tbuckley/cabot-search huggingface dataset:
Transition of preference by American medical oncologists (AMOs) from platinum/taxane to platinum/pemetrexed as first-line chemotherapy in patients with stage IV lung adenocarcinoma (l-ACA) over the interval 2008-2010.
Authors: A. J. Wozniak, H. J. West, J. Willey, T. McGee, S. L. Britton, B. Tiscione, K. E. Lemke, M. R. Green
Journal: Journal of Clinical Oncology (2011)

e18022 Background: In 9/07, Scagliotti et al reported that Pem-Plat produced superior OS vs. gem-plat as 1st line therapy in pts. with stage IV lung nonsquamous histologic subtypes of NSCLC. Subsequently other studies have also shown the optimized impact of pem-based treatment regimens in this same subgroup. Pem received a U.S. FDA indication as part of 1st line therapy in combination with platinum for stage IV NSCLC in Sept 2008. Methods: For several years we have used Challenging Cases, an extensively tested, live, market-research platform, to quantitate prescribing plans of AMOs. Here we report our findings concerning changing prescribing plans from 2008-2010 among AMOs for 1st line therapy in pts with stage IV non-squamous NSCLC. Results: Among 401 AMOs assessed during 5 separate dates between 3 and 10/2008, 4% planned to prescribe a 1st line Pem-Plat regimen (initial chemo, independent of switch maint later in the 1st line setting) in a pt with L-ACA and PS 1. In 2009, among 335 AMOs across 4 separate events between March and Oct, the percentage planning to prescribe a Pem-Plat for the same indication was 35%. In 2010, this option was chosen by 59% of 382 AMOs assessed at 4 dates nearly evenly spaced between March and October on the same clinical scenario. This steady rise in Pem-Plat as 1st choice was associated with a decline in total 1st-line plat/taxane [total of all docetaxel, nab-paclitaxel, and paclitaxel regimens] prescribing plans from 92% in 2008 to 59% in 2009 and to 36% in 2010. AMOs also showed a similar trend of preferring Pem-Plat or pem alone vs. plat/taxane or taxane alone for a pt with L-ACA and PS 2 over the same time interval. Conclusions: Despite the absence of direct, head to head comparison, phase III trial data, Pem-Plat based therapy has displaced taxane based regimens as the planned 1st line therapy of choice among AMOs for pts with L-ACA and good PS. Year PS 1 PS 2 Plat/Pem Plat/taxane Other Plat/Pem or pem alone Plat/taxane or taxane alone Other 2008* 4% 89% 9% 17%/9% 34%/11% 30% 2009* 35% 59% 5% 42%/15% 30%/5% 9% 2010* 59% 36% 5% 56%/15% 13%/7% 9% * Rows may add up to other than 100% because of rounding to whole numbers.
Revealing melanoma in situ on time using DELM, for the period of last five years in former Yugoslavia
Authors: D. V. Nikolic, A. Nikolic, V. Stanimirovic, M. Granic, M. Opric
Journal: Journal of Clinical Oncology (2005)

