tbuckley/cabot-search huggingface dataset:
Pediatric oncology providers and use of medical marijuana in children with cancer.
Authors: Prasanna Janaki Ananth, Clement Ma, Hasan Al-Sayegh, Abby R. Rosenberg, Kelly Michelson, Leah Kroon, Victoria Klein, Claire M Wharton, Elise Hallez, Joanne Wolfe
Journal: Journal of Clinical Oncology (2016)

10581 Background: Widespread state legalization of medical marijuana (MM) has increased access for children with serious illness. However, MM use remains controversial in pediatrics. Among children with cancer, MM may have a role in supportive care. We investigated provider perspectives on MM use in pediatric oncology patients. Methods: A cross-sectional survey was sent electronically to 654 pediatric oncology providers at 3 National Cancer Institute-designated cancer centers in Illinois, Massachusetts, and Washington, where MM is legal. 313 (48%) responded; 301 (46%) were included in analyses. The 32-item survey elicited attitudes, practices, barriers, and awareness. Responses were analyzed descriptively. Results: Median age of providers (59% nurses, 29% physicians, 10% physician-extenders) was 35 (range 22-70); 85% were female, and 88% were white. Almost all providers (92%) were willing to help pediatric cancer patients access MM. Most providers approved of oral MM formulations (90%) and of using MM to manage symptoms in pediatric oncology patients (92%). 88% of providers felt MM would be appropriate near the end of life, while far fewer (34%) felt it would be appropriate in the early stages of cancer treatment. Most were unconcerned about substance abuse among patients who receive MM (62%). Nearly one-third of providers (30%) received requests from patients or families for MM ≥ 1 time in the past month. Among providers receiving requests, 14% facilitated access. Nausea, anorexia, and pain were the most common symptoms for which MM was solicited. 46% cited the absence of standards around formulations, potency, or dosing to be the greatest barrier to recommending MM. Regarding awareness, a large majority of providers (86%) knew that their state had legalized MM. Fewer (58%) knew that MM is against federal laws, and only 5% knew state-specific regulations concerning access, possession, and cultivation. Conclusions: Pediatric oncology providers hold predominantly favorable attitudes toward MM use in pediatric cancer patients. While MM inquiries are frequent among pediatric cancer patients and families in states where it is legal, more education is needed to increase provider awareness of state and federal regulations.
Retroperitoneal cancer viability after postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in good risk 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)

4551 Background: Four cycles of etoposide and cisplatin (EP × 4) or 3 cycles of bleomycin, etoposide, and cisplatin (BEP × 3) is the current standard of care for patients with good-risk testicular cancer. We sought to examine the differences in the tumor viability for patients treated with EP x 4 vs BEP x 3 in the (PC-RPLND) specimens. Methods: The Indiana University (IU) Testicular Cancer Database was queried to identify IGCCCG good-risk patients who received EP × 4 or BEP × 3 induction chemotherapy followed by PC-RPLND. The primary endpoint was PC-RPLND cancer viability vs teratoma presence. Results: A total of 291 patients treated between 1988 and 2017 met the inclusion criteria. Median age was 28 (14.6-70.8) years. Primary histology was non-seminoma in 92.8%. Induction chemotherapy consisted of EP × 4 in 45 (15.5%) patients and BEP × 3 in 246 (84.5%). One hundred and sixty-six patients (57.2%) received chemotherapy outside the IU and were subsequently referred for PC-RPLND. Using a logistic regression model after accounting for age and time to surgery, patients who received EP x 4 have approximately 2.5 times the odds of having residual cancer viability in the PC-RPLND (Odds ratio 2.548, 95% CI 1.130-5.744, p = 0.024) and no significant difference in the odds of having teratoma (Odds Ratio 0.669, 95% CI 0.343-1.303, p = 0.237). Conclusions: Our retrospective study has shown differences in pathological outcomes for good risk GCT patients treated with EP x 4 vs BEP x 3. Patients who received BEPx3 had less residual cancer in the RP specimen at the time of PC-RPLND compared to EPx4 after adjusting for age and time to surgery. We prefer to use BEPx3 as first line chemotherapy in good-risk patients unless there is a contraindication for bleomycin.
P01.042 Symptom clusters in newly diagnosed glioma patients: which clusters are associated with functioning and global health status?
Authors: M B Coomans, L Dirven, M van den Bent, A Bottomley, C Coens, R Stupp, M Weller, J C Reijneveld, M J B Taphoorn
Journal: Neuro-Oncology (2018)

