bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-oncologist physician knowledge of radiation therapy at an urban community hospital.
Authors: Siau Evan , Salazar Hernando , Klein Jonathan 
Published: March 2020

10534 Background: Appropriate referral for radiation therapy (RT) is crucial for cancer care. Previous work suggests that many non-radiation oncologists who care for cancer patients are uncomfortable referring for RT. We surveyed physicians in a community hospital in Bronx, New York to assess their training in RT and understanding of RT. Methods: Invitations to complete an online questionnaire were sent to all faculty and resident physicians at St. Barnabas Hospital. The questionnaire asked about previous training in oncology, RT knowledge self-rating and an objective knowledge assessment of RT indications and effectiveness. Statistical analysis used Pearson chi-square and Fisher’s exact test for categorical variables and Student’s t-test and ANOVA for interval variables. Results: 247 participants received the invitation email, and 87 responded (35% response rate). Among responders, 19 were attending physicians (22%) and 66 (76%) were residents (2 failed to disclose). 51 respondents (59%) were from Internal Medicine (IM) and 20 (24%) from Emergency Medicine. 72% of respondents reported caring for > 5 cancer patients in the past month, but 45% (37% of IM respondents) never refer patients for RT. 71% of respondents stated they received no formal radiation oncology training in medical school, and 47% reported no oncology training at all. Pluralities believed themselves to be “somewhat knowledgeable” about RT indications (49%), benefits (53%), and side effects (55%). Objective assessment mean score was 6.2/12 (median 7) for all respondents. IM respondents scored higher than others (mean 7.7 vs 3.5; p < 0.001), but only 28% of IM respondents (0% of others) scored 10/12 or higher. Scores did not differ between attending and resident physicians (p = 0.75), resident PGY level (p = 0.43), or receiving oncology training in medical school (p = 0.54). Factors cited by > 50% as affecting RT referral decisions either “somewhat” or “a lot” were: type of cancer, patient wishes, family wishes, poor functional status, and life expectancy. Conclusions: Many physicians are unaware of RT effectiveness or indications, which may affect referral patterns. Previous oncology training was not associated with higher knowledge scores.
Believe the H.I.P.E.: Hematology-Oncology Inter Professional Education to improve provider collaboration at an inpatient tertiary medical center.
Authors: Martin Richard Lewis , Hux Anna , Miller Ryan , Davidson Mario , Horn Leora , Gilbert Jill 
Published: March 2020

10538 Background: With projected provider shortages and increasing pharmaceutical complexity, Advanced Practice Providers (APPs) and Pharmacists are becoming increasingly utilized members of hematology/oncology teams. Despite significant interdependence in practice, inter-professional training remains rare. Medical IPE has been shown to improve learning satisfaction and attitudes, however, IPE has seldom incorporated inter-professionalism into content development nor has it been evaluated in terms of sustainability. Methods: We developed a pilot IPE curriculum consisting of six, 1-hour long, case-based sessions. A preparation phase required a lead APP, Fellow, and Pharmacist to collectively build a case around three teaching points; 1) diagnosis, 2) treatment, and 3) coordination of care. The APP and Pharmacist presented the case while the Fellow moderated to ensure active participation among all groups. Surveys on collaboration, interaction, interest, and connection, as well as open-ended comments on strengths and areas for improvement were collected after each session ( > 80% completion rate). Results: With 3 of 6 sessions completed (02/19), attendance was stable, averaging 10 of 18 (Fellow), 5 of 8 (APP), and 3 of 6 (Pharmacist). Sessions were rated an average of 4.6/5 on collaboration, 4.5/5 interactive, 4.7/5 application, 4.3/5 communication, and 4.2/5 professionalism. 69% of attendees reported being more likely to attend future conferences. 65% reported feeling more connected to the care team. The most common suggestion for improvement was giving more teaching opportunities to the APPs. Session leaders were initially recruited but quickly transitioned to eager volunteers. Conclusions: Our IPE curriculum shows promising initial sustainability with perceived high marks in collaboration and applicability. Incorporating inter-professionalism into content development and longitudinal delivery to providers in practice provides a novel approach to educating IP teams. Future steps include ensuring continued sustainability, conducting qualitative and quantitative analysis, and dissemination to other units.
Activity and safety of cabozantinib in patients with gastrointestinal stromal tumor after failure of imatinib and sunitinib: EORTC phase II trial 1317 CaboGIST.
Authors: Schoffski Patrick , Mir Olivier , Kasper Bernd , Papai Zsuzsanna , Blay Jean-Yves , Italiano Antoine , Benson Charlotte , Kopeckova Katerina , Ali Nasim , Dileo Palma , Le Cesne Axel , Menge Franka , Cousin Sophie , Charon-Barra Celine , Wozniak Agnieszka , Marreaud Sandrine , Litiere Saskia , Nzokirantevye Axelle , Gelderblom Hans 
Published: March 2020