7566 Background: The incidence of malignant melanoma is increasing every year. An accurate and timely diagnosis is important to reduce the morbidity and mortality associated with malignant melanoma. Revealing melanoma in situ on time is increasing good prognosis of these patients. Methods: To evaluate the role of digital epiluminescence microscopy (DELM) in the differential diagnosis of cutaneous pigmented lesions and to improve the early diagnosis of melanoma in situ, 9879 pigmented lesions from 4726 consecutive patients were evaluated using DELM, in the period of five years (1999–2004), in a prospective study at the Department of Surgical Oncology of the UMC “Bezanijska Kosa”. After clinical examination and skin-surface microscopy of the pigmented skin lesions, suspicious skin lesions, undergone to further surgical procedures of removing skin lesions, with ‘ex tempore’ biopsy. Results: From the total number of 4726 patients, we were suspicious about the malignancy of the pigmented skin lesion in about 172 patients. 172 patients underwent to the surgical treatment, from which all of 169 patients (98.3%) had pigmented skin lesion diagnosed by ‘ex tempore’ biopsy, during surgical management, as a malignant pigmented skin tumor (malignant melanoma). From the total number of patients with suspicious pigmented skin tumors (172 patients) on 98.3% patients diagnosis made by DELM was the same as diagnosis got from ‘ex tempore’ biopsy, which means that this procedure is highly accurate, especially if we know that all 24 patients with melanoma in situ verified with ‘ex tempore’ biopsy, was diagnosed prior with DELM, what is 100% accuracy. Conclusions: Digital epiluminescence microscopy is helpful device to the surgeon oncologist in deciding which pigmented lesions need surgical excision, as well as in diagnosing of early cutaneous malignant melanoma (melanoma in situ) which use will increase, with adequate surgical procedure, a 5 year survival period of these patients. No significant financial relationships to disclose.
Developing a standardized protocol for the prescription of oral chemotherapy.
Authors: Nirav Niranjan Shah, Donna L. Capozzi, Erica Casella, Suzanne McGettigan, Tara C. Gangadhar, Lynn Mara Schuchter, Jennifer Myers
Journal: Journal of Clinical Oncology (2014)

120 Background: Over the last 10 years there has been a dramatic increase in the use of oral chemotherapy in the treatment of cancer. However, despite the route of administration, oral chemotherapies carry many of the same risks as intravenous agents and may have greater risks of drug-drug interactions due to variability in absorption and metabolism. Due to these risks, ASCO included oral chemotherapy as part of their updated chemotherapy safety standards in 2013. With this in mind, we sought to examine and improve the reliability and safety of the oral chemotherapy prescription process at the Abramson Cancer Center (ACC) of the University of Pennsylvania. Methods: A multi-disciplinary quality improvement team consisting of oncologists, nurse practitioners, and pharmacists was formed to analyze the current state of our oral chemotherapy practice. We identified an absence of signed informed consent and lack of pharmacist prescription review as areas for improvement. To address these deficiencies, we electronically routed our oral chemotherapy orders to an oncology specific pharmacist for review and implemented a policy change requiring that oral chemotherapy have signed informed consent. These changes were applied to the melanoma group of the ACC. Results: Over a 3 month time period, 33 orders for oral chemotherapy were placed for 18 individual patients. Signed informed consent was obtained in 9 of 18 patients (50%). Of the 33 orders, all were reviewed by ACC pharmacists, and as a result, 11 interventions were made by these providers (33%). Types of interventions included dose adjustment (9%), modification of an interacting drug (27%), and additional monitoring specific to the oral agent (64%). Conclusions: Despite its route of administration, oral chemotherapy should be prescribed and reviewed with the same oversight as intravenous chemotherapy. At our institution, involvement of an oncology specific pharmacist in the review of oral chemotherapy led to meaningful interventions in about 1/3 of orders, and with a policy change, signed informed consent was performed in 1/2 of patients. Given these findings, and the clinical implications of this pilot, we plan to continue to study and disseminate this intervention throughout our cancer center.
Impact of watching prior to commencement of chemotherapy for metastatic colorectal cancer (mCRC): Findings from the South Australian Clinical Registry (SACR) for mCRC.
Authors: C. S. Karapetis, A. Townsend, C. Beeke, S. Bishnoi, J. Kunal, C. Luke, D. Roder, R. Padbury, T. J. Price
Journal: Journal of Clinical Oncology (2011)

