bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in primary care clinicians’ approach to non-small cell lung cancer (NSCLC) patients compared to breast cancer (BrCa)
Authors: Wassenaar T. R. , Eickhoff J. C. , Jarzemsky D. R. , Smith S. S. , Larson M. L. , Schiller J. H. 
Published: March 2020

7041 Background: Lung cancer is a disease associated with a stigma of being primarily self-induced via smoking and therefore avoidable. It is unclear if this stigma results in feelings of guilt and shame on the part of the patient, and a difference in care on the part of primary care physicians (MDs), both of which could lead to differences in treatment and patient self-advocacy, and ultimately poorer outcomes. Methods: We conducted a prospective survey study of 1,132 MDs who were randomized into 4 groups. Each group received a questionnaire representing a clinical scenario (smoker/NSCLC; nonsmoker/NSCLC; smoker/BrCa; nonsmoker/BrCa). The scenarios were identical in terms of stage, gender and outcome; but varied in the disease and smoking history (smoker (S) vs. nonsmoker (NS)). The primary objective was to collect preliminary data to determine if these MDs approached the care and referral of patients (pts) with NSCLC or BrCa differently. A secondary objective was to determine whether or not tobacco use influenced the MD’s approach to the cancer pts. Comparisons of response patterns between the groups were evaluated by Chi-square analysis. Results: 672 questionnaires were completed: 175 in the NS/BrCa, 177 in the S/BrCa, 166 in the NS/NSCLC and 154 in the S/NSCLC scenarios. We observed that MDs were less likely to refer pts with advanced NSCLC to an oncologist than BrCa pts (p=<0.001). More MDs knew that chemotherapy improved survival in pts with advanced BrCa than did MDs regarding chemotherapy use in advanced NSCLC (p=0.0145). In addition, more MDs stated they did not know the benefit of adjuvant therapy for NSCLC than for BrCa (p= <0.001). As a result, more pts with advanced BrCa were referred for further therapy vs. NSCLC pts, who were more likely to be referred only for symptom control (p=0.0092). BrCa pts also had more aggressive follow up than did pts with NSCLC (p=0.0256). There was no statistical significant difference when comparing smoking vs. non-smoking pts. Conclusions: We conclude that there is a significant lack of knowledge in the primary care physician regarding the treatment of pts with advanced stage NSCLC, and the role and benefit of adjuvant therapy. This might lead to a less aggressive referral pattern in these pts to clinical oncologists. [Table: see text]
Induction (Ind) plus concurrent (Con) chemotherapy with high-dose (74 Gy) 3-dimensional (3-D) thoracic radiotherapy (TRT) in stage III non-small cell lung cancer (NSCLC): Preliminary report of Cancer and Leukemia Group B (CALGB) 30105
Authors: Blackstock A. W. , Socinski M. A. , Bogart J. , Gu L. , Wang X. , Green M. , Vokes E. E. 
