tbuckley/cabot-search huggingface dataset:
Machine learning algorithm for predicting longer postoperative length of stay among older cancer patients.
Authors: Armin Shahrokni, Seyed Ali Rokni, Hassan Ghasemzadeh
Journal: Journal of Clinical Oncology (2017)

e21536 Background: To predict longer postoperative length of stay (LLOS) among older cancer patients, we have used a novel method to assess factors associated with this outcome. Methods: Our study was based on 47-item electronic Rapid Fitness Assessment (eRFA) data presented last year (Shahrokni, et al. (J Clin Oncol 34, 2016 (suppl; abstr 10011). LLOS was defined as LOS ≥8days.We used machine learning model to explore the relationship between &gt; 70 pre, intra, and postoperative variables with LLOS. A filter-based variable selection algorithm was utilized to only identify the most important variables as defined by information gain. We computed the mutual information between each variable and the LOS, and ranked them from high to low gain. To create an interpretable machine learning model, we used decision tree classifier. The tree started with the most informative variable as the root and branches based on a threshold value such that the entropy decreases by most. Results: In a cohort of 492 postoperative older cancer patients (median age 80), the variable selection algorithm showed that only 5 variables are sufficient for predicting LLOS with an accuracy of 77.2%, sensitivity 81.6% and specificity 61.31% in all patients. The algorithm started with operation time (OT) of &lt; or &gt; 4 hrs. For example, patients with OT &gt; 4 hours and social activity limitation (SAL) &gt; 7 were 78% likely to have LLOS. Patients with SAL ≤ 7 and OT &gt; 5 hours were 75% likely to have LLOS. Patients were 71% likely not to have LLOS if OT &lt; 4 hours and SAL ≤ 7. To avoid the effect of potential data collection errors and increase the accuracy of the model, we used the Bootstrap Aggregating (bagging) method which ensembles the decision of a set small trees. Particularly, we generated 3 datasets from randomly sampling patients from current dataset with replacement and built 3 different trees. As a result of combining 3 short trees we reach the accuracy of 83.2% with sensitivity 83.9% and specificity 82.4%. Conclusions: Machine learning model could be helpful for predicting LLOS among older cancer patients. Prospective studies are needed to validate this method in different academic and community settings.
Prostate radiotherapy in newly-diagnosed metastatic hormone-sensitive prostate cancer: A single-institution experience.
Authors: Scott Carlyle Morgan, Oliver Holmes, Julia Craig, Scott Grimes, Libni Eapen, Shawn Malone
Journal: Journal of Clinical Oncology (2018)

5017 Background: In patients presenting with metastatic prostate cancer (mPCa), the role of local therapy is undefined. Recent registry analyses have suggested, however, that external beam radiotherapy (RT) directed at the prostate may improve overall survival (OS). We reviewed the experience of primary tumor-directed RT in this setting at our center. Methods: The study population consisted of men with newly-diagnosed mPCa referred to a comprehensive cancer center between 2005 and 2015 and treated initially with androgen deprivation therapy. Patients were eligible for inclusion if they received 1) prostate RT with biologically effective dose at least that of a course of 40 Gy in 15 fractions or 2) no prostate RT. The association between receipt of prostate RT and OS was studied. OS was estimated using the Kaplan-Meier method while univariate and multivariate Cox regression were used to identify factors associated with OS. Results: A total of 304 cases were eligible. Prostate RT was received in 105 cases. Median age at diagnosis was 75 years (IQR, 67-82 years). Median follow-up was 72.2 months. On univariate analysis, prostate RT was associated with improved OS (HR 0.62, 95% CI 0.46-0.84, p = 0.002). 2-year and 5-year OS was 74.7% and 41.8% respectively in those receiving prostate RT and 56.9% and 27.6% respectively in those not receiving RT. Median OS in those receiving RT was 48.3 months versus 29.2 months in those not receiving RT. In a multivariate Cox model taking account of age at diagnosis, year of diagnosis, presenting PSA, T stage, N stage, and M1 subdivision, RT remained associated with improved survival (HR 0.64, 95% CI 0.43-0.96, p = 0.033). Conclusions: This cohort represents the largest single-center experience of primary tumor-directed RT in mPCa reported to date. In this population, receipt of prostate RT was associated with improved OS. The observed 19-month absolute difference in median OS is clinically significant. This analysis could not account for performance status, volume of metastatic disease, comorbidities, receipt of systemic therapies, and other potential confounders. Only large-scale RCTs will be able to definitively assess the value of prostate RT in this setting.
