tbuckley/cabot-search huggingface dataset:
Using mobile app technology for patient data capture and implementation.
Authors: Steven J. Nurkin, Stephen B. Edge, Venkata R. Kakarla, Nikhil I. Khushalani
Journal: Journal of Clinical Oncology (2012)

317 Background: Mobile application technology has quickly become an integral part of clinical cancer care. While this technology is most commonly used as a point of care reference or educational tool, it may also be an effective method to capture patient data. The purpose of this project was to create a mobile solution for fast, point-of-care data capture and implementation, patient reported outcomes, to generate a patient treatment summary and provide data for cancer registry and clinical trials. Methods: Using the “MedDB app” (Bitwise Analytics) on an iPad2 (Apple) device, an application was developed to collect patient data following breast surgery for cancer. Collected data included elements required for pathologic staging using the American Joint Committee on Cancer TNM system (7th Edition) with the application deriving pathologic TNM and Stage Group. In addition, the type of breast surgery, lymph node surgery, and the expected next steps in treatment are coded for collection. Data are entered into the App in the clinic and transferred using a blinded code number to a web-based database. This database is then used to generate a patient surgical treatment summary and care plan, and is available for uploading into a research database. We then developed an individual patient App for their own personal mobile device. The purpose was to collect patient reported outcomes through their adjuvant care and surviorship. Results: The initial pilot included data entry on 20 breast cancer patients who had surgery prior to adjuvant therapy. The time to complete data entry was less than 60 seconds per case. Conclusions: Mobile communication devices are increasingly becoming key tools for clinicians. They are primarily used to search for medical resource information and the review of medical records. This pilot demonstrates the potential for use of mobile computer devices for collecting key data for clinical trials, the cancer registry, generating a patient treatment summary and care plan at the point of service as well as patient reported outcomes through personalized patient apps. Future development will include studies of integration with the electronic health record, the cancer registry systems, and expansion to a complete survivorship care plan system.
The benefits of clinical pathways (CP) for radiation oncology in a large cancer care network.
Authors: Dwight Earl Heron, Sushil Beriwal, Hans Benson, Zach Lorinc, Amanda Barry, Kathleen Lokay
Journal: Journal of Clinical Oncology (2016)

148 Background: UPMC CancerCenter and the University of Pittsburgh Cancer Institute (UPMC) created a radiation oncology CP program (now incorporated separately as Via Pathways) in 2003 to standardize care at 19 radiation sites. The program exists to ensure consistency and rapid adoption of best evidence-based care in a large, integrated NCI-designated comprehensive cancer center. Methods: The web-based CP portal integrates with electronic medical records to provide point-of-care patient-specific decision support. CP content is developed and maintained by committees of oncologists culled from the network. Meetings occur semi-annually to review and update treatment recommendations for the nearly 95% of cancers covered. Evidence is evaluated hierarchically on efficacy, toxicity, then cost. When the committee modifies CP content, the software is updated within 35 days and new recommendations are available to the 38 network providers. Through analysis of the utilization data, leaders can monitor adherence to the CP recommendations and research practice patterns at an unprecedented level of granularity. Results: Since data collection in the portal began in 2009, UPMC has captured over 48,000 visits and adhered to CP recommendations 96% of the time. Off-pathway decisions were approved prior to treatment by a designated peer review radiation oncologist at UPMC. Reasons for going off pathway and the alternative approach to care were recorded. Efforts to increase efficiencies and trial accruals have been successful due in large part to access to such a vast and comprehensive database. Conclusions: CP are an integral part of standardizing to high-value care across large networks and geographic regions. The committee process, rapid electronic deployment, and easy access to evidence reviews have garnered high physician buy-in and consistent adherence to CP recommendations. Other benefits of the program include: a transition from volume to value care models; facilitation of onboarding new physicians, residency trainees, and fellows; providing transparency through peer review, a committee process, and evidence reviews. CP are now used by more than 1000 physicians across the US in a variety of academic and community settings.
Characteristics and outcomes of patients with advanced hepatocellular carcinoma treated on phase I trials.
Authors: Ishwaria Mohan Subbiah, Filip Janku, Apostolia Maria Tsimberidou, Aung Naing, Ahmed Omar Kaseb, David S. Hong, Vivek Subbiah, Kenneth R. Hess, Owais Akmal, Gerald Steven Falchook, Razelle Kurzrock
Journal: Journal of Clinical Oncology (2013)

