bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differentiating between adrenocortical carcinoma and pheochromocytoma by radiomics features at CT: A multi-institutional retrospective study.
Authors: Zhang Jingtong , Chao Yinyao , Yao Kai , Guo Shengjie 
Published: June 2024

4603 Background: Adrenocortical carcinoma (ACC), a highly malignant and rare tumor of the adrenal gland, shares similar CT characteristics with the less malignant pheochromocytoma (PHEO), resulting in low CT diagnostic accuracy. The standard therapeutic strategy for ACC differs from that of PHEO, making accurate diagnosis of ACC challenging but important. Radiomics offers an opportunity to classify adrenal tumors. However, previous research has primarily focused on differentiating malignant adrenal lesions from benign cases. In addition, the rarity of ACC makes it difficult to initiate large-scale studies, thus hindering further applications of radiomics. This study aimed to differentiate between ACC and PHEO using radiomics features based on contrast-enhanced CT. Methods: A total of 158 patients (median age, 47 years; inter-quartile range, 32-57 years; 76 males) pathologically diagnosed with ACC or PHEO between 2011 and 2023 were enrolled from three independent institutions. Radiomics features were extracted from different phases of contrast-enhanced CT images, and then selected by a two-step procedure. The radiomics model was developded and trained in the development cohort of 109 patients from Institution 1, then the model performance was tested in the test cohort of 49 patients from Institution 2 and 3. The area under the receiver operating characteristic curve (AUC) of the radiomics model was compared with two radiologists using the DeLong test. The SHAP method was used to improve the interpretability of the radiomics model. Results: We developed and tested a radiomics model that consisting of 10 selected radiomics features. In the test cohort, the radiomics model exhibited a significant improvement in diagnostic performance over 2 radiologists (AUC 0.92 vs. 0.79, 0.63) and achieved high accuracy (86%), sensitivity (81%) and specificity (88%) in differentiating between ACC and PHEO. Furthermore, the diagnostic process of this radiomics model was visualized using the SHAP method. Conclusions: To our knowledge, this is the first multi-institutional study to develop an interpretable radiomics model for preoperative differentiation between ACC and PHEO based on contrast-enhanced CT. The diagnostic performance of the radiomics model surpassed that of experienced radiologists, which may aid clinical decision making and improve treatment outcomes for ACC.
Smoking history requirement and lung cancer (LC) screening (LCS) eligibility disparities.
Authors: Smeltzer Matthew , Liao Wei , Fehnel Carrie , Goss Jordan , Qureshi Talat , Peppers Sara , Ray Meredith , Osarogiagbon Raymond U. 
Published: June 2024

