tbuckley/cabot-search huggingface dataset:
The timing of chemoradiotherapy after surgical resection and its impact on overall survival in glioblastoma.
Authors: Robert H. Press, Sarah L. Shafer, Renjian Jiang, Zachary S. Buchwald, Mustafa Abugideiri, Sibo Tian, Tiffany Morgan, Madhusmita Behera, Soma Sengupta, Alfredo Daniel Voloschin, Jeffrey J. Olson, Walter John Curran, Bree Ruppert Eaton, Hui-Kuo George Shu, Jim Zhong
Journal: Journal of Clinical Oncology (2019)

2051 Background: Prior studies examining time to initiate chemoradiotherapy (CRT) after surgical resection (S) in glioblastoma (GBM) have not provided clear consensus on its clinical impact. We sought to evaluate the effect that differential timing of adjuvant therapy may have on overall survival (OS). Methods: With the National Cancer Database (NCDB), patients (pts) with GBM who underwent S and adjuvant CRT from 2004-2013 were analyzed. Analysis was performed for the entire cohort as well as by Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) classes (i.e. I, II, and III). Time from S to CRT was grouped weekly (i.e. 0-1, 1-2, 2-3, 3-4, 4-5, 5-6, 6-7, 7-8, and &gt; 8 weeks). Pts were excluded if they died within the first 8 weeks to account for immortal time bias. Kaplan-Meier analysis, log-rank testing, and multivariate (MVA) Cox proportional hazards regression were performed with OS as the primary outcome. Results: A total of 30,414 pts were included for analysis. RPA class I, II, and III contained 903, 4,347, and 25,164 pts, respectively. The most common time to initiate CRT was week 4-5 (n = 7389), and this group served as reference for survival analysis. On MVA, weeks 0-1 (hazard ratio [HR] 1.18, 95% confidence interval [CI] 1.02-1.35), 1-2 (HR 1.24, CI 1.17-1.32), and 2-3 (HR 1.11, CI 1.07-1.15) demonstrated worse OS (all p &lt; 0.03). For RPA class I pts, week 1-2 (HR 2.07, CI 1.08-3.95) was associated with worse OS (p = 0.028). For RPA class II pts, weeks 1-2 (HR 1.34, CI 1.14-1.57), 2-3 (HR 1.18, CI 1.07-1.31), and 3-4 (HR 1.10, CI 1.0-1.21) were associated with worse OS (all p &lt; 0.05). For RPA class III pts, weeks 0-1 (HR 1.18, CI 1.02-1.38), 1-2 (HR 1.22, CI 1.14-1.3), and 2-3 (HR 1.09, CI 1.05-1.14) were associated with worse OS (all p &lt; 0.03). No time point after week 5 was associated with change in OS for the overall cohort or any RPA class subgroup. Conclusions: These data provide insight into the optimal timing of CRT in GBM and describe RPA-class specific outcomes. In general, OS was negatively impacted if CRT started less than 3 weeks from S. Waiting up to 8 weeks, however, was not detrimental to OS and suggests delaying CRT beyond week 4-5 should be considered if clinically indicated without undue concern.
Clinical and economic outcomes of pegfilgrastim in metastatic colorectal cancer.
Authors: Lalan S. Wilfong, Jody S. Garey, Bo He, Jad Hayes, Hope Ives, Susan Nga Hoang, Marcus A. Neubauer
Journal: Journal of Clinical Oncology (2019)

