tbuckley/cabot-search huggingface dataset:
Colon Cancer Screening among Patients Receiving Dialysis in the United States: Are We Choosing Wisely?
Authors: Christopher A. Carlos, Charles E. McCulloch, Chi-yuan Hsu, Barbara Grimes, Meda E. Pavkov, Nilka R. Burrows, Vahakn B. Shahinian, Rajiv Saran, Neil R. Powe, Kirsten L. Johansen
Journal: Journal of the American Society of Nephrology (2017)

The American Society of Nephrology recommends against routine cancer screening among asymptomatic patients receiving maintenance dialysis on the basis of limited survival benefit. To determine the frequency of colorectal cancer screening among patients on dialysis and the extent to which screening tests were targeted toward patients at lower risk of death and higher likelihood of receiving a kidney transplant, we performed a cohort study of 469,574 Medicare beneficiaries ages ≥50 years old who received dialysis between January 1, 2007 and September 30, 2012. We examined colorectal cancer screening tests according to quartiles of risk of mortality and kidney transplant on the basis of multivariable Cox modeling. Over a median follow-up of 1.5 years, 11.6% of patients received a colon cancer screening test (57.9 tests per 1000 person-years). Incidence rates of colonoscopy, flexible sigmoidoscopy, and fecal occult blood test were 27.9, 0.6, and 29.5 per 1000 person-years, respectively. Patients in the lowest quartile of mortality risk were more likely to be screened than those in the highest quartile (hazard ratio, 1.53; 95% confidence interval, 1.49 to 1.57; 65.1 versus 46.4 tests per 1000 person-years, respectively), amounting to a 33% higher rate of testing. Additionally, compared with patients least likely to receive a transplant, patients most likely to receive a transplant were more likely to be screened (hazard ratio, 1.68; 95% confidence interval, 1.64 to 1.73). Colon cancer screening is being targeted toward patients on dialysis at lowest risk of mortality and highest likelihood of transplantation, but absolute rates are high, suggesting overscreening.
Comparison of clinical presentation and prognosis between acral cutaneous melanoma and non-acral cutaneous melanoma.
Authors: Xieqiao Yan, Zhihong Chi, Xi Nan Sheng, Lu Si, Chuanliang Cui, Yan Kong, Bixia Tang, Li Li Mao, Xuan Wang, BIN LIAN, Jun Guo
Journal: Journal of Clinical Oncology (2015)

e20008 Background: Acral cutaneous melanoma (ACM) is rare in Caucasian populations. Whether patients with ACM have a worse prognosis than patients with non-acral cutaneous melanoma (NACM) has not been determined. This observational study aimed to summarize the data in our center and compare the clinical features between ACM and NACM. Methods: A database was prospectively established for the purpose of this analysis. Medical record of all patients since 2006 were retrieved and reviewed. Statistical analyses were performed by SPSS 16.0. Results: Data were available for 658 cases (61.1%) of ACM and 419 cases (38.9%) of NACM. The proportions with clinical stage I, II, III, and IV diseases were 10.3%, 50.8%, 24.5% and 14.4% in ACM and 6.9%, 40.8%, 33.2%, 19.1% in NACM. The ACM cases included more male (56.4% vs 50.1%, P= 0.044) and ulceration (72.0% vs 58.5%, P= 0.000). The 5-year overall survival rate was 44.7% in ACM patients and 52.6% in NACM patients; the median survival time (OS) were 55.0 and 68.0 months respectively (P= 0.027). 5-y survival rates with stage I, II, III, and IV diseases were 89.1%, 53.8%, 24.5% , 8.0% and 96.8%, 63.2%, 35.2% and 9.6%, respectively. The median survival for stage I patients was not reached in both groups, Stage II: 65 vs 87.0 months (HR = 1.630, P= 0.023), Stage III: 30 vs 36 months (HR = 1.371, P= 0.043), Stage IV: 12 vs 13 months (HR = 1.466, P= 0.048). The median disease-free survival (DFS) was shorter in ACM (31 vs 37 months (HR = 1.213, P= 0.042) in all the patients; Stage I: not reached in the both group; Stage II: 35 vs 47 months (HR = 1.340, P= 0.015); Stage III: 14 vs 23 months (HR = 1.498, P= 0.000). Multivariate analysis revealed that the subtype of the disease (ACM vs NACM) was significant prognostic factors for OS (HR = 1.80, P= 0.000) and DFS (HR = 1.725, P= 0.004). Conclusions: ACM is the most commonly diagnosed subtype of cutaneous melanoma in Asia. As compared to NACM, more ACM were diagnosed at earlier stage, but with higher proportion of ulceration. The type of ACM was significantly associated with clinical outcome in terms of OS and DFS. Patients of ACM were more susceptible to recurrence, and associated with worse prognosis than patients with non-acral cutaneous melanoma.