Published: March 2020

7042 Background: Combined chemoradiotherapy is the standard of care in stage III NSCLC. At standard TRT doses, local failures remain problematic and strategies exploiting the dose-response aspect of TRT are warranted. 3-D TRT allows escalation of TRT dose with acceptable toxicity (Socinski et al, J Clin Oncol 22:4341, 2004) and may enhance survival by improving loco-regional control. Methods: This is a two-arm randomized phase II trial evaluating 74 Gy with Con chemotherapy: Arm A- 2 cycles of Ind carboplatin (C) (AUC 6) and paclitaxel (P) (225 mg/m2) followed by weekly Con C (AUC 2/wk) and P (45 mg/m2) and 74 Gy; Arm B- 2 cycles of Ind C (AUC 5) and gemcitabine (G) (1000 mg/m2 d1,8) followed by Con G (35 mg/m2 twice weekly) and 74 Gy. The primary endpoint was a survival rate of ≥50% at 18 months after treatment initiation or med survival time (MST) of ≥18 mos. Results: 69 pts were entered (43 Arm A, 26 Arm B)- med age 61 yrs (39–77), 77% male, PS 0:1 42%:58%, stage IIIA:B 52%:48%. Ind therapy on both arms was well tolerated with no pts experiencing disease progression. ARM A- Overall response rate (RR) to all therapy was 61.9%. Gr 3–4 toxicities during Con therapy were anemia (15%), neutropenia (26%), esophagitis (9%), fatigue (9%), neuropathy (3%) and pulmonary (12%). There was 1 (3%) Gr 5 cardiac event. With med follow-up of 16.4 mos, the med progression-free survival (PFS) is 15.2 mos. The MST is not mature enough to estimate as only 15 deaths have occurred. ARM B- Closed early due to 3 (13%) Gr 5 pulmonary events. Overall RR to all therapy was 66.6%. Gr 3–4 toxicities during Con therapy were anemia (13%), fatigue (35%), esophagitis (35%), hemoptysis (4%), pulmonary (26% plus the 3 Gr 5 events). With med follow-up of 22 mos, the med PFS is 7.7 mos and the MST is 13.9 mos. There was a correlation between Gr 3–5 pulmonary toxicity and V20 ≥ 38% (p<0.05). Conclusions: 1) High dose 3-D TRT is feasible within CALGB, 2) the details of TRT (V20) are important with regard to toxicity, 3) the survival of pts on Arm A appears promising. [Table: see text]
Does downstaging in patients (pts) with IIIA-N2 non-small cell lung cancer (NSCLC) and a response to induction chemotherapy (ICT) influence outcome with surgery (S) or radiotherapy (RT)? An exploratory analysis of EORTC 08941
Authors: Van Meerbeeck J. P. , Kramer G. W. , Legrand C. , Smit E. F. , Passioukov A. , Giaccone G. , Van Zandwijk N. , Van Schil P. E. 
Published: March 2020

7047 Background: In EORTC 08941, no difference in overall and progression free survival was observed in 332 pts with irresectable stage IIIA-N2 NSCLC, treated with either S or RT after a response to platinum-based ICT (van Meerbeeck, JCO 2005; 23, 1095s). Postoperative radiotherapy (PORT) was given to 40% of pts. In the S-pts, non-randomized exploratory comparisons showed a statistically significant benefit in outcome for (bi-)lobectomy vs. pneumonectomy (p = 0.0088) and for mediastinal lymphnodes (MLN) downstaged vs.non-downstaged pts (p = 0.0009). No difference was observed between S-pts treated with/without PORT. By randomizing after response to ICT, MLN-downstaging is assumed to be equally distributed among both treatment groups but cannot be formally retrieved in RT-pts. In order to compare the influence of MLN-downstaging in each treatment arm, we estimated in an exploratory analysis the outcome in subsets of S-pts and matched paired subsets of RT-pts. Methods: The subsets of 129 actually resected S-pts are defined as follows: (i) pts with MLN-downstaging at resection, (ii) pts without MLN-downstaging. Each subset was compared to a randomly selected subset of 154 actually irradiated RT-pts, matched on 4 baseline factors: histological subtype, gender, T stage, response to ICT. Kaplan-Meier estimates for overall survival (OS) and logrank p-values were then computed. Results: A match was feasible for 54/61 downstaged, 59/68 non-downstaged pts. Estimated OS (with 95% CI) for each S-subset and RT-matched pair subset is in the table . Conclusions: From these exploratory analyses, it appears that: 1. RT improves OS in MLN-non-downstaged pts; 2. S does not improve OS in MLN-downstaged patients. This should however be prospectively assessed. [Table: see text] No significant financial relationships to disclose.
Pemetrexed in patients (pts) with relapsed small cell lung cancer (SCLC): A phase II study from the Hoosier Oncology Group
Authors: Hanna N. H. , Ansari R. , Bhatia S. , Govindan R. , Bruetman D. , Hosford M. , Fisher W. , White A. , Breen T. , Juliar B. 
