tbuckley/cabot-search huggingface dataset:
Computer use with post breast therapy pain syndrome &amp; lymphedema
Authors: E. H. Rosenbaum, A. Andrews, F. Manuel, C. M. Dollbaum, R. A. Wascher
Journal: Journal of Clinical Oncology (2005)

8185 Background: In our information-centric society, the ability to use a personal computer is an essential capability in the professional and private lives of millions of people around the world. The problem of persistent swelling or pain in one or both arms after trauma of any kind may affect computer usage, especially for people who must work on the computer for prolonged periods of time. The functional impairment of using a computer comfortably with Post Breast Therapy Pain Syndrome (PBTPS) and Lymphedema has received little literature or research attention. Methods: Pilot questionnaires were developed in September 2002 to evaluate the perceived utility of the Living with Lymphedema and Post Breast Therapy Pain Syndrome (PBTPS) educational content at CancerSupportiveCare.com. From September 2002 to November 2004 our website served 158,600 pages of PBTPS and Lymphedema information to interested patients, support teams and medical professionals from 134 countries, including the USA (number of hits is not included because the term hit is misleading, e.g. 1000 graphics + 1 web page = 1001 hits). Results: Score 1–4 (n=1162 responses, 643 Lypmhedema and 519 PBTPS) Of the 1162 responses, 993 were from patients and support teams (85%) and 169 were from health care professionals (15%) Overall 97% of the respondents felt that the educational information was somewhat-to-very helpful Conclusions: An Internet-based approach to educating patients and health care professionals about rarely discussed and under-reported complications of cancer therapy resulted in a >97% favorable response from readers in 134 countries. This Internet-based approach to the understanding of computer use with Post Breast Therapy Pain Syndrome (PBTPS) and Lymphedema facilitates interactions between patients and specialists in a non-threatening anonymous forum, and encourages a strong culture of support and reciprocal interactions. No significant financial relationships to disclose.
Early allogeneic transplantation for adults with <b><i>de novo</i></b> acute myeloid leukemia presenting with t(6;11)(q27;q23): Results from CALGB 8461
Authors: W. Blum, K. Mrozek, A. S. Ruppert, A. J. Carroll, K. W. Rao, M. J. Pettenati, J. W. Vardiman, R. A. Larson, C. D. Bloomfield
Journal: Journal of Clinical Oncology (2004)

6543 Background: AML with t(6;11)(q27;q23) is a well established but rare entity, and few reports describe full clinical, hematological, and outcome data of these patients (pts). Methods: We searched the CALGB database comprising 2667 adults with newly diagnosed de novo AML, enrolled from 1984 to 2003, and identified 16 (0.6%) pts with t(6;11). Literature review identified 40 previously published cases of t(6;11) adult de novo AML with treatment outcome data available. Results: CALGB pts had a median age of 45 years (range, 22–65); 8 were men. t(6;11) was the sole abnormality in 69% of pts. Pts commonly (81%) presented with French-American-British subtype M4 or M5. Gingival hypertrophy and high white blood cell count (>50 x109/l) were relatively frequent, each occurring in 5 (31%) pts. t(6;11) pts were more likely to be African-American (p=0.02) and to die during induction (p=0.03) than all other de novo AML pts without t(6;11). The complete response (CR) rate was 69% (11/16 pts); all 5 remaining pts died during induction. CR duration was short (median 8.5 months). Median overall survival (OS) was 10.7 months, and the estimated probability of 2-year survival was 13%. Both long-term survivors received allogeneic SCT, one in first CR and one after relapse. Two pts (one from CALGB, one from literature) are known to have had allogeneic SCT in first CR; both were long-term survivors. The table describes all t(6;11) AML cases with outcome data available. Conclusion: While patient numbers are small, early allogeneic SCT should be considered for adults with de novo t(6;11) AML who achieve CR, as the window of opportunity before relapse and death appears to be short. No significant financial relationships to disclose.
Adjuvant treatment for advanced stage endometrial cancer: Patterns of care and outcomes at a single institution
Authors: B. M. Buttin, M. S. Liao, D. G. Mutch, J. S. Rader, R. K. Gibb, M. A. Powell
Journal: Journal of Clinical Oncology (2005)