281 Background: Patients with advanced hepatocellular carcinoma (HCC) have limited effective therapies. With that purpose, we analyzed the outcomes and prognostic factors of such pts treated on phase I trials w an emphasis on locoregional and targeted agents. Methods: We reviewed the records of 100 consecutive pts referred to the Phase I Clinical Trials Program from March 2004 and assessed characteristics, types of clinical trials, progression-free survival (PFS), overall survival (OS) and oncogenic mutations. Results: Of 100 referred pts, 39 were not treated mainly due to poor performance status (n=22). Of 61 treated pts (49 male, 12 female, median age 60yrs), median # of prior therapies was 3 (range, 0-8). There were no treatment-related mortalities. One pt on a sorafenib regimen had g3 hand foot syndrome unresponsive to dose reduction. A 2 nd pt developed a L-sided visual blurriness after 5 days on a sunitinib regimen; CT showed a small R parieto-occipital hemorrhage, possibly related to therapy. Of 61 treated pts, 7 (11%) had stable disease (SD) &gt; 6 months, 4 (7%) partial response (PR), on protocols combining bevacizumab+sorafenib, pazopanib+everolimus, or single-agent novel oral multikinase inhibitor of VEGFR2-TIE2, or hepatic arterial infusion (HAI) of paclitaxel or oxaliplatin w IV bevacizumab. Median PFS on Phase I trials was 2.2 months vs. 4.4 months and 4.1 months for their 1 st - and 2 nd -line FDA-approved therapy (p 0.019). In univariate analysis, the presence of ascites, portal hypertension, cirrhosis, serum sodium, albumin, and poor Royal Marsden Hospital (RMH) prognostic score were associated with shorter PFS and OS (p &lt; 0.05). On multivariate analysis, independent factors of shorter OS were Caucasian race (p = 0.031), cirrhosis (p = 0.016), serum sodium (p = 0.0013), and poor RMH prognostic score (p = 0.0015). Molecular analysis in progress will be updated. Conclusions: Phase I therapy offer a reasonable therapeutic option for patients with advanced HCC. The RMH prognostic score was validated in this population. The SD &gt; 6 months/PR rate of 18% was observed with regimen of multikinase inhibitors with mTOR inhibitors and HAI therapy.
Pharmacogenetic studies in rectal cancer patients treated with preoperative chemoradiotherapy
Authors: D. Páez López-Bravo, A. Altés, F. J. Sancho-Poch, J. Garriga, M. Petriz, L. Pare, E. del Río, A. Barnadas Molins, M. Baiget, E. Marcuello
Journal: Journal of Clinical Oncology (2008)

14645 Background: Chemotherapy using 5-FU is known to be effective in the treatment of rectal cancer patients and more recently Oxaliplatin (OXA) has been added to preoperative FU-based pelvic chemoradiation. We report the study of polymorphisms in the TS, GSTP1 and different repair genes to evaluate their usefulness as pharmacogenetic markers in a cohort of 82 rectal cancer patients treated with preoperative chemoradiotherapy Methods: Radiation therapy was administered to all patients. 5-FU was administered alone in 38 patients and in combination with OXA in additional 44 patients. Genetic polymorphisms were determined by Real-Time PCR. The investigated polymorphisms were: TS (VNTR/ 5’ UTR, 3R G>C SNP, 1494del6), ERCC1 (Asn118Asn, 8092C>A, 19716 G>C), GSTP1 (Ile105Val), XRCC1 (Arg194Trp, Arg280His, Arg399Gln) and XPD (Lys751Gln). Pathological response, progression free survival and overall survival were evaluated according to each genotype. Results: Although no significant association was observed for pathological remission, a trend to a better response was seen in patients carriyng a G/G genotype for the 3’UTR SNP in the ERCC1 gene (44% of the G/G achieved a complete pathological response or a microfoci residual tumour, while 26% of G/T-T/T patients responded P= 0.07). Any of the markers analyzed showed a statistical significant relationship with PFS. If we considered only the group of patients treated with the 5-FU/OXA regimen, a significantly different PFS was observed according to the genotype of the Arg399Gln polymorphism in the XRCC1 genes (50 months for G/G patients, 39 months for G/A patients and 20 months for A/A patients; P=0.05). The univariate analysis showed that any of the molecular markers studies were of predictive value for overall survival. Conclusions: No clear associations between these genetic markers and the clinical outcome can be defined in local advanced rectal cancer patients treated with preoperative chemoradiotherapy. No significant financial relationships to disclose.
Performance of a low-dose computed tomography (LDCT) lung cancer screening program: Findings from a registry study.
Authors: Bernardo Goulart, David Madtes, Lisel Koepl, Andrew Karnopp, Judy Ann Nelson, Scott David Ramsey
Journal: Journal of Clinical Oncology (2014)

