bluuebunny/crossref_metadata_2025_split huggingface dataset:
A survey of Canadian medical oncologists on internet use for medical information and a needs assessment for an oncology education website
Authors: Verma S. , Horn L. , Chung J. , Vijayaratnam S. , Berry S. 
Published: March 2020

17072 Background: The internet offers an innovative resource for medical oncologists to share and discuss important medical information and advances. Despite the existence of many websites with oncology related information, there has not been a comprehensive assessment of how Canadian medical oncologists use the internet to access this information. Purpose: In the first phase of developing a new educational website (OncologyEducation.com), we surveyed Canadian medical oncologists to determine how they used the internet to access information and to assess their needs for a web based educational resource. Method: A structured survey was developed and assessed for face and content validity by medical oncologists from our local institution. The survey had several domains including: comfort level with computers, description of internet use for work, and key features they would want in an educational website. The survey was sent to all medical oncologists in Canada via regular mail and e-mail. Results: 58 % (144/247) of medical oncologists responded to our survey. The number of years in practice varied from <5 yrs (31%) to 5–10 yrs (30%), and 11–20 years (15%) with 85% having an academic appointment. 90% of respondents were comfortable with using a computer. The most common reasons for internet use were email (91%), literature updates (78%), and answering clinical questions (72%). 27% of respondents used the internet for clinical questions daily, and 29% on a weekly basis. 49% accessed the internet for work-related information for 1–5 hours weekly, 26% for 6–10 hours weekly, and 20% for more than 11hrs weekly. Respondents expressed a need for an educational website stressing the following content: (1) Canadian Oncologists Database to improve opportunities for collaboration (2) Key updates by disease sites (3) Access to information about upcoming conferences. Conclusion: The internet plays a major role in the daily clinical activities of Canadian medical oncologists. The development of an education website based on the needs assessed in this survey is warranted. We are currently developing this site (OncologyEducation.com) and plan to evaluate on an ongoing basis. No significant financial relationships to disclose.
Direct hospital costs of skeletal-related events (SRE) in Portuguese patients (pts) with breast cancer (BC) and bone metastases
Authors: Felix J. , Andreozzi V. , Soares M. , Gervásio H. , Moreira A. , Costa L. , Peralta F. , Furtado I. , Albuquerque C. , Passos- Coelho J. 
Published: March 2020

17084 Background: SRE such as pathological fractures, spinal cord compression, surgery or radiation therapy to bone and tumour- induced hypercalcemia account for substantial health resource utilization (HRU). The objective of this study was to investigate SRE-related direct hospital costs in Portuguese pts with BC and bone metastases. Methods: Pts with BC and at least one SRE within 12 months prior to study entry were eligible for this retrospective medical record review cost analysis study. SRE treatment cost were calculated by multiplying 12 month health resource utilization frequency (hospitalization, clinic visits, diagnostic tests, drugs) by the corresponding unit costs from the Portuguese Ministry of Health costs database. To account for the skewed nature of the data, costs were modelled using generalized linear models with gamma distribution and log link. Results: A total of 121 pts (age at bone metastases, mean 56.8 years, range 21- 89) from six different hospitals in Portugal were included. Median time from BC diagnosis to bone metastases was 38 months [CI95%: 24–57]. ECOG performance status at the time of SRE was 0 in 24.6% of pts, 1 in 45.9%, 2 in 18.0%, 3 in 8.2% and 4 in 3.3%. Total number of SRE over twelve months was 142 (mean 1.2 SRE/pts, SD=0.4) distributed as follows: pathological fractures (12.7%), spinal cord compression (4.9%), surgery to bone (1.4%), radiation therapy to bone (74.7%) and tumour induced hypercalcemia (6.3%) . Mean SRE treatment cost over 12 months was 5,963€ (SD=3,646€): hospitalization 1,312€, clinic visits 36€, diagnostics 103€, radiotherapy 1,481€, drugs 3,031€. According to biphosphonate (Bph) use in the prior 12 months, the mean (SD; pts) unadjusted SRE treatment cost was: no Bph 2,282€ (1,491; n=4), oral Bph 1,579€ (1,123; n=5), zoledronic acid 6,221€ (2,923; n=77), pamidronate 6,766€ (4,476; n=33). When excluding Bph costs, pamidronate pts were 1.8 [95% CI: 1.3–2.7] times more expensive than zoledronic acid when controlling for pts’ clinical characteristics. Conclusions: This study confirms prior data on the high cost of SRE in pts with BC metastatic to bone [Table: see text]
Phase I trial of gemcitabine (GEM) infused at fixed-dose rate (FDR) with high-dose docetaxel/melphalan/carboplatin (GEM-DMC) and autologous stem-cell transplant (ASCT)
Authors: Nieto Y. , Rifon J. , Perez-Calvo J. , Zafra A. , Zufia L. , Viudez A. , Viteri S. , Sayan O. , Hernandez M. , Aldaz A. 
Published: March 2020

