tbuckley/cabot-search huggingface dataset:
Prognostic factors of mortality and recurrence of malignant pleural effusion in high-risk tumors according to the LENT Score.
Authors: Fernando Abrao, Mariana Campello de Oliveira, Igor Abreu, Geisa Garcia, Renata D'Alpino D'Alpino, Carolina Marciano, Mariana Belaunde Toledo, Riad N. Younes
Journal: Journal of Clinical Oncology (2017)

e21666 Background: The aim of this study was to identify predictors of overall survival (OS) and recurrence after palliative pleural procedures in patients with malignant pleural effusion (MPE) and high-risk tumors according to the LENT Score. Methods: Data was collected from our database between January 2013 and December 2015 of patients with MPE and high-risk tumors according to the LENT Score. All patients were followed-up for at least 30 days after the pleural procedure. We evaluated radiological aspects, biochemical and hematologic parameters as well as clinical features. For OS analysis, patients were divided into two groups. Group I included OS &lt; 30 days and group II included OS &gt; 30 days. Prognostic factors for pleural recurrence and OS were identified by univariate analysis, using Fisher's exact and Student's t-test. Subsequently, significant variables were entered into a multivariate logistic regression analysis ( p &lt; 0.05). Results: A total of 134 patients were included. Median follow-up time for surviving patients was 56 (range: 2-623) days. High-risk primary tumors included lung (66.4%), gastrointestinal (24.6%) , sarcoma (3.7%), urologic (3.7%) and others (1.5%). Forty-four patients in Group I had OS &lt; 30 days while 22 patients had MPE recurrence. Factors affecting OS in univariate analysis were: type of procedure, ECOG, albumin, leukocytes, neutrophil to lymphocyte ratio( NRL) and hemoglobin. Factors affecting recurrence were: type of procedure, chemotherapy line (CT), albumin and platelets. In multivariate analysis for Group I, type of procedure (therapeutic pleural aspiration – TPA) ( p= 0.011), ECOG 3/4 ( p= 0.004), NLR &gt; 5 ( p= 0.037) and leukocytes &gt; 8000 ( p= 0.042) were identified as independent predictors of OS. In terms of recurrence, only CT beyond first line ( p = 0.042) was identified as an independent prognostic factor. Conclusions: Patients with MPE who underwent TPA, had ECOG 3/4, leukocytes &gt; 8000, and NLR &gt; 5 were significantly associated with shorter OS,. CT beyond first line was associated with recurrence. The identification of these prognostic factors may assist physicians in choosing the optimal palliative technique.
Preliminary results of the VENUS study: Bevacizumab efficacy and safety in recurrent, platinum-sensitive ovarian cancer—A real-life ambispective study.
Authors: Jerome Alexandre, Vincent Launay-Vacher, Jean-PHilippe Spano, Frédéric Selle, Jean-Baptiste Rey, Fabien Brocard, Anne Floquet, Claire Garnier-Tixidre, Claire Giraud, Jean F. Morere, Anne Patsouris, Virginie Pottier, Nadia Raban, Gilbert Deray, Isabelle Laure Ray-Coquard
Journal: Journal of Clinical Oncology (2017)

e17093 Background: The aim of the VENUS study was to report on the efficacy/safety of bevacizumab (Bev) in recurrent, platinum-sensitive, ovarian cancer (OC). Methods: VENUS is a multicentric, observational, ambispective study which included both retrospective and prospectice patients (pts). Pts were all naive of any antiVEGF. This analysis presents the results of the retrospective cohort (52 pts) included from 2009 to 2013, with a 3-year follow-up (f/u). Results: Among 148 OC pts included (27 centres), 52 were retrospective. At inclusion, median age: 62.5 years; hypertension according to medical records with or without blood pressure (BP): 30.8%; proteinuria (Pu): 60.0%; abnormal BP (according to NCI-CTCAE 4.03): 71.0%. Mean duration of Bev: 12.7 months. Mean overall survival (OS) and progression free survival (PFS) were respectively 29.4 and 12.9 months. Safety results are presented in the Table. Univariate analysis reported that, at inclusion, Hb&lt;10 g/dL (anemia), ascites and low hematocrit were prognostic of poorer OS. Anemia and TMA (thrombotic microangiopathy) were prognostic of poorer PFS. Multivariate analysis reported that anemia at inclusion was prognostic of poorer OS and PFS. Conclusions: The preliminary results of VENUS (retrospective cohort pts in real life), show that OS and PFS are consistent with what clinical trials reported (29.4 and 12.9 months, respectively). In addition, de novo severe side-effects (grade 3-4 and TMA) were rare, and usual side effects (HTN, Pu) were common but were neither associated with OS nor with PFS. Safety/medical history of VENUS pts. [Table: see text]
Survival outcomes in gastric and gastroesophageal junction adenocarcinoma treated with peri-operative chemotherapy with or without pre-operative radiotherapy.
Authors: Sibo Tian, Renjian Jiang, Nicholas Andrew Madden, Matthew Jeffrey Ferris, Zachary Buchwald, Karen M Xu, Kenneth Cardona, Shishir Maithel, Mark William McDonald, Jolinta Y Lin, Walter John Curran, Madhusmita Behera, Bassel F. El-Rayes, Pretesh R Patel
Journal: Journal of Clinical Oncology (2018)

