tbuckley/cabot-search huggingface dataset:
Perioperative immunomodulation with interferon-alpha in patients with renal cell carcinoma: Early results of a controlled phase II trial
Authors: T. Klatte, A. Ittenson, F. Röhl, M. Ecke, E. P. Allhoff, M. Böhm
Journal: Journal of Clinical Oncology (2006)

14525 Background: Complex perioperative immunodysfunction occurs in patients with renal cell carcinoma undergoing surgery. Earlier, we presented evidence of a survival benefit in patients, who received perioperative immunomodulation with interleukin-2 (JCO 23 (16S):4601, 2005). Here, we report on the effect of interferon-alpha (IFN-α). Methods: Fifty-four consecutive patients, who underwent tumor nephrectomy, were enrolled into this prospective one stage phase II trial from June 2003 to May 2005. Patients were alternately assigned to the two study groups: 27 received immunomodulation with IFN-α (4 doses 9 million IU s.c a week before operation, followed by a daily dose of 3 million IU until a day before the operation), 27 did not. Parameters of immunity (differential blood count, CD3, CD4, CD8, CD16, CD19, CD28, CD56, HLA-DR, VEGF, IL-10) were measured in venous blood before and during IFN-α, one day before and immediately after the operation, and on the 1., 3., 5., and 10. postoperative day. The primary endpoint was tumor-specific survival. T-test, χ 2 -test and the log-rank test were used for statistical analysis. Results: The study groups did not differ with respect to age, sex, tumor stage and grade, histological type, operation time and technique. IFN-α related toxicity was WHO grade 0 (11%), 1 (59%), 2 (26%), and 3 (4%). During IFN-α administration leukocytes, CD19, HLA-DR and VEGF dropped significantly, while no difference was observed in T-cell and NK-cell markers, and IL-10. All patients showed postoperatively elevated leukocyte counts. T-cell and activation markers decreased, but CD3, CD4 and CD28 alterations were significantly less accentuated in patients who had been treated with IFN-α. Median follow-up was 14 months. The 1- and 2-year rates (±SE) of tumor-specific survival were 96% (±4%) and 83% (±12%) in the IFN-α group and 85% (±7%) and 85% (±7%) in the control group, respectively (p = 0.52). Also, no difference was seen in progression-free survival (p = 0.32). Conclusions: In this study with limited follow-up, perioperative IFN-α medication was not associated with a survival benefit, but was well tolerated. Interestingly, the decline in VEGF during administration suggests a role of IFN-α in the inhibition of angiogenesis. No significant financial relationships to disclose.
Getting Social: Physicians Can Counteract Misinformation With an Online Presence
Authors: Rita Rubin
Journal: JAMA (2019)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Abstract 705: Adult Stem Cells and Host Immune Response Synergize to Stimulate Angiogenesis after Myocardial Ischemia
Authors: Jakub Tolar, Elizabeth Braunlin, Abdul M Mansoor, Ron T McElmurry, Christopher J Lees, Lily Xia, Jianyi Zhang, Bruce R Blazar
Journal: Circulation (2007)

Bone marrow derived non-hematopoietic adult stem cells (ASC), termed Multipotent Adult Progenitor Cells, aid healing after myocardial infarction (MI). Remarkably however, host immune system was req...
Effects of prospective review of medical oncology treatment plans (TPs) on quality of care, payer denial, and cost.
Authors: William A. Flood, Erik Yedwab, Evan W. Alley, Paul Gilman, Kevin D. Frick, Arlene A. Forastiere
Journal: Journal of Clinical Oncology (2013)

