bluuebunny/crossref_metadata_2025_split huggingface dataset:
Virtual health in cancer care: Results from a semi-structured interview-survey of oncology health care providers.
Authors: Le Dan , Brain Amanda , Shenkier Tamara Nina , Ingledew Paris-Ann 
Published: June 2021

e13618 Background: The COVID-19 pandemic has compelled an increased use of virtual care delivery models in oncology. This study sought to examine the views of oncology health care providers (HCP) in British Columbia on the value and impact of virtual care models in clinical practice. Methods: A semi-structured interview-survey was developed to compare provider practice patterns between May 2019 and May 2020. Questions were designed to determine provider-perceived value and impact of virtual visits on clinical interactions with patients. HCP (including physicians, dentists, and nurse practitioners) at BC Cancer were invited to participate. Responses to the interview questions were de-identified and HCP names were replaced with a study code. Quantitative questions were interpreted with descriptive statistics. Qualitative results were analyzed and iteratively coded by multiple reviewers for emerging themes. Results: Among 531 invited participants, 61 completed the interview-survey and 60 were included in the final analysis. Of those interviewed, 47% were radiation oncologists and 33% were medical oncologists. The remainder of HCP interviewed (n = 12) included functional imaging physicians, general practitioners in oncology, hereditary cancer physicians, nurse practitioners, palliative care physicians, psychiatrists, and surgical oncologists. Most oncology providers (87%) desired the continuation of virtual visits as part of their clinical practice so long as barriers to integration were addressed. Barriers identified included limited access to physical resources, such as hardware (70% responses) and quiet spaces (54% responses), insufficient logistic support such as information technology services (84% responses) and operational workflows (46% responses), the absence of guidelines to select patients for this delivery model (38% responses), and concerns regarding HCP liability, security and privacy (30% responses). Conclusions: Oncology HCP value delivering patient care through virtual means, however, barriers to implementation must be better understood. These data may inform continued use and implementation of virtual care at other oncology centers.
An analysis of the reasons and motives of patients seeking telehealth-based second opinion for cancer.
Authors: Rajan Rejil , Jotwani Amit Kumar , Poovaiah Thirtha , Goud Rakesh Shankar , Waghmare Rama , Gururao Shashidhar 
Published: June 2021

e13621 Background: Incidence of cancer is rising with each passing year in India and a majority number of patients get diagnosed in later stages of disease that leads to poor outcomes. Studies have reported that patients and their caregivers feel the need to get more information about their treatment options making them opt for second opinions due to need for reassurance or inadequate time for communication with their treating oncologists. We sought to analyse the primary concerns and motives of patients seeking second opinion services through onco.com. Methods: A cohort of 918 eligible patients who availed online multidisciplinary tumour board opinion through Onco.com was included in the study. We analysed the primary concerns of 918 eligible patients who availed online second opinion through onco.com between January 2019 & December 2020. We looked at the specific questions they had for the multidisciplinary panel of oncologists. We also correlated the concerns with the stage of disease to understand if there was a variation for different stages of disease. Results: Of the total 918 patients, 864 had solid malignancies, out of which 16% had early (stage 1 & 2) disease, 27% had locally advanced (stage III) disease, 47% had metastatic disease & and 16% had recurrent disease. The most frequent motive for seeking a second opinion was the need for validation of ongoing treatment (72.5%) followed by enquiry for more advanced treatment options (37%), and to know any alternative treatment options (19%). Interestingly, only a minority of all patients were keen to know about clinical trials (3%). Conclusions: Our findings suggest that validation of ongoing treatment is the most frequent motive for patient driven second opinions in oncology. There was minimal interest to seek clinical trial options among patients, which could be due to general lack of awareness about clinical trials and some form of stigma associated with clinical trials due to negative perceptions and fears about adverse events. [Table: see text]
Consistency of O6-methylguanine-DNA methyltransferase in intracranial and extracranial lesions and the therapeutic effect of temozolomide in patients with advanced lung cancer and brain metastasis.