Abstract 19320: Whole Genome RNA Sequencing Analysis of Modified Delnido versus Whole Blood Cardioplegia in the Human Left Ventricle
Authors: Mahyar Heydarpour, Julius I Ejiofor, Michael S Gilfeather, Simon C Body, Sary F Aranki, Jochen D Muehlschlegel
Journal: Circulation (2016)

Introduction: During cardiac surgery with cardiopulmonary bypass (CPB), delivery of cardioplegia to achieve electromechanical cardiac quiescence is obligatory. Cardioplegia lowers the metabolic rate of the heart muscle thereby preventing cell death during aortic cross-clamping. The modified delNido cardioplegia (mdNc) solution has the advantage of less frequent dosing, however its consequences at a molecular level are unclear. Hypothesis: We performed whole genome RNA sequencing of human left ventricular (LV) myocardium pre and post cardioplegia. Methods: We prospectively enrolled 130 patients undergoing aortic valve replacement surgery with (CPB). Patients exclusively received either mdNc (n=37) or whole-blood cardioplegia (n=93). The LV apex was biopsied at baseline, and after a median of 74 min of cold, cardioplegic arrest. We performed gene expression differential analyses for 18,258 genes between the mdNc and whole-blood cardioplegia group using Limma. Clinical and demographic variables were adjusted...
Analysis of medical practices for French patients with BRAF mutant metastatic colorectal cancer.
Authors: Laetitia Mais, Héloise Bourien, Amelie Aboudaram, Astrid Lièvre, Marie Dupuy, Eric Francois, Pascal Artru, Helene Senellart, Romain Coriat, Julien Edeline, Rosine Guimbaud, Emmanuelle Samalin, Françoise Desseigne, Matthieu Sarabi, Pierre Guibert, Celine Ferlay, Christelle De La Fouchardiere
Journal: Journal of Clinical Oncology (2016)

e15070 Background: BRAF V600E mutations are rare in metastatic colorectal cancers (mCRC). Recent results showed that BRAF mutant tumors usually have a poor prognosis, resist to anti-EGFR treatment and may be more sensitive to a bevacizumab plus chemotherapy (CT) triplet combination. Methods: We retrospectively reviewed 153 consecutive patients’ files with BRAF mutated mCRC treated in 9 French Cancer Centers between May 2004 and November 2014. We report here the first results on clinical and biological features, treatment received and progression-free and overall survival. Results: There were 78 women and 75 men with a median age of 65 years [range 30-90]. In 15% of cases, patients (pts) had familial history of CRC. Primary tumor was most frequently localized in the right colon (54%). Peritoneum was the third most-frequent metastatic site (32%), after liver and lung (respectively 62% and 37%). Almost all pts had V600E BRAF mutation, and only one had a G596R mutation. MMR status was lacking for 65 pts (42.5%) and 15 (10%) of the BRAF mutant tumors exhibited a deficient MMR status (microsatellite instability). 142 pts (92.8%) received a 1st line chemotherapy, based on oxaliplatin in 82 (57.7%), irinotecan in 29 (20.4%) and 5FU only in 15 pts (10.5%). Only 11 pts (7.7%) received folfirinox first-line chemotherapy. 52 pts (36.6%) received an antiangiogenic (bevacizumab) including 4 with folfirinox. 14 (9.8%) received an anti-EGFR therapy. The 1st line chemotherapy was usually stopped because of tumor progression in 37% but also for chemotherapy holidays (33%). The median PFS in first line setting was 5.4 months, CI95% [4.1-6.7]. Only 99 patients (65%) initiated second-line chemotherapy and 62 (41%) a third-line. 12 patients (8%) had a secondary resection of liver metastases. Conclusions: BRAF mutant represent a distinct molecular subset of mCRC and an early identification could allow a more adequate management. In 1st line, few of them receive a triplet CT plus bevacizumab combination in clinical practice. Clinical guidelines and prospective clinical trials with innovative chemotherapy regimens and/or targeted treatment are strongly needed.
