tbuckley/cabot-search huggingface dataset:
Severe lack of comprehension of common prostate health terminology in underserved populations: External validation.
Authors: Viraj A. Master, Daniel Shin-Ping Wang, Caroline Gar-Ling Tai, Musu Sesay, Kerry L. Kilbridge, Michael Goodman, Ashesh B. Jani
Journal: Journal of Clinical Oncology (2013)

71 Background: Patients diagnosed with prostate cancer are often counseled about treatment options by healthcare providers who commonly use terms that are part of the ‘core’ vocabulary of prostate cancer. We hypothesized that a predominantly lower-literacy patient population would demonstrate a severe lack of comprehension of prostate cancer terms, which would validate the findings of Kilbridge et al. (JCO, 2009) who found a profound lack of comprehension in a single institution series. Methods: A previously developed survey was used to evaluate understanding of terms related to urinary, bowel, and sexual function. The survey was conducted by trained evaluators, recruiting patients, age ≥ 40, from two low-income safety-net clinics with primarily African-American populations. Comprehension was assessed using semi-qualitative methods coded by two independent investigators. Literacy and numeracy were also evaluated. Results: 109 patients completed the study. Overall prostate cancer knowledge was poor, with only 5% of patients understanding the function of the prostate, 15% understanding the term ‘incontinence’, 29% understanding ‘urinary function’ and 32% understanding ‘bowel habits’ (see Table). Comprehension decreased with the use of compound words, such as ‘intercourse’ (95%) vs. ‘vaginal intercourse’ (58%), validating previous work. Median school level completed was the 12 th grade; yet median literacy level was only 9 th grade, and reading level was significantly correlated with comprehension. Only 30% of patients correctly calculated both a fraction and a percent. Conclusions: Lack of comprehension of terms related to prostate health is pronounced in this patient population and may be widespread. This lack of comprehension potentially limits the ability of patients to participate in shared and informed decision-making. These results validate the findings of previous studies and support a continued need for refined methods of prostate cancer education. [Table: see text]
Ten-year follow-up of patients (pts) with metastatic renal cell carcinoma (mRCC) treated with interferon alfa-2b (IFN) as first-line therapy: Results from a randomized trial.
Authors: Henry Jacob Conter, Christopher G. Wood, Surena F. Matin, Pheroze Tamboli, Randall E. Millikan, Eric Jonasch, Nizar M. Tannir
Journal: Journal of Clinical Oncology (2013)

365 Background: We previously reported on improved tolerability and maintained efficacy of low-dose IFN in pts with mRCC treated in the cytokine era (Tannir, et al. Cancer 2006). Although VEGFR targeted agents have supplanted cytokines for most pts, IFN, in combination with bevacizumab, is a standard front-line therapy for good-risk and intermediate-risk clear-cell RCC. Methods: Between March 2002 and December 2003, a total of 118 pts (59/arm) were randomized to receive IFN 0.5 million units (MU) twice/day [IFN1] or 5 MU/day [IFN5]. Patients who were progression-free and tolerating therapy well continued IFN for a total of 5 years. The primary endpoint was progression-free survival (PFS). Secondary endpoints were objective response rate (ORR), overall survival (OS), safety, and quality of life (QOL). Results of PFS, ORR, safety, and QOL were previously reported. We provide here updated OS and long-term outcome of complete responders (CR). Results: At 10 years of follow-up, &gt;95% of participants have died. There was no significant difference in OS between the 2 arms (HR=1.32, 95% CI: 0.91-1.91), but favored IFN1 (median OS 2.1 years vs. 1.5 years, log-rank test p=0.14). Compared with IFN5, IFN1 was less toxic and was associated with better QOL. Two nephrectomised pts, 1 from each arm, 1 with multiple hepatic and lung metastases, and 1 with multiple lung and mediastinal metastases, performance status 1 and intermediate-risk clear-cell RCC, remain in unmaintained CR 10 years since starting IFN. Among pts who did not respond to IFN but remain alive, 1 patient received high-dose IL-2 and achieved durable CR; the other patient received multiple approved and investigational targeted agents sequentially. All responders to IFN had tumor regression as early as 8 wks, with PR or CR declared at 16 wks. Conclusions: IFN produces durable CRs and potential cure in about 2% of mRCC pts. Our data have implications for the front-line therapy of mRCC and suggest that IFN, like high-dose IL-2, can be discontinued after 16 wks, if a major response is not achieved. Our updated results are of interest, considering the paucity of durable CRs to VEGFR agents.
Characteristics and outcomes of adenosquamous carcinoma of the pancreas.
Authors: Christine G. Simone, Tania Zuluaga Toro, Ellie Chan, Thomas J. George
Journal: Journal of Clinical Oncology (2013)

