bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paclitaxel hypersensitivity reaction (HSR) rate: Titrated versus non-titrated infusions among gynecologic oncology patients.
Authors: Goldfeld Ester , Cantrell Leigh , Huang Marilyn 
Published: June 2024

e23240 Background: Paclitaxel is a common chemotherapeutic agent used for treatment of various cancers, and is associated with hypersensitivity reactions (HSR). An HSR is mostly likely to occur during first or second infusions. Prior studies have suggested that performing Paclitaxel infusions without titration may be safe for the majority of patients, but increase in number of HSRs. At our institution, Paclitaxel infusions without titration was implemented around April 2023. Our aim was to evaluate the rate of HSR in Paclitaxel infusions without titration among gynecologic patients. Methods: This was a retrospective review of hypersensitivity reactions in patients receiving Paclitaxel at the titrated rate versus the full rate from May 2022 through November 2023. Patients had newly diagnosed gynecologic cancers (ovarian, uterine, cervical), who presented for their first or second Paclitaxel infusions. Patients previously treated with Paclitaxel for any reason were excluded. Results: 145 patients were included in this study, each with one (4%) or two (96%) infusions, for a total of 281 infusion visits. There were 176 infusions with Paclitaxel dose titration (62.6%), and 105 infusions at full rate (37.4%). HSRs occurred in 19% of the full rate Paclitaxel infusions and in 11.9% of titrated Paclitaxel infusions (OR 1.74 [95% CI 0.89 – 3.38]; p = 0.10). When stratifying by first or second infusion, the HSR rate increased significantly for full rate second infusion to 22.4%, compared to 8.3% for titrated infusions (OR 3.18 [95% CI 1.14 – 8.86]; p = 0.026). Grade 3 or greater infusion reactions occurred in 45% of full rate infusion and in 14.2% of titrated infusion reactions (OR 4.91 [95% CI 1.08 – 22.14]; p = 0.0038). There was no difference in timing of hypersensitivity reactions in relation to initiation of Paclitaxel infusion. Conclusions: Overall, the HSR rate was higher with full rate first infusions, and significantly increased during the second infusion with full rate Paclitaxel. Additionally, Grade 3 infusion reactions were more likely to be seen with full rate infusions. There is significant variability in Paclitaxel infusion; further studies to determine optimal infusion rates are warranted.
Implementation of a hepatitis B screening program in patients receiving systemic anti-cancer therapy: A Canadian single center retrospective review.
Authors: Leigh Jennifer , Mallick Ranjeeta , Brule Stephanie Yasmin , Rambout Lisa , Newton Jennifer , Bosse Dominick , Moore Sara , Gotfrit Joanna 
Published: June 2024

e23242 Background: Cancer patients receiving non-endocrine anti-cancer therapies are at risk of hepatitis B virus (HBV) reactivation (HBVr). Medical society guidelines recommend HBV screening prior to treatment, but real-world uptake is slow and variable. The Ottawa Hospital Cancer Centre implemented a screening pilot program for all patients receiving FOLFOX based regimens or FOLFOXIRI between January and April 2023 which included incorporating HBV screening tests into treatment plan builds and specifying pharmacy and nursing pre-treatment checks. Methods: Charts were retrospectively reviewed, and patient and disease characteristics were collected. The primary endpoint was to identify the proportion of patients who underwent screening prior to treatment start. Univariate analyses assessed the association between baseline characteristics and failure to screen. We also reviewed quality metrics including time from consult to testing, time to result, number of duplicate screens, and treatment delays due to testing. Results: Baseline demographics of the 42 patients included can be found in Table 1. 32 patients (76.2%) completed screening and 5 (15.6%) had a positive screen. The majority of patients screened (78.1%) completed screening prior to first treatment as intended, however 38.1% were drawn on day of treatment. 9.52% of patients had duplicate screening inadvertently. All patients who tested positive were referred to Infectious Diseases. Of those, 1 received antivirals for chronic HBV, and 4 had resolved HBV and were recommended for monitoring. There were no treatment delays due to pending screening and no HBVr. Receipt of prior systemic therapy was significantly associated with failure to screen (55% vs 95%, OR 17.1 (95% CI 1.92-153), p = 0.011). Factors including age, sex, primary disease site, therapy intent, and regimen received were not significantly associated with screening completion or HBV positivity. Conclusions: The results of this pilot highlights the importance of building HBV screening into standardized treatment plans and engaging all team members to ensure high levels of screening. Prior systemic therapy receipt was associated with failure to screen, and thus programs should include education on the necessity of screening as recommended by medical guidelines. The prevalence of HBV in this population may also be higher than previously expected, which should be explored in future research. [Table: see text]
Sleep disturbance and fatigue in patients with ovarian cancer during chemotherapy and surgery compared to PARPi maintenance therapy.
Authors: Newell Abigail , Szamreta Elizabeth A. , Fortune Erica E. , Gonzalo Maria Belen , Saxton M. Claire , Andac-Jones Elif 
Published: June 2024

