tbuckley/cabot-search huggingface dataset:
Relationship of age and cancer treatment to receiving treatment summaries and survivorship care plans in female young adult cancer survivors.
Authors: Ksenya Shliakhtsitsava, Sally A. D. Romero, Samantha Roberts, Irene Su
Journal: Journal of Clinical Oncology (2017)

55 Background: For cancer survivors who were diagnosed with cancer during childhood, adolescence and young adulthood years, transitioning into survivorship and post-cancer treatment care remains challenging and may be aided by treatment summaries (TS) and/or survivorship care plans (SCP). Little research has been conducted on receipt of SCP and/or TS from the patient perspective. The objective of this study was to determine patient- and cancer-specific characteristics that are associated with receipt of SCP and/or TS (SCP/TS). Methods: 240 female young adult cancer survivors (YCS) between ages 18-44 were recruited to a national cohort study on reproductive health and completed a web-based survey that included report of receiving SCP and TS. We used logistic regression models to estimate odds ratios (OR) for characteristics associated with receipt of SCP/TS. Results: Mean age (standard deviation) was 32.8 (5.8) years; mean age at cancer diagnosis was 27.2 (7.1) years. Forty-eight (20%) participants were diagnosed with cancer at &lt; 21 years of age. Only 47% of participants reported receipt of SCP/TS. In unadjusted analyses, current age, younger age at diagnosis, education level, receiving chemotherapy and receiving bone marrow transplant were significantly associated with report of SCP/TS receipt. In multivariable analyses, survivors diagnosed at younger age ( &lt; 21 years) had 2-fold higher odds of SCP/TS receipt (OR 2.0, 95% CI 1.0-3.9). Chemotherapy treatment (OR 2.3, 95% CI 1.2-4.6) and bone marrow transplantation (OR 7.2, 95% CI 1.5-33.3) were also significantly associated with SCP/TS receipt. Conclusions: A significant proportion of YCS do not recall receiving a TS or SCP to aid in the transition to post-cancer treatment survivorship care. Receipt of these documents is not uniform across the young cancer survivor population. Improved integration of TS and SCP into cancer survivorship care is needed.
Unusual primary presentations of mantle cell lymphoma in the urinary tract and testes.
Authors: Deniz Peker, Timothy Edward Kubal, Eduardo M. Sotomayor, Lubomir Sokol, Jennifer L. Cultrera, Celeste M. Bello, Paul A. Chervenick, Elizabeth Sagatys, Mojdeh Naghashpour, Ling Zhang, Lynn Moscinski, Bijal D. Shah
Journal: Journal of Clinical Oncology (2012)

e18503 Background: The initial clinical presentation of Mantle Cell Lymphoma is protean, ranging from single sites of indolent disease followed for years without therapy to aggressive disseminated disease that requires treatment within weeks of diagnosis. While many cases of Mantle Cell Lymphoma present with disseminated disease, other patients may present with symptoms related to a primary extranodal site of disease. The majority of these primary extranodal cases are diagnosed in the gastrointestinal tract, other cases have been noted in the skin, conjunctiva, testes and male genitourinary tract. Methods: Database review of 204 patients diagnosed with Mantle Cell Lymphoma at Moffitt Cancer Center between May 1992 and December 2010. Results: Three cases of Mantle Cell Lymphoma presented with symptoms related to primary extranodal sites in the urinary tract and male genital organs. Two cases of testicular involvement presented with gradual enlargement of the testes. In patient 1, the orchiectomy specimen harbored both seminoma and mantle cell lymphoma. Low level bone marrow involvement by mantle cell lymphoma was present and in the presence of indolent features he was treated for his primary seminoma and followed expectantly for mantle cell lymphoma. In patient 2, orchiectomy revealed a pleomorphic variant of mantle cell lymphoma with no other sites of disease on staging workup. He was treated with 6 cycles of R-CHOP and prophylactic IT methotrexate with a complete remission. A third patient presented with obstructive urinary symptoms and was found to have mantle cell lymphoma of the prostate. Additional staging revealed diffuse lymphadenopathy, colon and bone marrow involvement. A complete remission was obtained with 6 cycles of R-CHOP. None of these three patients was found to have evidence of CNS involvement at diagnosis or in followup with only the second patient receiving intrathecal prophylaxis. Conclusions: Mantle Cell Lymphoma may present with unusual extranodal involvement at diagnosis including sites and symptoms related to the genitourinary tract and testes. Diagnostic lumbar puncture and intrathecal prophylaxis should be considered in these patients.
Image of the Month
Authors: Isabel Rauscher, Tobias Maurer, Katja Steiger, Markus Schwaiger, Matthias Eiber
Journal: Clinical Nuclear Medicine (2017)

