tbuckley/cabot-search huggingface dataset:
Incidence of brain metastases following trimodality therapy (TMT) in patients with esophageal and gastroesophageal (E-EGCJ) cancer.
Authors: Roopma Wadhwa, Takashi Taketa, Arlene M. Correa, Kazuki Sudo, Mariela A. Blum, Maria-Claudia Campagna, Ritsuko Komaki, Jeffrey H. Lee, Manoop S. Bhutani, Brian Weston, Zhongxing X. Liao, David C. Rice, Stephen Swisher, Wayne Lewis Hofstetter, Jaffer A. Ajani
Journal: Journal of Clinical Oncology (2013)

108 Background: Brain metastases in E-EGJ cancer patients following TMT are considered rare. We reviewed the cumulative incidence of brain metastases in a large cohort of patients who underwent TMT and had a long follow-up. Methods: Data were analyzedretrospectively for 579 E-EGJ cancer patients who underwent TMT between years 2000 and 2010. None had screening or surveillance brain imaging. Results: Median follow-up time was 57.4 months (95% confidence interval [CI]: 51.5-63.3 months). Common patient characteristics were as follows: median age: 59.5 years (range, 39-74 years), Caucasian ethnicity (90%), male gender (85%), pre-treatment clinical stage III (65%), and adenocarcinoma histology (90%). 197 (34%) of 579 patients developed distant metastases and of these 20 (3% of 579 and 10% of 197) patients developed brain metastases. 18 (90%) patients had brain metastases within the first 24 months (12 in the first 12 months and 6 in the following 12 months) of surgery. 18 (90%) of patients were symptomatic at diagnosis. 15 (75%) of 20 patients had a single metastasis, however, only 4 (25%) patients survived &gt;20 months (overall survival times were [in months]: 20, 30, 92 and 137). The median overall survival time of all 20 patients was 10.8 months (95% CI: 4.7-16.9). Conclusions: 3% of patients with E-EGJ cancer developed brain metastases after TMT and 90% of these occurred within the first 24 months of surgery. A few patients survived ≥20 months. These data rule out the use of screening and surveillance brain imaging for TMT-eligible patients. Supported by UT M. D. Anderson Cancer Center Clinical Research and Generous Donors.
Adult Recipients of Matched Related Donor Blood Cell Transplants (BCT) Given Pretransplant Low-Dose Antithymocyte Globulin (ATG) Have Less Chronic Graft-Versus-Host Disease (cGVHD) and Transplant-Related Mortality (TRM): A Matched Pair Analysis.
Authors: James A. Russell, A. Robert Turner, Loree Larratt, Ahsan M. Chaudhry, Oluyeme Jeje, Don Morris, Christopher B. Brown, Lynne Savoie, Nizhar Bahlis, Diana Quinlan, Douglas Stewart
Journal: Blood (2004)
Risk factors of chemotherapy-induced nausea and vomiting in patients with advanced pancreatic cancer receiving modified FOLFIRINOX.
