tbuckley/cabot-search huggingface dataset:
Outpatient palliative care encounters in stage IV lung cancer care: An institutional review.
Authors: Sophia Rizk, Elizabeth Horn Prsic, William Rafelson, John Leonard Reagan, Angela Marie Taber
Journal: Journal of Clinical Oncology (2015)

128 Background: Palliative Care (PC) is becoming increasingly integrated into standard oncologic care (SC). Previous research suggests that patients receiving PC report better quality of life, and may have prolonged survival. This study evaluates the effect of PC integration in patients diagnosed with stage IV non-small cell lung cancer (NSCLC) at a single institution. Methods: All patients diagnosed with Stage IV NSCLC between January 2010 and January 2013 were considered for inclusion and retrospective analysis of their care. Charts were reviewed to identify patients who received outpatient PC with a licensed PC physician in addition to SC. There were no guidelines regarding the nature of the PC intervention. Retrospective analyses of multiple factors were assessed, including: receipt of chemotherapy and/or radiotherapy, utilization of emergency and sick visits, frequency and timing of hospice referral, and duration of hospice utilization. Overall survival was also assessed. Results: 136 patients fulfilled study inclusion criteria. 29 patients received PC in addition to SC, and 107 received SC alone. No statistically significant difference was noted between the groups with respect to age, sex, lines of chemotherapy administered, number of emergency department visits, or number of clinic sick visits. Hospice was offered more frequently in the PC group; however, there was no difference in the amount of time spent on hospice, and no difference in overall survival. There was a trend towards longer survival in the PC group (220 days vs. 254 days). Patients seen in a multidisciplinary clinic were significantly more likely to receive a PC evaluation (RR 1.28 CI 1.073-1.52, p &lt; 0.006). Conclusions: This retrospective study examines how PC is integrated in actual clinical models. Multidisciplinary clinic patients were more likely to receive PC after controlling for comorbidities. There was no significant difference between PC and SC group outcomes. Although this study is small, it demonstrates common practice patterns, and identifies the need to identify the components of the PC encounter that are important in order to maximize the potential benefits of PC interventions.
Effect of regorafenib on angiogenesis in neuroendocrine tumors in vitro.
Authors: Tanja Milosavljevic, Elise Juge, Adrianne Reeks, Jennifer Owens, Yi-Zarn Wang, J Philip Boudreaux, Eugene Woltering
Journal: Journal of Clinical Oncology (2016)

232 Background: Regorafenib, a potent multikinase inhibitor, targets a broad range of receptor tyrosine kinases (RTKs), including but not limited to VEGFR, PDGFR, and FGFR, which play an integral role in angiogenesis. Human neuroendocrine tumors (NETs) rely on RTKs to mediate tumor neovascularization, development, and metastasis. Similar kinase inhibitors like PTK787 profoundly inhibit angiogenesis in human NETs. We hypothesized that Regorafenib would have antiangiogenic and antitumor effect on human NETs. This study demonstrates inhibitory activity of Regorafenib on pathologic angiogenesis in vitro using our human tumor angiogenesis model (HTAM). Methods: Human NETs were collected in cell culture media in the O.R. and transported to the laboratory at 4⁰C. Tumors were minced into 2 mm fragments, embedded in a fibrin-thrombin clot and supplemented with a nutrient culture media. Neovessels were visually scored and evaluated based on three parameters: percent initiation, angiogenic growth, and overall angiogenic response. An effective concentration was selected for all successive HTAM assays based on dose response experiments. Angiogenesis data was obtained for 77 patients and analyzed for significance using paired samples t-test (MedCalc). Results: Dose-dependent inhibition of angiogenesis was observed for all NETs (n = 77): primary tumors (n = 11), lymph nodes (n = 28) and organ (n = 38) metastases. Selected dose of Regorafenib [1100 nM] achieved statistically significant inhibition of angiogenic growth (59%) and overall angiogenic response (44.5%) in all NETs (p &lt; 0.0001). However, there was no significant inhibition of percent initiation for all NETs except in primary tumors (p = 0.0260). Conclusions: Regorafenib is an effective antiangiogenic agent for NETs in-vitro. Regorafenib targets angiogenic growth in all NETs and inhibits initiation of angiogenesis exclusively in NET primary tumors. This suggests preferential use of Regorafenib for NET patients who have not yet developed metastases. Alternatively, Regorafenib could be an effective adjuvant treatment for advanced stage patients.
