tbuckley/cabot-search huggingface dataset:
Epidermal growth factor receptor tyrosine kinase inhibitors with external radiation in unresectable non small cell lung cancer (NSCLC) patients: Indian Experience
Authors: R. Kapoor
Journal: Journal of Clinical Oncology (2008)

14685 Background: There is no evidence from existing literature on the role of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in conjunction with external beam radiation therapy (EBRT) in unresectable NSCLC patients (pts). The aim of this study was to analyze the role of EGFR TKI, Gefitinib, with EBRT in these pts in terms of overall survival, local control and radiation morbidity. Methods: This was a randomized prospective analysis of pts with inoperable NSCLC, Karnofsky Performance Scale>60 and no history of prior malignancy in previous 5 years. The pts were randomized into 2 groups of 50 each. In group1, pts were treated with EBRT and Gefitinib, 250 mg once daily concurrently. In group2, only EBRT was delivered (60Gy/30#/6 weeks with spinal shielding after 40Gy/20#/4 weeks). The primary endpoint was overall survival. Results: Median follow up in the whole group was 3.27 months. In group1, median follow up was 4.53 months (mean: 4.87months) and in group2, it was 3.87 months (mean: 3.27 months). At last follow up, 11 pts were disease free, 29 pts were alive with disease, and 10 pts died because of progressive disease in group1. In case of group 2, 10 pts were disease free, 26 pts were alive with disease, and 13 pts died because of progressive disease. The actuarial 8-month survival was 62.2% in group 1 (median: 4.67months) and 58.33% in group 2 (median: 3.03months) (p=0.2438). Using comparison of curves by Kaplan-Meyer’s method, the hazard ratio was found to be 0.61 with C.I. 0.28 -1.19 (p=0.13). Local control in group1 was found to be earlier at 5.3 months compared to group2 at 7.5 months. There was no grade 3–4 toxicity observed in either group. Conclusion: As Gefitinib was well tolerated and led to better local control, it can be used upfront as radiosensitizer in NSCLC pts with inoperable tumors. No significant financial relationships to disclose.
The epidemiology of opioid treatment in a population-based cohort of cancer patients
Authors: L. Jarlbaek, M. Andersen, J. Hallas, J. Kragstrup
Journal: Journal of Clinical Oncology (2004)

8221 Background: Denmark has the highest use of strong opioids per capita in the world. Our aim was to analyze cancer patients' use of opioids in this population. Both tramadol and transdermal fentanyl were marketed during the observation period. Methods: By linkage between the Danish Cancer Register and a population-based prescription database we retrieved individual information on all cancer patients (n=24,190) living in a Danish county (n ∼ 470,000; 9% of the Danish population) from 1994 to 1998, and all the opioid prescriptions they redeemed. Results: The cancer patients' total consumption increased from 20 kg to 37 kg oral morphine equivalents (omeq) per year. The proportion of cancer patients, who used opioids, increased from 17% to 20% on a yearly basis. The rate of new opioid users per year remained stable (around 14 per 100 cancer-years). The average opioid consumption per user increased from 7.6 to 10.7 g omeq per year. The proportion of patients, who were alive 2 years after their first opioid prescription, increased from 38% to 55%. Tramadol became the most frequently used opioid, and the consumption of transdermal fentanyl reached the same level as morphine in 1998. Conclusions: The large increase in the consumption of opioids among the cancer patients was caused by an increase both in the number of opioid users and in the average opioid consumption per patient. The substantial increase in 2-year survival after the first opioid prescription is most likely explained by an increasing tendency to initiate opioid treatment at earlier stages in the patients' symptomatic disease courses, which also could contribute to the other findings. No significant financial relationships to disclose.
Spontaneous regression of localized neuroblastoma detected by mass screening.
Authors: K Yamamoto, R Hanada, A Kikuchi, M Ichikawa, T Aihara, E Oguma, T Moritani, Y Shimanuki, M Tanimura, Y Hayashi
Journal: Journal of Clinical Oncology (1998)