Authors: Akira Shinohara, Masafumi Ikeda, Ai Irisawa, Misaki Kobayashi, Ryoko Udagawa, Hideki Funazaki, Yuko Asanagi, Shuichi Mitsunaga, Izumi Ohno, Hideaki Takahashi, Yusuke Hashimoto, Kumiko Umemoto, Kazuo Watanabe, Shinichiro Saito
Journal: Journal of Clinical Oncology (2016)

344 Background: Modified FOLFIRINOX (mFFX) has been reported to be a high incidence of chemotherapy-induced nausea and vomiting (CINV). However, CINV is difficult to adequately control in patients receiving treatment with mFFX. The aim of this study is to evaluate the incidence of delayed CINV and to identify as risk factors for CINV in patients receiving treatment with mFFX. Methods: The study subjects were patients with advanced pancreatic cancer treated with mFFX from December 2013 to June 2015 at National Cancer Center Hospital East. The mFFX regimen consisted of oxaliplatin 85 mg/m 2 , irinotecan 150 mg/m 2 , l-leucovorin 200 mg/m 2 and a 46-h continuous infusion of fluorouracil 2400 mg/m 2 . The antiemetic prophylaxis consisted of aprepitant (125 mg on day1 and 80 mg on day 2-3), palonosetron (0.75 mg on day1) and dexamethasone (12 mg on day1 and 8 mg on day 2-3). All adverse events, including nausea and vomiting were graded according to the Common Toxicity Criteria for Adverse Events (CTCAE version 4.0). Results: A total of 115 patients were enrolled in this study. The incidence rates of nausea and vomiting of any grade during the first treatment cycle were 45.2% and 5.2%, respectively. Grade 2-3 of nausea and vomiting were observed in 13.9% and 0.9% of the patients, respectively. Any grade of CINV occurred frequently during days 4 to 7 for the first treatment cycle. Univariate and multivariate analyses identified female and younger age ( &lt; 50 years) as significant independent factors associated with the incidence of any grade of CINV on days 4 to 7 for the first treatment cycle (Odds ratio [OR], 7.44; 95%CI, 2.21 to 25.1; p = 0.001; OR, 4.57; 95% CI, 1.04 to 20.1; p = 0.044). Conclusions: The risk factors of delayed CINV for the first treatment cycle were identified as female and younger age in patients treated with mFFX. Therefore, in patients with these risk factors, additional dexamethasone should be considered as an antiemetic treatment on day 4-5.
Prognostic factors and validation of prognostic nomograms in patients (pts) treated with three targeted therapies (TTs) for metastatic renal cell carcinoma (mRCC): Results from an Italian survey.
Authors: Roberto Iacovelli, Michele Milella, Matteo Santoni, Giuseppe Di Lorenzo, Cinzia Ortega, Roberto Sabbatini, Riccardo Ricotta, Vito Lorusso, Caterina Messina, Francesco Atzori, Paolo A. Zucali, Saverio Cinieri, Alessandra Mosca, Elena Verzoni, Francesca Primi, Chiara Baratelli, Enrico Cortesi, Giacomo Carteni, Cora N. Sternberg, Giuseppe Procopio
Journal: Journal of Clinical Oncology (2013)

470 Background: Outcomes of pts treated with three TTs for mRCC have not been well characterized. Survival data as well as existing prognostic criteria in this population were evaluated. Methods: Pts with clear-cell mRCC who received 3 TTs were included. A questionnaire was send to main Italian centers involved in the treatment of mRCC. Demographic data, history of RCC, type, and length of first-, second-, and third-lines were collected. Values of serum Hb, PLT, neutrophils, LDH and Ca, ECOG-PS, previous RT and number of metastatic sites &gt;2 before the start of third-line were evaluated. Cleveland Clinic, French, Heng, and MSKCC scores and relative survival were calculated. Results: Following the screening of 1,905 pts, 252 (13%) with 3 TTs were identified. The median age was 60 yrs (range 52-68), 73% were male, 96% had nephrectomy and 38% were metastatic at diagnosis. At first-line, the Motzer class was good, intermediate, and poor in 48%, 47%, and 5% of pts, respectively. The median OS from the start of third-line was 14.3 mos (95%CI, 10.1–18.6). Rate and survival by prognostic group according to each classification are reported in table below. When prognostic factors were considered separately, at the univariate analysis ECOG-PS≥2, Hb&lt;LLN, LDH&gt;1.5ULN, Ca&gt;ULN; PLT&gt;ULN; Neu&gt;ULN, and sites of disease &gt;2 had negative prognostic role. Multivariate analysis shows an independent prognostic role only for ECOG-PS≥2 (HR: 1.8; 95%CI: 1.1–2.8), Hb&lt;LLN (HR: 1.8; 95%CI: 1.2–2.6) and neu&gt;ULN (HR: 2.1; 95%CI: 1.2–3.8). Pts were stratified in 3 groups according to the presence of none, 1 or ≥2 prognostic factors. The median OS was 20.3, 13.6 and 7.8 months, respectively (p&lt;0.001). Conclusions: Current nomograms are able to predict survival in patients with mRCC before the third-line with TT. Neutrophils, hemoglobin and ECOG-PS were the most important prognostic factors. [Table: see text]
A novel 2-gene blood test for colorectal cancer recurrence.
