tbuckley/cabot-search huggingface dataset:
Primary care providers’ evaluation of survivorship care plans.
Authors: Deborah Mayer, Kim Dittus, Dorothy Dulko, Clare Pace, Brian Sprague, Adrian Gerstel, Janine M. Davies, Berta Geller, Nikki Hawkins
Journal: Journal of Clinical Oncology (2012)

188 Background: Survivorship care represents a distinct phase of the cancer care and addresses surveillance, the physical and psychosocial sequelae of the cancer and treatment, and health promotion. Survivorship care plans (SCP) were recommended in the 2005 IOM From Cancer Patient to Cancer Survivor as a tool to address these issues and will be required by the Commission on Cancer in 2015. As part of two studies implementing SCP using the JourneyForward (JF-SCP) template, we evaluated primary care providers (PCP) perspective on their use. Methods: JF-SCP were developed and delivered to patients and PCP at the end of treatment. We collected information about usability, comprehension, barriers to use, and respondent demographics. Results: Of the 61 PCP who responded: 86% were physicians, 60% were women, had an average of 20 years in practice. PCP strongly agreed/agreed that SCP were easy to understand (95.7%), the right length (73.9%), addressed the right topics (95.7%), would be useful in talking with patients about survivorship plans (91.3%), would improve communication with oncologists (74.4%) and with patients (74.4%). Significant barriers interfering with the PCP providing follow-up care included: limited access to survivors as they stay with oncologists (59.5%), insufficient knowledge of issues (53.4%), inadequate recommendations from the oncologist (43.9%), lack of survivor care guidelines (42%), lack of time (38%), and poor reimbursement (16.6%). Specific suggestions about the JF-SCP included making it shorter and being clear about which provider was responsible for obtaining recommended testing. PCP commented on the importance of ongoing primary care provided throughout the cancer continuum. Conclusions: PCP reported ease of SCP use but did identify areas for improvement. Many PCP were frequently not included or did not stay involved with the cancer patient when being seen by oncologists. The SCP was viewed as a tool to facilitate communication with oncologists and patients.
Imaging response during therapy (tx) with radium-223 (Ra-223) for castrate resistant prostate cancer (CRPC) with bone metastases (BM).
Authors: Daniel Keizman, Avivit Peer, Avivit Neumann, Eli Rosenbaum, Victoria Neiman, Maya Gottfried, Iryna Kuchuk, David Sarid, Eliahu Gez, Wilmosh Mermershtain, Keren Rouvinov
Journal: Journal of Clinical Oncology (2016)

282 Background: Ra-223 is an alpha emitter that selectively targets BM. It was shown to improve the survival of patients (pts) with CRPC and BM, and thus is approved as a standard tx for these pts. However, the imaging response during Ra-223 tx is poorly defined. We aimed to describe the imaging response in pts with CRPC and BM treated with Ra-223. Methods: We evaluated the CT and bone scans response among pts with CRPC and BM, who were treated with Ra-223. Tx consisted of an injection administered q 4 weeks up to 6 injections. Scans were done at baseline, after 3 injections, and upon completion of 6 injections. Logistic regression model was used to analyze clinicopathologic factors associated with scans response. Results: 51 pts were included (median age 72). 59% (n = 30) were treated post docetaxel chemotherapy. 47% (n = 24) were treated concomitantly with a systemic standard therapy (e.g enzalutamide or abiraterone). 76% (n = 39) completed the planned 6 injections. A clinical benefit (improvement of skeletal pain and performace status) was noted in 67% (n = 34). 53% (n = 27) had a decrease of alkaline phosphatase. The response of bone metastatic disease (number of lesions) at 3 months was improvement in 22% (n = 11), stable in 53% (n = 27), and progression in 25% (n = 13). 1/13 (8%) pts evaluated at 6 months, had a progression of BM versus the 3 months status. Progression (RECIST ) of extraskeletal sites (lymph nodes, lungs, liver, adrenal) at 3 months was noted in 35% (n = 18). Concurrent systemic standard therapy (e.g enzalutamide or abiraterone) (OR 3.3, p = 0.04), Pre-tx PSADT ≥ 3 months (OR 2.62, p = 0.02) and on treatment stable/decreasing LDH (OR 2.9, p = 0.05) were associated with on treatment stable extraskeletal metastatic disease. Conclusions: Progression of BM during Ra-223 was uncommon. A bone flare may be noted during the first 3 months, and should not be confused with BM progression. Clinician should consider repeating a CT scan at 3 months in pts with short pre-tx PSADT, and LDH increase during tx, to exclude extraskeletal metastatic disease progression.
