tbuckley/cabot-search huggingface dataset:
Are patients ready to participate in diet intervention trials in oncology? Experience from renal cell carcinoma (RCC) patients.
Authors: Emeline Colomba, Bruno Raynard, Annalisa Guida, Lisa Derosa, Bernard Escudier, Laurence Albiges
Journal: Journal of Clinical Oncology (2019)

628 Background: Diet intervention in oncology is currently under investigation. Nevertheless, some cancer patients are increasingly using various diet interventions with the hope to optimize the anti-tumor response or to control the side effects of oncological treatment. Thus, well conducted prospective trials are required. In order to design such trials, we conducted a prospective study in order to estimate(a) the number of patients already using diet interventions on their own and (b) the percentage of patients who would agree to follow a restrictive diet in combination to antitumoral treatment within a prospective trial, if offered by their oncologist. Methods: Metastatic RCC patients seen at a single institution as outpatient clinic between April and May 2018, were offered to take part in an anonymous feasibility questionnaire. Questions included current treatment status for RCC, gender, height, and weight and explored (a) self diet restriction practices and (b) willingness to take part in trial(s) that would evaluate various diet interventions: fasting, ketogenic, vegetarian or vegan diets (each of them being explained). The proposed diet intervention was supposed to be for a minimum of 3 months. Results: Overall, 119 patients filled out the questionnaire. Median age was 61,5 years, 79(66.3%) were under systemic treatment. At time of data collection, 7.5% patients reported ketogenic diet practices, 0.9% fasting, none vegan or vegetarian diet. Regarding willingness to take part in “diet therapeutic trials”, 42.0% of patients claimed to agree to participate in a ketogenic diet trial, 29.4% of patients would agree to take part in a trial exploring fasting, 28.5% a vegetarian diet trial, and 14.2% of patients a vegan diet trial. No link between being under treatment and willingness to participate in trial was observed (p = 0.365). Conclusions: For the first time, we report feasibility of diet intervention within an homogenous population of patients with RCC. Almost half of patients are really keen in participating, with more interest for ketogenic diet and fasting. Such study raises the question of the feasibility of such trials, and obviously would make randomized trials very challenging.
Deregulation and Potential Therapeutic Targeting of the Nf-Kappa B Pathway in High-Grade Childhood Brain Tumors
Authors: D.G. van Vuurden, E. Hulleman, P.M. van der Stoop, R. Gupta, L.E. Wedekind, C. Badr, D.H. Meijer, D.P. Noske, T. Würdinger, G.J.L. Kaspers, J. Cloos
Journal: Neuro-Oncology (2010)
Feasibility of lung cancer prediction from low-dose CT scan and smoking factors using causal models
Authors: Vineet K Raghu, Wei Zhao, Jiantao Pu, Joseph K Leader, Renwei Wang, James Herman, Jian-Min Yuan, Panayiotis V Benos, David O Wilson
Journal: Thorax (2019)

Low-dose CT (LDCT) is currently used in lung cancer screening of high-risk populations for early lung cancer diagnosis. However, 96% of individuals with detected nodules are false positives.In order to develop an efficient early lung cancer predictor from clinical, demographic and LDCT features, we studied a total of 218 subjects with lung cancer or benign nodules. Probabilistic graphical models (PGMs) were used to integrate demographics, clinical data and LDCT features from 92 subjects (training cohort) from the Pittsburgh Lung Screening Study cohort.Learnt PGMs identified three variables directly (causally) linked to malignant nodules and the largest benign nodule and used them to build the Lung Cancer Causal Model (LCCM), which was validated in a separate cohort of 126 subjects. Nodule and vessel numbers and years since the subject quit smoking were sufficient to discriminate malignant from benign nodules. Comparison with existing predictors in the training and validation cohorts showed that (1) incorporating LDCT scan features greatly enhances predictive accuracy; and (2) LCCM improves cancer detection over existing methods, including the Brock parsimonious model (p<0.001). Notably, the number of surrounding vessels, a feature not previously used in predictive models, significantly improves predictive efficiency. Based on the validation cohort results, LCCM is able to identify 30% of the benign nodules without risk of misclassifying cancer nodules.LCCM shows promise as a lung cancer predictor as it is significantly improved over existing models. Validated in a larger, prospective study, it may help reduce unnecessary follow-up visits and procedures.
Abstract P169: The Impact of Perceived Cardiovascular Risk on Cardiovascular Prevention Behaviors in People Living With HIV
Authors: Allison R Webel, Jackson Currie, Christine Horvat Davey, Julie Schexnayder, Hamed Al Battashi, Christopher Longenecker
Journal: Circulation (2019)