Impact of use of phosphodiesterase type 5 inhibitors (PDE5-I) after radical prostatectomy (RP) on biochemical recurrence-free (BCRF) and overall survival (OS): A retrospective study from the Northwestern University SPORE in prostate cancer.
Authors: Arden B. Roston, Irene B. Helenowski, William Catalona, Robin Leikin, Michael Gurley, Luke Trapp, Borko Jovanovic, Timothy M Kuzel
Journal: Journal of Clinical Oncology (2017)

27 Background: The correlation between PDE5-I use to improve erectile function post RP and BCRF and OS on prostate cancer (PCa) patients (pts) has yielded conflicting results among prior retrospective cohort studies (Michl, 2015). Recent data suggests that these drugs may have an impact on immunity that may explain possible benefits. This study’s purpose was to determine whether PDE5-I use affects BCRF and OS for pts treated with RP for PCa. Methods: This is an IRB approved retrospective cohort study analyzing a subset of pts consented to the SPORE in PCa at Northwestern University’s Lurie Cancer Center. Inclusion criteria included men diagnosed with PCa and treated with RP with curative intent between 2003-2015. Study population (n = 2,410) showed 834 (34.6%) received a PDE5-I post-RP, while 1,576 (65.4%) did not. Pts were grouped based on PDE5-I use and no PDE5-I use after RP. A PDE5-I user must have filled at least 2 prescriptions or completed at least 2 inpatient administrations of a PDE5-I. Continuous variables were summarized by descriptive statistics and differences between groups were assessed via the Wilcoxon rank sum test. Categorical variables were reported by frequencies and percentages and compared via Fisher’s exact test. OS and BCRF survival were summarized for 10-yr rates using Kaplan-Meier estimates. The difference in BCRF and OS between groups was evaluated via log-rank test. Results: Mean age at RP was 60, and 90.95 % were Caucasian. Except for pairwise comparisons for significance of Gleason 3+3 vs. 3+4 histology with higher prevalence of 3+4 in the PDE5-I group (p = 0.0004) and a higher percent of clinical stage T2b-c than T2a in the no PDE5-I group (p = 0.01), no differences were noted in demographics. The 10-yr BCRF survival among PDE5-I users was 92.53% compared to 79.63% among non-users after RP (p &lt; 0.0001). The 10-yr OS rate among PDE5-I users was 97.22% compared to 92.69% among non-users (p = 0.008). Conclusions: This retrospective analysis suggests that PDE5-I use improves biochemical recurrence free survival and overall survival in pts treated with RP for PCa.
Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy
Authors: Florian Rudolf Schroeck, Bruce L. Jacobs, Sam B. Bhayani, Paul L. Nguyen, David Penson, Jim Hu
Journal: European Urology (2017)
Efficacy of lanreotide depot (LAN) for symptomatic control of carcinoid syndrome (CS) in patients with neuroendocrine tumor (NET) previously responsive to octreotide (OCT): Subanalysis of patient-reported symptoms from the phase III ELECT study.