8016 Background: LCS eligibility criteria are not optimal. US Preventive Services Task Force 2021 criteria (USPSTF21) expanded eligibility, but race and sex disparities persist. We evaluated how 4 modified criteria impact LCS eligibility. Methods: We analyzed data from all persons enrolled into LCS and a non-screening detected Lung Nodule Program (LNP) in a prospective community-based cohort. The LNP used Fleischner Society guidelines. We compared sex, race, and Area Deprivation Index (ADI) of LCS-eligible persons and LC patients diagnosed based on USPSTF21 (Age 50-80, 20 pack-years [PY], 15 year quit duration [QD]) versus 4 more-relaxed smoking history criteria in LNP including the new American Cancer Society (ACS) criteria (Group 4, Table). Results: Of 38,740 individuals from 2015-2023, 11,886 had LCS and 26,854 were from LNP. Expanded criteria increased the total eligible over USPSTF21 from 3939, to 4572, 4611, 4950, 5747 in Groups 2-5, respectively. LC was detected in 3.7% of LDCT (17.4% of those with Lung-RADS 3/4), and in 21%, 20%, 19%, 19%, and 18% of LNP Groups 1-5; number needed to treat (NNT) was 26.8 (LDCT), 5.8 (LDCT Lung-RADS 3/4), and 4.9, 4.9, 5.2, 5.2, 5.5 in Groups 1-5. LC was most frequently adenocarcinoma (41-51%) or squamous (21-30%); with similar stage across groups (47-48% stage I/II). LC was diagnosed in 17%, 11%, 14%, and 13% of additional eligible persons vs. 21% in USPSTF21 (Table). The additional eligible individuals with LC were 42%, 58%, 40%, and 46% female in Groups 2-5. We compared % female in Group 3 with LNP (58 v 51%, p=.25) and LCS (58 v 52%, p=.22). In terms of race, additional eligible individuals were 11%, 47%, 10%, and 24% Black in Groups 2-5; with significant differences between Group 3 and both LNP (47 v 25%, p<.001) and LCS (47 v 16%, p<.001) cohorts. These groups (2-5) were 26%, 38%, 29%, and 33% in the highest (poorest) ADI quintile, with no differences between Group 3 and LNP (38 v 36%, p=.66) or LCS (38 v 42%, p=.56). Group 3 / 5 criteria yielded a 17% / 46% increase in persons screened, and a 9.5% / 28% increase in LC identified over USPSTF21. Conclusions: Relaxed smoking history requirements provided better access to LCS while maintaining diagnostic efficiency in terms of NNT. The shift from 20 PY to 20 years reduced race- and sex- based disparities in LCS eligibility and LC diagnosis, while still reaching the most socially disadvantaged groups. [Table: see text]
Cost-effectiveness in perioperative therapy in the era of immune checkpoint inhibitors.
Authors: Fujioka Masahiro , Aranishi Toshihiko , Shukuya Takehito , Shirai Yukina , Takahashi Kazuhisa 
Published: June 2024

8021 Background: The use of immune checkpoint inhibitors (ICIs) in lung cancer treatment, particularly in perioperative therapy, has significantly expanded. In Japan, atezolizumab was approved in 2022 for adjuvant therapy and nivolumab in 2023 for neoadjuvant therapy. Despite the long-term prognosis improvements associated with ICIs, their high costs have escalated healthcare expenses. This study evaluates the cost-effectiveness of perioperative therapies incorporating ICIs in Japan. Methods: A network meta-analysis (NMA) was conducted to derive hazard ratios (HRs) for disease-free survival (DFS) and overall survival (OS) from pivotal phase 3 clinical trials. Additionally, a partitioned survival model was developed to calculate quality-adjusted life years (QALYs) and life years (LYs). Cost data included drug and administration costs based on standard regimens. Results: ICIs with available DFS and OS data included atezolizumab, nivolumab, and pembrolizumab for adjuvant, neoadjuvant, and sandwich therapy, respectively. HRs (DFS/OS) compared to no perioperative therapy were as follows: adjuvant chemotherapy (0.81/0.86), neoadjuvant chemotherapy (0.87/0.80), adjuvant ICI (0.66/0.86), neoadjuvant ICI (0.55/0.49), and sandwich therapy (0.51/0.58). Cost/QALY/LY for each treatment were: no perioperative therapy (¥831,379/2.55/3.57), adjuvant chemotherapy (¥969,600/2.67/3.73), neoadjuvant chemotherapy (¥903,046/2.71/3.82), adjuvant ICI (¥9,209,863/2.70/3.74), neoadjuvant ICI (¥2,760,383/3.02/4.22), and sandwich therapy (¥8,235,047/2.95/4.10). Incremental cost-effectiveness ratios (ICERs) per QALY/LY were ¥425,189/¥295,036 for neoadjuvant chemotherapy and ¥6,152,576/¥4,592,090 for neoadjuvant ICI ($1 = \145). ICERs were not calculated for adjuvant chemotherapy, adjuvant ICI, and sandwich therapy due to extended dominance. Conclusions: In Japan, the general ICER threshold is ¥5,000,000, and ¥7,500,000 for treatments requiring special consideration, such as cancer therapies. The ICER for neoadjuvant chemotherapy was below the general threshold, and neoadjuvant ICIs below the special consideration threshold, making them cost-effective options for NSCLC patients in Japan. Other therapies were dominated, primarily due to 1) adjuvant chemotherapy being marginally more expensive and less effective than neoadjuvant chemotherapy, and 2) the high costs of long-term post operative ICI treatment for adjuvant ICI, and sandwich therapy.
Treatment outcomes in locally advanced, unresectable NSCLC treated with concurrent chemoradiation and PD-L1 consolidation: Real-world data from a NCI comprehensive cancer center with a racially diverse, high poverty catchment area.
Authors: Mirsky Matthew M. , Lee Ho Jun , Margevicius Seunghee P , Carsel Alex , Myers Katherine , Zablonski Kevin , Zhong Jeffrey , Fu Pingfu , Wang Qian , Dowlati Afshin , Bruno Debora S. , Hsu Melinda Laine 
Published: June 2024

