tbuckley/cabot-search huggingface dataset:
Readmission and emergency department visits in the peri-treatment period for head and neck cancers patients in Ontario.
Authors: Antoine Eskander, Monika K. Krzyzanowska, Hadas Fischer, Ning Liu, Peter Austin, Jonathan Crawford Irish, Danny Enepekides, Justin Lee, Eric Gutierrez, Elizabeth Lockhart, Michael J. Raphael, Simron Singh
Journal: Journal of Clinical Oncology (2016)

6044 Background: Mucosal head and neck squamous cell cancers are often managed with multimodality treatment which can be associated with significant toxicity. The objective of this study was to assess emergency department visits and non-elective hospitalizations for head and neck cancer patients during and immediately after their treatment. Methods: A cohort of patients treated for head and neck squamous cell carcinoma with curative intent was developed using administrative data. Emergency department visits and hospitalizations in the peri-treatment 90 day period following surgery, radiation, or chemoradiathion was determined. If a second treatment was initiated prior to the completion of 90 days, the attributable risk period was changed to the second treatment. Results: Cohort of 3,920 patients (1,317 larynx/hypopharynx; 2,603 oral cavity/oropharynx) from 2008-2012. The number of non-elective hospitalizations (per 100 patient days) attributable to surgery, radiation and chemoradiation was 0.35, 0.13, and 0.3 for larynx/hypopharynx and 0.11, 0.17, and 0.23 for oral cavity/oropharynx respectively. The number of emergency department visits (per 100 patient days) attributable to surgery, radiation and chemoradiation was 0.89, 0.34, and 0.7 for larynx/hypopharynx and 0.44, 0.36, and 0.55 for oral cavity/oropharynx respectively. Multimodality treatment rendered higher readmission and emergency department visits. Conclusions: Patients undergoing treatment for head and neck cancer have significant non-elective hospitalizations and visits to the emergency department in the peri-treatment period. Rates are higher in patients receiving multi-modality treatment, specifically, patients receiving chemoradiation have much higher non-elective hospitalizations and visits to the emergency department compared to those receiving radiotherapy alone or surgery alone. Further research is required to determine predictors of these outcomes and to identify high risk groups for which quality improvement interventions can be focused.
THU0250 Impact of gut involvement in early spondyloarthritis. the desir cohort
Authors: D. Wendling, X. Guillot, C. Prati, C. Miceli-Richard, A. Molto, R. Lories, M. Dougados
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Inflammatory bowel disease (IBD) is a well-known extra articular feature of spondyloarthritis (SpA), with increasing evidence of a pathophysiological relationship. <h3>Objectives</h3> The aims of this study were to evaluate in the DESIR cohort a) the prevalence of IBD at baseline and M60, and b) the incidence of IBD over the first 5 years of follow-up, c) factors (epidemiological, clinical, imaging, biological data available in the database) associated with IBD, a on the prevalent cases at baseline and at year 5 and also on the incident cases. <h3>Methods</h3> DESIR is a prospective observational cohort of patients with recent onset (&lt;3 years) inflammatory back pain, suggestive of axial SpA. All available factors in the database were compared between patients with and without past or present IBD at baseline and at M60, and with and without incident cases of IBD over the 5 years of follow-up, by uni and multivariate analysis. <h3>Results</h3> At baseline, 706 patients were analysed, 35 had a past history or a concomitant IBD: prevalence 4.94% [CI 95%: 3.3–6.5]. IBD was significantly associated (univariate) with family history of IBD, DMARD use, steroid use, history of uveitis, elevated ESR and negatively associated with psoriasis, HLA-B27 and NSAID score. In multivariate analysis IBD was positively and independently associated with history of uveitis; OR 3.62 [1.95–6.74], levels of DKK-1: OR 1.03 [1.02–1.05] and TNF serum levels: OR 1.17 [1.08–1.26]. IBD was not associated with phenotypic presentation (peripheral arthritis, enthesitis, dactylitis, uveitis) or baseline serum levels of other cytokines (IL-6, IL-17 A, IL-17 F, IL-23, IL-23). At M60, 480 patients were analysed, 58 with IBD: prevalence 12.1% [9.17–14.99]. In univariate analysis on prevalent cases, IBD was associated with lower NSAID score, worse activity and function indexes (ASDAS-CRP, BASFI, SF-36, HAQ, ASQoL), use of DMARD anti TNF, more sick leave. In multivariate analysis, IBD was associated with fulfilment of modified New York criteria: OR 4.85 [2.23–10.57], sick leave: OR 1.01 [1.005–1.014], BASDAI: OR 1.10 [1.05–1.16], and with smoking: OR 2.79 [1.53–5.07]. No association with MRI scores, enthesitis, psoriasis, BMD. After a 5 year follow-up period, 23 new incident cases of IBD were recorded, giving an estimated occurrence rate of 0.95/100 [0.57–1.35] patient-years in this population. Incidence of IBD was independently associated (multivariate) with: HLA B27: OR 0.36 [0.22–0.59], fulfilment of modified New York criteria at M0: OR 3.35 [1.85–6.08], family history of IBD: OR 3.31 [1.62–6.77]. <h3>Conclusions</h3> In early SpA, IBD occurs with an incidence of around 1/100 patient-years, and is associated with poor outcome at 5 years, family history of IBD, absence of HLA-B27, fulfilment of modified New York criteria. <h3>Disclosure of Interest</h3> None declared
Pulmonary events in patients with Hodgkin lymphoma after first line chemotherapy in the US Department of Defense (DOD) healthcare system.