5133 Background: The prognosis for early stage endometrial cancer is excellent. However, 5-year survival in stage III-IV disease declines to 18–50%. Adjuvant treatment for advanced stage endometrial cancer has traditionally been multimodal utilizing hormonal therapy, radiation, and various chemotherapies. To date, no true standard of care exists. We set out to compare recurrence and mortality rates between advanced stage endometrial cancer patients staged and treated at our institution. Methods: We reviewed medical records of all patients with FIGO stage IIIA-IVB endometrial cancers staged and treated at Washington University between 1998 and 2003. Data on demographics, pathologic diagnoses, treatment, recurrence, and mortality rates was analyzed for overall and progression-free survival. Subgroup analyses on high risk/lower risk histologic subtypes, different treatment strategies, and other prognostic factors were performed. Results: Records were available on 124 patients including 72 with stage III and 52 with stage IV disease. 54 (43.5%) had low risk (grade 1 and 2) cancers while 70 (56.5%) had high risk histologic subtypes. Mean follow-up was 20.5 months. Overall, 54 patients (43.5%) recurred and 45 (36.3%) died. Similar proportions were found even in patients with minimal extrauterine disease. 97 patients received adjuvant treatment, 35% with RT alone, 34% with chemotherapy alone, and 10% with combination chemotherapy and RT. Recurrence rates in each group approached 50%, however, there was a trend toward improved OS in the combination therapy group (83.3% versus 62% with chemotherapy and 67% with RT alone). When stratified by histologic risk, survival benefit after RT alone or combination therapy was confined to patients with lower risk endometrioid adenocarcinomas (P<0.05). Conclusions: Adjuvant treatment for advanced stage endometrial cancer remains controversial. Our data suggests that a subgroup of patients may benefit from more aggressive treatment with combination chemotherapy and RT. Stratification by traditional prognostic factors did not identify a subgroup at lower risk for recurrence/progression. No significant financial relationships to disclose.
Trastuzumab in the elderly: Is it age or cardiovascular risk profile that really matters?
Authors: C. Serrano, J. Cortés, M. Bellet, P. Gómez, C. Saura, P. Martínez, J. Pérez, F. Atzori, J. Baselga, S. Di Cosimo
Journal: Journal of Clinical Oncology (2009)

e20527 Background: Elderly breast cancer (BC) patients (pts) are usually excluded from clinical trials. Nevertheless, with the increased use of trastuzumab (T) there is a need to assess and predict T-related cardiotoxicity in this population. Methods: Data were collected from women ≥70 years with BC and serial cardiac monitoring treated with T at our institution since 2005. Cardiovascular risk factors (CRF) were analysed together with left ventricular systolic function (LVEF) assessed at baseline and during T. Results: Thirty pts with early (10) or advanced (20) BC, median age 75.7 years (range 70–87), were identified. WHO performance status was 0–1 in 90% of pts. Median duration of treatment was 45 weeks (range 2–87). Basal LVEF was 63.8% (range 46.3–76). Five of 30 pts (16.6%) experienced asymptomatic cardiotoxicity defined as an absolute drop ≥10% with a final LVEF &lt; 50% (13.3%, 4/30 pts) or any absolute drop &gt;20% (3.3%, 1/30 pts). Four of 30 patients (13.3%) developed symptomatic cardiac heart failure. Median time to LVEF decline was 9 weeks (range 3–87). LVEF recovered to normal values in a median time of 4 weeks (range 3–48) in all but one patient. CRF are shown in Table 1 . Pts with T-related cardiotoxicity presented more often with history of cardiac disease (22.2% versus 9.5%), diabetes (22.2% versus 5%) and BMI&gt;30 (68% versus 45%) as compared to the rest. No relevant difference was seen in terms of hyperlipemia, tobacco or hypertension. Previous or concomitant exposure to anthracyclines was not found as a risk factor either. Conclusions: Despite the limited numbers, this series shows that elderly BC pts treated with T experience reversible cardiac events similarly to those already described in younger pts. However, particular attention may be paid to cardiac history, diabetic and obese pts who appear more likely to develop T-related cardiotoxicity. [Table: see text] No significant financial relationships to disclose.
Neurologic, computed cranial tomographic, and magnetic resonance imaging abnormalities in patients with small-cell lung cancer: further follow-up of 6- to 13-year survivors.
Authors: B E Johnson, N Patronas, W Hayes, J Grayson, B Becker, D Gnepp, J Rowland, A Anderson, E Glatstein, D C Ihde
Journal: Journal of Clinical Oncology (1990)

