tbuckley/cabot-search huggingface dataset:
Patient preferences for provider roles in collaborative breast cancer survivorship care.
Authors: Lauren P. Wallner, Yun Li, Christopher Ryan Friese, Kevin C. Ward, Ann S. Hamilton, Reshma Jagsi, Steven J. Katz, Sarah T. Hawley
Journal: Journal of Clinical Oncology (2017)

99 Background: Prior studies have explored barriers to collaborative cancer care and suggest a need for greater clarity about clinician roles. However, little is known about patient’s preferences and expectations for which clinicians handle various aspects of care after primary cancer treatment. Methods: A weighted random sample of patients newly diagnosed with breast cancer in 2014-15 as reported to the Georgia and Los Angeles SEER registries were surveyed approximately 6 months after diagnosis (N = 2,342, 70% response rate). Patient preferences for which clinician handles the following aspects of care after treatment were ascertained: follow-up mammograms, screening for other cancers, general preventive care, treatment of comorbidities and reassurance about their breast cancer. Response categories included primary care clinician (PCP), cancer doctors, either or both. The associations between patient demographic and clinical factors with preferences for clinician roles were assessed using multinomial logistic regression. Results: The majority of women preferred to see oncologists for mammograms (65%), other cancer screening (64%), and reassurance about their cancer (69%), and PCPs for general preventive care (76%) and comorbidity care (79%). Black women and Hispanic women (vs. White) were more likely to prefer to see both clinicians (vs. PCP) for mammograms (Black OR: 2.8, 95%CI: 1.5, 5.1; Hispanic OR: 1.9, 95%CI: 1.1, 3.3), screening for other cancers (Black OR: 3.3, 95%CI: 1.8, 6.1; Hispanic OR: 1.8, 95%CI: 1.0, 3.1), general preventive care (Black OR: 3.5, 95%CI: 2.0, 6.0; Latina OR: 2.5, 95%CI: 1.4, 4.3) and comorbidity care (Black OR: 2.1, 95%CI: 1.3, 3.6; Hispanic OR: 2.0, 95%CI: 1.2, 3.3). Less than a high school education was also associated with a preference for seeing both clinicians for mammograms. Conclusions: While patients report clear preferences for which clinicians handle various aspects of their collaborative survivorship care, variation exists by race and education. Targeting these patients to clarify clinician roles may be particularly effective in interventions to improve collaborative cancer care.
C-reactive protein prior to cystectomy: An external validation of the TNR-C score.
Authors: Mario W. Kramer, Annika Heinisch, Gerd Wegener, Mahmoud Abbas, Inga Peters, Christoph A. J. von Klot, Hossein Tezval, Thomas R. W. Herrmann, Markus A. Kuczyk, Axel S. Merseburger
Journal: Journal of Clinical Oncology (2014)

344 Background: Systemic inflammation has been described as a common reaction to cancer progression. Besides other malignancies, elevated serum CRP levels have been sparsely reported in bladder cancer patients prior to treatment. The aim of this study was to analyze whether our patient cohort showed association of CRP levels and survival after radical cystectomy as well as for external validation of the recently described TNR-C score. Methods: We retrospectively reviewed charts of patients undergoing radical cystectomy and bilateral pelvic lymphadenectomy between 1996 and 2005 identifying 279 patients of which 194 had preoperative CRP levels and no concomitant infection. CRP levels were defined as elevated if they were &gt;5 mg/l. Cancer-specific outcome was predicted based on the aforementioned CRP-based scoring model (T=T-stage; N=N-stage; R=residual tumor; C=CRP). The mean follow-up was 29 months (0-131). Results: Elevated serum CRP levels were found in 89 (45.9%) patients preoperatively. These patients were more likely to have advanced tumor stages (pT3-4; p&lt;0.01), positive resection margins (p&lt;0.01) and positive lymph nodes (p&lt;0.05). Cancer specific survival was decreased by approx. 17% after 12, 36, and 60 months. In multivariate analysis, CRP was identified as an independent prognostic indicator for poor cancer-specific survival. The 3-year CSS in patients with a TNR-score in the ranges 0-2, 3-6, and 7-10 was 74.0%, 33.3%, and 4.0%, respectively (p&lt;0.001) with a concordance index of 0,833 (p&lt;0.001). Conclusions: Elevated preoperative CRP levels might be used in nomograms to predict poor survival after radical cystectomy. The prognostic impact of the TNR-C score could be validated. However, more evidence, especially from prospective studies is needed.
Survival of metastatic breast cancer (MBC): Is there a survival benefit over time?
Authors: M. Ufen, B. Rosien, T. Hammer, U. Schubert, E. Malik, C. Kohne
Journal: Journal of Clinical Oncology (2011)