e14139 Background: The role of chemotherapy in mCRC is firmly established and the option of watchful waiting (WW) has become an alternative rarely considered. Evidence from 2 pivotal studies is conflicting and of an era when only 5FU was available. Outcomes for mCRC have improved because of early detection through surveillance, surgery and more effective chemotherapy drugs. However, there may be a group of patients who are diagnosed early with low volume and asymptomatic disease that may be suitable for a WW plan. Methods: The SACR for mCRC collects data on all patients who have a diagnosis of mCRC established after 1/2/06. We examined cancer characteristics and outcomes of patients who were suitable for chemotherapy but had their treatment delayed by more than 3 months from diagnosis of metastatic disease. Results: Data from 417 mCRC patients who received chemotherapy as first intervention have been entered into the Registry to date. 41 (9.8%) of these patients had chemotherapy commencement delayed by more than 3 months from diagnosis. Median age was 76.7 yrs (range 38-87). Stage at diagnosis is as follows (n); I=2, II=8, III=25 and IV=6. For patients with initial stage I-III disease, median time to recurrence was 1.48 years (range 0.53-7.71). 30% and 32.4% had single site lung or liver metastasis respectively. Median delay from diagnosis of metastatic disease to chemotherapy was 5.32 months (range 3-28). Average number of lines of subsequent chemotherapy=1.4 (range 1-4) and 5 patients have received anti-EGFR Rx. The median survival for this group from diagnosis was 23.2 months. Survival is equivalent to that reported for the whole group (ASCO GI 2010, #472). Conclusions: WW is a controversial option. We found that almost 10% of all mCRC had a delay in the initiation of chemotherapy consistent with a WW approach. This group was older and was likely to have a single site of metastatic disease. The majority of these patients had metachronous mCRC and low volume disease, suggesting possible diagnosis by surveillance. Despite the treatment delay, the median survival was almost 2 years.
Targeted deep sequencing as a diagnostic and research method for detecting <i>EGFR</i> and A<i>LK</i> pathway driver genes in FFPE tissue of lung and colorectal carcinomas.
Authors: Sakari Knuutila, Katja Merkkiniemi, Mikko Rönty, Aino Wirtanen, Satu Maria Remes, Stuart Bloor, Kaisa Salmenkivi, Aija Knuuttila, Virinder Kaur Sarhadi
Journal: Journal of Clinical Oncology (2012)

39 Background: Molecular targeted tyrosine kinase inhibitor (TKI) treatments have made it crucial to perform diagnostic tests of multiple molecular targets. In lung carcinoma there are close to ten clinically relevant gene mutations, copy number alterations and/or gene fusions, such as ALK, EGFR, ERBB2, KRAS, BRAF, MET, PTEN, PI3KCA, ROS1 and RET. Presently, several different tests are utilized, requiring a high amount of tumor material and long turnaround time. Next generation sequencing or targeted deep sequencing (TDS) has opened a new era for rapid genome-wide analyses of mutations, copy number alterations and gene fusions. Our aimwas to 1) prove feasibility for applying TDS to FFPE samples, 2) compare mutations detected by prevalent methods &amp; TDS, and 3) mine novel clinically and biologically relevant genes in lung and colorectal carcinoma. Methods: For TDS, we selected 192 lung carcinoma and colorectal carcinoma related genes and microRNA genes, focusing on the EGFR and ALK pathways. In total, 98 FFPE specimens were studied. Agilent SureSelect system and Illumina sequencing was adopted for the analysis. For diagnostic validation the following genes were selected: EGFR, KRAS, BRAF, PTEN, PI3K, RET and ALK. TDS results were confirmed by PCR, FISH and IHC. Results: We focused on the genes selected for diagnostic validation. Successful results were obtained from all specimens. The results from TDS correlated significantly with those obtained from PCR, FISH, and IHC. Importantly, TDS revealed novel mutations not detected by targeted PCR. Conclusions: An enormous advantage of TDS is that multiple mutation screening can be achieved in one analysis (saving time and material), and most importantly, provides enormous amounts of novel information, for example understanding mechanisms for drug resistance. This study was supported by Finnish Academy, Sigrid Jusélius Foundation, Finnish Cancer Organizations, the special governmental subsidy research funds appropriated to the Helsinki and Uusimaa Hospital District (HUS EVO), Pfizer Oy, AstraZeneca AS, Lab21 Ltd, Abbott Molecular Inc.
Preliminary results of three dimensional conformal radiotherapy as salvage treatment for post-prostatectomy patients with rising PSA
Authors: C. G. Wood, L. R. Rosen, T. Woo, D. Shepherd
Journal: Journal of Clinical Oncology (2005)

