bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute myeloid leukemia: Comparison of epidemiology and treatment outcomes between insured and uninsured patients.
Authors: Srour Samer Ali , Machiorlatti Michael , Bhutta Usman , Pierson Namali , Cherry Mohamad Ali , Pant Shubham , Thompson David , Kurkjian Carla 
Published: March 2020

e17012 Background: The overall prognosis for most acute myeloid leukemia (AML) patients remains poor. The majority of adult patients (pts) with AML will ultimately need allogeneic stem cell transplant (allo-SCT). Limited data is available comparing epidemiology and treatment outcomes between uninsured and insured pts with AML. We describe a retrospective analysis of adult pts with AML treated at our institution. Methods: From January 2000 to June 2011 we identified 239 pts with AML, of which 185 met inclusion criteria. Patients were classified as having private insurance, public insurance (Medicaid and Medicare), or no insurance. Primary outcomes were overall survival at follow up (OS), complete remission (CR), and percent of pts receiving allo-SCT. Kaplan-Meier analysis was used to estimate survival rates. Results: Of the 185 pts studied, 146 (81%) were white, 16 (9%) African-American and 11 (6%) were Native American. The median age at diagnosis was 49 years. 75 pts had private insurance at the time of diagnosis, 70 had public insurance, and 33 were uninsured. Of those receiving allo-SCT (n=60; 38 male) 48% had private insurance, 30% public, and 22% were uninsured. Whether a patient underwent allo-SCT did not differ according to insurance source (p=0.2189) nor to status at follow-up (p= 0.6480). The proportion of patients achieving CR was higher among those undergoing allo-SCT (p=0.0002). Median OS was 920 days for those who underwent allo-SCT and 192 days for those who did not (p< 0.0001). Median OS did not differ by insurance type (p = 0.1454). The proportion of patients achieving CR did not differ by insurance type (p=0.2665) (66.7% of those with private, 62.7% of those with public, and 78.8% of those with no insurance). Conclusions: For the population referred to our institution, a tertiary referral center for the state, there were no differences in treatment outcomes or in the percent of pts receiving allo-SCT when pts were stratified according to insurance source. Further analysis of this dataset will identify the impact of pretreatment variables stratified by type of insurance.
Survival disparity in childhood acute lymphoblastic leukemia (CHD-ALL): Lessons from challenges in Nigeria (NGR).
Authors: Williams Christopher Kwesi Oladipupo 
Published: March 2020

e17013 Background: Survival disparity in CHD-ALL between developed (DVDC) and developing countries (DVPC) are linked to care assess gap but probably also to geographical variations in disease subtypes and biology. Methods: In 1982-1984, using international study protocol, 39 NGR ALL cases were immunophenotyped: in 18 < 15 yr.old, 4 were "common" (c-) (%) (22.2), 2 null (11.1), 7 T (38.9 ), 4 B (22.2), and 1 (5.6) unclassifiable; in 21 ≥ 15 yr.old, these were 8 (38.1), 1 (4.8), 11 (52.4) 1 (4.8) and 0 (0.0) respectively, giving estimated CHD-ALL incidence (x10-5) compared with DVDC as 0.8 vs 2.6 for ALL, and 0.18 vs 1.9 for c-, 0.31 vs 0.38 for T subtypes. Remission (RMS) induction course was with iv vincristine 2.0mg/m2/week x 4, and prednisolone 