tbuckley/cabot-search huggingface dataset:
Comparative survival after neoadjuvant vs adjuvant systemic therapy in resectable stage II and stage III non-small cell lung cancer: A retrospective study using the National Cancer Database.
Authors: Ghanshyam H. Ghelani, Roger Wong, Stephen L. Graziano, Jeffrey S. Ross, Alina Basnet
Journal: Journal of Clinical Oncology (2024)

8075 Background: Resectable Stage II and III Non-small Cell Lung Cancer (NSCLC) are managed with surgery and perioperative systemic therapy [Chemo/Chemo-Immunotherapy (IO)]. However, there lacks a consensus in optimal selection between neoadjuvant and adjuvant approaches. Hence, it underscores the necessity to undertake a comparative survival outcome associated with systemic therapy in these distinct settings. Methods: We conducted an analysis, of individuals aged 18 and above diagnosed with stage II and stage III NSCLC between 2004 - 2020, using data from the National Cancer Database (NCDB). Overall survival (OS) was compared for both Neoadjuvant and Adjuvant systemic therapy using Cox proportional hazards models after adjusting for sociodemographic (e.g., age, sex, race-ethnicity, and income) and health (e.g., insurance and facility type) related factors. The inclusion criteria involved restricting the analysis to individuals with no more than one lifetime cancer diagnosis and excluding those who received radiation therapy. Results: Among approximately 2 million total patients with NSCLC in NCDB, 8.38% and 20% were stage II and III respectively. After we identified a total of 137,473 eligible patients, 27,115 had relevant treatment information with 2,550 Neoadjuvant Chemo, 112 Neoadjuvant chemoIO, 24,175 Adjuvant chemo and 278 Adjuvant chemoIO. A statistically significant association between OS and treatment group was observed [χ2(3) =55.5, p&lt;.001]. The OS was notably higher in the Neoadjuvant chemoIO group (78.57%) compared to Adjuvant chemoIO group (55.76%), whereas the Neoadjuvant chemo-only group exhibited lower OS (45.41%) compared to the Adjuvant chemo group (47.98%). The Cox proportional hazards model showed 70% higher mortality risk in the Adjuvant chemoIO group compared to the Neoadjuvant chemoIO group (p=0.030, 95% CI 1.05-2.77). The 2-year and 5-year OS rates for Neoadjuvant ChemoIO were 77.9% and 68.8%, respectively versus 68.7% and 42.8% for Adjuvant chemoIO group. Conclusions: Our analysis reveals that Neoadjuvant chemoIO demonstrates superior survival outcomes compared to Adjuvant chemoIO. Additionally, our findings suggest the potential predictive value of Immunotherapy in combination with chemotherapy in the Neoadjuvant setting. Key Words: NSCLC, Neoadjuvant treatment, Adjuvant treatment, Chemotherapy, Immunotherapy, OS.
Predictors of symptom scores in myeloproliferative neoplasms: A real-world retrospective cohort study.
Authors: Muhammad Ali Khan, Syed Arsalan Ahmed Naqvi, Irbaz Bin Riaz, Jeanne M. Palmer
Journal: Journal of Clinical Oncology (2024)

6582 Background: Although high symptom burden indicates poor survival and informs treatment decisions, little is known about the impact of demographic, clinical, and laboratory features on total symptom score (TSS) in patients with myeloproliferative neoplasms (MPN). Methods: Patients with MPN (polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF)) were identified from the retrospective chart review. TSS, individual symptom scores (fatigue, early satiety, abdominal discomfort, inactivity, concentration problems, fever, night sweats, itching, bone pain, weight loss), demographic characteristics (race, ethnicity, age, gender), clinical features (time since diagnosis, depression status, obesity status, spleen size), laboratory results and season at the time of visit were recorded from the clinical encounter when index assessment of TSS was performed for each patient. Normality was assessed using visual inspection of data distribution, whereas multicollinearity was assessed using various inflation factors. A univariable regression followed by a multivariable regression analysis was conducted using a backward selection approach. A p-value &lt;0.05 indicated a statistically significant association of a given feature with TSS. Results: The chart review identified 252 patients (PV: 78; ET: 81; MF: 93). Mean age was 59 (SD: 17.7), 67 (SD: 13.0), and 68 (SD: 10.9) years for ET, PV, and