bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer prevention among residents: Practice and patterns.
Authors: Akogbe G. O. , Anumenechi N. , Ezigbo C. A. 
Published: February 2017

33 Background: At least a third of all cancer cases are preventable. Prevention offers the most cost-effective long- term strategy for the control of cancer; especially in resource deprived areas of the world. Tobacco is the single largest preventable cause of cancer in the world today. Dietary modification is another important approach to cancer control. Infectious agents are responsible for almost 22% of cancer death in the developing world and 6% in industrialized countries. This number is on the rise as result of HIV/AIDS pandemic, life style change and malnutrition. Residents constitute a very important arm of specialized cares in tertiary health institutions. They are the “gate-keepers” who are often the first to come in contact with patients that will benefit from cancer preventive measures. The purpose of this study is therefore, to examine the awareness, attitude and practice of cancer prevention by residents. Methods: Randomly selected residents from the major clinical oncology departments answered questionnaire that addressed these cancer prevention domains; awareness of behavioral modification and early screening, discussing cancer prevention with patients, and participating in screening for common cancer risk factors. Results: 77 out 100 questionnaire distributed were completed and returned; 77% response rate. 97% of the respondents are aware of cancer preventive measures but only 73% of these discussed the measures with patients. 9% of the respondents do not advise patient to quit smoking/not to smoke, only 22% advocate protection against sun, 23% do not advocate for early screening, and only 25% of the respondents themselves are screened for any of the common cancer risk factors while 74% are not. Conclusions: There is significant awareness of cancer prevention measures but not all put this knowledge to practice. Only a quarter of the respondents are themselves screened. Further studies are needed to determine interventions that can improve resident's attitude to cancer prevention in resource deprived economy with rising prevalence of cancer. With improved training opportunities for cancer control among professionals, more cancers will be diagnosed via early screening and detection. No significant financial relationships to disclose.
Quality of life in patients with pancreatic cancer during neoadjuvant chemotherapy using gemcitabine and bevazizumab: A pilot study.
Authors: Fitzal F. , Schindl M. , Wrba F. , Koelblinger K. , Goetzinger P. , Kornek G. , Sahora K. , Gnant M. , Kuehrer I. 
Published: February 2017

330 Background: Neoadjuvant chemotherapy (nCT) for pancreatic cancer is increasing due to the fact that 75% of patients diagnosed with pancreatic cancer are borderline or non-resectable. The use of antibodies may improve the efficacy of nCT. The influence on quality of life is not clear. Methods: We prospectively evaluated quality of life in patients comparing nCT with gemcitabine (1000mg/m2; 1, 8, 15 for 4 cycles) and bevacizumab (nCT-GA; n=8) with patients with (aCT-G, n=15) or without adjuvant gemcitabine (noCT; n=14) using the EORTC-QLQ PAN26 modul. We also included patients operated due to benign disease as a control group (B; n=15). Quality of life was measured before as well as 3-7 months after surgery. Results: 52 patients were included in the study. There was no difference between the four groups before surgery in overall quality of life sores (p=0.280). Overall quality of life was also not impaired three months after surgery in any group (nCT-GA: 45 ± 23 vs. 65 ± 23 p=0.196; aCT-G: 42 ± 16 vs. 58 ± 22 p=0.104; noCT: 42 ± 16 vs. 49 ± 24 p=0.462; B: 60 ± 22 vs. 58 ± 21 p=0.894). There were no statistic significant differences between the four groups three to seven months after surgery (p=0.578). Similar function scores such as appetite loss, digestive symptoms or others did not differ significantly. Conclusions: Chemotherapy with or without bevacizumab seems to be well tolerated. The similar appetite score in patients comparing malignant (±chemotherapy) with benign disease is of importance as weight loss is a bad prognostic marker in pancreatic cancer patients. Thus, chemotherapy with or without bevacizumab may be safe in this respect. Further prospective trials with larger patient numbers are needed. [Table: see text]
Effect of age on likelihood of treatment and outcome in pancreatic cancer.
Authors: Wheeler A. A. , Dale P. S. , Nicholl M. B. 
Published: February 2017