e23248 Background: Sleep disturbance and fatigue are prevalent among advanced ovarian cancer (OC) patients and are associated with poor health outcomes. It is unclear how sleep disturbance and fatigue vary across treatment timelines. This study evaluated how patients rate their sleep disturbance and fatigue levels at different points in their treatment trajectory. Methods: 200 U.S. patients with stage III/IV OC diagnosed in 2020-2023 were enrolled. Survey items asked patients to retrospectively assess their sleep disturbance and fatigue levels prior to diagnosis, during treatment, and presently. Sleep disturbance and fatigue were measured using a custom set of Patient-Reported Outcomes Measurement Information System (PROMIS) items based on previous findings. Most were receiving maintenance therapy (44%) or other treatments (34%), and 23% completed treatment. Nearly all participants received surgery (93%) and chemotherapy (97%). 44% of patients had received PARP inhibitor (PARPi) therapy, 18% received immunotherapy, and < 10% received other therapies. Repeated sample t-tests compared symptom burdens. Results: Participants ranked sleep disturbance as most intense during chemotherapy (52%), followed by surgery (33%), hormone therapy (32%), and PARPi (15%). Most participants ranked fatigue as most intense during chemotherapy (67%), followed by hormone therapy (31%), surgery (20%), and PARPi therapy (17%). Paired t-tests show that among participants who received only surgery, chemotherapy and PARPi therapy, sleep disturbance was perceived to be significantly more intense during chemotherapy than when receiving PARPi, t(55) = -2.83, p = .006) and in the 2 weeks after surgery than PARPi therapy, (t(55) = -2.08, p = .043) ( Table). Fatigue was significantly more intense during chemotherapy than when receiving PARPi, (t(55) = -6.21, p < .001) and following surgery than PARPi (t(54) = -4.16, p < .001). Conclusions: OC patients experience intense sleep disturbance and fatigue and perceive levels differently depending on treatment. Chemotherapy was rated the worst for both sleep disturbance and fatigue compared to PARPi and other therapies. Targeted screening and psychosocial support can address these symptoms throughout treatment, especially after chemotherapy. [Table: see text]
Real-world safety and efficacy of concurrent immunotherapy and thoracic chemoradiotherapy: A multi-institutional analysis.
Authors: Li Ying , Han Guang , Lu Ying , Bi Jianping , Zhang Li , Verma Vivek 
Published: June 2024

e23262 Background: Despite the success of Immune checkpoint inhibitors (ICIs) as consolidation following concurrent chemoradiotherapy (CCRT), 22% to 30% of patients still cannot be treated with durvalumab due to progression or adverse events (AEs) during or after CCRT. Concurrent ICIs with CCRT would offer the opportunity to receive ICIs and may provide treatment benefit to a greater proportion of patients. In this study, we performed a multicenter investigation to evaluate the safety and efficacy of ICIs and chemotherapy with concurrent thoracic radiotherapy. Methods: All patients from three institutions who underwent ICIs and concurrent thoracic radiotherapy were included. The rate of 12-month progression-free survival (PFS) was estimated using the Kaplan-Meier method and evaluated with 95% CIs calculated using the Greenwood formula. Therapy-related pneumonitis (TRP) and esophagitis (TRE) were defined per CTCAE v5.0. Statistics utilized logistic regression modeling and receiver operating characteristic (ROC) analysis. Results: 69 patients (median [range] age, 62 [52-76]; 61 [88.4%] male; median follow-up 30.4 months) were collected, including 18 (26.1 %) cases of non-small cell lung cancer (NSCLC), 26 (37.7 %) cases of small cell lung cancer (SCLC), and 25 (36.2 %) cases of esophageal cancer (EC). The 12-month PFS rates in NSCLC, SCLC and EC were 72.2%, 69.2% and 72.0%, respectively. The median PFS in NSCLC and SCLC was 24.3 and 13.1 months, and not reached (mean 29 months) for EC. The incidences of all-grade TRP and TRE were 60.7% and 57.7%, respectively. Grades 1-5 TRP occurred in 15.9%, 30.4%, 8.6%, 1.4%, and 0, respectively. Grades 1-5 TRE occurred in 20.2%, 28.9%, 8.6%, 0, and 0, respectively. On multivariable analysis, age and MLD significantly predicted for any-grade and grade ≥2 TRP. Only age significantly predicted for grade ≥3 TRP. ROC analysis was able to pictorially model RP risk probabilities for a variety of MLD and age thresholds. Conclusions: This real-world study can be helpful for understanding the true efficacy and toxicity of ICIs and chemotherapy with concurrent thoracic radiotherapy given the lack of robust clinical data. Close monitoring should be recommended in this patient population during RT and follow-up.
Different dosing strategies of pembrolizumab in the treatment of NSCLC: A real-world retrospective observational study.
Authors: Janzic Urska , Rus Zala , Knez Lea 
Published: June 2024

