tbuckley/cabot-search huggingface dataset:
Endarterectomy, Stenting, or Neither for Asymptomatic Carotid-Artery Stenosis
Authors: J. David Spence, A. Ross Naylor
Journal: New England Journal of Medicine (2016)

Important data from two large, randomized trials comparing early and late outcomes after carotid endarterectomy and carotid-artery stenting have now been published in the Journal.1,2 In common with every other large, multicenter, randomized trial to date, the Asymptomatic Carotid Trial (ACT I) and the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) showed that after the perioperative period, there was no difference in the rate of late ipsilateral stroke after endarterectomy or stenting. In ACT I, which included asymptomatic patients who were deemed to be at average risk, the 5-year rate of ipsilateral stroke (excluding the perioperative period) was . . .
Treatment of rectal carcinoid tumors and role of preoperative imaging.
Authors: T. Akasu, K. Sato, S. Yamamoto, T. Matsuda, Y. Saito
Journal: Journal of Clinical Oncology (2010)

3655 Background: To clarify the optimal management of rectal carcinoid tumors and role of preoperative imaging, retrospective analyses of prospectively accumulated data on treatment results and preoperative imaging were performed. Methods: Prospectively recorded clinicopathologic and imaging data of the 185 consecutive patients with rectal carcinoid tumors undergoing curative intent surgery between 1970 and 2006 were retrospectively analyzed. The recent 37 patients were examined preoperatively by transrectal ultrasonography (TRUS) or high-resolution magnetic resonance imaging (HRMRI). Results: There were 109 men and 76 women with a median age of 57 (range, 24-85) years. The patients were grouped according to tumor size: Group I, < 9 mm; Group II, 9-14 mm; Group III, > 14 mm. The clinicopathologic characteristics and treatment results are shown in the Table. Of the 37 patients examined by TRUS or HRMRI, 9 had invasion of the muscularis propria and 11 had regional lymph node metastasis. Sensitivity and specificity for detection of invasion of the muscularis propria were 100% and 100%, respectively. Sensitivity and specificity for detection of regional lymph node metastasis were 70% and 100%, respectively. Conclusions: Patients with carcinoid tumors measuring less than 9 mm can be treated with ER or LE alone; however, patients with tumors measuring 9 mm or larger should be first examined with TRUS or HRMRI and should be treated with ER or LE or RS according to the TRUS or HRMRI findings. Group No Invasion depth Metastasis Type of surgery 5-yr survival pT1 pT2-3 pN1-2 Liver ER LE RS HR I 120 120 0 0 0 91 20 9 0 100% II 49 44 5 11 1 21 16 12 1 96% III 16 8 8 5 5 3 6 7 5 66% Abbreviations: ER, endoscopic resection; LE, local excision; RS, radical surgery; HR, hepatic resection. No significant financial relationships to disclose.
Phase II study of bevacizumab with docetaxel and radiation in locally advanced head and neck squamous cell cancer
Authors: P. Savvides, J. Greskovich, J. A. Bokar, A. Narayan, W. van Heeckeren, D. W. Stepnick, M. Schuchter, J. Wasman, R. Rezaee, P. Lavertu
Journal: Journal of Clinical Oncology (2008)

6071 Background: Vascular endothelial growth factor (VEGF) expression has been shown to be up regulated in squamous cell carcinoma of the head and neck (SCCHN), representing a promising therapeutic target. Bevacizumab is an anti-VEGF monoclonal antibody that may potentiate the efficacy of concurrent radiation and docetaxel. This trial represents the first attempt, to establish the efficacy and toxicities of the addition of bevacizumab to concurrent radiation with docetaxel in patients with locally advanced SCCHN. Methods: Patients with previously untreated stage III-IVB SCCHN receive standard once-daily radiation (70.2Gy, 1.8Gy/day), weekly docetaxel (20 mg/m2/week for the duration of radiation) and biweekly bevacizumab (5 mg/kg/two weeks) during and for up to one year following radiation. A total of 30 patients will be enrolled in this study. Results: A total of 23 patients (20 males, 3 females), mean age 56.3 years (range 48–73), all with stage IV disease have been enrolled. Primary site: pharynx (n=17) and larynx (n=6). 21 patients have completed concurrent chemoradiation. After a median followup of 9 months (range: 3 - 23), 17 patients remain in complete response, 4 patients developed recurrent (n=1), metastatic (n=2) or recurrent and metastatic disease (n=1) and two of them died. The estimated one-year survival is 89% (95% CI, 64 to 97%). The estimated one-year progression-free survival is 78% (95% CI, 50 to 91%). 8/21 patients underwent planned neck dissection and they all had a pathologic complete response. 4/17 patients are currently receiving adjuvant bevacizumab. 8 patients required hospitalization during concurrent or adjuvant treatment (non-neutropenic infection [n=3], pneumonitis/pulmonary infiltrates [n=3], dehydration [n=1], wound infection [n=1]). No unexpected toxicities were encountered during chemoradiation. No episodes of severe bleeding were noted. No healing complications observed after planned neck dissections. Conclusions: For patients with locally advanced SCCHN, updated results suggest that the addition of bevacizumab to concurrent radiation with docetaxel is feasible, safe and active. Supported in part by Genentech, NIH grants CA62502 and M01 RR-000080 Clinicaltrials.gov identifier: NCT00281840 Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration sanofi-aventis sanofi-aventis Genentech™ BioOncology, sanofi-aventis
Implementing values-based advance care planning (ACP) in a community oncology network.
Authors: Cynthia Taniguchi, Marcus A. Neubauer
Journal: Journal of Clinical Oncology (2014)

