tbuckley/cabot-search huggingface dataset:
30 day readmissions in cancer patients in United States.
Authors: Kathan Mehta, Bruce Lee Jacobs, Keyur Patel, Hong Wang, Leonard Joseph Appleman, Rahul Atul Parikh
Journal: Journal of Clinical Oncology (2016)

6577 Background: National estimates of 30 day readmissions in cancer patients in US are unknown. Objective of our study was to identify 30 day readmission rates, predictors of readmissions and economic impact of readmissions. Methods: We used National Readmission Dataset (NRD - year 2013), an all payer dataset designed to generate national estimates for readmission analysis published by Healthcare Cost and Utilization Project (HCUP). The patients with all types of cancers were identified by ICD9 diagnosis codes. All cause unplanned 30 day readmission rates were calculated for patients admitted between January and November 2013 by excluding elective readmissions. The independent predictors of unplanned 30 day readmissions were identified by logistic regression adjusting for stratified cluster design of NRD. Cost of readmission was calculated by multiplying total charges with cost to charge ratio provided by HCUP. Results: The NRD contained 1,460,576 unique cancer patients with 2,503,052 admissions (weighted N = 5,742,184) in 2013. After excluding elective readmissions, the all cause 30 day readmission rate was 20.2%. The top causes of unplanned readmissions were septicemia (8.5%), complication of surgical procedures or medical care (5.0%), congestive heart failure (4.6%), pneumonia (4.1%) and complication of device or graft (3.3%). The multivariate predictors for higher 30 day unplanned readmissions were charlson comorbidity index (OR 1.11, p < 0.01), hematologic cancers (OR 1.13, p < 0.01), chemotherapy (OR 1.51, p < 0.01), radiation (OR 1.25, p < 0.01), blood transfusion (OR 1.4, p < 0.01), discharge to other facility (OR 1.21, p < 0.01) and home health care (OR 1.25, p < 0.01). The multivariate predictors for lower 30 day unplanned readmissions were age (OR 0.99, p < 0.01), female sex (OR 0.92, p < 0.01), elective admission (OR 0.65, p < 0.01) and operating procedure (OR 0.68, p < 0.01). Total cost of unplanned 30 day readmissions in cancer patients was $14.4 billion for 2013. Conclusions: Unplanned 30 day readmission rates are high in cancer patients. Further research is needed to identify preventable readmissions and strategies to reduce readmissions in cancer patients. Reduction in readmissions in cancer patients may lower economic burden on healthcare system.
Cost comparison of surveillance for HPV-positive versus HPV-negative oropharyngeal cancer.
Authors: Eugenie Du, Jennifer Spencer, Mark Christian Weissler, Bhishamjit S. Chera
Journal: Journal of Clinical Oncology (2018)

e18908 Background: The rise of human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) is changing current treatment paradigms. While significant efforts have been directed at treatment de-intensification and risk stratification, few have re-examined current surveillance strategies and none, to our knowledge, from a cost perspective. This study aims to compare cost per recurrence or distant metastasis detected between HPV negative and HPV positive OPSCC. Methods: A Markov transition model was created to model the National Comprehensive Cancer Network (NCCN) surveillance recommendations with a five-year time horizon from a Medicare perspective. Probabilities of detecting clinical recurrence for HPV negative and HPV positive OPSCC were derived from published literature. A standard discounting rate of 3% was used. Costs data was derived from the 4th edition of the Center for Medicare and Medical Services Fee Schedule. A theoretical cohort of 16,400 HPV-positive OPSCC and 6,500 HPV-negative OPSCC patients treated with in the United States was used. Results: The cost of surveillance of our theoretical cohort over the first five years post-treatment is $142,331,259 ($122,526,531 for HPV positive OPSCC and $37,796,725 for HPV negative OPSCC). Each HPV positive recurrence detected costs $24,708 as compared to $11,337 for each HPV negative recurrence identified. Each distant metastasis diagnosed costs $10,523 in HPV positive disease compared to $8,658 in HPV negative disease. Deterministic sensitivity analyses varying cost of work-up, effectiveness of salvage treatment, and starting case mix did not significantly vary the cost differential between HPV positive and HPV negative disease. Conclusions: It costs twice as much to identify an HPV positive recurrence as it does for HPV negative disease. It is also more expensive to identify each distant metastasis in this subgroup. Furthermore, risk of second primaries as well as recurrence patterns differ significantly between HPV positive and HPV negative OPSCC patients. Our current surveillance paradigm is not well-tailored to HPV positive OPSCC and an alternative schedule should be considered and assessed.