e23264 Background: Immune checkpoint inhibitors lack a dose-response relationship, allowing optimisation of dosing strategies that may reduce drug use. Pembrolizumab received its initial regulatory approval for the treatment of non-small cell lung cancer (NSCLC) at weight-based dosing (2 mg/kg every 3 weeks (Q3W)), as employed in pivotal clinical trials demonstrating its efficacy and safety. This dosing regimen was later replaced by the currently approved flat-dosing (200 mg Q3W or 400 mg Q6W) in all indications, potentially increasing drug use. This retrospective observational study evaluates differences in pembrolizumab use for different dosing strategies in a real-world patient cohort. Methods: Overall, 124 advanced NSCLC patients, treated with first-line pembrolizumab monotherapy at a single institution, were included. During the observation period, pembrolizumab flat-dosing was employed, with possible extensions of treatment administrations. Patient and treatment data were obtained from medical records. Duration of treatment was calculated from day 1 of first cycle to last day of last cycle, excluding treatment delays due to adverse events. Pembrolizumab use was calculated for 3 dosing strategies: i) as actually received, ii) as flat-dosing, iii) as body-weight dosing, capped at 200 mg Q3W. It is presented as median dose Q3W and cummulative dose in the whole cohort. Results: Included patients had a median weight of 73 kg (IQR: 65-84) and received a total of 1600 mg of pembrolizumab (IQR: 800-3600) over 24 weeks (IQR: 12-60). The median pembrolizumab dose was i) 190 mg Q3W (IQR: 172-200) as actually received by patients, and would be ii) 200 mg Q3W (IQR: 200-200) in case of flat dosing, and iii) 146 mg Q3W (IQR: 130-168) in case of body-weight dosing. Overall, total pembrolizumab dose in the whole cohort was i) 283,600 mg actually used, and would be ii) 327,800 mg in flat-dosing, and iii) 251,200 mg body-weight dosing, resulting in a 23.4% reduction of drug use in weight-adjusted vs flat-based dosing. Conclusions: Pembrolizumab dosing adjusted to body weight, as initially approved, would reduce drug use vs the currently approved flat-dosing, reaching nearly a 25% reduction in our cohort of patients.
Infections as a “cause of death” in patients with cancer: Need improved focus to improve outcomes?
Authors: Pendharkar Dinesh , Ather Mohammad Imam , Raj Abhishek , Hari Vishnu 
Published: June 2024

