tbuckley/cabot-search huggingface dataset:
Surgical resection of liver metastasis of breast cancer: A multidisciplinary approach—Study case-control.
Authors: P. Mariani, V. Servois, Y. de Ricke, M. Lae, J. Feron, M. M. Almubarak, J. Pierga, M. Falcou, F. Reyal, R. J. Salmon, B. Baranger
Journal: Journal of Clinical Oncology (2011)

e11086 Background: In patients with metastatic breast cancer, only the appearance of metastases in the liver occurs in 10% of cases. Unlike colorectal cancer, liver resection is rarely given and its place remains to be defined. The aim of this retrospective study was to compare the survival of two populations with resectable liver metastases (LM) treated for one only medically and for the other surgically preceded by a medical treatment. Methods: From 1988 to 2007, among 100 patients operated of liver metastases of breast cancer at the Curie Institute, 51 were included in this case-control study. Only a positive bone scan was authorized as other metastatic localization. Operated patients received chemotherapy and/or hormonal therapy before surgery and had to be either stabilized or in response. These patients were matched to 51 patients treated only medically. All patients had to have a performance status of 0-1 and the LM should be R0 resected (no residual microscopically desease) with less than 4 metastases. The matching criteria were: patient age, year of diagnosis of breast cancer, time to onset between breast cancer and metastasis, histological type, stage, and status of hormone receptors of breast cancer. The pairing was done 1/1/. Results: In univariate analysis, survival was better in the 2 populations if patients were N -, had no bone metastases or were operated. In multivariate analysis only the liver resection was prognostic. In a Cox model adjusted for paired data yields a RR. = 3.18 (p <0.0001) in favor of surgical treatment. Conclusions: In a selected population, hepatic resection of metastases of breast cancer is a real benefit in terms of survival.
Genetic Polymorphisms of β-Cell Differentiation Confer Risk of Alterations of Glucose Metabolism in Survivors of Childhood Acute Lymphoblastic Leukemia.
Authors: Pacharapan Surapolchai, Suradej Hongeng, Pat Mahachoklertwattana, Samart Pakakasama, Angkana Winaichatsak, Nittaya Wisanuyothin, Ekawat Pasomsub, Surakameth Mahasirimongkol, Nongnuch Sirachainan
Journal: Blood (2008)
The prevalence of objectively measurable disease in phase III trials of metastatic castration-resistant prostate cancer (mCRPC).
Authors: Ankit Madan, Mary K Baker, Jori E May, Gurudatta Naik, Sejong Bae, Guru Sonpavde
Journal: Journal of Clinical Oncology (2016)

215 Background: Given the historical low prevalence of measurable disease in mCRPC, phase II trials have employed suboptimal endpoints accounting for prostate specific antigen (PSA) and bone scan changes. Changes in bone scan and PSA have not always translated to survival improvement. Improved computerized tomography technology may be increasing the proportion of men with measurable disease, suggesting that measurable changes need to be reconsidered. We analyzed phase III trials of mCRPC to systematically quantitate the proportion of mCRPC with measurable disease. Methods: Data from the both arms of published phase III trials of mCRPC were eligible for analysis. Baseline characteristics were required including the number enrolled, setting (pre-docetaxel [D], D-based, post-D), proportion of patients with measurable disease and the year of completion of trial accrual. General Linear Model was used to evaluate the difference in measurable disease rate based on setting and year of completion of accrual. Results: Seventeen phase III trials totaling 17,609 men with mCRPC were evaluable; 5160 were pre-D, 7573 were D-based and 4876 were post-D. The trials completed accrual between 2002 and 2012. Ten trials used RECIST 1.0, 5 trials used RECIST 1.1 and 2 trials used other criteria. The overall proportion of men with measurable disease was 47.8%. The measurable disease rate (range) in trials in the pre-D setting was 40.5% (30.5-57), in the D-based setting was 51.9% (29.1-87.5), and in the post-D setting was 48.9% (38.8-56.6). There was no statistical difference in the proportion of men with measurable disease based on setting or year of completion of accrual. Conclusions: The proportion of men with measurable disease in phase III trials of mCRPC completing accrual between 2002 and 2012 was 47.8%% with no significant difference based on setting or year of completing accrual. Given these higher measurable disease rates compared to historical rates and recent demonstration of strong association of RECIST changes with OS in mCRPC, RECIST changes need to be considered as a co-primary endpoint in phase II trials to obtain a firm signal of efficacy before launching phase III trials.
Cisplatin plus gemcitabine third-line chemotherapy for NSCLC after failure to cisplatin and gemcitabine in separated schedules
Authors: B. M. Eyll, J. R. Pereira, M. T. Arruda, J. Y. Yamaguchi, J. E. Rangel, A. J. Santana, C. Mesquita, F. M. Feio
Journal: Journal of Clinical Oncology (2005)

