tbuckley/cabot-search huggingface dataset:
How do we bridge the gap? persistent differences in the preoperative experience for patients with gynecologic cancer treated at a public hospital.
Authors: Deanna Gerber, Olivia R Khouri, Melissa Kristen Frey, Leslie R. Boyd, John Patrick Curtin
Journal: Journal of Clinical Oncology (2019)

e17074 Background: Disparities in the treatment of patients (pts) with gynecologic cancer (ca) are well-documented. In 2016, we published our experience with structural barriers present preoperatively at a public and private hospital (H) treated by the same team of gyn oncologists. Since then, there have been system-wide changes to address inequalities in the preoperative (preop) work-up. Our goal was to evaluate if the streamlined preop work up at the public H was sufficient to close the gap in management. Methods: A retrospective review was conducted for pts who had surgery for a gyn ca at a public and private H between 7/1/15 and 7/1/16. This was analyzed and compared to the previously studied cohort reviewed from 7/1/13 to 7/1/14. Results: We included 251 pts for analysis (public H 47; private 204). There was no difference in age, type of ca, or stage between H. The public H pts had a longer wait from diagnosis to surgery (55 vs 39d; P &lt; .001) as well as surgical booking to surgery (25 vs 19d; P &lt; .001). When compared to the pts treated at the public H from 7/13-14, there was a significant improvement in wait time from diagnosis to surgery (55 vs 66 days; P &lt; .001), diagnosis to surgical booking (21 vs 28 days; p = 0.008) as well as booking to surgery (25 vs 26; P &lt; .001). There was no difference in the number of preop visits between the 2 groups at the public H. Conclusions: Since implementation of new preop guidelines at the public H, the wait times from diagnosis of ca to both booking and surgery have decreased. While this represents progress, there remain discrepancies when compared to the private H. There remains room for improvement in the preop experience for the pts treated at the public H. [Table: see text]
SWOG S1400B (NCT02785913), a Phase II Study of GDC-0032 (Taselisib) for Previously Treated PI3K-Positive Patients with Stage IV Squamous Cell Lung Cancer (Lung-MAP Sub-Study)
Authors: Corey J. Langer, Mary W. Redman, James L. Wade, Charu Aggarwal, Jeffrey D. Bradley, Jeffrey Crawford, Philip J. Stella, Mark H. Knapp, Jieling Miao, Katherine Minichiello, Roy S. Herbst, Karen Kelly, David R. Gandara, Vassiliki A. Papadimitrakopoulou
Journal: Journal of Thoracic Oncology (2019)
Molecular pathway activation-based analysis for personalized prescription of tyrosine kinase inhibitors for advanced solid tumor patients.
Authors: Elena Poddubskaya, Madina Baranova, Daria Allina, Marina Sekacheva, Lyudmila Makovskaia, Eugene Albert, Maria Suntsova, Alexey Aleshin
Journal: Journal of Clinical Oncology (2019)

e15636 Background: Tyrosine-kinases (TKs) play key roles in cancer by acting as major components of various signaling pathways. Tyrosine kinase inhibitors (TKIs) act by inhibiting TKs, thereby modulating downstream signaling. Here we report a molecular pathway analysis-based approach to personalize prescription of TKIs for advanced and recurrent solid tumors, exemplified by successful cases of off-label prescriptions of TKIs to unresectable metastatic cholangiocarcinoma (MCC) and to recurrent ovarian granulosa cell tumor (GCT) patients. Methods: To isolate RNA, we used patient’s tumor histologically verified formalin fixed, paraffin embedded (FFPE) tissue blocks containing &gt; 75% tumor cells. Gene expression levels were established using CustomArray platform. Tumor expression was compared with the corresponding normal tissues and a second-opinion platform Oncobox (Omicsway, USA) was applied for finding abnormally activated molecular pathways and for the corresponding ranking of target drugs. Results: For a 26-year-old woman with progressive ovarian GCT despite multiple previous lines of therapy who underwent salvage therapy selection, the following target drugs could be potentially most effective for treatment according to the Oncobox test: Regorafenib, Sorafenib, Sunitinib, Pazopanib, Axitinib, Imatinib. In Oct 2015, patient was administered Sorafenib, but it was not well tolerated, and this therapy was terminated after 2 months. However, ultrasound examination indicated an associated decrease in the size of neoplasms. Therapy regimen was switched to Imatinib, which was well tolerated and resulted in a disease stabilization. As for Feb 2019, Imatinib administration is continued and patient is physically active with Karnofsky scale index 90%. Another patient with MCC was prescribed with subsequent TKI monotherapies for Sorafenib and Pazopanib that occupied, respectively, 2 nd and 4 th positions of the Oncobox drug rating. It resulted in a two-year stabilization. Conclusions: Our results evidence that sequential personalized prescription of different TKIs based of gene expression tests may be a perspective avenue of further clinical investigations.
Case 22-1989
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Richard R. Liberthson, James F. Southern
Journal: New England Journal of Medicine (1989)

