tbuckley/cabot-search huggingface dataset:
Impact of pathologic complete response to preoperative docetaxel-based chemotherapy on disease-free survival in esophagogastric adenocarcinoma.
Authors: Sylvie Lorenzen, Nils Homann, Salah-Eddin Al-Batran, Florian Lordick, Tibor Schuster, Christian Peschel, Claudia Pauligk, Peter C. Thuss-Patience
Journal: Journal of Clinical Oncology (2013)

123 Background: The aim of this study was to evaluate the impact of pathologic complete response (pCR) on outcome in patients with gastric or esophagogastric junction (EGJ) adenocarcinoma after treatment with preoperative docetaxel/platin /fluoropyrimidine based chemotherapy. Methods: This analysis of a prospective database identified patients who received at least one cycle of preoperative docetaxel/platin/fluoropyrimidine-based chemotherapy for at least T3/4 and N+ disease. An association of pretreatment clinicopathologic factors and pCR was investigated. Overall survival, disease-free survival and disease-specific survival were analyzed according to the achievement of a pCR. Results: A total of 120 patients received preoperative docetaxel-based chemotherapy and underwent subsequent resection of the primary tumor. 15 pts (13%) had distant metastases (M1) at initial diagnosis. 18 patients achieved a pCR in the primary (15%). Median follow-up was 41.1months. The median DFS and OS for the whole population was 24.1 and 48.6 months, respectively. DFS was significantly prolonged in pCR compared to non-pCR patients (HR 2.65, 95% CI 1.1- to 6.2; 3-year DFS probability: 71.8%±10.7 and 37.7%±5.1, respectively, P-value log-rank test=0.018). For patients with a pCR the median DFS was not reached and for those without pCR the median DFS was 22.1 months. Patients with a pCR showed an almost 50% decreased risk of death compared to non-pCR patients (HR 0.53; 95%CI 0.23 to 1.23; P=0.131). Disease-specific survival (DSS) was significantly longer in pCR vs. non-pCR patients (HR 0.188, 95%CI 0.046-to 0.77; P= 0.021). Two clinicopathological parameters were identified as predictors of pCR: tumor localization in the EGJ (p=0.019) and intestinal tumor type according to Laurén’s classification (p=0.042). Conclusions: The analysis confirms that pCR to neoadjuvant chemotherapy is a predictor of favourable patient outcome in patients with gastric or EGJ adenocarcinoma. Tumor location in the EGJ and intestinal histology represent factors significantly associated with the achievement of pCR.
Diagnostic patterns of non-small cell lung cancer at Princess Margaret Hospital.
Authors: M. Nadjafi, G. D. C. Santos, L. W. Le, D. Hwang, M. S. Tsao, N. B. Leighl
Journal: Journal of Clinical Oncology (2011)

e18027 Background: Histologic subtypes of non-small cell cancer (NSCLC) may have differential benefit with selected systemic treatments. Hence, histological differentiation of NSCLC is becoming increasingly important in therapeutic decision-making. We reviewed the methods of diagnosing NSCLC at our institution and how often a specific histologic subtype is provided. Methods: Retrospective chart review was undertaken at a major cancer center, identifying patients with advanced stage NSCLC diagnosed between January 2007 and January 2009. Results: A total of 238 patients were diagnosed with advanced (stage IV) NSCLC and had 274 samples. 42 patients (17%) required a second invasive procedure to confirm the diagnosis of malignancy. Bronchoscopy (26%) and CT-guided procedures (25%) were the most common first methods of procuring a sample. 150/274 (55%) of the samples were from the primary tumour. Among the samples, 37% were core biopsies, 42% were fine-needle aspirate biopsy (FNAB), and the remaining were other cytologic assessments including bronchial washings and pleural effusions. In 19% of all cases, specific histologic subtype was not determined. 40% of all samples had IHC performed. Successful diagnosis of malignancy was associated with sample type (p<0.001): 61% cytology (effusion, bronchial washings), 89% for FNA of mass, and 90% for core biopsy. The method of procuring the sample was also significantly associated with success of the initial attempt (p=0.0001). CT-guided sampling with an on-site cyto-pathologist yielded a diagnosis in all cases. Site of initial sample was also an important predictor of diagnostic success of the initial sample with metastatic site (96%) and primary tumour (84%) having the highest rate of success. Pleural effusion had the lowest rate of success at 70%. Conclusions: Up to 19% of cases of NSCLC diagnosed at a tertiary cancer centre may not have a specific histologic diagnosis. CT-guided FNA and core biopsies were associated with the highest diagnostic yield.
