tbuckley/cabot-search huggingface dataset:
Decision involvement and mastectomy use among racially/ethnically diverse breast cancer patients
Authors: S. T. Hawley, N. K. Janz, A. S. Hamilton, S. J. Katz
Journal: Journal of Clinical Oncology (2008)

6511 Background: Prior research suggests that more patient involvement in treatment decisions is associated with receipt of mastectomy. This study addresses this issue using a large, population-based sample of racially/ethnically diverse breast cancer patients. Methods: 2,030 women with breast cancer diagnosed between 8/05–5/06 and reported to the LA SEER registry were identified and surveyed about 9 months after diagnosis. Latinas and African Americans (AA) were over-sampled (N=1,338, eligible response rate 71%). We compared the proportion of women who received mastectomy by race/ethnic groups (white, AA, and Latina low and high acculturation, determined by the Short Acculturation Scale for Hispanics) and level of decision involvement (surgeon-based, shared, or patient-based, determined from the Control Preferences Scale) adjusting for demographic and clinical variables. We also examined the role of patient fear of recurrence on receipt of surgery. Results: 911 patients with no clinical contraindications to BCS stage 0-II were studied (29% white, 24% AA, 20% Latina-low, 22% Latina- high). 15% of women initially received mastectomy. 35% of women reported a patient-based decision, 37% a shared decision, and 28% a surgeon-based decision. Neither receipt of mastectomy nor decision involvement varied by race/ethnic group. Women who reported a patient- based decision were much more likely than those who reported a shared or surgeon-based decision to have received mastectomy (25% vs. 12% and 6%, respectively, P<0.001). This association was significant and consistent across race/ethnic groups (Table). Among women with patient-based decisions, fear of recurrence was strongly associated with mastectomy across race/ethnic groups (p<0.001). Conclusions: Patient-based decisions strongly favored receipt of initial mastectomy even for Latinas with different levels of acculturation. Some women may be subject to over treatment because of inaccurate perceptions about disease recurrence. Receipt of mastectomy by race/ethnicity and decision involvement Decision involvement Latina-Low (%) Latina-High (%) AA (%) White (%) Surgeon 8 6 4 5 Shared 15 11 11 10 Patient 29** 36** 18* 21* ** P<0.001; * P<0.01 No significant financial relationships to disclose.
Retrospective review of patients with a diagnosis of testicular germ cell tumor seen in Waterford Regional Hospital, Ireland, in a 5.5-year period.
Authors: M. G. McNamara, J. O'Brien, E. Murphy, M. O'Connor, P. Calvert
Journal: Journal of Clinical Oncology (2011)

e15111 Background: Testicular germ cell tumours (GCTs) account for approx 95% of testicular cancers. GCTs can be divided into 2 main groups, seminomas and nonseminomas. The majority of men with testicular cancer are long-term survivors. Following treatment, these men require oncologic surveillance. The purpose of this study was to assess adherence to NCCN guidelines for follow up of patients on surveillance, following chemotherapy, or radiotherapy. Methods: During the period September 2004 to March 2010, 39 patients with a diagnosis of testicular carcinoma were followed up in clinic in Waterford Regional Hospital with tumour markers, chest X-ray, and computed tomography. Results: The mean age at diagnosis of testicular carcinoma was 40 years (18-47 years). 2 patients died during follow up, 1 in circumstances unrelated to diagnosis while in complete remission and 1, NSGCT, due to progressive disease. 3 patients defaulted to follow up and 1 patient’s follow up was in another institution. 3 patients relapsed during surveillance, 2 with NSGCT and 1 with a mixed diagnosis. Adherence to NCCN guidelines was achieved in 12 (36%) of all documented cases with full adherence being noted from August 2009 to date. Conclusions: NCCN practice guidelines are available for follow up of patients diagnosed with testicular carcinoma with the purpose being to detect recurrence. Adherence in Waterford Regional Hospital was achieved in the first year of follow-up with decreasing adherence noted in subsequent years. Outline of treatment. Subtypes Number (%) Treatment Number (%) Seminoma 15 (38%) Unknown Orchidectomy and surveillance Orchidectomy and radiotherapy Orchidectomy and chemotherapy Orchidectomy and chemotherapy and RPLND 1 (6.66%) 2 (13.33%) 8 (53.3%) 3 (20%) 1 (6.66%) NSGCT 16 (41%) No treatment Orchidectomy Orchidectomy and surveillance Orchidectomy and chemotherapy Orchidectomy and chemotherapy and RPLND 1 (6.25%) 1 (6.25%) 5 (35.5%) 7 (43.75%) 2 (12.5%) Mixed 8 (21%) Orchidectomy Orchidectomy and surveillance Orchidectomy and chemotherapy Orchidectomy and chemotherapy and RPLND 2 (25%) 2 (25%) 2 (25%) 2 (25%) Abbreviation: RPLND, retroperitoneal lymph node dissection.
