tbuckley/cabot-search huggingface dataset:
Effectiveness of cisplatin versus carboplatin-based doublet chemotherapy in elderly Medicare patients with advanced non-small cell lung cancer.
Authors: Elizabeth B. Lamont, Nancy Lynn Keating, Christopher G. Azzoli, Mary Beth Landrum
Journal: Journal of Clinical Oncology (2014)

284 Background: There is some evidence that cisplatin-based chemotherapy doublet regimens are more efficacious than the less toxic carboplatin-based doublet regimens for advanced non-small cell lung cancer (NSCLC) but little evidence of effectiveness in elderly cancer patients treated in the usual care setting. We estimated differences in survival and post-treatment morbidity between first-line cisplatin-based and carboplatin-based doublet regimens in elderly Medicare patients with advanced NSCLC. Methods: We identified 13,406 elderly Medicare patients who were diagnosed with stage IV NSCLC between 1995-2009 in SEER regions and treated with either a cisplatin-based doublet chemotherapy regimen or a carboplatin-based doublet chemotherapy regimen in the subsequent six months. Using propensity score weighting, we balanced the two treatment cohorts with respect to observable attributes. We then estimated survival and toxicity according to treatment. Results: Overall patients treated with cisplatin-based doublets lived nearly two weeks longer on average than patients treated with carboplatin-based doublets (i.e., 7.4 months vs. 7.0 months, p=0.05) survival differences were not appreciated in subsets of patients with adenocarcinoma or squamous carcinoma. Patients treated with cisplatin-based doublets were slightly more likely than those patients treated with carboplatin-based doublets to be hospitalized (i.e., 42.9% vs 39.8%, p&lt;0.01) and use intensive hospital-based care. Conclusions: Among elderly Medicare patients with advanced NSCLC, those treated with first line cisplatin-based doublet chemotherapy regimens lived slightly longer than those treated with carboplatin-based doublet regimens, but also utilized more hospital-based care following treatment. The difference in overall survival is not clinically significant, and does not appear to justify the added toxicity.
Prognostic factors for response and survival in primary central nervous system lymphoma (PCNSL) from a randomized phase III trial (G-PCNSL-SG-1).
Authors: K. Jahnke, A. Korfel, P. Martus, S. Lokka, R. Moehle, F. Griesinger, M. Rauch, A. Roeth, B. Hertenstein, T. Fischer, T. Hundsberger, H. Mergenthaler, M. Leithäuser, T. Birnbaum, U. Herrlinger, J. Schubert, A. Florschütz, L. Fischer, M. Weller, E. Thiel
Journal: Journal of Clinical Oncology (2011)

2004 Background: The purpose of this study was to establish prognostic factors in newly diagnosed primary central nervous system lymphoma (PCNSL) in immunocompetent patients. Methods: Four-hundred and eleven patients (median age 63 years, median Karnofsky performance status (KPS) 70%) enrolled in a German multicenter randomized phase III trial (G-PCNSL-SG-1) between May 2000 and May 2009 were analyzed using univariate and multivariate logistic regression analyses to identify prognostic factors for overall response (OR) and progression-free (PFS) and overall survival (OS). Patients were treated upfront with high-dose methotrexate (HDMTX) or HDMTX plus ifosfamide and were whole-brain irradiated thereafter if randomized to radiotherapy and treated with high-dose cytarabine (patients without complete remission) or just followed-up (patients with complete remission) if randomized to chemotherapy alone. Results: On multivariate analysis, female gender (p = 0.003), no corticosteroid medication at study entry (p = 0.003) and <2 tumor lesions (p = 0.009) were highly predictive for OR. Age (<60 vs. ≥60 years; p = 0.007) and KPS (≥70 vs. <70%; p <0.001) were strongly associated with OS. Further favorable prognostic factors (0.05 >p ≥0.01) on multivariate analysis were: HDMTX plus ifosfamide vs. HDMTX monotherapy (for OR), body mass index ≤25 (for OS), <2 tumor lesions (for PFS and OS), and KPS ≥70% (for PFS). Conclusions: This is the first study that established prognostic factors for OR and survival in PCNSL derived from a multicenter, prospective, randomized phase III trial. The data, especially the strong association of age and KPS with OS, should be taken into consideration in the design of future studies in PCNSL.
