tbuckley/cabot-search huggingface dataset:
Current status of availability of radiotherapy machines in Nepal.
Authors: Ambuj Karn
Journal: Journal of Clinical Oncology (2017)

e18042 Background: Nepal is a developing country with about 29 million populations. The incidence of cancer is 100-120 per 100 thousand populations and the number is increasing. The most common cancers in Nepal are of lung (13.2%), cervix (9.5%) and breast (8.6%). More than 80% of cancer patients present in advanced or metastatic stage where palliation can only be the goal of treatment. Radiotherapy is one of the essential treatment modalities for cancer, for both curative and palliative intent. This study aims to find the availability of radiotherapy machines throughout the country. Methods: Data regarding Radiotherapy machines in the country were collected by on site visit and by telephone conversations. Results: There are only seven centers having radiotherapy machines. Bir hospital was the first to start radiotherapy with telecobalt machine. At present there are 4 Tele-Cobalt machines, 5 Linear Accelerators and 5 High Dose Rate (HDR) Brachytherapy machines in the country. Most of the centers do only conventional 2-dimensional radiotherapy treatment. Newer centers which are non-government centers have high end linear accelerators with IMRT and IGRT facilities. HDR brachytherapy are used for intracavitory radiotherapy for endometrial and cervical cancers only. Conclusions: Nepal is far below the World Health Organization (WHO) recommendation of one megavoltage machine per million populations which means that Nepal should have at least 29 megavoltage machines. Combined efforts of public, government and international agencies are required to upgrade the situation.[Table: see text]
Retrospective review of concurrent chest radiation and chemotherapy (CRT) in newly diagnosed stage IV non-small cell lung cancer (NSCLC) with oligometastatic disease (OM) treated with stereotactic radiation.
Authors: Preeti Narayan, Anamaria R Yeung, Olushola Ogunlari, Chris G Morris, Priya Kadambi Gopalan
Journal: Journal of Clinical Oncology (2017)

e20539 Background:The primary treatment for patients (pts)with stage IV NSCLC is palliative chemotherapy (CT), with a median OS of approximately 10-12 months, and 5-year survival of ~2%. Several studies have demonstrated that pts with a lung nodule with a solitary brain or adrenal metastasis can achieve relatively high 5-year survival rates with resection of the metastasis and the lung nodule. Studies have also demonstrated that OM can be effectively treated with stereotactic body radiation (SBRT) or stereotactic radiosurgery (SRS) to the brain. We hypothesize that treatment of OM with SBRT and/or SRS and treatment of the thoracic disease with CRT will improve survival over palliative chemotherapy alone. Methods:A retrospective review of charts in the RADTRACS database at the Univ of Florida was conducted between 1/1/2010 - 6/30/2015 to identify pts with newly diagnosed stage IV NSCLC with 5 or less OM at diagnosis that were treated with concurrent CT and definitive RT (60-66 Gy) to the primary lung mass in addition to SRS and/or SBRT to the OM. Date and site of first progression, and date of death/last follow-up were noted. Endpoints included median progression free survival (PFS) and median overall survival (OS). Results:26 pts met these criteria. 20 pts (77%) had recurrence of disease after treatment with CRT + SRS/SBRT. Median PFS was 6 months, and median OS was 14.4 months. Of the 20 recurrences, 10 (50%) were in the brain, while 10 (50%) were in non-CNS sites. One year OS was 60% and 3-year survival was 33% in our patients. When pts with CNS OM at diagnosis were compared to non-CNS OM, PFS (5.5 vs 5.8 months, respectively, p &gt; 0.05) and OS (16.6 vs 13.8 months, respectively, p &gt; 0.05) were similar. 8/12 CNS OM pts progressed in the brain while only 3/9 non-CNS OM progressed in the brain. Of the 5 patients with no progression, 4/5 had non-CNS OM at diagnosis. Conclusions:When compared to standard palliative CT where median OS 10-12 months, median OS was 14.4 months in our pts treated with CRT + SBRT/SRS. This data suggests a possible role for more aggressive treatment of stage IV NSCLC pts with SBRT/SRS to OM and definitive chest CRT.
Chemotherapy in the ICU: Association between palliative care consultation and care goal documentation.
Authors: Audrey Brown, Kenneth G Bensch, Rebecca Rdesinski, Erik K Fromme
Journal: Journal of Clinical Oncology (2017)

