tbuckley/cabot-search huggingface dataset:
Emotional experiences of oncologists treating women with metastatic breast cancer (MBC).
Authors: Adam Brufsky, Musa Mayer, Robyn Bell Dickson, Marc L. Citron
Journal: Journal of Clinical Oncology (2015)

97 Background: Research on the psychological status of medical oncologists (MO) is limited. The Make Your Dialogue Count survey explored emotional experiences of licensed US MOs who treat ≥ 5 women with MBC/month as well as women ( ≥ 21 y) with MBC. Methods: A survey was conducted (June-Aug 2014) online, by paper and telephone; MOs responded online only. Patient (pt) data were unweighted. MO data were weighted by geographic region and years in practice by sex to match actual proportions in the population. Statistically significant differences between groups were determined by standard t-test of column proportions and means at the 95% confidence level (marked by *). Results: 359 pts (median age 53 y) and 252 MOs (median age 49 y; median 15 y in practice) completed surveys. At initial MBC diagnosis, more MOs than pts felt that showing care and compassion (81% vs 72%) and helping pts cope with the diagnosis (63% vs 51%) were very important, and fewer felt that referring pts to support services (24% vs 38%) was very important. More MOs practicing &lt; 15 y vs ≥ 15 y said it was very important to refer pts to support services at first diagnosis (30% vs 19%*). Slightly more MOs with more experience perceived emotions like anxiety, commitment, hopefulness, and determination in their pts at initial diagnosis. Many MOs (42%) reported that treating women with MBC had a lot/a great deal of negative emotional impact; 81% strongly/somewhat agreed that it is unprofessional to let emotions impact treatment recommendations; and 23% reported that emotions kept them from providing some information to pts. Less experienced MOs said their emotions kept them from providing some information to their pts than their more experienced counterparts (29% vs 17%*). Most MOs (93%) did not want to give their pts false hope; yet 27% reported that in certain situations, they do not discuss with pts that MBC is incurable. Conclusions: MOs empathize with pts and feel responsible for providing them emotional/psychological support. MOs revealed the negative emotional weight of their work. MOs with less experience were more impacted by their emotions than MOs with more experience. Acknowledging MOs’ emotions is important and underscores their own need for psychological/emotional support.
Assessing solid tumor response with and without RECIST.
Authors: Aileen Deng, Benjamin E Leiby, Russell J. Schilder, William Kevin Kelly, Sandeep Deshmukh, Ashwin Reddy Sama
Journal: Journal of Clinical Oncology (2016)

504 Background: Response Evaluation Criteria in Solid Tumors (RECIST) has become widely accepted as gold standard for response evaluation in clinical trials. It remains underutilized in routine clinical practice. We compared tumor response assessment made with and without RECIST. Methods: This study included patients with solid tumors who underwent imaging from January 2013 to December 2014 at a single academic center. Tumor response was assessed by a radiologist using RECIST and by an oncologist (Onc) and resident (Res) without using RECIST (standard report). Tumor response was classified as progressive disease (PD), stable disease (SD), partial response (PR) and complete response (CR). Agreement in assessment between RECIST and standard report was determined by percent agreement and Kappa statistic. Results: 292 imaging studies were included. Concordance between RECIST and Onc-interpreted standard report is presented in Table 1. Overall agreement between RECIST and Onc-interpreted standard report was 56% (95% CI: 46-65%) and Kappa was 0.31 (95% CI: 0.19-0.44). Similar results were seen between RECIST and Res-interpreted standard report (Table 1). Overall agreement between RECIST and Res-interpreted report was 54% (95% CI: 44%-63%) and Kappa was 0.26 (95% CI: 0.13-0.40). Conclusions: Our study found variability in tumor response assessment between clinicians and radiologists. RECIST-classified PD was often interpreted as SD and vice versa, a distinction that affect treatment decisions. Our study highlights the need to standardize tumor response assessment. [Table: see text]
The impact of palliative resection (PR) of the primary tumor on overall survival (OS) in metastatic colorectal cancer (mCRC).
Authors: Gillian Gresham, Daniel John Renouf, Matthew Chan, Winson Y. Cheung
Journal: Journal of Clinical Oncology (2013)