TCT-49 Transformational Pathways for AMI Management in Developing Countries - Rolling 600,000 Remote Patient Encounters to D2B Interventions
Authors: Sameer Mehta, Roberto Botelho, Francisco Fernandez, Mauricio Prudente, Ricardo Cavalcanti, Jamil Cade, Cesar Dusilek, Fausto Feres, Alexandre Abizaid, Marco Alcocer-Gamba, Alfredo Estrada, Mario Torres, Daniel Rodriguez, Lucas Lauar Cortizo Vidal, Daniel Vieira
Journal: Journal of the American College of Cardiology (2018)
Results of clinical study of induction chemoimmunotherapy (iCIT) in patients (pts) with non-small cell lung cancer (NSCLC).
Authors: Yuriy N. Lazutin, Oleg Ivanovich Kit, Igor N. Turkin, Anna Pavlovna Kharitonova, Liubov Yu Vladimirova, Gennadiy Z. Sergostyants, Sergey P. Pyltsin, Anna V. Chubaryan, Tamara G. Ayrapetova, Pavel A. Anistratov, Igor A. Leyman
Journal: Journal of Clinical Oncology (2016)

8530 Background: Induction chemotherapy (iCT) for NSCLC has potential advantages over adjuvant CT, high therapeutic compliance, the ability to influence the primary tumor and metastatic disease. Standard approaches to iCT improving are largely exhausted. However, the development of iCIT techniques using recombinant cytokines and assessment of the effectiveness of its clinical application remains poorly understood. Methods: Clinical trial included 65 pts. with stage IIB, IIIA (N2), IIIB (T4 ipsi. nod.) NSCLC, randomized in main (n = 33) and control (n = 32) groups with comparable clinical and pathological characteristics: m 23 (69.7) vs. 23 (71.8%), W 10 (30,3%) vs. 9 (28.2%); stage IIB - 8 (24.4%) vs. 9 (28.6%), IIIA - 22 (66.6%) vs. 19 (59.4%), IIIB - 3 (9%) vs. 4 (12.5%); median age 58.4 vs 57.8. Pts. of the control group received 2 iCT cycles: cisplatin 75 mg / m2 i.v. 1 day and gemcitabine 1000 mg / m2 i. v. 1 and 8 days; pts. of the main group additionally received recombinant tumor necrosis factor coupled with thymosin (TNF-T Farmaclon Russia) 50. 000 ED / m2i.v. 3, 5 and 7 days of the cycle. The direct results were evaluated 3 weeks after completion of induction. Pts. who underwent radical surgery received 2 cycles of platinum-based adjuvant CT. DFS was studied by the method of Kaplan-Meier. Results: 90% of pts. in the main group completed еherapy, in the control- 87%. The overall response rate was 73.3% in main and 46.4% in the control group (p = .063): CR-3 (10%) vs. 1 (3.6%), PR- 19 (63.3 %) vs. 12 (42.8%), SD-7 (23.3%) vs. 13 (43.3%), PD-1 (3.3%) vs. 2 (7.1%). Surgery was performed for 29 (87.8%) patients of the main group and 26 (81%) of the control group. Squamous cell carcinoma-13 (44.2%) vs.14 (53.8%), adenocarcinoma 16 (55.2%) vs.12 (46.2%). With a median follow-up of 16.8 months. The median survival in the control group was 23 months, in the main group is not reached. 2-year DFS in the main group was 71% compared with control 45% (log rank test; p = .05421). Conclusions: Clinical trial of the effectiveness of iCIT with using immune drug TNF-T demonstrated a pronounced tendency to improve 2-year DFS, which favors further studies on a larger number of pts.
