tbuckley/cabot-search huggingface dataset:
Analysis of associations of CXCR3 ligands with immune microenvironment and aggressiveness in murine and human pancreatic ductal adenocarcinoma.
Authors: Andrew Cannon, Christopher M Thompson, Pranita Atri, Rakesh Bhatia, Sushil Kumar, Surinder Batra
Journal: Journal of Clinical Oncology (2020)

762 Background: The complex milieu of cytokines within pancreatic ductal adenocarcinoma (PDAC) promotes tumor progression and immune suppression thereby contributing to the dismal prognosis of patients with PDAC. However, the roles of many cytokines, including CXCR3 ligands, in PDAC have not been thoroughly investigated. Methods: Bioinformatics analyses of PDAC microarray and TCGA datasets were used to identify cytokines overexpressed in PDAC, their association with patient survival as well as the expression of cognate cytokine receptors. Comparative analysis of cytokine expression in Kras LSL-G12D -P53 LSL-R172H -Pdx1-Cre (KPC) and Kras LSL-G12D -Pdx1-Cre (KC) murine PDAC models were used to validate these findings. Pathway and CIBERSORT analyses were employed to determine mechanistic basis of altered survival associated with cytokines of interest. Results: Of the 149 cytokines analyzed, CXCR3 ligands CXCL9 and CXCL10 were highly and consistently overexpressed in PDAC datasets. Concurrently, CXCL9, CXCL10 and PF4 were overexpressed in the aggressive KPC murine model compared to the indolent KC model. CXCR3 showed robust expression in PDAC in microarray, TCGA and IHC analyses. Interestingly, high expression of CXCR3 ligands was associated with shorter overall survival (p = 0.04 for CXCL9, 10 and 11 and p = 0.02 for PF4) while high expression of CXCR3 was associated with increased overall survival (p = 0.03). Pathway analysis of genes correlated with CXCR3 and/or its ligands showed that CXCR3 ligands may promote T-cell exhaustion (p &lt; 0.001). Finally, CIBERSORT analysis of TCGA data demonstrated that high CXCR3 expression was associated with increased CD8 T-cell and naïve B-cell signatures and loss of plasma cells signatures. High CXCR3 ligand expression was associated with increased CD8 T-cell, and M1 macrophage, and loss of NK-cell signatures(p &lt; 0.05). Conclusions: CXCR3 ligands are overexpressed in PDAC and are associated with poor survival, likely related to alterations in tumor immune infiltrate/activity and may represent targets to augment anti-tumor immunity.
An endothelial microRNA-1–regulated network controls eosinophil trafficking in asthma and chronic rhinosinusitis
Authors: Asawari Korde, Farida Ahangari, Maria Haslip, Xuchen Zhang, Qing Liu, Lauren Cohn, Jose L. Gomez, Geoffrey Chupp, Jordan S. Pober, Anjelica Gonzalez, Shervin S. Takyar
Journal: Journal of Allergy and Clinical Immunology (2020)
The relationship between naldemedine administration and the maximum dose of oral opioids.
