tbuckley/cabot-search huggingface dataset:
Observations on cancer of the breast among Arab-American women.
Authors: O. R. Signori, K. A. Schwartz, H. Dakhlallah, R. M. Pandit, E. E. Signori
Journal: Journal of Clinical Oncology (2011)

1577 Background: Breast Cancer Care among Arab American women (ArA) in the U.S. is not well documented. Dearborn, Michigan (a suburb west of Detroit) is home to a large and diverse population of Arabic ancestry. Oakwood Hospital and Medical Center (OHMC) is located in Dearborn. Methods: We analyzed Breast Cancer cases among ArA at OHMC between 2000 and 2009 and compared with European American women (EA). ArA were identified by utilizing a validated name algorithm (Schwartz 2004). Data were obtained from the Detroit SEER registry and OHMC data bases. Results: Breast Cancer was diagnosed in 121 ArA and 2464 EA. Forty nine ArA (40%) and 516 (20%) EA were age <50 at diagnosis (p value <.0001). In contrast 16% ArA (40%) and 36% EA were age >70 at diagnosis (p value <.0001). Carcinoma in Situ was found in 14% of ArA and 24% of EA (p value <.0001). Regional or metastatic disease at diagnosis was present in 51 ArA (42%) and 722 (29%) EA (p value <.0001). Stage difference between the groups was most noticeable under the age of 50. There was not statistical significant difference in the rate of Mastectomy between ArA 51 (42%) and EA 916 (37%) (P value 0.3442). The administration of radiation and hormonal therapy was similar between the 2 groups and among younger and older women; however 65% of ArA age <50 vs. 46% of EA age <50 received chemotherapy. At the time of this analysis 87% of ArA and 82% of EA were alive. No ArA were enrolled into Clinical Trials and only 4 underwent genetic/familial high risk assessment. Conclusions: At OHMC, ArA were diagnosed with Breast Cancer at a younger age and with more advanced stage than EA but their survival was comparable. Mastectomy rates for the 2 groups were similar. Chemotherapy was given more frequently to younger ArA. Cultural differences did not seem to influence treatment; however ArA did not enroll in Clinical Trials and were unlikely to be evaluated for hereditary cancer syndromes.
Primary care referral patterns for adolescent and young adult (AYA) cancer patients: A multistate study.
Authors: L. M. Gordon, R. H. Johnson, M. A. Au, K. H. Albritton
Journal: Journal of Clinical Oncology (2011)

e16626 Background: Cancer patients in late adolescence and young adulthood may be referred for treatment to either pediatric or medical oncologists; research is exploring the impact of specialty and treatment regimen on outcomes. Recognizing the role of the initial referral decision by the primary care physician (PCP), we sought to determine physician and patient factors that influence referral patterns of AYA oncology patients. Methods: Surveys were mailed to 1129 PCPs: 50% pediatricians, 50% non-pediatricians with representative distribution of Family Medicine, Internal Medicine, General Practice, Emergency Medicine, Gynecology in North Carolina (NC) and Washington (WA). PCPs provided demographics, then reviewed hypothetical patient vignettes that independently varied 8 patient factors by fractional factorial design: age (13-22), gender, diagnosis, race, social support, insurance, transportation, patient preference for site of care, and denoted to whom (pediatric or non-pediatric oncologist) they would refer the patient. Results: Response rate was 33.2% in NC and 38.6% in WA, totaling 406 completed surveys. By univariate and multivariate analysis, the only significant PCP characteristic was specialty; referral to a pediatric oncologist was made in 60% of vignettes by pediatric PCPs and 36.5% of non-pediatrician PCPs (p-value < 0.0001). Regardless of PCP specialty, referral patterns shifted with patient age: 89% of 13 year olds (yo), 74% of 16 yo, 25% of 19 yo and 9% of 22 yo were referred to pediatric oncologists. Compared to germ cell tumors, acute lymphoblastic leukemia (OR = 4.29; 95% CI: 2.77 - 6.64), Hodgkin’s lymphoma (OR = 3.88; 95% CI: 2.57 - 5.84), and Ewing’s sarcoma (OR = 4.77; 95% CI; 3.10 - 7.35) were more likely to be referred to a pediatric provider. Those lacking private insurance were more likely referred to pediatric oncologists (OR 1.42; 95% CI 1.09-1.87). Conclusions: PCP specialty, patient age, type of cancer and insurance status were significant drivers of referral patterns for AYA cancer patients. Referrals to pediatric oncology drop dramatically over age 18. Because site of oncologic care can impact outcomes, awareness and education efforts regarding AYA cancer should include PCPs.
