tbuckley/cabot-search huggingface dataset:
Hospitalizations in elderly glioblastoma patients.
Authors: Claire Elizabeth Moroney, James R. Perry, Derek S Tsang, Denise Bilodeau, Christina Mueller, Hany Soliman, Sten Myrehaug, Arjun Sahgal, Chia-Lin Tseng, May Tsao
Journal: Journal of Clinical Oncology (2017)

e21529 Background: Elderly glioblastoma (GB) patients are at risk of hospitalizations due to the morbidity of the disease and possible treatment toxicity. Methods: In this observational cohort study, 255 newly diagnosed GB patients age 65 years and older were included. Survival, emergency room visits and admissions to an acute care hospital were determined. Mean and median total health care costs were calculated. Risk factors for Emergency room visits and acute care hospital admissions were determined. Results: Median overall survival was 6 months. The majority of patients (68%) had at least one visit to the emergency department and 77% had at least one admission to acute care. The mean and median length of hospital stay per patient was 20.5 days and 14 days respectively. Forty-three percent of patients spent 0-4% of their survival as an inpatient. Only 3% spent 70% or more of their survival as an acute care inpatient. There was a mean of 79.7 days and a median of 43 days from the last emergency department visit to death. The mean and median total costs (hospital, ambulatory, physician billing, other health care costs) per patient were $162 479.78 (CAN) and $125 511.00 (CAN), respectively. Treatment with radiation or treatment with radio-chemotherapy was associated with a relative risk (RR) of 2.31 (95% CI 1.44, 3.7; p = 0.0005) and 2.19 (95% CI 1.28, 3.74; p = 0.0 04), respectively for emergency department visits as compared to patients who were managed with comfort measures only. Patients with a baseline ECOG 0 had a RR of 1.71 (95% CI 1.06, 2.77; p = 0.0289) and patients with baseline ECOG 1 had a RR of 1.49 (0.98, 2.26; p = 0.0623) for hospital admission as compared to patients with ECOG 4. Conclusions: A large proportion of elderly GB patients (particularly those with good baseline performance status who underwent active treatment) presented to the emergency department and had at least one admission to acute care.
Emergency etoposide-cisplatin (Em-EP) for patients with germ cell tumors (GCT) and trophoblastic neoplasia (TN).
Authors: Charleen Chan Wah Hak, Christopher Coyle, Arwa Kocache, Delia Short, Naveed Sarwar, Michael Seckl, Michael Gonzalez
Journal: Journal of Clinical Oncology (2018)

e16539 Background: Etoposide (E) at 100 mg/m2 combined with Cisplatin (P) at 20 mg/m2 is an induction 2-day regimen embedded in our clinical practice for patients with both advanced GCT and TN at high risk of early death. This study represents the first retrospective analysis on 24/7 Em-EP administration to this combined cohort at our Emergency Cancer Treatment Centre (ECTC). Methods: Patients who received Em-EP between 1st January 2012 and 31st December 2016 were identified from electronic databases at Imperial College Healthcare NHS Trust. Data collected included patient demographics, treatment details and clinical outcome. Results: Em-EP chemotherapy was administered in the emergency setting to 104 patients, predominantly young adults (median age 35, range 17-71). Half the cases (n = 52) were GCT: 22 male (6 seminomas, 16 non-seminomas), of which 14 (64%) had a poor International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic classification; 30 female (2 dysgerminomas, 28 non-dysgerminomas). The other 50% (n = 52) were treated for TN: 48 gestational (GTN) and 4 non-gestational. The International Federation of Gynecology and Obstetrics (FIGO) risk score was high (≥7) in 39 GTN patients (81%). Primary disease sites included: uterine (n = 44, 42%), gonadal (n = 41, 39%), extragonadal (n = 10, 10%) and unknown (n = 9, 9%). Most patients received Em-EP for a new cancer diagnosis (n = 100, 96%), within 24 hours (n = 93, 89%) and out-of-hours (n = 74, 70%). 66 patients (63%) were symptomatic, 51 (49%) had high-burden disease and 9 (9%) required Intensive Care Unit admission. Two deaths (2%) occurred early at < 4 weeks (1 GCT, 1 TN). The prevalence of neutropenic sepsis was 5%. At follow-up (median 9 months, range 0-64 months), overall survival for patients who received Em-EP was 81%, higher in TN (92%) than for GCTs (69%; OR 0.19, p = 0.0053, 95% CI 0.06-0.61). Conclusions: Em-EP represents a standard approach at our ECTC for the initial management of high-risk patients with both GCT and TN. Despite the potentially fatal complications encountered in the acute setting, early mortality with Em-EP is low. In contrast to GCT, almost all patients with TN who receive Em-EP are eventually cured following definitive treatment.
TCT-828 Clinical Outcomes Following Focal Ablation – a New Technique for the Performance of Alcohol Septal Ablation
Authors: Youssef Rahban, David Zisa, Carlos Davila, Ethan Rowin, Sophie Wells, Martin Maron, James Udelson, Catherine Carroll, Navin Kapur, Andrew Weintraub, Benjamin Wessler, Carey Kimmelstiel
Journal: Journal of the American College of Cardiology (2018)
Serum NMR Metabolomics Identifies Similar Associations of Lipoproteins and Lipids With Risk of Myocardial Infarction and Ischemic Stroke but Not With Hemorrhagic Stroke
Authors: Michael V Holmes, Iona Y Millwood, Christiana Kartsonaki, Michael R Hill, Ruth Boxall, Robin G Walters, Mika Ala-Korpela, Sarah Parish, Robert J Clarke, Zhengming Chen
Journal: Circulation (2016)