4752 Background: A subset of patients with rising prostate-specific antigen following prostatectomy can benefit from salvage radiotherapy to the prostate fossa. This population includes those patients with local recurrence in the absence of occult metastatic disease. This study attempted to identify those most likely to benefit from radiotherapy based on biochemical and pathological factors in addition to prostacint scan. Methods: 33 patients with rising prostate-specific antigen following radical prostatectomy received computed tomography-guided three dimensional conformal radiotherapy. Biochemical, pathological, and radiological variables were evaluated to identify predictors of prostate-specific antigen failure after salvage radiotherapy. Results: Median follow-up from completion of radiotherapy was 32 months. At time of analysis, all patients were living, and 29 out of 33 patients (88%) displayed no biochemical evidence of disease. When variables including pre-surgery prostate-specifc antigen, Gleason score, seminal vesicle status, margin status, extracapsular extension, type of surgery, pre-radiation prostate-specific antigen, prostacint scan status, radiation dose, and time to failure following prostatectomy were evaluated, radiation dose showed the greatest trend toward statistical significance. When radiation dose and type of surgery were considered together, presence or absence of biochemical failure was correctly predicted for 31 out of 33 patients (94%). Conclusions: Computed tomography-guided three dimensional conformal radiotherapy can provide biochemical control among patients with a rising prostate-specific antigen following prostatectomy. Longer follow-up is necessary to identify prognostic factors regarding biochemical control. No significant financial relationships to disclose.
Effect of physical activity (PA) perceptions in cancer survivors on PA behaviors: Helping health care providers improve patient communication.
Authors: Hiten Naik, Geoffrey Liu, Xin Qiu, Dan Pringle, Catherine Brown, Lawson Eng, Mary Mahler, Henrique Hon, Kyoko Tiessen, Henry Thai, Valerie Ho, Christina Gonos, Rebecca Charow, Vivien Pat, Margaret Irwin, Lindsay Herzog, Anthea Ho, Jennifer M. Jones, Wei Xu, Doris Howell
Journal: Journal of Clinical Oncology (2014)

201 Background: While engagement in PA can lessen fatigue, improve quality of life (QOL) and/or improve survival in cancer survivors, to what extent patients are aware of this and how it affects their behavior is unclear. Methods: 1,244 adult cancer survivors across disease sites and stages (mostly curative) at the Princess Margaret Cancer Centre (PMCC) were surveyed about their perceptions of PA, the barriers that prevent them from being physically active, and their level of PA currently. Multivariable logistic regression evaluated the associations between clinical and socio-demographic factors on these perceptions and current activity levels. Analyses were adjusted for performance status and important covariates. Results: Cancer survivors were surveyed at a median of 26 months after diagnosis. 16% had breast, 12% GI, 26% gyne/GU, 14% head and neck, 6% lung and 19% hematologic cancers. 55% of survivors reported being physically active. Overall, 76% believed PA could lessen their fatigue, 91% reported PA could improve their QOL, and 89% felt PA could improve their 5-year survival. Common barriers to PA were: being too ill (41%), too tired (33%), too busy (29%) and having too many home responsibilities (28%). Older patients were more likely to believe that PA would not improve their fatigue (p=0.005) and not improve their 5-year survival (p=0.001). Lower household income was associated with belief in lack of benefit of PA on fatigue (p=0.0001) or QOL (p=0.02). Not perceiving benefit of PA on fatigue, QOL, or survival was associated with substantially lower levels of PA (p&lt;0.01; each comparison), as was being older and having a lower income (p=&lt;0.01, each comparison). Conclusions: Older patients (even those with good performance status) and those coming from a lower socioeconomic status were more likely to have negative perceptions of the effect of PA on major cancer outcomes, resulting in lower PA levels. At PMCC, we are using this information to shape how we communicate with our patients in our survivorship program to help them with their decision-making on PA.
Further Elucidation of the Potential Benefits of Testosterone Therapy in Older Men
Authors: Eric Orwoll
Journal: JAMA Internal Medicine (2017)

