tbuckley/cabot-search huggingface dataset:
Fostering a deeper understanding of COVID-19-associated mucormycosis – A commentary on “The mucormycosis coinfection in the context of global COVID-19 outbreak: A fatal addition to the pandemic spectrum” (Int. J. Surg. 2021:106031)
Authors: ArunSundar MohanaSundaram, Shanmugarajan Thukani Sathanantham, Vijay Chinchole, Bhushan Patil, Ravichandiran Velayutham
Journal: International Journal of Surgery (2021)
Pulmonary Rehabilitation in 2021
Authors: Carolyn L. Rochester, Martijn A. Spruit, Anne E. Holland
Journal: JAMA (2021)

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 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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
Disruptions in cancer screening and diagnoses during the COVID-19 pandemic in 2020.
Authors: James Staib, Kierstin Catlett, Stacey DaCosta Byfield
Journal: Journal of Clinical Oncology (2021)

315 Background: The pandemic resulted in reductions in cancer screenings, potentially compromising the ability to detect cancers early. We add new data to this growing research, and report screening and cancer diagnosis (Dxs) rates for four cancer types: breast (BC), cervical (CC), colorectal (CRC), and lung (LC). To learn whether home-based cancer screening options for colorectal cancer exhibited similar patterns, we examined screening rates for fecal occult blood (FOBT), fecal immunochemical (FIT), and Cologuard (CG) tests. Methods: We conducted retrospective analyses using de-identified medical claims data (2018-2020) from a national US health insurer. To assess screening rates, no indication of cancer Dxs prior to screening event were included. BC screenings (BCS), LC screenings (LCS), and CRC screenings (CRCS) were identified from CPT and HCPCS codes for digital mammography, low dose CT-scans (LDCT), colonoscopies, and home-based CRC tests. CPT, HCPCS, and ICD-10 codes defined CC screenings (CCS). Cancer Dxs were defined if individuals had ≥1 claim with an ICD-10 cancer code and no prior cancer dx within 24 months of continuous eligibility. Advanced cancer Dxs (ADxs) were defined if a malignancy code on a claim with a date of service (DOS) within 60 days of diagnosis DOS was present. Screening and Dxs changes were compared circa mid-March (5 weeks prior and 5 weeks after). Adjustments were made for changes in enrollment. Results: The table summarizes screening changes. Dxs decreased circa shutdown in LC, BC, CS, and CRC by -40%, -61%, -55%, -55%, respectively. Compared to 2019, DXs decreased in LC, BC, CS, and CRC -19%, -16%, -6%, -18%, respectively. Compared to 2019, ADxs in LC, BC, and CRC were -14%, -9%, -8%, respectively. CS exhibited an increase in ADxs by 2%. Conclusions: The pandemic impacted cancer care for multiple cancer types. Dxs and ADxs decreased during the pandemic except advanced CS. While cancer screenings increased after the shutdown, only LCS and Cologuard returned to pre-pandemic levels by the end of 2020, though these had low utilization even in the periods prior to the pandemic. Limitations include that administrative programs supporting home-based tests (e.g. FIT and FOBT) may not generate claims, and procedures received may have been incorrectly coded. Future studies will assess the clinical impact of missed care and whether certain groups were disproportionately impacted.[Table: see text]
OS06.7A METPlatform identifies brain metastasis vulnerabilities and predicts patient response to therapy
Authors: L Zhu, C Blanco-Aparicio, L Bertero, R Soffietti, T Weiss, J Muñoz, J Sepúlveda, M Weller, J Pastor, M Valiente
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND The diagnosis of brain metastasis involves high morbidity and mortality and remains an unmet clinical need in spite of being the most common tumor in the brain. Exclusion of these cancer patients from clinical trials is a major cause of their limited therapeutic options. MATERIAL AND METHODS We report a novel drug-screening platform (METPlatform) based on organotypic cultures which allows identifying effective anti-metastasis agents in the presence of the organ microenvironment. We have applied this approach to clinically relevant stages of brain metastasis using both experimental models and human tumor tissue (by performing patient-derived organotypic cultures - PDOCs -). We have also used METPlatform to perform unbiased proteomics of brain metastases in situ to identify potential novel mediators of this disease and explore resistance mechanisms to targeted therapy. Finally, we have exploited METPlatform as “avatars” to predict response to therapy in patients with primary brain tumors. RESULTS We identified heat shock protein 90 (HSP90) as a promising therapeutic target for brain metastasis. DEBIO-0932, a blood-brain barrier permeable HSP90 inhibitor, shows high potency against mouse and human brain metastases from different primary origin and oncogenomic profile at clinically relevant stages of the disease, including a novel model of local relapse after neurosurgery. Furthermore, in situ proteomic analysis of brain metastases treated with the chaperone inhibitor revealed non-canonical clients of HSP90 as potential novel mediators of brain metastasis and actionable mechanisms of resistance driven by autophagy. Combined therapy using HSP90 and autophagy inhibitors showed synergistic effects compared to sublethal concentrations of each monotherapy, demonstrating the potential of METPlatform to design and test rationale combination therapies to target metastasis more effectively. Finally, we show that brain tumor PDOCs predict the response of the corresponding patient to standard of care, thus proving the potential of METPlatform for improving personalized care in cancer. CONCLUSION Our work validates METPlatform as a potent resource for metastasis research integrating drug-screening and unbiased omic approaches that is fully compatible with human samples and questions the rationale of excluding patients with brain metastasis from clinical trials. We envision that METPlatform will be established as a clinically relevant strategy to personalize the management of metastatic disease in the brain and elsewhere.