Alloreactive CD8+ Effector T Cells Proliferate and Persist Upon Chronic Exposure to Alloantigens through Reactivation of Stem Cell Transcriptional Programs.
Authors: Koji Kato, Shuaiying Cui, Rork Kuick, Shin Mineishi, Elizabeth Hexner, James LM Ferrara, Victor E Marquez, Stephen G. Emerson, Yi Zhang
Journal: Blood (2009)
The cost of one added day of survival by targeted therapy in metastatic colorectal cancers.
Authors: Helmy M. Guirgis
Journal: Journal of Clinical Oncology (2014)

421 Background: Data was collected to assess the cost of one day of added survival over control in metastatic cancer. Aflibercept and regorafenib have been approved as last resort treatments in refractory colorectal cancer (mCRC). Objective: Study the impact of number of cycles on overall survival gain (OSg) in refractory and first -line mCRC. Methods: Average Wholesale Prices in United States dollars (US$) of evaluated drugs and ancillary costs were added. The total was divided by reported median OSg in days. Plans were designed to rate and score drugs. Results: See Table. The data was collected to share with physicians, patients, and authorities, not for drug comparison. Conclusions: The cost of one-day survival gain by aflibercept and regorafenib was relatively high. Increased number of cycles of targeted therapy increased cost/OSg and decreased ratings and scores. [Table: see text]
Radiation exposure in patients (pts) with newly diagnosed breast cancer (BC) within first year (yr) from diagnostic procedures (DP).
Authors: Lubna Chaudhary, Sarah Knapp, Samuel Hester, Sijin Wen, Jie Xiao, Gary Marano, Sobha Kurian, Hannah Hazard, Ginger Layne, Geraldine Meerbott Jacobson, Jame Abraham
Journal: Journal of Clinical Oncology (2013)

123 Background: Radiation exposure is associated with an increased risk of secondary cancers. Few studies have examined radiation exposure from DP in BC. Methods: We retrospectively analyzed the cumulative radiation doses (millisievert [mSv]) of routine DP done in 305 pts during the 1st yr following BC diagnosis between Jan 2008-Oct 2010. Data regarding the frequency of DP including mammograms, sentinel lymph node biopsies, X-rays, computed tomographic (CT) and/or positron emission tomographic (PET) scans, MUGA scans and bone scans were collected. Mean radiation doses of DP were obtained from Departments of Nuclear Medicine and Radiation at our institution. Kruskal-Wallis test and post-hoc pairwise comparisons were used to assess the influence of various factors including age, histology, ER/PR (Estrogen/Progesterone) status and stage on the amount of radiation exposure. Results: Mean radiation exposure relative to various factors is shown in the Table. Pts &lt; 40yrs had a significantly higher radiation dose as compared to pts &gt; 60yrs (35.9mSv vs. 19.2mSv; p = 0.009). Pts with DCIS (ductal carcinoma in situ) had a significantly less radiation exposure as compared to IDC (infiltrating ductal carcinoma) and ILC (invasive lobular carcinoma) (8.5mSv vs. 26.7mSv and 22.4mSv respectively; p&lt; 0.0001). Stage ≥ IIB disease was associated with a significantly higher radiation exposure (p&lt; 0.0001). Stage ≥ IIIA was the only factor associated with a higher radiation dose from PET/CTs (p&lt; 0.0001). Conclusions: Radiation exposure from DP is significant in the 1st yr of BC diagnosis, especially for younger and advanced stage pts. Risk is small but relevant, especially in younger pts. [Table: see text]
Phase I dose-escalation of the oral MEK1/2 inhibitor GSK1120212 (GSK212) dosed in combination with the oral AKT inhibitor GSK2141795 (GSK795).
