tbuckley/cabot-search huggingface dataset:
Analyses of updated overall survival (OS) and prognostic effect of neutrophil-to-lymphocyte ratio (NLR) and CA 19-9 from the phase III MPACT study of nab-paclitaxel (nab-P) plus gemcitabine (Gem) versus Gem for patients (pts) with metastatic pancreatic cancer (PC).
Authors: David Goldstein, Robert Hassan El-Maraghi, Pascal Hammel, Volker Heinemann, Volker Kunzmann, Javier Sastre, Werner Scheithauer, Salvatore Siena, Teresa Macarulla, Luis Teixeira, Giampaolo Tortora, Jean Luc Van Laethem, Darryl Neil Penenberg, Brian Lu, Alfredo Romano, Daniel D. Von Hoff
Journal: Journal of Clinical Oncology (2014)

4027^ Background: In the phase III MPACT trial, nab-P + Gem demonstrated superior OS vs Gem (primary endpoint; median 8.5 vs 6.7 months; HR 0.72; P< 0.001) with manageable toxicity in pts with metastatic PC. The primary analyses were based on a cutoff of Sep 17, 2012, at which time 80% of pts had died. Here, we report an updated OS analysis (post hoc) and an assessment of pts with elevated NLR or elevated CA 19-9 at baseline, 2 accepted markers of poor prognosis. Methods: 861 pts with metastatic PC and a Karnofsky performance status ≥ 70 were randomized at 151 community and academic centers 1:1 to receive nab-P 125 mg/m2 + Gem 1,000 mg/m2 on days 1, 8, and 15 of each 28-day cycle or Gem 1,000 mg/m2weekly for 7 wks followed by 1 wk of rest (cycle 1) and then days 1, 8, and 15 of each 28-day cycle (cycle ≥ 2). The data for the OS analysis were collected through May 9, 2013. Baseline NLR and CA19-9 were measured in blood samples collected before treatment. Results: As of the updated data cutoff, 380 of 431 pts (88%) in the nab-P + Gem arm and 394 of 430 pts (92%) in the Gem-alone arm had died. OS was superior for nab-P + Gem in the intent-to-treat (ITT) population, and longer follow-up identified > 3-yr survivors in the nab-P + Gem arm (Table). In a pooled–treatment-arm analysis, a NLR ≤ 5 was associated with longer OS vs a NLR > 5 (median 9.1 vs 5.0 months; HR 1.839; P < 0.001). Median OS was longer with nab-P + Gem vs Gem for pts with a NLR > 5 and pts with CA 19-9 > 59 × upper limit of normal (ULN; Table). Conclusions: Updated data confirmed the treatment effect favoring nab-P + Gem for OS. Additional follow-up has identified long-term survivors in the nab-P + Gem arm. The improved OS for pts treated with nab-P + Gem who have a NLR > 5 or an elevated CA 19-9 supports the relative benefit of the combination, even for pts with markers of poor prognosis. Clinical trial information: NCT00844649.Updated OS (May 9, 2013). nab-P+ Gem n = 431 Gem n = 430 HR P value ITT population Median OS, mo 8.7 6.6 0.72 < 0.001 OS rates by mo, % 6 66 55 12 35 22 24 10 5 36 4 — 40 3 — 42 3 — Subsets with markers of poor prognosis Median OS, mo NLR > 5 (n = 309) 5.6 4.3 0.81 0.079 CA 19-9 ≥ 59 × ULN (n = 392) 8.4 5.7 0.61 < 0.001
Prevalence of hypomagnesemia in patients with HER2–positive breast cancer receiving pertuzumab treatment.
Authors: Tracy Ann Proverbs-Singh, Karen Anne Cadoo, Gianna Torre, Sujata Patil, Ayca Gucalp, Chau T. Dang, Clifford A. Hudis, Ilya G. Glezerman, Tiffany A. Traina
Journal: Journal of Clinical Oncology (2015)

