tbuckley/cabot-search huggingface dataset:
Gemcitabine in the treatment of recurrent epitherlial ovarian cancer
Authors: M. J. Inbar, D. Matceyevsky, F. Kovner, I. G. Ron, T. Safra
Journal: Journal of Clinical Oncology (2004)

5141 Background: Five years survival of patients with advanced epithelial ovarian cancer (EOC) is 25–40% and once the disease recurs, treatment is mainly palliative. We would like to give that treatment with the longest time to progression (TTP) together with the best quality of life. Our objectives in this study were to evaluate the safety and to determine the TTP of monotherapy Gemcitabine in heavily pretreated patients with recurrent or persistent EOC. Methods: nineteen heavily pretreated patients with recurrent or persistent EOC were treated with single agent Gemcitabine during 1995–2003 in the Oncology Division in Tel Aviv Sourasky Medical Center. Fifteen of them were retrospectively evaluated (4 had died and received the drug for =< 1.5 months - less than two cycles). All patients were previously treated with cisplatin combinations and had received a median of 3 prior chemotherapy regimens (range 2–6). Seven (47%) patients were considered platinum sensitive and 8(53%) platinum resistant. Median age was 64(43–78) years. Protocol schedule was Gemcitabine 1000mg/m2 over one hour administration days 1, 8 and 15 every 28 days. Results: Fifteen patients are evaluable for response by CA-125 reduction or stability and clinical improvement (pain, ascites etc). Patients were not on preplanned protocols and for that, follow-up CT's were not done routinely. Clinical benefit (PR or SD by CA-125 and symptom relief) was noted in 12 out of 15(80%) patients. Median TTP was 4 months (range 2–14). Median OS was 6 months (range 3–28) and 5 patients are still alive. Toxicities: Grade III-IV toxicity was found in 4(27%) patients with anemia, 4(27%) with thrombocytopenia, 1(6%) with fatigue and 2(13%) with leg edema. Conclusions: Gemcitabine is an active drug in heavily pretreated patients with EOC and has a very favorable toxicity profile. It's use as a monotherapy and in combination with platinum salts drugs should be studied. No significant financial relationships to disclose.
Expert witness testimony
Authors: Leo Uzych
Journal: JAMA (1985)

<h3>To the Editor.—</h3> The recent editorial by Dr Lundberg,<sup>1</sup>together with two related MEDICAL NEWS stories<sup>2,3</sup>in the same issue ofThe Journal, present an articulate, informed analysis of selected issues associated with the physician in the role of courtroom witness. Regrettably, law as practiced in the courtroom and medicine seem often-times to function as virtual polar opposites. Litigation by its nature is adversarial, whereas science is directed toward objectivity and truth gathering. Therefore, the expert medical witness may suffer a wrenching experience as a seasoned trial attorney tortures the "truth" in the effort to obtain a good result for the client. The suggestion in the editorial that it may be better for the court, rather than the litigants, to obtain the best, unbiased expert consultation and testimony is worthy of serious consideration. I have some questions about this, however. How will the court ascertain the "best" witness?
Candidate secreted biomarkers for early prostate cancer detection
Authors: M. Jendoubi, C. Chavany, S. Chen, S. R. Schramm, O. J. Semmes, R. P. C. Valle
Journal: Journal of Clinical Oncology (2004)

9736 Background: Evaluation of prostate specific antigen (PSA) is the current screening method for early detection of prostate cancer. PSA is more prostate specific than cancer specific, and elevated PSA can also be found in benign conditions of the prostate. Thus, in spite of the overall success of PSA screening, there is a continued need for more sensitive and specific methods for early detection of prostate cancer. Methods: We have developed an antibody-based approach to biomarker discovery in cancer, focusing on differential protein expression, using: i) a large collection of high affinity polyclonal antibodies raised against individual human proteins and their isoforms; ii) a proprietary multiplex protein array immunoassay, namely the matrix protein array technology (MPAT), coupled to a readout and data analysis system, and iii) clinical samples (tissue and serum) from normal, benign prostate hyperplasia (BPH), early and advanced prostate cancer patients. Protein extracts from specimens were printed onto a membrane, then allowed to interact with 20,000 individual antibodies from our collection. Antibody-sample reaction was detected by chemiluminescence, and quantified by computer analysis of a CCD-acquired image, followed by statistical analysis. Results: In the screening of tissue specimens we have identified three distinct panels of antibodies, specific for cancer, BPH and prostate tumor, respectively. In addition, screening of 150 serum samples revealed antibody panels discriminating early versus late stage prostate cancer. We have further characterized these biomarkers by western blot analysis. Conclusions: These biomarkers offer potential applications in the early diagnosis of prostate cancer, and discrimination from benign conditions of the prostate. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Milagen, Inc. Milagen, Inc. Milagen, Inc.
Phase II study of docetaxel, cisplatin, and irinotecan in advanced esophageal and gastric cancer
Authors: P. C. Enzinger, J. Clark, D. Ryan, J. Meyerhardt, M. Kulke, P. Fidias, C. Earle, M. Vincitore, A. Michelini, C. Fuchs
Journal: Journal of Clinical Oncology (2004)

