tbuckley/cabot-search huggingface dataset:
Impact of nodal and margin status in pancreatic cancer patients undergoing surgery and chemotherapy: National Cancer Database analysis 2004-2014.
Authors: Sukamal Saha, Mohamed Elgamal, Suresh Mukkamala, Meghan Cherry, David Livert, Swetha Pentapati, David Wiese, Kiran Devisetty, Jack Nettleton, Hesham Gayar, Sandeep Singh Grewal, David S. Eilender, Trevor Singh, Madan L. Arora
Journal: Journal of Clinical Oncology (2018)

e16223 Background: Pancreatic cancer (PCa) patients (Pts) have dismal survival with surgery alone; hence chemotherapy (ChemoRx) has been used often. We analyzed the role of lymph node (LN) and margin (M) status after neoadjuvant (NA) vs adjuvant (AD) vs NA+AD in PCa pts. Methods: Data was obtained from the National Cancer Database from 2004-2014 for PCa pts undergoing surgery along with NA (gp A) or AD (gp B) or NA+AD (gp C) chemoRx. Survival analysis for 1, 2 and 3 years (yrs) was done in pts stratified by LN and M status using Pearson chi-squared test for significance. Results: Of the 26,083 surgical pts with LN and M status, there were 3106 pts in gp A (NA), 21,638 pts in gp B (AD) and 1339 pts in gp C (NA+AD). Pathologically +ve LN and M were lowest in gp A (42% and 17%) vs highest in gp B (70% and 25%) respectively (Table -1A). Best 1 yr survival was in gp C with -ve LN and M status (93%) vs worst in gp B with +ve LN and M status (64%). Best 3yr survival was in gp B with -ve LN and M status (36%) vs worst in gp A with +ve LN and M status (13%) (Table -1C). Best overall survival was in gp C and worst in gp B for all 3 yrs (Table -1B). Conclusions: PCa pts even after surgery have poor survival. Use of NA+AD therapy provides the best 1, 2 and 3 yrs survival. Future prospective randomized trial will provide further validation. Table 1:. Survival analysis in gp A (NA), B (AD) and C (NA+AD). Total # of pts 26,083 Table - 1A: LN and M status in gp A,B and C Lymph node (LN) Margin (M) Negative (-ve) % (Positive) +ve % (Negative) -ve % (Positive) +ve % gp A (NA) 58 42 83 17 gp B (AD) 30 70 75 25 gp C (NA+AD) 44 56 80 20 Table - 1B: Overall survival % in gp A, B and C gp A (NA) % gp B (AD) % gp C (NA+AD) % 1 Yr 80 75 88 2 Yrs 46 42 49 3 Yrs 24 23 25 Table -1C: Overall survival in gp A, B and C according to LN and M status Margin gp A (NA) - 3106 pts gp B (AD) - 21638 pts gp C (NA+AD) - 1339 pts Negative (-ve) Positive (+ve) Negative (-ve) Positive (+ve) Negative (-ve) Positive (+ve) Lymph node (-ve) (+ve) P (-ve) (+ve) P (-ve) (+ve) P (-ve) (+ve) P (-ve) (+ve) P (-ve) (+ve) P 1 Yr 83 77 .000 74 72 .537 84 76 .000 73 64 .000 93 85 .000 83 86 .599 2 Yrs 52 42 .000 37 32 .229 57 41 .000 38 28 .000 59 43 .000 45 42 .572 3 Yrs 29 19 .000 17 13 .151 36 22 .000 21 13 .000 34 21 .000 24 16 .113 # Pts 1569 999 229 309 5301 10924 1245 4168 502 563 84 190
An open-label, single-arm, multi-institutional phase II trial of avelumab for recurrent, metastatic nasopharyngeal carcinoma.