311 Background: Adenosquamous carcinoma of the pancreas (ASCAP) is a rare pancreatic malignancy variant reported to have a worse prognosis than adenocarcinoma of the pancreas (ACP). Most reports demonstrate a survival rate of less than two years. This study was undertaken to characterize this subtype in the context of a contemporary ACP cohort. Methods: This retrospective analysis included all patients who underwent definitive pancreatic cancer resection at the University of Florida from 2001 to 2011. Central pathology review of suspected ASCAP cases was undertaken. Patient characteristics, tumor features, treatment, and outcomes were collected with t-test analysis for differences. Results: Eight of 237 patients (3.3%) were histologically confirmed as ASCAP. Differences between the ASCAP and ACP cohorts are listed in the Table. ASCAP patients were similar to patients with ACP with no differences in presentation, symptoms or reported tumor markers including CA19-9, CEA, or hypercalcemia. However, ASCAP patients were slightly older, smoked less, and had more involvement of the body and tail. None (0/8) of the ASCAP diagnoses were identified on fine needle aspiration, only surgical specimen review. Post-operative therapy was inconsistently provided to the ASCAP patient population. With a median f/u of 2.9 years, 31% of ACP and 37% of ASACP patients are alive with median overall survival favoring patients with ACP (0.6 vs. 1.7 years; p&lt;0.006). Conclusions: In a contemporary cohort, ASCAP remains a rare malignancy with a relatively worse prognosis than ACP. Diagnostic biopsy may be non-confirmatory for ASCAP and may lead to under-reporting. Aggressive surgical resection is curative for a subset of ASCAP patients, but overall survival remains poor. Further investigation into the role of adjuvant therapy and risk factor modification for this variant may be valuable. [Table: see text]
CT imaging interval after complete cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (HIPEC) for well-differentiated adenocarcinoma of the appendix (WDAA).
Authors: Karen A. Beaty, Joshua S. Hill, Safia Rafeeq, Michael J. Overman, Tara L. Sagebiel, Aurelio Matamoros, Richard E. Royal, Paul F. Mansfield, Keith F. Fournier
Journal: Journal of Clinical Oncology (2012)

434 Background: WDAA with peritoneal dissemination (PD) is a rare disease with a prognosis related to the ability to perform adequate cytoreductive surgery (CRS) with cytoreductive scores of 0 or 1 (CC0 or CC1) followed by HIPEC. Diagnostic imaging is an important aspect of post-operative surveillance. Often, surveillance imaging follows metastatic colon cancer guidelines with frequent CT scans performed during the first 5 years after resection (every 3 months for 2 years, then every 6 months). Minimal evidence-based data exists to direct recommendations regarding optimal imaging intervals in patients with WDAA. Methods: All patients with a pathologic diagnosis of WDAA with PD who were evaluated at a single institution between August 1993 and January 2010 were retrospectively reviewed to identify patients who underwent a CC0 CRS and HIPEC. Parameters evaluated included demographics, time to recurrence and time to intervention after recurrence. Disease free survival was calculated using the Kaplan-Meier method. Results: 688 patients were evaluated during the study period. 67 patients (9.7%) had WDAA and underwent CC0 CRS/HIPEC. The mean age at diagnosis was 54.8 years. Twenty-two (32%) were male. Mean follow-up was 50.4 months. Disease free survival of the entire cohort at 10 yrs was 72 %. Eleven patients (16 %) experienced a recurrence. Median time to recurrence was 18.2 months. After recurrence, mean time to intervention was 6 months. In those patients that recurred, only 3 patients underwent intervention within 24 months of the index CRS/HIPEC (4% of overall cohort). Recurrence after 36 months occurred in only one patient (1.5% of cohort). Conclusions: Patients with WDAA/PD who undergo CC0 CRS/HIPEC have an overall very favorable prognosis and low risk of recurrence. Surveillance imaging, as often done for colorectal cancer, every 3-4 months is inappropriate. For this group of patients, follow-up CT scans every 6 months for 2 years, and then annually is recommended.
Prevalence of KRAS, BRAF, NRAS, PIK3CA, and PTEN alterations in colorectal cancer: Analysis of a large international cohort of 5,900 patients.
Authors: Gargi Dan Basu, Joanne Xiu, David Arguello, Rebecca A. Feldman, Sherri Z. Millis, Ryan P. Bender, Zoran Gatalica, Les Paul, Fadi S. Braiteh
Journal: Journal of Clinical Oncology (2014)