8067 Background: The PACIFIC trial established concurrent chemoradiotherapy (CCRT) followed by consolidation durvalumab as standard of care for unresectable stage III non-small cell lung cancer (NSCLC). This study showed a progression free survival (PFS) of 16.9 mo and an overall survival (OS) of 47.5 mo. There is a paucity of real world data with PACIFIC, especially in diverse patient populations. We present real world outcomes of the PACIFIC regimen in a NCI-designated comprehensive cancer center (CCC) with a racially diverse, high poverty catchment area. Methods: Retrospective chart review identified patients treated with durvalumab for NSCLC after CCRT per PACIFIC. Demographic data included sex, race, age, stage, address, smoking status, immunotherapy adverse events (irAE). Poverty index was assessed using the SAIPE tool by percent of children in poverty at the school district level based off 2021 census and stratified to above and below 15.1%. Annual air particulate matter (PM) 2.5 was obtained at the zip code level from the Socioeconomic Data and Applications Center. PFS was from date of first dose durvalumab; OS was from date of NSCLC diagnosis to death or last follow up. Results: 203 patients with unresectable NSCLC were included. Of these, 18.2% were of Black race compared to 2.0% in the PACIFIC trial. 42.4% of patients lived in high poverty areas, 44.3% were current smokers. Patients had a median annual PM 2.5 exposure of 7.9 ug/m3. 42.7% had PD-L1 expression >50%. The irAE rate was 27.6% (Table 1). Overall median PFS was 23 mo (95% CI 16.1-31.9) and 28.2 mo (95% CI 11.1-50.7) for patients of Black race. Overall median OS was 52.4 mo (95% CI 31.2-NR) and 52.4 mo (95% CI 18.2-NR) for Black patients. Conclusions: In this diverse cohort treated with the PACIFIC regimen at a NCI CCC, favorable real world PFS (23.0 vs. 16.9 mo), and OS (52.4 vs. 47.5 mo) were demonstrated. This cohort is more representative of the US patient population than that of a stringent clinical trial population with at least comparable results. This unexpected result may arise from institutional practices leading to equitable access to care and other biological characteristics of the population. Clinical trial enrollment representative of the broader population remains paramount for equitable care delivery. [Table: see text]
Phase 2 study of pembrolizumab plus pemetrexed for older patients with non-squamous non-small cell lung cancer with PD-L1 tumor proportion score of less than 50%: CJLSG1901.
Authors: Kogure Yoshihito , Hashimoto Hiroya , Daga Haruko , Fukuda Yasushi , Bessho Akihiro , Yamada Tadaaki , Toi Yukihiro , Kimura Tomoki , Yoshioka Hiroshige , Azuma Koichi , Furuya Naoki , Fukui Yasutaka , Saka Hideo , Kondo Masashi 
Published: June 2024