17500 Background: More active ASCT regimens are needed. We combined GEM, which inhibits DNA damage repair, with the potent DMC regimen (BBMT 11:297–306,2005). GEM infusions at FDR of 10 mg/m2/min, targeting steady-state concentrations (Css) <20 μM, which in vitro do not saturate its intracellular activation to GEM-triphosphate (GEM-TP), result in greater activity but more myelotoxicity than its usual short infusions. Methods: Pts with advanced, refractory tumors and normal organ function were eligible. Study endpoints: to define the maximum tolerated duration (MTD) of GEM at FDR with ASCT, dose-limiting toxicity (DLT) and regimen-related toxicity (RRT) of GEM-DMC, and pharmacokinetics (PK) of high-dose GEM and docetaxel. Daily GEM FDR infusions (d-5 to d-2) were extended in sequential cohorts (total length: 9 to 20 hr), followed on d-5 by docetaxel (350 mg/m2), on d-4 to d-2 by melphalan (50 mg/m2/d) and carboplatin (333 mg/m2/d), and ASCT on d0. Results: 52 pts accrued (breast ca [N=31], Ewing's [5], germ-cell [4], lymphoma [4], Hodgkin's [3], sarcoma [5]), median age 40 (6–66), 3 median prior chemo regimens and 3 organs involved. GEM MTD: 5 hr/d x 4 (total 20 hr, 12 g/m2). Neutrophils engrafted on d+8 (6–10) and platelets on d+11 (8–33). There were 3 non-RRT deaths (1 aspiration, 2 catheter-related sepsis). At the MTD (N=25), enteritis (20% G3) was DLT; all other RRT were = G3 and reversible (28% stomatitis, 8% ileus, 8% rash). The response rate was 97% (60% complete). At median follow-up of 18 (7–27) months, 58% EFS (median 22 mo) and 85% OS rates (median not reached). All pts had GEM Css <20 μM. The infusion length correlated linearly with the AUC of GEM (r2= 0.65, p<10-5) but not with its clearance (r2=0.03) or t1/2 (r2= 0.02). GEM AUC was associated with G3 RRT (p<10-3). The AUCs of GEM and GEM-TP (/106 mononuclear cells) correlated on d-5 (r2=0.5, p=0.01), but not on d-2 (r2= 0.05) due to late GEM-TP accumulation. Docetaxel had 3–4 fold higher AUC and peak levels and similar clearance compared to its standard-dose population PK. Conclusions: GEM-DMC, markedly extending GEM infusions at FDR, is tolerable and highly active, without saturating the activation of GEM to GEM-TP. High-dose GEM and docetaxel show adequate linear PK. No significant financial relationships to disclose.
To assess the response and toxicity of imatinib mesylate and low-dose cytarabine in imatinib non-responder chronic myeloid leukemia, chronic phase (CML-CP) patients: A pilot study
Authors: Singh N. , Kumar L. , Kochupillae V. , Raina V. , Sharma A. , Velpandian T. 
Published: March 2020

