tbuckley/cabot-search huggingface dataset:
Trends in transfusion incidence among cancer patients receiving chemotherapy (2005-2008).
Authors: H. J. Henk, Z. Cong, S. DaCosta Byfield, R. J. Nordyke
Journal: Journal of Clinical Oncology (2010)

e19506 Background: Erythropoiesis-stimulating agents (ESAs) are indicated for anemia due to concomitantly administered chemotherapy to reduce the incidence of red blood cell transfusions. Since 2007, ESA use has been increasingly restricted in product labels, reimbursement, and practice guidelines. We described transfusion incidence from 2005 to 2008 to assess the impact of recent ESA restrictions. Methods: This was a retrospective analysis of the INGENIX database. Episodes of chemotherapy care in cancer patients (EOCCs) from 2005 to Q3 2008 were identified by a gap in chemotherapy of ≥90 days. Proportion of EOCCs with ESAs and transfusions were reported. Due to varying EOCCs durations, we also present transfusion incidence per 100 person-months after adjusting for time at risk. Main analyses included EOCCs with ESAs starting in 2005-2007. Sensitivity analysis included EOCCs with ESAs censored at Q3 of EOCC start year in 2005-2008. Log rank trend tests for ordered groups were conducted for both analyses. Results: From 2005 to 2008, 52,194 EOCCs among 45,974 patients were observed. The proportion of EOCCs with ESAs decreased but the proportion with transfusions increased. Due to data truncation and practice pattern changes, observed average EOCC duration decreased in main analyses. Transfusion incidence per 100 person-months in EOCCs with ESAs increased significantly in both analyses (Table). Conclusions: We found that transfusion incidence among commercially insured cancer patients receiving chemotherapy and ESA increased significantly since recent restrictions on ESA use. As a number of factors could affect calculated transfusion incidence, methods adjusting for EOCC duration may better reflect the impact of practice changes. Transfusion incidence in EOCCs with ESA use EOCCs with ESA EOCCs with ESA censored at Q3 With transfusions With transfusions Year n (%) EOCC Mean (SD) EOCC duration (day) %EOCC Per 100 person-months n (%)EOCC Mean (SD) EOCC duration (day) % EOCC Per 100person-months 2005 7,102 (46) 289 (218) 11 1.2 4,988 (40) 144 (73) 9 1.9 2006 6,411 (45) 308 (185) 11 1.1 3,911 (39) 127 (72) 8 1.8 2007 5,434 (37) 283 (120) 13 1.6 3,481 (32) 139 (70) 10 1.9 2008 2,209 (25) 179 (48) 18 3.3 p value <0.01 <0.01 <0.01 <0.01 Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen Amgen I3 Innovus
Phase I/II study of sequential-intermittent docetaxel (D) and imatinib (Im) in hormone refractory prostate cancer (HRPC) (NYU 04–47)
Authors: F. Lan, H. Ballard, A. Chen, A. Chachoua, S. Taneja, A. Ferrari
Journal: Journal of Clinical Oncology (2007)

15613 Background: Platelet-derived growth factor (PDGF) is frequently expressed in advanced prostate cancer (PC) lesions where it supports PC cell growth and neo-angiogenesis. Im. is a PDGF inhibitor that blocks cell cycle progression in G1-S through inhibition of erk1–2 kinase. D. blocks cell cycle progression in G2-M. Anti-tumor responses can increase when the block to cell cycle progression in G2M precede the blocks in G1-S. This study was designed to determine tolerablity and activity of sequential D followed by Im in HRPC patients (pts). Methods: Eligibility: 2 prior hormone manipulations, any prior chemotherapy, PSA= 5 ng/ml, ECOG PS 0–2. Treatment schema: D IV day 1 followed in 24–36 hours by Im PO daily x 14 days, every 21 days until toxicity or