bluuebunny/crossref_metadata_2025_split huggingface dataset:
The experience in the management of 15 patients with chronic myeloid leukemia (CML) in a community clinic in Puerto Rico.
Authors: Castro Justiniano 
Published: March 2020

e18015 Background: CML is a malignant clonal disorder of the hematopoietic stem cells that results in an increased myeloid cells but also erythroid and platelets in the peripheral blood and marked myeloid hyperplasia in the bone marrow. The management of this condition in a rural community clinic is a challenge due to the complexity in the routine monitor of these patients with molecular studies. In addition, data from Hispanic population treated with imatinib in USA is limited. Methods: A total of 15 patient with CML followed in a private clinic form June 2001 to January 2012 were included in the analysis for the study. Results: The patients included 10 males and 5 females. Median age was 51 years. All patients received imatinib 400mg. There were 4 patients with initial WBC > 50,000/mm3. All patients were in chronic phase with less 1% of blasts, except for one that had 7%. Twelve patients had a low Harford score, 2 with moderate and 1 high risk. Conclusions: Our data suggest that imatinib is highly effective in this population of patients. The CCR at 6 months was 80% and the MMR at 12 months was 80% compared with the data from the IRIS (CCR at 6 months, 74.7%) and DASISON (MMR at 12 months, 28%) trials. This group of patients demonstrates high CHR, CCR and MMR in comparison of what is reported in the literature. The study also present a group of Hispanic patients were the information about imatinib response is limited. The possibly that certain ethnic group has a different pattern of response as compared with Caucasian is intriguing. Lastly, it is evident that adequate care could be offer event in rural community clinics. [Table: see text]
Does presence of chronic obstructive pulmonary disease (COPD) influence clinical behavior in patients with early-stage non-small cell lung cancer (ESNSCLC)?
Authors: Yamamoto Satomi , Kawaguchi Tomoya , Tamura Taro , Asami Kazuhiro , Okishio Kyoichi , Atagi Shinji , Yoon Hyungeun , Matsumura Akihide , Shimizu Shigeki , Kitaichi Masanori , Takada Minoru , Hirata Kazuto 
Published: March 2020

e18530 Background: CDPD and lung cancer sometimes occurs simultaneously. COPD has been recognized as an inflammatory disease and may potentially affect biology of the accompanying tumor. It is not fully understood whether presence of CDPD influences clinical characteristics, pathological findings and/or clinical outcomes in patients with ESNSCLC. Methods: Retrospective and consecutive data were collected from the medical records of patients who underwent surgical resections at Kinki-chuo Chest Medical Center, Japan, between January 2009 and December 2010. CDPD status was classified as absence of COPD, stage I and II COPD based on the criteria of Global Initiative for Chronic Obstructive Lung Disease (GOLD). Histology, vascular / lymphatic invasion and the status of epidermal growth factor receptor (EGFR) were determined using the surgical materials. Results: A total of 319 cases was included with median age of 67 (range, 36 - 89). There were 81 cases of relapse and 40 cases of death during the median follow up of 28 months (11 days to 49 months). In the subgroup of non-COPD, stage I and II COPD, the median age, the number of case in gender (male/female), performance status (PS, 0/1), histology (squamous cell carcinoma [SQ] /non SQ), smoking status (never/ever), and EGFR status (wild type/mutant) were 67, 72, 72 (p<0.001) and 105/110, 48/12, 38/6 (p<0.001) and 170/40, 53/7, 27/14 (p=0.029) and 31/184, 12/48, 14/28 (p<0.001) and 89/122, 7/53, 2/39 (p=0.002) and 47/37, 21/3, 9/3 (p=0.013), respectively. No significant difference was observed in disease-free survival (DFS, log-rank p=0.411) and overall survival (OS, log-rank p=0.127) between the patients with and without COPD. In multivariate analysis adjusted for age, gender, PS, histology, smoking status, pathological stage, vascular / lymphatic invasion and EGFR status, presence of COPD did not affect DFS (HR=1.457, p = 0.279) nor OS (HR=0.993, p = 0.990).Conclusions: Although COPD was significantly associated with the elderly, male gender, presence of symptoms, SQ histology, ever smoking, and wild type EGFR, it did not add values of prognostic factors in patients with ESNSCLC.
Capecitabine-gemcitabine in thymic epithelial tumors.
Authors: Palmieri Giovannella , Buonerba Carlo , Di Lorenzo Giuseppe , Federico Piera , Nappi Lucia , Rescigno Pasquale , Calabrese Filomena , Ottaviano Margaret , De Placido Sabino , Damiano Vincenzo 
Published: March 2020