17507 Background: To overcome primary imatinib mesylate (Gleevec ) resistance, we used a combination of imatinib mesylate and low dose cytarabine to treat patients of CML-CP. Methods: Between January 2005 and July 2006, 30 patients (median age 34 years, range 20 to 57 years, M:F ratio 5:1) were enrolled. 2/30 patients had primary hematological and 28/30 had primary cytogenetic resistance. 7 patients had been pretreated with interferon alpha. Treatment consisted of imatinib 400mg daily and cytarabine 10mg subcutaneous daily for 10 days every month. Median of 5 cycles (range 3–6) was administered. Patients were monitored on outpatient basis with weekly blood counts. Bone marrow cytogenetics was done 3 monthly to assess cytogenetic response (CGR). Toxicity was recorded as per NCI CTC (version 2). Primary end points were response and toxicity at the end of 6 cycles. We measured plasma imatinib levels by HPLC in 20 of these patients (J Chromatography B 2004;84:431–34) and compared the levels with 20 patients who were imatinib responders. Results: 11/30 (37%) patients obtained major CGR including complete CGR in 6/30 (20%). None of the patients with primary hematological resistance responded. Grade 3/4 hematological and non hematological toxicities were seen in 3.33% (n=1) and6.66% (n=2) patients respectively. 8/30 (27%) patients discontinued treatment due to reversible cardiac arrest (n=1), hepatitis (n=1), progression to BC/AP (n=2), grade 4 thrombocytopenia (n=1), loss of CHR (n=2), and consent withdrawl (n=1). The mean plasma imatinib levels in non responders were significantly lower, compared to imatinib responders (0.70 micro moles vs 2.34 micro moles, p=0.002). Conclusions: Present study confirms the activity of low dose cytarabine and imatinib in patients having primary cytogenetic resistance. The reasons for low plasma imatinib levels among non responders and methods to circumvent so as to achieve higher plasma levels of imatinib needs further study. No significant financial relationships to disclose.
Dasatinib phase I/II study of patients with chronic myeloid leukemia (CML) resistant or intolerant to imatinib: Results of the CA180031 study in Japan
Authors: Sakamaki H. , Ishizawa K. , Taniwaki M. , Fujisawa S. , Morishima Y. , Tobinai K. , Okada M. , Ando K. , Ueda K. , Ohno R. 
Published: March 2020

17515 Background: Dasatinib is a potent, orally active, multi-targeted kinase inhibitor of BCR-ABL and SRC family kinases. Studies outside Japan have shown dasatinib to be highly effective in overcoming resistance and intolerance to imatinib, inducing durable cytogenetic (CyR) and hematologic responses (HR) in this population. The maximum tolerated dose was not reached in the Phase-I trial outside Japan and a 70-mg BID dose was determined to provide the optimal benefit-risk profile. Methods: This Phase-I/-II study was designed to assess the safety and efficacy of dasatinib in Japanese patients with imatinib-resistant or -intolerant CML or Ph+ALL. In the 4-week Phase-I portion in patients with chronic-phase (CP) CML, three dose levels were evaluated: 50 mg, 70 mg, and 90 mg BID. The Phase-II portion is currently evaluating the CyR of dasatinib in patients with CP-CML at 24 weeks, and the HR rate in accelerated- (AP) or blast-phase (BP) CML and Ph+ ALL at 12 weeks. Results: As of December 2006, 17 eligible patients have been treated in Phase I. Six patients (4F, 2M; median age 43 y [range 27–56]) were treated with 50 mg BID and 1 dose-limiting toxicity (DLT) was observed (Grade 4 thrombocytopenia). Two patients experienced transient Grade 3 ALT elevations but as treatment was uninterrupted, these were not considered DLTs. Six patients (6M; median age 42 y [range 27–55]) were treated with 70 mg BID and again 1 DLT was observed (Grade 4 thrombocytopenia). No DLT has been observed among 4 patients (3M, 1F; median age 41 y [range 27–64]) at the 90-mg BID dose. Major CyRs have been achieved in all three cohorts in the Phase-I segment of the trial. Thirty six patients were enrolled and treated in the Phase-II part of the trial (12 CP-CML, 7 AP- CML, 4 BP-CML, and 13 Ph+ALL). Efficacy and safety data as well as the baseline BCR-ABL mutation data are currently being assessed and will be presented. Conclusions: Dasatinib can be safely administered at doses of up to 90 mg BID to Japanese patients with imatinib-resistant or -intolerant CP-CML. No significant financial relationships to disclose.
Pattern of extramedullary relapse in latin patients with acute promyelocytic leukemia (APL) treated with all-trans-retinoic acid (ATRA) and chemotherapy
Authors: Casanova L. A. , Quintana S. M. , Neciosup S. P. , Samanez C. A. 
Published: March 2020