e17565 Background: Retrospective review of chemotherapy TPs for compliance with expected care presents financial and quality risks to providers, patients and payers. Prospective assessment of TPs before oncology care is delivered may limit these risks. Methods: Through the eviti web-based decision support platform, oncologists/staff submit TPs for review. The eviti Evidence-Based Library incorporates all recognized guidelines (ASCO, NCI, ASTRO, NCCN and others), the supporting literature and NCI registered clinical trials. Evidence-based treatments are approved while unexpected variances are not reported to the payer until medical record review and peer to peer (P2P) discussion when records are insufficient. The eviti data base was queried for all off-study treatment plans submitted by medical oncology providers in a single state from January 2011 through October 2012. The nature of variation, results of P2P discussion and final recommendation to the payer were then determined. Net cost differences between the proposed and expected care were calculated using ASP+6% in November 2012. Results: Of a total of 202 TPs submitted on 116 individual patients, 89 TPs (44%) included 92 unexpected variations of care at initial submission, 11 of which (12%) presented safety issues documented in the peer reviewed literature and guidelines. The total net cost difference for one cycle of the proposed care and expected standard was $304,055. Of these 92 unexpected variations, only 29 (32%) of the variations could not be unjustified and referred for probable denial by the payer. After review of medical records, 21 (23%) were referred to the payer as medical justified variations (MJV), while after P2P 17 (18%) were considered MJV’s and 25 (27%) were modified to fit expected patterns of care. Additional analysis by drug classes and cost will be presented. Conclusions: In this TPs set, prospective review of treatment plans decreased the incidence of non-EBM care, the rate of potential denials, and the cost of care. Prospective TPs review can limit risk to all parties in cancer care.
Safety assessment of trastuzumab diluted in 100 ml of saline in the treatment of HER2-positive breast cancer patients.
Authors: Hajime Abe, Tsuyoshi Mori, Yuki Kawai, Kaori Tomida, Yoshihiro Kubota, Tomoko Umeda, Tohru Tani
Journal: Journal of Clinical Oncology (2013)

e11555 Background: The infusion rate is considered to affect incidence and severity of infusion reaction (IR) caused by infusion of protein formulations. Trastuzumab (TRS) is approved for 90-minute infusion as the initial dose followed by 30-minute infusion with 250 ml saline. We evaluated the safety of TRS intravenously administered over 30minutes with 100 ml saline to reduce burden of patients although safety of infusion with 250 ml saline is established. Methods: Women with HER2 positive breast cancer, ≥18 years and ≥55% left ventricular ejection fraction (LVEF) were registered in the study. Patients received 8mg/kg of TRS 250 ml over 90 minutes diluted in 250 ml saline followed by 6mg/kg of TRS in 100 ml saline over 30 minutes in a three-week cycle. The primary endpoint of this study was the incidence of infusion reactions, and secondary endpoints were as follows: incidence of adverse events and effects on cardiac function. Results: Between June 2011 and June 2012, a total of 31 patients were recruited; 24 for adjuvant therapy and seven with metastases. The median age was 59 years (range, 39 to 82). Hormone receptor was positive in 18 patients (58%). Previous treatment with anthracyclines was reported in seven patients and radiation therapy in fourteen patients. The total number of TRS doses ranged from 5 to 17 with the median of 15. Mild IR occurred in two patients and rash occurred in one patient at the first dose. However, no IR and adverse events were observed after reducing to 100 ml saline. The average LVEF measured every 3 months was between 62.3% and 64.8%. No significant decrease in LVEF was reported with the largest decrease of 8% in one patient at the 12th month on treatment. Conversely, brain natriuretic peptide levels tended to decrease as the number of received doses increased. None of the subgroup analysis (age groups, adjuvant vs. metastatic setting, previous anthracycline treatment, and previous radiotherapy) showed statistical significance. Conclusions: Intravenous infusion of TRS with 100 ml saline over 30 minutes in breast cancer patients is considered safe based on results from the study. The safe treatment with shorter infusion time has benefit for both healthcare professionals and patients. Clinical trial information: UMIN000006710.
Sequence variation at the MTHFD1L-AKAP12 and FOPNL loci does not influence multiple myeloma survival in Sweden
Authors: Mina Ali, Konstantinos Lemonakis, Anna-Karin Wihlborg, Ljupco Veskovski, Ingemar Turesson, Ulf-Henrik Mellqvist, Urban Gullberg, Markus Hansson, Björn Nilsson
Journal: Blood Cancer Journal (2019)
Quality of life and survival in patients receiving chemotherapy for advanced non-small cell lung cancer (NSCLC)
Authors: D. M. St-Pierre, H. Kreisman, G. Kasymjanova, J. S. Agulnik, T. Swanson, C. Pepe, L. Lajeunesse, S. Gagne, E. Dajczman, L. Pereira, D. Small
Journal: Journal of Clinical Oncology (2007)

