tbuckley/cabot-search huggingface dataset:
How do first-line treatment and other factors affect the receipt of second-line treatment for elderly metastatic colon cancer patients?
Authors: Zhiyuan Zheng, Ebere Onukwugha, Nader Hanna, Emily S Reese, Brian S. Seal, C. Daniel Mullins
Journal: Journal of Clinical Oncology (2013)

592 Background: Metastatic colon cancer (mCC) patients might receive multiple lines of chemotherapy to improve survival or quality of life. However, factors associated with receipt of 1 st and 2 nd line treatment (TX) haven’t been fully investigated. Methods: Elderly (65+) SEER-Medicare patients diagnosed with mCC in 2003-2007 were followed until death or 12/31/2009 to examine factors for receipt of 1 st and 2 nd line TX. A Cox regression framework and inverse probability weighting (IPW) method were used to adjust for patients’ informative (death) and non-informative (dropout or end-of-study) censoring histories. Additionally, we controlled for patients’ 1 st line TX in the IPW to determine factors for receipt of 2 nd line TX. Results: Of 7,951 mCC patients, 3,266 patients received at least 1 line TX, and 1,440 went on to 2 nd line TX. For 1 st line TX, significant clinical factors were CCI = 2 (HR = 0.86; p = 0.02), oxygen use (HR = 0.74; p = 0.04), walking aid use (HR = 0.58; p = 0.02), and wheel chair use (HR = 0.50; p &lt; 0.01); significant demographic characteristics were age groups 95 + (HR = 0.11; p &lt; 0.01), 85-94 (HR = 0.24; p &lt; 0.01), 75-84 (HR = 0.70; p &lt; 0.01), as compared to 65 + -74, female (HR = 1.12; p &lt; 0.01), married (HR = 1.43; p &lt; 0.01), and African American (AA) (HR = 0.80; p &lt; 0.01); significant factors for socio-economics status were state buy-in status (SBI) (HR = 0.97; p &lt; 0.01), and zip code level household median income (HR = 1.03; p &lt; 0.01). For 2 nd line TX, significant factors were hospital bed use (HR = 2.82; p = 0.05), oxygen use (HR = 0.68; p = 0.02), age group 85-94 (HR = 0.718; p = 0.02) as compared to 65 + -74, and days delayed for 1 st line TX (HR = 0.998; p &lt; 0.01). Conclusions: Various factors were associated with receipt of 1 st line TX. Conditional on the receipt of 1 st line TX, many factors became insignificant for receipt of 2 nd line TX, such as age, female, marriage status, AA, SBI, and zip code level household income. Hospital bed use reduced the probability of receipt of 1 st line TX, but increased the probability of receipt of 2 nd line TX.
Chemoselection with induction chemotherapy followed by chemoradiation or surgery versus chemoradiation for patients (pts) with locally advanced squamous cell carcinoma of the oropharynx (LASCCOP).