e11608 Background: Human Epidermal growth factor Receptor-2 (HER2) is a member of the epidermal growth factor (EGFR) family of transmembrane receptors and is overexpressed in ~20% of breast cancers (BC). Pertuzumab (P) blocks HER2 dimerization with HER3, EGFR, and HER1. When administered with trastuzumab (T) and chemotherapy, P prolongs overall survival in patients (pt) with HER2+ metastatic BC (MBC). P is FDA-approved for pt with HER2+ MBC and high risk, early stage BC. We observed unexplained CTCAE grade (G) 3 hypomagnesemia (HypoMg) and urine Mg wasting in a pt receiving P. This phenomenon was noted with other EGFR inhibitors (e.g. cetuximab, panitumumab) following their approval and widespread use. The kidney distal convoluted tubule is the site of active transcellular Mg reabsorption under direct EGF control. We therefore hypothesized that P-mediated blockade may inhibit Mg reabsorption and sought to further define the phenomenon. Methods: With IRB approval we retrospectively reviewed the electronic records of pt with HER2+ BC receiving P at MSKCC from 10/2013-01/2015 who had serum Mg data available. Hypothesis generating descriptive statistics, including prevalence, mean and time to event, were performed. Results: 353 pt received P, 233 had serum Mg data available (143 MBC and 90 early stage BC). Of the pt with MBC who received P, HypoMg ( ≥ G1) was identified in 20/143 (14%); 11 had additional risk factors for HypoMg (prior platinum n = 4, diarrhea n = 4, antibiotic n = 3). In the (neo)adjuvant setting, HypoMg ( ≥ G1) was observed in 8/90 (9%) pt receiving P. Time to onset of HypoMg in pt receiving P: MBC = 216 (3-1022) days; (neo) adjuvant = 33 (5-94) days. Conclusions: HypoMg may be a class effect of EGFR family inhibitors and the interaction of P with EGFR/HER1 may underpin the potential to increase the risk of HypoMg. T is not known to be associated with HypoMg but the differing mechanism of action of P or the impact of dual HER2 blockade may have implications for magnesium handling. We plan to assess HypoMg rates in pt with HER2+ BC who have not been treated with P to provide additional insight into whether this is a distinct characteristic of P therapy. If confirmed, these data could support Mg monitoring in pt receiving P.
Compliance of recommendations with French clinical practice in the management of thromboembolism in patients with cancer: The CARMEN study.
Authors: Marie-Antoinette Sevestre, Cristina Belizna, Cecile Durant, Lionel Vedrine, Eric Desruennes, Philippe Debourdeau, Isabelle Bonnet, Gilles Pernod, Anne-Marie Stoppa, Toufik Berremili, Jerome Connault, Irene Kriegel, Isabelle Mahe, Juliette Camuset, marie-Therese Barrellier, Grigoris Gerotzafias, Francis Cajfinger, Beatrice Terriat, Jean-Luc Bosson, Dominique Farge
Journal: Journal of Clinical Oncology (2012)

1580 Background: Long-term treatment with low-molecular-weight heparin (LMWH) is recommended for treatment of venous thromboembolism (VTE) in cancer patients. Few data are available on compliance in this population. Our study measured whether the management of VTE in patients with cancer was consistent with French recommendations. Methods: Compliance with recommendations (CR+) was analysed according to malignancy and VTE from a 500-patient cross-sectional observational study run between May and October 2010. CR+ was defined as the compliance to initial 10-day treatment followed by long-term LMWH for at least 3 months, avoiding LMWH in patients with renal insufficiency (SRI). All inpatients with a diagnosis of cancer and VTE of less than 6 months were included in the study. Results: Of 500 patients included in 47 centers, 242 (49%) were male, 81 (18%) had local (T+), 83 (18%) had loco-regional (N+) and 287 (64%) had metastatic malignancies. Malignancies were gastro-intestinal (25%), gynaecologic (23%), pulmonary (21%), haematological (14%), urologic (10%) or other (8%). Twelve patients had SRI. Overall, treatment was CR+ in 289/500 patients (58% [95% CI 53%-62%]). Out of 12 patients with SRI only 3 (25%) were treated long-term with vitamin K antagonists (VKA), as usually recommended. Tumour site influenced CR+ (p=0.02). Treatment for haematological malignancy was poorly compliant with recommendations (32%) while patients with lung malignancy had the best compliance (68%). TNM stage and VTE location had no influence on treatment compliance. Conclusions: In French practice, treatment of cancer-related VTE is CR+ in 58% of cases. TNM stage and VTE location do not influence compliance which remains insufficient, especially in patients with haematological malignancy. [Table: see text]
Using the symptom distress thermometer (SDT) in patients with breast cancer to identify psychosocial supportive needs.
Authors: Alyssa Gillego, Rohan Singh, Siyung Chen, Celina Parris, Jeremy Winell
Journal: Journal of Clinical Oncology (2017)