Authors: Assuntina Gesualda Sacco, Karen Messer, Rom S. Leidner, A. Dimitrios Colevas, Jorge J. Nieva, Nicole Grace Chau, Chaitali Singh Nangia, Benjamin Pinsky, Kathryn A. Gold, Gregory A. Daniels, Ezra E.W. Cohen
Journal: Journal of Clinical Oncology (2017)

TPS6092 Background: The majority of patients with nasopharyngeal carcinoma (NPC) present with locally advanced disease, with a predilection for early systemic dissemination. For patients who develop recurrent and/or metastatic (R/M) NPC, survival is poor. Following first-line platinum-based regimens, there is no well-defined paradigm for subsequent therapies. Inhibition of PD-L1 with Avelumab is an attractive strategy because Epstein-Barr virus (EBV), the primary causative agent in NPC pathogenesis, universally upregulates PD-L1 expression; proposed mechanisms of upregulation include immune resistance via innate (EBV-induced latent membrane protein-1) and adaptive (Interferon-gamma) mechanisms; increased PD-L1 expression is an independent poor prognostic factor for disease-free survival. Methods: Patients with histologically/cytologically confirmed, EBV-related NPC not amenable to curative intent therapy who received ≥1 prior line of systemic therapy for R/M disease are eligible. Patients must be at least 18 years old, ECOG 0-2, willing to undergo tumor biopsy, have adequate organ and marrow function, and no prior therapy with PD-1/PD-L1 inhibitors. 39 patients will be enrolled across 6 sites. Patients will receive Avelumab 10 mg/kg IV on days 1 and 15 of each 28-day cycle. Treatment will continue until disease progression, unacceptable toxicity, investigator/patient decision. A newly obtained tumor specimen is required at enrollment; optional biopsy at time of progression. EBV plasma DNA titers will be evaluated at baseline, during treatment and at progression, using an EBV BamHI-W DNA PCR. Blood samples at baseline and 12 weeks after treatment initiation will be obtained for correlatives. Primary endpoint is overall response rate (ORR; complete and partial responses) at 6 months per RECIST. A two-stage design will reject H 0 (ORR 15%) if the observed ORR is ≥30%, α 0.1, β 0.8, required sample size n = 39. Secondary endpoints include duration of response, progression-free and overall survival. Correlative analyses will evaluate PD-L1 expression, T and B-cell subsets, frequency and clonality. The study has accrued 2 of planned 39 patients. NCT02875613. Clinical trial information: NCT02875613.
Association of Albuminuria With Intraglomerular Hydrostatic Pressure and Insulin Resistance in Subjects With Impaired Fasting Glucose and/or Impaired Glucose Tolerance
Authors: Akihiro Tsuda, Eiji Ishimura, Hideki Uedono, Akinobu Ochi, Shinya Nakatani, Tomoaki Morioka, Katsuhito Mori, Junji Uchida, Masanori Emoto, Tatsuya Nakatani, Masaaki Inaba
Journal: Diabetes Care (2018)

OBJECTIVE Little is known about the relationships between insulin resistance, intrarenal hemodynamics, and urinary albumin excretion (UAE) in humans with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). The aim of the current study was to examine intrarenal hemodynamic abnormalities, insulin resistance, and UAE in subjects with IFG or IGT. We hypothesized that intrarenal hemodynamic abnormalities would be associated with insulin resistance. RESEARCH DESIGN AND METHODS Fifty-four kidney donors underwent 75-g oral glucose tolerance and inulin and para-aminohippuric acid clearance testing. Insulin sensitivity index (ISI) was evaluated by the Matsuda index. Intrarenal hemodynamic parameters were calculated by the Gomez formulae. RESULTS Of the 54 subjects, 33 exhibited IFG or IGT and 31 exhibited normal glucose tolerance (NGT). Glomerular hydrostatic pressure (Pglo) and UAE were significantly higher in the IFG or IGT subjects with obesity (P = 0.015 and 0.0001, respectively). Log ISI correlated significantly and negatively with Pglo (r = −0.351, P = 0.009) in all subjects. In multiple regression analyses among all subjects, log ISI was associated significantly and independently with Pglo (β = −0.316, P = 0.015), after adjustment for age, sex, and systolic blood pressure. Further, BMI (β = 0.517, P = 0.0004), Pglo (β = 0.420, P = 0.004), and log ISI (β = −0.366, P = 0.008) were each associated significantly and independently with UAE after adjustment. CONCLUSIONS We demonstrated that increased insulin resistance is associated with increased Pglo and UAE in IFG or IGT subjects. These hemodynamic burdens and insulin resistance may cause injury to the glomeruli even in subjects with IFG or IGT.
