tbuckley/cabot-search huggingface dataset:
Secondary malignancies in essential thrombocythemia and polycythemia vera: A retrospective analysis of 437 patients from a single institution.
Authors: S. Pierce, M. A. Cherry, H. Pham, H. Kantarjian, A. Al-Ameri, J. E. Cortes, L. Zhou, S. Verstovsek
Journal: Journal of Clinical Oncology (2011)

6621 Background: Essential thrombocythemia (ET) and polycythemia vera (PV) are chronic myeloproliferative neoplasms (MPN). Patients (pts) are at risk of thrombohemorrhagic complications for which they are often treated with different agents. Previous studies suggested that the risk of secondary malignancy (SM) may be increased in pts with PV or ET treated with Hydroxyurea (HU) or Alkylating agents (ALK). We report the incidence of SM in pts with ET and PV at our institution and treatment received. Methods: We performed a retrospective chart review of all pts with ET and PV seen at MD Anderson (diagnosis according to WHO) between January, 1960 and September 2010, recorded the pathological diagnosis of SM, and performed an analysis to look for differences in risk of SM according to treatment received. Results: A total of 437 pts charts (ET 263, PV 174) were evaluated. 29 pts developed SM [12 ET (4.6%), 17 PV (9.8%)] with median time to diagnosis of 68 months (14-167) in ET pts and 76 months (1-247) in PV pts. 6 pts developed 2 SM. 23 Pts had 29 solid tumors [7 Skin cancers (ET 2, PV 5), 5 breast (ET 2, PV3), 4 lung (ET 3, PV1), 4 genitourinary (ET 2, PV 2), 2 Thyroid (PV 2) and 7 other cancers]. 6 pts had hematologic malignancy [4 AML (ET 2, PV 2), 1 CLL (ET) and 1 NHL (ET)]. 341 (78%) of the 437 pts [222 (84%) ET; 119 (68%) PV] received one or combination of: 1- HU: 259 (60%) pts [162(62%) ET; 97 (56%) PV]; 2- Anagrelide (AG): 145 (33%) pts [112 (43%) ET; 33 (19%) PV]; 3- interferon (INF): 69 (16%) pts [47 (18%) ET; 22 (13%) PV]; 4- ALK (busulfan, melphalan or chlorambucil): 23 (5%) pts [16 (6%) ET; 7 (4%) PV]. Median follow up (MFU) was 69 months (1-396) with 27% of pts followed > 10 y. Risk of SM was 7% in pts treated with HU (ET 6%; PV 8%), 5% with AG (ET 4%; PV 9%), 4% with INF (ET 6%, PV 0%), and none of the pts receiving ALK developed SM (perhaps due to low number of pts and short MFU). 8 (8%) of the 96 pts not receiving any treatment developed SM. No statistical difference in SM risk was observed among treated and non treated groups. Conclusions: Our analysis confirmed inherited risk of developing SM in pts with ET and PV. Contrary to previous reports, the type of therapy received did not increase that risk, perhaps due to a relatively short MFU.
Tumoral and angiogenesis factors in hepatocellular carcinoma (HCC) after drug eluting bead (DEB) transarterial chemoembolization (TACE) with doxorubicin.
Authors: A. B. Farris, R. Dhanasekaran, N. Dursun, I. Coban, E. B. McIntosh, V. Adsay, H. S. Kim
Journal: Journal of Clinical Oncology (2010)