19649 Background: Quality of life (QoL) is an important endpoint measure in clinical cancer trials. We evaluated prospectively the effects of two cycles of chemotherapy (CT) on QoL and the relationship between QoL and survival in advanced NSCLC patients (pts). Methods: The short-form of the SF36 was completed prior to and after 2 cycles of chemotherapy. An ITT analysis was used; a score of 0 was assigned to those who died and the last observation was carried forward for those with missing data. Results: Fifty-nine pts consented to participate and pre-chemo evaluation was available for 58 pts. Of these 58, only 40 pts completed the study (4 died, 14 did not complete the post evaluation). There were 26M: 32F with a median age of 61±11 years. Fifty pts (86%) were stage 3B (pl. eff)/4 and 50pts (86%) were PS 0–1. Overall QoL decreased significantly from 100±19 to 91±36 after two cycles of chemotherapy (p=0.03). This decline was attributed to a significant decrease in the physical health subscale (p=0.001), with 36% of pts reporting a clinically significant decline of =2. No change in the mental health subscale was observed. The symptoms that had the most profound negative impact on the physical health subscale were: ‘easily get sick’ (54%), ‘increased pain’ (30%) and ‘decreased activities’ (27%). SD+PR occurred in 36 (62%) pts, whereas 22 (38%) pts had PD after two cycles of chemotherapy. No correlation was found between response to chemo and change in QoL. The median survival (15±6.8mo), of pts whose QoL score remained stable or improved (n=36) was significantly better than those (n=22) whose QoL decreased (9±3.2 mo) (p=0.01). Conclusions: QoL decreased following chemotherapy due to a decrease in the physical health subscale. Further studies are required to determine if training can improve physical health and thus QoL and survival. No significant financial relationships to disclose.
Ratios between VEGF ligands and receptors in tumor and stroma have impact on the outcome in resectable NSCLC.
Authors: Eloisa Jantus-Lewintre, Marta Usó, Elena Sanmartin, Sandra Gallach, Rafael Sirera, Ana Blasco, Cristina Hernando, Nieves Martinez, Santiago Figueroa, Enrique Casimiro, Carlos Camps
Journal: Journal of Clinical Oncology (2013)

e22147 Background: In tumor angiogenesis there is a complex interplay between endothelial, stromal and tumor cells. Some key regulators of this process are the members of the vascular endothelial growth factor (VEGF) family of ligands and receptors and the neuropilins (NRP). This study analyzes the correlations between the expression of these angiogenic factors in tumor cells and tumor stroma, and their prognostic role in tissue samples from resected non-small cell lung cancer (NSCLC) patients. Methods: Representative tumor and stroma areas from FFPE tissue samples of 125 early-stage NSCLC patients were carefully micro-dissected. RNA isolated from the samples was retrotranscripted and preamplified. RTqPCR was performed using hydrolysis probes (TaqMan, Applied Biosystems) and relative quantification was calculated using GAPDH and CDKN1B as endogenous controls. Results were normalized against a human cDNA (Clontech) as a reference. All statistical analyses were considered significant at p&lt;0.05. Results: Paired Wilcoxon test revealed differences between tumor and stroma gene expression for VEGFB (p&lt;0.0001), VEGFC (p&lt;0.0001), VEGFR-1 (p&lt;0.0001), VEGFR-2 (p=0.020), VEGFR-3 (p&lt; 0.0001), NRP-1 (p=0.001) and NRP-2 (p&lt; 0.0001). Survival analyses showed that those patients with higher levels of the Ratio Stromal-VEGFA/ Tumoral-VEGFR-2 had worse time to progression (TTP) (median 26.23 months vs NR, p=0.013) and overall survival (OS) (median 29.50 months vs NR, p=0.001). Similarly, those patients with higher levels of the Ratio Stromal-VEGFC/Tumoral-VEGFR-3 had worse TTP (median 23.30 vs 70.53 months, p=0.015) and OS (median 37.20 months vs NR, p=0.023). Conclusions: Our results show significant differences in the expression of VEGF family members between tumor and stromal cells. This may indicate the importance of the tumor-stroma interaction when trying to understand the angiogenic process. Furthermore, the combination of the ligands expression in stroma and their receptors in tumor may have a prognostic value in NSCLC patients. Supported by grants PS09-01149 and RD06/0020/1024 from ISCIII.
Abstract P372: Coronary Angiography Use, Results and Revascularization Trends in Olmsted County, Minnesota, 2000 to 2015
Authors: Yariv L Gerber, Susan Weston, Jill Killian, Matteo Fabbri, Sheila Manemann, Rabea Asleh, Veronique Roger
Journal: Circulation (2018)

