tbuckley/cabot-search huggingface dataset:
Measuring chemotherapy appointment duration and variation utilizing real-time location systems (RTLS).
Authors: Constance Barysauskas, Gina Hudgins, Katie Kupferberg Gill, Kristen Camuso, Janet Bagley, Sheila Rozanski, Sarah Kadish
Journal: Journal of Clinical Oncology (2014)

154 Background: Clinical schedules drive resource utilization, cost, and patient wait time. Accurate appointment durations ensure appropriate staffing ratios to the daily caseload and maximizes scarce resources. Dana-Farber Cancer Institute (DFCI) adjusts infusion appointment durations for each chemotherapy regimen using a consensus method of experts including pharmacists, nurses, and administrators. Utilizing RTLS, we examined the accuracy of appointment duration compared to suggested duration. Methods: Appointment duration was calculated using RTLS in three disease centers at DFCI between August 1st and September 30th, 2013. Duration was defined as the amount of time a patient occupied an infusion chair. The top 10 administered infusion regimens were statistically investigated (n=805). Results: All median observed appointment durations were statistically different than the suggested durations. Appointment duration was shorter than scheduled 98% [C], 95% [I], and 75% [F] of the time and longer than scheduled 77% [A] and 76% [G] of the time. Almost all C and I appointments were more than 30 minutes shorter than scheduled. Among A appointments longer than scheduled, 56% were more than 30 minutes longer than scheduled. Conclusions: RTLS provides reliable and unbiased data to improve schedule accuracy. Replacing consensus with system-based data may improve clinic flow, relieve staff stress, and increase patient satisfaction. Further investigations should elucidate factors that cause variation in appointment duration. [Table: see text]
Topoisomerase I inhibition in BRCA+ and BRCA- ovarian cancer (OC): A single-institution experience.
Authors: D. M. Hyman, Q. Zhou, A. G. Arnold, R. N. Grisham, J. Bhatia, C. Aghajanian, A. Iasonos, D. R. Spriggs, N. D. Kauff
Journal: Journal of Clinical Oncology (2011)

e15557 Background: BRCA+ OCs appear to have enhanced sensitivity to platinum chemotherapy due to impaired homologous recombination, the DNA repair pathway responsible for the high-fidelity resolution of platinum-induced double-stranded DNA breaks. Topoisomerase I inhibitors, topotecan (T) and irinotecan (I), also cause double-stranded DNA breaks and are commonly used in platinum-refractory OC. We performed a retrospective analysis to determine the response rate (RR) and progression free survival (PFS) of BRCA+ and BRCA- patients (pts) to these two agents. Methods: Eligible pts: (1) were seen at Memorial Sloan Kettering from 1995-2011, (2) had histologically confirmed ovarian, fallopian tube or primary peritoneal cancer, (3) were tested for BRCA1/2 mutations, and (4) received treatment with T or I. Responses were adjudicated by the treating physician based on imaging. Progression was defined as radiologic progression, worsening of disease related symptoms, intolerance of treatment, or death. Results: 79 pts were identified. 22 pts were excluded because they were still receiving treatment or had received treatment concurrently with an additional anti-neoplastic agent. Data from the remaining 57 pts were analyzed (9 BRCA+, 48 BRCA-). The median age of BRCA+ and BRCA- pts was 60 and 62, respectively (p=0.22). The median number of prior therapies for both groups was 5 (range 2-9). All pts had high-grade serous carcinoma. All BRCA+ pts received T. Among BRCA- pts, 85% (41/48) received T and 15% (7/48) received I. The clinical benefit rate in BRCA+ and BRCA- pts was 0% and 25% (6 PRs, 6 SDs), respectively (p = 0.18). Median PFS in BRCA+ and BRCA- pts was 1.71 months (mon.). (95%CI: 0.95 – 2.80) and 2.52 mon. (95%CI: 1.94 - 2.80), respectively (p=0.88). Median time to best response was 1.97 mon. and median response duration 2.65 mon. Conclusions: The RR reported here is consistent with the phase II data of T in platinum-refractory OC. This analysis does not support the superiority of topoisomerase I inhibitors in BRCA+ OC. Preclinical data suggest some BRCA+ tumors may reactivate normal BRCA function after treatment. It is unknown whether a different outcome would be observed in a less heavily pretreated cohort of pts.
Family history (FH) and the risk of head and neck cancer (HNCA)
Authors: S. Gupta, U. A. Patel, F. Rosen
Journal: Journal of Clinical Oncology (2008)

