tbuckley/cabot-search huggingface dataset:
Overall survival (OS) in the management of pretreated patients with unresectable stage III/IV melanoma: A systematic literature review and meta-analysis.
Authors: S. Kotapati, P. Dequen, M. Ouwens, M. van Baardewijk, R. A. Ibrahim, S. Wagner, J. P. Jansen
Journal: Journal of Clinical Oncology (2011)

8580 Background: Ipilimumab is the first treatment to show an OS benefit in a phase III trial (MDX010-20) compared with a gp100 vaccine. The majority of ipilimumab-associated adverse events were mechanism based, inflammatory in nature and although generally mild, can be severe. Toxicities were managed using product-specific treatment guidelines. Data on comparative effectiveness with other routinely used therapies for advanced melanoma is lacking. The objective of this study was to systematically identify, review, and synthesize available evidence related to OS for 2nd line systemic treatments for unresectable stage III/IV melanoma. Methods: A systematic literature search was performed to identify relevant clinical trials. From these trials, Kaplan-Meier (KM) OS curves for each intervention were digitized, survival proportions over time were obtained from these images, and data were combined with a fixed-effects Bayesian meta-analysis using Weibull survival distributions. The Korn algorithm (Korn EL. JCO. 2008;26:527) was used to adjust for differences in prognostic patient characteristics between identified trials and MDX010-20. The outcome of interest was expected OS (mean survival; area under the curve [AUC]). Results: 38 trials were reviewed, 25 of which reported KM curves that were included in this analysis. Populations included in the trials were of broadly comparable age, gender, race, performance, and M status, but not in regard to previous systemic treatment or inclusion of patients with brain metastases. After adjustment based on Korn, the expected OS for ipilimumab 3 mg/kg was 16.7 months (95% Credible Interval 12.8-22.4) compared with 10.1 months (6.9-14.9) for gp100, and about 11 months for all other treatments. Conclusions: Results of this meta-analysis suggest that expected OS (AUC) with ipilimumab is greater than that of alternative systemic therapies, and gp100 is similar to existing treatments, for the management of pretreated patients with unresectable stage III/IV melanoma.
Investigation of the Safety and Usefulness of Computed Tomography-Guided Percutaneous Needle Biopsy of Paraaortic Lymph Nodes.
Authors: Takeshi Aramaki, Takashi Ikeda, Michihisa Moriguchi, Takahiro Tsushima, Masahiro Endo, Koiku Asakura, Akihiro Sawada, Fumihiko Kimura
Journal: Blood (2009)
Perception of quality of physician communication by cancer patients before and after the implementation of a communication strategy in a regional cancer center in India
Authors: S. Nayak, J. Parija, B. Pradhan, S. Reddy, J. L. Palmer, T. Zhang, E. Bruera
Journal: Journal of Clinical Oncology (2005)

8088 Background: Physician communication is one of the areas where cancer patients express their lowest level of satisfaction. Very few studies have used patient based outcomes in the developing world. Methods: We conducted a survey of 400 consecutive patients attending our outpatient clinic [Phase I]. An 8-item questionnaire (Yes/No) was administered anonymously by a trained paramedical worker immediately after the clinic consult. The results were used to make changes in the physical layout of the setting by setting up curtains to form small private areas, to increase privacy, decrease interruptions by avoiding phone calls and to educate staff regarding practical techniques on communication skills [Phase II]. A second group of 400 patients were interviewed immediately after the implementation of the new communication strategy using the same 8-item questionnaire. 183 patients of these had participated in Phase I [Phase III].The largest improvements were seen in perception of improved privacy, less interruption, use of clear language, and clearing doubts. During Phase III improvement was not significantly different between new patients [n=217] and previously established patients [n=183]. Patients older than 65 and manual laborers were significantly more satisfied with communication both during Phase I [p=0.12 and 0.02] and during Phase III [p=0.01 and 0.008], respectively. Our results suggest that cancer patients in developing countries have significant unmet communication needs and that simple changes in physical layout and oncologists’ attitude towards better communication skills can have major impact on perception of communication. No significant financial relationships to disclose.
Feasibility of implementing a personalized electronic health record for patients with head and neck cancer.
Authors: S. B. Fleishman, M. Bookbinder, E. Silen, B. Buddhdev, S. Shah, P. Homel, J. Nabatian, V. Rosenwald, R. H. Blum
Journal: Journal of Clinical Oncology (2011)

