tbuckley/cabot-search huggingface dataset:
A reappraisal of staging laparoscopy in three subtypes of cholangiocarcinoma: A multi-institution analysis from the U.S. Extrahepatic Biliary Malignancy Consortium.
Authors: Jesse Davidson, Linda Jin, Bradley Krasnick, Cecilia Grace Ethun, Timothy M. Pawlik, George A. Poultsides, Thuy Tran, Kamran Idrees, Chelsea A Isom, Sharon M. Weber, Ahmed I. Salem, William G. Hawkins, Steven M. Strasberg, Robert C. G. Martin, Charles Raben Scoggins, Perry Shen, Harveshp Mogal, Carl Richard Schmidt, Shishir Kumar Maithel, Ryan C. Fields
Journal: Journal of Clinical Oncology (2016)

226 Background: Staging laparoscopy (SL) has been shown to be useful in extrahepatic biliary tumors (EHBTs) to avoid unnecessary laparotomies in unresectable disease. However, the added value of SL for EHBTs has not been well characterized in the era of modern imaging. Methods: We reviewed patients from ten institutions who underwent attempted resection of EHBTs between 1998 and 2015, including gallbladder, distal, and hilar subtypes. Yield of laparoscopy = (Number of positive SL / Total number of SL). Accuracy of laparoscopy = (Number of positive SL / Patients with unresectable disease). These data were compared by use of the chi-squared test and significance was p &lt;.05. Results: A total of 1,075 patients were taken to the OR for attempted curative resection, of which 250 patients (23%) underwent staging laparoscopy. SL identified unresectable disease in 42 patients (yield 17%). Of 208 patients who underwent exploratory laparotomy (EL) after negative SL, 19 were found to be unresectable (false negative rate 9%). Amongst gallbladder, hilar, and distal pathology types, the yield of SL were 18%, 13%, 17%, respectively (p=0.78). Accuracy of SL was 61%, 71%, and 91% respectively (p=0.17), with an accuracy of 68%. A total of 825 patients went directly to EL, of which 103 (13%) failed. The rate of failure for patients going straight to EL was significantly higher for patients with gallbladder (n=66/287, 23%) when compared with hilar (n=15/274, 6%) and distal EHBT (n=22/264, 8%) (p&lt;0.001). Conclusions: Our analysis demonstrates that staging laparoscopy still has added utility in preventing unnecessary laparotomies in unresectable disease for selected patients with EHBTs, although the overall yield is low. Patients with gallbladder cancer had high rates of failed laparotomies, representing a subset who may benefit from more frequent use of staging laparoscopy at the time of resection. [caption]Yield and accuracy of detecting unresectable disease with staging laparoscopy. [/caption] [Table: see text]
Thrombophilic Genetic Mutations Have No Impact in the Pathogenesis of Thromboembolism in Gastro-Intestinal Cancer Patients.
Authors: Odoardo M. Olimpieri, Gaia Schiavon, Barbara Giannetti, Maria C. Tirindelli, Daniele Santini, Sergio Valeri, Bruno Vincenzi, Roberto Coppola, Giuseppe Tonini, Giuseppe Avvisati
Journal: Blood (2004)
Types, frequency, and adherence of molecular tests in chronic myelogenous leukemia at chronic phase (CML-CP) in the U.S. community setting.
Authors: Clara Chen, Lei Chen, Rahul Dhanda, Hsingwen Chung, Debajyoti Bhowmik, Solveig Ericson, Nicholas DiBella
Journal: Journal of Clinical Oncology (2013)

