tbuckley/cabot-search huggingface dataset:
Fluorescence-targeted laparoscopic lymph node dissection in prostate cancer.
Authors: Stephan Hruby, Christine Englberger, Lukas Lusuardi, Tobias Schaetz, Thomas Kunit, Ahmed Magdy, Martina Hager, Guenter Janetschek
Journal: Journal of Clinical Oncology (2015)

70 Background: Recently we have introduced fluorescence by means of Indocyanin Green(ICG) in addition to radio-guided dissection using Technetium 99(Tc99) for laparoscopic pelvic sentinel node dissection (Urology 2012). Hence we could show that ICG alone gave equal results compared to TC99. Since ICG visualizes the complete drainage system we have as an evolution now left the sentinel concept to completely remove this template. Methods: 38 consecutive men with intermediate and high risk prostate cancer have undergone targeted Lymphnode dissection during laparoscopic radical prostatectomy. 2ml ICG were injected transpeineally into each lobe under TRUS guidance. After removal of the complete ICG visualized Lymphnode template of each side, a standard ePLND was added as control. All Lymphnodes were evaluated by 250 ym sections and imunohistochemistry. Results: Transperineal Injection allowed for precise deposit without any periprostatic extravasation. Fluorescence stained (F+) nodes were found on both sides in all patients except one. In total 596 nodes (17,9 +-8,4/patient) were removed, of which 473 nodes (14,3 +- 8,51/pat.) were F+. LN Metastases were found in 15 pat.(39,5%), of which 2 pat. (5,3 %) had solitary micrometastases. In addition 3 patients (7,9 %) the LN contained Tumor Cell Cluster. No non-stained metastases were found in addition to F+ Metastases. Met outsi de the template of extended PLND occurred in 5 patients(27,8% of N+). Conclusions: Fluorescence-targeted lymphnode dissection allows to identify the lymphatic drainage of the prostate with great reliability. It proved to be more precise than extended lymphnode dissection in patients with intermediate and high grade prostate cancer
Quality improvement for symptom control in underserved Chinese cancer patients.
Authors: Lara Dhingra, Kin Y. Lam, William Cheung, Theresa Shao, Victor Tsu-Shih Chang, Jack Chen, Sabrina Cheng, Vanessa Li, Wan Lam, Selina Chan, Marilyn Bookbinder, Graciete Lo, Russell Portenoy
Journal: Journal of Clinical Oncology (2012)

132 Background: Chinese Americans, the largest Asian subgroup, have high cancer rates. Many are recent immigrants who are economically disadvantaged. Patients often present with advanced illness and poorly controlled pain. Although quality improvement (QI) methodologies, such as rapid-cycle QI, may improve clinical practice and patient outcomes, few QI programs for pain management exist for this population. We aim to 1) test the effectiveness of a rapid-cycle QI intervention to enhance the processes and outcomes of pain management for poor and underserved ethnic Chinese patients; 2) determine whether a rapid-cycle QI intervention for pain can be generalized to other symptoms (fatigue and dyspnea), and 3) identify demographic, cultural, and other barriers and facilitators that are related to intervention uptake. Methods: In this ongoing community study, we are developing and testing a rapid-cycle QI model to improve pain among underserved Chinese American cancer patients, and evaluating factors that influence its uptake and sustainability. Ethnic Chinese patients and clinicians from four oncology practices are the intervention targets. The systems-based intervention incorporates repeated “plan-do-study-assess” QI cycles, including: pain screening, follow-up and early treatment for pain, referral, and provider education. Results: Initial data demonstrates that documentation of pain scores improved from 24-71% of patients overall. In one practice, 37% of 89 patients screened over 45 days had moderate or severe pain; 90% with moderate pain had follow-up appointments within 1 week; 92% with severe pain had immediate clinician attention. Intervention effectiveness will be determined by 2-week longitudinal surveys. The primary outcome is the change in the proportion of patients who achieve adequate and timely pain control after initial presentation. Conclusions: Multiple cultural, system-related, and provider challenges to QI implementation are being addressed. Findings will show the importance of QI interventions to reduce pain disparities, the importance of programs that address underserved Chinese Americans, and the relevance of community-based QI programs for long-term changes in clinical pain management.
Final results of a multicenter, open-label phase II trial of dovitinib (TKI258) in patients with advanced urothelial carcinoma with either mutated or nonmutated <i>FGFR3</i>.
Authors: Matthew I. Milowsky, Christian Dittrich, Ignacio Duran Martinez, Satinder Jagdev, Frederick E. Millard, Christopher Sweeney, Dean F. Bajorin, Linda Cerbone, Robert M. Dunn, Paramita Sen, Michael Shi, Andrea C. M. Kay, Matthew Squires, Cora N. Sternberg
Journal: Journal of Clinical Oncology (2013)