To determine the subsequent evolution of neurologic, neuropsychologic, and intracranial anatomic findings in long-term survivors of small-cell cancer, we repeated an evaluation done 4 years previously in patients 6 to 13 years after treatment. Fifteen patients were reevaluated with a history and physical examination, mental status examination, neuropsychologic testing, computed cranial tomographic (CCT) scans, and magnetic resonance imaging (MRI). All but one was ambulatory and none were institutionalized. Thirteen of 15 had neurologic complaints, 10 of 15 had an abnormal neurologic examination, seven of 14 had an abnormal mental status examination, 12 of 14 had abnormal neuropsychologic testing, 12 of 15 had abnormal CCT scans, and seven of 15 had white-matter abnormalities on MRI scans. No dramatic decline in performance status, functional status, neurologic symptoms, or neurologic examination occurred in these patients with 4 years of additional follow-up. More patients showed a decline in mental status examinations and neuropsychologic testing than demonstrated improvement. Anatomic studies showed no dramatic changes in the CCT scans and MRI confirmed these findings. From these data we conclude that there is a slow decline in neuropsychologic function in some of the patients surviving more than 6 years from a diagnosis of small-cell lung cancer. The anatomic abnormalities documented by CCT scans and MRI are more frequent in patients with abnormal neuropsychologic function.
A randomized phase II study of gemcitabine (G) vs gemcitabine/carboplatin (GC) as consolidation therapy to concurrent chemoradiotherapy (CRT) for stage III non-small cell lung cancer (NSCLC): A Lung Cancer Research Group (LCRG) study
Authors: K. Lam, T. S. Mok, J. Lee, L. Zhang, Y. Wu, S. Lu, M. Liao, C. Yang, C. Zhou, M. Boyer
Journal: Journal of Clinical Oncology (2008)

7559 Background: Consolidation chemotherapy following concurrent CRT may improve systemic control and possibly prolong survival of pt with stage III NSCLC. Phase II study using docetaxel showed promising result but subsequent phase III study was negative. We explored the role of single agent gemcitabine (G) and combination with carboplatin (C) as consolidation chemotherapy. Methods: Study was conducted by Asian mutli-center group. Eligible criteria: stage IIIA/B, histologic/cytologic confirmed NSCLC, completed concurrent CRT according to preset cisplatin and RT doses, attained CR/PR/SD from CRT, randomized within 6 weeks from last day of CRT, ECOG 0–1, adequate organ function, no brain met. Exclusion: unresolved radiation pneumonitis/esophagitis. Randomized to G at 1250mg/m2 day 1,8 q21d x3 or G at same dose plus C at 5 x AUC at day 1 x3. Primary and 2nd end points are 2-yr survival rate, median survival and toxicity, respectively. Sample size was estimated to detect a 15% difference in 2 yrs survival rate. Results: Between 3/04 and 6/06 we screened 111 pts and enrolled 61. 10 pts were excluded because of unresolved pneumonitis/esophagitis. Pt characteristics are similar between 2 arms.(Table) Median age: 56. Dose of RT/cisplatin during CRT were similar. 3 pts in G arm skipped day 8 G while 10 in GC arm (p=0.16). 3 pt and 2 pt attained higher response status during G and GC respectively, while 3 and 4 pt progressed. Survival outcomes are similar. More hematologic toxicity in GC arm (G3/4 Anemia 3 v 44%; Neutro 25 v 51%; Plat 15.6 v 31%) 5 out of 61 pt had grade 3/4 post gemcitabine radiation pneumonitis and all 5 are from G arm. Conclusion: It is feasible to give G-based consolidation chemotherapy in selected patients after concurrent CRT. Combination therapy with platinum did not improve survival but it added to myelotoxicity. “Re-call” radiation pneumonitis by gemcitabine is relatively uncommon. Patient Characteristics and Primary Efficacy G (n=32) GC (n-29) p M/F 29/3 26/3 IIIA/IIIB 5/27 7/22 0.4 Adenocarcinoma/Non-adenocinoma 15/17 13/16 0.87 Median # of cycles 2 2 0.84 2 yr survival rate 46.3% 42.2% 0.89 1 yr progression free rate 34.4% 38.7% 0.53 Median survival 1.78 yr 1.75 yr 0.98 Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Abraxis, AstraZeneca, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer, Roche AstraZeneca, Eli Lilly, Merck, Novartis, Pfizer, Roche Bayer, Novartis
Phase II results of mitomycin and vinorelbine in second line chemotherapy for NSCLC
Authors: A. Babiak, M. Hetzel, C. Schumann, L. G. Vitulli, M. Pietsch, J. Hetzel
Journal: Journal of Clinical Oncology (2005)

