tbuckley/cabot-search huggingface dataset:
COMBAT-CRPC: Concurrent administration of bipolar androgen therapy (BAT) and nivolumab in men with metastatic castration-resistant prostate cancer (mCRPC).
Authors: Mark Christopher Markowski, Mary-Ellen Taplin, Rahul Raj Aggarwal, Hao Wang, Aliya Lalji, Channing Judith Paller, Catherine Handy Marshall, Michael Anthony Carducci, Mario A. Eisenberger, Angelo M De Marzo, Samuel R. Denmeade, Emmanuel S. Antonarakis
Journal: Journal of Clinical Oncology (2021)

5014 Background: During BAT, intramuscular (IM) testosterone (T) is administered, which results in rapid cycling of serum T levels from supraphysiologic to near-castrate in men with metastatic castration resistant prostate cancer (mCRPC). We previously observed anecdotal clinical responses to immune checkpoint blockade (ICB) in mCRPC patients (pts) previously treated with BAT and hypothesized that that a BAT/ICB combination would be synergistic. Here we report a prospective phase 2 study of men with mCRPC treated with BAT in combination with nivolumab. Methods: This was a multi-center, single arm, open label phase 2 trial (NCT03554317) of men with mCRPC who received T cypionate 400mg IM (BAT) every 28 days and nivolumab 480mg IV every 28 days. LHRH agonist treatment was continued. All pts received BAT as single agent therapy for a 12-week lead-in prior to the addition of nivolumab. Eligible pts were those with asymptomatic mCRPC who had soft tissue disease amenable to biopsy and progressed on at least one prior novel AR targeted therapy. Up to one line of chemotherapy was allowed for the treatment of mCRPC disease. The primary endpoint was confirmed PSA 50 response rate. Key secondary endpoints included safety, objective response rate (ORR), and radiographic progression-free survival (rPFS). The trial was designed to detect a 20% absolute increase in PSA 50 response rate from the null of 25%. Results: 45 pts were enrolled on study and treated. The confirmed PSA 50 response rate was 40.0% (N=18/45, 95% CI: 26-56%, P=0.02 against the 25% null hypothesis). For pts with measureable disease, the ORR was 23.8% (N=10/42). Median rPFS on BAT and nivolumab was estimated at 5.7 months (95% CI: 4.9-7.8 months). 11.1% (N=5/45) of pts were free from radiographic progression for 11 or more months. One patient achieved a complete radiographic response, which is ongoing (&gt;13 months). The majority of adverse events (AE) were Grade &lt;2. The most common AEs were edema (20%), nausea (20%), and back pain (13%). Immune related AE (irAE) were generally mild (Grade &lt;2) with N=2 Grade 3 irAE observed (pericarditis, lipase elevation). Serial biopsies were obtained on trial for translational studies. Conclusions: BAT plus nivolumab was well tolerated without concerning safety signals. The combination met the pre-specified primary endpoint of confirmed PSA 50 response in a heavily treated population. Durable responses were observed in a subset of pts. Biomarker analysis is ongoing to identify a molecular signature predictive of response. Clinical trial information: NCT03554317. [Table: see text]
Survival disparities in top five cancers in the United States: A population based study.
Authors: Snigdha Nutalapati, Quan Chen, Bin Huang, Zin Myint
Journal: Journal of Clinical Oncology (2021)