Authors: Tod A. Morris, Joseph Feliciano, Kathleen Fox, Carlos Alzola, Amber Evans, Akshara Richhariya
Journal: Journal of Clinical Oncology (2018)

e22070 Background: Multi-agent chemotherapy including bleomycin has been the standard of care for initial treatment of Hodgkin lymphoma (HL) for over 30 years. The incidence of pulmonary events associated with bleomycin are unpredictable and sometimes fatal and may result in permanent morbidity for those in long-term remission. The objective of this study was to estimate the rate of new comorbid pulmonary events in HL patients treated with multi-agent chemotherapy +/- radiation (RT). Methods: A retrospective cohort study supplemented by chart abstraction included newly diagnosed adult HL patients (≥18 years) from the US DOD military healthcare system between 1/1/2005 and 12/31/2013 and followed until death, disenrollment or 6/30/2016. Patients with prior primary malignancies and those receiving < 2 chemotherapy agents as first-line treatment were excluded. Pulmonary events (pulmonary fibrosis, pneumonitis, interstitial lung disease, pneumonia, bronchiolitis obliterans, acute respiratory distress syndrome) after exposure to bleomycin +/- RT were identified through ICD-9/10 codes from the electronic medical records. Results: A total of 642 HL patients were identified, 551 received bleomycin; mean age (SD) of 31.6 years (12.97), 67% male, 35% stage 3/4 at diagnosis, mean follow-up of 4.1 years. Bleomycin-containing regimen was received by 85.2% of patients during 1st line (median doses per patient = 8), and 4.7% during 2nd line. Among those treated with bleomycin alone (n = 337), 29% experienced new pulmonary events, while 30% of patients who received bleomycin and radiation therapy (n = 214) experienced new pulmonary events. Conclusions: A high proportion of HL patients experienced new pulmonary events within 2 years of receiving initial treatment containing bleomycin. While many events occurred during treatment, the majority happened up to 36 months after completion. Cumulative Pulmonary Events, Post Bleomycin+/- RT Treatment N = 551 0-6 months 0-12 months 0-24 months 0-36 months 0-48 months Overall (total follow up period) No, n (%) 499 (90.6) 466 (84.6) 428 (77.7) 413 (75.0) 403 (73.1) 388 (70.4) Yes, n (%) 52 (9.4) 85 (15.4) 123 (22.3) 138 (25.0) 148 (26.9) 163 (29.6)
P05.11 Combined FET PET/MRI radiomics for the differentiation of radiation injury from recurrent brain metastasis
Authors: P Lohmann, M Kocher, G Ceccon, E K Bauer, G Stoffels, S Viswanathan, M I Ruge, B Neumaier, N J Shah, G R Fink, K Langen, N Galldiks
Journal: Neuro-Oncology (2018)

The aim of this study was to investigate the potential of combined radiomics textural feature analysis of contrast-enhanced MRI (CE-MRI) and static O-(2-[18F]fluoroethyl)-L-tyrosine (FET) PET for the differentiation of recurrent brain metastasis from radiation injury. Fifty-two patients with newly diagnosed or progressive contrast-enhancing brain lesions on MRI after radiotherapy (predominantly radiosurgery, 84% of patients) of brain metastases were additionally investigated using FET PET. Based on histology (n=19) or clinicoradiological follow-up (n=33), local recurrent brain metastases were diagnosed in 21 patients (40%) and radiation injury in 31 patients (60%). Forty-two textural features were calculated on both unfiltered and filtered CE-MRI and summed FET PET images (20–40 min p.i). After feature selection, logistic regression models using a maximum of five features to avoid overfitting were calculated for each imaging modality separately and for the combined FET PET/MRI features. The resulting models were validated using cross-validation. Diagnostic accuracies were calculated for each imaging modality separately as well as for the combined model. For differentiation between radiation injury and brain metastasis recurrence, textural features extracted from CE-MRI had a diagnostic accuracy of 81%. FET PET textural features revealed a slightly higher diagnostic accuracy of 83%. However, the highest diagnostic accuracy was obtained when combining CE-MRI and FET PET features (accuracy, 89%). Our findings suggest that combined FET PET/CE-MRI radiomics using textural feature analysis offers a great potential to contribute significantly to the management of patients with brain metastases.
