tbuckley/cabot-search huggingface dataset:
Predictors of radiation therapy (RT) use among Medicare patients with metastatic non-small cell lung cancer (NSCLC).
Authors: Miranda Kim, Deborah Schrag, Ling Li, Aileen B. Chen
Journal: Journal of Clinical Oncology (2015)

124 Background: Palliative RT can improve quality of life, but also incurs time and financial costs. We evaluated factors associated with use and intensity of palliative RT for metastatic NSCLC. Methods: Using SEER-Medicare data, we identified patients diagnosed with pathologically confirmed stage IV NSCLC from 2004-2011. Receipt of RT and total fractions in the first RT course was collected. Univariable and multivariable logistic regression were used to identify factors associated with RT receipt and higher intensity RT ( &gt; 10 fractions). Models were adjusted for clustering at the county level. Results: Among 53,371 patients with stage IV NSCLC, 39% (20,937) received palliative RT. Among patients receiving RT, 48% (10,048) received &gt; 10 fractions and only 3.5% (724) received single fraction RT. On multivariable analysis, factors associated with greater RT use included younger age group (overall p &lt; .01), lower Charlson comorbidity score (overall p &lt; .01), female gender (OR 1.1, p &lt; .01), married status (OR 1.1, p &lt; .01), South (OR 1.0) and Midwest (OR 1.1) SEER region vs. Northeast (ref) or West (OR 0.9) (overall p &lt; .01), higher radiation oncologist density tertile (OR 1.1, overall p = .02), hospice use (OR 1.47, p &lt; .01), and chemotherapy use (OR 3.61, p &lt; .01). Among patients treated with RT, predictors for &gt; 10 fractions were older age group (overall p = .03), no hospice use (OR 1.1, p &lt; .01), chemotherapy use (OR 1.9, p &lt; .01) and freestanding vs. hospital-based RT facility (OR 1.66, p &lt; .01). Conclusions: A combination of patient, treatment, and health service factors influenced whether a patient received palliative RT. In contrast, most patient factors (except age) did not influence the decision to treat with higher intensity radiation. The receipt of chemotherapy and treatment at a freestanding RT facility were highly predictive for extended RT fractionation, which may have been partially driven by higher reimbursement rates to freestanding facilities during this period.
Abstract 19724: Renoprotective Effect of Remote Ischemic Peri-conditioning During Air Medical Transport of Patients With ST-segment Elevation Myocardial Infarction
Authors: Oladipupo Olafiranye, Adetola Ladejobi, Christian Martin-Gill, Catalin Toma
Journal: Circulation (2015)

Background: Acute kidney injury (AKI) manifesting as acute increase in serum creatinine is a recognized complication to cardiac catheterization. Patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) have a markedly increased risk of developing AKI. At present, there is no universally accepted strategy for prevention of AKI in the setting of primary PCI. We assessed whether remote ischemic peri-conditioning (RIPC) stimulus during ambulance transport of STEMI patient would reduce the rate of creatinine rise post primary PCI. Method: We evaluated STEMI patients transferred to two hospitals participating in the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG) between March, 2013 and March, 2015. Patients were transferred by an air medical critical care service utilizing RIPC as part of a standard protocol and compared to controls matched by referring location/facility. Patient demographics, clinical characteristics, treatments, cardiac biomarkers, left ventricular function, serum creatinine and rate of any increase in creatinine post PCI were compared by the presence or absence of RIPC during transport. Results: Out of the 221 STEMI patients (Age, 63±12.7 yrs; 32.6% female) in this analysis, 107 received RIPC and 114 did not. Baseline characteristics were similar between the two groups. RIPC group had significantly lower rate of creatinine rise post PCI (38.6% vs 55.2%; OR, 1.40; CI, 1.03-1.90; p=0.03) despite having similar baseline serum creatinine (median (IQR), 1.0(0.36) mg/dl vs. median (IQR), 1.0(0.4) mg/dl; p=0.46). In multivariable logistic regression analysis adjusting for demographic factors and clinical characteristics, RIPC (OR, 1.62; CI, 1.12-2.35; p=0.01) was independently associated with lower rate of creatinine rise post PCI. Conclusion: Among patients with STEMI undergoing primary PCI, RIPC before hospital arrival compared with no RIPC was associated with significantly lower rate of creatinine rise post PCI. The use of RIPC as a potential renoprotective strategy for STEMI patients warrants further investigation.
Health care utilization and costs in patients with early onset myelodysplastic syndrome in a commercially insured population.
Authors: A. Powers, K. Stein, R. L. Knoth, M. Broder, E. Chang
Journal: Journal of Clinical Oncology (2011)