e18545 Background: Health inequity is an important field in cancer research and it is vital to determine the underlying etiologies to eliminate health disparities. Health insurance differences in survival outcomes have been reported for patients residing in California and New Jersey. Likewise, we aim to explore the impact of variations in insurance status and demographic factors on survival outcomes in patients with the top five cancers in the United States using a nationwide cancer registry. Methods: Surveillance, Epidemiology, and End Results (SEER) 18 program was queried to identify patients with a primary diagnosis of lung, breast, colorectal, prostate cancer, and melanoma from 2007 to 2016. Patient characteristics included are age (≥20 years), sex, marital status, metropolitan or non- metropolitan residence, insurance status (private vs. Medicaid vs. uninsured), education level, stage at diagnosis, and survivals. Descriptive and survival analyses were performed using Pearson Chi-square, Kaplan-Meier and Cox regression tests. Results: A total of 935,916 patients were included, of which 344,022 (37%) had breast cancer, 209,762 (22%) prostate cancer, 151,553 (16%) colorectal cancer, 151,468 (16%) lung cancer, and 79,111 (8%) melanoma. Most patients were aged &gt; 50 years (76%) and 55% were female. Privately insured accounted for 83% of all patients, 13% had Medicaid and 4% were uninsured. Male gender, married, patients with higher education level, residing in metropolitan areas were more likely to have private insurance (p &lt; 0.001) compared to female gender (84.3% vs. 81.2%), unmarried (90.1% vs. 68.7%), subjects with very low to moderate education level (88.2% vs. 80.8%), and ones residing in non- metropolitan areas (83.4% vs. 76.3%). Patients with private insurance were more likely to be diagnosed at localized stage compared to Medicaid insured and uninsured (59.2% vs. 38.2% and 36.6%; p &lt; 0.001). On bivariate and multivariate analyses across of all five cancers, age &gt; 50 years (HR 2.0; p &lt; 0.001), male gender (HR 1.3; p &lt; 0.001), single (HR 1.3; p &lt; 0.001), Medicaid insurance (HR 1.2; p &lt; 0.001), and uninsured (HR 1.3; p &lt; 0.001) were associated with worse overall survival than age &lt; 50 years, female, unmarried, and privately insured. Conclusions: Along with noticeable survival disparities by insurance status in lung, breast, colorectal, prostate and melanoma, we noted that privately insured patients are more likely to be presented at an earlier stage compared to patients with Medicaid and uninsured. Additionally, elderly age, lower education level, unmarried and low socioeconomic status had a negative impact on survival. Multidisciplinary care team efforts are critical in mitigating these health disparities.
Impact of Medicaid expansion on two-year mortality among stage IV breast cancer (BC) patients according to race.
Authors: Catalina Malinowski, Xiudong Lei, Hui Zhao, Sharon H. Giordano, Mariana Chavez Mac Gregor
Journal: Journal of Clinical Oncology (2021)

6525 Background: Inadequate access to healthcare services is associated with worse outcomes. Disparities in access to cancer care are more frequently seen among racial/ethnic minorities, uninsured patients, and those with low socioeconomic status. A provision in the Affordable Care Act called for expansion of Medicaid eligibility in order to cover more low-income Americans. In this study, we evaluate the impact of Medicaid expansion in 2-year mortality among metastatic BC patients according to race. Methods: Women (aged 40-64) diagnosed with metastatic BC (stage IV de novo) between 01/01/2010 and 12/31/2015 and residing in states that underwent Medicaid expansion in 01/2014 were identified in the National Cancer Database. For comparison purposes, 2010-2013 was considered the pre-expansion period and 2014-2015 the post-expansion period. We calculated 2-year mortality difference-in-difference (DID) estimates between White and non-White patients using multivariable linear regression models. Results are presented as adjusted differences (in % points) between groups in the pre- and post-expansion periods and as adjusted DID with 95%CI. Covariates included age, comorbidity, BC subtype, insurance type, transfer of care, distance to hospital, region, residence area, education, income quartile, facility type and facility volume. In addition, overall survival (OS) was evaluated in pre- and post-expansion periods via Kaplan-Meier method and Cox proportional hazards models; results are presented as 2-year OS estimates, hazard ratios (HRs), and 95% CIs. Results: Among 7,675 patients included, 4,942 were diagnosed in the pre- and 2,733 in the post-expansion period. We observed a reduction in 2-year mortality rates in both groups according to Medicaid expansion. Among Whites 2-year mortality decreased from 42.5% to 38.7% and among non-Whites from 45.4% to 36.4%, resulting in an adjusted DID of -5.2% (95%CI -9.8 to -0.6, p = 0.027). A greater reduction in 2-year mortality was observed among non-Whites in a sub-analysis of patients who resided in the poorest quartile (n = 1372), with an adjusted DID of -14.6% (95%CI -24.8 to -4.4, p = 0.005). In the multivariable Cox model, during the pre-expansion period there was an increased risk of death for non-Whites compared to Whites (HR 1.14, 95% CI 1.03 to 1.26, P = 0.04), however no differences were seen in the post-expansion period between the two groups (HR 0.93, 95% CI 0.80 to 1.07, P = 0.31). Conclusions: Medicaid expansion reduced racial disparities by decreasing the 2-year mortality of non-White patients with metastatic breast cancer and reducing the gap when compared to Whites. These results highlight the positive impact of policies aimed at improving equity and increasing access to health care.
Prognostic nomogram for pediatric nasopharyngeal carcinoma in the intensity-modulated radiotherapy era.
Authors: Yizhuo Zhang, Ye Hong, Huimou Chen, Yanpeng Wu, Jia Zhu, Junting Huang, Juan Wang, Feifei Sun, Yi Que, Lian Zhang, Binbin Chen, Suying Lu
Journal: Journal of Clinical Oncology (2021)

