bluuebunny/crossref_metadata_2025_split huggingface dataset:
Induction bevacizumab, etoposide and cisplatin followed by whole brain radiotherapy (WBRT) versus WBRT alone in breast cancer with untreated brain metastases: Results of a randomized phase II A-PLUS trial.
Authors: Lu Yen-Shen , Dai Ming-Shen , Tseng Ling-Ming , Chen Shin-Cheh , Chen Wei-Wu Tom , Chao Tsu-Yi , Chao Ta-Chung , Chang Yuan-Ching , Chiu Chang-Fang , Liu Chien-Ting , Lin Chingh-Hung , Liu Chun-Yu , Chen Ya-Fang , Chang Twan Ying , Yu Jyh-Cherng , Rau Kun-Ming , Hsieh Yao-yu , Shen Shih-Che , Huang Shu-Min , Cheng Ann-Lii 
Published: May 2020

1082 Background: Our previous study ( Clin Cancer Res. 2015;21(8):1851) demonstrated that bevacizumab preconditioning followed by etoposide and cisplatin (BEEP) is a highly effective treatment for breast cancer (BC) patients (pts) with brain metastases (BM) progressing from WBRT. We conducted a randomized phase II study A-PLUS (NCT02185352) to test whether using BEEP as an induction therapy could enhance the efficacy of WBRT and provide systemic control. Methods: BC pts with measurable BM not suitable for surgery/radiosurgery and had not received WBRT were randomized (2:1) to experimental arm: induction BEEP for 3 cycles (~2 months [ms]) followed by WBRT or control arm: upfront WBRT. The BEEP regimen consists of bevacizumab 15 mg/kg on day 1, and etoposide 70 mg/m2/day on days 2-4, cisplatin 70 mg/m2 on day 2, followed by prophylaxis GCSF, every 21 days. After WBRT in both arms, pts received treatment of physician’s choice except BEEP until BM progression. Stratification was based on the Graded Prognostic Assessment score. Primary endpoint was brain-specific progression free survival (BS-PFS) based on RECIST 1.1, with a total of 108 pts, power of 0.8 at the 2-sided α level of 0.2. Results: Of 112 enrolled pts, 74 were in experimental arm and 38 in control arm. Baseline patient characteristics were generally balanced between arms. With median follow up of 28.7 ms, median BS-PFS was 8.1 vs. 6.5 ms ( p= 0.146; HR 0.71 [95% CI 0.44-1.13]), which met the primary endpoint (pre-defined α level of 0.2). Results of preplanned analysis included: 2-month brain-specific objective response rate of BEEP alone vs. WBRT was 41.9% vs. 52.6% ( p= 0.613); 8-month BS-PFS rate was 48.7% vs. 26.3% ( p= 0.027); median PFS was 6.4 vs. 4.7 ms ( p= 0.071; HR 0.67 [95% CI 0.43-1.04]), and extra-BM PFS was 7.9 vs. 5.0 ms ( p= 0.141; HR 0.71 [95% CI 0.46-1.12]). Median overall survival was 15.6 vs. 13.6 ms ( p= 0.855; HR 0.96 [95% CI 0.59-1.55]), with 31.6% of pts in control arm received BEEP regimen treatment after BM progression. The most common all-grade adverse events (AEs) in experimental arm were neutropenia (30.2%), nausea (27.9%), anemia (27.4%), and leukopenia (24.2%). Most AEs were mild to moderate in severity. Two pts discontinued BEEP treatment due to grade 4 nephrotoxicity and grade 3 infection, respectively. Conclusions: BEEP as induction treatment followed by WBRT for BC pts with BM may improve control of both BM and systemic disease. Further validation by a phase III study is necessary. Clinical trial information: NCT02185352 .
Mutation profile differences in younger and older patients with advanced breast cancer using circulating tumor DNA (ctDNA).
Authors: Clifton Katherine , Luo Jingqin , Tao Yu , Saam Jennifer , Rich Thereasa A. , Roshal Anna , Frith Ashley Elizabeth , Rigden Caron E. , Ademuyiwa Foluso Olabisi , Weilbaecher Katherine N. , Hernandez-Aya Leonel Fernando , Peterson Lindsay Leuthen , Bagegni Nusayba Ali , Suresh Rama , Opyrchal Mateusz , Bose Ron , Wildes Tanya Marya , Ma Cynthia X. 
Published: May 2020