105 Background: Oncologists often embrace the concept of having discussions with patients regarding end-of-life care. Still, challenges remain with initiating these discussions early in the metastatic setting so that the full ACP process can be satisfied. A framework and infrastructure are needed to systematically initiate and promote the ACP process at a time when metastatic disease is identified and patients are better able to make thoughtful decisions regarding their future care. Methodology is needed for documenting and updating the ACP process within the patient’s health record. Methods: During a 15 month period, 32 independent sites of service within a nationwide community oncology network implemented an electronic health record (EHR)-based program for initiating ACP conversations with patients having a metastatic cancer diagnosis. Patients were identified for program engagement based on clinical criteria populated within the EHR. Identified patients received a brief introduction to ACP by the physician or other clinician and were encouraged to meet with a trained ACP Counselor to engage the full process. ACP Counselors provided guidance to the patient to discover and share personal values and goals for care. Values for care were documented within the EHR. Counselors provided appropriate patient education regarding code status and state-specific advance directives. At end-of-life, practices included hospice and death details within the EHR. Results: For metastatic patients (n = 29,389), ACP counseling was provided for 1,034 individuals (4%). Code status was visible in 3648 health records (12%) and patient values were included for 376 patients (1%). 2,206 patients (8%) transitioned to hospice care during the 14-month period. EHR-based infrastructure allowed for ongoing ACP visibility by the healthcare team. Conclusions: Use of an EHR-based ACP process demonstrates promising outcomes for realizing meaningful delivery of ACP. Essential components are patient identification early in the metastatic trajectory, assessment of patient values for care, thorough patient education regarding code status and advance directive documents, and full visibility of the ACP process within the health record.
A population based study of the incidence, clinical course and prognostification of GIST in Scotland in the pre-imatinib era (1995–1999)
Authors: J. S. Graham, G. Dunbar, S. Walsh, C. Dick, J. D. White
Journal: Journal of Clinical Oncology (2007)

10050 Background: GIST's are rare tumours characterised by C-KIT and or CD34 positivity. Population based studies have been performed in countries including Iceland, Spain, Sweden and Holland but this is the first in the United Kingdom. Methods: Pathology records from the entire country were screened for actual or potential GIST cases and the tissues stained with CD117 for C-KIT to confirm a genuine diagnosis of GIST. The primary endpoint was to calculate the incidence of GIST in Scotland from 1995–1999. Secondary endpoints included information re stage, site, survival, sex, age and geographical distribution, and to validate the NIH (National Institute for Health) prognostic index currently used. To date 132 patients have been confirmed with GIST who were previously diagnosed as having either GIST or another similar malignancy. We await final information from 1 region. Results: Primary Endpoint. The incidence of GIST in Scotland from 1995–1999 was 5.2/million/year. Secondary endpoints. Median age at time of diagnosis was 69 with a similar male to female ratio. Original tumour site was 55.8% gastric, 38 % small bowel, 2.3 % colorectal; other sites were &lt; 1 % each. 50.4% were originally diagnosed as GIST's. Other diagnosis included leiomyoma (21.7%) and leiomyosarcoma (14%). All others were &lt;5% each. According to the prognostic index 10.9% were very low risk, 26.4% low risk, 23.3% intermediate, 30.2% high risk Conclusions: Although C- KIT staining was not standard practice during the study period a high percentage of patients were correctly diagnosed originally. Despite a study designed to maximise case ascertainment we report an incidence of GIST in Scotland lower than that of other studies (11 to 14.5 million/ year). This discrepancy may be due to differing study designs and/or failures in the original pathology coding; fundamental in our methodology. Ongoing work to assess the importance of original tumour site, size, prognostic index, etc is underway and this data will be available prior to the 2007 Annual Meeting. No significant financial relationships to disclose.
AT1 receptor antagonism before ischemia prevents the transition of acute kidney injury to chronic kidney disease
Authors: Roxana Rodríguez-Romo, Kenia Benítez, Jonatan Barrera-Chimal, Rosalba Pérez-Villalva, Arturo Gómez, Diana Aguilar-León, Jesús F. Rangel-Santiago, Sara Huerta, Gerardo Gamba, Norma Uribe, Norma A. Bobadilla
Journal: Kidney International (2015)
Effect of TKI258 on plasma biomarkers and pharmcokinetics in patients with advanced melanoma
Authors: M. Shi, K. B. Kim, J. Chesney, X. Wang, M. Motwani, J. Wang, M. Steed, O. Anak, G. Jones, J. Saro, J. Kirkwood
Journal: Journal of Clinical Oncology (2009)