Observational cohort study of first-line bevacizumab with oxaliplatin or irinotecan and fluoropyrimidines in metastatic colorectal cancer: HGCSG0802—Analysis of early tumor shrinkage (ETS).
Authors: Satoshi Yuki, Hiroshi Nakatsumi, Kentaro Sawada, Takashi Kato, Takashi Meguro, Michio Nakamura, Ichiro Iwanaga, Nobuyuki Ehira, Norikazu Sonoda, Mineo Kudo, Kanji Kato, Susumu Sogabe, Toraji Amano, Kota Ono, Keita Sakamoto, Noriyuki Miyamoto, Kohsuke Kudo, Naoya Sakamoto, Yuh Sakata, Yoshito Komatsu
Journal: Journal of Clinical Oncology (2016)

753 Background: It was reported that early tumor shrinkage (ETS) was associated with better overall survival (OS) in patients (pts) with metastatic colorectal cancer (mCRC) receiving first line chemotherapy. We investigated association of ETS with progression-free survival (PFS) and OS in pts with mCRC treated with first-line bevacizumab (BV)-based chemotherapy (HGCSG0802). Methods: The objective of HGCSG0802 was to evaluate PFS, OS, response rate (RR), safety and so on. The key eligibility criteria were evaluable lesions, older than 20 years old, ECOG PS 0-2. This analysis evaluated the association of ETS at 8 weeks from the start of chemotherapy with pts characteristics, PFS and OS. To identify factors associated with ETS, if there were clinical variables with p &lt; 0.2 in univariate analysis, we planned a multivariate analysis using the logistic regression model. To identify predictive and prognostic factors, a multivariate analysis was performed using Cox proportional hazard model with backward elimination for variables with p &lt; 0.2 in univariate analysis. Results: Of 108 pts (the full analysis set), 99 pts were evaluable for ETS. Sixty-eight pts (68.7%) had ETS ≥20%. The pts characteristics between ETS ≥20% (ETS) and &lt;20% (Non-ETS) were well balanced. In univariate analysis to identify factors associated with ETS, there were no clinical variables with p &lt; 0.2. The median PFS and OS were 7.3/18.3 months in Non-ETS versus 10.0/25.2 months in ETS (HR 0.529; p=0.006 and HR 0.627; p=0.107). In multivariate analysis for PFS and OS, although there was no significant difference between ETS and Non-ETS for OS (HR 0.709; p=0.186), there was significant difference for PFS (HR 0.524; p=0.006). Conclusions: ETS was observed in 68.7% (68/99) and non-ETS in 31.3% (31/99) of patients with metastatic colorectal cancer received bevacizumab combined first line chemotherapy. In univariate analysis, it could not identify any factors associated with ETS. In the results of multivariate analysis, ETS showed an independent predictive impact, but not prognostic impact. Clinical trial information: UMIN000018935.
