tbuckley/cabot-search huggingface dataset:
Major prognostic value of modeled AUC<sub>hCG-AFP</sub>, a dynamic kinetic marker characterizing tumor marker decline of nonseminomatous germ cell tumors (NSGCT) intermediate-poor-risk patients according to the IGCCCG
Authors: H. Boyle, B. You, L. Fronton, B. Ribba, P. Girard, B. Tranchand, M. Tod, H. Coquelin, J. Droz, A. Flechon
Journal: Journal of Clinical Oncology (2009)

5085 Background: The level of human chorionic gonadotrophin (hCG) and alpha-foetoprotein (AFP) serum tumor marker is well established in NSGCT as prognostic factor, the relevance of marker kinetic analysis under treatment is still unclear. This may be due to the inaccuracy of methods employed so far, simplifying complex exponential decrease curves by a median half-life (HL). We propose to model patient's AFP and hCG decline profiles in order to calculate area under the curve of marker concentrations versus time (AUC hCG-AFP ) and to test its prognostic value. Methods: Our retrospective study involved 65 pts treated by 4 cycles of bleomycin-etoposide-cisplatin (BEP) regimen for an intermediate-poor-risk group NSGCT in the same center between 1997 and 2008. A kinetic population approach with NONMEM software was used to model equations of hCG and AFP individual decrease profiles between day 7 (D7) and D42 after the first BEP cycle. AUC hCG and AUC AFP were calculated between day D0 and D42 as: AUC 0–42 =AUC 0–7 +AUC 7–42 where AUC 0–7 = trapezium area between D0 and D7 while AUC 7–42 =integral of modeled equation. Survival univariate and multivariate analyses tested the prognostic value of AUC hCG-AFP regarding PFS. Results: Mono-exponential models best fitted AFP and hCG decreases: C AFP (t) = 381*e - 0.14 *t +3.27 and C hCG (t) = 1230*e - 0.25 *t +1.22. Three prognostic groups (AUC hCG-AFP ) were determined according to AUC AFP median and AUC hCG terciles: good if AUC AFP &lt;=11729.4 and AUC hCG0–42 &lt;=6670; intermediate if AUC AFP &gt;11729 and/or if 6670&lt;=AUC hCG &lt;18178 and poor risk if AUC hCG &gt;18178 whatever AUC AFP . AUC hCG-AFP was a significant prognostic factor in the univariate analysis on the 2 year PFS (100% vs 73.8% vs 67.7%, p = 0.035) as well as IGCCCG score (poor/intermediate risk groups), primary site (mediastinal/other) and HL hCG-AFP . Yet AUC hCG-AFP was the only significant independent factor in the multivariate Cox model (HR = 3.3, 95%CI = [1.2–9.2], p = 0.032). Conclusions: Modeled AUC hCG-AFP is a dynamic kinetic marker characterizing NSGCT patient marker decline during BEP treatment. These results must be validated in a prospective cohort. It may be a major prognostic factor. No significant financial relationships to disclose.
Growing Healing Touch as supportive cancer care in western New York.
Authors: Suzanne M Hess, Lynda M. Beaupin
Journal: Journal of Clinical Oncology (2017)

176 Background: Healing Touch (HT) is a specific energy medicine modality that incorporates several techniques to balance the human energy field to help promote healing. It is a safe and non-invasive therapy that complements traditional, standard care and is recognized by NIH’s National Center for Complementary and Integrative Health. HT was first introduced to cancer survivors at our NCI-designated Comprehensive Cancer Center in 2013. We demonstrate HT is well-received and easy to integrate into traditional cancer care. Methods: A Certified Healing Touch Practitioner taught pediatric survivors and families HT techniques, as well as trained staff and volunteers to participate in the pilot program and to offer HT sessions throughout the year. Results: See Table. Qualitative analysis of participant’s feedback indicate benefits in the following themes: 1. Physical Symptom Relief 2. Emotional Issue Relief 3. Spiritual/Grief Support 4. Recommendation to Other Patients. Conclusions: Healing Touch is an energy medicine modality that is easy to teach, simple to integrate into routine cancer care, and beneficial for caregivers and survivors alike. [Table: see text]
Misunderstandings in general practice prescribing decisions: a qualitative study
Authors: N Britten, FA Stevenson, CA Barry, N Barber, CP Bradley
Journal: BMJ (2000)