9020 Background: TKI258 (dovitinib lactate), is a multi-tyrosine kinase inhibitor of VEGF receptors-1,2,3, FGF receptors-1, 2, 3, PDGFR-β, and c-KIT. A phase I study was conducted to determine the maximum tolerated dose (MTD), the biological activity and the preliminary efficacy of TKI258 in patients with advanced melanoma. A panel of plasma biomarkers of angiogenesis and soluble receptors were evaluated to determine the pharmacodynamic effect of TKI258. Methods: Patients were treated orally with 200, 300, 400 or 500 mg/day on a once daily continuous dose schedule. The MTD was defined at 400 mg/day. Plasma samples from 43 patients were collected. Plasma concentration of TKI258 was measured by LC/MS/MS. Plasma VEGF, placental growth factor (PLGF), basic FGF (bFGF), and soluble VEGFR1 and VEGFR2 (sVEGFR1 and 2), and c-Kit were measured by multiplex assays using the Meso-Scale Discovery platform. Plasma FGF23 was evaluated by ELISA as a pharmcodynamic marker of FGFR1 inhibition. Results: Following 400 mg or 500 mg continuous daily dosing, the mean plasma exposure (AUC24hr) was approximately 3000 ng/mL*h and 4100 ng/mL*h, respectively. No accumulation in TKI258 plasma exposure was observed at doses of 400mg or below, while accumulation up to 2.5-fold was observed on day 15 following the 500 mg daily dose. At the end of the first treatment cycle, mean plasma VEGF, PLGF and FGF23 levels increased over baseline by 100%, 198% and 68%, respectively, while mean plasma sVEGFR2 levels decreased by 15% in patients treated with 400 and 500 mg/day TKI258. Further analysis of correlations with pharmacokinetic and clinical parameters is ongoing. Conclusions: TKI258 therapy is associated with increases of plasma VEGF and PLGF as well as decreases of sVEGFR2 suggesting VEGFR inhibition. Induction of plasma FGF23 suggest that FGFR may be inhibited at doses of 400 mg/day and above. This panel of circulating proteins may have utility as pharmacodynamic biomarkers of TKI258 activity in patients with advanced melanoma. [Table: see text]
Clinical presentation of relapse in a cohort of patients (pts) with complete response to initial treatment of advanced epithelial ovarian cancer (EOC)
Authors: J. W. Orr, P. T. Taylor, J. S. Berek, I. A. Dark, C. F. Nicodemus
Journal: Journal of Clinical Oncology (2005)