304 Background: Many centers are establishing LDCT lung cancer screening programs after the 2013 grade B recommendation from the United States Preventive Services Task Force (USPSTF). Uncertainty remains regarding the extent to which new programs will adhere to recommended selection criteria, as well as screening program performance. We analyzed adherence to selection criteria, rate of positive screens, and prevalence of incidental findings in a single-center LDCT screening registry study. Methods: We established a prospective, longitudinal registry study of patients undergoing LDCT screening at the Seattle Cancer Care Alliance. Baseline data include socio-demographic characteristics and eligibility for LDCT screening. We conduct chart reviews at 6 and 12 months to determine screening results (based on NLST definitions); lung cancer diagnosis; and incidental findings. Results: From August 2012 to April 2014, 62 out of 105 (59%) screened patients enrolled in the registry. Mean age is 62 years; 38 (61%) are male; 52 (84%) are white; mean household income is $97,363; 31 (50%) are current smokers; and 39 (63%) have a smoking history ≥ 30 pack-years. A total of 28 (45%), 31 (50%), and 31 (50%) of patients were eligible for screening based on criteria used in the NLST or recommended by the NCCN or USPSTF guidelines, respectively. Sixteen patients (26%) were not eligible for screening based on any of these criteria. For fourteen (88%) of these patients, LDCT screening was ordered by a primary care provider as opposed to a lung cancer specialist. Initial screening results were positive in 7 (13%) patients, with 1 patient diagnosed with lung cancer. At least one incidental finding was reported in 40 (74%) patients, including cardiac and pulmonary abnormalities in 28 (70%) and 25 (63%) patients. Conclusions: About one quarter of patients undergoing LDCT screening do not meet recommended criteria, with primary care providers most commonly ordering the LDCT screen for these patients. Primary care provider education may improve adherence to screening guidelines. Incidental findings were more frequently reported than in the NLST; their impact on healthcare outcomes and costs deserves further investigation.
Preclinical activity of the heat shock protein 90 inhibitor ganetespib in clear cell renal cell carcinoma.
Authors: Mansi Parasramka, David A. Proia, Richard Wayne Joseph
Journal: Journal of Clinical Oncology (2014)

478 Background: Resistance invariably develops in all patients with metastatic ccRCC treated with mTOR inhibitors. Previously we demonstrated that dual inhibition of Hsp90 and the mTOR pathway in lung cancer models leads to synergistic reductions in tumor growth. Herein, we tested the efficacy of ganetespib as a single agent and in combination with mTOR inhibition using in vitro and in vivoccRCC models. Methods: For the in vitro work we utilized the following seven ccRCC cell lines: Caki-1, Caki-2, A-498, A-704, 769-P, 786-O, ACHN. For the in vivo work we used A498 xenografts. In vitro, we determined the single agent EC 50 of everolimus and ganetespib at 72 hours by assessing percent viability of A498 cells compared to vehicle using the MTS assay. We then performed combinations of ganetespib and everolimus at EC 20 , EC 30 , and EC 50 in A498 cells. Translating these studies in vivo, we compared the combinatorial activity of ganetespib and temsirolimus to monotherapy in mice bearing A498 tumor xenografts. Results: As a single agent, all ccRCC cell lines tested were sensitive to ganetespib at nanomolar concentration (EC50 15 – 75 nm) and to everolimus at micromolar concentrations (EC50 4 – 54 mm). In vitro, the combination of ganetespib and everolimus also decreased cell viability in an additive fashion. In vivo, ganetespib and temsirolimus demonstrated comparable single agent activity at sub-MTD doses (T/C = 63 and 60, respectively). Combining ganetespib with temsirolimus improved tumor growth suppression by ~30% (T/C = 43). Conclusions: Given the broad in vitro sensitivity of ccRCC cell lines to single agent ganetespib as well as the in vivo activity of the combination of ganetespib and temsirolimus, we believe ganetespib warrants further study in ccRCC. Updated results will be presented at the conference including the in vivo activity of the combination of ganetespib and antivascular endothelial growth factor agents.
Molecular profiling of patients (pts) with advanced colorectal cancer (CRC): Princess Margaret Cancer Centre experience.
Authors: Joanne W. Chiu, Philippe L. Bedard, Michael H. Roehrl, Stefano Serra, Monika K. Kryzanowska, Jennifer J. Knox, Helen Mackay, David W. Hedley, Malcolm J. Moore, Geoffrey Liu, Neesha C. Dhani, Suzanne Kamel-Reid, Emina Torlakovic, Tao Wang, Ming-Sound Tsao, Dianne Chadwick, Tong Zhang, Celeste Yu, Eric Xueyu Chen, Shingo Sakashita
Journal: Journal of Clinical Oncology (2014)