e18036 Background: There was no prognostic nomogram model exclusive for pediatric nasopharyngeal carcinoma (NPC). This study aimed to establish a nomogram, incorporating clinical characteristics and MRI features, for predicting progression-free survival (PFS) and overall survival (OS) in pediatric NPC. Methods: Children with nonmetastatic NPC treated with intensity-modulated radiotherapy (IMRT) in Sun Yat-sen University cancer center in China between 2004 to 2018 were enrolled and separated in a 3:1 ratio into a training cohort and a validation cohort. The data of the training cohort were analyzed to identify the variables independently associated with PFS and OS, and these variables were used to construct the prognostic nomogram. The predictive accuracy and discriminative capability of the nomogram were evaluated by the calibration curve and the concordance index (C-index). The nomogram was validated in the validation cohort. Results: A total of 200 patients were enrolled: 152 in the training cohort and 48 in the validation cohort. Age, serum lactate dehydrogenase level, and invasion of the clivus were the independent prognostic factors for PFS in the training cohort. The C-index of the nomogram constructed using these variables was 0.86. The calibration curve showed consistency between the nomogram prediction and the actual observation for 5-, 6- and 7-year PFS. In the validation cohort, the C-index of the nomogram was 0.64, and the calibration curve showed good consistency between the nomogram and actual observation for 5-, 6- and 7-year PFS. For OS, no independent prognostic factors were identified. Conclusions: The prognostic nomogram could be a useful tool for predicting PFS in pediatric NPC patients treated with IMRT.
Author Correction: A global database of COVID-19 vaccinations
Authors: Edouard Mathieu, Hannah Ritchie, Esteban Ortiz-Ospina, Max Roser, Joe Hasell, Cameron Appel, Charlie Giattino, Lucas Rodés-Guirao
Journal: Nature Human Behaviour (2021)

In the version of this article initially published, errors occurred in Figs. 2 and6.Figure 2 showed a lack of alignment between the years presented on gross domestic product (GDP) per capita values across countries.These figures-presented in GDP per capita adjusted for purchasing power parity, measured in international dollars-have now been aligned.This correction was necessary because the most recent year for which GDP data is available from the World Bank is different across countries.The GDP alignment issue will have affected all countries in the dataset, some to a very small (unnoticeable) degree when GDP has not significantly changed year-to-year, but more visibly for countries with strong growth rates (e.g., China).Figure 6 incorrectly indicated that no vaccine for Ebola exists.In fact, the first vaccine against Ebola was approved in the European Union and the USA in 2019.These errors have been corrected in the PDF and HTML versions of this article.
Real-world patterns and predictors of first-line maintenance use among patients with newly diagnosed advanced ovarian cancer: Is there an opportunity for change?
Authors: Jinan Liu, Premal H. Thaker, Janvi Sah, Eric M. Maiese, Oscar Bee, Jean Hurteau, John Chan
Journal: Journal of Clinical Oncology (2021)

