tbuckley/cabot-search huggingface dataset:
Outpatient management of pediatric oncology patients with low-risk fever and neutropenia: Implementation of new clinical practice guideline at Texas Children's Hospital.
Authors: Abhishek Amar Bavle, Amanda Bell Grimes, Sibo Zhao, Daniel Joseph Zinn, Andrea Jackson, Timothy Porea, Ankhi Dutta, Andras Heczey
Journal: Journal of Clinical Oncology (2017)

26 Background: Traditionally, pediatric oncology patients with fever and severe neutropenia (absolute neutrophil count [ANC] &lt;500) are admitted on empiric intravenous (IV) antibiotics pending blood cultures, fever resolution, and a rising ANC. Based on significant evidence that risk-stratification of these patients with fever and neutropenia (FN) and outpatient management of “low-risk” FN (LRFN) patients with oral antibiotics can be safe and effective, we implemented an institutional clinical practice guideline (CPG) to provide outpatient care for children with LRFN. Methods: A validated “Alexander” clinical decision rule was adopted to risk stratify pediatric oncology patients with FN. A new CPG was formulated for the outpatient management of LRFN patients, with either discharge on presentation or at 24-48 hours after admission, with levofloxacin and close follow-up. All stakeholders were educated regarding the new guidelines and process prior to implementation, and the guidelines were approved by the institutional Evidence Based Outcomes Center. Results: In 9 months since guideline implementation, 10/11 (91%) of the eligible patients have been managed outpatient for LRFN (mean ANC 160, range 0 - 480). Seven patients were discharged home from the ER or oncology clinic. Three patients were discharged early at 24 – 48 hours after admission. Outpatient management was safe, and all but one patient had resolution of fever within 48 hours and negative blood cultures. One patient had a positive blood culture with Staphylococcus epidermidis and was admitted for IV antibiotics with no complications. Parents of 9/10 patients responded to surveys. All 9 families found outpatient management to be a good experience, follow-up easy, and reported no adverse effects with levofloxacin. One family preferred inpatient care due to anxiety, while importantly 8/9 (89%) parents said they preferred outpatient care compared to inpatient observation. Conclusions: Pediatric oncology patients with low-risk fever and neutropenia were successfully idenitified and managed in the outpatient setting without adverse events with a high level of parent satisfaction.
Imaging of Chemokine Receptor 4 Expression in Neuroendocrine Tumors - a Triple Tracer Comparative Approach
Authors: Rudolf A. Werner, Alexander Weich, Takahiro Higuchi, Jan S. Schmid, Andreas Schirbel, Michael Lassmann, Vanessa Wild, Martina Rudelius, Theodor Kudlich, Ken Herrmann, Michael Scheurlen, Andreas K. Buck, Saskia Kropf, Hans-Jürgen Wester, Constantin Lapa
Journal: Theranostics (2017)

C-X-C motif chemokine receptor 4 (CXCR4) and somatostatin receptors (SSTR) are overexpressed in gastro-entero-pancreatic neuroendocrine tumors (GEP-NET).In this study, we aimed to elucidate the feasibility of non-invasive CXCR4 positron emission tomography/computed tomography (PET/CT) imaging in GEP-NET patients using [ 68 Ga]Pentixafor in comparison to 68 Ga-DOTA-D-Phe-Tyr3-octreotide ([ 68 Ga]DOTATOC) and 18 F-fluorodeoxyglucose ([ 18 F]FDG).Twelve patients with histologically proven GEP-NET (3xG1, 4xG2, 5xG3) underwent [ 68 Ga]DOTATOC, [ 18 F]FDG, and [ 68 Ga]Pentixafor PET/CT for staging and planning of the therapeutic management.Scans were analyzed on a patient as well as on a lesion basis and compared to immunohistochemical staining patterns of CXCR4 and somatostatin receptors SSTR2a and SSTR5.[ 68 Ga]Pentixafor visualized tumor lesions in 6/12 subjects, whereas [ 18 F]FDG revealed sites of disease in 10/12 and [ 68 Ga]DOTATOC in 11/12 patients, respectively.Regarding sensitivity, SSTR-directed PET was the superior imaging modality in all G1 and G2 NET.CXCR4-directed PET was negative in all G1 NET.In contrast, 50% of G2 and 80% of G3 patients exhibited [ 68 Ga]Pentixafor-positive tumor lesions.Whereas CXCR4 seems to play only a limited role in detecting well-differentiated NET, increasing receptor expression could be non-invasively observed with increasing tumor grade.Thus, [ 68 Ga]Pentixafor PET/CT might serve as non-invasive read-out for evaluating the possibility of CXCR4-directed endoradiotherapy in advanced dedifferentiated SSTR-negative tumors.
대한간학회 제 8 차 춘계학술대회 초록집 / 포스터 전시 : 사산과 관련된 원발성 담즙성 간경변증 1 예
Authors: 오길찬, 박상훈, 임해성, 송진영, 박철희, 한태호, 박현주, 이동근, 김종혁, 박충기, 박혜림
Journal: Clinical and Molecular Hepatology (2002)
An intervention to reduce sexual violence on university campus in Ghana: a pilot test of Relationship Tidbits at the University of Cape Coast
Authors: Sarah Rominski, Eugene Darteh, Michelle Munro-Kramer
Journal: The Lancet Global Health (2017)