Pattern of malignant diseases in Lagos, Nigeria.
Authors: O. F. Adetayo
Journal: Journal of Clinical Oncology (2011)

1604 Background: The burden of cancer in Nigeria is appreciable. According to the World Health Organisation (WHO), there are an estimated 100,000 new cancer cases in the country each year. This study seeks to determine the pattern of admission of patients with cancer in the surgical wards with a view to assessing the crude incidence rate of the disease in our hospital. Methods: The admission records of the surgical wards were studied and relevant data about patients with malignant diseases were extracted. These included the age, the type of malignancy, the site of the malignancy. The age range, mean age and peak age range for each malignant disease was determined and the result presented in tabular form. The male female ratio was determined for the common ones. Results: Between January 2008-December 2009, 4,832 adult patients were admitted into the surgical wards. Of these, 774 (16%) of the patients were diagnosed as having malignant disease (see table). Conclusions: Malignant diseases are quite prevalent in our hospital accounting for 16% of hospital admission on the surgical wards. Cancer of the breast, prostate and colon are the most common ones. Cancer by site No. of cases % Age range (yrs) Mean age (yrs) Peak age range (yrs) Male: female ratio Ca breast 214 27.65 20-85 47.60 41-50 1:42 Ca prostate 139 17.96 48-93 66.67 61-70 – Ca colon 57 7.36 24-80 56.81 51-60 2:1 Sarcomas 44 5.68 17-61 29.44 21-30 8:1 Ca stomach 37 4.78 20-75 55.60 51-70 3:1 Head and neck cancers 28 3.62 14-78 48.4 41-50 – Lungs and bronchial cancer 27 3.49 16-80 53.74 61-70 1.7:1 Anorectal cancer 24 3.10 24-78 53.21 51-60 5:3 Cancer of the pancreas 23 2.97 14-84 57.87 61-70 1:1.3 Skin cancer 22 2.84 21-76 49.00 21-30 3.5:2 Cancer of the esophagus 21 2.71 21-72 58.33 61-70 4:3 Cancer of unknown primary (CUP) 18 2.32 22-72 48.64 41-50 1:1 Others 120 – – – – –
Methylation analysis of DCR2 gene using tumor and serum DNA of neuroblastoma patients
Authors: S. Yagyu, T. Gotoh, T. Iehara, Y. Katsumi, K. Kikuchi, S. Tamura, K. Tsuchiya, T. Sugimoto, T. Sawada, H. Hosoi
Journal: Journal of Clinical Oncology (2008)

11067 Background: Since more than half of patients with high-risk neuroblastoma (NB) do not have a known, poor prognostic marker; MYCN amplification (MNA), it is crucial to find a novel predictor for the high-risk group in non-NMA NB patients to improve their outcome with the risk-adopted therapy.Rapidly progressing neuroblastomas have recently been associated with aberrant hypermethylation of the Tumor Necrosing Factor Related Apoptosis Inducing Ligand (TRAIL) decoy receptor 2 gene (DCR2) promoter. We developed a method to evaluate DCR2 methylation status in tumor and serum DNA, and assessed its utility as a prognostic factor and indicator of therapeutic efficacy in NB patients. Methods: Using DNA-based real-time PCR, we evaluated the ratio of a methylated-DCR2 specific sequence (M) and a reference sequence (R) located in a part of the DCR2 promoter that is unaffected by methylation in 5 NB cell lines and 53 NBs. Of these patients, 13 had MNA NB, and 40 had non-MNA NB. The association between DCR2-methylation and stage was evaluated by Fisher’s exact test, and differences of event-free survival (EFS) were evaluated by the Kaplan-Meier method. Results: DCR2 aberrant methylation was detected in all 5 NB cell lines and 16 of the 53 tumor samples. DCR2 methylation was associated