e18536 Background: Thymic epithelial tumors (TET) are a rare disease. Once loco-regional treatments have failed, platinum-based chemotherapy is employed to prolong survival and palliate symptoms. In November 2005, we started prospective multi-center trial to test capecitabine-gemcitabine in pretreated TET. Mature results are awaited. We here retrospectively review all patients with TET treated at our Institution with this schedule. Methods: Patients with pathologically confirmed TET receiving at least one cycle of capecitabine-gemcitabine were included in this analysis. Descriptive statistics and frequency counts were used to summarize characteristics of the study population. Median numbers were presented with interquartile ranges. Results: Twenty-three patients were included in this single-center analysis. Six patients had a thymic carcinoma, while three, eight, two and four patients had a B1, B2, B2/B3 and B3 TET, respectively. Median age was 52 years (47-58).Eleven patients were female. Gemcitabine was delivered at the dose of 800-1,000 mg/m2 by 30-minute infusion on days 1 and 8 every 3 weeks along with oral capecitabine at the dose of 500-650 mg/m2 twice daily on days 1 to 14. Fourteen patients had an ECOG performance status of 0, one of 2, the remaining of 1. Seven patients had an IV a tumor, while the remaining had a IVb tumor. All patients, except for three for whom capecitabine-gemcitabine was the first line of therapy, had received a platinum-based regimen. Only one patient was primary refractory, while a complete response was obtained in 2 patients, a partial response in four patients, and the remaining had stable disease. Median PFS was 7 months (range, 4-9). Median survival was 12 months (6-20). Treatment was well tolerated. Twelve patients showed grade 3/4 toxicity, of whom two patients showed severe anemia, six severe neutropenia, four severe thrombocytopenia, two severe diarrhea and one severe fatigue. Conclusions: In this retrospective analysis, gemcitabine-capecitabine was confirmed to have a high activity in TET. Mature results from the ongoing multicenter trial are awaited.
Did the 2004 World Health Organization (WHO) histologic classification result in better prognostic categories for resected thymomas as compared to 1999 WHO classification scheme?
Authors: Yonan Yousif , Zander Dani , Varlotto John M. , Toth Jennifer , Reed Michael , Gilbert Christopher , Flickinger John Charles , Recht Abram , Belani Chandra Prakash , DeCamp Malcolm M. 
Published: March 2020

e18552 Background: The classification of thymic epithelial neoplasms is subject of controversy. The purpose of our investigation is to see whether the 2004 histologic classification results in better prognostic categories than that of the 1999 classification. Methods: The SEER 18 database was used to investigate incidence and overall survival/cause-specific survival (OS/CSS) of resected thymomas during 2000-2009. Incidence was examined by frequency and trend analyses. Patients diagnosed with first primary localized thymoma/thymic carcinoma were selected in two time periods (2000-2003: N=201; 2005-2009: N = 497). The median follow up is 79 months and 27 months respectively. OS/CSS in two patients group were analyzed by Kaplan-Meier estimation, log-rank tests, and multivariate proportional hazards modeling. Results: The proportion of six histology categories (A, AB, B1-B3,C) did not change significantly during the two time periods. Compared to patients diagnosed in 2000-2003, OS was not significantly different in patients diagnosed in 2005-2009 in the log rank tests or multivariate analysis after accounting for treatment, tumor factors, and patient characteristics (OS, HR=0.737, p=0.1580; CSS, HR=0.731, p=0.3711). Histology as 6 categories is a significant predictor for OS in the multivariate analysis in 2005-2009, but not in 2000-2003. However, the predictive role of histology is similar in both time periods in the multivariate analysis of CSS. Complete resection, classification C, and tumor stage are significantly linked to OS and CSS. Conclusions: Patients diagnosed after 2004 did not have better survival outcomes than earlier patients. The WHO classification of 2004 may be a better predictor of OS than that of 1999 as shown by the wide-spectrum of pathologists reporting to SEER.
Clinical value of PET/CT's SUV max at baseline, early follow-up, and end of treatment reevaluation as a prognostic factor in small cell lung cancer patients with extended disease.
Authors: Ponce Aix Santiago , Manneh Kopp Ray , Sepulveda Juan Manuel , Núñez Juan A. , Iglesias Lara , Pascual Tomas , Parrilla Lucia , Ruiz Solis Sebastian 
Published: March 2020