200 Background: Psychological distress is common among cancer patients. In order to optimize patient care there is a need to understand the type of patient problems contributing to distress. SDT is a well-recognized tool for assessing distress in 5 broad problem categories including, practical, family, emotional, spiritual/religious, and physical (NCCN distress guidelines: Cancer 2005). The objective of this study was to evaluate categories of distress commonly experienced by breast cancer patients undergoing radiation therapy (RT). Methods: This is a retrospective study on patient symptoms of distress as recorded on SDT surveys. Patients completing SDT have the opportunity to score distress on a scale of 0-10 and list the category of distress. For the purpose of this study, we defined low distress score to be ≤ 3, and high distress score of ≥ 4 requiring referral/intervention. Patient population included 121 patients receiving a 3-6 week course of breast RT and who completed ≥ 2 weekly surveys during therapy. A total of 433 surveys were reviewed for score and category of distress. Results: Median age was 56 years (range 32-88). Each patient completed an average of 3.58 surveys. The median distress score was 3 (range 0-10). Overall distribution of any distress by problem category was 1.6% spiritual/religious, 3.7% family, 10.6% practical, 23.3% emotional, and 60.8% physical. Further, we noted that 63 patients (53%) described a high distress score (≥ 4). Among this cohort, 47 patients (74.6%) reported that their distress was secondary to emotional problems. We observed no association between high distress score and patient age or stage of disease. Conclusions: Physical problems were the most common symptom reported on SDT in our study population. However, among the patients identified to have high distress score, emotional problems emerged as the most common cause of distress. These observations suggest that although patients undergoing treatment have many physical complaints, the more significant symptoms requiring referral/intervention were in the emotional category. The identification of more significant problems experienced by patients would help optimize their psychosocial supportive needs.
Comparison of toxicity and outcomes of concurrent radiotherapy with carboplatin/paclitaxel (PC) or cisplatin/etoposide (PE) in stage III non-small cell lung cancer (NSCLC).
Authors: Mun Sem Liew, Joseph Sia, Samuel John Harris, Alireza Tafreshi, Maud HW Starmans, Malcolm Feigen, Paul C Boutros, Shane White, Allan Solomon Zimet, P. Lambin, Paul Mitchell, Tom John
Journal: Journal of Clinical Oncology (2013)

