tbuckley/cabot-search huggingface dataset:
Extended impact of an embedded palliative care program in a community cancer center.
Authors: Angela Kalisiak, Lyn A. Glenn, Mark Weinmeister
Journal: Journal of Clinical Oncology (2014)

24 Background: High-level evidence has demonstrated that earlier palliative care (PC) improves outcomes for patients with advanced cancers, but a limited PC workforce and lack of outpatient resources remain barriers to access. In 2010, a productive intersection of oncologist-driven response to new evidence and Providence Cancer Center assessment of end of life care quality metrics resulted in funding of an outpatient Oncology Palliative Care Program (OPCP). An initial NP/LCSW team began concurrent PC for advanced lung and pancreas carcinoma patients in a specialty clinic setting in 2011. Scope of service was expanded to include other diagnoses in 2012. Early positive outcomes and oncology team feedback led to Cancer Center funding of a second PC team at a separate service site in August 2013; the OPCP simultaneously transitioned to an embedded care model. Methods: Retrospective chart review of patient deaths for all Providence Medical Group (PMG) Cancer Center patients not served by OPCP; review of OPCP referral data since adoption of embedded model (n= 177). Quarterly quality metrics included: % patients on hospice at time of death; % patients with evidence of an Advance Care Planning (ACP) discussion documented in the electronic medical record (EMR); and % patients receiving chemotherapy at end of life. Results: A significant improvement in the % PMG oncology patients with evidence of an ACP discussion occurred from 2010 baseline of 59.5% to 74.5% in 2013 (z=4.03, p&lt;.001). In addition, % patients receiving chemotherapy in the last 14 days of life decreased from 5.9% in 2010 to 2.7% in 2013 (z=1.9; p&lt;.05). For patients referred to the OPCP, referral diagnoses evolved from 100% lung and pancreas carcinoma to 34 % lung and pancreas carcinoma and 66 % other diagnoses. Conclusions: Incremental growth of the Providence OPCP has demonstrated successful expansion to diagnoses beyond end stage lung carcinoma. Improvement in end of life care quality metrics for oncology patients not served by the program (perhaps by elevating "generalist" PC skills) may be an additional benefit and value of a highly visible embedded PC team in a community cancer center, particularly with respect to modeling best practice of early goals of care discussions and ACP.
Combination of capecitabine, oxaliplatin with bevacizumab in treatment of advanced hepatocellular carcinoma (HCC): A phase II study
Authors: W. Sun, D. G. Haller, K. Mykulowycz, M. Rosen, M. Soulen, M. Capparo, T. Faust, B. Giantonia, K. Olthoff
Journal: Journal of Clinical Oncology (2007)

4574 Background: Hepatocellular carcinoma (HCC) is one of the most common cancers globally and its incidence of in USA is increasing. Unfortunately, most patients with HCC are unsuitable for surgical resection or transplantation. Because of the heterogeneity of this disease and poor liver function in many patients, there is no generally accepted standard chemotherapy regimen for HCC. Efforts have been made to investigate effective and tolerable therapy for patients with advanced HCC. We conducted a phase II study to evaluate the efficacy and feasibility of the combination of bevacizumab, oxaliplatin and capecitabine in patients with advanced or metastatic HCC. The primary goal of the study was to evaluate the progression-free survival rate. The secondary endpoints include response, overall survival and toxicity. Methods: Patients with advanced or unresectable untransplantable metastatic HCC who had adequate bone marrow, liver and renal function (ANC ≥ 1,500/mm 3 , platelets ≥ 75,000/mm 3 , serum creatinine ≤ 2.0 mg/dl, total bilirubin ≤ 3.0 mg/dl, transaminases ≤ 5 upper limit of normal, and INR ≤ 1.5) were eligible to the study. Bevacizumab (5 mg/kg) and oxaliplatin (130 mg/m2) were administered intravenously day 1 of each 21- day cycle. Capecitabine (825 mg/m2, twice a day) was administered days 1 to 14. Results: Thirty patients (male/female ratio of 23/7) have been enrolled, with a median age of 57 (range 23–85). The average number of treatment cycles was 8 (2–25 cycles). Of evaluable patients, 3 patients (11%) achieved partial response, 21 patients had stable disease (78%) with a disease control rate of 89%. The mean PFS was 5.4 months with 3- and 6- months PFS of 70%, and 40%. There were 33% Gr. 2/3 oxaliplatin-related peripheral neuropathy and 11 % capecitabine-related Gr. 2/3 hand- foot syndrome. One patient had gastrointestinal perforation and sepsis after his first administration of bevacizumab and oxaliplatin. Two patients had esophageal varices-related bleeding, likely disease-related. Conclusions: The results demonstrate that the combination of bevacizumab, oxaliplatin and capecitabine is effective and tolerable in treatment of advanced HCC and should be considered for the further investigation. [Table: see text]
Magnitude of risks and benefits of the addition of bevacizumab (BEVA) to chemotherapy (CT) for patients (pts) with advanced breast cancer (ABC): Metaregression analysis of randomized trials (RCT).
Authors: F. Cuppone, E. Bria, I. Sperduti, V. Vaccaro, C. Nisticò, P. Carlini, M. Milella, A. Fabi, D. Giannarelli, F. Cognetti
Journal: Journal of Clinical Oncology (2010)

