tbuckley/cabot-search huggingface dataset:
Survival and cardiac outcomes in elderly individuals with breast cancer: A retrospective study from an academic center.
Authors: Ruby Maini, Nitin Tandan, Manjari Rani Regmi, Priyanka Parajuli, Odalys Estefania Lara Garcia, Cameron Koester, Asad Cheema, Hamsa Sahib, Noupama Mirihagalle, Sabree Abedrabo, Zurain Niaz, Abdisamad M. Ibrahim, Bishal Bhandari, Alexander Johnson, Kristin Delfino, Kathy Robinson, Meghna R. Desai, Abhishek Kulkarni
Journal: Journal of Clinical Oncology (2020)

e13635 Background: Approximately 40% of females over the age of 65 are newly diagnosed with breast cancer. When considering elderly patients with breast cancer ( &gt; 65 years old), complex decision making is required as patients have multiple cardiac comorbidities that may confound treatment goals. In this abstract, we aim to identify survival and cardiac outcomes in elderly individuals. Methods: This study was conducted using a retrospective cohort design with use electronic patient records. ICD diagnoses codes were used to identify breast cancer patients. Our initial search criteria revealed 1618 patients. Our eligibility criteria included adult patients 18 years and older with newly diagnosed breast cancer from January 1 st , 2014 – January 31 st , 2017 which yielded 478 patients. All data was collected through retrospective chart review. Analysis was performed with SAS v9.4 software. Qualitative variables were analyzed using Chi-Square Test. Survival curves are estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival are assessed with Cox proportional hazards regression analyses. All significance was assumed at the p &lt; 0.05 level and reported as hazard ratios (HR). Results: Of our 478 breast cancer patients, 260 (59.5%) patients were less than age 65 and 177 (40.5%) patients were older than age 65. Of these two age groups, cardiac events including new diagnosis of heart failure (HF), heart failure (HF) hospitalization, and acute coronary syndrome were studied. For patients with age less than 65: n = 11 for new diagnoses of HF, n = 4 for HF hospitalizations, and n = 3 for ACS. For patients with age greater than 65: n = 5 for new diagnoses of HF, n = 3 for HF hospitalizations, and n = 2 for ACS. Comparing these two groups, there was no statistically significant cardiac event (p = &gt; 0.05). Comparing survival among these two age groups also did not yield statistically significant results (p &gt; 0.05). Conclusions: Per our data, it appears that there is no statistically significant difference in cardiac outcomes in different age groups for patients with breast cancer. Additionally, there was no difference in mortality among different age groups with breast cancer patients. Further prospective studies should be performed to confirm trends of mortality.
Clinical and pathologic factors associated with survival in BRAFV600E colorectal cancers.
Authors: Van K. Morris, Bryan K. Kee, Michael J. Overman, David R. Fogelman, Arvind Dasari, Kanwal Pratap Singh Raghav, Imad Shureiqi, Benny Johnson, Christine Megerdichian Parseghian, Robert A. Wolff, Cathy Eng, Naveen Garg, Scott Kopetz
Journal: Journal of Clinical Oncology (2020)

4047 Background: BRAF V600E mutations occur in fewer than 10% of all patients (pts) with metastatic colorectal cancer (mCRC) and arise from sessile serrated adenomas. Despite efficacy with targeted therapies against MAPK signaling and with immunotherapies in this population, survival outcomes for pts with BRAF V600E mCRC in general are poor. Characteristics distinguishing pts with BRAF V600E mCRC with favorable versus unfavorable outcomes have not been well annotated. Methods: Records of 188 pts with BRAF V600E mCRC evaluated at MD Anderson Cancer Center between 3/2010-1/2020 were reviewed. Pts with the shortest and longest metastatic survival (N = 25 for each group) were compared. Associations between prognostic group and clinical/pathologic features were measured by odds ratio and for median survival by log-rank testing. Results: Median metastatic survival differed between the 2 BRAF V600E mCRC populations (8.6 vs 84 months, p &lt; .0001). Pts with poor survival more commonly had primary tumors arising from the hepatic flexure/proximal transverse colon (44% vs 16%, p = .04) and more frequent hepatic involvement (75% vs 28%, p = .001). Pts with favorable survival were more likely to develop metachronous metastases (52% vs 16%, p = .01), have fewer distant organ involvement (median 1 vs 2, p = .02), and undergo definitive locoregional therapy to metastatic disease (44% vs 0%, p = .01). Microsatellite instability (36% vs 4%, p = .008) and a history of tobacco use (44% vs 16%, p = .04) were associated with a favorable prognosis. Durable responses to MAPK-targeted therapies (5/25) and immunotherapy (3/25) were noted in the favorable group. Conclusions: Pts with BRAF V600E mCRC can achieve excellent long-term survival which belies conventional context and is driven by locoregional and systemic treatment options alike. Anatomic localization of the primary tumor and prior exposures may highlight environmental influences on tumor biology which account for the clinical heterogeneity of pts with BRAF V600E mCRC.
Digital Health Equity as a Necessity in the 21st Century Cures Act Era
Authors: Jorge A. Rodriguez, Cheryl R. Clark, David W. Bates
Journal: JAMA (2020)