progression. Cohorts (C) planned were: #1, D. 60 mg/m2, Im. 400 mg; #2, D 70mg/m2, Im 400 mg; #3, D 70mg/m2, Im 600 mg. Results: 12 pts enrolled: 6 in C#1, 3 each in C#2,3. Median age,73 (range: 61 to 85). Median number cycles (Cy) 3 (range: 2 to 10). Toxicity grade (TG)1–2 observed in 9 (75%) pts (6, 2, 1 in C#1, 2,3 respectively): anemia 9, neutropenia 1, lymphopenia 6, thrombocytopenia 3, hyperglycemia 8, hyponatremia 2, abnormal bicarbonate 7, hypoalbuminemia 3, fatigue 5, neuropathy 3, nausea/vomiting 3, constipation 2, pain 2, fever 2, increased creatinine 2. TG3: afebrile neutropenia, 4 pts. Cy1. TG 4: febrile neutropenia,1 pt C#1,Cy1; GI bleed/intestinal perforation, 1 pt C#3, Cy7. PSA decline =50%: 1 pt C#2; 2 pts C#3. Conclusions: sequential and intermittent dosing of D and Im was well tolerated with high doses of both drugs. The most common toxicity was neutropenia which was prevented with growth factors. The MTD was not reached. PSA responses occurred at the higher doses. An ongoing phase II study of sequential D. 70mg/m2 and Im. 600 mg x 14 days will define activity. No significant financial relationships to disclose.
Differences in uptake of postoperative adjuvant chemotherapy for lung cancer: Results from the Project for an Ontario Women's Health Evidence-Based Report Card (POWER) study
Authors: L. C. Barbera, M. Krzyzanowska, L. Elit, R. Saskin, A. Bierman
Journal: Journal of Clinical Oncology (2009)

6556 Background: The goal of the POWER study is to improve health and reduce inequities among women of Ontario using performance measurement. Indicators are selected to facilitate assessment of care by sex and neighbourhood income. Results pertaining to the uptake of postoperative adjuvant chemotherapy for non-small cell lung cancer (NSCLC) are presented. Methods: An expert panel process was used to identify performance measures feasible to be evaluated from administrative data. Recent evidence suggests that adjuvant chemotherapy after resection of NSCLC is associated with improved survival. This measure was selected the by the expert panel. Data from Ontario Cancer Registry, Registered Persons Database as well as provincial billing and hospital databases was used to evaluate this measure stratified by age, sex, income and region. All adult patients who underwent resection of NSCLC between April 2003 and May 2004 were included in the cohort. Claims indicating chemotherapy administration within 6 months of surgery were considered adjuvant chemotherapy. Results: Overall in Ontario, the use of postoperative chemotherapy in NSCLC was 17.6% (95% CI 15.3%-20.2%) in April 2003 increasing to 32.9% (95%CI 29.8%-36.3%) in May 2004. In May 2004. use of chemotherapy decreased with increasing age: 47% of patients &lt;65 years received chemotherapy versus 27% of patients aged 65–79. There was significant variation by region: in those under 65 years the rate of chemotherapy use among 14 regions ranged between 24–70 percent; in those 65–79 years it ranged between 18–35 percent. There was no difference in chemotherapy use between men or women or by neighbourhood income quintile. Conclusions: Rates of chemotherapy use almost doubled from April 2003 to May 2004, suggesting uptake of the new evidence in the treating community. Age and region-related, rather than sex or income, differences exist in the uptake of this new evidence. Further work is necessary to determine how these differences in uptake affect outcomes. No significant financial relationships to disclose.
D-thyroxine reduces lipoprotein(a) serum concentration in dialysis patients.