Introduction: In observational studies, major circulating lipids (e.g. low density lipoprotein cholesterol) are associated with risk of myocardial infarction (MI) and ischemic stroke (IS), but thei...
Translating molecular subtypes of gastric and gastroesophageal junction cancer (GC and GEJC) to the metastatic (met) setting: Prevalence and outcome dataTranslating molecular subtypes of gastric and gastroesophageal junction cancer (GC and GEJC) to the metastatic (met) setting: prevalence and outcome data.
Authors: Itziar Gardeazabal, Cinta Hierro, Cristina Viaplana, Paolo Nuciforo, Ana Vivancos, Teresa Macarulla Mercade, Elena Garralda, Maria Eugenia Semidey, Juan Francisco Grau Bejar, Rodrigo Dienstmann, Stefania Landolfi, Maria Alsina
Journal: Journal of Clinical Oncology (2018)

4071 Background: GC is the third cause of cancer death worldwide. Treatment options are limited and a molecular classification on top of HER2 may help to guide therapy. To date, the reported molecular classifications are based on localized tumors with scarce clinical follow-up. We report the first comprehensive tumor profiling of met GC/GEJC. Methods: 171 tumor samples from patients (pts) treated at Vall d’Hebron Institute of Oncology (2010–17) were analyzed by next generation sequencing, HER2 status by immunohistochemistry (IHC) and in situ hybridization (ISH), microsatellite instability (MSI) by IHC and Epstein-Barr virus (EBV) by ISH. Results were correlated with histology and clinical variables. Results: Median age was 60 years, 70% men, 22% GEJC. At diagnosis, 63% pts had only 1 met site (43% lymph nodes, 40% peritoneum, 33% liver); 41% diffuse and 40% intestinal subtype. TP53mut was found in 60%, equally in diffuse and intestinal subtypes. Molecular subtypes were defined as Chromosomal Instability TP53mut (CIN), CIN_HER2- (23%) and CIN_HER2+ (23%); no_CIN or TP53wt (19%); MSI (8%) and EBV (3%; 1 East-Europe pt, 2 Spanish pts with lymphoepitelioma-like histology). All subtypes equally distributed along the stomach and GEJ (24% had missing TP53mut status but were HER2, MSI and EBV neg). CIN subtype was associated with liver met (p = 0.004) and non_CIN with peritoneum met (p = 0.025). The median overall survival (mOS) was 24.2 months (m). MSI pts (1 out of 8 received immunotherapy) had lower mOS (9.83m v 22.2m, p = 0.003). None of the other molecular subtypes including CIN_HER2+ was prognostic for mOS. Conclusions: To our knowledge, this is the first broad molecular report of met GC/GEJC with clinical annotation. The molecular epidemiology in met disease differs from the previous classifications of localized GC/GEJC. We identify MSI as a poor prognostic factor while HER2+ did not impact on outcome. EBV positivity was predominantly found in rare histologies and East-Europe pts.
Abstract 17937: Effect of Remodulin in Pulmonary Hypertension Associated With Heart Failure With Preserved Ejection Fraction (PH-HFpEF)
Authors: Jian Hu, Ana L Mora, Mark T Gladwin, Yen-Chun Charly Lai
Journal: Circulation (2017)

Background: Pulmonary hypertension associated with heart failure with preserved ejection fraction (PH-HFpEF or CpcPH; WHO Group 2) is the most common cause of PH worldwide, and at present, it has n...
The Power of the Nudge to Decrease Decision Fatigue and Increase Influenza Vaccination Rates
Authors: Suchitra Rao, Ann-Christine Nyquist
Journal: JAMA Network Open (2018)