Promising activity of nelfinavir-bortezomib-dexamethasone in proteasome inhibitor–refractory multiple myeloma
Authors: Christoph Driessen, Rouven Müller, Urban Novak, Nathan Cantoni, Daniel Betticher, Nicolas Mach, Axel Rüfer, Ulrich Mey, Panagiotis Samaras, Karin Ribi, Lenka Besse, Andrej Besse, Catherine Berset, Stephanie Rondeau, Hanne Hawle, Felicitas Hitz, Thomas Pabst, Thilo Zander
Journal: Blood (2018)
Number needed to treat (NNT) and cost of preventing an event (COPE) of PD-1/PD-L1 antibodies for previously treated advanced non-small cell lung cancer (NSCLC) patients in Brazil.
Authors: Fernanda Oliveira, Joao PsDN Lima
Journal: Journal of Clinical Oncology (2018)

e18899 Background: We estimated the cost of one extra NSCLC patient alive at 12 and 24 month under Brazilian-approved second-line PD-1/PD-L1 therapy (nivolumab [Nivo], pembrolizumab [Pemb] or atezolizumab [Atezo]) compared to standard chemotherapy under Brazilian supplementary health system perspective. Methods: We used the NNT and cost of preventing an event (COPE), here death, to reach our results. NNT is the inverse of the absolute risk reduction of an intervention versus control.COPE is the NNT multiplied by the treatment costs, hence the lower the COPE the more cost-efficient the intervention. The absolute risk reductions for overall survival were extracted from published randomized trials (ChekMate 017, CheckMate 057, KEYNOTE 010, and OAK). The median progression-free survival (PFS) was used as surrogate for the treatment duration. Treatment costs (US dollars) were based on dosage and administration as per product label, restricted to drug costs within the 2017 Brazilian market prices. Results: Main findings are summarized in the table below. The median PFS of all drugs in all scenarios ranged from 2.3 months to 4.2 months. The COPEs varied considerably with 12 month COPE for > 1% PD-L1+ patients ranging from $155,509 with nivo to $450,056 with pemb (180% variation). For 24 month, the COPE for all comers ranged from $160,951 with nivo to $347,351 with atezo (72% variation). Conclusions: The COPE approach can provide initial guidance on cost comparisons of different technologies. Third-party payers may find these results helpful to optimize resource allocation and increase efficiency. Patients should also be involved in this discussion to provide a comprehensive view of costs and relevant outcomes. Nivo Non-squamous Nivo Non-squamous PD-L1 ≥1% Nivo Squamous Nivo Squamous PD-L1 ≥1% Pemb PD-L1 ≥1% Atezo Atezo PD-L1 ≥1% 12 month overall survival NNT 8.3 4.1 5.6 8.5 11.6 7.1 6.7 12 month COPE USD 174,364 155,509 176,891 268,496 450,056 199,392 185,495 24 month overall survival NNT 7.7 5.0 6.7 8.5 6.4 10 12.5 24 month COPE USD 160,951 191,097 212,270 268,496 248,107 277,880 347,351
Radiation for bone metastases: Reconsidering the optimal timing.