e21062 Background: Whether survival of patients with MBC is improved over time remains controversial. Randomised clinical trials demonstrated if at all a small benefit between different therapies and a meaningfull translation into clinical practice is doubtfull. Methods: Excluding patients with local recurrence only, we analysed 839 patients, treated at our institution from 1985-2009, according to date of primary diagnosis or date of first metastasis. The influence of hormonal receptor status (HR+, HR-), metastasis free interval (MFI) (< 24 months up to >60 months) and diagnosis before and after 1996 (introduction of taxanes and aromatase inhibitors) was examined. Results: Improvement of survival was observed, when the primary tumor was diagnosed later (intervalls of 1985-1989, 1990-1994, 1995-1999, 2000-2004, 2005-2009) (p= 0,006) however, no survival effect was observed according to date of metastasis (p= 0,11). Median survival of patients with HR+ was 32.1 vs. 17.0 months for in HR- (p< 0,0001). A shorter metastasis free intervall was associated with a shorter OS (MFI < 24 months: 22.0 mo, MFI 24-60 months:31.1 mo, MFI > 60 months: 36.0 mo) (p< 0,0001). HR+ patients survived longer when metastasis occurred in a later period (5 year intervals between 1985-1999 median ~ 32.0 months vs. 2000-2004 median ~38 months) (p=0,02). No significance for HR- patients. No survival difference before or after 1996 was observed for the total cohort (median 27.1 vs. 30.0 months) (p=0,58), HR+ patients (p= 0,92) or HR- patients (p=0,93) and also not for patients with metastasis free interval < 24 months (19.1 vs. 22.0 months) (p=0,86). Conclusions: A survival difference is only seen for HR+ patients with metastasis diagnosed after 2000. An influence of taxanes in aggressive disease (metastasis free interval < 24 months) is unlikely. Whether aromatase inhibitors have an influence on survival for the overall cohort (HR+ and HR-) is unclear, but may explain the survival benefit seen in HR+ patients. The tumor biology has probably a greater impact on survival in MBC than any new antineoplastic agent.
The influence of vitamin D and receptor status in colorectal cancer.
Authors: Ravi Kumar Paluri, Leona Council, Balananda Kumar Putcha, Trafina Jadav, Upender Manne, James Posey
Journal: Journal of Clinical Oncology (2014)

435 Background: Since vitamin D is a modifiable factor, we have proposed to evaluate vitamin D levels and cognate receptor expression in patients presenting with colorectal cancer (CRC). Previously, we retrospectively assessed vitamin D receptor (VDR) level in 98 CRC tumor tissues and noted a variation of expression with tumor stage (GI ASCO 2009 abs # 371). Methods: We prospectively evaluated 38 cases of CRCs newly diagnosed during 3 consecutive summers and assessed demographics, pathological characteristics and long-term clinical outcomes. Skin color was determined by the Fitzpatrick photo typing scale. At the time of enrollment, vitamin D levels were assessed, and a twenty point lifestyle assessment questionnaire was administered. Descriptive statistics were performed. Tumor and corresponding normal tissues are being evaluated to identify the patterns of VDR expression and expression of the Wnt/B-catenin inhibitors-Dickkopft 1(DKK-1) and Dickkoft-4 (DKK-4), which have been implicated in development of CRCs. Results: 38 patients diagnosed with CRC 24 were men and 14 were women with median age at diagnosis was 59 yrs (range, 28-78 yrs). Median follow up after diagnosis was 2.1 yrs (range, 0.06, 3.68 yrs). Histological grades of adenocarcinomas were well differentiated as well (13%), moderately differentiated (66%), and poorly differentiated (7%), and mucinous types (11%). Patients were staged as I (8%), II (39%), III (34%), or IV (19%). 81% of patients were treated with chemotherapy in an adjuvant or neo-adjuvant setting. The median serum total 25-hydroxy vitamin D level was 23 ng/ml (range, 6-87 ng/ml). There was no substantial difference in median vitamin D levels between lower and higher stages (25 vs 21). Lower stages of CRC were associated with lighter skin types (Fitzpatrick scale types I and II) and advanced stages with darker skin types (IV-VI); this could be a reflection of variable VDR expression. Conclusions: We are analyzing VDR expression as a covariate to compare to vitamin D levels, skin color, and stage. Results will be reported at the time of presentation. These studies were supported by a pilot project grant by the UAB Comprehensive Cancer center.
Chemoradiotherapy versus gemcitabine-based chemotherapy in patients with unresectable, locally advanced pancreatic cancer.
Authors: K. Nio, H. Ueno, T. Okusaka, C. Morizane, A. Hagihara, S. Kondo, H. Mayahara, Y. Ito
Journal: Journal of Clinical Oncology (2010)