Authors: I. Y. Dobrosotskaya, E. Light, J. M. Maxwell, S. A. Byrd, M. E. Spector, B. Kumar, F. Y. Feng, A. Eisbruch, G. T. Wolf, M. Prince, J. Moyer, T. N. Teknos, D. B. Chepeha, H. M. Walline, J. B. McHugh, K. G. Cordell, S. Urba, C. R. Bradford, T. Carey, F. P. Worden
Journal: Journal of Clinical Oncology (2011)

5546 Background: Optimal treatment for HPV- and HPV+ LASCCOP is not well defined. Here we retrospectively compare survival and toxicity outcomes from two different organ preservation protocols in pts with LASCCOP. Methods: From 1999-2007, 114 pts with operable stage III/IV LASCCOP were enrolled in 1 of 2 chemoradiotherapy (CRT) trials. Pts on trial 9921 were treated with 1 cycle of induction chemotherapy (IC) with 5-FU (1,000mg/m2/d days 1-5) and cisplatin (CP) 100mg/m2 or carboplatin (CA) AUC 6 on day 1. This was followed by concurrent CRT: 70Gy in 2Gy fractions with CP or CA, dosed as above, on days 1, 22, and 43 in pts with > 50% response to IC or surgery in pts with < 50% to IC. Pts on trial 0221 were treated with concurrent CRT: 70Gy in 2 Gy fractions with weekly CA (AUC 1) and paclitaxel (30 mg/m2). These strategies were compared for OS, DSS, toxicities and persistent G-tube dependence at 6 mos using a propensity score matched analysis. The matched dataset consisted of 35 pts from each trial matched on age, stage, smoking and tumor HPV status (p16 IHC), adjusted using multivariate statistics and cluster analysis to account for the correlated nature of the matched pairs. Results: HPV status was balanced across the dataset yielding 27 HPV+ and 8 HPV– tumor specimens from each trial. Of the 70 total pts analyzed, 13 (37%) from 0221 and 5 (14%) from 9921 had ECOG PS 1 (p=0.03). At 6 mos post-treatment, 4 (11%) from 0221 and 9 (26%) from 9921 were G-tube dependent (p=0.12). Grade 3 and 4 toxicities were more frequent in 9921, as were overall toxicities. Of the 70 pts analyzed, 3 from 0221 died w/in 2 yrs (0/3 from disease-specific cause), and 10 pts from 9921 (6/10 from disease-specific cause). There was evidence that OS and DSS was improved in 0221 (p<0.01 for each), with 2 years of follow-up. When stratifying by HPV status, among both HPV+ and HPV- pts, there was a trend for improved DSS in the 0221 cohort. OS did not differ significantly across trials after stratifying by HPV status. Conclusions: Data from this retrospective review suggests that survival outcomes in pts with HPV+/HPV- LASCCOP are not compromised with weekly chemotherapy and RT (WCRT), and WCRT is generally more tolerable.
Needs and perceptions of spiritual care among advanced cancer patients
Authors: T. A. Balboni, A. Ng, S. D. Block, M. J. Balboni, L. A. Kachnic, M. A. Stevenson, T. S. Hong, E. D. Trice, A. A. Wright, H. G. Prigerson
Journal: Journal of Clinical Oncology (2008)

9560 Background: Little is known about the frequency and types of spiritual issues that arise for advanced cancer patients and the responses of clinicians to them. Methods: Randomly-sampled, advanced cancer patients receiving palliative radiotherapy at Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham and Women’s Hospital, and Dana-Farber Cancer Institute were interviewed about spiritual issues arising in the cancer experience and desires for spiritual care from oncology physicians and nurses. Results: We approached 80 patients and 59 (74%) gave informed consent. A total of 55 were interviewed. Mean age was 61 years; 53% were female and 18% were non-white. Most were at least slightly religious (81%) or at least slightly spiritual (92%); 85% experienced at least 1 spiritual issue, and among these patients, a median of 3 spiritual issues was reported (Table 1). The majority (89% and 87%) believed it at least mildly important that oncology physicians and nurses, respectively, consider patients’ spiritual needs as part of care, with 65% and 69% scoring this as moderately to very important. Controlling for age, race, Karnofsky score, and sex, increasing patient-reported religiousness and spirituality were positively associated with ratings of the importance of doctors (p = 0.003 and p < 0.001) and nurses (p = 0.001 and p < 0.001) considering patient spiritual needs. Most reported having never received spiritual care from oncology physicians (91%) or oncology nurses (80%). Conclusions: Spiritual concerns arise for most patients with advanced cancer, with the majority reporting multiple spiritual issues. These issues frequently surround meaning-making, seeking deeper existential connections, forgiveness, and existential questions or doubts. While most patients believe that spiritual needs should be addressed by oncology providers as part of their cancer care, most do not receive spiritual care. Table 1. Spiritual issues arising in the setting of advanced cancer Advanced Cancer Patient Spiritual Issues† N (%) Any spiritual issue reported = 45/53‡ (85%) Seeking a closer connection with God (or your faith) 28 (62) Doubting your belief in God (or your faith) 10 (22) Finding meaning in the experience of cancer 27 (60) Being angry with God 10 (22) Wondering why God has allowed this to happen 13 (29) Thinking about forgiveness (being forgiven and forgiving others) 23 (51) Thinking about what gives meaning to life 29 (64) Other spiritual issues 12 (27) † What spiritual issues have you had during your illness? ‡ 53 completed all questions. No significant financial relationships to disclose.