1045 Background: The addition of BEVA to CT for ABC demonstrated to improve activity and efficacy in RCT over CT alone. Nevertheless, concerns still exist with regard to the overall safety profile and the magnitude of the benefits. Methods: Following a literature-based approach, hazard ratios (HR) with 95% confidence intervals (CI) were extracted for progression-free and overall- survival (PFS, OS); event-based relative risks (RR) with 95% CI were determined for responses (ORR) and toxicities, with a random-effect model. Heterogeneity and sensitivity analyses according to treatment lines were performed. A meta-regression analysis with clinical predictors was conducted. Absolute differences (AD) and the number of patients needed to treat/harm (NNT/NNH) were calculated. Results: 5 RCTs (3,841 pts; first/second line: 3/2) were gathered. 5 predictors were identified: >3 sites, no adjuvant CT, visceral site, hormonal receptors negative (RN), prior taxanes (T) or anthracyclines (A). A significant interaction according to treatment line was found for PFS (p=0.027); PFS was significantly improved as first line (HR 0.68, 95% CI 0.56, 0.81, p<0.0001, Het. 0.003), with a 1-yr AD of 8.4% (NNT 12). A nonsignificant trend was found in OS, and in PFS for second line. Activity and toxicity results are shown (Table). At the meta-regression analysis for the first line,>3 sites (p=0.032), no adjuvant CT (p=0.00013), RN (p=0.009), and prior A-exposure (p=0.019), did significantly affect PFS. Conclusions: Although with heterogeneity, the addition of BEVA to first-line CT significantly improves PFS, and overall activity. Hypertension should be weighted with the overall benefit on the individual basis. Outcome RR (95% CI) p value Het. (p) AD (%) NNT/NNH ORR (first line) 1.46 (1.21, 1.77) <0.0001 0.008 11.5 8.7 ORR (second line) 1.58 (1.00, 2.52) 0.05 0.092 8.4 12.0 Hypertension 5.15 (1.60, 16.6) 0.006 <0.0001 4.5 22 Proteinuria 9.55 (3.44, 26.5) <0.0001 0.96 0.4 250 Neurotox 1.20 (1.01, 1.43) 0.044 0.61 2.6 39 Febrile neutro 1.39 (1.07, 1.83) 0.015 0.60 2.1 46 Bleeding 3.05 (1.13, 8.23) 0.028 0.56 0.6 175 No significant financial relationships to disclose.
Should be no different from other people
Authors: S. Stevens
Journal: BMJ (1995)

disease than with nodal disease.'Although these differences suggest aetiological and biological heterogeneity, the evidence that diabetes has a role in either type of non-Hodgkin's lymphoma, as suggested by the Japanese data, is not strong.A cohort study in 1982 of people with diabetes mellitus found an excess of lymphoma,' but the authors attributed this to inappropriate referent population rates.'They also observed no associa- tion in a cross sectional study.'Further studies will require more accurate determinations of diabetes and nodal status in non-Hodgkin's lymphoma.
Cost-effectiveness of rituximab plus CVP for first-line treatment of advanced indolent lymphoma
Authors: J. Hornberger, C. Reyes, E. Verhulst, D. Lubeck, N. Valente
Journal: Journal of Clinical Oncology (2007)

