tbuckley/cabot-search huggingface dataset:
Interest and use of alternative/holistic therapies amongst cancer patients at a large urban safety-net hospital.
Authors: Bartlomiej Posnik, Romy Jose Thekkekara, Sushma Bharadwaj, Barbara Yim, Shweta Gupta
Journal: Journal of Clinical Oncology (2019)

e18289 Background: Patient interest in alternative/holistic therapies during cancer treatment is common in oncology. Studies have shown that 1 in 3 cancer patients in Europe turn to alternative therapies in combination with conventional medicine. Observational studies have shown some benefit of herbal medications in treating chemotherapy-associated complications; however, there remains skepticism in clinical practice. This study was undertaken to evaluate the interest and use of alternative treatments amongst cancer patients at a large urban safety-net hospital. Methods: An anonymous optional survey was offered in a random fashion to malignant hematology/oncology patients at Cook County Hospital in downtown Chicago. Results: One hundred seventy patients completed the survey comprised of 51% men, 78% being over age 50, and 67% with a high school or higher level of education. Responses included 35% African Americans, 34% Hispanics, and 25% Caucasians. At the time of the survey 16% of patients were currently using alternative treatments, while another 12% were planning to. Eighty-seven percent stated that they believed alternative treatments were very/somewhat beneficial, 77% expressed being very/somewhat interested in their use, and 77% stated they were very/somewhat likely to use such treatments. The treatments of interest included herbal supplements/oils in 40%, meditation/prayer in 29%, and cleanses/diets in 26%. Media and internet were the primary sources of information for 41% patients, while 36% heard about these treatments from family/friends. Although 51% of patients described having some safety concerns of such therapies, 77% had not discussed with their doctor. Conclusions: Our data showed that 28% of patients were either already taking or planning to take alternative/holistic therapies in conjunction with conventional medicine for their cancer care. Data also shows that an even larger number of patients are interested in such options and perceive them to be beneficial; however, there is a general reluctance to discuss it with the treating physician. The use of complementary therapies needs to be more openly discussed in order to better guide patients and assure safety.[Table: see text]
Differential copy number alteration profiles among gynecological malignancies.
Authors: Ignacio Romero, Raquel López-Reig, Antonio Fernandez-Serra, Zaida Garcia-Casado, Carmen Illueca, Cristina Zorrero, Andres Poveda, Jose Antonio Lopez-Guerrero
Journal: Journal of Clinical Oncology (2019)

e14744 Background: Copy number alterations (CNA) constitutes a genomic hallmark that defines specific outcomes in gynecological neoplasms, as evidenced by the integrated analysis of the high-grade serous ovarian carcinoma (HGSOC) and endometrial carcinomas (EC) performed by the TCGA Consortium. The purpose of this study is to set up an NGS-based technology to obtain CNA profiles on formalin-fixed paraffin-embedded (FFPE) samples with clinical utility. Methods: FFPE blocks from 14 EC and 12 HGSOC were analyzed using a SureSelectXT custom panel plus OneSeq backbone, interrogating 147.000 SNPs (Agilent). CNA groups were defined in EC with a RF algorithm