tbuckley/cabot-search huggingface dataset:
NCOG-56. THE NATURAL COURSE OF ATYPICAL MENINGIOMA AFTER GROSS TOTAL RESECTION WITHOUT ADJUVANT TREATMENT
Authors: Hee Jun Yoo, Jeong Hoon Kim
Journal: Neuro-Oncology (2020)

Abstract Atypical meningioma represent more aggressive clinical behaviors than WHO grade I meningiomas. In this study, We research natural course of atypical meningioma after gross total resection without adjuvant treatment. MATERIAL AND METHODS: We retrospectively reviewed the records of patients with histopathologically diagnosed atypical meningiomas between June 1990 and December 2015 at Asan Medical Center, Korea. Patients treated with Simpson grade I, II resection were included. Patients variably underwent adjuvant radiation therapy according to each surgeon’s preferences. RESULTS: In this study, 117 patients were enrolled and the average follow-up was 43 months (range 3~228 months). In Simpson grade I tumor resection group, recurrence was confirmed in 10 out of 63 patients without adjuvant treatment, and 1 out of 13 patients with adjuvant radiation treatment. There were 12 recurrence cases in Simpson grade II tumor resection and no adjuvant treatment group, of the total 32 cases. There was 4 recurrence case of total 8 cases of Simpson grade II tumor resection with adjuvant radiation treatment group. In groups with no adjuvant treatment, Simpson grade I resection group had a better prognosis on 5-year PFS (82.9% vs 54.9%, p=0.005) compared to Simpson grade II resection group. DISCUSSION: The results of this study show that there is a significant difference in 5-year PFS between the Simpson grade I and II groups without adjuvant treatment, commonly referred to as the gross total resection group. Although this study report adjuvant RT is not superior to observation, more intensive post-operative imaging surveillance protocols would be considered in Simpson grade II resection group without adjuvant treatment. CONCLUSION: The natural course of atypical meningioma after gross total resection without adjuvant treatment signified Simpson grade I and II resection show significant different prognosis.
Parallel genomic and immune profiling of relapsed and metastatic osteosarcoma to reveal bases of low immunogenicity.
Authors: J Andrew Livingston, Hannah Beird, Chia Chin Wu, Shaolong Cao, Shailesh M Advani, Davis Ingram, Wei-Lien Wang, Alexander J. Lazar, Cheuk Hong Leung, Heather Y. Lin, Alexandre Reuben, Youyun Zheng, Jason Roszik, Wenyi Wang, Shreyaskumar Patel, Robert S. Benjamin, Richard Greg Gorlick, Valerae O. Lewis, Andrew Futreal, Najat C. Daw
Journal: Journal of Clinical Oncology (2018)

10520 Background: Despite the high levels of point mutations, rearrangements, and other genomic instability events such as kataegis and chromothripsis, immune checkpoint inhibitors have shown limited clinical activity in osteosarcoma (OS). We completed in-depth parallel genomic and immune profiling in a cohort of 48 patients with high-grade osteosarcoma (relapsed or metastatic in 42) to determine potential mechanisms of primary resistance to immunotherapy and identify strategies to enhance immunogenicity. Methods: We utilized whole-genome sequencing (average coverage 75X), RNA sequencing, and immune profiling by T-cell receptor (TCR) sequencing and immunohistochemistry to analyze mutation load, cytotoxic and suppressive cell activity, relevance of checkpoint-related genes, and characterize immune infiltration in a clinically annotated set of primary resection, local relapse, and metastatic OS tumor specimens and matched normal tissue. Results: We observed high levels of gene rearrangements in approximately 60% of OS patient samples, however transcriptome sequencing showed a lack of fusion transcript expression from these rearrangements. Further, < 10% of point mutations were expressed, generating few neoantigens. Immune-related pathways, including immunosuppressive PD-L1 were upregulated in samples from older patients as compared to younger patients. Higher numbers of deleted genes were associated with higher immune infiltrate. Overall TCR clonality was low and did not correlate with mutation burden. T cell clonality did not differ by PTEN or HLA status. Conclusions: In the majority of OS, there is a lack of neoantigen expression and presentation. However, a subset of patients exhibit increased PD-L1 expression associated with lower levels of T-cell clonailty, for which immune checkpoint blockade may be beneficial and warrants further investigation.
Stereotactic body radiation therapy to generate comparable survival to surgery in treating hepatocellular carcinoma (HCC): Results of 756 patients.
Authors: Feng Ming Kong, Yong Zang, Wenhu Pi, David Long, Susannah Ellsworth, Naoyuki Saito, Marwan Ghabril, Marco A Lacerda, David M Agarwal, Bert O’Neil, Mark Tann, Richard C. Zellars, Mary A. Maluccio
Journal: Journal of Clinical Oncology (2017)

