tbuckley/cabot-search huggingface dataset:
Surgical results of non-small cell lung cancer in never-smokers as a separate entity
Authors: T. Yano, N. Miura, T. Takenaka, T. Ohba, T. Kometani, F. Shoji, Y. Maehara
Journal: Journal of Clinical Oncology (2008)

7505 Background: Recent information about epidermal growth factor receptor gene mutations suggests that there are two etiologically different forms of lung cancer based on the smoking status. In order to propose ‘never-smoking non-small cell lung cancer (NSLC)‘ as a separate entity, the clinico-pathologic differences of operable NSLC between never smoking patients and patients with a history of smoking were investigated. Methods: The medical records of 1405 patients with primary NSLC who underwent a complete resection at our institution from 1974 through 2004 were reviewed for the clinico-pathologic variables and postoperative survival. Results: The proportion of never-smoking patients with NSLC has been significantly increasing over 30 years from 15.9% in the 1970's to 32.8% in the 2000's. A significantly greater proportion of female patients or adenocarcinoma patients was found in the ‘never-smoking NSLC‘ group in comparison to the ‘smoking NSLC’ group (85.8% vs. 11.2%; 87.8% vs. 49.1%, respectively). The distribution of the pathologic T status was significantly different between the never-smoking NSLC group and the smoking NSLC group (more T1 patients in the never-smoking NSLC group), although that of the pathologic N status was not different. In both the overall and cancer-specific survivals, the ‘never-smoking NSLC’ patient group was significantly superior to the ‘smoking NSLC’ group. In addition to the smoking status, the factors significantly associated with the postoperative survival rate were gender, histologic type, T-status and N-status by the univariate analyses. A multivariate analysis revealed the never-smoking status to be an independent prognostic factor, besides a pathologic T and N status. Conclusions: From now on, ‘never-smoking NSLC’ should therefore be both clinically and basically investigated as a distinct entity from ‘smoking-associated NSLC’. No significant financial relationships to disclose.
Gemcitabine and capecitabine as third-line treatment in patients with metastatic colorectal cancer after failure of irinotecan and oxaliplatin.
Authors: M. Qiu, F. Bi, J. Liu, Q. Li, C. Yi
Journal: Journal of Clinical Oncology (2011)

620 Background: There is no standard chemotherapeutic regimen for patients with advanced colorectal cancer (CRC) progressing after combination regimens including irinotecan and oxaliplatin and having good performance status. 5-FU and gemcitabine are synergistic in preclinical studies of colon cancer cells. And gemcitabine also increases intracellular release of 5-FU from capecitabine. The aim of this study is to evaluate the efficacy and tolerance of the gemcitabine/capecitabine combination as third-line treatment for patients with advanced colorectal cancer. Methods: Between May 2007 and September 2009, the data on 12 patients with metastatic colorectal cancer after failure of irinotecan- and oxaliplatin-containing regimens reviewed retrospectively. The median patient age was 54.0 years (range 37-77). The ECOG performance status was 0, 1 or 2. All patients has 2 or more previous chemotherapy. Patients received GemCap regimen (oral capecitabine 1,000 mg/m 2 twice daily on days 1 to 14 plus Gem 1,000 mg/m 2 on days 1 and 8 every 3 weeks). Eleven patients were evaluable for the response and all patients were evaluable for toxicity. Results: No partial response was achieved and disease stabilization in 4 (36.4.3%) cases. Median progression-free survival and median overall survival were 9.1 weeks (range 3.0-18.0) and 22.3 weeks (range 10.5- 53.0). Four patients with disease stabilization had longer median progression-free survival than those with disease progression (13 weeks vs. 6.2 weeks). No toxic deaths occurred. Grade 3 toxicities were thrombocytopenia (in 2 patients), neutropenia (in 2 patients) and mucositis (in 1 patient), hand-foot syndrome (in 1 patient) and GI toxicity (in 2 patients). Conclusions: The combination of gemcitabine and capecitabine was found to be a safe palliative regimen for heavily pretreated patients with metastatic CRC. Despite no patients had radiologic response, patients with disease stabilization achieved better progression-free survival. This regimen seems to be potentially effective regimen in the treatment of CRC. No significant financial relationships to disclose.