Are breast cancer quality metrics being met?
Authors: A. M. Murphy, G. Rauscher, D. Dupuy, R. Alvarez, T. Macarol, E. Knightly, D. Ansell, P. Grabler, P. A. Robinson, E. A. Marcus
Journal: Journal of Clinical Oncology (2011)

6051 Background: In Chicago, Illinois, the 3rd largest city in the United States, Black women are 62% more likely to die from breast cancer (ca) than White women, a disparity exceeding the US breast ca mortality disparity (41%) and New York City (27%). Geographic variability in mortality rates suggests health system rather than biologic differences as a significant cause. The Metropolitan Chicago Breast Cancer Task Force’s mission is to eliminate this disparity. In 2009, the Quality Consortium, a project of the Task Force, became the nation’s first Patient Safety Organization dedicated solely to breast health. Methods: We collected aggregate screening and/or treatment quality data for calendar year 2006 from 41 hospitals. The proportion of patients with screening, diagnostic follow up and treatment procedures aligned with clinical guidelines were used to determine whether institutions met benchmarks. 7 screening measures and their associated benchmarks included: proportions recalled for diagnosis (benchmark <15%), lost to follow-up at imaging (<20%), lost to follow-up at biopsy (<20%), follow-up imaging within 30 days of screening mammogram (>=80%), ca detection rate per 1000 screens (4-9), proportions diagnosed as minimal (>30%), and diagnosed as stage 0 or 1 (>50%). Three treatment measures and associated benchmarks included: proportions with treatment initiated within 1 month of diagnosis (>=80%), breast-conserving surgery (BCS) who received radiation (>=80%), and tested for hormone receptors (>=90%). Results: Varying percentages of institutions were able to show that they met benchmarks for recall rate (62%) lost to follow-up at imaging (62%) and at biopsy (44%), timely follow-up imaging (38%), ca detection rate (38%), proportion minimal (31%), proportion early stage (26%), timely treatment (33%), radiation after BCS (52%) and hormone receptor testing (86%). Conclusions: A majority of institutions were unable to show they provided breast ca care meeting benchmarks. Many were unable to provide measures, or measures reflected inaccurate/incomplete data collection. This study highlights the difficulty with collecting data on quality. Strategies to improve collection will be necessary before meaningful improvements in quality of care can be implemented.
Upfront Autologous Stem Cell Transplantation for Newly Diagnosed Elderly Multiple Myeloma (MM) Patients: A Prospective Multicenter Study
Authors: Laurent Garderet, Cyrille Touzeau, Anne-Marie Stoppa, Denis Caillot, Lionel Karlin, Philippe Moreau, Jean Fontan, Myriam Labopin, Emmanuelle Polge, mor Seny Gueye, Eric Beohou, Souhila Ikhlef, Zora Marjanovic, Didier Blaise, Mohamad Mohty
Journal: Blood (2015)
Human papillomavirus (HPV)–related, p16 positive head and neck squamous cell carcinomas (HNSCCs) after stem cell transplantation (SCT) and solid organ transplantation (SOT).
