tbuckley/cabot-search huggingface dataset:
Challenges in accessing reproductive health care in young cancer survivors.
Authors: Bridgette Thom, Catherine Benedict, Danielle Novetsky Friedman, Debbie Diotallevi, Nirupa Jaya Raghunathan, Elaine Pottenger, Joanne Frankel Kelvin
Journal: Journal of Clinical Oncology (2017)

107 Background: Infertility and early menopause are well-established late and long-term effects of many cancer treatments. Fertility preservation (FP) before (and in some cases after) treatment allows many survivors to achieve their family building goals despite gonadotoxic treatment. FP, however, is costly, and there is inconsistent, incomplete, or absent coverage across insurances. Furthermore, as many young survivors are un- or underinsured, disparities in referrals and service utilization have emerged. This presentation provides an overview of reproductive health care-related financial issues affecting young adult survivors, including cost of care, access to services, and relevant advocacy efforts, and highlights an analysis of the impact of income on FP decisions in a national sample of female survivors. Methods: We recruited female survivors aged 18-35 via social media and collected data using a web-based survey. Analyses included bivariate statistics and multiple logistic regression. Outcomes were receiving a fertility intervention (undergoing evaluation and/or fertility preservation of any sort) and freezing eggs/embryos before or after treatment. Results: 346 survivors, who were an average of 4.9 years (sd = 5.4) post-treatment, participated. 296 (86%) reported income: 35% &lt;$50K; 39% $50K-100K; and 26% over 100K. Of 259 respondents who did not undergo FP, 27% reported cost as a barrier. In logistic regression, income was significantly related with receiving an intervention and freezing eggs/embryos. Controlling for age and nulliparity, high-income survivors were more likely to receive a fertility intervention (OR = 3.0, 95% CI: 1.3, 6.9) and to freeze eggs/embryos (OR = 3.4, 95% CI: 1.2, 9.5) than low-income survivors. Conclusions: Our findings of disparity in utilization of reproductive health care among cancer survivors were similar to the published literature, with income impacting respondents’ receipt of fertility intervention and freezing of eggs/embryos. Clinical interventions and policy initiatives must address this service gap. Health care providers can help ensure that cancer survivors have access to available financial resources to assist with cost to facilitate their reproductive health care.
A phase II study of the combination of BKM120 (buparlisib) and bevacizumab in patients with relapsed/refractory glioblastoma multiforme (GBM).
Authors: Kent C. Shih, Sajeel A. Chowdhary, Kevin P. Becker, Joachim M. Baehring, William H. Liggett, Howard A. Burris, John D. Hainsworth
Journal: Journal of Clinical Oncology (2015)

2065 Background: BKM120 is an orally bioavailable, pan-class I PI3K inhibitor that is known to cross the blood brain barrier. The PI3K pathway is frequently dysregulated in GBM patients causing abnormal cell growth and proliferation. This phase II multicenter study evaluated the combination of BKM120 with bevacizumab in patients with relapsed/refractory GBM. Methods: Patients with relapsed/refractory GBM following 1st line radiation/chemotherapy and surgical resection were treated with BKM120 60 mg PO daily and bevacizumab 10 mg/kg IV every 2 weeks of each 4 week cycle. Following an amendment, responses were evaluated every 8 weeks per RANO criteria; prior to this amendment, responses were assessed by MacDonald criteria. Treatment continued until disease progression or intolerable toxicity. The primary endpoint was median PFS. Secondary endpoints included RR, OS and toxicity. Results: Sixty-eight patients were treated with a median age of 57 years (range, 19-77). 13 patients (19%) had received prior bevacizumab. Median treatment duration was 16 weeks (range, 1-120); 6 patients (9%) remain on treatment. Disease progression (51%) and toxicity (13%) were the most common reasons for treatment discontinuation. Overall RR was 32% (CR, 2; PR, 20); 18 patients (26%) had stable disease. In patients who received prior bevacizumab, 1 patient each experienced a CR and a PR and 4 experienced SD for a clinical benefit rate (CR+PR+SD) of 46%. Median PFS and OS (95% CI) were 5.3 months (3.8, 7.5) and 10.8 months (9.1, 22) respectively. Treatment-related toxicities included fatigue (37%), hyperglycemia (26%) and increased ALT (25%); 1 patient experienced grade 4 hyperglycemia. Forty patients (59%) experienced CNS symptoms while on study, 5 (13%) of which were treatment-related grade 3 toxicities: mood alteration, suicidal ideation, altered mental status, confusion, and psychosis (1 patient each). Conclusions: The combination of BKM120 and bevacizumab was well-tolerated and clinical activity was observed, including 6 patients who received prior bevacizumab. Accrual to this study in patients previously treated with bevacizumab continues. Clinical trial information: NCT01349660.
Pretreatment neurocognitive function (NCF) status in head and neck cancer (HNC) patients (pts) with comparison to control cohort.
Authors: Albiruni Ryan Abdul Razak, Hui Kong Gan, Gregory Russell Pond, Kattleya M Tirona, Eric Xueyu Chen, Kelvin Chan, Andrew J. Hope, Joon-Hyung J. Kim, Lillian L. Siu, Lori J Bernstein
Journal: Journal of Clinical Oncology (2012)