1089 Background: Although the noninvasive nature of ctDNA testing is attractive in an older adult population, less is known regarding the mutation profiles of ctDNA in the older adult breast cancer population as this population is often excluded from studies. Previous tissue testing has shown differences in mutation profiles between older and younger adults with breast cancer. The objective of this study is to assess differences in mutation profiles in the older and younger adult breast cancer population using a ctDNA assay. Methods: Patients (pts) with advanced breast cancer underwent molecular profiling using a plasma-based ctDNA NGS assay (Guardant360) between 5/2015-10/2019 at Siteman Cancer Center. Clinicopathological histories were obtained from the medical record. The results of a multicenter database of pts with advanced breast cancer who had undergone molecular profiling using Guardant360 were obtained. Associations between mutations and age were measured using a Fisher’s exact test. Results: In the single institution cohort, of the 214 patients who underwent testing, 148 (69.16%) were < 65 and 66 (30.84%) ≥ 65 years-old. The most frequently mutated genes in age < 65 pts were TP53 (48.65%), PIK3CA (35.81%), and ESR1 (30.41%) while the most frequently mutated genes in age≥65 pts were PIK3CA (56.06%), TP53 (51.52%), ESR1 (25.76%), and ATM (21.21%). ATM, BRAF and PIK3CA mutations were found more frequently in age≥ 65 pts with ER+ HER2- breast tumors (p < 0.01). MYC and ESR1 mutations were not significantly associated with age, overall or within subtype. Overall ctDNA resulted in change in management in 19.8% pts (40/202). In the larger multicenter cohort, of the 8803 pts who underwent testing, 5367 (61.0%) were < 65 and 3417 (38.8%) ≥ 65 years-old. ATM, ESR1 and PIK3CA mutations were more common in age≥65 pts (p < 0.0001) and MYC mutations were less common in age≥65 pts (p < 0.0001). Conclusions: This study found that ctDNA is a feasible, attractive alternative to traditional biopsies and may identify actionable mutations in older adults with breast cancer. When controlling for subtype, results from a single institution were similar to the larger multicenter cohort showing ATM and PIK3CA were more common in the older adult population. This data suggests there may be additional molecular differences between breast cancer in older compared to younger adults that warrants further investigation.
Efficacy and safety of liposomal mitoxantrone (Lipo-MIT) in advanced breast cancer (ABC): A randomized, open label, active-controlled, single-center, phase II clinical trial.
Authors: Wang Leiping , Zhao Yannan , Li Ting , Cao Jun , Du Yiqun , Tao Zhonghua , Peng Wenxia , Wang Biyun , Zhang Jian , Wang Zhonghua , Huan Xiulin , Dou Jing , Hao Chunyan , Li Xiaojing , Wang Xiaodong , Meng Zhibin , Lv Yanan , Gao Cuixia , Hu Xi-Chun 
Published: May 2020

1093 Background: Anthracyclines are associated with cardiotoxicity and myelosuppression in breast cancer (BC) patients. A new drug delivery system, liposomal preparation has shown higher anti-cancer effect and lower toxicity due to modified drug release and particle shape. This trial aimed to evaluate the efficacy and safety of Lipo-MIT in ABC. Methods: This is a randomized, open label, active-controlled, single-center, phase II clinical trial. Eligible patients were randomized in a ratio of 1:1 to receive Lipo-MIT or mitoxantrone hydrochloride injection (MIT) intravenously. The dosage was 20 mg/m2 for Lipo-MIT and 14 mg/m2 for MIT, once every four weeks (i.e., one treatment cycle). The primary endpoint was objective response rate(ORR). The secondary endpoints were progression free survival (PFS) and safety. Results: From Oct 2015 through Jul 2017, 60 patients were randomized to Lipo-MIT group (n = 30) or MIT group (n = 30). The Median (Q1,Q3) age was 56.0 (41.0,62.0) years in Lipo-MIT group and 54.5 (44.0,62.0) years in MIT group. Nineteen patients in Lipo-MIT group and 23 in MIT group received < 4 cycles of treatment, 11 patients in Lipo-MIT group and 7 in MIT group were treated for 4 or more cycles. When Lipo-MIT group was compared with MIT group, ORR was 13.3% (4/30) and 6.7% (2/30), disease control rate (PR+SD) was 50% (15/30) and 30% (9/30), median PFS was 2.30 (95% CI: 1.74-3.91) and 1.86 (95% CI: 1.74-2.40) months ( P> 0.05). Lipo-MIT showed significantly lower incidence of all-grade white blood cell decreased (86.7% vs 96.7%), neutrophil count decreased (80.0% vs 96.7%), conjugated bilirubin increased (53.3% vs 56.7%), aspartate aminotransferase increased (40.0% vs 53.3%), and troponin T increased (3.3% vs 36.7%) than MIT, but higher incidence of anemia (76.7% vs 46.7%), skin hyperpigmentation (66.7% vs 3.3%), and platelet count decreased (56.7% vs 53.3%) than MIT. Conclusions: Lipo-MIT provided numerically better ORR, DCR, and PFS than MIT in ABC. Lower incidence of troponin T increased might suggest lower cardiotoxicity of Lipo-MIT. It is worthwhile to further explore the clinical utility of Lipo-MIT in ABC. Clinical trial information: NCT02596373 .
Social media use among NCI designated cancer centers: Where is the diversity?
Authors: Velazquez Manana Ana I. , Leibrandt Ryan , Wu Lesley , Bernabe Ramirez Carolina , Olazagasti Coral , Nguyen Nina Thuha , Rodriguez Bonilla Carlos , Duma Narjust 
Published: May 2020