Rebecca H. Kim, MD, MPH; Susan C. Day, MD, MPH; Dylan S. Small, PhD; Christopher K. Snider, MPH; Charles A. L. Rareshide, MS; Mitesh S. Patel, MD, MBA, MS
Precision oncology experience at a tertiary care center.
Authors: Meena Sadaps, Pauline Funchain, Petros Grivas, Bassam N. Estfan, Jame Abraham, James Stevenson, Nathan A. Pennell, Alok A. Khorana, Brian James Bolwell, Davendra Sohal
Journal: Journal of Clinical Oncology (2017)

e18118 Background: Precision oncology – use of tumor genomic profiling to guide therapies – is widely discussed but with limited real-world data. We have previously reported our prospective study on feasibility and clinical utility of routine somatic genomic testing of solid tumors [ J Natl Cancer Inst. 2015; 108(3)], and here we report our longitudinal experience, focusing on therapeutic impact. Methods: Records were reviewed for consecutive adult patients seen at Cleveland Clinic for a solid tumor malignancy without known curative options where tumor genomic profiling was ordered using FoundationOne™ (Cambridge, MA). Results were discussed at the Cleveland Clinic Genomics Tumor Board, and therapeutic recommendations were conveyed to the primary oncologist. Data for this cohort study approved by the Cleveland Clinic IRB included subsequent therapies and clinical outcomes. Results: From 2013 to 2016, 330 patients had tumor genomic testing ordered. Median age was 61 years (range, 24-94); 170 (51.5%) were female; 289 (87.6%) were Caucasian. Colorectal (21.5%), breast (17%), lung (16.1%), and pancreatobiliary (11.5%) cancers were the most common diagnoses. In 300 resulted cases, a median of 4 (0-20) alterations per specimen were noted; the most commonly altered genes were TP53 (n = 174), KRAS (n = 75), APC (n = 65), CDKN2A/B (n = 49), and PIK3CA/ PIK3R (n = 46). A specific therapy targeting an actionable alteration was recommended in 51% (153/300) of patients, and 11.7% (n = 35) received such therapy: 14 on clinical trials, 5 on-label, and 16 off-label. Most common targets for therapy were PIK3CA/PIK3R/PTEN (n = 7), HER2 (6), BRAF (3), EGFR (3), and ALK, FLT3, NTRK1 and RET (2 each). At last follow-up, of 35 patients receiving targeted therapy, best responses were: complete response (n = 1, 2.9%), partial response (n = 5, 14.3%), stable disease (n = 14, 40%), progressive disease (n = 11, 31.4%); data not available for 4 patients. Non-availability of clinical trials was a common reason for non-receipt of targeted therapy. Conclusions: Tumor genomic profiling influenced treatment in 11.7% of patients in this cohort, and 57% of those receiving targeted therapy experienced clinical benefit. These data can help guide real-world discussions of precision oncology.
Biomarker-enriched efficacy of cetuximab-based therapy: Squamous subset analysis from S0819, a phase III trial of chemotherapy with or without cetuximab in advanced NSCLC.
Authors: Fred R. Hirsch, Mary Weber Redman, Roy S. Herbst, Edward S. Kim, Thomas John Semrad, Lyudmila Bazhenova, Gregory A. Masters, Kurt R. Oettel, Perry Guaglianone, Christopher M. Reynolds, Anand B. Karnad, Susanne M. Arnold, Marileila Varella-Garcia, James Moon, Philip C. Mack, Charles David Blanke, Karen Kelly, David R. Gandara
Journal: Journal of Clinical Oncology (2016)

