tbuckley/cabot-search huggingface dataset:
Erlotinib as a salvage treatment for patients with advanced non-small cell lung cancer after failure of gefitinib treatment: Is there a rationale for a clinical trial?
Authors: Nello Salesi, Barbara Di Cocco, Francesca Calabretta, Alida Armida Ciorra, Crescenzo Cirino, Carolina Cauchi, Giorgio Pistillucci, Venerina Sciacca, Rosalinda Rossi, Enzo Veltri
Journal: Journal of Clinical Oncology (2013)

e19099 Background: Patients (pts) with advanced NSCLC and sensitizing EGFR mutations who initially respond to gefitinib or erlotinib eventually develop acquired resistance to the TKIs. Our goal was to determine the effects of erlotinib 150 mg/d in EGFR mutated pts resistant to gefitinib 250 mg/d, because the EGFR TKI erlotinib is given at a higher biologically active dose than gefitinib. Methods: Retrospective review of 5 EGFR mutated (exon 19 deletions) patients that were given gefitinib and subsequently erlotinib. Results: All pts responded to gefitinib with median progression-free survival of 13 months (95% confidence interval, 4-16). After gefitinib resistance, 60% (3 of 5) of these pts displayed progressive disease while on erlotinib with progression-free survival of 2 months (95% confidence interval, 2-3). These pts acquired the T790M mutation. 2 gefitinib-resistant pts with the acquired L858R-L747S EGFR, which in vitro is sensitive to achievable serum concentrations of erlotinib 150 mg/d, achieved a partial response to erlotinib. In literature doesn’t exist a prospective study about the stratification of pts ordered by PS, age, gender, smoker/non-smoker, which could test the efficiency of the erlotinib after gefitinib in pts with different EGFR mutations. We only have at our disposal few studies control-case in non-selected pts which show a potential efficiency of erlotinib after the failure of the gefitinib, nevertheless, without an evident increase of the overall survival. Conclusions: In EGFR mutated tumors resistant to gefitinib 250 mg/d, a switch to erlotinib 150 mg/d does not lead to responses in most pts. These findings are consistent with preclinical models, because the common mechanisms of TKI resistance (T790M and MET amplification) in vitro are not inhibited by clinically achievable doses of gefitinib or erlotinib. Alternative strategies to overcome TKI resistance must be evaluated.
Abstract 150: A Case Of Kawasaki Disease Complicated By Autoimmune Hemolytic Anemia In A Boy
Authors: Seung-Taek Yu, Dong-Sup Kim, Jong-Duck Kim, Yeon-Kyun Oh, Chang-Woo Lee, Du-Young Choi
Journal: Circulation (2015)

Introduction: Kawasaki disease is a systematic disease, usually affecting infants and toddlers. It can be characterized by rare complications or by unusual associations. One of these is autoimmune hemolytic anemia that has been observed seldom up to now. In this report, we present a case with this rare association. Case: A previous healthy 7-year-old boy was transferred form a primary clinic due to fever and neck mass. Neck CT showed acute pharyngitis with focal abscess formation and multiple enlarged lymph nodes at both retropharyngeal space. He was treated intravenous antibiotics for 3 days. On the 4th hospital days, the patient sustained high fever and presented diffuse maculopapular rash, conjunctival injection without exudate, erythema and edema of the hands and feet. Laboratory finding showed Hb 11.6 g/dL; hematocrit (Hct) 33.9 %; WBC count 15,350 μL; platelets count 308,000 μL; AST 123 IU/L; ALT 237 IU/L; CRP 103.14 mg/L; creatinine kinase (CK) 28 IU/L; CK-MB 0.6 ng/mL; pro-BNP 783.2 pg/mL. Mild dilatation of right coronary artery (4.14mm) was noted in echocardiogram. The patient was diagnosed Kawasaki disease and treated intravenous immunoglobulin (IVIG) (2g/kg) and aspirin. Retreatment with IVIG was administered for persistence of fever 48 hours after the first infusion. Thereafter, his symptoms gradually improved. On the 12th hospital day, his follow-up laboratory finding showed decreased Hb 7.1 g/dL and Hct 20.8 %; reticulocyte 10.71 %; peripheral blood smear: normocytic normochromic anemia with anisopoikilocytosis, immune hemolytic anemia; Direct polyspecific antiglobulin test positive. There was no hemodynamic instability. Prednisolone 2mg/kg/day P.O. was given for hemolytic anemia and hemolysis resolved following treatment. On follow-up, hemoglobin and hematocrit increased gradually. He made a good clinical recovery without cardiovascular complication. Conclusion: A 7-year-old boy presented with the fever, skin rash, conjunctival injection and lymphadenopathy. He was diagnosed Kawasaki disease. Autoimmune hemolytic anemia occur on the way of improving state after treatment. The authors report a case of autoimmune hemolytic anemia during Kawasaki disease
Definitive chemoradiotherapy with capecitabine and cisplatin in elder patients with squamous cell esophageal carcinoma.
Authors: Ligang Xing, Jiandong Zhang, Fuli Wang, Fengjun Liu, Xinshuang Yu, Meijuan Song
Journal: Journal of Clinical Oncology (2012)