based on genotyping data as previously reported (Romero, ASCO 2018) and in HGSOC Homologous recombination deficiency (HRD) was determined by sequencing a serie of 35 HR genes. saasCNV pipeline was used to perform CNA calling. Results: Ten (38.50 %) of our cases were classified as CN Low (CNL), 8 as CN high (CNH)-RF (30.75 %) and 8 CNH-HRD (30.75 %). CNL profiles from EC and OC are homogenous in terms of genomic stability. CNH-RF and CNH-HRD cases harbor the highest percentage of genomic instability (p = 0.012) with distinct patterns of CNA. CNH-HRD is characterized by a higher ratio of genomic losses (p = 0.023). However, CNH-RF is mainly defined by gains (p = 0.011) (Table). Conclusions: Our NGS-based approach represents a FFPE clinically available procedure to define CNA alterations in gynecological cancer with distinct CNH patterns with prognostic potential.[Table: see text]
AB1055 FINAL DIAGNOSES OF THE PATIENTS WHO WERE REFERRED TO A TERTIARY PEDIATRIC RHEUMATOLOGY OUTPATIENT CLINIC FOR LABORATORY ABNORMALITIES
Authors: Hafize Emine Sonmez, Şerife Gül Karadağ, AyŞe Tanatar, Nuray Aktay Ayaz
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rheumatology laboratory tests are commonly ordered by clinicians to screen for rheumatic diseases. <h3>Objectives</h3> The study aimed to determine the frequency of use of common rheumatology tests and the final diagnosis of the patients who were referred to a tertiary pediatric rheumatology outpatient clinic for the presence of laboratory abnormalities. <h3>Methods</h3> We prospectively evaluated the patients who were referred due to the abnormal laboratory findings. <h3>Results</h3> A total of 216 patients were examined. Among them, 62 patients had anti-streptomycin O positivity, 47 patients had ANA positivity, 41 patients had elevated acute phase reactants, 16 patients had RF positivity, 9 patients had elevated creatine kinase levels, 2 had lupus anticoagulant positivity. Regarding patients were referred due to carrying <i>MEFV</i> variants (n=35). A diagnosis of rheumatic disease was made in 54 of patients, while the others had non-rheumatic conditions. Final rheumatological disease diagnoses were as follows: familial Mediterranean fever (n=29), juvenile idiopathic arthritis (n=12), systemic lupus erythematosus (n=4), reactive arthritis (n=3), Raynaud's phenomenon (n=3), chronic recurrent multifocal osteomyelitis (n=1), vasculitis (n=1), acute rheumatic fever (n=1). <h3>Conclusion</h3> Diagnosing a rheumatic disease mainly base upon clinical findings rather than laboratory test results. However, clinicians usually prefer to screen rheumatology laboratory tests when patients suffer from non-specific musculoskeletal findings or symptoms such as fatigue. As our study shows most of patients who were referred due to the abnormal laboratory findings, finally diagnosed as having a non-rheumatological condition. Therefore, systemic and careful approach may be needed to reduce unnecessary use of rheumatology laboratory tests. <h3>References</h3> [1] Hashkes PJ, Profile of a pediatric rheumatology practice in Israel, Clin Exp Rheumatol. 2003 Jan-Feb;21(1):123-8. [2] Rosenberg AM, Analysis of a pediatric rheumatology clinic population. J Rheumatol. 1990 Jun;17(6):827-30. <h3>Acknowledgement</h3> None <h3>Disclosure of Interests</h3> None declared
CX-072, a PD-L1 Probody therapeutic, as monotherapy in patients with advanced solid tumors: Preliminary results of PROCLAIM-CX-072.
