemorrhage.
Effect of anamorelin/ONO-7643, a selective ghrelin receptor agonist, on tumor growth in a lung cancer mouse xenograft model.
Authors: Northrup Robert , Kuroda Ken , Manning Duus Elizabeth , Routt Barnes Sheri , Wiley Tim , Pietra Claudio 
Published: March 2020

e19577 Background: Anamorelin/ONO-7643 is an orally-active ghrelin receptor agonist in development for non-small cell lung cancer (NSCLC)-related cachexia/anorexia. It displays both anabolic and orexigenic properties via its ghrelin and growth hormone (GH) secretagogue activity. However, increasing GH and insulin-like growth factor-1 (IGF-1) in cancer patients raises potential concerns of stimulating tumor growth. In this study, we investigated the effect of ghrelin and Anamorelin/ONO-7643 on tumor growth in a NSCLC xenograft model. Methods: On Day 1 (D1), 21 days after implanting A549 tumors, female nude mice were sorted into six groups (n=15/group) and administered ghrelin (2 mg/kg i.p.), Anamorelin/ONO-7643 (3, 10, or 30 mg/kg p.o.) or vehicles (saline i.p. or de-ionized water p.o.) for 28 days, starting on D3. Tumor growth, body weight, and food consumption were monitored. Mice used to assess plasma levels of murine GH (mGH) and IGF-1 (mIGF-1) were sorted into three groups (n=21/group) and treated for 28 days with ghrelin, the high dose of Anamorelin/ONO-7643 or vehicle (de-ionized water p.o.). Results: After 28 days of treatment, there was no difference in median tumor volumes (D30 values: 1008, 936, 1080, 666 and 847 mm3 for vehicle, ghrelin and Anamorelin/ONO-7643 at 3, 10 and 30 mg/kg, respectively). Ghrelin significantly increased mGH compared to controls, while Anamorelin/ONO-7643 modestly increased mGH. Peak mIGF-1 levels were slightly higher in animals given ghrelin or Anamorelin/ONO-7643 compared to vehicle, although not significantly. Anamorelin/ONO-7643 at 10 and 30 mg/kg/day showed a statistically significant (p<0.01) increase in body weight from D1 to D30 compared to control animals, with no change in food consumption. Ghrelin treatment had no effect on body weight or food consumption. Conclusions: Anamorelin/ONO-7643 or ghrelin treatment for 28 days had no effect on tumor growth in A549 tumor-bearing nude mice, despite increased mGH and a trend of increased mIGF-1. Anamorelin/ONO-7643 also significantly increased body weight at 10 and 30 mg/kg/day. These results support using ghrelin receptor agonist-based treatments in managing NSCLC-related cachexia/anorexia.
Long-term use of sustained-release cytarabine for symptomatic management and treatment of meningeosis neoplastica.
Authors: Jahn Franziska , Behlendorf Timo , Globig Cordula , Jordan Berit , Wolf Hans-Heinrich , Jordan Karin , Schmoll Hans-Joachim 
Published: March 2020

e19579 Background: Treatment of meningeosis neoplastica remains challenging due to advanced systematic disease and limited treatment options including a high treatment burden. Liposomal Cytarabine (DepoCyte) is a slow-release formulation of cytarabine that maintains cytotoxic concentrations in the Cerebrospinal fluid (CSF) for >14 days following a single injection. This two week interval has potential benefit due to reduced interventions especially in palliative settings. Methods: We reviewed all patients at our institution treated with liposomal cytarabine (LC) between 3/2004 and 9/2011.The data included tumor type, ICF-cell-count, neurologic disorders due to meningeal affection and time interval from intrathecal therapy to progression and to death of the patient.Assessment for meningeosis neoplastica included neurological examination, CSF assessment and brain MR imaging. LC was administered intralumbar at 50 mg every 2-weeks until progression or appearance of severe side effects. Results: To date 51 adult patients eligible for safety evaluation (48 pts. for efficacy evaluation) (median age 61 y [range 23 - 81 y]) were treated with LC. 72.5% of the included patients had lymphoma, 5.9% breast cancer and 21.6% other solid malignancies. Concurrent systemic chemotherapy was given in 82% of the patients. A total of 160 doses were administered (mean 2.9, range 1- 13). The most frequent side effects were mucositis (21.6%), elevated body temperature (15.7%), backpain (9.8%) and nausea/vomiting (7.8/5.9%). In two lymphoma patients with long term use of LC (13/ 4 applications) cauda equina syndroms appeared. In 61.9% of patients a reduction of neurological symptoms could be achieved; 53% of the patients attained a cytological response in CSF. Median overall survival was 20 months. Conclusions: The obtained results are comparable to those previously reported for methotrexate given 3 times a week. Thus our trial indicates that the 14-day dosing interval is on one hand effective to decrease neurological symptoms caused by meningeosis neoplastica with a favourable safety profile and on the other hand is less burdensome for the patients due to reduced manipulation and treatment burden respectively.
Observational study of ifosfamide (Ifos) neurotoxicity (N): The prospective use of a nursing assessment tool.
Authors: Held-Warmkessel Jeanne , Davey Monica , Litwin Samuel , Lee John , Smith Mitchell Reed , Millenson Michael M , Cohen Adam D. , Somaiah Neeta , Hudes Gary R. , Plimack Elizabeth R. , Wong Yu-Ning , Kim Sharon , vonMehren Margaret 
Published: March 2020