17031 Background: In the US, tobacco, alcohol and the synergistic combination of tobacco and alcohol are the most common risk factors for HNCA. Increasingly, worldwide and in the US as well, human papilloma virus has become a major risk factor for HNCA, surpassing tobacco and alcohol in cancers of the oropharynx. Family history (FH) is an independent risk factor for many malignancies such as colon cancer, breast cancer and ovarian cancer but has not been identified as an important risk factor in HNCA. The purpose of this retrospective analysis is to identify and quantify the co-existence of HNCA and a FH of cancer of the aero-digestive tract or unrelated malignancies. Methods: Review of patient charts seen by the attending medical oncologist in the multidisciplinary ENT tumor clinic between December 2003and December 2007. Results: Charts of 387 patients with H&N cancer reviewd. The data from 95 (24.5) patients was not complete. Of the remaining 292 patients, 139 (47%) patients had a positive FH with 193 total cancers reported. 37% of pts reported a first degree relative with cancer. 37.3% of cancers were from the aerodigestive tract, half of which were from the head and neck. The primary was unknown in 22%. Of the remaining cancers, breast and GI were most common. Mean age of onset of cancer (53) was the same for both groups. 90% of the patients with positive FH were smokers as opposed to 82.8% without FH. 73% of patients with positive FH consumed heavy alcohol vs 65% with no FH of cancer. Conclusions: FH of cancer is common in pts with HNCA. There is a trend toward more tobacco and alcohol use, traditional risk factors, in HNCA pts with a FH of cancer. This could be a potential target of further study and intervention in the future No significant financial relationships to disclose.
Radiation therapy for palliation of osseous metastasis from hepatocellular carcinoma.
Authors: Steven Lau, Amit G. Singal, Adam Charles Yopp, Jeffrey John Meyer, Daniella Hall, Michael Ryan Folkert
Journal: Journal of Clinical Oncology (2016)

204 Background: Osseous metastasis from hepatocellular carcinoma (HCC) is uncommon, and optimal palliative management for palliation is unclear. We present our clinical experience with palliative radiotherapy (RT) for osseous metastasis from HCC. Methods: Patients were identified using two prospectively maintained databases at our institution: all patients with HCC who developed metastases and all patients undergoing RT. Medical records were retrospectively reviewed following Institutional Review Board approval. We identified 146 patients with metastatic HCC, of which 28 patients with 38 osseous metastases were eligible for this analysis. All patients are seen in a multi-disciplinary clinic where consensus for management is developed. Most (89%) had metastasis at the time of initial tumor diagnosis, including 22 (79%) patients with osseous lesions at diagnosis. Tissue confirmation of metastasis was obtained in 22 (79%) patients. Outcomes of interest included patient-reported pain relief at time of follow-up, radiographic response at 6-12 months, and overall survival. Statistical analysis was performed with SPSS (IBM Corporation). Results: Median age at diagnosis was 61 years, and 86% (n = 24) were male. The most common site of metastasis was vertebral body (n = 26, 70%). Median time from bone metastasis diagnosis to RT was 1 month (range, 0-20). Only 1 patient received concomitant systemic therapy at the time of RT. Metastases were most commonly treated using 2D techniques (n = 26, 68%) to 30 Gy in 10 fractions (n = 18, 47%). Pain relief was complete, partial, and absent for 8 (21%), 24 (63%), and 6 (16%) metastases, respectively; no patient reported an increase in pain after treatment. Prescription BED 3 &gt; 50 Gy was associated with improved local control (P = .03). 7 (18%) radiographic local failures were observed at a median time of 5.4 months, and the 6-month local failure rate was 20.2%. Median survival was 3.4 months, with a 6-month survival rate of 39.1%. Conclusions: Mortality for patients with osseous metastasis from HCC is high, but palliative RT is associated with significant pain relief and/or disease control in many patients. This data on efficacy of palliative RT helps guide optimal management of these patients.
A weighted-adjusted indirect comparison of everolimus (EVE) versus axitinib (AXI) in second-line metastatic renal cell carcinoma (mRCC) patients who previously failed sunitinib therapy.
Authors: Steven A. Sherman, Xufang Wang, Billy Amzal, Roman Casciano, Haitao Gao, Sotirios G. Stergiopoulos, Emiliano Calvo
Journal: Journal of Clinical Oncology (2014)

