tbuckley/cabot-search huggingface dataset:
A phase II trial of preoperative one cycle of induction chemotherapy [capecitibine (CAP), CDDP] followed by concurrent chemoradiation (CRT) in patients (pts) with resectable esophageal cancer
Authors: S. B. Kim, S. I. Park, J. H. Kim, H. Y. Jung, G. H. Lee, J. H. Park, J. H. Ahn, K. J. Cho, H. Y. Song, Y. I. Min
Journal: Journal of Clinical Oncology (2005)

4063 Background: Further efforts for optimal combination of CRT before surgery (S) were needed to increase patient (pt) compliance to surgical resection based on our phase III report (JL Lee, SB Kim. Ann Oncol, 2004). Induction chemotherapy followed by concurrent CRT treatment strategy was used and 5-FU was replaced with CAP in this study with an endpoint of pathologic complete response (pCR). Methods: : From Mar 2003 to Oct 2004, stage II, III resectable esophageal cancer pts enrolled and tumors were staged by CT, PET scan and EUS (when feasible). Pts received one cycle of induction chemotherapy [CDDP 60mg/m2, d1, CAP 1000mg/m2 bid, d1–14] and followed by radiotherapy (RT) [46 Gy, 2Gy/ fraction] concurrent with weekly chemotherapy [CDDP 30mg/m2, d1, 8, 15, 22, CAP 800mg/m2 bid, 5 days/week] and then S. S was performed 4∼6 weeks after RT was completed. Preoperative chemoradiation was done at outpatient clinic. Results: Thus far, 49 pts were enrolled. 4 pts dropped out due to economic problem (3) and unexpected seizure (1). 45 pts were evaluable for response and toxicity. The median age was 64 years (range, 45∼74). Clinical response was 97% including 44% (20/45) of complete response rate. Nine out of 45 pts did not undergo S; fear to S (2), symptom improvement (3), progressive disease (1), poor general condition (2), equivocal bone uptake in PET scan (1). 36 pts had surgical resection. Pathologic complete remission was achieved in 47% (17/36) of the pts who undertook S after CRT. One pt failed to resect due to tumor invasion to descending aorta. There were 8 pts with Gr3 neutropenia, 3 with Gr3 thrombocytopenia, 4 with Gr3 esophagitis, 1 with Gr1 hand foot syndrome, 1 with Gr1 AST/ALT elevation. 91% of planned dose of CAP were administered. Conclusions: This treatment regimen is well tolerated at outpatient clinic and effective for resectable esophageal cancer with excellent major clinical response rate (97%) and pCR (47%). No significant financial relationships to disclose.
Correlation of activated AKT and MAPK expression in liver metastases with clinical outcome in colorectal cancer patients receiving irinotecan/cetuximab treatment.
Authors: Mario Scartozzi, Riccardo Giampieri, Alessandra Mandolesi, Elena Maccaroni, Michela Del Prete, Luca Faloppi, Alessandro Bittoni, Maristella Bianconi, Eva Galizia, Rosa Rita Silva, Lucio Giustini, Alberto Zaniboni, Roberto Labianca, Italo Bearzi, Stefano Cascinu
Journal: Journal of Clinical Oncology (2012)