MF respectively. Most patients were white (PV, MF: 92%; ET: 83%) and females (ET: 75%; PV: 60%; MF: 53%). The TSS of patients was highest with PV (mean: 18.5; SD: 16.9) followed by MF (mean: 18.1; SD: 15.4) and ET (mean: 14.3; SD: 15.9). Fatigue was the most reported symptom whereas the least reported symptoms were fever and weight loss. Univariable regression analyses showed depression (B: 17.7; p=0.02), female gender (B: 10.6; p=0.01), platelet count (B: 0.03; p=0.03), and hemoglobin (Hb) (B: -2.6; p=0.01) in PV patients, depression (B: 19.8, p=2x10 -5 ) in ET patients and depression (B: 11.0, p=0.03), white blood cell (WBC) count (B: 0.2; p=0.01), neutrophil count (B: 0.3, p=0.01), and non-neutrophil WBC count (B: 0.6; p=0.02) in MF patients to have significant association with TSS. Multivariable regression analyses ( Table) showed Hb (B: -2.5; p=0.01) and platelet count (B: 0.02; p=0.03) in PV patients, depression (B: 19.7; p=2x10 -5 ) in ET patients and depression (B: 12.3, p=0.01) and WBC count (B: 0.3; p=0.002) in MF patients to have a significant association with TSS. Conclusions: Depression in ET and MF and low Hb in PV were identified as significant drivers of symptom burden. Identifying and managing patients with these comorbidities could improve their quality of life with a potential survival benefit. [Table: see text]
The impact of HIV and CD4 count stratification on all cause mortality for adenocarcinoma and squamous cell lung cancers in the antiretroviral therapy era: Analysis of National Veterans Affairs and Kaiser Permanente Northern cohorts.
Authors: Elizabeth Y. Chiao, Devesh Malgave, Christine Hartman, Jennifer Kramer, Rulin Hechter, Lori C. Sakoda, Wendy Leyden, Katherine Pak, Alexandra Lea, Efthalia Zafeiropoulou, Ado Rivera, Peter Richardson, Yongquan Dong, Donna L. White, Lilie L. Lin, Matthew J Boyer, Michael Silverberg
Journal: Journal of Clinical Oncology (2024)

8070 Background: Since the widespread introduction of antiretroviral therapy (ART), people living with HIV (PWH) have experienced substantially decreased morbidity and mortality. However, PWH are at higher risk for lung cancer and have decreased cancer survival rates compared to people without HIV (PWoH). Few studies have evaluated histology-specific lung cancer survival by stage and HIV immune control. Methods: A retrospective cohort study was conducted with newly diagnosed non-small cell lung cancer (NSCLC), including PWH with PWoH, identified between 2008 and 2020 from the US Department of Veterans Affairs and Kaiser Permanente, California. Adjusted hazard ratios for 5-year survival by CD4 count (≥ 500 cells/mm 3 , &lt;500 cells/mm 3 , ref: PwOH) were estimated using Cox models stratified by subtype (adenocarcinoma, squamous) and TNM (I, II/III, IV) stage. Results: This cohort consisted of 562 PWH (53% adenocarcinoma, 33% squamous cell) and 91,370 PWoH (52% adenocarcinoma, 33% squamous cell, 15% not specified). The PWH cohort tended to be younger (62 vs. 69 years), male (97% vs. 83%), and non-Hispanic Black race (48% vs. 14%), compared to PWoH. Among PWH, 41% had CD4 ≥500 cells/mm 3 , 59% had CD4 &lt;500 cells/mm 3 . The median survival in years for PWoH, PWH CD4 count ≥500 cell/mm 3 and &lt;500 cells/mm 3 were: 2.4 ±0.10, 2.3 ± 0.17, 2.0±0.17, respectively for adenocarcinoma, and 2.1±0.01, 2.3±0.21, 1.6±0.17 respectively for squamous cell carcinoma. The table shows the adjusted HR for all-cause mortality for Adenocarcinoma and Squamous Cell Carcinoma comparing PWH ≥500 and PWH&lt;500 to PWoH (as reference) stratified by stage. Conclusions: Although it is well known that low CD counts (&lt;200) are associated with poor cancer outcomes, higher CD4 counts (CD&lt;500) at the time of lung cancer diagnosis may still play a role in the treatment outcomes of NSCLC. PWH who have CD4 counts ≥500 appear to have similar survival compared to PWoH, but CD4&lt;500, those with (vs. without) HIV have higher rates of mortality for both adenocarcinoma and squamous cell histologies. Adjusted hazard ratios (HR)* with 95% confidence intervals (CI) for 5-year all-cause-mortality associated with HIV by CD4 count (reference: PWoH), across Adenocarcinoma and Squamous Cell Cancer histology and baseline cancer stage. [Table: see text]
Taiwan national lung cancer early detection program for heavy smokers and non-smokers with family history of lung cancer.