Authors: Fan Ying , Shan Qian Yun , Gong Jia Li , Han Na , Lu Hongyang 
Published: June 2021

e14001 Background: Targeted drugs have made a major breakthrough except small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) of brain metastasis (BM) patients with negative driving gene. Because of the difficulty to obtain pathology of intracranial metastases lesions and the low acceptance of patients, the heterogeneity of O6-methylguanine-DNA methyltransferase (MGMT) between extracranial lesions and intracranial metastatic lesions worth exploring. Methods: 10 patients were administered TMZ after the progression of radiotherapy and chemotherapy and included in one group; the efficacy and safety of TMZ were assessed. Moreover, 15 patients who underwent resection of the lung and brain without neoadjuvant therapy formed another cohort. The promoter methylation status of MGMT was analyzed and compared in the paired primary and BM lesions. Results: The overall response (OS) rate of TMZ was 50% and the disease control rate was 80% in patients with BM lesions. The median progression-free survival was 13.6 months, and the median overall survival was 18.9 months after a median follow-up of 120 months. No grade 3 or higher side effects were reported, but grade 1 or 2 side effects, such as leucopenia, nausea, or vomiting, occurred. However, in another cohort, MGMT promoter methylation was detected in 2 patients (with primary lesions; unmethylation was detected in BM lesions, and the methylation status of MGMT promoter was consistent in paired primary and BM lesions).Conclusions: TMZ was effective against SCLC and NSCLC combined with BM having negative driving genes. Whether primary lesions can replace the MGMT methylation level of BM lesions, as well as the consistency of the promoter methylation status of MGMT in patients with advanced lung cancer, needs exploration.[Table: see text]
Progression of tumors with development of cerebral metastases is accompanied by suppression of thyroid and glucocorticoid functions.
Authors: Bandovkina Valeria A. , Frantsiyants Elena M. , Salatova Ayna M. , Kharagezov Dmitry A. , Kit Oleg I. 
Published: June 2021

e14005 Background: Cutaneous melanoma (CM), breast cancer (BC) and lung cancer (LC) metastasize to the brain most frequently. Early diagnosis of cerebral metastases is challenging and requires new prognostic criteria. Imbalance of thyroid and glucocorticoid hormones changes the growth and development of malignant tumors. The purpose of the study was to identify readily available prognostic criteria for cerebral metastases in cancer patients at various stages of treatment and follow-up. Methods: Blood levels of cortisol and total triiodothyronine (tT3) were determined by RIA (Immunotech, Czech Republic) in patients with BC (n = 50), LC (n = 50) and CM (n = 50) without brain metastases and in patients with BC (n = 25), LC (n = 25) and CM (n = 25) with cerebral metastases. Results: Blood levels of cortisol in BC, LC and CM patients were normal in 63-84% and elevated on average by 1.7 times in 16-37%. Levels of tT3 in LC were normal, and in BC and CM – within the normal limits, but 1.3 times lower than the mean values. In patients with cerebral metastases, cortisol was lower than the norm by 4.9, 2.5 and 3.6 times in 36% BC, 75% LC and 45% CM cases, respectively. Levels of tT3 in all patients with cerebral metastases were lower than the norm or values in patients without metastases by 2 times and lower. Conclusions: Decreased levels of both cortisol and tT3 in patients with BC, LC and CM may serve as one of prognostic markers of possible development of cerebral metastases. The dynamic determination of levels of thyroid and glucocorticoid hormones is required in cancer patients at various stages of treatment and follow-up.
Outcomes of ER, PR, HER2, and triple-negative mutated breast cancer with brain metastasis.