6583 Background: The addition of rituximab (RTX) to CVP (cyclophosphamide, vincristine, prednisone) in the treatment of advanced follicular lymphoma increases median time to progression by 17 months (15 month v 32 months; p &lt; 0.0001) (Marcus et al, Blood 2005). A societal cost-effectiveness analysis was performed to estimate projected lifetime clinical and economic implications of this treatment. Methods: The cost-effectiveness (CE) of RTX + CVP versus CVP was estimated for a 50 yr old patient. Kaplan-Meier estimates of progression-free and overall survival, up to 4 years, were obtained from the M39021 trial. After 4 years, transition rates from initiation of treatment to progression or death were assumed to be the same in both arms. The clinical and economic implications of relapse and its treatment were included in the model. Incremental costs associated with addition of RTX were estimated using Medicare reimbursement rates and published retail price data. Costs included drug and administration costs, adverse events, treatment of relapses, and end-of-life costs. Utility estimates were derived from the literature and a 3% discount rate was employed. Results: Projected mean overall survival is 1.5 yrs longer for patients assigned to RTX+ CVP versus only CVP (13.7 v 12.2 yrs). The addition of RTX to CVP is estimated to cost an additional $26,439 on average, with an expected gain of 0.85 year of quality-adjusted survival. Over a lifetime, the cost per QALY gained is $31,329. Sensitivity analyses revealed that the variables that most influenced cost-effectiveness were the time horizon (range: $18,800- $31,240) and the unit drug cost of RTX (range: $24,000-$38,000). Conclusion: The model estimates a cost-to-QALY gained ratio that is below that of many treatments used for oncology patients. The use of RTX + CVP for first-line treatment of advanced follicular lymphoma is projected to be cost-effective compared to CVP alone under a range of sensitivity analyses. No significant financial relationships to disclose.
Spontaneous mutation to chemotherapy resistance: implications of the Goldie-Coldman model for the management of ovarian cancer.
Authors: A J Dembo
Journal: Journal of Clinical Oncology (1984)

Article Tools Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.1984.2.12.1311 Journal of Clinical Oncology - published online before print September 22, 2016 PMID: 6512579 Spontaneous mutation to chemotherapy resistance: implications of the Goldie-Coldman model for the management of ovarian cancer. A J DemboxA J DemboSearch for articles by this author https://doi.org/10.1200/JCO.1984.2.12.1311 First Page PDF © 1984 by American Society of Clinical Oncology
Abstract 14973: Correlates of Aortic Root Dilatation among Young Adults Over a 20 Year Period: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Gisela Teixido-Tura, Andre Almeida, Eui-Young Choi, Ola Gjesdal, Hongyan Ning, David Jacobs, Harry Dietz, Kiang Liu, Stephen Sidney, Cora Lewis, Samuel Gidding, Artur Evangelista, Joao Lima
Journal: Circulation (2012)

Aortic dilatation and stiffening at mid- to advanced adulthood predict future cardiovascular events. However, recent work has demonstrated important aortic biomechanical changes early in the lifesp...
Abstract P1-03-03: Experience in the community oncology practice with a 25-gene hereditary cancer panel
Authors: Sami Diab, Patricia Rodriguez, Anna Leininger, Lisa Clark, Mike F Janicek, Ellen B Smith, John Sandbach, Jennifer Saam, Lucy Langer
Journal: Cancer Research (2015)

Abstract Introduction: The identification of patients with an inherited cancer syndrome is becoming increasingly relevant in the treatment and prevention of cancer. Testing with a panel of genes provides the opportunity to rapidly identify or rule out deleterious mutations in several genes simultaneously and, thus, has the potential to streamline the testing process and more efficiently and accurately provide results. We report on the experience of panel-based testing in the community oncology setting. Objectives: To evaluate the performance of a 25-gene hereditary cancer test in the community oncology setting and describe the patient characteristics and test findings. Methods: We retrospectively evaluated the 25-gene panel testing data obtained between September 2013 and February 2014 in 6 large community oncology practices. The gene panel was based on next generation sequencing and rearrangement analysis of 25 genes with cancer risk data: BRCA1, BRCA2, MLH1, MSH2, MSH6, PMS2, EPCAM, APC, MUTYH, CDKN2A, CDK4, PALB2, CHEK2, SMAD4, BMPR1A, STK11, TP53, CDH1, PTEN, ATM, NBN, BARD1, BRIP1, RAD51C, and RAD51D. Personal and family history was obtained by health care provider report on test requisition forms. Results: The panel test was performed on 359 individuals during the time period. 69.9% of these patients had a phx of at least one of the eight panel cancers: breast, ovarian, colorectal, endometrium, pancreas, melanoma, prostate, and/or stomach. cancer diagnosis. 97.8% of the patients tested met the 2013 NCCN guideline criteria for HBOC, 2012 NCCN guideline criteria for Lynch Syndrome, or both. 37 pathogenic mutations were found in 34 distinct patients. The variant rate in this population was 35.4%. Mutations were identified in 16 different genes, and only 20 of the 37 mutations (54.1%) were found to be in the 6 genes included in HBOC and Lynch Syndrome testing (BRCA1, BRCA2, MSH6, MLH1, MSH2, PMS2). Conclusion: The 25-gene hereditary cancer panel increased the identification of deleterious mutations which would otherwise not have been detected. The variant rate in this setting is similar to the rate reported previously in both community and academic centers where panel testing is used. Use of a hereditary cancer panel in the community oncology practice may improve detection rates and provide an opportunity for enhanced cancer management. Citation Format: Sami Diab, Patricia Rodriguez, Anna Leininger, Lisa Clark, Mike F Janicek, Ellen B Smith, John Sandbach, Jennifer Saam, Lucy Langer. Experience in the community oncology practice with a 25-gene hereditary cancer panel [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-03-03.
Phase II study of gefitinib for non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) gene mutations detected by PNA-LNA PCR clamp
Authors: A. Sutani, Y. Nagai, K. Udagawa, Y. Uchida, Y. Murayama, T. Tanaka, H. Miyazawa, M. Kanazawa, K. Hagiwara, K. Kobayashi
Journal: Journal of Clinical Oncology (2006)