Germ-line BRCA mutations in high-grade ovarian cancer: A case for routine BRCA mutation screening after a diagnosis of invasive ovarian cancer.
Authors: K. Alsop, S. Fereday, C. Meldrum, A. deFazio, P. Webb, M. J. Birrer, M. Friedlander, S. B. Fox, D. Bowtell, G. Mitchell
Journal: Journal of Clinical Oncology (2011)

5026 Background: It has been accepted that 5-10% of all invasive epithelial ovarian cancer cases can be attributed to hereditary pathogenic mutations in cancer predisposition genes. Consequently genetic testing is mostly offered to those patients who also have a strong family history of relevant cancers or specific ancestry. We investigated the frequency and clinical characteristics, including the treatment response to platinum therapeutics, of germline BRCA1/2 pathogenic mutation carriers in a large population-based prospective cohort of Australian women with ovarian cancer. Methods: Participants were ascertained from the Australian Ovarian Cancer Study which recruited women presenting for surgery for ovarian cancer between 2002-2006. Women were eligible for BRCA1/2 genotyping if diagnosed with invasive epithelial ovarian, peritoneal or fallopian tube tumors. Mucinous histology was excluded from analysis. Full BRCA1 and BRCA2 analysis was done by gene sequencing and multiplex ligation-dependent probe amplification. Germline status was related to tumor features, clinical response and potential familiality in first degree relatives, including incidences of early onset breast cancer. Results: 134 pathogenic germline mutations were identified within the cohort, for an overall mutation frequency of 13.3% in the Australian ovarian cancer population. 113 (84.3%) mutations were associated with serous histology. 57% of mutation carriers had no evidence of familiality. Mutation carriers were more responsive to primary platinum treatment than non-carriers (87.4% had >6 months progression free survival, versus 68.4%), and were more likely to respond to platinum upon relapse (86% of mutation positive women responded to secondary platinum after relapsing <6 months after primary platinum treatment versus 60% of mutation negative women). Conclusions: Pathogenic BRCA1/2 mutations are common in invasive ovarian cancer and are associated with improved overall survival and response to systemic chemotherapy. BRCA testing should be implemented for all ovarian cancer patients as mutation status has important prognostic and therapeutic clinical utility.
Activity of fractionated radioimmunotherapy with clivatuzumab tetraxetan combined with low-dose gemcitabine (Gem) in advanced pancreatic cancer (APC).
Authors: A. J. Ocean, M. J. Guarino, K. L. Pennington, A. J. Montero, T. Bekaii-Saab, S. A. Gulec, N. Teoh, D. V. Gold, W. A. Wegener, D. M. Goldenberg
Journal: Journal of Clinical Oncology (2011)

240 Background: The 90 Y-labeled anti-mucin humanized mAb, clivatuzumab tetraxetan ( 90 Y-hPAM4), is in clinical development in APC. A phase I/II trial of 90 Y-hPAM4 with low-dose radiosensitizing Gem has now concluded 90 Y-dose escalation. Methods: Pts with untreated, inoperable, stage 3-4 APC received 200 mg/m 2 Gem once-weekly x 4 with 90 Y-hPAM4 on wks 2-4, and with 90 Y escalated in cohorts by 3+3 design. Tumor responses were assessed by CT, FDG/PET and serum CA19.9, with cycles repeated until progression or unacceptable toxicity. Results: Of 42 pts (40-87 yrs, ECOG PS 0-1, 36 stage 4), 4 withdrew early while 38 received weekly x 3 90 Y doses of 6.5 (N=4), 9 (N=12), 12 (N=17) and 15 (N=5) mCi/m 2 . Treatment was well-tolerated with few non-hematologic side-effects, including 13 pts retreated with 1-3 additional cycles. CTCv3 grade 3-4 plts or ANC developed in 21/38 (55%) pts after cycle 1 and all (100%) retreated pts after last cycle. Escalation reached limits on radiation doses to the marrow, but hematologic