tbuckley/cabot-search huggingface dataset:
A biomarker trial of BR-DIM (BioResponse 3,3’- Diindolylmethane) in patients with prostate cancer who undergo prostatectomy.
Authors: E. I. Heath, C. Hwang, M. L. Cher, L. K. Heilbrun, I. Powell, M. Menon, J. Li, M. Heath, S. Sethi, F. H. Sarkar
Journal: Journal of Clinical Oncology (2011)

e15185 Background: DIM acts as an anti-androgen which down-regulates the androgen receptor (AR) and prostate specific antigen (PSA). We conducted a biomarker trial to measure the level of DIM and its effects on AR in prostate tissue after treatment of prostate cancer (PCa) patients with BR-DIM. Methods: Patients with clinically confined PCa who were candidates for surgery were treated with BR-DIM at a dose of 225 mg orally twice daily for a minimum of 14 days. Patients did not receive any prior therapy for prostate cancer and had adequate organ function. Men received their last dose of BR-DIM the day before surgery. Blood samples for DIM levels were collected at pre-treatment and at ~12 h after the last dose of BR-DIM (just prior to the surgery). The prostate was removed during surgery and DIM concentration was measured in the prostate tissue. AR was evaluated by immunohistochemistry. Results: 21 patients were treated at 2 institutions. The 20 evaluable patients had median age 60 (range 41 - 76), 10 were Caucasian, and 10 were African American. Toxicity was minimal; only two patients with grade 3 headache. DIM was found at a mean trough level of 10 ng/ml (range, < 1 to 23) and 15 ng/g (range, < 1 to 26.8) in plasma and prostate tissue, respectively. PSA remained the same pre and post BR-DIM treatment. In our interim analysis for AR expression, 20 PCa control specimens (non-intervention samples) and 8 patient’s tumors from BR-DIM intervention samples, and two cases having pre-DIM diagnostic biopsy and subsequent post BR-DIM samples were evaluated. Strong AR expression was found in 9 of 20 randomly selected PCa specimens (45%) and others showed weak or no positive staining. Of the 8 PCa specimens after BR-DIM intervention, AR staining was seen in 3 cases (37.5%). These results suggest that BR-DIM intervention slightly down-regulated AR expression, consistent with pre-clinical findings. Conclusions: BR-DIM was well tolerated by our 21 patients. DIM was detected in both plasma and prostate tissues at ~12 h post dosing. AR expression was lost in 5 of 8 patients after BR-DIM treatment. Additional studies using BR-DIM in PCa are warranted.
Skype programme is effective for people with chronic knee pain
Authors: Jacqui Wise
Journal: BMJ (2017)

An internet delivered programme produced meaningful improvements in pain and function among patients with chronic knee pain, research published in the Annals of Internal Medicine shows.1

Osteoarthritis is the leading cause of persistent knee pain, affecting around a quarter of adults. Its prevalence is rising because of an ageing population and increasing levels of obesity.

Exercise has been shown to improve pain and function in people with knee osteoarthritis and …
Analysis of chemokine receptor expression on circulating tumor cells (CTC) in patients with solid tumors.
Authors: A. Fusi, Z. Liu, V. Kuemmerlen, J. Jeske, A. Rietz, U. Keilholz
Journal: Journal of Clinical Oncology (2011)

