tbuckley/cabot-search huggingface dataset:
<sup>124</sup>I-cG250 PET scan for early detection of response to sunitinib in patients (Pts) with metastatic clear cell renal cell carcinoma (MccRCC).
Authors: Steven M. Larson, Robert John Motzer, Neeta Pandit-Taskar, Roman Bartz, Darren Richard Feldman
Journal: Journal of Clinical Oncology (2012)

362 Background: Mutation and/or methylation of the von Hippel-Lindau gene leading to overexpression of hypoxia-inducible factor-1 alpha (HIF1α) has been implicated as a driving event in the pathogenesis of ccRCC. Downstream effectors of HIF1α such as VEGF have become key targets of novel therapies for MccRCC (eg, sunitinib (S)). Carbonic anhydrase-IX (CAIX) transcription is also regulated by HIF1α and is overexpressed in ~95% of ccRCC. Linkage of cG250 (Girentuximab), a chimeric antibody to CAIX, to radioactive iodine ( 124 I), has resulted in a radiotracer specific for ccRCC; 124 I-cG250 ( 124 I-Girentuximab) PET/CT demonstrated a sensitivity of 86% and a specificity of 87% for detecting primary ccRCC (Uzzo AUA 2010). Since responses to targeted therapies likely occur on a molecular level before they are detectable with standard imaging, we hypothesize that 124 I-cG250 PET/CT could allow earlier recognition of response or progression to S than CT in pts with MccRCC. Methods: This is a pilot study of 124 I-cG250 PET/CT in 25 pts with MccRCC planned to begin treatment (Tx) with S. 124 I-cG250 PET/CT will be assessed for its ability to predict Tx response during (days 25–28) and at completion (days 39-42) of the first cycle of therapy, in comparison to standard CT imaging at routine intervals. PET/CT and CT will each be interpreted by 1 nuclear medicine physician, who will be blinded to the results of the comparator imaging modality, but aware of the clinical history of the pts. Eligibility include age ≥18, ECOG PS &lt; 2, histologically confirmed MccRCC, Tx planned with S, and radiographic evidence of unidimensionally measurable disease with at least one lesion ≥2 cm in diameter on 16-slice multi-detector CT. Key exclusion criteria include uncontrolled/unstable hyperthyroidism or Grave’s Disease, unstable cardiac disease and uncontrolled seizure disorder or history of CVA or TIA within the past 12 months. Results: NA. Conclusions: This is the first clinical trial to prospectively evaluate the use of a histologically specific imaging modality to measure early changes in ccRCC CAIX protein expression as a predictor of response to biologically targeted Tx. Enrollment will commence in November 2011.
Detection of prostate cancer with histoscanning: A retrospective analysis in 85 patients.
Authors: Robin Epplen, Julius van Essen, Thomas van Erps, Daniel Porres, David J. K. P. Pfister, Axel Heidenreich
Journal: Journal of Clinical Oncology (2012)

53 Background: HistoScanning is a tissue differentiation and visualization tool which identifies changes to solid organ tissues. It uses a specific three dimensional transrectal ultrasound device to acquire and transmit data to a software program. Data is processed and suspicious areas in the prostate are projected in 3D. Our objective was to compare HistoScanning with histopathology of radical prostatectomy specimens and to determine sensitivity regarding the detection of cancer volume and localization. Methods: We analyzed the preoperative results of histoscanning in 85 men underwent radical prostatectomy. All prostatectomy specimens were processed according to the Stanford protocol by an experienced uro-pathologist.Results were correlated with final pathology according to localisation and volume. A match was defined as a HistoScan positive lesion in a correspondent histopathologically positive area.Results were analyzed according to pT-stadium, GS, PSA, cancerous tissue volume and volume of HistoScanning-lesions. Results: Mean patients’ age was 62,8 yrs, PSA 11.83ng/ml, prostate volume was 47,5 ml and mean tumor volume was 4,80ml. 44 patients had a pT2 tumor, 38 had a pT3 carcinoma (3 pts pT4). 8 pts had salvage prostatectomy. 9 patients had GS of 6,50 and 18 pts had GS 7 and GS ≥8 respectively. HistoScanning had 74% overall sensitivity.Sensitivity was higher for pT3 tumors (92%) than for pT2 carcinoma (61,36%). HistoScanning detected (5/9=55%) of GS 6, (37/50= 74%) of GS 7 and 15/18=83% of GS ≥8 carcinoma. Preoperative PSA had no statistical significance. HistoScanning detected small tumors (&lt;1 ml) in 50%, intermediate (1-5ml) in 57,5% and large(&gt;5ml) in 86% respectively. Identical results are seen regarding the volume of suspicious lesions. For small (≤0,5 ml), intermediate (0,5-2ml) and large (&gt;2ml) lesions, it correctly predicted prostate cancer localisatio 33%, 78,5% and 64,7%, respectively. Conclusions: HistoScanning seems to have a great potential in the detection of significant prostate cancer. In particular, extracapsular, poor differentiated and large prostate cancers show a high detection rate. However, larger prospective studies are needed to verify these preliminary results.
A recover survey of cancer survivors in Beijing
Authors: P. Li, Y. Qin
Journal: Journal of Clinical Oncology (2008)