Randomized phase III study of platinum-doublet chemotherapy followed by gefitinib versus continued platinum-doublet chemotherapy in patients (pts) with advanced non-small cell lung cancer (NSCLC): Results of West Japan Thoracic Oncology Group trial (WJTOG
Authors: T. Hida, I. Okamoto, T. Kashii, M. Satouchi, Y. Ichinose, N. Katakami, M. Ando, T. Kurata, K. Nakagawa, M. Fukuoka
Journal: Journal of Clinical Oncology (2008)

LBA8012 Background: Gefitinib is a small molecule inhibitor of the EGFR tyrosine kinase. When combined with chemotherapy, no survival gain was observed compared to chemotherapy alone (INTACT I and II). We have conducted a randomized phase III trial to evaluate whether gefitinib improves survival as maintenance therapy after platinum-doublet chemotherapy in pts with advanced NSCLC. Methods: Chemotherapy-naïve pts with advanced stage (IIIB/IV) NSCLC, ECOG PS of 0–1, and adequate organ functions were randomized to either, A) platinum-doublet chemotherapy (Carboplatin AUC 6+Paclitaxel 200mg/m2 day1 Q3w, Cisplatin 80mg/m2 day1+Irinotecan 60mg/m2 day1,8,15 Q4W, Cisplatin 80mg/m2 day1+Vinorelbine 25mg/m2 day1,8 Q3W, Cisplatin 80mg/m2 + Docetaxel 60mg/m2 day1 Q3W, or Cisplatin 80mg/m2 day1+Gemcitabine 1000mg/m2 day1, 8 Q3W) up to 6 cycles or B) platinum-doublet chemotherapy for 3 cycles followed by gefitinib 250 mg orally once daily. Pts were stratified by disease stage, gender, histology and chemotherapy regimens. The primary endpoint was overall survival (OS); secondary endpoints include progression-free survival (PFS), response rate (RR), safety and QOL. A sample size of 300 pts per group was estimated on the basis of a projected median survival of 9 months (m) in arm A and 11.4 m in arm B, with a power of 80% at 0.05 two-sided alpha to compare both group. Results: 603 pts were randomized between March 2003 and May 2005, and pt characteristics were equally distributed between arms. There was a statistically significant improvement in PFS (HR, 0.68; 95% CI, 0.57–0.80; P<0.001) in arm B; however, OS result did not reach statistical significance (P=0.10). In a pre-specified analysis of OS by histologic groups, arm B had significantly better OS than arm A in adenocarcinoma histology (n=467; HR, 0.79; 95% CI, 0.65–0.98; P=0.03). Conclusions: These results demonstrate a possible clinical benefit for maintenance therapy of gefitinib, especially in adenocarcinoma histology. No significant financial relationships to disclose.
Defining the optimal timing of adjuvant therapy for resected pancreatic cancer: A statewide cancer registry analysis.
