tbuckley/cabot-search huggingface dataset:
Adherence for members taking oral oncolytic agents undergoing dose modification strategies.
Authors: Timothy Barnett, Cliff Rutter, Shehla Zaidi, Elisea Avalos-Reyes, Kelly McAuliff, Dipti Shah, Rashmi Grover, Lucia Feczko, William Cavers, Kjel Andrew Johnson
Journal: Journal of Clinical Oncology (2024)

e23058 Background: The use of oral oncolytic agents has transformed oncology care. Previous studies have reported that patient, treatment, and health system-related factors may influence adherence rates in patients prescribed oral oncolytic agents. The purpose of this study is to assess adherence rates in members of a large national pharmacy benefit manager taking oral oncolytic agents who experienced a modification to their dosing regimen. Methods: Adult members receiving palbociclib, abemaciclib, ribociclib, axitinib, lenvatinib, or cabozantinib between 01/01/2021 and 12/31/2022 were eligible for the study. Members who did not maintain continuous eligibility for 180 days prior to and 2 years after the first fill in the study period were excluded. Members were stratified by presence of dose modification, defined by a change in daily dose from one prescription to the next. Adherence was assessed via the proportion of days covered (PDC) which is the total days with medication coverage divided by the number of days between the index fill and exhaust of the final fill in the study period. Optimal adherence was defined as PDC ≥ 0.85. Standard statistical tests for continuous and categorical variables were utilized. Logistic regression was performed with the endpoint of optimal adherence. P values &lt; 0.05 are significant. Results: 13,641 members were included in the final analysis, with 7,093 (52%) experiencing a modification to their dosing regimen during the study period. Several significant differences in sociodemographic variables were present in this study with members experiencing a dose modification being older (mean [standard deviation (SD)]: 65.7 [11.9] vs. 64.9 [13.0] yr; p &lt; 0.001), more likely to be male (23.3% vs. 15.0%; p &lt; 0.001), more likely to reside in high socioeconomic status (SES) regions (23.7% vs. 21.5%; p = 0.005) and more likely to receive tyrosine kinase inhibitors (TKIs) (37.6% vs. 23.6%; p &lt; 0.001). Adherence was high overall with 74.6% of members achieving a PDC ≥ 0.85; however, members with dose modifications were less likely to be adherent (69.7% vs. 80.0%; p &lt; 0.001). Holding other confounders constant, having a dose modification was associated with a decreased likelihood of adherence (Odds Ratio [95% Confidence Interval]: 0.6 [0.55-0.65]; p &lt; 0.001). Conclusions: Dose modification was associated with significant decreases in adherence to oral oncolytic medications. Interventions designed to minimize dose modifications or to provide additional member support during a dose modification may optimize oral oncolytic adherence.
Are people in the US getting cancer at a younger age?
Authors: Ayse Levent, Serafina Adabra
Journal: Journal of Clinical Oncology (2024)

e23321 Background: Advanced age is a well-known risk factor for the development of cancer. One-third of all cancer diagnoses occur in patients aged 75 or older 1 . In general, cancer incidence rates are very low in younger populations, with only 25 cases per 100,000 in those aged 20 years or younger and about 350 cases per 100,000 in those between the ages of 45 and 49 2 . However, in recent years, studies have started to show an uncharacteristic rise in cancer diagnoses amongst young people in the United States. Methods: The Ipsos Oncology monitor is an online, multi-center medical chart review of oncology patients receiving drug therapy. Over 2,200 cancer treating physicians in the United States were screened for seniority and caseload and submitted data on 385,912 cancer patients (aggregate; all tumour types) between January 2018 to December 2023. Data captured included tumor type, patient age, whether the patient was newly diagnosed, follow-up or relapsed patient status and the treatment they received. Results: Reported patient age across all cancer types remained stable over time, recording an average age of 64.19 years in 2023. However, shifts in prevalence amongst younger age groups were recorded in select tumor indications. Within reported newly diagnosed breast cancer patients, the proportion of those aged 55 years or younger shifted significantly from 23% in December 2018, to 27% in December 2023. Over this same period, a similar trend was recorded in reported newly diagnosed colorectal cancer patients, with the proportion of those 55 years or younger rising from 17% to 22%. In contrast, sampled newly diagnosed melanoma and prostate patients reported decreased diagnoses in the 55 or younger age group. Conclusions: This demonstrates that the oncology patient cohort in this study remains mostly stable in age overall. However, the declining age of diagnosis in both reported breast and colorectal cancer may merit concern. These results outline the importance of robust screening efforts and suggest performance of routine screening at an earlier age may be beneficial. In addition, expansion of clinical trials and other oncology research to younger patient populations may be needed. Further investigation using comparator cohort is warranted. Age and cancer (2023) Cancer Research UK. Available at: https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/age-and-cancer (Accessed: 31 January 2024). Risk factors: Age (no date) National Cancer Institute. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/age (Accessed: 31 January 2024). Ugai, T. et al. (2022) ‘Is early-onset cancer an emerging global epidemic? current evidence and future implications’, Nature Reviews Clinical Oncology, 19(10), pp. 656–673. doi:10.1038/s41571-022-00672-8.