11006 Background: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal malignancy of the gastrointestinal tract. Advanced GIST is treated with tyrosine kinase inhibitors (TKIs). Most patients (pts) develop resistance over time. We reported in 2013 (Van Looy CTOS) that cabozantinib (cabo), a TKI targeting KIT/MET/AXL/VEGFR, showed activity in GIST xenograft models through inhibition of tumor growth, proliferation and angiogenesis, both in imatinib-sensitive and -resistant tumors (Gebreyohannes Mol Cancer Ther 2016;15:2845-28). Cohen (Cancer Res 2015;75:2061-70) found that cabo can overcome compensatory MET signaling in GIST in vitro. EORTC 1317 assessed the safety and activity of cabo in pts who had progressed on imatinib and sunitinib. Methods: In this multi-center, open label, single arm Phase 2 study eligible metastatic GIST pts received 60 mg (freebase weight) cabo p.o./d. Primary endpoint was progression-free survival rate at wk 12, assessed by local investigator per RECIST 1.1. If at least 21 of 41 eligible and evaluable pts were progression-free at wk 12, the activity of cabo was sufficient to warrant further exploration (A’Hern one-stage design). Results: A total of 50 consenting pts were eligible and started treatment between 02/2017 and 08/2018, with 16 (32%) still continuing cabo at the database cut-off in 01/2019. The number of 3 wk treatment cycles ranges from 2-28+. Among the first 41 eligible and evaluable pts, 24 were progression-free at wk 12, satisfying the study decision rule. Among all 50 pts, 30 were progression-free at wk 12 (60%, 95% confidence interval (CI) 45-74%). A total of 7 pts achieved a confirmed partial response (PR) (14%, 95%CI 6-27%) and 33 had stable disease (SD) (66%, 95%CI 51-79%). Progression as best response was seen in 9 pts (18%, 95%CI 9-31%), one was not evaluable. Disease control (PR+SD) was achieved in 40 pts (80%, 95%CI 66-90%). Median progression-free survival was 6.0 mo (95%CI 3.6-7.7). The most common cabo-related grade ≥3 adverse events were diarrhea (74%), hand-foot syndrome (58%), fatigue (46%), hypertension (46%), weight loss (38%) and oral mucositis (28%), with 33 (66%) pts requiring dose reductions, 25 (50%) treatment interruptions and no cabo-related deaths. Conclusions: EORTC 1317 met its primary endpoint, with 24/41 pts (58.5%) being progression-free at wk 12. Results of this trial confirm preclinical data and warrant further exploration of cabo in GIST. Clinical trial information: NCT02216578.
Exploration of tumor genetic alterations and associations with clinical outcomes: Retrospective genomic analysis of archived liposarcoma (LPS) and leiomyosarcoma (LMS) samples from phase III trial of trabectedin (T) versus dacarbazine (D).
Authors: Thomas Shibu , Joshi Shilpy , Shen Dong , Knoblauch Roland Elmar , Gormley Michael , Wang George C. , Ricci Deborah S. , Motley Clifford , Maki Robert G. , von Mehren Margaret , Patel Shreyaskumar , Demetri George D. 
Published: March 2020

