tbuckley/cabot-search huggingface dataset:
Quantifying the tradeoffs of active surveillance for low-risk prostate cancer: A clinical decision analysis.
Authors: D. Liu, H. P. Lehmann, K. D. Frick, B. Carter
Journal: Journal of Clinical Oncology (2011)

4636 Background: Recent results suggest that active surveillance is a reasonable alternative for men diagnosed with low-risk prostate cancer, but there is a lack of data on the tradeoffs of immediate treatment vs. delayed intervention to guide clinical decision-making. Existing studies using quality-adjusted outcomes are difficult to apply clinically due to differences in individual preferences. Further, benefits of treatment may vary substantially based on age and baseline health status. Methods: Monte Carlo simulations using Markov Models were used to simulate the life course of men diagnosed with low-risk prostate cancer in the modern PSA era when treated with radical prostatectomy or monitored with active surveillance. Primary outcomes were life expectancy and average years of side effects from treatment, and a clinical incremental
Cost and patterns of care among patients with advanced non-melanoma skin cancer.
Authors: S. DaCosta Byfield, D. M. Chen, D. D. Ramanan
Journal: Journal of Clinical Oncology (2011)

e16517 Background: Few studies examine health care utilization (HCU) and cost among basal cell carcinoma (BCC) patients. Although BCC has no specific ICD-9 code, it is known to constitute ~80% of all non-melanoma skin cancers (NMSC). More than 1 million new cases of NMSC were reported in the US in 2010, and there were ~1000 deaths due to NMSC. Methods: A claims-based analysis was conducted using data from January 2002 to March 2010 from a national commercial health insurer. Patients with ≥ 2 claims with a NMSC diagnosis (ICD-9-CM 173.xx) at least 60 days apart, or at least 1 claim for a skin cancer-specific excision with diagnosis code 173.xx were identified. Those with additional primary cancers were excluded. Patients were grouped into 1 of 3 cohorts: metastatic, locally advanced (LA), or “all other.” Metastatic patients had ≥ 2 claims with a metastasis code (ICD-9-CM 196.xx-198.xx) at least 30 days apart. LA patients had ≥ 2 visits with a medical oncologist, ≥ 1 diagnostic imaging service, ≥2 services for radiation therapy or ≥1 visit to 2 or more physician specialties. The remaining patients were “all other.” The time of first NMSC or metastatic disease diagnosis was considered the index date. Total HCU and average per-patient per-month (PPPM) costs during follow-up were estimated. Results: Among 188,795 patients, 155 (0.1%), 2,412 (1.3%) and 186,228 (98.6%) patients, were identified as metastatic, LA or “all other,” respectively with an overall mean follow-up of 917 days. Compared to “all others,” metastatic and LA patients were significantly older and had a higher baseline Charlson comorbidity index (0.64 vs. 2.08 and 1.46 respectively, p-value <0.01). Compared to “all others” and LA patients, more metastatic patients had inpatient stays (19% and 30% vs. 48% respectively, p-value <0.01) and emergency room visits (37% and 43% vs. 55% respectively, p-value <0.01). In addition, total PPPM costs for LA and metastatic patients were ~2x or ~3x higher, respectively, than costs for “all others (p-value <0.01). Conclusions: HCU and cost for NMSC (which includes ~80% BCC) increases significantly as disease advances. Effective treatment could reduce this burden.
Impact of primary care providers on patient screening mammography and initial presentation in an underserved clinical setting.
Authors: Ajaratu Keshinro, Ioannis Hatzaras, Shubhada Dhage, Kenneth Rifkind, Kathie-Ann P. Joseph
Journal: Journal of Clinical Oncology (2015)