8540 Background: Immune checkpoint inhibitor plus platinum-containing chemotherapy is the standard of care for patients with advanced non-small cell lung cancer (NSCLC). Pembrolizumab combined with pemetrexed and cisplatin/carboplatin is approved as first line treatment for patients with metastatic non-squamous NSCLC based on the results of KEYNOTE-189. However, data on the efficacy and safety of this regimen are limited for patients aged ≥75 years. In preclinical models, anti-PD-L1 antibody with pemetrexed enhanced the antitumor effect more than the combination of pemetrexed with carboplatin. These results suggest that pembrolizumab plus pemetrexed can be effective while potentially sparing severe side effects by omitting carboplatin. Methods: This multicenter, open-label, phase 2 trial was conducted at 42 institutions in Japan to evaluate the efficacy and safety of pemetrexed plus pembrolizumab. Eligible patients had metastatic/recurrent non-squamous NSCLC without sensitizing EGFR or ALK mutations, were aged ≥75 years, had a PD-L1 TPS of less than 50%, had received no prior systemic chemotherapy, and had an ECOG performance status of 0 or 1. Patients received pemetrexed (500 mg/m2) plus pembrolizumab (200 mg/body) on day 1 of each 21-day cycle. Treatment continued until radiographic progression or unacceptable toxicity was observed. The primary endpoint was the objective response rate (ORR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), and safety. This trial is registered with ClinicalTrials.gov (NCT04396457) and the Japan Registry of Clinical Trials (jRCTs041200012). Results: From July 2020 to May 2022, 49 patients were enrolled in this study. The median follow-up time was 15.4 months. The median age was 79.0 years (range 75-91), 77.6% of the patients were male, and 57.1% had a PD-L1 TPS ≥1%. The ORR was 36.7% (95% CI 23.4-51.7), and the disease control rate was 65.3% (95% CI 50.4-78.3%). The median PFS was 7.6 months (95% CI 4.8-16.2), and the median OS was 19.4 months (95% CI 11.8- not reached). The most common grade 3 or 4 adverse events were neutropenia (31.3%), leukopenia (20.8%), and anemia (12.5%). Serious adverse events were observed in 14 patients (4 with pneumonitis, 2 with decreased appetite, 2 with febrile neutropenia). No treatment-related deaths were observed. Conclusions: Pembrolizumab plus pemetrexed demonstrated an ORR of 36.7% and met the primary endpoint. The safety profile was tolerable and manageable. This combination therapy is a promising candidate as a novel first line treatment strategy for older patients with metastatic non-squamous NSCLC. Clinical trial information: NCT04396457 .
Sotorasib plus panitumumab for pre-treated non-small cell lung cancer with KRASG12C mutation: A phase 1b study.
Authors: Langer Corey J. , Galot Rachel , Prenen Hans , Hong David S. , Victoria Iván , Salgia Ravi , Chenard-Poirier Maxime , Furqan Muhammad , Chan Emily , Nolte-Hippenmeyer Jane , Xia Caihong , Li Bob T. 
Published: June 2024