e23281 Background: Infectious diseases are a significant contributor to both morbidity and mortality in cancer patients. Cancer's impact on the immune system and the immunosuppressive effect of its treatment make patients more susceptible to infection. Furthermore, cancer's involvement of multiple organs increases the risk of infection. It is crucial to consider causes of death beyond cancer when evaluating overall survival, as effective treatment alone is not sufficient. We conducted a study to investigate infection as a cause of in-hospital death among cancer patients in a tertiary hospital. Methods: We collected data on the causes of death for all patients with cancer who passed away in our hospital in 2022 and 2023. This included detailed medical histories, investigation charts, and test results related to infections. Infections were defined as those listed as the cause of death in the hospital records. We had access to data on age, sex, primary tumor site, and laboratory test results related to infections. Infections were identified through microbiological cultures and PCR panels for bacteria, fungi, and viruses. Percentages were used to analyze standard statistical variables. Results: The death toll for the year period amounted to 113 individuals, which included 77 males and 36 females, with ages ranging from 16 to 88 and a mean of 63.2 years, with a median of 64 years. Among the 91 patients with classifiable stages, 86% had metastatic disease. Many of the patients, amounting to 75%, were suspected or confirmed to have contracted an infection at the time of death. In 69/113 (61%) cases, the infections were confirmed through laboratory and radiological tests. Out of 90 patients in whom cultures and infection PCR tests were sent, 53/90 (59%) showed positive microbiology reports, and 37/90 (41%) had negative microbiological culture reports. Among the 41 patients with positive microbiology culture reports, 41% had blood culture positivity but no localizing signs, 34% had lung infections, 15% had both lung and blood culture positivity, and around 8% had urological origins of infection. Around 60% of the patients had bacterial infections, while approximately 4% had documented fungal infections. No cases of viral infections were recorded. Half of the patients, or 50%, were directly admitted to the Intensive Care Unit (ICU) during their last admission, while the remaining 50% were transferred from the ward to the ICU. Infection as a cause of death was attributed to 81/113 (71.6%) of the patients. Conclusions: Infectious diseases appear to be a major cause of death. Its control may play a significant role in reducing the overall survival and improving quality of life. Increased focus on detection and intervention to manage infections could substantially add to desirable endpoints in oncology. Therefore, there is an urgent need to focus on the management of infections.
Bevacizumab combination therapy versus standard chemotherapy for ovarian cancer in shorter and longer followup duration: A systematic review and meta-analysis of randomized controlled trials.
Authors: Farooq Muhammad Zain , Ur Rehman Obaid , Fatima Eeshal , Imran Hiba , Akram Umar , Ahmad Amna Badar , Nadeem Zain Ali , Fatima Laveeza , Hussain Ahmad , Mabrouk Manar Ala , Jaglal Michael Vishal 
Published: June 2024

e23296 Background: Bevacizumab is an anti-angiogenesis drug commonly added to standard chemotherapy regimens in the treatment of ovarian cancer. However, its comparative efficacy and safety in shorter and longer followup duration leaves a research gap that needs to be addressed. This systematic review and meta-analysis aims to evaluate the efficacy and safety of bevacizumab in patients with ovarian cancer in shorter and longer follow up duration. Methods: We searched Medline, Cochrane CENTRAL, Scopus, and Google Scholar for all phase 3 randomized controlled trials (RCTs) that administered bevacizumab to women with ovarian cancer. Review Manager 5.4 was used to calculate risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (95% CIs). We assessed the quality of included studies using version 2 of the Cochrane Risk of Bias tool (RoB 2). Results: After screening the titles, abstracts, and full texts, we included nine RCTs in our systematic review and meta-analysis. Four RCTs had low risk of bias while five had some concerns. Bevacizumab was associated with a progression free survival benefit for < 36 months (HR 0.59, 95% CI 0.45 to 0.76, p < 0.0001, I2= 90%) and > 36 months (HR 0.66, 95% CI 0.55 to 0.80, p < 0.0001, I2= 80%), and an overall survival benefit for < 36 months (HR 0.87, 95% CI 0.78 to 0.98, p = 0.02, I2= 0%) but not for > 36 months (HR 0.98, 95% CI 0.89 to 1.09, p = 0.77, I2= 30%). There was no difference in deaths between intervention and control groups < 36 months (RR = 0.95, 95% CI 0.86 to 1.04, p = 0.26, I2= 10%) or > 36 months (RR 1.02, 95% CI 0.97 to 1.06, p = 0.50, I2= 0%). Bevacizumab reduced disease progression < 36 months (RR 0.82, 95% CI 0.72 to 0.92, p = 0.0008, I2= 82%) but not at > 36 months (RR 0.83, 95% CI 0.58 to 1.19, p = 0.30, I2= 94%). The adverse events reported with Bevacizumab use included thrombocytopenia, neutropenia, leukocytopenia, anemia, hypertension, bleeding or hemorrhage, and gastrointestinal, cardiac, and dermatological adverse events. Conclusions: Bevacizumab may improve progression free survival within and after 36 months, overall survival within 36 months, and reduce disease progression within 36 months. Future studies should explore the long-term effectiveness of bevacizumab in diverse patient populations and focus on individual patient-tailored treatment approaches to optimize outcomes.
In-hospital outcomes of patients with lung cancer with and without superior vena cava thrombosis: A nationwide analysis.
Authors: Sanghvi Ankushi , Nanavaty Dhairya , Patel Sagar , Vachhani Bhavyakumar , Gaddam Mrunanjali , Ginjupalli Manasa , Jayakumar Jayalekshmi , Adhikari Nawaraj , Sinha Rishav , Kumar Vikash , Hotwani Priya , Nadeem Ahmed 
Published: June 2024

