tbuckley/cabot-search huggingface dataset:
Magnetic marking clip for easier laparoscopic localization of small gastrointestinal tumors.
Authors: Sang Hoon Kim, Bora Keum, Han Jo Jeon, Se Hyun Jang, Kang Won Lee, Sanghyun Kim, Seong ji Choi, Jae Min Lee, Hyuk Soon Choi, Eun Sun Kim, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Chang Duck Kim
Journal: Journal of Clinical Oncology (2020)

386 Background: Laparoscopic surgery for gastrointestinal tumors requires fast and precise tumor localization. As tumor palpation is not possible during laparoscopic surgery, tumor identification is often difficult for some cases. Despite various methods, such as tattooing or endo-clipping, have been introduced for the localization of tumors, these methods own clear limitations. To overcome the drawbacks of these conventional marking methods, we designed a magnetic marking device linked to an endo-clip(MMC, Magnetic Marking Clip) for endoscopy. We performed preoperative endoscopic clipping with MMC and analyzed the intraoperative localization efficacy and safety during laparoscopic surgery. Methods: Study enrolled 30 patients with gastric and colorectal neoplasms scheduled to undergo endoscopic clipping before laparoscopic surgery at the Korea University Medical Center, Korea, between August 2017 and June 2019. A silicone-coated high-power neodymium marking device (ring or rod type) was fixed together with an endo-clip and applied on the center of the lesion during preoperative endoscopy. During laparoscopic surgery, a detecting magnetic body was inserted through a laparoscopic trocar and was used to localize the tumor that is marked with MMC. The time needed for endoscopists to place MMC at the lesion, laparoscopic clip detection time and success rate were studied. Results: Endoscopists placed MMC within 30 seconds. It was possible to find MMC in all cases of laparoscopic surgery. Time needed to find the MMC laparoscopically was relatively shorter than the time conventionally taken just with an endo-clip itself. There was no reported dislodgement of the clip before the surgery or any other adverse events associated with the MMC procedure. Conclusions: The MMC method enabled simple and fast tumor localization and showed excellent outcomes in efficacy of tumor localization. The MMC method may help surgeons localize GI tumor lesions easily and safely during laparoscopic surgery.
Patient-Clinician Communication Issues in Palliative Care for Patients With Advanced Cancer
Authors: Anthony L. Back
Journal: Journal of Clinical Oncology (2020)

The delivery of palliative care to patients with advanced cancer and their families, whether done by oncology clinicians or palliative care clinicians, requires patient-centered communication. Excellent communication can introduce patients and families to palliative care in a nonthreatening way, build patient trust, enable symptom control, strengthen coping, and guide decision making. This review covers deficiencies in the current state of communication, patient preferences for communication about palliative care topics, best practices for communication, and the roles of education and system intervention. Communication is a two-way, relational process that is influenced by context, culture, words, and gestures, and it is one of the most important ways that clinicians influence the quality of medical care that patients and their families receive.
Symptom Severity, Mood, and Healthcare Use Are Associated With Satisfaction in Patients With Irritable Bowel Syndrome
Authors: Prashant Singh, Sarah Ballou, Jesse Katon, Eve Takazawa, Vikram Rangan, Rupa Mukherjee, Johanna Iturrino, Judy Nee, Anthony Lembo
Journal: Clinical Gastroenterology and Hepatology (2020)
First results for Australasian Gastrointestinal Trials Group (AGITG) control net study: Phase II study of 177Lu-octreotate peptide receptor radionuclide therapy (LuTate PRRT) +/- capecitabine, temozolomide (CAPTEM) for midgut neuroendocrine tumors (mNETs).
Authors: Nick Pavlakis, David Turner Ransom, David Wyld, Katrin Marie Sjoquist, Rebecca Asher, Val Gebski, Kate Wilson, Andrew Ddembe Kiberu, Matthew E. Burge, William Macdonald, Paul Roach, David A Pattison, Patrick Butler, Timothy Jay Price, Michael Michael, Benjamin James Lawrence, Dale L. Bailey, John Charles Leyden, John Raymond Zalcberg, J. Harvey Turner
Journal: Journal of Clinical Oncology (2020)