Disease- and Therapy-Specific Impact on Humoral Immune Responses to COVID-19 Vaccination in Hematologic Malignancies
Authors: David J. Chung, Gunjan L. Shah, Sean M. Devlin, Lakshmi V. Ramanathan, Sital Doddi, Melissa S. Pessin, Elizabeth Hoover, LeeAnn T. Marcello, Jennifer C. Young, Sawsan R. Boutemine, Edith Serrano, Saumya Sharan, Saddia Momotaj, Lauren Margetich, Christina D. Bravo, Genovefa A. Papanicolaou, Mini Kamboj, Anthony R. Mato, Lindsey E. Roeker, Malin Hultcrantz, Sham Mailankody, Alexander M. Lesokhin, Santosha A. Vardhana, David A. Knorr
Journal: Blood Cancer Discovery (2021)

Abstract Coronavirus disease-19 (COVID-19) vaccine response data for patients with hematologic malignancy, who carry high risk for severe COVID-19 illness, are incomplete. In a study of 551 hematologic malignancy patients with leukemia, lymphoma, and multiple myeloma, anti–SARS-CoV-2 spike IgG titers and neutralizing activity were measured at 1 and 3 months from initial vaccination. Compared with healthy controls, patients with hematologic malignancy had attenuated antibody titers at 1 and 3 months. Furthermore, patients with hematologic malignancy had markedly diminished neutralizing capacity of 26.3% at 1 month and 43.6% at 3 months, despite positive seroconversion rates of 51.5% and 68.9% at the respective time points. Healthy controls had 93.2% and 100% neutralizing capacity at 1 and 3 months, respectively. Patients with leukemia, lymphoma, and multiple myeloma on observation had uniformly blunted responses. Treatment with Bruton tyrosine kinase inhibitors, venetoclax, phosphoinositide 3-kinase inhibitors, anti-CD19/CD20–directed therapies, and anti-CD38/B-cell maturation antigen–directed therapies substantially hindered responses, but single-agent immunomodulatory agents did not. Significance: Patients with hematologic malignancy have compromised COVID-19 vaccine responses at baseline that are further suppressed by active therapy, with many patients having insufficient neutralizing capacity despite positive antibody titers. Refining vaccine response parameters is critical to guiding clinical care, including the indication for booster vaccines, for this vulnerable population. See related article by Tamari et al., p. 577. This article is highlighted in the In This Issue feature, p. 549
Letter to the Editor: Rethinking public health measures to reduce liver injury from therapeutic acetaminophen ingestion
Authors: Penelope Hey, Paul Gow
Journal: Hepatology (2021)

Abbreviation APAP acetaminophen. To the Editor, We wish to congratulate Louvet et al. on their significant contribution to the literature surrounding the important issue of acute liver injury caused by therapeutic acetaminophen (APAP) dosing.[1] Their paper highlights that this syndrome invariably occurs in one of three clinical situations: excessive alcohol intake, fasting ≥ 1 day and malnutrition, and prolonged APAP ingestion. This syndrome is an important, preventable cause of serious liver injury and hospitalization. In Victoria, Australia, over a 7‐year period, APAP toxicity was the cause of more than 14,000 hospital admission, of which 15% were due to unintentional toxicity.[2] Unintentional toxicity with APAP has been reported in the medical literature now for two decades but remains poorly recognized by many clinicians and the lay public generally. APAP toxicity accounts for more than 50% of causes of acute liver failure in the developed world.[3] Despite this, few measures have been implemented to curb this important public health issue. In 1998, restricted package size and use of blister packs for over‐the‐counter APAP was implemented in the United Kingdom. This reduced hospital admissions from APAP overdose by 27%, but does not address the issue of unintended overdose or liver injury from therapeutic dosing.[4] In 2009, the Food and Drug Administration recommended, but not mandated, a reduction in maximum daily APAP dosing in adults from 4000 to 3250 mg.[5] Louvet et al. conducted a sensitivity analysis finding that 40% of patients with acute liver injury from therapeutic dosing reported taking doses ≤ 3 g/day. Interestingly, this cohort suffered more severe liver injury than those taking 3–6 g/day based on the presence of ≥ 1 King's College criteria. It appears that blanket reductions in maximum daily dosing may not prevent severe liver injury from therapeutic dosing, while potentially reducing the analgesic effects of APAP in not‐at‐risk groups. The greatest benefits with respect to preventing this important syndrome must be made with increased education. Public awareness campaigns and education of pharmacists and primary care providers would be a simple step to inform the public of this important issue. These measures, combined with government‐mandated safety warnings for APAP‐containing compounds describing that accidental poisoning may occur in people with chronic alcohol intake ≥ 30 g daily, malnutrition, or fasting ≥ 24 h, may go a long way to reduce the incidence of this syndrome in years to come. CONFLICT OF INTEREST Nothing to report.