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 Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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) 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
Role of bile leakage test in preventing bile leakage during partial liver resection
Authors: Zhiyi Liu, Hu Jin, Ming Liu, Tieliang Sun, Chunliang Zhai, Yang Gu
Journal: BMJ (2014)

To evaluate the value of an intraoperative bile leakage test during liver resection in the prevention of bile leakage after hepatic resection. A sterile fat emulsion was injected through the duct of gallbladder among patients from the treatment group so as to observe leakage status on hepatic resection plane; the leakage points were timely handled. The hepatic resection plane was treated with conventional methods among patients from the control group. The incidence rates of bile leakage and other complications were analyzed between two groups. Two (4%) of 53 patients from the treatment group had bile leakage versus 8 (15%) of 54 patients from the control group. Significant differences existed between two groups in terms of the incidence of bile leakage (P 0.05). An intraoperative bile leakage test is sensitive in detecting interoperative bile leaks and can effectively prevent bile leakage after hepatic resection. And it does not increase the likelihood of other complications.


Key words: 
Postoperative complications, bile leakage; Hepatectomy
Phase I study of the Bcl-2 inhibitor venetoclax with DA-EPOCH-R as initial therapy for aggressive B-cell lymphomas.
Authors: Sarah C. Rutherford, Jeremy S. Abramson, Nancy L. Bartlett, Stefan K. Barta, Nadia Khan, Robin Joyce, Kami J. Maddocks, Ying Yuan, Trisha Ali-Shaw, Silvia Senese, Jason Westin, John Paul Leonard
Journal: Journal of Clinical Oncology (2020)

8003 Background: Dose-adjusted (DA) EPOCH-R is a frontline treatment for aggressive B-cell lymphomas. Bcl-2 is associated with chemoresistance due to BCL2 gene rearrangement or protein overexpression in lymphomas and is antagonized by BH3 mimetic venetoclax (ven). We conducted a phase I study combining ven with DA-EPOCH-R in aggressive B-cell lymphomas. Methods: This phase 1 study used Bayesian optimal interval design with dose expansion. Eligible patients (pts) were 18 years with newly diagnosed diffuse large B-cell (DLBCL), primary mediastinal, and high grade B-cell lymphoma (HGBCL) with double hit (DHL) or not otherwise specified (NOS). Ven was dosed at 400 mg (DL1), 600 mg (DL2), and 800 mg (DL3) daily for 10 days with 6 cycles of DA-EPOCH-R. A subsequent cohort received ven 600 mg daily for 5 days (DL2B). Toxicities were graded by CTCAE v4.0 and response assessed by Lugano criteria. Dose limiting toxicity (DLT) period was cycle 1 and primarily included grade (gr) ≥3 neutropenia on cycle 2 day 1, gr ≥4 febrile neutropenia/thrombocytopenia, and gr ≥3 nausea, vomiting, diarrhea despite supportive care. Results: 30 pts enrolled with median age 64 (24-79), and 50% female. Ann Arbor stage was III-IV in 23. IPI was high risk in &gt; 50%. Diagnosis was DHL (15), DLBCL NOS (13), and HGBCL NOS (2). 18 had MYC and 14 had BCL2 rearrangements. Bcl-2 was expressed ≥50% by IHC in 21/26 with data. There were no DLTs in DL1 (3 pts) or DL2 (9 pts). 1/6 had DLT in DL3 (gr 4 thrombocytopenia). Ven dose reductions occurred in subsequent cycles in 4 (2 in DL2; 2 in DL3). Of 18 in DL1-3, EPOCH was escalated above level 1 in 1 and de-escalated below level 1 in 7. Because of delays and ven dose reductions in DL2-3 due in part to cytopenias, infections and GI toxicities, we accrued DL2B. In DL2B, 0/12 pts had DLTs or ven dose reductions. EPOCH was escalated above level 1 in 4 and de-escalated below level 1 in 3. 1 died of sepsis during cycle 3. Most common gr 3-4 toxicities across all dose levels were cytopenias; febrile neutropenia occurred in 57%. Most common non-hematologic toxicities of all grades were hypocalcemia, nausea, diarrhea, hypokalemia and fatigue. ORR (N = 30) ITT was 97% with 27 (90%) complete and 2 (7%) partial responses; 1 was not evaluable. Follow up is ongoing. Of 15 DHL, ORR and CRR were 93% and 80%. Conclusions: We identified ven 600 mg for 5 days per cycle as RP2D with DA-EPOCH-R. DL2B was well tolerated and required no ven dose reductions. Further efficacy and safety is being evaluated in Alliance 51701, DA-EPOCH-R/R-CHOP in DH/double expressor lymphomas, using the dosing regimen defined by this study. Clinical trial information: NCT03036904 .
Effectiveness of monitoring common chronic diseases in community by integrated traditional Chinese medicine and western medicine
Authors: Ling Shi, Zhonghua Liu, Zihui Tang, Liping Shen, Haidong Kuang, Xiaolei Wu
Journal: BMJ (2017)