Authors: Shinya Kajiura, Shingo Chikaoka, Ayaka Kadota, Sakie Fukai, Takako Matsushita, Naomi Hayashi, Nobukazu Ryu, Yuta Yagi, Akiyoshi Takaki, Hideyo Horikawa, Yoshinori Takemura, Kazunori Sakamoto, Astushi Furuichi, Tomoko Shima, Iori Motoo, Takayuki Ando, Ichiro Yasuda, Ryuji Hayashi
Journal: Journal of Clinical Oncology (2020)

818 Background: Opioid-induced constipation (OIC) is the most common side effect of opioid therapy. Laxatives are usually used as a first-line treatment for OIC. Treatment options for OIC are switching to other opioids associated with less frequent OIC, such as Fentanyl. Naldemedine is an orally active peripherally acting µ-opioid receptor antagonists that was approved in Japan from 2017 for management of cancer-related OIC. The aim of this study is to investigate the relationship between Naldemedine administration and the maximum dose of oral Oxycodone which is the most frequently used oral opioids at our hospital. Methods: During June 2017 and December 2018, a total of 217 patients with cancer-related pain received Oxycodone at our institution. The first group of the patients concurrently received Naldemedine 0.2 mg daily (group A, n = 101), and the second group didn’t receive it (group B, n = 116) for cancer-related OIC reduction. We compared the maximum Oxycodone dose between two groups by medical record retrospectively. Results: The median age of group A was 69 y.o. (range 20-87 y.o.), and the median age of group B was 67 y.o. (range 27-88y.o.). There was no significant difference in common patient background between group A and B. The median dose of maximum Oxycodone dose of group A was 40 mg/day (range 10-480 mg/day), and that of group B was 20 mg/day (range 10-320 mg/day). There was a significant difference in the median dose of maximum Oxycodone between group A and B (Mann-Whitney U test, P &lt; 0.0001). In Group A, the administration was started in 31 patient Naldemedine and Oxycodone at the same time. As for 70 remaining patients, the administration was started when they had constipation after oxycodone was administrated. In those patients, the median days was 19 days from the Oxycodone administration starting date to the Naldemedine administration starting date. Conclusions: Naldemedine administration in patients with cancer-related OIC may increase the maximum dose of oral Oxycodone.
Nonoperative management (NOM) in rectal cancer: Physician perspectives on offering NOM as standard of care.
Authors: Andrea Marie Covelli, Fayez A. Quereshy, Erin Diane Kennedy, Sami A. Chadi, Frances Catriona Wright
Journal: Journal of Clinical Oncology (2020)

79 Background: 20% of rectal cancer patients will have a complete clinical response (cCR) following neoadjuvant chemoradiotherapy. Non-operative management (NOM) with close surveillance can spare patients proctectomy and avoid the sequelae of surgery. Patients are interested in and advocate for NOM, whereas oncologists appear to be reluctant to offer this option. We wished to identify the perceptions and barriers that oncologists face when considering NOM. Methods: This qualitative study explored oncologists’ experiences treating rectal cancer and identified their perceptions and values around NOM. Purposive and snowball sampling identified medical, radiation and surgical oncologists’ who treat a high volume of rectal cancer across Canada. Oncologists varied in length/location of practice and gender. Data were collected via semi-structured interviews. Constant comparative analysis identified key concepts. Results: Data saturation was achieved after 40 interviews: 20 surgeons, 12 radiation and 8 medical oncologists. The dominant theme was “NOM is not ready for prime time’. Most oncologists felt that there is insufficient long-term data around NOM and single center studies appear ‘too good to be true’. Physicians voiced concerns about worsening oncologic outcomes in the setting of regrowth, the challenges in determining a cCR and apprehension around patient compliance to surveillance. Some oncologists felt that NOM is limited to a very select population and voiced reluctance in offering it to younger patients or patients with more advanced disease. There was little consideration to improved functional outcomes with NOM. Overall the majority of participants felt that NOM is ‘ trading the benefit of saving the rectum for the uncertainty of an inferior oncologic outcome’. Conclusions: Oncologists felt that NOM should not be offered as a standard of care option following a cCR. Most felt that there is insufficient data supporting NOM and are concerned around worse oncologic outcomes. Patient views of NOM are critically needed to assess if patients value the same outcomes. Additional research is needed to address barriers should patients wish to consider NOM as a treatment option in the setting of a cCR.
Eligibility of real-world patients with stage II/III colorectal cancer (CRC) in adjuvant chemotherapy (AC) trials.