5587 Background: There is increasing evidence that NCF abnormalities may occur in cancer pts. Data on pre-treatment NCF in HNC pts are lacking. This study reports NCF in pts with newly diagnosed, curable HNC compared to controls. Methods: HNC pts underwent a 2-hour battery of NCF tests prior to radio +/-chemo(bio)therapy. Domains tested were intelligence (IQ), memory, language, attention, processing speed, executive function and manual dexterity. Test performances were transformed into Z-scores using normative data (score &lt; -1 signified deficit). Pts also had self-reported assessments for NCF, quality of life (QOL), fatigue and affect. Data obtained were compared to non-cancer controls who underwent the same tests. Results: Eighty HNC and 30 control subjects were assessed. Objective NCF testing demonstrated that HNC and control cohorts were similar across all domains, except for IQ, with pts having higher scores (mean 0.55 vs 0.12, p=0.03). However, individual analysis showed that 39% of HNC and 43% of control subjects had abnormal Z-scores in ≥ 2 domains. Multivariable analysis of factors associated with ≥ 2 abnormal NCF domains included: low education level, significant smoking history (≥ 10 pack year), previous mild brain injury, gender, and group (pt vs control). Amongst pts, HPV -ve status and non-oropharyngeal tumors were also associated with decreased NCF. Pts reported statistically worse subjective baseline symptoms compared to controls: NCF (mean FACT-COG 33.7 vs 18.2, p=0.002), QOL (FACT H&amp;N 33.8 vs 14.9), fatigue (FACT-F 35.1 vs 15.1), anxiety (HADS 7.0 vs 3.1) and depression (HADS 3.9 vs 1.2), p&lt;0.01 for all five parameters. Conclusions: Objectively assessed NCF was similar between HNC pts and controls, but a proportion of participants in both cohorts have multi-domain abnormal Z-scores. Several patient demographics and disease characteristics were associated with abnormal NCFs. Subjectively, pts reported worse NCF, QOL, fatigue and affect. These data suggest that participant and disease characteristics may play a larger role in determining NCF than previously shown. Whether such characteristics impact subsequent NCF is under investigation in a longitudinal study.
Clinical impact and prevalence of MRSA CC398 and differences between MRSA-TetR and MRSA-TetS in an area of Spain with a high density of pig farming: a prospective cohort study
Authors: E. Reynaga, C. Torres, M. Garcia-Nuñez, M. Navarro, A. Vilamala, E. Puigoriol, G.E. Lucchetti, M. Sabrià
Journal: Clinical Microbiology and Infection (2017)
MLN9708, an investigational proteasome inhibitor, in patients (pts) with relapsed/refractory lymphoma: Emerging data from a phase I dose-escalation study.
Authors: Peter Martin, Julie E. Chang, Robert M. Rifkin, Ai-Min Hui, Deborah Berg, Neeraj Gupta, Guohui Liu, Alessandra Di Bacco, Sarit E. Assouline
Journal: Journal of Clinical Oncology (2012)