Objective: To examine whether HIV status influences knowledge, beliefs and perception of risk for cardiovascular disease (CVD) and how this influences CVD prevention behaviors (exercise, diet, and adherence to preventative CVD drug therapy). Methods: We conducted a cross-sectional study of HIV infected and demographically similar uninfected adults ≥ 30 years of age. Participants completed a self-reported survey on CVD risk perceptions, a self-reported CVD medication adherence survey, and three dietary intake interviews to assess overall diet quality. All wore an ActiGraph accelerometer for 7-10 days to measure physical activity. Wilcoxon rank-sum and t -tests were used to analyze the differences between groups and multiple linear regression was used to analyze the extent to which perceptions were associated with CVD prevention behaviors. Findings: Overall, 191 (105 HIV-infected and 86 HIV-uninfected) persons participated. Participants were on average 54 years old, 58% male, and 81% African American without difference by group (all p &gt;0.05). People living with HIV (PLHIV) engaged in significantly less moderate-to-vigorous physical activity (median 0 vs 34 minutes per week, p =0.006). However, participants had similar, but poor, overall diet quality (overall Healthy Eating Index score 45.14), and similar smoking rates (56.5%), statin use (51%) and blood pressure medication use (50%; p for all comparison &gt;0.05). PLHIV reported significantly better adherence to CVD prevention medications (94 vs 68%, p &lt;0.001). There were no differences in perceived CVD risk between the two groups ( p &gt;0.05). In age and sex-adjusted models, HIV status was positively associated with medication adherence ( p &lt;0.001), and the interaction of HIV status and perceived severity of CVD were inversely associated with physical activity ( p &lt;0.05). Conclusion: Overall, PLHIV were more likely to adhere to CVD prevention medications than well-matched HIV-uninfected adults and less likely to engage in moderate-to-vigorous physical activity in this study. However, this difference in physical activity is attenuated among those who perceive higher risk from CVD. Interventions targeting perceived CVD susceptibility and severity may help to increase physical activity in this population.
Abstract 17347: The Blood Triglyceride Level in Adolescence is Positively Associated With Nonalcoholic Fatty Liver Disease in Adulthood: The Kangwha Study
Authors: Jung Hyun Lee, Su Jin Lee, Yong-Woo Jeon, Hyeon Chang Kim, Il Suh
Journal: Circulation (2018)

Introduction: Several studies have examined the association between blood lipids levels and fatty liver. However, there have been few longitudinal studies regarding the association between lipids level in adolescence and nonalcoholic fatty liver disease in adulthood. Hypothesis: We assessed the hypothesis that blood lipids level in adolescence is associated with nonalcoholic fatty liver in adulthood. Methods: The Kangwha Study was a community-based prospective cohort study that started in 1986 in Kangwha County. A total of 269 participants (148 men; 121 women) were enrolled in our study after excluding heavy drinkers in adulthood, where their blood fasting total cholesterol, triglyceride, and high density lipoprotein (HDL) cholesterol level were measured at least once during adolescence (1992-1996), and the fatty liver was assessed by computed tomography (CT) scan in adulthood (2014-2017). A fatty liver was defined as a liver with values, at least, equal to or larger than 10 of difference between hounsfield unit (HU) of spleen and HU of liver, by measuring CT scan images at L1 vertebral level. For evaluating the association between lipids level at adolescence and fatty liver in adulthood, we used multiple logistic regressions. The fitness of models was evaluated by Hosmer and Lemeshow test. Results: The presence of fatty liver in adulthood was 5.6% (15 of 269). Mean age of study participants at enrollment is 13.9 years (SD, 1.6 years), and that in adulthood is 36.1 years (SD, 0.8 years). When adjusted for age, sex, body mass index, and blood pressure in adolescence, the adjusted odds ratio (aOR) of total cholesterol was 0.83 for 10 mg/dl increment (95% confidence interval (CI), 0.63-1.11), that of triglyceride was 1.17 for 10 mg/dl increment (95% CI, 1.02-1.35), and that of HDL cholesterol was 1.77 for 10 mg/dl increment (95% CI, 0.78-4.01). Our model satisfied the goodness of fit (p=0.75). Conclusions: In conclusion, the blood triglyceride level in adolescence is positively associated with nonalcoholic fatty liver disease in adulthood, but blood total and HDL cholesterol level is not. The results of our study supported the usefulness of lipid measurements in adolescence.
Abstract MP28: Early Menopause is Associated With Early-Onset Cardiovascular Disease Before Age of 60 Years
Authors: Dongshan Zhu, Hsin-Fang Chung, Nirmala Pandeya, Annette Dobson, Gita Mishra
Journal: Circulation (2019)