e19514 Background: A 2006 Institute of Medicine report, “From Cancer Patient to Cancer Survivor: Lost in Transition,” found gaps in communication, inattention to long- and short-term sequelae of treatment, and lack of guidance post- treatment. This pilot developed, implemented and evaluated a Personal Health Record (PHR) for head and neck cancer survivors (HNCS) consisting of a comprehensive care summary and individualized follow-up plan to bridge those gaps, address multiple post-treatment needs, and improve health and quality of life (QoL). Methods: Prospective 1 year study of 100 HNCS without recurrence at 6 months, age 29-86y (mean 57.5y). The PHR included demographics, diagnostics, treatment summaries, follow-up, prevention and counseling information. QoL was assessed at baseline (N=95), 6 months (N=53) and 1 year (N=33) using the FACT- H&N. A 10 patient subset completed a Brief Assessment Scale for caregiver burden and Satisfaction with Survivorship Care Plan survey. All patients received a PHR on paper, and 96 on a 1GB flash drive as a record for community-based providers. We examined barriers to implementation. Results: Statistically significant improvements were shown in overall QoL, physical well-being, functional well-being, and items specific to HNCS: dry mouth, swallowing, eating solid foods, communicating, all likely resulting from the healing process. Social and emotional well-being remained stable. HNCS (n=9) were very satisfied or satisfied with the PHR. Caregiver distress could not be measured as many patients came without a caregiver and others felt too overwhelmed to complete the questionnaire. The next step is to overcome barriers to implementation and to integration into clinical practice, including synthesizing treatment data from disparate charts into a unified PHR in the absence of uniform electronic health records. Conclusions: 1) It is feasible to provide a paper or electronic PHR post-treatment. 2) The PHR empowers patients, and facilitates communication and awareness of treatment sequelae and responsibility for transition to survivorship in multimodal complex treatment of HNC. 3) Patients were satisfied with the PHR, though sample size was small.
Long-term treatment with tamoxifen activates MAP kinase and mTOR pathway and enhances interaction between growth factor receptor and ERα in breast cancer cells
Authors: P. Fan, W. Yue, J. Wang
Journal: Journal of Clinical Oncology (2005)

828 Background: Tamoxifen is an important antiestrogen drug for breast cancer patients. Unfortunately, resistance often happens after long-term treatment. In this study, breast cancer cell line MCF-7B cells were used to detect the signal pathway and receptors changes after long-term treated with tamoxifen(TAM). Methods: Breast cancer cells MCF-7B were treated with 10−7 mol/L TAM. Western blots were used to detect intensity of Akt, MAPK (the mitogen-activated protein kinase), mTOR (mammalian target of rapamycin), p70S6K, 4EBP-1 and ERα. Immunoprecipitation was used to detect the changes of EGFR, IGF-1R and ERα.Results: After about one month treatment, TAM could remarkedly induce p42/44 MAPK activation and phosphorylation residues Thr389 of p70S6K. But Akt and 4EBP-1 do not change. U0126(10uM), an inhibitor of the MAPK and rapamycin(2nM), an inhibitor of the mammalian target of mTOR, could result in decreasing the p70S6 kinase phosphorylation induced by TAM. MCF-7B cells with increased phosphorylation of p70S6K were insensitive to TAM, but two inhibitors or combining with TAM could significantly inhibit the MCF-7B growth. After long-term tamoxifen treatment, there was no change in ERα expression detecting by Western blots. After performing IGF-1R and EGFR immunoprecipitation, there was no significant difference between TAM treated cells and control cells in immunoblotting IGF-1R and EGFR. But ERα binding with EGFR and IGF-1R is significantly higher in TAM treated cells than that in control.Conclusions: Long-term TAM treated MCF-7B cells can increase phosphorylation of MAPK and p70S6K. At early time breast cancer cells can use this way to survive. And MCF-7B cells could resistant to long-term tamoxifen treatment through increasing expression level of ERα binding to growth factor receptors such as EGFR and IGF-1R. No significant financial relationships to disclose.
Real-life survival in unselected adult glioblastoma patients: A population-based study.
Authors: M. Preusser, A. Woehrer, N. Zielonke, H. Heinzl, C. Auer, T. Waldhoer, K. Roessler, C. Marosi, J. A. Hainfellner
Journal: Journal of Clinical Oncology (2011)