Ga prostate-specific membrane antigen (PSMA) HBED-CC PET/CT in a 65-year-old man with first diagnosis of prostate cancer (PC) and a history of multiple myeloma showing multifocal PSMA ligand uptake in the skeleton with corresponding osteolytic lesions in CT. Although osteolytic bone metastases are very rare in PC, PSMA expression in PET raised the suspicion of PC bone metastases. Bone marrow biopsy excluded PC metastases with immunohistochemistry showing endothelial expression of PSMA in small vessels within the myeloma.
Validation of a microarray-based gene expression test for tumors with uncertain origins using formalin-fixed paraffin-embedded (FFPE) specimens
Authors: R. Pillai, R. Deeter, C. T. Rigl, M. Halks-Miller, W. D. Henner, L. Buturovic
Journal: Journal of Clinical Oncology (2009)

e22015 Background: Microarray-based gene expression has been validated as an aid in the diagnosis of tumors with uncertain origins when the specimen is frozen tissue. Microarray use has been largely limited to RNA derived from frozen specimens. This study evaluated performance of a microarray-based test in identifying the tumor type in FFPE specimens. Methods: ZFFPE human tumor specimens (n=405) representing the 15 tissue of origin sites on the Pathwork® Tissue of Origin Test panel were blinded and evenly distributed between two independent processing labs. All specimens consisted of a 10-μm-paraffin curl containing at least 60% viable tumor and were either metastatic or poorly differentiated primaries. Each specimen was processed through RNA extraction, amplification, labeling, hybridization to a Pathchip® microarray, and was scanned to generate a qualified data file. A pre-specified classification algorithm utilizing more than 1500 genes was applied to each data file to yield Similarity Scores corresponding to the 15 tissues on the test panel. Results were then unblinded and compared to the available diagnoses. Results: Of the 405 specimens, 352 yielded qualified data files (87%). Based on the top Similarity Score, the overall agreement with available diagnoses was 89% (95% CI, 85%-92%) and for each specimen an average of 12 out of 15 tissues could be ruled out with &gt; 99% probability. Results for all tissue types were highly informative with diagnostic odds ratios ranging from 178 to 28509. Performance was similar for metastatic (n=150; 91% agreement) and poorly differentiated primary specimens (n=202; 87% agreement). Conclusions: The large size of this study allows an accurate estimate of the confidence of test predictions for both ruling in and ruling out tissues as likely sites of primary origin. The Pathwork Tissue of Origin Test makes the potential benefits of microarray-based gene expression tests for tumors with uncertain origins available for use with the most common type of histology specimen, FFPE. [Table: see text]
KRAS mutations preclude tumor shrinkage of colorectal cancers treated with cetuximab
Authors: W. De Roock, J. De Schutter, G. De Hertogh, M. Janssens, B. Biesmans, N. Personeni, K. Geboes, C. Verslype, E. Van Cutsem, S. Tejpar
Journal: Journal of Clinical Oncology (2007)