509 Background: The role of PR of the primary tumor in mCRC remains unclear. Using population-based data, we explored the impact of PR on OS. Methods: Patients (pts) with mCRC who were referred to 1 of 5 regional cancer centers in British Columbia between 2006 and 2008 were reviewed (n=802). Pts with prior early stage CRC who relapsed with mCRC were excluded (n=285). We conducted survival analysis using Kaplan Meier methods and determined adjusted hazard ratios (HR) for death using Cox proportional hazards models. A secondary propensity score matched analysis was performed to control for baseline differences between pts who underwent PR and those who did not. Results: A total of 517 pts with mCRC were identified: median age was 63 years (range 23-93), 54% were men, 55% had ECOG 0-1, 76% had a colon primary, and 31% had &gt;1 metastatic site. The majority (n=378; 73%) underwent PR of the primary tumor and a significant proportion (n=327; 63%) received palliative chemotherapy (CT). Compared to pts without PR, those with PR were more likely to be men (62 vs 51%, p=0.03), aged &lt;65 years (63 vs 52%, p=0.03), ECOG 0-1 (61 vs 38%, p&lt;0.0001), and receive palliative CT (68 vs 50%, p=0.0004). PR was associated with improved median OS across groups (Table). The benefit of PR on prognosis persisted in multivariate analysis (HR for death 0.56, 95%CI 0.43-0.72, p&lt;0.0001 for entire cohort; HR 0.51, 95%CI 0.37-0.70, p&lt;0.0001 for individuals who were treated with CT; and HR 0.54, 95%CI 0.34-0.84, p=0.007 for those who did not receive CT). In a propensity score matched analysis that considered age, gender, ECOG, and receipt of palliative CT, prognosis continued to be more favorable in the PR group (HR 0.66, 95% CI 0.50-0.86, p=0.0019). Conclusions: In this population-based analysis, PR of the primary tumor in mCRC was associated with a significant OS benefit. [Table: see text]
Long-term prognostic factors of node-negative invasive breast cancer of luminal subtype: A comparison between histologic grades and molecular markers including Ki-67 and HER2.
Authors: M. Ono, H. Tsuda, C. Shimizu, K. Yonemori, M. Ando, K. Tamura, N. Katsumata, T. Kinoshita, Y. Fujiwara
Journal: Journal of Clinical Oncology (2011)

e11050 Background: It is unclear whether Ki67 labeling index or conventional histopathological parameters is more efficient to identify the patients with higher-risk node-negative invasive breast cancerof luminal type. In the present study, we retrospectively compared the prognostic impact of Ki67 and histological/nuclear grade in 560 cases surgically resected between 1996 and 2000 in a single hospital. Methods: For available 530 tumors, hormone receptors (HRs), HER2, and Ki67 antigen were examined by immunohistochemistry (IHC). HRs and HER2 were defined positive if Allred score was 3 or more and if score 3+ or score 2+/FISH positive, respectively. Ki67 cut-off value was set at 20%. These tumors were classified into 409 luminal type (HR+) with luminal A (HR+/HER2-/Ki67-) and luminal B (HR+/HER2+ or Ki67+) subtypes, 48 HER2-enriched type (HR-/HER2+), and 73 triple-negative type (HR-/HER2-). In these 409 patients with luminal type, adjuvant chemotherapy was performed for 176 (CMF for 117 and UFT for 59). For the 409 luminal type, prognostic significance of Ki67, HER2, and histological grade/nuclear grade (HG/NG) were analyzed by Cox’s univariate and multivariate analyses. Results: Median follow-up time was 118 months (0.6-160 months), and 10-yr DFS and OS for luminal type were 87.6% and 91.9%. Ki67 was positive in 138, HER2 was positive in 58. Luminal A and B subtypes were 240 and 169. Histological grade was 1 in 107, 2 in 182, and 3 in 114. Nuclear grade was 1 in 160, 2 in 105, and 3 in 137. By univariate analyses, higher Ki67 (>=20%), histological grade (3 vs 1 and 2), nuclear grade (3 vs 1 ad 2) were significant risk factors of recurrence (p = 0.007, 0.008, and 0.009, respectively). HER2 did not show significant prognostic impact (p = 0.15). Luminal A or B subtypes were also significantly associated with recurrence (p = 0.0001). By multivariate analyses, luminal A or B subtypes only remained significant as prognostic factor (p = 0.01). Conclusions: For the prognostication of patients with pN0-IBC of luminal type, HG/NG and Ki67 were equally effective, but the impact of combination of Ki67 and HER2, i.e., intrinsic subtyping by IHC, might surpass that of HG/NG.
Epidemiology and survival of small cell carcinoma of gastrointestional tract: A Surveillance, Epidemiology, and End Results (SEER) database review.
Authors: Abhijeet Kumar, Srinath Sundararajan, Haiyan Cui, Hitendra Patel, Emad Elquza
Journal: Journal of Clinical Oncology (2016)