604 Background: Single agent 177Lu-octreotate peptide receptor radionuclide therapy is now a standard of care for progressive mNETS. High activity was seen with LuTate and concurrent CAPTEM chemotherapy in a single arm Phase I/II trial. This study was undertaken to determine the relative activity of adding CAPTEM to LuTate PRRT in patients with mNETs. Methods: Non-comparative randomised open label phase II trial of PRRT +/- CAPTEM in patients with mNETs, with 2:1 randomisation: PRRT /CAPTEM (experimental arm) vs. PRRT (control). PRRT /CAPTEM: 7.8GBq LuTate day(D) 10, 8 weekly (wkly) x 4, with b.i.d. oral CAP 750mg/m 2 D1-14 &amp; TEM 75mg/m 2 D10-14, 8 wkly x 4, vs. PRRT 8 wkly x 4. Primary endpoint: progression free survival (PFS) at 15 months assuming 15 month PFS of 66.4% in the control arm, aiming for PFS rate &gt; 80%; secondary endpoints: objective tumour response rate (complete or partial response) (OTRR), clinical benefit rate (complete or partial response, stable disease) (CBR), toxicity, and QOL. Results: 47 patients enrolled (Dec 2015 - Feb 2018): 33 PRRT/CAPTEM and 14 PRRT. Two patients withdrew prior to treatment. Patient characteristics were balanced except gender (female 58% vs. 14%). Two patients received 2 prior systemic regimens. After a median follow-up of 32 months, the 15 month PFS was 90% (95% CI: 73-97%) v 92% (95% CI: 57-99%); OTRR 25% vs 15%; and CBR 97% vs 92% for PRRT/CAPTEM v PRRT respectively. For treatment related adverse events 22/32 CAPTEM patients experienced one Grade 3 event (69%) vs 5/13 (38%, PRRT); 4/32 pts experienced one Grade 4 event (13%) v 1/13 (8%) respectively. Only one patient failed to complete therapy due to toxicity (PRRT/CAPTEM). Conclusions: This initial planned analysis demonstrates similarly high 15 month PFS for CAPTEM/PRRT relative to PRRT alone. OTRR is numerically higher but at the cost of greater toxicity. Longer follow up is required to determine if the activity of PRRT/CAPTEM is sufficient to warrant Phase III evaluation. Clinical trial information: ACTRN12615000909527.
Impact of gastric cancer treatment pathways on patient outcomes in a community oncology practice setting.
Authors: Andrew Scott Paulson, Lisa M. Hess, Bismark Baidoo, Curtis Waycaster, Anindya Chatterjee, Astra M. Liepa
Journal: Journal of Clinical Oncology (2020)

299 Background: Gastric cancer (GC, including gastroesophageal junction adenocarcinoma) pathways have been implemented and refined since 2010 in the US Oncology Network (USON), a community-practice-based network. This study was designed to evaluate the impact of 4 pathway periods (PP): pre-pathway: pre-Aug ‘10; Level 1: Sept ‘10-Nov ‘14; Clear Value, Dec ‘14-Feb ‘17; Value: After Mar ‘17, on treatment heterogeneity, treatment duration, and overall survival (OS). Methods: Adult patients were eligible if they were treated at a participating USON site and were diagnosed with and treated for GC; follow up was through Mar 2019. Heterogeneity was measured by the Herfindahl-Hirschman Index (HHI), which is evaluated from 0.0 to 1.0 (complete to no heterogeneity). Time to treatment failure (TTF) was defined as initiation of the line of therapy until start of the subsequent line of therapy or death. OS was estimated from start of first-line (1L) therapy. Time-to-event outcomes were estimated using Kaplan-Meier. Results: Of 3191 eligible patients, 2297 received treatment for advanced/metastatic disease. Of these, patient median age was 65.3 years, 60% were male, 70% were initially diagnosed with stage IV disease. Pre-pathway, common 1L regimens were single-agent fluorouracil (15%) and docetaxel-cisplatin-fluorouracil (14%); FOLFOX (45%) was most frequent during the value PP, 941 (41%) received second-line (2L) therapy. During Level 1 PP, single-agent irinotecan (11%) was most common during 2L, whereas in Value PP, ramucirumab+paclitaxel (43%) was most common. HHI and TTF are presented in the table. Median OS was 12.6 months (95% confidence interval, CI: 11.9, 13.5), which did not change significantly over PPs. Conclusions: 1L and 2L heterogeneity was initially high, and was reduced over time; TTF showed modest increase. OS data are limited by high levels of censoring in the latter PPs, which reduces the ability to evaluate changes in more recent years. [Table: see text]
Abstract 17255: Standard 12-Lead Electrocardiogram Can Predict Diffuse Myocardial Fibrosis in Patients With Atrial Fibrillation
Authors: Dragana Rujic, Saman Nazarian, Per L Madsen, Benoit Desjardins, Ling Kuo, Claus Graff, Manan Pareek, Tina Hansen, Kenneth Egstrup
Journal: Circulation (2018)