e21516 Background: Patients receiving chemotherapy in the intensive care unit (ICU) are at high risk of morbidity and mortality. A growing consensus supports proactively addressing goals of care (GOC) - prognosis, goals, fears, and treatment preferences - rather than waiting until treatment options are exhausted. Palliative care consultations frequently address GOC but most often occur late in cancer care. We hypothesized that palliative care consultation is associated with an increased likelihood of GOC documentation. Methods: We reviewed electronic medical records of all patients who received chemotherapy for a cancer diagnosis in OHSU ICUs from 2010-2015, collecting patient demographics, cancer diagnoses and comorbidities, timing of palliative care consultation, chemotherapy administration, GOC documentation, and survival at 30 and 180 days following ICU discharge. Survival and diagnosis were also checked against the OHSU Tumor Registry. Results: 214 patients met our inclusion criteria. Demographics reflect the Oregon population, but with a male predominance (64.5% male, N = 138). A majority of ICU patients receiving chemotherapy had a hematologic malignancy (80%, N = 172), and acute respiratory failure as the reason for ICU admission (42%, N = 90). The majority (84%, N = 179) survived their ICU stay and 67% (N = 143) survived 30 days post-ICU discharge, whereas 50% (N = 108) died by 180 days post-ICU discharge. Documentation of GOC discussions was found for 95 patients (44%) and was more likely in patients receiving palliative care consult (71/72 = 99%) compared to those who did not (24/142 = 17%), p &lt; 0.0001, Fisher’s exact test. 63% of conversations occurred after chemotherapy had already been given (60.6% when palliative care was consulted, 70.8% when not, p = 0.4656). Conclusions: Chemotherapy in the ICU was associated with a 16% chance of dying in the ICU and a 50% 6 month mortality overall. Despite this, only 44% had documented GOC conversations and 63% of the conversations occurred after chemotherapy was initiated. Palliative care consultation was not associated with earlier GOC conversations. We recommend routine GOC conversations be initiated by oncologists prior to giving chemotherapy in the ICU setting.
Genomic index in pediatric synovial sarcoma (SYNOBIO study): The European Pediatric Soft Tissue Sarcoma Group (EpSSG) experience.
Authors: Daniel Orbach, Veronique Mosseri, Daniel Pissaloux, Bernadette Brennan, Andrea Ferrari, Frederic Chibon, Gianni Bisogno, Gian Luca De Salvo, Camille Chakiba, Nadege Corradini, Veronique Minard-Colin, Anna Kelsey, Dominique Ranchère-Vince
Journal: Journal of Clinical Oncology (2017)

10529 Background: A genomic index (GI) tool using array comparative genomic hybridization (aCGH) on tumor cells has recently been developed, and shown a high prognostic value in adult soft tissue sarcomas. GI correlates with genomic instability, and has emerged as independent prognostic factor associated with the risk of metastases developing in synovial sarcoma (SS). The aim, therefore, was to assess GI in pediatric patients with SS, to assess its value as a prognostic factor and its role in risk stratification. Methods: All pediatric/adolescent/young adults’ (&lt;25 years) with localized SS prospectively included in the European EpSSG-NRSTS05 protocol with a contributive aCGH were selected. Tumors had a central pathological review or harbored the specific fusion transcript (SYT-SSX). Definition of GI was A 2 /C, where A is the total number of alterations (segmental gains and losses) and C is the number of involved chromosomes on aCGH results. GI 1 group corresponds to cases with no or few alterations (flat profile, GI≤1) and GI 2 group cases with many alterations (complex CGH profile; GI&gt;1). Results: A total of 48 patient’s samples were available. The median age of the cohort was 13 years (range: 4-24). Patients received surgery only (19%), with adjuvant therapy (17%) or perioperative therapy (64%). GI 1 group corresponded to 54.2%, and GI 2 to 45.8%. After a median follow up of 58 months (range: 0.1-107), 10 tumor events occurred and 5 patients died. Patients with high GI have more axial (P&lt;0.01), invasive (P=0.04) and higher therapeutic risk groups’ tumors (unresectable/axial tumors; P&lt;0.015). Respectively for GI 1 vs. GI 2 groups, 5-year event free survival (EFS) rates were 91.8±5.6% vs. 58.9±11.2% (P&lt;0.0084) and 5Y-Metastatic Free Survival 91.8±5.5% vs. 68.6±10.6% (P=0.055). In multivariate analysis, GI adjusted for IRS groups, site and tumor size remains prognostic for EFS (P&lt;0.025). Conclusions: Although tumor events were rare for SS in NRSTS 2005, high GI selected patients with high risk tumor features and predicted a poorer outcome. GI may explain aggressive behavior of some pediatric SS. Founding sources: “Enfant-et-santé/SFCE,” “Info sarcome,” and “La ligue contre le cancer.”
Attendance at National Cancer Institute Cancer Centers (NCI-CC) by older adults with myeloma.
Authors: Tanya Marya Wildes, Mark A Fiala
Journal: Journal of Clinical Oncology (2017)