4026 Background: Peri-operative chemotherapy (POC) is one approach in treating resectable cancers of the stomach and gastroesophageal junction (GEJ). Pre-operative chemoradiotherapy plus adjuvant chemotherapy (PCRT) is a strategy under investigation with unclear outcomes. We aimed to compare survival between PCRT and POC using a large database. Methods: The National Cancer Data Base was queried for patients diagnosed between 2004 -2013 with clinical stage Ib-IIIC (excluding T2N0) adenocarcinoma of the stomach or GEJ. Patients treated with definitive surgery, POC with or without pre-operative radiotherapy of 41-54 Gy were included. Overall survival (OS) was defined from date of definitive surgery to death or last follow-up and estimated using Kaplan-Meier methods; distributions were compared using log-rank tests. 14 patient and treatment variables were used for propensity score matching (PSM). Results: 1,048 patients were analyzed: 53.2% received POC and 46.8% PCRT. The primary site was GEJ for 69.1% of cases, and stomach for 30.9% of cases. Median age at diagnosis was 60 years. The number of lymph nodes (LN) sampled were 1-14 for 35.8%, 15-29 LNs for 45.2%, and ≥30 LNs for 16% of patients. 90-day mortality was 1% in both POC and PCRT (p = 0.93). The use of PCRT was associated with a greater pathologic complete response (pCR) rate of 12.9% vs 8.1% (p = 0.01). In the univariate setting POC was associated with superior OS with hazard ratio (HR) 0.83 (POC vs PCRT, p = 0.043). OS was greater in patients who achieved pCR (HR 0.58, p = 0.002), and for gastric primaries (HR 0.76, p < 0.01). Treatment group was not significant for OS in the multivariable model (HR 0.83, p = 0.106). Using PSM cohorts, POC was associated with superior OS (HR 0.70, p = 0.015). Median OS was 45.1 vs 31.4 months, 1-year OS was 90.8 vs 84.6%, and 5-year OS 40.7% vs 33.1% (POC vs PCRT). Survival favored POC in both gastric (HR 0.41, p = 0.07) and GEJ subgroups (HR 0.77, p = 0.08). Conclusions: The addition of pre-operative radiotherapy to POC does not appear to benefit resectable gastric and GEJ cancers. Until results from the randomized setting on PCRT are known, POC should remain a standard of care.
P01.015 Survival rates in patients with glioblastoma multiforme after combined therapy: a population-based study
Authors: A V Rozumenko, V M Kliuchka, V D Rozumenko, Z P Fedorenko
Journal: Neuro-Oncology (2018)