6636 Background: Febrile neutropenia (FN) resulting from myelosuppressive chemotherapy can lead to increased hospitalizations and mortality. Pegfilgrastim can be used to reduce the risk of FN; however, few studies address pegfilgrastim’s value in patients with metastatic solid tumors. This observational study compared outcomes for pegfilgrastim-treated (peg-tx) and peg-untreated (no peg) patients with metastatic colorectal (CRC) at US Oncology practices (USO) participating in the Oncology Care Model. Methods: Patients with metastatic CRC treated at USO from July 1, 2013 – December 31, 2014 and a qualifying baseline OCM episode were included. Propensity scoring was used to match (1:2) peg-tx and no peg cohorts based on line of therapy, number of comorbidities, age, gender, ECOG performance status, chemotherapy neutropenic fever risk, and dose reduction. Outcomes assessed included all-cause and infection-related hospitalization rates; total cost of care per 6-month OCM episode; and overall survival (OS). Results: Matched peg-tx and no peg samples were 149:298. The all-cause hospitalization rate was higher in the peg-tx vs. no peg population, 45% vs. 32% (OR 1.7, (1.1, 2.5), p = 0.011). Infection-related hospitalization rates were no different in peg-tx vs. no peg cohorts, p = 0.367. Cost of care was significantly higher for peg-tx patients vs. no peg ($58,787 ± $20,490 vs. $37,811 ± $19,593 respectively, p &lt; .001). OS was 19.5 months (peg-tx) vs. 19.7 months (no peg), p = 0.882. Conclusions: While peg use in curative treatment settings for high risk patients is standard of care, in our Medicare population use in metastatic CRC did not result in a lower all-cause or infection-related hospitalization rate or impact in OS. There was a higher 6-month total cost of care associated with those patients who received peg during chemotherapy.
Satisfaction survey from an innovative cancer care delivery model (Pendharkar model), creating access at scale: An outcome research.
Authors: Chandramauli Tripathi, Dinesh Pendharkar, Bhure Singh Saitya
Journal: Journal of Clinical Oncology (2019)

e18002 Background: With the aim of empowering alternate oncology workforce, to resolve the issue of access, a unique cancer care delivery model (Pendharkar model) was launched in 4 states of India, spread across 125 districts with population coverage of around 210 million. The model has established nodal cancer units in every government run district hospital and created a point of contact for cancer- a physician-medical officer. Hundreds of patients have been seen by these hospital in last four years. The aim of this analysis was to survey the patient population attending and their satisfaction level. Methods: An elaborate survey was conducted amongst patients coming to district hospital. It sought information on satisfaction, choices. The written responses were sought, and data analysed. Results: Overall.186 patients were surveyed. Nearly 62 % of the patients had visited hospital multiple times before. Referral pattern showed that about 7 % of the patients were referred by other patients who were treated here, 62 % of the patients were referred by other medical professional, including nearby cancer hospitals and specialists. More than half of the patients (54.1) had taken cancer treatment outside district hospital, at some point of time. On question of comparison of service 65 % felt services to be better in government run setup, the time to start of therapy was much faster (74%).The time given by the doctor to the patient was satisfactory, highly appreciated by 97% of the respondents. Ease of accessibility of the staff was positively accepted by 100 %. All were happy with the level of communication by the doctors and nursing staff. Chemotherapy experience was better in district hospital set up for 58 % of the patients. More than 95% rated nursing services of high quality and all were happy with the behaviour of nurses. 80% were interested in continuing chemotherapy in same government hospital. Majority said that they are happy with their decision of taking chemotherapy in district hospital and would definitely refer other patients here. Conclusions: The survey strongly favours the model of empowerment of alternate oncology workforce in government run district hospital, and achieves high level of satisfaction amongst cancer patients.
Association of total hysterectomy with survival among newly diagnosed uterine cancer patients with distant organ metastasis.
Authors: Yuefeng Wang, Todd D. Tillmanns, Michael Farmer, Lillian Rinker, Bradley G. Somer, Matthew T. Ballo
Journal: Journal of Clinical Oncology (2019)