Authors: Pan-Chyr Yang, Tony Hsiu-Hsi Chen, Kuo-Ping Huang, Li-Ju Lin, Chao-Chun Wu
Journal: Journal of Clinical Oncology (2024)

8009 Background: Lung cancer incidence in Taiwan has been rising with the epidemiological profiles distinct from Western country. Notably, nonsmoking lung cancers accounts for more than 60% and half of lung cancers were diagnosed in advanced stages. For early detection, a national program is therefore initiated to offer biennial low-dose computed tomography (LDCT) screening for heavy smokers and subjects with lung cancer family history (LCFH). Here, we report basic screening findings, analyze relevant effectiveness in reducing advanced lung cancer, and project the potential benefit of mortality reduction. Methods: Taiwan National Lung Cancer Early Detection Program was launched on July 1, 2022 to offer heavy smokers (30 pack-years) and nonsmokers (including light smokers) with a LCFH aged 45-74 years for female and aged 50-74 years for male. This is a continuous screening program using before and after study design for evaluation. We provided the overall first-year basic screening findings until Dec 31, 2023 and did per protocol analysis of stage II+ cancer reduction in comparison with tumor stage distribution in the year preceding the introduction of the national program. The corresponding findings were presented for subjects with LCFH and heavy smokers. The result for heavy smoker was compared with those per-protocol findings from previous randomized controlled trials. The potential mortality reduction was further projected. Results: A total of 78,000 individuals participated in this program, male 44,381 (56.9%) female 33,619 (43.1%); 31,111 participants (39.9%) were heavy smokers, 43,853 (56.2%) nonsmokers but with a LCFH, and 3,036 (3.9%) had both risk factors. Lung cancer confirmed in 956 subjects by surgery or biopsy, 85.0% were stage 0-1. The lung cancer detection rate was 1.2%. Subjects with a LCFH exhibited a higher detection rate (overall: 1.6%, nonsmokers: 1.7% and light smokers 0.9%) compared to heavy smokers (0.7%) and both (1.1%). Early detection of LDCT led to a statistically significant 77% (51%-89%) of reducing advanced stage of lung cancer, 53% (-3%-78%) reduction for heavy smokers, consistent with the corresponding 36%-64% reduction derived from the NLST trial and the Nelson trial, and 85% (67%-93%) reduction for nonsmokers with a LCFH. The benefit of reducing stage II or severe in conjunction with five-year stage-specific survival rate further projected 55% (10%-78%) of mortality reduction from lung cancer. Conclusions: This is the first large-scale LC screening service enrolling 40% heavy smokers and 60% non-smoker with a LCFH. The potential effectiveness of early detection was demonstrated for both targets. As the results based on per-protocol analysis for heavy smoker were consistent with those of previous evidence-based studies the similar and significant intention-to-treat results as before while waiting for the subsequent follow-up would be expected.
Effect of pre-transplant functional status on length of hospital stay in patients undergoing allogeneic hematopoietic stem cell transplant in an outpatient transplant program.