20740 Background: We did a survey of 857 cancer survivors in Beijing to find out the way of cancer recovery and requirements, in order to give pts scientific guiding. Methods: There are 857 cases involved in the survey in Oct.30. 2007. All survivors are members of Beijing cancer recovery association. All of them finished systemic treatments. The questionnaire used QOL SF-36 and the way of recovery questionnaire was designed by specialist. Pts status: Average age 57y (28–82). M 114 (13%), F 742 (87%). Education status: Up university 25%, high school 52%, under middle school 23%. Occupation: Technician 21%, staff of government 20%, workers 19%, others like attendants, farmers etc. 40%. Retired Pts 38%. Average survivor time 6y (0.5–36y). Tumor status: BC 54% (463), CRC 9% (78), NSCLC 6% (49), ovary cancer 6% (51), gastric cancer 5% (42). Others like renal, lymphoma etc. 20% (168). Results: Health status: best 8% (72/856), very well 19% (163/856), well 31% (269/856), general 39% (332/856), not well 2% (20/856). 836 Pts still take medicine. 79% (660) for enhance immunity. 825 Pts normally to see Traditional Chinese Medicine (TCM) doctors. For holism regulate body is about 87% (725). Pts get very help and help from TCM is 42%, 57% separately. Most Pts (94%) see TCM Dr. in cancer hospital or TCM hospital department of tumor. 96% (818/854) Pts insist on exercise. Main way is walking 78% (644/818). Qi Gong 36% (296/818). Tai Ji 19% (163/818), others 20% (167/818). The question of what helps you requires: Health guidance 67% (565/849), specialist counsel 61% (519/849), diet guidance 59% (504/849), TCM knowledge 48% (408/849). Conclusions: TCM holism regulation and exercise is a major way in cancer survivors of Beijing cancer recovery association. Most Pts felt benefit from TCM and exercise. At the same time most Pts hope to get specialist counseling. No significant financial relationships to disclose.
Second primary malignancies in gastric cancer: A U.S. population-based study.
Authors: Binay Kumar Shah, Amit Khanal
Journal: Journal of Clinical Oncology (2015)

191 Background: Risk of second primary malignancies (SPM) is not known in gastric cancer. In this population based study, we analyzed rates of SPM in gastric cancer. Methods: We selected adult (≥18 years) patients with gastric cancer as first primary malignancy diagnosed from January 1992 to December 2011 from Surveillance, Epidemiology and End Result 13 database. We used SEER*stat’s multiple primary standardized incidence ratio (MP-SIR) session to calculate the risk of SPM diagnosed 6 months after the diagnosis of index gastric cancer. Results: Among 31,818 patients with first primary gastric cancer, 1674 (5.26%) developed 1,839 SPM with observed/expected (O/E) ratio of 1.09 (95% CI = 1.05-1.15, p&lt;0.0001) and excess risk of 16.15 per 10,000 population. The median time to first SPM from the time of diagnosis of stomach cancer was 49 months (range 6 months to 19.08 years). There was significantly increased risk of gastrointestinal malignancies [O/E ratio 1.65 (CI=1.53-1.79, p&lt;0.001)], thyroid cancer [O/E ratio 1.98 (CI=1.32-2.84, p&lt;0.01)] and myeloid leukemia [O/E ratio 1.47(CI=1-2.09, p&lt;0.05)]. Interestingly, there was significantly decreased risk of melanoma, breast cancer and prostate cancer. Conclusions: Our study showed that patients with gastric cancer are at higher risk of gastrointestinal malignancies, thyroid cancer and myeloid leukemia. Similarly, risk of melanoma, breast cancer and prostate cancer in patients with gastric cancer is lower than general population.
Primary resistance to abiraterone acetate (AA) after docetaxel treatment in metastatic castration-resistant prostate cancer (mCRPC): A multicenter retrospective analysis.
Authors: Marco Maruzzo, Umberto Basso, Alberto Diminutto, Ugo De Giorgi, Lucia Fratino, Giovanni Lo Re, Alessandro D'Angelo, Maddalena Donini, Francesco Verderame, Raffaele Ratta, Giuseppe Procopio, Enrico Campadelli, Francesco Massari, Donatello Gasparro, Sveva Macrini, Caterina Messina, Monica Giordano, Francesca Maines, Vittorina Zagonel, Orazio Caffo
Journal: Journal of Clinical Oncology (2015)