Authors: C. P. Rodriguez, D. Chute, R. Seth, B. Burkey, J. Scharpf, A. P. Hoschar, D. I. Ives, D. J. Adelstein
Journal: Journal of Clinical Oncology (2011)

5571 Background: It is well-recognized that patients who undergo SCT or SOT are at risk for second malignancies, including HNSCC. While viral oncogenes have a defined role in some post-transplant cancers, the link between HPV infection and HNSCC in immunosuppressed patients has not been well studied. Methods: We reviewed the Cleveland Clinic SCT and SOT databases and identified patients who developed HNSCC after transplantation. Demographics, primary site and stage were noted. In situ hybridization for high risk HPV subtypes (HPV-ISH) and p16 immunohistochemistry results were recorded if available, or were performed in patients with sufficient pathologic material. Results: Twenty-one patients with HNSCC after transplantation were identified; 9 (43%) after SCT and 12 (57%) after SOT. Eighteen patients (86%) were male, and all were Caucasian, with a median age at HNSCC diagnosis of 57 (range 31-72) years, and a median time from transplantation to HNSCC diagnosis of 6.1 (range 0.4-16.4) years. The primary site was in the oropharynx in 8 patients (38%), oral cavity in 6 (28%), larynx in 5 (24%), hypopharynx in 1 (5%), and unknown in 1 (5%). HNSCC stage was I in 4 (20%) patients, II in 4 (20%), III in 4 (20%), IVA in 5 (24%), and IVB in 1 (5%). Data on disease stage was not available in 3 patients. HPV-ISH and p16 status could be determined in 17 patients; 6 were both p16 and HPV-ISH positive, 1 was p16 positive but insufficient tissue was available for HPV-ISH testing, and 1 was p16 positive and HPV-ISH negative. Five of the p16 positive HNSCCs occurred in SOT recipients, 3 were diagnosed after SCT. The remaining 9 patients were both p16 and HPV negative. Among the 8 p16 positive patients, primary sites were in the oropharynx in 4, larynx in 2, and oral cavity in 2. Among the 9 p16 negative patients, primary sites included oral cavity in 3, oropharynx in 3, hypopharynx in 1, larynx in 1 and unknown in 1. Conclusions: In this small retrospective study, the HNSCCs that developed after SCT and SOT were frequently positive for HPV-ISH and p16. Unlike HPV-related HNSCCs in immunocompetent patients, HPV and p16 positivity was often identified outside of the oropharynx.
Relative impact of chemotherapy with or without bevacizumab on cytokines and angiogenic factors (CAFs) in metastatic colorectal cancer.
Authors: C. H. Lieu, H. T. Tran, S. Fiorentino, Z. Jiang, M. Mao, M. J. Overman, C. Eng, L. M. Ellis, J. Heymach, S. Kopetz
Journal: Journal of Clinical Oncology (2011)

401 Background: CAFs were previously shown to be modulated in patients (pts) with metastatic colorectal cancer (mCRC) after bevacizumab-containing chemotherapy. Validation of these prior findings is warranted. In addition, the relative impact of bevacizumab and the cytotoxic chemotherapy components on CAFs has not been previously described. Methods: Plasma samples from 403 mCRC pts were obtained prior to any chemotherapy (Group A) or after progression on a regimen without or with bevacizumab (Group B and C, respectively) between 2002 and 2008. Samples were matched for number of metastatic disease sites (Groups A, B, C) and for prior chemotherapy duration, and time from last chemotherapy dose to sample collection (Groups B, C). Levels of 48 CAFs were measured by suspension bead multiplex assays (BioRad and EMD). Comparisons of Groups A v C (n=169 pairs) and Groups B v C (n=65 pairs) were by the two-sided, nonparametric Wilcoxon paired test, with p&lt;0.05 significance for confirmation of previous CAF results. Results: Prior chemotherapy duration (6.5mo, 6.7mo), and time from last chemotherapy dose to sample collection (1.3mo, 1.2 mo) were similar for Groups B and C, respectively. Results were available for 80% of the samples. Compared to Group A, Group B had reductions in multiple CAFs, including IL-8 (-38%, p&lt;0.0001) and PDGF (-62%, p&lt;0.0001). Commensurate with prior results, PlGF, Eotaxin and TRAIL were increased in Group C by 30% (p&lt;0.0001), 23% (p=0.024) and 19% (p=0.008) respectively. Most CAF changes were attributable to chemotherapy alone. However, PlGF (-31%, p&lt;0.0001) and TRAIL (+26%, p=0.037) significantly differed in Groups B v C. In group C compared to A, multiple changes were seen in the EGFR-axis including decreases in EGF (-52%, p=0.032), epiregulin (-25%, p=0.0023), and HB-EGF (-40%, p&lt;0.0001) as well as an increase in sEGFR (+10%, p=0.004). Conclusions: Most changes in CAFs after treatment with bevacizumab-containing chemotherapy appear to be due to chemotherapy alone and not attributable to anti-VEGF therapy, with several notable exceptions. Chemotherapy-induced changes in the EGFR-axis have not previously been described in mCRC and warrant further investigation. [Table: see text]
A shape memory alloy probe for electrovaporization of renal cell carcinoma.