Authors: Susanne Kartin Pedersen, Erin L Symonds, Scott Mansfield, Susan Byrne, Libby Bambacas, Paul Hollington, David Murray, Rohan Baker, Lawrence Charles LaPointe, Graeme P Young
Journal: Journal of Clinical Oncology (2016)

495 Background: Annual computed tomography (CT) scans and periodic carcinoembryonic antigen (CEA) testing are monitoring methods for colorectal cancer (CRC) recurrence. We have previously described a 2-gene blood test for CRC (methylated BCAT1 and IKZF1) that may indicate tumour DNA shedding into the blood. The aim was to compare the 2-gene and CEA blood tests at detecting recurrence in CRC surveillance patients. Methods: Methylated BCAT1/IKZF1and CEA (positive ≥5ng/mL) were measured in patients previously diagnosed with CRC (excluding those undergoing active treatment). McNemar’s test was used for statistical analyses, using clinical findings including CT to diagnose recurrence. Results: At study midpoint, 340 patients were enrolled (64% men, average 64yr at diagnosis), including 59 patients with blood testing done pre- and post-resection, and 105 with CT surveillance scans (median 18 months after primary diagnosis). Following resection (median 2.3 months), 91% of patients who were 2-gene positive prior to treatment showed either no detectable methylated BCAT1/IKZF1(26/35) or significantly reduced levels in blood (6/35). Residual disease was found in two patients (2/3) who remained gene positive post treatment. Recurrence was identified in 30/105 (29%) patients with surveillance CT scans. Of these, 67% and 27% were 2-gene and CEA positive, respectively, with 8 (27%) cases positive by both tests (Table 1, p&lt;0.001). In 13 cases with local recurrence, 54% were 2-gene positive, with only 1 (8%) positive by both tests (p=0.03). In 17 cases with distant recurrence, respective 76% and 41% were 2-gene and CEA positive (p=0.03). In patients with no evident disease, 20% were positive for one test but not the other (2-gene test, 16%; CEA, 4%; p = 0.04). Conclusions: Following resection, most patients had either reduced or no methylated BCAT1/IKZF1 in blood, indicating a correlation with the presence of cancer. Two-gene positivity correlated with local (54%) and distant (76%) recurrence with 2.5-fold more recurrence cases detected than with CEA. The 2-gene test may be better than CEA for recurrence monitoring. [Table: see text]
What care is appropriate and necessary for metastatic gastric cancer patients? Results of a RAND/UCLA expert panel.
Authors: Alyson L. Mahar, Lucy K. Helyer, Carol Jane Swallow, Calvin Law, Lawrence Frank Paszat, Rajini Seevaratnam, Roberta Cardoso, Robin S. McLeod, Alina Bocicariu, Natalie G. Coburn
Journal: Journal of Clinical Oncology (2012)

70 Background: Most gastric cancer patients present with advanced stage disease precluding curative surgical treatment. The utility of surgical and non-surgical options for non-curative, advanced disease is debated and the appropriate treatment strategy unclear. Methods: A multi-disciplinary expert panel of 16 physicians from 6 countries, scored 47 scenarios using the RAND/UCLA Appropriateness Methodology. Appropriateness was scored from 1 (highly inappropriate) to 9 (highly appropriate). Median appropriateness scores (AS) from 1-3 were considered inappropriate, 4-6 uncertain, and 7-9, appropriate. Agreement was reached when 11 of 16 panelists scored the statement similarly. If a statement was agreed to be appropriate, it was then given a necessity score (NS) in the same manner. Results: Surgical resection and bypass were agreed to be inappropriate in patients with minor symptoms and visible carcinomatosis, liver metastases or more than one site of metastatic disease for cardia and distal lesions (AS 1.0-3.5). The expert panel disagreed on the role for surgical resection in patients who were cytology positive only (AS 4-6). The role of resection for patients with major symptoms if they had visible carcinomatosis, liver metastases or more than one site of metastatic disease (AS 2-5) was indeterminate. Patients with distal tumours and major symptoms and multiple liver metastases or more than one site of metastatic disease were considered indeterminate for surgical resection (AS 2). Best supportive care was agreed to be appropriate for patients with minor symptoms and multiple liver metastases or more than one site of metastatic disease (AS 8, NS 5-6). Conclusions: The role of surgery in metastatic gastric cancer treatment decision-making is not supported by experts for the majority of scenarios. Continued uncertainty in appropriate and necessary treatment decision-making for advanced patients with a minimal burden metastatic disease exists and underscores the need for randomized controlled trials.