206 Background: AA improves survival in mCRPC patients pre-treated with docetaxel. All patients eventually become resistant at different interval times, but some of them show an early progression and should be considered as primary resistant (PRES). To date, no factors have been identified as predictive of primary resistance. Methods: The clinical outcomes of a consecutive series of patients treated with AA after docetaxel failure in 19 Italian Hospitals within a Named Patient Program (NPP) was previously reported (BJU 2014). In the present analysis, we focus on patients who achieved an investigator-assessed PFS ≤ 3 months (PRES) and those with PFS ≥ 12 months (long term responders, LR). The main aim is to determine clinical characteristics associated with primary resistance. Results: Among the 265 patients enrolled in the NPP, we identified 97 PRES (37%) and 71 LP (27%). Poor performance status, visceral metastases, presence of pain, low baseline haemoglobin level, increased LDH and ALP levels, and short time from diagnosis to AA therapy were significantly associated with early progression (Table). Conclusions: Several clinical parameters appear to correlate with early progression under AA. Their role as potential predictive factors of resistance deserve further exploration in order to develop alternative treatment strategies. [Table: see text]
Prognostic factors associated with recovery from mechanical ventilation in advanced cancer patients admitted to intensive care units
Authors: S. Kim, D. S. Heo, I. I. Na, E. K. Song, H. C. Shin, T. Yun, K.-W. Lee, D.-W. Kim, Y.-J. Bang, N. K. Kim
Journal: Journal of Clinical Oncology (2005)

8179 Background: The outcome of mechanical ventilation for cancer patients is poor. It is often complicated to decide which patients should receive aggressive intensive care units (ICU) care. Old age, leukopenia, performance status, progression or recurrence of cancer have been known to be prognostic factors of recovery from mechanical ventilation. We have analyzed the treatment outcome of cancer patients requiring mechanical ventilation to identify prognostic factors for survival from hospital care. Methods: We have reviewed medical records of advanced cancer (including solid tumor and lymphoma) patients who admitted to medical ICU and required mechanical ventilation from January, 2003 to June, 2004 in Seoul National University Hospital. Patients who admitted to ICU for perioperative care after curative surgery were excluded. Results: 80 patients were evaluated. 51(63.8%) patients died in ICU, and among 29(36.3%) patients who survived their ICU stay, additional 13(16.2%) died in general ward. Overall in-hospital mortality was 80%. (64/80) Median survival from the time of intubation was 13 days for all patients (including survivors). Uncontrolled disease (disease progression after previous chemotherapy) and intubation more than three days after hospitalization were significantly associated with in-hospital deaths in uni-variate and multi-variate analysis. Old age (>60yrs), leukopenia, and performance status were not significant prognostic variables associated with in-hospital deaths. Conclusions: Mortality of cancer patients admitted to ICU for mechanical ventilation was very high. Patients with uncontrolled disease or long-term hospitalization prior to respiratory failure are not likely to benefit from intensive care. No significant financial relationships to disclose.
Use of an electronic health record to improve follow-up of elevated lab results: The PSA safety net.
Authors: Kim N. Danforth, Steven J. Jacobsen, Lauren N. Miyaguchi, Hui Zhou, Jeff M. Slezak, Ronald K. Loo
Journal: Journal of Clinical Oncology (2012)