suppression was reversible without major infections or bleeding events, except for 3 pts after repeated cycles, one with extensive marrow tumor infiltration. By CT, the overall disease control rate was 55%, including 6 pts (16%) with partial responses (PRs) by RECIST criteria and 15 pts (39%) with stabilization as best response. After cycle 1, 43% (10/23) improved by PET studies (negative or &gt;25% reduced uptake), and 36% (9/25) with elevated CA19.9 levels had &gt;50 decreases. With 26% (10/38) of pts still in follow-up, 55% (21/38) have now achieved survival of ≥ 6 months [18% (7/38) ≥ 1 yr]. Treatment outcome may increase with 90 Y dose, since pts treated at 3 x ≥12 mCi/m 2 vs ≤9 mCi/m 2 had 19% vs 6% PRs by CT, 47% vs 22% CA19.9 decreases, 63% vs 25% PET improvement, and 64% vs. 44% survival ≥ 6 months. Anecdotally, PS and pain level improved, which needs validation. Updated survival will be presented at the meeting. Conclusions: Fractionated 90 Y-hPAM4 plus low-dose Gem showed encouraging therapeutic activity with manageable hematological toxicity. The 12-mCi/m 2 dose level was selected for continued dose exploration now underway, involving standard Gem doses and adding maintenance Gem. [Table: see text]
A comparison of patients with liver cancer receiving palliative care at two Veterans Affairs (VA) Medical Centers.
Authors: Sarah Lee, Zhen Wang, Sejal Kothadia, Yucai Wang, Ellen Olson, Yeun-Hee Anna Park, David Klein, Fengming Zhong, Victor Tsu-Shih Chang
Journal: Journal of Clinical Oncology (2016)

75 Background: Liver cancer is a leading cause of death. Lack of data exists on palliative care in this group, and care varies by location. We aim to determine if there are differences in palliative care for patients (pts) with liver cancer by VA site. Methods: In an IRB approved protocol, we reviewed medical records of pts at 2 VA medical centers (S1, S2) with liver cancer, who were seen by Palliative Care between 2006 and 2012. Veterans were compared by 1) demographics: Karnofsky performance status &gt; 50 (KPS), marital status, DNR/DNI, 2) palliative intervention: goals of care discussion, referrals to psychology and PT/OT, and 3) outcomes: ED visit within 1 month (mo) of death, ED visit within 6 mo of death, ICU within 30 days of death, and hospice as site of death, time from diagnosis to palliative care, and time from DNR to death. Chi-square, Fisher’s Exact, and T-test were performed with Stata. Results: here were 82 men, 30 from S1 and 52 from S2, median age 61 (35-87) and 63 (54-88) yrs, respectively. Pts were Caucasian 30 (36%), African American 47 (57%), and other 5 (0.1%). Cancer stages were locoregional 15 (50%), metastatic 13 (43%), and unknown 2 (0.1%) at S1 and 28 (54%), 20 (38%), 5 (0.1%) at S2. Differences were seen in KPS &gt; 50: (S1, S2) [10 (33%), 15(29%) p = 0.010], married: (S1, S2) [7 (23%), 24(46%) p = 0.024], DNR/DNI: (S1, S2) [19 (63%), 13(25%), p = 0.001]. Regarding palliative intervention: goals of care discussion (S1, S2) [26 (87%), 44 (85%), p = 0.044], referral to psych (S1, S2) [16 (53%), 42 (81%) p = 0.014], referral to PT/OT (S1, S2) [17 (57%), 15 (29%), p = 0.007]. Finally in regards to outcome: ED visit within 1 mo of death (S1, S2) [7 (23%), 31 (60%), p = 0.001], ED visit within 6 mos of death (S1, S2) [18 (56%), 35 (67%) p = 0.031], ICU within 30 days of death (S1, S2) [0 (0%), 9 (17%) p = 0.019}, and hospice as site of death (S1, S2) [19 (63%), 21 (40%), p &lt; .0001]. Other key differences included median number of days from diagnosis to initial palliative care consult (S1, S2) [97, 39, p = 0.001] and median number of days from DNR to death (S1, S2) [33, 14, p = 0.001]. Conclusions: Results show there are site-specific differences between VA medical centers. These data may be important in the comparison of other centers and provide a baseline for future studies.