449 Background: An aberrant activation of the EGFR downstream signaling pathway via MAP-kinase and Akt could be responsible for resistance to anti-EGFR treatment. We tested the interaction between phosphorylated Akt and MAPK in primary colorectal tumours and corresponding metastases and clinical outcome in terms of response rate (RR), progression free survival (PFS) and overall survival (OS) to identify a group of patients more likely to benefit from EGFR-targeted treatment among those harbouring a K-RAS wild type status. Methods: Seventy-two advanced K-RAS wild type colorectal cancer patients treated with irinotecan-cetuximab were analysed. Primary tumour were available in all cases, whereas paired tumour samples from metastatic sites were available in 37 patients. Phosphorylated Akt and MAPK were analyzed by immunohistochemistry. Results: Akt resulted overexpressed in 31 primary tumours (43%) and 23 metastases (62%), whereas MAPK was over-expressed in 32 primary tumours (44%) and 20 metastases (54%). Akt altered expression in primary tumours correlated with a statistically significant worse median PFS (2.4 months vs. 6.5 months, p= 0.0006) and OS (7.8 months vs. 26.7 months, p &lt; 0.0001), without any significant correlation with RR. No significant correlation could be found between MAPK expression in primary tumours and RR, PFS or OS. In metastases Akt expression correlated with RR (9% vs, 58%, p= 0.004), PFS (2.3 months vs.9.2 months p &lt; 0.0001) and OS (6.1 months vs.26.7 months p &lt; 0.0001). Analogously MAPK expression in metastases correlated with RR (10% vs, 47%, p = 0.002), PFS (2.3 months vs.8.6 months p &lt; 0.0001) and OS (7.8 months vs.26 months p = 0.0004). At multivariate analysis Akt and MAPK status in metastases was able to independently predict PFS. Akt status in metastases independently correlated with RR as well. Conclusions: We suggest that Akt and MAPK expression in metastases may have a relevant role in determining the activity of anti-EGFR treatment strategies. Our observations seem also to indicate that for some molecular determinants of resistance the biological profile in metastases is prominent.
Brain metastases occurrence among metastatic breast cancer: A single oncology center experience
Authors: K. Uygun, H. Karagol, F. Tokatli, M. Caloglu, S. Donmez, F. Tas
Journal: Journal of Clinical Oncology (2005)

874 Background: It has been shown that the occurrence of brain metatases in patients with breast cancer decreases survival and alters the quality of life. In the present study, we have searched for predictive factors of brain metastases in patients with metastatic breast cancer. Methods: Medical records of 306 breast cancer patients who admitted to our oncology center between 2000–2004 were evaluated. Patients with non-metastatic disease at the last visit and brain metastases as first relaps were excluded from the analysis. Evaluated variables as risk factor were the age, menapose status, initial stage of disease, histological grade of tumor, hormone reseptor status, adjuvant treatment, metastasis free interval, first metastatic site. Results: The risk factors for brain metastases were determined in 76 metastatic breast cancer patients. The presence of lung metastases (odds ratio=20, 95% Cl:3.4–125 and p=0.001), liver metastases (odds ratio=11.5, 95% Cl:2.1–62.5 and p=0.005), local relapse (odds ratio=18.5, 95% Cl:2.8–125 and p=0.002) as first metastatic site were the only predictive factors associated with the occurrence of brain metastases in the multivariate analysis. Conclusions: The presence of lung metastases, liver metastases and local relaps as first relapsed site were the predictive factors associated with the occurrence of brain metastases in breast cancer patients. High risk patients may benefit from screening or prophylactic treatment. No significant financial relationships to disclose.
Development of an electronic point-of-care quality monitoring system for palliative care.
Authors: Arif Kamal, Janet Bull, Amy Pickar Abernethy
Journal: Journal of Clinical Oncology (2012)

291 Background: Most current quality monitoring programs involve retrospective, manual data collection. These are inherently limited by accuracy issues and do not integrate well with national efforts to integrate electronic data documentation in all parts of medical practice. We aimed to build and test a prospective system for continuous quality monitoring in palliative care. Methods: Within a four-organization, academic/community quality consortium, we first conducted a focus group to inventory characteristics of an effective system. Then, with an interdisciplinary team of providers informatics, data security, and software programmers, we created an electronic solution for quality data collection and reporting. A usability study with think-aloud protocols followed using twenty providers and two mock cases across paper, laptop, and tablet computer platforms. Finally, a feasibility test assessing satisfaction, burden, and logistical issues was conducted. Results: Identified priorities for a proposed system were: 1. Use of information technology (IT); 2. Point-of-care use; and 3. Immediate, provider-level reporting on quality conformance. A previous systematic review of quality measures informed the development of a 92 item dataset comprised of variables drawn from validated clinical instruments and aligned with the National Consensus Project quality domains. To foster electronic, point-of-care data capture, the Quality Data Collection Tool (QDACT) user interface was then developed. Use at point-of-care in community-based palliative care settings can inform 82% (125) of identified relevant quality measures; a color-code reminder system provides immediate conformance feedback. The usability study demonstrated high satisfaction with electronic platforms, less than 15 minutes for completion, and a low error rate. Feasibility testing across 572 patient encounters demonstrated high acceptability and further improvements to the user interface. Feedback from an additional cycle of feasibility testing will inform further changes. Conclusions: Electronic systems that can integrate point-of-care quality monitoring and clinical assessments are buildable and usable in palliative care.
Effect of discharge to subacute rehabilitation (SAR) on hospitalized patients with progressive gastrointestinal (GI) cancer.
Authors: Andrew S. Epstein, Anjali V. Desai, Leonard Saltz
Journal: Journal of Clinical Oncology (2016)