Objectives: To identify and describe misunderstandings between patients and doctors associated with prescribing decisions in general practice. Design: Qualitative study. Setting: 20 general practices in the West Midlands and south east England. Participants: 20 general practitioners and 35 consulting patients. Main outcome measures: Misunderstandings between patients and doctors that have potential or actual adverse consequences for taking medicine. Results: 14 categories of misunderstanding were identified relating to patient information unknown to the doctor, doctor information unknown to the patient, conflicting information, disagreement about attribution of side effects, failure of communication about doctor's decision, and relationship factors. All the misunderstandings were associated with lack of patients' participation in the consultation in terms of the voicing of expectations and preferences or the voicing of responses to doctors' decisions and actions. They were all associated with potential or actual adverse outcomes such as non-adherence to treatment. Many were based on inaccurate guesses and assumptions. In particular doctors seemed unaware of the relevance of patients' ideas about medicines for successful prescribing. Conclusions: Patients' participation in the consultation and the adverse consequences of lack of participation are important. The authors are developing an educational intervention that builds on these findings.
Weekly <i>nab</i>-paclitaxel (<i>nab</i>-P) plus gemcitabine (gem) or carboplatin (carbo) vs gem/carbo as first-line treatment for metastatic triple-negative breast cancer (mTNBC) in a phase 2/3 trial (tnAcity).
Authors: Denise A. Yardley, Javier Cortes, Robert E. Coleman, Pier Franco Conte, Adam Brufsky, Joyce O'Shaughnessy, Gail Lynn Shaw Wright, Janice F. Eakle, Sharon Wilks, Mikhail Shtivelband, Robyn R. Young, Carmelo Bengala, Huiling Li, Julie Ann Miller, Debora Barton, Nadia Harbeck
Journal: Journal of Clinical Oncology (2015)

TPS1106 Background: Treatment of mTNBC is an unmet clinical need. First-line nab-P with gem or carbo/bevacizumab has demonstrated efficacy and safety in female patients (pts) with mTNBC. nab-P significantly improved pCR vs solvent based-paclitaxel in pts with early TNBC. The phase II/III tnAcity (triple-negative Albumin-bound paclitaxel combination international treatment study) trial will compare the efficacy and safety of 2 nab-P combination regimens (with gem or carbo) vs gem/carbo as a control as first-line treatment for mTNBC. Methods: 790 female pts ≥ 18 yrs with measurable mTNBC will be enrolled at ≈150 sites globally per major eligibility criteria (Table 1). In phase II, 240 pts will be randomized 1:1:1 to receive nab-P 125 mg/m2 + gem 1000 mg/m2 (arm A), nab-P 125 mg/m2 + carbo area under the curve (AUC) 2 (arm B), or gem 1000 mg/m2 + carbo AUC 2 (arm C), given D 1 and 8 q3w. Pts will be treated until disease progression. Stratification factors are disease-free interval (≤ 1 yr vs > 1 yr) and prior taxane exposure (phase III only). A ranking algorithm of 5 efficacy and safety parameters will be used to identify the nab-P combination for the phase III portion in which 550 pts will be randomized 1:1 to receive the selected nab-P regimen (arm A or B) or gem/carbo. Pts in phase II will not be in the phase III population. The phase III primary endpoint is PFS by independent radiological assessment. Study design provides ≈ 90% power to detect an HR of 0.70 for PFS with a 2-sided 5% significance level. Secondary endpoints: ORR, OS, disease control rate, duration of response, and safety. Exploratory analyses include tumor biomarkers and circulating tumor cells analyses. Current enrollment as of submission: 128 pts. Clinical trial NCT01881230. Clinical trial information: NCT01881230.Key eligibility criteria. ER and PgR expression both < 1% of tumor cell nuclei HER2 IHC 0 or 1+ or FISH−, or IHC 2+ and FISH− ECOG PS 0-1 Peripheral neuropathy grade < 2 No prior chemo for metastatic disease Prior adjuvant/neoadjuvant anthracycline treatment required unless contraindicated Prior taxane, gem, or platinum treatment permitted if completed ≥12 months before randomization
Effect of maintenance bevacizumab (Bev) plus pemetrexed (Pem) after first-line cisplatin/Pem/Bev in advanced nonsquamous non-small cell lung cancer (nsNSCLC) on overall survival (OS) of patients (pts) on the AVAPERL (MO22089) phase III randomized trial.
Authors: Achim Rittmeyer, Arnaud Scherpereel, Vera A. Gorbunova, Radj Gervais, Anders Vikström, Christos Chouaid, Antonio Chella, Joo-Hang Kim, Myung-Ju Ahn, Martin Reck, Antonio Pazzola, Heung Tae Kim, Joachim Aerts, Harry J.M. Groen, Claire Morando, Anderson Loundou, Fabrice Barlesi
Journal: Journal of Clinical Oncology (2013)