Introduction: Evidence has shown that early menopause is linked to higher risk of cardiovascular disease (CVD) in women. A prevailing view is that endogenous estrogen may confer protection against heart disease, so the reduction of endogenous estrogen at menopause triggers vascular ageing and accelerate the progression of coronary heart disease (CHD). Hypothesis: If estrogen protection against coronary heart disease is true, we hypothesized that earlier menopause might also lead to earlier onset of CVD, and years of exposure to low estrogen level after menopause may play a role. The higher risk of CVD with early menopause might be driven by a longer duration experienced after menopause. Methods: A total of 151 951 naturally postmenopausal women without experiencing CVD and had no use of menopause hormone therapy (MHT) before menopause were included. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the associations between age at natural menopause and subsequent incident CVD events (binominal model), as well as age at onset of CVD (multinomial model). Age at menopause was categorized as &lt;40 (premature), 40-44 (early), 45-49, 50-51 (reference), 52-53, and 54 years and above. Age at onset of CVD (defined as the first occurrence of CHD or stroke, and validated by hospital record of diagnosis) was grouped as &lt;60, 60-64, 65-69, ≥70 years and no CVD (reference). We also examined how the associations changed with number of years experienced after menopause (categorized as &lt;5, 5-9, 10-14, 15-19, and ≥20 years). All ORs were adjusted for age at last follow-up, race/ethnicity, education level, body mass index, smoking status, hypertension status, and MHT status after menopause. Results: There were 6042 CVD events reported, including 4232 CHD and 2075 strokes. 1.7% and 6.5% of women experienced premature and early menopause respectively. Women who experienced premature or early menopause or menopause at 45-49 years had increased odds of experiencing incident CVD events compared with menopause at 50-51 years, with adjusted ORs (95% CI) of 1.86 (1.26, 2.75), 1.62 (1.31, 2.00) and 1.25 (1.10, 1.41) respectively. Women with early menopause (&lt;45 years) had the highest likelihood of experiencing incident CVD before the age of 60 years (OR 2.20, 1.85-2.63), and the odds was attenuated to 1.30 (1.18-1.44) for onset of CVD at 60-64 years. Similar results were found when CHD and stroke were analyzed separately. The elevated odds of incident CVD in women with early menopause did not appear until 15 years after menopause. Conclusions: Premature and early menopause were significantly associated with higher odds of experiencing incident CVD, and were strongly associated with early-onset CVD before the age of 60 years. The elevated odds of incident CVD in women with early menopause did not appear until 15 years after menopause.
Time to biochemical and radiographic progression in patients treated with adenovirus-PSA vaccine for non-metastatic/early metastatic castrate-resistant prostate cancer: Phase 2 trial results.
Authors: Daniel A. Vaena, Kenneth Gerard Nepple, James A. Brown, Karen Griffith, Pamela Zehr, David Lubaroff
Journal: Journal of Clinical Oncology (2015)

