tbuckley/cabot-search huggingface dataset:
Racial disparities in follow-up care of early-stage lung cancer survivors.
Authors: Jyoti Malhotra, Lisa E. Paddock, Yong Lin, Sharon Pine, Salma K. Jabbour, Antoinette Stroup, Sharon Manne
Journal: Journal of Clinical Oncology (2021)

12025 Background: Follow-up care and surveillance in lung cancer survivors is essential formanagement of treatment- and disease-related symptoms as well as for the early detection of cancer recurrence. To investigate if race impacts receipt of follow-up care in lung cancer survivors, we conducted a cross-sectional study in lung cancer survivors recruited through the New Jersey State Cancer Registry (NJSCR). Methods: Between May 2019 and December 2019, survivors of early-stage NSCLC were identified and recruited from the NJSCR. Participants were eligible if they had surgery for stage I or II NSCLC between 2014 and 2017 and, completed all treatment at least one year prior to enrollment. Eligible participants were asked to complete a paper survey questionnaire and medical record release form sent to them by mail. The survey had questions about demographics, smoking, cancer history and treatment, quality of life, follow-up care, barriers to care and informational needs. Study measures were compared between the groups using t-test or chi-square test as applicable. Results: Of the 482 survivors contacted, 23% (n = 114) mailed back the survey questionnaire. Of the 112 survivors who returned a completed survey; 78 (70%) were non-Hispanic (NH) Whites and 34 (30%) were NH Blacks. Mean age was 67 years, 61% were female, 92% had cancer in remission. 82% of participants reported receiving a surveillance scan (CT or PET) within one year of completing the study survey. More NH White survivors received a scan within a year compared to NH Black survivors (89% vs 64%; p = 0.006). Also, 88% of survivors reported that they were informed of the need for follow-up care by their provider with more NH White survivors reporting receiving this information (94%) compared to NH Blacks (71%; p = 0.002). About 57% of the survivors reported receiving a written treatment summary and 92% reported being seen by a physician within the past year; no racial differences in these measures were noted.There was also no racial difference in receipt of age-appropriate cancer screening; 66% and 80% reported receiving regular colon and breast cancer screening, respectively. A significantly higher percentage of NH Blacks reported currently smoking compared to NH Whites (16% vs 12%). The most significant barriers to care for both populations were concern for out-of-pocket costs (26% NH Whites, 19% NH Blacks), non-coverage of test (14% NH Whites, 10% NH Blacks) and lack of insurance (8% NH Whites, 16% NH Blacks). Conclusions: Significant racial disparity was identified between NH Blacks and NH Whites in receipt of surveillance scans, guidance about follow-up care and smoking cessation. The most significant barriers to follow-up care was lack of insurance in NH Blacks and financial concerns about cost and coverage of tests in NH Whites. Future interventions to increase survivorship care should target these specific needs in survivor populations.
Phase 2 Study of Pracinostat in Combination with Ruxolitinib in Patients (pts) with Myelofibrosis (MF)
Authors: Prithviraj Bose, Naveen Pemmaraju, Kurt Schroeder, Alessandra Ferrajoli, Elias J. Jabbour, Naval Daver, Courtney D. DiNardo, Yesid Alvarado, Musa Yilmaz, Julie Huynh-Lu, Wei Qiao, Xuemei Wang, Aurelio Matamoros, Lingsha Zhou, Sherry Pierce, Hagop M. Kantarjian, Srdan Verstovsek
Journal: Blood (2017)
Adverse events and estimated costs with the combination of ipilimumab and nivolumab in metastatic melanoma patients.