Natural history of venous thromboembolism in gastrointestinal cancers.
Authors: Robert Lewin Metcalf, Nicholas Hopley, Thomas Henry, Jurjees Hasan
Journal: Journal of Clinical Oncology (2014)

593 Background: Venous thromboembolism (VTE) is a leading cause of mortality in patients with cancer. Characterisation of VTE in cancer will guide prophylactic anti-coagulation of high risk populations. Methods: We performed a retrospective analysis using electronic patient records, of 910 upper GI (UGI) cancer and 1,299 colorectal cancer (CRC) patients referred to a tertiary cancer centre to identify the incidence of VTE, its relationship to chemotherapy and impact on survival. VTE risk scores were calculated using the Khorana index (Khorana AA et al. Blood 2008 May 15;111(10):4902-7). Results: VTE were identified in 88/910 (9.7%) patients with UGI cancer (oesophageal 37%, gastro-oesophageal 24%, gastric 39%), comprising 50 deep vein thromboses (DVT) and 43 pulmonary emboli (PE). 52% were stage I-III and 48% stage IV. 56% of patients received chemotherapy up to 4 weeks before VTE. Median time to VTE from cancer diagnosis was 5.3 months (range -3 to 31.2). No difference in survival was seen for patients with VTE compared to a stage matched control group without VTE (median OS 12.5 v 9.4 months, log rank p=0.2). VTE (DVT:PE, 69:49) affected 115/1299 (8.9%) patients with CRC (25% stage I-III, 75% stage IV). Median time to VTE from CRC diagnosis was 5.4 months (range -4.3 to 54.5) for stage I-III and 8.6 months (range -4.3 to 77) for stage IV CRC. Chemotherapy was received by 41% (stage I-III) and 78% (stage IV) of patients within 4 weeks before VTE. Data to perform VTE risk score were available for 72/115 CRC patients with VTE, which classified 61.1% as low-risk (stage I-III 81.2% (13/16); stage IV 55.3% (31/56)). Again, no difference in survival was seen for patients with VTE compared to a control group without VTE matched for stage and performance status (median OS for stage I-III, 40 vs. 50.3 months p=0.41; stage IV, 20.7 vs. 18.8 months, p=0.52). Conclusions: VTE affects nearly 1 in 10 patients with GI cancer receiving chemotherapy. The peak incidence is in the first 6 months following diagnosis. Most patients have DVT and 36% are asymptomatic. No adverse impact on survival was seen for patients with VTE compared to stage matched controls implying VTE is not a prognosticator of poor outcomes in gastrointestinal cancers. Mature data will be presented at the meeting.
Infographic: oral health in elite athletes
Authors: Ian Needleman, Paul Ashley, Peter Fine, Fares Haddad, Mike Loosemore, Akbar di Medici, Nikos Donos, Tim Newton, Ken van Someren, Rebecca Moazzez, Rod Jaques, Glenn Hunter, Mark Shimmin, John Brewer, Lyndon Meehan, Steve Mills, Stephen Porter
Journal: British Journal of Sports Medicine (2017)
Association of smoking status with p16 and cyclin D1 (CCND1) expression with clinical characteristics and overall survival (OS) in oropharyngeal squamous cell carcinoma (OSC).