A prospective cohort study of fatigue after adjuvant therapy for breast cancer: Association with hematologic, endocrine, and immune parameters
Authors: D. Goldstein, B. Bennett, B. Cameron, F. Boyle, P. DeSouza, N. Wilcken, M. Friedlander, E. Scott, I. Hickie, A. Lloyd AM
Journal: Journal of Clinical Oncology (2008)

9596 Background: Persisting fatigue states after cancer therapy remain a major survivorship issue, with up to 40% of individuals reported to experience disabling post cancer fatigue (PCF). An immunologic mechanism has been proposed. Methods: Women with early stage breast cancer from six metropolitan teaching hospitals in Sydney, were enrolled post surgery. Clinical assessment and blood sampling was conducted at baseline (post surgery), end of adjuvant treatment, and then at 1, 3, 6, 9 and 12 months. Structured interviews and self-report questionnaires were used to record physical and psychological health and disability. Provisional PCF cases were assessed at 6 months to exclude alternative medical and psychiatric causes of fatigue. Nested case-control series were selected for hematologic (full blood count), endocrine (thyroid stimulating hormone, follicle stimulating hormone) and immune (cytokines, leukocyte subsets) testing. Results: Data from 218 enrolled women (median age 52 years) were evaluated. The PCF case rate was 24% (n=51) post surgery, 42% (90) at end-treatment, 19% (40) at 6 months and 14% (30) at 12 months. At each time point, approximately half of the PCF cases had co-morbid psychological disorder. Predictors of PCF both at end-treatment and at 6 months were fatigue post-surgery and mood disturbance post-surgery. There was no association between PCF and clinical, treatment, hematologic or endocrine parameters. Serum levels and in vitro production of cytokines (interleukin [IL]1, IL2, IL4, IL6, IL10, IL12, tumor necrosis factor and interferon gamma) did not differ between cases and controls. The proportion of activated leucocyte subsets were also comparable. Conclusions: PCF is common, frequently associated with co- morbid mood disturbance, but only a small minority of cases experience substantial disability for more than 12 months. There is no evidence for immunologic disturbance as the underlying mechanism. This group requires further study to identify aetiology and appropriate targeted intervention(s). No significant financial relationships to disclose.
Prognostic significance of plasminogen system in advanced prostate cancer: A pilot study
Authors: M. A. Alikhan, R. Dennis, H. J. Spencer, M. Kohli
Journal: Journal of Clinical Oncology (2005)

4766 Background: Plasminogen system plays a significant role in cancer cell invasion and metastasis. Elevated tumor urokinase plasminogen activator (uPA), its receptor- uPAR, and inhibitor, plasminogen activator inhibitor (PAI-1) levels are associated with poor prognosis in several cancers (Manders et al. Cancer 2004, Duffy MJ. Clin Biochem 2004).We conducted two preliminary studies to evaluate its prognostic significance in advanced prostate cancer. Methods: In the first study fresh tissue from patients with local stage (n=9 prostatectomy specimens) and advanced stage (n=6 transurethral prostate resections) was collected. uPA and plasminogen (PLG) mRNA expression was evaluated by real-time polymerase chain reaction. Transcript abundance was normalized to 18s (control) and t-test used for detecting differences between means of both groups. In a second study plasma uPA, uPAR and PAI-1 levels were measured in advanced stage patients (pts) undergoing androgen deprivation (n=40) who were followed for overall and progression free survival (PFS). Mean values of all variables with and without progression were compared and univariate Cox proportional hazard ratios (HR) calculated. Results: uPA and PLG gene expression was found in all fresh tumor specimens (table). Elevated expression was observed in advanced stage specimens. In the second study 25/40 pts were found to have events (radiological progression) after a median follow up of 36.1 months, of these 17 have died. Prognostically only elevated uPAR levels were found to be statistically significant for PFS. Mean uPAR in pts with events versus without events was 11.04 vs 17.89 ng/ml (HR= 0.75, p= 0.028). Conclusions:This is the first analysis evaluating the role for the plasminogen system in advanced prostate cancer. Elevated uPAR was associated with 25% increase in PFS. We propose a prospective study of various plasminogen system proteases in advanced prostate cancer to better define its impact on survival. No significant financial relationships to disclose.
Clinical predictors of prolonged clinical benefit (PCB) from pemetrexed (P) therapy in metastatic non-small cell lung cancer (mNSCLC).