7076 Background: The responsiveness to gefitinib has been reported to closely link to the presence of EGFR gene mutations. We developed a method, PNA-LNA PCR clamp, capable of detecting EGFR mutations in the presence of 100-fold background of wild type EGFR from normal cells (Can Res. 2005;65:7276). This study was prospectively designed to evaluate 1) the sensitivity and the specificity of the PNA-LNA PCR clamp (sample size &gt; 100 pts) and 2) a phase II study of gefitinib for NSCLC patients (pts) with EGFR gene mutations (sample size &gt; 25 pts to show the lower limit of 95% CI &gt; 50%). Methods: Clinical samples (sputum, pleural effusion, bronchial fluid and paraffin tissue) were obtained from consecutive NSCLC pts with informed consent in our institution, and were tested by the PNA-LNA PCR clamp. After the second informed consent, for PS 0–2, inoperable stage III and IV pts with EGFR mutations, gefitinib (250mg P.O. daily) was given as the second treatment after docetaxel containing chemotherapy. In case of poor PS pts, the first line chemotherapy was omitted. Results: From Sept. ’04 to Oct. ’05, samples from 100 of a total of 107 pts were informative of EGFR mutation status. PNA-LNA PCR clamp detected EGFR mutations in 38 pts (38%) (15 males/23 females; median age:62; adenoca.:33 pts). Exon 19 deletions, L858R and L861Q were found in 25 (66%), 12 (32%) and 1 (2%) patients, respectively. But 62 pts (51 males/11 females; median age:66; Ad:43 pts) were judged to have wild type EGFR. Between positive and negative pts in EGFR mutation, there was significant difference in the distinction of sex (p = 0.00001). Gefitinib was given to 26 pts with EGFR mutations as the first line (4 pts) or the second line treatment (22 pts). One patient and 20 patients showed CR and PRs, respectively, and the response rate was 81% (95% CI: 61–94%). For patients with wild EGFR genes, gefitinib was given to 5 patients and one patient (20%) showed PR. The response rate was significantly different between wild and mutant EGFR genes detected by the PNA-LNA PCR clamp (p = 0.017). Conclusions: PNA-LNA PCR clamp could reliably detect EGFR mutations, indicating the method is useful to detect EGFR mutations in clinical specimens. Updated data will be presented at the meeting. No significant financial relationships to disclose.
A randomized clinical study of chemoradiotherapy versus radiotherapy in locoregional advanced unresectable esophageal cancer
Authors: D. Zupanc, A. Roth, K. Kolaric, Z. Tometic
Journal: Journal of Clinical Oncology (2007)

4565 Background: To compare the treatment results chemoradiotherapy that include split-course radiotherapy versus continuous radiotherapy for patients with locoregional advanced unresectable esophageal cancer. Methods: The randomized clinical study included 120 patients, of them 107 eligible. The eligible patients with locoregional advanced unresectable esophageal cancer were randomized in two groups. The first group of 55 patients was treated with chemotherapy in combination with split-course radiotherapy and second group of 52 patients received radiation therapy alone.The chemoradiotherapy group was treated with 5-fluorouracil (1,000 mg/m 2 i.v. for six hours) and cisplatin (20 mg/m 2 i.v.) for four consecutive days at the beginning of each part of therapy plus split-course irradiation (2x20 Gy, 200 cGy daily) separated by a rest of 2 weeks. The patients in radiotherapy group received totally up to 60 Gy, 200 cGy daily. Chemotherapy for clinical recurrence and salvage therapy. Results: The 2-,5-,10- years overall survival rate were 32.2 %, 24.5% and 7.3% in the chemoradiotherapy group and 22.2%,14.5% and 1.9% in the radiotherapy group.Median survival was 15 months in the chemoradiotherapy group and 11.5 months in the radiotherapy group. There was the statistically significant difference (p&lt;0.05) between the groups due to overall survival. The hematological toxicity, nausea and alopecia were more common in the chemoradiotherapy group, but esophagitis and pain in the irradiated region were more common in the radiotherapy group. Conclusions: Chemoradiotherapy with cisplatin, 5-fluorouracil and split-course radiotherapy showed superior results to radiotherapy alone and did not produce any severe side effects in patients with locoregional advanced unresectable esophageal cancer. No significant financial relationships to disclose.
The prognostic value of TP53 mutations in oesophageal adenocarcinoma: a systematic review and meta-analysis
Authors: Oliver M Fisher, Sarah J Lord, Dan Falkenback, Nicholas J Clemons, Guy D Eslick, Reginald V Lord
Journal: Gut (2016)