4162 Background: TACE has been used as a bridge to orthotopic liver transplant (OLT) in patients with HCC. TACE with doxorubicin DEB is a new novel locoregional treatment modality for HCC. The current study explores tumoral and angiogenesis factors on HCC after DEB TACE. Methods: Liver explants of consecutive patients receiving OLT for HCC were studied with regard to tumor burden, stage, grade, and extent of necrosis. Immunohistochemistry was performed for cytokeratin CK7, CK19, P53, Ki-67 and vascular endothelial growth factor (VEGF), and the extent of staining was analyzed within and surrounding the HCC. Statistical analysis was performed using SAS JMP software. Results: Explants without pretransplant therapy (n = 31), and 55 explants with pretransplant TACE were studied. Patients who received no treatment (group A, n = 31, 50%) were compared with conventional TACE (group B, n = 13, 23%) and DEB TACE (group C, n = 13, 23%). Pathologic and histologic factors of tumor burden, stage, and grade were similar between treatment group and control group. Mean % necrosis between groups A, B, and C was 6%, 73 %, and 42%, respectively, and group A versus B: p < 0.0001 for, A versus C: p = 0.0002, and B versus C: p = 0.009. By immunohistochemistry, only the DEB group showing any positivity of peritumoral CK19 in 17% of cases (Pearson chi square = 0.04). None of the groups had tumoral CK19 positivity. Using a threshold of 50% of tumoral cells, tumoral VEGF was significantly different between groups, with groups A, B, and C having this degree of positivity in 67%, 33%, and 18% (p = 0.02 between groups); however peritumoral VEGF was not significantly different between the groups. The cellular proliferation fraction measured by % Ki-67 positivity was higher in the treated groups (16%, 25%, and 37% for groups A, B, and C, respectively, with a significant difference between group A and C, p < 0.05). There were no statistically significant differences in tumoral or peritumoral CK7 or P53. Conclusions: DEB TACE with doxorubicin for HCC results in tumoral necrosis, increased tumoral Ki-67 and peritumoral CK19 and decreased tumoral VEGF. No significant financial relationships to disclose.
Population-based comparison of breast cancer screening and treatment utilization by remoteness of residence in British Columbia.
Authors: R. A. Olson, N. R. Caron, I. Olivotto, C. Speers, A. Davidson, S. K. L. Chia, A. Coldman, A. Nichol, C. Bajdik, S. Tyldesley
Journal: Journal of Clinical Oncology (2011)

593 Background: Cancer care is difficult for rural residents due to limited access to cancer screening and treatment. This study assessed whether breast cancer screening and treatment was lower for patients from rural communities, in a jurisdiction with universal publicly-funded health coverage for mammography and cancer treatment. Methods: All patients diagnosed with breast cancer in British Columbia (BC) during 2002 were identified from the cancer registry and linked to the provincial Screening Mammography database. Patient demographics, pathology, stage, treatments delivered, mammography use, and death dates were abstracted. Patients were categorized as residing in rural, semi-urban or urban locations based on postal code. Use of health care resources and outcomes were compared across residence categories. Results: All 2,872 women diagnosed with breast cancer in 2002 were included. Patients from rural communities (n=138; 4.8%) presented with more advanced stage than those from urban (p=0.010) and semi-urban (p=0.077) regions. On multivariable analysis, patients from rural, compared to urban communities, were significantly less likely to be screening mammography attendees (OR=0.587; p=0.004). Mammography use was most disparate among women in their 40s; 18.8% versus 55.4% (p=0.004) were mammogram attendees in rural versus urban communities, respectively. Women from rural communities with early-stage breast cancer were significantly more likely to undergo mastectomy (multivariable OR=2.364; p<0.001). Among patients receiving breast conserving surgery, adjuvant radiotherapy use was not significantly different by residence (p=0.967). Likewise, there was no significant difference in use of chemotherapy (p=0.712) or hormonal therapy (p=0.989) by residence category. With a median follow up of 7.4 years, overall survival (HR=1.235; 95% CI=0.804-1.899) and breast cancer specific survival (HR=1.213; 95% CI=0.704-2.088) were not significantly worse for rural compared to urban patients. Conclusions: Breast cancer screening and treatment use varied by community remoteness, but with short follow-up, did not translate into significantly worse outcomes.
The impact of hospice services in the care of patients with advanced stage non-small cell lung cancer.
Authors: Sara Hildebrand, Kristy Tayapongsak, Richard Stephenson, Nathan Paul Streer
Journal: Journal of Clinical Oncology (2014)

104 Background: Prior research has shown that early incorporation of palliative care alongside standard oncological care in metastatic non-small cell lung cancer (NSCLC) patients results in longer survival and less aggressive treatment at the end of life. The purpose of our study was to profile the continuum of care of stage IV NSCLC patients, comparing it to quality indicators for excellence in end-of-life (EOL) cancer care, as defined by the Quality Oncology Practice Initiative and other published studies. Specifically, our aim was to explore the connection between hospice enrollment and end-of-life quality measures. Methods: 197 deceased stage IV NSCLC patients diagnosed between 2008 and 2010 at two separate tertiary care centers within the same county were identified. A retrospective review was conducted, collecting data from electronic medical records regarding antitumor treatment services received, post-diagnosis hospital admissions, palliative care consultations, hospice referrals and enrollments, and circumstances surrounding the patient’s death. The patients were separated into two groups depending on their status of hospice enrollment, and the remainder of the measures compared accordingly. Results: There was no significant difference in number of lines of chemotherapy received and total number of post-diagnosis hospital admissions between the patients who were enrolled in hospice and those who were not. However, the group who received hospice services had a significantly lower number of hospitalizations in the last 30 days of life (p&lt;0.001), emergency department admissions in the last 30 days of life (p&lt;0.01), and intensive care unit admissions in the last 30 days of life (p&lt;0.001). Median survival, measured by the length of time between diagnosis and death, did not differ between the two groups. Conclusions: This study demonstrates that, among patients with metastatic NSCLC, hospice enrollment was associated with optimized end-of-life oncological care, as seen with fewer hospital admissions in the last 30 days of life, without incurring a lower median survival.
BRAF mutations in colonic high-grade neuroendocrine carcinoma.
Authors: Chandrasekhar Padmanabhan, Kimberly Brown Dahlman, Jordan Berlin, Eric Liu, Raul S. Gonzalez, Yan Guo, Chanjuan Shi, Kamran Idrees
Journal: Journal of Clinical Oncology (2016)