Published: March 2020

7063 Background: Patients with relapsed SCLC have a dismal prognosis. Pemetrexed is a well tolerated agent, which is active against non-small cell lung cancer. We postulated that Pemetrexed may also be active and well tolerated in pts with relapsed SCLC, for whom few effective options exist. Methods: Eligible pts had small cell or a poorly differentiated neuroendocrine cancer, received 1 or 2 prior chemotherapy regimens and had an ECOG PS 0–2. Pts received Pemetrexed 500 mg/m2 iv once every 3 weeks along with vitamin B12, folic acid, and dexamethasone for up to 6 cycles or progressive disease or intolerable side effects. Chemosensitive (S) pts (relapse > 90 days following 1st line chemo) and chemoresistant (R) pts (PD ≤ 90 days following 1st line chemo) were analyzed separately. The primary objective of this phase II study was to estimate the clinical benefit rate [partial response (PR) or stable disease (SD)] in the 2 populations. Pts were to be accrued in 2 stages. If 8 of 18 and 3 of 21 pts achieved a PR or SD in the S and R populations, respectively, accrual would have continued to a total of 46 (S arm) and 50 (R arm) pts in each arm. Results: From 1/05 to 9/05, 43 pts were enrolled. Criteria to proceed to stage II were not met for either arm. S arm (n = 20): M/F 12/8; median age 63 (range, 45–79), PS 0/1/2 7/8/5. R arm (n = 23): M/F 17/6; median age 65 (range, 42–79), PS 0/1/2 7/10/6. Select grade 3/4 toxicities (combined group): 4 pts with neutropenia; 2 pts each with anemia, AST/ALT, bilirubin elevation; 1 pt each with thrombocytopenia, febrile neutropenia, infection with neutropenia, and rash. S arm: 1 PR and 1 SD were confirmed. R arm: 1 PR and 1 SD were confirmed. Conclusions: Pemetrexed 500 mg/m2 has minimal single agent activity in pts with relapsed SCLC. [Table: see text]
A phase II trial of pemetrexed in patients with recurrent thymoma or thymic carcinoma
Authors: Loehrer P. J. , Yiannoutsos C. T. , Dropcho S. , Burns M. , Helft P. , Chiorean E. G. , Nelson R. P. 
Published: March 2020

7079 Background: Few prospective trials have been conducted in patients with advance thymic malignancies. Pemetrexed a multi-targeted antifolate with a broad range of clinical activity, but previously untested in thymic malignancies. As a result, a phase II trial was initiated to evaluate the clinical activity of pemetrexed in previously treated patients with thymoma (THY) and thymic carcinoma (TC). Methods: From February, 2005 to November, 2005, twenty-seven previously treated patients with unresectable stage IVA (n = 16) or stage IVB (n =11) disease were treated with pemetrexed at a dosage of 500 mg/m2 every three weeks for a maximum of 6 cycles or until undue toxicity or progressive disease. All patients received folic acid, vitamin B12 and steroid prophylaxis. Profile of patients include: median age = 52 years (range 26–84); M: F = 13:14; PS 0/1= 17/10; median number of prior therapies = 2 (range 1–6); 21 had prior radiation therapy; and histology (THY = 16, TC = 11). Results: The median number of cycles administered was 5 (range 1–6). Eleven patients had grade 3 toxicities including: dyspnea, infections, fatigue, abnormal chemistries and neutropenia. No Grade 4 toxicities were noted. Accrual was completed in November, 2005 with four patients still on therapy. In 23 fully evaluable patients, two complete and two partial responses (RECIST) were noted. All four responding patients had had stage IVA thymoma. Five patients progressed on therapy and two patients discontinued therapy for intolerance to chemotherapy (constipation, dyspnea) and 1 patient for progressive Morvan’s Syndrome. The median time to progression for all patients was 45 weeks (THY = 45.4 weeks vs. TC = 5.1 weeks). With three deaths thus far, the median overall survival has not been reached. Conclusions: Pemetrexed is an active agent in a heavily pretreated population of patients with recurrent thymoma. Patients with recurrent thymic carcinoma appear to have a much more aggressive clinical course than thymoma. [Table: see text]
Temporal trends in small cell lung cancer: Analysis of the national Surveillance, Epidemiology, and End-Results (SEER) database
Authors: Navada S. , Lai P. , Schwartz A. G. , Kalemkerian G. P. 