Authors: Joanna C. Yang, Brittany Hsu, Abraham Jing-Ching Wu, Zachary Kohutek, T. Jonathan Yang
Journal: Journal of Clinical Oncology (2017)

10122 Background: Bone metastases impair function and decrease quality of life due to acute or chronic pain. The standard approach for patients with multiple bone metastases is systemic therapy and palliative radiation therapy (RT) when the metastases become symptomatic. This study aims to understand the characteristics and outcomes for inpatients admitted for painful bone metastases. Methods: An inpatient radiation oncology consult registry was created in 2015 to evaluate patterns of care for patients receiving RT in the inpatient setting. Of the 1151 consults requested between 7/2015 and 6/2016, 28% (n = 323) were for evaluation of symptomatic bone metastases in patients who were hospitalized for acute or chronic pain. Among this cohort, 64% (n = 208) went on to receive RT for 225 bone metastases. Sixty percent of RT courses were initiated while the patient was hospitalized. Clinical characteristics correlated with overall survival (OS) were evaluated through Cox regression analysis. Results: The median follow up for the 208 patients who received RT was 4 months (0.1-9 months). Patient median age was 61 (10-92 years), and the median KPS was 70 (20-90). The most common sites treated were spine (50%), joints such as hip and shoulder (11%), long bones including femur and humerus (11%), and pelvis (10%). Sixty-one percent (n = 138) of the treated metastases were diagnosed ≥4 months prior to RT. The median survival after receiving palliative RT was 4 months (0-19 months). Among the 141 patients who had died at the time of analysis, 92 (65%) died within 2 months, and 128 (91%) within 6 months. Eighteen patients (9%) discontinued RT to transition to hospice care. OS after RT is significantly correlated with KPS (p &lt; 0.0001) at the time of consult but not with patient age or site of treated disease. Conclusions: In this select group of inpatients who were evaluated for palliation of symptomatic bone metastases, we found a short OS after RT. The majority of metastases were present for ≥4 months prior to RT. This study suggests that earlier RT for high-risk metastases should be considered to prevent development of symptomatic disease that requires hospitalization. Risk factors for development of painful bone metastases are being studied prospectively at our institution.
The prevalence of germline mutations in Chinese colorectal cancer patients with mismatch repair deficiency.
Authors: Ying Yuan, Lizhen Zhu, Dong Xu, Ju Haixing, Yan Sun, Pei-Rong Ding, Jian Dong, Chengliu Liu, Lin Wang, Xianli Yin, Baoping Wu, Meng Qin, Xiefu Zhang, Xinru Mao, Wei Yan
Journal: Journal of Clinical Oncology (2018)

e13518 Background: Mismatch repair deficiency (dMMR) assessed by microsatellite instability (MSI) or immunohistochemistry (IHC) is a feature of Lynch syndrome, a major hereditary colorectal cancer (CRC). Chinese Lynch syndrome criteria was proposed based on the decreasing family numbers: In a pedigree, it should have at least 2 CRCs, and at least 2 of them are first-degree relatives of each other. Besides, any one of following criteria should be met: 1) at least 1 CRC should have multiple primary synchronous/metachronous colorectal carcinoma/adenoma; 2) at least 1 CRC should be diagnosed before 50 years old; 3) in the pedigree, at least 1 should be diagnosed with other Lynch syndrome-related cancer (i.e. gastric, endometrial, small bowel, ureter, or renal-pelvic, ovarian and hepatobiliary cancers). The purpose of this multi-center study is to derive prevalence of germline mutations in Chinese dMMR CRC, especially taking different screen criteria for Lynch syndrome into consideration. Methods: ColonCore panel is designed for simultaneous detection of MSI and mutations in 41 CRC-related genes by next generation sequencing (NGS). Primary CRC patients with loss of expression of any one of four MMR proteins (MLH1, MSH2, MSH6 and PMS2) in IHC were recruited. DNA was extracted from paired tumor-normal tissue for MSI detection and germline and somatic sequencing by ColonCore panel. Results: A total of 205 patients were enrolled. The MSI detection by NGS achieved 94% concordance with IHC. We revealed 32% patients had pathogenic germline mutations, with 14%, 7%, 5%, 2% and 3% patients carrying MLH1, MSH2, MSH6, PMS2 and other gene mutations respectively. Among all 205 patients, 7%, 12% and 42% patients met Amsterdam II criteria, Chinese Lynch syndrome criteria and revised Bethesda Guidelines respectively. Besides, 100%, 80% and 53% patients had pathogenic mutations and 27%, 24% and 15% patients with pathogenic germline mutations were missed according to Amsterdam II criteria, Chinese Lynch syndrome criteria and revised Bethesda Guidelines respectively. Conclusions: We found that 32% IHC dMMR CRCs have pathogenic germline mutations, and Chinese Lynch syndrome criteria is an effective screening criteria.