Background: The pathophysiology of atrial fibrillation (AF) involves a continuum of myocardial remodeling with increased diffuse fibrosis. Purpose: To examine whether the extent of diffuse fibrosis in the left atrium (LA) and left ventricle (LV), evaluated using the surrogate marker, post-contrast T1 myocardial relaxation time on cardiac magnetic resonance imaging (CMR), in patients with paroxysmal and persistent AF is associated with ECG markers obtained during sinus rhythm. Methods: This is a prespecified secondary analysis from the randomized controlled trial INSPIRE-AF (n=95) (ClinicalTrials.gov NCT02764619). Patients with paroxysmal and persistent AF underwent CMR. Post-contrast T1 times were quantified in 47 paroxysmal AF (mean age, 63 ±8 years), and 43 persistent AF (mean age, 54 ±7 years) patients using a previously validated modified look-locker inversion-recovery sequence. Standard resting 12-lead ECGs were analyzed using commercially available software. Results: Baseline characteristics were generally similarly distributed between AF groups. Mean LA T1 time was 492 +/- 72 ms and mean LV T1 time was 494 +/- 49 ms. P-wave area, P-wave terminal force, PR-interval, P-wave peak amplitude, and P-wave duration were unassociated with LA T1 time, and no significant interactions with AF type were detected. Similarly, neither R-wave duration, corrected QT interval (Bazett’s formula), nor QRS duration were associated with LV T1 time. P-wave terminal force in lead V1 did not differ between groups of investigation, but the joint mean value of -0.04 mm/s in the two groups is prominently different from normal controls. AF type significantly interacted with the association between R-wave duration and T1 time (P=0.03 for interaction), and between QRS duration and T1 time (P=0.009 for interaction). Specifically, R-wave duration and QRS duration were only significantly associated with T1 time among patients with persistent AF. Conclusions: Diffuse fibrosis in the LV, defined as post-contrast T1 time, was associated with R-wave duration and QRS duration in patients with persistent AF. Our findings suggest that surface 12-lead ECG obtained in sinus rhythm could provide predictive information regarding diffuse myocardial fibrosis.
Retrospective analysis of institutional outcomes with FOLFIRINOX versus nab-paclitaxel plus gemcitabine in metastatic pancreatic cancer.
Authors: Amisha Singh, Rachna T. Shroff, Ali McBride
Journal: Journal of Clinical Oncology (2020)

776 Background: With an estimated six percent five-year survival, metastatic pancreatic adenocarcinoma is one of the most lethal cancers in the United States. Previously, treatments with FOLFIRINOX (FFX) or gemcitabine plus nab-paclitaxel (G+A) have demonstrated improved overall survival versus gemcitabine alone. The purpose of this study is to compare institutional outcomes for the two regimens, FFX vs. G+A in metastatic pancreatic cancer. Methods: We conducted a retrospective review of medical records of all metastatic pancreatic cancer patients from 2010 to 2018 who received first line treatment with FFX or G+A at University of Arizona Cancer Center. Results: Thirty-five patients received combination treatment with G+A and 29 patients received FFX. Patient demographics: median age was 66 years in FFX vs 70 years in the G+A group; baseline CA-19-9 was 791 in FFX vs 738 in the G+A group. Median ECOG score was 1 for both groups. Median overall survival was 11.5 months in the FFX group (range 0-39 mos) vs 5 months in the G+A group (range 0-37 mos). Overall survival at 6 months was 75.9% vs 51.4% in FFX vs G+A groups respectively. Median progression-free survival was 6 months with FFX (range 0-25 mos) and 3 months with G+A (range 0-24 mos). Twenty-one of 29 patients in the FFX group pursued second line treatment, compared to 12 of 35 patients in the G+A group. Time to next treatment was 6 months in the FFX group vs 5 months in the G+A group. More adverse effects were noted with FFX, the most common being neuropathy and neutropenia, leading to treatment discontinuation due to adverse effects in 31% of patients, compared to 3% of patients in the G+A group. FFX patients required a higher median no. of office visits (35 visits vs 18 visits in the G+A group). Conclusions: FFX showed improved progression-free survival vs G+A; however, this could be due to more patients pursuing second line treatment in the FFX group. Compared to G+A, FFX patients had higher rates of treatment discontinuation due to adverse effects. FFX patients also required more office visits and further analysis is necessary to assess whether this resulted in poorer quality of life and increased total cost of care for patients treated with FFX.
Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study
Authors: Hiroshi Gotanda, Ashish K Jha, Gerald F Kominski, Yusuke Tsugawa
Journal: BMJ (2020)