Nationwide real-world usage of blood-based (liquid) biomarker testing in Japan.
Authors: Yasushi Yatabe, Daisuke Ennishi, Yuko Kotera, Ryosuke Watanabe
Journal: Journal of Clinical Oncology (2024)

e23311 Background: Despite the advances in precision oncology with biomarker testing including CGP (comprehensive genomic profiling), not all patients are able to benefit from tissue-guided treatment decisions, underscoring a significant demand for advancements in liquid-based biomarker testing for such patients. However, the treatment landscape based on the application and integration of liquid biopsy in clinical practice has yet to be fully characterized in Japan. Methods: Center for Cancer Genomics and Advanced Therapeutics (C-CAT), the national datacenter in Japan, was established by the Ministry of Health, Labour and Welfare (MHLW) with the start of cancer genome medicine since June 2019. The database collects the clinical and genomic data from 68,242 patients who underwent CGP by the end of 2023. This study included all patient records who underwent liquid CGP testing using FoundationOne Liquid test from the C-CAT database up to June 2023. Results: We analyzed data from 7,461 records, where the patients had an average age of 65.1 (±12.0) years; 58.8% were male. A majority (51.3%) exhibited an ECOG performance status of 0, and 66.5% reported a family history of carcinoma. Predominant cancer types included pancreatic (1,825; 24.5%), prostate (1,182; 15.8%) and biliary tract cancers (838; 11.2%). Following review by an MTB (molecular tumor board), new treatments were initiated in 5.8% (434) of cases, with targeted therapy (181; 41.7%) and chemotherapy (174; 40.9%) being the primary interventions. Separately, 9 (2.1%) of new treatments post-MTB occurred as part of clinical trials. Median (IQR) durations from specimen collection to MTB, MTB to treatment initiation, and specimen collection to post-MTB treatment were 28 (24-34), 35 (13-64), and 63 (42-94) days, respectively. The largest proportion of biomarker testing occurred after the start of second line of therapy (1,720; 23.1%) Pancreatic and biliary tract cancer patients tend to have biomarker testing at the earlier line, whereas prostate and ovarian cancer patients tend to have at the later line. Conclusions: Although the positioning of liquid CGP testing may differ among cancer types, it is important for patients to select appropriate tissue- and liquid-based biomarker testing at the right timing. Understanding this descriptive landscape of biomarker tests utilized in real-world settings will aid decision-making for addressing unmet needs (e.g., low accessibility to treatment) in cancer genome medicine and its positioning in improving the standard of cancer care.
Malignant mesenchymoma: A demographic analysis of the National Cancer Database.