11019 Background: To explore tumor genomic associations with response/resistance as potential predictive or prognostic biomarkers for T and D in metastatic LMS and LPS tumor samples. Methods: Genomic alterations [single nucleotide variants (SNVs) or gene copy number variations (CNVs)] were identified using whole exome sequencing (WES) of archived tumor samples from NCT01343277. Association of tumor-subtype or genetic alterations with clinical outcomes including maximum tumor volume reduction (MTVR), overall survival (OS), progression free survival (PFS) and treatment cycles received was assessed using multivariate Cox proportional hazard models. Results: A total of 178 uterine LMS (uLMS), 121 non-uterine LMS (non-uLMS), 60 de-differentiated LPS (ddLPS), 40 myxoid LPS (mLPS) and 14 pleomorphic LPS (pLPS) tumors underwent WES. Homozygous deletions (HD) were observed at relatively high frequency in 4 genes -AC092821.1 (36.4%), LCE3B (35.4%), LCE3C (32.1%), HEATR4 (24.4%) across all sarcoma subtypes. These genes are involved in cell proliferation, innate immune response and differentiation. HD in any of these genes was associated with improved OS in the T treatment arm. Tumors with MDM2 amplifications showed worse clinical outcome in the T treatment arm in terms of PFS and OS consistent with T-mediated induction of p-53 dependent apoptosis (Table). Conclusions: HD in any of 4 genes was associated with longer OS in patients treated with T. This molecular signature, which covers 40% of total sarcoma and 0.4% of overall solid tumors population, warrants further prospective validation. Novel genetic alterations and clinical associations. [Table: see text]
Multi-institutional analysis of outcomes in patients with dedifferentiated chondrosarcoma (DDCS).
Authors: Bui Nam , Dietz Hilary , Hirbe Angela C. , Ganjoo Kristen N. , Van Tine Brian Andrew , Keedy Vicki Leigh , Davis Elizabeth J. 
Published: March 2020

11028 Background: DDCS is a rare bone tumor with a poor prognosis. While no standard therapy exists, NCCN guidelines recommend osteosarcoma regimens (ORs). Methods: We performed a retrospective review (January 1, 2007-June 1, 2018) at three sarcoma centers and identified 46 patients (pts) with DDCS to evaluate treatments and outcomes. Results: Median age was 62.5 years (23-83); 61% were male. Median tumor size was 10.5cm (2-34). Most pts had localized disease at diagnosis (dx) (80%), extremity primary (76%), and did not receive neo/adjuvant chemotherapy (70%) or radiotherapy (69%). Local and distant recurrences were frequent (35% and 57%, respectively) and rapid (6.6 months (m) and 5.4 m, respectively). Twenty-eight pts received chemotherapy, 9 neo/adjuvant and 19 for metastasis (met) (Table). Response rate to first line ORs was poor (53% progressed). Notably, 11% had a partial response (D/I). Tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) led to stable disease. Median overall survival was 22.8 m and 7.2 m; 5-year survival rates were 30% and 0% in localized and metastatic disease, respectively. Median follow-up was 12.5 m (1.4-120). A multivariate cox proportional hazards model (age, sex, location, met at dx) identified met at dx as the only risk factor for worse prognosis (HR 2.8, p=0.026). Conclusions: DDCS is an aggressive malignancy with a poor prognosis. Despite guidelines to treat with ORs, the benefit is unclear, illustrating the need for randomized trials comparing standard regimens to novel agents. [Table: see text]
Italian survey of second tumors in patients with diagnosis of GIST (gastrointestinal stromal tumor).
Authors: Gasperoni Silvia , Messerini Luca , Fumagalli Elena , Manglaviti Sara , Vincenzi Bruno , Mazzocca Alessandro , Pantaleo Maria A. , Nannini Margherita , Badalamenti Giuseppe , Incorvaia Lorena , Ottaviano Margaret , Palmieri Giovannella , Grignani Giovanni , D'Ambrosio Lorenzo , Meoni Giulia , Paderi Agnese , Fancelli Sara , Caliman Enrico , Tofani Lorenzo , Mini Enrico 
Published: March 2020