Patients’ preferences for adjuvant chemotherapy for breast cancer: What makes it worthwhile in a Latin American population?
Authors: M. Debiasi, M. C. Bozzetti, C. H. Barrios
Journal: Journal of Clinical Oncology (2011)

e16524 Background: Adjuvant chemotherapy (AC) for breast cancer (BC) improves survival, but is associated with toxicity and can be inconvenient for patients (pts). Previous studies conducted in non-Latin American populations have shown that many women with BC who had already experienced AC consider negligible benefits sufficient to make it worthwhile. Methods: We carried out 101 interviews with consecutive consenting pts who had completed AC for BC from 3 to 60 months before. The study was conducted from April/2010 to January/2011. All patients answered the Portuguese version of WHOQOL-BREF. The primary end point of the study was the minimum survival benefit that would make AC worthwhile. This was considered as a dichotomous variable (one day vs. more than one day). Data was obtained by instructing pts to choose an option in a scale varying from one day to ten years of survival benefit. To check for consistency, 15 randomly selected pts answered the questionnaire a second time 3-7 months after the first interview. The prevalence ratio (PR) for the primary endpoint was calculated via Robust Poisson regression, considering socio-demographic (e.g., age), clinical (e.g. stage) and treatment (surgery, chemotherapy) aspects, as well as the physical, psychological, social and environmental domains of WHOQOL-BREF. Results: Mean age of the pts was 55.42 years (SD 11.75). AC was considered worthwhile for a gain of just one more day of life by 82 (81.2%) pts. Those in the superior quartile of the physical domain of WHOQOL-BREF (p = 0.02) and not grading chemotherapy as a very unpleasant experience (p = 0.03) were more likely to accept a gain of just one day for the AC. Preferences were not associated with: time between the end of the AC and the interview (p = 0.89), presence of dependants (p = 0.64), node positive status (p = 0.80) or having a friend or relative who died from cancer (p = 0.14). The kappa coefficient among the 15 repeated interviews was 0.67 for the primary endpoint. Conclusions: It is impressive that more than 81% of Brazilian women treated in a public reference cancer center considered AC worthwhile even for a gain of just one more day in their lives. The finding was confirmed in the repeated interviews.
Colorectal cancer patient outcomes in Nigeria: Results from the African Colorectal Cancer Group.