e14643 Background: The purpose of this study is to investigate the feasibility and efficacy of concurrent or sequential chemoradiotherapy (CRT) with capecitabine and cisplatin in elderly patients with squamous cell esophageal carcinoma. Methods: 75 patients elder than 70 years with histologically proven squamous cell esophageal carcinoma were retrospectively reviewed. 40 patients were treated with concurrent CRT (CCRT) consisted of two cycles of intravenous cisplatin and oral capecitabine during and after radiotherapy. 35 patients were treated with sequential chemoradiotherapy (SCRT) as two cycles of capecitabine plus cisplatin before and after radiotherapy. The response rate, overall survival (OS), progression free survival (PFS) and toxicity were compared between two groups. Results: The response rate in the CCRT group was significantly higher than those in the SCRT group (82.5% vs 60.0%, p=0.023). The median OS time and PFS time of the CCRT group were significantly longer than those of the SCRT group (OS: 30.5 vs. 15.7 months, p=0.01; PFS: 25.4 vs. 11.6 months, p=0.014). The acute toxicities was more frequent in the CCRT group than SCRT group, but the grades 3 and 4 acute and late toxicities were similar in the two groups. Conclusions: It suggested that both CCRT and SCRT with capecitabine and cisplatin are tolerable and effective in elderly patients with esophageal squamous cell carcinoma. Concurrent CRT might be superior to sequential chemoradiotherapy.
Sedation vs Intubation for Patients With Acute Stroke Undergoing Thrombectomy
Authors: Hartmut Buerkle, Ulrich Goebel
Journal: JAMA (2017)

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Microvessel density predicts behavior in pediatric optic pathway/hypothalamic gliomas
Authors: U. K. Bartels, C. Hawkins, J. Ma, A. Ray, P. Dirks, J. Rutka, E. Bouffet
Journal: Journal of Clinical Oncology (2004)