e18710 Background: With the advent of poly(ADP-ribose) polymerase inhibitors (PARPi), options for first-line (1L) maintenance therapy in ovarian cancer (OC) have evolved in the US. This study described the use of 1L maintenance and assessed predictors of 1L maintenance use among PARPi-eligible patients (pts) with OC in a real-world setting. Methods: This retrospective cohort study included pts with newly diagnosed stage III/IV epithelial OC who received 69 cycles of 1L platinum-based chemotherapy (PBC) and primary or interval debulking surgery following neoadjuvant chemotherapy between Jan 1, 2016, and Feb 29, 2020, from the nationwide Flatiron Health electronic health recordderived deidentified database. The end of the last cycle of 1L PBC was defined as the index date. Those pts who started second-line chemotherapy within 2 months of the index date were excluded. Logistic regression was used to analyze variables with regard to 1L maintenance use. Results: In total, 463 pts were included; 21% received maintenance therapy, 79% received active surveillance. Baseline characteristics are shown in the table. Overall maintenance therapy use increased over the study period, from 7.7% to 37.7%. Pts with BRCA wild type were significantly less likely to receive maintenance therapy (odds ratio [OR]: 0.30; 95% CI, 0.160.59) than pts with BRCA mutation. Pts treated in 2018 (OR: 2.73; 95% CI, 1.255.98) and 2019 (OR: 8.78; 95% CI, 4.1518.55) were significantly more likely to receive maintenance therapy than pts treated in 2017. Age, race, practice type, ECOG score, and residual disease status were not significant predictors of 1L maintenance use. Conclusions: Nearly 40% of pts with advanced stage OC received upfront maintenance therapy with an increasing trend over time, particularly in those with biomarker guidance. Research is warranted toward addressing barriers to the appropriate use of maintenance therapy.[Table: see text]
Engineering (Bio)Materials through Shrinkage and Expansion
Authors: Mian Wang, Wanlu Li, Guosheng Tang, Carlos Ezio Garciamendez‐Mijares, Yu Shrike Zhang
Journal: Advanced Healthcare Materials (2021)

Abstract Although various (bio)fabrication technologies have achieved revolutionary progress in the past decades, engineered constructs still fall short of expectations owing to their inability to attain precisely designable functions. Shrinkable and expandable (bio)materials feature unique characteristics leading to size‐/shape‐shifting and thus have exhibited a strong potential to equip current engineering technologies with promoted capacities toward applications in biomedicine. In this progress report, the advances of size‐/shape‐shifting (bio)materials enabled by various stimuli, are evaluated; furthermore, representative biomedical applications associated with size‐/shape‐shifting (bio)materials are also exemplified. Toward the future, the combination of size‐/shape‐shifting (bio)materials and 3D/4D fabrication technologies presents a wide range of possibilities for further development of intricate functional architectures.
Application of Autologous Artificial Tears in a Case of an 8-Year-Old Girl with Vernal Keratoconjunctivitis (Spring Catarrh)
Authors: Pawel Jozef Laguna, Jolanta Antoniewicz-Papis, Alina Szajkowska, Magdalena Letowska, Tomasz Szczepański, Michal Matysiak
Journal: Blood (2017)
Provision of subspecialized expert oncology (SEO) opinions using Navya Cancer Data Model (NCDM), a technology-based platform: Prospective study to facilitate access to care.
Authors: Tiffany A. Traina, Philip W. Kantoff, Matthew J. Matasar, Lara Dunn, Claire Frances Friedman, Martin H Voss, Andrew David Seidman, Oren Cahlon, Marjorie Glass Zauderer, Cole Manship, Emily Kauff, Gitika Srivastava, Naresh Ramarajan, Ghassan K. Abou-Alfa
Journal: Journal of Clinical Oncology (2021)