Authors: Atul Batra, Shiying Kong, Winson Y. Cheung
Journal: Journal of Clinical Oncology (2020)

50 Background: The results of AC trials in stage II/III CRC are often generalized to real-world patients. However, clinical trials have stringent inclusion and exclusion criteria, which can potentially lead to poor generalizability of results and slow accrual. This study was conducted to determine the proportion of real-world patients with stage II/ III CRC who would be eligible for AC trials based on common eligibility criteria and to compare the outcomes in eligible and ineligible patients. Methods: We identified all patients diagnosed with stage II/III CRC in 2004-2015 from the Alberta Cancer Registry. Patients meeting any one of the following criteria were considered ineligible: age &gt;75 years, anemia, comorbid conditions (heart disease, uncontrolled diabetes, kidney disease, liver disease) and history of a prior malignancy or immunosuppression. Logistic regression was used to describe the likelihood of receiving AC and Cox regression models were constructed to determine overall survival (OS). Results: A total of 7841 patients with stage II/III CRC were identified, of whom 52% were men and median age at diagnosis was 71 years (IQR: 61-79 years). Approximately 59% patients were deemed trial-ineligible and the most common reasons for ineligibility were advanced age (36%), renal dysfunction (27%), and cardiac disease (17%), respectively. In the real-world, 54% of eligible patients received AC as compared to 23% of ineligible patients [odds ratio 3.89, 95% confidence interval (CI) 3.53-4.28, P&lt; 0.0001]. The 5-year OS of trial-ineligible patients who received AC was significantly better than those treated with surgery alone (table). Conclusions: Majority of real-world patients with stage II/ III CRC are unable to participate in AC trials due to strict exclusion criteria, but a fair proportion of these patients still derive some benefit from AC. The eligibility criteria of AC trials in CRC should be broadened to be more representative of real-world patients. [Table: see text]
AVM0703 as a novel stand alone or combination therapy for lymphoma.
Authors: Margaret Taylor, Colleen Rylatt, Stephanie Lee-Diaz, Arya Ashok, Peter Jarzyna, Vaishnavi Parthasarathy, Kendra Poulin, Yumna Zahid, Theresa Deisher
Journal: Journal of Clinical Oncology (2020)

42 Background: Chemotherapy remains a vital part of cancer treatment. There is an urgent need to reduce the toxicities associated with chemotherapy-based treatments especially in the pediatric and young adult population where the risk for chemo-induced secondary cancers is high. AVM0703 is a new treatment option that can be used as a stand-alone or in combination with chemo for relapsed/refractory lymphoma patients. AVM0703 is effective at lymphoablating while sparing red blood cells, platelets, and hematopoietic stem cells. AVM0703 is a novel patent-pending formulation of a repurposed drug without the toxic excipients unlike existing formulations. AVM0703 has anti-tumor activity in an immunocompetent mouse model of B-cell lymphoma (A20) as both a stand-alone treatment and in combinations with current therapeutics. Methods: Wild-type BALB/c mice were implanted with A20 tumor cells suspended in a 50% Matrigel mixture and implanted subcutaneously. Palpable tumors were visible within seven days. Mice were dosed with either high-dose AVM0703 alone, or in combination with intraperitoneal cyclophosphamide and fludarabine. Mice were then monitored for tumor growth and changes in body weight. Results: Mice dosed repeatedly with AVM0703 survived 20 days longer than mice dosed with placebo and displayed no significant toxicity or body weight loss. In a separate study, mice treated with 2 doses of Cy/Flu had a loss of tumors similar to 1 dose of AVM0703 + 1 dose of Cy/Flu. Additionally, when compared to standard treatments like CHOP, in the same A20 lymphoma model, the AVM0703 + Cy/Flu combination had better tumor efficacy than 2 cycles of CHOP. Unlike 2XCHOP treatment, which induced greater than 30% body weight loss and death of 18% of the mice due to drug toxicity, the AVM0703 + Cy/flu combination had no observed toxicity or body weight loss. Conclusions: AVM0703 can reduce the number of chemotherapy cycles without affecting efficacy and decrease the toxicities associated with chemo and will help to provide a better quality of life for patients.