Authors: N. Hashemi Sadraei, C. Jones, A. Tan, P. Elson, T. Mekhail, N. A. Pennell
Journal: Journal of Clinical Oncology (2011)

e18056 Background: P is an effective agent in mNSCLC, however many patients (pts) get minimal or no benefit from P while a subset has PCB. To date there are no established models to guide P therapy. Methods: From 9/2004 to 12/2008, 135 pts with mNSCLC were treated with P at a single institution. Pts were retrospectively analyzed for clinical predictors associated with PCB from P using chi-square and Fisher’s exact tests, and logistic regression models. Variables assessed included age, gender, race, smoking history, ECOG performance status (PS), stage at initial diagnosis, histology, number (n) and sites of metastatic disease, n of treatment lines, interval from metastasis (M) to initiation of P, timing of P in terms of lines of therapy (1 through 5), n of P cycles, toxicity (tox) and creatinine clearance pre- and post P therapy. Results: Median age was 63 years (34-84). P was given for a median of 3 cycles (1-66) with the majority of pts receiving it as 2nd line therapy (59%) and as a single agent (85%). There were no statistically significant differences between the different lines of treatment with respect to patient characteristics, toxicity, objective response, progression-free survival (PFS) or overall survival (OS). Overall 28% of pts achieved partial response, and median PFS and OS from the time of initiation of P were 2.9 and 9.0 months (mos), respectively. PCB was defined as PFS ≥12 mos whereas limited CB (LCB) was defined as PFS ≤6 mos. 14% of pts had PCB; 59% had LCB. In multivariable analysis of PCB vs LCB, that initially considered all the factors described above, ≤ 2 sites of M (p=.005), time from M to P therapy ≥ 12 m (p=.02) and PS ≤1 (p=.05) were independent predictors of PCB. Using these factors prognostic groups were formed based on the n of favorable features (FF) present; pts with ≤2 sites of M, ≥12 mos interval from M to P, and PS≤1 had a 69% PCB rate compared to 41% for pts with 2 FF and 2% for pts with 0-1 FF. Conclusions: No clinical difference was seen based on line of therapy. Limited sites of M, prolonged time to initiation of therapy, and PS were predictive of PCB from P and could be used to define 3 distinct prognostic groups. These findings however will need to be validated in an independent cohort of pts.
Phase I/II trial of bevacizumab (B) and erlotinib (E) with induction (IND) and concurrent (CON) carboplatin (Cb)/paclitaxel (P) and 74 Gy of thoracic conformal radiotherapy (TCRT) in stage III non-small cell lung cancer (NSCLC).
Authors: T. Stinchcombe, M. A. Socinski, D. T. Moore, S. N. Gettinger, R. H. Decker, W. J. Petty, A. W. Blackstock, G. Schwartz, S. Lankford, D. E. Morris
Journal: Journal of Clinical Oncology (2011)

7016 Background: Agents which target the epidermal growth factor receptor (EGFR) and inhibit angiogenesis have been shown to improve overall survival (OS) in advanced NSCLC and have radiosensitizing properties Methods: Patients (pts) received Cb (AUC=6), P (225 mg/m2) and B (15 mg/kg) on days 1 and 22. On day 43 patients received Cb (AUC=2) and P (45 mg/m2) weekly x 7 weeks (wks) with TCRT to 74 Gy; cohort 1 (n=5) received B 10 mg/kg q 2 wks, cohort 2 (n=5) and cohort 3 (n=5) both received B 10 mg/kg q 2 wks as well E at 100 mg and 150 mg Tuesday-Friday each week of concurrent therapy. After completion of concurrent therapy pts received consolidation therapy (CT) with B+ E for 6 cycles. All histologies were eligible; an early stopping rule for pulmonary hemorrhage (PH) was included for the squamous (SQ) pts. The primary end-point was 1-year progression free survival (PFS). Results: 45 patients eligible patients were accrued; median age 61 yrs (range 34 to 74), 33 non-SQ and 12 SQ; 29 stage IIIA and 16 stage IIIB; 33 pts PS 0 and 12 PS of 1. Cohort 2 was expanded to the phase II trial. CT was determined to not be feasible and SQ cohort was closed due to PH. Grade ≥ 3 toxicity observed with IND therapy was neutropenia (42%) and grade 3 hypertension (2%). Grade ≥ 3 toxicities observed with CON were esophagitis (29%), pneumonitis (2%); neutropenia (13%), hgb (7%), thrombocytopenia (7%); one trachoesphogeal fistula was observed. In SQ cohort 3 of 12 patients experienced PH; 1 grade 3, 2 grade 5. 33 pts have experienced disease progression or death; the 1-year PFS rate observed was 44% (95% CI, 29-58%), median PFS was 10 months (95% CI, 8-22). 27 pts have died, and the median follow-up for survivors is 37 months (range 5-54); median OS was 19 months (95% CI, 13 to 33). The median OS observed in the non-SQ and SQ cohorts was 19 and 17 months, respectively. Conclusions: The PFS and OS with the addition of B+E to CbP with 74 Gy TCRT appears similar to previous experience with CbP alone with 74 Gy TCRT.