Impact of a community-based molecular cancer conference on physician practice and clinical care.
Authors: Andrew McKenzie, Holli Hutcheson Dilks, Suzanne Fields Jones, Davey B. Daniel, Edward Arrowsmith, Kimberly Tucker, David R. Spigel, Howard A. Burris
Journal: Journal of Clinical Oncology (2018)

e18774 Background: Molecular tumor boards are useful for understanding molecular profiles and matching patients to targeted therapies. But, a scalable committee to review a high volume of patient reports and provide scientific guidance to oncologists affiliated with non-academic institutions does not yet exist. Sarah Cannon initiated a Molecular Cancer Conference (MCC) in May 2017 to review molecular results for Sarah Cannon’s community-based network of medical oncologists. Here, we report the results of a MCC pilot at a community oncology practice. Methods: The MCC reviews the next-generation sequencing results ordered by treating oncologists as a part of standard patient care. The committee met every two weeks to provide scientific guidance for targeted therapy selection, immunotherapy options, therapy contraindications, potential clinical trial options, and potential hereditary cancer syndrome implications based on molecular results. Results: Molecular profiling more than doubled (2.1 fold increase) since the initiation of the MCC (from 14 to 32 orders/month). Physicians participating in the MCC used more recent biopsies – instead of archival tissue – for molecular testing than those not participating in the MCC (64.3 and 128.9 days between biopsy and test, respectfully). Clinical trials were discussed for 218 cases, 35 patients enrolled on a clinical trial, and 4 patients were enrolled on two different clinical trials. Of those enrolled, 15 remain on study with either a partial response (2) or stable disease (13) with response times ranging from 1 month to 9 months. 17 patients have stopped clinical trial treatment due to progressive disease (response times between 1 and 6 months) and 2 patients stopped clinical trial treatment due to patient choice. Conclusions: Molecular profiles reviewed at the molecular conference committee lead to the suggestion of clinical trials 95.2% of the time. Physician education led to changes in the frequency, point in care, and utility of molecular profiles. These data demonstrate the need to study the clinical benefit of having scientific review of molecular profiles, and potentiate the need for physician education and training around the importance and utility of molecular profiling.
Improving Pediatric Electronic Health Record Usability and Safety Through Certification
Authors: Raj M. Ratwani, Ben Moscovitch, Josh P. Rising
Journal: JAMA Pediatrics (2018)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Pediatrics journal
Relationship between inhibin B, puberty, and secondary sex characteristics in childhood cancer survivors.