e14504 Background: The purpose of this retrospective analysis was to compare the long-term outcome of patients with unresectable, locally advanced pancreatic cancer (LAPC) treated with chemoradiotherapy (CRT) or gemcitabine (GEM)-based chemotherapy (CT) as first-line therapy. Methods: The records of 267 patients with histopathologically confirmed LAPC, who had been treated with CRT (n = 199, 5FU/RT 139, GEM/RT 34, S-1/RT 26) or GEM-based CT (n = 68, GEM 55, GEM/S-1 9, GEM/erlotinib 4) in our hospital between April 2001 and March 2008, were analyzed. Results: Median progression-free survival and overall survival were 7.3 months (95% confidence interval [CI], 6.2-8.4 months) and 12.4 months (95% CI, 13.6-19.0 months), respectively, for the entire group of 267 patients, and they were 8.0 months (95% CI, 6.6-9.3 months) and 12.4 months (95% CI, 11.0-13.8 months), respectively, in the CRT group and 6.2 months (95% CI, 4.4-8.0 months) and 12.6 months (95% CI, 9.6-15.6 months), respectively, in the GEM-based CT group. There was no significant difference in progression-free survival (p = 0.73) or overall survival (p = 0.36) between two groups. A multivariate analysis using the Cox proportional hazards model demonstrated that opioid use (hazard ratio [HR] 1.764, p < 0.001), initiation of therapy before September 2004 (HR 0.636, p = 0.001), leukocyte count ≧ 5,500 (HR 0.694, p = 0.006), AST level ≧ 21 (HR 1.439, p = 0.008), CRP level ≧ 0.1 (HR 1.696, p = 0.001), CEA level ≧ 4.0 (HR 1.406, p = 0.012), and CA19-9 level ≧ 503 (HR 1.591, p = 0.001) were independent poor prognostic factors, but therapy (CRT vs. GEM-based CT) was not. Conclusions: The results of this study showed no differences in long-term outcome between CRT and GEM-based CT as first-line therapy for LAPC. No significant financial relationships to disclose.
Long term survival benefit after adjuvant treatment of high risk cutaneous melanoma with dacarbazine and low dose natural interferon alpha: A controlled, randomised, multicentre trial
Authors: R. Stadler, T. Luger
Journal: Journal of Clinical Oncology (2005)

7516 Two hundred and fifty-three patients with cutaneous melanoma stages Iia to IIIb of disease were randomised after complete tumour resection to receive either two monthly applications of dacarbazine (DTIC 859 mg/m2) followed by a 6-month treatment with highly purified natural interferon-alpha (nIFN-a, 3 MIU, thrice weekly, arm A) or no adjuvant treatment (arm B). The primary ITT target group was patients with high-risk (HR) melanoma (stage IIb, IIIa and IIIb), comprising 80 A and 76 B patients who were all, except one patient, followed up for 7 years or more. Treatment with DTIC and nIFN-a was well tolerated. The estimated 5-year relapse-free survival (RFS) rates in the HR group were 42% and 17% in arm A and B, respectively (log rank test, p=0.0018). The actual 7-year OS rate, calculated using a worst case scenario, was significantly higher (51% vs 30%, p=0.0077), and the estimated 9-year survival was more than twice as high, in the treated as in the non-treated patients (51% vs 24%). The benefit of adjuvant treatment was particularly evident on late mortality. Supportive evidence for the efficacy of the regimen used were the findings of highly significant differences between the two arms of the study in terms of distant-metastases-free survival (DMFS). There were no statistical differences regarding RFS, OS or DMFS in stage IIa, low-risk, patients. These results imply that low dose nIFN-a therapy following DTIC is an effective, durable and tolerable adjuvant treatment for patients with cutaneous melanoma, and suggest that the treatment is more effective in high-risk than in low-risk patients. No significant financial relationships to disclose.
Correlation of PDL1 tumor expression and treatment outcomes in patients with renal cell carcinoma (RCC) receiving tyrosine kinase inhibitors: COMPARZ study analysis.
Authors: Toni K. Choueiri, David J Figueroa, Yuan Liu, Robert C. Gagnon, Keith C. Deen, Christopher Carpenter, Arundathy N. Bartlett-Pandite, Paul De Souza, Tom Powles, Robert John Motzer
Journal: Journal of Clinical Oncology (2014)