17520 Background: Extramedullary relapse (EMR) is a rare event in APL and reports have suggested a possible rol of ATRA in its pathogenesis. Our study intent to determine the pattern of EMR in Latin patients treated whit trans-retinoic acid (ATRA) and chemotherapy (CT). Methods: We evaluated 87 patients diagnosed of APL from January 2001 to December 2005. They were treated with ATRA and chemotherapy. Results: 74/87 received ATRA plus chemotherapy. Median age was 28 (5–68). 39/74 (53%) patients were female. Subtype M3v constituted 21/74 (28%). 76% presented disseminated intravascular coagulation (DIC). Extramedullary deposit was observed in 7 cases, more frequent was central nervous system (CNS). According the Sanz Index, 32/74 (32%) were High Risk, 40/74 (54%) Intermediate Risk, 2 Low Risk. 31/55 (56%) presented t(15,17). 52/74 (70%) patients had complete response. EMR was documented in 8 (15%) (CNS: 5, External Auditory Foramen: 3), 4 were High Risk. Median time to EMR was 11.5 months (7.03–27.3). 55% are alive at date. The following median was 36 months, 41 months of Disease Free Survival (DFS), rate was 62 % to 3 years. Overall survival was 44 months; rate was 83% to 3 years. Conclusions: EMR incidence was 8%, higher report that other series, this event was presented in CNS and external auditory foramen. It suggest to establish EMR risk factors and to include CNS prophylactic treatment. No significant financial relationships to disclose.
Imatinib mesylate in newly diagnosed patients of chronic myeloid leukemia chronic phase: A comparative study
Authors: Jacob L. A. , Bapsy P. P. , Govindbabu K. , Lokanatha D. 
Published: March 2020

17521 Background: Two single centre experiences from India on the use of Imatinib mesylate in the treatment of chronic myeloid leukemia chronic phase (CML-CP) have shown somewhat similar results. While complete hematological response (CHR) achieved in the two studies was comparable to Western data, major cytogenetic response (MCR) and complete cytogenetic response (CCR) were much lower. Both studies had included newly diagnosed as well as previously treated patients. This study was undertaken to evaluate the efficacy and safety of imatinib mesylate, only in newly diagnosed patients of CML-CP and to compare the results obtained with those reported in literature. Methods: The study population included 100 newly diagnosed patients of CML-CP. Therapy was initiated with imatinib mesylate 400mg orally daily and patients monitored carefully for any adverse effects. After 6 months of treatment, bone marrow aspiration and cytogenetics were repeated to ascertain the response. In patients not achieving a MCR, the dose of imatinib was increased to 600mg daily and therapy continued. Results: In the present study, although imatinib produced CHR in 90% of the patients; only 50% achieved a MCR at 6 months and 55% at 12 months as compared to the 86- 87% reported in major trials involving newly diagnosed patients of CML-CP. The drug was safe and well tolerated. A comparison of patient characteristics with those in the Western studies revealed that majority of the Indian patients probably presented late in the disease course. A higher incidence of adverse genomic factors at diagnosis leading to rapid progression of disease could be the probable explanation for this. Conclusions: Thus based on our present study, we conclude that there is a difference in the efficacy profile of imatinib in Indian patients as compared to the West, the reasons for which needs to be investigated and validated. No significant financial relationships to disclose.
Outcome of prophylactic cranial radiotherapy in children with ALL
Authors: Ozden S. , Ozyurt H. , Ozgen Z. , Ozseker N. , Parlak C. , Mayadagli A. 
Published: March 2020