Authors: Y. Naito, A. Kawauchi, K. Kamoi, K. Okihara, T. Miki
Journal: Journal of Clinical Oncology (2011)

e15090 Background: We developed a new shape memory alloy (SMA) probe for percutaneous treatment of renal cell carcinoma (RCC) by electro-vaporization, and investigated its efficacy and safety in experimental models. Methods:The SMA electrode can be manipulated to any shape at room temperature and regains its original shape at ≥ 65 °C. By adding a high-frequency electric current to the probe, the electrodes quickly regain their original shape and vaporize tissues into a spherical defect. The performance of this probe was tested using agar, dog kidney and rat RCC models. The treatment effect was evaluated by magnetic resonance imaging (MRI) and histological examination. Results: The vaporizing electrode produces heat due to its own resistance to the high frequency electric current, and vaporizes surrounding agar. In the agar model, the electro-vaporization inside the spherical electrode was successfully achieved in several seconds. The area of ≥ 60 °C extended about 5 mm beyond the periphery of the vaporized part, and corresponded with the histological findings on the dog kidney that an irreversible heat denaturation occurred to the same extent. A tumor model made by transplanting RCC cell line in the subcutaneous tissue of nude rats. After applying the electorical current, the electrode part completely recovered to a full sphere shape. The study on the RCC model also confirmed that about 5 mm extent of heat denaturation was seen in the muscular tissue adjacent to the tumor. In the study using the RCC model, some remaining tissues close to the tumor were observed after vaporization. However, dynamic MRI demonstrated no enhancement in this area and no viable tumor cells were documented by histological examination. Conclusions: This novel tissue ablation system has potential as a viable option for percutaneous treatment of renal tumors.
Clinical outcomes of patients (pts) age 80 or older treated with docetaxel (DOC) as first-line chemotherapy for castration-resistant prostate cancer (CRPC): Results of an Italian multicenter retrospective study (DELPHI study).
Authors: Antonello Veccia, Salvatore Luca Burgio, Giuseppe di Lorenzo, Cinzia Ortega, Florinda Scognamiglio, Michele Aieta, Fable Zustovich, Rodolfo Mattioli, Giovanni Mansueto, Gaetano Facchini, Giuseppe Procopio, Alessandro D'Angelo, Gilbert Spizzo, Maddalena Donini, Roberto Bortolus, Giovanni Vicario, Paolo A. Zucali, Umberto Basso, Giovanni Lo Re, Orazio Caffo
Journal: Journal of Clinical Oncology (2014)

92 Background: Docetaxel (DOC) represents the treatment of choice in the first line treatment for patients (pts) with castration-resistant prostate cancer (CRPC). However, when CRPC is diagnosed in pts age 80 or older, the fear of high toxicity degree usually limits chemotherapy use due to both pts frailty and several comorbidities occurrence. The present retrospective study is aimed to assess the clinical outcomes in this very elderly CRPC population. Methods: In this multicentric retrospective study, after Ethical Committee approval, we have reviewed the clinical records of all pts age 80 and older CRPC pts from participating institutions, treated with DOC in clinical practice, recording the pre- and post-DOC clinical history, the DOC treatment details and outcomes. Results: To date we collected a consecutive series of 115 pts from 28 Italian hospitals. The median age was 82 (range 80 to 90). The median baseline prostate-specific antigen (PSA) was 92 ng/ml (range 3 to 2,981); 83% of the pts had bone metastases, while nodal, lung and liver metastases were