BackgroundSexual assault is a significant challenge for universities worldwide, affecting the health and academic success of students. Although sexual violence prevention programmes are common at universities in the USA, they are non-existent in Ghana. In this study, we tested an adapted sexual violence prevention programme in students at the University of Cape Coast (UCC), Ghana.MethodsWe adapted a sexual violence prevention programme created at the University of Michigan, USA, for use at UCC, Ghana. In February, 2016, we ran focus-group discussions that contributed to the initial adaptation to create a programmed called Relationship Tidbits. In April, 2016, we tested the adapted programme with UCC students. We recruited participants for the beta testing from their halls of residence and via snowball sampling. Students interacted with the programme in small groups of six participants and were encouraged to think aloud and ask questions. Participants completed a pre-programme and post-programme survey that included demographic information and measures of attitudes towards sexual violence and gender equity that had been previously validated for UCC using cognitive interview techniques. These measures are the Illinois Rape Myth Acceptance (IRMA) scale, the Gender Equitable Men (GEM) scale, and the Sexual Relationship Power Scale [SRPS]. We used paired samples t-tests to compare pre-programme and post-programme results.Findings71 students—36 men and 35 women with a mean age of 22·9 years (SD 4·7 years)—participated in the programme and testing. Male participants showed improvements in several measures including an increase in the overall mean IRMA scale score (from 60·1 (SD 13·1) to 73·4 (18·3); p<0·0001) as well as the "she asked for it" (p<0·0001), "he didn't mean to" (p=0·004), and "she lied" (p=0·001) subscales. Men also showed an increase in mean GEM score (from 54·5 to 59·5; p=0·011), suggesting more gender equitable attitudes after the training, as well as increases in the violence and reproductive health and disease prevention domains of the GEM (p=0·004 and p=0·021, respectively). Scores for female participants did not change significantly after the programme.InterpretationOur preliminary findings suggest that the adapted programme for university students could change attitudes that are known to be associated with the perpetration of sexual violence. Because rape myth acceptance is common in this setting, the reduction in rape myth acceptance in men is important. Future work will include a more rigorous evaluation of the outcomes of this programme with respect to sexual violence attitudes and behaviours.FundingNone.
Association of topotecan with improved performance status (PS) in relapsed small cell lung cancer (SCLC) patients with poor PS at baseline
Authors: J. Levin, R. C. Lilenbaum, G. A. Masters, S. R. Lane, J. Treat
Journal: Journal of Clinical Oncology (2004)