4040 Background: A phase I trial at DFPCC has demonstrated the safety and tolerability of weekly docetaxel, cisplatin, and irinotecan (TPC) given on day 1 and 8 every 21 days (Proc ASCO 2001:A2087). Major responses in patients (pts) with esophageal and gastric cancer were noted. Methods: We now report preliminary phase II results of our weekly regimen in patients with measurable, metastatic chemo-naïve esophageal and gastric cancer. Results: Thirty-two pts have been enrolled: median age = 60 (31–78), M/F = 23/9, ECOG 0/1 = 14/18, and gastric/gastroesophageal junction/esophageal adenocarcinomas = 14/2/16. The first 18 patients were treated with docetaxel 30mg/m2, cisplatin 25mg/m2, and irinotecan 65mg/m2. Grade III/IV toxicity included: diarrhea - 8pts (44%), neutropenia - 4 (22%), dehydration - 3 (17%), nausea - 2 (11%), vomiting - 1 (6%). Consequently, irinotecan was reduced to 50mg/m2 and, among the subsequent 15 pts, grade III/IV included: diarrhea - 1 (6%), neutropenia - 1 (6%), nausea - 4 (27%), vomiting - 2 (13%). One patient died of a pulmonary embolism in the setting of diarrhea and vomiting. Among 26 pts evaluable for response, major responses (RECIST), including one complete response, were noted in 15 pts (RR = 58%; 95% CI, 39–77). Five of 10 gastric cancer pts (50%) responded and 10 of 16 esophageal pts (63%) responded. Prior to the aforementioned dose reduction (irinotecan = 65mg/m2), 9 of 15 pts (60%) responded, whereas following the change in dose (irinotecan = 50 mg/m2), 6 of 11 pts (55%) responded. Additionally, 9 pts (35%) in the overall cohort had stable disease as their best response. Conclusions: The TPC regimen with irinotecan at 50mg/m2 is a well-tolerated treatment and has a promising response rate in patients with esophageal and gastric cancer. Accrual to this dose level continues. Supported by Aventis and Pfizer. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis Aventis; Pfizer
Abstract 2054: Neuron-specific Enolase as a Prognostic Parameter in Patients Treated with Mild Hypothermia After Cardiopulmonary Resuscitation for Out-of-hospital Cardiac Arrest
Authors: R. Schneider, C. Stumpf, A. Yilmaz, G.H. Wasmeier, C. Schlundt, C. Garlichs, W.G. Daniel, S. Achenbach
Journal: Circulation (2008)