399 Background: Colorectal cancer (CRC) is the third most common cancer worldwide, with metastatic disease accounting for 40 to 50% of newly diagnosed patients. EGFR monoclonal antibodies (Mab), cetuximab and panitumumab, are effective treatment for KRAS wild type CRC. Although mutations in KRAS predict resistance to EGFR Mab therapy, only 80% of CRC patients with KRAS wild-type (WT) status respond to treatment. This study is a retrospective evaluation of genomic alterations in the EGFR pathway such as alterations in KRAS, BRAF, NRAS, PIK3CA and PTEN that may predict lack of response to EGFR Mab therapy in CRC patients. Methods: A large database of 5,900 consecutive CRC patients was analyzed from 2011 onwards for demographics (sex, age, geography, site of tumor) and biomarkers that might correlate with response to EGFR Mab therapy. Comprehensive testing included gene sequencing for KRAS, BRAF, NRAS, PTEN, and PIK3CA (next-generation sequencing, Sanger, pyrosequencing) and immunohistochemistry for PTEN protein expression. Results: Analysis revealed the incidence of KRAS mutation of 42% which is consistent with published literature. Analysis of the KRAS WT cohort revealed a mutation rate of 13.8 % for BRAF, 6.8% for NRAS, and 40% for patients with either PTEN loss of expression/mutation or a PIK3CA mutation. Earlier studies support that mutations in NRAS, BRAF and activation of the PI3K pathway by PTEN/PIK3CA analysis result in lower response rates to EGFR Mab therapy in CRC. Furthermore, multiplex biomarker testing revealed the rare occurrence of concurrent mutations: 1/5,900 subject harboring a BRAF and NRAS mutations, 7/5,900 others with BRAF and PIK3CA mutations, and 8/5,900 subjects with NRAS and PIK3CA mutations. Conclusions: This is a comprehensive analysis of a large international cohort evaluating the prevalence of predictive molecular aberrations suspected of lack of response to EGFR Mab therapy in patients with WT KRAS. Prospective controlled studies are in progress to validate the role of BRAF, NRAS, PIK3CA, and PTEN in clinical management of CRC. It is imperative to further explore the molecular pathology of CRC beyond KRAS in patient selection for EGFR Mab therapy.
Single-agent methotrexate for low-risk gestational trophoblastic disease.
Authors: Q. K. Lippmann, R. K. Hanna, J. T. Soper
Journal: Journal of Clinical Oncology (2011)

e15501 Background: The objective of this study was to examine the efficacy of single-agent weekly intramuscular methotrexate (MTX) for the treatment of low-risk gestational trophoblastic neoplasia (LR-GTN). We evaluated patient characteristics that might predict success of this regimen. Methods: We retrospectively analyzed 24 LR-GTN patients from 2004 – 2010 who received weekly MTX for LR-GTN. The patients were prospectively scored based on the FIGO 2000 criteria. Patient demographics, disease characteristics, response to therapy, toxicity and survival were collected. Results: Four patients received 30mg/m2 and 20 patients received 50mg/m2. The study population consisted of 12 Latina (50.0%), 6 White (25.0%), 3 African American (12.5%), 2 unknown race (8.3%) women and 1 Asian (4.2%) woman. The index pregnancy was a molar pregnancy in 22 cases and an abortion in two cases. Eight patients were diagnosed with Stage III disease, 2 patients with Stage II and 14 with Stage I disease. The median FIGO score was 2 with a range from 1-6. Thirteen patients (54.2%) achieved primary remission with a median of 7 treatments. Ten patients (41.7%) required actinomycin-D (ACT-D) for nonresponse using hCG levels after a median of 8 cycles. One of these patients further required EMA-CO for resistant disease. One patient’s treatment with MTX is ongoing. FIGO score was of borderline significance in predicting response to MTX therapy (p=0.08). Age, race, lung metastasis (all of which were diagnosed on CT scan), primary hysterectomy, type of prior mole and bHCG value were not associated with MTX failure. There are no documented treatment failures: 22 patients (91.7%) had sustained remission following chemotherapy. One patient was lost to follow-up and one patient is still receiving MTX treatment. Conclusions: The data support MTX as an appropriate first-line chemotherapy for LR-GTN irrespective of patient characteristics as it is the least toxic to the patient. Failure of MTX does not impact eventual remission and patient survival in patients requiring second-line treatment.
Safety and efficacy of endoscopic spray cryotherapy for esophageal cancer.
Authors: Franklin C Tsai, Shireen Ghorbani, Bruce D Greenwald, Sunguk Jang, John A. Dumot, Matthew J McKinley, Nicholas J. Shaheen, Fadlallah Habr, Herbert C. Wolfsen, Julian A. Abrams, Charles Lightdale, Norman S Nishioka, Mark H. Johnston, Alvin Zfass, Walter Coyle
Journal: Journal of Clinical Oncology (2016)