41 Background: SAR may be an alternative when hospice is declined. However, the outcomes of discharges to SAR in cancer patients with progressive (chemotherapy-refractory) disease are not known. We examined the characteristics and outcomes of patients with debility from progressive metastatic GI cancer who were discharged to SAR after an admission to our center. Methods: An institutional electronic database was queried to identify patients of the GI medical oncology service of Memorial Sloan Kettering Cancer Center who had been discharged to a SAR facility. Patient exclusion criteria were: incomplete follow-up, non-metastatic cancer, low grade neuroendocrine tumors, patients receiving first-line chemotherapy or with newly diagnosed cancer awaiting planned chemotherapy, patients off treatment with a remote history of metastatic cancer, and a primary admitting diagnosis representing an acute complication of cancer treatment. Results: From 2008-2014, 22 patients meeting criteria were identified. Median overall survival from the time of discharge to SAR was 0.8 months (range 0.2-5.2 months). Of the 22 patients, 7 (32%) died at the SAR. Twelve (55%) and 19 (86%) died within 1 and 3 months of discharge to SAR, respectively. For 7 patients (32%), documentation indicated that hospice, instead of SAR, had been recommended by clinicians but declined by family. Nine patients (41%) ultimately were transitioned to hospice within 3 months of discharge to SAR. Eight (36%) were readmitted to hospital within 1 month of discharge to SAR. Two (9%) were able to follow up with their medical oncologist for an outpatient appointment after discharge to SAR. None of the 22 patients received further chemotherapy after discharge to SAR. Conclusions: SAR is not a productive alternative to hospice in hospice-eligible patients with GI malignancies.In patients with metastatic GI cancers whose diseases had progressed beyond first-line therapy and who were hospitalized for reasons other than acute reversible toxicity, discharges to SAR were not associated with either prolonged survival or resumption of chemotherapy. These data can help inform decisions and establish goals of care in advanced GI cancer patients.
Use of endoscopic ultrasound scoring to estimate the malignant potential of branch duct type intraductal papillary-mucinous neoplasms of the pancreas.
Authors: S. Lee, J. Y. Cho
Journal: Journal of Clinical Oncology (2011)

182 Background: Intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas are characterized by intraductal papillary epithelial growth, mucin hypersecretion, and cystic dilation of main or branch pancreatic ducts. However, it is still difficult to differentiate between benign and malignant, when it only involves the branch duct. The purpose of this study was to evaluate the role of endoscopic ultrasound (EUS) scoring in predicting malignancy in branch-duct type IPMNs, thus providing a convenient guideline to a clinician before considering surgical resection. Methods: We retrospectively reviewed all patients between Dec 1997 and April 2010 who underwent diagnostic and/or preoperative EUS for IPMNs. Borderline malignancy and invasive carcinoma were defined as a malignancy. Results: Of the 32 patients (mean age, 62 years), 13 male and 19 female were identified. Twelve people underwent operation, and there were 23 benign cases, and 9 malignant cases (borderline, n=6; invasive carcinoma, n=3). Among the six parameters (age, cyst size, mural nodule, associated main pancreatic duct dilation, patulous opening, thick septum) that have been known as important parameters for predicting malignancy in main duct type IPMNs, four were significant by Fisher's exact tests—namely, cyst size (p=.002), mural nodule (p =.003), associated main pancreatic duct dilation (p =.001), patulous opening (p =.05). In sizing the cysts, we scored 0 (cyst size ≤10 mm), 1 (11-20 mm), 2 (21-30 mm), 3 (&gt;30 mm). In sizing the mural nodules, we scored 0 (no mural nodule), 1 (&lt;5 mm), 2 (5-&lt;10 mm), 3 (≥10 mm). For main pancreatic duct dilation, we scored 2, if there presented any associated main pancreatic duct dilation, and 0 if not. For the patulous opening, we scored 1 for present, 0 for not. Patients were dispersed from the highest score nine, to the lowest score zero. Mean score for benign cases was 2.47 (±1.59 SD), and 6.33 (±1.87 SD) for malignant cases (p =.001). Conclusions: We strongly recommend a radical surgery for patients scoring above 7(score 7, 8, 9), and a consideration of operation for scoring between 4 and 6, and careful follow up for scoring below 3. No significant financial relationships to disclose.
Multimodality therapy for borderline resectable pancreatic cancer: A single-institution experience.
Authors: Jose Mario Pimiento, Tai Hutchinson, Jill M. Weber, Manish R. Patel, Pamela Joy Hodul, Michael D. Chuong, Gregory M. Springett, Sarah E. Hoffe, Richard C. Karl, Barbara Centeno, Jason Klapman, Ravi Shridhar, Dung-Tsa Chen, Mokenge Peter Malafa
Journal: Journal of Clinical Oncology (2012)