Authors: R. Kurzrock, A. Patnaik, L. Rosenstein, S. Fu, K. P. Papadopoulos, D. A. Smith, G. S. Falchook, G. Chambers, J. L. Gauvin, A. Naing, L. S. Smith, T. Gonzalez, A. M. Tsimberidou, T. A. Mays, D. S. Cox, D. S. Hong, D. J. DeMarini, N. T. Le, S. R. Morris, A. W. Tolcher
Journal: Journal of Clinical Oncology (2011)

3085 Background: The RAS/RAF/MEK and PI3K/AKT pathways are activated in many human cancers. GSK212 is a potent and selective allosteric inhibitor of MEK1/2 and GSK795 is a potent ATP-competitive inhibitor of all three isoforms of AKT. The objectives of this study were to evaluate the safety, pharmacokinetics (PK) and pharmacodynamics (PD) of GSK212 dosed in combination with GSK795 in adults with advanced solid tumors. Methods: Both GSK212 and GSK795 are given orally, once daily. This is a three-part study: Part 1, dose escalation; Part 2, expansion in selected tumor types to evaluate recommended Phase II doses (RP2D); Part 3, PK/PD assessment using tumor biopsies or FDG-PET. Results: 23 patients (pts) received ≥1 dose of GSK212 and/or GSK795 with 7 remaining on study. Dose escalation has proceeded using a zone-based escalation procedure enabling evaluation of multiple combination doses in parallel cohorts: 0.5mg GSK212 + 25, 50 or 75mg GSK795, 1mg or 1.5mg GSK212 + 25mg GSK795, and 1mg GSK212 + 50mg GSK795. Dose escalation is continuing. The RP2D for single-agent GSK212 is 2mg and the MTD for single agent GSK795 is 75mg. Dose-limiting toxicities (DLTs) are ≥14 day interruption of study drug for Grade 2 AST and ALT elevation and Grade 3 chest pain in association with sustained ventricular tachycardia. All DLTs were reversible with drug interruption. The most common adverse events (≥10%) were nausea (26%; G3/4 0%), AST elevation (22%; G3/4 9%), fatigue (22%; G3/4 0%), rash (22%; G3/4 0%), decreased appetite (17%; G3/4 0%), hypokalemia (17%; G3/4 0%), anemia (13%; G3/4 0%), confusional state (13%; G3/4 0%), dry mouth (13%; G3/4 0%), peripheral edema (13%; G3/4 0%), and vomiting (13%; G3/4 0%). At the lowest dose level (0.5mg/25mg) concentrations of each drug were similar when each compound was dosed alone or in combination. 3 of 13 pts evaluable for response had tumor regressions of 8% (ovarian), 16% (endometrial) and 17% (ovarian) after 8 weeks on study. Conclusions: The combination of the MEK1/2 inhibitor GSK212 and the AKT inhibitor GSK795 was well tolerated with reversible, predictable toxicities and has preliminary signals of clinical activity.
5-flourouracil (5FU) shortage: Clinical implications and costs in a single month.