Long-term outcome after neoadjuvant radiochemotherapy in locally advanced noninflammatory breast cancer and predictive factors for a pathologic complete remission: Results of a multivariate analysis.
Authors: Christiane Matuschek, Edwin Boelke, Hans Bojar, Stephan L. Roth, Matthias Peiper, Vanessa Speer, Johann Wolfgang Janni, Werner Audretsch, Carolin Nestle-Kraemling, Rolf Sauer, Wilfried Budach
Journal: Journal of Clinical Oncology (2012)

154 Background: An earlier published series of neoadjuvant radio-chemotherapy (NRT-CHX) in locally advanced noninflammatory breast cancer (LABC) has now been updated with a follow-up of more than 15 years. Long-term outcome data and predictive factors for pathologic complete response (PCR) were analyzed. Methods: 315 LABC patients (cT1-cT4 /cN0-N1) were treated during 1991-1998 with NRT-CHX. Preoperative radiotherapy (RT) consisted of external beam radiation therapy (EBRT) of 50 Gy (5 × 2 Gy/week) to the breast and the supra-/infraclavicular lymph nodes combined with an electron boost in 214 cases afterwards or—in case of breast conservation—a 10-Gy interstitial boost with 192Ir afterloading before EBRT. Chemotherapy was administered prior to RT in 192 patients, and concomitantly in 113; 10 patients received no chemotherapy. The update of all follow up ended in November 2011. Age, tumor grade, nodal status, hormone receptor status, simultaneous vs. sequential CHX and the time interval between end of RT and surgery were examined in multivariate terms with as endpoint pCR and overall survival. Results: The total PCR rate after neoadjuvant RT-CHX reached 29.2 % with LABC breast conservation becoming possible in 50.8%. In initially node-positive cases (cN+), a complete nodal response (pN0) after NRT-CHX was observed in 56% (89/159). The multivariate analysis revealed that a longer time interval to surgery increased the probability for a pCR (HR 1,17 [95% CI 1,05-1,31], p&lt;0,01). However, in large tumors (T3-T4) a significantly reduced pCR rate (HR 0.89 [95% CI 0.80 to 0.99], p = 0.03) could be obtained. Importantly, a pCR was the strongest prognostic factor for long-term survival (HR 0.28 [95% CI 0.19-0.56], p&lt;0.001). Conclusions: A PCR identifies patients with a significant better prognosis for long-term survival. However, a long time interval to surgery (&gt; 2 months) increases the probability of a pCR after NRT-CHX.
The impact of time to metastasis on survival in treatment-naïve prostate cancer patients.