280 Background: Multimodality therapy has been advocated for borderline resectable pancreatic cancer (BRCP); however, specific regimens vary widely by institution. Outcomes of these interventions need to be examined to inform future investigation of the optimal therapy for these patients. This study represents the experience of multimodality therapy for BRPC at an NCI designated cancer center. Methods: We identified all patients (pts) with operable pancreatic ductal adenocarcinoma (PDA) from 2006 to 2011. Patients were divided into two groups: resectable group and BRPC group as per the NCCN and AHPBA consensus guidelines. Primary outcomes were resection rate, microscopic negative margin (R0) resection rate, overall survival (OS), and disease free survival (DFS). Fisher's exact and chi-square were used for group comparison while Kaplan-Meier estimates was used for survival analysis. Results: 160pts were identified with operable PDA. 100 (63%) pts had resectable tumors, and 60 (37%) pts had borderline resectable tumors. Neoadjuvant therapy (NT) was administered to 0% in the group with resectable tumors, and 100% in the group with borderline resectable tumors. The resection rate was 100% in pts with resectable tumors and 58% in pts with borderline resectable tumors. R0 resection rates were 80% in the resectable tumors and 97% in the borderline resectable tumors following NT. Perioperative mortality was &lt;1% (1/125) for resectable tumors and 0% in borderline resectable tumors. Median OS was 22.6 months (m) for pts that had resectable tumors and 13.9m for all pts with borderline resectable tumors (p=0.017); however, the median OS for resected pts with borderline resectable tumors was 21.5m (p=0.6). Improved DFS was seen in patients with resectable tumors when compared with resected borderline resectable tumors (15 vs. 9.5m; p=0.04). Conclusions: Multimodality therapy leads to high rates of R0 resections in borderline resectable pancreatic cancer; however 42% of patients progressed during NT. The overall survival for patients with resected borderline resectable pancreatic cancer following NT is similar to patients who undergo resection for resectable pancreatic cancer.
Respective PROGNOSTIC Value of the International Harmonization PROJECT (IHP), Gallamini and London Criteria for Interim FDG PET-CT Performed AFTER 4 Courses of ABVD IN HODGKIN'S LYMPHOMA
Authors: Thomas Gastinne, Pierre-yves Le roux, Caroline bodet-Milin, Beatrice Mahe, Viviane Dubruille, Nicolas Blin, Nadine Morineau, Herve Maisonneuve, Anne Moreau, Philippe Moreau, Jean-Luc Harousseau, Pierre-Yves Salaun, Françoise kraeber-Bodere, Steven Le Gouill
Journal: Blood (2010)
Outbreak of Nosocomial Respiratory Syncytial Virus Infections in a Hematology and Transplant Unit.
Authors: Nicola Lehners, Paul Schnitzler, Gerlinde Egerer, Peter Dreger, Christoph Eisenbach, Elisabeth Aichinger, Benedikt Weißbrich, Uwe Frank, Klaus Heeg, Anthony D Ho
Journal: Blood (2012)
Evaluation of serum IL-17 levels during ipilimumab therapy: Correlation with colitis.
Authors: M. K. Callahan, A. Yang, S. Tandon, Y. Xu, S. K. Subudhi, R. A. Roman, A. I. Heine, E. Pogoriler, D. Kuk, K. Panageas, J. D. Yuan, J. P. Allison, J. D. Wolchok
Journal: Journal of Clinical Oncology (2011)

