tbuckley/cabot-search huggingface dataset:
Predictive factors for winged scapula in breast cancer patients after immediate axillary dissection.
Authors: Luiz Felipe Nevola Teixeira, Visnu Lohsiriwat, Paolo Veronesi, Mario Rietjens, Luiz Carlos Teixeira, Cristina Garusi, Alberto Luini, Maria Claudia Simoncini, Fabio Sandrin, Luis Otavio Zanatta Sarian, Sara Gandini, Mario Casales Schorr, Andre Deeke Sasse
Journal: Journal of Clinical Oncology (2013)

e20634 Background: Axillary lymph node dissection is an inevitable part of breast cancer surgery in certain cases. Definitive data regarding the incidence of postoperative winged scapula remains inconsistent. Ignorance of its diagnosis may lead to under-treatment and result in physical morbidity. Methods: All breast cancer patients who underwent axillary lymph node dissection procedures were recruited. In the early postoperative period, within 24 hours after surgery, the physiotherapy staff performed physical examinations to evaluate and identify the physical signs of long thoracic nerve injury by means of two specific orthopedic evaluation tests. The factors that may relate to winged scapula were recorded and analyzed. Results: From July to October 2012, 51 out of 187 patients were diagnosed with winged scapula (27.2%). The median age was 49.0 years old. 130 patients had undergone mastectomy and 100 cases had immediate breast reconstruction. Age, BMI, history of shoulder joint morbidity and previous breast surgery were not significantly associated with winged scapula. Administration of neoadjuvant treatment, mastectomy or breast conservative surgery, immediate reconstruction and its type, tumor size and nodal involvement also did not show any correlation. Conclusions: The winged scapula is not an infrequent sequela after axillary lymph node dissection in the breast cancer patient. It is usually underestimated and overlooked. There is no association between age, BMI, neoadjuvant treatment, type of breast surgery, tumor size or nodal stage. As breast reconstruction plats an ever-increasing role in current breast surgery practice it is interesting to note that reconstruction with prosthesis, even with serratus muscle dissection does not increase the incidence of winged scapula. Post reconstruction morbidity could interfere with the physical evaluation and outcome, but the result of our subgroup analysis showed no significant correlation among them. In our clinical experience, this sequela is not irreversible, being a transitory problem. Our series show only immediate 24 hr result that lack of long term follow-up and still need physical therapy proctocols to evaluate the recovery.
Out-of-Pocket Spending Among Commercially Insured Patients for Epinephrine Autoinjectors Between 2007 and 2014
Authors: Kao-Ping Chua, Rena M. Conti
Journal: JAMA Internal Medicine (2017)

This study uses data from the Truven MarketScan Commercial Claims and Encounters database to track out-of-pocket spending among comercially insured patients for epinephrine autoinjectors between 2007 and 2014.
Broussonetia kazinoki SIEB.由来の2種の新規ピロリジンアルカロイド,ブロウソネチンYとZ及びブロウソネチン類のN‐アルキル化によるグルコシダーゼ阻害
Authors: Tsukamoto D, Shibano M, Kusano G
Journal: Nature Medicine (2003)
Final results of a phase II immunotherapy trial for stage III and IV melanoma patients.
Authors: Adam Irwin Riker, Gabriela R. Rossi, Leonard C Alsfeld, Fiona Denham, Lucinda Tennant, William Jay Ramsey, Charles J. Link, Marilynn Harrison, Nicholas N. Vahanian
Journal: Journal of Clinical Oncology (2012)