Presentation of CaseA 17-year-old girl was admitted to the hospital after sudden collapse with ventricular fibrillation.She was in excellent health until about four weeks earlier, when coryza developed, and she used phenylpropanolamine hydrochloride and chlorpheniramine maleate for relief of symptoms.Nineteen days before entry, while she was playing a vigorous game of ice hockey, the patient abruptly collapsed face down on the ice, and seizure activity was observed. A bystander promptly administered cardiopulmonary resuscitation of unknown duration and effectiveness. Emergency medical technicians soon arrived, and an electrocardiogram showed ventricular fibrillation. Lidocaine was injected, and defibrillation was performed with . . .
Patient characteristics associated with treatment of cervical cancer in the United States.
Authors: Shelby Corman, Chizoba Nwankwo, Youngmin Kwon, Ruchit Shah
Journal: Journal of Clinical Oncology (2019)

e17020 Background: Treatment options for cervical cancer include surgery, radiation therapy, chemotherapy, and immunotherapy depending upon the disease stage. There is limited real-world evidence providing us with a clinical profile for a treated cervical cancer patient. The objective of this study was to compare cervical cancer patients who were currently receiving treatment versus those not receiving treatment. Methods: This was a retrospective, cross-sectional analysis of Medical Expenditure Panel Survey (MEPS) data (2006-2015). Cervical cancer cases were identified using ICD-9 CM code 180 or clinical classification software code 26. Patients receiving only chemotherapy, radiation therapy, undergoing surgery, or a combination of these treatments in a given year were regarded as “currently receiving treatment”. The comparator cohort included patients “not currently receiving treatment”. The two cohorts were compared in terms of patient clinical characteristics using bivariate analyses. Results: The analytic cohort consisted of 275,246 cervical cancer cases (mean age: 42 years, Caucasian: 88.0%, having private insurance: 55.3%) of which 115,639 (42.01%) were “currently receiving treatment”. The most common treatment option was undergoing surgery only (88.21%), followed by combination therapy (6.82%), chemotherapy only (3.84%), and radiation therapy only (1.12%). The “currently receiving treatment” cohort had a significantly higher proportion of patients having a history of myocardial infarction (4.21% vs 3.50%), congestive heart failure (2.73% vs 1.42%), chronic obstructive pulmonary disorder (29.5% vs 23.2%), connective tissue disease (20.5% vs 11.6%), renal disease (2.49% vs 0.48%), and diabetes (17.7% vs 11.7%) compared to those “not currently receiving treatment”. The latter cohort had a higher proportion of patients with moderate/severe liver disease (0.46% vs 5.32%). Conclusions: The observed real-world patient characteristics and treatment patterns were indicative of a cohort of largely early stage cervical cancer patients. Patients receiving treatment appeared to have a higher comorbidity burden which may subsequently result in poorer quality of life and activity limitations.
Brain metastasis in patients with hereditary <i>BRCA-</i>mutated invasive breast cancer.
Authors: Haven Garber, Akshara Singareeka Raghavendra, Kenneth R. Hess, Banu Arun, Nuhad K. Ibrahim
Journal: Journal of Clinical Oncology (2019)