e18559 Background: Concurrent chemoradiotherapy (CCRT) has become the standard of care for patients (pts) with unresectable stage III NSCLC. Although 60Gy of radiotherapy is accepted as the standard radiation dose, the concurrent chemotherapy regimen is idiosyncratic to the institution with PC generally reserved for older and less fit pts. We retrospectively reviewed outcomes and toxicity of two widely used regimens at our institution (Austin Health, Melbourne): weekly PC (Belani et al, 2005) versus (vs) PE given weeks 1 and 5 (SWOG 9019) each with concurrent chest radiotherapy. Methods: Charts from stage III NSCLC pts treated with radical dose CCRT between 2000-2011 were reviewed. Clinical data including demographics, toxicity, and response were reviewed. Results: A total of 83 (PC: 50, PE: 33) pts were treated. PC pts were older [median age (range) 70 year (44-83) vs 63 year (32-76); p=0.001]. Other characteristics were comparable in PC and PE groups (Table). Increased grade (gr) ≥3 neutropenia was seen with PE (39% vs 12%, p=0.008). Other gr ≥3 toxicities were similar including febrile neutropenia, esophagitis and pneumonitis. With a median follow up of 17.2 months (mo), no statistical difference in overall survival (OS) (median PC 21.3 mo vs PE 13.7 mo; p=0.690) and relapse free survival (median PC 12.0 mo vs PE 11.1 mo; p=0.934) were observed. In multivariate analysis, where treatment type and age were included in the model, only more advanced stage predicted poorer OS (p=0.045). Conclusions: PC was more likely to be used in elderly pts. Despite this, PC resulted in significantly less hematological toxicity but achieved similar survival outcomes compared to PE. PC is an acceptable CCRT regimen especially in older pts. [Table: see text]
Predictive cytokine biomarkers for survival in patients with advanced pancreatic cancer randomized to sequential chemoimmunotherapy comprising gemcitabine and capecitabine (GemCap) followed by the telomerase vaccine GV1001 compared to concurrent chemoimmunotherapy in the TeloVac phase III trial.
Authors: John P. Neoptolemos, William Greenhalf, Trevor F. Cox, Eithne Costello, Victoria Shaw, Juan W. Valle, Fareeda Y. Coxon, Jonathan Wadsley, David Propper, Paul J. Ross, Srinivasan Madhusudan, Tom Roques, David Cunningham, Martin McKinlay Eatock, Tim Iveson, Kinnari Patel, Angel Garcia-Alonso, Gemma Nanson, Gary Middleton
Journal: Journal of Clinical Oncology (2014)

4121 Background: The TeloVac trial randomized 1,062 patients with advanced pancreatic cancer to a control chemotherapy Arm1, using GemCap; sequential chemoimmunotherapy Arm 2, GemCap for 8 wks followed by GV1001 and GMCSF (d1, 2, 5 during wk 9, then once on wks 10, 11, 12, 14, followed by once 4-wkly) with further GemCap given if there was PD at wk 8; and concurrent chemoimmunotherapy Arm 3, GemCap and GV1001 and GMCSF (d1, 2, 5 during wk1, then once on wks 2, 3, 4, 6, andthen once 4-wkly) . The final results (ASCO 2013) did not show improved survival with the addition of GV1001 to GemCap. A translational component examined predictive cytokine biomarkers Methods: 27 cytokines plus CRP were measured (Luminex) in 38 patients in Arm2 at baseline and in 50 at wk8 (after 2 cycles of GemCap, no vaccine) and in 41 patients in Arm3 at baseline and in 51 at wk10 (3rdcycle GemCap, 4 wks after the previous vaccine dose). The results at baseline and post-treatment were compared between the two arms and survival. Results: 19 cytokines showed a significant fall (P<0.05) between pre- and post-treatment in Arm2 (PDGF, IL1b, 1ra, 2, 4, 5, 7, 10, 12, 13 and 17, GCSF, IFNg, eotaxin, FGFb, MIP1b, RANTES, TNFa, VEGF; but not CRP, IL6, 8, 9, and 15, GMCSF, IP10, MCP1, MIP1a) and none in Arm3. Baseline eotaxin levels predicted median (95% CI) overall survival in Arm3 (high eotaxin=14.8 [10.1-20.5] mths; low eotaxin=7.9 [5.9-11.3] mths; p=0.0135) but not in Arm2 (high eotaxin=9.8 [5.5-11.8] mths; low eotaxin=6.2 [3.4-10.5] mths; p=0.1138 Conclusions: GemCap chemotherapy induced a fall of a distinct range of cytokines which was prevented by GV1001 given with GemCap. High eotaxin (CLL11) levels may predict improved survival in patients given GV1001 with GemCap but its role in advanced pancreatic cancer is subject to prospective trial validation Clinical trial information: 43482138.
Impact of breast cancer detection method on survival in a multiracial population.
Authors: Jared David Acoba, Jodi Kagihara, James W. Davis
Journal: Journal of Clinical Oncology (2015)