e19008 Background: Patients with metastatic melanoma have a poor outcome. We hypothesize that combination immunotherapy can synergistically activate host immunity to generate an effective treatment option for high risk, resected stage III, recurrent, refractory or stage IV melanoma patients. Methods: We completed a phase II clinical trial of HyperAcute-Melanoma vaccine (HAM, NLG12036, NewLink Genetics) combined with pegylated interferon (Sylatron, Merck). Trial design was a 12-week regimen with the initial 4 weekly treatments consisting of HAM alone (intradermally) followed by 8 additional treatments of HAM + Sylatron (subcutaneously, 6 µg/kg). Trial endpoints include clinical response, overall safety and correlative findings for observed anti-tumor effect. Results: N=25, median age 60, 68% male with 21 patients completing the trial, 4 stopped due to progressive disease (PD). HAM-related common side effects include erythema and induration at the injection site, without significant grade 3 or 4 toxicities associated with the vaccine. By RECIST criteria, of 16 stage IV patients, there were 2 complete responders (CR), 2 with stable disease (SD) and 3 with no evidence of disease (NED) after resection. For stage III patients, 3/9 remain NED, 1 patient with slowly progressive disease remaining alive for over 30 months. The median overall survival is 29 months, with 50% of the patients surviving for 2 years and 12/25 (48%) still alive. The anti-αGal Ab values increased after vaccination in 24/25 patients by up to 100-fold (median 15, range 3-127). All evaluable patients (21/21) seroconverted, developing autoimmune antibodies. Anti-tyrosinase Ab’s developed in 7/23 correlating with 1 CR and 1 patient NED. Vitiligo developed in 4/25 patients, correlating with 2 CR and 2 NED. Conclusions: Combinatorial immunotherapy with HAM plus Sylatron shows clinical efficacy with tumor regression and concomitant immune activation. Optimization of dosing schedules and addition of other potentially synergistic agents should be explored to further enhance the benefit of this immunotherapeutic approach.
Expression III: What do primary and recurrent ovarian cancer (OC) patients expect from their doctors and therapy management? Results of a survey in eight European countries with 1,743 patients (NOGGO/ENGOT-OV9 study).
Authors: Gülten Oskay-Özcelik, Maren Keller, Sandro Pignata, Domenica Lorusso, Florence Joly, Dominique Berton-Rigaud, Ignace Vergote, Joke De Roover, Michal Maciejewski, Marcin Jedryka, Antonio Casado Herraez, C. Mendiola, Antonio Gonzalez-Martin, Patrick Achimas, Daniel Uwe Reimer, Alain G Zeimet, Hans-Joachim Hindenburg, Rolf Richter, Jalid Sehouli
Journal: Journal of Clinical Oncology (2013)

5569 Background: The primary aim of this study was to investigate information needs and preferences among patients with ovarian cancer, focusing especially on doctor-patient relationships and therapy management in different European countries. Methods: A questionnaire was developed based on the experiences of expression II, a German survey, and then provided to primary and recurrent ovarian cancer patients via internet (online) or as a print-version in 8 countries in Europe (Austria, Belgium, France, Germany, Italy, Poland, Rumania, Spain). In the first part basic data (age, tumour status, therapy) were requested from the patient. In the second part, most of the questions tried to evaluate the expectations and needs concerning their therapy management and doctor-patient communication. Results: From December 2009 to October 2012, a total of 1743 patients with ovarian cancer from 8 European countries participated in the survey.The median age was 58 years (range 16-89). Nearly all patients (96,3%) had a primary surgery and a first-line chemotherapy (91,5%). About 423 (25,7%) patients were included in another clinical trial.Most of the patients in each country were pleased with the completeness and understandability of the explanations about the therapies from their doctors. About 68% of patients would be interested in having the opportunity to have a second opinion. The three most important aspects, which were proposed by patients to improve therapy against ovarian cancer were: “the therapy should not induce alopecia” (42%), “there must be more done to counter fatigue” (34%), and “the therapy should be more effective” (29%). Conclusions: This study underlines the high need of ovarian cancer patients to discuss all details concerning treatment options and clinical management with only minor difference between the countries. Patients also need more information about side effects of cancer therapies and second opinion opportunities. Besides effectiveness of therapy, alopecia and fatigue are the most important side effects bothering the patients.
Can total psoas area predict toxicity after stereotactic body radiation therapy in borderline resectable and locally advanced pancreatic cancers?
Authors: Will Jin, Eric Mellon, Jessica M. Frakes, Gilbert Murimwa, Pamela Joy Hodul, Jose Mario Pimiento, Heloisa P. Soares, Richard D. Kim, Mokenge Peter Malafa, Sarah E. Hoffe
Journal: Journal of Clinical Oncology (2017)