9090 Background: The SWOG 0819 study compared chemotherapy (CT) (+/- bevacizumab) to CT combined with cetuximab and included 1,313 eligible patients (pts) of which 321 had squamous histology (SCC). No difference in the primary endpoint, overall survival (OS), was seen in the entire study population or in the EGFR FISH+ population (progression-free survival (PFS) (Herbst et al, WCLC 2015). A secondary analysis suggests an OS benefit in SCC pts with FISH+ tumors. Methods: EGFR FISH analysis was performed in a centralized laboratory using the Colorado EGFR scoring system, which defines both gene amplification (EGFR/CEP>2 or ≥10% cells with ≥15 EGFR copies) and high polysomy (≥40% cells with ≥4 EGFR copies) as FISH+. IHC for EGFR protein was assessed using Dako PharmDX antibody and using the H-score system, defining EGFR IHC positivity as H-score≥ 200. The IHC was also performed in a centralized laboratory. Results: Of 1,313 pts, EGFR FISH status is known for 976 pts; with 400 EGFR FISH+: 355 with high polysomy and 45 with gene amplification. EGFR IHC status is known for 945 pts: 295 IHC+. There were 142 pts with both IHC+ and FISH+. Table 1 includes an analysis of OS. No statistical significant difference between the two treatment arms was seen regarding EGFR IHC and/or FISH for pts with adenocarcinomas. Conclusions: In a large prospective randomized study with CT +/- cetuximab, no difference in outcome was seen for the overall population. However, an explorative analysis of patients with SCC histology showed that pts with FISH+ tumors or IHC+ tumors had improved outcome when cetuximab was added to CT, and particularly if the SCC tumor was positive both for EGFR IHC and EGFR FISH. This biomarker selection concept should be prospectively studied and include other therapeutic EGFR antibodies. Clinical trial information: NCT00946712. All FISH+ IHC+ FISH+ and IHC+ N Med* HR* N Med HR N Med HR N Med HR All pts 0.94 0.83 0.78 0.61 Cetuximab Arm 656 10.9 199 13.4 159 12.1 72 12.9 Control Arm 657 9.4 201 9.8 136 9.0 70 7.5 2-sided p-value 0.34 0.10 0.06 0.01 SCC pts 0.85 0.56 0.64 0.32 Cetuximab Arm 160 9.6 55 11.8 70 9.3 30 12.3 Control Arm 161 8 56 6.4 59 6.9 28 4.9 2-sided p-value 0.18 0.01 0.03 0.0004 * Med = Median, HR = hazard ratio
Comparison of survival-post-treatment of stage 4 v.s. distant recurrent primary breast cancer.
Authors: Yoshihiko Kamada, Naoko Takigami, Kentaro Tamaki, Kanou Uehara, Nobumitsu Tamaki
Journal: Journal of Clinical Oncology (2018)

e13067 Background: With the advent of subtype conscience therapies, we have experienced prolongation of survival time for stage 4 primary breast cancer, dramatic in some cases. This is in contrast to the significant but not so pronounced improvement of survival in post-operative cases with systemic recurrence. We present data, and hypothesize that more aggressive first line therapy for systemic recurrence akin to first line treatment for metastatic disease, might improve survival in cases failing after operation. Methods: Operable primary breast cancer patients operated in our institute who developed distant recurrence were compared to cases with metastatic disease on presentation. The cases were stratified by subtype according to immunohistochemistry (i.e. Luminal type, Luminal-HER2 type, non-Luminal-HER2 type, Triple negative type). Overall survival was compared. Results: The median survival, and 5-year survival rate, and inter-group analysis is as in the table. There was no significant difference between groups. However, in the cases with metastatic disease, survival ceased to drop at 38% in the Luminal cases after 6 years, at 60% in the Luminal-HER2 cases after two years, and at 25% in the non-Luminal-HER2 cases after 4 years. Conclusions: Stage 4 breast cancer might be becoming a curable disease if treated appropriately according to the presenting subtype, albeit individual host factors might also play a critical role. Accumulating treatment data of exceptional responders in the metastatic setting might provide insight for the treatment of recurrent disease. Group Cases (n) Median survival (mo) 5-year survival rate Wilcoxon Leveling of survival Metastatic - Luminal 46 52.1 42.0% by 6 years at 38% Recurrent - Luminal 122 54.3 44.3% p = 0.7399 by 11 years at 12% Metastatic - Luminal HER2 11 n.r. 59.7% by 2 years at 60% Recurrent - Luminal HER2 24 48.2 24.3% p = 0.5051 by 5 years at 24% Metastatic - Non-Luminal HER2 18 31.5 25.2% by 4 years at 25% Recurrent - Non-Luminal HER2 25 29.1 29.1% p = 0.5270 by 6 years at 21% Metastatic - Triple negative 15 33.0 33.2% last case died at 6.5 years Recurrent - Triple negative 40 29.1 26.5% p = 0.1157 by 6 years at 15%
Clinicopathologic characteristics and outcomes of transformed diffuse large B-cell lymphoma in hepatitis C virus-infected patients: A case-control study of 84 patients.
Authors: Jeff Hosry, Roberto N. Miranda, Francesco Turturro, Minas P. Economides, Felipe Samaniego, Harrys A. Torres
Journal: Journal of Clinical Oncology (2017)