Symptom management in glioma patients remains a challenge, as patients suffer from various concurrent occurring symptoms. This study aimed to identify symptom clusters and to examine the relation between these symptom clusters and functioning. We prospectively included individual patient data from previously published international randomized controlled trials (RCTs) in glioma patients. Symptom prevalence and level of functioning were assessed with EORTC QLQ-C30 and QLQ-BN20 questionnaires. The magnitude of the associations between symptoms were examined with Spearman correlation coefficients and correlation matrices. Hierarchical cluster analyses (looking at euclidean distances) were performed to identify symptom clusters. Multivariable regression analyses were performed to analyze associations between the symptom clusters and functioning, adjusted for confounding variables. Data of 3595 newly diagnosed glioma patients who completed the questionnaires before randomization indicated that many patients (44%) suffered from 5–10 symptoms simultaneously. The most prevalent symptoms were fatigue, drowsiness and motor dysfunction, experienced by 86%, 59% and 55% of the patients respectively. Five symptom clusters were identified with hierarchical cluster analyses: motor cluster, fatigue cluster, headache cluster, gastrointestinal/seizures cluster and hair loss/itchy skin cluster. Having symptoms in the motor cluster had a clinically relevant and significant negative influence (≥10points difference) on the global health status/quality of life scale, and physical, role, cognitive and social functioning (Beta’s ranged from -10.9 to -18.6, all p<0.001). Similarly, having symptoms in the fatigue cluster had a clinically relevant negative influence on the global health status/quality of life scale, and role and social functioning (Beta’s ranged from -10.7 to -15.5, all p<0.001) Two symptom clusters, the fatigue and motor cluster, were frequently affected in glioma patients and demonstrated to negatively influence functioning and global quality of life. Implementation of interventions targeting fatigue and motor problems would therefore contribute to improved functioning and quality of life in glioma patients.
Selection for active surveillance in mRCC by the CLEAR multigene score.
Authors: Ravindran Kanesvaran, Kellynn Oen, Huihua Li, Hui Shan Tan, Jian Cheng Hong, Yukti Choudhury, Min-Han Tan, Quan Sing Ng, Chee-Keong Toh
Journal: Journal of Clinical Oncology (2018)

e16552 Background: Active surveillance (AS) is a well-recognized clinical option in the first-line management of patients with metastatic renal cell carcinoma (mRCC). AS has potential advantages to up-front targeted therapy in terms of quality of life, achieving similar overall survival outcomes. Clinical selection of patients with indolent disease is however a key issue. The CLEAR score has been previously reported as a formalin-fixed paraffin embedded (FFPE) tissue-based eight-gene predictor predicting prognosis and therapeutic outcomes in mRCC (Eur Urol 2015). Therefore, we investigated the CLEAR score as a potential molecular predictor for AS selection. Methods: A patient cohort with mRCC (2005-2017) in one Singapore centre for whom CLEAR scores were generated were retrospectively identified (n = 102). Following planned exclusion to minimize self-selection bias, 67 patients were selected for analysis. AS was defined as ≥ 3 months between diagnosis of mRCC and planned first-line drug therapy. Overall survival, cancer-specific survival (CSS) and time to treatment were analyzed as outcomes in univariable and multivariable models, notably with treatment initiation being considered as a time varying covariant. Results: Variables correlating with poorer prognosis on univariable analysis included CLEAR score, nephrectomy status, grade, IMDC status, and choice of upfront treatment selection. Higher CLEAR scores correlate with poorer prognosis in both univariable and multivariable analysis after adjustment for AS status (p = 0.01 and 0.03). Lower CLEAR scores were observed in patients selected for active surveillance by clinicians (p = 0.03). Conclusions: The CLEAR score may potentially select patients with more indolent disease for upfront active surveillance. A prospective trial is warranted to investigate the CLEAR score as an AS predictor, allowing patients to be spared unnecessary upfront toxicities and costs.
Cell-free DNA detected by “liquid biopsy” as a potential prognostic biomarker in patients with different subtypes of breast cancer.
Authors: Sara Ravaioli, Roberta Maltoni, Valentina Casadio, Maria Maddalena Tumedei, Flavia Foca, Samanta Salvi, Filippo Martignano, Daniele Calistri, Andrea Rocca, Sara Bravaccini
Journal: Journal of Clinical Oncology (2016)