Authors: Lizamarie Bachier-Rodriguez, Scott R. Solomon, Asad Bashey, Lawrence Morris, Henry Kent Holland, Melhem M. Solh, Xu Zhang, Joanna Collins, Adam Drumm, Lan Lei, Catrina Kure, Briana Ford
Journal: Journal of Clinical Oncology (2024)

6560 Background: The use of reduced intensity conditioning regimens including non-myeloablative regimens in allogeneic hematopoietic stem cell transplant (allo SCT), has expanded the pool of transplant candidates in the United States. Nonetheless, allo SCT, is associated with significant morbidity and mortality especially in patients 65 and older. In our outpatient transplant program, allo SCT patients undergo a comprehensive physical and occupational therapy (PT/OT) evaluation pre-transplant. Methods: We retrospectively reviewed all patients undergoing an allo SCT between January 2019 and December 2022 who had a PT/OT evaluation pre-transplant. We analyzed lower extremity functional scale (LEFS) and fatigue score (FACIT). The FACIT score is a patient reported outcome tool where the lower the score, the less fatigue impacts a patient’s performance. Results: We identified 218 patients who had at least one variable reported. Eighty-one patients were 65 years of age or older. All patients in the 65 and older group had a RIC or NMA conditioning regimen. In the 65 and older group, 72.8% had an HCTCI score of 3 or more compared to 59.1% in the group younger than 65. In patients younger than 65, those who had a lower LEFS (ie less lower extremity strength), had a statistically significant longer hospital stay of 15.5 days compared to 9 days (p=0.003). In patients 65 and older, lower FACIT scores (ie less patient reported fatigue), resulted in a statistically significant shorter hospital stay of 7.5 days compared to 13 days (p=0.019). In addition, there was a trend towards shorter hospital stays in patient 65 and older who had a higher LEFS of 5 days compared to 12.5 days (p=0.07). There was no difference in survival outcomes but there was a trend towards better overall survival in patients 65 and older with high LEFS (p=0.08) and a trend towards better NRM in this group (p=0.11). Conclusions: Our study highlights the need for comprehensive assessments in patients undergoing allo SCT. Geriatric functional status assessments are necessary to determine patients at risk for complications and to optimize such patients with exercise and cognitive rehabilitation programs prior to allo SCT. [Table: see text]
ALK testing patterns in early-stage non-small cell lung cancer: A real-world evidence study.
Authors: Ticiana Leal, Jesse Sussell, Celina Ngiam, Qing Zhang, Thomas Majda, Daniel Sheinson, Sarika Ogale, Ilze Bara, Katja Schulze, Jason Porter
Journal: Journal of Clinical Oncology (2024)

8074 Background: Comprehensive biomarker testing in advanced non-small cell lung cancer (aNSCLC) is standard of care, but disparities exist. As new clinical data emerge in early disease (eNSCLC), the set of actionable lung driver mutations (LDMs) and therefore the testing landscape in that setting will change. In particular, following the results of the ALINA trial, therapies that target ALK fusions are anticipated to become part of routine treatment of eNSCLC in 2024.This study thus sought to identify the factors associated with receipt of timely ALK testing in eNSCLC, prior to this shift. Methods: We retrospectively analyzed patients with resected stage I-IIIa NSCLC diagnosed between 2018-2023 using the expanded nationwide (US-based) de-identified Flatiron Health EHR-derived database; data were consolidated from approximately 280 US cancer clinics (≅800 sites of care), using natural language processing with machine learning (ML) to extract patient characteristics. The primary endpoint was ALK testing results (by any modality) within 90 days of initial diagnosis. We used multivariable logistic regression to assess the association between clinico-demographic characteristics and likelihood of testing. Results: The sample contained 21,982 stage I-IIIa patients. Of these, 6,685 (30%) were tested within 90 days, and 15,297 (70%) were not. Patients were more likely to be tested within 90 days if they were diagnosed in more recent years (2023 vs. 2018 odds ratio (OR) 2.12); had no history of smoking (OR 1.21); had highest socioeconomic status (SES) quintile (OR vs. lowest SES 1.14); had more advanced disease (stage IIIa vs. stage I OR 2.43); or were treated in a community setting (OR vs. academic 1.13), all p &lt; 0.05. Patients with Medicare insurance (OR vs. commercial insurance 0.89, p = 0.014) or squamous histology (OR vs. non-squamous 0.46, p &lt; 0.01) were less likely to be tested. There were no significant differences between black and white patients (OR 0.91, p = 013). Conclusions: In this real-world analysis of patients diagnosed between 2018-2023 most patients did not have testing within 90 days of diagnosis. Our data show variation in the baseline probability of testing with respect to clinico-demographic factors. Given that barriers to testing persist in aNSCLC, this suggests that once ALK inhibitors become part of routine care in eNSCLC, some groups might be less likely to be tested and therefore to receive efficacious targeted treatment. Preemptive measures such as education of patients, providers, payers, and policy makers could help prevent disparities from emerging.
Trends in the thrombotic complications of myeloproliferative neoplasms: A nationwide analysis.