40mg/m2 po daily x 28 days, iv doxorubicin hydrochloride 20-30mg/m2/day x 3 or cytosine arabinoside (ARA-C) 50mg/m2 iv q12 hours days 1 to 7, and Cyclophosphamide 650mg/m2 weekly x 2, this being repeated once in non-complete responders. Methotrexate (MTX) 12.5 mg/m2 or ARA-C 50mg/m2 was administered every 5 days x 6-8 doses intrathecally. Cranial irradiation and L-Asparaginase were not available. Complete and partial responders received 6-mercaptopurine 100mg/m2 daily and MTX 12.5mg/m2 per dose twice weekly as maintenance. RMS consolidation therapy was with 1-2 cycles of induction phase regimen but only 2 weeks of prednisolone. Results: Treatment (Rx) as planned (CRx) vis-à-vis deviant incomplete Rx were associated with RMS rate of 80% and 83%, mean RMS duration (days)157.8±115.3 and 83.4±52.2 (p>0.05), survival duration 193.5±156.4 and 174.3±114.0 (p>0.05). 25/26 patient had ≥1/7 adverse prognostic features. Rx failure due to CNS complications was rare in CRx. Conclusions: Rx outcomes were poor regardless of Rx quality. While the Rx regimen used differed from the contemporarily regimen in DVDC, equivalence in efficacy appeared likely, and unlikely to explain the failure pattern in NGR . Other explanations include the low CHD-ALL incidence in NGR as being due to the rarity of favorable and highly prevalent ALL subtypes of DVDC vis-à-vis less common poor prognostic subtypes of NGR. Improvement in CHD-ALL survival in DVPC requires novel Rx in addition to improved access to care.
Tolerability and toxicity of adjuvant cisplatin and gemcitabine for non-small cell lung cancer.
Authors: Li Xiao , Yang Fan , Jiang Guanchao , Wang Jun 
Published: March 2020

e17504 Background: The combination of cisplatin and vinorelbine is the evidence supported regimen for adjuvant chemotherapy of non-small cell lung cancer (NSCLC). But this doublet has considerable toxicity and unfavorable tolerability, and resulted in poor compliance. Cisplatin and gemcitabine regimen is one of the most active and well tolerated regimens against advanced NSCLC, but its toxicity and tolerability have not been adequately evaluated in the adjuvant setting. Methods: From a lung cancer database we retrospectively reviewed NSCLC patients receiving adjuvant chemotherapy of cisplatin (75 mg/m2) and gemcitabine (1250 mg/m2) between January 2005 and December 2011. Postoperative demographics, compliance to adjuvant therapy and toxicity were retrieved from medical records. Results: A total of 132 patients met the criteria and included in the study, 96 were males (72.7%)and 36 females (27.3%). Median age was 60.5 years (range, 29-75 years), and 41.7% patients were ≥65 years old. Overall, 68.2% received all four planned cycles, and cumulative dose delivered for gemcitabine was 8333 mg (83.3% planned) and cisplatin 248 mg (82.7% planned). There were no treatment-related deaths. Grade 3/4 neutropenia developed in 47 (35.6%) patients and was the predominant hematologic toxicity. Common grade 3/4 non-hematologic toxicities were nausea/vomiting (22.0%), infection (12.3%), and febrile neutropenia (11.4%). Conclusions: Cisplatin and gemcitabine are feasible in the adjuvant setting with favorable toxicity profile and superior tolerability compared with published data of cisplatin and vinorelbine.
Clinical characteristics, diagnosis, treatment, and prognosis in lung cancer patients under the age of 45.