e17548 Background: We and others have previously demonstrated racial disparities in breast cancer survival despite adjustments for tumor and socioeconomic factors. Method of detection has been postulated to have an adverse prognostic value in breast tumors, however this has not been studied extensively in a racially diverse cohort. We performed an evaluation of the method of detection of breast cancers in a multiracial population to determine the degree to which detection method impacts survival. Methods: Data from 3992 consecutive stage I-IV breast cancer patients were collected from a hospital tumor registry between 1998 and 2010. Multivariable regression models for survival were built for race, age at diagnosis, stage, histologic grade, receptor status, insurance status, and method of detection. Clinical detection was defined as diagnosis by patient or physician exam and compared to diagnosis by mammogram. Results: Breast cancer was clinically detected in 1439 (36%) patients and detected by mammography for 2553 (64%) of patients. Mammography was more often the method of detection for older patients, early stage tumors, low grade tumors, and hormone receptor positive tumors. Clinical diagnosis was more common among Hawaiian patients and uninsured/Medicaid patients. Univariate analysis revealed that clinical method of detection was an adverse prognostic factor, HR 2.2, 95% CI 1.9-2.6. However after adjusting for age, stage, race, and insurance in a multivariate regression analysis, method of detection no longer significantly impacted prognosis, HR 1.1, 95% CI 0.9-1.5. Conclusions: Analysis of this multiracial population revealed racial and socioeconomic disparities in method of breast cancer detection. Univariate analysis demonstrated an adverse impact of clinical detection on survival. However subsequent adjustment for tumor and demographic factors known to impact breast cancer outcomes demonstrated that detection method no longer significantly affected prognosis.
Assessing and comparing quality of life in breast and colorectal cancer survivors in a southern Irish hospital.
Authors: Emily O'Connor, Brian Richard Bird, Conleth G. Murphy, Diarmuid Duggan, Jo O' Keeffe
Journal: Journal of Clinical Oncology (2014)

e20597 Background: Cancer survival rates in Ireland have improved significantly over the last ten years. Relatively little survivorship research has been conducted in Ireland to date. Breast and colorectal cancer remain two of the most commonly diagnosed cancers in the Irish population. The aim of this study was to assess the quality of life (QOL) in a population of breast (BR) and colorectal cancer (CRC) survivors and to compare the QOL between these two groups. Methods: BR and CRC survivors treated in the Bon Secours Hospital, Cork, were invited to participate in this cross-sectional study by completing the validated EORTC QLQ-C30 questionnaire. Participants selected a score from 1 (not at all) to 4 (very much) to assess functional QOL and symptom scales. Raw scores were transformed to a linear score ranging from 1 to 100 with high scores indicating a higher level of functioning or worse symptomatology. Results: Of 181 questionnaires returned, 110 were completed by BR and 71 by CRC survivors (32% response rate). The mean global QOL scores were 75.53 and 79.16 for BR and CRC survivors, respectively. Both groups reported high QOL scores (>80) for physical, role, cognitive and social functioning. BR survivors had a statistically significant lower emotional functioning (EF) score (78.89 v 86.19, p< 0.05) than CRC survivors. Two-way ANOVA showed that BR and CRC survivors in the youngest age group had a significantly lower EF score compared to the two older age groups (74.3 vs 82.5 and 84.6, respectively, p<0.05). The most problematic symptoms common to both groups (BR v CRC) were insomnia (30.26 v 16.43), fatigue (23.43 v 19.56), and constipation (15.75 v 12.20). BR survivors had worse scores in comparison with CRC survivors for all symptoms except diarrhoea (4.2 v 10.47, p<0.05). Conclusions: CRC survivors reported an overall better QOL in comparison with BR survivors. Both groups reported on-going symptoms after treatment ended. Young BR survivors may represent an under-served population among cancer survivors. These findings offer guidance to health care professionals about the long-term management of BR and CRC survivors and may help to develop a focused cancer survivorship programme in the future.
Seeing the Effect of Health Care Delivery Innovation in the Safety Net
Authors: Courtney Lyles, Urmimala Sarkar
Journal: JAMA Internal Medicine (2017)