Authors: Shweta Gupta, Prantesh Jain, Saurabh Gupta, Barbara Yim, Michael Russell Mullane
Journal: Journal of Clinical Oncology (2012)

663 Background: Capecitabine (XELODA) is an orally active fluoropyrimidine that is absorbed intact through the gastrointestinal tract and converted in to 5FU. Standard chemotherapy for advanced colon cancers includes infusional 5FU with leucovorin in combination of oxaliplatin (FOLFOX) or irinotecan (FOLFIRI). With the national shortage of 5FU we had to switch our FOLFOX and FOLFIRI regimens to XELOX or XELIRI. Although in trials the xeloda regimens were non-inferior, the PFS (progression free survival) and OS (overall survival), survival curves tailed behind the infusional 5FU regimens. Methods: At our institution over one month period from August 18th 2011 to September 18th 2011, all patients who were switched from 5FU to xeloda due to national shortage were identified. All charts were retrospectively reviewed identifying patients with colon cancer. Patients with other cancer histologies, were excluded. The charts were reviewed for number of cycles, clinical toxicity, admission to hospital. Results: A total of 90 patients were switched form 5FU to xeloda. 51 had colon cancer. Out of which, 6 (11.7%) patients had the drug discontinued due to toxicity and 4 out of the 6 required hospitalization due to adverse effects of xeloda, mainly diarrhea and vomiting. 80% of these had left sided colon cancer and 50% each received oxaliplatin and irinotecan respectively. The total number of hospitalization days was 20. The average wholesale price (AWP) of one cycle of xeloda for body surface area range from 1.5m2 to 2m2 ranges from 2605.68$ to 3474.24$ for every 3 week cycle. In comparison the corresponding AWP for 2 cycles of 5FU over a month is 51.81$ to 69.08$. This would become a net higher price of 2553.87$ to 3405.16$ for BSA of 1.5 to 2m2 per month for the switch to xeloda. There were 51 patients who received xeloda at least one cycle which costed about 151,954.50$ if we average the body surface area. Additionally there were 20 admission days costing about 50,000$, making the net costs of switching to xeloda more than 200,000$ in a single month. Conclusions: Although xeloda is non-inferior to 5FU and can be a substitute, left sided colon cancers tend to do have more adverse effects. Additionally Xeloda is associated with higher administration costs.
The prevalence of colorectal polyps in patients with gastric cancer.
Authors: Kyoung-Joo Kwon, Ki-Nam Shim, Sung-Ae Jung, Hye-Kyung Jung, Seong-Eun Kim, Kyoung Ae Kong
Journal: Journal of Clinical Oncology (2016)

549 Background: Gastric polyps are found frequently in various colonic polyposis syndromes. Genetic alterations of several genes occur in gastric adenomas and colorectal adenomas. However, it is unknown whether patients with gastric cancers are at higher risk for colorectal adenomas. Methods: We retrospectively reviewed the medical records in 112 patients with gastric cancers from January 2005 to December 2009. Patients who were diagnosed with gastric cancers and had colonoscopy within 6 months were compared to 220 sex and age-matched controls from 3,725 persons who underwent esophagogastroduodenoscopy and colonoscopy for screening at the Center for Health Promotion in Ewha Womans University Medical Center. High risk polyp was defined by any of the following: (1) the presence of three or more polyps; (2) polyp size at least 10mm; (3) high-grade dysplasia or adenocarcinoma confirmed by histopathologic examination. Otherwise the polyps were defined as low risk. Results: Mean age was 59 years-old and 70% was male in patients with gastric cancer. Overweight (BMI ≥ 23) was more common in control group (gastric cancer versus control: 56% and 69%, respectively, P = 0.025). Colorectal polyps were identified in 67 of 112 patients (59.8%) with gastric cancer and in 153 of 220 controls (69.5%). The prevalence of high risk polyps were numerically higher in the gastric cancer group than the control group, although not statistically significant (9% vs. 4%, P = 0.267). In contrast, the prevalence of low risk polyps were significantly frequent in the control group (91% vs. 96%, P = 0.024). The mean size and number of colorectal polyps were not different between the two groups. Adenocarcinoma was diagnosed from polyps in five patients (7%) with gastric cancer and four patients (2%) with control group (P = 0.190). Conclusions: The overall colorectal polyps, especially low risk polyps, were more prevalent in the control group. In contrast, high risk polyps and adenocarcinoma is more frequently found in patients with gastric cancer although not significant. Therefore, we suggest that colorectal polyps should be cautiously examined in patients with gastric cancer.
Association of interleukin-6 levels and neutropenia during gemcitabine monotherapy for advanced pancreatic cancer.
