bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative rehabilitation in patients with thoracic tumors and borderline abnormal spirometry results: Preliminary report.
Authors: Glogowska Oliwia Anna , Szmit Sebastian , Tchorzewska-Korba Hanna , Glogowski Maciej 
Published: March 2020

e18529 Background: The role of preoperative pulmonary rehabilitation is unclear. The aim of the study is short-term efficacy of pulmonary rehabilitation in patients with thoracic tumors and borderline abnormal spirometry results before thoracic surgery. Methods: We observed 12 patients (7 women, 5 men) in mean age of 64 (range 46-82) years. Clinical inclusion criteria were: diagnosis of thoracic tumors and reduced values of FEV1 and FVC predicting postoperative complications. Spirometry and 6MWT were chosen for evaluation of lung function and physical performance during rehabilitation. These tests were performed twice during screening phase to eliminate the factors of learning, and were repeated after first and second week of rehabilitation. Pulmonary rehabilitation included two weeks of training on the treadmill with individually selected speed, physiotherapy exercises and breathing training with using of Triflo. Results: The analyses of results of spirometry and 6MWT before and after 2 weeks of pulmonary rehabilitation indicated the significant differences in values of: 1)FEV1 (L): 1,38 ± 0,23 vs 1,61 ± 0,29 (p=0,01) 2) FEV1 (%N): 56,3 ± 13,9 vs 67,8 ± (p=0,007) 3) FVC (L): 2,24 ± 0,37 vs 2,74 ± 0,67 (p=0,03) 4) FVC (%N): 73,5 ± 15,7 vs 91,2 ± 12,7 (p=0,01) 5) 6MWT distance (m): 251 ± 79 vs 310 ± 74 (p=0,003). Although improvement after rehabilitation, 3 patients were disqualified from lobectomy due to unsatisfactory performance status. Another 3 patients experienced complications during perioperative period. Analysis of pulmonary rehabilitation efficacy showed that 6 patients with favourite outcome after thoracic surgery differed significantly in comparing to others. They achieved significantly higher difference in following parameters: 1) FEV1 (L): 0,4 vs 0,06 (p=0,02) 2) FVC (L): 0,91 vs 0,09 (p=0,02) 3) 6MWT distance (m): 93 vs 25 (p=0,016). Conclusions: A two-week pulmonary rehabilitation leads to significant improvement of lung function and physical performance in patients with thoracic tumors and borderline abnormal spirometry results. A clinically significant increase of absolute values of FEV1, FVC and 6MWT distance may indicate a favourite outcome after thoracic surgery.
Preoperative thrombocytosis as a predictor of unfavorable survival in resectable non-small cell lung cancer.
Authors: Wang Jiwen , Luo Min , Wu Hanmo , Sheng Liming , Su Dan , Mao Weimin 
Published: March 2020

e18531 Background: Activated platelet is thought to promote cancer cells growth and metastasis, playing an important role in progression of cancer. However, the association between platelet counts and prognosis of patient with non small cell lung cancer (NSCLC) had not been fully elucidated. The aim of this study is to investigate the prognostic value of platelet counts in resectable NSCLC. Methods: A total of 636 primary NSCLC patients who had curatively resected surgery in Zhejiang Cancer Hospital from November 2006 to January 2011 were retrospectively analyzed. Preoperative platelet counts and clinicopathological factors were collected from the medical record database. Patients were followed up for disease progression free survival (PDS) and overall survival (OS) until January 20, 2013. The association between platelet counts and patients’ outcome were evaluated. Results: In all patients, 13.8% (88/636) had increased platelet count (>300 × 109/L), referred to as thrombocytosis. The proportion of thrombocytosis was significantly higher in male, squamous-cell carcinoma and stage III than that in female, other histological types and early stage NSCLC. Moreover, thrombocytosis was associated with significantly shortened survival. Multivariate Cox analysis showed patient with thrombocytosis not only had a 1.66 time elevated risk for disease progression (95% CI, 1.14-2.41, p=0.009), but also had and a 1.47 time risk for death (95% CI, 1.04-2.08, P=0.029), compared with that in those having normal platelet count. More interestingly, the risk for replase was increased to 3.19 times (95% CI, 1.41-7.23, p=0.006) in stage I NSCLC with thrombocytosis than that in patients with normal platelet count after stratified analysis by stage. Conclusions: Preoperative platelet count is an independent prognostic predictor in operable NSCLC, especially in early stage I NSCLC. Platelet count may serve as a useful indicator and potential target for personalized treatment with antiplatelet reagent.
Carboplatin and etoposide followed by once-daily thoracic radiotherapy in limited-disease small-cell lung cancer.
Authors: Yılmaz Ufuk , Anar Ceyda , Korkmaz Esra , Yapicioglu Sena , Karadogan Ilker , Ozkok Serdar 
Published: March 2020