2014 Background: Historically, median overall survival (OS) times of glioblastoma (GBM) patients ranged from 6–9 months with 3-year survival rates of 2–5 %. In 2005, a randomised phase III trial demonstrated significant survival improvements with a 3-year survival rate of 16% and established concomitant radiochemotherapy as standard therapy of GBM. We analyzed in a country-wide survey in Austria (population: approximately 8.000.000) to what extent these improvements have translated to the population-level. Methods: All patients aged >18 years who received a first histological diagnosis of GBM in Austria in 2005 were included in our study. The patient cohort was followed-up until 31–12–2008. Survival analyses were performed using the Kaplan-Meier method and log-rank tests. Results: We included a total of 375 adult primary GBM cases, corresponding to age-standardized incidence rates of 4.3/100.000 person-years (95% confidence interval 3.7–4.9) in males and 2.6/100.000 person-years (2.2–3.0) in females. The age at diagnosis ranged from 18.8-87.0 years (median 63.8 years). OS rates in the total cohort were 39.2% (34.3–44.1%) at 1 year, 20.0% (16.1–24.2%) at 2 years, and 15.5% (12.0–19.3%) at 3 years. We found significant differences (p < 0.0001) in OS between the age groups 18–69 (n=257, 68.5 %) and >70 (n=118, 31.5 %). In the age-group 18–69, OS rates were 47.9% (41.6–53.8%) at 1 yr, 26.1% (20.9–31.6%) at 2 yrs, and 19.8% (15.2–24.9%) at 3 years, while the respective rates in the age-group >70 were 20.3% (13.6–28.0%), 6.8% (3.2–12.3%), and 5.9% (2.6–11.2%). Conclusions: We show on a population-level that survival of adult GBM patients has increased in comparison to historic data, possibly due to recent innovations including the introduction of radiochemotherapy as therapy standard. Survival times have improved predominantly in the age-group 18–69 and are still poor in patients aged >70.
Very late recurrence of Ewing sarcoma (ES): Report on three cases and review of literature.
Authors: H. Cornille, N. A. Delepine, S. Alkhallaf, G. Delepine
Journal: Journal of Clinical Oncology (2011)

e20005 Background: ES is the second malignant bone tumour in children and young adults. Most relapses occur the first years following the diagnosis. We report 3 very late ES recurrence (11, 20, 24 y after primary tumour). 2 occurred a long time after a first relapse. Methods: P 1: In 1991 a 21 y old girl was treated for tibia non metastatic ES by neo and adjuvant chemotherapy, extra-tumoral surgery. Tumour necrosis (TN) was 100%. In 2002 after local trauma, she had a first local relapse. She remained 3 y in remission, after second line of treatment included complete surgery. She died in 2007, after a second local recurrence, in spite of contaminated surgery, chemotherapy and radiotherapy. P 2: In 1990 an11 y old boy was treated for superior femoral ES by neoadjuvant chemotherapy, surgery. TN was 93%. Parents refused adjuvant chemotherapy. In 1993, he presented a first inguinal local relapse treated by neo and adjuvant chemotherapy, partial surgery, local radiotherapy. TN was 5%. In June 2010, 17 years after the first relapse, he presented a sacral metastasis and one isolated pulmonary metastasis; he was treated by chemotherapy and sacral radiotherapy. He is still in treatment, with stable pulmonary and no evolutive sacral disease. P 3: In 1986, a ten y old girl was treated for L3 non metastatic ES by neoadjuvant and adjuvant chemotherapy, contaminated surgery. TN was 100%. She didn’t have radiotherapy. In January 2011, 7 and 9 years after 2 pregnancies, she had local relapse Diagnosis was delayed for 3 months after erroneous interpretation of symptoms. Results: In Rizzoli experience of ES outcome, patients who relapse after combined treatment is very poor. However, when the relapse is late, patients seem to be more receptive to traditional treatment and outcome better. Dubois reported in 2008, 2 ES late relapses during pregnancy. Conclusions: These cases pointed out the need to remain vigilant for ES, a long time after diagnosis. Late relapses must be envisaged as a cause of symptoms, to avoid diagnosis delay.
Influence of ABO blood group on the natural history of advanced pancreatic adenocarcinoma (PC).
Authors: MinYuen Teo, Mohd Syahizul Nuhairy Mohd Sharial, Jarushka Naidoo, Anuradha Jayaram, Thevaraajan Jayaraman, Raazi Bajwa, Michelle O'Brien, Felicity McDonnell, Kevin C. Conlon, Justin Geoghegan, Derek Gerard Power, William Grogan, Raymond S. McDermott
Journal: Journal of Clinical Oncology (2013)