TCT-424 A New Intravascular Ultrasound-Guided Stenting Strategy Compared with Angiography on Stent Expansion and Procedural Outcomes in Patients with Positive Lesion Remodeling
Authors: Diaa Hakim, None Firas Al Solaiman, Mohamed Effat, Massoud Leesar
Journal: Journal of the American College of Cardiology (2018)
Anal cancer: Outcomes in men who have sex with men.
Authors: Maria Chaudhry, Allan Louie Cruz, David John Perry
Journal: Journal of Clinical Oncology (2016)

e15057 Background: Anal Cancer incidence has been rising with a rate of 2.2% per year for the past 10 years in the United States. Human papilloma virus infection through high risk sexual behaviors is a major risk factor. However, very limited data are available about racial disparities among men who have sex with men (MSM). We aimed to compare response rate and survival between MSM and non-MSM patients with anal cancer treated in our institute. Methods: A 10 year cross sectional study from 2004 to 2014 in our institution identified 45 patients with anal cancer. Study was approved by Institutional Review Board. Retrospective chart review was done. Patients were stratified and compared based on sexual orientation and race. Non-MSM group was 28 (26 female and 2 male) and MSM group was 17 (16 males and one transgender). Kaplan Meier estimate was used to compare probability of survival between groups. Results: Among 45 patients with anal cancer, 26 (57.8%) were females and 19 (42.2%) were males. Median age was 57 years. Majority were African Americans (AA) (65.6%). Stage distribution included: 13% were stage I, 27% were stage II, 56% were stage III and 4% were stage IV. Stage distribution was similar between groups (p = 0.2439). Highest rate of HIV infection was seen in AA MSM (10 out of 11, 91%, p < 0.0001). In non-MSM group, 96% received concurrent chemotherapy and radiation. In MSM group, all non-AA (n = 6), mostly Caucasian (n = 5), received CRT while 7 out of 11 (64%) AA received only radiation therapy. Chemotherapy was not given to 36% of AA MSM due to poor performance status, comorbidities and/or patient’s refusal. Complete response (CR) was achieved in 75% of non-MSM group, and 29% in MSM group (p = 0.014). After median follow up of 39 months, 62% were alive in the entire cohort. Median overall survival (OS) of MSM group was lower than non-MSM group (24 months vs. 85 months, p = 0.0236). African American MSM group had significantly higher hazard rate for death than non-AA, non-MSM patients (HR = 6.144, p = 0.0264). Conclusions: In our study, MSM patients with anal cancer had worse CR and OS compared to non-MSM patients. High HIV rate and poor performance status, likely, contributed to insufficient treatment with standard CRT in MSM patients leading to poor outcomes.
Efficacy and safety findings from DREAM: A phase III study of DHP107 (oral paclitaxel) vs IV paclitaxel in patients with gastric cancer after failure of first-line chemotherapy.