Authors: Sierra Alban, Mark Moroz, Jasika Grover, Kat Chin, Peter T. Silberstein, Craig Heise, Beau Hsia
Journal: Journal of Clinical Oncology (2024)

e23556 Background: Malignant mesenchymoma is a rare, aggressive soft tissue tumor characterized by the presence of two or more histologic subtypes of sarcoma. As a result of these characteristics, this cancer has a poor prognosis and a lack of proven treatment options. It may be epidemiologically beneficial to analyze the diagnostic trends to further understand the factors contributing to the disease. This study examines the demographic factors of malignant mesenchymoma, ICD-O-3 Code 8990, through the National Cancer Database (NCDB). Methods: The 2004-2020 NCDB was used for retrospective analysis. 72 patients were identified and their demographic factors such as age, sex, race, Hispanic status, educational attainment, insurance status, facility type and location, distance from facility, and Charlson-Deyo score were analyzed using descriptive statistics. Regression analysis was used to interpret incidence trends. Results: The NCDB contains 72 recorded cases of malignant mesenchymoma from 2004-2020 with an average age at diagnosis of 49.9 ± 21.3 years, with the incidence rate exhibiting variability (R2= 0.1028). Women had a considerably higher diagnosis rate (67%) compared to men (33%). The majority of patients were White (75%), and 11% of patients were Black. Most patients were of non-Hispanic origin (81%). A higher percentage of patients fell into the fourth quartile of income earners (32%) compared to the top three quartiles. A significant portion of patients (26%) did not have a high school degree. The sites with the highest cancer prevalence were the retroperitoneum (10%) and endometrium (10%). A majority of individuals (78%) had Charlson-Deyo comorbidity scores of 0. The size of the tumors ranged from 10.0 to 250.0 mm with an average size of 61.6 ± 67.4 mm. A majority of the patients (72%) underwent surgery at the primary site. Most (96%) patients survived at least thirty days following their primary surgery, with 94% surviving for ninety or more days. The mean survival time was 91.0 months. The cancer’s 2-year, 5-year, and 10-year survival rates were 61.5%, 45.5%, and 43.1% respectively. Conclusions: Based on our searches, this is the first NCDB study on malignant mesenchymoma to address epidemiological gaps in the literature. Most malignant mesenchymoma patients identified as non-Hispanic and White with a primary site of either the retroperitoneum or endometrium. The majority of patients fell into the fourth income quartile, and a significant amount did not have a high school degree. Due to this cancer’s rarity, recent literature exploring the factors contributing to the disease course is scarce. Additional research is necessary to understand how demographics influence the diagnosis, treatment, and long-term outcomes of individuals diagnosed with malignant mesenchymoma.
An analysis of treatment trends in sclerosing epithelioid fibrosarcoma.
Authors: Prachi Saldhi, Maya Mary Samuel, Peter T. Silberstein, Jasleen Kaur Chaddha
Journal: Journal of Clinical Oncology (2024)

e23547 Background: Sclerosing Epithelioid Fibrosarcoma (SEF) is a rare, malignant, soft tissue sarcoma found in the arms, legs, head, and neck. Histologically, SEF is characterized by a distinctive architecture composed of cords, nests, and/or sheets of uniform epithelioid cells. Previous studies have demonstrated that surgery with wide surgical margins is associated with superior outcomes in SEF patients. However, on account of the rare nature of SEF, insufficient research has been conducted on the association of treatment types with long-term survival. Using the National Cancer Database (NCDB), this study analyzed the receipt of different types of surgery and adjuvant treatments on the overall survival of patients with SEF. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with SEF from 2004 to 2020 using histology code 8840 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Logistic Regression tests were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05. Results: Out of the 1226 patients with SEF, 1088 patients ( 88.7%) received a tumor resection at the primary site. Receipt of surgery was associated with a greater median overall survival compared to not receiving surgery ( 123.6 months vs 45.7 months; p &lt; 0.05). Of the surgical patients, 419 patients received a wedge/segmental resection ( 38.5%) and 609 patients received a lobectomy ( 56%). Wedge/segmental resections and lobectomy had improved outcomes compared to other surgery types ( p &lt; 0.001). In addition to tumor resection, 140 patients ( 12.9%) received adjuvant chemotherapy, 21 patients ( 1.9%) received adjuvant radiation, and 11(1%) patients received adjuvant chemoradiation. Furthermore, the receipt of adjuvant therapies including adjuvant chemo, adjuvant radiation, and adjuvant chemoradiation, was associated with improved overall survival compared to receiving surgery alone ( p = 0.03; p = 0.005; p &lt; 0.001, respectively). Patients who received adjuvant chemoradiation experienced 9.5 months longer median survival time than patients who received adjuvant chemotherapy ( p &lt; 0.001). Conclusions: SEF patients who received tumor resection had a marked increase in overall survival. Receiving wedge/segmental and lobectomy surgery types were associated with improved patient outcomes compared to other surgery types. Furthermore, receiving any adjuvant therapy was associated with improved overall survival compared to receiving surgery alone. Receiving adjuvant chemoradiation was associated with superior outcomes in SEF patients compared to receiving other adjuvant therapies and surgery alone. To improve overall survival in SEF patients, further research is needed to assess what factors influence treatment trends.