255 Background: Increased signaling through mutational activation of fibroblast growth factor receptor 3 (FGFR3) contributes to tumor development and vascularization of urothelial carcinoma (UC). Dovitinib (TKI258), an oral investigational inhibitor of angiogenic factors including FGFR3, has demonstrated inhibition of tumor growth and proliferation in preclinical UC models with FGFR3-activating mutations or protein overexpression. Methods: Advanced UC patients (pts) with 1-3 prior regimens received dovitinib 500 mg/day on a 5-days-on/2-days-off schedule. Pts were stratified into 2 groups based on presence (mut) or absence (non-mut) of FGFR3 gene mutation in archival tissue (initially analyzed by SNaPshot; later by Sanger sequencing for screening and confirmation). The primary objective was overall response rate (ORR) in each group using a Simon’s 2-stage design (20 pts planned for stage 1 and 20 for stage 2 if ≥ 2 responses seen in stage 1). Results: A total of 44 pts (median age, 67 years) were treated in stage 1: 12 FGFR3 mut, 31 FGFR3 non-mut, and 1 unknown mutation status. Over-recruitment of non-mut pts was due to rapid enrollment of non-mut pts with invasive bladder tumors and some tumors initially classified as mut by SNaPshot but reclassified as non-mut after sequencing. Most pts (77%) had metastases in ≥ 2 organs. ORR (local review) was 0% in the FGFR3 mut group and 3% in the FGFR3 non-mut group (1 partial response). Median progression-free survival was 3 months in the FGFR3 mut group and 1.8 months in the FGFR3 non-mut group. There were insufficient non-mut responders to proceed to stage 2. Since most pts in the mut group did not receive &gt; 6 months of treatment and meeting the response threshold to proceed to stage 2 was highly unlikely, the study was terminated. Common adverse events were diarrhea (73%), nausea (61%), and asthenia (50%) and were similar in both groups. Conclusions: Although there were difficulties in evaluating mutation status, dovitinib had limited single-agent activity in pts with advanced bladder cancer regardless of FGFR3 mutation status. Further studies are needed to understand the role of FGFR3 inhibition in advanced UC treatment. Clinical trial information: NCT00790426.
Symptomatic treatment of infections in patients with advanced cancer receiving hospice care
Authors: R. M. Navari, R. E. Reinbolt, A. M. Shenk, P. H. White
Journal: Journal of Clinical Oncology (2005)

8069 Background: Symptom control is one of the primary goals of hospice care. We prospectively followed patients with advanced cancer receiving outpatient hospice care to determine if the use of antimicrobials for a clinically suspected infection improved infection related symptoms. Methods: During a 24 month period, 1,731 patients with a cancer diagnosis were admitted to a community based outpatient hospice program. 1,598 patients (median age 63.1 yrs, range 27–89; 50% male) consented to be prospectively monitored for infection related symptoms (cough, disorientation, dyspnea, dysuria, fever, frequency, pain). 89% of the patients had a Karnofsky performance of ≤ 60%. 623 of 1,598 study patients were diagnosed with a total of 685 infections. 633 of the clinically suspected infections were treated with antimicrobials for at least 72 hours. Symptoms were recorded, clinically indicated cultures were obtained, and the choice of antimicrobial was instituted at the discretion of the attending physician. Patients were subsequently monitored to determine the effects of antimicrobials on infection related symptoms. Results: A complete or a partial response of infection related symptoms was observed in 79% of 265 patients with urinary tract infections, 43% of 221 patients with respiratory tract infections, 46% of 63 patients with oral cavity infections, 41% of 59 patients with skin or subcutaneous infections, and none of 25 patients with bacteremia. 52 of the infections were not evaluable due to refusal of antimicrobials or receipt of less than 72 hours of antimicrobials. Patient survival was not affected by the presence of infection or the use of antimicrobials. Conclusions: Although the use of antimicrobials improved symptoms in the majority of patients with urinary tract infections, symptom control was less successful in infections of the respiratory tract, mouth/pharynx, skin/subcutaneous tissue, or blood. There are limitations of the use of antimicrobials in patients with advanced cancer receiving hospice care. Treatment guidelines are proposed emphasizing the importance of patient preferences and the use of symptom control as the major indication for the use of antimicrobials in this patient population. No significant financial relationships to disclose.
The contribution of poor and rural populations to national trends in reproductive, maternal, newborn, and child health coverage: analyses of cross-sectional surveys from 64 countries
Authors: Cesar G Victora, Aluisio J D Barros, Giovanny V A França, Inácio C M da Silva, Liliana Carvajal-Velez, Agbessi Amouzou
Journal: The Lancet Global Health (2017)

