bluuebunny/crossref_metadata_2025_split huggingface dataset:
First- and second-line biomarker utilization in non-small cell lung cancer.
Authors: Leong Matthew , Azimpouran Mahzad , McCloskey Audrey , Sankar Kamya , Vail Eric 
Published: July 2024

e20564 Background: Targeted therapy has revolutionized the treatment of non-small cell lung cancer (NSCLC) since FDA-approval of the first EGFR-inhibitor in 2003. While number of actionable mutations and FDA-approved therapies has drastically increased, numerous studies have reported lackluster utilization rate of these therapies. Many of these studies take place in the community setting and focus on first line targeted therapy utilization. We aim to investigate the utilization rate of targeted therapies in an academic center, as well as explore utilization rate of newer second line therapies. Methods: The pathology database was queried for all stages of NSCLC cases with molecular testing (including qPCR, FISH, and NGS) from Jan 2016-Jan 2024. Patients with actionable alterations in EGFR, ALK, ROS1, BRAF, MET, RET, NTRK, KRAS, and ERBB2 ( HER2) that were detected six months prior to the first FDA approval for their respective targeted therapy were included. Patients who were lost to follow-up, those with early-stage non-metastatic tumors, or without progression on first line therapy at time of data cutoff (for actionable mutations with approved targeted second-line treatment) were subsequently excluded. Therapy plans and clinical course for the remaining patients were reviewed. Results: 355 NSCLC patients with actionable mutations were identified (210 EGFR, 63 ALK, 15 BRAF, 18 ROS1, 6 RET, 26 MET, 1 NTRK, 17 KRAS, 0 ERBB2). The following patients received an FDA-approved targeted first line therapy: EGFR (non-exon 20 insertion) 194/207 (94%), BRAF 8/15 (53%), ALK 60/63 (95%), ROS116/18 (89%), RET 5/6 (83%), MET 22/26 (85%), and NTRK 1/1 (100%). For FDA-approved second line therapy, KRAS 10/17 (59%) and EGFR (exon20 insertion) 2/3 (67%) patients received targeted therapy. No ERBB2 patients progressed. There was statistically significant difference between treatment rates between BRAF and non- BRAF first line therapies (p < .0002) and between rates of treatment with first and second line therapies (p < .0002). For those that did not receive eligible therapy, 15/37 (41%) received chemotherapy or immunotherapy treatment and 20/37 (54%) were too clinically severe for treatment. Conclusions: Despite most eligible patients receiving the appropriate targeted therapy (89%), there remains distinct subsets with significantly lower treatment rates. In particular, there is a large gap in treatment between the FDA-approved first and second line therapies as well as patients with BRAF mutations compared to other first line therapies. While the overall treatment rate based on molecular findings are higher than those reported from community settings, there remains patient populations which seemingly have their molecular findings overlooked. [Table: see text]
A single-arm phase II study of platinum doublet induction chemotherapy combined with toripalimab for driver gene-negative advanced NSCLC.