An integrated analysis of two phase II trials (JCOG0001 and JCOG0405) of preoperative chemotherapy followed by D3 gastrectomy for gastric cancer (GC) with extensive lymph node metastasis (ELM).
Authors: A. Tsuburaya, H. Katayama, J. Mizusawa, K. Nakamura, H. Katai, H. Imamura, A. Nashimoto, N. Fukushima, T. Sano, M. Sasako
Journal: Journal of Clinical Oncology (2011)

90 Background: GC with ELM (bulky N2 metastasis and / or para-aortic lymph node metastases [PAN]) is commonly regarded unresectable, while in JCOG combined modality treatment has been tested since 2000 (JCOG0001 and JCOG0405). Both trials met their primary endpoints (i.e., 3 year-survival of 27.3% in JCOG0001 and R0 resection of 82.4% in JCOG0405). The survival and the toxicity profile were quite different between the trials despite the similar eligibility with an outstanding 3-year survival of 58.8% in JCOG0405. This study is conducted to explore if survival is still better in JCOG0405 after adjusting baseline factors and if there is a subset of patients (pts) who benefit more from either treatment. Methods: Eligibility criteria for both included histologically proven gastric adenocarcinoma; bulky nodal involvement around major branched arteries to the stomach and/or PAN; cM0 (except PAN); negative lavage cytology; not linitis plastica type; PS of 0 or 1. Pts received two or three cycles of induction chemotherapy of IP: irinotecan (70 mg/m 2 on day 1 and day 15) and cisplatin (80 mg/m 2 on day 1) in JCOG0001, or SP: S1 (80 mg/m 2 from day 1 to 21) and cisplatin (60 mg/m 2 on day 8) in JCOG0405, followed by D3 gastrectomy. Multivariate analysis for overall survival adjusting baseline factors and treatment (IP/SP) was performed with a Cox regression model. Interaction tests were also carried out between baseline factors and treatment. Results: After adjusting baseline factors, SP was superior than IP for overall survival (HR=0.335: 0.184 – 0.612). There was only interaction effect between treatment and the status of lymph node metastases (bulkyN+/PAN- vs bulkyN-/PAN+ vs bulkyN+/PAN+; p=0.1306). Conclusions: SP was shown to be the favorable treatment for GC with ELM by multivariate analysis, while poor prognosis in pts having both bulky N+ and PAN+ may necessitate further treatment improvement. No significant financial relationships to disclose.