7096 Background: The objective was to evaluate the types, frequency and adherence of molecular tests utilized in patients (pts) with CML-CP who initiated 1st-line TKI therapy in the community practice (prac) setting. Methods: A retrospective study of newly diagnosed CML-CP pts; initiating 1st-line TKI during 06/2007 and 03/2011, with ≥18-mo follow-up was conducted. Data was collected from iKnowMed, various local &amp; national labs to evaluate whether qRT-PCR test results was reported in International Scale (IS) or not (non-IS). The proportion (prop) of pts tested for molecular response in 3-mo intervals was tallied. Results: The study identified 189 pts (mean age 57 yrs, 53% male), 15% had no cytogenetic (cyto, FISH included) or molecular test (MT) recorded during 1st-line TKI therapy. The median number of MT was 6 (range: 1-28). In 3-mo intervals, the prop of pts tested for cyto responses were: 0-3 mos (24%), 3-6 mos (21%), 6-9 mos (24%), 9-12 mos (22%), 12-15 mos (10%), and 15-18 mos (7%). The prop of pts had MT in the 3-mo intervals were: 34%, 47%, 54%, 47%, 51% , and 55%. Regional patterns show the Northeast (defined by U.S. census regions) had a higher prop of pts for MT at almost all of these intervals. The number of physicians seeing CML pts correlated with the prop of pts monitored at each interval. Of the 1,226 MT ordered, 25% were reported on IS, 9% were unknown and 69% were on non-IS (Data reported: 48% log reduction, 45% BRC-ABL%, 7% other). Labs in the Midwest report on IS most often (61%), followed by the Northeast, Western (29% for both), and the South (13%). As the prac size increased, so did the utilization of IS. Conclusions: A low prop of CML pts were monitored for cyto and molecular responses. Only a quarter of the MT results were reported in IS. These results suggest gaps in CML management that could be closed with effective educational programs stressing the importance of monitoring and using IS reporting labs.
Incremental impact of breast cancer SNP panel on risk classification and screening.
Authors: K. Armstrong, E. Conant, J. Chen, E. Handorf, M. Jones, L. Boghossian, S. M. Domchek
Journal: Journal of Clinical Oncology (2011)

1522 Background: Accurate breast cancer risk prediction could improve the performance of breast cancer screening. However, current models are limited, particularly among minorities. Multiple single nucleotide polymorphisms (SNPs) associated with breast cancer have been validated in multiple studies. While each SNP confers a relatively small increase in risk, a multiplicative allelic risk model generates relative risk estimates ranging from 0.45 to 3.77, which appear independent of other risk factors. Methods: Using a prospective cohort study, standard risk information and buccal swab specimen are being collected at the point of screening mammography. A 12 SNP panel was performed by deCODE Genetics. Minor allele frequencies were compared to reported frequencies and the total genetic risk ratio was calculated using reported risk ratios assuming independence. 5 year and lifetime risks incorporating SNPs were calculated by multiplying estimated Gail risk by genotype risk ratio. Concordance between the Gail model and the Gail+SNP model in identifying high risk women (5 year risk > 1.7, lifetime risk > 20) was measured using the kappa statistic. Results: SNP results were available for 601 women (39% AA, 61% W). Mean genetic risk ratios were 1.07 in W and 1.31 in AA women. High risk allele frequencies for W women were the same as previously reported for 8 SNPs and higher than previously reported for 4 SNPs. For AA women, high risk allele frequencies were higher in 8 SNPs, lower in 3 SNPs, and the same for 1 SNP. There was relatively low agreement between the Gail model and Gail +SNP model (kappa of 0.53 for 5-year risk and 0.435 for lifetime risk). Addition of SNP information had the greatest effect among AA women, with 12% of AA women identified as 5 year high risk by Gail alone, but 35% by Gail +SNPs, and 0.4% of AA women identified as lifetime high risk by Gail alone but 7% by Gail + SNPs. Conclusions: The addition of SNP information to traditional breast cancer risk prediction models reclassifies the high risk status of some women undergoing screening mammography, particularly among AA women. Further research is needed to determine the clinical validity and utility of this reclassification in breast cancer risk prediction, screening and prevention.
Severity of and contributors to distress in patients with acute myeloid leukemia (AML) receiving induction chemotherapy.
Authors: Thomas William LeBlanc, Steven Paul Wolf, Debra M. Davis, Greg Samsa, Susan C. Locke, Areej El-Jawahri, James A. Tulsky, Amy P Abernethy
Journal: Journal of Clinical Oncology (2015)