e16132 Background: AdPSA is an investigational replication-deficient adenovirus-based PSA vaccine. A prior phase I trial in patients with metastatic castrate-resistant prostate cancer (CRPC) showed safety and ability to generate immune responses. A phase II trial in early CRPC has completed accrual. Methods: Eligible patients were required to have CRPC defined as rising serum PSA level at 3 occasions despite ongoing androgen deprivation therapy. Patients with no metastases could have any serum PSA or PSA doubling time, while those with metastases were eligible if they were asymptomatic with a PSA doubling time greater than 6 months and a serum PSA less than 10 ng/ml. The treatment plan consisted of 3 separate monthly AdPSA injections. Androgen deprivation therapy was continued. The AdPSA vaccine dose was 10E8 PFU diluted in Gelfoam matrix. Patients were required to have bone scans at 3, 6, 12 months and then annually. If abnormal at entry, CT scans were also performed at 6 and 12 months and then annually. Time to biochemical progression (TTbP) was defined as time to PSA rise of 25% above nadir/baseline plus 2 ng/ml. Time to radiographic progression (TTrP) was defined as time to development of 2 new lesions on bone scan or new lesions/RECIST progression on CT. The clinical trial was IRB approved and all patients signed informed consent. Results: 33 patients (pts) were registered. One pt did not initiate therapy and was excluded from the analysis. Median age was 73 yrs (53-85). Median baseline serum PSA was 1.1 (0.16-16.7). The majority of pts had non-metastatic CRPC at baseline. The median duration of follow-up is currently 31 months (1-67) and 25 pts were alive at last follow-up. At this time 7 pts have not progressed (max.f/u 46 mo); 6 pts have only progressed biochemically (TTbP range 3-45 mo); and 18 pts had radiographic progression. Median TTrP was 7.5 months (3-49). 1 pt was not evaluable for progression. Conclusions: A significant proportion of men receiving AdPSA vaccine had prolonged metastasis-free survival. Further analysis of radiographic PFS and TTrP subsets by PSADT cohorts post-vaccine therapy is ongoing. Clinical trial information: NCT00583024.
Healthcare resource utilization and cost considerations in patients with soft tissue sarcoma treated with chemotherapy.
Authors: Chris M. Kozma, Terra L Slaton, R. Scott McKenzie
Journal: Journal of Clinical Oncology (2015)

6537 Background: Locally advanced or metastatic soft tissue sarcoma(STS) is frequently treated with chemotherapy when symptoms develop. Healthcare resource use(HRU) and cost in patients(pts) with STS have not been widely reported. This study provides real world evidence on HRU and costs associated with initiation of STS chemotherapy. Methods: Adult patients whose first claim for STS chemotherapy (doxorubicin, gemcitabine, docetaxel, ifosfamide, cyclophosphamide, paclitaxel, dacarbazine, temozolomide, pazopanib, methotrexate, epirubicin, vinorelbine, vinblastine, vincristine) within 90 days of a STS diagnosis were identified in a 2005-2013 U.S. healthcare claims database. Patients had ≥ 12 months continuous enrollment before and six months after the index date (chemotherapy initiation). STS chemotherapy combination regimens were defined as all STS therapies within 90 days of index date. HRU costs were evaluated for the six months following index date. Results: This analysis identified 1206 STS patients. Mean (SD) age was 55 (14) years; 50% were male. Common pre-index comorbidities included hypertension (35%), hyperlipidemia (17%), and diabetes (11%). Doxorubicin-based regimens were reported as initial therapy in 44% of patients and gemcitabine-based regimens in 39%. The mean number of months (SD) a claim for STS therapy was observed during the six month period was 3.6 (1.6) months. The proportion of patients with treatment-related claims included radiation oncology 26%, colony stimulating factors 69%, red blood cell growth factors 21%, red blood cell transfusions 16%. During the observation period, the mean (SD) number of hospitalizations was 1.0 (1.7) and mean number of hospital days was 6.2 (11.0). The overall mean (median) cost was $103,000 ($80,750). Component costs are shown in the table below. Conclusions: This analysis reported HRU and costs in patients with STS in the six months following initiation of chemotherapy. Such information is useful to stakeholders in understanding the management of patients with STS and those with interest in episode of care costs. Hospitalization Outpatient Pharmacy Emergency Room Mean component cost $26,300 $69,100 $6,500 $1,100
Validation and physiological association of changes in magnetic resonance imaging radiomic features in response to androgen deprivation therapy in patients with high-risk prostate cancer.
Authors: Hannah Tharmalingam, William Beasley, Roberto Alonzi, Alan McWilliam, Peter Hoskin, Ananya Choudhury
Journal: Journal of Clinical Oncology (2019)