8 Background: Screening mammography (SM) is a routinely used modality for earlier detection of breast cancer and is effective in reducing breast cancer-related morbidity and mortality. A better understanding of the impact of access to primary care physician (PCP), on the screening protocols and stage presentation, is needed to address the issue of breast cancer stage disparity amongst underserved women. Methods: A retrospective chart review of the electronic medical record, for breast cancer patients newly diagnosed from 2012-2013, was performed using the tumor registry at Bellevue Hospital Center, the largest public hospital in New York City. Patients with recurrent breast cancer, stage IV breast cancer, and those that weren’t managed surgically at our institution, were excluded from the study. Data including patient demographics, established relationship with PCP, and screening mammogram and palpable mass at presentation, were obtained and analyzed using SPSS Statistics Software. Results: 173 patients were included in the study of which 5 presented with bilateral breast cancer (n = 178). The majority of the patients seen at our institution were from minority groups, primarily Hispanic (34%) and Chinese (23%). 129 patients (72%) had a PCP at the time of diagnosis versus 49 patients (28%) without a PCP. Patients without a PCP were more likely to have a palpable breast mass at presentation, compared to patients with a PCP (73% vs. 42% respectively, p &lt; 0.05). Furthermore, only 32 % of patients without a PCP had a SM at time of presentation, compared to 61% of patients with a PCP (p = 0.003). Overall, in the group of patients with a PCP, the majority presented with stage I breast cancer (43%), followed by 29% with stage 0. In comparison, the majority of patient without a PCP presented with stage II (41%), followed by 29% with stage I (p = 0.019). Conclusions: There is a benefit for patients with access to a PCP, as it leads to a higher likelihood of breast cancer detection via SM, as opposed to a symptomatic presentation, such as a palpable mass. Therefore, these patients are more likely to be diagnosed with an earlier stage of breast cancer, which improves their mortality.
Irinotecan and carboplatin for treatment of brain metastases from small-cell lung cancer
Authors: D. H. Lau, G. Q. Chen, M. Huynh, A. Chen, L. Yavorkovsky, D. Goldstein, D. R. Gandara
Journal: Journal of Clinical Oncology (2008)

19032 Background: Brain metastasis occurs commonly in patients with small-cell lung cancer (SCLC). Herein we report the efficacy of irinotecan and carboplatin in the treatment of brain metastases from SCLC. In addition, we review the existing data on chemotherapy for brain metastases in SCLC. Methods: Eighty patients with metastatic or relapsed SCLC were enrolled in a phase II trial of irinotecan and carboplatin according to a 2-stage design. Chemonaive patients were treated with irinotecan 200 mg/m2 and carboplatin AUC of 5; whereas chemotherapy-treated patients received irinotecan 150 mg/m2 and carboplatin AUC of 5, every 21 days for 6 cycles. Results: The most common grade III/IV toxicity included neutropenia (50%), anemia (11%), thrombocytopenia (19%), diarrhea (20%) and nausea/emesis (11%). Among the 80 patients, 15 (19%) presented with brain metastases. An analysis of 14 assessable patients with brain metastases revealed an overall response rate of 65% after 2 cycles of chemotherapy, and a median survival of 6 months (1 to 24 months). Upon review of the literature, 8 studies were identified with more than 10 patients who had received chemotherapy for brain metastases from SCLC. Based on these studies, the response rate of brain metastases from SCLC to a variety of chemotherapy ranged from 22 to 85% and median survival of patients ranged from 3 to 9 months. Conclusion: Chemotherapy, including the regimen of irinotecan and carboplatin, is an effective treatment for brain metastases from SCLC. (Supported by Pfizer, Inc. and NCI K24CA10014) Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Pfizer, Inc.
MRI response to focal salvage HDR prostate brachytherapy for locally recurrent prostate cancer after external-beam radiotherapy.
Authors: Hans T. Chung, Gerard Morton, Laura D'Alimonte, Andrew Loblaw, Ananth Ravi, Matthew Wronski, Melanie Davidson, Masoom A. Haider
Journal: Journal of Clinical Oncology (2016)

e631 Background: For local recurrence after external-beam radiotherapy, salvage therapy options include surgery, brachytherapy, cryotherapy or high-frequency ultrasound, though there is a significant risk of serious complications (e.g. fistula, incontinence, bladder neck contracture). In the meantime, MRI technology has evolved (e.g. DCE and DWI) such that the sensitivity of detecting viable cancer within the prostate is now more than 70%. Therefore, we initiated a pilot study of focal salvage HDR prostate brachytherapy in patients screened with a MRI with the hypothesis that focal treatment, rather than whole gland, would lead to less complications but similar local control. The MRI response is presented here. Methods: This study was approved by the institution’s research ethics board. Eligible patients included: biopsy-confirmed local recurrence &gt; 30 months after completing XRT, MRI demonstrating solitary recurrence confined to the prostate, negative metastatic workup, IPSS &lt; 15, post-XRT PSA &lt; 10ng/mL, prostate volume ≤ 50cc. Salvage ultrasound-based HDR brachytherapy was performed with a prescription dose of 27Gy divided over two implants separated by 1 week to the target volume (TV) as seen on MRI with dose constraints to the urethra and rectum. All MRI scans were completed with 3T and included T2W, DCE and DWI. Lesions suspicious for cancer were scored using PI-RADS methodology pre-brachytherapy, and using a 5-point scale post-brachytherapy. Results: Fifteen patients were accrued. Thus far, 6 of 15 patients have completed a post-brachytherapy MRI (median 530 days; range 307-653). The baseline MRI characteristics of these 5 patients include: PI-RADS 4 (n = 1), 5 (n = 4), not specified (n = 1); median size 9 mm (range 7-9); T2 (n = 5) and T3a (n = 1); median prostate volume 28mL (20-63). In the post-brachytherapy MRI, the treated intraprostatic lesion no longer showed areas of cancer in 5 patients. Two patients developed a new focus of cancer in the prostate. Patients were not routinely biopsied after brachytherapy. Conclusions: Preliminary data from MRI suggests that there is a treatment response in most patients after focal salvage brachytherapy. Clinical trial information: NCT01583920.
Impact of S-1 on survival of patients with advanced pancreatic cancer in Japan: A retrospective single-institution analysis
Authors: Y. Nakai, H. Isayama, T. Sasaki, Y. Ito, K. Hirano, N. Sasahira, T. Tsujino, M. Tada, T. Kawabe, M. Omata
Journal: Journal of Clinical Oncology (2008)