with stage in both the NB group (n=53; p<0.001) and non-MNA group, (n=40; p<0.001), and patients with DCR2 methylation showed significantly poorer 5-year EFS in both the NB group (43% vs. 83%; p=0.002) and non-MNA group (34% vs. 96%; p<0.001). In 10 patients for which data was available, a strong correlation was observed between the M/R ratios in tumor and serum (r=0.825; p=0.006). Among 5 DCR2-methylated patients whose clinical courses were followed, the M/R ratios in serum fell to undetectable levels in the patients that experienced remission (n=2), whereas they increased to high levels in the relapsed patients (n=3). Conclusions: Our study indicates that DCR2 hypermethylation is a useful biomarker for predicting a poor prognosis in NB, especially in non-MNA NB patients. Furthermore, detection of methylated DCR2 in serum DNA might be an indicator of therapeutic efficacy in DCR2-methylated NB patients. No significant financial relationships to disclose.
Accelerated partial breast irradiation (APBI): A less toxic breast cancer treatment technique underutilized in the Hispanic population.
Authors: Elisabeth E. Arrojo, Alvaro Martinez, Michel Ghilezan, Eduardo Fernandez, Jeffrey D. Forman, Frank A. Vicini
Journal: Journal of Clinical Oncology (2015)

e12054 Background: Most recurrences after breast conservative surgery (BCS) are around the index lesion. That’s the rational for APBI, which treats only this portion of the breast at the highest risk of recurrence with a shortened course of high-dose radiation (RT), minimizing RT dose to healthy tissues. Methods: We used the Surveillance, Epidemiology, and End Results Program database between the years 2000 to 2011, to analyze RT treatment for breast cancer patients > 40 years, stages Tis to II, who undergo BCS in the USA, with special focus in APBI. Specific analyses of RT treatment differences by stage, Hispanic versus non-Hispanic races, causes of death, and survival outcomes was made. Chi Square and Z-test were used for the statistical analysis. Results: 274795 patients were found. The mean follow-up was 62.3 months. APBI use increased from 0.29% in 2000 to 5.72% in 2011 (p = 0), while external beam radiotherapy (EBRT) decreased (-7.36%; p = 0) and combined treatment (EBRT+brachytherapy) showed no changes. Deaths by heart disease were significantly lower in patients treated with APBI, compared with those treated with EBRT (-0.73%; p < 0.0001), combined RT (-1.54%; p < 0.0001), or no RT(-3.53%; p = 0). Breast related deaths were also significantly lower in patients treated with APBI compared to EBRT (-1.79%; p = 0), Combined RT (-1.32%; p = 0.0009) or No RT (-4.13%; p = 0). Conclusions: APBI utilization has significantly increased during recent years in USA. APBI has shown to be associated with a significantly lower rate of breast and heart related deaths versus other RT techniques, documenting a good safety record. RT is necessary to achieve equivalent survival results with BCS to mastectomy. Hispanic patients receive less APBI treatment, which is a less toxic treatment than conventional RT, and what is more worrying, they seem to be undertreated, receiving significantly less RT treatment than non-Hispanic patients. TREATMENT TYPE BY RACE APBI EBRT COMBINED NO RT HISPANIC (n = 21658) 2.59% 67.72% 0.22% 29.47% NON-HISPANIC (n = 253137) 3.55% 71.01% 0.38% 25.07% DIFFERENCES HISPANIC VERSUS NON-HISPANIC - 0.95% - 3.29% - 0.16% + 4.41% p < 0.0001 p = 0 p = 0.0002 p=0
Reducing hospital aquired pneumonia (HAP) with Massey Screen.