6580 Background: Outcomes for patients (pts) with cancer may vary widely based on accessibility and quality of care. Subspecialized expert care is associated with improved outcomes yet access to this scarce resource is limited. Providing SEO opinions in legacy ways is time-consuming and difficult to scale. We hypothesized that summarizing comprehensive pt records could enhance efficiency of a remote opinion process. In this prospective pilot, oncologists (MDs) at Memorial Sloan Kettering (MSK) tested the NCDM, a clinically-validated, semi-automated system which abstracts pertinent data elements from medical records into a structured summary to support SEO decision making for remote opinions. Methods: From July to December 2020, 12 MSK MDs provided remote opinions to consecutive pts from an international second opinion service who were specifically seeking MSK expertise. NCDM summaries, with relevant DICOM imaging, were provided to MDs via web and mobile app. MDs answered a brief survey about their experience after each opinion. Time spent to read and respond to an NCDM summary was tracked electronically. Pt feedback was collected by prospective phone follow up. Results: N = 101 remote opinions. Cancer type (N): breast (24), gastrointestinal (15), heme malignancy (14), prostate (12), renal (8), gynecologic (7), head &amp; neck (11), lung (9) and skin (1). 92% MD response rate. Pt characteristics: median age (60 years, range 17-83); stage of disease (early stage 41%, advanced 59%); 86% of pts had received prior treatment. MDs survey responses: median time to complete record review and render opinion = 4.8 min (IQR 2.7 – 7.9 min); NCDM provided adequate information needed to make a decision in this case = 95.7% (89/93); Decision making was easy in this case with data presented in the NCDM format = 96.8% (90/93). Pt survey responses (71/88): 92% shared recommendation with local MD; 87% received the recommended treatment; 99% stated they would recommend a NCDM enabled remote opinion service to others. Conclusions: NCDM summaries enabled subspecialized MSK cancer experts to provide oncology remote opinions with ease. Patients reported high satisfaction with the experience. Technology assisted abstraction and case summary can facilitate access to subspecialized expert opinions at a global scale.
Outcomes with CD34 stem cell boost for poor graft function after allogeneic hematopoietic stem cell transplantation for hematologic malignancies: A systemic review and meta-analysis.
Authors: Moazzam Shahzad, Iqra Anwar, Raheel Sufian Siddiqui, Tehniat Faraz Ahmed, Mahrukh Majeed, Maha Awaiz Hassan, Zahoor Ahmed, Karun Neupane, Tayyaba Ali, Muhammad Salman Faisal, Masooma Naseem, Sibgha Gull Chaudhary, Ramesh Balusu, Nausheen Ahmed, Anurag K Singh, Sunil H. Abhyankar, Joseph McGuirk, Faiz Anwer, Muhammad Umair Mushtaq
Journal: Journal of Clinical Oncology (2021)

e19021 Background: Poor graft function (PGF) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation (allo-HCT) characterized by severe multilineage cytopenia in the absence of mixed donor chimerism, relapse, or severe graft-vs-host disease (GVHD). We present a systemic review and meta-analysis aimed to assess the outcomes with stem cell boost (SCB) for PGF in adult allo-HCT patients. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, 752 articles were screened from 4 databases (PubMed, Embase, Cochrane, and Clinical trials.gov) using MeSH terms and keywords for “hematological malignancies”, “hematopoietic stem cell transplantation”, “CD34 antigen(s)” and “treatment outcome(s)” from the date of inception to Jan 2021. After excluding review, duplicate and non-relevant articles, we included 8 studies (1 prospective, 7 retrospective) reporting hematologic complete/overall response rate (CR/ORR), GVHD and overall survival (OS) after SCB for PGF after Allo-HSCT. Quality evaluation was done using the NIH quality assessment tool. Pooled analysis was done using the ‘meta’ package (Schwarzer et al, R programming language) and proportions with 95% confidence intervals (CI) were computed. Inter-study variance was calculated using Der Simonian-Laird Estimator. Results: We identified 217 patients who received SCB for PGF after allo-HCT. Median age, time since transplant and SCB dose were 48 (37-54) years, 133 (113-450) days and 3.43 (1.7-4.9) million CD34 cells/kg respectively. CR and ORR were 71% (95%CI 0.63-0.77, I 2 16%) and 80% (95%CI 0.74-0.85, I 2 0%) respectively. After median follow up of 41.5 (5-77) months, actuarial survival rate (ASR) was 54% (95%CI 0.48-0.61, I 2 0%). OS was reported from 80% (1y) to 40% (9y) Acute and chronic GVHD incidence after SCB was 17% (95% CI 0.12-0.23, I 2 =0%) and 17% (95% CI 0.08-0.32, I 2 =72%, n=197) respectively, and 25% (95% CI 0.14-0.39, I 2 =63%, n=163) deaths were due to relapse (Table). Conclusions: CD34 SCB improves outcomes after PGF after allo-HSCT with acceptable toxicity profile. However, current literature lacks high-quality randomized evidence and there remains an unmet need for prospective studies to address optimal dosing and manipulation of SCB. Outcomes with SCB for PGF after allo-HCT (n=217).[Table: see text]