Authors: Rodney F. Pommier, George A. Fisher, Edward M. Wolin, Pamela L. Kunz, Nilani Liyanage, Susan W. Pitman Lowenthal, Beloo Mirakhur, Montaser F. Shaheen, Aaron Vinik
Journal: Journal of Clinical Oncology (2017)

378 Background: In ELECT, LAN significantly reduced the need for short-acting OCT rescue medication for symptomatic control of CS in NET patients (pts) vs placebo (PBO) (primary result). Here we present flushing and diarrhea symptom data and biochemical response for pts with or without prior OCT use from the ELECT study. Methods: Adults with histopathologically confirmed NET and history of CS (diarrhea and/or flushing) who were OCT-naive or responsive to OCT long-acting release (LAR) (≤30 mg q4W) or short-acting OCT (≤600 μg daily) were randomized to LAN 120 mg (SC q4W) or PBO for 16 wks. Pts administered short-acting OCT if needed and recorded daily the frequency and severity of symptoms using Interactive Voice/Web Response System for 1 month pre-randomization and throughout the study. 24 hr urinary 5-hydroxindoleacetic acid (5HIAA) was assessed at baseline and wk 12. Results: Of 115 pts randomized, 51 (n=26 LAN; n=25 PBO) were OCT-naive and 64 (n=33 LAN; n=31 PBO) received prior OCT LAR (n=56) and/or short-acting OCT (n=24). The frequency of moderate or severe diarrhea and/or flushing decreased in both naive and prior OCT pts treated with LAN (Table). The least square mean percentage of days with moderate or severe diarrhea and/or flushing was significantly lower for pts treated with LAN (23.4%) vs PBO (35.8%) ( P=0.004, analysis of covariance adjusted for prior OCT use, region, and baseline values). By week 12, 5HIAA levels dropped by ≥30% to normal in 35% of OCT-naive pts and 29% of prior OCT pts treated with LAN. Among PBO pts, 5HIAA reductions were seen in 15% of OCT-naive pts and 7% of prior OCT pts. Conclusions: Pts showed improvement in CS symptoms of flushing and diarrhea and reduction in 5HIAA levels with LAN treatment, indicating efficacy of LAN in pts regardless of prior OCT use. Clinical trial information: NCT00774930; and EudraCT 2010-019066-92. [Table: see text]
Phase II study of low-dose paclitaxel and cisplatin in combination with split-course concomitant twice-daily reirradiation (XRT) in recurrent squamous cell carcinoma of the head and neck (SCCHN): Long-term follow-up of Radiation Therapy Oncology Group (RTOG) protocol 9911.
Authors: Corey J. Langer, Jonathan Harris, Eric M. Horwitz, Merrill S. Kies, Walter J. Curran, Stuart J. Wong, Qiang Zhang, K. Kian Ang
Journal: Journal of Clinical Oncology (2012)

5583 Background: Loco-regionally recurrent SCCHN or new second primary tumor (SPT) in a previous radiation field, if not curable by surgery, is virtually always fatal. Chemotherapy alone yields a median survival time (MST) of no more than 10 to 11 months, 1- and 2- year overall survival (OS) rates of 35% and 10-15% at best. Concurrent re-irradiation and chemotherapy is an alternative strategy. Methods: Eligibility for RTOG protocol 9911 stipulated measurable, recurrent SCCHN or SPT in a previous radiation field, PS 0-1, and adequate end-organ indices. Patients (pts) received twice-daily XRT (1.5 Gy per fraction BID x 5 d every 2 weeks x4), plus cisplatin 15 mg/m 2 IV QD x 5 and paclitaxel 20 mg/m 2 IV QD x 5 every 2 weeks x 4. G-CSF was administered days 6 - 13 of each 2-week cycle. Primary endpoints were OS and progression-free survival PFS at 1 and 2 yrs. Secondary endpoints included acute/late toxicities and patterns of failure. Results: 105 patients were enrolled from March 2000 through June 2003. 100 patients were analyzable (76% male, med age 60 yrs). Oropharynx (41%) and oral cavity (27%) were the predominant primary sites. 23% had SPT. Median prior XRT dose was 65.7 Gy. 73% of pts completed all chemotherapy. Grade &gt; 4 acute toxicity occurred in 28%, grade &gt; 4 acute hematologic toxicity in 21%. 9 treatment-related deaths (9%) occurred: five in the acute setting, four late (including three carotid hemorrhages at 116, 427 and 2772 days). 1-, 2-, and 5-year OS rates were 50%, 27%, and 15% respectively. PFS at 1, 2, and 5 yrs were 35%, 18%, and 7%. 64.9% died from the incident cancer, 3.2% from SPT, and 21.2% from other, non-cancer causes. Estimated 10 yr survival is 5% with 6 pts still alive, including 2 free from relapse. Conclusions: Despite a high incidence of grade 5 toxicity, 1-, 2-, and 5- yr OS rates for split-course bid XRT and concurrent cisplatin/paclitaxel exceed results usually seen with chemotherapy alone. At 5-10 yrs, we have observed longterm survivors free of recurrence.