7313 Background: Despite the development of new drugs to advanced NSCLC treatment, the overall survival is still poor. Platinum-based chemotherapy remains the main schedule for these patients. It's known that Gemcitabine inhibits DNA repair, and platinum resistance is due to increased DNA repair activity. Thus, it seems logical to use both drugs in combination. Despite the use of Docetaxel as a second line therapy being more common, there are studies that confirmed the role of Gemcitabine as a good option as well. Methods: We analyzed fifty-four patients that received Cisplatin plus Gemcitabine (PGZ) after failuring both platinum-based schedule in first line and monotherapy with Gemcitabine in second line in our institution between January 2001 and July 2004. They received Cisplatin 60 - 80 mg/m2 d1 and Gemcitabine 1500 mg/m2 d1. The response was evaluated by thorax X-ray after each cycle. Results: The median cycles for all patients was 2. Patients had ECOG performance status between 0 and 2. The median age was 60 years. Nine (16,6%) patients had objective response including 1 complete response. Eighteen (33,4%) patients had stable disease. The other 27 (50%) had progressive disease. Conclusions: After failure of each drug in different combination schedules, Cisplatin plus Gemcitabine may offer a boost in the survival even in the third line therapy for NSCLC patients who were still in a good performance status. No significant financial relationships to disclose.
Measuring baseline adherence to Choosing Wiselyrecommendations in regional oncology clinics: Challenges and strategies.
Authors: Karma L. Kreizenbeck, Erin E. Hughes, Kathryn Egan, Catherine R. Fedorenko, Ada Mohedano, Benjamin E. Greer, Linette Demers, F. Marc Stewart, Ken Berkes, Mehrdad Jafari, Barbara Jensen, Chris Bredeson, John Rieke, Julie C. Smith, Mary Gunkel, Rose Guerrero, Timothy Carlos, Scott David Ramsey
Journal: Journal of Clinical Oncology (2014)

133 Background: ASCO launched the Choosing Wisely campaign to reduce the use of interventions lacking evidence of benefit to cancer patients, but implementation may be a challenge. This project develops a stakeholder-informed process to prioritize and implement the 2012 ASCO Choosing Wisely (CW) recommendations in oncology clinic settings. Methods: Medical directors from 6 network-affiliated oncology clinics in the Puget Sound region selected 2 CW measures for implementation: (1) No biomarkers/advanced imaging following early breast cancer treated for cure, and; (2) No colony stimulating factor use for low FN risk chemotherapy. Results: Adherence is measured with data from each clinic’s tumor registry, billing records, lab results, pathology reports, and clinic notes. Challenges to measuring baseline adherence included translating non-specific guidelines into discrete data elements (e.g. when does surveillance start?) or required measuring the absence of something, presenting quality control challenges to distinguish between adherence and missing data. Additional challenges are shown in the Table. To address these challenges, the team developed these strategies: (1) creation of specific data elements, (2) mapping clinics separately to the criteria and (3) employing methods such as Natural Language Processing to efficiently collect data from EMR. Conclusions: It is feasible to measure adherence to ASCO CW recommendations with data sources available at oncology clinics. Variability in data platforms among clinics is inherent to the current medical landscape and must be accounted for in successful implementation of cross-clinic programs. [Table: see text]
Effect of better communication on patient care.
Authors: Yousef Khelfa, Munthir Mansour, Yousef Abdel-Aziz, Maria R. B. Tria Tirona, Yehuda Z. Lebowicz
Journal: Journal of Clinical Oncology (2016)