e18558 Background: Patients with Small Cell Lung Cancer (SCLC) have been staged by the two-stage system. This system defines limited disease (LD) when is confined to ipsilateral hemithorax that can be encompassed within tolerable radiation field; extended disease (ED) is defined as the disease extending outside the hemithorax. The IASLC recommended that TNM staging should be used in SCLC including clinical trials. However these systems have shown poor correlation between clinical findings and the pathological results. Objectives: Evaluate prognostic factors as age, ECOG and PET CT’s SUV max at base line, early follow up and end of treatment reevaluation; and their correlation with Overall survival (OS) and Progression free survival (PFS). Methods: Prospectively were recruited patients with histologically confirmed SCLC and ED and were evaluated with basal PET CT, early follow up (PET CT after 2 cycles of Platinum based chemotherapy) and end of treatment assessment with a PET CT after 6 cycles. Comprehensive database including clinical data were collected as age, ECOG, site of metastases, type of treatment and outcome. 23 patients were recruited from January 2010 to June 2012 and the follow up made until January 15th 2013. The Cox correlation test was used. Results: Median age 66,5 years (range 52-80) the OS was 7,9 months (CI 95% 6.7-9.1) and the PFS was 5,3 months (CI 95% 4,5-6,2). The baseline ECOG was an independent prognostic factor for OS (p= <0,0001) and PSF (p= 0,008). Age was not prognostic in our data. SUV max at baseline was an independent prognostic factor for OS (p= 0,001) and PFS (p= 0,009). For early follow up were evaluated 14 patients and for end of treatment reevaluation were assessed 9 patients. Differences between SUV max at baseline and early follow up or with end of treatment reevaluation were not predictive for PFS or OS. Conclusions: In our study the ECOG and basal PET CT SUV max are independent prognosis factors with consistent correlation with OS and PFS. The early follow up and end of treatment reevaluation with PET CT did not predict outcome in our patients. Further studies should be considered to test the value of follow up with PET CT.
Cytoplasmic ERß expression to predict efficacy and survival of EGFR-TKI in EGFR-mutant NSCLC.
Authors: Wang Zhijie , Wang Jie , Wang Xiaodong , Shen Zhirong , Ding Xiaosheng , Bai Hua , Duan Jianchun , An Tongtong , Wang Yuyan , Zhuo Minglei , Wang Shuhang , Wu Meina 
Published: March 2020

e19067 Background: Estrogen receptor pathway has been reported to be interacted with epidermal growth factor receptor (EGFR) signal pathway. This study focused on the impact of intracellular ERβ localization (cytoplasmic or nuclear) on efficacy of EGFR-TKI. Methods: Tumor tissue specimens from 149 stage IV NSCLC patients treated with EGFR-TKI were analyzed using immunohistochemistry (IHC) for ER expression (ERα or β) and their associations with clinicopathological variables and clinical outcomes. Significance of cyto-ERβ expression was further examined in NSCLC cell lines. Results: The expression of ERα and ERβ was detected in 15% and 28.9% of the patients, respectively. Cyto-ERβ positive cases showed shortened PFS compared with negative ones (3.1 months vs. 7.3 months, p=0.061). In the EGFR-mutant subgroup, differences of PFS were enlarged with significant statistics (4.7 months vs. 10.9 months, p=0.042). COX’s proportional hazard model showed that female, EGFR mutation and c-ERβ status were independent predictors for PFS. PC-9 cells present ERβ in cytoplasma and nucleus. Estrodial (E2) induced PC-9 cells moderately resistant to erlotinib with a 3-fold increase of IC50, and the resistance can be reversed by ER blocker (fulvestrant) or siRNA directed to ESR2. The E2 function was accomplished by nongenomic activation (MAPK phosphorylation) caused by E2 via cyto-ERβ. Combination treatment with erlotinib and fulvestrant turned out to be far more effective than either treatment alone in PC-9 cells. Conclusions: Cyto-ERβ expression may predict relatively poor efficacy to EGFR-TKI compared with non- cyto-ERβ expression in NSCLC patients harboring EGFR mutation.
Use of the 92-gene assay to identify tumor type and direct predictive biomarker testing in limited tissue specimens.
Authors: Operana Theresa N. , Schroeder Brock , Erlander Mark G. , Schnabel Catherine A. 
Published: March 2020