6552 Background: Myelodysplastic syndrome (MDS) affects about 1 in 10,000 individuals. After diagnosis, patients are treated with hypomethylating agents (HMA) and thalidomide analogues (TA) or receive best supportive care. Methods: This analysis describes the health care services utilized and the cost of these services among commercially insured patients aged ≥ 65 years old and newly diagnosed with MDS. This was a descriptive cohort study using medical and pharmacy claims from a large US insurer. The data were deidentified and HIPAA compliant. The study included patients who were ≥ 65 years old, had an initial MDS claim (ICD-9-CM 238.72-283.75) from 2/1/2007 to 7/31/2008, and were continuously enrolled for 6 months prior to and 12 months following the index claim. Baseline demographic variables were calculated in pre-index claims. Utilization and costs were calculated post-index. Patient demographic data were also reported. Results: A total of 578 patients were identified, all diagnosed with MDS, ≥ 65 years old and continuously enrolled in the health plan. Of these, 40% were 65-74, 47% aged 75-84, and 13% ≥ 85. Women made up 44% of the sample. In the first year after diagnosis, 93% (n=536) received best supportive care only and 7% (n=42) were treated with medication. Treatment consisted of HMA in 33 patients and TA in 9. In treated patients, a mean of 94.6 days (SD 94, Md 60) elapsed from diagnosis to HMA or TA treatment. Patients had a mean of 27.6 office visits (SD 19.7, Md 23) in the year after diagnosis. At least one hospitalization occurred in 51% of patients (n=296) and 17% were hospitalized 3 or more times. Mean length of stay among those hospitalized was 14 days. Mean total healthcare charges were $84,628 (SD 115,028, Md $46,816). Conclusions: In this study, few patients aged ≥ 65 and newly diagnosed MDS were treated with HMA or TA in the first year after diagnosis, despite the fact that the HMAs have been shown to lead to improvement in clinical and economic outcomes and are recommended in the NCCN guidelines. MDS was associated with frequent hospitalizations and outpatient visits, and high costs. More appropriate treatment for MDS may reduce the burden associated with this condition.
Quality care and patient involvement in their care: Preferences for transitioning cancer follow-up care to the community.
Authors: Lindsay Herzog, Doris Howell, Shari Moura, Xin Qiu, Catherine Brown, Ashlee Vennettilli, Lawson Eng, Linda Chen, Noor Malik, Svetlana Zvetkova, Aein Zarrin, Aditi Dobriya, Devalben Patel, Wei Xu, Carol Townsley, Geoffrey Liu
Journal: Journal of Clinical Oncology (2014)

75 Background: The cancer survivor rate is rising and a new focus has turned to the appropriate survivorship care for this new population. Although several models of survivorship care are currently present in Canada, few studies have examined cancer patient preferences. This study compared patient preferences for direct referral back to one’s primary care practitioner (PCP) after 2-3 years of oncology specialist care versustransition through a specialized transitional clinic before exclusive follow-up by one’s PCP. The main objectives were to: (1) assess patient interest in a specialized cancer transitional clinic model, and (2) compare patient and demographic characteristics by such preferences. Methods: A cross-sectional scenario-based survey of cancer survivors who had undergone curative therapy at the Princess Margaret Cancer Centre assessed patient preferences for the transitioning of their post-treatment cancer care. Regression models compared clinico-demographic and psychosocial variables (anxiety, depression, distress) to one’s preference for transition of care. Results: Among 242 cancer survivors, 54% were male, 78% Caucasian, 43% with a college degree, median household income between 60-75K, 71% married, with a wide distribution of curable cancer sites (anal, colorectal, breast, testicular, lymphoma, head/neck, lung). 77% preferred transition through a specialized transitional clinic versus direct referral back to their family doctor. No factors were found to be related to preference for transition of care, except individuals who scored high on anxiety using the ESAS scale were significantly more likely to prefer referral to the specialized transitional clinic (p&lt;0.05). No differences in preference were found by other clinico-demographic factors. Conclusions: A specialized transitional clinic is a preferred survivorship option in three-quarters of cancer patients. Anxiety, but not other variables, was associated with preference for the specialized clinic. This study highlights the need for individual decision-making regarding survivorship options. This individualization of transitioning may help improve patient’s perception of quality cancer care.
Randomized phase II study with window-design to evaluate anti-tumor activity of the survivin antisense oligonucleotide (ASO) ly2181308 in combination with docetaxel for first-line treatment of castrate-resistant prostate cancer (CRPC).
Authors: Pawel J. Wiechno, Piotr Chlosta, Joanna Pikiel, Bradley G. Somer, Begoña Mellado, Ignacio Duran Martinez, Daniel E. Castellano, Steffen Wedel, Jose Manuel Cervera Grau, Sophie Callies, Valerie Andre, Jacqueline Brown, Karla Hurt, Michael M. F. Lahn, Michael Stöckle, Christoph Reuter, Bernhard Heinrich
Journal: Journal of Clinical Oncology (2013)