Analysis of clinical and research implications of expanding next-generation sequencing (NGS) libraries in the treatment options of gastrointestinal cancers in a large cancer center.
Authors: Miguel Gonzalez Velez, Narjust Duma, Valentina Jaramillo Restrepo, Pablo Lopez-Zertuche, Sejal Kothadia, Veronica Mariotti, Ricardo Daniel Parrondo, Beth Boseski, Andrew Jennis, Martin Gutierrez
Journal: Journal of Clinical Oncology (2017)

774 Background: The use of next-generation sequencing (NGS) in clinical practice has increased the therapeutic options for many cancers. Multiple NGS assays are now commercially used. The genomic libraries used by these assays are continuously being expanded, resulting in increased detections of genomic alterations (GAs) leading to potential new treatments. The aim of this study was to identify the clinical and research implications of a database expansion in the detection of GAs in patients with gastrointestinal cancers (GIC). Methods: We retrospectively analyzed 83 consecutive patients with GIC that had NGS at the John Theurer Cancer Center between 01/2014 and 08/2016. GAs were identified using the FoundationOne assay (Foundation Medicine, Cambridge, MA). GAs, number of genomic-directed therapies and number of clinical trials were reviewed. Results: Period 1 (P1) comprised 01/2014-09/2014, period 2 (P2) comprised 10/2014-08/2016. The NGS assay interrogated 236 genes and introns of 19 genes during P1, and was expanded to 315 genes and introns of 28 genes during P2. The 21 samples analyzed during P1 harbored a total of 82 GAs with an average of 3.9 GAs/sample (range 1-7). The 62 samples analyzed during P2 harbored a total of 342 GAs with an average of 5.5 GAs/sample (range 1-20); representing an increase of 42% in GAs from P1 to P2. 41 GAs in 29 genes were detected in P2 that were not interrogated during P1. The average of genomic-directed therapies with potential clinical benefit increased from 1.8 during P1 vs 2.6 during P2 (44.4% increase in potential therapies). Based on new genomic findings, more clinical trials were made available during P2; an average of 8 vs 4 clinical trials (100% increase in available clinical trials). Conclusions: Periodical updates on NGS and the expansion of genomic libraries increase the detection of GAs, potential new genomic-directed therapies and available clinical trials. Continued expansions of NGS are needed to improve genomic characterization, and increase in the personalized therapeutic options for our patients with GIC.
Role of FDG PET–CT (Positron Emission Tomography and Computed Tomography) scan in the staging of locally advanced/recurrent breast cancer as a single modality in comparison to multiple organs directed conventional investigations.