Authors: Hayder M. Saeed, Dima Hnoosh, Bin Huang, Eric B Durbin, Patrick McGrath, Erin Maynard, Mahesh R. Kudrimoti, Lowell Brian Anthony, Peter Joel Hosein, Philip A. DeSimone, Ching-Wei David Tzeng
Journal: Journal of Clinical Oncology (2015)

406 Background: Recent long-term results from the ESPAC-3 trial suggest that while completing adjuvant therapy (AT) is necessary after resection of pancreatic adenocarcinoma (PDAC), early initiation of AT before 8 weeks may not be associated with improved overall survival (OS). The primary aim of this study was to evaluate the impact of early vs. late AT initiation on OS in a statewide population-based analysis. Methods: Among all patients with stage I-III PDAC in the Surveillance Epidemiology and End Results (SEER) - Kentucky Cancer Registry (KCR) from 2004-2012, those undergoing pancreatectomy were stratified by postoperative chemotherapy/radiotherapy delivery and timing. Patients with preoperative therapy, no AT, or postoperative therapy beyond 16 weeks, were excluded. Remaining patients were stratified into 2 groups defined as “early” (&lt;8 weeks) and “late” AT (8-16 weeks). A Cox regression model was created to analyze the impact of AT timing, adjusting for clinicopathologic variables. Results: Of the 4,882 total patients with PDAC, 1,193 (24%) underwent pancreatectomy. Of these, only 364 (30%) received AT within 16 weeks. With median age 65 years (range 20-101), 86% patients were stage II and 76% were node-positive. Median time to AT initiation was 52 days (range 5-111). Timing of AT did not affect OS (median OS: early AT, 19.5 vs. 19.7 mo, late AT, p=0.63). Median OS for stages I, II, and III were 46.1, 19.3, and 8.6 mo, respectively (p&lt;0.001). Poorly/undifferentiated tumors were associated with worse median OS 17.6 vs. 21.3 mo for well/moderately differentiated tumors (p&lt;0.001). Lymph node positivity was associated with worse median OS 18.1 vs. 25.8 mo for node negativity (p&lt;0.001). On multivariate analysis, factors that affected OS included stage (II, HR 2.54, p=0.022; III, HR 5.16, p&lt;0.001), node positivity (HR 1.57, p=0.008), poorly/undifferentiated grade (HR 1.50; p=0.002), but not AT timing. Conclusions: In this SEER-KCR analysis, there was no difference in OS between early and late AT initiation. Despite its proven value, the ideal window for AT initiation remains unknown as tumor biology continues to trump current treatment regimens.
Long-Term Safety, Efficacy, and Survival Findings From Comfort-II, a Phase 3 Study Comparing Ruxolitinib with Best Available Therapy (BAT) for the Treatment of Myelofibrosis (MF)
Authors: Francisco Cervantes, Jean-Jacques Kiladjian, Dietger Niederwieser, Andres Sirulnik, Viktoriya Stalbovskaya, Mari McQuity, Deborah S. Hunter, Richard S. Levy, Francesco Passamonti, Tiziano Barbui, Giovanni Barosi, Heinz Gisslinger, Alessandro M. Vannucchi, Laurent Knoops, Claire N Harrison
Journal: Blood (2012)
Aneuploidy in Clinical-Grade Mesenchymal Stem Cells Is Not Linked to Cell Transformation and Not Related to Culture Method
Authors: Karin Tarte, Jean-jacques Lataillade, Loïc Fouillard, Julien Gaillard, Martine Becker, Delphine Monnier, Helene Rouard, Andrei Tchirkov, Jean-Paul Vernant, Norbert C Gorin, Patrick Gourmelon, Luc Sensebe
Journal: Blood (2008)
Poly(NIPAM- co -MPS)-grafted multimodal porous silica nanoparticles as reverse thermoresponsive drug delivery system
Authors: Sushilkumar A. Jadhav, Valentina Brunella, Dominique Scalarone, Gloria Berlier
Journal: Asian Journal of Pharmaceutical Sciences (2017)

Hybrid drug delivery systems (DDS) have been prepared by grafting poly(NIPAM-co-MPS) chains on multimodal porous silica nanoparticles having an inner mesoporous structure and an outer thin layer of micropores. The hybrid thermoresponsive DDS were fully characterized and loaded with a model drug. The in vitro drug release tests are carried out at below and above the lower critical solution temperature (LCST) of the copolymer. The results have revealed that due to the presence of small diameter (~1.3 nm) micropores at the periphery of the particles, the collapsed globules of the thermoresponsive copolymer above its LCST hinders the complete release of the drug which resulted in a reverse thermoresponsive drug release profile by the hybrid DDS.