4080 Background: Stereotactic Body Radiation Therapy (SBRT) has emerged as a viable treatment option in patients with hepatocellular carcinoma (HCC). This study aimed to compare survival outcomes after SBRT with other front line local treatments for HCC. Methods: This is a retrospective analysis of patients identified through our cancer registry from 2000 to 2016. Patients treated with any local therapy alone were eligible: SBRT, surgery, conventional external beam radiation (CEBRT), and other local therapies including brachytherapy. Patients treated with combined therapies such as SBRT plus liver transplant were excluded. The primary endpoint was overall survival which was estimated from the time of diagnosis. Differences between the groups were compared using log-rank test. The data are presented as median (95%CI). Results: A total of 756 patients with a median follow-up of 45 months (mo) met the selection criteria: 116, 380, 43, and 217 patients received SBRT, surgery, CEBRT, and other local treatment, respectively. Median age was 61, 60, 61 and 60 years, respectively. The median overall survival/3 year overall survival rate were 49 (32-66) mo /53% (44-65%) for patients treated with SBRT, which were not significantly different from 75 (57-94) mo /63% (58-69%) of surgery (p = 0.27), non-significantly better than 22 (13-31) mo /41% (27-60%) of CEBRT (p = 0.13), significantly better than 15 (13-20) mo /26% (20-34%) of other local treatments (p = 3×10 -7 ). After adjusting for significant prognostic factors including age, race, status of tobacco abuse, history of alcohol use, tumor size, histology grade and stage, the survival outcomes of SBRT remained to be insignificantly different from surgery (HR = 0.8, p = 0.2), have a trend of significant difference from CEBRT (HR = 1.4, p = 0.1) and remarkably superior to that of other local treatments (HR = 1.8, p = 2×10 -4 ). Conclusions: This study suggests that SBRT is an excellent front line option for HCC, potentially comparable to surgical resection and associated with longer survival than other front line local treatments. Randomized studies are needed to validate these findings.
The prognostic value of teratoma in the primary tumor and postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) specimens in patients with germ cell tumors (GCTs).
Authors: Fadi Taza, Michal Chovanec, Anna Snavely, Nabil Adra, Nasser H. Hanna, Clint Cary, Timothy A. Masterson, Lawrence H. Einhorn, Costantine Albany
Journal: Journal of Clinical Oncology (2018)

4553 Background: A retrospective study using an institutional database from MSKCC [ASCO 2017, abstract # 4555] on 231 patients, showed that the presence of teratoma (T) in the primary testicular cancer was proposed to be an important clinical predictor of long-term outcome in men with GCT. We hypothesized that neither the presence nor the absence of T predicts the long-term survival in GCT patients. Methods: Metastatic non-seminoma (NSGCT) patients who received chemotherapy and had a primary testicular cancer (PTC) specimens available were included in this retrospective study. The cohort was divided into two groups according to the presence or absence of T in the primary tumor. The Indiana University Testicular Cancer Database was reviewed and survival data were correlated with the histopathological findings. Differences in overall survival (OS) and progression free survival (PFS) between the two groups were evaluated using log-rank test Results: PTC specimens were available from 1224 pts diagnosed between 1990-2016. Median age was 27.3 years (range 13.1-70.8) and median follow-up 1.9 y (range 0.1-30.1) since the initiation of chemotherapy. The element of T was present in 689 pts vs 535 without T. At the start of chemotherapy, 61.5%, 14.1% and 24.4% of pts were stratified as good, intermediate, and poor IGCCCG risk. The 5-year PFS in pts with the T present vs. absent was 61.9% (95% CI, 57.1% to 66.2%) and 63.1% (95% CI, 58.0% to 67.8%); P= 0.66, respectively. The 5-year OS in pts with the T present vs. absent was 82.2% (95% CI, 77.9% to 85.8%) and 81.4% (95% CI, 76.5% to 85.3%); P= 0.91, respectively. We then evaluated 503/1224 who underwent PC-RPLND, 327 had pure T and 146 had only necrosis in the resected lymph nodes. Five-year OS for pts with T vs necrosis was 90.3% (95% CI, 83.6% to 94.4%) and 93.4% (95% CI, 85.8% to 97.0%) respectively, P = 0.21. Conclusions: The presence of teratoma in primary tumor and PC-RPLND was not a prognostic factor in this retrospective study of patients with NSGCT.
Angiogenesis inhibitor bevacizumab and symptomatic anal ulcers in metastatic colorectal cancer patients: A single center experience.
Authors: Francesca Battaglin, Francesca Bergamo, Beatrice Salmaso, Sabina Murgioni, Rossana Intini, Luca Saadeh, Francesco Cavallin, Chiara Manai, Federica Urbano, Sara Lonardi, Carmelo Lacognata, Camillo Aliberti, Vittorina Zagonel, Carlo Castoro, Marco Scarpa
Journal: Journal of Clinical Oncology (2017)