5019 Background: In prostate cancer, expression of survivin, a protein that inhibits apoptosis, is associated with resistance to taxanes and poor outcome. LY2181308 reduces survivin expression and consequently is expected to improve activity of taxanes, such as docetaxel. A randomized phase II study was conducted to assess the activity of the combination. Methods: Adult patients (pts) with CRPC, ECOG performance status &lt;2, and no bone or CNSmetastases were randomized 1:2 to standard docetaxel/prednisone every 21 days (Arm A) or standard therapy combined with LY2181308 given as a 3-hr IV infusion (Arm B). Analysis was planned and performed after 130 pts progressed or died. This assessment provided a 70% chance of detecting a difference in progression-free survival (PFS) at the 10% significance level. Initially, LY2181308 was given as a loading dose (3 consecutive days) and then as a weekly 3-hr IV maintenance dose. Arm B also included a window treatment with LY2181308 monotherapy equivalent to a 21-day cycle of docetaxel before starting combined treatment. The primary endpoint was PFS. Results: This study enrolled 154 pts. The median PFS for Arm B was 8.64 (90% CI, 7.39–10.45) months vs. 9.00 (90% CI, 7.00–10.09) months in Arm A, showing no statistical difference (log rank p=0.755). The median overall survival (OS) for Arm B was 27.04 (90% CI, 19.94–33.41) months vs. 29.04 (90% CI, 20.11–39.26) months for Arm A (log-rank p= 0.838). The PSA responses (&gt;50% reduction in PSA) were similar: 56.9% for Arm A and 56.1% in Arm B (p=0.856). Most pts had no pain or mild pain at baseline and during the active period. Pts treated in Arm B had a higher frequency of serious and nonserious adverse events (AEs) than those in Arm A. The observed AE and pharmacokinetic (PK) profiles were consistent with the known safety and PK profiles of LY2181308 and docetaxel. Conclusions: The addition of LY2181308 to a standard docetaxel/prednisone regimen showed no improvement in PFS, PSA response, and OS in first line CRPC pts. The safety profile of docetaxel and LY2181308 is predictable and consistent with the known safety profiles. Clinical trial information: NCT00642018.
Molecular predictors of metastases and stage of thymoma.
Authors: S. S. Badve, C. Goswami, Y. Gokmen-Polar, R. P. Nelson, J. Henley, N. Miller, R. K. Jain, R. J. Mehta, N. A. Zaheer, G. W. Sledge, L. Li, K. Kesler, P. J. Loehrer
Journal: Journal of Clinical Oncology (2011)