1556 Background: Optic pathway/hypothalamic gliomas (OPHG) are predominately low-grade tumors. However, OPHGs show an unpredictable behavior and there is no recognized histologic or molecular marker anticipating this behavior. This study was performed to investigate angiogenic features as possible independent prognostic factors. Methods: We searched the databases of the Hospital for Sick Children for patients with pathologically diagnosed OPHGs between 1985 and 2002. Tumor specimens were reviewed and reconfirmed as low-grade gliomas. Those with sufficient tissue for staining were included in the study. Sections were immunostained with factor VIII (F8) and counted for microvessel density (MD). A ratio of alpha-smooth muscle actin to F8 immunostaining was calculated to give a vascular maturity index. Vascular endothelial growth factor (VEGF) and VEGF-receptor immunostaining was performed to assess angiogenic features and MIB-1 labeling index (LI) to assess proliferation. These factors were evaluated with respect to progression-free survival (PFS) and outcome of treatment. Results: 60 patients were identified and 41 had sufficient material for further analysis. All patients underwent surgery. 30 required additional treatment (16 chemotherapy, 8 radiation, 6 chemotherapy + radiation). 8 patients had NF1. 38 are alive. MD showed a wide range of variation between tumors (4.8–73.6, median: 28 vessels/1.2 mm2). The absolute number of F8 stained vessels was significantly higher in infants (p < 0.01). A high MD (> 20 vessels/1.2mm2) was associated with a significantly shorter PFS compared to tumors with a low MD (<20 vessels/1.2 mm2)(p=0.025). MIB-1 values ranged from 0–10 (median 2.5). Intensity and distribution of VEGF and VEGFR staining and MIB-1 LI were not significantly associated with outcome. Conclusions: Our findings suggest that angiogenesis is important in low-grade glioma and MD rather than MIB-1 has a prognostic value in OPHGs. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration project was supported by b.r.a.i.n.child, Toronto
Clinical value of PET/CT's SUV max at baseline, early follow-up, and end of treatment reevaluation as a prognostic factor in small cell lung cancer patients with extended disease.
Authors: Santiago Ponce Aix, Ray Manneh Kopp, Juan Manuel Sepulveda, Juan A. Núñez, Lara Iglesias, Tomas Pascual, Lucia Parrilla, Sebastian Ruiz Solis
Journal: Journal of Clinical Oncology (2013)

e18558 Background: Patients with Small Cell Lung Cancer (SCLC) have been staged by the two-stage system. This system defines limited disease (LD) when is confined to ipsilateral hemithorax that can be encompassed within tolerable radiation field; extended disease (ED) is defined as the disease extending outside the hemithorax. The IASLC recommended that TNM staging should be used in SCLC including clinical trials. However these systems have shown poor correlation between clinical findings and the pathological results. Objectives: Evaluate prognostic factors as age, ECOG and PET CT’s SUV max at base line, early follow up and end of treatment reevaluation; and their correlation with Overall survival (OS) and Progression free survival (PFS). Methods: Prospectively were recruited patients with histologically confirmed SCLC and ED and were evaluated with basal PET CT, early follow up (PET CT after 2 cycles of Platinum based chemotherapy) and end of treatment assessment with a PET CT after 6 cycles. Comprehensive database including clinical data were collected as age, ECOG, site of metastases, type of treatment and outcome. 23 patients were recruited from January 2010 to June 2012 and the follow up made until January 15 th 2013. The Cox correlation test was used. Results: Median age 66,5 years (range 52-80) the OS was 7,9 months (CI 95% 6.7-9.1) and the PFS was 5,3 months (CI 95% 4,5-6,2). The baseline ECOG was an independent prognostic factor for OS (p= &lt;0,0001) and PSF (p= 0,008). Age was not prognostic in our data. SUV max at baseline was an independent prognostic factor for OS (p= 0,001) and PFS (p= 0,009). For early follow up were evaluated 14 patients and for end of treatment reevaluation were assessed 9 patients. Differences between SUV max at baseline and early follow up or with end of treatment reevaluation were not predictive for PFS or OS. Conclusions: In our study the ECOG and basal PET CT SUV max are independent prognosis factors with consistent correlation with OS and PFS. The early follow up and end of treatment reevaluation with PET CT did not predict outcome in our patients. Further studies should be considered to test the value of follow up with PET CT.
Competing mortality (CM) risk in patients with resected stage I and II non-small cell lung cancer (NSCLC): A Surveillance, Epidemiology, and End Results (SEER) analysis.
Authors: Gayathri Nagaraj, Janakiraman Subramanian, Feng Gao, Siddhartha Devarakonda, Ramaswamy Govindan
Journal: Journal of Clinical Oncology (2013)