2505 Background: Ipilimumab is the first agent to demonstrate a survival benefit in patients with metastatic melanoma in a randomized phase III clinical trial. Immune-related adverse events (irAEs) are the most common side effects associated with ipilimumab. Grade III/IV irAEs occur in approximately 10-15% of patients, and colitis is the most common irAE within this group. Ipilimumab-associated colitis has been managed effectively with immunosuppressive medications in clinical trials. IL-17 is an important mediator of autoimmunity and inflammation that has been implicated in colitis. We evaluated serum IL-17 levels in patients treated with ipilimumab, comparing patients who developed colitis to those without irAEs. Methods: Patients with metastatic melanoma received 10 mg/kg of ipilimumab on an expanded access protocol (EAP) (CA184-045). We obtained serum samples from 52 serially accrued EAP patients. Samples were collected pre-treatment and at appointed intervals during treatment. The serum concentration of IL-17 at each time point was quantitated using the Meso Scale Discovery system. Patients were classified into three groups based upon clinical symptoms: (1) colitis, (2) no irAE, or (3) non-colitis irAE. Results: Pairwise comparison of serum IL-17 levels in patients with colitis (n=13) versus no irAEs (n=16) demonstrated significantly higher serum IL-17 levels in patients with colitis at week 7 (p=0.007) and week 12 (p=0.02). In individual patients, development and resolution of colitis symptoms temporally correlated with increases and decreases in serum IL-17, respectively. Upon resolution of clinical symptoms, IL-17 levels in patients with colitis decreased to levels comparable to patients without colitis. Pre-treatment IL-17 levels were not significantly different between patients with or without colitis or between patients and healthy donor controls. This pattern was unique when compared with several additional cytokines tested. Conclusions: We report that the development and resolution of colitis is significantly associated with fluctuations in serum IL-17 in this subset of ipilimumab-treated patients, reinforcing the immune-based mechanism of the most common ipilimumab side effect.
The impact of sarcopenia on survival in locally advanced rectal cancer.
Authors: Andrew Gamenthaler, Erin M. Siegel, Whalen Clark, Ann Chen, Xiuhua Zhao, Kristen Maddox, David Shibata
Journal: Journal of Clinical Oncology (2014)

604 Background: The association between sarcopenia (or muscle loss) and worse oncologic outcomes has been documented in several different cancers and is thought to be a potential marker of a diminished host response to tumor. The prognostic role of sarcopenia in rectal cancer (RC) patients has yet to be elucidated. We sought to examine the impact of radiologically-defined sarcopenia on outcomes of RC patients treated by neoadjuvant chemoradiation (NCR) and radical resection. Methods: Between 1998-2010, we identified 90 patients with stage II/III RC treated by NCR and radical surgery. Sarcopenia was assessed using 3 CT-based measures derived at the L4-L5 level including mean psoas density (MPD; Hounsfield Units), total psoas area (TPA; mm 2 ) and muscle mass index (MMI=TPA/height 2 ; mm 2 /m 2 ). Clinicopathologic data (age, gender, pretreatment and final tumor stage, treatment response and CEA level) were collected. Associations were analyzed by Wilcoxon Rank Sum while the Kaplan–Meier method, log-rank test, and Cox proportional hazards models were used to evaluate overall survival (OS) and disease-free survival (DFS). Results: Our population consisted of 50 males and 40 females with a median age at diagnosis of 61 (range 35-87). By univariate analyses, only age &gt;61 was associated with the presence of sarcopenia by all 3 measures [MPD (p=0.0003), MMI (p=0.0001), and TPA (p=0.0008)]. Female gender was associated with increased muscle loss by MMI (p&lt;0.0001) and TPA (p&lt;0.0001). By Cox multivariate analysis, MPD (range 14.5-77.3 HU) was independently associated with a worse OS (AHR= 0.94; 95% CI, 0.88-0.99; p= 0.04) and marginally associated with DFS (AHR= 0.95; 95% CI, 0.89-1.00; p= 0.056) when controlling for age, gender and pathologic response. This translates to a 28.5% reduction in risk of death with every 5 HU decrease in MPD. Conclusions: We have demonstrated that pre-treatment sarcopenia as measured by MPD is associated with worse OS and possibly DFS in patients with RC treated by NCR and radical surgery. Larger scale studies of sarcopenia and RC are warranted. Strategies targeting reversal of processes associated with muscle loss may play a potential future role in the multidisciplinary management of rectal cancer.