Authors: Makrilia Nektaria , Strimpakos Alexios S , Gkiozos Ioannis , Syrigos Kostas N 
Published: March 2020

e17508 Background: Lung cancer remains uncommon among young adults but it causes great loss of life expectancy in this age group. The definition of young age varies in the published studies from 40 to 50 years of age. Methods: Our aim was to assess whether patients diagnosed at young ages have unique clinicopathological and prognostic characteristics. We retrospectively reviewed records of patients aged 45 or younger who were treated for primary lung cancer at a large tertiary center between June 2003 and June 2011. Results: 2,651 patients with lung cancer were screened of whom 73 (2.8%) were aged ≤45. The male-to-female ratio was 1.6:1 and the median age at diagnosis was 42. 89% of patients were smokers. Performance status (PS) was 0, 1 and 2 in 61%, 29% and 10% of patients, respectively. The most common histological types were adenocarcinoma (47%), small-cell lung cancer (SCLC) (18%) and squamous cell carcinoma (18%). The median time elapsing between beginning of symptoms and diagnosis was 3 months. Chronic hepatitis B or C was mentioned in the medical history of 5/13 (38%) SCLC patients, whereas it was present in 4/60 NSCLC patients under 45 (p=0.008) and in 16/518 SCLC patients over the age of 45 (p<0.0001). Patients were diagnosed with stages I, II, III and IV in 2 (3%), 11 (18%), 13 (22%) and 34 (57%) of NSCLC cases, respectively, whereas 7 of 13 (54%) SCLC patients were diagnosed with limited disease. The median overall survival was 21 months and multivariate analysis indicated that PS and time until diagnosis were independent prognostic factors. Conclusions: Although more than half of young patients are at stage IV when diagnosed, prognosis does not seem as dismal as previously considered. Larger studies need to be conducted in order to elucidate the possible role of chronic hepatitis in the pathogenesis of SCLC in young patients.
Hyperthermic intrapleural chemotherapy combined with endostar by video-assisted thoracoscopic surgery for lung adenocarcinoma with pleural dissemination.
Authors: Yu Lei 
Published: March 2020

e17542 Background: Patients with lung adenocarcinoma and malignant pleural effusions have limited life expectancy. The treatment of lung adenocarcinoma with malignant pleural effusions remains controversial. The purpose of our study is to evaluate the use of video-assisted thoracoscopy to perform hyperthermic intrapleural chemotherapy combined with Endostar (recombinant human endostatin) for disseminated pleural adenocarcinoma. Methods: From 2007 to 2010, there were 46 patients with lung adenocarcinoma and pleural dissemination undergoing thoracoscopic surgery and intrathoracic hyperthermic perfusion with chemotherapy in combination of Endostar. After thoracoscopic surgery, the hyperthermic perfusion system was set up for hyperthermic intrapleural chemotherapy. The thoracic cavity was perfused at a speed of approximately 1.8-2.3 L/min with 0.9% normal saline (4-5L), containing cisplatinum (100 mg). The intrathoracic temperature remained between 42°C to 43°C. This process of perfusion lasted for 1 hours. Following this, 2L of 0.45% saline with Endostar (30 mg) at a temperature of 30 °C was put into the pleural cavity and kept for 30 min. Results: There were no peri-operative deaths. During the hyperthermic perfusion, patient's core temperature varied from 36.3ºC and 39.3ºC and pulse from 59 beats/m and 126 beats/m. Intraoperative sinus tachycardia occurred in 2 elderly cases. No hematologic toxicity and nephrotoxicity was observed within one week after surgery. Postoperative pneumonia occurred in 1 elderly case. The median survival time was 21 months. During the follow-up period, only one patient suffered from continuing pleural effusion due to atelectasis, one elderly patient died of heart failure one year after surgery and the remaining patients were completely free from pleural effusion during the last follow-up. Conclusions: Hyperthermic intrapleural chemotherapy combined with Endostar by thoracoscopic surgery offers a safe and effective treatment for lung adenocarcinoma with pleural dissemination. It may be time-consuming, but beneficial and may have an encouraging impact on its long-term survival.
Erlotinib as neoadjuvant treatment in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC) with activating epidermal growth factor receptor (EGFR) mutation (NCT01217619, ESTERN).