Authors: C Bommer, E Werle, I Walter-Sack, C Keller, F Gehlen, C Wanner, M Nauck, W März, H Wieland, J Bommer
Journal: Journal of the American Society of Nephrology (1998)

Uremia raises lipoprotein(a) (Lp(a)) serum concentration and the risk of arteriosclerosis in dialysis patients. The treatment of high Lp(a) levels is not satisfactory today. The decrease of Lp(a) in hypothyroid patients on L-T4 therapy raised the question of whether dextro-thyroxine (D-thyroxine) reduces not only serum cholesterol, but also Lp(a) serum concentration. In a single-blind placebo-controlled study, the influence of D-thyroxine therapy on Lp(a) serum concentration was evaluated in 30 hemodialysis patients with elevated Lp(a) serum levels. Lp(a) was quantified in parallel by two methods, i.e., rocket immunoelectrophoresis and nephelometry, and apo(a) isoforms were determined by a sensitive immunoblotting technique. Regardless of the apo(a) isoforms, 6 mg/d D-thyroxine reduced elevated Lp(a) levels significantly by 27 +/- 13% in 20 dialysis patients (P < 0.001) compared with 10 control subjects (-9.9 +/- 8.4%). In parallel, D-thyroxine therapy significantly lowered total cholesterol (P < 0.001), LDL cholesterol (P < 0.001), and LDL cholesterol/HDL cholesterol ratio (P < 0.01); raised T4 and T3 serum levels; and suppressed thyroid-stimulating hormone secretion without causing clinical symptoms of hyperthyroidism in any of the patients. D-Thyroxine reduces elevated serum Lp(a) concentration in dialysis patients. The effect in nondialysis patients can be expected but remains to be proven.
Association between inflammatory markers and prognosis in resected pancreatic cancer (PC).
Authors: Maria Carmen Riesco Martinez, Cristina Pernaut Sanchez, Jorge Adeva Alfonso, Carlos Gomez-Martin, Laura Lema, Robles Diaz Luis, Lucia Parrilla Rubio, Maria Blazquez Arroyo, Antonio Merida Garcia, Jose A. Lopez-Martin
Journal: Journal of Clinical Oncology (2015)

250 Background: Inflammatory markers like the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) or fibrinogen (F) and nutritional markers like albumin (alb) have a prognostic value in different types of cancer. However, the paucity of data in pancreatic cancer (PC) keeps their role in this setting unclear. We aimed to determine whether NLR, PLR, F and alb may be prognostic factors in resectable PC. Methods: Demographic, histologic and serologic characteristics (pre and postoperative blood counts) of 77 consecutive PC patients (pts),who underwent curative surgery at our centre between January 2003 and December 2013,were retrospectively collected. We investigated the association of presurgical NLR, PLR, F and alb with overall survival (OS) and disease free survival (DFS) and analyzed the impact of their kinetics after surgery on the outcomes. Results: main pts characteristics are showed in Table. Median OS and DFS were 23 months (m), (95% CI 13.4-32.5) and 10 m (95% CI 7.4 - 12.6) respectively. Pts with NLR &lt; 5 had a significant improvement in OS compared to those with NLR &gt; 5 (29 m vs.16 m, log rank p &lt;0.05 ). F values &lt; 450 mg/dl were also associated with increased OS (30 vs. 16 m, log rank p=0.032). After adjusting by the Cox regression model, only NLR remained an independent prognostic factor for OS (HR, 1.6; p&lt;0.05). PLR (grouped in 3 cutoffs: &lt; 150, 150-300 and &gt;300) and alb (&lt;2, 2-3.5, &gt;3.5 mg/dl) were not associated with significant differences in outcomes. Pre and postoperative values were compared. No association was found between a drop on NLR to &lt;5 after surgery and OS or DFS. Conclusions: our results support that NLR could be a prognostic factor in PC pts undergoing surgery. Changes in NLR due to surgery do not seem to impact the outcome. PLR, F and alb did not correlate with prognosis. [Table: see text]
Phase I trial of pemetrexed, cetuximab, and concurrent radiotherapy (RT) in head and neck cancer (HNC)