7208 Background: Topotecan is approved for the treatment of patients with relapsed SCLC and is the only single agent proven in randomized clinical trials to provide symptom palliation in these patients. Previous data have demonstrated that topotecan provides improvement even in patients with poor PS (PS=2). In this analysis, we investigated whether treatment with topotecan is associated with an improvement in PS assessed by the frequency of conversion from PS 2 to PS 0/1. Methods: A retrospective analysis of data from 5 clinical trials (N = 479) investigating topotecan in relapsed SCLC patients was performed. A total of 98 patients with PS 2 at baseline were included. All patients received topotecan 1.5 mg/m2/day on days 1 through 5 of a 21-day course. Results: Sixty-six patients had disease sensitive to first-line chemotherapy, and 32 patients were chemoresistant. A total of 341 courses of therapy were administered in patients with PS 2 (median, 2; range, 1 to 14 courses). Of the 98 PS 2 patients, 32 (33%) experienced PS improvement to PS 0/1 during topotecan treatment. Approximately two thirds of these patients converted to PS 0/1 after the first course of topotecan, and the improvement in PS persisted for at least 2 courses in 24 of the 32 patients. Overall antitumor response to topotecan was 46% in patients who experienced PS conversion compared with 8% in patients who had no improvement. Similarly, median overall survival in patients with PS improvement was 37 weeks (95% CI = 30, 45 weeks), compared with 12 weeks (95% CI = 9, 16 weeks) in patients with no improvement. Conclusions: A significant proportion of patients with poor PS at baseline experience PS improvement after treatment with topotecan. This may also be associated with a survival benefit. Improvement in PS seems to be an early surrogate for benefit from topotecan. Based on this analysis, a substantial proportion of patients with relapsed SCLC and PS 2 experience an improvement in PS and should not be denied treatment with topotecan. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration GlaxoSmithKline GlaxoSmithKline GlaxoSmithKline Bristol-Myers Squibb Oncology; GlaxoSmithKline GlaxoSmithKline
Phase II study of thalidomide and daily cyclophosphamide for adults with malignant glioma
Authors: A. Desjardins, J. A. Quinn, D. A. Reardon, J. N. Rich, J. J. Vredenburgh, C. Efird, H. S. Friedman
Journal: Journal of Clinical Oncology (2004)

1554 Background: We performed a phase II study to determine the activity and toxicity of thalidomide plus daily cyclophosphamide in patients with recurrent anaplastic astrocytomas (AA) and anaplastic oligodendrogliomas (AO). Methods: Eligibility: adult patients with AA or AO in first relapse with measurable disease; interval of at least 3 weeks between surgical resection or 6 weeks between radiotherapy or chemotherapy; Karnofsky ≥ 60%; negative pregnancy test; and adequate marrow, renal, and hepatic function. Thalidomide was begun at 100 mg at bedtime and increased by 100 mg weekly to a maximum dose of 400 mg. Cyclophosphamide was administered at 100 mg daily. Responses were assessed every eight weeks and patients remained on study for up to one year or until disease progression or unacceptable toxicity. Results: To date, 11 patients with recurrent AA (n = 10) or AO (n=1) have been enrolled (planned accrual=30). Median age is 38 years (range: 27 to 51). All patients received prior radiation therapy and chemotherapy (median: 2, range: 1 to 3). Grade 3 or greater toxicities included neutropenia (grade 3, n=3; grade 4, n=2), and hyponatremia (grade 3, n=1). Responses include one complete and one partial, both of these patients completed one year of treatment and remain off therapy with no evidence of disease progression. One patient achieved stable disease and is in the 21st week of therapy. Five patients progressed after cycle one. Two patients are too early for evaluation and one patient died of intratumoral hemorrhage after six days on protocol. Conclusions: Thalidomide plus daily cyclophosphamide demonstrates encouraging activity and is well tolerated among patients with recurrent AA or AO. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Celgene
A multicenter phase II study of capecitabine plus oxaliplatin (CapOx) in advanced biliary system adenocarcinomas
Authors: O. Nehls, H. Oettle, J.-T. Hartmann, R. Hofheinz, A. Hochhaus, M. Makowski, D. Arnold, C. Burkart, M. Gregor, B. Klump
Journal: Journal of Clinical Oncology (2004)