Authors: Aung Naing, Fiona C. Thistlethwaite, Alexander I. Spira, Javier Garcia-Corbacho, Manreet Randhawa, Ferry Eskens, Bert O'Neil, Javier Lavernia, Nataliya Volodymyrivna Uboha, Omid Hamid, Anthony B. El-Khoueiry, Beverly A. Benson, William Garner, Vanessa Jessica Huels, Hendrik-Tobias Arkenau, Patricia LoRusso
Journal: Journal of Clinical Oncology (2019)

2513 Background: Anti-programmed cell death ligand 1 (PD-L1) immunotherapies have improved survival in many cancers, but immune-related adverse events (irAEs) have been observed, especially in combination therapy. CX-072 is an investigational Probody therapeutic directed against PD-L1, designed to be preferentially activated in the tumor microenvironment and to reduce irAEs. Methods: This is an ongoing phase 1/2a study (PROCLAIM-CX-072; NCT03013491) evaluating CX-072 in patients (pts) with metastatic or unresectable solid tumors with no further standard curative treatment options and with no prior anti-PD1, PD-L1 or anti-CTLA4 treatment. Pts were unselected for PD-L1 expression. We report preliminary results from expansion cohorts in anal squamous cell carcinoma (SCCA), cutaneous squamous cell carcinoma (cSCC), small bowel adenocarcinoma (SBA), triple-negative breast cancer with skin lesions (TNBC), or undifferentiated pleomorphic sarcoma (UPS). Pts were treated with CX-072 monotherapy 10 mg/kg intravenously every 14 days. Results: As of 30 Nov 2018, 51 pts received CX-072 10 mg/kg monotherapy: SCCA (n = 9), cSCC (n = 5), SBA (n = 9), TNBC (n = 9), and UPS (n = 19). Median age was 63 y (range, 32-80), 67% were female, and pts had a median of 3 prior regimens (range, 1-12). Median treatment duration was 1.8 mo (range, 0.3-14.7). A grade 3/4 treatment-related adverse event (AE) was observed in 1 pt (2%; gr 3 generalized rash). No grade 3/4 irAEs were observed. Two pts discontinued treatment due to AEs: nausea (pt with SCCA) and sepsis (pt with SBA), neither treatment-related. Partial responses (confirmed and unconfirmed) were observed in cSCC (n = 1), TNBC (n = 2), and UPS (n = 1) (Table). Conclusions: CX-072 10 mg/kg monotherapy demonstrated anticancer activity in heavily pretreated pts with advanced solid tumors, including responses in cSCC, TNBC with skin lesions, and UPS, with a safety profile that compares favorably to historical controls. Clinical trial information: NCT03013491. [Table: see text]
Neoadjuvant dabrafenib combined with trametinib for resectable, stage IIIB–C, BRAFV600 mutation-positive melanoma (NeoCombi): a single-arm, open-label, single-centre, phase 2 trial
Authors: Georgina V Long, Robyn P M Saw, Serigne Lo, Omgo E Nieweg, Kerwin F Shannon, Maria Gonzalez, Alexander Guminski, Jenny H Lee, Hansol Lee, Peter M Ferguson, Robert V Rawson, James S Wilmott, John F Thompson, Richard F Kefford, Sydney Ch'ng, Jonathan R Stretch, Louise Emmett, Rony Kapoor, Helen Rizos, Andrew J Spillane, Richard A Scolyer, Alexander M Menzies
Journal: The Lancet Oncology (2019)
Tumor specific DNA in bronchial lavage as a new diagnostic tool in lung cancer.
Authors: Caroline Brenner Thomsen, Torben Hansen, Rikke Fredslund Andersen, Henrik Hager, Kristian Rasmussen, Anders Kristian Moeller Jakobsen, Ole Hilberg
Journal: Journal of Clinical Oncology (2019)

3047 Background: A considerable fraction of lung cancer patients raise diagnostic challenges requiring invasive procedures with a certain risk of complications. Therefore, new diagnostic tools are of major interest. Aberrant methylation of the HOXA9 gene occurs in almost all malignant lung tumors and HOXA9 methylated DNA (meth-ctDNA) is shed into the circulation. The present study aimed at a prospective investigation of the possible diagnostic value of HOXA9 meth-ctDNA in bronchial lavage (BL). Methods: Patients enrolled were referred from the general practitioner suspecting lung cancer. The diagnostic package according to national guidelines includes chest and abdominal CT scan, bronchoscopy, relevant blood tests, and histopathological or cytological verification. Twelve ml liquid was collected at bronchoscopy for analysis of meth-ctDNA based on ddPCR technology according to our published method. The analysis was performed blinded to the clinical data and compared to the final diagnosis. Results: Eighty-nine patients were consecutively included from the 1 November 2018 to 31 January 2019. Fifty-six patients (62.9%) were diagnosed with lung cancer and 33 (37.1%) with a variety of benign diseases. Meth-ctDNA was found in 42/56 of the patients with a malignant tumor, sensitivity = 75.0% (95%CI=61.6-85.6%), whereas 31/33 of the patients without cancer were negative, specificity = 93.9% (95%CI= 79.8-99.3%). Table summarizes the results. The false negative samples were mainly from patients with peripheral tumors. The two false positive patients included one patient with Cryptogenic Organizing Pneumonia and one with unspecific nodule. Conclusions: The presence of meth-ctDNA in BL has a high sensitivity and specificity. If validated, the analysis represents a valuable adjunct in the diagnosis of lung cancer. Potentially, it could save the patients from numerous examinations with potential harmful risks and ensure a fast diagnosis. The relation between meth-ctDNA and final lung cancer diagnosis (N= 89). [Table: see text]
A phase II study of cryoablation (cryo) of an enlarging tumor in patients (pts) with advanced lung cancer or melanoma receiving post-progression immune checkpoint inhibition (ICI).