e19072 Background: Limited tissue availability from biopsies can limit comprehensive diagnostic testing and individualized care. The 92-gene assay is a gene expression-based cancer classifier that requires a minimal number of tumor cells (~300) and may improve the efficiency of tissue usage as a molecular complement to IHC in cases with limited diagnostic material. In this study, the reporting rate and utility of molecular classification in limited tissue cytology specimens, as well as the frequency of directed predictive biomarker testing were examined. Methods: Four hundred thirty eight FFPE cytopathology cases (ie, fine needle aspirates, pleural effusions, ascites) with indeterminate diagnosis where the 92-gene assay (CancerTYPE ID, bioTheranostics Inc.) was used in clinical care were included in the analysis. The 92-gene assay reporting rate and tissue availability to perform downstream biomarker testing were analyzed. Results: The 92-gene assay provided a molecular diagnosis in 86% (n=378) of cytopathology specimens submitted for diagnostic testing. Twenty-four distinct tumor types were predicted including: 9% lung (n=41), 8% urinary bladder (n=34), 8% pancreaticobiliary (n=34), 8% ovary (n=34), 7% gastroesophageal (n=32), 5% intestine (n=20), and 1% melanoma (n=5). In 66 patients with molecular diagnoses where reflex biomarker testing was applicable (lung, CRC, melanoma), 33% of cases had additional predictive biomarker testing performed, and 2 or more biomarker tests were performed on 15% of cases. The most common tests ordered were EGFR mutations (n=16), KRAS mutations (n=8), BRAF mutation (n=8), and ALK rearrangement (n=5). Conclusions: These findings demonstrate the suitability and high reporting rate of the 92-gene assay in limited tissue cytologic specimens and successful predictive biomarker testing in appropriate cases. With the growing number of molecularly-targeted therapies requiring predictive biomarker testing, use of the 92-gene assay may have increased utility in indeterminate cancer cases where limited tissue specimens are the only option for diagnosis and treatment planning.
Metronomic weekly paclitaxel in metastatic or recurrent non-small cell lung cancers.
Authors: Tandon Nidhi , Noronha Vanita , Prabhash Kumar 
Published: March 2020

e19095 Background: Metastatic non small cell lung cancer (NSCLC) has a median survival of 4 months in absence of therapy. We present our experience with metronomic weekly paclitaxel in patients with metastatic or recurrent NSCLC and those with poor performance status. Methods: This is a retrospective analysis of prospectively collected data of patients with metastatic or recurrent NSCLC without significant neuropathy who were heavily pretreated or platinum ineligible from Feb 2010 to Oct 2012 at our centre. Patients were treated with paclitaxel at 80 mg/m2 over 1 hour weekly and underwent regular follow up. Chemotherapy was discontinued on disease progression or intolerable side -effects or patients choice. Patients who received at least 4 cycles of chemotherapy were included in the analysis. Toxicity was graded according to CTCAEv4.03. Statistics were calculated using SPSSv18.0. The progression-free survival was calculated from date of start of paclitaxel till date of symptomatic deterioration, radiological progression or start of next line of therapy or death due to any cause. Overall survival was calculated from date of start of paclitaxel to the date of death due to any cause. Results: Of the 100 patients studied (median age = 57 y, range 29–77 y), 74% were males, 51% were smokers, 45% had comorbidities, 35% had PS>2 and 74% had adenocarcinoma. About 53% received >2 prior lines of chemotherapy. Patients received a mean of 16.9 cycles of paclitaxel (range 4-72) after which it was withheld in 63% due to PD (53% radiological, 10% clinical) and in 12% due to toxicity. The response rates were 37% (CR-3% and PR-34%) while 35% had SD. 9% required dose reduction while 32% had delay in dose administration. G.3 adverse events observed were 12%-anaemia, 10%-neutropenia, 2%-febrile neutropenia, 15%- sensory neuropathy and 4%-motor neuropathy. The median OS was 12 months while median PFS was 5 months. Conclusions: Weekly paclitaxel is a promising and well tolerated therapy for advanced NSCLC.
Non-invasive and quantitative analysis for EGFR T790M mutation in the patients with advanced non-small cell lung cancer received EGFR-TKI therapy.
Authors: Chen Rui , An Tongtong , Wang Jie , Bai Hua , Wang Zhijie , Zhao Jun , Wu Meina , Zhuo Minglei , Duan Jianchun , Wang Yuyan , Wang Shuhang 
Published: March 2020