Authors: Lin Jinghui , He Zhiyong , Li Meifang , Chen Shijie , Weng Lihong 
Published: July 2024

e20565 Background: PD-1/PD-L1 inhibitors combined with platinum doublet chemotherapy have become the standard first-line treatment for driver gene-negative advanced non-small cell lung cancer (NSCLC). However, not all patients can benefit from this treatment. Previous studies have shown that induction chemotherapy can reduce tumor burden, induce tumor immunogenic cell death, and improve the tumor immune microenvironment. Therefore, effective induction chemotherapy may enhance the efficacy of PD-1/PD-L1 immunotherapy. This single-arm, phase II clinical trial aims to evaluate the efficacy and safety of induction chemotherapy followed by immunotherapy (Toripalimab: PD-1 inhibitor) in treatment of driver gene-negative advanced NSCLC. Methods: Eligible patients received platinum doublet chemotherapy for 2-4 cycles (pemetrexed + platinum for adenocarcinoma; paclitaxel or gemcitabine + platinum for squamous cell carcinoma). patients who achieved tumor response (CR/PR/SD) received Toripalimab (240mg Q3W) for 2 years or until disease progression or intolerable toxicity. The primary endpoint was progression-free survival (PFS), which was defined as the duration from the initiation of induced chemotherapy to either tumor progression or death from any cause,and the secondary endpoints were toxicity, overall survival (OS), and clinical tumor response including objective response (defined as complete [CR] or partial response [PR]) and disease control (defined as CR, PR, or stable disease [SD]) during the course of combination treatment with Toripalimab following induction chemotherapy. Results: During the period from February 2020 through October 2023, a total of 19 qualified patients were enrolled in the study. As of December 31. 2023,the median follow-up was 22,9 months (range,15.9 to 30 months).11 patients (57.9%) experienced PFS events and 7 (36.8%) died, mOS were not reached. mPFS was 7.9 mo (95% CI,4.8-15.0months).12-month and 18-month PFS rate were 43% and 35%, respectively. One patient has not received tumor response assessment. Among the remaining 18 pts, 10 patients had a PR,5 patients had SD, and 3 patients had PD. The ORR and DCR were 55.6% and 83.3% respectively.42.1% (8/19) pts experienced immune-related adverse events(irAEs), included immune-related pneumonia (21.1%), rash (10.5%), hypothyroidism (10.5%). 2 pts experienced ≥3 grade irAEs, including grade 3 rash and grade 4 immune-related thrombocytopenia. Conclusions: Induction chemotherapy combined with Toripalimab achieved impressive 12-month and 18-month PFS rates in pts with driver gene-negative advanced NSCLC, along with manageable toxicities. These findings demonstrate the potential of induction chemotherapy could enhance the efficacy of immunotherapy. Clinical trial information: NCT04613804 .
Analysis of thromboembolic events in patients with non-small cell lung cancer treated with immune checkpoint inhibitors: A single-center real-world study.
Authors: Kim Tae-Hwan , Yang Cheongin , Choi Yong Won , Kwon Minsuk , Lee Hyun Woo , Kang Seok Yun , Ahn Mi Sun , Choi Jin-Hyuk 
Published: July 2024

e20580 Background: Thromboembolic events (TEEs) are serious complications leading to significant morbidities and mortality in cancer patients (pts). Although incidences of 7-17% for TEEs were reported in non-small cell lung cancer (NSCLC) pts undergoing palliative chemotherapy, there were few reports on TEEs in NSCLC pts receiving immune checkpoint inhibitor (ICI) monotherapy. Methods: This study retrospectively analyzed 232 pts with stage III/IV or recurrent NSCLC who initiated palliative ICI monotherapy (1st line: 52, ≥2nd line: 180) from September 2017 to August 2022 in a single center. TEE occurrences were confirmed in pts during ICI treatment or within 6 months post-completion, while TEEs after regimen change were excluded. Results: Pembrolizumab (107 pts) was the most frequently administered agent, followed by atezolizumab (63 pts) and nivolumab (62 pts). TEEs were identified in a total of 14 pts (6.0%), and pulmonary thromboembolism was the most common type of TEEs (7 pts). No significant risk factors associated with TEE occurrence were identified, including age, performance status, Khorana score, type of drugs, and the line of chemotherapy. Conclusions: TEEs occurred at a relatively lower incidence in NSCLC pts receiving ICI monotherapy compared to previous studies involving cytotoxic chemotherapy, particularly platinum-based regimens. Nevertheless, the incidence is non-negligible and careful monitoring for TEEs in NSCLC pts undergoing ICI monotherapy is needed.
Real-world outcomes of osimertinib in Peruvian patients with advanced NSCLC with EGFR T790M-positive: A multi-institutional experience.