216 Background: Considerable medical research done in the last decade, have brought new diagnostic and therapeutic options to the medical oncology field. This has, fortunately, greatly improved treatment options and outcomes of our cancer patients. Newer therapies such as immunotherapies have changed the toxicity profile of our interventions. In addition to “classic chemotherapy toxicity” these therapies can induce autoimmune phenomena including pneumonitis, colitis, etc. that may not initially be considered in patients’ differential diagnosis. We have noted that, we are frequently not being notified of our patients’ hospital admission. This creates an environment in which we can’t contribute to the patients care while they are in the hospital, and makes it difficult to gauge the degree of toxicity our therapies may be causing. Direct communication with the admitting services, asking them to consult us upon patients’ hospitalization would improve rate of consultation. This, we believe, will translate into better patient care. Methods: An official letter was sent to all admitting services’ head of department and program director in our hospital requesting them and their staff to notify/consult the oncology team regarding any cancer patient being admitted to the hospital. We reviewed 406 admissions prior to letter and 145 post. We compared consultation rates before and after the letter. Results: Consultation rate went up from 42 % before the letter to 59 % after, with an absolute increase of 17%. The odds ratio was 1.96 with 95% confidence interval [1.315-2.947], and statistically significant p value of 0.00066. Conclusions: Direct communication with admitting services showed an increase rate of consultation, which we believe improves inpatient care as well as outpatient follow up. This method is simple and we believe cost effective, taking in consideration that better patient care, likelihood of shorter hospital stay and proper outpatient follow up, outweigh the cost of consultation service. Also, we believe, that the presence of consulting service will provide fruitful educational environment for our residents.
Proportion of elderly patients with advanced bladder cancer receiving cisplatin-based chemotherapy: A large Medicare database study.
Authors: Guoqing J. Chen, Matt D. Galsky, David M. Latini, Guru Sonpavde
Journal: Journal of Clinical Oncology (2013)

276 Background: The frequency of employment of cisplatin-based chemotherapy in elderly patients presenting with advanced (unresectable or metastatic) bladder cancer is unclear. We examined the use and pattern of chemotherapy in Medicare fee-for-service elderly patients with newly diagnosed advanced bladder cancer (ABC). Methods: SEER-Medicare linked data were used to identify incident ABC patients presenting with the following stages of bladder cancer: T4b, N0, M0; Any T, N1–N3, M0; Any T, Any N, M1) between 2004 and 2007, with claims data until 2009. Outpatient and inpatient Medicare claims data were queried for receipt and type of chemotherapy used. The descriptive analyses were performed to examine associations between receiving chemotherapy and patient demographics, and clinical characteristics. Results: A total of 1,031 Medicare FFS elderly patients with ABC met inclusion criteria. The median age was 74 years, 69.8% were men. 40.1% were T4bN0M0, 55.3% were any N1-3M0 and 4.6% were any T, any N, M1. Overall use of chemotherapy occurred in 51.6% of the study patients. Of these patients receiving chemotherapy, carboplatin accounted for 50.6% in the initial treatment, followed by cisplatin in 39.7% and other agents in 9.8%. 37.5% of patients received chemotherapy within 6 months, 14.1% after 6 months, and 48.4% had not receive any chemotherapy over the study period. There were no statistical differences according to gender, race, and age. There were variations in receiving chemotherapy by stage: T4bN0M0 (51%), any T, N1-3, M0 (52.3%) or any T, any N, MI (48.9%), p&lt;0.05. Conclusions: Among elderly patients presenting with ABC in the SEER-Medicare linked database, only 51.6% received chemotherapy and of these only 39.7% received cisplatin. Drug development for this population should focus on chemotherapy-ineligible and cisplatin-ineligible patients. Further analysis will explore practice patterns in prescribing chemo regiments in the initial treatment of ABC and its impacts on patient outcomes.
Early response assessment and bone flare phenomenon on 18F-fluorocholine positron emission tomography/computed tomography (FCH-PET/CT) in patients (pts) with metastatic castration-resistant prostate cancer (CRPC) treated with abiraterone acetate.
Authors: Salvatore Luca Burgio, Federica Matteucci, Cecilia Menna, Paola Caroli, Andrea Moretti, Emanuela Bianchi, Lorena Rossi, Barbara Kopf, Carla Masini, Francesca Fabbri, Dino Amadori, Ugo De Giorgi
Journal: Journal of Clinical Oncology (2013)