In the current study, we present the results of the survival analysis of patients with newly diagnosed glioblastoma multiforme (GBM) in Ukraine. A total of 3763 cases of patients with histologically confirmed newly diagnosed GBM who were treated over a 9-year period (2008–2016) were included. All patients were grouped as younger adults (<45 years at diagnosis) - 734 (19.5%) cases, middle-aged (45–64 years) - 2360 (62.7%), and older adults (>64 years) - 669 (17.8%). Clinical parameters and survival rates were defined for every three 3-year periods: 2008–2010, 2011–2013, and 2014–2016. The overall median survival was 12.2 ± 0.2 month. Higher survival rate was observed in young adults 17.4 ± 1.4 month (p<0.001). The hazard ratio (HR) of middle-aged group was 1.79 (95% CI 1.60–2.00; p=0.017) and for older age - 1.51 (95% CI 1.32–1.72; p<0.001). The patients treated in the second period achieved better prognosis with a median survival in 12.6 ± 0.3 months (p<0.001) with HR 0.75, 95% CI 0.66–0.85, p<0.01). The median overall survival in combined therapy protocol group was 16.3 ± 0.5 months, and the worst prognosis was in surgery alone group - 7.5 ± 0.3 months (p<0.001). The HR for surgery with radiotherapy was 1.36 (95% CI 1.22–1.51; p<0.001), and for surgery alone it raised up to 1.94 (95% CI 1.73–2.17; p<0.001). The HR for a combination of surgery with chemotherapy was 1.18 (95% CI 0.90–1.53), but it was not significant (p=0.25). The using of combined therapy including surgery and chemoradiotherapy was associated with a survival advantage for all age groups and time periods.
Testicular cancer awareness in a large urban school system: Evaluation of a pilot program.
Authors: Kathleen Ruccione, Aaron Plant, Emerald Snow, Timothy Kordic, James Hu, Terry David Church, Stuart E. Siegel
Journal: Journal of Clinical Oncology (2018)

e18667 Background: Testicular cancer is the most common cancer among males age 15-34. Lack of understanding and awareness of testicular cancer and self-examination are barriers to early detection. A program aimed at increasing testicular cancer awareness and self-examination was created and implemented in the LAUSD in 2017. Effectiveness of this program is presented here. Methods: Twelve classrooms at six high schools (34%-99% Hispanic) participated in the one-week program. Students completed a questionnaire (n = 1,382) before the program began and an identical questionnaire upon program completion (n = 1,338). The 16-item instrument measured knowledge and attitudes toward testicular cancer and self-examination. Male students completed three additional items about self-examination, self-efficacy, comfort speaking to a health provider, and self-examination in the past month. A 16-item teacher questionnaire was administered at the end of the program. Results: Seven of nine knowledge/awareness items had statistically significant increases from the pre-test to post-test survey. The percentage of students strongly agreeing that testicular self-examination is important for men’s health increased from 53.8% to 75.5% (p < .001). Among male participants, there were increases in the percentage who strongly agreed they could recognize signs of testicular cancer (14.5% vs. 36.6%; p < .001) and comfort in speaking to a health provider about their testicular health also increased (27.4% vs. 36.0%; p < .001). The percentage of male students who had performed a testicular self-examination in the past month increased from 29.1% to 48.2% (p < .001). The teacher survey revealed a high level of satisfaction with the quality and content of the lessons, as well as possible ways to improve the program. Conclusions: The results of this pilot program were promising. The evaluation showed increases in knowledge, awareness, and attitudes, and a nearly 20% increase in testicular self-examination among males. Next steps will include refinements to the program, followed by implementation with a larger sample with a more rigorous study design to determine if wide-scale dissemination of the program throughout the district and beyond is warranted.
Childhood leukaemia: Novartis immunotherapy drug approved after deal with NHS
Authors: Nigel Hawkes
Journal: BMJ (2018)

The NHS in England has struck a deal with Novartis that will make an immunotherapy drug for leukaemia available to a small number of children.

The agreement, announced on 5 September by Simon Stevens, chief executive of NHS England, came less than 10 days after the drug—Kymriah (tisagenlecleucel)—was approved by the European Medicines Agency (EMA) and a week after the National Institute for Health and Care Excellence (NICE) rejected a similar drug from Gilead, Yescarta, on grounds of cost.

The difference was that Novartis was prepared to offer the drug at a price sufficiently discounted to overcome any reluctance, and the market is small— no more than about 15 to 20 children a year with acute lymphoblastic leukaemia who …
Comorbidity and cause of death after surgery for early stage colorectal cancer (CRC).
Authors: Carla Francesca Justiniano, Zhaomin Xu, Adan Z Becerra, Christopher Thomas Aquina, Francis P. Boscoe, Maria J. Schymura, Larissa K. F. Temple, Fergal J. Fleming
Journal: Journal of Clinical Oncology (2017)