8559 Background: Sotorasib, a selective and irreversible KRASG12C inhibitor, is approved for treatment of adults with KRAS G12C-mutated advanced non-small cell lung cancer (NSCLC) who received ≥ 1 prior systemic therapy. EGFR pathway alterations have been observed as an acquired resistance mechanism with sotorasib monotherapy. Treatment with sotorasib plus an EGFR inhibitor, such as panitumumab, may enhance efficacy over sotorasib monotherapy, as demonstrated in chemotherapy refractory metastatic colorectal cancer. Our current study assesses sotorasib plus panitumumab in pre-treated advanced NSCLC. Methods: Key eligibility criteria for this dose expansion cohort of the CodeBreaK 101 study (NCT04185883) included advanced NSCLC positive for KRAS G12C, ≥ 1 prior treatment for advanced disease, and no prior KRASG12C inhibitor exposure. Patients (pts) with active brain metastases were excluded. Primary endpoint was safety. Secondary endpoints included investigator-assessed objective response rate (ORR), disease control rate (DCR), duration of response (DOR), time to response (TTR), progression free survival (PFS), as well as overall survival (OS). Results: As of January 11, 2024, 40 pts (median age, 67.5 years; 55% female) received oral sotorasib 960 mg daily and panitumumab IV 6 mg/kg every 2 weeks. 43% of pts had a history of brain metastases. Median number of prior lines of therapy was 1; 42% received ≥ 2 regimens and 38% had disease progression as their best response to last line of therapy. Most pts received anti-PD-(L)1 therapy (90%), platinum-based chemotherapy (85%), or both (78%). Most common (> 30%) treatment-related adverse events (TRAEs) attributed to any study drug were: diarrhea in 19 (48%) pts, dermatitis acneiform in 18 (45%), and dry skin in 16 (40%). Most common grade ≥ 3 TRAEs were increased ALT and AST in 7 (18%) and 4 (10%) pts, respectively, dermatitis acneiform in 5 (13%), diarrhea in 3 (8%), and hypomagnesaemia in 2 (5%) pts. Overall response rate was 45% (all partial responses), with a DCR of 90% (Table). Median PFS was 5.8 months (median follow-up 14.0 months). At a median follow-up of 11.0 months, OS data were not yet mature. Conclusions: This cohort of sotorasib plus panitumumab in pre-treated patients with KRAS G12C advanced NSCLC demonstrated safety consistent with each drug's profile. The ORR appears promising in this pretreated population and may warrant further investigation. Clinical trial information: NCT04185883 . [Table: see text]
Molecular Expression Assays Improve the Prediction of Local and Invasive Local Recurrence After Breast-Conserving Surgery for Ductal Carcinoma In Situ
Authors: Hahn Ezra , Sutradhar Rinku , Paszat Lawrence , Nguyen Lena , Rodin Danielle , Nofech-Mozes Sharon , Trebinjac Sabina , Jerzak Katarzyna J. , Fong Cindy , Rakovitch Eileen 
Published: June 2024

PURPOSE Ductal carcinoma in situ (DCIS) is routinely treated with adjuvant radiotherapy (RT) after breast-conserving surgery (BCS). The inability to accurately estimate an individual's risk of local recurrence (LR) and invasive LR using clinicopathologic factors (CPF) contributes to the overtreatment of DCIS. We examined the impact of the 12-gene DCIS Score (DS) and the 21-gene Recurrence Score (RS) on the accuracy of predicting LR and invasive LR. METHODS A population-based cohort diagnosed with pure DCIS treated with BCS ± RT from 1994 to 2003 was used. All patients had expert pathology review and assessment of the DS and RS. Predictive models (CPF alone, DS + CPF, and RS + CPF) were developed using multivariable Cox regression analyses to predict 10-year LR and invasive LR risks. Models were evaluated on the basis of c-statistic, –2log likelihood estimate (–2LLE), and Akaike information criterion. Calibration was performed using bootstrap resamples, with replacement. RESULTS The cohort includes 1,226 women treated with BCS; 712 received RT. 194 women (15.8%) experienced ipsilateral LR as a first event; 112 were invasive. Models including the DS or RS performed better in predicting the 10-year risk of LR compared with models on the basis of CPF alone with excellent calibration. The two molecular-based models also performed better in predicting invasive LR compared with the CPF model but the model incorporating the RS did not perform better in the prediction of invasive LR compared with the DS-based model. CONCLUSION Models incorporating the DS or RS more accurately predicted the 10-year risk of LR and invasive LR after BCS compared with models on the basis of CPF alone. Inclusion of the RS, compared with DS, did not improve the prediction of the 10-year risk of invasive LR.
Clinical Oncology Pharmacy Technician: Impact of a New Role on Pharmacy and Patient Metrics at a Large Academic Cancer Center
Authors: Wooten Austin , Wright John , Thakrar Teresa , Barron Adri , Grove Meagan , Duggal Raj , Lee Benjamin J. , Doh Jean , Di Tomasso Pamela Maree , Joe Melanie D. , Griffin Shawn P. 
Published: June 2024

PURPOSE
To describe the impact of an inpatient clinical oncology pharmacy technician program.