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Molecular profiling with the 92-gene assay and decision-impact on cancer treatment: Interim results from a prospective, multidisciplinary study.
Authors: Sachdev P. Thomas, Fadi S. Braiteh, Karen Ann Cherkis, Theresa N. Operana, Nichole Renee Blatner, Brock Schroeder, Catherine A. Schnabel
Journal: Journal of Clinical Oncology (2015)

249 Background: Metastatic lesions with unknown (CUP), unclear, or differential diagnoses pose significant challenges, particularly when presenting in the GI tract, leading to suboptimal treatment and outcomes. In clinical studies, molecular classification with the 92-gene assay demonstrated improved diagnostic accuracy compared to standard pathology techniques and improved survival in patients treated based on assay results. The current study assessed the utility of the 92-gene assay in diagnoses and treatment decision-making in clinical practice. Methods: Cases in which the 92-gene assay was ordered as part of routine clinical care were submitted into a study database via web-based, standardized, discipline-specific questionnaires. Utilization and impact of the assay were characterized for medical oncologists and pathologists. Physician-reported results from medical oncologists are included in this interim analysis of 134 cases. Results: Results from this registry-based reporting study showed that molecular profiling impacted treatment decisions in 53% of cases. Significantly, 46% of these cases reported a change in treatment regimen associated with integration of 92-gene assay results. Clinical scope included 18 tumor types with 52% having a molecular diagnosis of GI origin. The top 3 diagnoses were pancreaticobiliary, intestine, and gastroesophageal adenocarcinoma. The pre-assay working diagnosis was unknown in 41%, a differential diagnosis in 26%, and a single suspected site in 33% of cases. Conclusions: Findings from this study demonstrate that use of the 92-gene assay impacted treatment decisions and selection in a significant proportion of patients, and further define its role in clinical practice in the diagnosis and treatment planning of diagnostically-challenging metastatic cancer. [Table: see text]
Second cancers screening in pediatric cancer survivors: A single institution study
Authors: C. Laverdiere, C. Medeiros-Nancarrow, L. Diller
Journal: Journal of Clinical Oncology (2005)

8538 Background: Pediatric cancer survivors have an increased risk of developing second cancers. Few studies have looked at the cancer screening practices in this population. Methods: Retrospective analysis of the results of second cancer screening in a cohort of survivors seen at DFCI in a 20-month period. Inclusion criteria were: more than 1 year (y) off cancer treatment; exposure to chemotherapy and/or radiotherapy; no recurrence of the primary cancer; clinical dictation notes available. Screening tests to detect second cancers were tailored depending on the patient’s (pts) exposure and symptoms. Results: Between January 2002 and August 2003, 290 pts were seen at the survivor clinic. 259 pts were included: leukemia (32%), lymphoma (23%) and solid tumors (45%). Median age at the first cancer diagnosis: 6 years; median time off treatment: 13 y (1–43). 224 (86%) pts received chemotherapy and 192 (74%) radiation therapy. 23 second cancers were detected in 21 pts (8% of the cohort; including 9 pts with Hodgkin Disease). 15 (65%) of these tumors were malignant and 8 (35%) were benign. Malignant tumors included: thyroid (2) and breast carcinomas (2), soft tissue sarcomas (2), basal cell carcinomas (5), melanoma (1), squamous cell carcinoma (1) and synovial sarcoma (1). The median time between the initial diagnosis and the diagnosis of a second cancer was 24 y (7–42). Of these pts with second cancer, 5 presented with symptoms needing a medical evaluation, 14 with physical signs, 1 with both symptoms and for 3 pts, the second cancers were detected by an abnormal laboratory or a radiological test. Overall, 6% (3/48) of the mammograms done were positive for a tumor and 31% (4/13) of the thyroid ultrasounds. Conclusions: In our cohort of pediatric cancer survivors, the majority of the pts who developed a second cancer presented with either symptoms or signs. This emphasizes the importance of comprehensive regular evaluations with a complete physical exam. In the presence of suggestive symptoms or signs of a second cancer, a rapid investigation must be performed. No significant financial relationships to disclose.