7553 Background: Chronic hepatitis C virus (HCV) infection is associated with development of marginal zone lymphoma (MZL) and diffuse large B-cell lymphoma (DLBCL). Preliminary data showed particular characteristics of HCV-associated DLBCL; such as frequent transformation from indolent lymphomas and aggressive oncologic courses. We studied herein the clinicopathologic characteristics and outcomes of HCV-infected patients (pts) with transformed DLBCL. Methods: In this case control study, the medical records and pathology reports of HCV-infected (cases) and HCV-uninfected (controls) pts with transformed DLBCL seen at our institution (6/2004 - 5/2015) were reviewed. Included pts had a concomitant or a history of a low grade lymphoma. To determine their clinicopathologic characteristics, cases were compared to controls at a ratio of 1:3. To determine predictors of oncologic relapse, we compared pts with DLBCL relapse after first line chemotherapy to those who did not relapse in univariate and logistic regression analyses. Results: Twenty-one cases were compared to 63 controls. Compared to controls, cases were younger (median year age [interquartile range], 54 [49-62] v 62 [53-66], P = .01), had advanced Ann Arbor stages, 3-4 (95% v 76%, P = .05), and upper gastro-intestinal involvement (48% v 25%, P = .05). Immunophenotypically, cases had more CD10-negative B-cells (76% v 43%, P = .008) and CD5-positive B-cells (39% v 7%, P = .004) compared to controls, consistent with an activated B-cell phenotype. A comparison between pts who relapsed after first line chemotherapy (n = 42) and those who did not (n = 40) revealed that having CD5-positive B-cells was the only factor associated with DLBCL relapse in univariate (24% v 6%, P = .03) and multivariate analyses (OR = 10.7, P= .02). Conclusions: HCV-infected pts with transformed DLBCL are younger, present with advanced stages, are more commonly CD5-positive, and have an activated B-cell phenotype, suggesting more frequent transformation from MZL compared to HCV-uninfected pts. The higher frequency of CD5-positive B-cells might explain the higher DLBCL relapses previously described in HCV-infected pts.
Stage IA2 cervical cancer: Long-term outcomes with less radical as opposed to more radical surgical management.
Authors: Jill Tseng, Yukio Sonoda, Ginger J. Gardner, Oliver Zivanovic, Nadeem Abu-Rustum, Mario M. Leitao
Journal: Journal of Clinical Oncology (2016)

e17011 Background: Standard treatment for stage IA2 carcinoma of the cervix consists of modified radical hysterectomy or pelvic radiation. The objective of this study was to compare outcomes of less radical surgery (LRS, defined as conization, trachelectomy or simple hysterectomy) with more radical surgery (MRS, defined as modified radical or radical hysterectomy) in young women with stage IA2 cervical cancer. Methods: Using the Surveillance, Epidemiology and End Results (SEER) database, we identified women younger than age 45 diagnosed with FIGO stage IA2 squamous cell, adenocarcinoma, or adenosquamous carcinoma of the cervix between 1998 and 2012. Associated factors and disease-specific survival (DSS) of LRS vs MRS were analyzed. Appropriate univariate and multivariate statistical testing was performed. Results: Of the 1343 women who met inclusion criteria, 872 underwent LRS (conization 24%, trachelectomy 4%, simple hysterectomy 72%) and 471 underwent MRS (modified radical hysterectomy 19%, radical hysterectomy 26%, modified radical/radical hysterectomy 55%). For LRS vs MRS, 80% vs 65% of women had disease of squamous cell histology (p < .001), 30% vs 94% underwent regional lymphadenectomy (p < .001), and 2% vs 4% had positive lymph nodes (p = .04). Median age, race, marital status, and SEER region did not differ significantly between the two groups. Those with adenocarcinoma, adenosquamous carcinoma, or grade 3 disease were more likely to undergo MRS than LRS (OR 1.74, 95% CI 1.29-2.34; OR 2.39, 95% CI 1.31-4.37; OR 1.84, 95% CI 1.15-2.92). With a median follow-up of 110 months (range, 0-179), 10-year DSS for LRS vs MRS was 98.3% vs 98.2% (SE ± 0.5, 0.7; p = .87). Lymph node positivity was the only factor independently associated with DSS (HR 11.63, 95% CI 2.08-65.23). When stratified by histologic subtype, DSS for LRS vs MRS was as follows: squamous cell, 98.5% vs 97.6% (SE ± 0.5, 0.1; p = .69); adenocarcinoma, 97.7% vs 100% (SE ± 1.7, 0.0; p = .20); and adenosquamous carcinoma, 93.8% vs 96.3% (SE ± 6.1, 3.6; p = .87). Conclusions: In young women with stage IA2 cervical cancer, treatment with conization, trachelectomy, or simple hysterectomy does not appear to compromise DSS.