Background: A decline in all forms of coronary revascularization has been previously reported. Whether the decline has continued after the turn of the century is unknown as well as whether it is influenced by trends in the use and results of coronary angiography. Methods: All diagnostic and therapeutic coronary procedures performed among Olmsted County, MN residents from 2000-2015 were analyzed. Standardized rates (per 100,000 population) were calculated applying the direct method and temporal trends compared using Poisson regression models. Trends in disease severity, defined as 3-vessel and/or left main coronary artery disease (CAD), were assessed using logistic regression models. Results: Between 2000 and 2015, 11,691 coronary angiographies were performed (63% men; 54% ≥ 65 years of age). The age- and sex-standardized rates of angiography decreased over time (p trend &lt; 0.001; Figure). Overall, 30% of the subjects had 3-vessel and/or left main CAD, and this proportion decreased over time (age- and sex-adjusted odds ratios (95% CI) for severe CAD: 0.68 (0.62-0.76) in 2005-2009 and 0.69 (0.63-0.77) in 2010-2015 compared with 2000-2004). Among 5,222 coronary revascularization procedures performed, 78% were PCI and 22% CABG. The age- and sex-standardized rates of any revascularization declined during the study period, reflecting temporal decreases in both PCI and CABG (all p trend &lt; 0.001; Figure). The declines in angiography rates, CAD severity, and revascularization utilization were consistently greater in women than men (all P for interactions &lt; 0.01). Conclusions: Declines in all forms of coronary revascularization, which were greater in women than men, have occurred in Olmsted County, MN, from 2000-2015. The declines occurred in the context of fewer angiograms performed in the population and reduced severity of anatomic CAD.
Interferon-alpha (INF) and gefitinib or imatinib in patients (pts) with metastatic renal cell carcinoma (RCC)
Authors: J. Jac, Q. Zhai, M. Kareidy, J. Hernandez, L. Marsh, R. J. Amato
Journal: Journal of Clinical Oncology (2006)

14616 Background: Overexpression of EGFR is associated with aggressive clinical behavior in several solid tumors and is frequent in RCC. We recently found that the majority of RCCs express c-kit and PDGFR-beta. EGFR tyrosine kinase (TK) is inhibited by GEF, while IM is an inhibitor of Bcr-Abl, c-kit and PDGFR TKs. IFN has activity in MRCC and is used in front-line therapy. This trial evaluates time to progression (TTP) determined from time of study entry and response rate of INF in combination with GEF or IM, as well as tumor expression of c-kit and EGFR-beta. Methods: Pts with MRCC were assigned to a treatment arm: IFN/GEF or IFN/IM. Eligibility included: MRCC, any previous therapy, PS ≤2, adequate organ/marrow function and no active CNS involvement. Pts received IFN 3MU subcutaneously TIW on week 1, then 6MU TIW thereafter. GEF dose is 500 mg and IM 600 mg daily. Tumor response is assessed using RECIST every 12 weeks. Results: 16 MRCC pts (12 M/4 F) with a median age of 58 (24–77) have been enrolled. Histology: 6 papillary, 7 clear cell, 1 chromophobe, 1 collecting duct and 1 unclassified. 14 pts received IFN/GEF and 4 pts IFN/IM. Two pts crossed over from IFN/IM to IFN/GEF. Of 14 pts on IFN/GEF, 3 demonstrated a partial response (PR) and 7 had stable disease at 12 weeks. Of 6 papillary, 3 had PR. 8 pts progressed on IFN/GEF at a median of 20 weeks (1–36). 4 pts are still on treatment. On IFN/IM, 3 pts had stable disease at 12 weeks, 2 at 24. 2 pts progressed at 4 and 14 weeks, two crossed over to GEF at 24 weeks. Adverse events of IFN/GEF included skin rash and diarrhea and of IFN/IM skin rash, thrombocytopenia and leukopenia. Both arms had flu-like symptoms and fatigue. Conclusions: IFN/GEF and IFN/IM combinations are well tolerated. Preliminary results show the potential of delaying TTP in pts with MRCC. The observed high tumor response rate of the papillary type to IFN/GEF requires validation in a larger number of pts. Enrollment is ongoing. Updated response data and tissue correlates will be presented. [Table: see text]
Chronic kidney diseases in agricultural communities: report from a workshop
Authors: Susan R. Mendley, Adeera Levin, Ricardo Correa-Rotter, Bonnie R. Joubert, Elizabeth A. Whelan, Brian Curwin, Erik H. Koritzinsky, Denise M. Gaughan, Paul L. Kimmel, Shuchi Anand, Pedro Ordunez, Ludovic Reveiz, Diane S. Rohlman, Madeleine K. Scammell, Robert O. Wright, Robert A. Star
Journal: Kidney International (2019)
Treatment patterns of pediatric patients with atopic dermatitis: A claims data analysis
Authors: Amy S. Paller, Elaine C. Siegfried, Francis Vekeman, Abhijit Gadkari, Mandeep Kaur, Usha G. Mallya, Julie Héroux, Raymond Miao, Paola Mina-Osorio
Journal: Journal of the American Academy of Dermatology (2019)