e18540 Background: There has been a trend to replace cisplatin with carboplatin in the treatment of small-cell lung carcinoma. The goal of the present study was to determine the efficacy of carboplatin and etoposide followed by thoracic radiotherapy in patients with previously untreated limited disease small-cell lung carcinoma. Methods: From February 2001 to March 2007, 47 patients with limited disease small-cell lung cancer were enrolled in the study. Etoposide, 100 mg/m2, was administrated intravenously on days 1-3 in combination with carboplatin, AUC 6, on day 1 every 21 days for 6 cycles. In cases considered to have non-progressive disease following induction chemotherapy, thoracic radiotherapy was given with in a once daily fraction of 2.0 Gy, 5/wk, up to 50-60 Gy. Results: Forty-one patients were evaluated. Median age was 62 (range, 40-78), 88% of patients were male. ECOG PS was 0-1 in 38 patients. Seven of the 41 patients (17.5%) had pleural effusion (one malignant) and 7 patients (17.5%) had involved supraclavicular lymph nodes. Ninety percent of patients had elevated serum lactate dehydrogenase levels. Median follow-up was 13.5 mo. A total of 209 cycles of chemotherapy was administered (median, 6; range, 1-6). Thoracic irradiation was given to 33 patients. The overall response rate to combined modality on an intention-to-treat basis was 73%. Median survival time was 13.7 months (95% CI, 10.3-17.1), and median progression-free survival was 9.5 months (95% CI, 8.6-10.4). Two- and four-year overall survival was 23% and 7%, respectively. Grade 3-4 neutropenia and leukopenia were the most common adverse events and occurred in 46.0% and 24.0% of the patients, respectively. Six (14%) patients experienced febrile neutropenia. Three patients (7%) died of sepsis and neutropenic fever. Non-hematological toxicities were mild. Conclusions: Carboplatin and etoposide chemotherapy followed by thoracic radiotherapy in LD-SCLC appears to be unsatisfactory.
Assessment of treatment patterns in patients with malignant mesothelioma in the United States: A retrospective database analysis.
Authors: Wu Bingcao , Pawaskar Manjiri , Tunceli Ozgur , Dalvi Tapashi , Ibrahim Ramy A. , Tavakkoli Fatemeh , Deeter Robert 
Published: March 2020

e18543 Background: Mesothelioma is a rare malignancy primarily attributed to asbestos exposure and has limited life expectancy. This study examined patient characteristics, and treatment patterns in commercially insured mesothelioma patients in real world setting. Methods: Patients aged ≥18 yrs with mesothelioma diagnosis were identified using ICD-9 and CPT codes/clinical algorithm between 7/1/2006 and 4/30/2011 from HealthCore Integrated Research Database. Patients with other cancers and without continuous insurance enrollment for ≤ 6-mos before or 12-mos post-diagnosis were excluded. Treatments were grouped into surgery, systemic chemotherapy (Ctx), and best supportive care (BSC) and were assessed descriptively. Results: A total of 184 patients were identified (mean age 64 yrs with 41% patients between 45 and 64 yrs old and 48% ≥65 yrs old, 64% males) with diagnosis of mesothelioma. 61% patients had pleural, 25% had peritoneal and 14% had pericardial disease. Only 10% patients received surgery, 27% received Ctx, while 50% received BSC (including radiation). Among patients who received 1st line Ctx (mean duration 90 days), almost half of patients received pemetrexed based regimen {pemetrexed + cisplatin (18%) or carboplatin (10%) and pemetrexed alone (20%)} followed by carboplatin monotherapy (42%). Among 41% who received 2nd line Ctx regimens (mean duration 105 days), most commonly used (65%) were pemetrexed based regimens {pemetrexed alone (35%) and pemetrexed + cisplatin (15%) or carboplatin (15%)} followed by single agent gemcitabine (15%). No patients received vinorelbine (0%). In patients who received Ctx, 35% died before receiving 2nd line Ctx and an additional 15% of patients died before receiving 3rd line Ctx. Only 16% received 3rdline Ctx. Around 41% patients had at least one emergency room visit and 80% had at least one hospitalization. Conclusions: Mesothelioma is predominant in males and older adults in commercially insured patients in the United States. Systemic chemotherapy remains the main treatment strategy with pemetrexed based therapy being most commonly used regimen. This study highlights limited treatment options and high unmet need in this population.
Clinical significance of downstaging in patients treated with chemoradiotherapy for limited-disease small cell lung cancer.
Authors: Go Se-Il , Keam Bhumsuk , Kim Tae Min , Lee Se-Hoon , Kim Dong-Wan , Kim Hak Jae , Wu Hong-Gyun , Chung Doo Hyun , Heo Dae Seog 
Published: March 2020