Authors: Galvez-Nino Marco , Roque Katia , Namuche Fernando , Ruiz Rossana , Paitan Amaro Victor , Coello Roberto , Cabrera Maria del Pilar , Maco Lorenzo , Ezquerra Juan Carlos , Perez Roca Rodolfo , Coanqui Ofelia , Valdivieso Natalia , Olivera Hurtado de Mendoza Mivael , Aguilar Cartagena Alfredo , Mas Luis 
Published: July 2024

e20605 Background: Osimertinib is the standard of care for advanced NSCLC patients with EGFR T790M-positive whose disease has progressed to EGFR TKI therapy, however, the knowledge on the real benefit of these therapies in the Latin American setting remains unclear due the lack of access in the most countries. The aim of this study is to evaluate the outcomes of Osimertinib as sencond line treatment of advanced NSCLC patients with EGFR T790M-positive in a real-world Peruvian setting. Methods: This is a retrospective study of advanced NSCLC patients with EGFR T790M-positive treated with osimertinib at seven Peruvian institutions between July 2018 and May 2023. Outcomes were objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and OS from the start of first-line treatment to death. Results: We analyzed 41 T790M-positive patients with a median age of 60 years (range 36-87y), most of them were females (65.9%), 17.1% had smoking history and 19.5% biomass exposition as a main risk factor. About diagnosis and clinical features, T790M mutation was detected by liquid biopsy in 29.3% of cases, 36 patients (87.8%) had status performance 0 - 1 (ECOG) and 10 (24.4%) presented brain metastases as progression to the previous line of treatment. About outcomes, the ORR was 70.8%; with a median follow-up of 36 months, the median PFS was 15.2 months (95% IC, 9.6 - 20.7) and median OS since the start osimertinib was 16.3 months (95% IC, 7.6 - 24.9), no differences were found regarding the presence of brain metastases (p = 0.06 and p = 0.32) or type of mutation (p = 0.27 and p = 0.46) in both PFS and OS. Median OS from the start of first-line treatment was 46.6 months (95% IC, 34.5 - 58.7). As supplementary analysis, in the same period of time, 11 T790M-positive patients who did not receive osimertinib as second line of treatment achieved a median OS from the start of first-line treatment of 23.5 months (95% IC, 16.5 - 30.5). This OS was significantly lower compared to those who did receive osimertinib (p = 0.001). Conclusions: This study confirms the efficacy of osimertinib in the real world when used as a second line of treatment in T790M-positive patients, in addition the feasibility of osimertinib in this setting may significantly impact the survival.
Time-to-treatment for metastatic non-small cell lung cancer in the era of biomarker testing.
Authors: Akanbi Maxwell Oluwole , Kenmoe Jerry , Adekolujo Samuel O , Saleem Muhammad , Koduru Ujwala , Hrinczenko Borys 
Published: July 2024

e20623 Background: In 2011, the National Comprehensive Cancer Network (NCCN) recommended biomarker testing in patients with metastatic non-small cell lung cancer (mNSCLC) based on improved survival with targeted therapies and immunotherapy reported in clinical trials. The requirement for biomarker testing before the commencement of treatment could inadvertently contribute to delays in treatment initiation. We investigated the time to treatment for mNSCLC in the US general population in the era of advanced therapies for lung cancer. Methods: We obtained data from 32,518 adults with mNSCLC between 2004 and 2019 from the Surveillance, Epidemiology, and End Results (SEER) database. We categorized time to treatment to < 1 month or ≥ 1 month, and period of diagnosis to 2004-2011 and 2012-2020. We used separate logistic regression models to investigate the relationship between time to treatment, period of diagnosis, and year of diagnosis, adjusting for age, sex, household income, residence, and race. Results: The mean age of the study population was 66 (SD 10) years, 41% Female and 76% White. The majority (84%) were Metropolitan dwellers. A total of 23,322 (76%) were diagnosed between 2004 and 2011, and 9,186 (28%) from 2012 to 2019. Overall, 40% of patients initiated cancer therapy within a month of diagnosis, with no significant difference between patients who commenced treatment between 2004-2011 (40.2%) and 2012-2019 (39.9) (chi2 = 0.3492 P = 0.555). In both logistic regression analyses, there was no significant relationship between time to treatment and period or year of diagnosis. However, race/ethnicity and age independently predicted the time to treatment. Compared to Whites, Blacks (Odds ratio (OR) 1.08, 95% CI 1.01- 1.16, p = 0.04) and Hispanics (OR 1.26, 95% CI 1.03-1.24, p 0.01) were more likely to initiate treatment ≥ 1 month from the time of diagnosis. The odds of initiating treatment ≥ 1 month also increased with age (Age/year OR 1.01 (95% CI 1.01-1.01). Conclusions: We did not identify delays in treatment initiation for mNSCLC in the current era of biomarker testing. Biomarker testing has become an essential diagnostic tool for mNSCLC, guiding targeted therapies that have been shown to improve treatment outcomes. However, some vulnerable populations continue to experience delays in treatment initiation, which could lead to poorer survival. Improvements in cancer therapeutics must be complemented by service delivery improvements to optimize treatment outcomes.