Authors: Olusegun Isaac Alatise, Akinwunmi O. Komolafe, Olusola C Famurewa, Aba Ibrahim Katung, Olufemi O Ariyibi, Adedeji A Egberoungbe, Samuel Adegboyega Olatoke, Olayide S Agodirin, Olaejinrinde O Olaofe, Oladapo Adedayo Kolawole, Anne Eaton, T. Peter Kingham
Journal: Journal of Clinical Oncology (2016)

729 Background: Colorectal cancer (CRC) is a growing problem in sub-Saharan Africa. There are, however, limited data describing the demographics, risk factors, presentation, treatments, and outcome of patients with CRC there. We established the African Colorectal Cancer Group (ARGO) to prospectively capture data and tissue from patients with CRC in Nigeria. This is vital to guide screening and treatment trials. Methods: The Consortium consists of 5 hospitals in Nigeria and MSKCC (USA). We have been prospectively collecting data since 2013. Tissue and blood samples were obtained. Ultrasounds and CT scans were provided by an NCI grant. Overall survival from date of diagnosis was estimated using Kaplan-Meier methods. Results: 152 patients have been accrued. The majority was male (56.8%), the median BMI was 22, the majority were non-smokers (89.1%) and non-drinkers (73.5%). Many patients had symptoms, as 65.8% of patients presented with obstruction or bleeding, 52.1% of patients had pellet like stool, and 88.4% had weight loss. 33.3% saw a traditional healer prior to presentation. The common locations of the primary tumor were rectum (52%) and right colon (23%). 8 patients (6.4%) had CEA &gt; 30 ng/mL. The majority of patients presented with advanced disease. 43 (32.3%) patients had T3 tumors; 87 patients (66.9%) had T4 tumors. AJCC stage was II (n = 12, 9.3%), III (n = 34, 26.4%), and IV (n = 83, 64.3%). 97 patients (66%) had surgery. The most common operations were right hemicolectomy (23.1%) and diverting colostomy (22.4%). 110 patients (88.7%) had chemotherapy recommended; only 71 patients (61.2%) received chemotherapy. The reasons for not receiving chemotherapy included patient finances (n = 19) and mortality (n = 12). The commonly utilized chemotherapies were FOLFOX (n = 24) and XELOX (n = 15). 62 patients died with a median follow-up among survivors of 4.4 months. Overall 12-month survival from date of diagnosis (N = 138), was 48.4% (95% confidence interval 38.9-60.1). Conclusions: The majority of patients that present to hospitals in Nigeria with CRC are stage IV. The mortality rate is high. These data serve as a baseline to judge current screening trials. Identifying high-risk patients for screening is vital to improve outcomes.
Effect of age on likelihood of treatment and outcome in pancreatic cancer.
Authors: A. A. Wheeler, P. S. Dale, M. B. Nicholl
Journal: Journal of Clinical Oncology (2011)

332 Background: Pancreatic cancer is a disease primarily diagnosed in elderly patients; however, a significant number of young patients will also be affected. We hypothesized young patients with pancreatic cancer would be treated more aggressively and therefore have better prognosis. Methods: A retrospective review of a prospectively maintained cancer database was queried for all patients treated for pancreatic cancer at our institution. Age 50 years was selected to stratify pancreatic cancer patients as young or old. Results: Of 320 pancreatic cancer patients identified from the database, 56 (18%) were ≤ 50 years old. Exocrine cancer was the most common histology (90%). Young patients were significantly more likely to have an endocrine cancer (23% vs. 7%, p&lt;0.001). For all tumor histologies, there was no difference between young and old patients regarding stage, grade, or likelihood curative intent surgery; however, young patients were more likely to receive chemotherapy (59% vs. 40%, p=0.008) and radiation therapy (27% vs. 15%, p=0.03). There was a trend toward improved overall survival in young patients (23.9 months vs. 13.8 months, p=0.06). When only exocrine pancreatic cancers were considered, there was no difference between young and old patients regarding stage, grade, location, or likelihood of undergoing surgical treatment. In this group, young patients were again more likely to receive chemotherapy (65% vs. 40%, p=0.002) and radiation therapy (35% vs. 16%, p=0.003). There was no difference in overall survival between young and old patients with exocrine pancreatic cancer. Conclusions: A considerable number of patients with pancreatic cancer are ≤ 50 years old. Exocrine cancers are the most common pancreatic neoplasm regardless of age; however endocrine tumors are more common in young patients. Despite more frequent use of adjuvant treatment in exocrine pancreatic cancer patients ≤ 50 years old, there is no improvement in overall survival. Significant improvements in pancreatic cancer survival are not dependent on aggressive use of adjuvant therapies, but await the development of new treatment strategies. No significant financial relationships to disclose.