Authors: Divya Solipuram, Kathan Mehta, Sudeep Kumar Siddappa Malleshappa
Journal: Journal of Clinical Oncology (2024)

6581 Background: Thrombotic complications are a well known cause of morbidity and mortality in Philadelphia-negative Myeloproliferative Neoplasms[Polycythemia Vera, Essential thrombocythemia, Primary Myelofibrosis]. Current study evaluated thrombotic events incidence and outcome trends in Myeloproliferative Neoplasms[MPN] from 2012 to 2020. Methods: This is a longitudinal study of thrombotic events in MPN using the Nationwide Inpatient Sample. All patients with a diagnosis of MPN admitted with any thrombotic event including arterial or venous thrombosis were included in the study. Arterial thrombotic events included Myocardial infarction[MI], Ischemic stroke[IS], Transient Ischemic Attack[TIA] while venous thrombotic events included Deep Vein Thrombosis[DVT], Pulmonary Embolism[PE], Budd-Chiari Syndrome[BCS], Portal Vein Thrombosis[PVT]. Thrombosis related inpatient mortality rate, incidence, length of hospital stay, and total hospital charges were calculated. Results: Mortality rate from any thrombotic event overall[arterial plus venous] increased from 2.3% to 2.6% from 2012 to 2020. There was an increase in mortality rates from 2.8% to 3.8% among arterial thrombosis while there was a decrease in venous thrombosis related mortality from 1.7 to 0.4%. Specifically MI and IS related mortality increased from 3.7% to 4.3% and 3% to 4% respectively over the same period. The incidence of any thrombotic event declined from 2 to 1.3 cases/100,000 persons from 2012 to 2020. A similar decline in incidence of arterial, venous events, MI, IS were observed. The mean length of stay decreased from 5.8 days in 2012 to 5.2 days in 2020 among MPN patients with venous thrombosis which was statistically significant. Similar decline was noted in MI patients as well. Though the mean length of stay increased from 7.9 to 9.5 days among MPN patients with IS, this increase was not statistically significant. The mean hospitalization charges for thrombotic events increased from $53,421 in 2012 to $101,598 in 2020 after adjusting for inflation. Similar trends were noted in all types of thrombotic admissions which were all statistically significant. Upon age based stratification of MPN, mortality for those less than 60 years reduced from 2% to 0.3%, while it increased from 4.1 to 5.6% in those more than 60 years from 2012 to 2020. Conclusions: Inpatient mortality from thrombotic events in MPN has shown an increasing trend from 2012 to 2020 though there was a decline in overall incidence of thrombosis during the same period. Despite the decreasing trend in length of stay, the total economic burden of thrombotic complications in MPN is increasing in the US. Specifically the effects were more pronounced in those greater than 60 years. This points to the need for revisiting guidelines regarding thromboprophylaxis in MPN.
Efficacy and surgical safety of sequential surgical resection after neoadjuvant chemoimmunotherapy for unresectable stage III NSCLC.
Authors: Yana Qi, Yulan Sun, Hui Zhu, Hongbo Guo
Journal: Journal of Clinical Oncology (2024)

8073 Background: Neoadjuvant chemoimmunotherapy has been successfully used in resectable non-small cell lung cancer (NSCLC) patients. However, its application in advanced stage unresectable NSCLC remains a topic of debate. This retrospective study was designed to evaluate the efficacy and safety of neoadjuvant chemoimmunotherapy followed by surgical resection in patients with initial unresectable stage III NSCLC, focusing on the surgical resection rate and the survival benefits of surgery. Methods: Patients unresectable stage III NSCLC who received 2-4 cycles of neoadjuvant chemoimmunotherapy between January 2021 and December 2022 were retrospectively identified. Data on characteristics, radiological and pathological responses, and survival outcomes were collected. Results: In total, 148 patients with unresectable stage III NSCLC were recruited. After the last cycle of neoadjuvant therapy, 105 (70.9%) patients were evaluated to be eligible for surgery, and 102 patients ultimately underwent surgery. The rate of complete (R0) resection was 100%, with a major pathological response (MPR) observed in 63.7% and a pathologic complete response (pCR) in 41.2%. Postoperative complications were observed in 9 patients (8.8%), and there was no surgical-related mortality within 30 days. With a median follow-up of 21.9 months, the median progression-free survival (PFS) was 19.6 months in the non-surgery group and not reached in the surgery group. The median overall survival (OS) was not reached in either group. Conclusions: The use of neoadjuvant chemoimmunotherapy is effective in converting unresectable stage III NSCLC into resectable NSCLC. Subsequent radical surgery is safe with low complications and surgical-related mortality.