tbuckley/cabot-search huggingface dataset:
A real-world longitudinal assessment of the treatment-related symptoms and associated burden among patients receiving chemotherapy.
Authors: Peter Trask, Emelly Rusli, Tracy Holt, Mordecai Kramer, Aaron Galaznik
Journal: Journal of Clinical Oncology (2024)

e23158 Background: For patients (pts) with cancer, treatment with cytotoxic chemotherapy is associated with a variety of treatment-related symptoms including nausea, vomiting, diarrhea and constipation. Often the ability to manage these symptoms when they occur is the difference between completion of chemotherapy and early discontinuation. The first weeks of treatment are critical for understanding the pts’ acute experience with chemotherapy. The objective of this study is to longitudinally evaluate treatment-related symptoms and associated treatment burden among chemotherapy pts through a real-world electronic remote symptom monitoring system. Methods: Pts treated with chemotherapy in U.S. academic cancer centers were enrolled in Carevive’s Patient Reported Outcomes Mobile Platform (Carevive PROmpt®) between September 2020 and Dec 2023, with 3 month median follow-up. A total of 476 pts were enrolled, across early (81%) and late (19%) stage disease. Weekly PRO-CTCAE-derived surveys assessed severity, frequency, and interference for 16 symptoms often associated with cancer treatment: anxiety, constipation, cough, decreased appetite, diarrhea, fatigue, general pain, insomnia, mouth/throat sores, muscle pain, nausea, numbness and tingling, rash, sadness, shortness of breath, and vomiting. The GP5 assessed weekly overall bother with the side effects of treatment. Questionnaires were administered weekly starting at treatment initiation. Results: The mean age of chemotherapy pts was 67.3 (SD = 13.2) years, with 75% female, and 20% African American. At treatment initiation, 302 pts reported symptoms by PRO-CTCAE, and 100 completed the GP5. At week 1, constipation, general pain (GP), nausea, numbness/tingling (N/T), and shortness of breath were experienced by 20-25% of pts. Over the first 4 weeks of treatment, pts reported an increase in constipation, decreased appetite, diarrhea, and nausea at week 2, with a return to week 1 frequency over the remaining weeks. Diarrhea, however, remained elevated. While week 1 capture rates were lower, patterns for treatment bother were similar. At week 1, 34% of pts reported being bothered at least “Somewhat” by the side effects of treatment. This increased to 48% at week 2, but returned to near the week 1 frequency over the remaining weeks. Conclusions: For remote-monitored pts in this real-world data set treated with chemotherapy both alone and in combination, the most frequent symptoms at the start of treatment were nausea, GP, and N/T. The frequency of pts with GP and N/T did not change over the course of treatment suggesting their possible presence prior to the observed regimen. Increases in chemotherapy-related symptoms show the importance of ongoing assessment over the first 4 weeks of treatment, ideally with feedback to treating physicians and concomitant symptom management to optimize successful chemotherapy completion.
Clinicopathologic features of patients with breast cancer in a single tertiary hospital in the Philippines.
Authors: Maria Carmela Yasay Vistal, Marie Belle Dela Cruz Francia, Agnes Evangelista Gorospe, Margarita Guevarra, Sofia Dominique Unson
Journal: Journal of Clinical Oncology (2024)

e23313 Background: Breast cancer incidence in the Philippines is among the highest in Asia - the WHO reported it to be as high as 33,079 in 2022. Data provided by the Philippine Cancer Society and Department of Health Rizal Cancer Registry in 2009 included 1,615 breast cancer patients and noted a significant increase in breast cancer incidence from the year 1980 to 2002 in 7 cities in Metro Manila. This retrospective study aims to describe and analyze clinicopathologic and treatment data of Filipino breast cancer patients in a tertiary hospital. This study represents the largest pooled data in the Philippines on breast cancer demographics. Methods: Patients diagnosed with invasive breast cancer in St. Luke’s Medical Center (SLMC) from 2009 to 2020 were included. Patients diagnosed with other breast histopathologic results [i.e. ductal and lobular carcinoma in situ without invasive component] and double primaries were excluded. The study was approved by the Ethics Review Committee (Reference No.: SL-19157). Results: A total of 5,462 breast cancer patients were included. Majority of the patients were late