4132 Background: A recent study has shown that the presence of a KRAS mutation is associated with the absence of objective response to cetuximab (CTX) in advanced colorectal cancers (mCRC). Our hypothesis was that CTX cannot induce any tumor shrinkage in KRAS mutant mCRC. Methods: We analyzed KRAS exon 2 mutation status by Taqman, PCR and sequencing on 37 available tumor samples from patients with mCRC progressive on chemotherapy. Twenty patients received CTX combined with irinotecan (BOND) and 17 received CTX in monotherapy (7 BOND, 10 SALVAGE). We measured the change in tumor size between baseline and the consecutive evaluations. At week 12 and at week 24, we statistically tested the change from baseline between the groups with KRAS wild type (WT) and KRAS mutation (MUT) using the t-test. RECIST criteria for tumor response were used. Results: 3 patients had progressive disease (PD), 26 stable disease (SD), 8 partial response (PR) and 0 complete response. A KRAS MUT was found in 17 tumors (46%): 2 in PD (66.7%), 15 in SD (57.7%) and none in PR patients (p&lt;0.01; responders vs. non responders). At 12 weeks there was a mean decrease in tumor size of 23.1% (SE=7.38) in the KRAS WT and an increase of 2.6% (SE=4.13) in the KRAS MUT mCRC. At 24 weeks KRAS WT and MUT mCRC had a 45.8% (SE=8.61) and a 1.3% (SE=6.67) mean decrease respectively (p= 0.0081 at 12 weeks; p=0.0015 at 24 weeks). The mean tumor size of the KRAS WT did not decrease further after 24 weeks. In the subgroup of SD tumor size regression was observed but only in WT patients. Mean time to progression was 32 (range 12–96) and 30 weeks (range 12–84) for KRAS WT (SD + PR) and MUT respectively. Conclusion: We confirmed KRAS MUT precludes objective response to CTX in mCRC. In addition we found tumor size regression in SD patients being restricted to WT patients. We observed rapid onset of these differences suggesting an important role of KRAS MUT status in early tumor shrinkage. However the onset of progression was not different according to KRAS MUT status. [Table: see text]
Demographics, tumor characteristics, and survival in inflammatory breast cancer.
Authors: Ryan Austin Denu, John M Hampton, Adam D. Currey, Roger T. Anderson, Rosemary Donaldson Cress, Steven Fleming, Joseph Lipscomb, Xiao-cheng Wu, J. Frank Wilson, Amy Trentham-Dietz
Journal: Journal of Clinical Oncology (2015)

e12602 Background: Inflammatory breast cancer (IBC) is a rare form of breast cancer that makes up 1-6% of all breast cancers and has a median overall survival of less than 4 years. To identify patient characteristics associated with improved survival, we examined differences in demographics, tumor characteristics, and survival of IBC patients compared to locally advanced breast cancer (LABC). Methods: We analyzed data for patients diagnosed with IBC (T4d, N0-1, M0-1; n = 170) and LABC (stage IIIB or IIIC; n = 375) and included in the Breast and Prostate Cancer Data Quality and Patterns of Care Study (POC-BP), containing information from cancer registries supplemented with medical record re-abstraction and physician verification in 7 states. Chi square tests were used to examine differences in patient characteristics for IBC compared to LABC. Survival was analyzed using 5-year survival rates and log-rank tests. Results: IBC tumors were more likely to be HER2-positive and ER/PR-negative (p = 0.03), and of higher grade (p = 0.12) compared to LABC tumors. IBC patients were more likely that LABC patients to be diagnosed symptomatically rather than by screening (p < 0.0001) and to be treated at larger hospitals (p = 0.05) but were similar in terms of comorbidities, health insurance, and body mass (all p > 0.05). Overall, IBC patients had significantly worse 5-year survival compared to LABC patients (44% vs 58%, respectively; p < 0.001). While survival was similar for white IBC patients (54%) and white (59%), black (52%), and Hispanic (67%) LABC patients, 5-year survival was worse for black (27%) and Hispanic (10%) IBC patients. Survival was also worse for IBC patients on Medicaid (36%), living in census tracts with lower socioeconomic status (23-33%), and with triple negative tumors (26%) compared to other IBC patients and LABC patients (range, 40-68%). Conclusions: Results of the POC-BP highlight differences between IBC and LABC as well as disparities in IBC severity and survival based on race and socioeconomic status. Further work is needed to better understand the causes behind these disparities and develop methods to improve outcomes among these populations.
Phase II study of weekly scheduled irinotecan and capecitabine treatment in advanced colorectal cancer patients.
Authors: Wenhua Li, Jin Li, Jianming Xu, Lin Shen, Tianshu Liu, Wei jian Guo, Wen Zhang
Journal: Journal of Clinical Oncology (2013)