11003 Background: The NCI-Designated Cancer Centers (NCC) are recognized for their leadership, research, and education of health care professionals (HCP). NCC are required to study and improve cancer disparities in their communities. Since the introduction of social media (SM), online platforms have become a source of health information and peer support among patients with cancer, leading to its adoption by NCC across the nation. We aimed to analyze the use of SM among NCC and how the racial/ethnic (RE) diversity represented in their SM messaging compares to their communities. Methods: We reviewed all original SM posts from adult NCC-specific Facebook (FB) and Twitter (TW) pages between 1/1/2019 to 12/31/2019. Basic laboratory NCC pages and retweets were excluded. A 1-year time period was selected to account for variation during health campaigns months. We analyzed each post’s language and content, and the gender and RE of individuals presented in images and videos (IV). Content was categorized into: screening, clinical trials, HCP, or patient story. Data was analyzed using chi-square and Wilcoxon signed-rank tests. Results: We reviewed the FB and TW pages of 56 NCC. The median account age was 10 years for FB and 9 years for TW with a median number of followers of 9,861 and 6,066, respectively. The median number of posts per NCC was 250 in FB and 332 in TW. Only 5 NCC posted in a non-English language (range 1 – 5 posts). Among SM IV, >60% of pages displayed females in ≥50% of their posts, African Americans (AA) were presented in 12-14% and Hispanics in 5%. When compared to their city demographics, Whites and Asians were significantly over-represented while Hispanics and AA were under-represented in NCC’s SM messaging (Table). When compared to the US census, over-representation of Asians and under-representation of Hispanics persisted. Cities with ≥20% AA or Hispanics displayed a higher proportion of IV presenting the respective RE group (p<0.05). Content was not associated with RE makeup. Conclusions: By analyzing the IV posted by NCC on 2 SM platforms, we identified that Hispanics and AA were under-represented in NCC’s SM messaging. Furthermore, SM outreach for non-English speakers was abysmal. Equitable visual representation of diverse RE in NCC’s SM messaging has the potential to serve as a tangible means to demonstrate cultural competency and close the gap in cancer disparities. [Table: see text]
Design-based bone marrow biopsy training.
Authors: Brondfield Sam , Harmon Derek , Romero Dylan , Tai Jenny , Hsu Gerald 
Published: May 2020

11007 Background: Hematology/oncology fellows must achieve bone marrow biopsy proficiency. However, a cost-effective, high-fidelity system to practice these procedures has not been described. Other specialties utilize 3D printing to practice procedures. Using design thinking, we developed, implemented, and evaluated a bone marrow biopsy training session with 3D pelvis models. Methods: We printed two models using an NIH template and optimized them through iterative prototyping. We covered a hole at the intended biopsy site with a replaceable cap simulating cortical bone, used cork as medullary bone, and used sand and water as marrow. Caps of two densities simulated softer and harder bone. Fellows could lift silicone skin pads to view anatomy. A flat base minimized movement. In July 2019, we conducted a one-hour practice session (“3D session”) with eight fellows during orientation. After an anatomy review, fellows practiced biopsies using the models with faculty feedback. Fellows also attended a one-hour session with a hematologist demonstrating a biopsy on a patient (“patient session”), the only session offered in previous years. We used a t-test to compare course ratings and pre/post-orientation self-assessed comfort with biopsies (5-point scales). Six months later, we surveyed attendings about fellow biopsy skill and success rate compared to prior years. S.B. conducted a content analysis of a focus group with four fellows and email feedback from one fellow. Results: Fellows rated the 3D and patient sessions highly (4.50 vs 4.75, p = 0.51). Procedural comfort improved significantly after orientation (2.13 to 3.63, p = 0.03). Attendings noted no difference between the 2019 fellows and prior years. Fellows called the 3D session “helpful” and “high-yield.” They praised the opportunity to practice repeatedly with high-fidelity anatomy, rehearse mechanics, receive feedback, and internalize anatomy and muscle memory for later recall. Fellows noted that the model did not allow for patient positioning practice and that the denser cap was too hard. Fellows suggested incorporating a female pelvis and more soft tissue. Conclusions: We developed, implemented, and evaluated a design-based bone marrow biopsy training session. Though we did not find outcome differences compared to traditional training, 3D printing represents a feasible, cost-effective, and high-fidelity educational tool. 3D sessions, in conjunction with patient sessions, may augment understanding of anatomy and provide opportunities for practice and feedback. Future iterations should incorporate user feedback to optimize model fidelity and utility.
The Matilda effect: Under-representation of women in hematology and oncology awards.
Authors: Patel Shruti R , St-Pierre Frederique , Velazquez Manana Ana I. , Ananth Snegha , Durani Urshila , Anampa-Guzmán Andrea Carolina , Castillo Katerina , Dhawan Natasha , Ruddy Kathryn Jean , Oxentenko Amy S , Duma Narjust 
Published: May 2020