5583 Background: There is growing evidence that definitive local therapies (surgery or radiotherapy) may increase patient’s survival for some types of metastatic cancers. However, the role of total abdominal hysterectomy (TAH) for newly diagnosed uterine cancer with distant organ metastasis has not been established. The objective of this study is to determine the potential overall survival (OS) benefit associated with TAH for distant metastatic uterine cancer. Methods: The National Cancer Database was analyzed to evaluate OS for newly diagnosed uterine cancer patients with metastasis to brain, lung, liver, bone or distant lymph node, treated with chemotherapy with or without TAH. Those without treatment, treated with definitive pelvic radiotherapy, or without baseline variables were excluded. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. In order to control the selection biases, we performed Landmark analysis, and survival analysis by the sequence of chemotherapy and TAH. Separate survival analysis was performed for patients who received chemotherapy plus definitive pelvic radiotherapy (RT) or chemotherapy plus TAH and definitive pelvic RT. Results: From 2010 to 2014, 1,809 uterine cancer patients with distant organ metastasis received chemotherapy alone and 1,388 patients received chemotherapy plus TAH. At a median follow-up of 13.4 months, addition of TAH to chemotherapy was associated with improved survival on univariate (HR 0.57; P &lt; 0.001) and multivariate analysis (HR 0.59; P &lt; 0.001) compared to chemotherapy alone. Propensity score-matched analysis demonstrated superior median survival (19.8 vs 11.0 months) and 2-year OS (44% vs 28%) with TAH (multivariate HR 0.59; P &lt; 0.001). Landmark analyses limited to long-term survivors of ≥0.5, ≥1, and ≥2 years showed improved OS with TAH in all subsets (all P &lt; 0.05). The benefit of TAH was present among not only those involving one metastatic site (HR 0.59; P &lt; 0.001), but also those involving multiple metastatic sites (HR 0.60; P &lt; 0.001). Separate survival analyses showed chemotherapy plus definitive pelvic RT or chemotherapy plus TAH and RT were both superior to chemotherapy alone. Conclusions: In this large contemporary analysis, uterine cancer patients with distant organ metastasis receiving TAH and chemotherapy had substantial longer survival than patients treated with chemotherapy alone. Prospective trials evaluating TAH for metastatic uterine cancer are warranted.
Abstract P182: Role of Obesity for the Risk of Hypertension in Youth
Authors: Corinna Koebnick, Matthew F Daley, Yasmina D Mohan, Kristi Reynolds, Xia Li, Margo A Sidell, Amy H Porter, Joel Handler, Stephen Daniels, Beatriz D Kuizon
Journal: Circulation (2016)

Background: National data on the incidence of and risk factors for pediatric hypertension are scant and the role of obesity during childhood in the development of incident hypertension in children and adolescents is ill-defined. Study Design: For this population-based cohort of youth in southern California, members of a health plan between 3 and 17 years of age and without hypertension (n = 279,708) were passively followed. Blood pressure (BP) and baseline body mass index were extracted from electronic health records. We classified BP using the definitions of the Fourth Report (NHBPEP 2005). Results: The cohort was racially/ethnically diverse (52.5% Hispanic, 9.9% Black, 7.4% Asian) and 51.2% were under the age of 12 years. During 1,124,912 person-years of follow-up (over a median of 5.0 years), we identified 9,158 youth with incident hypertension. In analyses adjusted for age and sex, participants who were severely obese had a relative risk (RR) of hypertension of 5.34 (see table) compared to their normal weight counterparts. After additional adjustment for baseline BP (normotensive, single, or repeated medical visits with prehypertension), the association was substantially attenuated (RR of 4.44). When we further adjusted for race/ethnicity and socioeconomic status, the relation was essentially the same. Conclusions: Severe obesity was a strong predictor of hypertension in children and adolescents. Our study demonstrates a strong, graded and positive relationship between adiposity in youth and hypertension. Strategies aimed at prevention of adiposity in youth may play an important role in the prevention of hypertension.
An analysis of the sociodemographic factors contributing to patient nonadherence to recommendations for screening mammograms.
Authors: Ahmer Mohammad Ansari, Irene Mohammad Pericot-Valverde, Krupa Mohammad Merchant
Journal: Journal of Clinical Oncology (2019)