A phase 2 study to assess the safety and efficacy of umbralisib (TGR-1202) in pts with CLL who are intolerant to prior BTK or PI3Kδ inhibitor therapy.
Authors: Anthony R. Mato, Stephen J. Schuster, Nicole Lamanna, Ian Flinn, Jacqueline Claudia Barrientos, Suman Kambhampati, Bruce D. Cheson, Paul M. Barr, John M. Pagel, James Andrew Reeves, Frederick Lansigan, Jeffrey J. Pu, Alan P. Skarbnik, Gustavo A. Fonseca, Colleen Dorsey, Eline Luning Prak, Dana Paskalis, Peter Sportelli, Hari P. Miskin, Danielle M. Brander
Journal: Journal of Clinical Oncology (2018)

7530 Background: Although KI therapies are generally well-tolerated, intolerance is the most common reason for discontinuation, thus representing an unmet medical need. Umbralisib (TGR-1202), a next generation PI3Kδ inhibitor, has a discontinuation rate due to adverse events (AEs) of < 10%. Methods: We report results from a Ph 2 study assessing the safety/efficacy of umbralisib in CLL pts who were intolerant (defined per protocol) to a prior KI within 12 mos. AEs must have resolved to ≤ GR 1 prior to umbralisib therapy. Umbralisib (800mg QD) administered until progression or toxicity. Primary endpoint is progression-free survival (PFS). Results: 40 pts were treated as of 2/2018 (36 BTK & 4 PI3Kδ intolerant). Baseline demographics: median (med) age 69 yrs (range 52-96), med prior therapies 2 (1-7), 55% male, ECOG 0-1 (92%), del17p (20%), del11q (23%), IGHV unmutated (60%). 80% required treatment within 6 mos of prior KI discontinuation. Most AE's leading to KI discontinuation were: arthralgia, rash (9 events each), A-fib (6), diarrhea (4), bleeding, fatigue and weight loss (3 each). AEs on umbralisib are listed in the table: GR ≥3 PI3Kδ-associated AE's were limited: AST/ALT (3%); diarrhea (7.5%); rash (3%). 4 pts discontinued umbralisib due to intolerance (rash, pneumonia, pneumonitis, pancreatitis), and 1 pt due to study noncompliance. No pt discontinued umbralisib as a result of a prior KI intolerant AE. 3 pts (7.5%) had dose reductions (headache, hematologic, and colitis) and were successfully re-challenged (colitis pt on study in PR now 12 mos). Med PFS not reached with 90% of pts progression free at a med follow up 6.5 mos (range 1–15). Conclusions: Umbralisib appears to be safe and effective in KI intolerant CLL pts. These are the first data to confirm that switching from KI to an alternate PI3Kδ (umbralisib) can result in disease control (PFS) without recurrence of KI intolerance toxicities. BTK mutations and CYP polymorphisms are being assessed. Clinical trial information: NCT02742090.Umbralisib AEs (all causality) in > 15% pts (n = 40). Adverse Events All Grades % All Grades GR 3/4 % GR 3/4 Diarrhea 17 43% 3 8% Nausea 17 43% Thrombocytopenia 11 28% 4 10% Insomnia 9 23% Neutropenia 9 23% 7 18% Dizziness 8 20% Fatigue 8 20% Rash 7 18% 1 3%
Effectiveness and safety of pazopanib (PAZO) and everolimus (EVE) in a changing treatment (Tx) landscape: Interim results of the non-interventional study PAZOREAL.