Background: Overall prognosis in comatose survivors of Cardiopulmonary resuscitation is poor and the degree of hypoxic brain damage is usually the most important prognostic factor. Elevation of the neuron-specific enolase (NSE) as measured with 72 hours after admission has been identified as a predictor of neurologic outcome, and a threshold level of 33 ng/ml has been proposed as a highly specific cut-off value, above which neurologic outcome will be unfavourable. Therapeutic hypothermia is a new concept to improve neurologic outcome in patients after resuscitation, and the prognostic relevance of elevated NSE levels in patients treated by hypothermia has not yet been assessed. Methods: Mild therapeutic hypothermia (33–34°C) was applied via an intravenous cooling catheter for 24 hours in 38 consecutive patients admitted after successful on-site resuscitation following out-of-hospital cardiac arrest (28 male, 10 female, age 38 – 83 years, mean age 64.4±12.7 years). 72 hours after admission, NSE level was measured. Clinical and neurologic outcome was assessed at 1 and 4 weeks. Results: Out of 38 patients, 4 patients died within the first 72 hours. In 2 additional patients, NSE measurement was impossible because of haemolytic serum. NSE levels displayed a wide range (9.8 ng/ml − 720 ng/ml). Of the 32 patients available for analysis, 17 patients suffered severe ischemic brain damage or died during the further course (NSE 11.0 –720 ng/ml, mean 150.4±185.9 ng/ml). 15 patients recovered and had favourable neurologic outcome (NSE 9.8 – 47.9 ng/ml, mean 21.1±11.9 ng/ml). Using the recommended threshold value of 33 ng/ml, the sensitivity for ischemic brain damage was 76.5%, specificity was 80.0%, and the positive predictive value was 81.3%. Conclusions: Based on prior experience in patients without therapeutic hypothermia, a cut-off level of 33 ng/ml has been recommended as a highly specific threshold above which neurologic outcome in patients resuscitated for out-of-hospital cardiac arrest will be poor. Our data demonstrate, however, that favourable outcome can be achieved even for higher NSE levels in patients who are treated with therapeutic hypothermia. Thus, the prognostic value of NSE in these patients must be reconsidered.
A single institution experience: Paclitaxel/ifosfamide/cisplatin (TIP) chemotherapy in refractory or recurrent germ cell tumors
Authors: H. Karagol, D. Derin, A. Yazar, M. Basaran, S. E. Bavbek, H. Onat
Journal: Journal of Clinical Oncology (2004)

4733 Background: There is no established standard chemotherapy (CT) regimen for patients with refractory or recurrent germ cell tumors. Method: Thirteen patients with germ cell tumors who were either refractory to prior cisplatin-based chemotherapy (CT) or recurrent disease have been treated with TIP (paclitaxel 175mg/2 given as a 3 hour infusion, ifosfamide 1.2 gr/m2 in 4 hour infusion with mesna for 5 days and cisplatin 20 mg/m2 for 5 days, q3wks) between 2002 and 2003 at Istanbul University Oncology Institute. Results: The median age was 29 (range: 20 - 40). Two patients (15%) had seminomatous and eleven (85%) had non-seminomatous histology. One of 15 patients have extragonadal germ cell tumor. All patients received BEP chemotherapy previously. Among these, four patients were refractory (relapsed while on therapy) to the BEP CT. The remaining group had a median recurrence time of 11 months. Response evaluation was done after 2 or 3 cycles of CT with radiological assessment and tumor markers. At the time of recurrence, 10 patients (77%) had elevation of either AFP or b-hCG. The radiological CR rate after CT was 15%. Despite normalization of tumor markers, two patients had radiological evidence of residual tumor. One patient has been operated for the residual tumor and one of the responding patients undergone autologous stem cell transplantation. Grade III or IV neutropenia was observed in all patients, febrile neutropenia in 7 (54%), and anemia in 7 (54%), and thrombocytopenia in 9 (69%) patients. Dose modification was needed in 7 (54%) patients and a dose delay greater >1 week was done in 8 (62%) patients. Currently 9 patients are alive and the median time to progression (TTP) was 3 months. Conclusion: TIP combination CT failed to yield a favorable outcome in terms of TTP in patients with refractory or recurrent germ cell tumors. No significant financial relationships to disclose.
Improved survival of patients with metastatic colon carcinoma treated with a planned sequential chemotherapy approach
Authors: A. Hageboutros, P. McLaughlin, C. Dalsania
Journal: Journal of Clinical Oncology (2004)

