tbuckley/cabot-search huggingface dataset:
Clinical impact of FDG-PET for recurrent ovarian cancer
Authors: Y. Ebina, D. Akashi, M. Takeda, H. Watari, R. Yamamoto, N. Sakuragi
Journal: Journal of Clinical Oncology (2004)

5124 Background: Recurrence is a major problem for ovarian cancer patients during follow up. We evaluated the clinical contribution of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for recurrent ovarian cancer. Methods: PET scans were performed in 44 women who had undergone cytereductive surgery and chemotherapy for ovarian cancer (FIGO stage I, 11 cases; stage II, 2 cases; stage III, 27 cases; stage IV; 4 cases). All patients also underwent physical examination, CA 125 level and CT. PET findings were compared with the final diagnoses obtained by histopathology or by clinical follow up. Results: Of the 44 patients, 19 had recurrent disease. PET correctly identified recurrent diseases in 18 of 19 cases and ruled out recurrence in 24 of 25 cases. PET was false negative in a patient with pleural effusion. In one patients unspecific gastric activity was misinterpreted as metastatic tumor (false-positive finding). Diagnostic accuracy is given in the table below. Using PET, clinical impact was found for 10 of 18 PET-positive patients. In 4 patients whose serum CA 125 was elevated, the CT findings were negative, however, PET revealed high uptake that suggested disseminated disease. These patients immediately underwent additional chemotherapy. One patient whose PET findings suspected the sacrum bone metastasis received radiation therapy. Another 5 patient confirmed solitary (non-disseminated) recurrent disease by PET finding underwent operation. Conclusions: These preliminary findings suggest that PET scan may be the most effective means of detecting recurrence in ovarian cancer patients. Moreover, using PET scan, we can differentiate solitary recurrent tumor from multiple disseminated diseases. Accurate and prompt identification of these patterns of recurrence may have a significant impact on determining whether to resect the tumor surgically or to treat with additional chemotherapy. No significant financial relationships to disclose.
Phase 2 feasibility study of dose-dense doxorubicin and cyclophosphamide (AC) followed by eribulin mesylate with or without prophylactic growth factor (GF) for adjuvant treatment of early-stage breast cancer (EBC).
Authors: Tiffany A. Traina, Peter Andrew Kaufman, Karen Anne Cadoo, Clifford A. Hudis, Cassandra Chang, Erhan Berrak, James Song, David Cox, Andrew David Seidman
Journal: Journal of Clinical Oncology (2014)

TPS670^ Background: In a previous phase 3 randomized, open-label trial, eribulin mesylate demonstrated antitumor activity and significantly improved overall survival (OS) in patients (pts) with heavily pretreated locally advanced or metastatic breast cancer. This trial will assess feasibility of eribulin as adjuvant therapy following dose-dense AC for pts with HER2-normal EBC. The study required prophylactic pegfilgrastim with each AC cycle; with eribulin, GF was used following a neutropenia episode (Cohort 1). Based on neutropenic events without prophylactic GF in Cohort 1 and to improve feasibility, Cohort 1 was closed and the study was amended to require prophylactic GF with eribulin (Cohort 2). Methods: Pts with confirmed HER2-normal, stage I-III invasive EBC and adequate bone marrow, liver, and renal function may enroll. Pts receive dose-dense AC (doxorubicin 60 mg/m2 IV + cyclophosphamide 600 mg/m2 IV) on Day 1 of a 14-day cycle x 4 cycles, followed by 4 cycles of eribulin mesylate (1.4 mg/m2 IV) on Days 1 and 8 every 21 days. A protocol amendment established 2 cohorts. Cohort 1 includes the 55 pts enrolled, who received GF at physician’s discretion following a neutropenic event during eribulin treatment (per original protocol). Cohort 2 will include 55 new pts who will receive prophylactic GF on Days 3, 4, 10, and 11 of each eribulin cycle. Feasibility is determined by the ability to complete the eribulin portion of the regimen with no dose delay/reduction due to eribulin-related AE. A feasibility target of 80% was set. Feasibility rates will be calculated separately in the 2 cohorts. Relative dose intensity of eribulin and toxicities will be summarized by cohort. Exploratory objectives include efficacy endpoints of 3-year disease-free survival and OS. Clinical trial information: NCT01328249.
Factors associated with loss of employment among metastatic patients.
Authors: Amye Tevaarwerk, Ju-Whei Lee, Mary E Sesto, Abigail Terhaar, Mary Lou Smith, Charles S. Cleeland, Lynne I. Wagner, Michael Fisch
Journal: Journal of Clinical Oncology (2014)

