tbuckley/cabot-search huggingface dataset:
Can we identify patients at risk for discordance in preferred and actual role in cancer treatment decision making?
Authors: Leah L. Zullig, Christel Rushing, Fumiko Ladd Chino, Greg Samsa, Ivy Altomare, James A Tulsky, Peter A Ubel, Jonathan Nicolla, Amy Pickar Abernethy, Jeffrey M. Peppercorn, Yousuf Zafar
Journal: Journal of Clinical Oncology (2014)

6615 Background: Assuring treatment-related decision-making aligns with patients’ preferences is a critical component of quality care. Yet often patients’ preferred and actual treatment-related decision-making roles are discordant (i.e., patients may play a more or less active role in decision-making than was preferred). We examined whether patient characteristics predict discordant treatment decision-making roles. Methods: We surveyed adults receiving anti-cancer therapy. First, patients were asked to state their preferred role: to make treatment decisions with little or no input from their oncologists; to let their oncologists make the decision for them; or to engage in shared decision-making. Second, patients were asked about their actual role: the role they played when treatment decisions were actually made, using the same categories. A dichotomized variable measured discordance between preferred and actual decision-making roles. Multivariable regression examined the association between characteristics (age, gender, race, education, income, financial distress, employment, insurance, marital status, treatment intent, time on treatment, income, quality of life, out-of-pocket costs) and decision-making role discordance. Results: Of 300 respondents (86% response), 12% preferred to make decisions with little or no input, 7% preferred their doctor to make decisions, 25% preferred their doctor to make decisions after considering their input, and (55%) preferred shared decision-making between patients and their oncologists. The most common discrepancy was patients preferred a shared decision, but in actuality doctors made the decision after considering patients’ opinion (5%). 81% reported decision making consistent with preferences. None of the examined patient characteristics were associated with decision-making role discordance. Conclusions: There was relatively little discordance between preferred and actual decision-making style.Readily identifiable patient characteristics were not associated with role discordance. Therefore, it may be important for clinicians to simply ask patients what role they would prefer to play in cancer treatment decision-making.
Next Generation Sequencing-Based BCR-ABL1 Kinase Domain Mutation Screening in De Novo and Tyrosine Kinase Inhibitor-Resistant Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia: Results of a Prospective Study
Authors: Simona Soverini, Luana Bavaro, Margherita Martelli, Caterina De Benedittis, Cristina Papayannidis, Antonio Percesepe, Maria Antonella Laginestra, Simona Sica, Federica Sorà, Francesco Albano, Livio Pagano, Marianna Criscuolo, Sara Galimberti, Marzia Salvucci, Mario Annunziata, Giovanni Marconi, Antonio Curti, Sabina Russo, Annalisa Imovilli, Daniele Mannina, Dario Ferrero, Manuela Stulle, Claudia Basilico, Elisabetta Abruzzese, Flavio Mignone, Stefano A. Pileri, Giovanni Martinelli, Michele Cavo
Journal: Blood (2018)
Reverse phase protein microarray for identification of IL6 receptor ligation-induced insulin receptor, PI3K/AKT, and JAK/STAT signaling pathways in the CARD11 mutated lymphoma cell line OCI-Ly3.
Authors: Greg Coffey, Akiko Futamura, Shruti Shrivastav, Yoshinori Tanizawa, Takeomi Inoue, Naoko Iwata, Yasuyuki Kirii, Pamela Conley, Anjali Pandey
Journal: Journal of Clinical Oncology (2014)