e18020 Background: Older adults with myeloma (MM) have poorer survival than younger patients. NCI-CC attendance is associated with superior outcomes in many cancers. Studies show that older adults are reluctant to be treated in university settings and are more likely to be treated in the community setting. We aimed to define the factors associated with NCI-CC attendance in older adults with mm from a nationally representative sample and its association with survival. Methods: We identified all mm cases in the SEER-Medicare linked database from 2000-2011. Included cases were enrolled in Medicare Part A and B &gt; 1 year prior to diagnosis; we excluded those enrolled at age &lt; 65. Any center designated a NCI-clinical or -comprehensive center in 2002, 2005, or 2010 was considered an NCI-CC; attendance was defined as ≥2 separate claims from an NCI-CC in the 1-year after mm diagnosis. CM were calculated using the Charlson Comorbidity (CM) Index (CCI). Poor performance status indicators (PSi) were coded as present or absent. Logistic regression was performed to determine if age was associated with NCI-CC attendance. Cox regression was determined the association of NCI-CC attendance with survival. Results: 21,843 cases were included; median age was 77 years. Overall 10.6% of the cohort attended an NCI-CC. Increasing age was associated with decreasing NCI-CC attendance rates: 18.6% (age 65-69), 13.9% (age 70-74), 9.0% (age 75-79) and 6.0% (age ≥80). After controlling for race, gender, socioeconomic status, and urban/rural regions, increasing age, poor PSi and CCI were each associated with lower odds of NCI-CC attendance [Age: OR 0.925/year (95% CI 0.92-0.93); Poor PSi: OR 0.87 (CI 0.76-1.00); CM: 0.94/CCI point (CI 0.90-0.97)]. After controlling for sociodemographics, PS and CCI, NCI-CC attendance was associated with lower mortality [HR 0.74 (95% CI 0.70-0.78)]. Conclusions: With increasing age, poor PS indicators and CM, pts are less likely to attend an NCI-CC. After controlling for other prognostic factors, attendance at an NCI-CC was associated with lower mortality. Data from trials in older mm pts from NCI-CC or other tertiary care centers must be viewed with caveat that pts tend to have better PS and fewer CM.
TCT-473 Left bundle branch block after TAVI with Edwards Sapien 3 System: influence of the valve depth
Authors: Leire Unzue, Eulogio García, Belén Díaz-Antón, Francisco Javier Parra, Leticia Fernández-Friera, Francisco Jose Rodriguez Rodrigo, Rodrigo Teijeiro, Alberto Rubio, Maria Jesus Fernandez del Cabo, Miguel Rodriguez del Rio
Journal: Journal of the American College of Cardiology (2018)
Impact of vitamin K dosing during sorafenib treatment for hepatocellular carcinoma: Effect on ischemic tumor cell damage caused by sorafenib.
Authors: Yoshimichi Haruna, Noriko Hasegawa, Kazuho Imanaka, Atsuo Inoue, Masatoshi Kudo
Journal: Journal of Clinical Oncology (2016)

e15585 Background: Sorafenib’s anticancer effects are limiting. It was reported that combination of vitamin K and sorafenib inhibited HCC growth in vitro and in vivo study. We examined retrospectively the impact of vitamin K dosing during sorafenib treatment. Methods: Sixty-four patients (the Barcelona Clinic Liver Cancer (BCLC) stage B/C 24/40) were studied. Twenty-eight out of them were orally given vitamin K2 (45mg daily) during sorafenib treatment. There were no relevant differences between the vitamin K dosing and sorafenib alone groups in characteristics at baseline. The radiologic assessment was performed according to modified RECIST. Results: Median PFS was 7.0 months vs. 2.0 months in vitamin K dosing group and sorafenib alone one (P < 0.001), respectively. Vitamin K dosing also prolonged OS significantly (median survival: 12.5 months vs. 10.0 months, P = 0.016). Subgroup analysis revealed that vitamin K dosing prolonged OS especially in patients without vascular invasion or extrahepatic spread. In such patients, median OS was 29.0 months in vitamin K dosing group, whereas that of sorafenib alone group was 15.5 months (P = 0.014). On the other hand, a unique difference in DCP changes (pre vs. 8 weeks after) were observed in patients with partial response or stable disease. Serum DCP levels was increased in sorafenib alone group despite suppressed tumor growth (2.28±0.91 → 2.64±1.03 Log mAU/mL, P = 0.048). In contrast, vitamin K dosing group showed decreased DCP levels (2.01±0.58→1.30±0.29 Log mAU/mL, P = 0.003). Discussion and Conclusions: DCP is an indicator reflecting vitamin K deficiency and ischemic status of HCC tumor cells. DCP elevation seen in the sorafenib alone group shows ischemic status of tumor cells resulting from impaired angiogenesis. The DCP elevation could jeopardize sorafenib’s antitumor action, because DCP is reported to work as a growth factor for HCC and vessel endothelial cells. Large amount of vitamin K dosing suppresses DCP production by increasing vitamin K concentration inside tumor cells. The nontoxic agent, vitamin K, dosing could augment antitumor action of sorafenib possibly by enhancing ischemic damage of tumor cells.
A phase Ib/II study of cancer stemness inhibitor napabucasin (BB608) combined with weekly paclitaxel in advanced non-small cell lung cancer.
Authors: Carlos Becerra, Alexander I. Spira, Paul R. Conkling, Stephen Lane Richey, Wahid Tewfik Hanna, Gregory Michael Cote, Rebecca Suk Heist, Adrian Langleben, Scott Andrew Laurie, William Jeffery Edenfield, Kimiko Kossler, Stephanie Hume, Youzhi Li, Matthew Hitron, Chiang Li
Journal: Journal of Clinical Oncology (2016)