6585 Background: Up to a third of those diagnosed with cancer do not return to work. Metastatic patients seem particularly vulnerable, but few data exist. We examined employment outcomes for working age metastatic patients on EZ202 (a symptom-based study conducted through ECOG) to understand metastatic employment patterns, and potentially modifiable factors associated with employment loss. Methods: E2Z02 prospectively enrolled cancer patients irrespective of therapy or stage. Employment was assessed by questionnaire: “Has your employment status changed due to illness?” [Answer = Yes/No] and “What is your current employment status?” [Answer = full-time; part-time; not in the workforce]. We excluded patients >65 years and without metastatic cancer. Factors associated with employment group (no longer working vs. stably employed) were evaluated using logistic regression. Variables examined included cancer type (breast, prostate, colon, lung), therapy status (none, hormone, all other treatment), gender, age (≤ 45, >45-55, >55-65), race/ethnicity (non-Hispanic white, all other), metastatic sites (none, bone/soft tissue, visceral, other, >2 sites), ECOG performance status (0-1, 2-4) and symptom interference on the MD Anderson Symptom Inventory (none-mild, moderate-severe). Factors with p-value <0.10 on the univariable analysis were further fitted into the multivariable model. Results: 3,106 analyzable patients accrued between 3/06 and 5/08; 668 metastatic patients had employment data. 236 of 668 (35%) worked full or part-time; 154 of 236 (65%) reported working without any change. Among patients no longer working, 302 of 432 (70%) reported change as being due to illness. PS, race/ethnicity, therapy status, and symptom interference were significantly associated with no longer working in multivariable analysis (respectively, p=0.0007, 0.03, 0.03, 0.0008). Conclusions: Working age metastatic patients often remain employed. Worse ECOG performance status and higher symptom interference were more likely among patients no longer working while hormone therapy and non-Hispanic white race were more likely among those stably working. These factors should be considered when counseling metastatic patients about continued employment. Clinical trial information: NCT00303914.
Early prediction of response to chemotherapy by circulating nucleosomes and CYFRA 21–1
Authors: S. Holdenrieder, P. Stieber, J. Von Pawel, V. Heinemann, H. Raith, D. Nagel, K. Feldmann, D. Seidel
Journal: Journal of Clinical Oncology (2004)

7149 Background: Increasing options of antitumor therapies enable the modulation of treatment on an individual basis. On the diagnostic side this means a growing need to early predict the insufficient response to therapy in order to save time and costs by changing early the treatment protocol and avoiding unnecessary toxic side effects. Methods: We investigated the courses of nucleosomes (ELISA, Roche), CYFRA 21–1, CEA, NSE (ElecSys, Roche), and ProGRP (ELISA, ALSI/IBL) in sera of 311 patients with newly diagnosed, advanced non small cell lung cancer in close meshed manner during the 1st cycle and before each new cycle of 1st line chemotherapy. Therapy response was objectified by whole body CT before the 3rd cycle according to WHO-criteria. Results: In univariate analysis, patients with remission showed significantly (p<0.05) lower values of nucleosomes and CYFRA 21–1 for the pretherapeutic baseline values of cylce 1, 2, 3 (BV1, BV2, BV3), and -already during the first therapeutic week -for the area under the curve of the days 1–8 (AUC1–8) and day 8 than patients with progression. Additionally CEA (BV3, BV1–2, BV1–3), and NSE (BV2) discriminated significantly between both groups. ProGRP had no discriminating power. Among these predictors, nucleosomes (day 8) and CYFRA 21–1 (BV2) exhibited the highest PPV for progression (77.8% resp. 76.0%) with the best sensitivity (42.4% resp. 54.3%) given a 90%-specificity to patients with remission. Both markers were independent on each other and on clinical parameters (stage, performance score). In a multivariate model they could predict progression with a certainty of 100% in 29.0% of the cases -even in a subgroup of patients with ECOG 0–2. Conclusion: The combination of nucleosomes and CYFRA 21–1 offers the appealing possibility to predict early and with high certainty the insufficient response to therapy and should be included in prospective therapeutic trials. No significant financial relationships to disclose.
Inverse-probability weighted and propensity score-based analysis of long-term clinical outcomes comparing 3D conformal radiotherapy (3DCRT) with intensity-modulated radiation therapy (IMRT) in the treatment of esophageal cancer.
Authors: Steven H. Lin, Lu Wang, Bevan H Myles, Peter F. Thall, Wayne Lewis Hofstetter, Stephen Swisher, Jeffrey Edwin Lee, Manoop S. Bhutani, Dipen M Maru, Jaffer A. Ajani, Linus Ho, James D. Cox, Ritsuko Komaki, Zhongxing X. Liao
Journal: Journal of Clinical Oncology (2012)