15653 Background: Efficacy of S-1 in the treatment for advanced pancreatic cancer (PC) was reported as combination therapy with gemcitabine (Gem) or as monotherapy. S-1 was introduced in February 2005 in our institution. The aim of this study was to elucidate the impact of S-1 in addition to Gem on prognosis of patients with advanced PC. Methods: A total of 103 consecutive pts with advanced PC were treated with Gem-based systemic chemotherapy at the University of Tokyo Hospital between April 2001 and June 2006, and were categorized into two groups: PreS-1 group (53 pts who started chemotherapy between April 2001 and January 2005) and PostS-1 group (50 pts who started chemotherapy between February 2005 and June 2006). Pts characteristics, protocols, treatment results were compared between two groups. Prognostic factors were analyzed by the Cox proportional hazard model. S-1 was administered in combination with Gem as first line treatment or in monotherapy as second line treatment for Gem-refractory PC. Results: Pts characteristics at baseline were not statistically different between two groups. First-line treatment in PreS-1 group was Gem monotherapy, followed by 5-FU in 2, 5-FU based chemoradiotherapy in 3, and S-1 in 3. First-line treatment in PostS-1 group was Gem monotherapy in 35, followed by 5-FU based chemoradiotherapy in 3 and by S-1 in 13, and Gem combined with S-1 in 15, followed by Gem combined with oxaliplatin in 5. The rate of pts receiving only Gem monotherapy was 83.0% and 42.0%, while the rate of pts who received both Gem and S-1 during the clinical course was 5.6% and 56.0% in PreS-1 and PostS-1 group. As to the protocol of first line treatment, RR was 26.7%/3.4% (p=0.008), PFS was 9.2/4.4 months (mo) (p=0.045) and OS was 18.4/10.1 mo (p=0.060) in Gem & S-1combination therapy and in Gem monotherapy. As to the treatment group, PFS with the first line chemotherapy was 4.7/4.4 mo (p=0.170) and OS was 13.3/9.5 mo (p=0.050) in PostS-1 and PreS-1 group. The Cox hazard model revealed poor PS (HR2.90, p=0.001), distant metastasis (HR1.77, p=0.016), and PreS-1group (HR1.92, p=0.005) as poor prognostic factors. Conclusions: Introduction of S-1 might lead to improvement of prognosis of patients with advanced PC in Japan. No significant financial relationships to disclose.
Impact of adjuvant therapies on survival in patients with cholangiocarcinoma.
Authors: Laura Dover, Rojymon Jacob, Thomas Wang, Robert Oster, Derek Dubay
Journal: Journal of Clinical Oncology (2014)