8014 Background: Maintenance monotherapy has been associated with improved survival for NSCLC pts. AVAPERL was designed to evaluate the safety and efficacy of bevacizumab with or without pemetrexed as continuation maintenance treatment and demonstrated improved progression-free survival (PFS) (Barlesi, JCO in press). Methods: Pts with advanced nsNSCLC received first-line Bev (7.5 mg/kg), cisplatin (75 mg/m 2 ), and Pem (500 mg/m 2 ) every 3 weeks (q3w) for 4 cycles. Those non progressing were randomized to maintenance Bev (7.5 mg/kg) +/-Pem (500 mg/m 2 ) q3w until progressive disease or unacceptable toxicity. The primary end point (PFS) was met. An independent update analysis has been conducted to assess OS. Results: A total of 376 pts receive induction treatment; 125 and 128 were randomized to the Bev-alone and Bev+Pem arms, respectively. Induction therapy resulted in confirmed disease control in 71.9% of pts. After a median follow-up of 14.8 months, PFS for the Bev+Pem arm was significantly improved both from induction (10.2 v 6.6 m, HR 0.58 [0.45-0.76], p&lt;.0001) and randomization (7.4 v 3.7 m, HR 0.57 [0.44-0.75], p&lt;.0001). With 58% of events, OS for the Bev+Pem arm was also improved both from induction (19.8 v 15.9 m, HR 0.88 [0.64-1.22], p=.32) and randomization (17.1 v 13.2 m, HR 0.87 [0.63-1.21], p=.29). The PFS and OS improvements were comparable across age, PS, smoking status, and response to induction (SD vPR/CR) subgroups. No new safety signal was observed during this updated analysis. Conclusions: Continuation maintenance with Bev+Pem in an unselected population of nsNSCLC pts who had achieved disease control after induction was associated with an increase by almost 4 months in OS benefit over standard Bev alone. Clinical trial information: NCT00961415.
Incidence of colorectal carcinoma following liver transplantation: A retrospective analysis using the United Network for Organ Sharing (UNOS) database.
Authors: Mridula Krishnan, Laila Gharzai, Ahmad Qurie, Osama Diab, Mahesh Anantha Narayanan, Renuga Vivekanandan, Ryan W Walters
Journal: Journal of Clinical Oncology (2017)