Disparities in hospitalized cancer patients receiving palliative care consultation.
Authors: Cardinale B. Smith, Katherine Ornstein, Lee Stefanis, Diane E. Meier, R. Sean Morrison
Journal: Journal of Clinical Oncology (2014)

7 Background: Racial and ethnic disparities in healthcare have been well documented among minority groups with respect to access to care, receipt of care, and quality of care. As a result, minority populations are diagnosed with late stage cancer and have inferior outcomes likely leading to increased suffering. Little is known, however, about disparities in access to and outcomes of patients receiving specialty palliative care (PC). Methods: We used data from the Palliative Care for Cancer Patients (PC4C) study, a multisite observational study of the effect of inpatient PC on patient health outcomes and health services use among advanced cancer patients. We limited our sample to patients that received PC from established, interdisciplinary consult teams. We used univariate analyses and multiple regression analyses to compare differences in outcomes among minority (black and Hispanic) and non-minority patients receiving PC. Results: 583 (19%) patients received a PC consult. Of those, 166 (28%) were minorities and 418 (72%) non-minorities. Mean days to a palliative care consult was 4.4 vs. 3.2 in non-minorities and minorities, respectively (p=0.65). At baseline, minority patients reported a higher burden of symptoms as measured by the condensed memorial symptom assessment scale (CMSAS). Similarly, they were less likely to have talked about their wishes with their doctor (p=0.04); less likely to have completed a living will (p&lt;0.001), or have a proxy (p&lt;0.001); had no difference in pain but were less likely to be taking pain medications (p&lt;0.001) or report relief from pain medicines (p=0.05). After PC consult all CMSAS symptoms improved for minority patients (except worry; p=0.03). Additionally, after PC consult there were no longer any significant differences among minorities with respect to discussing their wishes (p=0.27), DNR completion (p=0.72), proxy assignment (p=0.22) and taking pain medications (p=0.22) when compared to non-minorities. Conclusions: PC is associated with improvements in symptom control and discussions of care goals among minority patients who have worse baseline health assessments. Future efforts need to focus on increasing the availability and use of specialty PC for this at-risk population.
Staging laparoscopy with cytology analysis in gastric cancer.