Objective To clarify the prognostic role of tumour protein 53 (TP53) mutations in patients with oesophageal adenocarcinoma (OAC) as there is a need for biomarkers that assist in guiding management for patients with OAC. Design A systematic review was conducted using MEDLINE, Embase, PubMed and Current Contents Connect to identify studies published between January 1990 and February 2015 of oesophageal cancer populations (with OAC diagnoses &gt;50% of cases) that measured tumoural TP53 status and reported hazard ratios (HR), or adequate data for estimation of HR for survival for TP53-defined subgroups. Risk of bias for HR estimates was assessed using prespecified criteria for the appraisal of relevant domains as defined by the Cochrane Prognosis Methods Group including adherence to Grading of Recommendations, Assessment, Development and Evaluation and REporting recommendations for tumor MARKer prognostic studies guidelines, as well as assay method used (direct TP53 mutation assessment vs immunohistochemistry) and adjustment for standard prognostic factors. A pooled HR and 95% CI were calculated using a random-effects model. Results Sixteen eligible studies (11 with OAC only and 5 mixed histology cohorts) including 888 patients were identified. TP53 mutations were associated with reduced survival (HR 1.48, 95% CI 1.16 to 1.90, I 2 =33%). A greater prognostic effect was observed in a sensitivity analysis of those studies that reported survival for OAC-only cohorts and were assessed at low risk of bias (HR 2.11, 95% CI 1.35 to 3.31, I 2 =0%). Conclusions Patients with OAC and TP53 gene mutations have reduced overall survival compared with patients without these mutations, and this effect is independent of tumour stage.
Tumor biology in African-American women with breast cancer treated with preoperative chemotherapy: Lack of pathologic complete response is related to p53 overexpression
Authors: K. A. Dookeran, X. Gao, K. Ferrer, E. Sciupokiene, R. De La Torre, L. Diaz de Leon, B. Lukaszczyk, S. Zhang, M. Sekosan, H. A. Zaren
Journal: Journal of Clinical Oncology (2004)

880 Background: African-American (AA) women with breast cancer have increased risk of death compared with white women. Biologic differences may contribute to outcome disparities for AA women. Our prior study demonstrates that AA women treated with preoperative (preop) chemotherapy have reduced pathologic complete response (pCR) rates compared to non-AAs. Methods: To further evaluate differences in tumor biology as a cause for this disparity, we examined tumor histology and markers on samples from women who received preoperative therapy, at the MBCCOP, Stroger Hospital of Cook County, in Chicago. Results: There were 21 AA (0% pCR) and 21 non-AA (19% pCR) women included. The number of women with grade 1, 2 or 3 tumors respectively was 2, 2 & 17 for AAs, and 0, 8 & 13 for non-AAs. Hormone receptor (HR) status was negative for 15 AAs and 11 non-AAs. HER2 overexpression was seen in 6 AAs and 7 non-AAs. Extra-capsular lymph node tumor extension was seen in 5 AAs and 7 non-AAs. Although AAs were more likely to have grade 3 tumors which were HR negative, these differences were not significant. Immunohistochemistry on paired samples for AAs from pre and post chemotherapy specimens, demonstrated mild decreases in HR and estrogen receptor beta immunostaining, and no change in epidermal growth factor receptor or p27 immunoreactivity. However, p53 immunoreactivity with both Pab1801 and D07 antibodies was increased in the post chemotherapy specimens. Conclusions: Higher tumor grade and HR negative status seen in AAs in our study, are more commonly associated with favorable response to preop therapy. However, pCR did not occur in these women. Mutant p53 may be associated with an unfavorable response to preop therapy, and the demonstrated increase in p53 overexpression in AAs in this study may be responsible for the observed lack of pCR. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration This research was funded in part by the NCI (MBCCOP Grant CA95867), Aventis Pharmaceuticals Inc. & the Avon Foundation