Authors: Pankaj Kumar Garg, S V Suryanarayana Deo, Rakesh Kumar, Nootan Kumar Shukla, Sanjay Thulkar, Ajay Gogia, Dayanand Sharma, Sandeep R Mathur
Journal: Journal of Clinical Oncology (2015)

e11508 Background: Multiple organs directed imaging has been the conventional way of assessing the distant metastasis in locally advanced/ recurrent breast cancer. This study is designed to evaluate the role of single FDG Positron Emission Tomography & Computed Tomography(PET-CT) scan in comparison to multiple organ directed conventional investigations (CI) as a staging tool in locally advanced/ recurrent breast cancer to detect regional and distant metastasis. Methods: A comparative prospective study which included 65 patients of locally advanced (Stage –III)/ recurrent breast cancer was conducted in a breast cancer clinic of a tertiary care centre. All eligible patients were subjected to CI (mammography, chest roentgenography, abdominal sonography, and bone scintigraphy) followed by a single 18-FDG PET- CT scan. All FDG PET CT detected metastatic lesions were considered positive if they were multiple with typical appearance of metastasis (multiple lung nodules or lytic lesions in the skeleton) else they were confirmed by histopathology (MRI in case of equivocal skeletal lesions) or by clinical/ imaging follow up. Results: FDG PET-CT detected distant metastasis in 31 (47.7%) patients while CI could identify distant metastasis in only 15 (23.1%) patients. FDG PET-CT detected N3 disease in 26 (40%) patients - supraclavicular lymphadenopathy in 14 patients and internal mammary nodes in 21 patients; this regional lymphadenopathy is not detected by conventional imaging. Overall, FDG PET-CT upstaged the disease in 35 (53.8%) patients (distant metastasis and regional lymphadenopathy) as compared to CI which upstaged the disease in only 15 (23.1%). Overall concordance between CI and FDG PET-CT was 76.9% (100% for contralateral breast, 90% for lung metastasis, 861% for skeletal metastasis, and 86.1% for liver metastasis). Conclusions: Our preliminary results show the potential of FDG PET-CT scan to upstage the disease in a significant number of locally advanced/recurrent breast cancer patients in contrast to CI; this would help in accurate staging and better prognostication of disease.
Non-sentinel lymph node status and prognosis of the breast cancer patients with micrometastatic sentinel lymph nodes
Authors: H. Jinno, T. Onishi, M. Takahashi, M. Sakata, Y. Kitagawa, N. Kitamura, T. Nakahara, M. Mukai
Journal: Journal of Clinical Oncology (2009)

e11504 Background: Sentinel lymph node biopsy (SLNB) has become a standard therapy for clinically node-negative breast cancer patients and improvements of histopathological and molecular analysis of sentinel lymph node (SLN) have increased the rate of micrometastases identified. However it remains controversial whether to perform axillary lymph node dissection (ALND) for patients with micrometastases in SLNs and their prognostic significance is also a matter of debate. The purpose of this study is to determine the non- sentinel lymph node (NSLN) status and prognosis of the patients with micrometastatic SLNs. Methods: A prospective database of 666 breast cancer patients with the tumor size less than 3cm and clinical negative node, who underwent SLNB from January 2002 to July 2007 at Keio University Hospital was analyzed. SLNs were detected using a combined method of isosulfun blue dye and small-sized technetium-99m-labeled tin colloid. SLNs were diagnosed with standard hematoxylin and eosin (HE) staining and immunohistochemical (IHC) analysis. Results: Micrometastases in SLNs were found in 50 (7.5%) of 666 patients. Twenty nine (58.0%) of 50 patients with micrometastatic SLNs underwent ALND and revealed no NSLN metastasis. Among 21 (42.0%) patients with micrometastatic SLNs who skipped ALND, no axillary lymph node recurrence has been observed in the median follow-up time of 43 months, although 20 patients (95.2%) in 21 patients received adjuvant systemic therapy. There is no significant difference in recurrence free survival between the patients with micrometastatic and negative SLNs (98.0% vs. 95.7%, respectively). Conclusions: These date suggested that it may not be necessary to perform ALND for the patients with micrometastases in SLNs and the presence of micrometastases in SLNs may not be associated with prognosis. No significant financial relationships to disclose.
Upfront surgery, neoadjuvant, and definitive chemoradiation for clinical T2N0 esophageal adenocarcinoma: A propensity score matched analysis from the National Cancer Database analysis.