e21053 Background: In the majority of cases metastases show an organ-specific pattern of spread. The soil theory states that different organs have special abilities to arrest, attract, and promote specific types of cancer cells. In the seed concept cancer cells co-opt chemokine-mediated signalling (seed-factor). We investigated the expression of the chemokine receptors [CR] on circulating tumor cells [CTC] in a cohort of patients with solid tumors. Methods: Twenty millilitre blood were collected after informed consent from 68 consecutive patients affected by metastatic melanoma [M] (n=29) or carcinoma [C] (n=39). Blood was enriched for tumour cells by CD45 depletion using a magnetic bead separation technique. Potential CTC were identified using flow cytometry with the surface marker EpCAM and intracellular cytokeratin 7-8 (C specimens) or melanoma surface chondroitin sulphate proteoglycan (M specimes). Multiparameter cytometry assessed surface expression of the combinations of CXCR4 and CCR6 and for M specimens also CCR7 and CCR9. Results: Forty-nine patients (71%) [28 C; 21 M] showed presence of CTC. The median number of CTC was 3 (range: 1-94)/10mL [C: 2 (range: 1-21)/10mL; M 4 (range: 1-94)/10mL]. Median number of CR-positive cells and positivity rates are depicted in the table. Altogether CXCR4 was significantly higher expressed on CTC than CCR6 (p = 0.015). Expression rates of CXCR4 and CCR6 did not significantly differ between C and M. No correlation was observed between expression of CR on CTC and presence of liver or lung metatastasis. The median number of cells negative for expression of CR was significantly higher compared to the median number of cells positive for at least one of the CR examined (p=0.013). Conclusions: CTC expressed the CR CXCR4, CCR6, CCR7 and CCR9. A correlation between expression of CR and metastatic pattern was not observed and a consistent number of CTC did not express the CR we investigated. Median number of CR-positive CTC and positivity rates (PR). Total (n=49) C (n=28) M (n=21) CXCR 4 PR Median 82% (40/49) 1 [1-14] 86% (24/28) 1 [1-14] 76% (16/21) 2 [1-8] CCR 6 PR Median 59% (29/49) 1 [1-14] 61% (17/28) 1 [1-14] 57% (12/21) 2 [1-8] CCR 7 PR Median 29% (6/21) 1 [1-5] CCR 9 PR Median 57% (12/21) 2 [1-5]
Strategy of using herbal extract preparations for stage IV cancer in palliative care: An enhanced and maintenance therapy.
Authors: Pu Rong, Zhang Lingyan, Zhou Xiaoxia, Yin Weihua, Zhang Xiulian, Liu Hong, Duan Xiaopeng, Yu Cui, Luo Xiaolu, Zhong Qingfeng, Zhao Fen, Li Xianyong
Journal: Journal of Clinical Oncology (2016)

89 Background: Palliative care is focused and seems as rationally anti-cancer way that have low systemic toxicity and acceptable effectiveness for stage IV cancer, especially herbal extracted medicines, which can regulate tumor microenviroment and body immune system. Our previous lab studies have indicated that TGF-beta, EGF, VEGF, IL-10 cytokines expression and mico-vessel density can be downgraded in tumor microenviroment by herbal extract preparation from Ginseng, Herba Agrimonia, Hairyvein and Arginine etc. Methods: 13 patients with unresectable pancreatic cancer, 31 patients with liver cancer, and 168 patients with stage IV lung cancer were studied. Herbal extract preparation, which was approved by the China Food and Drug Administration; hyperthermia; and psychological rehabilitation were initiated as alternative therapies. Survival time, quality of life and toxicity were evaluated during treatment. Results: The average ECOG score decreased from 3 to 2, and appetite and sleep improved in all three groups. According to CTCAE criteria, no severe hematology and digestion side-effect above grade 2 were observed. In pancreatic cancer group, the median and the average survival time were 5.1 and 6.5 months. The longest survival time was 16.7 months and patient still alive. The 3-, 6-, and 10-month survival rates were 92.3%, 46.2% and 30.8%, respectively. In liver cancer group, the average and median survival time were 12.48 and 5.03 months, respectively; the longest survival time was 84.17 months. The 3-, 6-, and 12-month survival time rates were 77.42%, 38.71%, and 29.03%, respectively. In lung cancer group, 31.58% patients suffered from pleural effusion. The 6 month, 1-, 2- and 5-year survival time rates were 33.93%, 19.05%, 14.29% and 4.17%, respectively. Furthermore, once the survival time was beyond 6 months, the average and median survival time reached 29.98 and 14.80 months; and the 1-, 2- and 5-year survival time rates were up to 56.14%, 42.11% and 12.28%, respectively. Conclusions: Herbal extract preparations, which are a part of palliative care, show acceptable effectiveness and toxicity. Thus, it may prove to be a considerable strategy and optional maintenance therapy for stage IV patients.
Changing the culture for psychosocial care: Does it need changing?
Authors: Cindy L. Carmack, Patricia A. Parker, Daphine Lambert, Sujin Ann-Yi, Alan D. Valentine, Frank V. Fossella, Eduardo Bruera, Janet L. Williams, Lorenzo Cohen
Journal: Journal of Clinical Oncology (2016)