5048 Background: Most pts with advanced EOC experience complete response following initial surgery and platinum/taxane based chemotherapy; however, disease recurrence is common. Subsequent interventions are typically palliative. An optimal postreatment surveillance strategy to has not been established. This report evaluates the relapse patterns in a cohort of pts recently participating in a randomized phase II consolidation trial with oregovomab vs placebo [Berek JCO 22:3507]. Methods: Clinical outcomes for a cohort of 145 pts with stage III/IV EOC were assessed for the role of physical examination, CT scan and CA125 in the diagnosis of relapse. Results: 98 of 145 pts (68%) experienced clinical relapse during the observation period. Relapse was identified by physical exam in only 19% of cases (17 pelvic findings, 2 non-pelvic) and by CT in absence of physical findings in 75%. 2 pts were diagnosed on a second look laporatomy and one patient on incidental surgery. CA125, which was not used for diagnosis of relapse in the clinical trial, was in the normal range at relapse in 34 pts (35%), although all had originally presented with CA125 elevation. CA125 values were reduced or unchanged for 5% of pts, while 30% experienced at least a doubling of CA125 in the three month interval preceding relapse. 84% of pts with abnormal physical findings had elevated CA125. Of those without elevated CA125, recurrence was diagnosed on CT scan in 32 pts (91%). Conclusions: The clinical presentation of relapse in EOC is diverse, and reliance on any single diagnostic modality is unreliable. Pelvic findings were commonly accompanied by elevation of CA125, whereas occult perihepatic and retroperitoneal metastases were more commonly associated with normal CA125. Optimal posttreatment patient surveillance involve careful use of multiple modalities. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Unither
Angiopoietin-like protein 2 increases renal fibrosis by accelerating transforming growth factor-β signaling in chronic kidney disease
Authors: Jun Morinaga, Tsuyoshi Kadomatsu, Keishi Miyata, Motoyoshi Endo, Kazutoyo Terada, Zhe Tian, Taichi Sugizaki, Hiroki Tanigawa, Jiabin Zhao, Shunshun Zhu, Michio Sato, Kimi Araki, Ken-ichi Iyama, Kengo Tomita, Masashi Mukoyama, Kimio Tomita, Kenichiro Kitamura, Yuichi Oike
Journal: Kidney International (2016)
Venous thromboembolism: What pharmacists know? What do they need?
Authors: Jean-Baptiste Rey, Pierre Kreit, Jerome Sicard, Damien Parent, Nicolas Jovenin, Dominique Hettler, Philippe Nguyen, Jean-Luc Ducrocq
Journal: Journal of Clinical Oncology (2014)

212 Background: Venous thromboembolism is frequent in cancer. Low molecular weight heparins (LMWH) are recommended for prevention/treatment of thrombosis in cancer. Community pharmacists are very often faced with patients' questions (dosage, tolerance, treatment duration). The aim of this study was to assess the community pharmacists' knowledge regarding 'thrombosis in cancer'. Methods: A web-questionnaire (built by a multidisciplinary group) was open between October and November 2013 to community pharmacists in Champagne-Ardenne region. Collected data were 1) pharmacy's general organization for cancer patients' management, 2) management of ambulatory patients with 'thrombosis and cancer' and 3) pharmacists' knowledge assessment through a simple case report: after an initial 10-days hospital prescription, what should a patient receive as anticoagulant treatment? Results: 180 (38%) community pharmacists answered the questionnaire. Among those, in 65%, the number of patients with cancer was 6-15/pharmacy. In 70% the number of patients with thrombosis and cancer was 1-10/pharmacy. In 93%, the pharmacists had no specific competency in oncology and/or supportive care. Moreover, 96% were not aware of the existence of national/international recommendations regarding 'thrombosis in cancer'. At last, only 49% gave the correct answer to the case report (LMWH). The most expressed needs were information, continuous education, and information booklets for patients. Conclusions: This regional questionnaire is currently extended to all French regions. Continuous education sessions are being put in place. Another questionnaire will be launched at the end of 2014 to assess education sessions' efficacy.
Abstract 4410: Spatial Distribution of Tissue Components in the Left Anterior Descending Coronary Arteries Detected by Optical Coherence Tomography Color-coded Maps
Authors: Yoshiyuki Ishihara, Masanori Kawasaki, Tomoki Kubota, Takahiko Yamaki, Arihiro Hattori, Takuma Aoyama, Kazuhiko NIshigaki, Genzo Takemura, Shinya Minatoguchi
Journal: Circulation (2009)