11012 Background: The proportion of women in the field of hematology and oncology (H&O) has increased over recent decades, but representation by women in leadership positions remains a challenge. Our aim was to examine representation of winners of recognition awards by gender and race from the major international hematology and oncology societies. Methods: Published award recipients from the seven major H&O societies were reviewed, with 26 years of data included (1994-2019). Awardee demographics and academic rank were collected and included in the analysis. Gender was determined based on awardee full name and verified by public data. Chi-square and Cochran-Armitage tests were used to analyze the data. Results: Over the past 26 years, 942 awards were presented at the 7 major H&O societies. We excluded 27 gender specific awards from the analysis. Of the 915 awardees included in analysis, award recipients were overwhelmingly men (77.9%) and non-Hispanic white (84.7%). Gender breakdown by society is described in table. ESMO and ASTRO represented the lowest distribution of women at 9.1% and 11.1%, respectively. Women awardees received 30.3% of the awards categorized as humanistic and education-related, while only receiving 16.0% of awards in the basic sciences category (p<0.01). The Cochran-Armitage test demonstrated an upward trend in the number of women awardees, from 10% between 1994-1998 to 25.6% between 2014-2019 (p=0.0004). Over the past five years, the average proportion of women medical oncologists was 35.6% per the AAMC. In this time period, women oncologists have received only 24.0% of all awards, suggesting the awardees included in the study period do not represent the proportion women in the field (p=0.00424). Black, Hispanic, and Asian awardees represented 3.7%, 3.3%, and 6.8% of the total awardees, respectively. Of the 64 Black and Hispanic awardees, 60.9% of the awards were for investigating healthcare disparities and only 4.6% were given for basic science research. Conclusions: During our study period, women physicians and investigators were less likely to receive recognition awards from the seven major H&O societies compared to men. We also observed a considerable low proportion of minority awardees in all oncology subspecialties. While the proportion of women awardees has increased over time, significant underrepresentation remains. [Table: see text]
Gender differences in faculty rank and subspecialty choice in academic medical oncology.
Authors: Graham Laura , Khaki Ali Raza , Sokolova Alexandra , Davidson Nancy E. 
Published: May 2020

11013 Background: The gender gap in the United States healthcare field has been closing. In 2000 women made up 45% of medical school matriculants and by 2017 outnumbered men. Based on our personal observations at academic meetings, however, we hypothesized that gender differences persist in faculty rank and subspecialty choice in academic medical oncology. Methods: We created a database of medical oncologists at the top 15 cancer centers as ranked by the U.S News and World Report in 2019. We identified all medical oncology faculty in the subspecialty fields of breast, gastrointestinal (GI), genitourinary (GU) and thoracic oncology from institution websites (12/2019-1/2020). Faculty working only at satellite clinics (i.e. non-research appointments), and the few faculty in more than one subspecialty group, were excluded. Gender (determined by pictures), subspecialty and academic rank were recorded based on data from institution websites and professional social networking sites. Proportions of men and women in each subspecialty and at each faculty rank were calculated; odds ratios (OR) and χ2 tests were used for comparisons. Results: 346 men and 244 women were identified as subspecialty medical oncologists, comprising 59% and 41% of faculty members, respectively. Gender representation by subspecialty and academic rank are shown in the Table. Breast oncology had more women oncologists than men (OR 2.9, p < 0.001); GU oncology had fewer women (OR 0.3, p < 0.001). The representation of women and men was comparable at the lower academic ranks (instructor, assistant and associate professors). But at the top rank of full professor, only 31% were women (OR 0.54, p = 0.001). Notably, even in breast oncology, the one subspecialty with a greater proportion of women, women still comprised a lower proportion of full professors than men. Conclusions: Gender differences persist in academic medical oncology. At the top 15 US cancer centers, gender differences are seen in subspecialty representation, with more men in GU oncology and more women in breast oncology. Fewer women than men achieve the rank of full professor, even in breast oncology. Additional research is needed to explore the causes of, and contributors to, these differences as well as their impact. [Table: see text]
Effect of participation in the annual Immuno-oncology Young Investigators’ Forum (IOYIF) on the competency and performance of young researchers.
Authors: Fowler Joan B. , Taylor Bryan Carson , Gitzinger Susan H. , Carranza Vanessa 
Published: May 2020