612 Background: The WHO 2010 has classified GI neuroendocrine neoplasms into well-differentiated neuroendocrine tumor (NET) and high-grade neuroendocrine carcinoma (NEC). NEC is more aggressive than NET. Whole genome sequencing (WGS) has provided insight into the genetic underpinnings of NET but little is known about NEC. The aim of this study is to perform genomic profiling of NEC to better characterize the underlying mutations in this aggressive disease. Methods: We identified 9 patients who underwent biopsy or resection for NEC between 1/2005 - 6/2013 with histological blocks available. WGS was performed on DNA extracted from tissue from 2 patients with ≥80% tumor cellularity using the Illumina HiSeq 2500 platform. Validation and mutational analysis of the BRAF gene was performed on 2 WGS patients and an additional 7 patients via Sanger Sequencing of exon 11 and 15. Results: 7 of 9 patients (78%) presented with metastasis at initial diagnosis (Table). 8 patients died of disease within 25 months. In 2 NECs, we identified BRAF mutations on exon 15 by WGS. Patient S1 presented with cecal NEC and had an A1781G:p.D594G mutation on exon 15. Patient S2 presented with a descending colon NEC and had a c.1799T&gt;A: p.V600E mutation on exon 15. An additional 7 colonic NECs were analyzed with Sanger Sequencing of exons 11 and 15. 2 had BRAFV600E mutations. Overall, BRAF mutations were present in 4 of 9 (44%) colonic NECs. The 3 cases with V600E mutations were large cell NECs, whereas the case with a D594G mutation was a small cell NEC. Conclusions: High grade colonic NEC is an aggressive tumor with high frequency (44%) of activating BRAF mutations. Further investigation is warranted to ascertain the incidence of BRAF mutations in a larger population as BRAF inhibition may be a potential avenue of targeted treatment for these patients. [Table: see text]
Association of <i>EGFR</i> CA simple sequence repeat 1 (CA-SSR1) variant with cetuximab (cet)-induced skin toxicity (ST) in Japanese metastatic colorectal cancer (mCRC) patients (pts) with overexpressed EGFR and <i>KRAS</i> exon 2 wild-type (<i>KRAS</i> wt) (JACCRO CC-05/06 AR).
Authors: Wataru Ichikawa, Yu Sunakawa, Akihito Tsuji, Takehiro Takahashi, Tadamichi Denda, Ken Shimada, Mitsugu Kochi, Masato Nakamura, Masahito Kotaka, Yoshihiko Segawa, Hiroaki Tanioka, Yuji Negoro, Akinori Takagane, Satoshi Tani, Tatsuro Yamaguchi, Toshiki Masuishi, Masahiro Takeuchi, Heinz-Josef Lenz, Masashi Fujii, Toshifusa Nakajima
Journal: Journal of Clinical Oncology (2015)