e15139 Background: Early stage (I/II) CRC is traditionally associated with relatively good prognosis at 90% relative survival. The probability of non-cancer death in CRC patients is associated with comorbidity burden; however, there is paucity of data evaluating this association in colon versus rectal cancer. This study examines the impact of comorbdity on 5-year mortality and cause of death after resection for early stage CRC. Methods: Linked patient-level data from the New York State Cancer Registry &amp; Statewide Planning and Research Cooperative System was queried for 2004-2013 patients who underwent colectomy or proctectomy for Stage I-II CRC who survived beyond 30 days. Comorbidity burden was defined as the sum of Elixhauser Comorbidites plus steroid use, MI history, CVD (cardiovascular disease), and dementia to capture maximum number of unique comorbidities and characterized as low (0-1 comorbidity), moderate (2-3 comorbidities), and high (4+ comorbidities). Causes of death were evaluated according to comorbidity group and colon versus rectal cancer. Results: 24,643 (colon 21,384, rectal 3,250) met inclusion criteria, of which 5,464 (22%) died within 5 years. While both colon cancer (CC) and rectal cancer patients (RC) had identical overall mortality (22%), significant differences existed in the proportion of deaths due to the primary cancer with disease-specific mortality of 7% for CC and 11% for RC. Deaths due to CC decreased while CVD causes increased with escalating comorbidity burden. Deaths due to RC accounted for nearly 50% of all deaths even with increasing comorbidity burden (Table). Conclusions: CC is the predominant cause of 5-year mortality in early stage patients with low comorbidity burden while CVD drives mortality in high comorbidity burden patients. In contrast, RC drives early stage mortality regardless of the comorbidity burden; thus, emphasizing the importance of tailored survivorship programs to each cancer. [Table: see text]
Micro- and macro-metastatic disease kinetics: Results from the French cohort Melbase.
Authors: Anais Vallet, Stéphane Dalle, Laurent Mortier, Caroline Dutriaux, Marie Thérèse Leccia, Sophie Dalac-Rat, Philippe Saiag, Bernard Guillot, Jean Philippe Lacour, Thierry Lesimple, Jean-Philippe Arnault, Delphine Legoupil, Francois Aubin, Julie De Quatrebarbes, Eve Maubec, Vincent Descamps, Florence Granel Brocard, Pierre-Emmanuel Stoebner, Bastien Oriano, Celeste Lebbe
Journal: Journal of Clinical Oncology (2017)

9538 Background: In the past decade, the prognosis of advanced melanoma has been greatly improved by new therapeutic agents such as immune and targeted therapies, which are now being evaluated as adjuvant therapies. Although the kinetic of metastatic disease is correlated to patient survival, the unfolding of the dormant disease remains hardly predictable and data from the literature on the topic is controversial (Karakousis, Francken). We hypothesized that the course of the advanced disease could be predicted from time to distant recurrence. Methods: Melbase is a French multicentric cohort dedicated to the prospective follow-up of adults with unresectable stage III or IV melanoma. Date of primary excision, time to recurrence, progression free survival (PFS) and overall survival (OS) of 298 patients treated in first line by immune therapies (IT, n = 148), targeted therapies (TT, n = 68) or within clinical trials (n = 73) were collected on September 5 th , 2016. Patients with unknown primary or de novo metastatic melanoma were not included. Time to distant recurrence was analyzed as a continuous variable and as a categorical variable ( &lt; 12 months; 12 to 24 months; ≥ 24 months). Results: Patients’ characteristics at baseline are: mean age 62 years, PS 0-1 84%, elevated LDH 32%, BRAF mutated 39%, brain metastases 18%. Time to recurrence studied as a continuous variable was not correlated to PFS (HR = 0.96; 95%CI: 0.85-1.07) or OS (HR = 0.89; 95%CI: 0.77-1.03). These results remained insignificant after stratification upon treatment or even when time to recurrence was analyzed as a categorized variable. Conclusions: Our data showed no correlation between the time from primary to distant recurrence and PFS or OS in patients treated with TT or IT. Therefore, kinetics of advanced disease cannot be predicted by the history of dormant disease. Dormancy and metastasis proliferation are thus probably driven by different molecular and cellular mechanisms.
P02.02 NKG2D ligand expression and tumor dormancy in brain metastases
Authors: C Flueh, V Mafael, V Adamski, K Hattermann, M Synowitz, J Held-Feindt
Journal: Neuro-Oncology (2018)