Assessing clinician familiarity with integrative oncology and uptake of an electronic medical record–based education resource.
Authors: Jiang Joshua , Gonzales Nikko , Anand Sidharth 
Published: July 2024

e21001 Background: Integrative oncology is the practice of incorporating complementary and alternative medicine (CAM) into the conventional care of cancer. CAM encompasses a broad realm of treatment modalities, ranging from nutrition and exercise to acupuncture, supplements, and behavioral therapy. Few oncologists discuss CAM with their patients while patients under-report their usage of these treatments to their oncologists. Our project aim was to assess clinician familiarity with integrative oncology and to improve education on the topic using a clinician-facing tool accessible through the electronic medical record (EMR). Methods: We distributed a survey from May through July 2023 to assess attitudes towards CAM and practice patterns at an academic oncology department. Respondents used a five-point Likert scale to rate their understanding of CAM, role in counseling patients on CAM, and factors affecting their discussion of such topics. We created EMR-accessible clinician guides which reviewed the evidence base for common complementary treatments in breast, colon, and lung cancer. Results: Fifteen of 64 (23%) affiliated oncologists completed the survey. Eleven (73%) respondents agreed or strongly agreed that it is their responsibility to learn about CAM. Fourteen (93%) respondents agreed or strongly agreed that it is their responsibility to ask patients about CAM usage, although two-thirds of respondents initiated conversations about CAM “sometimes” or less. Six (40%) felt comfortable providing resources on CAM to their patients. Respondents reported greatest awareness of the evidence for exercise and psychotherapy (average rating 3.8 out of 5; higher is more familiar) and least awareness for supplements (average 3.2). The factors most strongly affecting respondents’ practices of discussing CAM with patients were a lack of credible resources and fear that supplements might replace conventional cancer treatment. Ten (67%) respondents reported that patients undergoing active treatment often or always ask about CAM and nine (60%) reported that survivors often or always ask about CAM. Three practicing oncologists and two fellows had added our clinical guides to their EMR shortcuts six months after their introduction. Conclusions: Certain forms of CAM remain controversial within oncology practice. Although oncologists in our department reported a sense of responsibility to understand and counsel patients on CAM, multiple barriers impeded physician comfort with the topic and uptake of a novel educational resource was limited. Patients undergoing active treatment and survivors alike asked clinicians about CAM, which suggests it is an important area of competence for oncologists regardless of treatment phase.
Knowledge and confidence gaps in differentiating PARP inhibitors among community oncology providers.