e23081 Background: Conventional biomarkers used to define breast cancer (BC) subtypes are not always capable of predicting prognosis. Thus, the search for new biomarkers that can be easily detected by liquid biopsy is ongoing. Recent studies have shown that cell-free DNA (cf-DNA) could be a promising diagnostic marker in different tumor types. However, its prognostic value in BC has yet to be confirmed. This retrospective study evaluated the prognostic role of cf-DNA quantity of BCAS1, PI3KCA, HER2 and c-Myc, 4 frequently altered genes in BC, considering different BC subtypes (luminal A, luminal B, triple negative, HER2 positive). Methods: A total of 80 serum samples were collected before surgery from women at first diagnosis of BC operated on in the Breast Unit of Forlì Hospital (Italy) from 2005 to 2008. Twenty relapsed patients and 60 non-relapsed patients (5 relapsed and 15 non-relapsed for each tumor subtype) were paired by subtype and age. Blood samples were also collected from 10 healthy donors. All samples were analyzed by Real Time PCR for cf-DNA quantity of BCAS1, PI3KCA, HER2 and c-Myc. The relationship between cf-DNA quantity values and prognosis was analyzed by a nonparametric ranking statistic test. Accuracy was measured by the area under the ROC curve (AUC). Results: Significantly higher median values for the absolute quantity (ng) of HER2, BCAS1 and PI3KCA cf-DNA were found in BC patients than in healthy controls (HER2 0.238 vs 0.067, p = 0.0160; BCAS1 1.259 vs 0.085, p = 0.0011; PI3KCA 1.619 vs 0.174, p= 0.0015). A difference in the quantity of HER2 cf-DNA was observed between non-relapsed and relapsed patients although non-statistically significant (median values 0.202 vs 0.438, p = 0.057), independently of tumor subtype. Of the 4 analyzed oncogenes, HER2 and PI3KCA showed AUC values of 0.639 and 0.612, respectively, showing the highest accuracy in predicting relapse of disease. Conclusions: The present study supports the rationale for a liquid biopsy approach to detect prognostic biomarkers on which to base the clinical management of patients independently of BC subtype. Our preliminary data now require validation in a larger case series to establish their prognostic value in BC.
Psychiatric illness and medical comorbidities in endometrial cancer (EC) patients.
Authors: Ahmed Y. Abdelbadee, Mohamed A. Bedaiwy, Felicia L. Bahadue, Kristine M. Zanotti
Journal: Journal of Clinical Oncology (2016)

e17116 Background: Psychiatric disorders are common among gynecologic cancer patients. Anxiety and depression are the most common diagnoses in this population. While rates reported in the literature are as high as 30%, few studies examine the impact of psychiatric illness in gynecologic cancer patients. The purpose of this study was to examine the association between psychiatric co-morbidity on both medical and oncologic presentations in a cohort of EC patients. Methods: A retrospective exploratory cohort analysis of EC patients that underwent surgical treatment at University Hospitals Case Medical Center medical records between 2008 and 2014 was undertaken. A psychiatric diagnosis was present if patients self-reported a formal diagnosis, diagnosed during therapy or if actively prescribed psychotropic medication. Chi square test and t-test were employed to examine significance of differences between EC patients with and without psychiatric illness. Results: 156 patients were analyzed; 24.4% (n = 38) had diagnosis of psychiatric illness. Psychiatric illness included anxiety (5.1%), depression (12.2%), anxiety and depression (5.8%), bipolar disorder (0.6%) and schizophrenia (0.6%). Although there were no differences in age, histopathology or tumor grade, advanced FIGO stage at diagnosis was significantly associated with psychiatric illness (I: 81.6% vs. 90.7%, II: 7.9% vs. 0%, III: 7.9% vs. 7.6%, IV: 2.6% vs. 1.7%, P = 0.02). Elevated mean body mass index (38.3 vs. 34.9 kg/m2, P = 0.03), obstructive sleep apnea (23.7% vs. 5.1%, P = 0.01), pulmonary disease (23.7% vs. 10.2%, P = 0.03), hyperlipidemia (60.5% vs. 41.5%, P = 0.04), and prior history of cancer (23.7% vs. 8.5%, P = 0.01) were associated with psychiatric illness. Conclusions: Psychiatric co-morbid conditions are common in EC patients and significantly associated with higher stage at presentation. Moreover, co-morbid conditions associated with EC are identified significantly more often among those with psychiatric illness. These data identify a particularly high risk subset among EC patients and serve to inform further studies analyzing the impact of psychiatric illness on diagnoses timelines, recommended therapies compliance and treatment and oncologic outcomes.
Predictors of overall survival (OS) in veterans with non-metastatic castration resistant prostate cancer (nmCRPC).
Authors: Alexander D. Fuld, Yinong Young-Xu, Sophia Li, Dominic Pilon, Rachel Bhak, Emilie Duchesneau, Michael Hellstern, Rhiannon Kamstra, Ajay S. Behl, Patrick Lefebvre, Stephen J. Freedland
Journal: Journal of Clinical Oncology (2018)