3644 Background: Studies have shown that CPT-11 based regimen in metastatic colon carcinoma are better than 5-FU/LV alone. Our goal is to determine if a planned sequential approach has an impact on overall survical in patients with metastatic colon carcinoma using CPT-11 based regimen as 1st line. Methods: A retrospective analysis was conducted on 20 patients with metastatic colon carcinoma diagnosed from Oct. 1999 to Oct. 2001. 18 (90%) patients had ECOG Performance Status-0 and 1, whereas 2 (10%) patients had ECOG PS-2 at presentation. Our 1st line in all patients was CPT-11 based regimens given weekly for 4 weeks every 6 weeks (Saltz regimen). Responses were assessed by serial CT scans after every 2 cycles. At progression, chemotherapy was changed to 2nd, 3rd 4th or 5th line with Oxaliplatin based regimen, Capecitabine, Cetuximab and other investigational drugs. For patients with complete response a total of 6 cycles of 1st line was given and observed until progression. Results: Mean of 6.9 cycles of 1st line was administered. Median time to progression from the start of 1st line was 10.25 months. 15 (75%) patients progressed to receive 2nd line out of which 8 (40%) received Oxaliplatin based regimen, 5 (25%) received Capecitabine and rest received other regimens. The total number of patients who received 2nd, 3rd, 4th or 5th line was 15 (75%), 9 (45%), 7 (35%) and 4 (20%) respectively. The median overall survival was 18.65 months, with 1-year survival rate of 85%. Conclusions: Our planned sequential chemotherapeutic approach based on CPT-11 with 5-FU/LV as 1st line achieved overall median survival of 18.65 months compared to 14.8 months and median time to progression of 10.25 months compared to 7 months in Saltz trial. The high rate of patients receiving second line therapy may have contributed to the high 1-year survival and median survival rate. We recommend further evaluation of this sequential approach in large randomized control trials. No significant financial relationships to disclose.
Survival of good-risk germ cell tumor patients following post-chemotherapy retroperitoneal lymph node dissection: The effect of bleomycin during induction chemotherapy.
Authors: K. Clint Cary, Jose A. Pedrosa, Hristos Z. Kaimakliotis, Timothy A. Masterson, Lawrence H. Einhorn, Richard Foster
Journal: Journal of Clinical Oncology (2014)

4565 Background: Patients presenting with metastatic International Germ Cell Cancer Collaborative Group (IGCCCG) good risk testicular cancer may receive either 4 cycles of etoposide and cisplatin (EP) or 3 cycles of bleomycin, etoposide, and cisplatin (BEP). Those with residual retroperitoneal masses following either of these induction chemotherapy regimens will require a post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND). We sought to examine differences in survival following PC-RPLND between patients receiving EPx4 compared to BEPx3. Methods: The Indiana University Testis Cancer database was queried to identify IGCCCG good risk PC-RPLND patients who received either EPx4 or BEPx3 induction chemotherapy. The primary outcome was overall survival (OS). Kaplan-Meier plots were generated for the EPx4 and BEPx3 groups and compared using the log-rank test. Survival time was calculated from the date of surgery until date of death or the last date the social security death index was accessed. Results: A total of 226 patients met inclusion criteria between 1985 and 2011. Induction chemotherapy consisted of EPx4 in 47 (21%) patients and BEPx3 in 179 (79%). Most patients (78%) received their chemotherapy at outside institutions and were subsequently referred for PC-RPLND. Of the 12 patients who received adjuvant chemotherapy following PC-RPLND, 8 (66%) had received induction EPx4 while 4 (33%) had received BEPx3 (Fisher's exact p=0.001). Median follow-up was 126 months (IQR: 65-228) during which 16 deaths occurred. The 10-year OS for the EPx4 and BEPx3 groups were 87% and 98%, respectively (log-rank p<0.01). Of the 29 patients with active cancer in the PC-RPLND specimen, the 10-year OS for EPx4 was 50% compared to 83% in the BEPx3 group (log-rank p=0.03). Conclusions: Good risk testicular cancer patients who received BEPx3 may have a modest improvement in survival compared to those who received EPx4 as induction chemotherapy in this retrospective analysis. The overall burden of treatment may be higher with EPx4 as those patients also received more adjuvant chemotherapy compared to those who received induction BEPx3.
Lung cancer quality of care in Uruguay: First experience in a public hospital.
Authors: Maria Clara Rodriguez Palleiro, Virginia Rodriguez, Viviana Dominguez, Siul Salisbury, Alonzo Rodriguez, Lucia Beatriz Delgado, Mauricio Cuello Toledo
Journal: Journal of Clinical Oncology (2017)