8574 Background: A subset of diffuse large B cell lymphoma of the activated B cell subtype bear mutations that drive B cell antigen receptor (BCR) independent chronic activation of NFkB. The consequence appears to be loss of dependency for survival on BCR proximal kinases (BTK, SYK) and the initiation of a cytokine autocrine stimulation loop conferring an alternate survival mechanism. In the OCILy3 cell line, for example, IL6 is produced de novo as a consequence of NFkB gene transcription, and both neutralizing anti-IL6 antibody and small molecule JAK inhibition affects cell survival. The exact nature of this survival mechanism, however, is unclear. The goal of our studies was to more clearly define the molecular events induced by IL6 stimulation that promote survival inOCILy3 DLBCL. Methods: Reverse phase protein microarray is a high throughput methodology to evaluate multiple intracellular phosphoryaltion events in whole cell lysates. Using a panel of 180 phospho-specific antibodies, we assessed phosphorylation events in OCILy3 cells following IL6 receptor stimulation with and without treatment with the dual SYK/JAK inhibitor PRT062070 (Cerdulatinib). Results: 28 of the 180 phosphorylation events tested were induced by approximately 20% or greater upon IL6 receptor stimulation. The most heavily represented categories were within the PI3K/AKT/mTOR, insulin receptor, and JAK/STAT signaling pathways. This was evidenced most notably by robust IL6-mediated induction of Akt, Foxo3a, insulin growth factor receptor and insulin substrate, as well as STAT3 and STAT5 phosphorylation. Treatment with PRT062070 completely inhibited these phosphorylation events. Moreover, PRT062070 dramatically reduced basal phosphorylation of STAT3 Y705, Foxo3a S253, S6Rb S235/236, NFkB p65 S536, BIM S69, and BCL2 T56, and inhibited OCILy3 survival. Conclusions: We conclude from these data that in a subset of B cell lymphomas, IL6 receptor signaling likely contributes to survival via induction of multiple signaling arms, not limited to JAK/STAT pathway activation.
Severe Coombs Positive Autoimmune Hemolytic Anemia after Alemtuzumab Infusion for Relapsing Remitting Multiple Sclerosis. What Can We Learn?
Authors: Parth Anil Desai, Chase Mathew Romere, Linda Nguyen, Annapurna Saksena, Siddiqui J Abdullah, Adolfo E Diaz
Journal: Blood (2018)
Barriers to insurance coverage of next-generation tumor sequencing by U.S. payers.
Authors: Julia Rachel Trosman, Christine B. Weldon, Robin Kate Kelley, Kathryn A Phillips
Journal: Journal of Clinical Oncology (2014)

6545 Background: Next-generation tumor sequencing (NGTS) panels, which include tens to hundreds of targets of varying clinical significance applicable across cancers, are crossing from research to clinical practice, but are not formally covered by U.S. payers. Lack of consistent coverage policy may impact access and adoption. Our study aimed to identify considerations used by payers for NGTS coverage decisions. Methods: We conducted semi-structured interviews with senior executives of 7 large national and 3 regional plans in the U.S., covering >125 million members. We used the framework approach of qualitative research for thematic analyses. Results: Most payers (80%) believe NGTS has a potential to transform cancer care, but all (100%) report barriers to coverage. (1) 70% of payers view NGTS as a ‘bundle” of cancer markers, vs. comprehensive tumor characterization, and thus may evaluate evidence for one target and one cancer type at a time. Sufficient evidence for all targets included in an NGTS panel may be required for a positive coverage decision. (2) 80% of payers may predicate coverage policy for NGTS not only on validity of included targets, but also on outcomes from therapies informed by NGTS, with 30% requiring Phase 3 evidence for each new marker / drug indication. (3) 70% of payers note that NGTS converges clinical care and research by interrogating both established and novel targets, and thus does not fit the coverage framework separating “medically necessary” vs “experimental / investigational”. Therefore, payers may not cover panels that include novel targets. However, 40% also note health reform requirements to cover trials for terminal conditions and may use NGTS as a means for complying with this requirement. (4) Payers cite challenges in assessing accuracy and value of bioinformatics required to implement NGTS. 70% do not believe that bioinformatics should be reimbursed. Conclusions: Next-generation tumor sequencing does not fit the current payer coverage and evidence framework and thus faces potential barriers to access. The entry of this rapidly evolving technology into clinical practice requires ongoing dialogue among payers, providers, and policy-makers to develop an innovative roadmap to coverage and reimbursement.
Postoperative neutrophil-to-lymphocyte ratio as a predictor of surgical complications, recurrence-free (RFS), and overall survival (OS) among esophageal adenocarcinoma patients after induction chemoradiation followed by esophagectomy.
Authors: Dante Dali, Howard Trent, Shawna Grimm, Charles David Goldman, Jan Franko
Journal: Journal of Clinical Oncology (2014)