Evaluation of plasma osteopontin as early detection and prognostic marker in malignant pleural mesothelioma
Authors: A. Beck, A. Ivanova, S. Ivanov, L. Price, J. Goldberg, A. Wali, M. Harbut, M. Carbone, H. I. Pass
Journal: Journal of Clinical Oncology (2008)

11074 Background: Osteopontin (OPN) has been characterized as an early detection marker in serum of patients with mesothelioma (MM). Existing assays have specified that OPN should be measured in plasma and not serum. This study was designed to (1) validate plasma OPN as a biomarker for MM (2) investigate whether plasma OPN is a prognostic marker for MM. Methods: Plasma OPN from 39 MM (mean age 63+ 8.4 years;9 females, 30 males; 11 Stage I/II, 28 Stage III/IV; 21 having surgical cytoreduction) and from 79 asbestos- exposed (AE) individuals (mean age 63+ 10.6 years; 9 females, 70 males) was measured with the Research and Diagnostics (R&D, Minneapolis MN) and Immuno-Biological Laboratories(IBL,Minneapolis, MN) kits. Differences in OPN levels in MM and AE individuals were compared using ROC curves and sensitivity and false positive rates based on logistic models for each of the test kits. Survival for MM was estimated using Kaplan-Meier curves; comparisons between groups are based on log rank chi-square tests. Hazard ratios and 95% confidence intervals were estimated from Cox proportional hazards models. A formal cut point analysis was performed using the maximum chi-square with p value adjustment method to determine the OPN values that were most strongly associated with survival. Results: The area under the ROC curve was 0.93 (R&D, cutpoint corresponding to a sensitivity of 0.91 and false positive rate of 0.23 = 59.6 ng/ml) and 0.96 (IBL, cutpoint corresponding to a sensitivity of 0.91 and false positive rate of 0.10 =132.6 ng/ml). The median overall survival for all 39 MM was 11 months (95% CI: 5, 13) with a 37 month median overall follow up for survivors. Patients with OPN levels greater than or equal to 212.6 ng/ml had 5.7 (95% CI: 2.4, 13.3) times the mortality risk of patients with lower levels (adjusted p value = 0.007). Additional multivariable analyses indicate that lower stage (HR: 5.0; 95% CI: 1.7, 15.0; p = 0.004) and OPN level from the R&D kit less than the cutpoint of 212.6 ng/ml (HR: 3.5; 95% CI: 1.5, 8.4; p= 0.004) were significantly associated with improved survival. Conclusions: These data confirm that plasma OPN may be a sensitive discriminator for the development of MM in high risk AE cohorts, and also that OPN levels in MM patients may be of prognostic importance. No significant financial relationships to disclose.
Canadian cancer risk management model: A new health policy tool useful in policy decisions related to lung cancer.
Authors: W. K. Evans, M. Wolfson, W. Flanagan, J. Oderkirk, J. R. Goffin, J. Shin, G. Lockwood
Journal: Journal of Clinical Oncology (2011)

e16541 Background: Fiscal constraint is forcing decision-makers to make choices about which cancer control initiatives to fund in publically funded health care systems. A Cancer Risk Management (CRM) model has been developed for the Canadian Partnership Against Cancer as a web enabled platform to support health policy decision-makers. Methods: The CRM uses dynamic, longitudinal microsimulation techniques to simulate and project realistic, representative populations. Each disease-specific module interacts within a single framework that incorporates Canadian demographic characteristics (births, mortality, immigration, emigration, interprovincial migration), educational status, risk factors (smoking, radon exposure, other as appropriate to the disease being modelled) and economic factors (earnings, taxes, government transfers). CRM utilizes current data lung cancer (LC) and colorectal cancer incidence, disease management and case fatality in Canada to assess impacts on population health and the cost to the health care system. Data sources include large national surveys, cancer registries and census data, as well as medical literature and expert opinion. Results: The CRM has simulated the impact of prevention strategies for LC, adjuvant therapy for resected LC and new therapies for advanced disease. For example, a 50% reduction in current smoking prevalence could result in a 10% reduction in lung cancer incident cases at 10 years and result in a cumulative direct health care cost saving of $215 M in Canada. The recent identification of a 20% mortality reduction using low dose computerized tomographic screening in high-risk individuals will be modeled using this platform once the full publication of results is available, including details of the frequency of investigation for false positives and the interventions utilized to investigate these cases. Conclusions: The CRM will likely become a key resource to Canadian decision-makers as fiscal constraints and new screening and treatment approaches increasingly come into conflict with each other.