7321 Background: Second line chemotherapy using docetaxel is considered to be the standard therapy in advanced NSCLC. Single-agent activity of vinorelbine or mitomycin in patients with NSCLC was demonstrated previously in phase III trials. Methods: A Phase II single arm trial was completed, including 42 patients. All patients were pretreated with platinum containing chemotherapy according to treatment guidelines for unresectable NSCLC. Chemotherapy was given over 6 cycles (vinorelbine 25mg/m2 day 1 and 8, mitomycin 8mg/m2 day 1, q28 days). Primary end point of the study was survival. Results: For evaluation 42 patients were eligible (stage IIIB 17%, stage IV 83%). 5 patients had PR, 13 SD and 24 PD. Median survival was 8.5 months. 1-year follow up was completed in 39 patients. Based on Kaplan-Meier analysis the 1 year survival was 34%.Grade 3 and 4 adverse events were leukopenia (26.2%), anaemia (9.5%), nausea/vomiting (9.5%) and fatigue (2.4%). Thrombocytopenia grade 3 or 4 was not reported. Conclusion: Chemotherapy applying mitomycin and vinorelbine is effective in non chemonaive patients with advanced NSCLC. It gives promising results for survival and toxicity. However mitomycin specific toxicities have to be monitored. Compared to docetaxel the combination of mitomycin and vinorelbine shows an excellent cost-effectiveness. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration medac GmbH, Germany medac GmbH, Germany
Significant higher pathological response rate in invasive ductal vs lobular carcinomas after primary systemic chemotherapy with EC high dose in locally advanced breast cancer
Authors: U. Euler, J. Tio, H. Volkholz, M. Buehner, A. H. Tulusan
Journal: Journal of Clinical Oncology (2005)

752 Background: Primary systemic chemotherapy has become an important option in the treatment of locally advanced breast cancer. The aim of this retrospective analysis was to investigate if there are differences in pathological response, local or distant recurrence rate or overall survival regarding histological tumor types. Methods: 152 eligible patients (pts) with locally advanced breast cancer (cT2-T4) primarily not suitable for breast conserving therapy were treated with preoperative chemotherapy consisting of 3 cycles of Epirubicin (120mg/m2) and Cyclophosphamide (600mg/m2), applied every 2 or 3 weeks prior to surgery. After the 3rd cycle surgery was performed. The following adjuvant therapy depended on clinical and histological response. In case of CR/PR response a 4th cycle of EC was applied followed by 2 cycles of CMF. In NC/PD response the therapy was changed to a regimen containing Paclitaxel (175mg/m2,q21d) and 5‘-FU (2g/m2,q7d). Results: After surgery 123 pts (80.9%) were diagnosed with ductal and 29 (19.1%) with lobular carcinoma. In ductal carcinomas pCR was observed in 4.9%, PR in 74.0% and NC 21.1%. Lobular carinomas showed pCR in 3.4%, PR 69.0%, NC 21.2% and PD 3.4% (p=0.02). Local recurrences in pts with ductal carcinomas were seen in 4.9%, pts with lobular carcinomas showed none so far (p=0.2). Metastases were seen in 16 pts with ductal carcinoma (13.0%) and in 2 pts with lobular carcinoma (p=0.5). 10 pts with ductal and 1 pt with lobular carcinoma have died. The follow-up was 48.3 months. Conclusions: Primary systemic chemotherapy with EC high dose is significantly more effective in ductal carcinomas. This histological tumor type shows a higher pathological response rate. Regarding distant or local recurrences or overall survival no differences between these two tumor types could be found. No significant financial relationships to disclose.
Improving the quality of care and decreasing the morbidity of patients with lung cancer through routine symptom screening
Authors: D. J. Dudgeon, S. King, E. Hughes, J. Gilbert, L. deWaal, D. Howell, H. Angus, C. Sawka
Journal: Journal of Clinical Oncology (2008)