542 Background: Since 1988, approximately 145,000 liver transplants (LT) have been performed in the United States, with 7,127 in 2015 alone. Several malignancies occur more frequently in solid organ transplant recipients. Studies have shown increased risk of Colorectal cancer (CRC) post LT in adults with primary sclerosing cholangitis, whether the risk of de novo CRC is increased or not remains controversial. Methods: A retrospective analysis was conducted using the UNOS database. Between-group differences in CRC rates were compared using Fisher’s exact test whereas, the differences in observed years between liver transplant and CRC were compared using negative binomial regression models. Results: We retrospectively analyzed 12,337 recipients of LT within the UNOS database. The overall incidence of CRC post LT was estimated to be at 3.8 percent. Interestingly, the incidence was higher in women and non-obese recipients. All immunosuppressive agents within the limits of the database were analysed for maintenance and anti-rejection. The two agents with some increase in incidence were cyclosporine and cellcept but this was statistically insignificant.(Table 1) Women and elderly ( &gt; 65 years) were likely to develop CRC approximately 25 percent earlier than men and younger patients (p = 0.003 and p = 0.001, respectively). Conclusions: Studies have shown a trend toward increased incidence of CRC post LT. These studies were limited by the sample size and were single-center trials. To date there are no elaborate guidelines on surveillance of CRC in LT recipients. In our study there was a shorter interval to development of CRC in older patients and women, suggesting that this population may benefit from early initiation of screening. [Table: see text]
Development of a preliminary model of connectedness with healthcare providers for adolescents and young adults with cancer.
Authors: Celeste Phillips, Joan Haase
Journal: Journal of Clinical Oncology (2017)

92 Background: Adolescents and young adults with cancer (AYA) have poorer outcomes than younger or older cancer patients. AYA survivorship outcomes are complicated by psychosocial late effects and engagement in risky lifestyle behaviors that may increase secondary cancers and other chronic illnesses. Earlier identification and enhancement of protective factors that foster healthy lifestyle behaviors is an NIH/NCI priority. Early connectedness with healthcare providers (HCPs) may diminish risk-taking behaviors and foster healthcare self-management in AYA survivors .The purpose of this presentation is to describe the processes of developing a preliminary model of connectedness with HCPs for AYA. Methods: A preliminary model of connectedness was initially derived from a concept analysis that systematically critiqued 28 peer-reviewed sources. The preliminary model of connectedness was then validated and expanded by results of a phenomenological study of AYA cancer survivors (n = 9) regarding their experience of connectedness with HCPs. Results: The concept analysis identified 7 critical attributes of connectedness: intimacy, belonging, empathy, caring, trust, respect, and reciprocity. Outcomes included: greater self-esteem, enhanced interpersonal skills, enhanced emotional adjustment, and greater identify exploration. Results of the phenomenological study uncovered two additional attributes of connectedness specific to AYA experiences of connecting with HCPs: a sense of gratitude and disconnectedness. The disconnectedness attribute indicated there are processes that can occur that either lead to an outcomes of sustained connectedness or disconnectedness. If AYA felt more connected (vs. disconnected) to their HCPs as a whole, then they continued to engage in long-term follow-up. On the other hand, if AYA felt more disconnected to their HCPs, it led to unwillingness to participate in long-term follow-up. Conclusions: A preliminary model of connectedness with HCPs for AYA was derived from two studies. This model can be used to help guide the development of interventions aimed at enhancing early connectedness and fostering long-term follow-up practices of AYA.
Effect of advanced age, elevated bilirubin, and disease extent on outcomes of unresectable pancreatic cancer (UPC) patients receiving first-line chemotherapy: A population-based study.
Authors: Hannah Marie Cherniawsky, Ying Wang, Sunita Ghosh, Winson Y. Cheung, Maria Yi Ho
Journal: Journal of Clinical Oncology (2017)