Authors: O'Shea Patrick Joseph , Tatineni Vineeth , Rauf Yasmeen , Jia Xuefei , Murphy Erin Sennett , Chao Samuel T. , Suh John H. , Peereboom David M. , Ahluwalia Manmeet Singh 
Published: June 2021

e14009 Background: Breast cancer is the second most common cause of metastatic brain tumors. The presence of estrogen receptors (ER), and progesterone receptors (PR), and HER2 receptors have been used to guide both hormonal and targeted therapies for breast cancer. The presence or absence of these receptors may impact patient outcomes in breast cancer brain metastasis (BCBM). Methods: Patients with BCBM and known tumor marker status treated at our tertiary care center from 2010-2019 were evaluated. Overall Survival (OS) was measured from diagnosis of BCBM to date of death or last follow up. Many of these patients received multiple lines of treatment including hormonal and targeted therapies at some point during their care. The Cox proportional hazard model was used to determine differences in OS. Results: 137 patients with BCBM were included. Of these, 48 were ER or ER/PR positive (ER+), 3 were PR positive (PR+), and 47 were HER2, HER2/PR, HER2/ER, or HER2/ER/PR positive (HER2+), and 37 were triple-negative. For ER+ tumors the median age at diagnosis was 60 years (Interquartile range (IQR) 31-87) and 86% were white. For PR+ tumors the median age at diagnosis was 67 years (IQR 66-74) and 75% were white. For HER2+ tumors the median age at diagnosis was 55 years (IQR 31-84) and 79% were white. For triple-negative tumors the median age at diagnosis was 56 years (IQR 34-91) and 83% were white. OS for ER+, PR+, HER2+, and triple-negative patients had a median of 57.7, 19.8, 137.4, and 54.6 months and a 2-year rate of 76%, 33%, 82%, and 73%, respectively. With ER+ patients as a reference, PR+ patients had an OS hazard ratio of 1.49 (95% CI = 0.35 - 6.23, p = 0.59), HER2+ patients had an OS hazard ratio of 0.62 (95% CI = 0.36 - 1.06, p = 0.082), and triple-negative patients had an OS hazard ratio of 0.92 (95% CI = 0.54 - 1.57, p = 0.77). Conclusions: HER2+ tumors were associated with an increase in OS when compared to ER+, PR+, and triple-negative tumors in patients with BCBM. The OS of the other three tumor marker groups was not significantly different from one another. Further studies need to be done within tumor marker cohorts to determine the most effective treatments within those cohorts.[Table: see text]
Successful salvage therapy with cetuximab-based modalities in the non-sensitive EGFR-mutant lung cancer patients with leptomeningeal metastasis who have heavily pretreated histories.
Authors: Wu Jinchun , Zhao Jie , Li Xiangping , Zhang Jin , Zeng Shan , Zhou Rongrong , Li Bin 
Published: June 2021

e14011 Background: Leptomeningeal metastasis (LM) is the deadliest complication of lung cancer. No standard therapy for the LM harbor non-sensitive epidermal growth factor receptor (EGFR)-mutant|(neither E19 del, E21 p.L858R nor E18 p. G719X mutation ). Previous studies showed cetuximab held the potential for treating the EGFR mutants who had failed 2 or more lines of standard cytotoxic chemotherapy and reversible EGFR TKIs. Methods: We screen the lung cancer patients with LM treated with Cetuximab-based regimen from July 1st, 2020 to Dec 31th 2020. The medical records were retrospectively reviewed and analyzed. Results: Three lung cancer patients with LM were included. All of them were heavily pretreated with various TKIs, chemotherapy, or/and with antiangiogenesis and PD-1 antibodies. When they were referred to our department, all these patients were in severe medical conditions. Case 1 has severe multiple cranial nerve impairment with cauda equina syndrome and massive malignant pleural effusion. Case 2 has intensively violent headaches with vomit and lumbosacral pain due to more than 500mm H2O of intracranial hypertension. Case 3 has acute pancreatitis due to oppressive obstruction of pancreatic duct by multiple metastatic tumors. The molecule test of tumor tissue or liquid from malignant pleural fluid have revealed E20 p.C797S in cis with p.T790M accompanied E19 del of EGFR gene in case 1, E21 p. R831H with E19 p.L747P of EGFR