582 Background: Associations of EGFR gene copy number (GCN) and EGFR CA-SSR1 polymorphism with clinical outcome still remain controversial in mCRC pts treated with cet. Interethnic differences in the repeat number of EGFRCA-SSR1 have been reported between Caucasian and Asians, however, there have been few reports about the associations with clinical outcome in Japanese pts. The aim of this study was to evaluate the predictive value of two biomarkers in Japanese mCRC pts treated with cet. Methods: This study enrolled 77 pts with tumor available from two prospective clinical trials evaluating combination of cet with oxaliplatin-based chemotherapy as first-line treatment in mCRC pts with KRAS wt and EGFR-expressing tumors, modified FOLFOX6 (n=28/57, UMIN000004197) and SOX (n=49/67, UMIN000007022). Genomic DNA isolated by macro-dissection from tissue was screened for the EGFR GCN determined by FISH on FFPE tumor specimens with the cut-off value of 2.9, adopted as previously reported (Cappuzzo F, et al., 2008), and the EGFR CA-SSR1 short (S; ≤19) / long (L; ≥20) determined by PCR amplification and fragment length analysis using capillary electrophoresis. Associations of the biomarkers with efficacy, including response, progression-free survival, and overall survival, were evaluated. Additional analysis was addressed at a possible association between the EGFRCA-SSR1 and ST. Results: The frequency of the L alleles of the EGFR CA-SSR1 was 64%. There was no significant association between two biomarkers and efficacy. However, the EGFR CA-SSR1 variant significantly correlated with ST evaluated on 8 weeks after initial administration. The rate of ST with grade 2 or 3 was 33% (10/30), 19% (5/26), and 64% (7/11) in LL, SL, and SS genotype, respectively (fisher's exact test p=0.03). Conclusions: Our study provides first evidence that the EGFR CA-SSR1 variant was associated with cet-induced ST in Japanese mCRC pts. No predictive value for cet treatment could be identified in our screened biomarkers, however, extended RAS mutations analysis is warranted (UMIN000010635).
A Prospective Randomized Double Blind Phase 3 Clinical Trial of Anti- T Lymphocyte Globulin (ATLG) to Assess Impact on Chronic Graft-Versus-Host Disease (cGVHD) Free Survival in Patients Undergoing HLA Matched Unrelated Myeloablative Hematopoietic Cell Transplantation (HCT)
Authors: Robert J. Soiffer, Haesook T. Kim, Joseph McGuirk, Mitchell E. Horwitz, Laura Johnston, Mrinal M Patnaik, Witold Rybka, Andrew Artz, David L Porter, Thomas C. Shea, Michael W Boyer, Richard T. Maziarz, Madan H. Jagasia, Paul J. Shaughnessy, Usama Gergis, Hana Safah, Ran Reshef, John F. DiPersio, Patrick J. Stiff, Madhuri Vusirikala, Jeff Szer, Jennifer Holter, James D. Levine, Paul J. Martin, Joseph A. Pidala, Ian D. Lewis, Vincent T. Ho, Edwin P. Alyea, Jerome Ritz, Frank Glavin, Peter Westervelt, Yi-Bin Chen
Journal: Blood (2016)
Reducing the time from diagnosis to treatment of patients with stage II/III rectal cancer at a large county hospital.
Authors: Ryan Jacobs, Marc Steven Hoffmann, Lori Ann Leslie, Lymesia W. Jackson, Alyssa G. Rieber, Nishin Anil Bhadkamkar
Journal: Journal of Clinical Oncology (2014)

141 Background: The treatment of stage II/III rectal cancer is complex and requires multidisciplinary collaboration. Delays in definitive treatment may increase morbidity and compromise outcomes. The goal was to reduce the time from pathologic diagnosis to initiation of treatment by 30% for patients with stage II/III rectal cancer at Lyndon B. Johnson General Hospital (LBJGH), which provides care to uninsured and underinsured patients in Harris County, TX. Methods: The charts of 32 patients with rectal cancer diagnosed between July 2012 and December 2013 were reviewed. Baseline data regarding diagnostic and treatment time points were collected. Potential areas for improvement were identified through analysis of the baseline data, affinity sorting, and fishbone diagrams. A multidisciplinary rectal cancer working group with all relevant administrative and subspecialty stakeholders was created to discuss potential interventions and implementation strategies. The project was approved by the MD Anderson Quality Improvement Assessment Board. Results: Twenty-four of the thirty-two patients reviewed had stage II/III rectal cancer and were eligible for multimodality therapy with curative intent. The median time from pathologic diagnosis to treatment initiation was 62 days. The referral process was identified as the greatest source of delays. The median times from diagnosis to medical oncology and radiation oncology referral were 15 and 32 days, respectively. The median time for eligibility verification and clinical review by Case Management was 13 days. Conclusions: Based on these findings, two primary interventions have been instituted: (1) A synchronized referral process that will result in simultaneous consultation of all involved subspecialty services (surgery, medical oncology, and radiation oncology) was created for patients with rectal cancer; (2) Redundancy in the clinical review process was eliminated by coordination between Case Management and the Medical Oncology Chief Fellow. In tandem, these interventions are projected to reduce the time from diagnosis to treatment by approximately 50% (from 62 to 29 days).
Do survivors of adolescent and young adult cancer value follow-up cancer care?
Authors: Sapna Kaul, Eduardo Zamora, Rochelle Smits-Seemann, Kevin Boyle, Holly Perlman, Anne C. Kirchhoff
Journal: Journal of Clinical Oncology (2016)