455 Background: Total Psoas Area (TPA), a marker of sarcopenia, found clinical utility as an independent predictor of clinical outcomes in gastrointestinal cancers as a proxy for nutritional status. Our study evaluated the relationship of TPA and other proxies of nutrition like Body Mass Index (BMI) and Body Surface Area (BSA) with outcomes in Borderline Resectable Pancreatic Cancer (BRPC) and Locally Advanced Pancreatic Cancer (LAPC) patients receiving Stereotactic Body Radiation Therapy (SBRT). Methods: In retrospective analysis of an IRB approved database, 183 BRPC and LAPC patients treated with SBRT from 2009-2016 met our selection criteria. Patients underwent gemcitabine based or FOLFIRINOX chemotherapy for 3 months prior to SBRT. Eligible patients were those with pre-SBRT planning CT imaging on Pinnacle, a treatment planning system, and an identifiable L4 vertebra. Bilateral psoas muscles were manually contoured at the L4 vertebral level. This area was normalized by patient height (median = 876.505 mm 2 /m). ROC curves were created for TPA, BMI and BSA. Toxicities were evaluated by binomial logistic regression; survival functions were evaluated by Kaplan-Meier. Significance was set at p &lt; 0.05. Results: Low TPA (OR = 1.903, p = 0.036) and BSA (OR = 1.836 p = 0.048) were predictive of acute toxicities but only TPA was predictive of Grade 3+ acute toxicities (OR = 10.24, p = 0.040). Both findings were independent of tumor resectability. No association was found between TPA/BMI/BSA and late toxicities, overall survival, local progression or local recurrence. However, BRPC patients survived longer (median = 21.98 months) than their LAPC (median = 16.2 months) counterparts (p = 0.002), independent of nutritional status. Conclusions: Pre-SBRT TPA measurement is readily available and more specific than BMI or BSA as a predictor of serious acute radiotoxic complications following SBRT in BRPC/LAPC patients. However, tumor resectability remains as the only predictor of overall survival in this cohort. Whether initial pre-chemo TPA may predict acute toxicity related to chemotherapy and guide individualization of systemic regimen warrants further investigation.
Impact of body surface area on efficacy of gefitinib in patients with non-small cell lung cancer harboring activating epidermal growth factor receptor mutation.
Authors: Eiki Ichihara, Katsuyuki Hotta, Akiko Hisamoto, Nagio Takigawa, Masahiro Tabata, Mitsune Tanimoto, Katsuyuki Kiura
Journal: Journal of Clinical Oncology (2012)