Authors: Mei-Kim Ang, Siok Hoon Ang, Sai Sakktee Krishna, Wallace Jian Jun Chen, Minn Minn Myint Thu, Wai Meng David Tai, Daniel S. W. Tan, Eng-Huat Tan, Puay Hoon Tan, Siok Gek Jacqueline Hwang, Wan-Teck Lim
Journal: Journal of Clinical Oncology (2012)

5551 Background: Smoking-related head and neck cancer (HNC) is genetically different, with higher mutation rates compared with non-smokers (NS). Human papillomavirus (HPV)-positive (+) OSC has a superior prognosis independent of treatment. Among HPV+ patients (pt), current or prior smokers (CS) have poor OS compared with NS. Expression of p16, a known HPV surrogate, and CYD1, a cell cycle marker often dysregulated in HNC, was evaluated with respect to smoking status and OS. Methods: Expression of p16 and CYD1 was assessed by immunohistochemistry in 108 OSC pt treated between 1999-2009, using cutoffs of ≥70% (p16+) and ≥10% (CYD1+) stained tumor cells. Associations between expression, clinical characteristics and OS were evaluated by Kaplan-Meier method and compared by log rank test. Hazard ratio (HR) for death was estimated using Cox models. Results: 31 pt (28.7%) were p16+ and 80 pt (75.5%) were CYD1 negative(-). p16+ pt were younger (median age 57 v 66 yrs, p=0.002), more likely female (35.5% v 15.2%, p=0.035), NS (51.6% v 13.9%, p&lt;0.001) with lower combined age-comorbidity score (ageCS) (p=0.003). CYD1+ pt were older (median 66 v 57 yrs, p=0.015), more likely CS (81.5% v 48.1%, p=0.002) with higher ageCS (p=0.018). At a median f/u of 65.7 months, median OS was 57.3 months. p16+ pt had better OS than p16- pt (median OS not reached (NR) v 22.3 mths, p&lt;0.001). CYD1+ pt had poorer OS than CYD1- pt (median OS NR v 17.7 mths, p&lt;0.001). On multivariable analysis p16 and CYD1 status were independently associated with OS (HR 0.412, p=0.045 and HR 4.06, p=0.011 respectively), independent of smoking status (HR 5.01, p=0.008), ageCS (HR 1.32 per 1 point increase, p&lt;0.001) and stage. Strikingly, among NS, 5-year OS in p16+ compared with p16- pt was 100% vs 67% (p&lt;0.001). In contrast, among CS, p16 status had no association with OS (HR 0.97, p=0.943), while CYD1 status and ageCS were independent predictors of death (HR 4.70, p=0.025 and HR 1.28, p&lt;0.001 respectively). Conclusions: In OSC, NS with high p16 expression have excellent prognosis. Among CS, pt with fewer comorbidities and low CYD1 expression have better OS. p16 status was not prognostic in the latter group of patients.
Prognostic Impact of Additional Chromosomal Aberrations (ACA) to 5q- in Patients with primary Myelodysplastic Syndrome.
Authors: Maria del Mar Mallo, José Cervera, Julie Schanz, Blanca Espinet, Esperanza Such, Elisa Luño, Christian Steidl, María Luisa Martín, Ulrich Germing, Javier Grau, Michael Pfeilstoecker, Jesús M Hernández, Thomas Noesslinger, M.a José Calasanz, Peter Valent, Rosa Collado, Christa Fonatsch, Encarna Bureo, Michael Lübbert, Rafael Ríos, Reinhard Stauder, Eva Arranz, Barbara Hildebrandt, Marilyn L. Slovak, Juan Cigudosa, Virginie Eclache, Otto Krieger, Carmen Pedro, Marta Salido, Leonor Arenillas, Guillermo Sanz, Miguel A. Sanz, Ana Valencia, Lourdes Florensa, Detlef Haase, Francesc Solé
Journal: Blood (2008)
Potential factors to explain decreased survival for ethnic subgroups with gastroesophageal adenocarcinoma.