459 Background: The prevalence of somatic mutations other than KRAS, PIK3CA and BRAF in CRC has not been well described. This study reports molecular profiling of pts with advanced CRC in clinical practice. Methods: Pts with advanced CRC are enrolled in an ongoing institution-wide screening program. Molecular profiling is performed on FFPE archival tissues using a customized Sequenom panel (23 genes, 279 mutations) or the Illumina MiSeq TruSeq Amplicon Cancer Panel (48 genes, 212 amplicons, ≥ 500x coverage) in our CLIA-certified laboratory. PTEN negative tumor is defined by IHC with H score &lt;1. Demographic and clinical data are collected. Data was analyzed by chi-square test. Results: From March 2012 to August 2013, 132 pts were enrolled. One or more mutations were found in 50% (58/117) and 93%(14/15) of pts using Sequenom and MiSeq platforms respectively. Mutation rate was 40% for KRAS, 9% for PIK3CA, 2% for BRAF, 4% for NRAS, and 1% for each of CTNNB1, ERBB2, FGFR3, and EGFR. Mutations outside of codons 12/13 were found in 8% (4/53) of tumors with KRAS mutations. MiSeq showed additional mutations including ERBB4 (1/15), SMAD4 (1/15), FRXW7 (1/5), APC (5/15), and TP53 (12/15) in CRC. Co-mutation with KRAS was found in 58% (7/12) of pts with PIK3CA mutation and 80% (4/5) of pts with APC mutation. PTEN negative tumor was present in 20% (11/55) of pts. Presence of any mutation was significantly more common for pts with right-sided CRC (73%) compared to those with left-sided CRC (47%) and rectal CRC (38%) (p &lt; 0.01). There was a trend toward increased proportion of KRAS mutation in right-sided CRC (p=0.06). There was no difference in age, ethnicity, gender, smoking status, stage at presentation, pathology grade, and response to first-line chemotherapy between right and left-sided CRC. Conclusions: Somatic alterations are common in advanced CRC. Targeted next-generation DNA sequencing identifies additional clinically relevant alterations than multiplex genotyping. Differences in the mutation profile of right and left-sided CRC tumors should be further investigated. Updated results will be presented at the meeting.
Young cancer survivors’ expectations of physicians for issues of mental health, interpersonal relationships, and reintegration to society.
Authors: Ying Wang, Pierre Camateros, Winson Y. Cheung
Journal: Journal of Clinical Oncology (2016)

208 Background: As patients transition from cancer treatment to survivorship, issues surrounding the social and mental health impacts of survivorship gain increased importance. In this study, we examined young cancer survivors’ expectations of their physicians with respect to mental health, interpersonal relationships, and reintegration back to work and school. We also explored factors associated with these expectations. Methods: We surveyed patients aged 20 to 39 years who were diagnosed with solid tumors, evaluated at any 1 of 5 regional cancer centers in British Columbia, and alive at 2 or more years after their diagnosis. We explored the relationship between patient factors and expectations, adjusting for confounders through the use of multivariate regression models. Results: With a survey response rate of 57%, a total of 447 patients were analyzed: median age was 35 years (IQR 31-38), 30% were men, and 89% had ECOG 0. Tumor sites included breast (222; 50%), testicular (126; 28%), gynecological (76; 17%), and colorectal (23; 5%). Decreasing levels of expectations of cancer specialist (CS) were seen with 72%, 48%, and 28% of patients indicating that their CS should have some to full responsibility on issues related to mental health, social counselling, and reintegration, respectively. Compared to CS, patients held much higher expectations of their primary care physician (PCP) taking some to full responsibility for these same issues (see Table). Expectations of their PCP were further increased when there was frequent contact between patient and PCP. Conclusions: The majority of young cancer survivors in our survey expected their PCP more than their CS to have a significant degree of responsibility for mental, interpersonal, and social issues arising from their cancer or treatment. Early integration of PCP into survivorship care models may augment the work provided by the psychosocial cancer team and ease the transition to survivorship for patients. [Table: see text]
Predictive markers of utilization of chemotherapy in patients with advanced colorectal cancer (CRC): A population-based study.
Authors: S. Ahmed, T. Zhu, R. Lee-Ying, C. Ubhi, V. Kundapur, R. Alvi, K. Haider
Journal: Journal of Clinical Oncology (2011)