HPV vaccination and factors influencing vaccine uptake among people of Indian ancestry living in the United States.
Authors: Philip Ratnasamy, Anees B. Chagpar
Journal: Journal of Clinical Oncology (2021)

126 Background: Despite HPV vaccine availability, approximately one-third of annual global cervical cancer deaths occur in India. This may be related to cultural norms that lead to vaccine hesitancy. We sought to determine whether people of Indian ancestry (POIA) who move to the US continue to have disproportionately lower HPV vaccination rates than the rest of the US population and factors that influence HPV vaccine uptake in this group. Methods: The National Health Interview Survey (NHIS) is the largest source of health information for Americans and is designed to be representative of the entire civilian non-institutionalized US population. We utilized the 2018 NHIS to compare HPV vaccine initiation and completion rates between POIA and the general US population and factors correlating with HPV vaccine uptake in this group. Results: There were 17,004 people, representing 185,065,802 in the population, who were between the ages of 18-64 and who responded to questions regarding racial ancestry and HPV vaccination. Of this cohort, 1.69% identified themselves as being of Indian ancestry. Compared to other racial groups, POIA had a significantly lower rate of HPV vaccination (8.18% vs. 12.16%, 14.70%, 16.07%, and 12.41%, in White, Black, Other Asian, and those of other/mixed ancestry, respectively, p = 0.003). However, of those who received one HPV shot there was no difference in vaccine series completion between racial groups (3.17% vs. 4.27%, 3.51%, 4.31%, and 5.04% for POIA vs. White, Black, Other Asian, and those of other/mixed ancestry, respectively, p = 0.465). Among POIA, younger individuals and those who were single were more likely to obtain HPV vaccination (vaccination rates of 38.12%, 6.45% and 1.79% for ages 18-25, 26-45, and 46-64, respectively, p = 0.018, and 29.53% vs. 3.11% for single vs. married, respectively, p = 0.006). All individuals who were vaccinated had some form of health insurance (p = 0.020). Those born in the US had a higher rate of vaccination than those who were not (p = 0.019); however, duration of residence in the US did not influence vaccination rates among POIA (p = 0.502). While high levels of English proficiency were associated with a higher vaccination rate (p = 0.029), education status was not correlated (p = 0.231). Interestingly, both male and female POIA had equivalent rates of vaccination (3.12% and 2.81%, respectively, p = 0.949). Conclusions: POIA are significantly less likely to receive HPV vaccination than the general US population but are equally likely to complete the vaccine series if initiated. Age, insurance status, being born in the US, English speaking proficiency, and marital status significantly influence HPV vaccine initiation among POIA. These data suggest that public health measures promoting HPV vaccination among POIA immigrants may significantly improve vaccination rates among this population.
Evaluation of direct oral anticoagulant use for cancer-associated venous thromboembolism (VTE) in lung cancer.