70 Background: National organizations recommend routine screening for psychosocial distress in cancer patients. American College of Surgeons (ACoS) Commission on Cancer mandates screening for accreditation with requirements for timing/method/tool for screening; assessment/referral; and documentation. Methods: MD Anderson routinely screens patients for distress with policies and algorithms for the process. We sought to enhance this standard process by incorporating a dedicated psychosocial liaison in the clinic to ensure screening based on NCCN guidelines, follow-up with patients at the medical visit, and clear documentation and referral per ACoS standards. This study compared the standard process to the enhanced process (which occurred in parallel) through a 6-month retrospective chart review of Thoracic Center patients identified as distressed by either process. Results: The enhanced process utilized the Distress Thermometer (DT) cut-off &gt; 4 resulting in optimal specificity (.77) and sensitivity (.64) compared to the standard process using &gt; 6 (specificity = .87; sensitivity = .34). In the enhanced process (N = 71), 99% were seen during the clinic visit, compared to 13% in the standard process (N = 92) (Fishers Exact; P &lt; .0001). In the standard process, 18% were contacted by phone, 10% were seen later while in-patient, and 33% received a phone message; for 26%, no note was dictated. In the enhanced process, there were high rates of documentation of assessments of suicide (100%), depressive symptoms (100%) and anxiety symptoms (96%) compared to the standard process where documentation occurred less often (suicide 5%; depressive symptoms 11%; anxiety symptoms 11%) (Fishers Exact; all P’s &lt; .0001). Conclusions: Results support the institution’s recent practice change to &gt; 4 on the DT. The enhanced process utilizing a psychosocial liaison facilitates screening at the clinic visit and can support existing mental health providers who may have competing responsibilities. Findings also suggest having standards for distress documentation. Overall, the enhanced process fully meets ACoS standards in all required areas.
68Ga-PSMA Uptake by Dermatofibroma in a Patient With Prostate Cancer
Authors: Funda Aydin, Arzu Akçal, Betül Ünal, Sema Sezgin Göksu, Firat Güngör
Journal: Clinical Nuclear Medicine (2017)

Prostate-specific membrane antigen (PSMA) is a typ. 2 transmembrane protein that is highly expressed in prostate cancer cells. Ga-PSMA PET/CT imaging is a modality used to determine the extent of prostate cancer. Various other neoplasias may also express PSMA, which appears as Ga-PSMA uptake in PET/CT imaging. A 71-year-old man with prostate cancer underwent Ga-PSMA PET/CT imaging for restaging after having an elevated prostate-specific antigen level. Subcutaneous lesions showing focal PSMA uptake were detected, one of which was excised. The histopathologic diagnosis was dermatofibroma.
Variability of physician perspectives toward advance care planning for patients with incurable cancer and congestive heart failure.
Authors: Manisha Chandar, Bruce Brockstein, Alan Zunamon, Irwin Silverman, Sarah Dlouhy, Kathryn Ashlevitz, Cory Tabachow, Bernard Ewigman, Theodore Mazzone, Jennifer Carrie Obel
Journal: Journal of Clinical Oncology (2015)

12 Background: Advance Care Planning (ACP) discussions afford patients and physicians a chance to better understand patients’ values and wishes regarding end-of-life care; however these conversations typically take place late in the course of a disease, or not at all. The goal of this study was to understand attitudes of oncologists, cardiologists, and primary care physicians (PCPs) towards ACP. We also aimed to identify persistent barriers to timely ACP discussion following a quality improvement initiative at our health system aimed at improving ACP completion rate. Methods: A 23-question cross-sectional online survey was created and distributed to cardiologists, oncologists, primary care physicians and cardiology and oncology support staff at the NorthShore University Health System (NorthShore) from February-March 2015. A total of 117 individuals (46% of distributed) completed the surveys. The results were compiled using an online survey analysis tool. Results: Only 15% of cardiologists felt it was their responsibility to conduct ACP with their congestive heart failure (CHF) patients. In contrast, 68% of oncologists accepted responsibility for ACP in incurable cancer patients. Sixty-eight percent of PCPs felt personally responsible for conducting ACP discussions with CHF patients, while only 34% felt the same about cancer patients. Documentation of ACP in the electronic health record (EHR) was inconsistent among specialties. Among all surveyed specialties, lack of time was the major barrier limiting ACP discussion. Perceived patient discomfort and discomfort of the patient’s family towards these discussions were also significant reported barriers. Conclusions: Attitudes toward ACP implementation vary considerably by medical specialty and medical condition, with oncologists in this study feeling more personal responsibility for carrying out these discussions with cancer patients than cardiologists with their heart failure patients. Robust implementation of ACP across the spectrum of medical illnesses is likely to require a true collaboration between office-based PCPs and specialists in both the inpatient and ambulatory settings.
Prostate cancer – major changes in the American Joint Committee on Cancer eighth edition cancer staging manual
Authors: Mark K. Buyyounouski, Peter L. Choyke, Jesse K. McKenney, Oliver Sartor, Howard M. Sandler, Mahul B. Amin, Michael W. Kattan, Daniel W. Lin
Journal: CA A Cancer Journal for Clinicians (2017)