360 Background: Surgical resection is the only curative option for Cholangiocarcinoma (CC) and currently there are no clear guidelines for adjuvant therapy following resection. Given the high incidence of local and distant recurrences following resection, we evaluated the impact of adjuvant chemotherapy or chemoradiation (CRT) on median survival (OS). Methods: A retrospective review was performed identifying all patients with CC who underwent curative surgical resection at our institution between 2002 and 2012. Patients who underwent aborted or palliative procedures were excluded. Survival estimates were quantified using Kaplan Meier curves, and differences between groups were compared with the log-rank test and Cox regression models. Results: During the study period, 103 patients underwent curative resection for CC at our institution. Tumor location was intrahepatic, perihilar and distal in 37% (n=38), 23% (n=24) and 40% (n=41) respectively. A total of 49 (48%) patients received adjuvant chemotherapy (n= 28) or CRT (n=21). Observation with no additional therapy was employed in the remaining 54 (52%) patients. No patient was treated using radiation alone. OS was 21.4 and 41.4 months (m) for those receiving adjuvant therapy versus observation (p=0.08). OS for adjuvant therapy versus observation were 28.4 m and 19.4 m respectively, if surgical margins were positive (p=0.036); and 79.1 m and 26.3 m respectively (p=0.4) with negative resection margins. OS was 41.4 m and 38.0 m with adjuvant chemo versus CRT respectively (p=0.1). Tumor stage was the only statistically significant pathologic indicator of outcome (p=0.019). Conclusions: A trend towards significant improvement in OS was observed with the use of adjuvant therapy among all patients following resection of CC. Adjuvant therapy significantly improved OS among CC patients with positive margins of resection. The small number of patients with negative margins of resection also benefitted, though not significantly. These data suggest that while adjuvant therapy should be considered for all patients irrespective of margin status; patients with positive margins are likely to benefit the most.
The Significance of BAALC Expression and CEBPa Mutations as New Prognostic Factors in Pediatric Acute Myeloid Leukemia with Normal Karyotype.
Authors: Yasuhiro Mizushima, Souichi Adachi, Tomohiko Taki, Akira Shimada, Yasuhide Hayashi, Ichiro Tsukimoto, Masahiro Yui, Yuri Kamitsuji, Yoshimi Hiraumi, Hiroshi Matsubara, Motonobu Watanabe, Ken-ichiro Watanabe, Tatsutoshi Nakahata
Journal: Blood (2006)
A phase II study of ECX in patients with carcinoma of unknown primary (CUP): Prospective evaluation of molecular classifiers.
Authors: H. S. Wasan, T. R. J. Evans, M. Nicolson, D. Bowtell, K. Oien, M. G. Erlander, J. Paul, M. Maclean, L. McMahon
Journal: Journal of Clinical Oncology (2011)

e21065 Background: Carcinomas of unknown primary origin (CUP) constitute 3-10% of all cancers, and rank in the top ten commonest malignancies. The prognosis is poor, with a median survival of 8-12 months. Many patients initially present with metastases of uncertain primary origin and the diagnostic work-up leads to delays in treatment initiation. Post-mortem analysis of CUP patients suggest that the commonest primaries found do not match proportionately for site of origin, with the newer evolving and rapid molecular diagnostic techniques, but this has never been prospectively validated. There is no global consensus treatment standard for CUP. Methods: This is a multi-centre single-arm phase II trial of epirubicin, cisplatin and capecitabine (ECX) incorporating the prospective validation of three diagnostic molecular classifiers at the outset, in a blinded design. All metastatic, potential CUP patients after a core tissue biopsy, are eligible for the translational diagnostic trial, except certain categories of well-defined subsets, such as mid-line tumours of suspected germ-cell origin, isolated axillary or neck lymphadenopathy, neuroendocrine, lymphomatous, or sarcomatous pathologies. Patients in whom a primary site is subsequently conclusively identified remain valid for study in the translational part only. This will allow prospective validation of new diagnostic molecular tools in a blinded comparison with detailed immunohistochemistry, correlated with clinical datasets. Patients in whom a primary site remains un-identified, can be entered into the pilot CUP clinical trial, a single-arm phase II design, which aims to establish the efficacy of the ECX regimen. If validated, this pilot phase may form the basis of a future treatment regimen in combination with new biological agents, selected rationally from the pathology and molecular analysis and signatures of the translational part of this trial. Recruitment: To date there are 32 patients recruited to part one (translational), 19 in parts one and two (translational/phase II) and 1 in part two (phase II). This trial should allow a logical framework to elucidate, both clinically and biologically, how metastatic cancers might be efficiently and economically investigated and managed in the future.
Combined impact of diet and lifestyle after diagnosis on risk of prostate cancer death.
Authors: Stacey A. Kenfield
Journal: Journal of Clinical Oncology (2016)