11032 Background: GISTs are the most common mesenchymal tumors of the digestive tract. As of recent, new links are being made between GISTS and secondary malignancies. However, whether the coexistence of GISTs with other tumors is stochastic, or the result of related pathogenetic mechanisms is still unknown. Methods: We retrospectively reviewed clinical and molecular features from all GIST patients with second tumors treated in seven Italian GIST reference centers. Qualitative variables were compared using the Fisher exact test. Results: Clinical data of 184 patients with diagnosis of GIST were evaluated. Median age at diagnosis was 66 years, KIT exon 11 resulted the most frequent mutation (73%) while seven patients (3.8%) had a genetic syndrome. The most common primary GIST localizations were stomach (54%) and small intestine (33%). Second tumors arose mostly from gastrointestinal and genitourinary tract. Fourtythree patients had two primary tumors other than GIST and five patients had three other primary malignancies. According to Miettinen criteria, 45% of non-metastatic patients at diagnosis belong to low or very low-risk classes. We highlighted a significant correlation (P=0.002) between risk class and second/third tumor localization, with considerably high percentage of GI second malignancies in low/very low risk GISTs (table). Conclusions: The high frequency of second/third tumors reported in low and very low GIST calls for a careful follow-up also in these patients. Furthermore, this population requires further genetic investigation, NGS analysis is ongoing. [Table: see text]
Determinants of secondary alterations in WWTR1-CAMTA1 fusion epithelioid hemangioendothelioma.
Authors: Seligson Nathan David , Awasthi Achal , Millis Sherri Z. , Liebner David A. , Hays John L. , Chen James Lin 
Published: March 2020

11045 Background: Epithelioid hemangioendothelioma (EHE) is a rare vascular sarcoma characterized by the WWTR1- CAMTA1 fusion ( WC-F) in a majority of cases. EHE demonstrates a biphasic clinical course; remaining indolent for many years before suddenly demonstrating aggressive progression. Cell cycle mutations have been previously noted to account for some secondary alterations; however, little is known regarding the chronicity of these secondary alterations or their clinical implications. Here we present the largest assessment of secondary genomic variants and their clinical import. Methods: Comprehensive genomic profiling from 45 WC-F positive EHE patients (pts) were provided by Foundation Medicine (FMI). 8 of these 45 pts were treated at The Ohio State University (OSU) and were evaluated retrospectively through chart review. Known deleterious alterations, variants of unknown significance (VUS), and genomic copy quantification for the WC-F was included in our analysis. Targetable gene variants were defined by OncoKB. Chi-square and student’s t-tests were used as appropriate. Results: Genomic copy number of the WC-F best fit a log-normal distribution (range: 13-2,131 copies). 20 pts (44%) did not exhibit any secondary genomic variants. The most commonly altered genes included: CDKN2A/B (7 variants), RB1 (3 variants), and ATRX (3 variants). Commonly identified pathways included: cell cycle (9 pts, 20.0%), epigenetic modulators (7 pts, 15.6%), and DNA damage repair (7 pts, 15.6%). Eight pts exhibited targetable gene variants (18%) as defined by OncoKB. Subjects ≥50 years of age exhibited a greater proportion of clinically targetable variants (27.6% vs 0%; p = 0.02). Pts with a secondary genomic variant exhibited elevated WC-F copy numbers (p < 0.001). OSU pts with aggressive EHE were more likely to have a second genomic variant (80% vs 0%; p = 0.03) when compared to indolent EHE, with trends toward higher WC-F copy numbers (809±315 vs 207±147; p = 0.2) and older age at diagnosis (59.5±5.5 vs 36.7±8.8; p = 0.1). Conclusions: In this study, secondary genomic variants in WC-F driven EHE are more common in older patients ( > 50 yo). Further, the presence of secondary genomic variants is associated with an aggressive phenotype and may drive poor prognosis. Prospective research is needed to confirm these findings.
Does the addition of chemotherapy to neoadjuvant radiotherapy impact survival in high-risk extremity and trunk soft tissue sarcoma?
Authors: Chowdhary Mudit , Chowdhary Akansha , Sen Neilayan , Zaorsky Nicholas George , Patel Kirtesh R. , Wang Dian 
Published: March 2020