Authors: Yoon-Koo Kang, Min-Hee Ryu, Se Hoon Park, Sook Ryun Park, Jong Gwang Kim, Jin Won Kim, Sang Hee Cho, Young Iee Park, Sun Young Rha, Myoung Joo Kang, Jae Yong Cho, Seok Yun Kang, Young Seon Hong, Baek-Yeol Ryoo, Byung-Ho Nam, Yeong Woo Jo, Koung Eun Yoon, Sang Cheul Oh
Journal: Journal of Clinical Oncology (2016)

4016 Background: Paclitaxel is currently only available as an IV formulation. DHP107 is a novel oral formulation composed of lipid ingredients and paclitaxel. DHP107 has demonstrated comparable efficacy, safety and pharmacokinetics to IV paclitaxel as second-line therapy in patients (pts) with advanced gastric cancer (AGC). DREAM (#NCT01839773) is a multicenter, open-label, prospective, randomized phase III study of pts with histologically or cytologically confirmed, unresectable recurrent/AGC after failure of first-line therapy. Methods: Pts were randomized 1:1 to either DHP107 (200 mg/m2 po bid d1, 8 & 15 q4 w) or IV paclitaxel (175 mg/m2 infused d1 q3 w). Pts were stratified by ECOG PS, disease status and prior treatment with response evaluation (RECIST v1.1) every 6 w (±1 w). Primary endpoint: non-inferiority of progression-free survival (PFS); secondary endpoints: overall response rate (ORR), overall survival (OS), safety. Results: 236 pts (n = 118 in each arm) were randomized; baseline characteristics were balanced. Prior first-line therapy was fluoropyrimidine + platinum in 93% of pts. Median PFS (per protocol) was 3.3 m (95% CI 1.9–4.0) for DHP107 and 2.7 m (1.9–2.9) for paclitaxel (HR = 0.86; 95% CI 0.65–1.14; p = 0.294). Median OS (ITT) was 9.7 m (95% CI 7.1–11.5) for DHP107 vs 8.9 m (95% CI 7.1–12.2) for paclitaxel (HR = 1.04; 95% CI 0.76–1.41; p = 0.824). ORR was 17.8% for DHP107 (CR 4.2%; PR 13.6%) vs 25.4% for paclitaxel (CR 3.4%; PR 22.0%; p = 0.155); DCR was similar between arms. Nausea, vomiting, diarrhea and mucositis were more common with DHP107; peripheral neuropathy was more frequent with paclitaxel. Grade ≥ 3 adverse events (AEs) were infrequent; the most common was neutropenia (42% vs 55%); febrile neutropenia was rare (5.9% vs 2.5%). Serious AEs and treatment discontinuations were comparable; there were no hypersensitivity reactions with DHP (vs 2.5% with paclitaxel). Conclusions: DHP107 was non-inferior to paclitaxel in terms of PFS when given as second-line treatment for AGC. Other efficacy parameters and safety signals were comparable. DHP107 is the first oral paclitaxel with proven efficacy and safety for the treatment of AGC. Clinical trial information: NCT01839773.
Does timing of palliative care consults impact end-of-life health services utilization in pancreatic cancer patients?
Authors: Nizar Bhulani, Ang Gao, Arjun Gupta, Chul Ahn, M. Elizabeth Paulk, Stephanie Houck, Jenny Jing Li, Chad Michael Guenther, Syed Mohammad Ali Kazmi, Muhammad Shaalan Beg
Journal: Journal of Clinical Oncology (2018)

10006 Background: Early palliative care consult can influence end of life health care utilization in controlled clinical trials. However, the effect in large scale, real world setting is not known. We explored the effect of early vs. late palliative care consult on end of life health care utilization in Medicare patients with pancreatic cancer. Methods: Pancreatic cancer patients diagnosed between 2000 - 2009 with palliative consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Early palliative care was defined as a consult received in the first 4 weeks of diagnosis. Patients older than 66 years, with survival more than 3 months and known date of death were included. Trend of palliative care consults and health services utilization was studied for patients with early vs late palliative care consults. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Out of the 1966 patients with palliative care consults, 840 (43%) received early palliative care. On univariate analysis, age, sex, state of residence and stage at diagnosis were associated with early palliative care consult (p < 0.001). On multivariate analysis, patients with early palliative care consults were more likely to be women, older than 85 years and have stage 4 disease. Race and state of residence were not associated with early vs late palliative care consult. Patients with early palliative care had lower number of visits to the ED (2.4 vs. 3.0 p < 0.001) and lower cost of ED care ($3043 vs. $4117, p < 0.001). Early palliative care patients were admitted less frequently to the ICU compared to late palliative care patients (0.68 vs. 0.94, p < 0.001) and the duration of Intensive care unit stay was shorter (3.0 days vs 3.7 days, p 0.04). Cost of ICU care was not statistically different between both the groups. Conclusions: In this claims analysis of elderly pancreatic cancer patients, those with early palliative care had lower health care utilization as measured by ED and ICU stay. This provides real world evidence to support oncology societies’ recommendations for early integration of palliative care.