Dose dense neoadjuvant chemotherapy (NACT) with carboplatin-paclitaxel in locally advanced cervical cancer.
Authors: Domenica Lorusso, Ilaria Sabatucci, Giuseppa Maltese, Stefano Lepori, Elisa Tripodi, Giorgio Bogani, Umberto Leone Roberti Maggiore, Antonino Ditto, Fabio Martinelli, Diego Rossetti, Francesco Raspagliesi
Journal: Journal of Clinical Oncology (2018)

5534 Background: NACT followed by radical surgery is considered a valid therapeutic approach in locally advanced cervical cancer (LACC). The standard neoadjuvant treatment has not yet been identified. The most widely used regimen is the TIP (Cisplatin-Paclitaxel-Ifosfamide) combination which is effective but highly toxic. The aim of the study is to evaluate clinical (CR) and pathologic (PR) response to carboplatin-paclitaxel dose dense regimen as NACT in LACC. Methods: Consecutive patients with stage FIGO IB2-IIB were prospectively enrolled and treated with 3 cycles of neoadjuvant Carboplatin (AUC5) d1 and Paclitaxel (80 mg/m2) d1, 8, 15 q21 chemotherapy. After 4 weeks from completion of NACT, patients were submitted to radical hysterectomy and pelvic lymphoadenectomy. Abdomino-pelvic MRI and gynaecological evaluation were performed at baseline and after 3 cycles in order to evaluate CR. PR was defined as follows: PR0: no residual disease, PR1: residual disease ≤ 3 mm stromal invasion, PR2: residual disease > 3 mm. A two-stage optimal Simon design was applied in order to detect a 60% of PR0+PR1: if at least 7 responses were registered among the first 16 patients, the trial would continue the enrolment. Results: 67 patients were enrolled in 40 months. After the enrollment of the first 16 patients, at least 7 responses were detected, so the trial proceed to the second step of enrolment. 11 patients (16%) went out from the study because of allergic reaction to the first paclitaxel administration and were not evaluable. 4 of the 56 patients experienced stable or progression disease and did not underwent surgery. The only grade 3-4 registered toxicity was neutropoenia in 10.7% of patients. Patients characteristics and responses are reported in the table below. Conclusions: Combination of dose dense Carboplatin-paclitaxel resulted in encouraging clinical and pathologic responses and in a favourable toxicity profile. This scheme merits further evaluation in randomized clinical trials versus TIP. Patients characteristics. N° % FIGO STAGE: IB2 19 28 IIA 15 23 IIB 33 49 GRADING: G3 39 58 HISTOTYPE: SQUAMOUS 10 15 ADENOCARCINOMA 57 85 CLINICAL RESPONSE: CR 10 18 PR 42 75 SD 1 2 PD 3 5 PATHOLOGIC RESPONSE: PR0 14 27 PR1 10 19 PR2 28 54
Anti-VEGF treatment to modulate tumor microenvironment (TME) prior to chemotherapy in EBV-positive nasopharyngeal carcinoma (NPC).