134 Background: In this prospective study, in patients with CRPC previously treated with docetaxel, we evaluated prostate specific antigen (PSA) and FCH-PET/CT for early response assessment to abiraterone acetate, and assessed frequency of early FCH-PET/CT discordant with PSA and clinical response. Methods: Twenty nine metastatic CRPC pts progressing after docetaxel chemotherapy received abiraterone acetate 1,000 mg daily with prednisone 5 mg twice daily in continuous 28-day cycles. Patients were evaluated monthly for serological PSA response and safety. FCH-PET/CT was repeated after 4-6 weeks and a CT scan was done after 3 months of abiraterone acetate. FCH-PET/CT bone flare was defined as the combination, after 3 months of therapy, of an interpreting radiologist’s report indicating progressive disease (PD) in context of a ≥50% decline in PSA, no PD at 3-month CT scan, with FCH-PET/CT improvement or stability 2-3 months later. Results: Three of 29 patients treated with abiraterone acetate did not perform the follow-up FCH-PET/CT due to rapidly PD with a decline in performance status. Of the remaining 26 patients, 4 are still undergoing early response evaluation. Twenty two pts, median age was 71 yrs (range, 57-86 yrs) were evaluable for this analysis. A ≥50% PSA decline was observed in 15/22 (68%) evaluable pts. Undetectable PSA levels (≤0.1 ng/mL) occurred in one case. Early FCH PET/CT response assessment was as follows: complete response (n=2, 9%), partial response (n=7, 32%), stable disease (n=3, 14%), PD (n=10, 45%), but in 4 of 10 pts with PD a bone flare phenomenon on FCH PET/CT was observed. PSA decline ≥50% and FCH PET/CT response correlated in 19 of 22 pts (86%). Conclusions: Discordant findings between serologic PSA response and increases in early FCH-PET/CT bone lesion intensity are reported here for the first time in CRPC. Further investigation is needed to clarify the confounding effect of FCH-PET/CT bone flare on patient management and interpretation of results.
Validation of electronic prostate cancer quality-of-care measures in the Veterans Health Administration (VHA).
Authors: Jeremy Bradford Shelton, Ted A. Skolarus, Jennifer Malin, Anna Liza M. Antonio, Ren He, Christopher Saigal
Journal: Journal of Clinical Oncology (2012)

213 Background: Quality measures based on chart abstraction are the “gold-standard,” but the costs of measurement limit widespread adoption. Electronically specified measures (e-measures) promise to change this; however, the fidelity of electronic abstraction compared to chart abstraction is unknown. We sought to validate e-measure versions of VHA-developed prostate cancer quality of care measures. Methods: Quality measures were chart abstracted on 11,263 men in the VHA with incident prostate cancer in 2008. We identified and linked VHA cancer registry and administrative data for the same cohort. E-measures were specified iteratively and validated by comparing the sensitivity and specificity of measure denominators and numerators, and the overall pass rates to chart abstracted results. Results: 3 of 6 quality measures and 7 of 10 descriptive measures were successfully validated (see Table). Conclusions: The VHA’s electronic medical record environment and information technology infrastructure are sufficiently advanced to support valid e-measurement that is equivalent to that performed by chart abstraction. [Table: see text]
Long-term symptom burden after radiation treatment for oropharynx cancer: A comparison of 3D and IMRT techniques.
Authors: D. I. Rosenthal, G. B. Gunn, T. R. Mendoza, A. S. Garden, B. M. Beadle, W. H. Morrison, X. S. Wang, S. J. Frank, R. S. Weber, K. K. Ang, C. S. Cleeland
Journal: Journal of Clinical Oncology (2011)

5539 Background: Long-term patient reported symptom burden data is lacking and required for the adequate support of OPCa survivors. The long-term impact of IMRT has not been evaluated. Methods: A cross sectional study of 122 OPCa patients in remission treated at a single institution since 2000 was performed using the M. D. Anderson Symptom Inventory-Head/Neck (MDASI-HN). The relationship between treatment group and symptom burden was evaluated using chi-square or Fisher exact tests. Results: 122 patients were included. 90% were men. Patients with T1-2 and T3-4 tumors, and N0-2a and N2b+ numbered 85 and 37, and 41 and 81 respectively. All had RT with 93 and 29 having IMRT and 3DRT respectively. For chemotherapy, 49 had none, 34 induction alone, 39 concurrent alone, and 10 both. The follow up exceeds 5 years for 75%, and the median is 5.8 years. The top 7 frequent symptoms with moderate to severe levels are listed for all patients, 3DRT and IMRT technique with the p-value for the difference between techniques, respectively. Dry mouth 43, 70 and 35% (.002); problems swallowing 27, 42 and 22% (.04), aspiration 27, 31 and 14% (.04); taste 16, 17 and 15% (NS); mucus 14, 40 and 6% (.001); and fatigue 14, 29 and 9% (.008); pain 9,17 and 7% (NS). The trends are the same for RT-alone and chemo-RT. Conclusions: There is significant long-term symptom burden for OPCa patients. IMRT is associated with a >50% reduction in the proportion of patients with moderate to severe symptoms as compared to 3DRT. Pain and fatigue affect >10% patients and require long-term surveillance and interventions.
ECOG 1599: Randomized phase II study of paclitaxel/carboplatin or gemcitabine/cisplatin in performance status (PS) 2 patients with advanced non-small cell lung cancer (NSCLC)
Authors: W. J. Tester, P. Stephenson, C. J. Langer, J. H. Schiller, D. H. Johnson, B. L. Rapoport
Journal: Journal of Clinical Oncology (2004)