The impact of inflammatory biomarkers, BMI, and sarcopenia on survival in advanced hepatocellular carcinoma treated with immunotherapy.
Authors: Mehmet Akce, Yuan Liu, Katerina Mary Zakka, Dylan J. Martini, Amber Draper, Olatunji B. Alese, Walid Labib Shaib, Christina Wu, Joel Wedd, Marty T. Sellers, Mehmet Asim Bilen, Bassel F. El-Rayes
Journal: Journal of Clinical Oncology (2020)

553 Background: Sarcopenia and inflammation are independently associated with worse survival in cancer patients. This study aims to determine the impact of inflammatory biomarkers, BMI and sarcopenia on survival in advanced hepatocellular carcinoma (HCC) patients treated with immunotherapy. Methods: We performed a retrospective review of advanced HCC patients treated with immunotherapy-based therapies at Winship Cancer Institute between 2015 and 2019. Baseline computed tomography and magnetic resonance imaging scans were collected at mid-L3 level, assessed for skeletal muscle density using SliceOmatic (TomoVision, version 5.0) and converted to skeletal muscle index (SMI) by dividing it by height (m) 2 . Gender-specific sarcopenia was defined by median value of SMI. The optimal cut for continuous inflammation biomarker was determined by bias-adjusted log-rank test. Overall Survival (OS) was set as primary outcome and Cox proportional hazard model was performed. Results: 57 patients were included; 77.2% male, 52.6% Caucasian, 58.5% ECOG PS 0-1, 80.7% Child Pugh A. Treatment was second line and beyond in 71.9%. The median follow-up time was 6 months. Sarcopenia cut-off for males and females was SMI of 43 and 39, respectively. 49.1% of patients had sarcopenia. Median OS was 5 vs. 14.3 months in sarcopenic vs. non-sarcopenic patients (p=0.054). Median OS was 5 and 17.5 months in patients with BMI &lt;25 and BMI ≥25 respectively (p=0.034). Median OS was 3.6 and 14.3 months for patients with neutrophil to lymphocyte ratio (NLR) ≥ 5.15 vs. NLR &lt; 5.15 (p&lt;0.001). In multivariable Cox regression model, higher baseline NLR was associated with worse OS (HR: 4.17, 1.52-11.39, p=0.005). Gender specific sarcopenia showed a trend of worse OS (HR: 1.71, 0.73-4.00, p=0.215) but was not statistically significant. BMI&lt;25 was associated with worse OS (HR: 2.73, 1.15-6.53, p=0.023). In the association with PFS, neither baseline BMI nor gender specific sarcopenia showed statistical significance. Conclusions: Baseline BMI and NLR may predict OS after immunotherapy treatment. After controlling for baseline Child Pugh Score and NLR, gender specific sarcopenia was not associated with OS significantly.
Early experiences with triple immunochemotherapy in young adults with high-risk fibrolamellar carcinoma.
Authors: Claire O'Grady, Ariel Gliksberg, Paul Kent
Journal: Journal of Clinical Oncology (2020)

510 Background: Fibrolamellar Carcinoma (FLC) is a rare liver cancer affecting young adults without underlying liver disease. Surgery is the only proven therapy, and recurrence is common. There are no proven systemic treatments, especially for high-risk FLC (unresectable, relapse, progression, metastatic). Research suggests that immunotherapy may work. We share our experience using systemic “triple immunochemotherapy” (TT): 2 week cycles of 7 days continuous infusion 5FU or oral capecitabine, interferon alpha-2b on days 1,3,5,7 or PEG-Interferon and nivolumab on day 1. Methods: Data from all patients who received TT from 5/2018 to 9/2019 was reviewed to assess tolerability, survival and toxicity. Results: 14 patients were treated with TT of which 10 (8F,2M with a median age of 20) were evaluable. They received a median of 13 cycles (6-31). At time of analysis, the median progression free survival was 6 months, 22% longer than prior to TT, with 80% of patients (8) stable or improving, 1 progression, and 1 who died 2 months after initiating TT. For the 4 patients who achieved surgical remission, none have relapsed (PFS 9 months). Overall objective response (CR+PR) and tumor control rate (CR+PR+SD) were 60% and 80%, respectively. There were no withdrawals from treatment due to side effects, though 2 had dose adjustments. All experienced mild adverse effects, most commonly fever and headache, but only 2 patients had grade 3 toxicity. Conclusions: Our early results of TT for high-risk FLC are promising, with good tolerability and treatment response, particularly in patients who have achieved surgical CR. Further longitudinal data is needed to confirm outcomes, especially in patients still early in their treatment. [Table: see text]
Stereotactic MR-guided on-table adaptive radiation therapy (SMART) for locally advanced pancreatic cancer.