43 Background: Biochemical response to neoadjuvant androgen deprivation therapy (nADT) predicts relapse-free and overall survival for prostate cancer (PCa). Radiomic features change in response to nADT, showing potential as prognostic imaging biomarkers. Using multi-parametric MRI (mpMRI) before and after nADT, we aim to validate these changes, evaluate reproducibility and assess their association with previously described ADT-induced reductions in quantitative blood flow (BF) and blood volume (BV) imaging parameters. Methods: 20 patients with high-risk PCa received 4 mpMRI scans, 2 pre-nADT and 2 after 3 months therapy. T2-weighted sequences were used to define tumour regions-of-interest (ROI) which were subtracted from the prostate outline to form the benign prostate ROI. Established kinetic models were applied to dynamic contrast susceptibility MR sequences to derive changes in BF and BV in both ROI. Pyradiomics was used to extract homogeneity and energy features from both ROI. A paired student T-test compared feature values pre- and post-nADT. An inter-class correlation coefficient (ICC) calculated using mean values from consecutive scans assessed reproducibility. Feature changes and physiological parameters were correlated using Pearson’s coefficient. Results: In response to nADT, homogeneity and energy values significantly increased in benign prostate (p &lt; 0.001) and decreased in tumour (p &lt; 0.005). Both features exhibited high reproducibility pre- and post-nADT; all ICC ≥0.89. The reduction in tumour homogeneity and energy showed a positive association with the decline in BF and BV induced by ADT; all r 0.69-0.78, all p &lt; 0.001. No correlation was seen in benign prostate. Conclusions: Energy and homogeneity radiomic features in benign and malignant prostate are reproducible and show significant reciprocal change in response to nADT. Validation of these changes and the strong association in tumour with ADT-induced physiological effects confirms their potential as prognostic biomarkers in high-risk PCa.
Frequency of severe complications after ileus management in patients diagnosed with obstructing colorectal cancer and synchronous metastases.
Authors: Jagdeep Singh, Thomas Bachleitner-Hofmann, Patrick Starlinger
Journal: Journal of Clinical Oncology (2015)

e14505 Background: Neoadjuvant chemotherapy followed by resection of disease sites is the treatment of choice for patients diagnosed with metastatic colorectal cancer (mCRC). However, in patients with an obstructing primary tumor, chemotherapy cannot be initiated until symptoms of ileus have resolved. Major complications after ileus management may therefore significantly delay the initiation of chemotherapy. Aim of this retrospective analysis was to assess the frequency of severe complications after ileus management in patients diagnosed with synchronous mCRC at our Institution. Methods: Forty-four patients (17 women, 27 men; median age: 64 years; range: 38 to 87 years) treated between March 2001 and April 2013 were included in the present analysis. The management of ileus and associated complications (graded according to the Clavien-Dindo classification) were evaluated. Complications > grade 2 were considered as major. Results: Ileus management included: resection and anastomosis (21), discontinuity resection (10), colonic stenting (6), diverting stoma (4), palliative bypass surgery (2) and resection and anastomosis with loop ileostomy (1). Importantly, 15 of 44 patients (34%) developed a major complication, including 4 of 6 patients (67%) in the stent group. In patients receiving resection and anastomosis, the anastomotic leak rate was 14% (3/21). The in-hospital mortality was 9% (4/44). Conclusions: While resection and anastomosis was reasonably safe, colonic stenting was associated with a major complication rate of 67%. Although we analyzed a small sample size, the incidence of severe complications in the stent group would not allow us to recommend this therapy for ileus management in patients with synchronous mCRC.
Buried lumen-apposing metal stent (LAMS) in esophagogastric anastomosis: the LAMS-in-LAMS rescue treatment
Authors: Sergio Bazaga Pérez de Rozas, Prabhleen Chahal, Ramon Sánchez-Ocaña, Francisco Javier García-Alonso, Ana Yaiza Carbajo, Carlos de la Serna-Higuera, Pérez-Miranda Manuel
Journal: Endoscopy (2019)

A 61-year-old man presented with progressive dysphagia and post-prandial vomiting 1 year after undergoing an esophagogastric anastomosis for adenocarcinoma of the gastroesophageal junction. Upper gastrointestinal endoscopy revealed a high grade, anastomotic stricture (1 cm in length) at 25 cm from the incisors, which failed to respond to multiple, serial 15-mm balloon dilation sessions. He subsequently underwent uneventful placement of a lumen-apposing metal stent (LAMS; Axios, 15-mm diameter; Boston Scientific, Marlborough, Massachusetts, USA). This resulted in complete resolution of his symptoms.