Answer questions and earn CME/CNE The eighth edition of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) Staging Manual has been updated and improved to ensure the highest degree of clinical relevance and to improve its utility for patient evaluation and clinical research. Major changes include: 1) pathologically organ-confined disease is now considered pT2 and is no longer subclassified by extent of involvement or laterality, 2) tumor grading now includes both the Gleason score (as in the seventh edition criteria) and the grade group (introduced in the eighth edition criteria), 3) prognostic stage group III includes select, organ-confined disease based on prostate-specific antigen and Gleason/grade group status, and 4) 2 statistical prediction models are included in the staging manual. The AJCC will continue to critically analyze emerging prostate cancer biomarkers and tools for their ability to prognosticate and guide treatment decision making with the highest level of accuracy and confidence for patients and physicians. CA Cancer J Clin 2017;67:245-253. © 2017 American Cancer Society.
Homologous recombination defects in sporadic breast cancers
Authors: J. Hannemann, L. Mulder, S. C. Linn, G. Sonke, R. Vijzelaar, A. Errami, M. Vrancken-Peeters, M. J. van de Vijver, S. Rodenhuis
Journal: Journal of Clinical Oncology (2008)

22102 Background: Homologous Recombination (HR) is the only mechanism that can reliably repair double-strand DNA breaks. Alternative DNA repair mechanisms, such as non-homologous end joining exist, but these induce DNA mutations and chromosomal aberrations. Hence, tumors that have deregulating mutations in the key players of HR are extremely sensitive to DNA damaging agents, such as bifunctional alkylators and are targeted specifically by Poly(ADP-ribose) Polymerase (PARP) inhibiting drugs. Defects in homologous recombination arise through dysfunction of BRCA1 or BRCA2 or by abnormalities in the Fanconi Anemia pathway. In addition, the recently discovered oncogene EMSY is amplified in a subgroup of breast tumors and blocks HR by inactivating the Brca2 protein. HR defects have been reported to be present in up to 30% of sporadic breast cancers. This study was designed to develop a clinically useful test to identify patients with tumors deficient in homologous recombination. Methods: We have prospectively tested 38 HER2-negative breast cancers scheduled for preoperative chemotherapy. Evidence of a HR defect was sought by A) sequencing of the BRCA1 gene in triple-negative tumors; B) analysis of the expression levels of BRCA1, FANCC and FANCF by quantitative RT-PCR; and C) analysis of the amplification status of the EMSY gene by FISH and/or Multiplex Ligation-dependent Probe Amplification (MLPA). Results: Nine out of 38 tumors (24) had evidence of an HR defect, 5 were triple-negative and 4 ER+/HER2- (luminal). Conclusions: Some 20% of sporadic breast cancers may be defective in HR. Triple-negative tumors are predominantly associated with low BRCA1-expression, luminal tumors with low expression of one of the Fanconi anemia proteins. An update of this ongoing study will be presented. Detected abnormalities in the nine individual samples Subtype BRCA1 Sequence BRCA1 Expression FANC C Expression FANC F Expression EMSY Amplification triple-negative mutation low low low normal triple-negative normal low normal normal normal triple-negative normal low normal normal normal triple-negative normal low normal normal normal triple-negative normal normal normal low NA luminal not done normal normal normal amplified luminal not done low low normal normal luminal not done normal low normal normal luminal not done normal low normal normal No significant financial relationships to disclose.
Analysis of cancer clinical trials in the United States with comparison of National Institute of Health (NIH) and pharmaceutical industry (PHARMA)-sponsored studies.
Authors: K. R. Oettel, N. R. Ruther, M. A. Mathiason, J. K. Keller, J. E. Schroeder, R. S. Go
Journal: Journal of Clinical Oncology (2010)