perimenopausal (50-59 yo, 30.06%), menopausal (60-69 yo, 23.03%), and premenopausal (below 44 yo, 19.28%,) at the time of diagnosis. Patients were diagnosed with stage II (N = 1,816, 47.24%), followed by stage I (N = 943, 24%), and stage III (N = 662, 17%). Sixty four percent (N = 1,498) were node negative while 46% (N = 1,300) were node positive. Among patients with de novo metastasis, 14.6% metastasized to the bone while visceral sites include chest wall (17.4%), lung (16.6%), liver (11.5%) and brain (7.45%). Luminal her2- (48.9%) was the most common clinical subtype followed by non-luminal her2+ (15.6%) and triple negative (6.7%). Definitive surgery was the mainstay of treatment – 94% (N = 4116) underwent modified radical mastectomy (MRM) while 5% (N = 223) underwent breast conserving surgery (BCS). Eight hundred patients (19%) received neoadjuvant treatment (hormonal and/or systemic chemotherapy) while 2,246 patients (54%) received adjuvant treatment. Total number of breast cancer patients who underwent adjuvant radiation was 1,399 (25.6%). Conclusions: Compared to middle-high income countries, data suggests that MRM is the preferred surgical technique over BCS. Majority of patients in the study are luminal her2-. However, only 54% received adjuvant treatment. Another observation is the low rate of neoadjuvant treatment by the study population. Further research on the risk factors or reasons for not receiving treatment as well as the outcomes of these patient cohorts is needed to shed light on these cancer care gaps.
Spindle cell rhabdomyosarcoma: A study of demographics and socioeconomic factors using NCDB.
Authors: Sukhmani Kaur Gill, Rawaan Khatib, Nikhita Tandon, Sadaf Sadighian, Peter T. Silberstein, Craig Heise, Beau Hsia
Journal: Journal of Clinical Oncology (2024)

e23539 Background: Spindle cell rhabdomyosarcoma (SC-RMS) is a rare malignancy characterized by elongated spindle cells displaying eosinophilic and fibrillar cytoplasm, resembling smooth muscle fibers. SC-RMS is primarily diagnosed in children with particular involvement of the nasopharynx, parotid gland, nasal cavity, and paratesticular regions. Though surgical resection and chemotherapy are the current recommendations, definitive treatment guidelines remain unestablished. Because SC-RMS is a novel cancer type, evaluating the diagnostic trend of the disease has the potential to provide valuable insights into its epidemiology. An analysis of the National Cancer Database (NCDB) was conducted to identify the demographic factors associated with patients who have been diagnosed with SC-RMS. Methods: A retrospective cohort analysis of the 2004–2020 NCDB, using ICD-O-3 code 8912/3, included patients with a histologically-confirmed diagnosis of SC-RMS (N = 132). Demographic factors (age, sex, race, Hispanic status, educational attainment, insurance status, facility type, distance from facility, and Charles/Deyo score) were analyzed by descriptive statistics and incidence trends were interpreted in regression analysis. Results: A total of 132 patients with a confirmed diagnosis of SC-RMS were identified, with a declining incidence of diagnoses per year (R² = 0.4507). The average age of diagnosis was 33.9 years (SD = 27.2, Range = 1-90). SC-RMS was more commonly observed among males (63%), with a majority of patients being non-Hispanic (87%) and White (74.2%). The top primary site was the testis (20%). Most patients (83%) had a Charlson/Deyo comorbidity score of 0. The majority (69%) of patients received surgery as their primary treatment. Most patients were privately insured (49%) and resided in metropolitan areas with a population greater than 1 million (48%). More (29%) patients were in the highest quartile of income earners of $74,063 or greater. Patients were treated most often at an academic/research program (19%) or comprehensive community care program (12%). Patients lived an average of 68.2 miles (SD = 267.9, Range = 0.6 - 2403.1) from the treatment facility. Conclusions: To the best of our knowledge, this is the first NCDB analysis on SC-RMS. Our analysis revealed that the majority of SC-RMS patients were young males with primary involvement of the testis, supporting previous studies. Analysis of the socioeconomic factors of SC-RMS patients revealed that more patients were privately insured, resided in densely populated metropolitan areas, and were part of the top quartile of income earners. Further research is supported to better understand the impact of socioeconomic factors on diagnosis, treatment options, and overall mortality rates associated with SC-RMS.