gene in case 2, and E20 p.S768_D770dup of EGFR gene in case 3, respectively. Their therapies were changed to cetuximab combined with TKI of afatinib or osimertinib, and local treatment including local radiation, intraventricular pemetrexed administration, or with intrathoracic drain. The disease control rate (DCR) was 100% of one partial remission (PR) and two stable disease (SD). The intracranial response was also observed in all the 3 patients showing CSF cytology turning negative or enhanced meningeal disappearance in MRI image with obviously relieved headache or/and improved cranial nerve palsy. The performance status of two patients was largely improved from Karnofsky Performance Status (KPS) scoring 20 to 90 and 50, respectively, and that of the other patient was stable with KPS scoring 50. The side effect is manageable skin rashes (grade II-III). Until this abstract was written, all the 3 patients were still alive. Conclusions: Cetuximab-based systemic therapy combined with local treatment demonstrated preliminary clinical activity in the rare EGFR-mutant lung cancer with LM who have already undergone heavily previous therapy, warranting further investigation.
Upfront stereotactic radiosurgery for brain metastases from triple-negative breast cancer.
Authors: An Ran , Wang Yan , Wang Fuchenchu , Singareeka Raghavendra Akshara , Gao Chao , Amaya Diana , Ibrahim Nuhad K. , Li Jing 
Published: June 2021

e14014 Background: Triple-negative breast cancer (TNBC) is an aggressive subtype with high propensity of brain metastases (BM). Outcomes after upfront stereotactic radiosurgery (SRS) for BM from TNBC patients are not well defined. We evaluated outcomes and identified prognostic factors for such patients. Methods: We reviewed 57 consecutive patients treated with upfront SRS for BM from TNBC in May 2008–April 2018 at a large-volume cancer center. Endpoints were overall survival (OS) from BM diagnosis and freedom from BM progression (FFBMP) after initial SRS. BM progression was defined as local and/or distant brain failure (LBF or DBF) after initial SRS; LBF was radiographic progression of treated lesions, assessed by a neuroradiologist or treating physician excluding post-radiation changes or radiation necrosis. Kaplan-Meier and Cox proportional hazard regression analyses were used to estimate survival outcomes and identify prognostic factors. Results: In this cohort of 57 patients with a median age of 53 y (range 26–82) at BM diagnosis and follow-up time of 12.2 months (mo, range 0.8–97.5), median time to BM development from TNBC diagnosis was 23.7 mo (range 0.7‒271.1). Estimated median OS time from initial BM diagnosis was 13.1 mo (95% CI 8.0‒19.5). In univariate analysis, Karnofsky performance score (KPS) > 70 (p = 0.03), having < 3 BMs (p = 0.016) at BM diagnosis, and BM as first site of metastasis (p = 0.041) were associated with longer OS. On multivariate analysis, KPS ≤70 was associated with higher risk of death (HR 3.0, p = 0.03). Of 46 patients with imaging follow-up for FFBMP assessment, 29 (63%) developed BM progression after initial SRS with an estimated median FFBMP of 7.4 mo (95% CI 5.7–12.7). Median times to LBF and DBF were 10 mo (range 0.3–97) and 5.9 mo (range 0.3–90.8). Estimated cumulative LBF rate was 17.8% (95% CI 2%–31.1%) and DBF 61.1% (95% CI 40.8%–74.4%) at 12 mo. Number of BMs at BM diagnosis (≥3 vs < 3) was not associated with FFBMP (p = 0.7). Of the 29 patients with BM progression, 5 did not receive salvage radiation therapy (RT) and 24 received salvage RT (SRS, whole-brain radiation [WBRT], or both SRS+WBRT). Receipt of salvage RT was associated with longer survival (median 21.7 mo vs. 7.0 mo for no salvage RT, p < 0.0001) and did not differ by type of salvage RT (median OS 18.6 mo for WBRT; 26.2 mo for SRS+WBRT; 35.9 mo for SRS, p = 0.08). Conclusions: We reported a median OS of 13.1 mo and FFBMP of 7.4 mo in TNBC patients with good local control. Good KPS was independent prognostic factor for better OS. FFBMP did not differ by number of SRS-treated brain lesions ( < 3 vs ≥3). Further prospective studies of larger numbers of patients needed for more accurate comparisons of treatment types.