e13077 Background: There were 2 million newly diagnosed cases of breast cancer in the United States during 2018 with 40,920 associated deaths 1 . The number of deaths has been decreasing over time due to effective breast cancer screening by mammogram. Routine mammograms lead to early recognition and treatment of breast cancer leading to an overall improvement in breast cancer outcomes. However, not all patients are adherent to screening mammogram schedules. The main aim of this study is to explore the current prevalence of breast cancer screening among women in the US. A secondary aim is to determine whether cancer screening is associated with identifiable sociodemographic determinants and cigarette smoking. Methods: Data were drawn from the Health Information National Trends Survey- (HINTS), a cross-sectional, nationally representative survey (N = 3,527) conducted in 2018. Responses from women aged 18-74 were used in this study. Descriptive analyses and chi-squared tests were conducted to estimate the prevalence of breast cancer screening by mammogram, as well as its association with certain sociodemographic characteristics and smoking status. Results: The survey sample included 1,722 women. The majority of the respondents were aged 45 years or older. A total of 5% of women had previously been diagnosed with breast cancer, most of them being between 65 and 74 years old. Overall, 22.1% of respondents reported that they had never had a mammogram. Breast cancer screening was significantly lower among young women aged 18 to 34 (76.0%), Hispanic (28.2%) and Asian (39.7%), and current smokers (24.6%). Conclusions: This study shows that there is a significant percentage of women in the US that do not adhere to screening recommendations for breast cancer. This study provides new and continuing evidence, regarding the profiles of women with poor adherence to these screening mammogram schedules. Overall, the findings from this study emphasize the importance of addressing racial and sociodemographic factors in an effort to improve screening mammogram adherence. References: 1. Cancer stat facts: Female breast cancer. Surveillance, Epidemiology, and End Results (SEER) Web site. https://seer.cancer.gov/statfacts/html/breast.html . Updated 2019. Accessed 02/10, 2019.
Endocrine-based targeted combination versus endocrine therapy alone as first-line treatment in elderly patients with hormone receptor-positive advanced breast cancer: Meta-analysis of phase II and III randomized clinical trials.
Authors: Claudia Omarini, Federico Piacentini, Isabella Sperduti, Monica Barbolini, Chrystel Isca, Cecilia Nasso, Angela Toss, Raffaella D'Onofrio, Laura Cortesi, Elena Barbieri, Stefano Cascinu, Luca Moscetti
Journal: Journal of Clinical Oncology (2019)

1046 Background: Combined endocrine approaches have been widely investigated as first-line treatment in hormone receptors positive metastatic breast cancer. In particular, multiple randomized trials showed that the addiction of CDK (cyclin-dependent kinase) 4/6 inhibitors to endocrine therapy (ET) increase progression free survival (PFS). Elderly patients (aged ≥65 years) are under represented in most of the clinical studies. Moreover, due to the multi-morbidity and the major toxicity associated with the targeted agents, the combination strategy in that subgroup is widely discussed. The present meta-analysis aimed to understand the role of the new endocrine approaches in women aged ≥65 years. Methods: This meta-analysis included first line phase II/III randomized published trials comparing (ET) to the experimental strategy. Trials with no data about hazard ratios (HR) for PFS in the subgroup of patients aged ≥65 years were excluded. The heterogeneity of the data was evaluated by Chi-square Q test and I 2 statistic. Results: 8 studies were included in the analysis. 4 trials (Paloma1/TRIO-18, Paloma2, Monaleesa2, Monarch3) investigated the role of CDK 4/6 inhibitors, 2 trials (SWOG and FACT) analysed the combination of Fulvestrant plus Aromatase Inhibitors, while other two trials explored the association of ET with Bevacizumab (LEA) and Temsirolimus (HORIZON), respectively. Overall, the meta-analysis showed a PFS advantage for the experimental arms [HR 0.77, p 0.016] with a significant high/moderate heterogeneity [I 2 65.46%, p 0.005]. The 4 studies adding CDK4/6 inhibitors to ET showed a significant improvement in PFS compared to ET alone. No significant advantages for the addition of anti-angiogenic agents or Fulvestrant to ET have been found in elderly population subgroup. Conclusions: The novel experimental combo-strategies in the first line setting showed an improvement in PFS in the subgroup of elderly patients. Adding CDK4/6 inhibitors to ET significantly prolongs PFS as compared to ET alone. The magnitude of PFS benefit due to addition of CDK4/6 inhibitors to ET is age-independent.
Toxicity syndromes, patient-related clinical indicator of toxicity burden induced by intensive triplet chemotherapy-based regimens in metastatic gastrointestinal cancers.
Authors: Gemma Bruera, Stefania Mastropietro, Luigia Dari Salisburgo, Pierluigi Cosenza, Enrico Ricevuto
Journal: Journal of Clinical Oncology (2019)