Authors: Naruhiko Ikoma, Elena Elimova, Mariela A. Blum, Jaffer A. Ajani, Y. Sabrina Chiang, Keith F. Fournier, Paul F. Mansfield, Brian D. Badgwell
Journal: Journal of Clinical Oncology (2016)

35 Background: The purpose of this study was to identify clinicopathologic factors associated with the identification of peritoneal disease in patients with gastric cancer and to compare the yield of laparoscopy over time. Methods: The medical records of 7,404 patients with gastric or gastroesophageal adenocarcinoma presenting to our institution (1/1995 to 12/2012) were reviewed to identify patients who underwent diagnostic laparoscopy as a staging procedure before treatment. Associations between clinicopathologic factors and peritoneal disease were examined with chi square and logistic regression analysis. The yield on laparoscopy was stratified according to time. Results: We identified 880 patients who underwent staging laparoscopy for gastric adenocarcinoma. Excluded patients included those with recurrent gastric cancer, those who underwent prior chemotherapy and/or radiation therapy, those with known distant metastatic disease (except for equivocal radiological findings), and those who underwent procedures not for staging purposes, leaving 711 patients in this study: 43.5% with gastroesophageal junctional tumors, 72.9% with poorly differentiated adenocarcinoma, and 53.0% with signet ring cell morphology. Endoscopic ultrasound (EUS) most commonly identified T3 (83.9%) and N-positive (66.4%) tumors. As results of laparoscopy, 148 patients (20.8%) were found to have macroscopic peritoneal carcinomatosis. Among 514 macroscopically negative patients who had peritoneal lavage cytology analysis, 68 (13.2%) were found to have positive. Of the 711 study patients, 42 (5.9%) had other unexpected clinically important findings (e.g., distant metastasis, cirrhosis). Multivariate analysis showed a high positive rate of laparoscopy in patients with poorly differentiated pathology, linitis plastica, or equivocal CT scan, after adjusting race, signet ring cell, and tumor location. The yield of laparoscopy did not change over time when divided into three 6-year periods (p = 0.58). Conclusions: Laparoscopy remains an important staging procedure to evaluate for peritoneal spread when considering treatment or surgery, even in the current era of high-quality imaging evaluation.
Changing focus: Living with advanced cancer—Development of a palliative care transition project.
Authors: Paul Joseph Daeninck, Simone Stenekes, Tara Carpenter-Kellett, Jill Talylor-Brown, Mark Kristjanson, Ruth Loewen, Joel Roger Gingerich
Journal: Journal of Clinical Oncology (2015)

152 Background: The improvement in cancer screening, detection and treatment is changing the illness trajectory and experience for patients. Many cancer patients are living longer with advanced disease as treatment options have expanded. Thus, accurate prognostication is becoming challenging and referral to palliative care programs is often delayed until close to death. This has made the transition to a predominantly palliative approach to care complex to navigate for the health care team, patient and family. Methods: CancerCare Manitoba has undertaken an innovative project “Changing Focus: Living with Advanced Cancer” to enhance communication with primary health care providers (HCPs) and assist patients and caregivers in the transition to a palliative approach to care. The project includes development of an individualized patient treatment summary that provides details of the patient’s cancer treatment and symptoms, identifies the role of the HCPs involved with the patient and family, as well as the expectations for follow up care at the cancer centre and in the community. The transition appointment includes discussion around the treatment summary, standardized follow up care plan, and written information about palliative care, decision making, symptom management, unique issues for caregivers and details about local supports and resources is provided. Results: This presentation will focus on the development and implementation of this project within the cancer centre and throughout the province. Evaluation of this approach is ongoing. Family members and patients will provide feedback using a standardized questionnaire, and ongoing improvement will be built into the evolution of this program. HCPs will also be engaged in evaluation from their perspective. Conclusions: We expect this intervention will allow patients and families better quality of life and possibly improve the interval between the termination of chemotherapy and death.
Paclitaxel (TLX) and cetuximab (CTX) combination efficiency after failure of a platinum-based chemotherapy in recurrent/metastatic head and neck squamous cell carcinoma (RMHNSCC).
