tbuckley/cabot-search huggingface dataset:
Safe chemotherapy: Clinicians driving technology and not the other way around.
Authors: Vishal Kukreti, Roxanne Cosby, Annie Cheung, Marie Hamasoor, Sherrie Hertz, Leonard Kaiser, Sara Lankshear
Journal: Journal of Clinical Oncology (2012)

183 Background: Although information technology (IT) has the potential to improve the quality and safety of patient care, introduction into the clinical work flow may create unanticipated consequences. IT solutions such as computerized physician order entry (CPOE) are often designed and executed without end-user involvement. An evidence based guideline for systemic treatment (ST) CPOE was developed. The guideline looks at the features, functionalities and components of a ST CPOE system required to ensure safe and high-quality care. Methods: The guideline was developed by an interdisciplinary panel of physicians, nurses, pharmacists, methodologists, IT specialists, and human factors experts. A systematic review was conducted of the available clinical and technology literature and key informant interviews were conducted. Role-specific CPOE functionalities were process mapped for physicians, nurses and pharmacists. Two expert panels (i.e., clinical and supporting tools) were convened to review the information and provide feedback on guideline content. The guideline was also reviewed externally by content experts from provincial, national and international organizations. Results: The resulting evidence-based guideline focused on two distinct yet interconnected parts: clinical practice (e.g., error prevention, unanticipated consequences, impact on practice, clinical decision support), and technology requirements (e.g., usability features, system integration, effective alerts, audit logs, regimen building). The recommendations also highlight the importance of change management strategies and clinician engagement. Conclusions: This innovative guideline provides an approach to technology evaluation focusing on clinical practice needs driving IT solutions. Future research to help standardize design and usability of such systems is necessary. The non-vendor specific recommendations can be used as the foundation for evaluation of ST CPOE systems to reduce errors, improve safety, and support clinical practice. The application of the recommendations as an assessment of ST CPOE system guideline concordance will also be valuable.
Low pretreatment hemoglobin and advanced age: Important adverse prognostic factors in head and neck cancer independent of treatment modality. A large single institutional study
Authors: B. Mehrotra, N. Seetharamu, D. Janson, K. Heller, D. Myssiorek, J. Pollack, S. Nissel-Horowitz, A. Thomas, N. Kohn
Journal: Journal of Clinical Oncology (2005)

5524 Background: Prognosis of Head and Neck Cancer (HNC) patients (pts.) is known to be related to stage of disease at the time of presentation. Anemia among patients receiving radiation therapy (XRT) is associated with a worse outcome. However, the role of anemia irrespective of the modality of therapy is unclear as a prognostic factor. Also, the role of age as a prognostic factor is unclear in HNCs. Methods: Approval from the Institutional Review Board was obtained for this study. We performed a retrospective review of records of pts. diagnosed with squamous cell HNC at our institution between 1/95 and 12/02. Information on age at diagnosis, gender, primary site of tumor, stage of disease, treatments used, pre-treatment hemoglobin level and survival data were recorded. Patients with known distant metastases, nasopharyngeal cancers and salivary tumors were excluded. Hemoglobin levels were stratified as low, medium and normal (Males:<11, 11-<13, ≥ 13; Females: <11, 11-<12, ≥12 g/dl respectively). Age groups were stratified <50, 50-<60, 60 <70 and ≥70 years. Sites were identified as, larynx, pharynx, lip & oral cavity and others. Results were stratified for early stage (I &II) and advanced stage (III & IV) disease separately. These factors were used in a Cox regression to examine multivariate effects. Results: 497 pts. were evaluable. Cox regression (multivariate) analyses identified low hemoglobin, age at diagnosis ≥ 70 years. and primary site of disease as significant prognostic markers in all patients (Table). Survival was not significantly affected by gender or modality of therapy. A significant difference in survival was noted based on stage. Conclusions: Pre-treatment low hemoglobin levels and older age at diagnosis emerge as significant adverse prognostic factors for squamous cell HNC irrespective of treatment modality. Author Disclosure STAGE I & II Factor Risk Ratio (95% CI) p-value Hgb:Low 2.0 (1.2–3.5) <0.0103 Age at DX: 70 2.6 (1.6–4.2) <0.0001 Primary Site: Pharynx 2.0 (1.0–3.9) <0.0388 Primary Site: Other 2.5 (1.3–4.8) <0.0040 STAGE III & IV Hgb: Low Med 1.6 (1.0–2.4) 1.5 (1.0–2.3) <0.0410 <0.0488 Age at Dx: 50- <60 60- <70 ≥70 2.1 (1.0–2.3) 2.0 (1.0–4.1) 3.1 (1.6–6.2) <0.0375 <0.0435 <0.0013 Primary Site: Pharynx 0.6 (0.4–0.9) <0.0150 No significant financial relationships to disclose.
Comparative analysis of uptake for 18F-fluorodeoxyglucose (FDG) versus 18F-fluorodeoxythymidine (FLT) PET scans in rectal cancer.
Authors: Arshin Sheybani, Sudershan Bhatia, Yusuf Menda, Laura Boles-Ponto, Brandie Ann Gross, William Rockey, Sarah Marie McGuire
Journal: Journal of Clinical Oncology (2014)