Authors: Martin Boegemann, Jens Bedke, Martin Schostak, Manfred Welslau, Christiane Hering-Schubert, Thomas Wolf, Jan Schleicher, Alexander Petzold, Christian Doehn, Carsten Grüllich, Viktor GrÃ¼nwald, Thomas Steiner, Rainer Ehness, Dunja Klein, Tanja Medinger, Peter-Juergen Goebell
Journal: Journal of Clinical Oncology (2018)

4584 Background: The therapeutic landscape for metastatic renal cell carcinoma (mRCC) has evolved rapidly with the approval of targeted therapies like tyrosine kinase-, mTOR-, multikinase-, and immune checkpoint inhibitors. Real-world data are urgently needed to monitor the translation of these approaches into daily practice. Methods: PAZOREAL is a prospective, non-interventional study to evaluate efficacy, tolerability, safety, and quality-of-life (QoL) in mRCC patients (pts) treated with first-line PAZO, second-line nivolumab (NIVO) or EVE, or third-line EVE (± lenvatinib) after NIVO. The primary variable was time on drug (TD) in the respective Tx lines. Other endpoints were overall survival (OS), dosing, safety, and QoL. Results: Between Dec 2015 and Nov 2017, 421 pts were enrolled. Interim results for 385 pts treated with PAZO in first line are presented here, majority of pts presented with ECOG 0-1 (81.0%) and clear cell carcinoma (80.3%). Median TD was 6.5 months (95%CI, 5.5-8.3). Using commonly applied trial eligibility criteria i.e. Karnofsky PS ≥ 70%, normal hemoglobin and clear-cell histology, the median TD in trial-eligible pts (39.5% of 385 pts) was 8.0 months (95%CI, 6.2-11.2). Progressive disease (n = 104/212 pts) was the most common reason for end of PAZO Tx, followed by toxicity (n = 34) and unrelated adverse events (AEs) (n = 20). 75 pts subsequently received NIVO as second-line treatment. Median OS was not reached. Death was reported for 20.8% of pts. Survival follow-up is ongoing. PAZO Tx was well tolerated. Treatment-emergent AEs (TEAEs) were reported for 308 of 378 pts included in the safety analysis, PAZO-related TEAEs for 246 pts (65.1%), and PAZO-related grade 3/4 TEAEs for 75 pts (19.8%). Most commonly reported AEs were diarrhea, nausea, and fatigue. QoL evaluated by EQ-5D-5L remained stable during PAZO Tx. Conclusions: The PAZOREAL study demonstrated acceptable efficacy, safety and tolerability of PAZO in the real-world setting. For patients considered trial-eligible, TD was comparable with results from clinical trials. The sequence of PAZO followed by NIVO as second line Tx is commonly applied in Germany.
A cancer precision medicine platform for multiple simultaneous genomic assays from metastatic biopsies (bx) in ER+ metastatic breast cancer.
Authors: Nikhil Wagle, Karla Helvie, Maxwell R. Lloyd, Lori Marini, Adrienne Gropper Waks, Ofir Cohen, Coyin Oh, Carrie Sougnez, Nelly Oliver, Qaren Quartey, Asaf Rotem, Parin Shah, Neal Ian Lindeman, Ian E. Krop, Levi A. Garraway, Eric P. Winer, Nancy U. Lin
Journal: Journal of Clinical Oncology (2016)

11513 Background: The ability to perform multiple genomic tests on metastatic (met) bx may enable cancer research and precision medicine. Questions remain about feasibility of obtaining multiple met cores, usability of met bx for genomics, and utility of genomic profiling for identifying relevant targets. Methods: We developed a prospective bx protocol where multiple research bx are collected from mets and used for: pathology; ER/PR/HER2; OncoPanel, a CLIA 300 gene sequencing (seq) panel; whole exome seq (WES); transcriptome seq (RNA-seq); and single-cell RNA-seq (sc-RNA-seq). In some cases, tissue is used for cell line and xenograft generation. Archival primary bx is obtained when possible for parallel genomic studies. Patients (pts) are followed and serial bx obtained. Cell free DNA (cfDNA) is collected at time of biopsy and serially. Results: We obtained 51 met bx from 49 pts. 6 cores were taken per bx on avg (range 1-12). The number of bx with sufficient material for each test and success rates is shown in the Table. cfDNA was collected at 88 timepoints from 46 pts. In 2/51 bx, pathology found a tumor type other than breast cancer. Of the remaining 49, 12% changed ER or HER2 status. Of pts w OncoPanel data, 37.5% had ESR1 LBD mutations, 50% PIK3CA mutations, 16% ERBB2 mutations, and 3% FGFR1 amplifications. Overall, 75% had alterations in at least one of these genes, which are criteria for trials at our institution. Many pts had alterations in genes involved in resistance to therapies in preclinical studies (RB1, MYC, CCND1, NF1). Conclusions: A met bx program for cancer precision medicine is feasible, with ~90% of bx yielding sufficient tissue for pathology, receptors, CLIA targeted sequencing, WES, and RNAseq. Met bx have clinical implications, identifying a different cancer (4%), different targetable receptors (12%), and specific trials (>75%). For many genes, the mutational landscape differs significantly from primary breast cancer—highlighting the value of met bx. Sufficient to Test Completed Pending Successful Pathology/Receptors 51 (100%) 51 0 51 (100%) OncoPanel (CLIA) 49 (96%) 38 11 35 (92%) WES 45 (88%) 29 16 28 (97%) RNA-seq 45 (88%) 14 31 12 (86%) sc-RNA-seq 38 (75%) 1 37 1 (100%)
Patient-provider language concordance and choice of treatment for prostate cancer.