Authors: Bianca Gautron Moura, Camille Léa Gérard, Nathalie Testart, Marian Caikovsky, Alexandre M. Wicky, Veronica Aedo-Lopez, Grégoire Berthod, Krisztian Homicsko, John Prior, Clarisse Dromain, Lana E. Kandalaft, Michel A. Cuendet, Olivier Michielin
Journal: Journal of Clinical Oncology (2021)

e21529 Background: The combination of ipilimumab and nivolumab in metastatic melanoma patients increases response rates (RR) and survival outcomes. As checkpoint inhibitors bear a significant financial impact on the healthcare system, we performed a study that addresses the global costs of the treatment, focusing on immune-related adverse event (irAE) management costs. Methods: We conducted a retrospective analysis of 62 metastatic melanoma patients treated with ipilimumab and nivolumab at the Oncology Department of Lausanne University Hospital (CHUV) between June 1, 2016 and August 31, 2019. The frequency of irAEs, the duration, management, and outcomes were evaluated. All melanoma-specific costs were analyzed by mining the electronic healthcare record and billing data of the hospital. Results: The median follow-up was 32 months (range 20-1066 days). In our cohort, 54/62 (87%) patients presented at least one irAE, and 22/62 (35%) presented a grade 3 irAE. One patient died from an irAE (pneumonitis). The most common irAEs were diarrhea 23/62 (37%) any grade, 8/62 (13%) grade 3-4; hepatitis 22/62 (36%) any grade, 9/62 (15%) grade 3-4; and skin rash 21/62 (34%) any grade, 6/32 (10%) grade 3-4. The overall response rate was 29/62 (47%), with 15/62 (24%) of complete response (CR) and 14/62 (23%) of partial response (PR). The majority of patients who had a CR 13/15 (87%) and 20/28 (71%) of overall responders presented a grade 3-4 toxicity, and there were no responses in patients without toxicity. However, toxicity does not imply response, as only 29/54 (54%) of patients with toxicity (any grade) and 20/31 (65%) (grade 3-4) responded. The toxicity costs represent only 3% on average of the total expenses per patient. The most significant contributions were medication costs (44%) and disease costs (39%, mainly disease-related hospitalization costs). Patients with a CR had the lowest global cost per week (2,860 USD, converted from CHF) despite the associated toxicities and patients who had progressive disease, the highest one (9,999 USD). Except for the one patient who had a grade 5 toxicity (7,472 USD/week), we observe that less severe toxicity grades (11,603 USD/week for grade 1), or even the absence of toxicity (12,266 USD/week), are associated to higher median costs per week (against 4,039 USD/ week for grade 4 and 3,524 USD/week for grade 3). Conclusions: The cost of toxicities was unexpectedly small (only 3%) compared to the total costs, especially medication costs (44%). Also, patients with a higher degree of toxicity had lower costs and better outcomes.
Depression, chronic pain, and high-impact chronic pain among cancer survivors.
Authors: Nosayaba Osazuwa-Peters, Katherine M. Polednik, Nhial T. Tutlam, Raymond Tait, Jeffrey Scherrer, Justin Michael Barnes, Mario Schootman, Eric Adjei Boakye
Journal: Journal of Clinical Oncology (2021)

12085 Background: The majority of the 17 million individuals living with a cancer diagnosis in the United States have experienced pain, either from the disease itself or from its treatment. Pain negatively impacts psychosocial quality of life and is associated with poorer overall outcome. However, the impact of pain on daily living differ among cancer survivors, and there is a paucity of research on chronic pain, especially high-impact chronic pain (HICP) in this growing population. We estimated the prevalence of chronic pain, and HICP among cancer survivors, and described the association between depression and these outcomes. Methods: This study used data from the 2015-2017 National Health Interview Survey. Outcomes of interest were chronic pain, defined as pain on most days or every day in the past six months, and HICP, defined as chronic pain that limited life or work activities on most days or every day during the past six months. Weighted, adjusted multivariable logistic regressions estimated association between depression and chronic pain and HICP among cancer survivors, while controlling for age, gender, marital status, education, employment, health insurance, smoking status, number of doctor’s visit, general health, and comorbidities. Results: Among 49,326 survey respondents, 11.7% (n = 5,335) had a cancer diagnosis. An estimated 43.6% of cancer survivors reported chronic pain; and 19.2% reported HICP. We found an association between depression and both chronic pain and HICP in unadjusted analyses. In the adjusted models, cancer survivors depressed within the last month had more than double the odds of reporting both chronic pain (aOR = 2.32; 95% CI 1.75, 3.07) and HICP (aOR = 2.12; 95% CI 1.50, 3.01). Other factors associated with both chronic pain and HICP among cancer survivors included being a current smoker (aOR chronic pain = 1.63; 95% CI 1.14, 2.34; aOR HICP = 1.83; 95% CI 1.18, 2.84) and being unemployed (aOR chronic pain = 1.44; 95% CI 1.10,1.90; aOR HICP = 3.10; 95% CI: 2.00−4.81). Cancer survivors with ≥2 comorbidities also had 55% increased odds of reporting chronic pain (aOR = 1.55; 95% CI 1.17,2.04) compared with those without comorbidities. Conclusions: Over 40% of cancer survivors may have a history of chronic pain, and survivors reporting being depressed are significantly more likely to report both chronic pain and HICP. The association between depression and pain in cancer survivors calls for personalized management of chronic pain, especially in cancer survivors with a history of depression.