Early clinical results of intraoperative radiation therapy (IORT) during breast conservation using an electronic brachytherapy (EBX) technique.
Authors: V. Elayne Arterbery, Pamela Johnson
Journal: Journal of Clinical Oncology (2013)

83 Background: Intraoperative radiation therapy (IORT) as an alternative to whole breast irradiation (WBI) has been described for patients with early-stage breast cancer. The randomized phase III TARGiT trial demonstrated similar recurrence rates to WBI and a lower overall toxicity profile. IORT-related effects and early postoperative outcome were assessed. We report our clinical experience using a 50 Kv EBX HDR radiotherapy delivery system using a balloon technique. We assessed institutional postoperative complications, clinical outcome and histological findings in patients undergoing IORT for breast cancer on a physician sponsored study. Methods: 22 patients (median age 71 years, negative LN and tumor less than 3 cm) underwent lumpectomy, sentinel lymph node (SLN) biopsy, and concurrent IORT from December 2010 to January 2013. 18 were treated on the study and 4 refused enrollment and elected to be treated off protocol. Patients received IORT (20 Gy) during breast conserving surgery using an EBX technique. WBI was added according to clinical guidelines. Cosmetic results and quality of life were evaluated. Results: Postoperative complications and toxicity was rare without grade 3/4 toxicities. The most frequent postoperative side effects were palpable seroma (8.3%). Erythema grade 1-2 of the breast was found in (13%); whereas in some (3.4%), mastitis. In 80% of the cases patient had IFDCA, the remainder DCIS and tumor size ranged between 0.7 and 2.6 cm (median = 1.0cm). At median 1 year follow-up, no patient suffered a local recurrence. Cosmetic outcome was perceived excellent in most patients and 100% would recommend the procedure. One patient required WBI due to close margins at re-excision. No patient had positive SLN on final path. Conclusions: IORT using electronic brachytherapy as part of breast conservation is safe. The potential advantages of IORT are minimal time needed for cellular repopulation between surgery and radiation treatment, cosmetic outcome and significant logistical advantages and reduced cost. Careful surgical assessment minimizes the need for WBI. Longer follow-up will determine clinical results for cosmetic outcome and local control.
Using cancer registry records linked with health insurance records to measure costs and services at end-of-life.
Authors: Karma L. Kreizenbeck, Catherine R. Fedorenko, Kristine Stickney, Cara L McDermott, Ted Conklin, Bruce Smith, Gary H. Lyman, Scott David Ramsey
Journal: Journal of Clinical Oncology (2016)

186 Background: Studies suggest that end-of-life (EOL) care for persons with cancer in the United States is variable and often misaligned with patient and family preferences. To better understand these issues, we developed reports on high-priority quality indicators and costs at EOL. Methods: Surveillance, Epidemiology, and End Results (SEER) records for solid tumor patients diagnosed with cancer in Western Washington state between 1/1/2007 and 12/31/2015 were linked with enrollment and claims from two regional commercial insurers. Using claims, we then developed algorithms to characterize EOL care for breast, colorectal, and non-small cell lung cancer (NSCLC), including costs of care at 90- and 30-days prior to death. Costs include all claims paid for ED, hospital, outpatient, and pharmacy care. We estimated patient out-of-pocket costs as the difference between allowed and paid claim amounts. Results: See Table. Across the largest 10 clinics in the region there was considerable variability in the average costs of cancer care in the last 90 days of life. The clinic-specific average ranged from $24,532 to $72,931 for breast cancer, $30,495 to $65,975 for colorectal cancer and $23,320 to $59,641 for NSCLC. Conclusions: At the end of life, care for patients with advanced breast, lung, and colorectal cancer is highly variable, costly to patients, and may be misaligned with the goals and preferences for patients and their family members. While the results may reflect both appropriate and unnecessary care, the large variation across clinics suggests opportunities for improvement. Further research is needed to identify factors associated with use of low-value, high-cost services at the end of life. [Table: see text]
Using tablet technology in routine patient-reported outcome measure surveys to improve cancer quality care: A patient acceptability assessment.