6053 Background: The introduction of second generation therapy has significantly improved the prognosis of patients with advanced CRC. In clinical practice compared with a clinical trial setting less strict eligibility criteria are used for utilization of chemotherapy. Our study aims to determine the predictive factors of chemotherapy utilization in advanced CRC patients in the era of second generation chemotherapy. Methods: Medical records of patients with advanced CRC diagnosed in the province of Saskatchewan from 1992-2005 who were treated at the two major Cancer Center were reviewed. A logistic regression model was used to assess various clinical factors for their correlation with utilization of palliative chemotherapy in patients with advanced CRC. Results: A total of 1378 eligible patients were indentified. Median age was 71 yrs (range: 22-98) and M: F was 57:43. Of 1378 patients, 583 (42%) patients received 5FU-based therapy and 222 (16%) received a second line therapy. Median overall survival (OS) of all patients was 7.2 months. Patients who received chemotherapy had median OS of 15.9 months compared with 3.6 months if they did not receive chemotherapy (p<0.0001). 46.3% of patients who were diagnosed after the year 1999 received chemotherapy with a median survival of 17.5 months compared with 38.9% patients with a median survival of 14.7 months who were diagnosed before the year 2000 (p=0.0058). On multivariate analysis ECOG performance status (PS) <2 (odd ratio [OR] 4.1, 95% CI: 3.0-5.7), age <65 years (OR 2.6 (95% CI: 2.0-3.3), liver metastases (OR 2.3, 95% CI: 1.7-3.1), removal of primary tumor (OR 2.3, 95% CI: 1.7-3.1), palliative radiation (OR 2.0, 95% CI: 1.4-3.0), metastesectomy (OR 1.7, 95% CI: 1.2-2.5), diagnoses after the year 1999 (OR 1.5, 95% CI: 1.2-1.9), and treatment center (OR 1.33, 95% CI: 1.03-1.73) were significantly correlated with utilization of palliative chemotherapy. Conclusions: In addition to known variables such as good PS, patients who were treated with curative resection or underwent removal of the primary tumor were more likely to received chemotherapy. A greater utilization of palliative chemotherapy was noted with the availability of second line therapy.
Efficacy trend of hepatic resection for hepatocellular carcinoma with large multinodular tumor or macrovascular invasion.
Authors: Jian-Hong Zhong, Le-Qun Li, Xin-Ping Ye, Yang Ke, Lin Wang, Fei-Xiang Wu, Bang-De Xiang, Liang Ma, Xue-Mei You, Jie Chen
Journal: Journal of Clinical Oncology (2015)

427 Background: Official guidelines and retrospective studies have different view on the role of hepatic resection (HR) for patients with large (≥5 cm) multinodular (≥2) hepatocellular carcinoma (HCC) and those involving macrovascular invasion (MVI). We aim to evaluate the efficacy and its variation trend and the safety of HR for these patients in three tertiary care settings. Methods: A consecutive sample of 1,824 patients with Child-Pugh A liver function and large/multinodular HCC or involving MVI and who underwent initial HR were divided into four groups: large/multinodular HCC of the previous (2000-2004, n = 496) and recent five years (2005-2010, n = 765), involving MVI of the previous (n = 242) and recent five years (n = 321). Results: Among our patient sample, the hospital mortality was less than 5% and had a downward trend. Moreover, patients in recent five years have statistically significant longer survival time. Among patients with large/multinodular HCC, patients in recent five years showed a significantly better overall survival than those in previous five years at 1-year (92% vs. 84%), 3-year (69% vs. 61%), and 5-year (45% vs. 40%) (P = 0.004). Moreover, among patients involving MVI, overall survival in recent five years was significantly higher at 1-year (83% vs. 78%), 3-year (50% vs. 41%), and 5-year (25% vs. 17%) (P= 0.033). However, the disease-free survival of recent five years was only slightly higher than that of the previous five years in the two subgroups. Conclusions: HR offers good overall survival for patients with resectable large/multinodular HCC or those involving MVI and with preserved liver function. Outcomes have tended to improve in recent decade.