4091 Background: To evaluate the feasibility of capecitabine and oxaliplatin combination therapy (CapOx) in unresectable or metastatic adenocarcinomas of the biliary system. Patients and methods: 56 pts (25M, 31F) were included (median age, 63 yrs). Major eligibility: histologic proven, measurable disease, age 18–75 yrs, ECOG PS 0–2. A total number of 250 cycles (median: 5; range 1–16) of oxaliplatin (130 mg/m2, d1) plus capecitabine (2000 mg/m2, d 1–14) were administered 3 weekly for gallbladder carcinoma (GBC) (20 pts), extrahepatic (20 pts), and intrahepatic (16 pts) cholangiocarcinoma (CCC). Pts were assessed for response according to WHO standard criteria. Clinical outcome was determined separately for pts with either GBC/extrahepatic CCC or intrahepatic CCC (mass-forming type), because these two distinct presentations have been supposed to differ substantially from each other according to clinical behaviour. Results: Grade 4 toxicities (WHO) were diarrhea in 1 pt (1% of cycles), thrombocytopenia in 1 pt (1%), leukopenia in 1 pt (1%), and fever in 2 pts (1%); grade 3 toxicities were: diarrhea in 2 pts (1%), thrombocytopenia in 3 pts (2%), and fever in 1 pt (1%). Grade 3/4 peripheral sensory neuropathy (Lévis scale) was found in 10 pts (15%). Two pts were removed from study due to oxaliplatin-related allergic reactions. One patient harboring intrahepatic CCC died with septic shock after the first treatment cycle. On 31 evaluable pts with GBC or extrahepatic CCC the response-rate was as follows: complete response (CR), 2 pts (6% of the pts); partial response (PR), 7 pts (23%); stable disease (NC) 15 pts (48%). Thus, the overall disease control rate (CR + PR + NC) was 77%, whereas 7 pts (23%) had progressive disease (PD). In contrast, in 16 evaluable pts with intrahepatic mass-forming CCC no CR or PR was observed, but 4 pts (25%) were found to have NC, and in 12 pts (75%) PD was encountered. Conclusions: Our preliminary data suggest the CapOx regimen to be well tolerable and highly active for advanced GBC and extrahepatic CCC (disease-control rate: 77%), whereas outcome might be poorer in intrahepatic CCC. Survival data will be presented at the meeting. No significant financial relationships to disclose.
Daratumumab (anti-CD38) induces loss of CD38 on red blood cells
Authors: Harold C. Sullivan, Christian Gerner-Smidt, Ajay K. Nooka, Connie M. Arthur, Louisa Thompson, Amanda Mener, Seema R. Patel, Marianne Yee, Ross M. Fasano, Cassandra D. Josephson, Richard M. Kaufman, John D. Roback, Sagar Lonial, Sean R. Stowell
Journal: Blood (2017)
Influence of cognitive behavioral therapy for insomnia (CBT-I) on quality of life (QOL) in cancer survivors.
Authors: Anita Roselyn Peoples, Charles E Heckler, Charles Stewart Kamen, Michelle Christine Janelsins, Luke Joseph Peppone, Karen Michelle Mustian, Gary R. Morrow, Joseph A. Roscoe
Journal: Journal of Clinical Oncology (2015)

e20743 Background: Cancer and its treatments produce a myriad of adverse side effects, resulting in diminished QOL that can affect survival. Poor sleep quality is significantly correlated with diminished QOL in cancer survivors, allowing for the possibility that improvement in sleep quality may improve QOL. We performed secondary analyses from a 4-arm RCT examining CBT-I with and without armodafinil, compared to armodafinil alone and placebo alone, for management of insomnia in cancer survivors. Herein, we examine the association of QOL with sleep quality and CBT-I over time. Methods: Analyses, collapsing across the armodafinil vs. placebo condition, were performed on 69 cancer survivors (mean age 56, 90% female, 70% breast cancer). QOL was assessed by the Functional Assessment of Cancer Therapy-General (FACT-G, higher is better) and sleep quality by the Pittsburgh Sleep Quality Inventory (PSQI, lower is better) and sleep diary (SD, 1-4 scale, higher is better), prior to the 7-week CBT-I intervention (baseline), at post intervention, and three months later (follow-up). Simple change scores from baseline to post and baseline to follow-up were calculated for all measures for patients who did (N = 36) or did not (N = 33) receive CBT-I. Pearson’s correlations and ANCOVA were performed. Results: For patients receiving CBT-I, mean scores at baseline, post and follow-up were: FACT-G: 80.3, 90.6 and 92.8; PSQI: 10.9, 4.5 and 4.1; SD: 2.1, 2.8 and 2.8. Corresponding scores for patients not receiving CBT-I were: FACT-G: 77.0, 78.7 and 78.3; PSQI: 12.3, 9.1 and 9.6; SD: 2.1, 2.2 and 2.2. Change scores in QOL were significantly associated with concurrent changes in sleep quality (PSQI: R’s = -0.40 and -0.41; both P’s ≤ 0.005 and SD: R’s = 0.31 and 0.50; both P’s ≤ 0.05). ANCOVA controlling for scores at baseline showed significantly better scores in all three measures at post and follow-up in the CBT-I group compared to non-CBT-I group (all P’s ≤ 0.005). Conclusions: In cancer survivors with insomnia, changes in QOL over time are associated with concurrent changes in sleep quality, and CBT-I improves both sleep quality and QOL. Funding: NCI grants R01CA126968 and R25CA10618. Study medication was provided by Teva Pharmaceuticals USA. Clinical trial information: NCT01091974.
Cancer penetrance of Lynch syndrome for <i>MSH2 A636P</i> mutation carriers
Authors: V. Moreno, G. Rennert, S. B. Gruber
Journal: Journal of Clinical Oncology (2007)