Effect of transarterial chemoembolization prior to selective internal radiation therapy on yttrium-90 microsphere delivery in hepatocellular carcinoma patients.
Authors: Mu-Han Lin, Babak Saboury, Homan Mohammadi, Fred M Moeslein, Michael David Chuong
Journal: Journal of Clinical Oncology (2016)

458 Background: Transarterial chemoembolization (TACE) and selective internal radiation therapy (SIRT) are commonly used for treatment of liver tumors. The use of TACE, which is macroembolic, prior to SIRT may cause hemodynamic changes in tumor vasculature that impair yttrium-90 ( 90 Y) microsphere delivery to the targeted lesions. This work aims to quantify dosimetric tumor coverage using positron emission tomography (PET) dosimetry after SIRT alone compared to TACE followed by SIRT. Methods: A total of 40 consecutive hepatocellular carcinoma (HCC) SIRT patients who had a post-SIRT PET scan were evaluated. Yttrium-90 PET scan was performed within 2 hours after completion of SIRT. 3D dose distribution of each patient was then reconstructed from the PET images. To quantify the quality of SIRT microsphere delivery, we evaluated the selectivity index (SI) defined as the ratio of the average dose inside the treated lesion(s) and the average dose of the normal liver. The SI values of patients were compared based on whether TACE was previously used. Results: Thirty patients had complete data for analysis. The average dose for a total of 125 targeted lesions was 106 Gy (range 0 Gy – 495 Gy). The average SI of the entire patient group was 3.0, indicating that the targeted lesion dose was three times higher than normal liver dose. The average SI was 1.7 for the 13 patients who had prior TACE and 3.8 for the 17 patients who did not have prior TACE (p = 0.01). Nearly 80% of the patients with prior TACE demonstrated poor 90 Ymicrosphere delivery (SI &lt; 2) while none demonstrated excellent microsphere delivery (SI &gt; 4). On the other hand, the incidence of SI &lt; 2 and SI &gt; 4 among patients with no prior TACE was 24% and 40%, respectively. Conclusions: 3D dose evaluation using post-SIRT PET suggests that 90 Y microsphere delivery to liver tumors is impaired among patients who received prior TACE compared to those who receive SIRT alone. These data warrant evaluation of clinical outcomes in SIRT patients based on prior use of TACE and may provide a rationale for the use of SIRT prior to TACE.
Meta-analysis of the chemotherapy versus EGFR-TKI in different selections of patients.
Authors: C. Xu, Q. Zhou, Y. L. Wu
Journal: Journal of Clinical Oncology (2011)

7600 Background: EGFR TKI has been the most perspective treatment in advanced non-small cell lung cancer in the past ten years. Several clinical trials have shown gefitinib and erlotinib is not as good as the chemotherapy in all the NSCLC patients. Some trials treated the patients with TKI according to the clinical characters such as pathological type, gender, smoking history or ethnicity. A few studies chose only EGFR mutation patients for TKI therapy. We want to find out how to select the proper patients for TKI or chemotherapy. Methods: We did a meta-analysis of all randomized controlled trials involving patients with advanced NSCLC treated with chemotherapy or TKI by different selections. Efficacy outcomes of interest were objective response rate (ORR), disease control rate (DCR) based on the Response Evaluation Criteria in Solid Tumors (RECIST) and 1 year survival of each treatment arm. Results: 12 randomized studies comparing chemotherapy versus TKI in advanced non-small cell lung cancer were selected. 8 trials enrolled 2753 NSCLC patients without selection and randomized to receive TKI or chemotherapy. Two trials selected 1526 patients by clinical selection of gender and smoking history in Eastern Asia. Three trials chose 606 EGFR mutation patients for TKI or chemotherapy randomize. By different selections the RR of ORR was 0.82 (95%CI 0.66-1.03) of without selection, 0.76 (95%CI 0.67-0.86) of clinical selection favor TKI and 0.54 (95%CI 0.46-0.64) of mutation selection favor TKI, respectively. The RR of DCR was 1.10 (95%CI 0.95-1.28) of without selection, not available of clinical selection and 0.91 (95%CI 0.85-0.97) of mutation selection favor TKI, respectively. The RR of 1 year survival was 1.08 (95%CI 0.97-1.21) of without selection, 0.96 (95%CI 0.90-1.03) of clinical selection and 0.76 (95%CI 0.59-0.97) of mutation selection favor TKI, respectively. Conclusions: For NSCLC patient without selection the TKI is not superior to the chemotherapy. When choosing the patients by clinical characters the ORR of TKI is better than the chemotherapy, though the 1 year survival is similar. For EGFR mutation patients the ORR, DCR and 1 year survival is better than chemotherapy significantly.