83 Background: Although surgery is traditionally the standard of care for esophageal cancer, esophagectomy carries significant morbidity and mortality. Alternative endoscopic therapies are needed for patients who are not candidates for conventional treatment. The objective of this study was to assess the safety, efficacy, and tolerability of spray cryotherapy of esophageal cancer. Methods: This study includes patients enrolled retrospectively and prospectively in an open-label registry and patients in a retrospective cohort from twelve academic and community practices. Endoscopic spray cryotherapy was performed until local tumor eradication was confirmed by biopsy or until treatment was halted due to progression of disease, patient withdrawal or co-morbidities. Results: One-hundred and eight patients (median age 75.5, 79.6% male, 93.5% adenocarcinoma, mean length 5.2 cm) underwent 442 treatments (mean 4.2 per patient). Tumor stages included 40 with T1a, 27 with T1b, 10 with unspecified T1, 15 with T2, and 16 with no T stage reported. One-hundred and six patients completed treatment with complete response of intraluminal disease in 54.7%, including complete response in 74.4% for T1a, 50% for T1b, 65.3% for all T1, 6.7% for T2, and 50% for those with no T stage reported. Mean follow-up was 17.3 months. There were no deaths or perforations related to spray cryotherapy. Strictures developed in 11 of 108 patients (10.2%) but were present before spray cryotherapy in 3 of 11. Conclusions: This study suggests that endoscopic spray cryotherapy is safe, well tolerated and effective for early esophageal cancer in patients who are not candidates for conventional therapy.
Functional imaging tests and CT scan: Detection of new metastases and clinical usefulness in digestive neuroendocrine neoplasms follow-up.
Authors: Elettra Merola, Marianne E. Pavel, Francesco Panzuto, Gabriele Capurso, Noemi Cicchese, Anja Rinke, Thomas Mathias Gress, Elsa Iannicelli, Daniela Prosperi, Patrizia Pizzichini, Patrizia Kump, Rainer Lipp, Stefano Partelli, Massimo Falconi, Bertram Wiedenmann, Gianfranco Delle Fave
Journal: Journal of Clinical Oncology (2016)

219 Background: Digestive Neuroendocrine Neoplasms (DNENs) express in up to 80% of cases somatostatin receptors (SSTRs), which can be detected by Functional Imaging Tests (FITs). FITs are needed at DNENs first diagnosis to define therapy but their role in follow-up (FU) is unclear. Moreover, with the introduction of targeted therapies, RECIST criteria are showing difficulties to assess tumor response to these drugs. The aim of this study was to evaluate, in metastatic DNENs FU, the diagnostic yield of FITs associated to Computed Tomography scan (CT) in terms of detecting new distant metastases (primary outcome) and of clinical usefulness (secondary outcome). Methods: Retrospective analysis of stage IV DNENs expressing SSTRs and with at least 24 month-FU. From 1995 to 2008 FIT performed was Octreoscan (OCT), subsequently it was 68Ga-DOTA- PET/CT (GaPET). CT was repeated every 6-12 months, FIT yearly. FU time was divided into 12 month-“units”, in which each patient had faced at least 1 CT and 1 FIT. Units were analyzed separately and then compared to each other. The gold standard adopted was the result of the imaging tests, the surgical and pathological findings collected for each patient during FU. Clinical usefulness was defined as “appropriate changes” in management (indication to further imaging tests, surgery, biopsy, change in therapy) due to CT and/or FITs. Results: Interim analysis of 381 units (median 3 per patient, range 2-7) obtained from 121 patients included so far (67.8% metastatic since diagnosis). New lesions were detected by CT alone in 82.3% of cases; adding OCT, the diagnostic yield was 9.6%, while adding GaPET 21.7% (P&lt;0.05). CT was responsible in 83.5% of cases of useful changes in patients management; adding OCT, the diagnostic yield was 9.7% (P&lt;0.05), while with GaPET 27.9% (P&lt;0.05). Conclusions: In metastatic DNENs FU, the addition of FITs to CT significantly improves the detection rate of new lesions; this advantage influences clinical practice increasing the clinical usefulness, especially when GaPET is adopted.
Predictor proteinuria and renal failure among patients with cancer.
Authors: C. U. Mai BA, I. Monnet, S. Poullain, E. Isabelle, M. Martin, T. Armelle
Journal: Journal of Clinical Oncology (2011)