325 Background: Superiority of FOLFIRINOX (FFN) and nab-paclitaxel plus gemcitabine (NG) over standard gemcitabine (GEM) monotherapy for UPC was shown in the PRODIGE and MPACT trials, respectively. However, both trials either excluded or limited enrollment of patients with locally advanced disease, elevated bilirubin and advanced age. We sought to determine the impact of age, bilirubin and disease extent on treatment outcomes in the real-world setting. Methods: We identified all patients newly diagnosed with UPC who received palliative chemotherapy at any 1 of 6 British Columbia Cancer Centers and the Cross Cancer Institute in Alberta from January 2014 to April 2016. Receipt of at least one cycle of chemotherapy represented treatment with group assignment based on the initial regimen delivered. Outcomes were compared while adjusting for age, bilirubin, extent of disease, and other measured confounders. Results: A total of 292 consecutive patients were identified of whom 161 (55%) were aged &gt; = 65 years, 164 (56%) were male, 74 (25%) had elevated bilirubin, and 205 (70%) had metastatic disease at the time of presentation. Patients who received FFN or NG had a longer median overall survival (OS) than those treated with GEM alone after adjusting for age, ECOG, bilirubin and extent of metastatic disease (11 vs 10 vs 4 months, respectively; FFN: HR 0.297, 95% CI 0.199-0.445, p &lt; 0.0001, and NG: HR 0.338, 95% CI 0.236 – 0.485, p &lt; 0.0001). Similarly, FFN and NG patients also had longer progression-free survival (PFS) in comparison to GEM alone (8.8 vs 6.9 vs 2.9 months, respectively; FFN: HR 0.33, 95% CI 0.22-0.499, p &lt; 0.0001, and NG: HR 0.47, 95% CI 0.33 – 0.67, p &lt; 0.0001). Advanced age and elevated bilirubin were not significantly associated with OS and PFS (p &gt; 0.05). Conclusions: The efficacy of FFN and NG were superior when compared to GEM alone for patients with UPC in the real-world setting. This population-based study showed that the benefits of FFN and NG persisted regardless of advanced age and hyperbilirubinemia.
CABG術後のACSに対して,血栓吸引カテーテル(TVAC)使用中にステントのcollapseを認めた一例
Authors: 高田裕之, 大里和雄, 村上達明, 守内郁夫, 三沢克史, 嶋田佳文, 小門宏全, 阪田純司, 嵯峨亮
Journal: Circulation (2004)
Increased 18F-FDG Uptake in Multiple Muscles in a Patient With Violent Cough
Authors: Yu Wang, Fuqiang Shao, Li Zhang, Xiufang Luo, Yue Chen
Journal: Clinical Nuclear Medicine (2017)

Increased muscular FDG uptake could be due to various causes. Detailed analysis combined with history might be helpful for image interpretation. We present FDG PET/CT findings of a 69-year-old woman with lung cancer. The images demonstrated intense FDG uptake in multiple muscles, likely due to cough before the PET/CT study. To relieve the patient’s cough, codeine was administrated. The second 18F-FDG PET/CT was performed 2 days later. The images showed that the abnormal muscular activity had become decreased, which was slightly lower than hepatic activity.
Analysis of the effect of adjuvant therapy on overall survival for resected gallbladder adenocarcinoma using the National Cancer Database.
Authors: David G. Brauer, Kian-Huat Lim, Maria Majella Doyle, William G. Hawkins, William C. Chapman, Ryan C Fields
Journal: Journal of Clinical Oncology (2017)