Authors: H. Okuyama, S. Mitsunaga, K. Nakachi, I. Ohno, S. Shimizu, H. Takahashi, T. Okusaka, H. Ueno, A. Ochiai, M. Ikeda
Journal: Journal of Clinical Oncology (2011)

178 Background: Neutropenia is an important dose-limiting toxicity of gemcitabine (GEM) in patients with advanced pancreatic cancer (PC). Serum haptoglobin, regulated by pro-inflammatory cytokines, is a predictor of neutropenia in PC patients under treatment with GEM. We conducted this study with the aim of identifying the association between serum levels of haptoglobin and cytokines and the risk of development of neutropenia in advanced PC patients receiving GEM therapy. Methods: Serum levels of haptoglobin and pro-inflammatory cytokines (GM-CSF, IFN-γ, IL-1β, IL-2β, IL-6, IL-8, IL-10, IL-12, TNF-α) were measured in 55 patients with advanced PC. All patients (median age: 67 years, male/female: 26/29, ECOG performance status: 0/1/2: 32/21/2,) received GEM monotherapy as the initial treatment for PC. The severity of neutropenia within the first 90 days of the GEM treatment was graded according to the NCI Common Terminology Criteria for Adverse Events, version 3.0. Categorical or and noncategorical data were compared using Student's t test. Multivariate regression analysis was performed using logistic regression modeling. The significance level was set at p&lt;0.05. Results: Grade 0 to 2 (G0/1/2) and grade 3 to 4 (G3/4) neutropenia were observed in 32 patients (58.2%) and 23 patients (41.8%), respectively. The G3/4 neutropenia group showed low serum levels of haptoglobin (mean 144.4 mg/dl vs. 186.7 mg/dl, p=0.097), IL-1β (mean 0.07 pg/ml vs. 0.24 pg/ml, p=0.044), IL-6 (mean 1.13 pg/ml vs. 6.43 pg/ml, p=0.002), IL-8 (mean 18.4 pg/ml vs. 44.8 pg/ml, p=0.015), and TNF-α (mean 6.28 pg/ml vs. 8.86 pg/ml, p=0.017) as compared to the G0/1/2 neutropenia group. Multivariate analysis revealed that only low serum IL-6 was significantly associated with the development of G3/4 neutropenia (OR=0.081, p=0.0011). Conclusions: Low serum IL-6 level was associated with severe neutropenia. Thus, circulating IL- 6 levels may be a predictor of the development of severe neutropenia in advanced PC patients receiving GEM therapy. No significant financial relationships to disclose.
Prediction of prostate cancer Gleason score using a MRI-based nomogram.
Authors: Mohummad Minhaj Siddiqui, Soroush Rais-Bahrami, Hong Truong, Lambros Stamatakis, Annerleim Walton-Diaz, Arvin George, Jason Rothwax, Daniel Su, Nabeel Shakir, Bradford J. Wood, Maria Merino, Baris Turkbey, Peter L. Choyke, Richard Simon, Peter A. Pinto
Journal: Journal of Clinical Oncology (2014)

255 Background: Gleason score grading is a cornerstone of risk stratification and management of patients with prostate cancer (PCa). The only reliable method to determine Gleason score remains by direct pathologic determination from a tissue specimen. In this work, we examine the feasibility of MRI and clinical patient characteristics to predict biopsy Gleason scores (bGS). Methods: We reviewed 143 men who underwent multiparametric prostate-MRI (MP-MRI) prior to any prostate biopsy from 8/2007 to 12/2012. Patient demographics, PSA, PSA density (PSAD), and imaging findings were assessed for association with PCa Gleason score on biopsy. Screen positive lesions (SPLs) were defined as lesions positive on T2W and DWI B-MRI images. Logistic regression modeling was used to assess association of the different parameters with bGS (no cancer, Gleason 6, 7, and ≥8). An optimized model for the prediction of bGS was determined and a nomogram was generated. Results: The mean age of the cohort was 60.7 ± 7.7 years and mean PSA of 6.8 ± 6.5 ng/ml. Factors associated with Gleason score include age, PSA, PSAD, prostate volume, MRI suspicion score, total lesions seen on MRI, number of SPLs. Various models were examined utilizing factors positively associated with Gleason score and the combination of PSA density with SPLs outperformed most other combinations. A nomogram was generated to derive the probability of No cancer, Gleason 6, 7, and ≥8 PCa using the inputs of PSAD and number of SPLs. The correlating c-indexes to Gleason 6, 7, and ≥8 PCa detection were 0.87, 0.87, and 0.92 respectively. When tested on the original cohort, the most probable nomogram generated Gleason score correlates with actual pathologic bGS findings in 53% of the men. The top two most probable nomogram Gleason scores contained the actual bGS findings in 81% of the men. Conclusions: PSAD combined with prostate MRI imaging characteristics shows potential for prebiopsy determination of prostate cancer Gleason score and presence. Further improvement in predictive performance of this test may ultimately yield a clinical tool that is of benefit for prebiopsy risk stratification of patients for PCa of clinical significance.