657 Background: FLT PET is a novel metabolite for imaging cellular proliferation and has shown promise for treatment response monitoring. The utility of FLT PET imaging in rectal adenocarcinomas (RA) has not previously been established. We set out to compare FDG and FLT uptake in RA and correlate FLT response during treatment to tumor regression. Methods: We evaluated 6 patients with RA who were treated on an institutional prospective clinical trial (NCT01717391). Patients were treated neoadjuvantly with concurrent chemoradiation therapy per standard of care. Patients had both FDG and FLT PET scans prior to starting treatment and FLT scans after 1 and 2 weeks of radiotherapy. Tumor volumes and pelvic lymph nodes measuring greater than 6 mm were contoured on the simulation CT scan and adjusted for bladder and rectal filling based on the attenuation correction CT for each PET scan. FLT and FDG SUVs were collected from a total of 40 lymph nodes among the six patients. Pretreatment and change in tumor FLT SUVs were correlated with histopathological regression. The sensitivity of FLT and FDG for identifying lymph nodes was compared using a Student’s t-test. Results: At the time of this analysis, there were post-treatment pathological data on five patients. All but one patient had a decline in the FLT tumor SUV after 2 weeks of treatment. This non-responder was the only patient who did not have histopathological tumor regression after treatment and was the only patient whose pretreatment FLT SUV was below 2. Tumor FDG SUV (4.54 ± 1.03) was consistently higher compared to FLT (2.42 ± 0.51) values, however nodal uptake for FDG (1.89 ± 1.08) was not higher compared to FLT (1.98 ± 0.96). To account for this difference, nodal uptake was normalized to the SUV of each patient’s primary tumor for both FLT and FDG. Mean normalized lymph node FLT SUVs were significantly higher (0.80 ± 0.36) than normalized FDG SUVs (0.44 ± 0.25) (p&lt;0.001). Conclusions: Preliminary data supports using FLT SUV as a biomarker for tumor response early during treatment. Relative FLT uptake in nodal metastasis also appears to be higher when compared to FDG. This indicates potential response and diagnostic applications for FLT PET imaging in RA Clinical trial information: NCT01717391.
Survivors preferences about the role of the oncologist and primary care provider.
Authors: Paolo Tralongo, Sebastiano Rametta Giuliano, Anna Maria Di Mari, Sebastiano Bordonaro, Fabrizio Romano, Vitalinda Pumo, Margherita Iacono, Eleonora Lanteri, Antonino Carmelo Tralongo, Sebastiana Roccaro, Sebastiana Iemmolo
Journal: Journal of Clinical Oncology (2016)