360 Background: The effect of adjuvant chemotherapy on survival after resection for gallbladder adenocarcinoma (GBC) is based on limited evidence. Since prospective trials are not generally practical for GBC, we sought to evaluate current best evidence to evaluate the role of adjuvant chemotherapy in multiple clinical scenarios by analyzing data from the U.S. National Cancer Database (NCDB). Methods: Patients who underwent resection for GBC diagnosed between 2004 and 2012 were identified in the NCDB. The effect of adjuvant therapy on overall survival (OS) was assessed using Kaplan-Meier analysis and Cox proportional hazards regression modeling. Results: 10,402 patients met inclusion criteria. Median follow-up was 14 months. Median survival was 16 months. One- and five-year OS were 57% and 23%, respectively. 3,509 patients (34%) received any modality of adjuvant therapy. Receipt of adjuvant therapy improved one-year OS (63% vs 55%, p &lt; 0.01), but median OS was minimally changed (17 vs 15 months, NS). Adjuvant therapy was associated with improved one-year OS in T3 and T4N1 disease (Table 1). Only chemoradiation therapy was associated with improved one-year OS for T2 disease. Adjuvant chemotherapy was associated with worse one-year OS in T1N0 disease. Conclusions: Using data from the US NCDB, adjuvant therapy for resected gallbladder adenocarcinoma is associated with improved one-year overall survival with the exception of T1N0 disease. In the absence of prospective studies in this rare disease, retrospective data can provide insights into successful treatment strategies and guidelines for GBC. [Table: see text]
Feasibility and efficacy of high doses of antimetabolites followed by high-dose sequential chemoimmunotherapy (R-HDS) and autologous stem cell transplant (ASCT) in patients (pts) with systemic B-cell lymphoma (BCL) and central nervous system (CNS) involvement: A multicenter phase II trial.
Authors: Andres J.M. Ferreri, Giovanni Donadoni, Maria Giuseppina Cabras, Caterina Patti, Michael Mian, Renato Zambello, Corrado Tarella, Massimo A. Di Nicola, Alfonso D'Arco, Marta Bruno Ventre, Marco Foppoli, Alessandro Fanni, Gianluca Doa, Antonio Mulè, Federico Caligaris-Cappio, Fabio Ciceri
Journal: Journal of Clinical Oncology (2014)

8577 Background: This is a phase II trial addressing a new treatment in pts with BCL and CNS disease (NCT00801216). Treatment is based on the encouraging experiences with high doses of antimetabolites in pts with primary CNS lymphoma (Ferreri et al. Lancet 2009) and with R-HDS/ASCT in pts with relapsed BCL (Tarella et al.JCO 2008). Methods: HIV- pts (18-70 ys; ECOG PS ≤3) with BCL and CNS disease at diagnosis or relapse were treated with 2 c. of methotrexate 3.5 g/m2 d1 + cytarabine 2 g/m2 x2/d d2-3, followed by R-HDS (cyclophosphamide 7 g/m2 d1, cytarabine 2 g/m2 x2/d d22-25, VP16 2 g/m2 d43) and BCNU-thiotepa conditioning + ASCT. Treatment included 8 doses of rituximab and 4 of intrathecal liposomal cytarabine. Primary endpoint: 2-yr PFS; planned accrual: 38 pts. Results: 40 pts were registered (age 32-70 ys, median 59; M/F ratio 1.5): 34 had DLBCL, 3 MCL blastoid variant, 3 FL. CNS disease (brain 23, meninges 6, spinal cord 2, multiple 9) was detected at diagnosis in 17 pts (all with extra-CNS disease) and at relapse in 23 (8 with extra-CNS disease). Response: CR in 23 pts and PR in 1 (ORR= 60%; 95%CI=45-75%), 1 pt had SD, 11 PD (CNS in all pts; plus extra-CNS in 4), 4 died of toxicity (sepsis 2, stroke). G4 neutropenia, thrombocytopenia and anemia were recorded in 90%, 76% and 8% of courses, febrile neutropenia in 26%; opportunistic infections (CMV 6 pts, aspergillosis 1) were successfully managed. Transient transaminases increase (2) and intestinal perforation (1) were the only G4 non-hematol toxicities. ASCs were collected in 23/25 (92%) pts (median 9.5 x 106/kg; range 6-19); 20 pts underwent ASCT. At a median f-up of 3 ys, 16 pts remain relapse-free, with a 2-yr PFS of 40±8%; 17 pts are alive, with a 2-yr OS of 41±8%; 2-yr OS of transplanted pts was 64±11%. Extra-CNS and/or meningeal disease did not affect survival. Conclusions: This feasible and effective treatment is recommended in pts ≤70 ys with secondary CNS lymphoma. Toxicity is usually haematological and manageable. Survival benefit is attainable also in pts with extra-CNS and/or meningeal disease. Clinical trial information: NCT00801216.