Authors: Meghan Mooradian, Florian Fintelmann, Riley Fadden, Krista M. Rubin, Aleigha Lawless, Marlena Vitali, Tatyana Sharova, Genevieve Marie Boland, Donald P. Lawrence, Justine Vanessa Cohen, Christopher G. Azzoli, Ryan J. Sullivan
Journal: Journal of Clinical Oncology (2019)

e14243 Background: Image-guided percutaneous cryoablation is an established minimally invasive oncologic treatment. Through direct modulation of the tumor, it is theorized that this local therapy may modify the immune microenvironment. We hypothesized that it can augment an anti-tumor response when used concurrently with ICI. Methods: In this phase II single-arm study, pts with advanced lung cancer or melanoma progressing on ICI undergo cryo of an enlarging lesion and ICI is continued for a minimum 2 additional cycles. Computed tomography is performed at 4-6 weeks following cryo to determine tumor response in non-ablated lesions per RECIST1.1, with confirmatory scans at 8-10 weeks. The primary endpoint is safety and feasibility. Secondary endpoints are overall response rate (ORR) and disease control rate (DCR) with DCR defined as the percentage of pts who achieve complete response (CR), partial response (PR), and stable disease (SD). Correlative analysis on pre- and post-cryo biopsy specimen, when evaluable, will be performed. A planned analysis to document preliminary safety and feasibility in the first 11 patients was performed. Results: 11 pts (out of planned 40) have been enrolled. 8 with melanoma, 3 with lung cancer. All pts received prior PD-1/PD-L1 monotherapy with 8 pts treated with pembrolizumab, 2 with nivolumab and 1 with atezolizumab. Treated lesions were in lung (n = 4), bone (n = 3), lymph nodes (n = 2), liver (n = 1) and adrenal gland (n = 1). No immune related adverse events occurred. There was one treatment-related CTCAE grade 3 event (osteomyelitis) but no grade 4/5 events. One pt. experienced grade 3 hyponatremia, unrelated to cryo. In evaluable pts (n = 10), ORR was 10% and DCR was 50% (4 SD, 1 PR). Conclusions: During this scheduled safety analysis, cryo following progression on ICI was feasible and had an acceptable side effect profile. Early efficacy data of this potentially synergistic approach is encouraging but warrants further investigation. Clinical trial information: NCT03290677. [Table: see text]
A phase II study of nivolumab in patients with advanced refractory biliary tract cancers (BTC).