Authors: Robinson Katie J.H. , Scully Emily , Rose Kristin R. , Esgro Robert A. , Lee Nita Karnik 
Published: July 2024

e21002 Background: Data and professional recommendations regarding the use of Poly(ADP-ribose) polymerase inhibitors (PARPis) for patients with ovarian cancer have evolved rapidly, challenging providers who manage patients with ovarian cancer (OC). Coupling confidence-based learning with continuing education (CE) is a proven tool to address such challenges towards enhanced patient care. Methods: A confidence-based continuing education (CE) activity was developed to address the evolving landscape of PARPi use in patients with OC. Pre-, intra-, and post-test assessment was used to quantify baseline parameters as well as the impact of education on knowledge and behaviors. The CME activity was available for credit from October 31, 2022 to October 30, 2023. Results: In total, 354 community oncology physicians or advanced practice providers (APPs) who see an average of 6 patients with OC per month completed the education. Baseline knowledge and confidence was low on topics related to strategies for molecular testing (29% correct) as well as the use of PARPis (27% correct). Moreover, on average, only 3% of those who answered correctly were confident in their response, highlighting a lack of confidence even in those who were correct. These knowledge and confidence gaps translated to only 24% of providers who use appropriate testing to determine BRCA1/2 and HRD status and only 16% feeling comfortable in differentiating PARPis. Additionally, while providers showed slight preference for olaparib in patients with homologous recombination deficiency (HRD) and niraparib in patients without HRD, on average 30% of providers were unsure of which agent to use in each clinical context. Overall, at baseline only 24% of providers reported individualizing the use of PARPis based on patient and tumor characteristics. Post-learning, there was a 46% increase in knowledge, and while the percentage of those who were confident and correct increased 21%, 76% remained unconfident. Still, these gains in knowledge and confidence resulted in two-thirds of providers making practice improvements in their use of PARPis, which resulted in improvements in patient health. Conclusions: The rapid evolution of the PARPi therapeutic landscape has caused gaps in knowledge, confidence, and behaviors. Ongoing and rapidly developed CE is a critical tool to address these challenges as data and recommendations for use continue to evolve rapidly.[Table: see text]
Behavioral analysis of social media and email usage among hematology-oncology fellowship applicants: A national survey.
Authors: Thakur Rahul Kumar , Vegivinti Charan Thej Reddy , Yusuf Hasiya , Gor Rajvi , Ray Barun , Thakur Monika , Deshpande Shweta , Kumar Abhishek 
Published: July 2024

e21003 Background: The advent of digital communication has transformed the landscape of fellowship programs, with social media(SoMe) emerging as pivotal platforms for information dissemination and engagement between applicants and programs. Despite its proven influence in surgical and urological specialty, the role of SoMe in Hematology-Oncology (HO) fellowships remains to be elucidated. This pioneering survey evaluates the utility and impact of SoMe alongside traditional email among Internal Medicine residents applying the fellowship application process in the era of virtual interviews. Methods: An anonymous, cross-sectional survey was administered via SurveyMonkey to residents applying to U.S. HO fellowships in the 2023-2024 cycle. Outreach methods included emails to all internal medicine program directors, SoMe, and online forums. The questionnaire probed the frequency of SoMe and email usage, types of content accessed, and the influence of these platforms on applicants' strategic choices and program preferences. Results: Analysis from 33 respondents revealed a demographic predominance of individuals aged 26-35 years, with an equal gender distribution and significant representation from the Middle Atlantic region. The majority were non-U.S. graduates (51.5%), predominantly identifying as Asian (54.5%). While 67% of respondents used Twitter/X, but only 13.6% used it for direct program contact, resulting in a minimal 4.5% receiving interview offers. Twitter/X was acknowledged as a useful information source by 55% of respondents, and 20% felt it influenced their program ranking decisions. Conversely, 70% and 45% used Instagram and LinkedIn respectively, but usage for fellowship applicants was minimal, with no respondents utilizing it for program outreach or reporting any increase in interview offers because of its use. Notably, 25% felt pressured to use SoMe to boost their application prospects. In contrast, 74% approached program directors through personalized emails, attributing a 34% increase in interview offers to this method. Conclusions: Our findings emphasize the enduring prominence of email in fellowship applications while illuminating the evolving but significant presence of SoMe. This divergence highlights a potential big change where SoMe particularly Twitter/X, begins to complement traditional methods. Such insights suggest that fellowship programs should strategically integrate digital tools into their application processes and actively improve their online engagement to align with applicant behaviors.