83 Background: Distress screening is a recommended component of comprehensive cancer care, and is now required as a condition of cancer center accreditation by the American College of Surgeons Commission on Cancer. However, the etiology and severity of distress in patients with AML has not been described. Methods: We enrolled hospitalized patients with AML initiating induction chemotherapy, and assessed their distress levels weekly during their month-long hospitalization using the NCCN distress thermometer (DT). The DT is a validated (0-10), 11-point ordinal scale with an accompanying 39-item problem list. We analyzed data using descriptive statistics and Kruskal-Wallis tests. Results: Twenty-six patients provided complete data for analysis.Mean age of study participants was 58.7 (SD 12.2). Patients had high-risk disease characteristics including 13 (50%) being &gt; 60 years old, 13 (50%) with high-risk cytogenetics, and 9 (31%) with relapsed disease. Distress levels were high during the first week of induction (median 5.5; IQR 2-8). The most frequent concerns were largely from the “emotional problems” section of the DT problem list, including: worry (77%), nervousness (62%), fears (54%), and sadness (54%). Physical problems like fatigue (69%) and sleep difficulties (58%) were also prominent. Median distress scores remained above the NCCN DT threshold for referral to support services (score ≥ 4) in weeks 2 and 3 (median scores: 4 (1-8) and 5.5 (2-7), respectively), but improved to 2 (1-6) in week 4. Nervousness and worry were significantly improved at week 4 (p &lt; 0.01), but sadness persisted in 32% and fatigue in 60% of patients at the 4th assessment. Problems with eating and with diarrhea were also still prominent in week 4, at 48% and 36% respectively. Conclusions: Distress is prominent among inpatients with AML receiving induction chemotherapy, with frequent psychological concerns upfront, and persistent symptom distress in later weeks of therapy. These findings underscore the burden of unmet palliative care needs among hospitalized patients with AML. Interventions are needed to address psychological and physical distress in this population.
IRS1 and SHP2 Signaling in Myelodysplastic Syndrome and Acute Myeloid Leukemia.
Authors: Fabiola Traina, João Agostinho Machado Neto, Arthur Antolini, Flavio Araújo Borges, Mariana Lazarini, Patricia M.B. Favaro, Leticia Fröhlich -Archangelo, Paulo C.A. Pernanbuco Filho, Adriana Silva Santos Duarte, Fernando Ferreira Costa, Sara T.O Saad
Journal: Blood (2009)
Molecular diagnosis of bacteriemia in patients with neutropenic febrile oncohematologic.
Authors: E. Gimeno, L. Sorli, E. Abella, A. Alvarez-Larran, J. P. Horcajada, L. Garrigos, A. Taus, A. Salar, B. Sanchez, C. Pedro, C. Besses, M. Salvado
Journal: Journal of Clinical Oncology (2011)

9033 Background: The rapid microbiologic diagnosis in the course of fever of unknown origin plays an important role for the appropriate treatment in neutropenic patients. Blood culture helps identify bacterial and fungal bacteriemia. However, its efficacy can be limited due to its low sensitivity when the patient is receiving antibiotics and to the long time required to identify the pathogen (24-72 hours). Septifast (Roche Molecular Systems) is a new molecular technique which detects in 6 hours the 25 most important bacterial and fungal species reported to cause bloodstream infections. The aim of the study was to compare Septifast with conventional blood cultures in blood samples from neutropenic febrile patients. Methods: Forty-five blood samples from 19 patients were prospectively tested. All of them presented fever with neutrophil count <0.5x109/L. The patients (pts) were receiving antibiotic therapy (piperaciline-tazobactam/imipenem (19pts), vancomicine (7pts), amikacine (3pts), aciclovir (2pts) and antifungal therapy (9pts). For each sample, two blood culture vials for aerobic/anaerobic cultures and an EDTA whole-blood samples for Septifast were drawn. Results: Thirty-two percent of patients presented a positive result. Eight of the 45 (17.7%) blood samples studied were positive by PCR assay (S.aureus: 2; P.aeruginosa: 3; E.coli: 1; Coagulase-negative Staphylococci: 2). Two blood samples were positive for P.aeruginosa and Coagulase-negative Staphylococci by both Septifastâ and blood culture. The entire negative PCR test results correlated with negative blood culture samples. The negative predictive value was 100% with a sensitivity of 100% and a specificity of 86% (Table). Conclusions: Septifast is an easy and sensitive method for detecting pathogens in severely immunocompromised patients, allowing results in a shorter time and with higher sensitivity than conventional blood cultures. Comparision results from Septifast test and conventional blood culture system. Blood culture Results Positive samples (%) Negative samples (%) Total Septifast Positive samples (%) 2 (4.4) 6 (13.3) 8 (17.7) Negative samples (%) 0 (0) 37 (82.2) 37 (82.2) Total (%) 2 (4.4) 43 (95.5) 45 (100)
Patient navigation in cancer diagnostics: Providing information and support for more effective care.
Authors: Julie Gilbert, Esther Green, Melissa Kaan, Laura Macdougall, Elaine Meertens, Judy Burns, Carol Anne Sawka
Journal: Journal of Clinical Oncology (2012)