Authors: Richard D. Kim, Dae Won Kim, Olatunji B. Alese, Daneng Li, Neal Shah, Michael J. Schell, Jun Min Zhou, Vincent Chung
Journal: Journal of Clinical Oncology (2019)

4097 Background: Biliary tract cancers (BTC) are often typically diagnosed at an advanced stage. There is no established second line option for patients with advanced BTC who have failed one prior systemic therapy. The phase II study evaluated safety and efficacy of nivolumab, anti PD-1 antibody in refractory BTC patients. Methods: Pts with histologically proven BTC who progressed on at least one line but no more than three lines of systemic therapy received nivolumab 240mg IV q2weeks for 16 weeks and then 480 mg IV every 4 weeks until disease progression or unacceptable toxicity. The primary endpoint of the study was objective response rate (ORR) by RECIST 1.1 every 8 weeks. The Simon two staged design was used to assess ORR.18 patients were accrued and if one response was seen, the plan was to accrue additional 34 patients. Secondary endpoints were PFS, OS and safety profile. Results: At data cutoff (Jan 14, 2018), 54 patients with BTC (female: 50%, Median age: 65 years) were enrolled. The primary sites of tumor were intrahepatic cholangiocarcinoma (63%) extrahepatic (11%), and gallbladder (26%). 30 pts (56%) failed 1 line of therapy and 24 (44%) failed more than one line of therapy. 45 pts (1 pt withdrew consent, 1pt just enrolled prior to data cutoff and 7 pts came off the study due to clinical progression) were evaluable for response rate. Out of 45 pts, 10 pts (22%) achieved PR (1 unconfirmed PR) and 17 pts (37.8%) achieved SD. DCR was 60%. All patients who responded were microsatellite stable. For evaluable 45 pts with median follow up of 13.34 months, median PFS was 3.98 months (95% CI: 2.33-5.98) and the median OS was 14.22 months (95% CI: 6.64-NA). 6 and 12month OS was 71.4 and 52.3% and 6 and 12 month PFS was 35.2% and 24.1% respectively. Most common treatment related AEs (TRAE) was alkaline phosphatase increased (24.5%). Grade III/IV TRAEs were seen in 11 pts (20.4%); most common were hyponatremia (3 pts) and elevated alkaline phosphatase (2 pts). No treatment related AEs led to discontinuation of the study drug. Tissue samples were collected in all pts with planned correlative studies underway including the PDL 1 status. Conclusions: Nivolumab was well tolerated and has shown promising efficacy in refractory BTC including durable responses lasting 2 years. Further randomized trial is warranted in refractory BTC. Clinical trial information: NCT02829918.
Tonsillectomy for the Management of Immunoglobulin A Nephropathy
Authors: Howard Trachtman
Journal: JAMA Network Open (2019)

Keita Hirano, MD; Keiichi Matsuzaki, MD, PhD; Takashi Yasuda, MD, PhD; Masako Nishikawa, PhD; Yoshinari Yasuda, MD, PhD; Kentaro Koike, MD, PhD; Shoichi Maruyama, MD, PhD; Takashi Yokoo, MD, PhD; Seiichi Matsuo, MD, PhD; Tetsuya Kawamura, MD, PhD; Yusuke Suzuki, MD, PhD
Inequities in healthcare
Authors: José G Merino
Journal: BMJ (2019)

Migrants can face many hardships in their search for a new life.On the journey, unofficial migrants may risk their lives crossing perilous terrains and dangerous waters.After the trip, they are at risk for illness and might not receive adequate medical treatment; since September, at least six migrant children have died after getting ill in the holding areas of US Border Patrol. 1 After they settle in their new country, they still face barriers when accessing healthcare.
Family history in primary hormone therapy for prostate cancer from a community-based multi-institutional Japan-wide database.
Authors: Masaki Shiota, Mizuki Onozawa, Shiro Hinotsu, Masatoshi Eto, Seiji Naito, Hideyuki Akaza
Journal: Journal of Clinical Oncology (2019)

e16549 Background: Although a positive family history is known to increase the risk of morbidity of prostate cancer, little is known about the prognoses with hormone therapy of individuals with familial prostate cancer. Thus, in this study we aimed to determine the associations between hormone therapy and outcomes of a cohort of men with familial prostate cancer from a large community-based multi-institutional Japan-wide registry. Methods: Data of patients with prostate cancer who had received hormone therapy were extracted from a nationwide community-based database established by the Japan Study Group for Prostate Cancer. Family history of prostate cancer was available for 15,873 of these patients, who thus comprised the study cohort. Prognostic variables, including progression-free survival, cancer-specific survival, and overall survival, were compared between men with familial and men with sporadic prostate cancer. Results: A positive family history was identified in 247 patients (1.6%). Patients with a positive family history were younger than those without; however, other clinicopathological characteristics and prognoses were comparable. In subgroup analysis, family history was identified as a significant favorable prognostic factor for progression-free survival among patients treated by castration, as was overall survival among patients with PSA level at diagnosis less than 100 ng/mL and those with low or intermediate J-CAPRA risk. Conclusions: Our findings indicate that familial prostate cancer has an early-onset feature or is diagnosed earlier than sporadic prostate cancer. However, with hormone therapy the prognoses of individuals with familial prostate cancer are comparable to those of individuals with sporadic prostate cancer.