259 Background: Oncologist and Primary Care Provider are both involved in cancer patients follow-up. Patient's preference is an important issue. Aims This observational study was made to investigate: a) if and how long after the diagnosis the patient prefers to be followed by PCPs, Oncologist or both; b) if they prefer to be followed in the same institute where they received acute phase care; c) if it's important to receive recommendations about their lifestyle. Methods: 150 patients were recruited between May and June 2015 in the transient phase. They were affected by different tumors (breast, colon, prostate, melanoma, gynecological cancers and lymphoma disease) 53 pts under 3 years, 38 pts 5 years, 59 pts 7 years since the diagnosis. A questionnaire investigating the aims of the study was administered. Results: Among the pts on 3 years follow-up, only one preferred to be followed by the PCPs for logistical reasons; 24/53 patients after 5 years follow-up preferred PCPs and 18/53 preferred to be followed only by the oncologist because of more competence. In the 5 and 7 years follow-up 80/97 pts preferred to be exclusively followed by the oncologist for these reasons: A) poor PCPs involvement during the acute phase. B) oncologist expertise in acute phase, follow-up and possible relapse; c) lack of interest shown by the PCPs for survivorship care plan. All pts (150) gave positive response on receiving advices about their lifestyle (diet, sport activities, etc...). For 63% of the patients a unique structure would be suitable for receiving follow-up too. Conclusions: The preferences of patients, followed in the transient phase, suggest that fear of relapse guides patient's choice and the relationship with the oncologist offers security.
Pilot study of dovitinib in patients with VHL disease.
Authors: Patrick Glen Pilie, Surena F. Matin, Ashley Henriksen Woodson, Valerie D. Marcott, Shelly Bird, Rebecca Slack, Greg Fuller, Ian E. McCutcheon, Eric Jonasch
Journal: Journal of Clinical Oncology (2016)

587 Background: Von Hippel-Lindau (VHL) is an autosomal dominant inherited disease occurring in 1 in 35,000 births. Individuals with germline mutations in the VHL gene may phenotypically express a variety of lesions including hemangioblastomas (HBs), pancreatic cysts, renal cysts, and renal cell carcinomas (RCC). Previous studies have shown differentially increased FGFR3 levels in HBs compared to RCC. In this pilot trial, we investigated the safety and efficacy profile of TKI 258 (dovitinib), a tyrosine kinase inhibitor of VEGF and FGF receptors, in VHL related lesions, focusing on HBs. Methods: A MDACC IRB-approved protocol planned to enroll 25 subjects who had genetically confirmed VHL disease or clinical diagnosis of VHL, and measurable HBs with no immediate risk of needing intervention. Dovitinib 500mg/day was given in a 4 week cycle on 5 day on/2 day off schedule. In the absence of adverse events (AE), treatment lasted 6 cycles or until disease progression. Evaluation of response to treatment was done every 8 weeks including imaging, laboratory, and clinical evaluation. The trial design used a continuous Bayesian stopping rule based on toxicities that resulted in discontinuation of dovitinib and another for lack of efficacy. Signed informed consent completed on all patients enrolled. Results: Trial stopped after six patients enrolled due to toxicity stopping rule. Patients’ ages ranged 18-61 with 5/6 being male. With regards to safety, 6/6 subjects had at least one AE with the most common AEs being rash, diarrhea, and fatigue including a grade 3 AE (severe rash) in one patient. 1/6 was stopped due to noncompliance, 1/6 stopped due to progression, 3/6 stopped due to side effects despite dose reduction, and 1/6 completed full six cycles at full dose. Best response in 6/6 subjects was stable disease (SD) in HBs. Conclusions: This pilot study of dovitinib in patients with VHL disease with measureable HBs did not show a favorable safety or efficacy profile for this dose and schedule. Half of the patients discontinued the drug due to AEs before study completion, and the best achieved response was SD. Further investigation into alternative scheduling and other FGFR inhibitors in the treatment of HBs is warranted given the strong pre-clinical data. Clinical trial information: NCT01266070.
Conventional Reinduction/Consolidation-Type Therapy Versus Short Course High Intensity Combination Chemotherapy As Post-Induction Treatment for Children with Relapsed Acute Lymphoblastic Leukemia. Early Results of Study ALL-REZ BFM 2002
Authors: Arend von Stackelberg, Junko Yamanaka, Gabriele Escherich, Cornelia Eckert, Richard Ratei, Johann K. Hitzler, Georg Mann, Lucie Sramkova, Jean-Pierre Bourquin, Martin Schrappe, Günter Henze
Journal: Blood (2011)
Caution in Generalizing the Use of Adjunctive Primary Corticosteroids in Kawasaki Disease to Unselected Non-Japanese Populations
Authors: Linny Kimly Phuong, Davinder Singh-Grewal, David Paul Burgner
Journal: JAMA Pediatrics (2017)