11054 Background: Large, high-grade extremity/trunk (ET) non-rhabdomyosarcoma soft-tissue sarcoma (STS) is at high risk for distant recurrence and death. The integration of chemotherapy (C) to standard of care neoadjuvant radiotherapy (RT) remains controversial, even for these patients. This study examines the impact of adding C to neoadjuvant RT on overall survival (OS) in high risk ET-STS. Methods: The National Cancer Data Base (NCDB) was queried for patients ≥18 years with high risk (≥5 cm + high grade) non-rhabdomyosarcoma ET-STS (WHO histology) who received neoadjuvant RT and limb sparing surgery from 2006-2014. Patients were next stratified based upon receipt of C (RT and CRT cohorts). Overall survival (OS) for RT vs CRT cohorts was analyzed using the Kaplan-Meier (KM) method, log-rank test, and Cox proportional hazards models. Propensity score-matched analysis (PSM) was employed to account for potential treatment selection bias between cohorts. Results: A total of 848 (71.1%) and 344 (28.9%) patients received RT and CRT, respectively. Patient cohorts were well-balanced except for the CRT cohort having higher rates of treatment in the West (22.1% vs 10.6%) & Midwest (28.3% vs 22.7%), Charlson-Deyo [CD] score 0 vs ≥1 (85.5% vs 79.4%), younger age (≤50) (45.9% vs 21.7%), synovial sarcoma histology (18.9% vs 3.2%), earlier year of diagnosis (2006-2010) (39.5% vs 32.3%), and positive lymphovascular invasion (2.0 vs 1.51%), (p < 0.05 each). The KM 5-year OS was significantly higher in the CRT vs RT cohort: 69.2% vs 58.1% on univariate (p < 0.0001) and multivariate analysis (Hazard Ratio [HR]: 0.66; 95% Confidence Interval [CI]: 0.52-0.85; p = 0.001) even after adjusting for age, race, income, CD score, histology, tumor size, tumor grade, and primary site (lower extremity; upper extremity; trunk). PSM identified evenly matched cohorts of 300 patients each with respect to age, income, CD score, histology, grade, tumor size, and primary site. The addition of neoadjuvant C remained prognostic for OS on PSM (HR: 0.74 [0.56-0.99], p = 0.042). Conclusions: The addition of C to neoadjuvant RT was associated with improved OS in patients with high risk non-rhabdomyosarcoma ET-STS in the NCDB. These hypothesis generating results support prospective evaluation.
Effects of exercise on cancer-related fatigue and muscular strength in patients with breast cancer.
Authors: Lin Po-Ju , Loh Kah Poh , Inglis Julia Ellen , Dunne Richard Francis , Kleckner Ian , Fung Chunkit , Gilmore Nikesha , Lopez Gilberto , Heckler Charles E. , Culakova Eva , Peppone Luke Joseph , Janelsins Michelle Christine , Kamen Charles Stewart , Mustian Karen Michelle 
Published: March 2020

11507 Background: Cancer-related fatigue (CRF) is a persistent daily lack of energy commonly experienced by breast cancer (BC) patients. Due to CRF, BC patients have difficulties carrying out daily activities, become less active and consequently reduce muscular strength. Exercise can improve muscular strength and increase energy level; therefore it may alleviate CRF. This phase II RCT assessed the effects of exercise on CRF and muscular strength in BC patients. Methods: Ninety BC patients (55.5±9.6 years, 79% white, 48% and 46% under radiation or hormone therapy) were randomized into two arms: a 6-week Exercise for Cancer Patients (EXCAP) program or standard care (Control). EXCAP is a home-based, personalized, progressive exercise program combining aerobic walking and resistance band training. The Brief Fatigue Inventory was used to assess CRF and CRF interference with daily activities and a 7-10 repetition maximum chest press and leg extension strength test was used to assess upper- and lower-body strength at pre- and post-intervention. T-tests and ANCOVA with pre-intervention as the covariate were used to analyze within- and between-group changes, respectively. Results: Participants in the EXCAP group decreased CRF (-0.9±0.3, p = 0.01) and CRF interference with daily activities (-1.1±0.3, p < 0.01) from pre- to post-intervention while participants in the Control group did not. The mean improvement (from pre- to post-intervention) in CRF and CRF interference of daily activities for the EXCAP group were significantly higher than the change in the Control group (both p < 0.01). Participants in the EXCAP group increased upper- (3.9±1.4, p < 0.01) and lower-body strength (6.4±1.3, p < 0.01) from pre- to post-intervention, while participants in the Control group did not. The mean increase (from pre- to post-intervention) in lower-body strength for the EXCAP group was significantly higher than the change in the Control group (p = 0.01). Conclusions: Exercise combining aerobic walking and resistance band training reduces CRF and CRF interference with daily activities and improves muscular strength in BC patients. Results from this study provide further evidence of the benefits of exercise for supportive cancer care. Clinical trial information: NCT00851812.