Coverage levels for essential interventions aimed at reducing deaths of mothers and children are increasing steadily in most low-income and middle-income countries. We assessed how much poor and rural populations in these countries are benefiting from national-level progress.We analysed trends in a composite coverage indicator (CCI) based on eight reproductive, maternal, newborn, and child health interventions in 209 national surveys in 64 countries, from Jan 1, 1994, to Dec 31, 2014. Trends by wealth quintile and urban or rural residence were fitted with multilevel modelling. We used an approach akin to the calculation of population attributable risk to quantify the contribution of poor and rural populations to national trends.From 1994 to 2014, the CCI increased by 0·82 percent points a year across all countries; households in the two poorest quintiles had an increase of 0·99 percent points a year, which was faster than that for the three wealthiest quintiles (0·68 percent points). Gains among poor populations were faster in lower-middle-income and upper-middle-income countries than in low-income countries. Globally, national level increases in CCI were 17·5% faster than they would have been without the contribution of the two poorest quintiles. Coverage increased more rapidly annually in rural (0·93 percent points) than urban (0·52 percent points) areas.National coverage gains were accelerated by important increases among poor and rural mothers and children. Despite progress, important inequalities persist, and need to be addressed to achieve the Sustainable Development Goals.UNICEF, Wellcome Trust.
A phase II trial of pegylated doxorubicin, rituximab, cyclophosphamide, vincristine, and prednisone (DR-COP) in patients with newly diagnosed AIDS-associated B-cell non-Hodgkin's lymphoma (ARL): An AIDS Malignancy Consortium trial (AMC 047).
Authors: A. M. Levine
Journal: Journal of Clinical Oncology (2010)

8034 Background: Previous studies of CHOP have shown some efficacy in patients with ARL; addition of rituximab has improved response. Response might be limited by MDR-1 resistance, reported in 66% at diagnosis (Leuk Res 2002: 26: 121-7). Infusional regimens such as (R)- EPOCH (Blood 2003:101: 4653-59) may overcome MDR-1, and have shown superior results, but phase III studies of CHOP- vs EPOCH have not been performed in HIV patients. Substitution of doxorubicin for pegylated doxorubicin may overcome MDR-1, and DR-COP would be easier to administer than a 96 hour EPOCH infusion. We wished to determine response rates, duration, median survival and infections after DR-COP. Methods: All patients received pegylated doxorubicin 40 mg/m2, rituximab 375 mg/m2, cyclophosphamide 750 mg/m2 and vincristine 1.4 mg/m2 (2 mg) IV on day 1, with prednisone, 100 mg daily × 5 days, every 21- 28 days for 6-8 cycles depending on interim response. Restaging was performed after cycles 2, 4 and 6. Anti-retroviral therapy was given to all. Results: 43 patients were enrolled; 2 withdrew prior to receiving therapy. Median age was 44 years (21-68); 10 were female. Major risk factors for HIV were homosexual/bisexual (41%), and heterosexual contact (39%). Median CD4 cell count at entry was 119 (5 - 1026); median HIV viral load was 27,175 copies/ml (undetectable to > 9 million). Stage IV was present in 56%. Diffuse large B-cell lymphoma was diagnosed in 98%. 46% completed treatment per protocol, 27% terminated early for disease progression, and 12% terminated early for adverse event. Complete remission was documented in 15 (37%); PR in 8 (20%). Twelve patients have died (29%), due to lymphoma in 11, and progressive multifocal leukoencephalopathy (PML) in 1. The overall survival at one year is 67% (95% CI, 47%, 81%). Conclusions: Preliminary results of the DR-COP regimen do not indicate equivalent efficacy to EPOCH based regimens in ARL. Only one patient died of infection (PML), despite use of rituximab. Future studies should build upon the EPOCH backbone in patients with ARL. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration NCI
Incorporating patient preferences and priorities into end-of-life care.
Authors: Eric Rackow, Afua Ofori, Wendy Rodkey, Roy A. Beveridge
Journal: Journal of Clinical Oncology (2015)