e14548 Background: IMRT has clear dosimetric advantages in the sparing of normal tissues when compared to the more conventional 3DCRT technique for the treatment of esophageal cancer, but there is currently no clinical outcomes evidence to support the use of IMRT. We hypothesized that the theoretical advantages of IMRT should translate to clinical outcomes benefits compared to 3DCRT. Methods: We analyzed a cohort of 676 patients (3DCRT=413, IMRT=263) treated with chemoradiation with or without surgery between 1998-2008. To correct for potential bias inherent in observational studies, we employed inverse probability of treatment weighted (IPW) methods based on propensity scores. Treatment probabilities (propensity scores) were estimated using logistic regression. Results: IMRT patients were less likely to receive induction chemotherapy and had poorer performance status. A fitted multivariate IPW-adjusted Cox model showed that overall survival was significantly associated with age, KPS, having surgery, tumor location, stage, having PET for staging, and radiation modality. Compared to IMRT, 3DCRT patients had a significantly greater risk of dying (72.6% vs 52.9%, IPW log rank test: p&lt;0.0001) and for local-regional recurrence (LRR) (p=0.0038). The improvement in LRR was only apparent in the non-surgically treated patients due to better tumor control in the primary site, but not in the recurrence in regional nodal sites. There was no difference in cancer-specific mortality, distant metastasis, or postoperative deaths between the two groups. An increased cumulative incidence of cardiac deaths was seen in the 3DCRT group (p=0.049), but the cause of most deaths were unknown (5 year estimate: 11.7% in 3DCRT vs 5.4% in IMRT, Gray’s test, p=0.0029). Analyses using propensity score as a covariate gave very similar results. Conclusions: Our results indicate IMRT improves treatment outcomes in the management of esophageal cancer when compared to 3DCRT. These results, while retrospective, support the use of IMRT for the treatment of esophageal cancer.
Patient interest and willingness-to-pay (WTP) out-of-pocket (OOP) for comprehensive tumor genetic profiling (CGP).
Authors: Julie Innocent, Elizabeth Handorf, Jennifer Madeline Matro, Yu-Ning Wong, Yana Chertock, Mary Beryl Daly, Michael J. Hall
Journal: Journal of Clinical Oncology (2015)

1545 Background: CGP via multiplex gene panels has emerged as a novel technology to identify mutations in pathologically relevant cancer genes for therapy targeting. While CGP is anticipated to alter the course of standard cancer care, its current clinical role remains ill-defined, and thus its perceived value for patients is unclear. In an effort to understand patient awareness and perceived value of CGP, we explored interest and WTP OOP for CGP among cancer patients receiving active treatment. Methods: Fox Chase patients were recruited to complete a 20 min survey. In addition to assessing demographics, cancer stage/treatment, and financial items (income, health insurance, co-pays), we queried awareness of CGP, and interest in CGP to guide therapy using items adapted from previous research by our group. We specifically assessed interest in CGP only if covered by insurance vs interest conditional on paying an OOP cost: ( < $200, $500, and > $1000). All p-values are significant at α = 0.05 using two-sided Fisher’s exact tests. Results: Participants were 88 patients of diverse cancer histology, time since diagnosis (51% > 2yrs), therapy line (60% > 2nd line) age (mean 58.9 yrs), sex (38% F), race/ethnicity (20% non-White), family structure (64% married; 21% no children), education [27% < high school (HS)], and financial status (37% income < $50,000; 38% Medicare/8% Medicaid; 40% reporting difficulty paying co-pays). 61% were aware of CGP, and 67% believed it could improve their treatment. In total, 79% were interested in CGP, with interest higher in younger (p = 0.005) and privately insured (p = 0.01). Patients with < HS education were less WTP OOP for any costs for CGP beyond those covered by insurance (p = 0.005). Those with income > $50K (p = 0.06) and private insurance (p = 0.001) were more WTP. Of those WTP OOP, 44% were WTP < $200, while 24% were WTP $500 and 32% WTP > $1000. WTP $500 or > $1000 for CGP was associated with White race (p = 0.05), education > HS, income > $50K, and private insurance (all p ≤ 0.001). Conclusions: Patients are interested in CGP and believe it can improve their cancer treatment. Those with lower income, less education and non-private insurance may be less likely to pursue CGP if accompanied by OOP costs.
Implementation to optimization: A tailored, data-driven approach to improve provider efficiency in using the electronic medical record.
Authors: Sarah Kadish, Erica L. Mayer, David Michael Jackman, Mark Pomerantz, Lauren Brady, Audra Dimitriadis, Jessica Cleveland, Andrew J. Wagner
Journal: Journal of Clinical Oncology (2017)