7055
Mortality reduction by talactoferrin alfa (TLF) in severe sepsis with different types of infections.
Authors: J. Crawford, K. K. Guntupalli, N. C. Dean, P. E. Morris, R. K. Malik, J. P. Schaumberg
Journal: Journal of Clinical Oncology (2011)

9024 Background: This randomized, placebo-controlled, double-blind study evaluated TLF, an oral agent with immunomodulatory and antibacterial properties, on 28-d all-cause mortality in patients with severe sepsis. TLF previously showed activity in NSCLC as monotherapy in the 2nd/3rd line setting and when added to a 1st line chemotherapy doublet. Methods: Eligible pts had onset of severe sepsis (at least 1 organ dysfunction) within 24 hours prior to randomization to TLF 1.5 g or placebo enterally (oral or by feeding tube) q 8 h for a maximum of 28 d in addition to standard care including drotrecogin alfa (activated). Results: Baseline characteristics of 190 randomized pts (97 TLF; 93 placebo [P]) were similar. The study met the primary endpoint of reducing 28-d mortality in the modified ITT population (14.4% TLF/26.6% P; 2-tailed P = 0.052 [Guntupalli ATS 2010]). The most common sites of infection were lung (46% TLF/52% P) and urinary tract (21% TLF/23% P). A positive culture was obtained in 66% TLF/71% P pts. Of the positive cultures, Gram + isolates were the most common (73% TLF/79% P) followed by Gram - (36% TLF/44% P) and fungal (16% TLF, 6% P). Of the positive cultures, blood was the most common site for isolation (59% TLF/49% P). Polymicrobial infection was present in 28% TLF/34% P pts. There was a consistent mortality decrease in the TLF arm by sites of infection (lung: 18% TLF/38% P p=0.04; urinary tract 5% TLF/29% P p=0.09), with the exception of intra-abdominal infection (31% TLF/14% P p=0.38). A consistent reduction in mortality also occurred in pts with a single isolate (19% TLF/29% P) and polymicrobial isolates (15% TLF/22% P). For single isolates, mortality was lower for Gram + (22% TLF/32% P) and Gram – (18% TLF/33% P) infections. Conclusions: The effect of TLF on mortality reduction appears consistent across different sites and types of infections. Further study of TLF in severe sepsis is warranted.
Tracking the fate and origin of clinically relevant adoptively transferred CD8 <sup>+</sup> T cells in vivo
Authors: Aude G. Chapuis, Cindy Desmarais, Ryan Emerson, Thomas M. Schmitt, Kendall C. Shibuya, Ivy P. Lai, Felecia Wagener, Jeffrey Chou, Ilana M. Roberts, David G. Coffey, Edus H. Warren, Harlan Robins, Philip D. Greenberg, Cassian Yee
Journal: Science Immunology (2017)

Adoptively transferred tumor-specific cells can mediate tumor regression in cancers refractory to conventional therapy. Autologous polyclonal tumor-specific cytotoxic T cells (CTL) generated from peripheral blood and infused into patients with metastatic melanoma show enhanced persistence, compared to equivalent numbers of more extensively expanded monoclonal CTL, and are associated with complete remissions (CR) in select patients. We applied high-throughput T cell receptor Vβ sequencing (HTTCS) to identify individual clonotypes within CTL products, track them in vivo post-infusion and then deduce the pre-adoptive transfer (endogenous) frequencies of cells ultimately responsible for tumor regression. The summed in vivo post-transfer frequencies of the top 25 HTTCS-defined clonotypes originally detected in the infused CTL population were comparable to enumeration by binding of antigen peptide-HLA multimers, revealing quantitative HTTCS is a reliable, multimer-independent alternative. Surprisingly, the polyclonal CTL products were composed predominantly of clonotypes that were of very low frequency (VLF) in the endogenous samples, often below the limit of HTTCS detection (0.001%). In patients who achieved durable CRs, the composition of transferred CTLs was dominated (57-90%) by cells derived from a single VLF clonotype. Thus, HTTCS now reveals that tumor-specific CTL enabling long-term tumor control originate from endogenous VLF populations that exhibit proliferative/survival advantages. Along with results indicating that naïve cell populations are most likely to contain cells that exist at VLF within the repertoire, our results provide a strong rationale for favoring T cells arising from VLF populations and with early-differentiation phenotypes when selecting subset populations for adoptive transfer.