Authors: Leila Rostamnjad, Ibiayi Dagogo-Jack
Journal: Journal of Clinical Oncology (2021)

243 Background: National Comprehensive Cancer Network recommends direct oral anticoagulants (DOACs) as preferred agents for treatment of cancer associated VTE in patients without gastric or gastroesophageal lesions. Currently at Massachusetts General hospital (MGH), DOACs are used in treatment of cancer associated VTE. This study was performed to evaluate the safety and efficacy of DOACs for treatment of VTE in patients with metastatic lung cancer. Methods: Retrospective chart review of patients at MGH with diagnosis of metastatic lung cancer who were prescribed edoxaban, rivaroxaban, or apixaban for treatment of VTE between January 2018 and January 2021 was performed. Patients were identified using electronic medical record reports. Data was collected on age, anticoagulation regimen, intent of anticoagulation therapy, presence of brain metastasis, renal function, liver function and platelet counts. The primary outcome was to assess the incidence of treatment failure, defined as VTE recurrence or major bleeding leading to a change in anticoagulation therapy. Results: 152 patients were evaluated, of which 57 received apixaban, 44 rivaroxaban, and 7 edoxaban. Most (n = 93) patients received enoxaparin for 14-90 days prior to transitioning to DOACs. Median age and creatinine clearance were 69 years and 63 mL/min, respectively. All patients had platelet count ≥ 50K/uL. Brain metastasis was present in n = 39 patients. Pulmonary embolism (PE)(n = 98), deep vein thrombosis (DVT) (n = 52), or both (n = 2) were the indication for DOAC therapy. Bleeding occurred in 14 patients including gastrointestinal bleeding (n = 5), hematuria (n = 4), epistaxis (n = 1), and hemoptysis (n = 4). Among patients with bleeding events, 7 received rivaroxaban and 7 received apixaban. Major recurrent VTE while on DOACs occurred in 5 of patients, including DVT (n = 2) and PE (n = 3). Patients with recurrent VTE received rivaroxaban (n = 7), apixaban (n = 3) and edoxaban (n = 1). All patient whom experienced bleeding and VTE were ≥ 60 years old. Brain metastasis was present in n = 2 of patients with bleeding events and n = 2 patients with recurrent VTE. Majority of patients (n = 93) received enoxaparin for 14-90 days prior to transitioning to DOACs. The median interval between initiation of DOACs and bleeding was 60 days (range 30-365) and recurrent VTE event was 90 days (range 60‐365). Conclusions: The results of this study suggest that outcomes of DOAC use for the treatment of cancer-associated VTE in patients with metastatic lung cancer are comparable to the results of large randomized controlled trials. DOAC therapy is a safe and effective anticoagulation option for lung cancer patients with cancer-associated thromboembolism.
P14.92 Combination of Tumor Treating Fields and CCNU chemotherapy as valuable option for the treatment of unresectable progressive glioblastoma: A case presentation
Authors: E Mergen, S Landrock, B Chizzali
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Tumor Treating Fields (TTFields) are low intensity (1–3 V/cm) alternating electric fields with an intermediate frequency of 100–300 kHz. TTFields in addition to temozolomide (TMZ) after radiochemotherapy according to Stupp significantly increased progression-free survival (PFS), overall survival (OS) and long-term survival rates in patients with newly diagnosed glioblastoma (GBM) in the multicenter phase 3, EF-14 trial. Post-hoc analysis of the trial revealed that TTFields in combination with second-line therapy after first recurrence significantly prolonged OS compared to second-line therapy alone. We here report on a GBM patient with partial resection showing regressive volume of unresected, previously progressive tumor under combination therapy of TTFields and second-line CCNU chemotherapy. MATERIAL AND METHODS In November 2018, MRI of a 59-year-old female patient revealed a large heterogeneous space-occupying lesion in the left occipital region with clearly contrast-enhanced margin, perifocal edema and two smaller contrast-enhancing lesions in the splenium corporis callosi and right of the trigonum suboccipitale. While the tumor in the left occipital region was completely resected, lesions in the right hemisphere remained unresected. Histopathology identified MGMT-promoter methylated GBM. The patient received concomitant radiochemotherapy followed by adjuvant TMZ. However, after three cycles, the unresected tumor progressed, TMZ was exchanged by procarbazine/CCNU and TTFields therapy was initiated. After two cycles, chemotherapy was changed to only CCNU due to further progression while TTFields therapy was continued. RESULTS One year after diagnosis, MRI showed no contrast-enhancing tissue in the resection cavity and regressive perifocal edema while lesions in the right hemisphere remained stable. Under tolerable hematotoxicity CCNU was continued together with TTFields, to which the patient showed high adherence far beyond the suggested threshold of 75%. Control examination in February 2020 reported regressive tumor volume in the right hemisphere under CCNU/TTFields therapy. Until January 2021, the tumor regressed even further without the detection of new lesions. The patient is currently continuing CCNU together with TTFields, achieving an average usage of 84% over the last twelve months. CONCLUSION In the presented case, the combination of TTFields and CCNU was feasible and safe in progressive GBM. The patient showed radiological response and local tumor regression under the combination therapy, whereas the tumor had previously progressed under chemotherapy alone. In conclusion, the addition of TTFields to chemotherapy is a valuable treatment option to improve clinical and radiological outcome of patients with progressive GBM. This example of TTFields use in clinical practice encourages its use beyond tumor progression.