Authors: Kerri Slavin, Robyn Dunbar, Cheryl Clements, Margaret Bonawitz, Joanne McGovern
Journal: Journal of Clinical Oncology (2016)

232 Background: Hospital Acquired Pneumonia (HAP) is a leading cause of prolonged hospitalization in patients. The oncology population is especially susceptible to critical illness related to an immunocompromised state. The purpose of this study was to implement the Massey Bedside Swallowing Screen upon admission to the oncology telemetry unit to detect any deficits that could potentially lead to HAP, in conjunction with strict oral care for identified high risk patients. Methods: The importance of the Massey Bedside Swallowing Screen upon admission and the knowledge that early detection leads to better patient outcomes was educated to the nursing staff. Every patient admitted to the oncology telemetry unit was screened with the Massey Bedside Swallowing Screen. Patients identified as high-risk were placed on nothing-by-mouth (NPO) precaution. A Speech and Swallow Evaluation was ordered to further evaluate the patient. Acutely ill oncology patients unable to perform their own oral care were placed on a strict oral care regimen performed by the nursing staff. The charge nurse audited compliance with this protocol. Results: The pre-intervention phase of the study evaluated January – April 2015 included 1,605 patient days. The data revealed 4 HAPs acquired on the oncology telemetry unit, demonstrating 2.45 incidence/1000 patient days. Post-intervention [May – August 2015] indicated 2 HAPs acquired on the oncology telemetry unit, signifying 1.35 incidence/1000 patient days. With the implementation of the Massey Bedside Swallowing Screen for each patient upon admission, and strict oral care regimen for high-risk patients, the overall incidence of HAP on the unit decreased by 50%. Conclusions: Oncology patients assessed with the Massey Bedside Swallowing Screen upon admission to the oncology telemetry unit were noted to have improved outcomes and lower rates of HAP. Every oncology patient admitted to an acute care unit should have an admission screen in place to evaluate risk for aspiration. Early detection of patients at high-risk for HAP and implementation of interventions to improve oral care in high-risk patients lead to improved patient outcomes through lower incidence of HAP in the acute care setting.
Impact of preoperative sarcopenia on morbidity in gastric cancer surgery.
Authors: Tsutomu Sato, Toru Aoyama, Tsutomu Hayashi, Haruhiko Cho, Taiichi Kawabe, Hirohito Fujikawa, Takashi Ogata, Takanobu Yamada, Shinichi Hasegawa, Takashi Oshima, Yasushi Rino, Munetaka Masuda, Takaki Yoshikawa
Journal: Journal of Clinical Oncology (2014)

40 Background: Skeletal muscle depletion, known as sarcopenia, is characterized by decrease in muscle mass and function. Recent reports demonstrated that sarcopenia was a significant risk factor for complications in colorectal cancer surgery. This study aimed to evaluate impact of preoperative sarcopenia on morbidity in gastric cancer surgery. Methods: Between May 2011 and June 2013, 293 consecutive primary gastric cancer patients who underwent curative surgery were retrospectively examined. All patients received the same perioperative care of enhanced recovery after surgery program. Preoperative skeletal muscle mass was evaluated by bioelectrical impedance analysis and was expressed as skeletal muscle index or SMI (muscle mass/height 2 ) by adjusting absolute muscle mass with height. Preoperative muscle function was measured by hand grip strength (HGS). Each cutoff value was determined as the gender-specific lowest 20% of the distribution of each measurement. Grade 2 or higher morbidity, evaluated by Clavien-Dindo classification, was picked-up from the patient record. Risk factor for morbidity was examined by uni- and multi-variate analyses. Results: Median age (range) was 68 years (37-85 years). Male to female ratio was 192:101. Operative procedure was 122 total, 169 distal, and 2 proximal gastrectomy. Lymphadenectomy was 162 D1+ and 131 D2 including 53 splenectomy. Pathological stage was I in 149, II in 39, III in 91, and IV in 14 patients. Morbidity included 7 pancreatic leakage, 12 anastomotic leakage, 4 intra-abdominal abscess, and others. In total, morbidity was observed in 39 patients (13.3%); 21 in grade 2, 16 in grade 3a, 1 in grade 3b, and 1 in grade 4. No mortality was observed. Univariate analysis showed that male, total gastrectomy, splenectomy, and low HGS were significant risk factor for morbidity. Low SMI was not a risk factor. By multi-variate analysis, low HGS(HR 2.457, p=0.029), male(HR 2.610, p=0.038)and total gastrectomy(HR 2.747, p=0.027)remained significant. Conclusions: Low hand grip strength was one of significant risk factor for morbidity in gastric cancer surgery. Hand grip strength as a surgical risk has a value to be examined in the future prospective studies.