e17057 Background: An estimated 40,000 men have nmCRPC in the US, with nearly half at increased risk of developing metastasis or death. This study aims to describe the characteristics of patients with nmCRPC and assess the impact of PSADT, baseline PSA and metastases on OS. Methods: Veterans Health Administration electronic health record data (01/2007-08/2017) were used to conduct a retrospective longitudinal study in Veterans with nmCRPC. Patients with castrate testosterone levels ( < 50 ng/dL) or continuous androgen deprivation therapy when testosterone was not available, PSA rise ≥25% from nadir with an absolute increase of ≥2 ng/mL (index), and a PC diagnosis ≤12 months before index were selected. Patients were excluded if they had < 12 months of enrollment before and 6 months after index, evidence of metastatic disease 12 months before index, or participation in a clinical trial. OS was assessed with a Cox proportional hazards model adjusted for baseline characteristics, log-transformed baseline PSA, PSADT, and a time-varying indicator for metastases (defined as first of diagnosis for metastatic disease, chemotherapy, immunotherapy, radiopharmaceuticals, or oral mCRPC therapy). Results: A total of 653,747 Veteran men had a PC diagnosis and 13,552 (49%) formed the nmCRPC study population. Mean (SD) age was 76.4 (9.5) years and most were white (66%). Mean (SD) follow up was 36 (26) months, there were 6,552 (48%) deaths, and median OS was 47 months. Moreover, median OS was 21, 36, and 54 months in patient with a PSADT < 3 months, 3 to < 9 months, and 9 to < 15 months, respectively. 15% had unknown PSADT. The Cox model showed that PSADT was a strong predictor of OS; compared to patients with a PSADT < 3 months, patients with a longer PSADT were less likely to die (e.g., for PSADT 3 to < 9 months: HR: 0.707, P < 0.001; 9 to < 15 months HR: 0.580, P < 0.001). Higher log PSA at baseline increased the risk of death (HR: 1.151, P < 0.001). Compared to patients without metastases, patients who develop metastases were > 3 times more likely to die (HR: 3.438, P < 0.001). Conclusions: In this study of Veteran men with nmCRPC, higher baseline PSA, a shorter PSADT, and the development of metastases were associated with an increase in the risk of death.
Predictive value of <sup>11</sup>C-Acetate PET/CT in metastatic renal cell carcinoma. Initial results.
Authors: Violetta Pankowska, Bogdan Malkowski, Bartlomiej Malkowski, Krzysztof Roszkowski
Journal: Journal of Clinical Oncology (2016)