9093 Background: Napabucasin (BBI-608, BB608) is a first-in-class cancer stemness inhibitor that works through inhibiting the STAT3 pathway, and it has shown potent synergistic anti-tumor activity with paclitaxel in vivo. In a phase Ib dose escalation study in patients (pts) with advanced solid tumors, BB608 plus weekly paclitaxel was well tolerated. Phase II accrual to disease-specific cohorts included patients with advanced, heavily pre-treated metastatic non-small cell lung cancer (NSCLC). Methods: Pts with metastatic squamous or non-squamous NSCLC who had progressed on prior systemic therapy were enrolled to assess safety, tolerability, and preliminary anti-cancer activity. BB608 was administered orally at a starting dose of 240 mg twice daily with paclitaxel 80 mg/m2 IV weekly 3 of every 4 weeks. A sample size of 40 set the bounds of the 90% CI at ±10% to 14%, assuming a disease control rate (DCR) of 60% to 80%. DCR is the proportion with stable disease (SD) of at least 8 weeks or objective partial (PR) or complete response (CR) per RECIST 1.1. Results: 27 pts were enrolled with a median number of 3 prior lines of systemic treatment; 26/27 pts (96%) had received prior taxane-based therapy. Treatment was well tolerated. Related grade 3 adverse events included diarrhea (n = 1) and hyponatremia (n = 1) and were rapidly reversible. For evaluable pts (n = 19), DCR was 79%, tumor regression occurred in 37%, and objective partial response (PR) in 16%. For evaluable non-squamous pts (n = 15), DCR was 87%, tumor regression occurred in 47%, and PR in 20%. Overall (ITT, n = 27), DCR was 56%, tumor regression occurred in 26%, and PR in 11%. Median progression free survival (mPFS) was 16 weeks and median overall survival (mOS) was 34 weeks. For non-squamous pts (ITT, n = 22), mPFS was 17 weeks and mOS was 37 weeks. Conclusions: Safety, tolerability, and encouraging signs of anti-cancer activity were observed in pts with heavily pretreated NSCLC who received BBI608 plus weekly paclitaxel. Objective response, tumor regression, durable disease control, and prolonged progression free survival and overall survival in this refractory population are notable, and further clinical evaluation is warranted. Clinical trial information: NCT01325441.
Post-gastrectomy complications and mortality in elderly patients with gastric cancer: A population-based study.
Authors: Larysa Jessica Sanchez, Michael J Sylvester, Shijia Zhang, Veronica Mariotti, Narjust Duma, Yucai Wang, Ricardo Parrondo, Jean Anderson Eloy, Martin Gutierrez
Journal: Journal of Clinical Oncology (2016)