Treatment of colorectal peritoneal carcinomatosis with systemic chemotherapy: A pooled analysis of NCCTG’s phase III trials N9741 and N9841.
Authors: J. Franko, Q. Shi, C. D. Goldman, B. A. Pockaj, G. D. Nelson, R. M. Goldberg, H. C. Pitot, A. Grothey, S. R. Alberts, D. J. Sargent
Journal: Journal of Clinical Oncology (2011)

3571 Background: Symptoms and complications of metastatic colorectal cancer (mCRC) differ by metastatic site(s) and other factors. There is a paucity of data regarding outcomes for patients with peritoneal carcinomatosis (pcCRC) as a manifestation of mCRC derived from prospective studies. We characterized the clinical course of pcCRC pts enrolled in prospective randomized trials of chemotherapy and contrasted that with other forms of mCRC (non-pcCRC). Methods: A total of 2,095 pts enrolled in (N9741 and N9841) were evaluated. Clinical outcomes included overall survival (OS) and progression-free survival (PFS). Stratified log-rank test was used to compare OS and PFS between pcCRC and non-pcCRC pts. The impact of systemic chemotherapy was analyzed separately for 1st (N9741) and 2nd line treatment (N9841). Cox model was used to assess the adjusted associations. Results: pcCRC group (n=364) was similar to the non-pcCRC pts in median age (63 vs. 61 years, p=0.23), gender (57% males vs. 61%, p=0.23), performance status (ECOG PS 0-1 94% vs. 96%, p=0.06), but differed in frequency of liver (63% vs. 82%, p<.001) and lung metastases (27% vs. 34%, p=0.01). Median OS (12.7 vs. 17.6 months, hazard ratio (HR) 1.3 [95% CI 1.2-1.5]) and PFS (5.8 vs. 7.2 months, HR 1.2 ([95% CI 1.1-1.3]) were shorter for pcCRC vs. non-pcCRC. The unfavorable prognostic influence of pcCRC remained after adjusting for age, PS, liver metastases and other factors (OS: HR 1.3, p<.001; PFS: HR 1.1, p=0.05). FOLFOX was superior to IFL as a first line treatment among pcCRC (HR for OS 0.62, p=.005) and non-pcCRC pts (HR 0.66, p<0.001; Table). Conclusions: pcCRC is associated with a significantly shorter OS and PFS as compared to other forms of mCRC. Trials for mCRC should consider stratiftification by pcCRC status. Non pcCRC pcCRC Treatment HR [95% CI] P HR [95% CI] P OS N9741 FOLFOX 0.66 [0.58 - 0.76] <0.001 0.62 [0.44 - 0.86] 0.005 IFL ref ref N9841 FOLFOX 0.99 [0.79 - 1.22] 0.899 0.73 [0.48 - 1.10] 0.128 IRI ref ref PFS N9741 FOLFOX 0.67 [0.58 - 0.76] <0.001 0.75 [0.53 - 1.04] 0.082 IFL ref ref N9841 FOLFOX 0.72 [0.58 - 0.90] 0.003 0.61 [0.41 - 0.92] 0.017 IRI ref ref