Brain metastases are the most common intracranial tumors in adults. Patients with breast cancer (BC) and pulmonary cancer (PC) regularly present with cerebral metastases. Dormant tumor cells resemble a population of non-apoptotic, low proliferating, “silent” tumor cells, which have the ability to be reactivated and are considered to be the source of recurrence. The Natural Killer Group 2, member D (NKG2D) receptor-ligand system is a major part of tumor immunogenicity. To date, the immunological characteristics of dormant tumor cells in cerebral malignancies are mostly unknown. We analyzed the expression profile and localization of NKG2DL (MICA, MICB, ULBP1, ULBP2) and several central (ephrin A5, insulin-like growth factor binding protein 5 and histone H2B type 1-K) and peripheral (platelet-derived growth factor β, fibroblast growth factor 2 and hypoxia-inducible factor 1 α) dormancy markers in solid human brain metastases of breast and pulmonary cancer patients using two color immuno-staining and quantitative RT-PCR. All investigated dormancy markers were detected in the investigated patients via qRT-PCR and immuno-staining. Expression of HIF1α and PDGFβ was higher than EphaA5 in PC and PC. All NKG2DL were expressed at stable levels. MICA expression was significantly higher than ULBP2 and 3 in PB. Immunostaining revealed a broad costaining of MICA and MICB with most peripheral dormancy markers in BC and PC. ULBP1 and 2 showed costaining with most central dormancy markers in both entities. Central dormancy markers showed a broad costaining with each other and a partial costaining with peripheral dormancy markers. This effect was more pronounced in PC. Costaining of dormancy markers and Ki-67 was not detected. Expression of peripheral dormancy markers was positively correlated with expression of NKG2DL, which was more pronounced in BC; we observed a negative correlation between expression of central and peripheral dormancy markers in BC, and with only some central dormancy markers in PC. There are differences between the different tumor entities; overall brain metastases seem to resemble a more peripheral type of dormancy rather than a central type. Due to their solid (co)-expression in the investigated samples, NKG2DL might play an important role in survival of dormant cells in cerebral metastases.
Association between health status and social integration/loneliness in survivors of adolescent and young adult (AYA) cancers.
Authors: I-Chan Huang, Conor Jones, Deo Kumar Srivastava, Melissa M. Hudson, Leslie L. Robison, Kevin R. Krull
Journal: Journal of Clinical Oncology (2017)

e21563 Background: AYA cancer survivors are at risk of various adverse health outcomes, but the relation between health status, social integration (i.e., social network and support) and loneliness is understudied. Methods: 102 AYA survivors (mean age = 25 years; diagnoses = leukemia 27%; lymphoma 24%; brain tumors 9%; solid tumors 41%) and 102 age-sex-matched controls were recruited from a community-based online panel. Participants reported social network information (e.g., contact frequency, resources for health counseling) for up to 25 of closest friends/relatives, which was used to create a functional social network index. UCLA Loneliness Scale, Duke-UNC Functional Social Support Questionnaire and PROMIS Health Profile were used to measure loneliness, social support and health-related outcomes (physical functioning, depression, anxiety, fatigue and pain), respectively. Multiple linear regression was used to compare functional social network, social support and loneliness between survivors and controls, and to assess the relation between health outcomes and perceived loneliness. Results: Compared to controls, survivors of lymphoma (b = 1.98; p = 0.005), leukemia (b = 1.67; p = 0.012) and solid tumors (b = 1.22; p = 0.030) had a higher functional social network index. However, social support did not differ between survivors and controls (p’s &gt; 0.05). Brain tumor survivors (b = 15.65; p = 0.006) and solid tumor survivors (b = 10.83; p &lt; 0.001) had more loneliness than controls. Compared to low loneliness controls, high loneliness survivors had significantly lower physical functioning (b = -7.72; p &lt; 0.001) and higher anxiety (b = 8.35; p &lt; 0.001), depression (b = 10.57; p &lt; 0.001), fatigue (b = 5.52; p = 0.011) and pain (b = 6.37; p &lt; 0.001) after adjusting for age, sex, education, social integration, and number of self-reported chronic health conditions. Conclusions: Loneliness is significantly associated with poor health-related outcomes in AYA survivors, which is independent of the influence of social integration. Future research is warranted to understand the relation between health status and social interactions among AYA survivors to inform intervention-based strategies.