332 Background: Pancreatic cancer is a disease primarily diagnosed in elderly patients; however, a significant number of young patients will also be affected. We hypothesized young patients with pancreatic cancer would be treated more aggressively and therefore have better prognosis. Methods: A retrospective review of a prospectively maintained cancer database was queried for all patients treated for pancreatic cancer at our institution. Age 50 years was selected to stratify pancreatic cancer patients as young or old. Results: Of 320 pancreatic cancer patients identified from the database, 56 (18%) were ≤ 50 years old. Exocrine cancer was the most common histology (90%). Young patients were significantly more likely to have an endocrine cancer (23% vs. 7%, p<0.001). For all tumor histologies, there was no difference between young and old patients regarding stage, grade, or likelihood curative intent surgery; however, young patients were more likely to receive chemotherapy (59% vs. 40%, p=0.008) and radiation therapy (27% vs. 15%, p=0.03). There was a trend toward improved overall survival in young patients (23.9 months vs. 13.8 months, p=0.06). When only exocrine pancreatic cancers were considered, there was no difference between young and old patients regarding stage, grade, location, or likelihood of undergoing surgical treatment. In this group, young patients were again more likely to receive chemotherapy (65% vs. 40%, p=0.002) and radiation therapy (35% vs. 16%, p=0.003). There was no difference in overall survival between young and old patients with exocrine pancreatic cancer. Conclusions: A considerable number of patients with pancreatic cancer are ≤ 50 years old. Exocrine cancers are the most common pancreatic neoplasm regardless of age; however endocrine tumors are more common in young patients. Despite more frequent use of adjuvant treatment in exocrine pancreatic cancer patients ≤ 50 years old, there is no improvement in overall survival. Significant improvements in pancreatic cancer survival are not dependent on aggressive use of adjuvant therapies, but await the development of new treatment strategies. No significant financial relationships to disclose.
Resectable pancreatic small cell carcinoma: The experience of two institutions and review of the literature.
Authors: Winter J. M. , Narang A. K. , Mansfield A. S. , Herman J. M. , Cameron J. L. , Laheru D. , Eckhauser F. E. , Olson M. , Miller R. C. , Andersen D. K. 
Published: February 2017

333 Background: Primary pancreatic small cell carcinoma (SCC) is rare, with just over 30 cases reported in the literature. Only 7 of these patients underwent surgical resection with a median survival of 6 months. Prognosis of SCC is therefore considered to be poor, and the role of adjuvant therapy is uncertain. Here we report two institutions' experience with resectable pancreatic SCC. Methods: Six patients with pancreatic SCC at the Johns Hopkins Hospital (4 patients) and the Mayo Clinic (2 patients) were identified from prospectively collected pancreatic cancer databases and re-reviewed by pathology. All six patients underwent a pancreaticoduodenectomy. Clinicopathologic data was analyzed, and the literature on pancreatic SCC was reviewed. Results: Median age at diagnosis was 50 years (range 27-60). Half of the patients were male, and half were known smokers. All six masses were limited to the pancreatic head. Median tumor size was 3 cm, and all cases had positive lymph nodes except for one patient who only had five nodes sampled. There was no perioperative mortality, although three patients had postoperative complications. All six patients received adjuvant chemotherapy therapy, five of whom were given cisplatin and etoposide. Of these five patients, three were known to have received radiation, while the remaining two had a plan for radiation at an outside facility. Median survival was 20 months with a range of 9-173 months. The patient who lived for 9 months received chemotherapy only, while the patient who lived for 173 months was given chemoradiation with cisplatin and etoposide and represents the longest reported survival time from pancreatic SCC to date. Conclusions: Pancreatic SCC is an extremely rare form of cancer with a poor prognosis. Patients in this surgical series showed improved survival rates when compared to prior experiences with both resected and unresectable cases. Cisplatin and etoposide appears to be the preferred chemotherapy regimen, although its efficacy remains uncertain, as does the role of combined modality treatment with radiation. No significant financial relationships to disclose.
Sorafenib versus cytotoxic chemotherapy for patients with advanced hepatocellular carcinoma: A retrospective, single-institution study.
Authors: Lee S. , Yoon S. , Shin S. , Choi H. 
Published: February 2017