The monitoring of chronic diseases, including diabetes, hypertension, coronary heart disease and osteoporosis among residents in the community was conducted by Shanghai Changfeng Community Health Service Center, and the identification of physical constitution according to Traditional Chinese Medicine system was performed simultaneously. The medical checkup report and advices on prevention and treatment was provided to the residents, so that they know better about their health condition and its management.


Key words: 
Chronic diseases; Population surveillance; Community health centers
Simulation modeling of budget-neutral expanded access to antineoplastic therapy from cost-savings derived from conversion to biosimilar pegfilgrastim-cbqv for the prophylaxis of chemotherapy-induced (febrile) neutropenia (CIN/FN) in early-stage breast cancer.
Authors: Ali McBride, Karen MacDonald, Ivo Abraham
Journal: Journal of Clinical Oncology (2020)

e19371 Background: Biosimilars not only have the potential to reduce the cost of prophylaxis of CIN/FN but such savings could be reallocated to provide access to anti-neoplastic treatment. To demonstrate this, we simulated in a 20,000-patient panel: 1) the savings that could be realized from CIN/FN prophylaxis with biosimilar pegfilgrastim-cbqv over reference pegfilgrastim with or without on-body injector (PEG/PEG-OBI), 2) a model of expanded access to adjuvant chemotherapy with doxorubicin/cyclophosphamide for localized breast cancer from cost-savings achieved from conversion from PEG/PEG-OBI, and 3) the number-needed-to-convert (NNC) to biosimilar pegfilgrastim-cbqv from PEG/PEG-OBI to purchase one additional treatment of doxorubicin/cyclophosphamide chemotherapy. Methods: Simulation modeling from the US payer perspective utilizing:average selling price (ASP) derived from CMS Q1 2020 reimbursement limits for PEG/PEG-OBI, pegfilgrastim-cbqv, doxorubicin and cyclophosphamide;between one and six cycles of prophylaxis in a panel of 20,000 cancer patients at risk for CIN/FN; and conversion rates from PEG/PEG-OBI to biosimilar pegfilgrastim-cbqv ranging from 10% to 100%. Results: Using current ASP, cost-savings of biosimilar pegfilgrastim-cbqv over PEG/PEG-OBI in a panel of 20,000 breast cancer patients range from $445,163 (for one cycle of prophylaxis at 10% conversion) to $26,709,788 (6 cycles at 100% conversion). In a single cycle of chemotherapy, these savings translate into expanded access to doxorubicin/cyclophosphamide ranging from 1,286 cycles at 10% conversion from PEG/PEG-OBI to 12,861 cycles at 100% conversion. The savings over six cycles could provide between 7,717 additional cycles of doxorubicin/cyclophosphamide (at 10% conversion) to 77,166 cycles (at 100% conversion). The NNC from PEG/PEG-OBI to purchase one additional cycle of doxorubicin/cyclophosphamide is 2. Conclusions: These models demonstrate that CIN/FN prophylaxis with biosimilar pegfilgrastim-cbqv can generate significant cost savings for supportive cancer care. Further, these savings could be reallocated to provide access to curative anti-neoplastic treatment on a budget-neutral basis, thus enhancing the value of cancer care to both payers and patients.
Economic burden of not testing for FLT3 to treat acute myeloid leukemia.
Authors: Raymond Henderson, Dave Smart, Declan French, Jordan Clark, Kenneth Joel Bloom, Derek Hosty, Mark Lawler
Journal: Journal of Clinical Oncology (2020)