1074 Background: In the past six months, two poly(ADP-ribose) polymerase (PARP) inhibitors have been approved for the treatment of patients with metastatic breast cancer and germline pathogenic variants in BRCA1 or BRCA2 ( gBRCA). In addition, recent data from the IMpassion 130 trial lends support for the role of immunotherapy in a subset of patients with triple negative breast cancer (TNBC). Approximately 60% of patients with gBRCA1 have TNBC. There is evidence that both PARP inhibitors and checkpoint inhibitors cross the blood-brain barrier and both classes of agents have entered clinical trials for patients with brain metastases in other tumor types. We studied the clinical course of breast cancer patients with gBRCA and brain metastasis at our institution to inform clinical trial design for this group of patients with poor outcomes. Methods: Patients with stage I to III invasive breast cancer, gBRCA, and eventual development of brain metastasis were identified from clinical databases. Data analyzed included breast cancer subtype and stage at diagnosis, treatment, time to distant recurrence and to discovery of brain metastasis, and overall survival from time of development of brain metastasis. Results: Patients in our cohort (n = 24, to date) were diagnosed at a young age (median age 39) and primarily had TNBC (21/24, 87.5%) with infiltrating ductal carcinoma histology. Nineteen patients had gBRCA1 and 4 patients had gBRCA2. All but 1 patient received anthracycline-based chemotherapy in the neoadjuvant/adjuvant setting. Median time to distant metastasis was 2 years (range: 0.8 – 15) and the brain was the first site of recurrence in 5 of 24 (21%) patients. Median time from diagnosis to development of brain metastasis was 2.6 years (range: 1.2 – 19) and most patients (18/25, 72%) had multiple brain metastases discovered on the initial brain MRI. Median overall survival (OS) was 3.7 years (range: 1.8 – 24) and median OS from the time of brain metastasis was 7 months (range: 1 month – 13 years). Conclusions: Breast cancer patients with germline pathogenic variants in BRCA1/2 who develop brain metastasis have a dismal prognosis. These patients may benefit from an agent with intracranial activity at the time of first distant recurrence.
Followup mammography after breast conservation therapy: Is 3D Tomosynthesis(3DT) worth it?
Authors: Shaakir Hasan, Steven Gresswell, Brittany Colosimo, Kevin Weinberger, Sidney Anderson, Matthew Bigbey, Rodney E Wegner, Beth Shindel, Thomas B. Julian, Mark G. Trombetta
Journal: Journal of Clinical Oncology (2019)

6628 Background: Screening three-dimensional tomosynthesis mammography (3DT) is more cost-effective than two-dimensional mammography (2DM) for detecting breast cancer, however cost-effectiveness as a follow-up for treated breast cancer is unknown. We retrospectively analyzed the downstream workup and costs associated with 3DT compared to 2DM when employed as initial follow-up imaging in breast conservation therapy (BCT). Methods: Between the years 2015-2017, 450 consecutive BCT patients ages 32 – 89 with a follow-up 3DT (n = 162) or 2DM (n = 288) were reviewed in this IRB-approved study. The primary endpoint was further workup after follow-up mammogram and associated healthcare costs at 1 year. Downstream workup was secondarily tested for correlation with clinical and treatment-related variables. A single 3DT cost an estimated $149 compared to $111 for a 2DM, based on Centers for Medicare claims data Oncology Care Model. Results: Patient clinical characteristics were : 6% DCIS, 10% T1a, 29% T1b, 35% T1c, 19% T2, 88% N0, 9% N1, 3% N2, 76% ER+/PR+/HerNeu2-, 12% TNBC, and 14% Her2Neu+. Whole breast radiation was given with conventional (59%) and hypo (39%) fractionation (81% with a boost), and 10% received accelerated partial breast irradiation. First post-treatment mammogram was received within 3 months (20%), 3-6 months (32%), and after 6 months (48%) following RT. There were no differences in breast density, patient age, T/N stage, receptor status, type of RT, or mammogram timing between those in the 2DM and 3DT groups. The following downstream workup ensued for 3DT compared to 2D imaging: 18% vs 29% short-interval (6-month) mammogram (OR = 1.83, P = 0.01), 6% vs 11% breast MRI (OR = 1.90, P = 0.08), 4% ultrasound for each, and 3% biopsy for each (1 positive in the 2D group). Including downstream workup, the estimated cost per patient in the 3DT group = $249.00 compared to $253.64 in the 2D group. With multivariable analysis the independent predictors for reduced downstream workup was the use of 3DT and follow-up mammogram at least 6 months after radiation (P &lt; 0.05). Conclusions: Excess workup was reduced with 3DT compared to 2DM in the post-treatment setting. A single 3DT costs approximately 34% more than 2DM, however in this study the associated reduction in downstream workup with 3DT actually made it more cost-effective.
Safety and efficacy of neoadjuvant chemotherapy with S-1 and oxaliplatin plus apatinib for locally advanced gastric cancer.
Authors: Ya'nan Zheng, Xiao Yang, Zhentian Ni, Zhenglun Zhu, Wei Xu, Zhongyin Yang, Wentao Liu, Min Yan, Zhenggang Zhu, Chen Li
Journal: Journal of Clinical Oncology (2019)