e16088 Background: Renal clear cell carcinoma poses considerable diagnostic difficulties in the identification of distant metastases. We used an 11C-Acetate PET/CT examination to determine metastases in patients diagnosed with renal cell carcinoma. The aim of this study was to establish whether the degree of metabolic activity (based on SUV) of metastases in advanced metastatic renal cell carcinoma may be a prognostic factor. Methods: The study was conducted in 31 patients with renal cell carcinoma in whom numerous distant metastases were detected using an 11C-Acetate PET/CT examination.The patients were divided into two subgroups depending on the standardized uptake value (SUV): those with the highest SUV ≤ 8 in all lesions (I); those with the highest SUV > 8 in all lesions (II). All patients were subjected to sunitinib chemotherapy at appropriate doses. Results: In subgroup I, median SUV was 5.5, while in subgroup II, median SUV was 9.4. Overall survival periods were longer in the subgroup of patients with higher SUV values: 25.5 months and 30 months, respectively (p = 0.03; log-rank test). Conclusions: The longer overall survival of patients with advanced renal cell carcinoma characterized by higher SUV values can be associated with a fast metabolism of tumor cells. These cells are probably more sensitive to the treatment with a protein kinase inhibitor. These preliminary results demonstrate that patients with advanced renal cell carcinoma and SUV values above 8–9 may be a good target for effective treatment. For ultimate confirmation of the results under the presented project, it will be necessary to recruit a much larger group of patients and conduct a long follow-up to allow correlation of the results of the analyses with clinical effects.
Anatomical and Functional Computed Tomography for Diagnosing Hemodynamically Significant Coronary Artery Disease
Authors: Csilla Celeng, Tim Leiner, Pál Maurovich-Horvat, Béla Merkely, Pim de Jong, Jan W. Dankbaar, Hendrik W. van Es, Brian B. Ghoshhajra, Udo Hoffmann, Richard A.P. Takx
Journal: JACC. Cardiovascular imaging (2018)
Sequential boost versus integrated boost intensity-modulated radiation therapy with concurrent chemotherapy for locally-advanced head and neck cancer (LAHNC).
Authors: Anthony Cmelak, Mark J. Stavas, Barbara A. Murphy, Yu Shyr, Jill Gilbert, Sheau-Chiann Chen, Gregory Vlacich
Journal: Journal of Clinical Oncology (2016)

6070 Background: Despite IMRT technological advances, toxicity in LAHNC pts remains extreme. Different IMRT techniques have been developed, including sequential boost (SeqB) and simultaneous integrated boost (SIB). However, the relative efficacy and toxicities of each technique remain unexplored. Methods: 209 pts with LAHNC were treated with SeqB (n = 68) or SIB (n = 141). A matched cohort multi-institution analysis was used. All 209 pts received 69.3Gy in 33 fxs of 2.1Gy to gross disease. SiB pts received 1.6Gy daily in 33 fxs (52.8Gy) to prophylactic nodes; SeqB pts received 2.1Gy for 24 fxs (50.4Gy) to gross disease and prophylactic nodes, followed by a boost of 18.9Gy in 9 fxs to gross disease. All pts received concurrent chemotherapy, 95% with weekly paclitaxel (40mg/m2) and carboplatin (AUC 1). Targets and organs at risk (OARs) contours, dose constraints, dosimetric plan evaluation, and toxicity assessment were alike and performed by a single experienced physician. Weekly toxicities were graded using the CTCAE. Tumor control and survival were estimated via Kaplan-Meier. Results: Median FU was 30.6 mo. At 3 years, OS was 69% for SeqB and 79% for SIB cohort (p = 0.13). 3-yr DFS was not different (63% vs. 73%; p = 0.27). There were no significant differences in local, regional, or distant RFS. There were no differences in weight loss (p = 0.291), incidence of G-tube (p = 0.494), or in prolonged G-tube dependence (p = 0.465). Rates of grade 3 or 4 dysphagia were higher for SiB than for SeqB (81% vs. 55%, < 0.001) as well as dermatitis (78% vs. 58%, p = 0.012). Fewer SIB pts received the total 69.3Gy IMRT dose due to acute toxicity (93% vs 100%; p = 0.03). OARs mean dose, Dmax, and percent volume receiving 30Gy and 70Gy were not statistically different between the two cohorts. Conclusions: There were no significant differences in tumor control or survival outcomes between the two IMRT delivery approaches. The SeqB IMRT technique resulted in lower grade 3 and 4 acute radiation dermatitis and dysphagia compared to SiB, and more pts completed treatment with SeqB than did pts treated with SiB IMRT. SeqB should be considered for LAHNC to lower treatment toxicity and improve delivery.