e23322 Background: Malignant superior vena cava syndrome (SVCS) is a clinical problem that results from the obstruction of blood flow in the superior vena cava by an underlying malignancy. It may be caused by external compression or internal obstruction due to a thrombus or direct invasion by tumor cells. Though lung malignancy is the most common cause of SVCS, there is a lack of data on in-hospital outcomes in these patients. Methods: We queried the National Inpatient Sample 2018-2020 to identify hospitalizations with lung cancer including both small cell and non small cell lung cancer. Hospitalizations with diagnosis of acute SVC thrombosis were determined by using ICD-10 codes.Demographics and mortality rates were compared between two groups using chi square for categorical variables and t test for continuous variables. Multivariate regression analysis was further performed to study the impact of SVC thrombosis on mortality, LOS and total hospitalization cost. Results: A total of 2011620 hospitalizations with lung cancer were identified. Of these, 2855 (0.0014%) had acute SVC thrombosis. These patients were younger with a mean age of 63 years. African-Americans and Hispanics were in a higher proportion in the cohort of hospitalizations with SVC thrombus as compared to those without. (Table 1). Multivariate regression analysis revealed higher odds of mortality (OR-1.94; C.I: 1.53-2.47; P < 0.001), LOS (OR 1.66; C.I:1.20- 2.31; P < 0.005) and total hospitalization cost (26211.15; C.I:22183.56- 30238.74; P < 0.001) in lung cancer hospitalizations. Conclusions: Our study shows that SVCT, has higher odds of mortality, length of stay and total hospital cost. Though the general recommendation is to continue anticoagulation, sometimes patients may require endovascular stent placement with/without thrombectomy. Though rare, SCVT can be life threatening and requires prompt attention.[Table: see text]
Survival trends of soft tissue sarcomas and gastrointestinal stromal tumors from 1995 to 2019: A SEER database analysis.
Authors: Hardy Nicole Janell , Deshpande Hari Anant , Olino Kelly , Costa Philippos Apolinario 
Published: June 2024

e23528 Background: In the last 25 years, new therapies have been developed for gastrointestinal stromal tumors (GISTs), while treatments for many soft tissue sarcomas (STSs) have remained relatively stagnant with 90% of phase I/II trials focusing on repurposing existing drugs. This study compares survival changes over time in patients with STSs and GISTs. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER)-9 registry were analyzed for patients aged 20+ diagnosed with GISTs and STSs from 1995 to 2019. Patients were categorized into time periods: 1995-2004, 2005-2014, 2015-2019. The primary outcomes were the 5-year overall survival (OS) difference between GISTs and STSs and survival variations across the periods. Survival was calculated using the Kaplan–Meier method, and differences were assessed with log-rank tests. Results: 26,633 STS and 3,818 GIST patients were identified. The 5-year OS rate was 53.0% (95% CI: 52.4-53.7) for STSs and 68.7% (95% CI: 67.1-70.3) for GISTs (p < 0.001), with a respective median OS of 72 (95% CI: 69-75) and 121 (95% CI: 113-128) months. For STS, the 5-year OS rate was 53.3% (95% CI: 52.3-54.4), 52.8% (95% CI: 51.9-53.8), and 54.2% (95% CI: 52.2-56.3) (p = 0.66) for groups 1995-2004, 2005-2014, and 2015-2019, respectively. For GIST, the 5-year OS rate was 60.7% (95% CI: 57.3-64.2), 70.6% (95% CI: 68.5-72.7), and 71.0% (64.5-78.3) (p < 0.001). In the locoregional setting (L), the GIST median 5-year OS was 70.5% (95% CI: 66.9-74.3), 78.1% (95% CI: 75.9-80.3), and 79.0% (95% CI: 71.4-87.4) (p < 0.001). In the metastatic setting (M) for GIST, the 5-year OS rate was 30.7% (95% CI: 24.8-37.9), 45.7% (95% CI: 41.1-50.7), and 46.3% (95% CI: 35.8-59.8) (p < 0.001). However, no significant difference was seen for STSs in either setting (L1995-2004 61.6% 95% CI: 60.5–62.8, M1995-2004 11.2, 95% CI: 9.7–12.9, L2005-2014 61.5%, 95% CI: 60.5–62.5, M2005-2014 10.2, 95% CI: 8.9–11.7, L2015-2019 63.4%, 95% CI: 61.2–65.7, M2015-2019 12.1, 95% CI: 9.4–15.6, p(L) = 0.71 and p(M) = 0.74). Conclusions: While GIST survival rates significantly improved, those for other STSs remain unchanged, highlighting an urgent need for novel STS therapies. [Table: see text]