Authors: M. K. Gibson, R. P. Smith, D. E. Heron, R. L. Ferris, S. Y. Lai, S. W. Kim, T. Boyer, J. T. Johnson, J. R. Grandis, A. E. Argiris
Journal: Journal of Clinical Oncology (2008)

2540 Background: Pemetrexed (P) is a multitargeted antifolate active in HNSCC that has radiosensitizing properties. Cetuximab (C) is an IgG1 monoclonal antibody directed against the epidermal growth factor receptor that increases survival when added to RT. This phase I study evaluates the dose-limiting toxicities (DLT) and maximum tolerated dose (MTD) of P combined with RT and C. Methods: Pts with high-risk HNC were treated in 2 cohorts: A: no prior RT; B: previously irradiated. A loading dose of C 400 mg/m2 was given 7 days prior to RT, followed by 250 mg/m2 weekly throughout RT given 2 Gy/day to 70 Gy (cohort A) or 60–66 Gy (cohort B). P was given on days 1 and 22 (and day 43 if >60 Gy given) as follows: starting level (0)-350 mg/m2, level (-1)-200 mg/m2, level (+1)-500 mg/m2. Accrual continued at the lower dose level while additional patients were entered at a higher dose level. Due to the unanticipated development of neutropenic fever, prophylactic antibiotics were added. Results: 31 pts (A:23; B:8) were accrued with these characteristics: median age 59 years (31–77); male/female 24/7; histology: squamous (24), thyroid (3), other (4). Two patients in cohort A were not evaluable for DLT and were replaced (1 transportation issues and 1 sudden death from aspiration). The MTD was reached: A (500 mg/m2); B (350 mg/m2). In cohort A, 2 DLTs (G 4 neutropenia with fever) occurred: 1/6 at level 0 and 1/6 at level -1. In cohort B, 2 DLTs occurred: 0/3 pts at level 0 and 2/3 pts at level +1 (one G 4 neutropenia with fever and one death from perforated duodenal ulcer and sepsis associated with G 4 thrombocytopenia and neutropenia). There were no G 4 nonhematologic toxicities. Other serious toxicities included febrile neutropenia with ANC >500 (n= 1), G 3/4 neutropenia (n=3/n=9), G 3 dysphagia (n=15), G 3 dermatitis (n=8), G 3 mucositis (n=18), G 3 fatigue (n=4), G 3 anemia (n=1). Conclusions: Addition of P to RT and C is feasible in pts with or without a history of prior RT. Neutropenia and in-field toxicities were predominant but manageable. Expansion of cohort B continues. P 500 mg/m2 is the recommended phase II dose combined with RT and C in non-previously irradiated patients. This regimen will be evaluated in a planned clinical trial. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Bristol-Myers Squibb, Genentech™ BioOncology, Lilly Oncology Bristol-Myers Squibb
A phase II study of weekly neoadjuvant chemotherapy followed by radical chemoradiation for locally advanced cervical cancer
Authors: M. McCormack, J. A. Ledermann, M. A. Hall-Craggs, R. P. Symonds, V. Warwick, H. Simonds, I. Fernando, A. Hackshaw
Journal: Journal of Clinical Oncology (2009)

5586 Background: Chemoradiation (CRT) is the standard of care for locally advanced cervical cancer but survival is poor among women with large tumours, advanced stage, or positive nodes. Neoadjuvant chemotherapy (NACT) prior to CRT to down-stage tumours and lengthen the exposure to systemic treatment is designed to improve outcome. Methods: Patients (pts) with locally advanced cervical cancer received dose-dense carboplatin (AUC2) and paclitaxel (80 mg/m 2 ) weekly, for 6 cycles, followed by CRT (external and brachytherapy) in week 7 with weekly cisplatin (40 mg/m 2 ). The primary end-point was complete and partial response rate (RR) 12 weeks post CRT. Secondary objectives were RR for NACT at 6 weeks, toxicity and survival. The target RRs were 50% and 85% for NACT and post CRT (12-weeks) respectively. Results: Baseline characteristics were: median age at diagnosis 43 yrs (23–71); 74% squamous-, 20% adeno- and 6% adenosquamous carcinomas; FIGO stage IB2 (11%), II (50%), III (33%), IV (6%). The trial closed in Oct 08 with 46 pts. Of the first 36 pts enrolled 9 failed to complete