e15065 Background: Neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation. It has been previously used with variable success to predict overall survival of patients with solid malignancies. There is limited data on utility of postoperative NLR for survival prediction, and none applicable for esophageal adenocarcinoma. We explored the utility of NLR to stratify a relatively homogenous group of patients with esophageal adenocarcinoma treated with neoadjuvant chemoradiation and resection in a community hospital. Methods: Thirty consecutive patients (24 male) who underwent induction chemoradiation and subsequent resection of esophageal adenocarcinoma in 2008-2013 were analyzed. Results: Mean age was 62.3±10.7 years, Charlson comorbidity index was 8.6±1.7. Mean NLR was 7.8±6.7 (range 1.9-33.6, interquartile range 4.6). Median overall survival for the whole group was 26.8 months since the diagnosis, and RFS was 25.8 months. Mean NLR was (4.5±1.5 vs. 9.8±7.9, p=0.006, Mann-Whitney test) for patients without major complication vs. with a major complication. NLR did not predict RFS (p=0.855) or OS (p=0.862). The value of NLR for patients disease-free vs. others at 12 months after esophagectomy was similar between the groups (6.7±5.8 vs. 8.2±7.1, p=0.307). Conclusions: Based on this small community-based data NLR may predict occurrence of postoperative complications, but not RFS or OS after esophagectomy.
Validation of the basic questionnaire of the MD Anderson Symptom Inventory (MDASI) for patients with cancer in Mexican population.
Authors: Oscar Galindo Vazquez, Jose Luis Aguilar Ponce, Abelardo Meneses Garcia, Cristina Aguilar, Edith Rojas Castillo, Corina Benjet, Miguel Angel Alvarez Avitia, Abraham Ruiz Garcia, Eduardo Tellez Bernal, Salvador Alvarado Aguilar
Journal: Journal of Clinical Oncology (2014)

e20713 Background: There are 10 symptoms prevalent in cancer patients during the treatment period and during the first months following treatment. Therefore, it is necessary to use valid and reliable instruments to determine the effects and benefits of treatments. To validate the basic questionnaire for symptoms M. D. Anderson (MDASI) for patients with cancer in Mexican population. Methods: 300 patients participated in the National Cancer Institute of Mexico (INCAN), of which 181 were women (60.5%) and 119 were men (39.5%); the average age was 49.5 ± 14.5 years. Procedure. The sample of participants was obtained of July 2013 to January 2014. Each of the participants signed the informed consent of research. For the concurrent validity was applied concurrently the MDASI, the inventory of quality of life (EORTC QLQ-C30) and Distress thermometer. Criteria for inclusion: 1) Patients in treatment (any type of treatment), palliative treatment or follow-up (maximum 1 year) period, (2) any type of diagnosis and stage of the cancer process and 3) reading and writing knowledge. Exclusion criteria: 1) Patients who have psychiatric history 2) patients, severe psychological crisis and 3) patients with severe cognitive, hearing and visual impairments. Results: Obtained a rate of sampling adequacy (KMO = 0. 925) that determined the usefulness of the structure of the final components. Determined the structure factor by means of a direct oblimin rotation, was a model of two factors (General and gastrointestinal symptoms) and the subscale of interference in lifestyle that explains the 64.35% of the variance. The internal consistency was a α = 0.91 for general symptoms, α = 0.82 for gastrointestinal symptoms, α = 0.90 interference; and a α = 0.93 for the global scale. The validity through correlation with concurrent measurements showed significant results between the MDASI, EORTC QLQ-C30 and Distress thermometer (Pearson's r p < 0.05). Conclusions: The MDASI in patients with cancer in Mexican population is a valid and reliable instrument. The detection of symptoms and interference in daily activities is derived on benefits for the Oncology population and appropriate and cost-effective care strategies.
Comparative Effectiveness of Rasburicase and Allopurinol in Children with Acute Lymphoblastic Leukemia: An Emulated Pragmatic Trial Using Observational Data
Authors: Regina M Myers, Kelly D Getz, Yimei Li, Yuan-Shung V. Huang, Rebecca Citrin, Caitlin W Elgarten, Benjamin L Laskin, Joseph P. Horowitz, Brian T. Fisher, Richard Aplenc
Journal: Blood (2018)
Induction Chemotherapy Response as a Guide for Treatment Optimization in Sinonasal Undifferentiated Carcinoma
Authors: Moran Amit, Ahmed S. Abdelmeguid, Teemaranawich Watcherporn, Hideaki Takahashi, Samantha Tam, Diana Bell, Renata Ferrarotto, Bonnie Glisson, Michael E. Kupferman, Dianna B. Roberts, Shirley Y. Su, Shaan M. Raza, Franco DeMonte, Ehab Y. Hanna
Journal: Journal of Clinical Oncology (2019)