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Glioblastoma multiforme (GBM) in the elderly: An Irish experience.
Authors: D. M. Graham, M. Teo, P. O'Dea, C. Keohane, S. O'Reilly, E. J. Moylan, D. G. Power
Journal: Journal of Clinical Oncology (2011)

e19621 Background: In an aging cancer population treatment decisions become more complex. Treatment options in GBM are increasing and there is a paucity of data in the elderly (>65 years). We sought to review our institution’s experience of treating this patient (pt) population. Methods: A prospectively maintained database was evaluated for pts with GBM reviewed at our institution between Aug 2004 and Dec 2009. Pts were divided into: age groups > and <65 years [yrs] (Gp A and Gp B) at diagnosis and treatment received. Optimal treatment was defined as radio-(+/-chemo) therapy followed by adjuvant chemotherapy. Charlson comorbidity score and ECOG performance status (PS) were recorded where possible. Data were analysed with Fisher’s exact and Mann-Whitney U tests. Results: Of 144 pts with GBM, 35 pts were >65 yrs (24.3%) and 4 pts were >75 yrs (2.8%). 132 pts received treatment (92%), which was optimal in 82 pts (57%). In Gp A 34 pts were treated (97%); of these, treatment was optimal in 15 (43%) compared with 61.5% in Gp B (p=0.077). In Gp A the median Charlson score was 6 (range: 6 – 10) and PS was 0 in 10 pts (29%), 1 in 18 pts (53%), 2 in 4 pts (12%) and 3 in 2 pts (6%), comparable to Gp B. Median overall survival (mOS) in Gp A was 5.8 months [mts] (CI: 3.0 – 8.6) compared with 10.1 mts (CI: 7.9 – 12.3) in Gp B (p=0.004). For all treated pts, mOS was 5.8 mts (CI: 3.0 – 8.6) in Gp A compared with 9.7 mts (CI: 8.5 – 11.1) in Gp B (p<0.0005). For pts receiving optimal treatment, mOS was 8.4 mts (CI: 3.2 – 13.5) and 14.2 mts (CI: 11.3 – 17.1) in Gp A and B, respectively (p=0.002). HR for death for age >65 was 3.52 (CI: 2.0 – 6.1). For the 4 pts over age 75 yrs, mOS was 9.8 mts (range 1.7–16.9) compared to 5.4 mts (range 1.5–47.4) in the 65–75 yr age group. Treatment related toxicities were broadly similar between Gps A and B (detailed analysis ongoing). Conclusions: A significant number of pts diagnosed with GBM are elderly. Our data suggest that they have worse overall survival independent of treatment received. A small subset of pts aged >75yrs had improved survival compared with those 65 – 75 yrs, suggesting that careful pt selection may result in improved survival. Prospective trials incorporating comprehensive geriatric assessment and molecular analyses could potentially identify pts who would benefit from treatment.
Expression analysis of genes involved in ovarian cancer metastasis
Authors: M. A. Martino, A. Elahi, R. Sutphen, C. Klippel, T. Boren, H. K. Dressman, A. Berchuck, J. M. Lancaster
Journal: Journal of Clinical Oncology (2005)

5038 Background: Epithelial ovarian cancer is the most lethal gynecologic malignancy. Patients with early stage ovarian cancer have an excellent prognosis, in contrast to patients with advanced stage disease, who have a 5-year survival of less than 30%. Although the transition from early to advanced stage disease is a critical determinant of survival, little is known about the molecular genetics that underlie metastasis. The purpose of this study was to evaluate the role of 5 genes previously implicated in human carcinogenesis (FABP4, P53, CCL19, FHL2, POLYDOM), in ovarian cancer metastasis. Methods: Expression levels of the FABP4, P53, CCL19, FHL2, and POLYDOM genes were measured using quantitative real time polymerase chain reaction (QRTPCR) in 39 ovarian cancer samples collected from primary and metastatic sites from 14 patients undergoing primary surgical cytoreduction for advanced stage (IIIC/IV) serous epithelial ovarian cancer. Twenty-five samples were resected from the left and/or right ovary and 14 samples from the omentum. All samples were subject to QRTPCR analysis in triplicate and mean values reported. Mean expression values were subject to statistical analysis by student’s t-test. This study was IRB approved and informed consent obtained. Results: Higher expression was identified in omental metastases compared to primary ovarian specimens in the CCL19 (7.8-fold), FABP4 (5.2-fold), POLYDOM (2.4-fold), and P53 (1.1-fold) genes. In contrast, FHL-2 gene expression was 1.25-fold higher in primary ovarian samples than matched omental metastasis. Conclusion: We have evaluated expression of 5 genes that may contribute to omental metastasis from epithelial ovarian cancer. All 5 genes have functions that are biologically consistent with a role in cancer progression and metastasis. Defining the molecular genetic changes associated with ovarian cancer metastasis identifies targets for novel therapeutic interventions that may improve survival for patients with advanced stage disease. No significant financial relationships to disclose.
Multidisciplinary optimization of oral chemotherapy delivery at the UW Carbone Cancer Center.
Authors: Daniel Mulkerin, Mary Mably, Jason Bergsbaken, Kari Schuhmacher, Chris Nemergut, Aaron Bohler, Jessica Fischer
Journal: Journal of Clinical Oncology (2016)