e14644 Background: The clinical application of combination therapy of irinotecan and capecitabine is at a standstill due to the consideration on severe diarrhea. The aim of the current phase II study was to explore the optimal administration mode of these two drugs, and evaluate the safety and efficacy of weekly-scheduled XELIRI regimen (wXELIRI) in mCRC pts. Methods: Pts with unresectable, histologically confirmed mCRC were enrolled to receive wXELIRI: irinotecan 90mg/m(2) on Day 1 and capecitabine 1200 mg/m(2) bid on Days 1-5 weekly. Both the first-line pts and second-line treatment pts who failed with FOLFOX or XELOX were eligible. The primary endpoint was rate of Grade 3/4 diarrhea. Secondary endpoints included progression-free survival (PFS), overall survival (OS) and other safeties. Results: From January 2011 to May 2012, totally 43 pts with measurable mCRC were enrolled, 18 of them were male and 25 were female. The median age was 60 yrs (range 32-70). No Grade 4 diarrhea was observed and the rate of grade 3 diarrhea was 4.7%. The most common Grade 3/4 toxicities included leucocyte(11.6%), neutrophile (18.6%), vomiting (4.7%), fatigue (2.3%), hand-foot-syndrome (2.3%) . With a median follow-up of 19.0 months, 23 PFS events were observed. The mPFS for all the 43 pts was 6.1 mons and the mOS was 15.5 mons. For the 31 first-line treatment pts, the mPFS was 7.5 mons and the mOS has not reached. In the second-line treatment group (12 pts), the mPFS was 5.4 mons and mOS was 13.8 mons. Conclusions: The weekly-scheduled irinotecan and capecitabine combination has a low rate of severe diarrhea and acceptable toxicity profile. It could be an alternative regimen for mCRC pts, especially in the second-line setting. Clinical trial information: NCT01322152.
Does a diagnosis of GIST predict a second primary cancer?
Authors: Myles JF Smith, Alyson L. Mahar, Calvin Law, Yoo-Joung Ko
Journal: Journal of Clinical Oncology (2013)

10537 Background: There have been reports of a high frequency of metachronous cancers in patients diagnosed with GIST. The purpose of this study was to identify and describe patients with GIST who develop second primary cancers, and to calculate standardized incidence ratios (SIRs) to quantify the risk of additional malignancy. Methods: This was a retrospective, population-based cohort study using SEER data. Individuals diagnosed with GIST from 2001-2009 were identified as having a malignant primary tumor in the digestive tract, and included the following sites: C15.0-C26.9; C48.0-48.8; C49.4-49.5; C80.9 and a recorded histology code of 8935 and 8936. This restricted timeframe was imposed to account for changes in the recording of GIST incidence. Individuals with a previous cancer diagnosis or diagnosed post mortem only were excluded. Multiple primary SIRs and 95% confidence intervals (CI) were calculated using SEER*Stat software (V.7.1.0) and compared to general population rates. The SIR was interpreted as an estimate of relative risk (RR). Comparison of characteristics between single and multiple cancer GIST patients was performed using chi-square tests, p-values of &lt;0.05 were considered significant. Results: We identified n=1397 cases of GIST, of which 1291 analyzed. We observed a statistically significant increased incidence of second tumours in patients with a primary GIST (n=78, RR 1.36, 95% CI:1.1-1.7). Older age (p&lt;0.001) and tumor grade (p=0.014) were associated with second primaries, with grade being the only significant variable remaining after logistic regression. In both sexes we observed a significantly increased incidence of kidney cancer (RR 4.3, 95% CI: 1.7-8.9). In females there was a 3 fold higher incidence of colon cancer (RR 2.96 95% CI: 1.2-6.1). Conclusions: Patients with a diagnosis of GIST have a higher incidence of second cancers when compared with standardized incidence in the general population. High grade GISTs were associated with an additional malignancy. Both sexes were observed to have increased incidence of kidney cancer, with females at an increased risk of developing colon cancer. As part of GIST surveillance, screening for colon cancer in females and kidney cancer in both sexes may be considered.
Application of pharmacokinetic (PK)-guided 5-fluorouracil (FU) in clinical practice.
Authors: Jai Narendra Patel, Allison Mary Deal, Bert H. O'Neil, Joe Ibrahim, Gary Bradley Sherrill, Janine Marie Davies, Stephen A. Bernard, Richard M. Goldberg, Oludamilola A. Olajide, Prashanti Atluri, John J. Inzerillo, Howard L. McLeod, Christine Marie Walko
Journal: Journal of Clinical Oncology (2013)