Authors: Wan Qin Chong, Chee Seng Tan, Chwee-Ming Lim, Woei Shyang Loh, Kwok Seng Loh, Yaw Chyn Lim, Siew Meng Chong, Ling-Zhi Wang, Samantha Tan, Gloria Chan, Yiqing Huang, Soo-Chin Lee, Boon C. Goh
Journal: Journal of Clinical Oncology (2018)

6030 Background: EBV-related NPC is chemosensitive but stage 4 disease has high relapse rate and short progression free survival (PFS). Almost all NPCs overexpress VEGF.We hypothesized that anti-VEGF (bevacizumab) prior to chemotherapy could promote vascular normalisation, improve tumor perfusion, and enhance immune response in NPC. Methods: We conducted a study using bevacizumab in 2 doses, 7.5mg/kg (Arm A) or 2.5mg/kg (Arm B), starting 7 days prior to 3 weekly cycle of cisplatin 75mg/m2 (Day 1) and gemcitabine 1g/m2 (D1, D8), for 3 cycles followed by concurrent chemo-radiotherapy in stage 4A/B (locally advanced) patients, and for 6 cycles in stage 4C (metastatic) patients, with the primary objectives to determine safety and response rate (RR), and secondary objectives to evaluate PFS and effects on the TME. Immunohistochemistry studies were performed by a blinded pathologist on serial fresh tumor biopsies at baseline and 7 days post cycle 1 bevacizumab. Results: 20 patients were recruited to Arm A, and 10 to Arm B. 1 screen failed and 2 withdrew consent. Objective RECIST response was seen in arm A (17/18 [94.4%] partial response (PR), 1/18 [5.6%] stable disease (SD)), vs arm B (8/9 [88.9%] PR, 1/9 SD [11.1%]). Metabolic PET-CT response was seen in all 25 evaluable patients with complete response in 4/17 [23.5%] patients in arm A. EBV DNA was detectable in 17 patients at baseline, and 12 patients had undetectable plasma EBV DNA by day 1 of cycle 2. 9/13 (69.2%) in arm A vs 1/4 (25%) in arm B had undetectable plasma EBV DNA post treatment. TME response to bevacizumab included increase in stromal inflammatory infiltrate, specifically CD4 (p = 0.0002) and CD8 T cells (p = 0.0069), and reduction in hyaluronic acid binding protein score (p = 0.0116), indicating increased vascular permeability within the TME. 3 patients had grade 3 hypertension and no patients had tumoral bleed related to bevacizumab use. Conclusions: In this first evaluation of bevacizumab prior to chemotherapy for NPC, tolerability and efficacy was established, and bevacizumab enhances stromal immune infiltration, and modulates TME, potentially improving vascular permeability. Clinical trial information: 2010/00693.
Treatment patterns of metastatic colorectal cancer (mCRC) in commercially-insured populations in Washington state.
Authors: Jeremy Williams Snider, Catherine R. Fedorenko, Greg S Warnick, Jordan Steelquist, Ed Wang, Sibyl Anderson, Scott David Ramsey, Veena Shankaran
Journal: Journal of Clinical Oncology (2017)

e15011 Background: Few studies have examined patterns of care relating to guideline-recommended therapies for metastatic colorectal cancer (mCRC) in real-world settings. The goal of this study was to investigate treatment patterns for initial and subsequent therapies for mCRC patients in two large commercial plans in Washington State, USA. Methods: We utilized the Hutchinson Institute for Cancer Outcomes Research linkage of Western Washington Cancer Surveillance System (CSS) SEER data with claims from Regence BlueShield and Premera BlueCross (representing 20% of the WA insured population) for patients diagnosed with mCRC between 2012 and 2016. We identified all patients with Stage IV CRC at diagnosis or stage I-III CRC with subsequent claims suggesting metastatic recurrence. We conducted descriptive analysis and multivariate modeling to evaluate the association between age, race, gender, and rurality with receipt of systemic therapy. We examined 1L (first line) regimens received in the first 15 days of treatment, and classified them as adherent or not to NCCN guidelines. In light of recent FDA approval for regorafenib (9/2012) and TAS-102 (9/2015), we examined use of these therapies for refractory mCRC. Results: Among 4,536 CRC cases identified in the database, 426 patients had evidence of metastatic disease and met all inclusion criteria. 87 (20.4%) received no systemic therapy. Of the 339 (79.5%) who received systemic therapy, FOLFOX was the most common 1L regimen (29.5%), followed by FOLFOX+bevacizumab (12.3%). There was evidence of 1L treatment outside of NCCN guidelines – 8.5% of patients received single-agent bevacizumab, and 8.0% received single-agent oxaliplatin. Patients who did not receive systemic therapy were more likely to be older and live in a large metropolitan area. For subsequent therapies, 24 (7.1%) patients received regorafenib, and 5 (1.5%) received TAS-102. Conclusions: In a commercially-insured mCRC cohort, a majority received 1L guideline-based therapy. Many patients did not receive systemic therapy despite current recommendations - further evaluation of factors contributing to these decisions are warranted. Use of regorafenib and TAS-102 was uncommon.