PURPOSE To clarify whether and when neuroblastomas identified through screening do regress, and to ascertain how to treat them appropriately, we observed screened patients who had localized tumors, without any therapeutic intervention. PATIENTS AND METHODS The criteria for the observation program were as follows: disease stage I or II; tumor less than 5 cm in diameter; no invasion to the intraspinal canal or growth to the great vessels; urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) less than 50 microg/mg creatinine; and informed consent. Of 25 patients identified through screening for 6-month-old infants in Saitama Prefecture, Japan between April 1994 and March 1996, 11 patients who met the criteria and one other patient with stage III tumor were enrolled onto the program. They were examined by abdominal ultrasonography (US) and their urinary VMA and HVA levels were assessed approximately once per month. The observation periods ranged from 4 to 27 months. RESULTS The 11 tumors decreased in size, although one of these 11 tumors initially enlarged until the patient was 12 months of age and decreased in size thereafter. One other tumor slightly increased in size. Urinary VMA levels decreased in all patients. None of the tumors had completely disappeared by the last observation day. CONCLUSION Our results suggest that regression of screened neuroblastoma is not a rare phenomenon. At present, it seems reasonable to adopt a wait-and-see strategy, with careful observation, for selected stage I or II tumors identified in infants screened at 6 months of age.
Abstract 13532: A Case Series Assessing the Suitability of Treatment with Apixaban Based on Renal Function
Authors: Brian Norcock, Julliana Newman, Cara de Reuck, Frank Rhodes
Journal: Circulation (2014)

Introduction: Clearance of the new oral anticoagulants (NOACs) relies in part on renal function. Before prescribing a NOAC, renal function should be estimated by calculating creatinine clearance (eCrCl). The European Society of Cardiology recommends calculating eCrCl using the Cockcroft Gault (CG) calculation.

Although estimated glomerular filtration rate using the Modification of Diet in Renal Disease method (eGFR MDRD) allows staging of renal function to facilitate monitoring and treatment of chronic kidney disease (CKD), it was not designed for drug dosing decisions, while the CG equation has been used for estimating renal function for drug use and dosing.

The CG equation is considered the gold standard for assessment of kidney function in the United States; however, most laboratories in Australia and Europe provide the eGFR-MDRD results only. If the decision to treat with NOACs is based on the eGFR-MDRD calculation, at-risk patients (e.g., extreme ends of weight and age) may seem eligible for treatment with a NOAC. In these borderline patients, clinicians should calculate eCrCl using the CG equation. Online calculators exist; this is not always a simple calculation.

Methods: In the table below we present a case series of 10 patients comparing their renal function using the eGFR-MDRD vs. the Cockcroft Gault calculation to determine suitability for treatment with apixaban. In Australia, treatment with apixaban based on the clinical trial protocol requires a CG ≤ 25 mL/min.

Summary: When assessing the suitability of NOACs in renally impaired patients, eGFR MDRD may overestimate the level of renal function. To better identify patients suitable for NOAC treatment, we recommend that Australian and European laboratories be required to report the CG calculation. This small change in laboratory results could improve patient outcomes. We also recommend the expansion of NOAC guidelines to provide clear guidance about the requirements for follow-up in borderline patients.

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Erythropoietin stimulating agent dose and use patterns in cancer patients
Authors: G. W. Daniel, D. L. Hurley, J. L. Whyte, W. D. Grochulski, V. J. Willey, J. D. Kallich
Journal: Journal of Clinical Oncology (2007)

19547 Background: Patients with cancer who develop anemia are often treated with erythropoietin-stimulating agents (ESAs), such as darbepoetin alfa (DA) or epoetin alfa (EA). This study compared baseline characteristics, patterns of ESA use, and dosing among cancer patients as observed in a large managed care claims database. Methods: Medical and pharmacy claims from a U.S. managed care database were used to identify 15,007 unique episodes of care (7,238 with DA, 7,769 with EA) among cancer patients between January 2004 and January 2006. Episodes were defined as the time over which consecutive ESA claims occurred with =42 day gap between claims, plus a duration of clinical benefit (DCB) based on the median days between consecutive doses for each product. Six sensitivity analyses were performed that examined the robustness of findings to study methods and assumptions. Results: The mean (± SD) number of administrations per episode was 3.7 (± 4.1) for DA and 5.3 (± 6.4) for EA. The mean ESA episode duration was 55.5 (± 64.7) days for DA and 59.2 (± 59.2) days for EA and median times between consecutive claims was 15 and 8 days, respectively. The estimated mean weekly dose, including the DCB, was 105 (± 56) mcg for DA and 34,242 (± 28,174) U for EA. Average weekly doses were found to be sensitive to the inclusion/exclusion of the duration of clinical benefit (dose ratio 1:326 vs 1:237, respectively). Compared to EA episodes, DA episodes were associated with younger age (75% &lt;65 years, for DA vs. 69% &lt;65 for EA), more platinum containing chemotherapy (31.9% DA vs. 28.4% EA (p&lt;.001), more classes of chemotherapy used (77% with one or more classes (DA) vs. 65% with one or more classes (EA) (p&lt;.001)) and higher comorbidity burden, as measured by the Deyo-Charlson index (54.3% with a score =8 (DA) vs. 46.6% (EA) (p&lt;.001). Conclusions: Patterns of ESA use differed significantly between DA and EA. Additionally, patients receiving DA differed significantly in baseline characteristics compared to patients receiving EA. Adjustments for patterns of use are necessary to appropriately compare the use of the two ESA’s. [Table: see text]
Vitamin D Supplementation and Increased Risk of Falling
Authors: Steven R. Cummings, Douglas P. Kiel, Dennis M. Black
Journal: JAMA Internal Medicine (2016)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
The impact on quality of life of adding chemotherapy (CT) or ovarian suppression (OS) to adjuvant tamoxifen (TAM): Outcomes from the UK NCRI Adjuvant Breast Cancer (ABC) trial
Authors: A. M. Brunt, J. M. Bliss, A. Benghiat, C. Dawson, J. Dewar, A. N. Harnett, P. Hopwood, D. Lawrence, C. Trask
Journal: Journal of Clinical Oncology (2004)