To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17).Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions.United States.A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey.Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons.37 819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change -28.0% (95% confidence interval -38.4% to -15.8%); adjusted absolute change -$122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (-29.0% (-40.5% to -15.3%); -$442; adjusted P<0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change -4.7 (-7.9 to -1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions.Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act's implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults.
Adjuvant chemotherapy (AC) for stage III colorectal cancer (CRC) in the elderly: An Irish experience.
Authors: Emily Harrold, Megan Greally, Niamh Peters, Jane Sze Yin Sui, John McCaffrey
Journal: Journal of Clinical Oncology (2020)

54 Background: Since 2004 6 months of adjuvant Oxaliplatin containing regimens (OCR) has been standard of care for Stage III CRC despite cumulative neurotoxicity. The IDEA collaboration evaluated 3 versus 6 months of OCR in high/low risk pts with regard to peripheral neuropathy (PN) and efficacy.The median pt age was 64; individual studies included pts ≤85. Methods: This study is part of a retrospective review of the clinicopathological records of consecutive CRC pts referred to the multi-disciplinary CRC team at an Irish tertiary referral centre from 2002-2018. We recorded pt characteristics, Rx received and outcomes. Overall Survival (OS) was assessed using Kaplan-Meier analysis. Results: 869 pts were identified; 37% (328) female. 63% (551/869) &lt; 70 and 37% (318/869) ≥ 70. Median OS for &lt; 70 cohort was 31.5 months versus 19 months in ≥ 70 cohort (p &lt; 0.0001).Stage distribution in &lt; 70: ≥70 cohorts was Stage II 14%( 79/551):20% (63/318), Stage III 47% (260/55):46% (142/318) and Stage IV 38% (207/551):34% (111/318). In &lt; 70 Stage III cohort 7% (37/551) pts received no AC, 42%(230/551) received FOLFOX, 3%(16/551) received FLOX or XELOX, 7%(38/551) received 5FU/LEU. 32%(78/246) of pts &lt; 70 developed PN with persistence at 6 months in 18%(44/256). In ≥ 70 Stage III cohort 58%(83/142) did not received AC. 23%(32/142) received an OCR and 16%(23/142) received 5FU/LEU; there was a statistically significant survival difference with an OCR. 47% (15/32) of pts ≥70 receiving OCR developed PN which persisted at 6 months in 28% (9/32). In &lt; 70 cohort there was no significant survival difference in the IDEA-trial-defined low risk group between 12 versus &lt; 12 FOLFOX. There was a numerical survival difference in the &lt; 70 high risk group between 12 versus &lt; 12 FOLFOX; this was not statistically significant. In the ≥70 age group there was no survival difference in either IDEA risk groups for 12 versus &lt; 12 FOLFOX. Conclusions: &gt; 50% of Stage III CRC patients ≥ 70 did not receive AC. OCRs were associated with a significant OS improvement but with higher PN than in &lt; 70 cohort and higher persistence at 6 months. Irrespective of IDEA-defined risk groups,there was no statistically significant survival difference for Stage III CRC ≥70 receiving 12 versus &lt; 12 FOLFOX.
Fibroblast Heterogeneity in the Pancreatic Tumor Microenvironment
Authors: Erin Helms, M. Kathrina Onate, Mara H. Sherman
Journal: Cancer Discovery (2020)