Phase II study of first-line combined chemotherapy bevacizumab with modified RPMI regimen for elderly or frail patients with unresectable or metastatic colorectal cancer (OGSG0802) update analysis.
Authors: Taroh Satoh, Takeshi Kato, Motoki Yoshida, Yasuhiro Miyake, Shigeyoshi Iwamoto, Masato Nakamura, Daisuke Sakai, Masaki Matsuoka, Toshio Otsuji, Hiroshi Furukawa
Journal: Journal of Clinical Oncology (2013)

e14601 Background: The first-line combined chemotherapy RPMI regimen with bevacizumab (Bmab) in AVF2192g tri al were active. According to the results of efficacy and safety, a fluoropyrimidine (FU) + Bmab regimen is regarded as one of treatment options for 1st-line chemotherapy in many guidelines. We planned a phase II study of modified RPMI regimen with Bmab especially for elderly or frail Pts. Methods: Pts with confirmed unresectable/metastatic colorectal cancer without previous chemotherapy, and not suitable for intensive chemotherapy were enrolled. Pts received modified RPMI regimen (5-FU 600 mg/m2 and l-leucovorin 200 mg/m 2 bolus day 1, 8, 15) and Bmab 5 mg/kg day 1, 15, q4w) until disease progression or study withdrawal. The primary endpoint was overall response rate (ORR), and the secondary endpoints were PFS, OS and safety. Results: 41 Pts were enrolled from 13 institutions. Pts characteristics were as follows; median age 76 (range 56-90); male/female, 18/23; ECOG performance status 0/1/2, 21/19/1. The ORR, the rate of best response, the disease control rate (CR+PR+SD) were 36.6%, 56.1%, 85.4%, respectively. Median follow-up period was 14.4 months(Updated results will be presented). 28 Pts (68%) had objective progression and a patient (2.4%) died without progression. The median PFS and OS were 9.0 months (95%CI, 7.5–19.6) and 24.0 months (95%CI, 20.1–NR). The incidences of grade 3 or 4 adverse events were: leukopenia (7%), neutropenia (24%), thrombocytopenia (2%), diarrhea (5%), anorexia (10%), fatigue (5%), stomatitis (7%) and hypertension (5%). Grade 3 febrile neutropenia and grade 4 pulmonary embolism was observed in one pt. Five pts (12%) discontinued the treatment due to severe or uncontrollable adverse event. Conclusions: The modified RPMI regimen with Bmab showed promising activity, and was well tolerated for elderly or frail Pts. ORR and the median PFS of this regimen were similar to historical data with FU + Bmab. This regimen may be a good option for patients with poor PS or elderly with advantages of not requiring percutaneous port placement nor compliance or oral agents. Clinical trial information: UMIN000002182.