17532 Background: The aim of this study was to evaluate influence of prophylactic cranial radiotherapy (RT) and prognostic factors on overall survival (OS) in patients with acute lymphoblastic leukemia (ALL), retrospectively. Methods: Forty nine children referred to Dr. Lutfi Kirdar Kartal Education and Research Hospital to undergo prophylactic cranial RT for the diagnosis of ALL between years 1997–2003 were analyzed retrospectively to determine cranial recurrence rate. Eleven patients were considered as loss due to loss of contact. Survival analyses were carried out by Kaplan Meier. Results: Median follow-up time was 49 months. Of the 49 cases, 30 (61,2%) were male, and 19 (38,8%) were female. Median age was 6 years (2–18). Moderate to high risk patients who revealed remission after chemotherapy (CT) had been referred to our clinic for RT. At the time of presentation, 5 patients had CNS involvement, and one patient had mass in his right eye. Craniospinal RT was performed to 4 patients while others received total cranial RT including C1–2 vertebra. RT was given with Co 60 in various dose and fractionation schedules (120–200cGy/fx) to total doses ranging from 11,4 to 24 Gy in 7–16 fractions. There was a statistically significant survival difference between cases treated at doses <18 Gy (n:15) and those treated at doses >18 Gy (n:23) in favor of higher RT doses (OS: 35,5 vs. . 44,1 months, p=0.01). Cases with no CNS involvement at presentation revealed a significant overall and disease free survival (DFS) advantage over cases with involvement (OS: 44,2 vs. 22,5 months, DFS:40,7 vs. 19,5 months, p=0.001). OS analyses of 24 cases whose leukocyte counts (LC) were determined at the time of diagnosis revealed OS of 57,5, 35,6, 36,2 months for those with LC of <10000 (n:9), 10000–50000 (n:5) and >50000 (n:10), respectively (p=0,01). There was no notable influence of sex or age on survival. CNS recurrence was seen in only 2 male patients. No morbidity related to RT was experienced in any of the patients that are still alive. Conclusions: Prophylactic cranial RT of 18 Gy is a well-tolerated treatment option for children with the diagnosis of ALL, and optimal dose for better outcome should be identified. No significant financial relationships to disclose.
Multivariate dimensions of hemotologic chaos indices for responders versus non-responders of patients with myelodysplastic syndromes (MDS) after treatment with ptx/cipro/decadron: A qualitative study
Authors: Huang R. R. , Raza A. 
Published: March 2020

17540 Background: In our clinical study of 35 MDS patients who were treated with PTX/Cipro/Decadron, there was an 80% response rate in terms of achieving improved hematopoiesis (responders) during a 4-week period. The primary question of interest was, “What were the hematologic dynamic patterns that transpired between patients who responded versus those who did not?” The purpose of this study was an attempt to answer this question by applying chaos theory to peruse the underlying patterns that may have prognosis utility. Methods: Responders and non-responders were identified and were matched by age, sex, and FAB type. Only those patients who have sufficient and complete hematologic evaluations after treatment with at least 6 months follow-up to derive stable chaotic indices were included. The resulted sample was 3 patients from the non-responded group and 4 patients from the responded group. The three selected hematoloic parametes were white blood count, hemoglobin and platelets. The selected chaos index to indicate its magnitude of across time was the fractal dimension that has three components, namely capacity, information and correlational. Results: The mean ages for the non-responders and responders were 68 and 65, respectively. The median number of weeks evaluated was 38 for the non-responders and 35 weeks for the responders. The three hematologic parameters were analyzed simultaneously in the form of 3-dimensional space. Table indicates the chaos fractal indices for the two groups. Conclusion: Across the three indices, non-responders have an average of 7.4 % larger than responders, suggesting the former exhibited a relatively higher degree of “chaos” than the latter. For prognosis purpose, this result also suggests that patients who exhibit lower magnitude of the chaotic phenomena, will have a higher probability of responding to therapy. This work was done while the authors were at Rush-Presbyterian-St.Luke’s Medical Center. [Table: see text] No significant financial relationships to disclose.
A phase II study of carboplatin (C) and weekly paclitaxel (P) with a selective cyclooxygenase-2 (COX-2) inhibitor, meloxicam, in advanced non-small cell lung cancer (NSCLC)
Authors: Suzuki R. , Yamamoto M. , Saka H. , Taniguchi H. , Shindo J. , Tanikawa Y. , Nomura S. , Oishi T. , Hasegawa Y. , Shimokata K. 
Published: March 2020