416 Background: The interaction of PDL1 (B7H1) with its receptor PD-1 on activated T cells contributes to suppression of antitumor immune responses. Tumor PDL1 expression has been associated with poor outcomes in RCC but has not been investigated as a biomarker of response in RCC patients receiving standard vascular endothelial growth factor (VEGF)-targeted therapy. Methods: Formalin-fixed paraffin-embedded tumor samples were collected at baseline from consenting patients enrolled in COMPARZ—a phase lll clinical trial comparing pazopanib and sunitinib as first-line interventions for metastatic RCC (Motzer et al, NEJM 2013). PDL1 expression was evaluated using the anti-PDL1 mouseIgG1 (clone 5H1; Thompson) on the Leica automated immunohistochemistry platform. Additional dual PDL1/CD68 staining was performed on tumor associated macrophages (TAMs). Tumor PDL1 expression was quantified by an H-score (HS). PDL1 + TAMs were assessed semiquantitatively. In addition, intra-tumor CD8 + T cells were quantified morphometrically. The association between PDL1 HS, CD8 + T cell counts, and survival was investigated using Kaplan-Meier analysis. Results: HS data were available from 453 of 1110 patients. 64% of patients had negative (HS = 0) PDL1 expression (HS range 0-290), but PDL1 expression was associated with tumours containing higher numbers of infiltrating macrophages. Peripheral CD8 + T cells in the invasive margin surrounding the tumor were also observed. Patients with HS &gt;50 (n = 61, 13%) had significantly shorter overall survival (OS) in both pazopanib (19.7 vs 31.6 mo) and sunitinib (15.3 vs 27.7 mo) arms. In both arms, patients with HS &gt;50 with intratumoral CD8 + T cell counts &gt;300 had the shortest OS. Results were similar for progression-free survival and persisted on multivariate analysis. Conclusions: This is the largest report to show that tumors’PDL1 expression and CD8 + T cell counts are associated with treatment outcome in metastatic RCC patients. Increased PDL1, or increased PDL1 plus tumor CD8+ T cell counts, were associated with shorter OS. These findings may have major implications for future trial designs that involve PD-1 inhibitors.
The role of the genomic breast cancer index in predicting pathologic complete response in breast cancer patients treated with neoadjuvant anthracycline plus taxane.
Authors: M. C. Mathieu, N. C. Kesty, H. Li, V. Scott, V. Marty, P. Viehl, J. Delacruz, S. Delaloge, C. Schnabel, M. G. Erlander, F. Andre
Journal: Journal of Clinical Oncology (2011)

573 Background: Breast Cancer Index (BCI), a gene expression assay combining HoxB13/IL17BR ratio and Molecular Grade Index (MGI), is prognostic for the risk of distant recurrence and overall survival in tamoxifen-treated and untreated breast cancer patients. Methods: The objective of this blinded study was to examine whether BCI is significantly associated with pathological complete response (pCR) in 160 breast cancer patients treated with neoadjuvant anthracycline + taxane chemotherapy . RNA was extracted from FFPE tumor samples and a real-time RT-PCR assay was completed to generate a BCI score and risk group categorization as previously described (Ma et al. Clin Can Res 2008). Results: Of the 160 patients (68% ER+, 54% PR+, 90% tumor grade 2/3, 63% ≥ 50 y old), 15% achieved a pCR (n=24). Multivariate analysis indicated that BCI and ER, but not tumor grade, were independently associated with pCR (p<0.05). BCI categorized 43% of patients as low risk, 34% as intermediate risk and 23% as high risk and was significantly associated with patients who achieved a pCR. The pCR rate for BCI risk categories was 2.9% (low risk), 20% (intermediate risk) and 30% (high risk; p=0.0001). A higher BCI score was associated with a more favorable response to chemotherapy (odds ratio of 6.77; CI: 1.37-33.31; p=0.02), whereas a lower ER expression was associated with increased response (odds ratio of 0.25; CI: 0.09-0.73; p=0.01). Within ER+ patients (n=106; pCR n=7), higher BCI was associated with higher rate of pCR (p = 0.059). Conclusions: In this study, high risk patients, as determined by BCI, had a 10-fold greater probability of pCR with neoadjuvant chemotherapy than low risk patients. These results suggest that BCI score may be predictive of chemotherapy benefit.
A phase II, multicenter evaluation of docetaxel, gemcitabine, and bevacizumab followed by bevacizumab alone in patients with locally advanced or metastatic non-small cell lung cancer (central localization excluded)
Authors: R. H. Ansari, M. A. Socinski, J. K. Choksi, D. Bradford, G. Gross, K. Kojouri, S. Kobina, K. M. Rowland
Journal: Journal of Clinical Oncology (2008)