protocol therapy (7 did not complete 6 NACT cycles, 2 did not complete the pre-specified minimum of 4 cycles of concomitant cisplatin). Using data currently available, the RR associated with NACT is 72% (95% CI 53–86%), and 81% at 12 weeks (95% CI 63–92%). Nonhaematological grade 3/4 toxicity was rare (&lt;5%). There was grade 2 alopecia in 25% pts. Grade 3 and 4 haematological toxicity was seen in 10% and &lt;3% of pts respectively. Updated results, including survival, will be presented for all pts. Conclusions: Dose-dense weekly NACT chemotherapy with carboplatin and paclitaxel followed by radical CRT is associated with a high response rate and is feasible. This approach merits further investigation in a phase III trial. [Table: see text]
Passive Smoking, Potential Atopy and Asthma in the First Five Years
Authors: C R Kershaw
Journal: Journal of the Royal Society of Medicine (1987)

Evidence of prolonged exposure to cigarette smoke was sought in a group of 86 children aged five years and under with moderately severe asthma, and in 1199 infants from a mixed background population of Armed Service and civilian families. Asthmatics with a normal serum IgE (less than +1 s.d. for age) made up almost half of the cases and, compared with those with an elevated serum IgE (+1 s.d. for age or more), a greater proportion were male, had experienced prolonged exposure to cigarette smoke, were from Service families and already had fixed chest deformity. It is suggested that, in addition to facilitating the expression of asthma in young potential atopics, passive smoking may be an important contributory cause of the more severe disease reported in the socalled ‘intrinsic’ group. Perhaps the burden of illness and the extent of exposure noted in this survey will prompt renewed efforts to be made to discourage smoking in families, particularly two years before and for at least five years after the birth of a child.
Is a new needs assessment tool necessary for head and neck cancer patients?
Authors: T. P. Reine, B. A. Murphy, J. Netterville, B. Burkey, A. Cmelak, N. Wells, V. Scott
Journal: Journal of Clinical Oncology (2004)

5571 Background: Instruments assessing supportive care needs of cancer patients are limited; and of those available, such as the Supportive Care Needs Survey (SCNS), the instruments are not specifically developed for head and neck cancer patients. A comprehensive needs assessment of cancer patients is necessary to determine appropriate allocation of supportive care resources and to optimize delivery of quality care. We conducted an exploratory study using qualitative methods, as phase two of a three phase project, to define and measure supportive care needs in head and neck cancer patients. Methods: A purposive sample of 9 multidisciplinary health care providers and 20 ambulatory patients with head and neck cancer completed a semi-structured interview exploring supportive care needs. We performed content analysis of interview transcripts using pre-specified categories of need from the literature (psychological, physical, social, informational, health system, and spiritual needs). Results: Mean age of participants was 60 yrs (32–86). Physical needs were the most frequently reported with the majority of responses related to symptom control. Psychological needs ranked second in frequency with most responses related to coping, distress, and body image. Social and spiritual needs were similar in frequency but higher than health system and informational needs. Conclusions: The needs items generated by this qualitative study will be compared to an existing valid and reliable needs assessment instrument (SCNS) to determine if there are any items relevant to head and neck cancer patients not captured by the SCNS. The outcome of these results may indicate the need for a head and neck specific needs assessment scale to be developed. No significant financial relationships to disclose.