339 Background: Prior to the sorafenib era, most of the advanced hepatocellular carcinoma (HCC) patients had to rely only on conventional cytotoxic chemotherapy. But the introduction of sorafenib in 2008 had given HCC patients additional option for their treatment. However, given that sorafenib has been a nonreimbursable drug under the Korea public health system, most of treatment strategy has largely been determined by patients' affordability of the drug rather than by difference in efficacy and toxicity of the two treatments. Therefore, we compared the efficacy and toxicity of the two treatments by observing HCC patients. Methods: From January 2002 to December 2009, 173 patients with unresectable HCC had been retrospectively analyzed. Among them, 44 (25.4%) had been treated with sorafenib and the remaining had received cytotoxic chemotherapy. We evaluated objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and toxicity profiles. Results: The median OS of sorafenib group was 23.0 weeks (95% CI, 8.1-37.9) vs. 43.6 weeks (95% CI, 34.0-37.9) for cytotoxic chemotherapy group. The median PFS for sorafenib group was 11.1 weeks (95% CI, 6.5-15.8) versus 12.4 weeks (95% CI, 8.1-16.7) for cytotoxic chemotherapy group. However, the difference in both findings had not been statistically significant (p=0.105 and p=0.496, respectively). ORR and DCR for sorafenib group were 2.3% and 52.3% versus 6.2% and 43.4% for cytotoxic chemotherapy group, respectively. Patients treated with chemotherapy had shown higher frequencies of grade 3 or 4 neutropenia, 19.7%, (vs. 0% for sorafenib). However, the group with sorafenib had reported a higher rate of all grade dermatologic toxicities such as hand-foot skin reaction, rash and pruritus. Conclusions: Our analysis indicates that efficacy of conventional chemotherapy is not inferior to that of sorafenib. Further research including novel target agent and cytotoxic chemotherapy is needed to improve clinical outcomes for advanced HCC. No significant financial relationships to disclose.
Laparoscopic hepatic resection: Favorable short-term outcomes for colorectal cancer metastases of the left hemiliver.
Authors: Enestvedt C. K. , Diggs B. S. , Sheppard B. C. , Orloff S. , Billingsley K. G. 
Published: February 2017

347 Background: Recent reports demonstrate the feasibility of laparoscopic liver resection for patients with benign and malignant conditions. We hypothesized that patients who underwent laparoscopic resections for colorectal cancer (CRC) metastases of the left liver would have short-term outcomes similar to those who had open surgery. Methods: A retrospective review compared laparoscopic left liver resections for CRC metastases to open controls for the years 2005-2010. There were two anatomic left hepatectomies in each group, with lesser segmentectomies in the remainder. Demographic information, pathology, tumor characteristics, procedure related factors, complications, and mortality were assessed. Univariate analysis was performed with significance of p<0.05. Results: Nine patients had laparoscopic resection during the study period, with 1 case converted to open (11%). There were no differences in demographics, tumor factors, margins, or major complications (Table). The laparoscopy group had significantly lower intraoperative blood loss and shorter length of stay compared to the open group. There were no deaths in either group. Conclusions: In this select group of patients undergoing resection of the left hemi-liver for CRC metastases, short-term outcomes favored the laparoscopic approach. Long- term data regarding disease recurrence and survival are needed in this group of patients. These results indicate that surgeons should consider laparoscopic resection of the left liver whenever technically feasible in the setting of CRC metastases. [Table: see text] No significant financial relationships to disclose.
Positron emission tomography (PET) with 89Zr-labeled trastuzumab (89Zr-trastuzumab): Monitoring HER2 expression in HER2-positive gastric cancer in vivo.
Authors: Janjigian Y. Y. , Villegas N. T. , Holland J. P. , Shah M. A. , Divilov V. , Kelsen D. P. , Lewis J. S. 
Published: February 2017