e18555 Background: Limited-disease small cell lung cancer (LD-SCLC) patients who do not achieve complete remission (CR) have a considerable relapse rate. The change of tumor burden after treatment can be related with prognosis, the change of TNM stage may influence the outcome of treatment. We investigated the impact of downstaging on overall survival (OS) in LD-SCLC patients treated with chemoradiotherapy (CRT). Methods: We retrospectively reviewed the 210 LD-SCLC patients, who were treated with CRT at Seoul National University Hospital from Apr 1999 to Nov 2012. The relationship between downstaging and OS was analyzed, and subgroup analysis on the responders was performed. Results: Patients showing CR, partial remission (PR), and stable disease (SD)/progressive disease (PD) were 37.1% (n=78), 46.2% (n=97), and 16.7% (n=35), respectively. The median OS for CR, PR, and SD/PD were 47.9 months (mo), 21.8 mo, and 11.2 mo, respectively (P <0.001). Patients showing downstaging and no change/upstaging were 61.5% (n=129) and 38.5% (n=81), respectively. The median OS for downstaging and no change/upstaging were 36.5 mo and 14.4 mo, respectively (P <0.001). Among the 97 patients achieving PR, OS were statistically differed by downstaging (26.0 mo in patients with downstaging and 17.7 mo in patients without downstaging [P =0.021]). In the multivariate analyses, female, downstaging, lower initial TNM stage, and prophylactic cranial irradiation were independent good prognostic factors for OS. Conclusions: Downstaging was independent prognostic factor in LD-SCLC. Especially, downstaging is useful for further stratification of patients achieving PR. Additional treatments after CRT may be needed for the patients who achieving PR without downstaging.
Is erlotinib for first-line use in EGFR+ non-small-cell lung cancer cost-effective?
Authors: Veenstra David L , Bajaj Preeti S. , Carlson Josh John , Goertz Hans-Peter 
Published: March 2020

e19001 Background: A recent phase III clinical trial, EURTAC, demonstrated that first-line treatment with erlotinib significantly improved progression-free survival (PFS) compared with standard chemotherapy in advanced non-small cell lung cancer (NSCLC) patients whose tumors harbored epidermal growth factor receptor (EGFR) mutations (Rosell 2012). We sought to estimate the cost-utility of treatment with erlotinib in this patient population from the US payer perspective. Methods: We developed a Markov model with three health states: PFS, progression, and death. Patients received treatment until progression, unacceptable toxicity or death; patients randomized to chemotherapy received a maximum of 4 treatment cycles. Transition probabilities were extrapolated from the trial. Median PFS was 9.7 months in patients receiving erlotinib and 5.2 months in patients receiving chemotherapy (p<0.0001). Cost and utility data were obtained from the literature. Probabilistic sensitivity analysis (PSA) was performed to assess uncertainty. We evaluated two scenarios: 1) first-line erlotinib vs. first-line chemotherapy, and 2) first-line erlotinib and mixed second-line treatments vs. first-line chemotherapy and second-line erlotinib. Results: First-line treatment with erlotinib vs. chemotherapy resulted in an increase of 0.60 life-years or 0.44 quality-adjusted life-years (QALYs). Mean total costs were $59,300 in the erlotinib arm and $17,800 in the chemotherapy arm, yielding an incremental cost-effectiveness ratio (ICER) of $98,338 with a 53% probability of being cost-effective at a willingness to pay (WTP) of $100,000/QALY. In the second scenario, the ICER was $50,002/QALY, with a 66% probability of being cost-effective. The main cost drivers in the model were the time spent in the PFS health state and drug costs. Conclusions: Treatment with erlotinib in first-line EGFR-positive NSCLC results in increased costs but also substantial increases in QALYs, demonstrating that this personalized approached to treatment may be cost-effective.
Development of brain metastases in stage III/IV non-small cell lung cancer patients treated with or without erlotinib.
Authors: Liu Jing , Kong Li , Meng Xue , Yue Jinbo , Sun Xindong , Yu Jinming 
Published: March 2020