8064 Background: MLN9708 is a reversible, orally bioavailable, specific 20S proteasome inhibitor. This study (NCT00893464) studied the safety and determined the MTD of IV MLN9708 in pts with relapsed/refractory lymphoma, and characterized pharmacokinetics (PK) and pharmacodynamics (PD). Methods: Pts aged ≥18 yrs who had failed ≥2 chemotherapeutic regimens received IV MLN9708 on days 1, 8, and 15 of 28-day cycles until disease progression or unacceptable toxicity. One pt was enrolled at the 0.125 mg/m 2 starting dose; dose doubling proceeded with 1 pt at each dose up to 1.0 mg/m 2 . Dose escalation occurred in ≤40% increments using a standard 3+3 scheme based on DLT occurrence in cycle 1. Blood samples were collected at multiple time points after dosing on days 1 and 15 of cycle 1 for PK/PD analyses. Results: At data cut-off (Dec 1 2011), 21 pts had been enrolled and treated: 1 each at 0.125, 0.25, 0.5 and 1 mg/m 2 , 4 at 1.4 mg/m 2 , 7 at 1.76 mg/m 2 , and 6 at 2.34 mg/m 2 . Median age was 57 yrs (range 23–78); 57% were male. Median number of prior therapies was 5; 29% had prior radiation, 24% prior stem cell transplant. Histologies included T-cell lymphoma (n=5), Hodgkin lymphoma (n=3), follicular lymphoma (n=2), DLBCL (n=1) and other indolent B-cell lymphoma (n=7). Pts had received a median of 2 cycles (range 1–22); 2 DLTs were seen (neutropenia at 1.76 and 2.34 mg/m 2 ). All pts experienced drug-related AEs, including fatigue (48%), nausea (29%), diarrhea (29%), pyrexia, thrombocytopenia, and vomiting (each 24%). 43% had drug-related grade ≥3 AEs, 1 pt discontinued due to drug-related grade 3 neutropenia (2.34 mg/m 2 ). Three pts had drug-related peripheral neuropathy (1 grade 1, 2 grade 2). There were no on-study deaths. Of 18 response-evaluable pts, 3 achieved PR (including 2 who remain in response and on-study for &gt;1 yr) and 4 SD. PK analyses showed linear PK (0.5–2.34 mg/m 2 ) and a terminal half-life of ~6–9 days. There was a dose-dependent increase in maximal whole blood 20S proteasome inhibition. Conclusions: These data suggest IV MLN9708 is generally well tolerated, with infrequent PN, and is clinically active in pretreated lymphoma pts. The trial is ongoing and updated data will be presented.
EBUS-TBNA for identifying biomarkers.
Authors: Kezhong Chen, Fan Yang, Hui Zhao, Zu li Zhou, Guanchao Jiang, Jun Wang
Journal: Journal of Clinical Oncology (2012)

e21103 Background: We assessed the usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to detect EGFR AK-ras AALK mutations from malignant mediastinal nodes of patients with NSCLC. Methods: From February 2010 to December 2011 , 52 specimens diagnosed lung adenocarcinoma by EBUS were used for molecular analysis . Needle puncture site for the EBUS was standard 22G needle, once cytology pathology diagnosed adenocarcinoma, at the same site with the conventional needle puncture method to obtain adequate biopsy specimen for further analysis. The tissue was fixed in 10% formalin and stored in -80°C. When histologic diagnosis confirmed adenocarcinoma, the sample was extracted DNA to detect EGFR mutation by both amplification refractory mutation system( ARMS) and mutation enriched method improved by our department. Partial specimens also extracted DNA or RNA to detect K-ras and ALK mutation. Results: All 52 specimens were successfully extracted DNA, 34 were male and 18 were female, mean age of 62.1 years (34 to 79 years). Somatic mutations of the EGFR gene were detected in 25 of 52 cases (48%), 15 cases of exon 19 mutation, 9 cases of exon 21 mutation, and 1 of T790M mutation in ARMS. The result was of slight difference in mutation enriched method. In the patients who requested other biomarkers analysis, 4 had K-ras mutations and 2 had ALK mutations. 6 patients of 25 cases of patients with EGFR mutations had a radical surgery after neoadjuvant chemotherapy, tumor specimens were tested again with EGFR gene mutation, the same result as the preoperative test results. Conclusions: EBUS-TBNA mediastinal lymph node biopsy in the detection of EGFR AK-ras and ALK mutations in tissue samples was feasible, through the highly sensitive methods, higher detection rate was available, the result can be used as evidence of personalized treatment of lung cancer.
Retrospective review of stage III non-small cell lung cancer (NSCLC) patients treated with carboplatin/paclitaxel plus radiotherapy followed by docetaxel
Authors: M. R. Patel, M. Weidner, J. W. Lynch, E. Walden, T. J. George
Journal: Journal of Clinical Oncology (2007)