Background:  It has been reported that thin-cap fibroatheroma (TCFA) clustered in the proximal sites of left ascending (LAD) and left circumflex coronary arteries. However, special distribution of each tissue component has not been elucidated well.   Methods:  Forty coronary atherosclerotic lesions in 15 LAD of 15 patients with stable angina were visualized by optical coherence tomography (OCT, Light Lab). Tissue characteristics and thickness of each tissue component were measured and color-coded maps were reconstructed.   Results:  The arc of the TCFA were negatively correlated with the distance from the branch within 5mm distal (r= −0.71, p=0.004) and proximal (r= −0.72, p=0.004) from the diagonal branch, and 5mm proximal from the septal branch (r= −0.62, p=0.02). Thickened fibrosis that run parallel to the arteries were seen in 10 LAD (10/15). Calcifications clustered around lipid pools. In cross-sectional analysis within 3mm distal and proximal from the septal branch, the maximum lipid areas were observed between 50 degrees and 70 degrees from the septal branch and the lipid areas were minimum in the opposite side of the septal branch (86%: 18/21), whereas the maximum lipid areas were observed in the opposite side of the diagonal branch and the lipid areas were minimum in the same side of the diagonal branch (75%: 18/24).   Conclusion:  This is the first clinical demonstration of the special distribution of each tissue component by color-coded maps. The color-coded map of OCT is a promising method for the longitudinal evaluation of tissue characterization of coronary plaques and provides us with a new insight into spread of atherosclerotic lesions in coronary arteries.
Targeting hyaluronan for the treatment of pancreatic ductal adenocarcinoma
Authors: Norihiro Sato, Xiao-Bo Cheng, Shiro Kohi, Atsuhiro Koga, Keiji Hirata
Journal: Acta Pharmaceutica Sinica B (2016)

Progression of cancer is often associated with interactions between cancer cells and extracellular matrix (ECM) surrounding them. Increasing evidence has suggested that accumulation of hyaluronan (HA), a major component of ECM, provides a favorable microenvironment for cancer progression. Pancreatic ductal adenocarcinoma (PDAC) is characterized typically by a dense desmoplastic stroma with a large amount of HA, making this molecule as an attractive target for therapy. Several studies have shown efficacy of inhibitors of HA synthesis or signaling for the treatment of PDAC. Recent studies have also demonstrated substantial improvements in the effects of chemotherapy by a targeted depletion of stromal HA in PDAC using an enzymatic agent. Thus, targeting HA has been recognized as a promising therapeutic strategy to treat this highly aggressive neoplasm. In this review article, we summarize our current understanding of the role of HA in the progression of PDAC and discuss possible therapeutic approaches targeting HA.
Prevalence and correlates of fatigue among patients at a comprehensive cancer center
Authors: A. A. Bharne, K. A. Shimabukuro, P. H. Vu, M. M. White, P. J. Mills, W. A. Bardwell, K. Messer, L. Bazhenova
Journal: Journal of Clinical Oncology (2009)

9608 Background: Cancer-related fatigue is a widely reported distressing symptom. We examined patterns and clinical correlates of fatigue among a series of patients with and without cancer at Moores UCSD Comprehensive Cancer Center (MCCC). Methods: All patients who come for initial consultation to MCCC complete a 39-question screen assessing problems including fatigue, sleep, and mood disturbance on a 5-point scale (0 = not a problem, 1 = mild, 2 = moderate, 3 = severe, 4 = very severe). We report prevalence of fatigue from 1,880 consecutive patients; the charts of 515 of these were reviewed for further data. Results: Overall 1,137 of 1,880 (61%) patients reported problems with fatigue. Of the 515, there were 321 cancer and 194 non-cancer patients. 40 patients not responding to the fatigue question were excluded. There was no significant difference in the proportion of cancer (189 of 296; 64%) and non-cancer patients (104 of 179; 58%) reporting fatigue. Prevalence was similar between genders. 126 of 208 (61%) chemotherapy-naïve cancer patients reported fatigue compared to 63 of 88 (72%) patients who received any chemotherapy (p=0.07). In comparison to the chemotherapy-naïve, 37 of 48 (77%) with ongoing or recent (&lt; 6 mo) chemotherapy reported fatigue as a problem (p=0.03); but among patients who underwent chemotherapy &gt; 6 mo prior to the questionnaire, fatigue was not significantly different (26 of 40; 65%). 51 of 189 (27%) cancer patients married or living with a partner reported moderate to severe fatigue compared to 39 of 104 (38%) with no partner (p=0.06). Among cancer patients without sleep or mood problems, 19 of 71 (27%) reported fatigue as a problem compared to 166 of 221 (75%) with sleep and/or mood problems (p &lt; 0.001). Conclusions: Fatigue is prevalent among cancer and non-cancer patients. Although more cancer patients with ongoing/recent chemotherapy reported fatigue compared to the chemotherapy-naïve, after 6 mo there was no significant difference, suggesting that fatigue may only be partly explained by chemotherapy. Social support from a spouse/partner may also help reduce problems with fatigue. Sleep and mood disturbance are associated with fatigue, but many cancer patients reported fatigue in its absence, consistent with previous data and suggestive of other etiologies. No significant financial relationships to disclose.