Authors: Katherine Ostapoff, Roderich Schwarz, John C. Mansour
Journal: Journal of Clinical Oncology (2012)

12 Background: Few studies focus on the reasons behind the inferior outcomes in Black and Hispanic patients compared to White and Asian patients. We investigated the association between racial survival differences and social, economic, and health systems factors not often included in large national databases. Methods: Tumor registry data were reviewed at a single cancer program from 1999−2009. Patients with gastric or esophageal adenocarcinoma were included. ANOVA and X 2 test were used for continuous and categorical variables. Median survival was estimated using the Kaplan−Meier method with log−rank comparison and Cox regression. Results: Of 515 patients with gastric or esophageal adenocarcinoma, 254 (50%) were Black or Hispanic. Overall survival for Black and Hispanic patients was decreased compared to the rest of study population (8.4 vs 11 months,p=0.002). Black and Hispanic patients are more likely to present with metastatic disease (56% vs 38%,p&lt;0.0001) and signet ring cell histology (p&lt;0.001). On univariate analysis, survival was decreased for patients without insurance (p=0.0003) and lower incomes (p=0.02). Black and Hispanic patients were more likely to have the high risk characteristics of lower income (p&lt;0.001) and lack of insurance (p&lt;0.001). On multivariate analysis, only racial background was associated with differences in survival (HR, 1.4; 95% CI, 1.16 to 1.76; p=0.001). For nonmetastatic gastric cancer patients, rates of curative intent surgery were similar between ethnic groups (80% vs 79%). Blacks and Hispanics with Stage 2−4 disease were less likely to receive or be recommended chemotherapy (53% vs 67%,p=0.009). Conclusions: Differences in survival for patients with gastric and esophageal adenocarcinoma are associated with biologic (signet ring histology and metastatic presentation) and social factors (insurance status and income). Black and Hispanic patients are more likely to belong to these poorer outcome groups. In addition, they may be less likely to receive complete multidisciplinary care. Despite controlling for these imbalances, ethnic status remains associated with inferior survival, indicating that additional factors may partake in this phenomenon.
Cholangiocarcinoma: A joint cancer database analysis.
Authors: Yehuda Ethan Deutsch, Danny Sleeman, Afonso Ribeiro, Dido Franceschi, Peter Joel Hosein, Ikechukwu Immanuel Akunyili, Jessica Macintyre, Heloisa P. Soares, Stuart Herna, Brian E. Lally, Joe U Levi, Caio Max S. Rocha Lima
Journal: Journal of Clinical Oncology (2012)

268 Background: Cholangiocarcinoma is an uncommon malignancy. In addition, only 10-30% of patients are eligible for curative surgical resection due to advanced disease at diagnosis. The role of adjuvant therapy is not yet established. The objective of this analysis is to assess the outcome of patients with cholangiocarcinoma managed with surgery, chemotherapy, radiation, and/or chemo-radiation. Methods: From 1997 to 2007, patients with biliary cancer from the joint tumor registry database at UMH, SCCC, and JHS had their demographics, stage, pathology, treatment (surgical management, adjuvant and palliative therapy) and survival collected. A total of 800 patients with the diagnoses of biliary cancer were reviewed. The site of cancer was the bile duct in 351 patients, gallbladder in 173, and ampulla of vater in 239 patients. Results: Cholangiocarcinoma - adenocarcinoma of the bile duct – in 334 patients of the 351 with bile duct tumors were analyzed. The mean age at diagnosis was 65 (range 26-92) and 55% of patients were male. Stage at presentation was as follows: 22% of patients presented with stage I, 18% with stage II, 21% with stage III, 26% with stage IV, and 13% were unknown. Potentially curative surgical resection was performed in 45% of the patients. 24% received chemotherapy, 20% received radiation, and 14% received chemo-radiation in combination. The overall median survival (MS) of all patients was 13 months - 22, 16, 14, and 10 months for stages I, II, III, and IV respectively. Surgery provided an overall survival benefit for all stages (24 vs. 9 months, p&lt;.001), including stage III (n=31/71; 20 vs. 10 months, p=.026) and stage IV (n=28/88; 23 vs. 6 months, p&lt;.001). Chemotherapy offered a trend to survival benefit for patients with stage IV (13 vs. 6 months, p=.06) and combined stages III and IV (13 vs. 10 months, p=.07). Combination chemo-radiation had a significant survival benefit in stage IV (19 vs. 6 months, p=.022) and in combined stages III and IV (14 vs. 10 months, p=.026). Conclusions: Chemotherapy and chemo-radiation had a positive impact on survival in patients with late stage cholangiocarcinoma. Surgery improved survival in both early and advanced stages. The lack of data on performance status and organ function did not allow factoring these variables in the analysis.