18007 Background: COX-2 overexpression is seen in many malignancies including lung cancer. Recent pre-clinical studies have shown that selective COX-2 inhibitors have demonstrated promising results when used with chemotherapy. Based on these observations, we are assessing the efficacy and tolerability of the combination chemotherapy consisting of C and P with meloxicam, a selective COX-2 inhibitor. Methods: Patients with stage IIIB or IV, ECOG PS 0 or 1, who had adequate organ function, were eligible. Patients received P 70 mg/m2 weekly for 3 of 4 weeks with C (AUC 6) on day 1, as well as daily meloxicam (10 mg/day). Response rate was the primary endpoint. Secondary endpoints were overall survival, toxicity profile and QOL (Using EORTC QLQ-C30 and LC13). Results: From March 2005 until September 2006, forty-four patients were evaluated in this study. Gender M/F; 31/13, median age; 64 yr (range, 34–75), stage IIIB/IV; 11/33, PS0/1; 22/22, histology Ad/Sq/Others; 29/6/9. Partial response was observed in 19 patients (43%), and no complete response, yielding an overall response rate of 43% (95% confidence interval, 28.5%-57.8%). Nineteen patients (43%) had stable disease. Seven patients (16%) had grade (G) 3 and three (7%) had G4 neutropenia. Three patients (7%) had G3 thrombocytopenia. As for non-hematological toxicities, one G4 toxicity (perforation of jejunum) was observed, but the other toxicities were mild (one muscle pain, 2 liver dysfunction, 1 fatigue and 1 nausea G3). Grade 2 peripheral neuropathy was observed in only one patient. Using EORTC QLO questioner, the global health status did not changed significantly during this therapy (before and 4 and 8 weeks later). Median follow-up was 9.6 months (range, 1.8–22.7 months). At the time of the final analysis (January 2007), 16 patients had died. The one-year survival rate was 70% and MST was not reached till now. Conclusions: Meloxicam in combination with C and weekly P chemotherapy showed promising activity with encouraging survival. This therapy is relatively well-tolerated in advanced NSCLC. No significant financial relationships to disclose.
Meta-analysis of pemetrexed (P) plus gemcitabine (G) in first-line, advanced (adv) non-small cell lung cancer (NSCLC)
Authors: Ye Z. , Treat J. A. 
Published: March 2020

18015 Background: Clinical trials with varying schedules and doses of P and G have demonstrated anti-tumor activity in NSCLC. Methods: This report summarizes best response and toxicity data of 4 clinical trials using PG regimens in 1st-line, adv NSCLC. Pt populations were similar and included measurable or evaluable Stage IIIB-IV disease. Results: *Excludes 1 pt considered inevaluble for neutropenia **One pt died due to thrombocytopenia. Conclusion: Based on the results of these 4 trials, PG was efficacious and well tolerated as 1st-line therapy for pts with adv NSCLC. A low incidence of alopecia and Gr 4 thrombocytopenia are noted. [Table: see text] [Table: see text]