231 Background: Improvement in quality of cancer care is a strategic health objective for the Ministry of Health in Uruguay. Lung cancer is the first cancer in mortality in men and the third in women in our country, there are few reports from Latino America about quality of cancer care, in our knowledge this is the first in lung cancer. Methods: We audit a public reference center in oncology that receive about 8 percent of new cases in the country, our objective was to perform a first study in quality of cancer care in non-small cell lung cancer. We reviewed the compliance with a group of 14 indicators (six general and eight NSCLC specific) selected from literature and used in different quality programs. We performed a retrospective analysis of medical records from 408 new patients seen between January 2011 and July 2016. Results: The median age was 62 years, 72,8% were male and 27,2% females, 76,6% were stage III-IV and 23,6% were stage I-II. The median adherence rate to core indicators were 84,2 (69% to 100%). PS was recorded in 76% of cases. Pathology report was present in 71,8% and stage in 97% of medical records. NSCLC indicators had a lower adherence rate 29,8% (5% to 56,3%). 60% receive adjuvant therapy based in platins but only in 5% of patients receive cisplatin. Histologic subtype was informed in 42% of pathology samples and EGFR mutation test were performed in 56% of patient with non-squamous lung cancer. Patients were treated with chemotherapy or radiotherapy as first treatment in 65,4%, stage IV patients receive as first line platin based chemotherapy in 42,7% of cases . Time between diagnosis and first treatment initiation was 28 days and the time to symptoms initiation to diagnosis was 3 months. Conclusions: This auditory identify a high rate of compliance in general indicators, compliance with lung cancer specific quality indicators is heterogeneous. Time to diagnosis need special attention. This study identify a room to improve in lung cancer quality of care and establish a starting point to evaluate the impact of future improvement efforts.
A peaked cornea
Authors: José Ferreira Mendes, Tiago Monteiro,
Journal: BMJ (2017)

A 28 year old man with no medical history was referred to an ophthalmologist with a three year history of gradually worsening visual acuity. His left eye uncorrected distance visual acuity was 20/100, and corrected distance visual acuity was 20/60 (Snellen scale). With direct ophthalmoscopy, we could observe scissoring of the red reflex, and a penlight shone from the temporal side would show a conical reflection on the nasal cornea. Figure 1⇓ shows a sagittal view of the left eye. Based on the clinical history, description of the ophthalmic examination, and sagittal view of the eye, what …
NABTC phase I/II trial of ZD-1839 for recurrent malignant gliomas and unresectable meningiomas
Authors: F. S. Lieberman, T. Cloughesy, H. Fine, J. Kuhn, K. Lamborn, M. Malkin, H. I. Robbins, W. A. Yung, P. Wen, M. Prados
Journal: Journal of Clinical Oncology (2004)

1510 Background: We update this trial evaluating ZD-1839(Iressa) for treatment of malignant gliomas recurring after radiation therapy and for unresectable benign or anaplastic meningiomas (MEN) progressing after radiation therapy. Methods: In the phase II component, patients who were not receiving enzyme inducing anticonvulsants (EIAED) or corticosteroids, were treated with 500mg/ day. The dose in patients receiving corticosteroids was escalated in two increments of 250mg to 1000mg/day. Phase II study was limited to patients with 2 or less relapses. For patients on EIAEDs, a phase 1 component began at 500mg/day and was escalating in 250mg increments. Subjects in the phase 2 component were evaluated for radiological response, time to progression (TTP), and percentage without progression at 6 months (%PFS-26wk). Results: The MTD for patients on EIAEDs is 1500mg/day. As of 11/19/03, 38 glioblastoma(GBM), 17 anaplastic glioma(AG), and 10 MEN patients had entered phase 2 study. The median TTP for GBM is unchanged at 8 weeks (95%CI:7–12weeks). The median TTP for AG is shortened at 12 weeks (95%CI:7-ND). For both GBM and AG, %PFS-26wk is unchanged at 9%(95%CI:3–27%), and 33%(95%CI: 13–81%). However, 1 GBM patient had SD for 66wks, and 1 is progression free at 93 wks; 4 AG patients had SD for over 50wks. Partial responses (not centrally confirmed) were seen in 5 GBM, 1 AO and 1 anaplastic oligoastrocytoma. No MEN has responed. Skin rash, transaminase elevations, fatigue, diarrhea, and hypokalemia were the most common toxicities. No pulmonary interstitial fibrosis was observed. Conclusion: The MTD for ZD-1839 in patients receiving EIAEDs is 1500mg/day. With complete accrual in both GBM and AG cohorts, ZD-1839 does not prolong TTP compared to historical controls, but subgroups of both GBM and AG demonstrated prolonged TTP. Microdisection based genotyping and determination of EGFR expression is in progress to determine if these tumors are distinguishable from those demonstrating rapid progression. No significant financial relationships to disclose.