491 Background: Both EVE and AXI have been approved for second-line treatment of mRCC after VEGFR-TKI therapy failure. No head-to-head clinical trial has compared clinical outcomes between EVE and AXI in this setting. This study aims to compare progression free survival (PFS) from two phase III clinical trials among mRCC patients with SUN as their only prior antineoplastic therapy and subsequently treated with EVE in the RECORD-1 trial vs. AXI in the AXIS trial, after adjusting for cross-trial differences. Methods: A weighted-adjusted indirect comparison using patient-level data from RECORD-1 and summary data from the AXIS trial publication was performed to align baseline characteristics from both trials and compare PFS (central review). A subset of N=43 second-line SUN -refractory mRCC patients treated with EVE were identified in RECORD-1 to correspond to a similar subset of patients (N=194) treated with AXI in AXIS. Logistic regression was used to identify factors predicting PFS in RECORD-1. The RECORD-1 subset was weighted to align the distributions of these key factors (i.e., MSKCC risk, gender, and time on prior SUN) with the AXIS subset. Weights were calculated for each patient using the following equation: W i = [P i (A AXIS )/P i (A RECORD-1 )] * [P i (B AXIS )/P i (B RECORD-1 )] * [P i (C AXIS )/P i (C RECORD-1 )], where A=Gender, B=MSKCC risk, and C=time on prior SUN. A weighted median PFS estimate with 95% bootstrap confidence interval (CI) and corresponding Kaplan-Meier (KM) curve were derived for EVE patients. Results: After weighting, the three key baseline characteristics were mostly comparable between the two studies, with the exception of MSKCC where a higher proportion of poor risk patients was evident in RECORD-1 (42%) vs. AXIS (33%). A median PFS of 5.1 months (95% CI: 3.6-10.7) was observed for weighted EVE patients compared to 4.8 months (95% CI: 4.5-6.4) reported in AXIS. Conclusions: The PFS estimates suggest similar efficacy between EVE and AXI in SUN-refractory mRCC patients. Further research is needed to confirm these results, which should be interpreted as those from an observational study.
Dosimetric evaluation of organs at risk to toxicities between multicatheter accelerated partial-breast irradiation and whole-breast external beam radiotherapy.
Authors: Tabitha Y Chan, Poh Wee Tan, Chek Wee Tan, Johann I Tang
Journal: Journal of Clinical Oncology (2014)

94 Background: This study aims to quantify the dosimetric reduction to the heart and lung when comparing Whole Breast External Beam Radiotherapy(WBEBRT) with Multicatheter Accelerated Partial Breast Irradiation(MCAPBI) for early stage left sided breast cancer. Methods: Planning CT data sets of 13 patients with left breast cancer receiving multicatheter brachytherapy post breast conserving surgery were used to create two independent treatment plans – WBEBRT prescribed to 50Gy/25fractions and MCAPBI prescribed to 34Gy/10fractions. Dose parameters for (i) heart, (ii) left anterior descending(LAD) artery and (iii) ipsilateral lung were calculated and compared between the two treatment modalities. Results: After adjusting for Equivalent Dose in 2Gy Fractions(EQD2), comparing MCAPBI with WBEBRT, the largest dose reduction was for the LAD artery whose point dose differed by a factor of 4.9. Although somewhat less pronounced, this was also true for the mean lung dose of the ipsilateral lung and mean heart dose with a factor of 3.8 and 2.1 respectively. Compared to WBEBRT, the mean MCAPBI heart D0.1cc (representing the dose received by the most highly exposed 0.1 cc of the risk organ, i.e. the dose peak) was significantly lower(16.43Gy vs 48.82Gy;p&lt;0.01) as well as mean heart dose(MHD) was significantly lower(2.33Gy vs 4.85Gy; p&lt;0.01). Similarly, mean point dose for MCAPBI LAD was significantly lower compared to WBEBRT(9.85Gy vs 47.92Gy; p&lt;0.05). Peak dose and mean lung dose(MLD) for ipsilateral lung was also lower for MCAPBI compared to WBEBRT (Peak dose: 22.19Gy vs 50.45Gy(p&lt;0.05); MLD: 2.31Gy vs 8.73Gy(p&lt;0.05). Conclusions: Compared to WBEBRT, MCAPBI showed a significant reduction in radiation dose for the heart and lung. This may translate into better cardiac and pulmonary toxicities for patients undergoing MCAPBI.
Trends in utilization of novel oral therapeutic agents for men with metastatic castrate-resistant prostate cancer within the United States Veteran’s Affairs Health System.
Authors: Elizabeth Henry, Abigail Silva, Elizabeth Tarlov, Ellen R. Gaynor
Journal: Journal of Clinical Oncology (2016)