41 Background: Patients with advanced illness often face painful conversations and difficult decisions. A program was deployed to help patients identify, communicate, and incorporate their personal preferences and priorities into decisions about their care. The program was assessed by measuring movement along the readiness for change continuum. Methods: Patients residing in the home and participating in a chronic care program were referred by their case managers based on clinical conditions and whether the patient appeared to be in their last 12 months of life. Counseling sessions with patients or family caregiver/s were designed to move participants toward the following actions: be fully informed about their medical situation, describe their detailed quality of life priorities, articulate a self-defined medical decision making process, effectively communicate to their family and physicians, and implement and repeat the aforementioned steps. After 5 months (Sept-2014 to Feb-2015), movement along the readiness for change continuum (pre-contemplation, contemplation, preparation, action, maintenance, and advocacy) was reported. Results: Of the 427 patients referred, 33 could not be reached, 116 were ineligible, 50 declined or did not engage. Of the 228 participants, 191 (84%) moved at least one step in readiness for change continuum over the 5-month period. In Nov-2014, 13% of participants were in action, maintenance, or advocacy, which increased to 19% by Feb-2015. The largest observed movement to action, maintenance, or advocacy was in defining quality of life priorities: 2% Nov-2014 to 21% Feb-2015. The least movement to action, maintenance, or advocacy was observed in articulating a self-defined medical decision making process: 3% Nov-2014 to 16% Feb-2015. Case managers reported discomfort in referring members based on their assessment of length of life. Early surveys show high levels of satisfaction. Conclusions: A very high percentage of patients progressed in incorporating their preferences and priorities into end of life care as measured by the readiness to change continuum. This program is currently expanding and the referral process is changing from case manager to algorithm based identification referrals.
Adjuvant treatment in stage III colon cancer: Comparison of patients recruited into trials and those treated outside a clinical trial: analysis of recruitment, trial effect and inclusion of elderly patients
Authors: J. Rodón, M. Garcia, J. Perez, M. Navarro, L. Pareja, J. R. Germà-Lluch
Journal: Journal of Clinical Oncology (2005)

6118 Background: Extrapolation of information from clinical trials (CT) to the practice has been hazardous due to several difficulties. In this work we pretend to evaluate the effect of three of them (recruitment rate, the trial effect and the inclusion of elderly patients) in the treatment of localized colon cancer. We analyzed data from the adjuvant treatment of Stage III colon cancer in a single free-access institution. Methods: Data from colon cancer patients (pts) treated at the Institut Català d’Oncologia (ICO) were prospectively collected in a database since I/1996 including stage and treatment information. These data were crossed and compared with data from pts treated in any of the 6 adjuvant CT carried out between I/1996 and XI/2004 collected on Clinical Research Unit prospective database. Diferences in survival between subgroups were compared with the log-rank test. Results: 2777 pts were treated at ICO in that period; 393 were stage III with an age distribution of: ≤50: 53; 51–64: 121; ≥65: 219. Of those, 286 were treated with adjuvant chemotherapy (72.8%); 89 of them in a CT (recruitment rate of 31.1%). With a median follow-up of 2.9 y, 3-year survival was 79.3% [95% CI: 74.8–83.9]. When comparing those who were not treated with those treated out a CT and those treated in a CT, 3-year survival were 61.1% [95% CI: 50.8–71.5], 82.9% [95% CI: 76.8–89.0] and 92.3% [95% CI: 86.5–98.2] respectively, with significant statistical differences between the last two groups (p=0.004). Elderly pts (≥65 y) treated in a CT (26 among the 125 who were treated -20.8% of recruitment rate-) had a non significant trend to benefit in survival (CT 95.8% [95% CI: 87.8–100]; no CT 82.4% [95% CI: 73.8–91.1]; p=0.09). Conclusions: In a centre with a high recruitment rate (29.7% in the global series and 20.8% among elderly pts) to be treated in CT seems to correlate with a better survival. Although elderly pts were majority in our series they are little represented in trials. No significant financial relationships to disclose.
High efficacy of sequential chemotherapy (CT) with dose-dense modified TCF regimen (TCF-DD) followed by CT with oxaliplatin, folinic acid (FA), 5-fluorouracil (5-FU) and irinotecan (COFFI) in metastatic gastric cancer (MGC)
Authors: M. Dalla Chiesa, G. Tomasello, S. Buti, F. Negri, M. Brighenti, S. Lazzarelli, A. Auzzani, A. Curti, M. Martinotti, R. Passalacqua
Journal: Journal of Clinical Oncology (2008)