Authors: Shusuke Akamatsu, Kenny Lynch, Peter Black, Martin Gleave, Larry Goldenberg, Kim N. Chi, Alan So
Journal: Journal of Clinical Oncology (2015)

212 Background: With the emergence of novel therapies, the treatment of advanced prostate cancer has evolved. However, patients eventually succumb to their metastatic disease. Nonetheless, little is known about the impact of time to metastasis on survival. To further expand on this, we separated metastatic prostate cancer patients into three groups according to the timing of metastasis and analyzed their survival. Methods: From 2008 to 2013, 157 CRPC patients were identified in our database. Of those, 92 with metastasis and sufficient data were analysed. The patients were classified into three groups according to the timing of metastasis. There were 35 de novo –M (metastasis within three months of initial diagnosis), 26 CSPC-M (initially metastasis free, metastasis found more than 6 months prior to CRPC), and 31 CRPC-M (metastasis found within 6 months of becoming CRPC, or after becoming CRPC). Patient characteristics were analyzed, and survival was calculated. Results: Median follow up were 2.2, 9.6, and 11.8 years for de novo-M, CSPC-M, and CRPC-M. 85 and 84 % in the CSPC-M and CRPC-M respectively had local therapies by surgery and/or radiation. The types of local therapies were similar between the groups. Mean time to PSA recurrence after intial therapy were 3.5 and 2.2 years for CSPC-M and CRPC-M, and median time to metastasis were 4.4 and 11.4 years respectively. Treatments after CRPC included Abiraterone, Enzalutamide, and Docetaxel, and the use of these agents were similar between the groups. Median time to CRPC were 1.4, 6.2, and 8.6 years, and median overall survival after diagnosis were 3.7, 12.3, and 15.8 years for de novo-M, CSPC-M, and CRPC-M. Conclusions: The overall survival and time to CRPC were significantly shorter in de novo-M. Although there was a marked difference in time to metastasis between CSPC-M and CRPC-M, there was no statistically significant difference in overall survival. Either treated with hormone therapy before or after emergence of metastasis, survival of more than 10 years after initial diagnosis is possible.
Association of baseline prostate atrophy with lower tumor volume in men with prostate cancer on repeat biopsy.
Authors: Daniel M. Moreira, Gerald L. Andriole, Ramiro Castro, Stephen J. Freedland
Journal: Journal of Clinical Oncology (2016)

122 Background: We have previously shown baseline prostate atrophy (PA) was independently associated with lower prostate cancer (PC) risk. Beyond PC risk, for those who develop PC it is unclear whether PA is associated with smaller, less aggressive and/or less advanced tumors. Thus, we evaluated whether baseline PA and PA severity in men with initial negative biopsy for PC was associated with PC volume at the 2-year repeat prostate biopsy. Methods: Retrospective analysis of 763 men 50-75 years-old with negative baseline prostate biopsy and positive 2-year repeat biopsy for PC with complete data in the REDUCE study. Presence and severity of PA, and tumor volume were determined by central pathology. The association of PA at baseline biopsies with 2-year repeat biopsy cancer volume variables was evaluated with linear and Poisson regressions and controlling for age, race, body-mass index (BMI), digital rectal exam (DRE), prostate volume, baseline and pre-repeat biopsy prostate-specific antigen (PSA) and treatment arm. Results: PA was detected in 458 (60%) baseline biopsies and was considered mild in 398 (87%) and moderate in 60 (13%) cases. Patients with PA had significantly larger prostates and lower baseline and pre-repeat biopsy PSA (P &lt; 0.01). PA was unrelated to race, BMI, DRE or treatment arm. At 2-year biopsy, men with baseline PA had significantly lower overall mean total tumor volume (2.04µL vs 3.02µL; P = 0.006), mean number of biopsy cores involved (1.79 vs 2.11; P = 0.001), mean percent of cores involved (17.9% vs 21.2%; P = 0.001), average core involvement (0.20µL vs 0.30µL; P = 0.001) and overall mean percent tumor involvement (1.64% vs 2.35%; P = 0.006) than those without PA. The results were virtually unchanged in multivariable analysis (all P &lt; 0.05 except for overall percent tumor involvement where P = 0.061). In the analysis of PA severity, a biological gradient was observed where moderate PA was associated with greater reduction in tumor volume compared to mild PA (data not shown). Conclusions: In a cohort of men with 2-year repeat prostate biopsy positive for PC after a negative baseline biopsy, baseline PA was associated with lower PC volume. These results suggest PA may be associated with less aggressive PC.