8 Background: Survivors of adolescent and young adult (AYA) cancer, diagnosed between the ages of 15-39, require life-long medical care. Cost is a known barrier. However, survivors’ valuation of follow-up care has not been investigated. We used willingness to pay (WTP), an economic tool for evaluating monetary values associated with medical services, to examine how survivors value follow-up care. Methods: AYA cancer survivors ≥18 years of age who had completed their primary therapy were identified by the Utah Cancer Registry. Of 137 randomly-selected survivors, 64 agreed to be contacted; 32 participated. We conducted 6 focus groups and 4 interviews from April-August 2015. Participants filled out a mini-survey, discussed cancer-related follow-up care, and responded to WTP questions. Focus group transcripts were coded in NVivo by 2 researchers (percent agreement = 97.8%). An interval regression identified factors associated with higher WTP. Results: 56% of participants were females and average age was 31 years. Over 45% reported ≥1 day of poor physical health in the previous month, with 15% reporting ≥10 days. Yet, 28% and 10% had no routine follow-up visit with a doctor in the previous 1-2 and 2-5 years, respectively. Focus group coding suggested that survivors valued follow-up care for early detection and management of health conditions, although this decreased over time because of other responsibilities (e.g., college/work/family), they felt the medical visits were costly/ineffective, and because they lacked easy access to specialists. WTP analysis showed that married survivors were willing to pay $456 more for an annual follow-up visit than never-married/single/separated (p = .05). Those with recent checkups were willing to pay more than others (p = .07). Insurance did not affect WTP. Conclusions: Targeted survivorship care strategies are needed to address the needs of AYA cancer survivors who are at risk for skipping follow-up care. Survivors with no recent medical visits or who are not married need additional support.
Symptom burdens and coping strategies in adolescent and young adult (AYA) cancer survivors with hematologic malignancies.
Authors: Fay J. Hlubocky, Lori S. Muffly, Joseline X. Gomez, Kate Breitenbach, Jennifer Lynn McNeer, Wendy Stock, Christopher Daugherty
Journal: Journal of Clinical Oncology (2016)

256 Background: Prior research reveals that AYA survivors face significant short-term and long-term physical and psychological symptom burdens (SB) as a result of disease and treatment. Yet, the prevalence of SB and their effect on AYA coping in hematologic survivors has not been described. Methods: AYA patients (15-40 years at diagnosis) of acute leukemia, aggressive non-Hodgkin lymphoma, and Hodgkin lymphoma undergoing curative intent therapy (on-treatment cohort) or 2 year completion of therapy and in remission (early survivor cohort) completed following measures: depression (CES-D), state anxiety (STAI-S), PTSD (PCL-C), HRQOL (FACIT-G), Coping (Brief COPE). Semi-structured interviews evaluated symptom burdens. Results: To date, 60 AYA subjects (26 on-treatment, 34 early survivors) were interviewed. For total population: median age at diagnosis 25y (15-40); 63% male; 58% Ca; 79% college/postgrad educated; 40% income &lt; $75,000yr; 51% and 48% lymphoma or leukemia dx, respectively. Median time from diagnosis to interview was 13 months (1-102). In general, 56% AYA reported experiencing current physical (e.g. pain, sleep) SB and 58% AYA experienced psychological (e.g. anxiety) SB. AYA on treatment reported moderate STAI-S anxiety (35.0 ± 10.3 v 31 ± 10.2, p = 0.03); and CES-D depression (21 ± 12.1 v 10.4 ± 8.0, p = 0.01). AYA on treatment had poorer overall FACT-G health-related QOL (76.5 ± 12.8 v 82.3 ± 17.0, p = 0.02). Re coping, AYA on-treatment with depression scored highest on self-blame (5.2 ± 2.7; range: 3.5-6.8). AYA on-treatment with anxiety scored highest on denial (4.3 ± 2.1; range: 1-6). AYA in remission reported severe illness-related PTSD symptoms (58 ± 24.3 v 29.4 ± 9.5, p = 0.01). Re coping strategies, AYA in remission with PTSD scored on average significantly higher on: denial (6.5 ± 3.2; range 4.6-8.0); self-blame (6.6 ± 2.3; range: 4.2-7.9) and substance use (5.9 ± 2.1; range: 2.9-8.0). Conclusions: AYAs with hematologic malignancies report experiencing significant physical and psychological SB in the short and long-term. Early integration of palliative care targeting these SB should be incorporated into routine cancer as well as survivor care.