220 Background: Therapeutic options for men with metastatic castrate resistant prostate cancer (mCRPC) have expanded significantly over the past 5 years with several new agents demonstrating improved survival, including two oral agents. Abiraterone acetate (AA), a CYP-17 androgen synthesis inhibitor, obtained initial FDA approval in 2011 for post-docetaxel (D) use, and gained expanded approval in 2012 for pre-D use. Enzalutamide (ENZ), an androgen receptor signaling inhibitor, also gained FDA approval in 2012 (post-D) and indication was expanded in 2014 (pre-D). Due to the relatively recent approvals of these agents, there is limited data on rates of uptake and prescribing patterns for patients (pts) with mCRPC. Methods: For this observational study, Veterans Affairs (VA) healthcare system data (including hospitalizations, outpatient visits, and pharmacy) were used to identify male veterans who received treatment for mCRPC between fiscal years 2008 and 2014. Descriptive statistics were used to classify treatment patterns. Results: During the time period, 75,199 pts with prostate cancer were medically or surgically castrated. Of those, 43,805 were treated with anti-androgens and 7,890 went on to receive advanced lines of therapy associated with mCRPC. The median age at the time of mCRPC treatment was 73y. Between 2008-2010 (pre-AA) and 2011-2014 (post-AA), the proportion of mCRPC pts treated with ketoconazole or D dropped from 95% to 59% (p &lt; 0.0001). Conversely, the proportion of pts who received AA or ENZ increased from 19% to 68% (p &lt; 0.0001). Among the 3,763 pts treated with AA or ENZ between 2011 and 2014, the proportion treated with first-line D decreased, while the proportion treated with first-line AA increased (p &lt; 0.00001). Conclusions: The FDA approval of AA and ENZ has had a significant impact on treatment patterns for men with mCRPC within VA, with decreased use of ketoconazole and delayed use of chemotherapy. Further information regarding patient and disease characteristics is needed. The rapid uptake of these novel agents has significant implications for disease-related outcomes as well as anticipated pharmacy costs within the VA.
Imaging approaches to assess mechanism-of-action and response in patients with advanced hepatocellular carcinoma treated with the novel oncolytic poxvirus JX-594.
Authors: Richard H. Patt, David H. Kirn, Caroline Breitbach, James M. Burke, Riccardo Lencioni
Journal: Journal of Clinical Oncology (2013)

210 Background: The novel oncolytic virus JX-595 has demonstrated anti-cancer mechanisms of action, as defined in preclinical models, which includes cytolysis, intra-tumoral vascular disruption, and immune-mediated tumor targeting. Methods: To determine whether mechanism(s) of action (MOA) of the novel anti-cancer oncolytic virus JX-594 could be demonstrated by MRI imaging in patients with advanced hepatocellular carcinoma (HCC), dynamic contrast-enhanced MRI of the liver was performed at baseline, day 5, and week 8 following intra-tumoral injection. Images were evaluated by a central reviewer blinded to treatment and dose using both modified RECIST and Choi response criteria. 17/30 subjects underwent day 5 (D5) post-treatment imaging; 28/30 had week 8 (W8) imaging. Results: Choi responses correlated more reliably than RECIST with JX-594 MOA. Evidence of intra-tumoral vascular shutdown, manifest by areas of reduced or non-enhancement (Choi response), was observed in 6 of 17 subjects on D5 5 MRI scans. Day 5 Choi responses were a predictor of week 8 Choi responses in all but 1 subject. Of the 11/17 D5 Choi non-responders, 3 were Choi responders at 8 weeks. Increase in size at D5 of small lesions present at baseline (“unmasking”) is compatible with oncolytic flare due to intra-tumoral edema contributed to by cell lysis and immune infiltration. RECIST criteria tumor measurements did not identify MOA of JX-594, and resulted in the appearance of pseudoprogression at D5 in some subjects. Conclusions: Hyperacute MRI post-therapy can be used to detect activity of the JX-594, a novel oncolytic anti-cancer therapy. Day 5 Choi responses were a predictor of subsequent response at week 8. Clinical trial information: NCT00554372.
Viral hepatitis associated hepatocellular carcinoma outcomes with Y-90 radioembolization.
Authors: Jessica M. Frakes, Yazan Abuodeh, Arash Naghavi, Mark Friedman, Richard D. Kim, Nishi Kothari, Ghassan El-Haddad, Bela Kis, Benjamin Biebel, Jennifer Sweeney, Junsung Choi, Daniel A. Anaya, Anna Giuliano, Sarah E. Hoffe
Journal: Journal of Clinical Oncology (2016)