8015 Background: To assess quality of life (QL) in a multicentre phase III randomised trial evaluating the benefit of adding CT and/or OS to adjuvant TAM in pre/perimenopausal women, and of adding CT to TAM in postmenopausal women. Key QL outcomes included systemic and menopausal symptoms, mood, sexual functioning, body image, role functioning and global QL. Methods: Patients reported QL using the EORTC QLQ-C30, BR23 breast cancer module, Hospital Anxiety and Depression Scale (HADS) and Menopausal Symptom Scale (MSS), before randomisation and at 3, 6, 9, 18, 30, 48 and 72 months. Results: From 1997–2000, 436/3854 patients in the ABC trial were recruited to the QL study (247 in +/-CT comparison, 199 in +/-OS comparison), median age 49 (range 28–79). Compliance with QL forms was high; 99.8% at baseline ranging to 86.3% at 30 months. The addition of CT was associated with worse QL during the first 9 months for depression (p=0.007), role function (p=0.003) and global QL (p=0.001) and a trend to worse QL for body image concerns (p=0.02), and sexual enjoyment (p=0.08). Systemic side effects (p=0.001) and menopausal problems (p=0.02) were worse over 30 months. The addition of OS resulted in increased menopausal symptoms (p<0.0001), depression (p=0.05) and anxiety (p=0.04) over 30 months but no deterioration in role function, global QL, body image or sexual function. Conclusions: Adverse QL counters the potential benefits of additional CT; therefore treatment choice should consider possible health gains and QL losses. The negative QL effect of OS is paralleled by a lack of clinical benefit in the ABC trial. No significant financial relationships to disclose.
Cardiopulmonary Resuscitation and Benefit to Patients With Metastatic Cancer
Authors: Benoit Champigneulle, Alain Cariou, François Vincent
Journal: JAMA Internal Medicine (2016)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
A phase II study of oxaliplatin and capecitabine (XELOX) in patients with unresectable cholangiocarcinoma, including carcinoma of the gallbladder and biliary tract
Authors: K. Y. Glover, M. B. Thomas, T. D. Brown, P. M. Hoff, M. Iwasaki, J. L. Abbruzzese
Journal: Journal of Clinical Oncology (2005)

4123 Background: Malignancies of the gallbladder and biliary tract are uncommon in the United States, but are common in certain Japanese, Chilean, and Native American populations. Most patients present with advanced disease and are not candidates for potentially curative resection. Response rates range from 10–20% for patients receiving palliative chemotherapy, indicating the need for new therapeutic regimens. Patients and Methods: We prospectively studied capecitabine (Xeloda) 750mg/m2 twice daily on days 1–14 in combination with oxaliplatin 130mg/m2 on day 1 every 21 days in patients (pts) with unresectable or recurrent cholangiocarcinoma, to determine the response rate (RR), safety, and survival of pts treated with XELOX. Twenty-six pts were enrolled; 8 men and 18 women with a median age of 63(range 46–77). Pathologically 96% were adenocarcinoma and 4% were squamous carcinoma. Pts were stratified into 2 arms according to prior chemotherapy (8 pts) versus no prior chemotherapy (18 pts). Results: Twenty-one pts were evaluable for response and 26 pts were evaluable for toxicity. The overall RR was 19% (4/21). RR with and without prior therapy were 0%(0/6) and 26.6%(4/15), respectively. Following 3 courses of therapy 38% had stable disease and 43% had disease progression. Grade 1 neurotoxicity, diarrhea, anorexia, and nausea, were common. Grade 3 fatigue and diarrhea occurred in 23% and 8% of the pts respectively. Following treatment of 12 pts the starting dose of oxaliplatin was reduced to 100mg/m2 after prolonged myelosuppression, fatigue, and decreased PS were observed at the 130mg/m2 dose. Conclusions: With careful attention to dose XELOX is well tolerated. A RR of 26.6% in previously untreated pts is encouraging. XELOX should be considered an active regimen in the treatment of unresectable gallbladder cancer and cholangiocarcinoma. Accrual will continue to 50 pts and survival data analyzed. The toxicity profile is similar to that seen in other malignancies. No significant financial relationships to disclose.
Differential impact of anti-diabetic treatments on pancreatic cancer cell growth in cell culture conditions mimicking different stages in the natural history of diabetes mellitus type
Authors: Y. Feng, N. Busaidy, M. Lee, S. Yeung
Journal: Journal of Clinical Oncology (2008)