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TRATAMIENTO DE GASTROPATIA HIPERTENSIVA DEL CIRROTICO MEDIANTE RADIOFRECUENCIA
Authors: F Pérez Roldán, P González Carro, E Tebar Romero, S Aoufi Rabih, E Romero Rodríguez, P Peña Martínez, ML Legaz Huidobro, E Bernardos Martín, N Sánchez-Manjavacas Muñoz, C Navarro López
Journal: Endoscopy (2015)

Introducción: La aparición de anemia de origen incierto y de difícil control puede suponer un grave problema en pacientes con cirrosis. Esta anemia se ha relacionado con gastropatía hipertensiva (GHT), además de otros posibles sangrados por lesiones vasculares en el resto del tubo digestivo. Recientemente se ha publicado la eficacia de radiofrecuencia (RF) en la ectasia vascular antral.
A predictive model for venous thromboembolism in patients with germ-cell tumors receiving chemotherapy.
Authors: Enrique Gonzalez-Billalabeitia, Maria Isabel Luengo, Xavier Garcia del Muro, Josep Guma, Ray Manneh, Jorge Aparicio, Alfonso Sanchez Munoz, Elvira Buxo, Alberto Saenz, Claudia María Valverde, Antonio Fernandez, Mireia Margeli, Marta Espinosa, Javier Sastre, Paula Jiménez-Fonseca, Juana Ascension Campillo Fuentes, Pablo Cerezuela Fuentes, Alberto Carmona Bayonas, David Hervas, Pablo Maroto
Journal: Journal of Clinical Oncology (2015)

e15545 Background: To develop a prediction model for venous thromboembolism (VTE) in patients with germ-cell tumors receiving chemotherapy. Methods: We designed a multi-institutional study with a sample size estimation of 660 patients to develop a model with 5 explanatory covariates. Patients with germ-cell cancer treated between 2000-2014 were pooled from the Spanish Germ-Cell Cancer Group (Grupo Germinal)/Spanish Oncology Genitourinary Group(SOGUG) registry and another 3 referral hospitals. The primary endpoint was the ocurrence of VTE. We applied a logistic regression with Penalized Maximum Likelihood Estimations (PMLE). The c-index corrected for possible overfitting using the bootstrap method was calculated to validate the model. Results: We enrolled 683 consecutive patients from 17 hospitals. Platinum-based chemotherapy was initially used in all cases: BEP (86%), EP (11%) and others (3%). A total of 56 VTEs (8%) were observed. Explanatory covariates in the PMLE regression model were: IGCCCG risk score (intermediate and poor risk categories), presence of bulky retroperitoneal lymph node metastasis (RPLN) at diagnosis (defined as N≥2), brain metastasis, age (continuous variable) and histology (seminoma vs no seminoma) (see Table). Of note, the chemotherapy schedule was not associated with VTE. This model is well calibrated (Hosmer-Lemeshow test, p˃0.1), with an optimism-corrected c-index of 0.795 (95% CI, 0.73-0.86) Conclusions: We have identified predictors associated with VTE, easily available to clinicians at the bedside, with potential implications for primary thromboprophylaxis in patients with testicular cancer starting chemotherapy. Logistic regression with PMLE for predicting VTE. Variable OR [95CI] p-value IGCCCG Intermediate risk 3.15 [1.52, 6.51] 0.002 Poor risk 6.60 [3.15, 13.82] <0.001 RPLN (N≥2) 2.32 [1.26, 4.27] 0.007 Brain Metastasis 2.91 [0.93, 9.08] 0.065 Age 1.03 [1.02, 1.89] 0.039 Histology (Seminoma) 2.07 [1.06, 4.04] 0.034