Real-world evidence on treatment patterns of pediatric patients with atopic dermatitis (AD) is sparse.To assess current treatment patterns in pediatric AD patients.Retrospective observational analysis of commercial insurance and Medicaid administrative claims data (January 2011-December 2016) for pediatric AD patients, stratified by age and provider type.The analytic sample comprised 607,258 pediatric AD patients. Median observation period was 30.3 months. Overall, 78.6% were prescribed ≥1 AD medication; 86.7% were prescribed topical corticosteroids, and 5.4% were prescribed a calcineurin inhibitor. Systemic corticosteroids (SCSs) were prescribed for 24.4% of patients, 51.8% of whom did not have asthma or allergic comorbidities. Of the 46.6% prescribed an antihistamine and 16.2% prescribed montelukast, 62.0% and 41.3%, respectively, did not have asthma or allergic comorbidities. Systemic immunosuppressants were rarely prescribed (<0.5%). Higher potency topical corticosteroid and SCS use increased with age. Treatment patterns varied by provider type; specialists were more likely to prescribe higher potency topicals and/or systemics, regardless of patient age. A minority of patients were treated by or referred to a specialist.Identification of AD patients relied on billing diagnoses; the disease severity was proxied by the treatment prescribed.Results indicate that SCSs, despite known risks, and other medications with disproven efficacy in AD are frequently prescribed, suggesting a need for safer and more effective alternatives.
A closer look at the number of lymph nodes examined in colorectal cancer: A VAMC experience
Authors: J. M. Kovar, H. X. Bui, J. P. Reynolds, H. Al-Ghawi, G. Luo, N. Abdel Karim, S. Samaan, A. Mehta, M. Molloy
Journal: Journal of Clinical Oncology (2009)

e15117 Background: Retrieval of 12 lymph nodes (LN) is a current benchmark in colorectal cancer (CRC) resections according to the National Quality Forum (NQF). Series of multiple institutions contain variability in surgical and pathologic techniques for lymph node retrieval. To ensure consistency in retrieving lymph nodes for satisfactory staging, we present a 12 year experience by a single surgeon and single pathology lab at one VAMC on 157 patients (mean age 67) undergoing CRC resection. Furthermore, the use of chemotherapy for Stage II patients &lt;12 LN retrieved is controversial and yields only a small survival benefit. Methods: The records of 157 patients from one surgeon's case log from 1994–2007 were reviewed. Strict guidelines were applied to remove the same distribution of pericolonic fat. The lab followed a two step approach to LN dissection: Step 1 search for grossly identifiable LN; Step 2 overnight Carnoy's immersion to find smaller LN. Statview and SAS software analyzed 1)Overall survival (OS) and association with finding &gt;12LN; 2)Number of LN identified and impact on AJCC tumor stage (TS) and overall survival; 3)Number of LN and WHO tumor grade (TG) with OS; 4)The impact of number of positive LN on OS. Results: Our mean LN found (14.75) is higher than the 12 recommended by the NQF and is not significantly associated with OS regardless of AJCC TS(p=0.06). The mean LN per TS was I=13.4(N=41)/II=16.3(N=56)/ III=14.3(N=38)/IV 14.2(N=22). Number of LN identified was not statistically significant in predicting TS(p=0.42) or OS(p=0.24). WHO TG is significantly associated to decreased OS, but only in AJCC TS II/III/IV and not stage I (Ip&gt;0.05/IIp=0.008/ IIIp=0.01/IVp=0.025). Higher number of positive LN was associated with lower OS (per each +LN, survival decreases by 0.15 months p=0.001) Conclusions: Contrary to multicenter studies, total number of LN identified does not impact AJCC TS or OS. Higher WHO TG and higher number of positive LN is associated with worse OS. This suggests that the tumor biology is more indicative of OS rather than host response (reactive lymphoid tissue) to the tumor. Stage II patients &lt;12 LN may not be ‘high risk’ and adjuvant chemotherapy based on this factor alone should be reconsidered. Further studies would be warranted. No significant financial relationships to disclose.