Authors: Han Baohui , Xiong Liwen , Sun Jiayuan , Li Rong , Lou Yuqing , Zhang Yanwei 
Published: March 2020

e17551 Background: Patients with stage IIIA N2 NSCLC have poor outcomes with 5-year survival rate. Tyrosine kinase inhibitor monotherapy have been demonstrated a significant improvement in OR rate and PFS as first-line treatment for metastatic NSCLC patients with EGFR mutation. The objective of trial is to explore the efficacy and safety profile of erlotinib as neoadjuvant treatment in patients of stage IIIA-N2 NSCLC with EGFR mutation. The purpose of this neoadjuvant regime is to down-stage and increase complete resection rate in this patients setting. Methods: This is a single arm, one center, phase II study of erlotinib as neoadjuvant treatment in patients with Endobronchial Ultrasound (EBUS) confirmed stage IIIA-N2 NSCLC with activating EGFR mutation in exon 19 or 21. The primary endpoint is to evaluate radical resection rate. The secondary endpoint is pathological complete resection rate (pCR), objective response rate (ORR), disease free survival (DFS), overall survival (OS), quality of life (QoL) and safety profile. A total of 44 patients will be enrolled. Patients with IIIA-N2 NSCLC with pathologically confirmed ipsilateral mediastinal metastasis by EBUS. The biopsy specimen shows EGFR mutation in exon 19 or 21. All patients will be treated by erlotinib 150mg orally per day for 56 days. Patients will be assessed by Chest CT for the efficacy evaluation in day 29 and right after day 56. Patients get benefit from neoadjuvant treatment and evaluated as technically resectable will receive surgery. All the post-operative patients will receive standard adjuvant treatment. The adjuvant regime is decided by the investigator for the patients’ benefits. After adjuvant treatment patients will enter nomal follow-up including regular chest CT and ultrasound examination Results: Current enrollment: The study has enrolled 5 patients. One male patient, aged 47, with stable disease after neoadjuvant treatment, got right upper lobe resection on 17 Jan 2012. Conclusions: Erlotinib as neoadjuvant treatment in patients of stage IIIA-N2 NSCLC with activating EGFR mutation is feasible.
Incidence, severity, and etiology of treatment-related lymphopenia in patients with stage III non-small cell lung cancer (NSCLC).
Authors: Campian Jian Li , Ye Xiaobu , Hooker Craig , Brock Malcolm , Grossman Stuart A. 
Published: March 2020

e17552 Background: Severe treatment-related lymphopenia (TRL) is associated with shorter survival in patients with glioblastoma and pancreatic cancer treated with concurrent chemotherapy and radiation (chemo/RT). This retrospective study sought to determine if patients with stage III NSCLC develop TRL and if this results from chemotherapy or radiation. Methods: Patients selected for this retrospective analysis had newly diagnosed stage III NSCLC, Karnofsky performance status >60, and chemo/RT and follow-up blood counts at Johns Hopkins Hospital. Patients were divided into those who received neoadjuvant chemotherapy followed by chemo/RT and those who received only chemo/RT. Serial lymphocyte counts were analyzed. Results: Forty-six adults met the above eligibility criteria. Their median age was 62 years (range 43-79), 65% were female, 74% were stage IIIA and 26% were IIIB, 72% had adenocarcinoma, and 68% were poorly differentiated. Surgery included pneumonectomy (7%), lobectomy (43%), wedge resection (7%), or biopsy (43%). Twenty patients received neoadjuvant chemotherapy consisting of 2 cycles of taxol/carboplatin (85%) or gemcitabine/carboplatin (15%). Their mean total lymphocyte count (TLC) prior to chemotherapy was 1416 cells/mm3 (SD 899). TLC remained unchanged after the neoadjuvant chemotherapy (mean 1519, SD 553). These patients then received concurrent chemo/RT (mean dose 58.4 Gy). TLC fell 68% at two months from a mean of 1519 (SD 553) to 490 (SD 305) (p<0.00001) with 55% having TLC ≤500 cells/mm3. The remaining 26 patients received only concurrent chemo/RT. Their initial TLCs were normal (mean 1807, SD 644) but two months later had fallen by 70% (mean 545, SD 397) (p<0.00001) with 54% having TLC ≤500 cells/mm3. Reductions in TLCs occurred irrespective of the chemotherapy administered with RT. Conclusions: TLCs are normal in patients with newly diagnosed stage III NSCLC and are unaffected by 2 cycles of neoadjuvant chemotherapy. However, with the addition of radiation TLCs drop in ~50% of patients to levels associated with severe immunosuppression. Further studies are needed to determine if this is associated with reduced survival as reported in other malignancies.