123 Background: The increasing use of Electronic Medical Records (EMR) has been coupled with a growing focus on physician dissatisfaction. A recent study revealed physicians spend twice as much time working on the EMR and related tasks as they spend with patients. Physicians also spent time at night on EMR-related work. Nine months after the implementation of a new EMR at Dana-Farber Cancer Institute, providers expressed frustration with the EMR burden. Following three group training sessions, providers requested individualized training. We sought to enhance efficiency in clinical review, documentation, placing orders and to reduce after hour use. Methods: Each provider was sent their EMR system usage by time of day and activity. Providers were also surveyed to elicit content for training and to gauge confidence. Prior to training, a trainer reviewed the survey results and system usage data. System usage data and a post training survey were utilized to quantify changes against baseline. Results: A total of 114 MDs, 37 NPs and 8 PAs completed training. Providers reported an increase in confidence across all activities. Almost all providers (98%) agreed the training enhanced their efficiency. Overall confidence rose from 58% to 94% strongly agree or agree post training. Overall time in system (TIS) per appointment and TIS reviewing a patient’s chart significantly improved. TIS spent on documentation, placing orders, or after hours did not significantly change. Conclusions: A tailored data-driven training approach improved overall efficiency and confidence. While changes to TIS were not significant across all activities or reduce after hour usage, ongoing training may continue to improve these measures. [Table: see text]
Role of androgen deprivation in EGFR and Her-2/neu gene expression patterns in prostate cancer
Authors: M. V. Midathada, R. Dennis, V. Kaushal, M. Kohli
Journal: Journal of Clinical Oncology (2004)

9574 BACKGROUND: Her2/neu and epidermal growth factor receptor (EGFR) signaling pathways have been implicated in prostate cancer progression. Androgenic regulation of these epidermal growth factors (EGF) has been previously reported in prostate cancer. To evaluate the effect of androgen deprivation, a standard treatment for advanced stage on EGF members, we compared HER2/neu and EGFR gene expression in freshly resected tissue from advanced, hormone sensitive, prostate cancer patients undergoing androgen deprivation (AD) and tissue from patients who had not received androgen deprivation. METHODS: Tissue from 9 early stage cancer patients (prostatectomy) and 6 advanced stage patients undergoing trans-urethral resection of prostate were analyzed. Gene expression was quantitated at mRNA level by real–time polymerase chain reaction. Transcript abundance was calculated relative to standard curves generated using a cDNA pool of all samples and was normalized to 18s (control). T–test for independent samples was used for detecting differences between means for the two groups. RESULTS: All specimens (n=15) expressed HER2/neu and EGFR. Mean expression and comparisons between groups are shown in Table 1. A correlation between EGFR and Her2/neu was also performed using Pearson's coefficient; r = 0.69 (95% CI: 0.27–0.89; 2 tailed p–value 0.0048). CONCLUSIONS: Stimulation of prostate cancer proliferation by androgens and EGFs has also been reported in cell culture (1). We hypothesize that AD decreased gene expression of EGF family members when patients are initially responding to this maneuver as seen in our study population. Additional inhibition of EGFR and/or Her2/neu during hormone sensitive disease may further prolong duration of response to AD and delay emergence of hormone refractoriness and should be tested in clinical trials. Ref 1 Ye, D. et al: Clin Can Research vol 5, 2171–77, 1999. No significant financial relationships to disclose.
The prognostic implication of brain metastasis (BM) in patients with advanced non-small cell lung cancer (NSCLC)
Authors: R. Srikantiah, A. E. Gomaa, D. Slone, A. R. Jazieh
Journal: Journal of Clinical Oncology (2004)