e21533 Background: We aimed to evaluate post-gastrectomy outcomes in patients (pts) age ≥ 75 using the Nationwide Inpatient Sample (NIS), as population based data in elderly pts are needed given the increased incidence of gastric cancer in the aging population. Methods: We used the NIS database to identify all gastric cancer pts admitted to US hospitals for gastrectomy from 2005-2010. Outcomes in elderly and younger pts were compared. Results: We identified 9455 pts, median age was 68; 3022 pts (32%) were in the elderly group (age ≥ 75) and 6433 (68%) were age 18–74. Elderly pts had more major post-operative (post-op) complications (table), higher in-hospital mortality (7.3% vs. 3.4%, p < 0.001), longer length of stay (LOS) (14.9 ± 11.8 (SD) vs. 13.3 ± 12.1 days, p = 0.010), and higher total hospital charges ($111,281 ± $115,804 vs. $101,559 ± $112,652, p = 0.009) compared to younger pts. In multivariate logistic analysis, age ≥ 75 was a significant predictor of in-hospital mortality (OR 2.00, CI 1.59-2.52, p < 0.001), as were post-op complications such as acute kidney injury (OR 3.02, 95% CI 2.24-4.06, p < 0.001), acute respiratory failure (OR 4.15, 95% CI 3.13-5.49, p < 0.001), severe sepsis/septic shock (OR 11.25, 95% CI 8.30-15.24, p < 0.001), and acute heart failure (OR 2.12, 95% CI 1.55-2.91, p < 0.001). Conclusions: Compared to younger pts with gastric cancer undergoing gastrectomy, elderly pts had significantly increased in-hospital mortality, post-op complications, LOS, and total hospital charges. Early recognition of complications may reduce morbidity/mortality and future studies are essential to determine optimal gastric cancer treatment strategies in the rapidly growing geriatric population. Post-op complication Age 18-74 n (%) Age ≥ 75 n (%) OR (95% CI), P value Deep Vein Thrombosis 113 (1.8) 81 (2.7) 1.54 (1.16-2.06), 0.003 Pneumonia 450 (7.0) 275 (9.1) 1.33 (1.14-1.56), < 0.001 Acute Kidney Injury 252 (3.9) 226 (7.5) 1.99 (1.65-2.39), < 0.001 Acute Respiratory Failure 297 (4.6) 205 (6.8) 1.51 (1.25-1.81), < 0.001 Severe Sepsis/Septic Shock 192 (3.0) 123 (4.1) 1.38 (1.10-1.74), 0.006 Delirium 33 (0.5) 48 (1.6) 3.13 (2.01-4.89), < 0.001 Acute Heart Failure 270 (4.2) 361 (11.9) 3.10 (2.63-3.65), < 0.001
Relationships between immune cell profiles and frailty in patients with breast cancer from pre- to post- chemotherapy: A University of Rochester NCI community oncology research program prospective, longitudinal study.
Authors: Nikesha Gilmore, Mostafa R. Mohamed, Lianlian Lei, Allison Magnuson, Ronald John Maggiore, Supriya Gupta Mohile, Benjamin Esparaz, Jeffrey K. Giguere, Jamal Ghazi Misleh, Michelle Christine Janelsins
Journal: Journal of Clinical Oncology (2018)

10099 Background: Frailty is an important factor for oncologists in determining risk of chemotherapy toxicity, especially for older adults. While inflammation has been associated with survival, its relationship with developing frailty is not understood. In this secondary analysis we sought to determine whether changes in immune cell profiles are predictive of frailty after chemotherapy. Methods: Patients (pts) had stage I-IIIc breast cancer (n = 583, mean age 53; range 22-81) scheduled to receive adjuvant/neoadjuvant chemotherapy. Frailty was assessed by a modified Fried score (0-4) using self-reported measures of weakness, exhaustion, physical activity and walking speed. Absolute counts of immune cell types as well as neutrophil:lymphocyte ratio (NLR) and lymphocyte:monocyte ratio (LMR) were calculated at pre-chemotherapy (PrC; ≤7 days of first cycle) and post-chemotherapy (PoC; ≤ 1 month of last cycle). Separate linear regressions were used to evaluate the associations between PrC cell counts and ratios with PoC frailty, controlling for relevant covariates and baseline frailty. Additional analyses examined the associations of changes in cell counts and ratios with changes in frailty (PoC minus PrC). Results: Chemotherapy significantly increased pts mean frailty score (PrC = 1.28, PoC = 2.0; p < 0.001). Higher PrC LMR was significantly associated with higher PoC frailty (β = 0.20; p = 0.035). Lower PrC NLR was marginally associated with higher PoC frailty (β = -0.158; p = 0.078). In both models higher baseline frailty and older age were significantly predictive of PoC frailty. From PrC to PoC, greater lymphocyte decrease (β = -0.27; p = 0.036) and NLR increase (β = 0.18; p = 0.015) were predictive of increased frailty change score. LMR decrease (β = -0.17; p = 0.058) was also marginally associated with increased frailty score. Conclusions: Baseline LMR and lymphocyte decline were both predictive of PoC frailty. Immune cell counts may help clinicians identify pts at risk of frailty PoC. Future research is needed to further elucidate inflammation-related mechanisms of frailty in cancer patients.