Neoadjuvant chemotherapy for gall bladder cancer: Does it increase resectability?
Authors: Dheeraj Raj, Shivendera Singh, Nikhil Gupta, Sudheer Rathi
Journal: Journal of Clinical Oncology (2016)

406 Background: Surgery is the treatment of choice for patients with carcinoma gall bladder patients (GBC). However, most of the patients are metastatic at the time of diagnosis with only a fraction of patients deemed non metastatic. Many are locally advanced either infilterating liver, orinvolving adjacent other organs. Studies with gemcitabine for metastatic biliary tract cancers have shown promising results. Extrapolating these results to locally advanced GBC might improve the outcomes in these otherwise poor risk patients. Methods: Patients with locally advanced GBC from January 2013 to June 2014 who were considered borderline resectable on cross sectional imaging were planned for preoperative gemcitabine based chemotherapy to downsize the tumor and make them resectable. Gemcitabine and cisplatin based chemotherapy was given to all these patients and evaluated after 3 cycles. Those who became resectable were taken up for surgery and rest were given additional three cycles of chemotherapy. Results: 840 patients of GBC were seen in the out patient department since January 2013. Of these, 40 patients with locally advanced GBC were considered for neoadjuvant chemotherapy (Gemcitabine and cisplatin). However, only 22 patients actually received neoadjuvant chemotherapy. Out of these 22 patients, 4 are still receiving chemotherapy. Of 18 patients who completed there chemotherapy schedule, 2 patients lost to follow up after receiving 3 cycles of chemotherapy. 15 patients (83.3%%) had good radiological response to chemotherapy and were advised surgery. One patient had no radiological response. 3 patients refused surgery inspite of good radiological response. 13 patients (including the patient who did not have radiological response) underwent surgery. Out of 13 patients, 4 patients had metastatic disease intraoperatively. 9 out of 16 patients (56.25%) underwent R0 resection. Conclusions: Best surgical outcomes are seen with those undergoing RO resection. Neoadjuvant chemotherapy can downsize the tumor in approximately 50% of the patients leading to R0 resection. Neoadjuvant chemotherapy should be considered in locally advanced GBC with the aim of increasing the resectablility in these patients.
Identification of a bona-fide biomarker of microRNA in serum exosomes to predict recurrence of hepatocellular carcinoma after liver transplantation.