e19692 Background: Kidney disease has become an important cause of morbidity and mortality in cancers patients. However, in the literature glomerular filtration rate (GFR) and proteinuria data are few. This study examines the prevalence of kidney disease and proteinuria in cancer patients without known kidney disease. Methods: This prospective study includes patients receiving chemotherapy in which subjects are followed with a detailed exam including serum creatinine and urine analysis. Cockcroft-Gault and abbreviated Modification of Diet in Renal Disease (aMDRD) equations were used to estimate glomerular filtration rate (eGFR). Renal disease prevalence was estimated from apparent kidney damage (proteinuria, hematuria or uninfectious leucocyturia) and kidney function and staged, according to the K/DOQI-KDIGO. Proteinuria, hematuria or leucocyturia was defined as > or = +1 on urine dipstick exam. Risk factors for renal dysfunction were determined using multivariable logistic regression analysis. Results: The study population had 208 patients (117 females and 91 males). The mean age was 62 years. The prevalence of chronic kidney disease (CKD) of any stage and CKD ≥ stage 3 was 68.8 and 25.9% by CG equation, respectively and 64.4 and 13.9% by MDRD equation, respectively. Proteinuria, hematuria and leucocyturia were present in 54.8, 11.1 and 12.5% of patients. In a multivariate analysis, age above 65 years, diabetes, hypertension, polymedication and smoking were associated with low eGFR. Conclusions: Our study has shown the burden of kidney disease in cancer patients. There is a significant difference between GFR estimates derived from CG and aMDRD equations. Proteinuria is likely essential factor for renal dysfunction in these patients.
Socioeconomic disparities in the receipt of radiation for node-positive prostate cancer.
Authors: Vinayak Muralidhar, Brandon Arvin Virgil Mahal, Yu-Wei Chen, Michelle Daniel Nezolosky, Paul L. Nguyen
Journal: Journal of Clinical Oncology (2016)

53 Background: Radiation therapy in the setting of node-positive prostate cancer has been controversial, although some recent data suggests a survival benefit to radiation in this setting. We evaluated socioeconomic disparities in the receipt of radiation for node-positive prostate cancer to identify groups that may be less likely to receive this potentially life-saving treatment. Methods: We identified 3,283 patients with N1M0 prostate cancer diagnosed 1982-2011 using the Surveillance, Epidemiology, and End Results database who were treated with radiation or no local therapy. We conducted multivariable logistic regression to determine socioeconomic predictors of not receiving radiation treatment. Results: Several patient and demographic factors were associated with a reduced likelihood of receiving radiation: African American (AA) vs non-AA race (31.7% vs. 37.7%, adjusted odds ratio [AOR] 0.74, p = 0.012); unmarried vs married status (31.9% vs 38.6%, AOR 0.72, p &lt; 0.001); bottom third vs top third in income level (33.7% vs. 39.8%, AOR 0.72, p &lt; 0.001); age over 65 versus &lt; = 65 years (34.6% vs 39.8%, AOR 0.81, p = 0.005); diagnosis before 2000 versus starting in 2000 (31.6% vs 43.5%, AOR 0.56, p &lt; 0.001). In a separate analysis, patients under the age of 65 who had Medicaid or no insurance were less likely than patients with other insurance to receive radiation (43.5% vs 55.9%, OR 0.61, p = 0.041), although on multivariable analysis, no significant association persisted (p = 0.512). Conclusions: African American race, unmarried status, lower income level, older age, and insurance status were all associated with significantly reduced odds of receiving radiation therapy for node-positive prostate cancer compared with no local therapy. Given the accumulating data suggesting that radiation therapy can improve survival in node-positive patients, it is increasingly important to understand the reasons for these treatment disparities so that they can be reduced.