e19011 Background: Non-small cell lung cancer (NSCLC) has a risk of death from brain metastases (BM) that exceeds potential mortality from extracranial disease progression. Erlotinib has been proved to be effective for NSCLC patients. We hold a study to evaluate value of erlotinib in preventing BM in stage III/IV NSCLC patients. Methods: Pathologically confirmed NSCLC stage III/IV patients were included and divided into erlotinib group and control group according to whether erlotinib administration (at least one month) in 1- or 2-line therapy or not. Stage IV patients with BM were excluded. Patients with any EGFR-TKI treatment were excluded from control group. Times of erlotinib administration to BM and to death or last follow-up were recorded for erlotinib group. Times of corresponding 1- or 2-line chemotherapy to BM and to death or last follow-up were recorded for control group correspondingly. Time to BM, 1- and 2-year incidence of BM were end points. Results: 140 patients were included (68 in erlotinib group and 72 in control group) and all clinical characteristics between two groups were balanced. At a median follow-up of 20.0 months, the median time to BM for all patients was 28.0 months (95% CI, 23.795-32.205 months). 1- and 2-year incidence of BM were 17.8% (95% CI, 10.744-24.856%) and 38.8% (95% CI, 27.236-50.364%) respectively. The median time to BM were 42.0 months (95% CI, 15.567-68.433 months) and 19.0 months (95% CI, 11.305-26.695 months) (P=0.028) for erlotinib group and control group. Erilotinib group has a lower BM incidence than control group (1-year: 14.4%, 95% CI: 4.992%-23.808%, vs 21.1%, 95% CI: 10.712%-31.488%, P=0.384; 2-year: 26.2%, 95% CI: 18.712%-33.688%, vs 50.2%, 95% CI: 34.128%-66.272%, P=0.005). Multivariate analysis shows interval to BM were longer for erlotinib group (HR, 2.531; 95% CI, 1.272-5.051; P=0.008) and stage III disease (HR, 2.093; 95% CI, 1.035-4.231; P=0.040). Conclusions: Erlotinib administration improves time to BM and 2-year incidence of BM of stage III/IV NSCLC patients. Erlotinib administration and stage III disease predicts lower incidence of BM in all patients.
The association of toxicities and outcomes with circulating endothelial cells (CEC) in non-small cell lung cancer (NSCLC) patients (pts) treated with bevacizumab (Bev).
Authors: Hashemi Sadraei Nooshin , Du Lingling , Yadav Ruchi , Grane Ronald , Jacobs Barbara , Hamulak John , Ma Patrick C. , Pennell Nathan A. , Elson Paul , Borden Ernest C. 
Published: March 2020

e19012 Background: Bev in combination with chemotherapy (CT) is a standard treatment for pts with stage IV NSCLC. However, there are no established biomarkers to improve benefit-to-risk profile of therapy. CEC are a marker of vascular turnover. We hypothesized CEC may be associated with treatment outcome/toxicity. Methods: Stage IV NSCLC pts were treated with Bev along with CT of choice per clinician. CEC were measured at baseline and after 2 cycles of Bev-containing therapy. CellSearch (Veridex, New Jersey) was used to capture and quantify CEC via immunomagnetic and immunofluorescence techniques. CEC were enumerated as nucleated, CD146+/CD105+/CD45- cells in 4 mL of blood. For comparison, baseline CEC were also collected in 3 other groups; healthy subjects, stage I-III NSCLC, and advanced solid tumor pts. Chi-square tests and non-parametric methods were used to assess associations between CEC and pt/disease characteristics, toxicity, and proportional hazards models were used for comparisons of progression free and overall survival (PFS and OS). Results: Evaluated were 62 individuals: 29 stage IV NSCLC, 10 stage I-III NSCLC, 13 advanced solid tumors (melanoma, sarcoma, renal and adrenal cancers), and 10 healthy subjects. The median of CEC/ml blood in healthy subjects was 6. Based on its distribution, CEC >13/ml was deemed elevated. Elevated CEC was seen in 48% of stage IV NSCLC (median 12/ml), in comparison to 20% of stage I-III NSCLC (8/ml) and 23% of advanced solid tumors (6/ml) Baseline CEC in stage IV NSCLC was independent of patient/ disease characteristics including site of disease and tumor size. CEC increased during treatment in most patients (61%). CEC doubling between baseline and cycle2 was associated with more cytopenia and hemorrhage. (75% vs 20%, p=0.05 and p=0.03 for absolute and relative CEC changes). Baseline CEC and changes during treatment did not correlate with response (p≥ 0.32) and pts with elevated baseline CEC had a trend towards worse PFS (p=0.09) and OS (p=0.10). Conclusions: CEC are commonly elevated in advanced NSCLC. CEC increases may be predictive of adverse events from Bev-CT and when elevated at baseline may suggest worse PFS.
Impact of dendritic cells combining with cytokine-induced killer cells synergized chemotherapy in patients of advanced non-small cell lung cancer.
Authors: Zhong Runbo , Zhong Hua , Han Baohui 
Published: March 2020