Authors: Emel Cabi Unal, Gulsum KADIOGLU Simsek, Nurdan Tacyildiz, Handan Dincaslan, Gulsan Yavuz, Zeynep Siklar, Merih Berberoglu
Journal: Journal of Clinical Oncology (2017)

e22018 Background: Prognosis in childhood cancer improved with intensive tx regimens, improved survival,concerns&amp;issues related to QOL become crucial point of interest. Methods: Gonadal functions were studied in 33M,22F survivors of childhood cancers treated w gonadotoxic chemotherapy,with HL,NHL, ALL,Osteosarcoma,Rhabdomyosarcoma. All event-free survivors for &gt; 1year, postpubertal, &gt; 15 years of age at the time of study, 8 pts received abdominal RT,9 pts had prophylactic cranial RT. Patients answered a questionnaire concerning sexual functions,underwent a comprehensive physical examination, clinical evaluation of pubertal development, secondary sex characteristics,menstrual history, measurement of FSH, LH,sex steroids, inhibinB, compared w age-matched controls. Results: All patients had normal pubertal development for age,Females showed no significant differences in secondary sex characteristics, than controls &amp;the progression of puberty, adult-type hair growth in males were significantly late (P:0.002) than controls, low levels of testosterone were found in all.Pubertal development normal in female patients, w elevated FSH than control.(P:0.025)FSH levels in males didn't differ,inhibinB levels were significantly lower than control.(P:0.022).We couldn't demonstrate significant association with age at dx,time elapsed after tx,dx type,gonadotoxic agent.. Conclusions: Our study showed tx of childhood cancer could lead to gonadal toxicity.Our study investigating relationship between puberty,secondary sex characteristics,inhibinB in early postpubertal stage. Findings suggest that, even in the presence of gonadal toxicity, in females, secondary sex characteristics&amp;puberty weren't affected.Inhibin B as a marker for gonadal toxicity is not superior to FSH. In fact that, we found a decrease in InhibinB as the only marker of gonadal dysfunction in males.With normal pubertal development &amp;FSH levels in postpubertal males,low detection of inhibinB can be used as an early,sensitive marker for gonadal toxicity.Late adult-type hair growth with low testosterone demonstrating chemotherapy-induced testicular damage. Clinical trial information: BAP-2734.
Are symptoms of ovarian cancer evident: A retrospective analysis of claims data to determine prior symptoms to diagnosis.
Authors: Denise Manon Langabeer, Cecilia Ganduglia Cazaban, Michael D Swartz, Trudy Krause
Journal: Journal of Clinical Oncology (2017)

5565 Background: There are no standard of care screening methods for ovarian cancer. Over sixty percent (60%) of ovarian cancer cases are found at Stage III and IV, which ultimately impacts a woman’s survival rate. The purpose of this study is to determine if specific symptoms are evident prior to diagnosis of ovarian cancer. Methods: A retrospective analysis of health insurance claims between 2008 through 2013 from a commercial payer was performed based on the following eligibility criteria: 1) women diagnosed with ovarian cancer, 2) at the time of diagnosis, 24 years of age or older, 3) enrolled in healthcare plan for a period of 24 months or more prior to diagnosis, and 4) resident in the state of Texas. Symptoms were identified based on ICD-9 diagnosis codes and categorized specific to pain, abdominal and pelvis, digestive, and bladder and were evaluated at minimum of six months prior to diagnosis. ICD9 codes are used for this analysis as the data is limited to years before the change to ICD10. Results: Baseline data of 3,641 women diagnosed with ovarian cancer were identified and were associated with 927,528 claims specific to the symptoms. The age of women diagnosed with cancer ranged between 24 and 88 (mean=52; SD: 0.1833). Nearly 70% of women were treated for one or more symptoms prior to diagnosis. The symptoms women experienced the most were associated with abdomen and pelvis at 60%. Pain, digestive, and bladder ranged between 20% and 30%. Conclusions: This research is intended to further explore whether symptoms are evident in women diagnosed with this disease, and if so, how long and how frequent did the symptoms occur prior to diagnosis. Additionally, a review of combination of symptoms is explored. This research is intended to provide a better understanding of the disease as well as support that women may need to be referred to an oncologist earlier for further evaluation should reoccurring symptoms present.