Myofibroblastic sarcoma: A study of demographic and socioeconomic factors.
Authors: Delaney Loken, Sandy Ng, Mark Moroz, Nisha Reddy, Peter T. Silberstein, Craig Heise, Beau Hsia
Journal: Journal of Clinical Oncology (2024)

e23545 Background: Myofibroblastic sarcoma is a type of non-rhabdomyosarcoma soft tissue sarcoma originating from spindle cells of mesenchymal origin with myofibroblastic differentiation. First described in 1998, there is little known about the prognostic factors of this rare and relatively new cancer. This typically non-metastasizing tumor is primarily found in the head, neck, or extremities. Treatment focuses on tumor excision, and the 5-year overall survival of low-grade myofibroblastic sarcoma cancer is 72%. This study analyzed data from the National Cancer Database (NCDB) to understand how demographic factors contribute to the treatment and prognosis of myofibroblastic sarcoma. Methods: A retrospective cohort analysis was conducted on demographic factors of patients with confirmed myofibroblastic sarcoma (ICD-8825-3) using the NCDB from 2004-2020. Regression analysis was used to study trends of patient age, sex, race, education, insurance status, distance from facility, and Charles/Deyo score within this population. Results: A total of 111 patients (N = 111) were identified in the database with a confirmed diagnosis of myofibroblastic sarcoma from 2004 to 2020 with an increasing frequency of diagnoses per year (R^2 = 0.6283). The average age of diagnosis was 47.3 (SD = 24.17, range = 0 - 90 years). Although Myofibroblastic sarcoma appeared throughout the body, the most prominent sites were the long bones of the lower limb and associative joints (6%) followed by the uterus (5%). The majority of patients were white (83%), non-Hispanic (86%), and female (63%). A higher percentage of patients lived in metropolitan areas with a population greater than 1 million (58%) compared to smaller metropolitan, urban, or rural counties (42%). Most of the patients were treated at an academic/research program (30%) followed by a comprehensive community cancer program (21%). More facility locations were based in the Pacific (15%) and the Middle Atlantic (11%) regions. The primary payer at diagnosis was private insurance/managed care (44%) followed by Medicare (32%) and Medicaid (19%). Few patients (5%) received palliative care. Conclusions: To the best of our knowledge, this is the first NCDB analysis on Myofibroblastic sarcoma. Based on our dataset, Myofibroblastic sarcoma tends to occur in the long bones of the lower limb and associative joints which differed slightly from what we found in previous reports, which described the head and neck as the two areas of highest prevalence. This is the first time the socioeconomic factors have been described in the literature: these patients are more likely to be non-Hispanic, female individuals, living in smaller towns. This study offers insight on how much further investigation is required to better understand the impact of demographic and socioeconomic factors on early diagnosis and treatments.
In-hospital outcomes of patients with lung cancer with and without superior vena cava thrombosis: A nationwide analysis.