6084 Background: We performed this study in order to describe the nature of current cancer trials in the US. Methods: From the National Cancer Institute website, we obtained a list of 2,262 therapeutic trials open to accrual on January 14, 2008. We included trials solely sponsored by NIH (62%) or PHARMA (38%) and excluded those with joint sponsorship or not stated (n = 42). Results: Majority of the trials were treatment studies (90%) with only a minority aimed at supportive care (7%) or prevention (3%). Over half were phase II trials (59%) while the rest were phase I (26%), III (15%), and IV (0.4%). Most were open only in the US (75%) with the rest being multinational. Adult trials predominated (88%). Most frequent cancers studied were breast (10%), lung (8%), leukemia (7%), lymphoma (7%), and prostate (6%). Multiple types of cancers were allowed in 26% of the trials. Distribution according to the type of therapeutic modality was systemic treatment (84%), radiation (9%), transplant (7%), and surgery (0.7%). The following exclusion criteria were commonly observed: ECOG performance status of > 1 (36%) or > 2 (97%), brain metastases (50%), and HIV positivity (35%). Only 7% of adult trials had an upper age limit. Among the NIH trials, 80% were investigator initiated trials, while the rest were cooperative group studies. Of the trials initiated by cooperative groups, the major sponsors were COG (22%), ECOG (21%), SWOG (21%), CALGB (19%), NCCTG (14%), and RTOG (10%). The top PHARMA sponsors were Pfizer (9%), GlaxoSmithKline (6%), Novartis (5%), Amgen (4%), and Bristol-Myers Squibb (4%). Compared to NIH, PHARMA trials were more likely to be treatment (92% vs. 88%), phase III/IV (20% vs. 12%), lung cancer (10% vs. 6%), and exclude patients with performance status of > 1 (46% vs. 31%). Conclusions: There is a plethora of cancer therapeutic trials in the United States, mostly focused on treatment with less emphasis on prevention and supportive care. Lung, colorectal, pancreatic, and liver cancers are relatively underrepresented when burden of mortality is taken into account. Compared to NIH, PHARMA trials are generally more treatment oriented, later phase studies, and more restrictive in eligibility criteria. No significant financial relationships to disclose.
Defining Successful Immune Reconstitution (IR) after Allogeneic Hematopoietic Cell Transplantation (HCT)
Authors: Mayada Salman Abu Shanap, Sarah Cooley, Xianghua Luo, Cao Qing, Julie Curtsinger, Rachel Bergerson, Nelli Bejanyan, Heather Stefanski, Claudio Brunstein, Daniel J. Weisdorf, Bruce R. Blazar, Jeffrey S. Miller, John E Wagner, Michael R. Verneris
Journal: Blood (2015)
The role of electronic records in reporting adverse drug reactions.
Authors: Alanna M. Poirier, Paul Nachowicz, Subhasis Misra
Journal: Journal of Clinical Oncology (2012)

309 Background: The Pharmacy and Therapeutics committee at a regional cancer center is responsible to report and trend existing adverse drug reactions. The electronic health record did not have an option to document the history of an event or have an alert function if a medication was re-ordered. The frequency of documented adverse drug reactions did not correlate to what was being observed on the units with the use of a paper document. Methods: InAugust 2010 a Lean Six Sigma project was initiated to improve adverse drug reaction reporting. An adverse drug reaction document along with standard work instructions was completed by March 2011. A report was built in the electronic health record and a computer based learning module was created and rolled out to clinical staff by October 2011. Results: The turn-around time in days to document an adverse drug reaction in the patients chart decreased from 6.8 days to 0.7 days. The documented adverse drug reactions increased by 37%; verified by the use of supportive medications. Conclusions: The root cause for under-reporting was attributed to lack of knowledge, process, and automation. The history of an adverse drug reaction can now be viewed and an automatic alert is produced requiring physician acknowledgement decreasing the chance of repeated discomfort or harm to the patient. Adverse drug reaction documentation can be retrieved within 24 hours, analyzed, trended, and used for educational purposes to improve patient safety. [Table: see text]