19077 Background: Platinum-based doublets are the standard of care for advanced and metastatic NSCLC; however many patients (pts) can not tolerate side effects of this combination. This study was designed to evaluate the efficacy and tolerability of Docetaxel + Gemcitabine in combination with Bevacizumab (D/G/B) in chemotherapy-naïve Stage IIIB(non-pleural effusion)/IV NSCLC pts. Methods: Newly diagnosed pts (> 18y) with histologically proven NSCLC (squamous cell excluded) and ECOG PS ≤ 2 were assigned to receive D/G/B: G -1000 mg/m2 IV over 0.5 hour on Days 1 and 8; D -75 mg/m2 IV over 1 hour on Day 8; and B -15 mg/kg IV on Day 1 over 21 day cycles, for 6 cycles maximum. Response was evaluated after every 2 treatment cycles (i.e. after Cycles 2, 4, and 6). Subjects with responding and stable disease (i.e., SD, PR, or CR) received bevacizumab 15 mg/kg IV every 21 days after completion of chemotherapy to complete 1 year of treatment, or until discontinuation. The primary endpoint for this study was PFS. Secondary endpoints included safety of the combination drugs, evaluation of treatment-related toxicities, tumor response rate, and overall survival. Results: A total of17 pts were enrolled; of the 17 pts in the safety population, 6 (35.3%) were male, 10 (58.8%) < 65y, 14 (82.4%) had an ECOG PS score 0 or 1; 16 (94.1%) had Stage IV disease. Mean ± SD number of cycles completed was 3.6 ± 3.06 (range 1–10). As of September 24, 2007, five deaths have been reported, three due to disease progression, two due to gastrointestinal perforation (GIP). One pt who died of disease progression had also experienced a GIP. The investigators and the sponsor agreed to close this study based on the reported incidence of GIP. Review of world-wide trials containing the D/G/B regimen confirmed an incidence of GIPs lower than the incidence reported in this trial. Conclusions: Additional safety (patients with GIP safety reports will be summarized) and efficacy data will be presented. The use of bevacizumab in combination with chemotherapy regimens in advanced NSCLC should be limited to controlled Ph II/III clinical trials until an acceptable safety profile is established. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration sanofi-aventis
The management of pulmonary nodules at diagnosis in patients with Ewing sarcoma (ES).
Authors: C. Owens, M. Le Deley, J. M. Michon, I. Marzouk, E. Thebault, P. Marec Bérard, O. Oberlin
Journal: Journal of Clinical Oncology (2011)

9527 Background: Cure rates for metastatic ES are poor and justify the stratification of treatment protocols by the presence of metastases at diagnosis. Lung metastases (mets) are the most common form of disseminated disease. Our goal was to assess the diagnostic performance of CT imaging of nodules at diagnosis to discriminate benign from malignant lesions. Methods: We reviewed the CT scan of all patients (pts) treated at four French centres, prospectively enrolled on the EuroEwing 99 trial between January 1999 and December 2009. Results: 342 patients were identified, 141 of whom had lung nodules at diagnosis, 18 with extra-pulmonary mets. Among the 123 other pts, 54 were considered as having lung mets without needing a biopsy (bx), 32 non-metastatic without needing a bx and 37 with doubtful lung lesions had a bx as part of the disease staging process. Of those 37 pts, three had lesions identified on plain chest x-ray and 35 had nodules only detected by CT. 16 pts had unilateral nodule(s). Bx showed lung mets in 21 and benign lesions in 16. The median number of nodules detected for the bx positive group was 4 (range 1-22) and 2 for the bx negative group (range 1-12). The median size of the largest nodule was 6 mm (range 3-15) for the bx positive group and 3mm for the bx negative group (range 1.5-8). Both ROC curves showed the poor diagnostic performance of the number of nodules and the size of the largest considered separately and advocate for combining the 2 criteria. According to the practice guidelines of the protocol 47 pts had nodule characteristics that placed them in the “treat as lung metastases without bx.” Among those, 11 had a bx, of which 9 were positive. All 7 pts with more than 2 nodules and largest nodule greater than 6 mm were metastatic, but 2 of 4 patients with more than 2 nodules the largest being 6 mm were not metastatic. 20 of 42 pts classified as requiring a bx had a bx, 11 of which were positive. Of the 22 pts for whom “bx was to be discussed on a case by case basis” five had a bx, which were all negative. Conclusions: Combining nodule imaging characteristics is appropriate. All patients with at least one nodule measuring between 3 and 10mm should have a lung biopsy. Nodules greater than 10mm in diameter can be considered metastatic.