A randomized phase II study of modified OPTIMOX1 or FOLFOX in advanced colorectal cancer.
Authors: C. Mikami
Journal: Journal of Clinical Oncology (2011)

519 Background: A combination of leucovorin (LV) and fluorouracil (FU) with oxaliplatin (FOLFOX) is a standard first-line regimen for advanced or unresectable colorectal cancer. Sensory neurotoxicity is its dose-limiting toxicity, but the OPTIMOX1 (stop and go) approach offers a reasonable strategy. This study evaluates a new strategy of intermittent oxaliplatin treatment that is based on FOLFOX4 or modified FOLFOX6 (+/− bevacizumab), a simplified leucovorin and fluorouracil regimen with normal-dose oxaliplatin. Methods: Previously untreated patients were randomly assigned to either FOLFOX administered every 2 weeks until progression (arm FOL) or FOLFOX for six cycles, maintenance without oxaliplatin for six cycles, and continued every six cycles until progression (arm OPT). Results: Sixty patients (arm FOL [n=35], arm OPT [n=33]) were enrolled. The median number of treatment cycles was 10 (range, 3-28) in arm FOL and 12.5 (range, 1-32) in arm OPT. Cumulative dose of oxaliplatin was 850 mg/m 2 in arm FOL and 552.5 mg/m 2 in arm OPT. Median progression-free survival was 8.5 months in patients allocated to arm FOL compared with 15 months in patients allocated to arm OPT. Response rates evaluated by RECIST criteria were 50% with arm FOL and 64% with arm OPT. National Cancer Institute Common Toxicity Criteria grade 3 toxicity was observed in 37.1% of the patients in arm FOL and 24.0% of patients in arm OPT. Grade 3 sensory neuropathy was observed in 22.8% of the patients in arm FOL and 6% of patients in arm OPT. Conclusions: Our modified OPTIMOX1 regimen may be effective and safe treatment to prevent oxaliplatin-induced neuropathy in advanced or unresectable colorectal cancer patients. No significant financial relationships to disclose.
The impact of age on first-line chemotherapy treatment of epithelial ovarian cancer and primary peritoneal carcinoma.