Eventration surgery of the diapragm via trans-thoracic aproach
Authors: Haluk Sasmaz, Akin Yildizhan, Nurettin Yiyit, Fatih Candas, Rauf Gorur, Turgut Isitmangil
Journal: European Respiratory Journal (2012)

Eventration of the diaphragm is a rare anomaly due to congenital or acquired etiology. Congenital eventration of the diapragm is probably a true congenital defect acquired during the fetal period. Eventration of the diaphragm also occurs in adults is thought to be caused by an acquired complete or in complete paralysis of the diaphragmatic leaf. Operative repair is indicated for older patient who has symtoms. A transthoracic approach and diapragmatic plication is preferred.  We performed 32 diaphragma plication at our instution between 2005-2011. Six of the cases on the right, 26 on the left. All operation performed under laterally decubitis position and one lung ventilation. The classical approach was a posterolateral thoracotomy through 7th intercostal space. The thinned diaphragmatic leaf was repaired with plication. We had no postoperative mortality or any other major complication.  The eventration of the diaphragm need to surgically repair to take away symtoms and respiratory relieve.
A1.1 Characterisation of lung inflammation and identification of shared citrullinated targets in the lungs and joints of early rheumatoid arthritis
Authors: Vijay Joshua, Gudrun Reynisdottir, Jimmy Ytterberg, Marianne Engström, Anders Eklund, Magnus Skold, Per-Johan Jakobsson, Johan Rönnelid, Vivianne Malmström, Lars Klareskog, Johan Grunewald, Anca I Catrina
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background and Objectives</h3> To investigate if changes in the lungs are present in rheumatoid arthritis (RA) patients early in the disease process and to address the contribution of these changes to the initiation of the disease. <h3>Materials and Methods</h3> 24 RA patients with patient-reported symptom duration less than one year and naive to DMARD treatment and 15 healthy individuals were subjected to bronchoscopy and mucosal bronchial biopsies were retrieved. Histological analysis for identification of inducible bronchia associated lymphoid tissues (iBALT) and lymphocyte infiltration, as well as immunohistochemistry (IHC) for PAD enzymes, CD3, HLA-DQ and HLA-DR were performed. Presence of citrullinated targets were detected by IHC using biotinylated ACPA isolated from synovial fluid of RA patients. Mass spectrometry was used for identification of citrullinated epitopes in 6 lung and 8 synovial biopsies from RA patients. An in-house ELISA was setup to measure reactivity against new identified citrullinated targets in the serum of RA patients in two distinct early RA cohorts (n = 393) and a cohort of non-RA patients (n = 236) as disease controls. <h3>Results</h3> Bronchial lymphocyte infiltration and iBALT formation was observed in 55% of the ACPA+ RA patients but only 17% of ACPA- patients and 7% of healthy volunteers. Higher expression of CD3, HLA-DQ, HLA-DR and citrullinated targets was observed in bronchial biopsies of ACPA+ as compare to ACPA- RA patients. BAL fluids were enriched in both IgG and IgA ACPA as compared to paired serum samples. Mass spectrometry identified 5 proteins in the synovium (in total 8 sites) and 4 in the lungs (in total 6 sites) containing citrullinated residues. Two vimentin derived citrullinated peptides were present in a majority of both synovial and lung biopsies with slightly higher citrullinated/unmodified peptides ratios in the smokers as compared to non-smokers.14.5% of the RA patients tested by ELISA showed antibody reactivity against the new identified citrullinated target compared to 3.4% in the disease controls. <h3>Conclusions</h3> Signs of inflammation and local ACPA enrichment are present early in bronchial tissues of ACPA+ RA patients. Shared citrullinated targets in the lung and joints as well as systemic reactivity against these targets are present in RA patients. Our findings support the notion that early inflammatory events in the lungs may represent a critical initiating factor in the development of ACPA+ RA.
A phase I study of bolus versus continuous infusion of the anti-CD19 immunotoxin, IgG-HD37-dgA, in patients with B-cell lymphoma
Authors: MJ Stone, EA Sausville, JW Fay, D Headlee, RH Collins, WD Figg, M Stetler- Stevenson, V Jain, ES Jaffe, D Solomon, RM Lush, A Senderowicz, V Ghetie, J Schindler, JW Uhr, ES Vitetta
Journal: Blood (1996)