Safety and efficacy of hypofractionated stereotactic radiosurgery with anlotinib targeted therapy for glioblastoma at first recurrence: A preliminary report.
Authors: Guan Yun , Zhu Huaguang , Li Jing , Mei Guanghai , Liu Xiaoxia , Li Chao , Gong Xiu , Dai Jiazhong , Pan Li , Wang Yang , Wang Enmin , Wang Xin 
Published: June 2021

e14015 Background: The optimal treatment for recurrent glioblastoma (rGBM) remains uncertain. Hypofractionated stereotactic radiotherapy (HSRT) and anti-vascular endothelial growth factor (VEGF) antibodies (e.g, bevacizumab and anlotinib) have been reported a promising survival benefit and acceptable toxicity in recent studies. This research aimed to investigate the efficacy and safety of hypofractionated stereotactic radiosurgery with anlotinib as a salvage treatment for rGBM within the radiation field at first recurrence. Methods: Between December 2019 and June 2020, rGBM patients treated with CyberKnife (CK) radiosurgery concurrently with anlotinib were retrospectively analyzed. Anlotinib was prescribed 12 mg daily during CK. Adjuvant anlotinib was administered 12mg d1-14 every 3 weeks. The primary endpoint was objective response rate (ORR) using response assessment in neuro-oncology (RANO) criteria, and secondary endpoints included overall survival (OS), progression-free survival (PFS) after salvage treatment, and toxicity. Toxicity was assessed using common terminology criteria for adverse events (CTCAE) 5.0. Results: A total of five patients were included in the study. The median planning target volume (PTV) was 26.94 cm3 (5.53 to 54.41 cm3). The prescribed dose was 25.0 Gy in 5 fractions. The median number of cycles of anlotinib was 9 (4 to 15 cycles). The median baseline Karnofsky Performance Status (KPS) is 80 (70 to 90). The follow-up ranged from 4 to 10 months. Three (60%) patients had the best outcome of partial response (PR), and 2 (40%) achieved complete response (CR), the ORR was 100%. No patient died or had progressive disease (PD) until the last follow-up. Two patients had grade 2 hand-foot syndrome and relieved after dermatology treatments, no other grade 3 or higher toxicities was recorded. Conclusions: Salvage radiosurgery with anlotinib showed a favorable outcome and acceptable toxicity for rGBM patients in this preliminary report. A prospective phase II study (NCT04197492) is ongoing to further investigate the regimen in rHGG. [Table: see text]
Molecular characteristics of H3 K27M mutation gliomas in Chinese adults.