18123 Background: Concurrent chemoradiotherapy is standard of care for unresectable patients and the most widely cited trials include the locally advanced multi-modality protocol (LAMP) study, SWOG S9019 and S9504. Our institutional approach represents a merger between the protocols utilized in two of these phase II studies: chemoradiotherapy from the LAMP study and consolidation therapy from SWOG S9504. Methods: We identified all stage III patients treated at the NF/SG VHS from Jan 2001 to Dec 2005. Eligible patients who had unresectable stage III NSCLC were included in the analysis. We treated 34 patients with weekly paclitaxel 45 mg/m 2 plus carboplatin AUC 2 and concurrent TRT 63.0 Gy over 7 weeks. Four weeks after the completion of chemoradiotherapy, docetaxel 75 mg/m 2 was given every 3 weeks for 21 days for 3 cycles as consolidation. Our primary endpoints were overall and progression free survival. The secondary endpoints were response rate and toxicity. Results: With a median age of 65 years and follow-up time of 25.9 months, median overall survival was 13.7 mos. Median progression free survival was 9.8 mos. The overall response rate was 68% including 5 CRs (15%). The most common grade 3/4 toxicities included pneumonitis (21%), esophagitis (21%), neutropenia (21%) [febrile neutropenia (9%)], neuropathy (18%), anemia (15%) and hypersensitivity to paclitaxel (9%). 62% of patients were able to complete the planned treatment. There were no treatment related deaths. At the time of this analysis, 9 patients were alive (26%) including 7 without progression (21%). Conclusions: Chemoradiotherapy with weekly carboplatin and paclitaxel followed by consolidation therapy with docetaxel is associated with comparable outcomes to other combined modality regimens. Given the advanced age and co-morbidities of our population, this regimen was generally well tolerated with the expected toxicities and can be considered as an option in the treatment of patients with unresectable stage III NSCLC. No significant financial relationships to disclose.
Radiotherapy versus radical prostatectomy for Gleason score 9-10 prostate adenocarcinoma: A multi-institutional comparative analysis of 1001 patients treated in the modern era.
Authors: Amar Upadhyaya Kishan, Jay P. Ciezki, Talha Shaikh, Richard Stock, Gregory Stephen Merrick, D. Jeffrey Demanes, Jason Wang, Jonathan W. Said, Ryan Fiano, Govind Raghavan, Kiri Ann Sandler, Chandana A. Reddy, Nicholas George Nickols, William J. Aronson, Ahmad Sadeghi, Mitchell Kamrava, Michael L. Steinberg, Eric M. Horwitz, Patrick Kupelian, Christopher R. King
Journal: Journal of Clinical Oncology (2017)

7 Background: To compare the outcomes of a modern cohort of patients with Gleason Score (GS) 9-10 prostate adenocarcinoma (CaP) following treatment with external beam radiotherapy (EBRT), extremely dose-escalated radiotherapy (as exemplified by EBRT with a brachytherapy boost [EBRT+BT]), and radical prostatectomy (RP). Methods: One-thousand-and-one patients with biopsy GS 9-10 CaP who received definitive treatment between 2000 and 2013 were included (347 treated with EBRT, 330 with EBRT+BT, and 324 with RP). Kaplan-Meier analysis and multivariate Cox regression compared 5- and 10-year rates of distant metastasis-free survival (DMFS), cancer-specific survival (CSS), and overall survival (OS). Prostate cancer-mortality (PCSM) rates were compared with a competing risk analysis. Results: The median followup periods were 4.8, 6.4, and 5.1 years among patients receiving EBRT, EBRT + BT, and RP. The median doses among EBRT and EBRT+BT patients were equivalent to 78 Gy and 90 Gy in 2 Gy fractions. Over 90% of patients treated with EBRT or EBRT+BT received ADT (median durations of 18 months and 12 months, respectively). Nearly 40% of RP patients received postoperative RT, primarily in the salvage setting. Five- and 10-year DMFS rates were significantly higher with EBRT+BT (91.6% and 81.3%) than with EBRT (79.6% and 65.8%; p &lt; 0.0001) or RP (77.9% and 60.1%; p &lt; 0.0001). Five- and 10-year PCSM rates were significantly lower with EBRT+BT (3.8% and 14.1%) than with EBRT (10.3% and 25.2%; 5- and 10-year hazard ratios of 0.38 and 0.47; p = 0.003) or RP (8.9% and 20.3%; 5- and 10-year hazard ratios of 0.39 and 0.55; p = 0.02). Overall 5- and 10-year OS rates were 85.7% and 64.7% and were similar between cohorts (p &gt; 0.1). Conclusions: Extremely dose-escalated radiotherapy offered improved systemic control and reduced PCSM when compared with either EBRT or RP. Notably, this was achieved despite a significantly shorter median duration of ADT than in the EBRT arm. This is hypothesis generating as it suggests that improved local control via dose-escalation may have systemic control and survival implications even for patients with very high risk disease.
Choice of chemotherapy in the treatment of metastatic squamous cell carcinoma of the anal canal.
Authors: Cathy Eng, Jane Rogers, George J. Chang, Y. Nancy You, Prajnan Das, Miguel A. Rodriguez-Bigas, Aki Ohinata, Jonathan Phillips, James L. Abbruzzese, Robert A. Wolff
Journal: Journal of Clinical Oncology (2012)