Authors: Parag Parikh, Daniel Low, Olga L. Green, Percy P. Lee
Journal: Journal of Clinical Oncology (2020)

TPS786 Background: Standard dose radiation therapy has been unsuccessful in inoperable pancreatic cancer; with a negative study (LAP07) for conventional chemoradiation and dropping of the stereotactic body radiation therapy arm in Alliance A021501. Recently, reports of using high dose ablative radiation therapy has been associated with increased survival in retrospective studies. Moreover, technological advances with MRI-guided radiation therapy offer improved targeting and the ability to change the radiation delivery on a daily fashion; allowing ablative radiation doses over one week. However, it is not clear whether this can be done safely on a multiinstitutional basis. Methods: We are conducting the largest prospective study of ablative radiation therapy in pancreatic cancer. The study is a single arm, multi-institutional phase II, industry sponsored study to investigate the safety and efficacy of Stereotactic, MR guided, on-table-Adaptive Radiation Therapy (SMART). Eligibility criteria include locally advanced and borderline resectable pancreatic cancer patients with ECOG PS of 0 or 1; who have non-metastatic disease after a minimum of 3 months of any systemic therapy; including investigational agents. Patients will receive MR-guided radiation therapy to a dose of 50 Gy / 5 fractions; with maximum tumor coverage delivered each fraction that allows keeping the gastrointestinal organs at risk to a dose of 33 Gy or less. Primary endpoint is grade 3 of higher gastrointestinal toxicity at 90 days. Secondary endpoints are overall survival at 2 years, distant progression free survival at 6 months, and changes in patient related quality of life at 3 and 12 months. Target sample size was calculated to show at a significance level 0.05, a reduction of the toxicity rate to 8% or lower by using SMART compared with 15.8%, the toxicity rate of conventionally delivered chemoradiation at a power level 0.8. Given an expected 15% drop-out, the enrollment goal is 133. Descriptive statistics will be used for secondary objectives. The study opened in January, 2019 and is currently opened at 4 centers; with other US and international sites pending. Sponsored by Viewray, Inc. Clinical trial information: NCT03621644.
Randomized Trial of a Smartphone Mobile App to Improve Symptoms and Adherence to Oral Therapy for Cancer.