7563 Background: CM risk has been identified as a potential confounder in the interpretation of treatment effects in head and neck cancer (Rose et al. J Clin Oncol. 2011). Lung cancer patients (pts) are at considerable risk for CM due to their advanced age at diagnosis and smoking related chronic diseases. We plan to identify risk factors for CM in pts with early stage NSCLC and develop a statistical model to estimate the effect of CM on power calculation for lung cancer clinical trials. Methods: Using SEER registry we identified 32104 pts who had undergone surgical resection with or without radiation for stage I and II NSCLC between 1994 and 2006. The data set was split into two groups: training set (75%) and testing set (25%). Risk factors for lung cancer-specific mortality (LCSM) and CM were identified using training data by Gray’s sub-distribution regression of competing risk. Pts from the testing data were then stratified according to CM risk and the impact of this risk on power loss was evaluated. Results: The 5-year cumulative incidence of death from lung cancer, other causes and overall mortality was 32.7%, 14.2% and 46.9% respectively. Risk factors for CM were: age (hazard ratio [HR] 1.05), male gender (HR 1.43), divorced (HR 1.30), widowed (HR 1.23) or single (HR 1.29) marital status, squamous (HR 1.40) or not-otherwise-specified (HR 1.22) histology, stage I NSCLC (HR 1.27) and sublobar resection (HR 1.23). The 5-year cumulative incidence of CM in low, mid and high-risk tertiles was 7%, 14% and 21% respectively. Sample size calculations based on all-cause mortality (ACM) result in over-estimation of power as the risk for CM increases. In order to restore the underestimated power in LCSM, 19% and 35% more pts are required in the mid and high CM risk groups respectively (Table). Conclusions: Our findings indicate that conventional sample size calculation methods can result in significant loss of power and incorporating CM risk models in power estimation should be considered for clinical trials involving early stage NSCLC pts. [Table: see text]
Are gynecologic oncology patients interested in weight loss surgery?
Authors: Robert Neff, Georgia Anne-Lee McCann, Kristen Carpenter, Jesse Mesenburg, David M. O'Malley
Journal: Journal of Clinical Oncology (2015)

e20622 Background: The aim of this study was to assess knowledge about obesity’s effects on cancer-related and overall health, as well as the impact of that knowledge on decisions regarding various weight loss options, specifically surgical weight loss. Methods: A cross-sectional design was used. Patients presenting to the gynecologic oncology (GO) ambulatory center at an NCI-designated Comprehensive Cancer Center completed a survey assessing knowledge about obesity and its health risks, healthy behaviors, previous weight loss attempts, and interest in surgical weight loss. Results: A total of 304 surveys were returned from among 350 distributed, yielding a participation rate of 87%. Patients without a diagnosis of cancer and those who completed less than 50% of the survey were excluded, yielding a final sample size of 244. Diagnoses included endometrial (38%), ovarian (37%), cervical (16%), and other GYN malignancies (8%). The mean BMI for sample was 31.6 (SD = 9.6). Despite almost 50% of respondents being clinically obese (BMI > 30), only 12% correctly identified their weight class, with most underestimating their weight. Morbidly obese patients (BMI > 40) made up 40% of obese responders. The majority (62%) of respondents stated they attempted weight loss in the previous five years; half tried at least two different weight loss modalities. Only 18% of the obese cohort stated they would consider weight loss surgery (WLS), most (50%) were morbidly obese. Despite nearly 50% stating WLS was effective for weight loss, most thought it was no better than diet and exercise or program directed weight loss. Obese patients who said they would consider WLS were significantly more likely to have a higher BMI, desire to lose more weight, and have attempted weight loss more often than those who would not consider WLS. Conclusions: This report demonstrates a low degree of understanding among patients of the superiority of WLS at achieving significant weight loss. A minority of obese GO patients would consider WLS compared to other weight loss options, however morbidly obese patients had the highest interest in WLS. Physicians should continue to focus efforts on weight loss management and consider morbidly obese patients as candidates for WLS.
Patient self-evaluation of side-effects related to adjuvant chemotherapy in breast cancer: A prospective study.
Authors: Filippo Montemurro, Gloria Mittica, Celeste Cagnazzo, Manuela Foresto, Virginia Longo, Paola Berchialla, Gianfranca Solinas, Paola Culotta, Rossella Martinello, Adele Calori, Bruna Grasso, Chiara Volpone, Gisella Bertola, Gisella Parola, Marina Del Torre, Piero Luigi Giuliano, Massimo Aglietta, Annamaria Ballari
Journal: Journal of Clinical Oncology (2015)