518 Background: Small cell carcinoma of the gastrointestinal tract is an uncommon histology. Limited literature is available to clinicians about the incidence, distribution and prognosis of small cell carcinoma of the gastrointestinal tract (SCGIT). We reviewed the Survival, Epidemiology and End Result (SEER) database of National Cancer Institute to understand its epidemiology and prognosis. Methods: SEER database was reviewed for patients with histologically confirmed SCGIT (8041-45) and its variants in the GIT between 2002-2007 (all stages). Variables included were age, gender, race, primary site and disease specific survival. The incidence pattern across race, gender, and site of origin for SCGIT was investigated. Chi square test was used to assess the difference of incidence pattern. 5-yr survival rate across various sites was estimated using the Kaplan–Meier method and the difference in 5-yr survival was tested by log-rank test. If the significant difference is detected, the paired comparison was performed and the p-values were adjusted by Tukey multiple-comparison method. Results: A total of 645 patients were included. The distribution of SCGIT was: colorectal (30.08%), esophagus (22.17%), pancreas (20.16%), hepatobiliary (11.63%), stomach (9.61%) and NOS (6.63%). The incidence pattern of SCGIT in males and female was significantly different (p &lt; 0.0008). Males had a higher incidence of esophagus; stomach and pancreas while females had a higher incidence of hepatobiliary, colorectal and NOS sites. Five-year survival of SCGIT was significantly associated with the primary site of disease (p = 0.03). Paired-comparison results showed that the 5-yr survival rate for patients with pancreas small cell cancer was significantly lower than patients with stomach or NOS(4.80% -pancreas vs 5.22 %-stomach and 12.81% - NOS) (p = 0.04 and p = 0.003 respectively). There was not a significant difference between other sites. Conclusions: Small cell carcinoma of the GI tract has difference in incidence patterns between genders. The 5-yr survival of patients with pancreatic small cell carcinoma is significantly lower as compared to stomach or NOS.
Benznidazole and Posaconazole in Eliminating Parasites in Asymptomatic T. Cruzi Carriers
Authors: Carlos A. Morillo, Hetty Waskin, Sergio Sosa-Estani, Maria del Carmen Bangher, Carlos Cuneo, Rodolfo Milesi, Marcelo Mallagray, Werner Apt, Juan Beloscar, Joaquim Gascon, Israel Molina, Luis E. Echeverria, Hugo Colombo, Jose Antonio Perez-Molina, Fernando Wyss, Brandi Meeks, Laura R. Bonilla, Peggy Gao, Bo Wei, Michael McCarthy, Salim Yusuf, Carlos Morillo, Sergio Sosa-Estani, Hetty Waskin, Brandi Meeks, Salim Yusuf, Rafael Diaz, Harry Acquatella, Julio Lazzari, Robin Roberts, Mahmoud Traina, Brandi Meeks, Laura R. Bonilla, Peggy Gao, Amanda Taylor, Iris Holadyk-Gris, Lindsey Whalen, M.C. Bangher, M.A. Romero, N. Prado, Y. Hernández, M. Fernandez, A. Riarte, K. Scollo, C. Lopez-Albizu, C.A. Cuneo, N.C. Gutiérrez, R.R. Milesi, M.A. Berli, M.H. Mallagray, N.E. Cáceres, J.S. Beloscar, J.M. Petrucci, H. Colombo, M. Dellatorre, Aldo Prado, W. Apt, I. Zulantay, L.E. Echeverría, D. Isaza, E. Reyes, F.S. Wyss, A. Figueroa, I. Guzmán Melgar, E. Rodríguez, J. Gascon, E. Aldasoro, E.J. Posada, N. Serret, I. Molina, A. Sánchez-Montalvá, J.A. Perez-Molina, R. López-Vélez, P.A. Reyes-López
Journal: Journal of the American College of Cardiology (2017)
Consensus-based standards for best supportive care in cancer clinical trials.
Authors: A. P. Abernethy, D. Currow, N. Cherny, F. Strasser, R. Fowler, Y. Zafar
Journal: Journal of Clinical Oncology (2011)