414 Background: Viral associated malignancies have been shown to have improved outcomes. We sought to evaluate outcomes of patients with and without viral hepatitis (HBV and HCV) treated with lobar yttrium-90 radioembolization (RE) for multifocal, unresectable hepatocellular carcinoma (HCC). Methods: After IRB approval, an institutional database of patients with HCC who received RE between 2009-2015 was queried and 99 patients were identified that received a total of 122 lobar RE. Charts were reviewed to capture previous treatments, α-fetoprotein values (AFP), Child-Pugh class (CP), albumin-bilirubin score (ALBI), portal vein thrombosis (PVT), volumes treated and doses delivered. Comparison was made with Chi-Square and Mann-U Whitney when appropriate. Intrahepatic control (IHC), extrahepatic control (EHC), progression free survival (PFS), and overall survival (OS) were calculated according to the Kaplan-Meier method via log-rank. Hazard ratios were calculated using Cox regression. Results: Median follow up for viral hepatitis and non-viral hepatitis patients was 10.9 months (range 0.8-46.7 months) and 11.8 months (range 1.1-62.8 months), respectively. Patients with viral hepatitis associated HCC (n = 44) were younger and had smaller liver volumes; however there was no difference with respect to gender, pre-treatment AFP, CP, ALBI, PVT, extrahepatic disease, previous treatments, and dose given. Median dose for viral hepatitis and non-viral hepatitis patients was 129.5 Gy (range 90-215.8 Gy) and 131 Gy (range 100.9-265 Gy), respectively. 1 year IHC was 67% for viral associated HCC versus 34% for non-viral HCC (p = 0.067). 1 year EHC was 63% for viral associated HCC versus 86% for non-viral HCC (p = 0.027). 1 year PFS was 45% for viral associated HCC versus 31% for non-viral HCC (p = 0.56). 1 year OS was 46% for viral associated HCC versus 55% for non-viral patients (p = 0.55). On MVA, patients that received salvage treatments, CP A, no PVT, and without extrahepatic disease had improved OS. Conclusions: Patients with viral hepatitis associated HCC had improved IHC and significantly worse EHC. Consideration should be made for systemic therapy following Y-90 embolization in patients with viral hepatitis associated HCC.
A whole greater than the sum of the parts: Close collaboration between palliative care and clinical ethics.
Authors: Nneka Obiajulu Sederstrom
Journal: Journal of Clinical Oncology (2016)

53 Background: The disciplines of palliative care (PC) and clinical ethics (CE) share common content but also important distinctions in method, skill set, and clinical role in a given patient encounter. Particularly in cases of advance care planning, complex decision-making, and clarifying goals oncology teams may be challenged to know which consultation service to involve. Methods: Case report and commentary. Results: A 60 year-old man with a 3-year history of glioblastoma multiforme presented with sudden onset right-sided weakness and altered mental status. In the emergency department, a computed tomography (CT) scan demonstrated a left-sided intracranial bleed with concomitant cerebral edema and left-to-right midline shift. The patient was admitted to a surgical intensive care unit (SICU) where neurosurgery declined to operate. Within hours of admission, while the patient’s son (also his durable healthcare power-of-attorney) was considering a do-not-resuscitate order, local police arrived at the hospital, having received a 911 call from the patient’s daughter who claimed her brother and medical providers were attempting to murder her father by shifting to comfort care. The SICU team urgently consulted PC and CE. Within an hour, PC and CE clinicians met with the patient’s family to review the patient’s advance directive, counsel regarding clinical management strategies and prognosis, broach comfort care, introduce hospice, and liaise with a hospice case manager. Additionally, PC collaborated with the SICU to provide best symptom management; CE worked with hospital risk management and security to ethically mitigate escalation of more reactive family members. Within 4 hours of the consults, the patient was being transferred to a local inpatient hospice facility, where he died several days later. Conclusions: As this case demonstrates, models of close collaboration between PC and CE consultative services may swiftly facilitate appropriate transitions in care for patients with advanced cancer and simultaneous de-escalation of hospital risk. Evolving models for quality supportive care should further examine such strategies.