A retrospective case series looking at the effectiveness of hyperbaric oxygen in treating radiation cystitis.
Authors: Scott Gorenstein, Aaron Katz, Kimberly Regan, Donna Hangan
Journal: Journal of Clinical Oncology (2015)

127 Background: A side effect of radiation therapy to treat genitourinary cancers is radiation-induced cystitis, which in its most severe form can be hemorrhagic cystitis (HC). Some studies have found the incidence of HC in radiation patients to range from 3% to 6.5% after radiation therapy and can develop anywhere from 6 months after radiation therapy to 10 years or more after the last treatment. The severity of symptoms, which includes hematuria, may drastically reduce quality of life. Recent studies have shown that hyperbaric oxygen therapy has improved symptoms of radiation cystitis in around 80% of patients. Methods: Sixty patients who received hyperbaric oxygen therapy (HBOT) for radiation-induced cystitis since 2010 at Winthrop University Hospital were identified. IRB approval was obtained for contacting these patients to gather outcome data. Patient reported outcomes were evaluated using a questionnaire that assessed the type and duration of radiation treatment, treatment other than HBOT for HC symptoms, surgical intervention, and patient perceived outcomes of HBOT. Results: 36 patients were consented. The average age of the patient was 71 with a range from 29-91. The majority of the patients 78% had prostate cancer with the Colon, Uterinem, Bladder and Testicular cancer also included The average time from completion of radiation to onset of symptoms was 3 years. The mean number of treatments was 35 with a range of 18-120 treatments. All treatments were for 90 minutes at 2.4 ATA. The majority of the patients (24) had external beam radiaiation and 12 patients had a urological procedure after completion of their therapy. 78 % of the patients reports either moderate improvement or complete resolution of symptoms. Conclusions: This case series seems to demonstrate that Hyperbaric Oxygen Therapy appears to be an effective treatment for radiation cystitis, however additional studies are necessary.
NCI Community Cancer Centers Program (NCCCP): Percent improvement in guideline-concordant breast and colon cancer care for disparate patient populations.
Authors: Pamela Spain, Stephanie Teixeira-Poit, Michael T. Halpern, Kathleen M. Castro, Irene Prabhu Das, Steven Clauser
Journal: Journal of Clinical Oncology (2014)

182 Background: The NCI Community Cancer Center Program (NCCCP) pilot launched in 2007 to improve quality and reduce disparities in patients receiving care in community hospital-based cancer centers. This study assessed the percent improvement in guideline-concordant cancer care since NCCCP initiation, overall and for disparate patient populations. Methods: We conducted a retrospective analysis of patients diagnosed and receiving treatment at one of 12 NCCCP sites. We compared percent improvement in concordance for NQF-approved quality measures: 3 breast (BCS-radiation following breast conserving surgery; HT-hormonal therapy; and MAC-multi-agent chemotherapy) and 2 colon (12RLN-12 regional lymph nodes examined during surgery; and ACT-adjuvant chemotherapy). Sample included patients diagnosed 2006 to 2007 (baseline, or pre-NCCCP) and 2008 to 2013 (NCCCP). Percent improvement was defined as the difference in concordance between baseline and NCCCP periods divided by baseline concordance. Results: Between baseline and NCCCP periods, improvement was noted for all 5 measures. The HT concordance rate improved by 55.1% (from 58.2% to 90.3%). For all breast measures, Black patients showed significantly larger than average percent improvement (p&lt;.05). For BCS and ACT, Medicaid and uninsured patients showed significantly larger than average percent improvement (p&lt;.05). Larger than average improvement was also noted in hospitals in high-poverty markets and in markets with few physicians. Conclusions: The percent of patients receiving guideline concordant breast or colon cancer care increased significantly since Program initiation, particularly among certain disparate patient subgroups. Future analyses will examine issues of disparities in timeliness of treatment.Funded by NCI Contract HHSN261200800001E. [Table: see text]