Authors: Jeff M. Slezak, Gary W. Chien, Virginia P. Quinn, Stephanie R. Reading, Steven J. Jacobsen
Journal: Journal of Clinical Oncology (2016)

6604 Background: While some research has suggested that language concordance between patient and provider can impact patient outcomes, it is not known whether language concordance could influence patient selection of treatment for prostate cancer. We studied a cohort of men to determine whether language concordance with their primary care provider (PCP) or urologist was associated with treatment choice after prostate cancer diagnosis. Methods: The cohort consisted of 5727 men diagnosed with prostate cancer between March 2011 and August 2013 in Kaiser Permanente Southern California, a large integrated prepaid health plan. Patient language preference and the language proficiency of their PCP and the urologist first seen after diagnosis were abstracted from the electronic medical record. Treatments were validated by chart review. Patients who did not begin therapy within six months of diagnosis were considered to have selected active surveillance. Logistic regression was used to model the association between language concordance and selecting active surveillance, adjusting for age, stage, PSA, Gleason and Charlson comorbidity index. Results: Patients’ and Providers’ language proficiency was available for 5409 men in the cohort. Patients’ language concordance was 95% with their PCP and 90% with their urologist. Overall, active surveillance was selected by 40.0% of the cohort with the rate highest in patients concordant with both providers (40.5%), and lower in those concordant only with their PCP (38.5%), only their urologist (29.6%), or with neither (32.2%). In the adjusted model, compared to those concordant with neither provider, patients who spoke the same language as both providers were significantly more likely to choose active surveillance (OR = 1.6, CI = 1.2-2.3), while those who spoke the same language as only their PCP (OR = 1.3, CI = 0.8-1.9) or urologist (OR = 1.0, CI = 0.5-2.0) were not. Conclusions: The ability of patients to speak to their providers in their own language may have significant effect on prostate cancer treatment choices.
Characteristics of Turkish colorectal cancer patients and bevacizumab preference.
Authors: Irfan Cicin, Mahmut Gumus, Dogan Uncu, Metin Ozkan, Saadettin Kilickap, Tamer E. Elkiran, Abdurrahman Isikdogan, Aziz Karaoglu, Berna Oksuzoglu, Feyyaz Ozdemir, Hande Turna, Oguz Kara, Ozgur Ozyilkan, Merve Guducu, Alper Erdogan, Ruchan Uslu
Journal: Journal of Clinical Oncology (2017)

e15055 Background: The aim of this registry was to collect demographic, diagnostic, treatment, and outcome information about Turkish patients with colorectal cancer (CRC). Methods: It was designed as a multicenter, cross-sectional, non-interventional study conducted on new and previously diagnosed CRC cases applied to 28 medical oncology outpatient clinics between 2012 and 2015. A total of 7547 male (n = 4314) and female (n = 3233) patients &gt; 18 years were included. Results: The mean age at diagnosis was 57.7±12.4 years. There was no familial or other primary cancer history in majority of patients. 22.9% of patients (n = 1579) were diagnosed at Stage 4. In 73,7% of patients (n = 5492), tumor was left-sided. Lymphovascular invasion was determined in 34.3% of patients, 87.6% had surgery. Liver-only metastasis rate was 53.1%. KRAS was tested in 717 of 1579 mCRC patients and mutation was positive in 39.3% of cases (n = 282). BRAF and KRAS tests were performed at 3.5% (n = 83) and 49.2% (n = 1158) for first line, whereas at 5.5% (n = 54) and 63.9% (n = 630) for second line metastatic treatments, respectively. In 25,5% of stage 4 bevacizumab users, bevacizumab was used both for first and second line treatment (n = 83). In KRAS mutant stage 4 patients bevacizumab was used 67% of first line (n = 185), and 40.2% of second line treatments (n = 51). In KRAS wild stage 4 patients bevacizumab was used 46,8% of first line (n = 197), and 24,5% of second line treatments (n = 58). Conclusions: In this study we found that 22.9% of Turkish colorectal patients were diagnosed at Stage 4. 45% of stage 4 patients were tested for KRAS and mutatian rate was 39.3%. BRAF testing rate was low in Turkish centers. Bevacizumab was a preferred agent both for KRAS mutant and WT patients.