159 Background: Several lifestyle factors have been independently associated with prostate cancer progression and mortality, but little is known about their combined effect.Our objective wasto develop scores based on post-diagnostic diet and lifestyle behaviors for the prevention of prostate cancer death. Methods: We developed four scores (food-only: range 0-5; food &amp; drinks: range 0-8; lifestyle-only: range 0-3; food, drinks &amp; lifestyle: range 0-11) among 3,583 men in the Health Professionals Follow-Up Study diagnosed with non-metastatic prostate cancer in 1986-2008 with follow-up through 2012. Potential factors and their cut-points were based on the literature. One point was given for each factor: not currently smoking or quit ≥ 10 years ago, BMI &lt; 30 kg/m 2 , ≥ 3 h/wk vigorous activity or ≥ 7 h/wk brisk walking, ≥ 1 serv/d cruciferous vegetables, ≥ 3 serv/wk nuts or oil-based dressings, ≥ 4 cups/d coffee, ≥ 7 serv/wk wine, &lt; 2 serv/wk processed meat, 0 serv/wk poultry with skin or poultry sandwiches, and &lt; 140 ug/d of supplemental selenium. We used multivariable Cox proportional hazards regression. Results: We observed 240 prostate cancer deaths during a median of 11 years follow-up. A 1-unit increase in each score was associated with a similar reduction in risk of prostate cancer death: food-only (HR = 0.71; 95%CI = 0.60,0.85); food &amp; drinks (HR = 0.71; 95%CI = 0.61,0.82); lifestyle-only (HR = 0.72; 95%CI = 0.56,0.92); and total diet &amp; lifestyle (HR = 0.71; 95%CI = 0.63,0.81). Men with 3 vs 0-1 points for the lifestyle-only score had a 51% decreased risk of prostate cancer death (95%CI = 0.28,0.83); men with ≥ 5 vs 0-2 points on the food &amp; drinks score had a 73% decreased risk of prostate cancer death (95%CI = 0.14,0.51); and men with 4-7 and 8-11 vs 0-3 points for the total diet &amp; lifestyle score had a 48% (95%CI = 0.32,0.84) and 75% (95%CI = 0.09,0.69) decreased risk of prostate cancer death. Conclusions: Adhering toa lifestyle characterized by frequent vigorous activity; not smoking; a healthy weight; a diet rich in cruciferous vegetables, healthy fats from vegetable sources, coffee, and wine and low in processed meat and poultry with skin; and avoiding excess supplemental selenium after prostate cancer diagnosis may lower risk of prostate cancer death.
Impact of margin status and re-excision on local control in patients undergoing breast-conservation therapy for ductal carcinoma in situ.
Authors: Talha Shaikh, Tianyu Li, Fatima Sheikh, Colin T. Murphy, Nicholas Zaorsky, Richard J. Bleicher, Elin R. Sigurdson, Lori J. Goldstein, Shelly B Hayes, Penny R Anderson
Journal: Journal of Clinical Oncology (2015)

57 Background: The purpose of this study was to identify the impact of final surgical margin (SM) status, SM width, and re-excision on outcomes in patients with ductal carcinoma in situ (DCIS) undergoing breast conservation therapy (BCT). Methods: The study population consisted of women diagnosed with DCIS undergoing BCT between 1989-2014. All women received adjuvant whole breast radiation plus a boost. The primary endpoint was local control (LC) defined as an ipsilateral breast failure. A negative SM was defined as &gt; 2 mm, close SM was defined as &gt; 0 to &lt; 2 mm, and a positive SM was defined as tumor at the inked SM. Cox proportional hazards model was used to determine predictors of outcomes on multivariate analysis (MVA). Actuarial incidence of LC was estimated using the Kaplan-Meier method. Results: A total of 498 patients were included. The median age was 58 (range 30-91) and the median follow-up was 8.3 years (3 months-27 years). A total of 400 patients had a final negative SM, 87 had a close SM, and 11 had a positive SM. A total of 172 patients received adjuvant hormonal therapy, 265 patients required at least one re-excision. Patients with positive or close SMs were more likely to receive a radiation dose &gt; 60 Gy (p &lt; 0.001) and undergo re-excision (p &lt; 0.01). The 10-year LC rates were not significantly different between patients with a negative (93.5%), close (91.8%), or positive (100%) SM (p = 0.57). There was no difference in 10-year LC rates according to a SM width of 0-1 mm (100%), &gt; 1 to 2 mm (88.5%), or &gt; 2 mm (93.5%) (p = 0.85). On univariate analysis, there was no significant difference in LC when comparing negative versus close or positive (p = 1.0) SMs. There was no difference in LC in patients undergoing re-excision for initial close or positive SMs (p = 0.55). On MVA, after controlling for age, dose, hormonal therapy, comedo subtype, and grade, there were no factors associated with LC. Conclusions: This large single-institution experience demonstrates that risks of local failure remain poorly characterized. Re-excision and whole breast radiation plus boost resulted in excellent LC for women with DCIS. Our data suggests that trials aimed at personalized de-intensified local therapy are warranted.