Evidence into practice: Changes in haploidentical versus double umbilical cord blood graft utilization for hematopoietic cell transplantation in the U.S. in relation to a pivotal randomized clinical trial.
Authors: Danh T. Tran, Ruyun Jin, Hong Zhu, Gabrielle Schmidt, Stephen R. Spellman, Karen K. Ballen
Journal: Journal of Clinical Oncology (2024)

e23306 Background: Randomized clinical trials are the “gold standard”, but expensive and not always practice changing. Umbilical cord blood (UCB) and haploidentical (haplo) are donor sources for hematopoietic cell transplant (HCT) patients who do not have a fully matched donor. The Blood and Marrow Transplant Clinical Trials Network (CTN) 1101 trial (2012-2018) compared outcomes of double UCB and haplo bone marrow (BM) transplantation. The trial showed a lower two-year overall survival after UCB compared to haplo (46% vs 57%, p = 0.04). Here, we quantified the change in graft selection in clinical practice in the U.S. after publication of the trial’s primary results. Methods: 11,190 U.S. HCT recipients 18-70 years of age who received either UCB (single or double units) or haplo transplants (BM or peripheral blood stem cells), for leukemias, lymphomas, myelodysplastic syndrome, myeloproliferative neoplasms, who reported to the Center for International Blood and Marrow Transplant Research database, were analyzed. Graft utilization was analyzed in 3 time periods: 2010-2012 (pre-study), 2013-2018 (during study), and 2019-2022 (post-study), using Chi-square test and multivariable logistic regression. Results: Over the 3 time periods, there was a practice change with an increasing proportion of haplo transplants vs UCB (32%, 68% and 91% of transplants, p &lt; 0.001; odds ratio (OR) of 4.67 and 21.38 for during-study and post-study periods, respectively, both with p &lt; 0.001, compared to pre-study period). Males and older patients were more likely to receive haplo (OR = 1.32, p &lt; 0.001, and OR = 1.74, p &lt; 0.001, respectively). Compared to White recipients, Black recipients were more likely to receive haplo (OR = 1.74, p &lt; 0.001), whereas Asian recipients were less likely to receive haplo (OR = 0.75, p = 0.002). Hispanic recipients had a similar likelihood of receiving haplo to White patients (OR = 1.03, p = 0.665). Conclusions: Practice change toward haploidentical graft utilization had begun before the CTN 1101 trial’s publication and continued to increase over time. Black patients were more likely than White patients to receive haplo, and Asian patients were more likely than White patients to receive UCB. Availability of both UCB and haplo as alternative graft sources allowed for HCT for a diverse population. [Table: see text]
Analysis of demographic and socioeconomic factors in mixed type rhabdomyosarcoma using NCDB.
Authors: Sukhmani Kaur Gill, Mark Moroz, Jasika Grover, Susan Rafie, Peter T. Silberstein, Craig Heise, Beau Hsia
Journal: Journal of Clinical Oncology (2024)

e23538 Background: Mixed type rhabdomyosarcoma is a rare soft tissue tumor characterized by the presence of two histologically different subtypes of rhabdomyosarcoma, commonly found in the testis. Despite a majority of the patients undergoing aggressive treatment, the prognosis is poor. Analysis of its diagnostic trends could prove valuable in understanding mixed type rhabdomyosarcoma’s epidemiology. The 2004-2020 National Cancer Database (NCDB) was analyzed to determine the demographic factors of patients with mixed type rhabdomyosarcoma. Methods: A retrospective cohort analysis of the 2004–2020 NCDB, using ICD-O-3 code 8902/3, included patients diagnosed with mixed type rhabdomyosarcoma (N = 94). Descriptive statistics were used to analyze various demographic factors such as sex, age, race, Hispanic status, educational background, insurance status, facility type and location, distance from facility, and Charlson-Deyo score. Incidence trends were examined through regression analysis. Results: The NCDB identified a total of 94 patients with a confirmed diagnosis of mixed type rhabdomyosarcoma from 2004-2020, with a slight decline in incidences diagnosed per year (R² = 0.0903). Females had a slightly higher likelihood of being diagnosed (55%) compared to males (45%), with average age at diagnosis being 40.06 years (SD = 2.8, Range = 1-90). The majority of patients were White (72%) and of non-Hispanic descent (82%). The top primary site was the testis (23%), with endometrium being another major site (15%). Most (83%) patients had a Charles/Deyo comorbidity score of 0. All patients received immunotherapy as primary treatment. Most (46%) patients were privately insured. A majority (26%) of patients received treatment at an academic/research program. A greater number (53%) of patients resided in metropolitan counties with a population larger than 1 million. Most (40%) patients belonged to the highest quartile of income earners of $74,063 or greater. Conclusions: Our research on mixed type rhabdomyosarcoma, the first NCDB analysis of its kind, aims to address a notable knowledge gap on the topic. Similar to information presented in earlier studies, our analysis revealed mixed type rhabdomyosarcoma has a relatively poor prognosis and is mostly observed in White, Non-Hispanic individuals. Analysis on the demographics of this patient population revealed most patients were top quartile income earners, resided in a metropolitan location, and were more likely to be treated at an academic/research program. Further research should aim to better understand the impact of such demographic and socioeconomic features on the diagnosis, treatment plans, and overall mortality rates of patients with mixed type rhabdomyosarcoma.