58 Background: Use of oral chemotherapy is expanding and offers advantages but introduces unique safety challenges. ASCO and ONS addressed these issues with inclusion of oral chemotherapy in published chemotherapy administration safety standards. Methods: The updated ASCO/ONS standards offered a framework for the University of Wisconsin Carbone Cancer Center to evaluate and improve our practice with the goal of full compliance with these standards. Gap analysis revealed noncompliance with five and partial compliance with eleven standards. We divided areas for improvement into three foci: patient education, workflow, and information technology. Multidisciplinary groups addressed each area generating twenty-five recommendations. Important changes included: defining chemotherapy, standardization of patient and caregiver education, mandated use of standardized electronic order sets incorporating safety checks, and standardizing dose modification documentation. The revised electronic process allows for prospective order review of all oral chemotherapy by pharmacists and supports automated processes for assessing adherence and toxicities utilizing a library of scripted drug specific materials. Results: Prior to implementation of new processes we estimated that only 39% of our oral chemotherapy was delivered with potential demonstrable compliance with ASCO/ONS standards. Audit of oral chemotherapy orders from February to July 2015 now shows compliance with use of electronic chemotherapy plans in 244/251 (97.5%) of cases. Prospective pharmacist order review resulted in one or more interventions in 24% of these cases.Identification of patients to receive adherence and toxicity monitoring calls is 100%. Conclusions: Closure of significant gaps between institutional practice and published standards was accomplished for our oral chemotherapy practice. Key elements of success included: multidisciplinary approach, defining chemotherapy, leveraging our electronic health record with mandated use of standardized order sets, and standardization of clinical and educational processes. We are disseminating this approach across our regional network and we believe our tools are broadly applicable.
Treatment sequencing patterns of novel agents in patients with prostate cancer.
Authors: Elisabetta Malangone, Kathleen A. Foley, Kathleen Wilson, Helen Varker, Alison Binder, R. Scott McKenzie, Lorie Ellis
Journal: Journal of Clinical Oncology (2014)

296 Background: The National Comprehensive Cancer Network (NCCN) guidelines recommend chemotherapy, immunotherapy or anti-androgen therapies for the treatment of advanced castration-resistant prostate cancer (CRPC). This study evaluated treatment sequencing of recently approved agents for CRPC [abiraterone (ABI), enzalutamide (ENZ), docetaxel (DOC), cabazitaxel (CAB), or sipuleucel-T (SIP)] among men with PC. Methods: This retrospective, observational study evaluated adult men with PC in the MarketScan Oncology EMR database, which includes data from over 900 contributing oncologists from over 100 community practices. Inclusion required a diagnosis of PC (ICD-9-CM diagnosis code 185) from 07/01/2011-03/31/2014, no treatment with ABI, ENZ, DOC, CAB, or SIP prior to 09/01/2012, no other primary cancers, and six months of medical record history prior to index date. The index date was the date of first prescription of ABI, ENZ, DOC, CAB or SIP between 09/01/2012 and 03/31/2014. First-, second- and subsequent-line treatments were evaluated prior to end of data availability or end of study. Results: In total, 812 PC patients were identified; mean age was 75 years and 68% had recorded metastasis. A single line of therapy was observed for 544 patients (67%). ABI was the most common first-line treatment (443; 55%), followed by DOC (167; 21%), ENZ (113; 14%), SIP (82; 10%) and CAB (7; 1%). A second line of therapy occurred in 268 patients (33%) and third line in 8%. The table below describes first-line and the two most common second-line therapies for those moving on to second-line. Conclusions: Of the five agents of interest, ABI was the most commonly prescribed first-line medication for advanced PC in this patient cohort. First-line DOC was more common than first-line CAB or SIP. Further studies with longer follow-up and other treatments are warranted. [Table: see text]