Authors: Vivien Pat, Catherine Brown, Ashlee Vennettilli, Aein Zarrin, Aditi Dobriyal, Linda Chen, Maryam Mirshams, Deval Patel, Henrique Hon, Margaret Irwin, Anthea Ho, Hannah Solomon, Kyoko Tiessen, Mary Mahler, Valerie Ho, Henry Thai, Lawson Eng, Wei Xu, Doris Howell, Geoffrey Liu
Journal: Journal of Clinical Oncology (2014)

155 Background: Patient-reported outcome measure (PROM) surveys are a tool used to collect information about clinically-relevant symptoms in patients. Touch-screen technology has been previously identified as a feasible and effective method of routinely capturing PROMs.Our aim was to evaluate cancer patients’ acceptance and perception of usefulness of tablet technology as a means of communicating PROMs to healthcare providers during delivery of quality care. Methods: 337 adult cancer patients across all outpatient clinics and disease sites at Toronto’s Princess Margaret Cancer Centre (PMCC) completed PROMs surveys using touch-screen technology. Acceptance and feasibility of completing the tablet-based PROMs data on a routine basis were also assessed. Results: The study population consisted of 45% males; median age 59 (19-91) years; 75% Caucasian, and 48% had a post-secondary degree.20% had lung cancer, 20% genitourinary, 16% breast, 16% lymphoma, 11% gastrointestinal, 7% gynecologic, and 7% head/neck. 88% were happy to complete the survey on a touch-screen tablet and 65% of these were willing to complete such surveys routinely. 86% did not find it time-consuming. Only 2% found that the completion of surveys made their clinic visit more difficult. Of the 72% that thought the survey was a useful means to inform the clinician of how they felt physically and emotionally, only 81% were willing to complete the survey at every visit. Conclusions: Tablet-technology was found to be an acceptable tool for survey administration, however, not on a routine basis. While the majority of patients found PROMs to be clinically important, almost 20% did not want to fill it in regularly at every visit. Current mixed-methods analysis is being utilized to help discern whether this discrepancy is related to the tablet technology or survey burden.
Survival, tumor control, and toxicity with TPF before accelerated radiotherapy potentiated with cetuximab for stage III-IV unresectable head and neck cancer: A phase II study.
Authors: C. Mercke, H. Sjödin, H. Haugen, G. Adell, G. Wickart-Johansson, E. M. Munck-Wikland, G. von Dobeln, J. Nyman
Journal: Journal of Clinical Oncology (2011)

5552^ Background: Concomittant cisplatin based chemoradiotherapy (CHRT) improves locoregional control compared to radiotherapy (RT) alone but with modest impact on survival. Toxicity is substantial. Neoadjuvant chemotherapy, now studied for CHRT, should augment toxicity further. The present phase II study explores TPF given before RT with the cytostatic component replaced by cetuximab (C) with the hypothesis of reasonable toxicity and potentially improved tumor control. Methods: Patients (pts) with untreated stage III-IV M0, WHO 0-1, unresectable squamous cell carcinoma of the oral cavity, oropharynx, larynx and hypopharynx were scheduled for 2 cycles of TPF (docetaxel and cisplatin 75mg/m2 day 1, 5-FU 1,000/m2 96 hours CI) every 3 weeks followed by RT (68Gy/4.5 weeks) with C given one week before (400mg/m2) and weekly during RT (250mg/m2). Brachytherapy (BT) of 8-15 Gy completed RT for oral and oropharyngeal tumors (except tonsillar T1-2). Neck dissection was considered for N2-3 disease. Tumor response was evaluated according to RECIST with CT, MRI or PET/CT before RT and 6 weeks follow up (FU). Toxicity (CTC 3.0) and QL (EORTC QLQ 30) was registered during and after treatment. Results: From 070401 to 090731 90 pts were enrolled in the study