Induction chemotherapy (IC) using cisplatin and 5-fluorouracil followed by bioradiotherapy (BRT) in stage IVb squamous cell carcinoma of oropharynx and oral cavity: Retrospective data analysis.
Authors: Igor Djan, Borislava Nikolin
Journal: Journal of Clinical Oncology (2018)

e18029 Background: Advanced head and neck squamous cell carcinoma (HNSCC) has a poor prognosis. The aim of the study was to evaluate overall survival (OS) in patients with locally advanced oral cavity and oropharingeal squamous cell carcinoma (SCC) after treatment with induction chemotherapy (IC) using cisplatin and 5- fluorouracil (CDDP+5-FU) followed by bioradiotherapy (BRT). Methods: In total 67 patients were enrolled. Eligibility criteria were SCC of oral cavity and oropharynx, stage IVb, M0. Patients were required to have inoperable disease with ECOG < 2, and were not eligible for chemoradiotherapy with high dose cisplatin. Due to limitation in usage of taxans (of label drugs for SCCHN), IC consisted only of CDDP+5-FU. In total 62 received IV cycles of IC and 5 received only II cycles because of neutropenia grade IV. After IC 67 patients received BRT. Following parameters were evaluated: age, N stage and OS. Data analyses were performed in SPSS 17 software. Results: Complete treatment was applied to 67 patients. Patients group consisted of 54 males and 13 females. Age vary between 53 and 80 years. OS after 12, 24 and 36 months (in percents) was 86.6%, 40.3% and 17.9%, respectively. Statistically significant difference in OS between N groups has been shown (p = 0,036). OS by N stage after 12, 24 and 36 months where: for N1 stage 94.7%, 36.4% and 15.8% respectively; for N2 stage 83.3%, 33.3% and 10% respectively and for N3 stage 81.8%, 54.5% and 27.3% respectively. After grouping by age (below and above 65 years), no statistical significance was observed for OS between groups. Mean overall survival in months was 25.86 ( < 65) and 21.08 (≥ 65). Table 1. Overall survival in total number of patients Conclusions: Considering poor prognosis for patients with IVb stage oral cavity and oropharynx, presented results showed optimal OS compared with other literature data. In cases of very advanced non metastatic SCC of oral cavity and oropharynx, doublet IC followed by bioradiotherapy can be good treatment option even in case of limitation in taxans usage. Time (months) OS % S. E. 6 100% 12 86.6% 0.042 18 55.2% 0.061 24 40.3% 0.060 30 26.9% 0.054 36 17.9% 0.047
Experience with advanced neuroendocrine tumors at a single center: Contributing factors for poor survival and activity of 177Lu-DOTATATE.