4640 Background: Diabetes mellitus type 2 (DM2) is well-known to be associated with increased risk as well as adverse outcome of pancreatic cancer. Only limited studies focused on translating this knowledge into potential clinical interventions that could modify the risk or outcome of diabetic pancreatic cancer patients. Methods: We investigated the impact of two interacting factors that changes at various stages of the DM2 disease process (hyperglycemia and hyperinsulinemia) on the proliferation of pancreatic cancer cells and examined whether some anti-diabetic drugs, namely metformin, rosiglitazone and exenatide, have direct inhibitory effects on MiaPaCa2 cells in vitro. Results: Our data demonstrated that insulin promoted the proliferation of MiaPaCa2 pancreatic cancer cells, but the growth promoting effect of glucose was dependent on insulin and was observed only at high insulin concentrations. Both insulin and glucose contributed to the chemoresistance of pancreatic cancer cells to gemcitabine. Treatment with metformin or rosiglitazone suppressed MiaPaCa2 cell growth via inactivation of Akt pathway, leading to apoptosis. Metformin activated AMPK and rosiglitazone increased the protein level of PTEN. The inhibitory effects of these 2 drugs were observed regardless of the various combinations of glucose and insulin concentrations mimicking different stages in the natural history of DM2. Both metformin and rosiglitazone resulted in further inhibition of MiaPaCa2 cell growth and increase in apoptosis when combined with gemcitabine in all the combinations of glucose and insulin concentrations. Exenatide did not have any inhibitory effects on MiaPaCa2 cells. Conclusions: Our results showed that either culture conditions mimicking hyperinsulinemia and hyperglycemia stimulated pancreatic cancer cell proliferation and conferred chemoresistance to gemcitabine. Two antidiabetic drugs, metformin and rosiglitazone, had direct effects on MiaPaCa2 cells and added to the inhibitory effect of gemcitabine. These results have significant therapeutic implications in terms of the choice of pharmacotherapy for DM2 in the context of diabetic pancreatic cancer patients. No significant financial relationships to disclose.
Definitive discrimination of cancer recurrence/metastasis versus de novo cancer formation
Authors: P. A. Finkelstein, S. D. Finkelstein, A. Radfar, M. M. Wilson, V. G. Vogel
Journal: Journal of Clinical Oncology (2005)

9504 Background: Distinguishing recurrent cancer from independent formation of a new cancer can be problematic. Similarly discriminating multicentric de novo cancer from intraorgan spread of malignancy can be difficult using staining techniques. Major treatment decisions may depend upon the certainty of this differentiation. To provide definitive, objective discrimination, we developed an integrated molecular pathology approach using tissue microdissection and genotyping of fixative treated tissues including biopsy specimens. Methods: 278 problematic cases involving new primary vs recurrence/metastasis were collected over a four year period. Adenocarcinoma (n=211, 76%) squamous cell carcinoma (n=47, 17%) were the most common shared histologies. When available, a minimum of 2 microdissection targets were obtained from each tumor using standard 4 um recut sections. The mutational profile for each neoplasm and time course of mutation acquisition was determined using PCR and quantitative genotyping for a broad panel of LOH markers targeting 1p,3p,5q,9p,10q,17p,17q,21q,22q and k-ras-2 sequencing when suitable (colon, lung). Extent of concordant mutational markers, specific alleles affected and time course of mutation acquisition was correlated, with clinical, pathologic and outcome features when available to validate relatedness determination. Results: 159 paired tumors of this series showed concordance which ranged from 74% to 100% supporting recurrence/metastasis. In 43 of these cases where independent means existed to determine relatedness, all cases proved to be recurrence/metastasis (100% accuracy). In the remaining 119 patients, concordance ranged from 0–27% supporting de novo cancer formation. In 28 verifiable cases, this proved to be correct (100%). Time course determination provided additional discrimination especially when total acquired mutation load was low. Conclusions: Discrimination between cancer recurrence/metastasis versus new primary cancer formation can be objectively and definitively accomplished by comparative mutational profiling if microscopic analysis and special stains cannot provide adequate certainty. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration RedPath Integrated Pathology RedPath Integrated Pathology RedPath Integrated Pathology