e15503 Background: Locally advanced gastric cancer (LAGC) has a poor prognosis. Neoadjuvant chemotherapy can reduce tumor loading, degrade staging and increase possibility of complete resection, thus prolonging the survival of LAGC patients (pts). We conducted a phase II trial to assess the feasibility of SOX regimen in combination with apatinib (an anti-angiogenic agent) as neoadjuvant therapy in LAGC. Methods: This study recruited untreated LAGC pts with pathologically and/or cytologically confirmed adenocarcinoma. Treatment included three 21-day cycles of apatinib (oral, 500 mg qd; discontinued in the last cycle), S-1 (oral, 40-60 mg, bid, day 1-day 14) and oxaliplatin (iv, 130 mg/m2, day 1), followed by radical surgery after 4 weeks. The primary outcome was neoadjuvant therapy related toxicity, and the secondary outcomes included tumor response, R0 resection rate, postoperative pathological evaluation and surgical morbidity. Results: Between December 2, 2016 and August 1, 2018, 31 patients were enrolled. Total 29 patients were eligible for safety and efficacy analyses of SOXA as NAC. During NAC treatment, the incidence of adverse events (AEs, any grade) was 100%, and the incidence of grade 3/4 AEs was 34.48%. No treatment-related death. The ORR of 79.31% (95%CI, 60.28-92.01%) and DCR of 96.55% (95%CI, 82.24-99.91%) were achieved. One patient was evaluated as PD with hepatic metastasis after 3 cycles of preoperative chemotherapy, and this case was inoperable. Resection with curative intent was undertaken in 28 patients with R0 resection rate of 100%. Operative morbidity was observed in 12 of 28 patients including fever (9, 32.14%), anastomotic leakage (1, 3.57%), fat liquefaction of post-surgical incision (1, 3.57%), and gastroparesis (1, 3.57%). Additionally, after surgery 1 patient had pulmonary infection and 1 patient had pleural effusion. The median tumor regression was 90% on pathological findings after surgery. Conclusions: Neoadjuvant therapy with apatinib plus SOX for LAGC showed acceptable toxicity and promising efficacy.
Abiraterone acetate in comparison to enzalutamide in African American patients with metastatic castrate-resistant prostate cancer: A single-center retrospective study.
Authors: Mohammad Telfah, Jeffrey M. Holzbeierlein, Xinglei Shen, Elizabeth Marie Wulff-Burchfield, Rahul Atul Parikh
Journal: Journal of Clinical Oncology (2019)

e16547 Background: African American (AA) patients with metastatic castrate-resistant prostate cancer (mCRPC) represent a high-risk population with higher mortality. Recent data suggested that abiraterone acetate (AbA) is more effective in AA in comparison to white patients. There are limited data regarding enzalutamide (Enz) use in AAs. Here, we report the outcomes of (AbA) and (Enz) in AA patients with mCRPC at our center. Methods: A retrospective chart review included AA patients who had a diagnosis of mCRPC and were prescribed AbA and/or Enz at KUMC from 09-01-2008 through 09-01-2018. Patients were divided into two groups: those who started with AbA (abiraterone group) and those who started with Enz (enzalutamide group). Baseline characteristics were compared between the two groups using Fisher’s exact test for categorical variables and the Wilcoxon rank-sum test for continuous variables. The primary outcome was progression-free survival (PFS) on AbA and Enz. PFS was measured from the time of starting either of the two medications to the time of formal relapse, defined by relapse that required therapy change or prostate-cancer-related death. A stepwise Cox proportional-hazard model was used to adjust for potential confounders. Results: During the study period, 28 AA patients with mCRPC received AbA and/or Enz. Twenty-two patients received AbA first, while six patients received Enz first. There were no significant differences in the baseline characteristics between the two groups. Median PFS for the abiraterone group was 24.3 months, while it was 11.7 months for the enzalutamide group, Log-rank test p-value 0.04). After adjusting for potential confounders, the hazard ratio of progression remained significant, favoring the abiraterone group, HR: 0.11, p-value 0.009. Median PFS on AbA after progression on previous Enz was 5.7 months, while it was 4.5 months for Enz after progression on previous AbA, p-value 0.2. Conclusions: In this single-center retrospective study, AA patients with mCRPC who were started on AbA rather than Enz had longer PFS. More studies are needed to understand the best sequence of the two medications in this population.
A retrospective study of mortality among teenage and young adult (TYA) cancer patients in India.
Authors: Prakash Chitalkar, Ankur Punia, Anushree Punia, C Deepak Yadlapalli
Journal: Journal of Clinical Oncology (2019)