e13652 Background: Acute myeloid leukemia (AML) is a hematologic neoplasm with poor 5-year survival (33%; US 2016), a median survival of only 4 months for relapsed/refractory cases, and in 2016, a US incidence of 19,950 cases and 10,340 deaths. With the largest patient cohort over 65, AML treatment costs in the first year are &gt; $25,000 per patient per month (PPPM); the initial month’s cost is $82,328. Mutations in the FMS-like tyrosine kinase 3 ( FLT3 + ) pathway confer resistance to standard chemotherapy and reduce the likelihood of survival after relapse. In 2017 and 2018, the FDA approved midostaurin and gilteritinib, two current FLT3 + precision medicines for AML. Here, we determine the economic burden of not testing for FLT3 + . Methods: AML healthcare costs were assessed and modelled for the following settings: hospital, outpatient, emergency, and primary care. Pharmaceutical activity and cost data were extracted from the Centers for Medicare and Medicaid Services (CMS) database, employing Diaceutics’ proprietary Global Diagnostic Index. Our model forecasts the economic impact of precision testing to guide FLT3 + precision medicines in 2017 through 2019. Our algorithm calculates the number of AML patients with FLT3 + based on AML Medicare patients in the Healthcare Cost and Utilization Project database and FLT3 + prevalence and switching data. Results: Total US 2016 AML costs were $1.574 billion (bn), consisting of (i) hospital care $1 bn (including $229 million (mn) for bone marrow transplantation and $20.5 mn for pharmaceuticals); (ii) outpatient care $9.8 mn; (iii) emergency care $553.9 mn; (iv) primary care $6.6 mn. Analysis of CMS data revealed a paucity of FLT3 + testing to guide therapy. We estimate that after testing, 2,164 FLT3 + Medicare patients could benefit from precision medicine interventions, generating 2,965 quality-adjusted life years (QALYs) or 2,783 QALYs when administering midostaurin or gilteritinib respectively. Conclusions: This study is the most detailed analysis of the economic burden of AML among US Medicare patients to date and is the only AML cost-of-illness study to incorporate data concerning patients’ QALYs lost by failure to employ precision medicine. This study not only illustrates the minimal FLT3 testing conducted, but also the lack of precision medicines administered.
Effect of smoking on endothelium-dependent vascular relaxing function and plasma apelin level
Authors: Dawei Wang, Yan Fu, Qiumei Cao, Bingchen Ma, Yixin Liu
Journal: BMJ (2018)

Objective
To explore the effect of smoking on endothelium-dependent vascular relaxing function and endogenous apelin-13 level.


Methods
Forty healthy volunteers, including 20 smokers and 20 non-smokers were randomly selected and participated in the study from December 2014 to April 2015. During the study period the smokers were asked to quit smoking for one month and the non-smoking group was given short-term smoking intervention. The changes of vascular endothelial function and plasma apelin-13 levels were compared between the smoking group and non-smoking group, and before and after intervention.


Results
Flow-mediated dilatation (FMD) in smoking group was significantly lower than that in non-smoking group [(5.34±1.83)% vs. (8.12±2.62)%, t=-3.75, P<0.01]. FMD in smoking group was significantly increased after 1 month of quitting smoking [(5.34±1.83)% vs. (9.05±2.18)%, t=-6.66, P<0.01], FMD in non smoking group was slightly decreased [(8.12±2.62)% vs. (7.78±1.96)%, t=0.90, P=0.38] after short-term smoking. The level of plasma apelin-13 in smoking group was significantly lower than that of non smoking group [(44.22±16.58)pg/ml vs. (70.12±24.35) pg/ml, t=-3.79, P<0.01]. The level of plasma apelin-13 in smoking group was significantly increased after 1 month of smoking cessation intervention [(44.22±16.58)pg/ml vs. (65.32±17.13) pg/ml, t=-4.26, P<0.01]. In non smoking group, the level of plasma apelin-13 was significantly decreased after short-term smoking [(70.12±24.35)pg/ml vs. (45.83±15.66) pg/ml, t=4.93, P<0.01].


Conclusion
Cigarette smoking leads to endothelial dysfunction. Short term occlusion of tobacco may significantly improve endothelial function and increase plasma apelin-13 level, suggesting that apelin-13 may be involved in the occurrence and development of endothelial dysfunction induced by cigarette smoking.