4570 Background: In the 2007 ASCO Annual Meeting we reported the high activity of TCF-DD in MGC. Previous phase II trials showed that regimens with O, I, FA, and 5-FU are very active in MGC. Based on these studies we tested a sequential CT in order to avoid the occurrence of drug resistance. Methods: Chemo-naïve patients (pts) with MGC, PS ≤1, received in 16 weeks: 4 cycles of TCF- DD (docetaxel [D] 70 mg/m2 day [d] 1, cisplatin 60 mg/m2 d 1, l-FA 100 mg/m2 d 1 and 2, 5-FU 400 mg/m2 bolus and then 600 mg/m2 as a 22 h c.i. d 1 and 2, every 14 days) followed by 4 cycles of COFFI (O 85 mg/m2 d 1, I 140 mg/m2 d 1, l-FA 200 mg/m2 d 1, 5-FU bolus 400 mg/m2 d 1 and then 2,400 mg/m2 as a 48 h c.i. every 14 days). In both regimens pegfilgrastim 6 mg on d 4 was included. End points were response rate (ORR) and TTP (RECIST criteria and ITT principle). Results: 40 consecutive pts were enrolled; in 8 pts CT is ongoing. Median age: 64, range 40–81; 63% male. 11/32 pts required a dose reduction of TCF-DD, mostly because of grade 3–4 haematologic, gastrointestinal toxicity and lethargy. 25/32 completed the 4 cycles of TCF-DD and 12/32 respected the schedule. 28 were evaluated for response (2 early suspension: 1 allergic reaction to D and 1 severe toxicity; 2 early deaths: 1 bowel perforation and 1 sepsis): 2 CR, 16 PR, 7 SD and 3 PD were observed, for an ORR of 56% (95% CI, 39–73). 21 pts proceeded to COFFI. 2 required a dose reduction because of diarrhoea; all 21 pts were evaluated for response. The 2 CR observed after TCF-DD were maintained after COFFI. Among the 16 pts with PR after TCF-DD, 2 achieved CR, 5 further improved the response, 5 mantained PR, 2 progressed and 2 did not start COFFI (1 early death and 1 protocol violation). Among the 7 pts with SD after TCF-DD, 2 achieved PR, 2 mantained SD, 1 progressed and 2 did not start COFFI (1 protocol violation and 1 for other reasons). The ORR in the 32 pts was 63% (95% CI, 46%-79%). At a median f-up of 19 months (95% CI, 16–23) median TTP was 9 months (95% CI, 6–9,7). 1- year survival was 31%. 2 pts with multiple liver metastases mantained CR after 33 and 16 months. Conclusions: A sequential dose- dense strategy using TCF-DD followed by COFFI is feasible, highly effective and deserves to be tested in randomized studies. No significant financial relationships to disclose.
The prognostic signficance of pretreatment leukocytosis in patients with anal cancer treated with radical chemoradiotherapy or radiotherapy.
Authors: Robyn Banerjee, George Roxin, Misha Eliasziw, Kurian Joseph, Donald Buie, Corinne Doll
Journal: Journal of Clinical Oncology (2012)

656 Background: There are emerging data showing prognostic significance of pre-treatment leukocytosis (elevated white blood cell count) in cervical cancer patients. However the prognostic impact of leukocytosis in anal cancer patients has not been previously reported. The purpose of this study was to determine the association of pre-treatment leukocytosis on outcome in patients with anal cancer treated with radical chemoradiotherapy (CRT) or radiotherapy (RT). Methods: 126 patients with anal cancer, treated with radical CRT (91.3%) or RT (8.7%) from 2 major Canadian cancer centers (University of Calgary, n=65 and University of Alberta, n=61), between 2000 and 2008 were evaluated. Demographic, clinical, hematologic and treatment factors were retrieved from retrospective review of the patients’ records. The association of clinical factors and hematologic status with overall survival (OS) and disease-free survival (DFS) was analyzed using Cox proportional hazards regression models. Results: Median follow-up was 24 months. Median tumor size was 4 cm. Mean age was 59 years and M:F was 29:97. Pre-treatment leukocytosis (WBC count greater than 10^9/L) was identified in 16% (20/126) of patients. After adjusting for gender, tumor size and stage in a multivariate analysis, leukocytosis remained significantly associated with worse 2-year OS [HR 2.9 (95% CI 1.1-7.9), p=0.036] and worse DFS [HR 2.2 (95% CI1.1-4.8), p=.045]. The patient group with both pre-treatment hemoglobin (Hgb) less than 125 g/L (lowest quartile) and leukocytosis had very poor outcomes, 2-year OS 61% versus 89% for patients without these factors; more than doubling the hazard for DFS [HR2.7 (95% CI 1.1-6.8), p=0.033] and for OS [4.5 (95% CI 1.5-13.2), p=.006]. Conclusions: Pre-treatment leukocytosis is associated with worse OS and DFS in patients with anal cancer treated with radical CRT or RT. Patients with both low Hgb and leukocytosis had very poor outcomes. These hematologic parameters represent potential biomarkers for prognosis and treatment response, and warrant further investigation to uncover the underlying biologic mechanisms and therapeutic strategies in this patient group.