The impact of chemotherapy on subjective cognitive complaints in breast cancer: Evidence from pooled analyses with longitudinal studies.
Authors: Heeju Kim, Sun-Ok Jung, Esther Kim, Ivo Abraham
Journal: Journal of Clinical Oncology (2021)

e24050 Background: Subjective cognitive impairment (SCI) is one of the most commonly occurring symptoms in breast cancer patients. Chemotherapy (CTX) may be an important contributing factor to SCI, yet its association with SCI has been inconclusive. The meta-analysis with longitudinal data can provide more conclusive evidence as to the impact of CTX on SCI. This meta-analysis aimed to (a) determine whether CTX is associated with time-dependent SCI outcomes in breast cancer patients with pooled longitudinal data and (b) identify at the time point with the highest impact of CTX on SCI. Methods: Data were collected from Pubmed, EMBASE, CINAHL, PsychInfo, and the Cochrane library in November 2020. Effect sizes (Hedges’ g) were calculated for the mean differences of the SCI level between the CTX treated patients and controls. Data were analyzed by and across clinical time periods; during CTX, within 1-month-post CTX, within 1-year-post CTX, and 1-year or longer post-CTX. Results: The longitudinal data were pooled with 9 data sets from 13 studies, including 857 patients treated by CTX, 410 patients not treated by CTX, and 517 healthy subjects. At baseline, CTX patients showed significantly better SCI compared to the non-CTX patient controls (ES=0.17, p=.031) and did not differ from healthy controls (ES = -0.04, p = .77). The CTX-treated patients had significantly worse SCI compared to both type of controls after initiating CTX. The effect sizes for the group differences were larger for the group comparison with healthy controls than the non-CTX control (- 0.16 for the comparison with non-CTX control, -0.51 for comparison with the healthy control). The largest time effect was found at the time point of within 1-month-post CTX in comparison with the healthy control (- 0.81). Conclusions: Our analysis indicated the association of CTX with SCI. Yet, more studies are needed to confirm the impact of CTX as (a) the effect size for the comparison with non-CTX control is very small and (b) limited data on the comparison with controls at the time point during active CTX and immediately after CTX. [Table: see text]
EPCT-06. PRECISION ONCOLOGY IN THE PEDIATRIC TARGETED THERAPY 2.0 PROGRAM
Authors: Jonas Ecker, Florian Selt, Andrey Korshunov, David Capper, Nicola Dikow, Steffen Hirsch, Christian Sutter, Cornelis van Tilburg, Andreas von Deimling, David T W Jones, Stefan M Pfister, Felix Sahm, Olaf Witt, Till Milde
Journal: Neuro-Oncology (2021)

Abstract Introduction Precise diagnoses and robust detection of actionable alterations is required for individualized treatments. By using extended molecular diagnostics, the Pediatric Targeted Therapy (PTT) 2.0 program aims at the improvement of diagnostic accuracy and detection of actionable alterations for pediatric high-risk patients. The impact of these analyses on clinical management is reported. Methods Pediatric patients with relapsed or progressive tumors after standard of care treatment were included, independent of histological diagnosis. Formalin fixed paraffin embedded material and a blood sample for germline correction were requested. DNA methylation array, targeted gene panel sequencing (130 genes), RNA and Sanger sequencing in selected cases, and immunohistochemistry (IHC) of selected markers (pERK, pAKT, pS6, PD-L1) were performed. A questionnaire-based follow-up was used to determine the clinical impact of the analysis. Results We enrolled n=263 patients from February 2017 to February 2019. Complete molecular analysis was possible for n=260 cases (99%). The most common entities were brain tumors (n=172/260, 65%). In brain tumors, DNA methylation array alone allowed robust diagnostic classification (score of &amp;gt;=0.9) in n=104/172 cases (60%). Actionable targets as detected by copy number calculation, gene panel sequencing, RNA sequencing and IHC were found in n=94/172 (55%) brain tumor cases. The most common actionable targets in brain tumors were MAPK (pERK, BRAF fusions, BRAF V600E), mTOR (pS6), PI3K (pAKT), CDK4/6 (CDKN2A/B loss), and immune checkpoints (PD-L1). Pathogenic germline alterations with clinical relevance were identified in n=12/172 brain tumor cases (6.9%) and were confirmed by Sanger sequencing, 5/12 (41%) of which were previously unknown. Clinical follow-up of subsequent treatment and outcome are ongoing. Conclusion The combination of next-generation diagnostics such as methylation arrays and targeted sequencing in addition to selected IHC markers added robust information with regard to diagnosis and actionable alterations. The impact on clinical decision-making and on outcome is currently being evaluated.