e19580 Background: Ifos chemotherapy is known to cause central nervous system toxicity. Risk factors have not been well identified in the literature, with limited information on the onset, duration, and severity of this toxicity. No clinical tools are available to assess and document N. Methods: We developed a clinical nursing assessment tool based upon review of the literature. Patients initiating inpatient Ifos chemotherapy, after informed consent was obtained under an IRB approved protocol, were prospectively monitored for signs and symptoms of N during 1 cycle of therapy. A full neurologic nursing assessment of 24 signs and symptoms including a hand writing sample was done at baseline and a basic assessment evaluating alertness, orientation, sense of well being and a hand writing sample was repeated every 12 hours. In the event N was identified, a full assessment was repeated; observed N was graded using the NCI CTC, version 3. Other variables collected were demographic traits, dose per day, hydration, and potential risk factors for N: renal function, albumin, largest pelvic tumor dimension, prior Ifos or cisplatin, use of other medications with potential for N, and alcohol use history. Individual factors were analyzed using Fisher’s exact test or the Wilcoxon two-sample test. Results: Eighty patients were accrued from 5/09-1/12. Median age was 54.5 (range: 21-85), 51% were males, PS 0 in 26.3%, 1 in 65%, 2 in 6.3% and 3 or 4 in 1.3% each. Diagnosis was sarcoma in 73.75%, lymphoma 22.5%, or germ cell tumor 3.75%. N was observed in 47.5% of patients. Toxicities in >15% of patients were sleepiness (25%), lethargy and restlessness (16.25% for each), and dizziness (15%). The majority were grade 1-2 (89.6%). Factors associated with N included generic versus brand formulation of Ifos (p=0.041) and prior history of a drug related neurotoxicity (p=0.047). BSA, performance status, gender, age, dose per m2, total planned dose, pretreatment Cr, and pretreatment albumin were not associated. Conclusions: The incidence of Ifos N is common using this nursing assessment tool, although usually low grade. We identified the formulation of Ifos and a prior history of drug related N as statistically correlated with developing N.
Surveillance after primary breast cancer treatment: What motivates ASCO experts?
Authors: Mogal Harveshp D. , Allam Emad S. , Margenthaler Julie A. , Chen Ling , Virgo Katherine S. , Johnson Frank E. 
Published: March 2020

e19593 Background: Breast carcinoma is the most common cancer among American women except for skin cancer. Over 200,000 patients are diagnosed with breast cancer annually in the U.S. Most receive curative-intent treatment. About 2.5 million women with a history of breast cancer are now alive and eligible for surveillance. ASCO has published evidence-based guidelines for surveillance after primary breast cancer treatment but dramatic variation in the actual practice patterns of ASCO clinicians has been shown. We sought to evaluate potential factors that motivate expert clinicians as they design their own surveillance strategies. Methods: A custom-designed survey instrument with 11 questions about putative motivating factors was e-mailed to the 3,245 ASCO members who had indicated that breast cancer was a major focus of their clinical practice. Responses were submitted on a 10-level Likert-type scale. The percentage of responses for each point on the scale for each of the potential motivating factors was tabulated. We ranked the factors in accordance with the percentage responses on the scale. Results: 1,013 responses (31%) were submitted; 734 (73%) were evaluable. “Potential detection of a second primary breast cancer” was the strongest motivating factor (53% with a score of "strongly agree"). Conclusions: We believe this is the first empirical evidence about factors that may motivate expert clinicians in selecting surveillance strategies. Understanding these factors may be useful in devising methods to decrease the present variation in these strategies. [Table: see text]
Frequency, indications, outcomes, and factors associated with successful opioid rotation in cancer patients presenting to an outpatient supportive care center.
Authors: Reddy Akhila Sunkepally , Yennurajalingam Sriram , Pulivarthi Kalyan , Kwon Jung Hye , Frisbee-Hume Susan , Bruera Eduardo 
Published: March 2020