Published: March 2020

7082 Background: Research interest in small cell lung cancer (SCLC) has waned over the past 10 years due to the lack of significant therapeutic advances and a presumed decline in the incidence of SCLC. Methods: We analyzed data on all patients with primary bronchogenic carcinoma registered in the national SEER database from 1973–2002. To identify temporal trends, the study period was divided into three decades: 1973–1982 (D1), 1983–1992 (D2), and 1993–2002 (D3). Results: Of 318,584 eligible patients, 59,704 (18.7%) had SCLC. The proportional incidence of SCLC relative to non-SCLC was higher in Caucasians than African-Americans (19.6% vs 13.9%), women vs men (21% vs 17.4%), and patients ≥ 50 yrs old vs < 50 yrs old (18.9% vs 16%). By decade, the proportional incidence of SCLC was: D1, 18.4%; D2, 19.8%; D3, 17.9%. The overall incidence rates for both SCLC and non-SCLC initially rose and then declined during the study period. The incidence rates for SCLC were similar in both Caucasians and African-Americans throughout the study period, while those for non-SCLC were significantly higher in African-Americans. The gap between incidence rates in men and women has narrowed to a similar degree for both SCLC (M/F: D1, 2.6/1 to D3 1.4/1) and NSCLC (M/F: D1, 3.3/1 to D3, 1.7/1). Only 0.8% of SCLC patients underwent surgical resection from 1988–2002. The use of radiotherapy decreased during the study period (D1, 53% to D3, 43%) with greater use in younger patients and African-Americans. Stage-specific 2- and 5-year survival rates for SCLC improved over time (regional 2-yr/5-yr: D1, 15%/6.8% to D3, 22%/11%; distant 2-yr/5-yr: D1, 3.4%/1.3% to D3, 5.6%/1.9%). In multivariate analysis, significant favorable prognostic factors included: younger age, Caucasian race, female gender, limited stage, and later year of diagnosis. Conclusions: The proportional incidence of SCLC has declined only slightly over the past three decades. While overall survival has modestly improved, SCLC remains a major public health problem. No significant financial relationships to disclose.
Targeting Lewis Y (LeY) in small cell lung cancer (SCLC) with a humanized monoclonal antibody, hu3S193
Authors: Krug L. M. , Milton D. , Chen L. , Jungbluth A. A. , Quaia E. , Nagel A. , Jones J. , Finn R. , Divgi C. 
Published: March 2020

7086 Background: LeY is a blood group antigen with dominant expression on the surface of epithelial tumors, including SCLC, making it a potential target for antibody-based immunotherapy. 3S193, an IgG3 mAb, has demonstrated superior specificity, affinity, and cytotoxicity over other anti-LeY antibodies. A phase I trial of humanized 3S193 (hu3S193) with dosing up to 40 mg/m2 demonstrated tumor targeting without serious toxicities or the development of human antihuman antibodies (Scott et al, ASCO, 2004). Methods: We tested the targeting and pharmacokinetics of hu3S193 in patients with SCLC. Eligibility required progressive SCLC treated with up to three prior chemotherapy regimens, measurable disease not previously irradiated, and tumor samples immunohistochemistry (IHC)-positive for 3S193. Patients received four weekly injections of hu3S193, 5 patients at 10mg/m2 and 5 patients at 20 mg/m2. The first and fourth injections were radiolabeled with 111Indium for gamma camera imaging. Results: Of 40 patients screened, 25/34 (74%) evaluable SCLC tumor samples were 3S193-positive by IHC: 1+ (n = 13), 2+ (n = 3), 3+ (n = 2), 4+ (n = 7). Ten patients were treated with hu3S193; eight completed all four injections (one had disease progression and one is still on treatment). At the lower dose, about 50% of lesions >2 cm diameter visualized on FDG-PET were also seen on 111In SPECT imaging. However, at the higher dose, essentially all FDG avid lesions showed targeting. The mean T1/2 for all infusions was 2.89 ± 0.84 days at 10 mg/m2 (n = 9) and 3.29 ± 0.66 days at 20 mg/m2 (n = 7). No difference was noted in imaging or pharmacokinetics between the first and fourth injections. At the 20 mg/m2 dose, patients experienced grade 2 urticaria (n = 1), grade 1 vomiting (n = 2), and grade 2 hypertension (n = 1) transiently after infusion. No other grade 2 or greater toxicities were observed. No objective responses were observed. Conclusions: SCLC has a high rate of Lewis Y expression. Given the strong tumor targeting, particularly at the higher dose, and the potential for immunomodulatory effects, administration of hu3S193 with chemotherapy would be warranted. Supported by the Ludwig Institute and the Experimental Therapeutics Committee of MSKCC. No significant financial relationships to disclose.