Treatments of Primary Basal Cell Carcinoma of the Skin
Authors: Aaron M. Drucker, Gaelen P. Adam, Valerie Rofeberg, Abhilash Gazula, Bryant Smith, Farah Moustafa, Martin A. Weinstock, Thomas A. Trikalinos
Journal: Annals of Internal Medicine (2018)

Background: Most interventions for basal cell carcinoma (BCC) have not been compared in head-to-head randomized trials. Purpose: To evaluate the comparative effectiveness and safety of treatments of primary BCC in adults. Data Sources: English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Embase from inception to May 2018; reference lists of guidelines and systematic reviews; and a search of ClinicalTrials.gov in August 2016. Study Selection: Comparative studies of treatments currently used in adults with primary BCC. Data Extraction: One investigator extracted data on recurrence, histologic clearance, clinical clearance, cosmetic outcomes, quality of life, and mortality, and a second reviewer verified extractions. Several investigators evaluated risk of bias for each study. Data Synthesis: Forty randomized trials and 5 nonrandomized studies compared 18 interventions in 9 categories. Relative intervention effects and mean outcome frequencies were estimated using frequentist network meta-analyses. Estimated recurrence rates were similar for excision (3.8% [95% CI, 1.5% to 9.5%]), Mohs surgery (3.8% [CI, 0.7% to 18.2%]), curettage and diathermy (6.9% [CI, 0.9% to 36.6%]), and external-beam radiation (3.5% [CI, 0.7% to 16.8%]). Recurrence rates were higher for cryotherapy (22.3% [CI, 10.2% to 42.0%]), curettage and cryotherapy (19.9% [CI, 4.6% to 56.1%]), 5-fluorouracil (18.8% [CI, 10.1% to 32.5%]), imiquimod (14.1% [CI, 5.4% to 32.4%]), and photodynamic therapy using methyl-aminolevulinic acid (18.8% [CI, 10.1% to 32.5%]) or aminolevulinic acid (16.6% [CI, 7.5% to 32.8%]). The proportion of patients reporting good or better cosmetic outcomes was better for photodynamic therapy using methyl-aminolevulinic acid (93.8% [CI, 79.2% to 98.3%]) or aminolevulinic acid (95.8% [CI, 84.2% to 99.0%]) than for excision (77.8% [CI, 44.8% to 93.8%]) or cryotherapy (51.1% [CI, 15.8% to 85.4%]). Data on quality of life and mortality were too sparse for quantitative synthesis. Limitation: Data are sparse, and effect estimates are imprecise and informed by indirect comparisons. Conclusion: Surgical treatments and external-beam radiation have low recurrence rates for the treatment of low-risk BCC, but substantial uncertainty exists about their comparative effectiveness versus other treatments. Gaps remain regarding high-risk BCC subtypes and important outcomes, including costs. Primary Funding Source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42016043353).
Docetaxel and cyclophosphamide as neoadjuvant chemotherapy in ER+ HER2- breast cancer.
Authors: Hiroshi Yagata, Hideko Yamauchi, Atsushi Yoshida, Naoki Hayashi, Yuka Kajiura, Reika In, Atsuko Kitano, Koichiro Tsugawa, Seigo Nakamura
Journal: Journal of Clinical Oncology (2012)

590 Background: Recently, docetaxel plus cyclophosphamide (TC) has been established as a standard regimen for adjuvant chemotherapy in operable breast cancer. However, the efficacy of TC as neoadjuvant chemotherapy remains unclear, especially in hormone-responsive breast cancer. We prospectively evaluated the response to TC neoadjuvant chemotherapy in patients with ER+ HER2- operable breast cancer. Methods: Eligible patients had ER+ and HER2- invasive breast cancer that measured more than 2 cm in diameter or was node-positive clinically between March 2009 and February 2011. Four cycles of TC (75 and 600 mg/m 2 ) were administered intravenously every 3 weeks as neoadjuvant chemotherapy, followed by breast and axillary surgery. We investigated the clinical response on MRI and the pathological complete response (pCR) of primary invasive breast tumors. Results: We enrolled 43 patients in 45 lesions. Allred score of ER was 7 to 8 in 40 lesions, 6 in 3 lesions and 4 in 2 lesions. PgR was 7 to 8 in 31 lesions, 5 to 6 in 6 lesions, 3 to 4 in 5 lesions, and 0 in 3 lesions. Nuclear grade was 1 in 31 lesions, 2 in 7 lesions, and 3 in 7 lesions. MIB-1 index was median 22% (range, 6 to 71%) in 40 measurable lesions. Clinical response (CR and PR) was observed in 33 lesions (73%) and SD in 12 lesions without any lesions of clinical PD. pCR was achieved in only 1 lesions (ER 8, PgR 3, Nuclear grade 3, MIB-1 index 32.6%). Conclusions: Neoadjuvant TC produced a good clinical response in ER+ HER2- operable breast cancer, while the pCR rate was very low, regardless of the characteristics of cancer cells. Therefore, pCR is not an appropriate prognostic factor in women with ER+ HER2- operable breast cancer who receive neoadjuvant TC. Whether clinical response is related to survival should be addressed in future studies. The efficacy of neoadjuvant TC in ER+ HER2- operable breast cancer is very limited, and more effective regimens are needed to achieve higher pCR rates.