11021 Background: Advancing the fight against cancer involves many types of research across different disciplines and professions, from PhD-trained scientists to medical oncology physicians. The IOYIF is a competitive academic research program where oncology junior faculty, clinical and post-doctoral fellows who are pursuing a career in academic research in IO are invited to submit an abstract of their unpublished, original research to a panel of expert judges for assessment. Methods: Performance and confidence change were objectively assessed by analyzing pre- and post-test results before and after the presentation of research. Statistical testing between pre- and post-participation were conducted via chi square analysis with a priori significance set at 0.05. Results: Participants experienced an improvement in mean abstract score following participation in the forum. The mean abstract score improvement was statistically significant for All Participants ( P< 0.001) and all sub-groups ( P< 0.001), with the sole exception of Clinician Scientists. Overall, PhD/Postdoctoral Research participants demonstrated the most improvement. The mean abstract score improvement was statistically significant for those who attended presentation coaching ( P< 0.001) as well as for those that did not ( P= 0.001); the magnitude of improvement was greater among those who attended coaching. Participant self-reported mean confidence scores increased with statistical significance from pre- to post-participation in the forum ( P< 0.001); this increase was noted across all participants and all sub-groups, and was observed in relation to both presentation skills and research defense. Young Investigators reported that lack of experience with grant writing is the most significant barrier they face to obtaining grant funding; they also listed lack of mentorship/guidance in publishing as a prominent barrier. Conclusions: This analysis demonstrates that an IO research forum designed for young investigators can improve the performance and confidence of these scientists. These findings highlight the robust, multifaceted impact of the IOYIF on advancing the professional development of the next generation of IO researchers. Identification of barriers demonstrates the tangible value of the IOYIF in providing needed mentorship to further research efforts, deliver axioms of grant writing guidance, and bridge the gap young researchers face in obtaining funding and publishing their work.
Introduction of a patient communication course to postgraduate oncology training in Russia.
Authors: Kotov Maxim 
Published: May 2020

11022 Background: Communication skills are an obligatory part of postgraduate oncology education in European and Western countries and its benefits for doctors, patients, and the healthcare system are well-known. However, teaching efficient patient communication is challenging in developing countries where the paternalistic model is still spread and medical professionals are unaware that these skills are lacking. We hypothesize that a short simulation-based course for oncology residents introduces communication skills and raises awareness about its value. Methods: A 2-day communication course based on the Calgary-Cambridge model was taught to a cohort of PGY2 oncology residents. Lectures, seminars, and clinical simulations emphasizing a patient-centered approach, including open questions, active listening, identifying patient concerns, empathy, summarizing, and bad news delivery were conducted by certified teacher. A simulation exam was administered to those who completed the communication course and those who did not complete the course. Scores (max. 130) from two clinical scenarios assessed by the examiner, actors, and participant were compared between groups. Results: Ten PGY2 residents completed the course and seven did not complete the course. Medians scores for the first scenario given by the examiner, actor and resident were 99 (IQR: 90 – 122), 125 (IQR: 122 – 127) and 102 (IQR: 91 – 108) for course participants and 15 (IQR: 7-35), 18 (IQR: 12-34) and 61 (IQR: 41-83) for non-participants, respectively. Medians scores for the second scenario were also higher in participant group: 113.5 (IQR: 100-117), 107 (IQR: 98-118) and 104 (IQR: 99-112) vs. 22 (IQR: 12-50), 18 (IQR: 10 - 44) and 66 (IQR: 43-81), respectively. Four (40%) course participants and seven (100%) non-participants evaluated themselves higher than the examiner and actor. Conclusions: A short patient communication course for young oncologists effectively improves communication skills and provider self-awareness in developing countries.