A System to Determine Risk of Osteoporosis in Patients With Autoimmune Hepatitis
Authors: Tobias Schmidt, Constantin Schmidt, Andre Strahl, Haider Mussawy, Tim Rolvien, Nico M. Jandl, Christian Casar, Ralf Oheim, Thorsten Schinke, Ansgar W. Lohse, Michael Amling, Christoph Schramm, Florian Barvencik
Journal: Clinical Gastroenterology and Hepatology (2019)
Responders to anti-PD1 therapy: Long-term outcomes and responses to retreatment in melanoma (mel).
Authors: Allison Betof Warner, Jessica S. Palmer, Alexander Noor Shoushtari, Debra A Goldman, Katherine Panageas, Margaret K. Callahan, Jedd D. Wolchok, Michael A. Postow, Paul B. Chapman
Journal: Journal of Clinical Oncology (2019)

9513 Background: Little is known about patients (pts) who discontinue anti-PD1 therapy after a complete response (CR) outside of clinical trials. There are also limited data about retreatment with a second course of anti-PD1 upon disease progression. Methods: We retrospectively studied pts (n = 398) at MSKCC with unresectable mel (non-uveal) who received ≥1 dose of single-agent anti-PD1 and were followed ≥3 months (mos) after treatment cessation. CR was defined radiographically or by a negative biopsy of residual tissue. Overall survival (OS) and time to treatment failure (TTF, time until next therapy or death) were calculated from time of CR. When to stop therapy and whether to retreat after progressive disease (PD) were at the discretion of the treating oncologist. A subset of pts received a second course of single-agent anti-PD1 ≥3 months after initial discontinuation; retreated pts were evaluable if they had radiographic or clinical evaluation to assess retreatment efficacy. Results: 102 pts (25.6%) achieved CR (n = 89 radiographic, n = 13 pathologic). Median follow-up was 22.6 mos for survivors who had a CR. Estimated 3-year OS from time of CR was 82.5% (95% CI 67.4-91.0). For pts who had a CR, therapy was discontinued due to CR (n = 72), toxicity (n = 24), or other reasons (n = 6). The median duration of treatment for CR pts was 9.4 mos (range 1.6-36.1). 20 CR pts later had progressive disease (PD). Median TTF has not been reached; at 3-years the estimated treatment-free survival for CR pts was 72.3% (95% CI 60.2-81.3). 34 pts received a second course of anti-PD1 for PD after a median of 11.6 mos off treatment (range 3.5-28.6). Best responses to the second course of treatment were: 2 CRs (5.9%), 3 with tumor shrinkage (8.8%), 9 (26.5%) with SD, and 20 with PD (58.8%). Of these pts who had had a CR (n = 8) or some lesser degree of tumor shrinkage (n = 13) to the initial course of anti-PD1 treatment, only 1 and 2 pts responded, respectively, to retreatment. Median duration of retreatment was 10.9 wks. Conclusions: In this largest dataset to knowledge of mel pts treated with a second course of anti-PD1, response rate was low, even in pts who had achieved a response initially. Further study is needed into the necessary duration of initial anti-PD1 treatment and optimal strategies for initial responders who discontinue and later develop PD.