10599 Background: Prediction of behavior of thymomas is difficult since complete surgical excision can be curative. In order to better understand the biology of the disease processes, we performed whole genome gene expression analysis to identify genes and pathways associated with adverse outcomes of these rare tumors. Methods: Fresh frozen thymic tissue from 36 patients with thymomas (Group I-10 A and A/B; Group II - 20 B1-2; and Group III - 6 B3 tumors). RNA was extracted from these tumors using TRIzol reagent. Using the Illumina BeadStudio platform and Human Ref-8 Beadchip, gene expression data was analyzed by Partek software using Quantile normalized log transformed data. Gene expression was correlated with histological features, stage, and metastasis. Predictive analysis of microarray (PAM) was performed to identify genes associated with stage and metastases. Confirmation of the 3 genes identified as differentially expressed was performed using quantitative real-time RT-PCR (qRT-PCR). Results: Unsupervised clustering resulted in identification of three clusters of tumors. Cluster 1 represented 75% of GI type of tumors, C2, 85% of GII type tumors, and C3 had an ambiguous distribution of GI, GII and GIII type tumors. The number of genes differentially expressed in cases with and without early stage disease and with and without metastases were 2 and 13 (FDR 0.25 and 0.50) and 1 and 5 (FDR 0.25 and 0.50) respectively. PAM identified a gene signature composed of 10 genes that predicted for lack of metastases with an error rate 4%. Similar analysis for stage showed that a set of 9 genes predicted the presence of early stage (stage I or II) disease with an error rate of 9%. The gene expression data was confirmed by qRT-PCR analysis of selected genes. Conclusions: Our gene expression analysis representing one of the largest series in literature, revealed at least four distinct clusters of thymic tumors. More importantly, PAM analysis identified genesets that could reliably predict early stage disease as well as lack of propensity to develop metastases. The study also identified number of metastasis associated genes that are potential candidates for therapeutics.
Differential EGFR and VEGFR mRNA expression in two subtypes of basal-like breast cancer identified by molecular classification
Authors: C. Papadimitriou, R. M. Wirtz, T. Economopoulos, E. Samantas, P. Papakostas, H. Gogas, E. Razis, E. Lianos, G. Aravantinos, G. Fountzilas
Journal: Journal of Clinical Oncology (2008)

22092 Background: Molecular classification based on only four genes [estrogen receptors (ER), progesterone receptors (PgR), HER2, and melanophilin (MLPH)] identifies two distinct basal-like subtypes in high-risk breast cancer patients, associated with poor prognosis. The objective of the present study was to investigate possible differential EGF and VEGF receptor mRNA expression in the two basal-like subtypes. Methods: Patients were treated with adjuvant anthracycline-based dose-dense sequential chemotherapy (E-CMF vs. E-T-CMF) in the context of a randomized Phase III study. RNA was isolated from 217 fixed tumor tissue samples, followed by kinetic one-step RT- PCR for mRNA expression analysis of EGFR, VEGFR2 and VEGFR3. Identification of the basal-like subtypes was based on 2D hierarchical clustering. Results: One of the basal-like subtypes (14 of 217 patients, 6%, group A) was found to retain some expression of the HER2, ER and MLPH genes. The second basal-like subtype (18 of 217 patients, 8%, group B) was characterized by low mRNA expression of all four genes. Significantly more patients in group A exhibited high VEGFR2 and VEGFR3 mRNA expression compared to group B (Fisher's exact test, p=0.026 and p=0.025, respectively). In contrast, no such difference was observed for EGFR mRNA expression. However, significantly more patients in the two basal-like subtypes combined exhibited high EGFR mRNA expression compared to a group of non-basal- like patients (86 of 217, 40%) exhibiting high mRNA expression of all four genes (p<0.0001). Conclusions: The results of this retrospective study suggest that patients from both basal-like subtypes may be candidates for new anti-EGFR agents. However, agents targeting the VEGF receptor family may only be active in the subgroup of basal-like patients retaining some expression of the HER2, ER and MLPH genes. Prospective studies are needed to validate these findings. No significant financial relationships to disclose.
Postradiation therapy sarcoma.
Authors: W. F. Mourad, A. A. Saad, S. Packianathan, Z. Zhang, R. A. Shourbaji, J. J. Caudell, R. L. Jennelle, M. C. Baird, S. Vijayakumar, M. A. Hussein
Journal: Journal of Clinical Oncology (2010)

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Factors influencing the CEA positivity in patients with colon cancer including race.
Authors: Ramya Thota, Mahmoud Abu Hazeem, Avyakta Kallam, Peter T. Silberstein, Shanmuga Subbiah
Journal: Journal of Clinical Oncology (2012)