A prospective study of pediatric renal cell carcinoma: A report from the Children’s Oncology Group study AREN0321.
Authors: James I. Geller, Nicholas Glenn Cost, Yueh-Yun Chi, Elizabeth Jones Perlman, Yeonil Kim, Mariana Cajaiba, Elizabeth Anne Mullen, Richard D. Glick, Geetika Khanna, Najat C. Daw, Peter F. Ehrlich, Conrad Vincent Fernandez, Jeffrey Dome
Journal: Journal of Clinical Oncology (2018)

10516 Background: Although renal cell carcinoma (RCC) is the second most common pediatric kidney cancer, no previous prospective clinical trials have been conducted. AREN0321 tested the hypothesis that RCC with localized completely resected disease, including those with lymph node involvement, has a favorable prognosis without adjuvant medical therapy. Methods: From 2006 to 2012, patients up to age 30 years with centrally reviewed pathology confirmation of RCC were prospectively enrolled. Patients with completely resected disease were followed without adjuvant therapy, independent of TNM stage. Results: 62 eligible patients enrolled (35 male: 27 female; median age 13.2 yr (range 0.17 - 22.1)). Histology was TFE-associated RCC (TRCC; 33, 53.2%), RCC NOS (21, 33.9%), papillary RCC (5, 8.1%) and Renal Medullary Carcinoma (RMC; 3, 4.8%). 58 (93.5%) patients had all disease completely resected at diagnosis with stages 1 (27, 43.5%), 2 (7, 11.3%), and 3 (24, 38.7%) disease. Three patients with stage 4 (M1) and one with stage 3 had an incomplete resection. Surgery included radical nephrectomy (50) and partial nephrectomy (12). Lymph node (LN) status was N0 (21 (33.9%)), N1 (19 (30.6%)), and Nx (22 (35.5%)). Histology for patients with N1 disease was: TRCC (13, 68.4%), RCC NOS (4, 21.1%) and RMC (2, 10.5%). Four-year EFS and OS for the completely resected group were: 87.2% (95% CI 77.0 – 97.4) and 94.6% (87.6-100), respectively; and by stage were: 1 (92.4% (80.7-100) and 96.2% (87.7-100)), 2 (100% and 100%), and 3 (77.6% (57.6 – 97.6) and 91.3% (77.1-100)) (EFS p-value 0.294, OS p-value 0.722). Four-year EFS and OS by histology for the overall group were: TRCC: 87.7% (74.2-100) and 93.6% (83.3-100), papillary RCC: 100% and 100%, RCC NOS: 87.7% (70.3-100) and 100%, and RMC: 33.3% (0-86.7) and 33.3% (0-86.7). For the 15 patients with completely resected N1M0 disease (of which 13 had TRCC), the four-year EFS and OS were 86.7% (64.7-100) and 93.3% (76.6-100), respectively. Conclusions: Favorable outcomes can be achieved without adjuvant therapy in children and adolescents with completely resected RCC, including those with locally advanced disease and lymph node involvement. Clinical trial information: NCT00335556.