High-dose ifosfamide, carboplatin and etoposide (HD-ICE) with peripheral blood stem cell transfusion (PBSCT) for limited stage small-cell lung cancer (LD-SCLC)
Authors: Katakami N. , Nishimura T. , Higashi Y. , Seo R. , Kubota M. , Naya R. , Hayashi M. , Ikeda A. , Tomii K. , Ishihara K. 
Published: March 2020

7090 Background: Efficacy of high dose chemotherapy with autologous PBSCT has been demonstrated in the treatment of lymphoma. The purpose of this trial is to determine progression-free survival and long-term survival for LD-SCLC patients (pts) who responded to first-line concurrent chemo-radiotherapy followed by HD-ICE with PBSCT. Methods: Patients (pts) with pathologically proven SCLC without malignant pleural and pericardial effusion, stage II-IIIB, ECOG-PS 0–1 were eligible. All pts were treated with cisplatin (P) 60 mg/m2 day1 and etoposide (E) 100 mg/m2, days 1–3, with concurrent hyperfractionted radiotherapy initially (1.5Gy X 2/day X 15 days, total 45Gy) and then two or three cycles of chemotherapy consisted of P 60 mg/m2, day 1, and E 120 mg/m2, days 1–3, or APE (adriamycin 30 mg/m2, day 1, P 60 mg/m2, day1 and E 100 mg/m2, days 1–3) were repeated. Pts with tumor shrinkage more than 90% after initial therapy received HD-ICE (ifosfamide 3 g/m2, days 1–3, carboplatin 400 mg/m2, days 1–3, etoposide 400 mg/m2, days 1–3) followed by PBSCT. All pts received prophylactic cranial irradiation (1.5 Gy × 2/day × 9 days, total 27 Gy). Results: Between 1996 and 2001, 15 pts were eligible and all 15 pts received HD-ICE with PBSCT. Patient characteristics included M/F:14/1, median age: 55 (47–62), PS 0/1: 7/8 stage IIIA/IIIB: 7/8. Grade IV neutropenia and thorombocytopenia were observed in all pts and 93% of pts experienced neutropenic fever after HD-ICE. There was no toxic death. Median follow up time was 83.2 months. Median progression free survival time was 10. 7 months and overall median survival time (MST) was 30.9 months. Two, 3 and 5-year survival rates after initial chemoradiotherapy were 67%, 33%, 25%, respectively. Conclusion: HD-ICE with PBSCT for LD-SCLC revealed promising MST and a 5-year survival rate with manageable treatment-related toxicity. A randomized phase III study comparing chemo-radiotherapy followed by HD-ICE with PBSCT to standard chemo-radiotherapy for LD-SCLC is ongoing. No significant financial relationships to disclose.
Pemetrexed (MTA) and carboplatin (CBDCA) in the treatment of advanced pleural mesothelioma (MPM)
Authors: Castagneto B. , Mencoboni M. , Degiovanni D. , Muzio A. , Giaretto L. , Rebella L. , Alabiso O. , Buosi R. , Cafferata M. , Botta M. 