e19018 Background: Advanced non-small cell lung cancer (NSCLC) remains an incurable disease by following conventional chemotherapy and is the major cause of cancer–related mortality worldwide. Dendritic cells (DC) play a central role in the induction of an effective antitumor immune response. Cytokine-induced killer (CIK) cells, the subset of T lymphocytes, have a profound capacity to cytolytically eliminate cancer cells. This study was designed to evaluate how the times of receiving DC/CIKs vaccination following regular chemotherapy impact the overall survival time in patients of advanced lung cancer. Methods: 43 patients suffering from IIIB-IV NSCLC were enrolled in the study between August 2004 and December 2008, and all received four courses of vinolbine-platinum (NP) chemotherapy followed by vaccinated with carcinoembryonic antigen (CEA) peptide-pulsed autologus dendritic cells and CIK cells. Vaccination was repeated at 30-day intervals until the patient refused to accept. The adverse effect and overall survival (OS) were evaluated. Results: Median survival time (MST) of all patients was 19.50 months. The 1-, 2- and 3-year overall survival rate was 66.50%, 41.04%, 28.14% respectively. The 1-, 2- and 3-year overall survival rate of patients who received no less than two times of vaccination therapy was 83.92%, 74.59%, 49.73% and who received only one time was 59.44%, 23.71%, 17.78% respectively. A statistically significant difference between the two groups was identified (p=0.0052). The adverse effect as a result of chemoimmunotherapy was tolerable. Conclusions: Advanced NSCLC patients can benefit from the combination of DC-CIK vaccination followed conventional chemotherapy,and the more vaccination therapy received the longer overall survival time observed.
The occurrence of grade 4 adverse events and survival outcomes in patients with nonsquamous non-small cell lung cancer receiving bevacizumab with chemotherapy in the phase III PointBreak and AVAiL studies.
Authors: Villaruz Liza Cosca , Socinski Mark A. , Patel Jyoti D. , Leon Larry , Hazard Sebastien , Reck Martin 
Published: March 2020

e19022 Background: Progression-free survival (PFS) is a key trial end point for clinical practice, as it relates to a change of treatment line. Grade 4 progression-free survival (G4PFS; defined as time from treatment start to the earlier of progressive disease [PD], onset of a G4 adverse event [AE], or death from any cause) is a composite end point incorporating a measure of tolerability to PFS. This post hoc analysis evaluates G4PFS and the effect of G4 AEs on PFS and overall survival (OS) in patients (pts) enrolled in PointBreak (PB) and AVAiL. Methods: Pts in PB were randomized to bevacizumab (BEV) 15 mg/kg q3w with carboplatin and paclitaxel (CP) or pemetrexed (CPem) for ≤4 cycles. Eligible pts received either BEV or BEV + Pem q3w until PD or unacceptable toxicity. Pts in AVAiL received cisplatin and gemcitabine for ≤6 cycles and either placebo or BEV (7.5 or 15 mg/kg) q3w until PD. AEs were graded via NCI-CTCAE v3.0. Kaplan-Meier and Cox model methods were used to estimate medians and hazard ratios (HRs) for PFS, G4PFS, and OS. PFS and OS were also compared in each arm for pts with occurrence of a G4 AE before week 12 of treatment vs those without. Results: Of those receiving BEV, ~30% of AVAiL pts and 38% of PB pts had a G4 AE. Uncomplicated neutropenia was the most common G4 AE in the CP + BEV arm of PB (26%) and in the BEV arms of AVAiL (11%). PFS, G4PFS, and outcomes by G4 AE occurrence are shown (Table). Conclusions: In both the PB and AVAiL trials, median G4PFS was numerically shorter than median PFS. G4 AE occurrence, however, did not affect subsequent PFS or OS in either trial. Clinical trial information: NCT00762034 and NCT00806923. [Table: see text]