Authors: P. Ceruse, E. Lavergne, G. Buiret, B. Pham, S. Chabaud, B. Favier, D. Girodet, P. Zrounba, J. Fayette
Journal: Journal of Clinical Oncology (2011)

5549 Background: Platinum-based chemotherapy is the current standard in first line treatment of RMHNSCC. CTX is known to be efficient alone (objective response rate ORR=10-13%) or combined with platinum (ORR= 36%). A phase II study showed 71% ORR with TXL/CTX (ASCO 2007 Abs 6012). The aim of this exploratory and retrospective study was to evaluate this combination. Methods: Between December 2007 and August 2010, 42 patients with RMHNSCC were treated with weekly TXL/CTX in two Lyon institutions (France). Study population was described and survival analysis since the TXL/CTX initiation was performed using the Kaplan Meier method. Results: Median age at TXL/CTX initiation was 60 [27-74]. Primary tumoral locations were oral cavity (31%), oropharynx (26%), hypopharynx (21%), larynx (10%). Eight patients had metastases including 5 at diagnosis. Sixteen patients received induction chemotherapy, including 11 with docetaxel (DXL), 4 with platinum and 1 with CDDP-5FU. Thirty one patients (74%) were irradiated and 21 received an associated chemotherapy during whom 2 patients received CTX. At TXL/CTX initiation, all patients (except 7) were resistant to platinum and most of them were symptomatic: 23 (55%) PS1 and 17 (41%) PS2. As expected, major TXL/CTX toxicities were neuropathy and skin rash (resp. 9 and 7 patients). Dose of TXL was reduced for 8 patients (19%) and 12 (29%) stopped treatment because of toxicity. Best response analysis reached to 74% of clinical benefit (2 CR, 14 PR and 15 SD). Interestingly, 2/6 (33%) previously treated with TXL, 6/8 (75%) with CTX and 13/16 (81%) with DXL presented a clinical benefit. With a median follow-up of 9.2 months, median PFS was 4.0 months (95% CI [2.5-4.7]) with a 6 months non-progressive rate of 28.6% (95% CI [16.0-42.5]). Median OS was 7.8 months (95% CI [4.7-9.5]) with 6 months survival rate of 61.2% (95% CI [44.7-74.2]). Conclusions: These results are consistent with a clinical efficacy of the TXL/CTX combination with a median OS of 7.8 months for platinum-resistant patients, and with bearable toxicity.
Valganciclovir for the Prevention of Complications of Late Cytomegalovirus Infection After Allogeneic Hematopoietic Cell Transplantation
Authors: Michael Boeckh, W. Garrett Nichols, Roy F. Chemaly, Genovefa A. Papanicolaou, John R. Wingard, Hu Xie, Karen L. Syrjala, Mary E.D. Flowers, Terry Stevens-Ayers, Keith R. Jerome, Wendy Leisenring
Journal: Annals of Internal Medicine (2015)

Optimal prevention of late cytomegalovirus (CMV) disease is poorly defined.To compare valganciclovir prophylaxis with polymerase chain reaction-guided preemptive therapy.Randomized, double-blind trial. (ClinicalTrials.gov: NCT00016068).Multicenter trial.184 recipients of hematopoietic cell transplantation (HCT) who were at high risk for late CMV disease (95 patients received valganciclovir and 89 received placebo).6 months of valganciclovir (900 mg/d) or placebo. Patients with polymerase chain reaction positivity at 1000 copies/mL or greater or a 5-fold increase over baseline were treated with ganciclovir or valganciclovir (5 mg/kg or 900 mg twice daily, respectively).The composite primary end point was death, CMV disease, or other invasive infections by 270 days after HCT. Secondary end points were CMV disease, CMV DNAemia, death, other infections, resource utilization, ganciclovir resistance, quality of life, immune reconstitution, and safety.The primary composite outcome occurred in 20% of valganciclovir recipients versus 21% of placebo-preemptive therapy recipients (treatment difference, -0.01 [95% CI, -0.13 to 0.10]; P = 0.86). There was no difference in the primary end point or its components 640 days after HCT. The incidence of a CMV DNAemia level of 1000 copies/mL or greater or a 5-fold increase over baseline was reduced in the valganciclovir group (11% vs. 36%; P < 0.001). Neutropenia was not significantly different at the absolute neutrophil count of less than 0.5 × 109 cells/L (P = 0.57); however, more patients received hematopoietic growth factors in the valganciclovir group (25.3% vs. 12.4%; P = 0.026). No significant differences were seen in other secondary outcomes.Some high-risk patients were not included.Valganciclovir prophylaxis was not superior in reducing the composite end point of CMV disease, invasive bacterial or fungal disease, or death when compared with polymerase chain reaction-guided preemptive therapy. Both strategies performed similarly with regard to most clinical outcomes.Roche Laboratories.