and were analysed 1 year FU. Median age 58, males 72, oral cavity 9, oropharynx 58, larynx 10, hypopharynx 13, stage IV disease 76 , (T4 22, T4N+ 15). Remission after TPF: CR 8, PR 44, SD 26 and PD 1, not evaluated 11 (off study 2) toxicity (acute): TPF cycles delayed 3, reduced 25, toxicity grade 5= 1 /90 pts (sepsis); cetuximab cycles delayed 18, reduced 10, grade 3 hypersensitivity reaction 3/90, grade 3 neck dermatitis 3/90 pts. Alive NED 1 year FU 77/90pts (86%), lost FU 2, DoD 7, dead intercurrent 2 (sepsis 1, pancreatic ca 1), alive with disease 2. Kaplan-Meier curves for locoregional control, disease-free and overall survival will be presented. Toxicity (1 year): 4 pts; grade 3 dysphagia 2 (1 PEG), fatigue 1, esophagitis 1. Conclusions: Neoadjuvant TPF can be given before bioradiotherapy with manageable, mostly acute toxicities. Antitumor effects are promising.
The Novel, Irreversible Proteasome Inhibitor PR-171 Demonstrates Potent Anti-Tumor Activity in Pre-Clinical Models of Multiple Myeloma, and Overcomes Bortezomib Resistance.
Authors: Deborah J. Kuhn, Qing Chen, Peter M. Voorhees, John S. Strader, Kevin D. Shenk, Congcong M. Sun, Susan D. Demo, Mark K. Bennett, Fred W. van Leeuwen, Robert Z. Orlowski
Journal: Blood (2006)
Aligning cancer quality metrics across the continuum of community-based and academic medicine using a prioritization tool.
Authors: Lisa M. Kidin, Susan Stary, Diane Schaub, Ronald Stewart Walters, Victoria S. Jordan, David Edwards, Mary E. Cianfrocca, William Simeone, Doug Browning
Journal: Journal of Clinical Oncology (2012)

270 Background: The Accountable Care Act (ACA) created a foundation for value based purchasing to increase quality of care. This resulted in a request for metrics from multiple organizations at both national and state levels interested in improving healthcare delivery through measurement. Competing with these are internal disease specific metrics requested by organizational leaders to judge the quality of services in their area. In 2009, Banner Health created a partnership with MD Anderson to form Banner MD Anderson Cancer Center. This partnership includes ensuring care provided across both organizations is comparable, and meets evidence based guidelines, including the challenges of developing and tracking clinical metrics that represented quality and value for both a community hospital and an academic medical center. Methods: Banner and MD Anderson compiled a list of all relevant external and internal metrics currently collected plus those in development to create a unified approach for collecting and comparison of cancer specific, hospital, physician, and department specific measures. However, both institutions faced the challenge of resource constraints, competing priorities and appropriate informatics infrastructure. To address this issue, an objective metrics prioritization tool was created based on Failure Mode and Effect Analysis and Quality Function Deployment methods used in quality improvement. The tool provides the flexibility of adjustable weights in the components of Quality, Data, and Organizational Utility for each organization. Results: Prior to the tool, both sites had no basis for comparison or strategic alignment as to which measures to report. The tool was independently scored by institution, resulting in 90% alignment. The remaining difference was attributed to variation in informatics systems and resource allocation. Conclusions: Data while limited, demonstrates that the tool provides an objective measure of comparison between two organizations. While it continues to evolve and require further testing, it does provide an opportunity to facilitate harmonization between measures and alignment of various stakeholders both internally and externally.