e15042 Background: Chemotherapy (CT) associated with angiogenesis inhibitor bevacizumab (bev) is a standard first line treatment in metastatic colorectal cancer (mCRC). Among adverse events related to bev, anal canal ulcers have never been extensively described. The aim of our study was to evaluate symptomatic anal ulcers development and its impact on clinical practice and proctologic management. Methods: We retrospectively reviewed clinical records of 601 consecutive mCRC patients (pts) undergoing first line CT from January 2010 to December 2015 at our Institute. Pts’ characteristics, treatments and proctology reports were analyzed. Anal pain was graded in a semi-quantitative scale. Vascularization of the anal canal was compared with contrast MRI in 5 pts treated with bev and 5 healthy controls. Non parametric statistics was performed. Results: Fifty out of 601 pts reported perianal complaints during treatment and underwent proctologic evaluation. Among those, 16 were found to have an anal ulcer. Symptomatic anal ulcers occurred only in pts receiving CT plus bev (16 out of 384, 4.2%) while none was observed in 217 pts treated with other regimens (p = 0.009). The peak incidence was 4-8 weeks after treatment start. Vascularization of anal canal was significantly lower in pts treated with bev (p = 0.03). Hypertension and hemorrhoids were associated with a lower risk of anal ulcer occurrence (p = 0.009 and p = 0.036) while a previous neoadjuvant pelvic CT-RT was not associated with a higher risk. Pain intensity was severe. All attempts at symptomatic treatment with topical and sistemic drugs only led to transient benefit. Pts with symptomatic anal ulcers suspended their first line therapy significantly earlier than other pts (HR = 0.30, 95%CI 0.07-0.80). Conclusions: Symptomatic anal ulcer in mCRC pts treated with CT plus bev is a common adverse event in our series. It can compromise oncologic treatment and pts’ quality of life. We recommend an early proctologic evaluation in case of anal symptoms with the aim to prevent and timely manage such complication in pts treated with bev. A more extensive analysis is ongoing considering subsequent treatment lines and other angiogenesis inhibitors.
Communication about immunotherapy: Barriers and information to discuss.
Authors: Kristen Gillespy, Margie D Dixon, Rebecca D. Pentz
Journal: Journal of Clinical Oncology (2017)

6543 Background: Since immunotherapy is a promising new therapeutic approach to cancer treatment, improving physician/patient communication about this approach is important. No communication guidelines exist. To begin to fill this gap, we identified provider and patient preferences for information, and identified barriers to communication about immunotherapy. Methods: We qualitatively interviewed 15 oncology professionals who offer immunotherapy treatment about the information they deemed important to communicate to patients and the communication barriers. After a discussion about immunotherapy options with a provider, we interviewed 18 oncology patients about the information that was most useful to them and their impressions of immunotherapy. We captured impressions on two 1-5 scales with 5 being ‘very positive impression’ and ‘very likely to be cured’ and by picking words from a list of positive and negative terms like ‘effective’ and ‘risky.’ All open-ended questions were qualitatively coded. We reached saturation of themes with 18 patients. Results: Patients identified 4 useful topics to discuss: treatment options, benefits, treatment logistics, and side effects. Providers identified 3 topics important topics to convey: side effects, realistic view of benefit and treatment logistics. The most frequently provider-identified barrier to communication was patients’ baseline misconceptions about immunotherapy’s effectiveness. Supporting this, patients’ impressions were very positive (average of 4 on impressions scale and 3.9 on potential to be cured scale.) The most frequently chosen word patients chose to describe immunotherapy treatment was ‘hopeful’ (10/18 55%). Conclusions: There is largely agreement on the important topics to discuss about immunotherapy, though half of the patients thought a discussion of treatment options would be useful and only one physicians mentioned options. Of note, communication is hampered by patients’ preconceptions about immunotherapy’s effectiveness. Communication guidelines should identify techniques to effectively overcome this barrier.
A fully automatic solution for structuring prostate pathology reports.
Authors: Peter Prinsen, Robbert van Ommering, Marco Janssen, Marc Loos, Amir Tahmasebi, Scott Thompson, Samuel Coons, Per Henrik Vincent, Claes Lindh, Olof Akre, Ardeshir Rastinehad, Lance A Mynderse, Paul J Chang
Journal: Journal of Clinical Oncology (2018)