Published: March 2020

7093 Background: Aim of this study was to evaluate the activity and toxicity of MTA and CBDCA combination as first line chemotherapy in advanced MPM. Methods: Chemonaive patients (pts) with histologically proven, an ECOG performance status (PS) 0–2, and measurable advanced MPM were considered. The schedule of administration was: pemetrexed 500 mg/m2 in combination with CBDA AUC 5, once every 21 days for 8 cycles. Results: From July 2003 to March 2005 76 pts (54 male and 22 female) have been treated with this combination chemotherapy. Median age was 62.7 years (range 40–70); median PS 0 (range 0–3); epithelial histologic findings were in 57 (75%), mixed in 13 (17.1%), sarcomatous in 3 (3.9%), and unspecified in 3 (3.9%) pts. A total of 537 cycles was administered (median 7, range 1 to 13). Grade 3 hematologic toxicity according to WHO criteria was seen in 43 (56.6%) pts (neutropenia in 30, thrombocytopenia in 8, and anemia in 5); grade 4 hematologic toxicity in 5 (6.6%) pts. The most common nonhematologic events were grade 3 nausea/vomiting in 10 (13.1%), and fever in 4 (5.3%) pts. 74 pts were evaluable for clinical response. There were 16 (21.%) partial responses (PR) and 3 (3.9%) complete responses (CR), for an overall response rate of 23.9%. 29 (38.2%) pts reported stable disease (SD). The overall survival was considered from date of diagnosis to date of death from any cause or to date of last follow-up. The median survival time for the entire group was estimated at 23 months. Conclusions: The results of this phase II study indicate that, at this dose and schedule, the combination of CBDCA and MTA is moderately active and that the profile of toxicity is acceptable in pts with advanced MPM. No significant financial relationships to disclose.
Cell cycle regulators and benefit of adjuvant chemotherapy in patients with non-small cell lung cancer
Authors: Pirker R. , Filipits M. , Dunant A. , Lantuejoul S. , Schmid K. , Huynh A. , Soria J. , Popper H. H. , Le Chevalier T. , Brambilla E. 
Published: March 2020

7100 Background: The International Adjuvant Lung Cancer Trial (IALT) demonstrated that adjuvant cisplatin-based chemotherapy improves the 5-year survival rate of patients with completely resected non-small-cell lung cancer (NSCLC) by absolute 4.1% (N Engl J Med 350, 351–360, 2004). The purpose of our study was to determine whether cell cycle regulators are of prognostic and/or predictive value in NSCLC patients who were enrolled into IALT. Methods: Expression of cell cycle regulators and Ki-67 was immunohistochemically assessed in tumor specimens obtained from 778 IALT patients. Prognostic and predictive analyses were based on Cox models adjusted on clinical and pathological parameters. Results: Expression of p16, p27, cyclin D1, cyclin D3, cyclin E and Ki-67 was considered as positive in 37%, 40%, 74%, 37%, 55% and 29% of tumor specimens, respectively. None of these biomarkers was significantly associated with overall survival of the patients. However, there was a relationship of borderline significance between p27 status and benefit of cisplatin-based chemotherapy (test for interaction, p = 0.04). Patients with p27-negative tumors who were treated with cisplatin-based chemotherapy had a longer overall survival than patients from the observation group (hazard ratio for death [95% CI]: 0.71 [0.55–0.93]), whereas in patients with p27-positive tumors overall survival was not different between the two groups (hazard ratio for death [95% CI]: 1.11 [0.81–1.51]). In contrast to p27, the other cell cycle regulators and Ki-67 did not predict benefit of adjuvant cisplatin-based chemotherapy. Conclusions: NSCLC patients with p27-negative tumors appear to benefit most from adjuvant cisplatin-based chemotherapy following complete tumor resection. Thus, the predictive value of p27 should be confirmed in prospective trials. No significant financial relationships to disclose.