292 Background: Follow-up of laboratory results is challenging in outpatient care, and research indicates an electronic health record (EHR) alone is insufficient to ensure appropriate follow-up of abnormal results. Methods: In April 2006, Kaiser Permanente Southern California implemented a Prostate-Specific Antigen (PSA) Safety Net to detect men with elevated serum PSA levels who had not yet received follow-up care at 6 months post-testing. The PSA Safety Net scanned the EHR to identify men age 45-79 with elevated PSA values. Men were then excluded if they had a prior prostate cancer diagnosis or evidence of follow-up care within 6 months of the PSA test, defined as any of the following: a subsequent visit with a urologist or oncologist, normal PSA value, biopsy, or prostate cancer diagnosis. In June 2009, the criterion for follow-up care was reduced from 6 to 3 months. The electronic Safety Net tool was refreshed daily, stored key data (e.g., contact information), and recorded actions of care managers (e.g., expedited appointment scheduled). We evaluated how many men were identified through the PSA Safety Net and whether they were systematically different from men followed through routine care. Results: From 4/2006-12/2010, 45,762 men had an elevated serum PSA level. Twenty percent (n=9,373) were identified through the PSA Safety Net. Of 7,729 prostate cancers diagnosed, 9.6% (n=739) were found through the PSA Safety Net. Age, race/ethnicity, and language preference was similar among men followed through the Safety Net vs. routine care. Men followed through the PSA Safety Net were less likely to be enrolled in kp.org (46% vs. 54% respectively, p&lt;0.001), which provides online access to lab results. Median PSA levels were slightly lower among those followed through the PSA Safety Net. Men in the Safety Net also were less likely to be diagnosed with Stage IV cancers than men followed via routine care (2.8% vs. 5.5%, p=0.002), although stage was similar overall. Conclusions: Within a health system using an advanced EHR, a substantial number of men with elevated PSA levels were identified and managed through a PSA Safety Net. These men were largely similar to those followed through routine care, although tended toward lower risk.
The effect of prior abiraterone (Abi) use on the activity of enzalutamide (Enza) in men with mCRPC.
Authors: Heather H. Cheng, Rosa Nadal, Roman Gulati, Arun Azad, Przemyslaw Twardowski, Ulka N. Vaishampayan, Neeraj Agarwal, Elisabeth I. Heath, Sumanta Kumar Pal, Hibba-tul Rehman, Amanda Leiter, Julia Anne Batten, Robert B. Montgomery, Matt D. Galsky, Kim N. Chi, Emmanuel S. Antonarakis, Evan Y. Yu
Journal: Journal of Clinical Oncology (2014)

18 Background: Enzalutamide (Enza) and abiraterone (Abi) are next generation hormonal agents for metastatic castration resistant prostate cancer (mCRPC). Whether these agents can be effectively sequenced is not yet well understood. Results of retrospective analyses of Abi after prior Enza have demonstrated modest responses of brief duration, suggesting common resistance pathways. Here, we retrospectively analyze response to Enza with or without prior Abi treatment. Methods: We retrospectively reviewed 195 patients from seven academic centers treated with Enza between January 2009 and August 2013. Data were collected on disease characteristics, prior therapies, and prostate-specific antigen (PSA) values at baseline and while on treatment. Logistic regression was used to evaluate association between 30% or greater PSA decline on Enza and either prior Abi treatment or 30% or greater PSA decline on prior Abi after accounting for potential confounders. Results: One hudred eighty three patients had non-missing PSA starting and nadir values on Enza, with starting PSA median 102.0 (range 1.1–5007.0) ng/mL. Overall, 42% (76 of 183) of Enza-treated patients achieved a 30% or greater PSA decline, with 39% (58 of 150) response among prior Abi-treated patients and 55% (18 of 33) response among Abi-naïve patients. Of 79 patients who lacked significant response to prior Abi, 30% (25 of 79) achieved a 30% or greater PSA decline and 19% (15 of 79) achieved a 50% or greater PSA decline with subsequent Enza. Odds of achieving a 30% or greater PSA response on Enza was 2.3 times higher for Abi-naïve patients versus prior Abi-treated patients (95% CI 1.0–5.5, P=0.06) and 1.9 times higher for Abi-responders vs Abi-non-responders (95% CI 1.0–3.7, P=0.06) after adjusting for prior docetaxel and concurrent steroid use. Conclusions: In this multi-center retrospective study, 39% of patients achieved a 30% or greater PSA decline with Enza after prior Abi treatment. While the activity of Enza appears to be blunted in the post-Abi setting, PSA declines still occur in a meaningful proportion of patients. Notably, 30% of patients without significant response to prior Abi responded to subsequent treatment with Enza, suggesting a subset of men with distinct biological resistance pathways. Data will be updated at the time of presentation.
Norris Cotton Cancer Center (NCCC) neuro-oncology glioma tumor quality improvement project.
Authors: Evelyn Schlosser, Camilo E. Fadul, Jennifer Snide, Karen Homa
Journal: Journal of Clinical Oncology (2012)