Phase II trial of sorafenib in conjunction with chemotherapy and as maintenance therapy in extensive-stage small cell lung cancer (SCLC): Final results.
Authors: Sharma Neelesh , Pennell Nathan A. , Halmos Balazs , Ma Patrick C. , Dowlati Afshin 
Published: March 2020

e17563 Background: Sorafenib (S) is a small molecule multi-tyrosine kinase inhibitor of Raf kinase, VEGFR, and PDGFR. Angiogenesis is important for growth and progression of SCLC. This trial was conducted to evaluate whether the combination of cisplatin (P) and etoposide (E) plus concurrent and sequential S could prolong survival at one year in patients (pts) with previously untreated SCLC. Methods: Previously untreated pts with extensive stage SCLC, with ECOG 0-2 and adequate organ function were treated with P 60 mg/m2 day 1, E 120 mg/m2 days 1, 2, 3 x 4 cycles, concurrent with S 200 mg orally bid starting day 1 cycle 1. Pts with no disease progression after 4 cycles continued S 400 mg orally bid as maintenance for maximum of 12 months or until unacceptable toxicity, disease progression or withdrawal from the study. The primary endpoint was one year survival with response rate and safety of the combination as secondary endpoints. Total accrual of 28 pts from 3 centers was planned. Response and progression were monitored by CT’s every 8 week using RECIST criteria. Results: 12 and 17 pts were evaluable for response and adverse effects (AEs) respectively. Median age was 63 years (range 45 to 82), 9 pts (53%) were male. One pt had CR, 7 pts had PR and 1 pt had stable disease with an overall response rate of 67%. Overall median survival was 7.4 months and 1 year survival among response evaluable pts was 25%. The most common treatment-related adverse events included fatigue, anorexia, rash, diarrhea, neutropenia and weight loss. Grade 5 GI bleeding, pulmonary hemorrhage and neutropenia occurred in one pt (5%) each. Grade 4 events included neutropenia: 8 pts (47%), pneumonitis, thrombocytopenia and hypocalcemia in one pt each. Grade 3 events included supraventricular tachycardia: 2 pts (11%), hypocalcaemia and hyponatremia in two pts each. Accrual was halted on the basis of safety profile as well as preliminary efficacy data. Conclusions: Although the combination of EP plus S has anti-tumor activity in patients with extensive stage SCLC, at the current dose levels, this combination has significant AEs, is unlikely to be superior to standard treatment and is not recommended for further study.
Abnormal elevation of erythrocyte mean corpuscular volume (MCV) in non-small cell lung cancer (NSCLC) patients treated with maintenance pemetrexed-based chemotherapy.
Authors: Velez Michel , Raez Luis E. , Perez Cesar Augusto , Gomez Jorge E. , Mudad Raja , Vazquez Adrienne Marie , Santos Edgardo S. 