Authors: E. Larbi, T. K. Madhuri, S. Essapen, A. Michael
Journal: Journal of Clinical Oncology (2010)

5118 Background: Standard treatment for epithelial ovarian (EOC) and primary peritoneal (PP) cancer is combination of surgery and chemotherapy. Most commonly used first-line drugs are carboplatin and paclitaxel (C/P). Treatment decisions involving elderly patients are complex and single agent carboplatin (C) is often preferred. To help the decision process we analysed the toxicity profile and outcome for elderly patients treated first line with both: C/P and C alone. Methods: A retrospective analysis of 82 elderly patients (> 75 years) treated for EOC and PP cancer between April 1996 and October 2009 was performed. Age, comorbidities, CA-125 at diagnosis, histology, stage, outcome of cytoreductive surgery (CRS), chemotherapy regimen, toxicity and clinical response were recorded. Results: The majority, 76% (63/82) of patients had serous ovarian cancer with 58.5% presenting as FIGO stage 3c, median CA-125 of 340.2 U/mL (range: 5-5702). 67.1% (55/82) had CRS with 61.9% (34) optimally debulked. 84.2% of patients (69/82) received chemotherapy and were therefore evaluable for the purpose of this analysis. 94.2% (65/69) completed treatment (mean number of cycles = 5.1). 35.4% (23/65) received C/P and 63.1% (41/65) received single agent C. The commonest complication was peripheral neuropathy- 56.5% (13/23) in combination arm. Treatment was deferred mainly due to haematological toxicity: neutropaenia – 13.9% (6/43) in the C arm and 11.1% (3/27) in C/P; grade 3/4 thrombocytopaenia-4 (3-C, 1-P/C); grade 3-anaemia-1 (C). Dose reduction was required for 46.1% (12/26) in the combination arm and 25.5% (11/43) in the C arm. There were 35 dose delays-34.6% (9/26) C/P and 60.4% (26/43) C. Median survival for this group of patients was 21.3months. Median PFS was 8.8 months in C/P arm and 7 months in the C arm (95% CI-0.71 to1.8-not statistically significant). Conclusions: The toxicity of combination treatment with C/P is comparable to single agent C in elderly population with frequent dose delays and dose reductions. Initial assessment of comorbidities and performance status is essential however effort should be made to offer patients optimal treatment with the combination regimen. No significant financial relationships to disclose.
Neoadjuvant chemotherapy alone with mFOLFOXIRI in locally advanced rectal cancer: A single-arm phase II study.
Authors: Yanhong Deng, Jianwei Zhang, Yue Cai, Huabin Hu, Jiayu Ling, Jian Xiao, Meijin Huang, Liang Kang, Lei Wang, Ping Lan, Jianping Wang
Journal: Journal of Clinical Oncology (2016)

TPS783 Background: Pre-operative 5-Fu based chemoradiation is still the standard of treatment for locally advanced rectal cancer (LARC). Although local recurrence rate had been controlled, about 30% of patients will develop distant metastases, which is the main obstacle for improving survival of LARC. Besides, preoperative radiation causes lots of concerns about anal and sexual functions. Whether systemic chemotherapy alone is effective enough in treating rectal cancer is not yet known. In our previous study of neoadjuvant mFOLFOX6 with or without radiotherapy in LARC, about 30% of patients in the arm with chemotherapy alone showed good response. And FOLFOXIRI had showed higher response rate in metastatic colorectal cancer. This phase II study is to explore whether pre-operative FOLFOXIRI could further improve the ratio of tumor downstaging (ypT0-2N0) in LARC. Methods: The primary endpoint is the ratio of tumor downstaging to ypT0-2N0M0 (pCR and stage I).The secondary endpoint included pathologic complete response rate, 3-year disease free survival rate, 3-year local recurrence rate, and safety. We hypothesized that FOLFOXIRI could improve the downstaging rate from 30% to 50% with 5% type I error and 80% power. 84 patients met inclusion criteria will be enrolled in the trial. All patients will receive the study regimen every 2 weeks for 4-6 cycles. MRI of the pelvic will be performed every 2 cycles of the therapy to assess clinical response. If the tumor response over 20% after 4 cycles of treatment, the patient will go to surgery (TME) directly or 2 more cycles of treatment before surgery under the decision of MDT. On the contrary, if the tumor show poor response (&lt; 20%), short-term radiotherapy will be performed before operation. After surgery, 6-8 cycles of mFOLFOX6 will be given as adjuvant chemotherapy. Clinical trial information: NCT02217020 Clinical trial information: NCT02217020.