Hearing the patient’s voice: Utilization of a patient-family advisory group in key cancer care initiatives.
Authors: Theresa Franco, Ann Yager
Journal: Journal of Clinical Oncology (2014)

74 Background: As patient participation and satisfaction move to center stage in defining quality care experience and providing a competitive edge, it has become necessary to develop strategies to secure patient input and engagement in strategic care initiatives. Methods: At the Nebraska Medical Center, a cancer patient advisory group was established to create a better understanding of the patient experience through the lens of the patient/family member. Our goal focuses on the 3 'P's"- people, processes, and places to improve the patient/family cancer experience. Participants were selected through an application/ interview process from a variety of diseases, backgrounds, and ages to represent a broad spectrum. Results: Initially the group provided feedback on educational formats, throughput, and communication methods. Our greatest opportunity to utilize this advisory group emerged in design and development of the Fred and Pamela Buffett Cancer Center. This 570,000 square foot facility includes a research tower as well as multi-disciplinary inpatient and outpatient clinical environments. Knowing this project would be transformational in cancer care delivery, it was critical that patient input be considered in every phase of design and process improvements. The patient advisory group became instrumental for exploring ideas ranging from the initial impression of the lobby, inpatient, infusion, and exam room layouts, to critical amenities, and way finding, signage. Input on equipment, furniture and technology choices was also sought. Their feedback, obtained through multiple venues, has become instrumental in driving change to enhance our care experience. These interactions have resulted in significant design modifications, a greater emphasis on efficiency in care, and the infusion of elements that individualize the cancer care journey. Conclusions: Engaging the patient advisory group has been critical in in advancing both current and future care initiatives. The health care team has benefitted, by creating a greater awareness of the most coveted aspects of a patient/family experience. It is a powerful conduit for hearing the patient’s voice and putting their words into action.
Risk of high-grade liver toxicity with pazopanib in patients with cancer: A meta-analysis.
Authors: S. Kapadia, S. Hapani, S. Wu
Journal: Journal of Clinical Oncology (2011)

4595 Background: Pazopanib, as an oral receptor tyrosine kinase inhibitor, has been approved for the treatment of advanced renal cell cancer (RCC) and undergoing evaluation in other tumors. Hepatotoxicity is a concern for clinical application. This study was conducted to determine the risk of high-grade liver toxicity with pazopanib by a systematic review and meta-analysis of clinical trials. Methods: Databases from PubMed, Web of Science and abstracts presented at ASCO meetings up to December 2010 were searched to identify relevant studies. Eligible studies included prospective clinical trials in which pazopanib was started at 800 mg daily as a monotherapy. Summary incidence rates, relative risks, and 95% confidence intervals (CIs) were calculated using a fixed-effects or random-effects model, depending on the heterogeneity of the included studies. Results: A total of 1,155 patients with a variety of solid tumors from eight clinical trials were included for the analysis. The incidence of all-grade ALT elevation was 41.7% (95% CI: 33.9-49.9%), with 8.2% (95% CI: 5.9-11.3%) being high-grade. Interestingly, there was a significant difference in the incidence of high-grade ALT elevation between RCC and non-RCC patients (10.9% vs 5.7%, p=0.012). The incidence of all-grade AST elevation was 39.3% (95% CI 30.2-49.2%), with 6.4% (95% CI: 4.6-8.8%) being high-grade. There was no significant difference in the incidence of high-grade AST elevation between RCC and non-RCC patients (7.4% vs 4.8%, p=0.22). In comparison with controls, pazopanib significantly increased the risk of high-grade ALT elevation (RR,7.95;95% CI: 2.22-28.55, p=0.001) and high-grade AST elevation (RR 9.01, 95% CI: 1.71-47.50, p=0.01). Conclusions: Pazopanib is associated with substantial risk of high-grade hepatotoxicity, which may vary with tumor types. Close monitoring and appropriate management are recommended during the therapy.