observed in 39%, 9%, and 8% of the pts, respectively. Median Cumulative Illness Rating Scale score was 3 (range 0 to 11), median Activity Daily Living index score was 0 (range 0 to 5), median Instrumental Activities of Daily Living score was 0 (range 0 to 5). The DOC was administered on 3 week or weekly schedule basis (43%/57%). A PSA reduction greater than 50% was observed in 55% of the pts; an objective response was observed in 15% of the 60 pts who underwent a radiological re-evaluation at the treatment end. Grade 3-4 toxicities were: anemia (2%), neutropenia (10%) , thrombocytopenia (2%), fatigue (10%), diarrhea (4%), nausea (2%), renal (2%), and febrile neutropenia (2%). The median progression-free survival (PFS) and overall survival (OS )were 7 months and 20 months, while the 1 year PFS and OS rates were 21.2% and 71.5%, respectively. Conclusions: This data suggests that selected very older (age 80 and older) CRPC pts may received DOC with a good toxicity profile. In this pts population the treatment, both on 3 week or weekly schedule, is able to produce survival outcomes comparable to pivotal trials (18 months).
Metformin and breast cancer incidence in postmenopausal diabetic women in the Women’s Health Initiative (WHI).
Authors: R. T. Chlebowski, A. McTiernan, A. K. Aragaki, T. Rohan, J. Wactawski-Wende, E. Ipp, D. Euhus, V. G. Kaklamani, M. Vitolins, R. B. Wallace, S. Liu, M. J. Gunter, L. Phillips, H. Strickler, B. Howard
Journal: Journal of Clinical Oncology (2011)

1503 Background: While results are somewhat mixed, emerging evidence suggests metformin may decrease breast cancer risk. However, metformin influence on breast cancer by hormone receptor status has not been reported. We measured associations between metformin use and breast cancer incidence by hormone receptor status in diabetic patients in the WHI cohort. Methods: The study population consisted of 156,229 postmenopausal women in which 9,277 medication-treated cases of diabetes were identified and followed over 11.1 (3.5) years, mean (SD) follow-up. Information on diabetes drug therapy was collected at baseline and after three years of follow-up. Self-reported invasive breast cancers were verified by centralized medical record review. Cox proportional hazard regression, adjusted for breast cancer risk factors including Gail risk score, BMI, physical activity, and hormone therapy was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Analyses compared the association of diabetes therapies incorporating metformin with those with non-metformin diabetes therapies on breast cancer incidence with women without diabetes as comparator. Results: Women with diabetes were older and were more commonly Black, obese and less physically active. Compared to women without diabetes, diabetic subjects receiving therapies without metformin had comparable breast cancer incidence. At baseline, diabetic subjects taking metformin reported a mean (SD) of 1.3 (1.7) years of use, compared to 4.8 (5.6) years for those receiving therapies without metformin. Diabetic subjects taking metformin had 38% fewer ER+/PR+ breast cancers (P=.02). Conclusions: In diabetic women, metformin use was associated with lower ER+/PR+ breast cancer incidence, providing support for testing metformin in chemoprevention. Diabetic therapy no metformin N (%) HR 95% CI 1 Diabetic therapy with metformin N (%) HR 95% CI) P value Invasive breast cancer Total 180 (0.41) 1.04 (0.87-1.24) 119 (0.45) 0.80 (0.63-1.03) .24 ER+/PR+ 101 (0.23) 1.03 (0.82-1.29) 61 (0.23) 0.62 (0.44-0.87) .02 ER-/PR- 32 (0.07) 1.32 (0.85-2.06) 16 (0.06) 0.87 (0.44-1.69) .43 1 All comparisons are against women without diabetes.