7268 Background: Patients (pts) with NSCLC and BM tend to have a poor outcome. However, the evolution of new management approaches to BM may impact the disease outcome. This study evaluated various prognostic factors in pts with advanced NSCLC with and without BM. Methods: A retrospective analysis of all patients with stage IV NSCLC at presentation managed at our institution between June, 1999 and June, 2003 was conducted. Bivariate analysis of overall survival (OS) with other factors including age, gender, race, histology, comorbidities, albumin, hemoglobin, presence and number of BM, and treatment types provided was conducted. A multivariate analysis was then performed on the aforementioned variables for each group. Results: Two hundred pts were included in the study with a median age 62 years (35–100). 58% were males, 61% were Caucasians, 37% African Americans. 139 pts (69%) had adenocarcinoma, 61 pts (31%) had squamous cell carcinoma. 74 pts (37%) had BM; 23 pts (31%) received stereotactic radiosurgery (STR) based treatment, 39 pts (53%) received non-STR based treatment such as WBRT and craniotomy, and 12 pts (16%) were not treated. The absence of BM was an independent adverse prognostic factor. The median survival (MS) of pts with BM was 6 months (1–29) compared to 5 months (1–45) for pts without BM (P value < 0.008). Among pts with BM, those who received STR-based treatment had a MS of 10 months (1–29) compared to 5 months (1–45) for those who did not receive STR (0.023). This was independent of the number of brain lesions. Other independent adverse prognostic factors included lack of treatment for BM, and low albumin (< 3.5 gm/dl). Conclusion: The presence of BM in our study of pts with advanced NSCLC did not adversely affect the patient outcome which is dependent on the type treatment administered. Low albumin is an independent adverse factor for pts with advanced NCSCLC. No significant financial relationships to disclose.
Enhanced chemosensory sensitivity in patients with idiopathic rhinitis and its reversal by nasal capsaicin treatment
Authors: Laura Van Gerven, Yeranddy A. Alpizar, Brecht Steelant, Ina Callebaut, Inge Kortekaas Krohn, Mira Wouters, François Vermeulen, Guy Boeckxstaens, Karel Talavera, Peter W. Hellings
Journal: Journal of Allergy and Clinical Immunology (2017)
Comparison of survival rates in carcinoma in situ of the breast treated with total mastectomy to breast-conserving surgery and radiotherapy
Authors: M. N. Ibrahim, Z. Abdullah, L. Healy, C. Murphy, I. Y. Yousif, M. J. Martin
Journal: Journal of Clinical Oncology (2007)

519 Background: Carcinoma in situ (CIS) of the breast is a precancerous lesion with the potential to progress to invasive cancer. In 2003, CIS accounted for 19% of all newly diagnosed invasive and non-invasive breast lesions combined in the United States. Current treatment options are mastectomy ± tamoxifen, and breast-conserving surgery with radiotherapy ± tamoxifen. As there are no randomized comparisons of these 2 treatments, data from the Surveillance Epidemiology and End Results (SEER) database was used to compare their survival rates. Methods: 88,285 patients were identified with CIS from 1988 - 2003. Of these, 27,728 patients were treated with a total mastectomy, and 25,240 patients received breast-conserving surgery with radiotherapy. Kaplan-Meier survival analyses and Cox proportional hazards regression were used to compare overall survival and disease specific survival at 5 and 10 years. Results: Kaplan-Meier analyses demonstrated 5 year overall survival rates for total mastectomy vs. breast conserving surgery with radiotherapy of 95.46% vs. 97.59% respectively (Log-rank P &lt; 0.0001). The 5 year rates for disease specific survival were 99.16% vs. 99.72% respectively (Log-rank P &lt; 0.0001). At 10 years the overall survival rates had fallen to 91.96% vs. 96.09% respectively (Log-rank P &lt; 0.0001). The 10 year disease specific survival rates were 98.61% vs. 99.50% respectively (Log-rank P &lt; 0.0001). Cox proportional hazards regression demonstrated a relative risk of 0.847 (95% confidence interval (CI) 0.790 - 0.907) and 1.110 (95% CI 0.931 - 1.324) for 5 year overall survival and disease specific survival respectively, when total mastectomy was compared with breast conserving surgery and radiotherapy. At 10 years, the relative risks were 0.865 (95% CI 0.820 - 0.913) and 1.035 (95% CI 0.900 - 1.190) for overall survival and disease specific survival respectively. Conclusions: Overall, when looking at disease-specific survival rates by multi-variate analysis, there does not appear to be a significant difference between total mastectomy and breast-conserving surgery with radiotherapy in the treatment of CIS. No significant financial relationships to disclose.