Authors: Ankushi Sanghvi, Dhairya Nanavaty, Sagar Patel, Bhavyakumar Vachhani, Mrunanjali Gaddam, Manasa Ginjupalli, Jayalekshmi Jayakumar, Nawaraj Adhikari, Rishav Sinha, Vikash Kumar, Priya Hotwani, Ahmed Nadeem
Journal: Journal of Clinical Oncology (2024)

e23322 Background: Malignant superior vena cava syndrome (SVCS) is a clinical problem that results from the obstruction of blood flow in the superior vena cava by an underlying malignancy. It may be caused by external compression or internal obstruction due to a thrombus or direct invasion by tumor cells. Though lung malignancy is the most common cause of SVCS, there is a lack of data on in-hospital outcomes in these patients. Methods: We queried the National Inpatient Sample 2018-2020 to identify hospitalizations with lung cancer including both small cell and non small cell lung cancer. Hospitalizations with diagnosis of acute SVC thrombosis were determined by using ICD-10 codes.Demographics and mortality rates were compared between two groups using chi square for categorical variables and t test for continuous variables. Multivariate regression analysis was further performed to study the impact of SVC thrombosis on mortality, LOS and total hospitalization cost. Results: A total of 2011620 hospitalizations with lung cancer were identified. Of these, 2855 (0.0014%) had acute SVC thrombosis. These patients were younger with a mean age of 63 years. African-Americans and Hispanics were in a higher proportion in the cohort of hospitalizations with SVC thrombus as compared to those without. (Table 1). Multivariate regression analysis revealed higher odds of mortality (OR-1.94; C.I: 1.53-2.47; P &lt; 0.001), LOS (OR 1.66; C.I:1.20- 2.31; P &lt; 0.005) and total hospitalization cost (26211.15; C.I:22183.56- 30238.74; P &lt; 0.001) in lung cancer hospitalizations. Conclusions: Our study shows that SVCT, has higher odds of mortality, length of stay and total hospital cost. Though the general recommendation is to continue anticoagulation, sometimes patients may require endovascular stent placement with/without thrombectomy. Though rare, SCVT can be life threatening and requires prompt attention.[Table: see text]
Bony reconstruction after internal hemipelvectomy: A retrospective analysis of 44 patients undergoing femoro-pelvic pseudoarthrosis.
Authors: Biplab Mishra, Mandip C. Shah, Chetan Anchan
Journal: Journal of Clinical Oncology (2024)

e23509 Background: After acetabular resection for sarcomas, achieving a bony femoro-pelvic fusion is very difficult, and prosthetic reconstructions have very high complication rates. We reconstructed the defects with a simple polypropylene mesh between the femoral head and the remaining part of the pelvis thereby aiming at a pseudo-arthrosis and analyzed its functional outcome. Methods: Between 2013 and 2022, 44 patients having bone tumors of the pelvis underwent acetabular resections and femoro-pelvic pseudoarthrosis. Commonest Histology was chondrosarcoma (23). According to Enneking’s classification, type II (3), type I+II (9) , type II+III (24), type I+II+IV (5), and type I+II+III (3) resections were carried out. A 30 x 30 cm polypropylene mesh was tied to the remains of the capsule around the head and was then turned on itself to make a strong braided rope-like structure. It was passed through the remaining ilium/ ischium/ sacrum and was tied to itself in proper rotation with heavy ethibond suture. In 4 cases, a proximal femur megaprosthesis and in 2, a nail cement spacer was implanted in femur to reduce shortening. Functional limb results were reported according to MSTS functional scores. Results: 37/44 patients attained independent ambulation. The mean time to full weight bearing was 4.7 months (3-9 months). There were 6 flap necrosis, 3 infections, 1 nerve injury, and 1 vascular injury. Local recurrence occurred in 6 (13%) and Systemic metastasis developed in 20 patients (47% of malignant tumors). At an average follow-up of 56 months ( 24 – 127 months), 26 are alive without any signs of disease. The average MSTS score was 22 (range 13–27). The best MSTS scores were with type II or II+III IH where ilium was left to support the femur while the worst was with type I+II+III resection patients. Patients with higher BMI have poorer functional outcomes with meshplasty. Conclusions: Mesh-pseudoarthrosis is a very simple reconstruction option that has an excellent functional outcome. It reduces surgical time and eliminates uncertainties about fusion/joint replacement. This should be strongly recommended as a method of reconstruction for patients undergoing acetabular resections.