e13110 Background: TYAs are a unique group struggling with cancer but also with personal transitions of life. Outcomes of cancer in this group are poorly reported as most reports either address pediatric or adult patients. We evaluated mortality among TYA cancer retrospectively to better understand their journey with cancer. Methods: Teenage and Young adults (15 – 29 years) , from four institutes were included in the retrospective study for the year 2017. Eight hundred and seven of 1310 patients with cancer diagnoses or caregivers were telephonically contacted, in a predefined questionnaire including questions on mortality. Results: Three hundred seventy-two (46.1%) of 807 TYA cancer patients died . Distance and time travel to hospital, demography and alternative medicine were a significant factor for increased mortality. Gender and the age epochs within the TYA group did not determine mortality. One hundred and sixty-two patients died while on treatment whereas 136 patients died while not on any treatment. Seventy-four patients died at disease relapse. Those who died of cancer survived for a median of 180 days (5 - 2340 days). One hundred and four patients (12.9%) died within 90 days of diagnosis.There were significantly more deaths ( 30.4%) in patients who abandoned treatment, than among patients who went on therapy ( 18.6%). ( p 0.0001). Conclusions: Mortality among TYAs with cancer in India is high and is determined largely by factors like demography and logistics.
Implementation of a brief screening tool to identify needs of cancer survivors.
Authors: Allison L. McDonough, Yvonne Y. Lei, Dana Haggett, Rachel Jimenez, Katherine T. Johnston, Beverly Moy, Laura Spring, Jeffrey M. Peppercorn
Journal: Journal of Clinical Oncology (2019)

e23075 Background: Innovation in health care delivery is needed to improve care for cancer survivors. We report a pragmatic study intended to evaluate our experience with adopting screening guidelines from the National Comprehensive Cancer Network (NCCN) to the routine care of breast cancer survivors in primary care and oncology follow up. Methods: We adapted the NCCN recommended screening questions into a plain language self-administered 1 page intake questionnaire. The tool was administered to a convenience sample of female breast cancer survivors in routine follow-up at an oncology or primary care clinic from September through December 2018. Domains included symptoms, lifestyle concerns, and financial issues. Frequency of concerns was assessed as “never”, “rarely”, “sometimes”, “very frequently” and “always”. We dichotomized results and evaluated feasibility of administration, prevalence of reported symptoms and qualitative assessment of burden as well as utility of the tool among participating clinicians. Results: 165 out of 169 patients offered the questionnaire participated (98%). Office staff provided the questionnaire at routine visits without notable impact on clinic flow. Most commonly endorsed concerns (sometimes or more) were: desire to improve fitness or nutrition (80%), worry about cancer recurrence (72%), and problems with sleep (57%). A majority also reported feeling nervous or worried (55%) and aches or pains in limbs or joints (55%). Several issues known to be underreported in clinic visits were endorsed including lack of satisfaction with sexual function (30% sometimes or more, 12% very often or always) and difficulty remembering things (47% sometimes or more, 13% very often or always). Among 7 participating clinicians, the tool was deemed useful and not burdensome. Several noted that it led to discussing issues that may not otherwise have been addressed. Suggestions included systematically identifying resources and strategies to address common issues and incorporating the tool into the electronic health record to increase utility. Conclusions: Screening for individual needs among survivors is feasible and efficient and may identify prevalent issues that otherwise can be missed in routine survivorship care.