Authors: Fabio De FigueirÃªdo Chaves, Duilio Reis da Rocha Filho, Ana Rosa Pinto Quidute, Julio Marcus Sousa Correia, Irwina Nogugis Barreira
Journal: Journal of Clinical Oncology (2016)

e15651 Background: Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with different malignant potential and behavior. Several treatment options are available. This study aimed to describe the demographic characteristics and overall survival, to observe outcomes of patients treated with 177Lu-DOTATATE and to identify predictors of higher risk of death at one cancer center. Methods: This retrospective study included patients with metastatic or unresectable NETs treated between 2006 and 2014 at Haroldo Juaçaba Hospital in Brazil. The primary endpoint was overall survival (OS), which was assessed using the Kaplan-Meier method. The Cox regression proportional hazard model was used to identify predictors for death. Percentages refer to total evaluable patients. Results: One hundred fourteen patients with NET were enrolled, including 73 (82%) with well-differentiated and 15 (17%) with poorly differentiated tumors. Median age was 56.1 years. Pancreas was the most common primary site (N = 29, 26%), followed by small intestine (N = 27, 24%) and unknown primary (N = 19, 17%). Thirty patients (26%) had carcinoid syndrome and 12 (12%) had MEN1. Sixty patients (61%) had their primaries resected, forty (41%) were treated with somatostatin analogues (SA) and 41 (36%) were exposed to 177Lu-DOTATATE. Nine out of 28 evaluable pts (32%) had response to 177Lu-DOTATATE, and 14 (50%) had stable disease. Median OS in the whole population was 107.3 months (95% CI 69.3-145.4). On multivariate analysis, non-resected primary (HR 0.11, 95% CI 0.02-0.45, P = 0.02) and poorly differentiated tumors (HR 0.09, 95% CI 0.01-0.65, P = .018) were independently associated with increased risk of death. Conclusions: Long OS was observed in patients treated at our center. Treatment with 177Lu-DOTATATE or SA provided long PFS. Non-resected primaries and poorly differentiated tumors were independently associated with increased risk of death.
Antitumor activity and safety of pembrolizumab in patients with advanced recurrent ovarian cancer: results from the phase II KEYNOTE-100 study
Authors: U.A. Matulonis, R. Shapira-Frommer, A.D. Santin, A.S. Lisyanskaya, S. Pignata, I. Vergote, F. Raspagliesi, G.S. Sonke, M. Birrer, D.M. Provencher, J. Sehouli, N. Colombo, A. González-Martín, A. Oaknin, P.B. Ottevanger, V. Rudaitis, K. Katchar, H. Wu, S. Keefe, J. Ruman, J.A. Ledermann
Journal: Annals of Oncology (2019)
Relationship between the cumulative burden (CB) of chronic health conditions (CHC) and health-related quality of life (HRQoL) among childhood cancer survivors (CCS): The St. Jude Lifetime (SJLIFE) cohort.
Authors: Nickhill Bhakta, Qi Liu, Matthew J. Ehrhardt, Kirsten K. Ness, Kevin R. Krull, Deo Kumar Srivastava, Patricia A. Ganz, Yutaka Yasui, Melissa M. Hudson, Leslie L. Robison, I-Chan Huang
Journal: Journal of Clinical Oncology (2017)

10560 Background: Adult CCS experience an excess burden of CHC. The association between disease burden (estimated using CB) and HRQoL has not been extensively assessed. Methods: 2878 CCS (mean [range] age 32.1 [18.3-66.2] years; time from diagnosis 25.0 [10.2-51.0] years) were enrolled in SJLIFE (eligibility: survived &gt;10 years and &gt;18 years of age) and clinically evaluated for 168 graded CHC using the St. Jude modified Common Terminology Criteria for Adverse Events. HRQoL was assessed using the Short Form 36 survey and categorized into Low (&lt; -0.5 SDs), Average (-0.5 to 0.5 SDs), and High (&gt; 0.5 SDs) subgroups from the Physical and Mental Component Summary (PCS, MCS) and Vitality Scale using cohort age- and sex-specific values. CB (average number of grade 3-4 [severe/life-threatening] CHC/survivor) for each CHC was calculated and summed for each HRQoL subgroup. Results: Survivors with low PCS had, on average, more CHC CB compared to those with High and Average PCS. Higher CHC CB was also associated with poorer Vitality and MCS, but the differences in effect size were smaller than PCS. When CB for each of the 3 HRQoL scores were compared by subgroups across 12 organ systems and subsequent neoplasms, CB at age 50 differed significantly (p&lt;0.05) across PCS, MCS, and Vitality in 9, 3 and 7 of the 13 systems, respectively. Conclusions: Survivors with lower HRQoL scores have more CHC, but the patterns of this association vary in PCS, MCS and Vitality by CHC organ systems, suggesting adult CCS adjust better to certain types of CHC than others. Future research will focus on CHC with greatest impact on functioning. [Table: see text]