e19507 Background: Best supportive care (BSC) is poorly-defined in clinical trials, with considerable variety in breadth, frequency, and documentation of care described. A standardized framework for delivery of BSC within clinical trials is needed utilizing best available evidence and allowing confirmatory replication of the studies. Methods: After conducting a systematic review of the literature (previously-published), we convened a panel of 36 experts internationally to develop consensus statements via the Delphi methodology. Experts were selected from fields including oncology, palliative care, clinical trial design, health services, nursing, and social work. Six rounds of surveys were completed. The first round included open-ended questions; subsequent rounds sought to develop consensus-based standards. Consensus was assessed by levels of agreement on a five-point Likert scale, and a score of 5 was required by >70% of panelists to meet the stringent definition set a priori for consensus. Results: The panel identified four key domains of BSC in clinical trials: multidisciplinary care, supportive care documentation, symptom assessment, and symptom management. Consensus was reached on 11 statements within these four domains. For example, 96% of panelists recommended routine similar assessment of symptoms in BSC and antineoplastic intervention arms, and 84% agreed that symptom management should be conducted in concordance with evidence-based guidelines. 92% recommended that published manuscripts should detail supportive care received in both arms. Availability of resources was most often cited as a challenge to implementation of the BSC standards. Participants rated new potential terms to describe standardized supportive care delivered in clinical trials (currently “BSC”); the highest-scoring term was “evidence-based supportive care.” Conclusions: Aspects of evidence-based supportive care in clinical trials can be standardized while accommodating for variability based on the patient’s need at the bedside. This care should be clearly documented, thereby improving internal and external validity of trial results.
Associations between receipt of a treatment summary, emotional concerns, and patterns of care among post-treatment cancer survivors.
Authors: Ruth Rechis, Ellen Burke Beckjord, Stephanie Nutt, Kerry Reynolds, Brandon M. Hayes-Lattin
Journal: Journal of Clinical Oncology (2012)

9136 Background: Treatment summaries (TS), a critical component of survivorship care plans, were identified as a tool to improve long-term outcomes for the 12 million cancer survivors alive in the US. Methods: In 2010, the Lance Armstrong Foundation fielded the LIVESTRONG Survey for People Affected by Cancer. Respondents were recruited through several channels including partnerships with national organizations such as ASCO. Over a 9 month period, more than people completed the survey, including 3,682 post-treatment cancer survivors (PTCS). The survey addressed post-treatment concerns including receipt of TS. Full survey results were presented at the 2011 ASCO Conference. Results: Receipt of TS data was available for 3042 PTCS: average age (50); female (65%); average time since diagnosis (6 years); received a TS (34%). PTCS who received TS reported that they were: Closer to time since diagnosis or since treatment ended (p&lt;0.01); more likely to have received chemotherapy (p&lt;0.01); more often receiving the majority of their health care from a medical oncologist (p&lt;0.05); experiencing significantly fewer (p&lt;0.05) post-treatment emotional concerns (including emotional distress; fears of recurrence; concerns about family risk; and appearance concerns) and were more likely to have received care; significantly less likely to say that they had “learned to live with” their concerns (p&lt;0.05) – the most common reason among participants for not receiving care. Finally, receipt of a TS was related to higher information efficacy (p&lt;0.01; which appeared to mediate the relationship between receipt of a TS and fewer emotional concerns). PTCS who received a TS more often reported that their needs were met including information received about possible late-effects; care they got during treatment; and care they received after treatment. Conclusions: These results support the provision of TS to PTCS. Receipt of TS was associated with a variety of positive outcomes; however, only about one-third of PTCS received one. Future studies focused on patient perspectives on care planning tools, such as treatment summaries and care plans, can help to improve optimal survivorship care delivery.
Randomized Phase II Study of Clofarabine-Based Consolidation for Younger Adults With Acute Myeloid Leukemia in First Remission
Authors: Xavier Thomas, Stéphane de Botton, Sylvie Chevret, Denis Caillot, Emmanuel Raffoux, Emilie Lemasle, Jean-Pierre Marolleau, Céline Berthon, Arnaud Pigneux, Norbert Vey, Oumedaly Reman, Marc Simon, Christian Recher, Jean-Yves Cahn, Olivier Hermine, Sylvie Castaigne, Karine Celli-Lebras, Norbert Ifrah, Claude Preudhomme, Christine Terré, Hervé Dombret
Journal: Journal of Clinical Oncology (2017)