5 Background: Patients frequently have a difficult time finding their way through the process of diagnostic testing for cancer; the uncertainty is stressful and anxiety can impede effective communication and decision-making. Patient navigation is an ideal approach to supporting patients during the diagnostic phase of cancer care. Methods: Between 2010 and 2011, 14 Patient Navigators were trained and introduced into Diagnostic Assessment Programs (DAPs) across Ontario. DAPs are designed to provide coordination and supportive care to patients undergoing diagnostic testing and assessment. A patient survey served to evaluate the impact of patient navigation on the patient experience. Standardized tools were introduced to measure symptom severity and symptom management. Interviews were done to gauge provider and team perspectives on the role. Results: During the pilot, patient symptoms improved in the areas of well-being, tiredness, anxiety and shortness of breath, each by 30% or more. The patient survey indicated that through the program, patients got the information and support they needed; 91% of patients surveyed said that they were either satisfied or very satisfied with their experience with the patient navigator. The navigation pilot sites saw their diagnostic wait times fall by 55%. The Patient Navigators have found their work to be highly satisfying and rewarding, enjoying the opportunity it provides to use their full scope of practice in a multidisciplinary environment. Physicians expressed a high degree of satisfaction with the support provided by the Patient Navigators, reporting that patients were better prepared and informed when they arrived for their clinic appointments. Conclusions: This work has shown that patient navigation enhances the experience of patients as they move along the diagnostic continuum. Patient Navigators assist patients with managing their physical and psychosocial symptoms and play a critical role in providing the information and support patients need during a time that is full of uncertainty and distress. The diagnostic phase is a prime example of where navigation can have an impact on both the quality of patient care and the effectiveness of the health care team.
GM-CSF &amp; IL-2 ± autologous whole cell vaccine as adjuvant therapy in cutaneous melanoma: A phase II clinical trial
Authors: S. L. Beam, E. G. Elias, J. L. Zapas, E. C. McCarron, J. H. Hasskamp, W. J. Culpepper
Journal: Journal of Clinical Oncology (2008)

20027 Background: The results of various adjuvant trials in high-risk melanoma patients have demonstrated significant improvement in survival, but the results have been inconsistent. GM-CSF and IL-2 are 2 cytokines with distinct mechanism of action that are synergistic, and seemed logical to investigate as adjuvant therapy. Methods: Forty-five patients enrolled in this single-arm, open- labeled, IRB approved, phase II trial, to evaluate safety, tolerability and treatment effectiveness. After potentially curative surgery, each patient received 2-years of adjuvant therapy. The first year GM-CSF was administered as 125μgm/m2/day, subcutaneous (SC) for 14 consecutive days, followed by IL-2: 9 million IU/m2/day, SC for 4 days, followed by 10 days of no treatment. In addition, patients with resected large metastases, that yielded ∼100 X106 tumor cells, also received autologous whole cell vaccine, starting at the second GM-CSF cycle. The second year of treatment, each patient received GM-CSF only, 250μgm, SC twice/week. In event of resected recurrence, the same adjuvant therapy was re-administered. Eleven patients donated blood for dendritic cell (DC) counts. Results: This program was safe, well tolerated and compliance was excellent. Toxicities were mild to moderate and no hospitalizations were required. There was no increase in the number of DC during or after GM-CSF administration. Duration of follow-up ranged from 1 - 50 months, median 15.9. Thirty-two patients are alive 9/13 stage IV, 16/25 stage III, and 7/7 stage II (3B/4C). The survival data were expressed by Kaplan-Meier, and showed disease-free survival of .60 [95% CI], and overall survival of .64 [95%CI] at 21 months. There was no statistical difference in the survival by Log Rank between those who received biotherapy only vs. those treated by biotherapy and vaccine (p=.8). Conclusions: This adjuvant program seemed to be safe and effective, and such an effect does not seem to be mediated by DC. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Berlex Oncology Chiron Corporation
CD4 Cells Engineered to Express an MHC Class I Restricted TCR Can Rescue CD8 Cells Tolerized to Tumour-Associated Antigens
Authors: Sara Ghorashian, Ben Carpenter, Angelika Holler, Emma Nicholson, Maryam Ahmadi, Mathias Zech, Clare Bennett, Shao-An Xue, Emma Morris, Hans Stauss, Ronjon Chakraverty
Journal: Blood (2012)
Pneumonitis associated with mTOR therapy in patients with metastatic renal cell carcinoma: Incidence, radiographic findings, and correlation with clinical outcome.
Authors: D. A. Dabydeen, J. P. Jagannathan, N. H. Ramaiya, K. M. Krajewski, F. A. B. Schutz, D. C. Cho, I. Pedrosa, T. K. Choueiri
Journal: Journal of Clinical Oncology (2011)