307 Background: An association between blood group (ABO) and PC has been demonstrated at epidemiologic and genomic levels. Variations in ABO type may lead to higher pro-inflammatory cytokines levels with modifications in cellular adhesionand signalling promoting carcinogenesis. This study investigated the influence of ABO on the clinical behaviour of advanced PC in patients (pts) , treated with chemotherapy (ctx). Methods: Pts with confirmed PC were identified from 4 institutional databases. Inclusion criteria were unresectable (UPC) or metastatic disease (MPC), receipt of ctx and availability of ABO data. Clinicopathologic details were collected. 200 random anonymied non-cancer ABO samples were collected as control. Descriptive statistics and survival analyses were performed. Results: Between 2001 and 2012, 222 pts met inclusion criteria. Median age was 63 years (range: 33 – 83) 56% were males. 60% of pts had MPC and 27% received doublet ctx. ABO distribution was: A (40%), AB (5%), B (11%) and O (44%). The incidence of blood type A was higher in PC cohort than control (40 vs 30%, p=.03) but identical between UPC and MPC (41 vs 40%, p=.84). Overall survival between type A and non A were identical for the entire cohort (5.8 vs 6.6 mos, HR 1.04 95% CI 0.76 – 1.40, p=.82), UPC (7.6 vs 9.5 mos, HR 1.08 95% CI 0.65 – 1.76, p=.77) or MPC (5.4 vs 4.7 mos, HR 0.94 95% CI 0.66 – 1.34, p=.78). For UPC, 56 pts (64%) had radiographic documentation of the pattern of progression. Type A pts had lower propensity for developing distant metastasis (7/21) than non A (23/35), at 33 vs 66%, p=0.03. Amongst pts with MPC, the incidence of hepatic and pulmonary metastases for type A and non A were identical (77 vs 74%, p=.83; 21 vs 18%, p=.81). However, peritoneal dissemination was less common in type A pts (6 vs 23%, p=.01). Conclusions: Consistent with existing epidemiologic data, the incidence of blood type A is significantly higher in pts with PC, although this does not appear to be stage dependent. ABO did not appear to influence OS in this cohort. However, our data suggests that the pattern of disease spreadmay be related to the ABO blood type. ABO-related glycosylated products could be a target for disease modulation in further studies.
Pancreaticoduodenectomy (PD) for periampullary tumors: Results from Tata Memorial Centre (TMC) over two decades.
Authors: Shailesh V. Shrikhande, Abhishek Mitra, Bhawna Sirohi, Munita Bal, Mahesh Goel
Journal: Journal of Clinical Oncology (2014)

366 Background: There is scarcity of short and long term data regarding results of pancreaticoduodenectomy done for periampullary tumours. Contrary to the western data, ampulla of Vater is the commonest site of involvement in Indian patients. Methods: A retrospective analysis PD was done for periampullary tumors from 1991 to July 2013 at TMC. The time period was divided into 4 spans A (1991 to 2001), B (2003 to July 2009), C (Aug 2009 to Dec 2012) and D (Jan 2013 to July 2013) based on the increasing surgical volumes and changing practice trends. Survival outcomes were analysed. Data was prospectively maintained from 2006 onwards. Results: 626 pts underwent PD for periampullary tumors over this time period. 144, 206, 150 and 126 pts were operated during span A, B, C and D respectively. Sites involved were ampulla (67.5%), head of pancreas (16.6%), duodenum (9.9%) and bile duct (6.9%). Adenocarcinoma was the most common histology (81.5%). The morbidity and mortality was 31.7% and 4.3%. Postoperative pancreatic fistula, delayed gastric emptying (DGE), post-pancreatectomy haemorrhage (PPH) and bile leaks were 12.4%, 2.8%, 4.8% and 2.7% respectively for the whole group. Morbidity, mortality, DGE, PPH and bile leak rates have declined over subsequent time periods. Majority of pts in span C and D received adjuvant chemotherapy with gemcitabine 1000mg/m2 on day 1,8 and 15 of a 28 day cycle. 2 year disease free survival (DFS) for periampullary adenocarcinoma-ampulla, bile duct &amp; pancreas from April 2006 for 294 pts was 79.3%, 68.6% and 41.8% respectively. Overall 2 year DFS was 74%. Conclusions: These data represent the largest single centre experience with PD from Indian subcontinent. The improvement of results over the 2 decades can be due to increasing volume of pts, standardisation of surgical technique and gradually increasing experience of the operating team. The impressive 2 year DFS can be attributed to a large number of good prognosis ampullary tumors.
Outpatient implementation of a patient self-reported symptom system in an integrated health system.
Authors: Christian S. Adonizio, Mark Wojtowicz, James Wade, Lisa Keifer, Thomas Graves, Jonathan Darer
Journal: Journal of Clinical Oncology (2014)