2607 Background: Gefitinib is an essential drug for the treatment of non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation. Its approved dosage is fixed at 250 mg/body/day without any adjustment by physical size. On the other hand, most cytotoxic agents are administered with body surface area (BSA) based dose-adjustment to reduce the pharmacokinetic inter-patient variability. However, the impact of BSA on efficacy of gefitinib has not been fully evaluated. We here tried to clarify this issue using our retrospective cohort. Methods: We reviewed the medical records of consecutive advanced NSCLC patients harboring EGFR mutation who underwent gefitinib monotherapy at Okayama University Hospital from October 2002, when gefitinib was approved in Japan, to October 2011. Results: A total of 101 patients with EGFR-mutant tumors who received gefitinib (250 mg/body/day) were included in this study. The median progression free survival (PFS) of patients with high BSA (≥1.5 m 2 : the median value in this cohort) was significantly worse than that of patients with low BSA (&lt;1.5 m 2 ) (10.4 vs. 18.0 months, p = 0.019 log-rank test). The multivariate analysis also showed a significant impact of BSA on PFS; (hazard ratio of 2.34 with 95% confidence interval of 1.78 - 2.89, p = 0.002). By contrast, such significant association between BSA and PFS was not observed in cytotoxic chemotherapy (5.4 months vs. 3.7 months, p = 0.49, log lank test). Conclusions: BSA affected PFS in the gefitinib monotherapy, potentially suggesting the need for appraisal of BSA-based dose adjustment even in this molecular-target therapy.
A phase II multicenter study evaluating combination immunotherapy with pembrolizumab and peginterferon alfa-2b for advanced cholangiocarcinoma.
Authors: Aiwu Ruth He, Michael Morse, Renuka V. Iyer, Davendra Sohal, Hongkun Wang, Karen Dorsch-Vogel, Michael J. Pishvaian, Mohamed E. Salem, Brandon George Smaglo, John Marshall
Journal: Journal of Clinical Oncology (2017)

TPS507 Background: No effective therapy is available for patients (pts) with advanced cholangiocarcinoma (CC) after disease progression on first-line chemotherapy. In Phase I studies, pembrolizumab (pem) showed activity in pts with advanced CC. Interferon alpha-2b was shown to increase tumor immune infiltrates. In order to improve the response rate (RR) of pts with CC to pem, we propose to combine sylatron with pem in an open-label, single-arm, multicenter Phase II study. Methods: To be eligible for study, pts must have CC, manifesting as either intrahepatic, extrahepatic or gallbladder cancer that is unresectable, metastatic, and has either failed to respond to or demonstrated progression on frontline chemotherapy. Forty-four pts will be enrolled on study to receive SC sylatron (200 mg) weekly for 12 weeks, and IV pem (200mg) once every 3 weeks, starting on week 4 (at the same time as the 4th dose of sylatron), until pts experience disease progression or unacceptable toxicity, or withdraw consent. CT scans will be performed every 9 weeks. The primary endpoints are overall RR (ORR) and the safety and tolerability of combined pem and sylatron therapy. Secondary endpoints include OS, PFS, and ORR by irRECIST. An initial 3-week window will exist in which to evaluate the effect of sylatron alone (following prior chemotherapy) on the tumor microenvironment: one biopsy (biopsy 1) will be obtained before the start of sylatron therapy, and another (biopsy 2) after the third but before the fourth injection of sylatron (and the initiation of pem plus sylatron combination therapy). The effect of sylatron on the CC immune microenvironment will be studied by comparing biopsies 1 and 2. Immune microenvironment in pem + sylatron responders will be compared with non-responders. The study will assess whether the addition of sylatron improves the RR of pem from 17% to 35% in pts with advanced CC. Simon’s two-stage optimum design will be used to test the null hypothesis that P ≤ 0.17 vs. the alternative hypothesis that P ≥ 0.350. This study design provides 80% power (one-sided significance level of 0.05). The time-to-event endpoints (PFS, OS) will be estimated using Kaplan-Meier methodology.
Circulating cytokines and angiogenic factors (CAF) as markers of clinical response in the study of trametinib (T) plus gemcitabine (G) versus placebo (P) plus gemcitabine for patients (pts) with untreated metastatic adenocarcinoma of the pancreas (MEK113487).
Authors: John Heymach, Hai T. Tran, Andrew B. Nixon, Herbert Hurwitz, Jeffrey R. Infante, Robert C. Gagnon, Klaudia Steplewski, Ngocdiep T. Le, Yuan Liu
Journal: Journal of Clinical Oncology (2013)