Purpose To evaluate the efficacy and safety of a clofarabine-based combination (CLARA) versus conventional high-dose cytarabine (HDAC) as postremission chemotherapy in younger patients with acute myeloid leukemia (AML). Patients and Methods Patients age 18 to 59 years old with intermediate- or unfavorable-risk AML in first remission and no identified donor for allogeneic stem-cell transplantation (SCT) were eligible. Two hundred twenty-one patients were randomly assigned to receive three CLARA or three HDAC consolidation cycles. The primary end point was relapse-free survival (RFS). To handle the confounding effect of SCT that could occur in patients with late donor identification, hazard ratios (HRs) of events were adjusted on the time-dependent treatment × SCT interaction term. Results At 2 years, RFS was 58.5% (95% CI, 49% to 67%) in the CLARA arm and 46.5% (95% CI, 37% to 55%) in the HDAC arm. Overall, 110 patients (55 in each arm) received SCT in first remission. On the basis of a multivariable Cox-adjusted treatment × SCT interaction, the HR of CLARA over HDAC before or in absence of SCT was 0.65 (95% CI, 0.43 to 0.98; P = .041). In a sensitivity analysis, when patients who received SCT in first remission were censored at SCT time, 2-year RFS was 53.3% (95% CI, 39% to 66%) in the CLARA arm and 31.0% (95% CI, 19% to 43%) in the HDAC arm (HR, 0.63; 95% CI, 0.41 to 0.98; P = .043). Gain in RFS could be related to the lower cumulative incidence of relapse observed in the CLARA arm versus the HDAC arm (33.9% v 46.4% at 2 years, respectively; cause-specific HR, 0.61; 95% CI, 0.40 to 0.94; P = .025). CLARA cycles were associated with higher hematologic and nonhematologic toxicity than HDAC cycles. Conclusion These results suggest that CLARA might be considered as a new chemotherapy option in younger patients with AML in first remission.
The effect of the trifunctional anti-EpCAM antibody catumaxomab on the development of tumor-specific immune responses in patients with gastric cancer.
Authors: H. Reinhard, S. K. Meyer, K. Bartels, R. Fischer, D. Seimetz, C. Bokemeyer, D. Atanackovic
Journal: Journal of Clinical Oncology (2011)

2601 Background: The abundant expression of the epithelial cell-adhesion molecule EpCAM on the surface of epithelial cancer cells renders it an attractive target for immunotherapy of gastric cancer (GC). The trifunctional antibody (Ab) catumaxomab targets EpCAM on malignant cells and CD3 on T cells while triggering antigen (Ag)-presenting cells via their Fcγ-receptor. Recently, catumaxomab has received approval for the treatment of malignant ascites; however, the exact immune mechanisms behind its clinical effects are unknown. Methods: In a phase II study, patients with operable GC received neoadjuvant chemotherapy followed by 1 dose of catumaxomab during surgery and 4 consecutive doses applied intraperitoneally in the adjuvant setting. We measured the immunomodulatory effects of catumaxomab in 6 patients at 3 time points: before surgery, after application of the first dose, and 1 month post treatment. Results: None of the patients had evidence of autologous EpCAM-specific Ab responses. However, the majority of patients developed Abs against different classes of Ags, namely cancer-testis Ags, after catumaxomab treatment. Monitoring T cell subsets, we observed a drastic decrease in peripheral CD4+ T cells carrying an effector and T-helper (Th)-1 phenotype (CXCR3+CCR4–) directly after Ab application, whereas the CD4+ Th2 population remained unchanged. At 4 weeks after catumaxomab, the number of CD4+ effector-type T cells in the peripheral blood (PB) had returned to baseline levels. Interestingly, we could demonstrate pre-existing EpCAM-specific CD4+ and/or CD8+ T cells in all patients. While these T cells seemed to disappear from the PB immediately after Ab exposure, we detected significantly increased numbers of peripheral EpCAM-specific cells 4 weeks after immunomodulatory treatment. Conclusions: Our data suggest that catumaxomab might exert its clinical effects through at least 3 different immunological routes: (1) the spreading of humoral immune responses to other Ags apart from EpCAM, (2) the redistribution of effector and Th1-type cells from the PB into peripheral tissues, and (3) the expansion of pre-existing EpCAM-specific T cells.