e18586 Background: A typical pathology report contains diagnoses of tissue types. Most pathology departments capture such information in free text, which makes it challenging to extract the information into a structured form. One application of such structured data is for Multi-Disciplinary Tumor Board (MDT) meetings, in which treatment options are discussed. A significant amount of time is usually spent prior to the meeting to manually summarize relevant information. In this paper, we propose a fully automatic solution for extracting information from free text prostate pathology reports. The proposed approach consists of several natural language processing modules that are developed with language-independence in mind. We store the data in a FHIR model specifically designed for prostate MDTs. Methods: Our solution uses a combination of ontologies, regular expressions and rules to detect the desired information. The FHIR data model is constructed for a typical prostate cancer MDT and based on guidelines available from multiple sites (English, Dutch, and Swedish). As an example, for anatomy detection, regular expressions were constructed to detect compound anatomical phrases. Each sub phrase corresponds to a set of prostate regions. To find the regions for to the compound phrase, the intersection of the regions corresponding to sub phrases were used. Results: Prostate pathology reports were available from multiple sites after ethics board approval and de-identification of the reports. Table 1 summarizes the performance of the proposed solution in terms of Recall, and Precision for three examples of information extraction modules. Conclusions: Structuring pathology reports is a challenging task currently performed manually. We presented a fully automatic solution to parse prostate pathology reports for MDT meetings and store them in a of FHIR model. English (291 reports from 3 sites) Dutch (73 reports from 3 sites) Swedish (40 reports from 1 site) Recall Precision Recall Precision Recall Precision Gleason score 99.7% 99.8% 100.0% 98.8% 99.4% 98.9% Vial 97.3% 99.4% 99.5% 98.9% 73.0% 97.5% Anatomy 97.6% 90.9% N/A N/A N/A N/A
Development of a dashboard for end-of-life care at an academic hospital.
Authors: Kerin B. Adelson, Neal J. Meropol, James Hamrick, Tyler Haydell, Jim Martineau, Joshua Kraut, Kimberly M Severino, Rogerio Lilenbaum
Journal: Journal of Clinical Oncology (2018)

6590 Background: Accurate, reproducible, transparent and continuous healthcare utilization measures derived from structured EHR data may facilitate higher value cancer care at the end of life in both community and academic settings. Prior manually abstracted data from Smilow Cancer Hospital at Yale-New Haven showed high rates of chemotherapy and hospital utilization within 30 days of death. However, these data were not actionable due to the challenges with manual collection, physician attribution and date of death. Methods: The Yale Smilow Cancer Hospital and Flatiron Health used a commercially-available obituary source to supplement EHR data for a cohort of patients who received care at Smilow and died in 2016 - 2017. We developed an algorithm to attribute each patient to the correct oncologist based on visit frequency. We then used structured EHR data to measure rates of utilization for the following measures within 30 days of death: inpatient admission, ICU, chemotherapy and immunotherapy. Automated reports with internal benchmarks were generated to summarize resource utilization by individual physician, disease team, and practice site with patient level detail. Prior to wide scale launch across our enterprise, we provided oncologists in our community based practices feedback on use of chemotherapy in the last 30 days of life. Results: We found high rates of utilization at the end of life at both academic and community sites, and were able to identify outliers at the site of care, disease team and physician level. In the group that received quarterly feedback on chemotherapy in the last 30 days of life we saw a 23% improvement (see table). Conclusions: Performance dashboards with patient-level granularity identify performance outliers and opportunities for care improvement interventions. The reusable date of death, physician attribution and dashboard infrastructure allows measurement over time and rapid development of new measures. Efforts are underway to apply patient risk stratification to interpretation of practice variation, in addition to benchmarking against a national patient sample. Chemotherapy in final 30 days. Timeframe Measure Score N 2017 Q1 30.3% (22.3, 39.5) 109 2017 Q2 24.6% (18.2, 32.5) 138 2017 Q3 23.3% (16.2, 32.3) 103
Changes in CTC burden and prevalence of specific CTC subtypes in mCRPC patients (pts) receiving alpharadin (Ra-223) as single agent or in combination with other therapuetics (Tx).
Authors: Ryan Vance Dittamore, Adam Jendrisak, Nicole A. Schreiber, Brigit McLaughlin, Ryon Graf, Angel Rodriguez, Martin Fleisher, Jerry Lee, James Kelvin, Yipeng Wang, Mark Andrew Landers, Howard I. Scher
Journal: Journal of Clinical Oncology (2017)