e19101 Background: Approximately 50% of advanced non-small cell lung cancer (A-NSCLC) patients with EGFR sensitive mutation who develop acquired resistance to EGFR-TKIs reportedly have a secondary EGFR T790M mutation. Establishing a dynamical, quantitative and noninvasive detection system of EGFR T790M mutation in process of disease therapy for NSCLC is critical to personalized targeted therapy. Methods: 135 A-NSCLC patients with EGFR mutation who received EGFR-TKIs and presented acquired resistance (PFS≥6 months) were included into this study. All patients provided the plasma samples for molecular analysis when disease progressed. 109 patients of them had matched TKI-naive plasma. T790M mutation was measured qualitatively and quantitatively by ARMS and Digital PCR (DggPCR), respectively. Association of T790M mutation with clinical charateristics were evaluated. Results: DgPCR was more sensitive than ARMs to detect T790M mutation in plasma [pre-treatment 29.4% (32/109) VS 5.5% (6/109); post-treatment: 43.0% (58/135) VS 25.2% (34/135)]. 32 patients with pre-treatment T790M mutation predicted shorter PFS and OS compared with 77 T790 M negative patients (PFS, F 12.7 VS 9.2 months, P=0.004, GOS, F 27.0 VS 18.8 months, P=0.002). Patients with or without post-treatment T790M mutation have no significantly different PFS and OS. However, quantified the ratio of copy number of mutant T790M to wild-type by DgPCR, patients were divided into high-frequency groups (≥5%), low-frequency group (0%-5%) and wild-group (0%) according to the number of positive signals observed from DgPCR results. 12 patients in high-frequency group showed shorter PFS and OS compared with wild group and low-frequency group (PFS 9.5 VS 11.9 months, P=0.033, G9.5 VS 13.6 months, P=0.028, GOS, F 18.5 VS 21.2 months, P=0.044, 18.5 VS 28.8 months, P=0.001). Conclusions: Non-invisive and quantitative detection of T790m mutation by digital PCR is feasible in clinical practice. High contents of T790M when disease progression after EGFR-TKIs therapy predicted poor prognosis.
Awareness about EGFR testing and use of TKIs in advanced lung cancer: A questionnaire-based survey of medical oncologists from India.
Authors: Parikh Purvish M. 
Published: March 2020

e19116 Background: EGFR is an important driver mutation in lung cancer. The pattern of usage of EGFR mutation testing is not well defined in the Indian population. Methods: A total of 70 medical oncologists from India were interviewed to identify current practices in the management of advanced lung cancer. They were in clinical practice for 2 to 35 (median 9) years. Their affiliation included medical college (21), regional cancer center (6), corporate hospitals (29) and private practice (14). Their collective experience in conducting international clinical trials in lung cancer was significant (range 0 to 35 trials). Results: The number of new patients with lung cancer seen by them in a month was a median of 8 (range 1 to 20). EGFR testing on the lung cancer tissue was recommended in a median of 60 % (range 10 to 100 %) of paients and was actually carried out in a median of 30 % (range 0 to 90 %). Tissue samples were inadequate for EGFR testing in 30 % of cases (range 2 to 95 %). Method of EGFR testing used included IHC by 06, molecular by 52 and both by 12 of the oncologists. The time to obtain a report was 10 days (range 5 to 21 days). EGFR testing showed mutation/ overexpression in approximately 25 % of cases (range 0 to 70 %. In a large national tertiary cancer center with inhouse laboratory that did testing by PCR and sequencing, EGFR mutations were seen in 30 % of 481 samples. The EGFR mutations considered clinically important included del 19 by 56, L858R by 41 and T790M by 31 of the responding oncologists. The first line therapy used in EGFR mutation positive Lung cancer patients was platinum doublet chemotherapy by 7, gefitinib by 55 and erlotinib by 8 oncologists. The side effects of TKIs considered important were diarrhea by 64, mucositis by 47, rash by all 70, paronychea by 50, nausea vomiting by 52, fatigue by 51 and myelosuppression by 6. The common methods of managing these side effects included dose reduction by 22, drug interruption by 50, symptomatic treatment by 49 and counseling by 22. Conclusions: The awareness about EGFR mutation and use of TKIs among medical oncologist is increasing in India. However availability of sufficient tissue for molecular testing remains a problem.