METHODS
A retrospective study was conducted to observe outcomes in patients discharged from the hematology/oncology or bone marrow transplant (BMT) units at Indiana University Health in the year before (April 1, 2016-March 31, 2017) compared with the year after (April 1, 2018-March 31, 2019) the implementation of expanded technician services. The technician performed admission medication histories and ensured access to discharge medications.

RESULTS

There were 1,169 and 1,112 encounters included in the pre- and post-technician cohorts. The median age was lower (54
v
61 years;
P
< .001), and there was a higher percentage of male patients (62%
v
52.3%;
P
< .001) in the pre- compared with post-technician cohort. There were a higher percentage of oncology (36.4%
v
31%;
P
= .007) and no difference in hematology (37.4%
v
40.2%;
P
= .17) nor BMT encounters (26.3%
v
28.8%;
P
= .18) in the pre- compared with post-technician cohort. The discharge prescription capture rate increased (42.7%
v
78.5%;
P
< .001) from the pre- to post-technician cohort, resulting in a 34.2% increase ($314,639.46 in US dollars [USD]-$422,129.20 USD) in retail pharmacy revenue. More admission medication histories were completed by pharmacy staff (64.4%
v
91.9%;
P
< .001), and there was an increase in the Hospital Consumer Assessment of Healthcare Providers and Systems–derived patient satisfaction results for both hematology/oncology (79%
v
88%;
P
< .001) and BMT units (77%
v
84%;
P
= .02) in the pre- compared with post-technician cohort. There was no difference in rates of unplanned readmissions (16.4%
v
18.2%;
P
= .69) in the pre- compared with post-technician cohort.

CONCLUSION
The overall capture rate of discharge prescriptions, revenue for the retail pharmacy, and patient satisfaction scores significantly increased after the implementation of expanded, inpatient clinical pharmacy technician services.
Experience and Needs of Patients With Young-Onset Colorectal Cancer and Their Caregivers: A Qualitative Study
Authors: Fletcher Kalen M. , Revette Anna , Enzinger Andrea , Biller Leah , MacDougall Katelyn , Brown Mary-Brent , Brais Lauren , Arsenault Brigette , McCleary Nadine , Chan Jennifer , Boyle Kathleen , Meyerhardt Jeffrey A. , Ng Kimmie 
Published: June 2024

PURPOSE
The incidence of young-onset colorectal cancer (YOCRC; defined as patients who are diagnosed with CRC before age 50 years) is rising rapidly, and CRC is predicted to be the leading cause of cancer death in this age group by 2030. Yet, there has been limited research into the experiences and needs of patients with YOCRC and their caregivers. The goal of this study was to better understand the experiences and needs of patients with YOCRC and their caregivers.

PATIENTS AND METHODS
Semistructured focus groups were conducted with patients with YOCRC, caregivers of patients with YOCRC, and bereaved caregivers of patients with YOCRC. Focus group discussion guides addressed the experience and impact of diagnosis and treatment of YOCRC. Results were analyzed using a thematic analysis informed by framework analysis.

RESULTS
Twenty patients and caregivers participated in three focus groups (eight patients, seven caregivers, and five bereaved caregivers). Four primary themes were identified: (1) feeling overwhelmed by the health care system and desiring patient navigation; (2) feeling isolated and wanting opportunities for peer support; (3) life disruption because of difficulty juggling multiple roles and desiring psychosocial support; and (4) enthusiasm about participation in research and genetic testing.

CONCLUSION
This study identified and described the unique experiences and care needs of patients with YOCRC and their caregivers. The findings provide evidence that specialized models of care are needed. The results of this study informed the development of a center dedicated to the care of patients with YOCRC.