2595 Background: Body surface area (BSA)-based dosing of FU results in up to 100-fold inter-individual PK variability. PK-guided FU compared to BSA-based dosing resulted in higher response rates and decreased rate of toxicities in two randomized clinical trials. A paucity of data exists on PK-guided FU dosing in the clinical setting. Methods: A total of 70 colorectal cancer (CRC) patients (pts) from 6 academic and community sites received mFOLFOX6 (FU 2,400 mg/m 2 over 46 h every 2 wks) +/- bevacizumab. Peripheral blood was obtained 2-44 h after start of FU infusion and AUCs were estimated using an immunoassay at Myriad Genetics. FU doses for cycles 2-4 (C2-4) were adjusted algorithmically to target an area under the concentration-time curve (AUC) of 20-25 mg*h/L. The primary outcome was the % of pts within target AUC by C4, with a secondary outcome of toxicity rates compared to historical data. Comparisons between cycles were made using generalized linear models, accounting for repeated observations within pt. Results: The % of pts within target AUC post C1 and C4 was 30% (17/57, 95%CI: 18-43%) and 46% (24/52, 95%CI: 32-61%), respectively (OR=2.16, p=0.05). For each subsequent cycle, the odds of a pt being within range increases by 28% (p=0.04) (Table). The median dose needed to achieve target AUC at C4 was 2,580 (range 1,920-3,484) mg/m 2 . The median AUC post C1 and C4 was 19 and 21 mg*h/L, respectively. Less grade 3/4 mucositis and diarrhea were seen compared to historical data (3 v 15% and 6 v 12%, respectively); however, no difference in grade 3/4 neutropenia was noted (27 v 33%). Nine pts were non-evaluable by protocol for PK analysis, largely due to sampling/processing errors. Conclusions: PK-guided FU resulted in a greater number of pts achieving the targeted AUC and fewer pts under-dosed at C4 compared to C1. Individualization of FU dosing in the front-line, community and academic, setting is achievable for the treatment of CRC; however, larger clinical trials are needed to define the clinical utility of PK-guided FU. Clinical trial information: NCT01164215. [Table: see text]
Comparison of outcomes in patients with locally advanced pancreatic adenocarcinoma treated with stereotactic body radiation therapy (SBRT) versus conventionally fractionated radiation: An analysis of the National Cancer Database.
Authors: Jim Zhong, Kirtesh R. Patel, Jeffrey M. Switchenko, Theresa Wicklin Gillespie, Richard John Cassidy, David A. Kooby, Jerome Carl Landry
Journal: Journal of Clinical Oncology (2017)