e15013 Background: Cancer treatments induce symptoms and signs superimposing on clinical and cancer-related status of individual patient, defining heterogenous toxicity syndromes (TS). We reviewed intensive first line triplet chemotherapy-based regimens developed in fit metastatic gastro-intestinal cancers (mGI), based on FIr/FOx schedule including fluorouracil and weekly alternating irinotecan and oxaliplatin. Methods: Metastatic colorectal (mCRC), pancreatic ductal adenocarcinoma (mPDAC), gastric carcinoma (mGC) patients were enrolled by careful decision-making in real life phase II studies: FIr-B/FOx, adding bevacizumab (BEV), in overall, and FIr-C/FOx-C, adding cetuximab (CET), in KRAS/NRAS wild-type mCRC, respectively; FIr/FOx in mPDAC; FD/FOx, adding docetaxel (D), in mGC. Toxicity, and individual limiting toxicity syndromes (LTS), classified as limiting toxicity alone (LTS-single site, LTS-ss) or associated to other limiting or G2 toxicities (LTS-multiple sites, LTS-ms) were evaluated and compared by chi-square test. Results: FIr-B/FOx and FIr-C/FOx-C in mCRC, FIr/FOx in mPDAC, FD/FOx in mGC, respectively reported activity, efficacy and limiting toxicities similar to other triplet chemotherapy-based regimens. Reported LTS: FIr-B/FOx in mCRC 44%, LTS-ms 24% and LTS-ss 20%, in young elderly (yE) 46%, LTS-ms significantly increased vs LTS-ss; FIr-C/FOx-C in KRAS/NRAS wild-type mCRC 65.5%, significantly increased LTS-ms vs LTS-ss, in yE 83%; FIr/FOx in mPDAC 27.5%, mostly LTS-ms, in yE 38.4% all LTS-ms; FD/FOx in mGC 30%, all LTS-ms, in yE 25%. Conclusions: LTS meet the need of an innovative clinical parameter of patient-related toxicity burden, indicating global and individual tolerability, including differential spectrum and intensities of TS related to cancer treatment and according to clinical status of the individual patient. LTS integrated with conventional toxicity evaluation may help properly select patients fit for intensive medical treatments in mGI cancers.
Thoracic twice-daily radiotherapy and brain metastasis in patients with small cell lung cancer.
Authors: Haiyan Zeng, Rui Li, Chen Hu, Guoqin Qiu, Hong Ge, Huiming Yu, Kaixian Zhang, Miaomiao Hu, Peng Zeng, Dan Xiao, Chuanwang Miao, Chuqing Wei, Meng Ni, Jingyi Shen, Hui Li, Xudong Hu, Feng-Ming Spring Kong, Shuanghu Yuan, Jinming Yu
Journal: Journal of Clinical Oncology (2019)

8560 Background: Although thoracic twice-daily radiotherapy (TDRT) is one of standards of care for small cell lung cancer, its impact on brain metastases remains unknown. This study aimed to compare TDRT with once-daily radiotherapy (ODRT) for the brain metastases rate after prophylactic cranial irradiation in patients with small cell lung cancer. Methods: Consecutive patients received TDRT (45Gy/30f)/ODRT(50-66Gy/25-33f), chemotherapy and prophylactic cranial irradiation were retrieved from eight hospitals’ databases between 2003 and 2016. The endpoints included brain metastases, progression-free survival and overall survival. Brain metastases rate was evaluated using competing risk analysis. A 1:1 propensity score matching approach was used to control confounding between these two groups. Confounding covariates included eight demographic variables and eight treatment related covariates. Results: Of the 778 eligible patients with median age of 55-year (IQR, 48-61), 204 (26.2%) were female. At a median follow-up time of 23.6 months (IQR, 14.2- 38.2), 131 (16.8%) experienced brain metastases. The rates in TDRT were significantly higher than ODRT (3-year, 26.0% vs. 16.9%; HR = 1.55, 95%CI 1.06-2.26, P = 0.03). Of the 338 matched patients (169 in ODRT vs. 169 in TDRT), 60 (17.8%) experienced brain metastases with 3-year rate of 14.9% in ODRT vs 26.0% in TDRT (HR = 1.71, 95%CI 1.02-2.88, P = 0.04). Progression-free survival was similar in both the whole cohort and the matched one. Overall survival in ODRT tended to be significantly longer after matching (median, 47.2 months in ODRT vs. 32.8 months in TDRT; HR = 1.41, 95%CI 0.99-2.01, P = 0.06). When jointly evaluated biologically effective dose (BED), start of any therapy to the end of radiotherapy (SER) and TDRT/ODRT in the multivariable analysis, the impact of ODRT/TDRT on overall survival become more significant (HR = 1.69, 95%CI 1.05-2.71, P = 0.03). Conclusions: Patients with small cell lung cancer who were treated with thoracic TDRT appeared to have higher risk of brain metastases than those with ODRT, which strongly supports the need for further prospective randomized clinical trials, especially in China or other parts of Asia.