The poor prognosis for patients with pancreatic ductal adenocarcinoma (PDAC) impels an improved understanding of disease biology to facilitate the development of better therapies. PDAC typically features a remarkably dense stromal reaction, featuring and established by a prominent population of cancer-associated fibroblasts (CAF). Genetically engineered mouse models and increasingly sophisticated cell culture techniques have demonstrated important roles for fibroblasts in PDAC progression and therapy response, but these roles are complex, with strong evidence for both tumor-supportive and tumor-suppressive or homeostatic functions. Here, we review the recent literature that has improved our understanding of heterogeneity in fibroblast fate and function in this disease including the existence of distinct fibroblast populations, and highlight important avenues for future study. SIGNIFICANCE: Although the abundant stromal reaction associated with pancreatic cancer has long been appreciated, the functions of the CAF cells that establish this stromal reaction remain unclear. An improved understanding of the transcriptional and functional heterogeneity of pancreatic CAFs, as well as their tumor-supportive versus tumor-suppressive capacity, may facilitate the development of effective therapies for this disease.
Validation of an Aptima-format Finnish new variant of Chlamydia trachomatis (FI-nvCT) surveillance assay, 2019
Authors: Barbara Weinbaum, Analee Williams, Ronza Hadad, Bryan Vinluan, Mirja Puolakkainen, Magnus Unemo, Damon Getman
Journal: Eurosurveillance (2020)

The Finnish new variant of Chlamydia trachomatis (FI-nvCT) is escaping diagnostics in Finland, Norway and Sweden. We have developed and validated an Aptima-format nucleic acid amplification test (NAAT) designed specifically to detect the FI-nvCT. This NAAT has high sensitivity (100%) and specificity (100%) for the FI-nvCT strain, enabling further investigation of the geographic distribution, prevalence and transmission of this diagnostic-escape mutant in screening populations in Europe.
Continued cetuximab in second-line treatment for patients with unresectable metastatic wild-type KRAS, NRAS, and BRAF colorectal cancer after disease progression during first-line cetuximab-based therapy.
Authors: Ying Liu, Feng Wang, Ning Ma, Shuning Xu, Lei Qiao, Ke Li, Gaizhen Kuang, Danyang Li, Yangyang Liu, Yanyan Xiong, Mingming Sun
Journal: Journal of Clinical Oncology (2020)

127 Background: Cetuximab plus chemotherapy is a first-line treatment option for metastatic RAS wild type colorectal cancer patients. Currently, no data are available on continuing cetuximab or changing bevacizumab as second-line therapy beyond first-line cetuximab-based chemotherapy. Methods: Patients (aged ≥18 years) with metastatic, histologically and genetically confirmed wild-type KRAS, NRAS and BRAF colorectal cancer progressing after first-line cetuximab plus chemotherapy were randomly assigned (1:1 ratio) to second-line chemotherapy with cetuximab (arm A) or with bevacizumab (arm B) 2·5 mg/kg per week equivalently. The choice between oxaliplatin-based or irinotecan-based second-line chemotherapy depended on the first-line regimen (switch of chemotherapy). The primary endpoints were progression-free survival (PFS) and objective response rate (ORR). The second endpoint was overall survival (OS). Results: 77 Patients (from July 1, 2016 to Sept 20, 2019, 77) were randomized (41 in arm A and 36 in arm B). ORR was 29.3% and 19.4% in Arm A and Arm B ( p= 0.31). PFS was 7.2 months (95% CI 5.2–9.2) for Arm A and 5.9 months (95% CI 5.1–6.7) for Arm B ( p= 0.677). OS was 18.5 months (95% CI 15.1–21.8) for Arm A and 17.5 months (95% CI 15.4–19·7) for Arm B ( p= 0.444). Patients with ECOG PS 0 had significantly longer PFS and OS than ECOG PS 1 in second-line therapy whether cetuximab or bevacizumab combined with chemotherapy. ECOG 0 group vs ECOG 1 group, PFS was 8.7 months vs 4.6 months (p = 0.00) and OS was 21.2 months vs 12.3 months (p = 0.00). Moreover, ETS may predict efficacy of second-line continued cetuximab. The most frequently grade 3–4 adverse events in both arms were neutropenia (19.4% VS 16.7%), diarrhea (7.5% vs 11.1%), and nausea(10% vs 13.9%). Conclusions: Continuing cetuximab or changing bevacizumab plus standard second-line chemotherapy in patients with metastatic wild-type KRAS, NRAS and BRAF colorectal cancer after first-line cetuximab plus chemotherapy have similar clinical benefits. ECOG score is an independent predictor of prognosis and second-line treatment efficacy for colorectal cancer.