4060 Background: Metastatic squamous cell carcinoma (SCCA) of the anal canal is an uncommon malignancy with no standard approach. The reported median overall survival (OS) is 9-12 months (M) following 5-FU + cisplatin (FC)-based therapy. The aim of this study is to evaluate first-line chemotherapy approaches in this patient (pt) population. Methods: A retrospective analysis was conducted of 428 pts with metastatic SCCA of the anal canal identified from the MDACC tumor registry between 1/1/2000 - 5/31/2011. Electronic medical records were reviewed for histology, date of diagnosis and/or recurrence, site of metastasis, type of therapy provided, response rate (RR), progression-free survival (PFS), OS, and lines of salvage therapy. All eligible pts were required to be treatment-naïve for metastatic disease and have radiographic imaging at MDACC. Waiver of informed consent was obtained. Results: 99 pts fulfilled all criteria; 10 were lost to follow-up; 12 did not initiate chemotherapy. 77 pts were evaluable; M: F = 20:57; median age = 55 years (range: 37 - 82); HIV(+) = 5% (4/77); prior chemoXRT with curative intent: 70% (54/77), complete response (CR): 87% (47/54), median time to development of metastatic disease =17M. 29% (22/77) presented with metastatic disease. Sites of disease included distant lymph nodes (41%); liver (45 %); lung (25%); bone (15%); and brain (8%). The median follow up was 37M. 73% (56/77) of patients were treated with platinum-based therapy; 51% (n=39) received FC and 22% (n= 17) received carboplatin + paclitaxel (CP). The median PFS was 6M; FC trended better than CP for PFS (7M vs. 5M, p&lt;0.067). The overall median OS = 29M. 40% (31/77) of pts received neoadjuvant first-line therapy followed by metastasectomy (68%), XRT (26%), or both (6%); resulting in a median OS = 35M. Conclusions: Metastatic SCCA of the anal canal is a malignancy in which 5-FU+cisplatin is a commonly used regimen. Our analysis suggests FC results in improved PFS over CP but is underpowered supporting further analysis. The short median PFS with front-line chemotherapy, and yet longer OS reflects the challenges in treating this patient population and the importance of multidisciplinary management in select cases.
How should we estimate costs of care attributable to cancer?
Authors: Aileen B. Chen, Ling Li, Angel Cronin, Gabriel Brooks, Brian D. Kavanagh, Deborah Schrag
Journal: Journal of Clinical Oncology (2015)

6503 Background: Costs of care attributable to cancer are distinct from total costs of medical care, and transparent methods are needed to inform decisions about value of interventions. We measure how alternative strategies for specification of cancer-free control cohorts influences estimation of cancer-attributable costs. Methods: Using SEER-Medicare data, we calculated mean Medicare spending from one month prior until 11 months following diagnosis among patients > 66 diagnosed with lung, breast, prostate, and colorectal cancers from 2007-2009. Cancer attributable costs were estimated by subtracting monthly costs for cancer patients from one of 3 alternative reference cohorts: 1) non-cancer Medicare patients individually matched by age, gender, race, and SEER region, 2) non-cancer Medicare cohort matched on demographic factors with the addition of modified Charlson comorbidity score, 3) monthly costs from 2 to 13 months prior to diagnosis, using cancer patients as their own control. Results: Cancer-attributable costs were highest for all patients when using their own pre-diagnosis costs as comparison. Cancer-attributable costs were higher among breast and prostate, but lower among lung and colorectal patients, when using non-cancer controls and matching by comorbidity in addition to demographic characteristics. The greatest variation was seen for prostate cancer, with 39-73% of total costs attributed to cancer depending on reference cohort. Meantotal and cancer-attributable costs are summarized in the Table. Conclusions: Choice of reference group can have a substantial impact on proportion of total costs attributed to cancer and should be clearly delineated in analyses of cost and value. Mean Medicare costs in year 1 ($). Cancer-attributable costs, by reference group (% total costs attributed to cancer) Total costs Non-cancer patients, demographic match Non-cancer patients, demographic and comorbidity match Cancer patients as own control, year prior to diagnosis Lung n = 43,196 47,366 31,703 (67) 28,725 (61) 35,476 (75) Breast n = 33,674 30,958 14,653 (47) 15,242 (49) 22,749 (73) Prostate n = 42,079 25,126 9,774 (39) 11,048 (44) 18,320 (73) Colorectal n = 29,075 54,144 38,184 (71) 37,235 (69) 43,621 (81)