Safety and efficacy of apatinib as third or later line treatment for advanced gastric cancer or gastroesophageal junction adenocarcinoma: A post-marketing phase IV study.
Authors: Jin Li, Shukui Qin, Lu Wen, Junsheng Wang, Wenying Deng, Weijian Guo, Tongfu Jia, Da Jiang, Guifang Zhang, Yifu He, Haijun Zhong, Yi Ba, Xiaoyan Lin, Jianwei Yang, Jun Zhao, Yuxian Bai, Xiangyuan Wu, Feng Gao, Ying Sun, Zhiguo Hou
Journal: Journal of Clinical Oncology (2021)

e16034 Background: Apatinib, a small molecule multi-target tyrosine kinase inhibitor with high selectivity for VEGFR-2, has been approved for the treatment of advanced gastric cancer or gastroesophageal adenocarcinoma in China by significantly improving progression-free survival (PFS) and overall survival (OS). Here, we report safety and efficacy data from an open-label, single-arm, multicenter, phase IV trial of apatinib as a third-line or later line treatment for advanced gastric cancer. Methods: Eligible patients had histologically or cytologically confirmed advanced gastric cancer or gastroesophageal junction adenocarcinoma; and an Eastern Cooperative Oncology Group (ECOG) performance status of 0–2; and adequate haematological and hepatic function; and failure of at least two lines of chemotherapy. Patients received oral apatinib until disease progression, death or unacceptable toxicity. The primary endpoint was safety, and secondary endpoints included PFS and OS. Results: The intention-to-treat population (ITT) included 2004 patients. At baseline, the median age was 59 (range, 19-85) years, ECOG performance status of 0/1/2 (%) was 15.4/68.8/15.1, and stage III/IV was 3.5/96.4; 98.8% had metastases, and among which metastatic foci≤2/ &gt; 2 was 64.5/34.2 (%), respectively. 89.6% of the patients were given apatinib 500mg as the initial does and the median treatment duration was 56 days. After a median follow-up of 126.5 days, adverse events (AEs) occurred in 95.1% of the patients and 70.3% were grade ≥3. 87.9% of the patients experienced treatment-related AEs (TRAEs), of which 51% had grade ≥3, 12.3% and 16.8% reduced dose and discontinued the treatment, respectively. 57 (2.9%) TRAEs-related deaths were reported, mainly because of gastrointestinal bleeding (16 cases), upper gastrointestinal haemorrhage (7), cerebral haemorrhage (2), and gastric perforation (1). The incidence of TRAEs of special interest was 74.3%; 38.1% of patients developed grade≥3, mainly including hypertension (26.3%), bleeding (5.1%), proteinuria (4.5%), and hand-foot syndrome (3.1%). In an ITT population, median PFS was 2.7 months (95%CI 2.23-2.79) and median OS was 5.8 months (95% CI 5.42-6.11). Conclusions: This study confirms that apatinib has a well-established and manageable safety profile and survival benefit as third or later line therapy for patients with advanced gastric cancer or gastroesophageal junction adenocarcinoma. Clinical trial information: NCT02426034.