4042 Background: T is a reversible and highly selective allosteric inhibitor of MEK1/MEK2. The addition of T to G did not improve overall survival (OS) as first-line treatment for pts with metastatic adenocarcinoma of the pancreas (ASCO GI 2013 #291). CAF profiles have shown potential for identification of prognostic and predictive markers in cancer pts (Tran, Lancet, 2012). Methods: Plasma samples (n = 144 baseline [BL]; n = 112 day 15) from pts who consented to participate in MEK113487 study were analyzed for 30 CAFs (ANG2, IGFBP3, IL2R, IP10, MMP2, MMP9, OPN, PDGFBB, SCF, TIMP1, IL6, MIP1B, SDF1, TRAIL, VEGF, MIP3A, MCP2, FGFB, IL8, VEGFR1, IL10, IL1A, IL12P40, PIGF, EGF, IL1B, TNFA, IL4, MIP1A, MCP3) using SearchLight multiplex assays in a CLIA-certified laboratory. Change from BL was assessed using either paired t tests or Wilcoxon tests. BL and change from BL CAF levels were tested for association with clinical outcome using proportional hazards regression within arm (P &lt; .01 for significance) and between arms (treatment arm by CAF level interaction, P &lt; .05 for significance). Results: Lower levels (&lt; median) of BL ANG2, IL6, TIMP1, and IL8 were associated with an average of 5 mo longer OS in both the T+G and G arms. Lower BL levels (less than first quartile) of IGFBP3 and PDGFBB were associated with 6 mo longer OS in the T+G arm, while higher levels (greater than third quartile) of IGFBP3 and PDGFBB were associated with 4.8 mo longer OS in the G arm. A combined model of low IGFBP3 and/or PDGFBB showed improved survival for T+G vs G (median OS, 10.3 vs 5.6 mo). Decreases of ANG2 and IL2R levels at day 15 from BL were observed in the T+G arm only; additional results will be presented. Conclusions: This study suggests that plasma CAF profiling may aid in the prognostic evaluation of pts, assessing therapeutic response, and identifying pathways modulated by treatment in pancreatic cancer pts. Low IGFBP3 and PDGFBB may identify patients who receive greater benefit from T+G compared with G in this population and merit further investigation as predictive markers. Clinical trial information: NCT01231581.
Incidence of venous thromboembolism (VTE) and Khorana´s score (KS) in ambulatory high-grade glioma (HGG) patients receiving chemotherapy.
Authors: Pedro Pérez Segura, Raquel Luque, Enrique Gallardo, Andres Munoz, Luis M Navarro, Eva Martinez de Castro, Vanesa Pachon, Mercedes Salgado Fernández, Purificación Martínez del Prado, Silvia Garcia Adrian, Ana Isabel Ferrer, Silverio Ros
Journal: Journal of Clinical Oncology (2015)

e13056 Background: VTE is a common complication in HGG; however, it´s incidence remain uncertain. KS is the only validated predictive model to gauge cancer patient´s cancer risk for developing VTE. Methods: The aim of this study is to analyze the incidence of VTE and KS in ambulatory patients (pts) with HGG receiving chemotherapy. We performed a retrospective review in 10 hospitals of the Cancer and Thrombosis Working Group of the Spanish Society of Medical Oncology (SEOM). A total of 469 consecutive patients from January 2008 through December 2011 were included in the analysis. Results: VTE was identified in 13.6% of pts. Median age: 60.5 (range 19-85). Type of glioma (GB/AA/O): 348/82/27. Previous VTE: 5 (1%). Previous arterial thromboembolism: 28 (5.9%). Type of first VTE: 84.3% pulmonary embolism (PE) and 15.7% others (deep vein trombosis (DVT) and superficial vein trombosis (SVT)). KS (Table 1). No difference was observed between VTE+ and VTE- groups in accordance with epidemiologic, concomitant treatment or oncological treatment (surgery, chemotherapy, antiangiogenics or surgery). Conclusions: The high incidence of VTE observed in this study is consistent with prior reports. We remark the high incidence of PE in the VTE+ group compared with other VTE locations.
Ranking Businesses and Municipal Locations by Spatiotemporal Cardiac Arrest Risk to Guide Public Defibrillator Placement
Authors: Christopher L.F. Sun, Steven C. Brooks, Laurie J. Morrison, Timothy C.Y. Chan
Journal: Circulation (2017)