Authors: Ravi Shridhar, Jamie Huston, Kenneth L Meredith
Journal: Journal of Clinical Oncology (2017)

103 Background: To compare overall survival (OS) of T2N0 esophageal adenocarcinomas treated with either upfront surgery (US), neoadjuvant chemoradiation (NCR), or definitive chemoradiation (DCR) from the National Cancer Database (NCDB). Methods: The NCDB was accessed to identify patients with T2N0 esophageal adenocarcinoma treated between 2004-2013 with either US, NCR, or DCR. NCR and DCR patients were included if they were treated with a radiation dose between 45-50.4 Gy and received chemotherapy. Propensity score matching (PSM) was performed against age and tumor length. Results: After PSM, 446 patients (US 98; NCR 203; DCR 145) were included in the analysis. There was no difference in age, tumor length, and grade. Clinical staging in US patients was accurate pathologically in 32.6% of patients. Median and 5 year OS for US, NCR, and DCR patients was 42.5 months and 40%, 48.5 months and 48%, and 22.9 months and 20%, respectively (p&lt;0.001). There was no difference in OS based on response to NCR compared to US. NCR was associated with improved OS in patients with tumors &gt;3 cm compared to US (median OS 43.8 versus 36.4 months; p=0.01). There was a trend toward improved OS with NCR in high grade tumors compared to US. UVA and MVA of OS revealed that DCR was associated with worse survival. Conclusions: Clinical staging for T2N0 esophageal adenocarcinoma continues to remain highly inaccurate. There was no difference in OS between US and NCR, however, improved OS was seen in NCR patients with tumors &gt;3 cm.
A randomized, double-blind, placebo-controlled, multicenter, multinational, phase II trial of L-BLP25 in patients with colorectal carcinoma following R0/R1 hepatic metastasectomy.
Authors: Carl Christoph Schimanski, Markus Hermann Moehler, Hauke Lang, Michael Schoen, Victoria Smith-Machnow, Stephan Kanzler, Susanna Hegewisch-Becker, Steffen Doerfel, Daniel Seehofer, Wolf Bechstein, Michael Heike, Friedrich Overkamp, Frank Kullmann, Matthias Voehringer, Volker Heinemann, Goetz von Wichert, Stefan Kasper, Richard Greil, Hellmut Samonigg, Peter Robert Galle
Journal: Journal of Clinical Oncology (2012)

TPS3641^ Background: Approximately 15-20% of patients diagnosed with colorectal cancer (crc) develop metastatic disease. Surgical resection remains the only potentially curative treatment. 5-year survival following R0-resection of liver metastases lies ~28 -39%. Recurrence occurs in ~70% of pts. Adjuvant chemotherapy has not significantly improved clinical outcomes. The primary objective of the LICC trial (L-BLP25 in Colorectal Cancer) is to analyze whether L-BLP25, an active cancer immunotherapy, extends recurrence-free survival (RFS) time over placebo in colorectal cancer pts following R0/R1 resection of hepatic metastases. L-BLP25 targets MUC1 glycoprotein, which is highly expressed in hepatic metastases from crc. In a phase IIB trial, L-BLP25 showed acceptable tolerability and a trend toward longer survival in pts with stage IIIB NSCLC. Methods: This is a multinational, phase II, multicenter, randomized, double-blind, placebo-controlled trial with a sample size of 159 pts from 20 centers in 3 countries. Pts must have stage IV cr adenocarcinoma limited to liver metastases. Following complete resection of the primary tumor and all syn-/metachronous metastases, eligible pts are randomized 2:1 to receive either L-BLP25 or placebo. Those allocated to L-BLP25 receive a single dose of 300 mg/m 2 cyclophosphamide (CP) 3 days before first L-BLP25 dose, then primary treatment with sc L-BLP25 930 μg once weekly for 8 weeks, followed by maintenance doses at 6-week (years 1 and 2) and 12-week (year 3) intervals until recurrence. In the control arm, CP is replaced by saline solution and L-BLP25 by placebo. Primary endpoint: RFS time. Secondary endpoints: OS time, safety status, tolerability, RFS/OS in MUC-1 positive cancers. Exploratory immune response analyses are planned. First recruitment was of Q3 2011. To date, 8 of 20 centers are initiated and 4 pts recruited. Completion of recruitment is scheduled for Q3 2013. Primary endpoint will be assessed in Q3 2016: Follow-up will end Q3 2017. No interim analysis is planned. Design and implementation of this vaccination study in colorectal cancer is feasible. No major issues identified during setup of the study.