5076 Background: Ra-223 prolongs life in mCRPC pts with symptomatic osseous metastasis with inconsistent effects on PSA. Survival times are prolonged further when combined with Abi/Enza. Data from preclinical studies suggest that Ra-223 may sensitize tumors to DDR agents and/or biologic therapies. But predictive biomarkers of benefit to each or both combinationso are lacking. We studied CTC counts and the prevelance of specific CTC subtypes in patients before and following Ra-223 therapy, both as a single agent and in combination, to identify biomarkers of sensitivity and treatement efficacy, and effects of Ra-223 on tumor biology. Methods: Pre and ~4 week post RA-223 therapy blood samples were collected from 35 pts (2 samples each) given as a single agent (n = 20 pts) or in combination with other therapies (n = 15 pts, 9 w/ Enza, 5 w/ Abi, 1 w/ Taxane). Samples were processed and CTCs analyzed using the Epic Sciences platform. Total CTC count and the prevalence of specific CTC phenotypes present pre and post Rx were identified utilizing high content digital pathology and associated with therapy type and post-treatment change. Results: CTC declines were observed in 55% (11/20) and 60% (9/15) of pts treated with single agent and combination respectively. In Ra-223 alone pts, a novel CTC subtype (high N/C ratio, high nuclear area) was identified at baseline 11/20 samples (med = 33% of CTCs). Which was no longer detected in 10 (90%) of the pts treated. This contrasts with a second novel CTC subtype present at baseline in 4 pts (med CTC = 9%) that increased to 9 cases (med CTC = 18%) at follow-up. Conclusions: A subset of pts demonstrate post-therapy CTC declines following Ra-223 alone or in combination. A novel CTC subtype resolved by RA-223 in conjunction with total CTC kinetics may indicate pt benefit from Ra-223. A novel emergent CTC subtype has also been identified in pts already receiving Ra-223. Single CTC sequencing and protein analysys of these CTC subtypes are ongoing, and may help describe tumor evolution and sensitization to novel therapuetics.
Assessment of practice patterns and quality indicators for lymphadenectomy in melanoma.
Authors: Robert John Feczko, Bryan Anderson, Colette Pameijer, Joseph J. Drabick, Rogerio Izar Neves
Journal: Journal of Clinical Oncology (2016)

e18183 Background: There is considerable variation in the quality of melanoma care. Quality indicators need to be identified to ensure optimal care. Hospitals could assess their melanoma care through feedback mechanisms from the National Cancer Data Base and can better direct quality improvement efforts. The American College of Surgeons, based on a landmark publication (Bilimoria 2009) found 3 quality measures regarding minimum number of resected lymph nodes from lymphadenectomy that must be pathologically documented and examined. They set minimum nodes for cervical (15), axillary (10), and inguinal (5) areas. Based on hospital level assessment and compliance of at least 90% of patients meeting the minimum, < 25% of US hospitals met the criteria. The objective of this study was to evaluate adequate nodal evaluation for melanoma in a single institution and identify compliance after a quality improvement project. Methods: A retrospective chart review of all patients that underwent lymphadenectomy due to diagnosis of melanoma from October 1999 to October 2015 was performed. Each chart was evaluated and the surgical pathology report used to determine how many lymph nodes were documented by the pathologist according to the lymph node basin. These were evaluated for variability and compliance with the minimums established by the American College of Surgeons Committee on Cancer before and after a quality improvement project was implemented by the Penn State Skin Oncology Program. Results: In the studied period 88% of cervical, 87% of axillary and 98% of inguinal lymphadenectomies met the minimum number of lymph nodes resected and examined. However, after the implementation of the quality improvement project the compliance to these minimums has risen to 100%, 94.2% and 100% respectively. Conclusions: With valid quality measures by using a formal, well-described methodology by ACS, we substantially reduced the variation in the quality of melanoma care delivered in our institution. Hospitals can use these indicators to direct quality improvement efforts, which thus offers an opportunity to standardize and improve the quality of care in patients with melanoma.