e15176 Background: mTOR inhibitors have been recently approved for use in patients with metastatic renal cell carcinoma (mRCC) and are under intense investigation in several other malignancies. We assessed the incidence, radiographic, and clinical presentation of pneumonitis associated with mTOR inhibitors in mRCC, as well as its correlation with clinical outcome. Methods: We reviewed clinical data and serial CT scans from 44 patients (pts) with mRCC treated with temsirolimus or everolimus at Dana-Farber Cancer Institute and Beth Israel Deaconess Medical Center. Serial chest CT scans were reviewed in consensus, read by two independent radiologists for presence of pneumonitis and corresponding clinical data were reviewed for symptoms and clinical outcome. The baseline and follow up CTs were also reviewed to determine radiological response by RECIST criteria. Correlation between radiographic response and radiographic pulmonary toxicity was assessed using a paired student t-test with significance at p<0.05. Results: The study population consisted of 44 pts, 21 treated with temsirolimus and 23 with everolimus (M:F 3.4:1; range 44-82 yrs). CT evidence of pneumonitis was seen in 14/44 pts (32%), at an average of 81 days on mTOR inhibitor treatment (range 31 to 214 days). Bilateral lower lobe subpleural and peribronchovascular reticular and ground glass opacities were seen in 12/14 pts (86%). 2/14 pts (14%) developed unilateral subpleural ground glass opacity. Stable disease was achieved in 12/14 pts (86%) who developed radiographic pneumonitis compared to 13/30 (43%) without pneumonitis. Progressive disease (PD) was present in 1/14 pts (7%) who developed radiographic pneumonitis compared to 16/30 (53%) without pneumonitis. The mean change of tumor long axis size for target lesions by RECIST was -2.9% in the pneumonitis group and +4.13% in the non-pneumonitis group (p=.005). Conclusions: Radiographically, pneumonitis is frequent in patients given mTOR therapy and is seen in up to one third of pts. Preliminary data suggest that pneumonitis maybe a marker of therapeutic benefit. Careful patient assessment should be taken before the drug is discontinued.
Scientific evidence underlying the National Comprehensive Cancer Network Guidelines for Supportive Care.
Authors: U. M. Sharma, R. S. Go
Journal: Journal of Clinical Oncology (2011)

e19506 Background: The National Comprehensive Cancer Network (NCCN) has published guidelines for supportive care of cancer patients. However, the level of scientific evidence on which these guidelines are based has not been systematically investigated. We performed this study to describe the distribution of categories of evidence and consensus (EC) among the 10 supportive care guidelines with regards to screening, treatment, and follow-up. Methods: We obtained the latest versions (January 18, 2011) of relevant supportive care guidelines from the NCCN website. The definitions for various categories of EC used by NCCN panel members were as follows: category 1 (high level evidence such as randomized controlled trials with uniform consensus), category 2A (lower level of evidence with uniform consensus), category 2B (lower level of evidence without a uniform consensus but with no major disagreement) and category 3 (any level of evidence but with major disagreement). Results: Amongst the 680 recommendations, 21%, 58%, and 21% were for screening, treatment, and follow-up respectively. Overall, the proportions of category I, IIA, IIB, and III EC were 5%, 92%, 3%, and 0% respectively. Category I EC were available for myeloid growth factors (16%), prevention and treatment of cancer-related infection (14%), cancer-related fatigue (12%), antiemesis (7%), venous thromboembolism (4%) and distress management (2%) but absent for palliative care, senior adult oncology, cancer and chemotherapy-induced anemia, and adult cancer pain. Amongst therapeutic recommendations, 9% were category I EC and were found in myeloid growth factors (33%), prevention and treatment of cancer-related infections (20%), cancer-related fatigue (18%), antiemesis (11%), venous thromboembolism (7%), and distress management (4%). There was no category I EC for screening or follow-up. Conclusions: NCCN supportive care guidelines are based predominantly on lower level of evidence but with uniform expert consensus. A huge opportunity exists for research to make the guidelines more evidence-based.
Persistent Impairments in Humoral and Cellular Immunity in Patients with Immune Thrombocytopenia Treated with Rituximab: A Sub-Study of a Randomized Controlled Trial
Authors: Ishac Nazi, John G. Kelton, Mark Larche, Denis P. Snider, Jane C. Moore, James W. Smith, Rumi Clare, Diana M. Moffatt, Joecyln Tufts, Donald M. Arnold
Journal: Blood (2012)