172 Background: To date, process-related outcomes dominate the landscape of the measurement of quality of oncologic care. Use of patient-reported outcomes has the potential to enhance value-based performance measurement. We performed a pilot study of integrating patient-reported data (PRD), into the daily work-flow of outpatient oncology clinics in an integrated health system, Geisinger Health System (GHS). Methods: All patients in the pilot were asked their pain scores by nurses according to existing procedures. In addition, the MD Anderson Symptom Inventory (MDASI) questionnaire was given to patients via touch screens in exam rooms. Four oncologists participated in the study at two sites. The study was reviewed by the GHS IRB and was granted exemption status. Results: 63 patients successfully used the touch screen monitors to complete the MDASI with minimal impact to clinic flow. Compared to the existing EHR-prompted nursing-collected pain score method, the PRD/MDASI method identified an additional 31% of patients with severe pain who were previously identified as having “no pain” (Table). 75% of patients identified as having “moderate pain” by the current method report “severe pain” by the PRD method. Conclusions: This pilot study demonstrates that the collection of PRD can be integrated into routine oncological clinic workflows with minimal interference with clinical flow. The study also shows that the collection of PRD may be superior to clinician screening at the time of the encounter alone. GHS will integrate PRD fully into its EHR in August 2014. GHS is developing evidence-based, standardized symptom management protocols and expanding the use of PRD in clinical care. [Table: see text]
Phase II study of lenalidomide (Len), bortezomib (Bz), and dexamethasone (Dex) in patients (pts) with relapsed or relapsed and refractory multiple myeloma (MM)
Authors: K. C. Anderson, S. Jagannath, A. Jakubowiak, S. Lonial, N. Raje, R. Schlossman, N. Munshi, R. Knight, D. Esseltine, P. G. Richardson
Journal: Journal of Clinical Oncology (2008)

8545 Background: Single-agent Bz and Len/Dex are approved for pts with relapsed MM following ≥1 prior therapy. In a phase I study, Len/Bz (MTD: 15mg/1.0mg/m2) ± Dex 20–40mg achieved a 58% response rate in relapsed/refractory MM pts. This phase ll study evaluated Len/Bz/Dex at the phase-l MTD in up to 65 pts with relapsed/refractory MM, following 1–3 prior lines of therapy. Methods: Pts received Len 15 mg, d 1–14, Bz 1.0 mg/m2, d 1, 4, 8, 11, and Dex 40/20 mg (cycles 1–4/5–8) on days of/after Bz, for up to eight 21d cycles. Based on safety data, Dex dosing was reduced to 20/10 mg. After cycle 8, pts with stable or responding disease received Len (d 1–14)/Bz (d 1, 8) at doses tolerated at end of cycle 8, and Dex 10 mg, d 1, 2, 8, 9. Pts received concomitant antiviral and anti-thrombotic prophylaxis. Response was assessed every 3 weeks according to modified EBMT and Uniform Criteria. Toxicities were assessed using NCI CTCAE v3.0. Pts with G≥ 2 peripheral neuropathy (PN) were excluded. Primary end point was TTP; secondary end points included response rate, DOR, PFS, and OS. Results: 43 pts enrolled to date, with data available on 41 pts (median age 67 years, 66% men, 63% IgG MM, 59% Durie-Salmon stage III at diagnosis); 24 with relapsed and 17 with relapsed/refractory MM. Median number of prior therapies was 2, including Len (2%), Bz (68%), Dex (90%), thalidomide (78%), and stem cell transplant (32%). Pts received a median of 7 cycles; 18 (44%) completed 8 cycles, 12 continue on maintenance, and 16 discontinued. In 33 evaluable pts, response rate (≥MR) to date is 73% (95%CI 55.6–85.1%), including 55% ≥PR and 36% VGPR/nCR/CR. Median DOR is 39 weeks (95% CI 13.5–63 weeks) with median TTP, PFS, and OS not yet reached. Toxicities have been manageable, consisting mainly of G1/2 myelosuppression. Attributable non-hematologic toxicities include DVT (2 pts), G3 PN (1 pt), and G3 atrial fibrillation (2 pts). Dose reductions have been required for Len (9 pts), Bz (5 pts), and Dex (14 pts). Conclusions: Len/Bz/Dex is active and well tolerated in relapsed/refractory MM pts, including those who received prior Len, Bz, thalidomide, and stem cell transplant. Durable responses have been seen. Accrual is ongoing and updated response data will be presented. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Millennium Pharmaceuticals Inc. Celgene, Millennium, Novartis Celgene, Millennium Celgene, Millennium, Novartis Celgene, Eli Lilly, Millennium, Novartis