Journal: Journal of the National Comprehensive Cancer Network (2020)

Patients with cancer are increasingly prescribed oral therapies, bearing greater responsibility for self-management of treatment adherence and adverse events. We conducted a randomized trial to test the use of a smartphone mobile app to improve symptoms and adherence to oral cancer therapy.From February 18, 2015, through December 31, 2016, 181 patients with diverse cancers who were prescribed oral therapy were randomized to receive either the smartphone mobile app or standard care. The mobile app included a medication plan with reminders, a symptom-reporting module, and patient education. Primary outcomes were adherence (per electronic pill caps), symptom burden (per MD Anderson Symptom Inventory), and quality of life (per the Functional Assessment of Cancer Therapy-General). Participants also completed self-report measures of medication adherence, anxiety and depression symptoms, social support, quality of care, and healthcare utilization. Linear regression was used to assess intervention effects on adherence and change in self-report outcomes from baseline to week 12, controlling for baseline scores and social support.Study groups did not differ across any outcome measure, with an overall mean adherence of 78.81% (SD, 26.66%) per electronic pill caps. However, moderation analyses showed that intervention effects on the primary adherence measure varied by baseline self-reported adherence and anxiety symptoms. Specifically, adherence rates per electronic pill caps were higher in patients randomized to the mobile app versus standard care within the subsamples of patients who reported baseline adherence problems (mean difference, -22.30%; 95% CI, -42.82 to -1.78; P=.034) and elevated anxiety (mean difference, -16.08%; 95% CI, -31.74 to -0.41; P=.044).Although the mobile app may not improve outcomes for all patients prescribed oral cancer therapy, the intervention may be beneficial for those with certain risk factors, such as difficulties with adherence or anxiety.
Prospective study for comprehensive genomic profiling (GP) in cancer of unknown primary (CUP): Feasibility, molecular landscape, and clinical utility in current era.
Authors: Kanwal Pratap Singh Raghav, Anneleis Willett, Ryan Huey, Nishat Dhillon, Jignesh Modha, Aurelio Aurelio Matamoros, Jeannelyn Estrella, Kunal Sanghavi, Andrey Antov, Linda Choquette, Cara Statz, Kevin Kelly, Shannon Rowe, Edison T. Liu, Jens Rueter, Scott Kopetz, Michael J. Overman, Gauri Rajani Varadhachary
Journal: Journal of Clinical Oncology (2020)

834 Background: CUP presents a unique niche and challenge for application of GP. Absence of a primary limits consensus regarding site-directed and availability of tissue specific targeted therapy. We evaluated the real time feasibility and clinical utility of GP in CUP. Methods: Treatment eligible CUP pts were prospectively enrolled. A novel next-gen targeted sequencing (NGS) assay (ActionSeq/FusionSeq) was used to find genomic alterations (GAs) (somatic mutations in 212 and fusions in 53 cancer-associated genes). The primary objective was to determine prevalence of GAs and to assess the clinical impact via change in pre-test planned therapy (either referral to biomarker pertinent clinical trial (CT) or off label use of FDA approved drugs). With 54 pts we achieved 80% power (α 0.05) to a treatment change in 10% (5% to 15%) pts. Results: Between 9/2016 and 8/2019, 150 pts were consented. Tissue for GP was available in 59 (39%) pts (for 91 pts, samples had exhausted or insufficient tissue). Test was successfully performed on 54 (92%) pts. Cohort characteristics include: median age: 58 yr, male 43%, ECOG PS ≤1 96%, median IHC 8 (range 2-26), median survival 33 m (95% CI 18-47). Median reporting time was 23 days. Four (7%) pts had no identifiable GAs. A fusion ( PTRPK) was seen in 1 (2%) pt. Among 50 pts, total number of GAs were 487; 123 (26%) were “clinically relevant” (median 2.5/pt, range 1-11) while 364 (76%) were variants of unknown significance. Of the 123 GAs, 94 were mutations and 29 were amplifications. The 5 most common mutations were TP53, KRAS, PIK3CA, ARID1A, and NRAS and amplifications were CCND1, FGFR3, ERBB2, EGFR, and MYC. Planned therapy change post ActionSeq occurred in 13 pts (22%, 95% CI 13-34) (2 received an off-label drug; 9 were CT eligible [2 enrolled, 5 had PS decline, 2 pending]; 2 were lost to follow-up). Responses were seen in 2 of 4 pts who received GP based treatment. Conclusions: Comprehensive GP should be offered early to CUP pts. GP can help identify novel therapy and clinical trial options. Given the high rate of insufficient tissue cases, integrating a tissue sensitive algorithm involving IHC and GP in therapeutic management of CUP is merited.