366 Background: As systemic therapy has improved for locally advanced pancreatic cancer (LAPC), efforts to improve local control have become critical. While conventionally fractionated radiation therapy (CFRT) has more recently shown a limited role in LAPC, stereotactic body irradiation (SBRT) is an emerging approach that delivers higher doses of radiation therapy, to small volumes, over a much shorter period of time. With no studies to date comparing SBRT to CFRT for LAPC, we utilized the National Cancer Database (NCDB) to evaluate these two modalities. Methods: Using the NCDB, patients with AJCC clinic cT2-4, N0-1, M0 adenocarcinoma of the pancreas diagnosed from 2004-2013 were analyzed. Radiation therapy delivered at 2 Gy per fraction or less was deemed CFRT, and 4 Gy or more per fraction was considered SBRT to allow inclusion of practice variations. Kaplan-Meier, log-rank test, and multivariable Cox proportional hazards regression were performed with overall survival (OS) as the primary outcome. Propensity score matching was employed to reduce treatment selection bias. Results: Among 8,450 patients, 7,819 (92.5%) were treated with CFRT, and 631 (7.5%) underwent SBRT. The median dose per fraction and number of fractions for CFRT and SBRT cohorts were 1.8 Gy per fraction in 28 fractions and 8 Gy per fraction in 5 fractions, respectively. Using propensity score matching, 988 patients were matched, with 494 patients in each cohort. Within the propensity-matched cohorts, the median OS was higher with SBRT (13.9 vs. 10.7 months), and 2-year OS of 21.5% and 15.9% for the SBRT and CFRT groups, respectively ( p = 0.0014). Multivariable analysis confirmed SBRT was a significant predictor for OS (Hazard ratio:0.84; 95% confidence interval: 0.75-0.93, p = 0.001). Additionally, pancreatoduodenectomy, low comorbidity index, chemotherapy use, and node negative disease also positively impacted survival. Conclusions: SBRT appears to be associated with an improved OS compared to CFRT for LAPC. Further prospective studies investigating these hypothesis-generating results are warranted.
Patient reported symptom severity in cancer survivors.
Authors: Kelly Bugos, Jessica Foran, Katrina Pose Sabati, Andre Valdez, Janis M. Petree, Caitlin Wellman, Douglas W. Blayney
Journal: Journal of Clinical Oncology (2017)

143 Background: At Stanford Health Care, patient-reported symptom severity is routinely assessed during cancer survivorship visits. Aim: Our objective is to identify the proportion of moderate to severe symptoms reported during first visit by patient group (breast cancer, lymphoma, allogeneic BMT recipients). Methods: Our cohort were unique patients evaluated in a cancer survivorship clinic between 9/1/15 and 8/31/16. Cohort patient report of presence and severity of 23 symptoms using a six-point Likert scale on a paper-based written instrument were collected and analyzed (0 = absent, 1-2 = mild, 3-4 = moderate, 5 = severe). Symptoms include fatigue, pain, constipation, diarrhea, uncontrolled loss of urine, limb swelling, shortness of breath, oral problems, trouble swallowing, muscle weakness, unusual sweating, ability to exercise, numbness in limbs, depression, fear, changes in sleep, body image, skin/hair, appetite, weight, sexual health, cognition and/or balance. Results: 337 unique patients (median age 50, female 64%) were a median of 140 days and mean of 851 days after treatment completion. Overall, the symptoms that have the highest responses in the moderate to severe range (score 3-5) are fatigue (31%), sleep change (23%), memory change (17%), depression (14%) and fear (19%). Breast cancer survivors had similar symptoms overall, but lymphoma survivors reported a higher rate of moderate to severe fatigue (49%), sleep change (38%), memory change (33%) and fear (29%), and the alloBMT group reported a higher rate of moderate to severe fatigue (39%), depression (20%) and fear (25%). Conclusions: Standard use of patient-reported symptom severity assessment shows a high prevalence of moderate to severe physical and psychological symptoms among patients seen in a cancer survivorship clinic. These findings can help focus management on the most prevalent and severe symptoms based on cancer type and time from treatment.