137 Background: Glioma patients represent 30% of the primary brain tumor population at NCCC, and often require surgical intervention prior to medical management. In order to ensure coordinated, comprehensive and timely care, reliable referral to the neuro-oncology program is needed. Earlier quality improvement efforts identified 10 best practices designed to facilitate referral into the neuro-oncology program, though over the years these practices lapsed. A manual record review of 2010 cases revealed 43 glioma patients, of which compliance with best practices ranged from 29% to 93%, and none of the patients had all best practices when indicated. Additionally, the percentage of 9 out of the 10 best practices (excluding post-operative order sets) completed for all consecutive patients from January 2010 to May 2011 was 63%. Methods: A project was chartered by leadership and a multidisciplinary team was convened twice a month from May to October 2011. The team was organized into three groups (entry into the system, surgical, and post-op care, and continuing care) and assigned a coach with instructions to flowchart the current processes and identify factors that contributed to poor performance. The three process maps were then combined to create one system map by which the team brainstormed improvement ideas to pilot. Results: Concurrent review of the individual case-level data during the project team meetings was helpful in identifying process weaknesses as changes were being piloted. Performance of best practices improved significantly when measured several months following completion of the project; furthermore, best practices completed for consecutive patients from June 2011-May 2012 was 87%. Conclusions: The team was challenged to identify changes in process that were not dependent upon individual providers/staff members and that took advantage of a newly implemented electronic medical record. Manual chart abstraction was replaced by electronic data abstraction. Sustained measurement and reporting of performance is essential and has been incorporated into the Neuro-Oncology Tumor Board meetings on a quarterly basis.
Long-term treatment with testosterone undecanoate injections and its effect of prostate cancer incidence in hypogonadal men.
Authors: Ahmad Haider, Michael Zitzmann, Aksam Yassin
Journal: Journal of Clinical Oncology (2014)

119 Background: Concerns regarding the safety of testosterone treatment, particularly regarding prostate cancer in elderly men, still hamper the use of testosterone in hypogonadal men. Methods: Registry studies of 942 men with testosterone levels less than or equal to 12.1 nmol/L from three German centers. Patients received testosterone undecanoate for up to 16 years. Results: In cohort A (mean age: 57.70 ± 6.76 years; Bremerhaven), prostate-specific antigen (PSA) increased from 1.77±0.97 to 2.0±1.01 ng/ml (p=0.0021). Prostate volume increased from 28.34±10.79 to 30.72±14.28 ml (p&lt;0.0001). Five out of 300 patients were diagnosed with prostate cancer. The proportion was 1.7% with an incidence of 39.4 per 10,000 patient-years. In cohort B (mean age: 59.53 ± 8.35 years; Norderstedt), PSA increased from 0.86±0.57 to 1.38±0.49 ng/ml (p&lt;0.0001). Prostate volume increased from 27.9±8.15 to 36.98±7.22 ml (p&lt;0.0001). Six out of 261 patients were diagnosed with prostate cancer. The proportion was 2.3% with an incidence of 54.5 per 10,000 patient-years. One patient in cohort B was treated with external beam radiation, all other patients underwent radical prostatectomy. In cohort C (mean age: 42.6 ± 13.4 years; Muenster), PSA increased from 1.6±0.4 to 1.9±0.4 (p&lt;0.001). Prostate volume increased from 16.9±5.1 to 19.9±5.3 ml (p&lt;0.001). No patient was diagnosed with prostate cancer. Conclusions: The PLCO trial reported an incidence of 116 per 10,000 patient-years (Andriole, NEJM 360(13):1310-9), the ERSPC trial 96.6 (Schröder, NEJM 366(11):981-90). Although these screening trials cannot be directly compared to our registries of hypogonadal men receiving testosterone replacement therapy, the incidence of prostate cancer in our registry studies does not suggest an increased risk in hypogonadal men on long-term testosterone treatment.