409 Background: Carcinoembryonic antigen (CEA) is a widely used tumor marker for surveillance in colon cancer. However, its accuracy is still debatable as its levels vary based on several factors. Hence we attempted to identify various clinicopathological factors influencing the CEA levels in patients with colon cancer. Methods: Retrospective analysis of 8910 colon cancer patients from 1995 to 2008 was done via the Veteran's Affairs Central Cancer Registry. Age at diagnosis, race, gender, stage, grade, CEA levels, depth of tumor invasion, nodal status, spread of tumor, smoking history, and family history data was studied. The influence of individual factors on CEA positivity was studied by using chi-square test for categorical variables and the unpaired t-test for continuous variables. Results: Out of 8919 patients identified, 3643 were CEA positive and 5276 were CEA negative. CEA levels varied significantly by race, stage, grade, nodal status, smoking history, and tumor size. African Americans have higher CEA levels (22% vs. 15.5%; P&lt;0.0001). CEA positivity increased with increase in stage (stage 1- 20.3% vs. 54.3%; stage 2 – 15.8% vs.22.5%; stage 3 – 10% vs. 12%; stage 4 – 54% vs. 11.4%; P&lt;0.0001). Increasing in T stage showed a proportionate increase in CEA positivity (T1 – 6.4% vs. 18%; T2 – 13.4% vs. 24%; T3 – 64.2% vs. 52%; T4 – 16% vs.7%; P&lt;0.0001). Majority of CEA positive patients are node positive (N0 – 49.4% vs. 70.4%; N1- 28% vs. 20%; N2 – 22.3% vs. 10%; P&lt;0.0001). CEA positive tumors had larger size of tumor compared to CEA negative tumors (54.2 mm vs. 45.6 mm; P&lt;0.0001). CEA positive patients had more poorly differentiated tumors (17.5 % vs. 14.2 %; P&lt;0.0001). Current smokers showed higher CEA levels (54% vs. 41.4%; P&lt;0.0001). Age, gender, location of tumor and family history showed no significant difference among CEA positive and negative tumors. Conclusions: Significant clinicopathological differences noted in CEA positive and negative tumors. African Americans had high-CEA levels and these patients had larger tumor diameter, advanced T stage, more positive nodes, advanced stage and in current smokers. Moreover, a significant difference in histologic tumor grade was observed in CEA positive and negative patient groups.
Bevacizumab in metastatic papillary renal cell carcinoma (PRCC).
Authors: T. Irshad, T. Olencki, D. L. Zynger, A. Coston, A. Mortazavi, J. P. Monk
Journal: Journal of Clinical Oncology (2011)

e15158 Background: PRCC accounts for 10-15% of all renal cancer. Historically metastatic disease is associated with a short median survival of 5.5 months. There are anecdotal accounts of activity with the use of agents targeting MTOR and some tyrosine kinase inhibitors that block vascular endothelial factor (VEGF) in patients with PRCC. The loss or silencing of Von Hippel Lindau (VHL) gene and subsequent increased expression of VEGF and its receptors is well established in the clear cell subtype but not in PRCC. However data exists for VHL independent pathways that lead to over expression of VEGF in PRCC. We initiated a phase II trial of bevacizumab alone in patients with advanced PRCC. Methods: Bevacizumab at a dose of 15 mg/kg IV was administered every three weeks to patients with metastatic or unresectable papillary renal cell carcinoma. Patients were required to have measureable disease, ECOG PS 0 or 1, and adequate organ function. Treatment was stopped for progression, toxicity, or withdrawal of consent. RECIST assessment was performed every 3 cycles. The primary end point was the proportion of patients free of progression at 12 months following initiation of bevacizumab. Sample size was based on intent-to-treat analysis, and was determined to be 41 patients for a study period of 2 years. Results: Five patients were accrued before the protocol closed due to slow accrual. Three patients had undergone a prior nephrectomy, one patient underwent resection of a liver metastasis. One patient had received prior temsirolimus. The progression free survival (PFS) for these patients were 25, 15, 11, 10, and 6 months for each patient. Bevacizumab was well tolerated with mainly grade 1-2 toxicities, such as hypertension, creatinine elevations and proteinuria. One patient whose PFS was 25 months experienced sudden death while on trial. An autopsy was not performed. Conclusions: The optimal treatment for advanced PRCC is unknown. The PFS in our small series of patients treated with bevacizumab alone suggests activity with minimal toxicity. Further investigation in a multi-center study seems warranted.