Efforts to guide automated external defibrillator placement for out-of-hospital cardiac arrest (OHCA) treatment have focused on identifying broadly defined location categories without considering hours of operation. Broad location categories may be composed of many businesses with varying accessibility. Identifying specific locations for automated external defibrillator deployment incorporating operating hours and time of OHCA occurrence may improve automated external defibrillator accessibility. We aim to identify specific businesses and municipal locations that maximize OHCA coverage on the basis of spatiotemporal assessment of OHCA risk in the immediate vicinity of franchise locations.This study was a retrospective population-based cohort study using data from the Toronto Regional RescuNET Epistry cardiac arrest database. We identified all nontraumatic public OHCAs occurring in Toronto, ON, Canada, from January 2007 through December 2015. We identified 41 unique businesses and municipal location types with ≥20 locations in Toronto from the YellowPages, Canadian Franchise Association, and the City of Toronto Open Data Portal. We obtained their geographic coordinates and hours of operation from Web sites, by phone, or in person. We determined the number of OHCAs that occurred within 100 m of each location when it was open (spatiotemporal coverage) for Toronto overall and downtown. The businesses and municipal locations were then ranked by spatiotemporal OHCA coverage. To evaluate temporal stability of the rankings, we calculated intraclass correlation of the annual coverage values.There were 2654 nontraumatic public OHCAs. Tim Hortons ranked first in Toronto, covering 286 OHCAs. Starbucks ranked first in downtown, covering 110 OHCAs. Coffee shops and bank machines from the 5 largest Canadian banks occupied 8 of the top 10 spots in both Toronto and downtown. The rankings exhibited high temporal stability with intraclass correlation values of 0.88 (95% confidence interval, 0.83-0.93) in Toronto and 0.79 (95% confidence interval, 0.71-0.86) in downtown.We identified and ranked businesses and municipal locations by spatiotemporal OHCA risk in their immediate vicinity. This approach may help policy makers and funders to identify and prioritize potential partnerships for automated external defibrillator deployment in public-access defibrillator programs.
High BMI in late adolescence predicts future severe liver disease and hepatocellular carcinoma: a national, population-based cohort study in 1.2 million men
Authors: Hannes Hagström, Per Tynelius, Finn Rasmussen
Journal: Gut (2017)

Objective A high body mass index (BMI) is associated with an increased risk for severe liver disease. It is unclear if this risk differs across BMI categories, and if the association is partially attributed to development of type 2 diabetes mellitus (T2DM). Design We used register data from more than 1.2 million Swedish men enlisted for conscription between 1969 and 1996. Data regarding new events of severe liver disease and T2DM during follow-up were obtained by record-linkage of population-based registers. We used Cox regression to estimate adjusted HRs for future inpatient care and mortality in severe liver disease and incidence of hepatocellular carcinoma (HCC) across BMI categories, using BMI of 18.5–22.5 kg/m 2 as reference. Results During a follow-up of more than 34 million person-years, 5281 cases of severe liver disease including 251 cases of HCC were identified. An association with severe liver disease was found for overweight (HR 1.49, 95% CI 1.35 to 1.64) and for obese men (HR 2.17, 95% CI 1.82 to 2.59). Development of T2DM further increased the risk for severe liver disease across all BMI categories, for instance, men with obesity and T2DM had a higher risk of severe liver disease (HR 3.28, 95% CI 2.27 to 4.74) than men with obesity free of T2DM (HR 1.72, 95% CI 1.72 to 2.54). Conclusions A high BMI in late adolescent men was associated with an increased risk of future severe liver disease, including HCC. Development of T2DM during follow-up was associated with a further increased risk of severe liver disease, independent of baseline BMI.