Authors: Zhang Peng , Han Tiantian , Lu Yi , Sun Weijie , Deng Wanglong , Lu Guanghua , Guo Didi , Li Xiaomin , Bu Fanfeng 
Published: June 2021

e14018 Background: Diffuse midline glioma H3 K27M–mutant is a specific entity added to the 2016 update of the WHO classification of CNS tumors. H3K27M-mutant gliomas are diagnosed primarily in children and adolescents with TP53 and/or ATRX mutations. However, the characteristics of H3 K27M-mutant gliomas in adults have not been explicitly described. Methods: We performed the 131-gene panel targeted sequencing on tumor samples from 33 adults H3 K27M-mutant gliomas( > 18 years) and 13 children and adolescents H3 K27M-mutant gliomas(≤18 years) in a CAP certified laboratory. Somatic mutations, copy number variations, and fusion genes were detected following the standard operating procedure (SOP). The MS-based assay measured MGMT promoter methylation. We calculated the tumor location and the median age in different cohorts. Results: In our adult cohort, 22/33（66.7%）had a midline location（spinal cord n = 2, thalamus n = 7, brainstem n = 6, cerebellum n = 3, pineal region n = 1, Basal ganglia region n = 3）, 6/33（18.1%）had a non-midline location (Lateral ventricle n = 2, Cerebral hemispheres n = 4). In the children and adolescents cohort, 11/13（84.6%）occurred in midline location, 1/13(7.7%) occurred in the Lateral ventricle. MGMT promoter methylation did not differ in adult and pediatric H3 K27M-mutant gliomas (12.1% vs. 0). H3 K27M-mutant adult gliomas significantly co-occurred with the NF1 mutation(P = 0.008937). The median age of H3 K27M-mutant adult gliomas with NF1 modification (13/33, 39.4%) is higher than the NF1 wild type (49 years vs. 38 years, P = 0.107), although the difference has no statistical significance. Conclusions: In Chinese adults, as in children, H3 K27M mutation gliomas are characterized by a constant midline location, low rate of MGMT promoter methylation. Inconsistently, H3 K27M mutant adult gliomas are featured by a higher rate of NF1 mutations. Our molecular profiling analysis revealed the H3 K27M mutation in adult gliomas. Our research suggests potential molecular pathogenesis of H3K27M mutant adult gliomas and identifies more therapeutic targets for precision medicine.
Comparison of next-generation sequencing and FISH/IHC for molecular classification in glioma.
Authors: Jia Deze , Lu Yi , Li Xiaomin , Han Tiantian , Deng Wanglong , Bu Fanfeng , Lu Guanghua 
Published: June 2021

e14021 Background: The updated 2016 edition of the WHO Classification of CNS tumors indicates that IDH1 R132H, H3 K27M mutations, and co-deletion of 1p19q are strong stratification and prognostic markers glioma. FISH/IHC, as the commonly detected methods, present specific false-negative rates in the actual condition. Methods: In our study, IDH1 R132H status of 158 cases was assessed by IHC and NGS, and H3 K27M statuses of 83 patients were evaluated by IHC and NGS. 22 positive cases of 1p/19q co-deletion, all confirmed by FISH, were assessed by NGS. Results: For IDH1 R132H, 2 cases were IHC negative and were positive as confirmed by NGS. Another 10 patients with weakly IHC positive results were negative in NGS. Combined with histologic hallmarks, 6 cases of these samples could be diagnosed as glioblastoma, IDH wildtype; 1 case with POLE could be diagnosed as giant cell glioblastoma; 3 cases with BRAF V600E mutation, BRAF fusion, and ATRX mutation, respectively, could be diagnosed as pilocytic astrocytoma. Towards H3 K27M, 3 cases with IHC weakly positive were negative in NGS. Among these samples, 2 cases were diagnosed as glioblastoma, IDH wildtype by molecular and histologic hallmarks, and 1 case was medulloblastoma, SHH. Using NGS, IDH1 R132H /H3 K27M statues can be distinctly distinguished in which that is unknown by IHC. The results of NGS and FISH showed a 90.9%(20/22) consistent rate for the 1p19q co-deletion. 1 case was 1p deletion and intact 19q by FISH while 1p19q co-deletion by NGS because of the 19p deletion. 1 case was 1p19q co-deletion by FISH but 1p19q wildtype by NGS, diagnosed as glioblastoma, IDH wildtype with chr7+/10-. Conclusions: In our study, the agreement between NGS results and clinical pathology diagnosis was approximately 100%. NGS may act as the primary technology of molecular classification in glioma in the future.