Multimodal therapy is a well-established approach for the treatment of sinonasal undifferentiated carcinoma (SNUC); however, the optimal sequence of the various treatments modalities is yet to be determined. This study aimed to assess the role of induction chemotherapy (IC) in guiding definitive therapy in patients with SNUC.Ninety-five previously untreated patients diagnosed with SNUC and treated between 2001 and 2018 at The University of Texas MD Anderson Cancer Center were included in the analysis. Patients were treated with curative intent and received IC before definitive locoregional therapy. The primary end point was disease-specific survival (DSS). Secondary end points included overall and disease-free survival, disease recurrence, and organ preservation.A total of 95 treatment-naïve patients were included in the analysis. For the entire cohort, the 5-years DSS probability was 59% (95% CI, 53% to 66%). In patients who had partial or complete response to IC, the 5-year DSS probabilities were 81% (95% CI, 69% to 88%) after treatment with definitive concurrent chemoradiotherapy (CRT) after IC and 54% (95% CI, 44% to 61%) after definitive surgery and postoperative radiotherapy or CRT after IC (log-rank P = .001). In patients who did not experience at least a partial response to IC, the 5-year DSS probabilities were 0% (95% CI, 0% to 4%) in patients who were treated with concurrent CRT after IC and 39% (95% CI, 30% to 46%) in patients who were treated with surgery plus radiotherapy or CRT (adjusted hazard ratio of 5.68 [95% CI, 2.89 to 9.36]).In patients who achieve a favorable response to IC, definitive CRT results in improved survival compared with those who undergo definitive surgery. In patients who do not achieve a favorable response to IC, surgery when feasible seems to provide a better chance of disease control and improved survival.
Prevalence of second primary cancers in a geriatric oncology hospital population.
Authors: Thierry Landre, Nassima El Hadj, Cherifa Taleb, Bernard Uzzan, Lydie Dulou, Georges Sebbane, Gaetan Des Guetz
Journal: Journal of Clinical Oncology (2014)

e20522 Background: The prevalence of multiple primary malignancies at any age ranges from 0.73% to 11.7%. Since the population is getting older and survival improves in many adult malignancies, there is an increasing need to identify those second primary cancers (SPCs) that might develop in the elderly survivors of cancer. The purpose of this study was to describe, and to estimate the prevalence, of second primary malignancies following cancers seen in the elderly. Methods: Using medical charts, we screened all patients with multiple primary malignancies, admitted to the geriatric oncology unit, and/or evaluated by means of comprehensive geriatric assessment (CGA) to determine the optimum treatment, between January 2011 and May 2013. Patients with cancer relapse, unknown primary cancer, Richter’s syndrome or basal cell carcinoma were excluded. Results: 574 elderly patients with cancer were assessed. Median age was 82.5 +/-7 years [66-103], 42% were male. Prevalence of SPC was 11.3% (65 patients). Median age of patients with SPC was 83+/-5 years [68-99]; 33 out of 65 patients were male (51%). Among these 65 cases, 13 (20%) had synchronous SPCs while 52 (80%) had metachronous tumours. Mean interval time from first to SPCs was 9 +/-10 years [0-41 years]. The most frequent locations of first primary cancers were breast, prostate, and colorectal cancer (CRC). Median age was 71 years. The most frequent locations of SPCs were lung (24%), CRC (17%) and renal/bladder (11%). Median age was 82 years. We found a large diversity of malignant associations, mainly lung-CRC (5%), breast-CRC (5%), head and neck-lung (4%) and renal/bladder-lung (4%). Secondary tumours had usually an advanced stage possibly explained by the low compliance of the patients to follow-up. Only 38% of them received chemotherapy. Conclusions: This is one of the first studies about the prevalence of SPCs in elderly patients hospitalized in oncology. SPCs are relatively frequent among the elderly (11%). We did not find a predominant association between first and second primary tumours.
Perioperative chemotherapy with FOLFOX in resectable gastroesophageal adenocarcinoma: Preliminary results of an AGEO multicentric retrospective study.
Authors: Florence Mary, Aziz Zaanan, David Malka, Pascal Artru, Marouane Boubaya, Emmanuelle Samalin, Romain Coriat, Jean Baptiste Bachet, Mourad Benallaoua, Pauline Afchain, Christophe Locher, Isabelle Baumgaertner, Cedric Lecaille, Thomas Aparicio
Journal: Journal of Clinical Oncology (2014)