Authors: Keishi Sugimachi, Tae Matsumura, Masahisa Ishibashi, Sayuri Akiyoshi, Ken Shirabe, Yoshihiko Maehara, Koshi Mimori
Journal: Journal of Clinical Oncology (2013)

183 Background: The predictive biomarker for the recurrence of hepatocellular carcinoma (HCC) has great benefit on the selection of treatment options including liver transplantation (LT) for HCC. Micro RNA (miR), a class of small non-coding RNA molecule, affect crucial processes in cancer development and offer great potential as biomarkers for cancer due to their remarkable stability in blood. The objective of this study is to identify specific miRs in exosomes of HCC recurrence from the serum and bone marrow of the patients and validate these molecules as novel biomarkers for HCC recurrence. Methods: We employed microarray-based profiling of miR expression from exosome in serum and bone marrow of the patient with HCC to define a biomarker that distinguishes between patients with and without HCC recurrence after liver transplantation or hepatic resection. This was followed by a real-time semi-quantitative PCR validation in a separate cohort of 63 HCC patients who underwent living related LT. Results: We found that 4 miRs which were differentialy (&gt;2 folds) expressed in the serum exosome with HCC cases that had recurrence after LT compared to those without recurrence. They were associated with tumor aggressiveness of HCC in the validated cohort series. To disclose the original cell fraction of each identified miR in bone marrow, we divided bone marrow cells into 3 fractions by cell surface markers, such as CD14+ (macrophage), CD14-/CD45- (lymphocyte) and CD14-/CD45-/EpCAM+ (epithelial cell), then we performed microRNA microarray in each fraction. The increased expression of miR-150, miR-135a, and miR-1225-5p were observed in the CD14-/CD45+ fraction of bone marrow of HCC cases with recurrence, which suggested the association of CD4+ lymphocyte impairment and tumor recurrence. Conclusions: Circulating miR in serum exosome has potential as a novel biomarker to predict recurrence of HCC. MiR profiling of serum and bone marrow may help to clarify the mechanism of recurrence of HCC. The identified miR/gene axis indicated that the disruption of the immune systems after LT should provoke the recurrence of HCC in the future.
Are out-of-pocket payments for oral oncologic therapies too high? Updated results from a U.S. claims data analysis.
Authors: M. L. Raborn, E. M. Pelletier, D. B. Smith, C. M. Reyes
Journal: Journal of Clinical Oncology (2011)

e16512 Background: Oral oncologic therapies increasingly are becoming part of treatment options for cancer. These agents often fall within the pharmacy benefit, with the potential for increased out-of-pocket payments (OOPP) for patients. This study evaluated OOPP for oral oncologics in U.S. managed care plans. Methods: Patients age 18+ years with 1 of 23 oral oncologics (altretamine, bexarotene, capecitabine, cyclophosphamide, dasatinib, erlotinib, etoposide, everolimus, gefitinib, imatinib, isotretinoin, lapatinib, lenalidomide, leucovorin, nilotinib, pazopanib, sorafenib, sunitinib, temozolomide, thalidomide, topotecan, tretinoin, vorinostat) were identified in 2009 from a nationally representative database of medical and pharmacy claims from over 100 U.S. health plans. OOPP were calculated as the allowed amount (dollars a plan allows for a therapy, including member liability) minus the paid amount (dollars paid by a plan for a therapy). Mean/median per-claim OOPP were reported. Results: 24,479 patients with at least 1 oral oncologic were identified in 2009. Mean age was 39 years, 44% were male, and 82% had a commercial payer. Per-claim OOPP for the 23 oral oncologics are provided in the table. Median OOPP ranged from $6 (gefitinib) to $41 (bexarotene). Medicare Risk and self-insured patients had higher OOPP for most therapies compared to commercial payers and Medicaid. Conclusions: OOPP in the U.S. differ among oral oncologic options and confirm previous findings. As costs for therapy become a greater part of treatment decisions, an understanding of patient cost burden will be critical in informing choices. 2009 median and mean OOPP. Oral oncologic therapy Total claims Median OOPP ($) Mean OOPP ($) Gefitinib 90 6 95 Leucovorin 6,725 7 9 Cyclophosphamide 2,625 10 19 Isotretinoin 46,246 10 35 Altretamine 38 10 38 Etoposide 409 10 41 Pazopanib 9 10 58 Tretinoin 354 10 84 Topotecan 53 21 70 Everolimus 264 25 135 Capecitabine 9,958 26 81 Lapatinib 1,352 26 170 Imatinib 8,533 26 173 Sorafenib 1,159 26 243 Erlotinib 3,310 26 246 Nilotinib 342 26 295 Vorinostat 97 26 351 Lenalidomide 4,510 30 321 Temozolomide 4,873 31 156 Sunitinib 1,588 31 204 Thalidomide 1,657 31 205 Dasatinib 779 36 504 Bexarotene 265 41 123