10528 Background: Mutations in mismatch repair genes are responsible for Lynch syndrome. Estimating the penetrance of cancer related to MSH2 A636P, a founder mutation identified in Ashkenazi Jewish population, has clinical implications. Methods: The mutation was genotyped in all subjects of the MECC study, a population-based case-control study carried out in North Israel during 1998–2004 that included 2,112 cases of pathology-confirmed colorectal cancer (CRC) and 2,060 population controls. Approximately 50% of the subjects were of Ashkenazi Jewish origin. Family history of cancer (among first and second degree relatives) was obtained by personal interview. Penetrance of MSH2 A636P was estimated from relatives using a kin-cohort approach by the marginal maximum likelihood method, estimating cumulative risk among carriers and noncarriers. Results: Thirteen MSH2 A636P carriers were identified, all among CRC cases. Their relatives formed a cohort of 138 subjects contributing 8,802 person years (py); 14 of 138 had CRC (173 per 100,000) and 5 endometrial cancer (112 per 100,000). The cohort of relatives of noncarriers summed 46,257 subjects contributing 2.8M py; 582 had CRC (20 per 100,000) and 142 endometrial cancer (EC)(10 per 100,000). For carriers, the cumulative risk to age 70 of CRC was 0.44 (0.19–0.90) and that of EC was 0.29 (0–0.84). The cumulative risk of any cancer related with Lynch syndrome was 0.66 (0.47–0.93). These estimates of penetrance were not substantially modified if the cohorts were restricted to first degree relatives, to Ashkenazi Jews, or when relatives of controls were excluded. Compared to noncarriers, the hazard ratios were 28.7 (2.8–112) for CRC, 9.1 (0–181) for EC and 19 (6.4–50) for Lynch syndrome cancers. Conclusions: The MSH2 A636P missense mutation is highly penetrant, with a cumulative risk of cancers related to Lynch syndrome that is similar to other truncating mutations in mismatch repair genes. These results have implications for the tailored management of patients with this Ashkenazi founder mutation. No significant financial relationships to disclose.
Elderly patients with resected stage II, IIIA non-small cell lung cancer, increased referral rate to medical oncologists, 1992-2002
Authors: J. Wang, Y. Kuo, J. L. Freeman, J. S. Goodwin
Journal: Journal of Clinical Oncology (2007)

18002 Background: Resectable non-small-cell lung cancer (NSCLC) has been once considered as a surgical disease and therefore managed by surgeons alone, as the primary therapeutic option was surgical resection. However, it is now widely accepted that the optimal care for NSCLC requires a multidisciplinary care approach between surgeons, radiation oncologists and medical oncologists. Methods: Using data from the Surveillance, Epidemiology, and End Results (SEER) Program, we identified 3266 patients over 66 years with Stage II, IIIA NSCLC who underwent resection between 1992 and 2002. We examined the trend of medical oncology referral, indentified the predictors associated with medical oncology referral and subsequent use of adjuvant chemotherapy. Results: From 1992 to 2002, 1562 patients (47.8%) with resected stage II, IIIA NSCLC were referred to the medical oncologists; there was a steady rising trend in the proportion of the patients referral to medical oncology over the ten year period. The medical oncology referral rate increased from 26.9% in 1992 to 60.5% in 2002 (P&lt;0.001). This change has paralleled to a rising trend in use of adjuvant chemotherapy in same population during same period. Among those seen by oncologists, 518 (33.2%) of patients received adjuvant chemotherapy. Female, white race, younger age, advanced tumor stage, adenocarcinoma, later year of diagnosis and being married were strong predictors to be seen by a medical oncologist. Patients older than 70 years of age, African American race and living in certain SEER geographic region were less likely to be referred to medical oncologists. Patients who had a medical oncology consultation were more likely to receive adjuvant chemotherapy (adjusted odds ratio [OR], 5.14; 95% CI, 4.11 to 6.43). Conclusions: The medical oncology referral rate doubled during last decade. Access to medical oncology consultation is linked to the use of adjuvant chemotherapy in the patients with resected Stage II, IIIA NSCLC. The steady increase in referral to medical oncologists paralleled an increase in the use of adjuvant chemotherapy. This changing pattern of medical oncology referral may mirror the changing attitude and perception towards to the benefits of adjuvant chemotherapy in the community. No significant financial relationships to disclose.