Published: March 2020

e17564 Background: Pemetrexed (Pem) is commonly used as frontline +/- maintenance chemotherapy (MCTx) in patients (pts) with advanced non-squamous (ns) NSCLC. Due to Pem toxicity profile, pts can remain on therapy (tx) for prolonged periods of time. We are reporting an increase in the erythrocyte MCV without apparent clinical significance. Methods: 54 ns-NSCLC pts previously treated with Pem-based tx either as initial treatment followed by MCTx Pem alone or Pem/bevacizumab (Bev) or second line tx were analyzed for elevation of MCV from a normal baseline (80-98 fl). All pts were on daily folic acid (FA) and vitamin B12 (vitB12) supplementation at least every 3 cycles of Pem. Co-factors such as FA, vitB12, homocysteine (Hom), and methylmalonic acid (MMA) were measured on those pts still alive, on active MCTx, and available who had high MCV. Results: 54 pts were evaluable; 50 pts received platinum/Pem/Bev triplet as initial tx followed by Pem/Bev or Pem MCTx and 2 pts with Pem/Bev and Pem alone as second line, respectively. Median age: 63 yrs old (34-84); 32 pts were male and 31 pts (56%) Hispanic. 32 pts (58%) developed an elevated MCV (range: 98.1-114). For the entire cohort, median # cycles of Pem given 11 (range: 2-38). In those pts who had high MCV, the median # of Pem cycles given was 12 (range: 5-38). All pts had normal or low MCV prior to tx, but one. Unfortunately, 33 pts had progressed and are no longer on MCTx. 12 pts out of the 19 still on MCTx had high MCV. In 5/12 pts, we were able to measure their co-factor levels. All values were within normal limits. The MCVs of these 5 pts were: 101.6, 100, 102.1, 102.2, and 104.8 from baseline values of: 74.4, 89.3, 92.8, 89.7, and 89.6, respectively. Their Hbg levels were: 12.2, 13.2, 15.4, 11.4, and 11 g/dL, respectively with normal WBC (and differential) and platelets. Conclusions: Pem is an antifolate agent that is associated with folate depletion (due to TS inhibition) and macrocytosis. We are reporting here patients treated with Pem for long time with proper FA and vitB12 supplementation that have an increased MCV with no apparent signs of folate, vitB12, MMA, and Hom deficiency. This observation needs a lengthened follow-up.
A phase II clinical trial of tumor-treating field (TTF) therapy concomitant to pemetrexed for advanced non-small cell lung cancer (NSCLC).
Authors: Pless Miklos , Betticher Daniel C. , Droege Cornelia M. , Salzberg Marc Oliver , Von Moos Roger 
Published: March 2020

e18012 Background: TTF therapy is a novel, non-invasive treatment modality for solid tumors recently approved by FDA for recurrent GBM. It uses intermediate frequency alternating electric fields to inhibit tumor growth, by mitotic spindle and plasma membrane integrity disruption during cytokinesis. Pemetrexed is a folate antimetabolite used as a first/second line and as a maintenance therapy for non-squamous NSCLC patients. Preclinical studies in NSCLC models demonstrated that TTF therapy and pemetrexed had additive efficacy, with no increase in toxicity. The current trial tested TTF therapy concomitant to pemetrexed in NSCLC patients. Methods: A single arm, multi-center, prospective trial was performed in 42 stage IIIB (with pleural effusion) and IV NSCLC patients, following progression after at least one prior chemotherapy. Patients received continuous 150 KHz TTF therapy (12 h/day) using the NovoTTF-100L system (NovoCure, Israel), concomitant to pemetrexed (Alimta™, Eli Lilly) q3w, until progression. Pemetrexed was in use for squamous histology when the study opened. Results: The trial included 35 patients with non-squamous histology and 7 patients with squamous histology. TTF Therapy was well tolerated by all patients enrolled in the trial, with high compliance (11 h/day). No TTF-related adverse events were reported apart from dermatitis caused by the application of transducer arrays. Median progression free survival was 22.7 and 10.3 weeks for non-squamous and squamous histology, respectively. Median overall survival was 12.4 and 13.8 months for nonsquamous and squamous histology, respectively. One- and two- year-survival was 53% and 27%, respectively. Conclusions: TTF therapy concomitant to pemetrexed was well tolerated and safe for patients with advanced NSCLC, of all histologies. Efficacy indices are promising, in view of the poor outcome previously reported for similar populations. This first clinical trial involving TTF as a treatment for NSCLC patients suggests that it should be further studied in larger clinical trials for squamous and nonsquamous NSCLC.