July 2021: Lisinopril for delayed inflammatory responses to hyaluronic acid fillers after COVID-19 vaccinations
Authors: Brett Sloan
Journal: Journal of the American Academy of Dermatology (2021)

In the April 2021 edition of JAAD Case Reports, Munavalli et al1Munavalli G.G. Knutsen-Larson S. Lupo M.P. Geronemus R.G. Oral angiotensin-converting enzyme inhibitors for treatment of delayed inflammatory reaction to dermal hyaluronic acid fillers following COVID-19 vaccination-a model for inhibition of angiotensin II-induced cutaneous inflammation.JAAD Case Rep. 2021; 10: 63-68Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar reported a case series of 4 patients in whom delayed inflammatory responses to dermal hyaluronic acid filler developed following COVID-19 vaccination. All the patients had the facial filler placed for >8 months prior to the vaccination and significant edema developed at the sites of the filler 24-48 hours after receiving the COVID-19 messenger RNA vaccination. Through a proposed novel mechanism of action, the authors reported a rapid improvement with lisinopril via the inhibition of angiotensin-converting enzyme. The SAR-CoV-2 spike protein produced from the currently available messenger RNA vaccines interacts with its target ligand, the angiotensin-converting enzyme receptor 2. Alijotas-Reig et al2Alijotas-Reig J. Fernández-Figueras M.T. Puig L. Late-onset inflammatory adverse reactions related to soft tissue filler injections.Clin Rev Allergy Immunol. 2013; 45: 97-108Crossref PubMed Scopus (98) Google Scholar postulated that quiescent filler granulomas can be activated via specific stimulation of the CD8+ helper T cell type 1 immune response by various triggers, including a viral infection or vaccine, resulting in the clinical findings of a delayed inflammatory response. Through the use of clinical images taken before and after the response as well as a detailed schematic, Munavalli et al1Munavalli G.G. Knutsen-Larson S. Lupo M.P. Geronemus R.G. Oral angiotensin-converting enzyme inhibitors for treatment of delayed inflammatory reaction to dermal hyaluronic acid fillers following COVID-19 vaccination-a model for inhibition of angiotensin II-induced cutaneous inflammation.JAAD Case Rep. 2021; 10: 63-68Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar demonstrated an impressive response after the use of lisinopril. They illustrated the potential mechanism of delayed inflammatory responses following the accumulation of proinflammatory angiotensin II and certain metabolites occurring downstream in the cutaneous renin-angiotensin system due to the inactivation of angiotensin-converting enzyme receptor 2 by the viral spike protein. Although the authors acknowledged that further studies are needed, they provided a promising treatment option for this unique vaccine-related phenomenon. None disclosed.
Mucinous colorectal cancer: Disease characteristics, treatment outcomes and the impact of metastasectomy.
Authors: Darren Cowzer, Emily Harrold, Jane Sze Yin Sui, Mairi Lucas, Helen M Fenlon, Karen C Redmond, Donna Eaton, John B Conneely, Gerry P McEntee, Ann E Brannigan, Conor J Shields, Jurgen Mulsow, Catherine Margaret Kelly, Megan Greally, John McCaffrey
Journal: Journal of Clinical Oncology (2021)

3586 Background: Mucinous colorectal cancer (CRC) differs from adenocarcinoma with regard to clinical and histological features and is reported to have inferior outcomes when compared to non-mucinous CRC. This study aims to evaluate the clinical features and outcomes of patients with mucinous CRC at our institution. Methods: Medical records of patients with CRC that were referred to medical oncology between September 1999 and September 2018 were retrospectively reviewed. Mucinous histology was defined as those containing &gt; 50% mucin identified on histology specimens. Statistical analysis was performed using Prism V9.0. Results: We identified 1,115 patients with CRC that were referred to medical oncology during this period. The tumours of 81 (7.3%) patients were classified as mucinous. Median age was 65 (28-94 years) and 45 (55.5%) were male. Forty-one patients (51%) had right sided tumours, 27 (33%) had left sided tumours and 13 (16%) had rectal tumours. Twenty-three (28.4%) had de novo metastatic disease. Eleven of 24 patients (46%) with stage II disease relapsed and 18 of 33 (55%) of those with stage III disease relapsed. Radiological surveillance identified 20/29 (69%) of relapsed disease, 5 (17%) were symptomatic and 4 (14%) had a rise in CEA. Median follow up for patients with stage II disease was 53 months and 3 year and 5-year disease free survival (DFS) was equal in both groups at 60.9%. For stage III disease 3- and 5-year DFS was 58.1% and 48.4% respectively with a median follow up of 43 months. In the metastatic setting, we observed no significant difference in overall survival (OS) between left and right sided tumours ( p = 0.550). Median OS for pts with stage IV mucinous CRC who received any treatment was 25 months. Metastasectomy was performed in 25/52 (48%) patients and was associated with a significant improvement in OS, 23 vs 51 months ( p &lt; 0.005, HR 0.4). Conclusions: Mucinous CRC has been associated with inferior responses to treatment and worse overall outcomes compared to non-mucinous histologies. Survival in advanced-stage disease in our cohort is higher than what has been reported in the literature. With an effective multi-disciplinary approach and the increasing use of metastasectomy as a treatment option, survival in the advanced disease setting may be comparable to non-mucinous CRC.