9606 Background: There is a growing interest in patient-reported outcomes (PRO) in cancer treatment. We evaluated a Common-toxicity criteria (CTC) v4.02-based, self-administered questionnaire to collect 10 common chemotherapy-related side effects (CSE) in patients (pts) undergoing standard adjuvant chemotherapy (ACT) for operable breast cancer. Methods: In this prospective study, 610 pts at 11 sites were administered the questionnaire after the first and the third cycle of ACT. For each item (nausea, vomiting, constipation, anorexia, taste alterations, diarrhea, fatigue, pain, neuropathy and dyspnea) the CTC v4.02 definitions of grade of severity were translated into Italian and rephrased. Pts were asked to choose the definition that best represented the worst CSE experienced after ACT. At each time/point, information on CSE was extracted from the medical charts to compare pts- vs doctors (drs)-reported CSE. Results: 596 and 581 questionnaires were collected after cycle 1 and cycle 3 of ACT. A median of 82% of the fields was completely filled-in. 594 and 573 pts-questionnaires had a corresponding drs-questionnaire. The frequency of G ≥ 1 CSE was systematically higher in pts than in drs questionnaires, as was the grade of severity. For example, Constipation (any grade), Anorexia (any grade) and Dysgeusia (any grade) were reported by pts almost twice as frequently as by drs. Notably, Paresthesia and Dyspnea (any grade) were rarely reported by drs (4% for both), but were reported by 24% and 27% of the pts, respectively, reaching grade 2 or higher in 6% and 11% of the pts respectively. Finally, we found a significant positive correlation between the magnitude of the discrepancy in the frequency of CSE reporting and the number of patients enrolled at each site, suggesting an influence of workload on discrepancy. Conclusions: Self-evaluation of adjuvant chemotherapy-related toxic effects according to the CTC system is feasible in the clinical practice and potentially time saving. Whether the observed discrepancy is due to pts overestimating or drs underreporting CSE needs to be clarified, but our results suggest a potential effect of the patient workload on this phenomenon.
Long-term outcome of patients with lower extremity Ewing sarcoma.
Authors: Andreas Ranft, Corinna Winter, Christiane Hoffmann, Dieter Rosenbaum, Claudia Rossig, Herbert Juergens, Uta Dirksen
Journal: Journal of Clinical Oncology (2017)

117 Background: With improved survival rates of patients with Ewing sarcoma the quality of long-term survivorship needs to be addressed. In this study, general recovery and restitution of function following intensive bone tumor treatment were analyzed by assessing the clinico-functional outcome and physical activity using self-reporting and objective measurement tools. Methods: Long-term outcome of 224 former patients with lower extremity Ewing sarcoma, registered between 1980 and 2009 in consecutive clinical trials of the GPOH, were assessed using the TESS, SF-36, BSI, and RSES questionnaire scales, and the accelerometric StepWatch Activity Monitor (SAM). To compare results with healthy subjects, 111 non-random peer controls were selected. Median observation time was 13.8 years from primary diagnosis (range 4.1-31.2). Results: Absolute values from the questionnaire scores indicated no major clinical findings in former patients. Compared to controls, unfavorable outcomes were however seen on physical TESS (d=-0.85), PCS (SF-36) (d=-1.08) and BSI-S scores (d=0.65) (P&lt;0.001), in contrast to mental MCS (SF-36), BSI-A, BSI-D, RSES scores (d&lt;0.40). Former patients were less active than the control group (10067 vs. 12430 steps per day; d=-0.56; P&lt;0.001), but on average did reach the recommended level for an active life-style (&gt;10000 steps). Comparing local therapy modality, physical scores for SAM, TESS, PCS were 10978, 91.2, T=50.2 for patients treated with surgery (N=101), 11097, 90.0, T=48.6 in patients with combined modality treatment (N=108), and 10093, 92.8, T=50.0 for patients with definite radiotherapy (N=15) (P=0.648; P=0.580; P=0.368). Conclusions: Survivors of primary lower extremity Ewing sarcoma exhibited moderately reduced self-reported and objectively measured physical outcome scores. Continuous long-term observation will be important in order to identify disease-specific prognostic factors for these patient-oriented outcomes.