Identifying intra-abdominal desmoid type fibromatosis mimicking recurrence/metastasis of GISTs using FAPI PET/CT.
Authors: Chunhui Wu, Xiaojie Lin, Fang Wen, Xin Hu, Yu Zeng, Fangzeng Lin, Kaiyu Sun, Shirong Cai, Shaoqing Huang, Xiangsong Zhang, Xiaoyan Wang, Xinhua Zhang
Journal: Journal of Clinical Oncology (2024)

e23516 Background: Intra-abdominal desmoid tumor (IADT) can mimic the recurrence/metastases of gastrointestinal stromal tumors (GISTs). However, it is difficult to radiologically differentiate IADT and recurrence/metastases of GISTs. This study aims to investigate the value of 18 F fibroblast activation protein inhibitor ( [ 18 F]FAPI-42) PET/CT in identifying intra-abdominal desmoid type fibromatosis mimicking recurrence/metastases of GISTs by comparing it to [ 18 F]FDG PET/CT. Methods: This study retrospectively included a total of 24 patients (12 patients with IADT and 12 patients with recurrent/metastatic GISTs). The differences in [ 18 F]FAPI-42 PET/CT parameters (SUV max -FAPI and SUV TLR -FAPI ), [ 18 F]FDG PET/CT parameters (SUV max -FDG and SUV TLR -FDG), SUV fapi /SUV fdg ratio of IADT and GISTs were compared. The difference in PET/CT parameters (SUV max , SUV TLR ) of IADT between FDG PET/CT and FAPI PET/CT were compared. Immunohistochemical verification was performed on IADT lesions of all 12 patients and expression profiles of GEO datasets were analyzed to validate the FAP expression of IADT. Results: Both [ 18 F]FAPI-42 PET/CT parameters, SUV max -FAPI [8.8 (2.0, 16.0) vs 1.9 (1.0, 6.0), P&lt; 0.001]and SUV TLR -FAPI [7.3 (2.0, 15.8) vs 1.7 (0.5, 6.9), P&lt; 0.001], of IADT was significantly higher than that of GISTs, while there was no statistically significant difference in [ 18 F]FDG PET/CT parameters, SUV max -FDG and SUV TLR -FDG, between this two group. The ratio (SUV fapi /SUV fdg ) of IADT was significantly higher than that of GISTs [3.3 (1.5, 8.0) vs 0.5 (0.1, 3.9), P= 0.001]. The SUV max and SUV TLR of FAPI PET/CT of IADT were significantly higher than that of FDG PET/CT [8.8 (2.0, 16.0) vs 2.5 (1.1, 6.2), P&lt; 0.001; 7.3 (2.0, 15.8) vs 0.9 (0.4, 2.7), P&lt; 0.001; respectively]. FAP expression was found to be expressed in all the examined tissues and highly expressed in most of them. GEO database analysis shows that the FAP gene expression in DT is significantly higher than that in GISTs. Conclusions: FAPI PET/CT is a promising method in differentiating IADT from recurrence/metastases of GISTs compared with FDG PET/CT since FAP expression in DT is significantly higher than that in GISTs.
Unveiling a low-hanging fruit: Single-center study on secondary immunodeficiency in newly diagnosed chronic lymphocytic leukemia and multiple myeloma.