Key words: 
Smoking; Endothelium, vascular; Dilatation; Apelin-13 peptide
Dementia risk among post-menopausal women treated with endocrine therapy for early-stage breast cancer in Ontario, Canada.
Authors: Phillip S. Blanchette, Melody Lam, Britney Le, Lucie Richard, Salimah Shariff, Kathleen I. Pritchard, Jacques Raphael, Theodore A. Vandenberg, Ricardo Fernandes, Danielle Desautels, Kelvin K. Chan, Craig Earle
Journal: Journal of Clinical Oncology (2020)

521 Background: The association between anti-estrogen therapy and risk of dementia remains controversial. We performed a population-based real-world study investigating the association between endocrine therapy use and dementia. Methods: We used health administrative data collected from post-menopausal women (aged ≥66 years) who were diagnosed with breast cancer and started on adjuvant endocrine therapy from 2005-2012. Patients were classified by use of either an aromatase inhibitor or tamoxifen and followed to measure an unadjusted cumulative incidence of developing dementia. A multivariable analysis adjusting for age, income quintile, medical comorbidities, and duration of endocrine therapy was completed using a Cox-proportional hazards model. Results: We identified 12,077 patients of whom 73% were treated with an aromatase inhibitor and 27% with tamoxifen. The median age was 73 years (IQR 69-78), 64% of patients were treated with lumpectomy, and 19% received adjuvant chemotherapy. The unadjusted event rate for developing dementia was Hazard Ratio (HR)= 0.70 (95% confidence interval (CI)=0.63-0.78, p-value&lt;0.0001) among patients receiving an aromatase inhibitor versus tamoxifen and the 5-year dementia incidence rate was 7.4% versus 9.2% respectively. Our multivariable analysis showed a significant decrease in the rate of dementia in patients treated with an aromatase inhibitor compared to tamoxifen (HR=0.88, 95% CI 0.78-0.98, p-value=0.02) with a median of 5.9 years of follow-up. Factors associated with the development of dementia included older age, previous history of ischemic heart disease, diabetes, hypertension and stroke. Duration of endocrine therapy and previous use of adjuvant chemotherapy were not associated with dementia in our study. Conclusions: This investigation indicates that use of aromatase inhibitors compared to tamoxifen is associated with a lower risk of developing dementia among post-menopausal breast cancer patients. Further prospective studies investigating the neurocognitive effects of endocrine therapy are warranted.
Oncolytic activity of a new group of non-classified rotavirus of Reoviridae family on human epidermoid carcinoma A431 growth.
Authors: Sergey A. Kolpakov, Elena P. Kolpakova, Elena Yu. Zlatnik, Evgeniya M. Nepomnyashchaya, Oksana G. Shulgina, Anastasia O. Sitkovskaya, Oleg I. Kit
Journal: Journal of Clinical Oncology (2020)

e15272 Background: Significant increase of malignant tumors` incidence all over the world in spite of vast arsenal of anticancer drugs and their combinations challenges the oncologists to develop new approaches to tumor treatment. Application of oncolytic virus is considered to be rather promising. Here we studied two strains of the new group of non-classified rotavirus of Reoviridae family (RVK): 100 and 228 ( http://jbks.ru/archive/issue-10/article-6 ). RVK are attenuated non-pathogenic virus growing on pig embryo kidney cell culture with concentration 5·10 9 per 1 ml. The aim of the study was to assess the effect of two RVK strains (100 and 228) on the growth of human epidermoid carcinoma A431 transplanted to nude mice in vivo. Methods: Mice Balb/cNude 22-24 g body weight (n = 13) were injected with 4х10 6 cells of human epidermoid carcinoma A431 subcutaneously in SPF-area of vivarium. After formation of palpable tumors (1 week after transplantation) administration of alive RVK strains 100 and 228 was performed. The 3 rd group was the control one and received 0.85% NaCl. The injections were performed once a week 0.3 ml. Tumor growth rate and its` volume were measured. 1 week after the completion of the course mice were sacrificed, tumors were weighted and their morphology was studied. Results: In mice injected with RVK tumor growth inhibition developed in early date after the injection and was statistically significant within 30 - 40 days of monitoring only after the administration of strain 100. In these animals tumor weight was 2.6 times lower than in control mice (6.3±3.0 и 16.6±2.3 g respectively, р &lt; 0.05), in mice having received strain 228 it was 1.7 times less tan in controls. Layers of high-grade sqamous carcinoma cells without keratinization with inflammatory and necrotic foci were observed in tumors of control mice while in tumors inhibited by RVK dystrophic changes and fragmentation, inflammation in places severe and necrotic foci were seen. Implication of the strain 100 resulted in 2-3 time reduction of tumor size, decrease of tumor cells` layers, mononuclear infiltration. Conclusions: In the in vivo model of human epidermoid carcinoma A431 transplanted to nude mice the inhibition of tumor growth under RVK administration was established. Our results confirm the oncolytic activity in RVK, particularly in strain 100.