e19599 Background: Opioids are first line medications for cancer pain. Opioid rotation (OR) is recommended for uncontrolled cancer pain (UCP) and opioid induced neurotoxicity (OIN). Limited data exist on frequency, indications and outcomes of OR in ambulatory cancer patients in outpatient setting. Methods: We reviewed consecutive outpatient visits to the Supportive Care Center in 2008 for OR. Data regarding demographics, Edmonton Symptom Assessment Scale (ESAS), Memorial Delirium Assessment Scale, pain characteristics, opioid use, indication for OR, outcomes, morphine equivalent daily dose (MEDD) and supportive counseling was collected in all patient visits who followed up within 5 weeks of OR. Successful OR was defined as a 2 point or 30% reduction in ESAS symptom score, resolved symptoms of OIN and continuation of new opioid at follow up. Stepwise logistic regression analysis was performed to determine factors associated with successful OR. Results: 244/2471(10%) patient visits had OR and 142 (58%) were followed up within 5 weeks. 40% (57/142) were consult visits. 74% (105/142) were white, 60% (85/142) male. Median age and performance status were 55 and 1. GI (24%) and lung (22%) were the most common cancer types with 77% (110/142) advanced cancer. Median time (Q1-Q3) between OR and follow up was 14 (7-21) days. Most common indications for OR were UCP 82% and OIN 13%. 34% had partial OR and 16% had more than one reason for OR. Pain characteristics were 49% nociceptive, 21% mixed and 11% neuropathic. Median (Q1-Q3) pain and symptom distress score improved: -2 (-4-0, P=.003) and -5 (-14-7, P=.004). Median MEDD (Q1-Q3) decreased from 162 (90-287) to 156 (90-280, P=.82). 66% (94/142) had successful OR. Fentanyl (34%) before and Methadone (55%) after OR were most common opioids. 17% (24/142) had another OR at follow up visit. High MEDD (P=.05) prior to OR was associated with successful OR. Conclusions: 10% of outpatient visits had OR with a 66% success rate in treating UCP and OIN. Further research is needed to determine predictors of successful OR.
Patient-reported KPS and other measures as predictors of survival in patients with advanced cancer.
Authors: Chang Victor T , Scott Charles B. , Gonzalez Melanie L. , Yan Houling , Einhorn Jan , Crump Barbara , Kasimis Basil 
Published: March 2020

e19606 Background: Understanding determinants of survival remains a challenge in patients(pts) with advanced cancer. Prognostic factors of interest include pts rating of their own performance status, and patient responses from the EQ-5D. Methods: This prospective study was approved by the VA New Jersey HCS IRB. Pts with metastatic cancer whose cancer had already been treated with standard or experimental chemotherapy with KPS < 80%, or who did not wish to receive systemic chemotherapy, were recruited in a specified manner. At entry, Karnofsky performance status (KPS) was estimated, pts rated their own KPS, and answered a modified version of the EQ-5D. Cox regression survival analyses were performed. Results: Of 242 pts enrolled, 237 pts were analyzable. Median (M) age was 67 years (range 44-88), with 56% white, 41% black and 3% other; lung (26%) and prostate (18%) were the 2 most common primary sites and M KPS was 60% (range 30-100%). The majority (97%) of pts have died, with M survival of 95 days, range 4-2032 days. Higher KPS is associated with decreased risk of death (p<.0001). Both patient KPS (p<0.0319) and physician rated KPS were predictive of survival (p<0.004). Discrepancy between physician and pt KPS was noted, with upstaging by pts 48%, same for 27%, and downstaging in 25%, with no effect on survival. Physician KPS was a better predictor than pt KPS at each level. The EQ-5D pain item showed an increased risk of death with increasing pain (p<0.0001). The pain item was associated with KPS: pts with no pain had average KPS 75; moderate pain average KPS 63; extreme pain average KPS 48. The patient’s EQ-5D health rating was positively correlated with survival (p=0.0054), and with KPS (r=0.36). The other items in the EQ-5D did not predict survival. When all the factors (physician KPS, pt KPS, pain, health) were incorporated into a Cox model, only physician KPS was statistically significant (p=0.0033). Conclusions: Pts ratings of health and pain are significantly associated with KPS. Pts have a more positive outlook on their performance status. Physician KPS may be a better predictor because physicians have a wider frame of reference. Physician KPS can contribute to determination of hospice eligibility. Supported by VA HSRD IIR 2-103