e15018 Background: Perioperative 5-fluorouracile (5-FU) associated with cisplatin chemotherapy improved overall and recurrence free survival, the R0 resection rate, in resectable gastro-oesophageal junction and gastric adenocarcinoma. The aim of this study is to evaluate the feasibility, R0 resection rate, survival and tolerance of the 5-FU with oxaliplatin perioperative chemotherapy. Methods: We enrolled all the resectable gastric or gastro-oesophageal adenocarcinoma who had at least 3 cycles of pre-operative folfox based regimen (simplified folfox 6; or folfox 6: oxaliplatin 100 mg/m2, 400 mg/m2, 5-fluorouracile bolus, and 2400 mg/ m2, 5-fluorouracile during 2 days). The following data were collected: age, weight, height, karnofsky index, toxicity, dose, surgery R0, histology, post-operative radiotherapy, recurrence and death. Overall and disease free survival was calculated with the Kaplan-Meyer method. Results: We enrolled 106 patients in 11 centers. There were 72 men, the median age was 66 years. Gastro-oesophageal junction represented 28.3%. The median number of chemotherapy cycle was 4 before surgery and 2.5 after. In univariate analysis the karnofsky index at inclusion was the only factor associated with the realization of 8 cycles chemotherapy. A grade 3-4 toxicity occurred in 13.8%. The R0 rate was achieved in 98 patients. The median overall and disease free survival was 41 and 28 month. The ACE rate was in univariate analysis a predictive factor for overall and disease free survival. The other predictive factor for overall survival was: Karnofsky index and the number of post surgery chemotherapy cycle. Conclusions: The oxaliplatine perioperative regimen is an alternative instead of cisplatin based regimen for the gastric and gastro-oesophageal junction resectable adenocarcinoma with a good tolerance and efficacy. A 12 cycle treatment is rarely achievable, 8 cycles seems to be more feasible.
Association of Parenteral Anticoagulation Therapy With Outcomes in Chinese Patients Undergoing Percutaneous Coronary Intervention for Non–ST-Segment Elevation Acute Coronary Syndrome
Authors: Ji-Yan Chen, Peng-Cheng He, Yuan-Hui Liu, Xue-Biao Wei, Lei Jiang, Wei Guo, Chong-Yang Duan, Yan-Song Guo, Xiao-Ping Yu, Jun Li, Wen-Sheng Li, Ying-Ling Zhou, Chun-Ying Lin, Jian-Fang Luo, Dan-Qing Yu, Zhu-Jun Chen, Wei Chen, Yi-Yue Chen, Zhi-Qiang Guo, Qing-Shan Geng, Ning Tan
Journal: JAMA Internal Medicine (2018)

The association of parenteral anticoagulation therapy with improved outcomes in patients with non-ST-segment elevation acute coronary syndrome was previously established. This benefit has not been evaluated in the era of dual antiplatelet therapy and percutaneous coronary intervention.To evaluate the association between parenteral anticoagulation therapy and clinical outcomes in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention.This cohort study included 8197 adults who underwent percutaneous coronary intervention for non-ST-segment elevation acute coronary syndrome from January 1, 2010, to December 31, 2014, at 5 medical centers in China. Patients receiving parenteral anticoagulation therapy only after percutaneous coronary intervention were excluded.Parenteral anticoagulation therapy.The primary outcome was in-hospital all-cause death and in-hospital major bleeding as defined by the Bleeding Academic Research Consortium definition (grades 3-5).Of 6804 patients who met the final criteria, 5104 (75.0%) were male, with a mean (SD) age of 64.2 (10.4) years. The incidence of in-hospital death was not significantly different between the patients who received and did not receive parenteral anticoagulation therapy (0.3% vs 0.1%; P = .13) (adjusted odds ratio, 1.27; 95% CI, 0.38-4.27; P = .70). A similar result was found for myocardial infarction (0.3% vs 0.3%; P = .82) (adjusted odds ratio, 0.77; 95% CI, 0.29-2.07; P = .61). In-hospital major bleeding was more frequent in the parenteral anticoagulation group (2.5% vs 1.0%; P < .001) (adjusted odds ratio, 1.94; 95% CI, 1.24-3.03; P = .004). At a median (interquartile range) follow-up of 2.96 years (1.93-4.46 years), all-cause death was not significantly different between the 2 groups (adjusted hazards ratio, 0.87; 95% CI, 0.71-1.07; P = .19), but the incidence of major bleeding was higher in the parenteral anticoagulation group (adjusted hazards ratio, 1.43; 95% CI, 1.01-2.02; P = .04). The propensity score analysis confirmed these primary analyses.In the patients undergoing percutaneous coronary intervention for non-ST-segment elevation acute coronary syndrome, parenteral anticoagulation therapy was not associated with a lower risk of all-cause death or myocardial infarction but was significantly associated with a higher risk of major bleeding. These findings raise important safety questions about the current practice of routine parenteral anticoagulation therapy while we await randomized trials of this practice.
Safety of Gemtuzumab Ozogamicin As Monotherapy or Combination Therapy in an Expanded-Access Protocol for Patients with Relapsed or Refractory Acute Myeloid Leukemia
Authors: Eunice S. Wang, Richard Aplenc, Deborah Chirnomas, Michael John Dugan, Salman Fazal, Swaminathan Iyer, Tara L Lin, Sucha Nand, Kristen J Pierce, Paul J Shami, Jennifer J Vermette, Camille N Abboud
Journal: Blood (2018)