9621 Background: The morbidity of patients with cancer would be significantly reduced if they received optimal symptom management. This requires early identification of the symptoms, comprehensive assessment and monitoring over time. Cancer Care Ontario implemented a quality improvement project for all lung cancer patients seen in 12 regional cancer centers (RCC). Aims of the project included: 90% of all lung cancer patients screened for symptom intensity; a comprehensive assessment done if scores ≥ 4/10 for pain and dyspnea or ≥ 5/10 for depression; and pain and dyspnea severity ≤ 6/10 within 72 hours of finding “severe” scores (≥ 7/10). Methods: All lung cancer patients seen in the 12 RCCs and community were asked to complete an Edmonton Symptom Assessment System (ESAS) on each visit. Data was collected and reported monthly to measure progress including: use of ESAS and whether pain and dyspnea severity were ≤ 6 within 72 hours. Monthly chart audits were completed to assess whether a comprehensive assessment was completed for scores ≥ 4 for pain and dyspnea and ≥ 5 for depression. Results: Over 10 months there was an increase in the number of ESASs completed per month (10,354). Provincially the percentage of lung cancer patients in RCCs screened at least once per month with ESAS increased from 3.5% to 47% over 10 months, with 2 regions reaching the aim of 90% of patients screened. The percentage with moderate severity (4–6) was 20.6% (pain), 16.0% (dyspnea), 16.4% (depression) and severe (7–10) was 11.7%, 9.9%, and 6.5%. The percentage of no evidence of comprehensive assessment was 27% (pain), 39% (dyspnea) and 50% (depression). Analysis of 4,466 ESASs showed that when a subsequent ESAS assessment was completed within 72 hours of a result of ≥ 7 for pain or dyspnea (170 pain and 124 dyspnea assessments), 69% of pain and 31% of dyspnea assessments decreased to ≤ 6. Conclusions: Uncontrolled symptoms continue to cause significant morbidity for cancer patients. Routine symptom screening is possible and provides the opportunity for improved patient care and aggregate data for performance indicators to make process and human resource improvements at a regional level. No significant financial relationships to disclose.
Cytokines and angiogenic factors in metastatic renal cell cancer: Association of pretreatment serum levels with survival
Authors: A. J. Montero, C. M. Diaz-Montero, J. Liu, K. Do, R. E. Millikan, N. M. Tannir
Journal: Journal of Clinical Oncology (2009)

e16036 Background: To correlate serum cytokine and angiogenic factor (CAF) levels and overall survival (OS) in metastatic renal cell cancer (mRCC) treated with interferon-alpha (IFN-α). Methods: Serum CAF levels were measured in 103 patients treated on a randomized trial with IFN-α 0.5 million units (MU) twice daily or 5 MU daily. Concentrations of 17 analytes including vascular endothelial growth factor (VEGF A ) and several cytokines were determined by multiplex bead immunoassays or ELISA (basic fibroblast growth factor). We used proportional hazards models to evaluate the effect of CAF levels and clinical factors on OS. Results: Pretreatment serum interleukin (IL)-5, IL-12p40, VEGF A , and IL-6 levels, and Memorial Sloan-Kettering Cancer Center risk grouping were independently correlated with OS, with hazard ratios of 2.33, 2.00, 2.07, 1.82 and 0.39, respectively (concordance index = 0.69 for the combined model versus 0.60 for the CAF model versus 0.52 for the clinical model). Based on an index derived from these five risk factors (RF), patients with 0–2 RF had a median OS time of 32 months, versus 9 months for patients with 3–5 RF (p &lt; 0.0001). Conclusions: Serum CAF profiling contributes to prognostic evaluation in mRCC and helps to identify a subset of patients with 20% 5-year OS. No significant financial relationships to disclose.
Novel and effective management of capecitabine induced hand foot syndrome
Authors: D. Yamamoto, C. Yamamoto, K. Tanaka
Journal: Journal of Clinical Oncology (2008)

20615 Background: Hand foot syndrome (Palmar plantar erythrodysesthesia) is common side effect of capecitabine. Grade II-III toxicity is seen in 10–50%of the patients and may lead to discomfort with activities of daily living. Interruption in the treatment and dose reductions are very frequent due to this toxicity. Although pyridoxine has been used for the prevention of HFS associated with capecitabine, its efficacy is controversial. Therefore the better treatment is needed. Aim of the study was to analyze efficacy of vitamin E supplementation on capecitabine induced toxicity, as it has been shown in previous study. Methods: Patients on capecitabine were followed for signs of hand foot syndrome. Forty two episodes were of grade II toxicity. All had dry furrowed skin, rash, desquamation on the palms of the hands and soles of the feet. All patients received orally Vitamin E supplementation (Alpha tocopherol, Juvela N, Eisai Pharmaceuticals, Tokyo, Japan) twice a day, during chemotherapy. Results: This application had a dramatic impact on dermatological complications within 7 days of initiation. The effect lasted till continuation of the application. It lead to reduction in desquamation, pain, and comfort level of all the patients improved. Neurological symptoms improved as well. All patients were able to complete the chemotherapy cycle as per the schedule and without interruption or delays. Efficacy was seen in patients where it was used prophylactically. 38/42 did not develop cutaneous manifestation and four had grade I toxicity. Conclusions: vitamin E containing preparation appears to be an excellent choice for the prevention and treatment of capecitabine induced hand foot syndrome. This minimizes drug delays, schedule interruptions and maintains the dose density. Owing to reduced morbidity, the drug tolerance and acceptance is considerably improved. No significant financial relationships to disclose.