35 Background: The ToGA study established HER2 is a target in the treatment of gastric cancer. Trastuzumab pharmacokinetics and organ distribution is varied in each patient and is heavily affected by the extent of tumor load (Oude Munnink, JCO 2010). 89Zr-trastuzumab HER2 PET can be used to image that variability and may aid in detection and staging of HER2-positive tumors. We are implementing 89Zr-radiolabeled trastuzumab PET in vivo for imaging of HER2-positive gastric cancer and for future non-invasive assessment of HER2 inhibition with a dual irreversible HER1/HER2 inhibitor, BIBW-2992. Methods: 89Zr (t1/2 = 3.17 days) was prepared via the 89Y(p,n)89Zr transmutation with high radiochemical yields (1.52±0.11 mCi/μAh) and purity (>99.99%). Trastuzumab was functionalized with the tris-hydroxamate chelate, desferrioxamine B (DFO) and radiolabeled with [89Zr]Zr-oxalate at room temperature. 89Zr-trastuzumab PET experiments in athymic nu/nu mice bearing sub-cutaneous NCI-N87 (HER2+) and/or SNU1 (HER2-) tumors were conducted. NCI-N87 gastric cancer cells were treated with BIBW-2992. Results: 89Zr-trastuzumab radiolabeling proceeded in high radiochemical yield and specific-activity of 2.82±0.05 mCi/mg. In vitro assays demonstrated >99% radiochemical purity with an immunoreactive fraction of 0.87±7. In vivo biodistribution experiments revealed high and specific uptake in HER2-positive tumors after 72 h (85.2±11.1% ID/g) with retention of activity for over 120 h. No uptake was seen in HER2-negative gastric cancer xenografts. In vitro, BIBW-2992 demonstrates dose dependent growth inhibition in the HER2+ gastric cancer cell line. Conclusions: 89Zr-trastuzumab provides quantitative and highly-specific delineation of HER2-positive gastric cancer. In vivo studies of BIBW2-2992 in gastric cancer with 89Zr-trastuzumab HER2 PET response assessment are underway. A Phase I study of 89Zr-trastuzumab PETin HER2-positive patients is to open at MSKCC imminently. No significant financial relationships to disclose.
Epidermal growth factor receptor (EGFR) as a predictive and prognostic marker in patients with advanced colorectal cancer (aCRC): The MRC COIN trial experience.
Authors: Adams R. A. , James M. D. , Smith C. G. , Wilson R. H. , Fisher D. , Kenny S. L. , Kaplan R. S. , Stoerkel S. , Maughan T. S. , Jasani B. 
Published: February 2017

359 Background: KRAS mutation has been shown to be a more effective (though negative) biomarker for selection of patients for EGFR targeted therapy in aCRC. However, positive EGFR immunohistochemistry (IHC) remains a license requirement and was an inclusion criterion in most trials to date. The MRC COIN trial recruited 2445 pts into 3 arms of oxaliplatin + fluoropyrimidine +/- cetuximab without prior EGFR assessment. This trial provides a unique opportunity to definitively examine the role of EGFR IHC as prognostic and predictive marker and potentially the evidence required to remove this assessment from the license for this drug. Methods: Formalin-fixed paraffin embedded (FFPE) tissue was stained retrospectively for EGFR using Dako kit in a national reference lab. Results were assessed by 3 reviewers (BJ, SS, RA) using digital imaging software in a blinded fashion, then by BJ/SS providing consensus for discrepancies. EGFR scoring was assessed as a prognostic variable in association with selected patient, tumor and biochemical data. Cut off points examined for +ve vs -ve tumours, in terms of total tumour cells demonstrating membrane staining, were: 0% vs >0%; <10% vs ≥10%; <20% vs ≥20%. Results: EGFR IHC was adequately assessed for 1621 pts (66% of randomised), 22% were negative (0%) and 78% positive (>0%), balanced across arms. EGFR was not prognostic for PFS within KRAS wt pts at the standardized cut off point 0% vs >0% HR=1.11 95% CI 0.91-1.36 p=0.31 but was at <10% vs ≥10% (HR=1.27 95% CI 1.07-1.52 p=0.008) this was robust to other prognostic variables. No effect was seen for overall response or survival. There was no prognostic effect for the KRAS mutant group. In the 1065 assessable pts randomised to +/- cetuximab, no evidence of EGFR IHC as a predictive marker for response or survival outcomes was observed for the addition of cetuximab to chemotherapy (OS HR=1.11 95% CI 0.70-1.75 p=0.66; PFS HR=0.95 95% CI 0.64-1.43 p=0.82). Conclusions: Extensive assessment of samples from this trial suggest a role for EGFR IHC as a prognostic marker in KRAS wt aCRC but refute the predictive value embedded within the licence for cetuximab used in combination with chemo in first-line therapy. [Table: see text]
GCC expression in lymph nodes (LNs) as a significant determinant of recurrence in stage II colon cancer (CC) patients (pts).
Authors: Sargent D. J. , Shi Q. , Bot B. M. , Resnick M. B. , Meyers M. O. , Goldar-Najafi A. , Clancy T. E. , Gill S. , Siemons G. O. , Fradet Y. 
Published: February 2017