Authors: Zeni Kharel, Himal Kharel, S. Shahzad Mustafa, Saad Jamshed
Journal: Journal of Clinical Oncology (2024)

e23215 Background: Infectious complications are the leading cause of morbidity and mortality in patients with chronic lymphocytic leukemia(CLL) and multiple myeloma(MM). Despite recognized risks, evaluation of immune function occurs inconsistently. Our retrospective study evaluated practice patterns for assessing secondary immunodeficiency (SID) in newly diagnosed CLL and MM patients. Our aim is to identify areas for improvement to guide future prospective studies. Methods: We analyzed various immune parameters in newly diagnosed CLL and MM patients at Rochester Regional Health, Rochester, NY, focusing on the first six months of their clinical course, with descriptive data analysis. Results: Conclusions: Current infection prevention guidelines for newly diagnosed CLL and MM patients lack robust evidence. Despite our study’s inherent limitations (small, retrospective, single-center), based on our clinical experience, we propose the following recommendations: Complete SID assessment in all new diagnoses of CLL and MM, and this should include not only Ig levels but also vaccine response. If found to have abnormal SID evaluation, consider prophylactic antibiotics and Ig replacement, and consider reevaluation when appropriate to better define the duration of immunoparesis. Consider short-term Ig replacement (irrespective of IgG levels) and antibacterial prophylaxis for all newly diagnosed MM patients due to high infection risk during the initial six months. A thorough immune evaluation is non-invasive and low-cost, yet it can reveal clinically significant immune dysfunction, potentially influencing management in CLL and MM. Consequently, we hope our study will prompt the development of prospective, randomized studies to systematically evaluate these recommendations. [Table: see text]
Mixed liposarcoma: A study of socioeconomic and demographic factors.
Authors: Delaney Loken, Yanick Tade, Mark Moroz, Nikhita Tandon, Peter T. Silberstein, Craig Heise, Beau Hsia
Journal: Journal of Clinical Oncology (2024)

e23527 Background: Mixed Liposarcoma (LS) is an extremely rare subtype of LS, with characteristics often spanning 2 or more of the other LS subtypes such as myxoid, round cell, or well-differentiated LS. To date, the cytologic features of this uncommon tumor has yet to be described. Analyzing trends in diagnoses may produce valuable information about its epidemiology. The National Cancer Database (NCDB) was analyzed to uncover the demographic factors in patients diagnosed with mixed LS. Methods: A retrospective cohort study from 2004 to 2020 was conducted using the NCDB. 199 patients were found with a histologically confirmed diagnosis of mixed LS (ICD-8855-3). Race, gender, Hispanic origin, type of treatment facility, insurance coverage, and distance from patient residence to treatment facility were analyzed via descriptive statistics, and trends in incidence were interpreted using regression analysis. Results: The majority of patients were white (89%) and non-Hispanic (83%) with a relatively equal split of males (56%) and females (44%). The most common primary site of mixed LS was the retroperitoneum (72%), and the frequency of diagnosis decreased from 2004 to 2020 (R2 = 0.4568). Patients were treated at academic/research programs (45%), comprehensive community cancer programs (25%) and integrated network cancer programs (18%) that were generally located in the Middle Atlantic (19%), South Atlantic (18%), and East North Central (16%). The two primary payers at diagnosis include private insurance/managed care (45%) and Medicare (43%). Most patients were from counties in metro areas with a population of at least 1 million (57%) followed by metro counties with a population of 250,000 to 1 million (18%). The largest median household income quartile was $74,063 or more (38%), followed by $46,227 - $57,856 (22%). Most patients had a Charlson-Deyo Score of 0 (83%) with a NCDB analytic stage of either I (28%), III (26%), or not applicable (21%). Conclusions: To the best of our knowledge this NCDB analysis on mixed LS is the first of its kind and therefore addresses a significant knowledge gap. Most patients tend to be white and non-Hispanic. Mixed LS most commonly is found in the retroperitoneum, which is similar to case reports. We found that mixed LS patients have a relatively high household income, most often live in high populated metro areas, and are most frequently treated at academic/research programs. These findings are significant because these socioeconomic factors have not been noted before in literature. Further examination of these demographic and socioeconomic factors is required to understand how they impact treatment, diagnosis of, and survival of patients with mixed LS.