369 Background: A multi-center prospectively specified retrospective study Validating Indicators to Associate Recurrence (VITAR) is assessing the relationship between guanylyl cyclase C (GCC) gene expression in formalin fixed LNs and recurrence risk in stage II CC pts not treated with adjuvant chemotherapy. Here we report the preplanned initial analysis performed with 241 pts. Methods: GCC mRNA was quantified by RT-qPCR using FFPE LNs tissues from untreated stage II CC pts diagnosed from 1999-2006 with at least 10 LN examined blinded to clinical outcomes. Cox regression models examined the relationship between GCC nodal status and the prespecified primary endpoint of recurrence risk. Results: Twenty-ninepts (12%) had a disease recurrence or cancer death, median follow-up was 60 months and median LNs examined was 15. The ratio of the number of GCC+ LNs over the total number of informative LNs (LNR) significantly predicted higher recurrence risk for 84 pts classified as high risk (HR, 2.38; p=0.02). The estimated 5-yr recurrence rates were 10% and 27% for the low and high risk group, respectively. After adjusting for age, T stage, number of LNs assessed, and MMR status, the significant association remained (HR, 2.61; 95% CI, 1.17-5.83; p=0.02). In a subset of 181 pts with negative margin, T3 tumor only and ≥12 LN examined, the GCC LNR had a HR for recurrence of 5.06 (95% CI 1.61-15.91, p=0.003), translating into 5-yr recurrence rates of 4% among low risk pts and 27% for the high-risk group. Conclusions: Our results suggest that GCC expression in LNs is a significant determinant of recurrence in appropriately staged CC pts not treated with adjuvant chemotherapy. The validation component of the study is ongoing. [Table: see text] [Table: see text]
Hypertension (HTN) as a potential biomarker of efficacy in patients (pts) with gastrointestinal stromal tumor (GIST) treated with sunitinib (SU).
Authors: George S. , Lechner T. , Li S. , Cohen D. P. , Demetri G. D. 
Published: February 2017

38 Background: HTN is a class effect of VEGF signaling pathway inhibitors. SU is a multitargeted inhibitor of VEGFRs and other receptor tyrosine kinases. Associations between SU-induced HTN and efficacy endpoints (OS, PFS, TTP, and ORR) in pts with imatinib-resistant/intolerant GIST from 2 prospective clinical trials were investigated retrospectively. Methods: This analysis included pooled data from 319 pts who received SU and had post-baseline blood pressure (BP) data available. Tumor response data were based on investigator assessments. Most pts (87%) received SU 50 mg/d on the standard 4-wk-on/2-wk-off schedule. BP was measured on the first and last day of dosing in each treatment cycle at a minimum. HTN was defined as max or mean SBP ≥ 140 or DBP ≥ 90 mmHg. OS, PFS, and TTP were estimated by Kaplan—Meier methods and compared between pts with vs. without HTN using the log-rank test. The influence of prognostic risk factors was analyzed using a Cox proportional hazards model. Results: 233 and 187 pts (73% and 59%) had ≥ 1 HTN episode as defined by max SBP and DBP, respectively. Efficacy results significantly favored pts who developed HTN on SU based on max SBP or DBP (eg, median OS for pts with HTN [max SBP] was 89.4 weeks vs. 53.1 weeks for pts without HTN [p = 0.0001]). Using HTN onset as a time-dependent covariate, HTN defined by max DBP was a significant predictor of prolonged TTP and PFS, and HTN defined by both max SBP and DBP was a significant predictor of prolonged OS (p < 0.05). In multivariate analysis, HTN defined by max SBP or DBP was a significant independent predictor of improved OS, PFS, and TTP (p < 0.0001). Analysis of any-grade and grade ≥3 cerebrovascular, ocular, cardiac, and renal AEs in pts with/without HTN is ongoing and will be presented. Clinical outcomes were not compromised in pts treated with anti-HTN medications. Conclusions: SU-associated HTN was significantly and independently associated with improved clinical outcomes, supporting the hypothesis that HTN is a biomarker for antitumor efficacy in pts with GIST treated with SU. Serial BP monitoring and standard use of anti-HTN medications, which were not shown to compromise efficacy, are recommended during SU therapy. [Table: see text]