tbuckley/cabot-search huggingface dataset:
Self-expressed needs and gaps in our care of metastatic breast cancer (MBC): An all-Ireland patient-led online survey (CTRIAL-IE 23-05).
Authors: Siobhan Gaynor, Frances K Duane, Emer Mulvaney, Catherine Weadick, Helen Greally, Rachel J Keogh, Yvonne O'Meara, Mary Jane O'Leary, Ann McBrien, Eibhlin Mulroe, Ieva Teiserskyte, Isabel Beristain, Jacinta Marron, Sarah McLoughlin, Victoria Donachie, Seamus O'Reilly
Journal: Journal of Clinical Oncology (2024)

12058 Background: Therapeutic advances have improved MBC survival rates, but patient self-expressed information needs have not been evaluated in Ireland to date. Heretofore, the patient’s voice has not been central to such an assessment, potentially leading to incorrect assumptions about MBC care. Methods: An anonymous online survey was designed by a cohort of 30 patients with MBC facilitated by a multidisciplinary breast cancer specialist taskforce. A questionnaire asked individuals to report their experience across three domains: credible information sources, palliative care access, and mental health. Patients with MBC 18 years or older living on the Island of Ireland were eligible to participate. The survey was publicised in the media and in oncology clinics nationally and was available for 10 weeks. The survey consisted of a mixture of open and closed questions and results were summarized by means of counts and percentages for categorical variables and by means of mean, standard deviation, median and range for continuous variables. Results: Between July-October 2023, 246 patients completed the survey. The median age of responders was 52.5. 99.4% of patients wished to have access to their personal medical records. Over 95% sought information about metastatic breast cancer outside of the clinic. The go-to information source varied (mostly online). No dedicated comprehensive information source on MBC was identified. Over 83% of patients with MBC were amenable to early palliative care referral but oncology teams did not raise this to the majority. Over 87% of patients reported mental health issues and the majority did seek support (88.4%). Living with uncertainty while awaiting scan results commonly led to feelings of anxiousness (79.5%), fearfulness (54.1%) and depression (15.2%). Conclusions: Patient-led research demonstrates that the patients’ voice is imperative to identify meaningful health interventions. System change including rapid streamlined access to personal medical records and the provision of a credible online information source dedicated to MBC may empower patients to enable them to live well for as long as possible. Routine discussion around early palliative care referral and an opt out approach may be of benefit. Acknowledging the high burden of mental health issues among this patient group and ongoing development of support services is crucial. Minimising the time patients live with uncertainty waiting for scan results should be prioritised.
Racial disparities in incidence and survival in renal cell carcinoma in adolescents and young adults (AYA).
Authors: Mustafa Wasifuddin, Ifeanyi Uche, Henry A. Becerra, Esther Yemisi Oluwadeyi, Htet Lin, Nosakhare Paul Ilerhunmwuwa
Journal: Journal of Clinical Oncology (2024)

e23153 Background: Renal cell carcinoma (RCC) has doubled in incidence over the past 50 years. Most cases are incidentally discovered. AYA cancer is defined as cancer in individuals 15 to 39 years. There is paucity of data in the literature on racial disparities in the incidence and survival outcomes of RCC in AYA. We aim to determine the influence of race on incidence and survival outcomes in AYA. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) 17 program were utilized to obtain annual percentage change (APC) of RCC from 2000-2020 for patients aged 15-39 years. Patient characteristics were expressed in proportions. Relative survival rate (RSR) was used to determine survival outcomes. The 5-year RSR was defined as the percentage of patients alive 5 years after the diagnosis of cancer. SEER*Stat software was used to determine the RSR. Results: We identified 8751 patients with RCC. A higher proportion of cases were males (57.9%) vs females (52.1%). Patients were predominantly non-hispanic whites (NHW, 54.7%), hispanics (24.9%), non-hispanic blacks (NHB, 11.4%), non-hispanic asian or pacific islander (NHAPI, 0.06%) &amp; non-hispanic american indian/alaska native (NHAIAN, 0.01%). There was significant increase in RCC incidence (APC: 4.0%, CI: 3.0, 4.9). Incidence was higher in males (APC: 4.0, CI: 3.1, 5.0) vs females (APC: 3.9, CI: 2.8, 5.0). Incidence was highest in Hispanics (APC: 5.6%, CI: 4.4, 6.8), followed by NHW (APC: 4.1 % CI: 3.1, 5.2, -2.3), NHAPI (APC: 3.3%, CI: 1.2, 5.5) and NHB (APC: 1.5%, CI: 1.1, 2.0). The 5-year RSR was 79.7% (CI: 77.7, 81.6). Survival was greatest in females (RSR: 82.8, CI: 79.8, 85.4) vs males (RSR: 77.3%, CI: 74.4, 79.9). NHB had the lowest survival (RSR: 65.9%, CI: 60.2, 71.0) compared to NHW (RSR: 83.9%, CI: 81.3-86.2). Conclusions: In AYA, RCC incidence has increased; consistent with global trends. Significant racial disparity in incidence and survival exists. Survival in NHB remained poorer than other racial groups despite minimal increase in incidence. More studies are needed to explore the reasons for these racial differences to improve the outcomes among AYA patients. [Table: see text]
Informal caregiving for older adults on systemic treatment for hepatocellular carcinoma.
Authors: Meng Wu, Deborah Watman, Sasha Perez, Yingtong Chen, Christopher D. Woodrell
Journal: Journal of Clinical Oncology (2024)

12059 Background: Hepatocellular carcinoma (HCC) disproportionately affects older adults who are often supported by informal or unpaid family caregivers (CGs). Despite rising incidence of advanced HCC worldwide, little is known about the experiences and unmet supportive needs of patients (pts) and their informal CGs, particularly in the context of contemporary first-line immunotherapy-based treatment. Methods: As part of two cross-sectional descriptive studies conducted in parallel at a single academic center, we interviewed non-dyadic older pts on systemic HCC treatment and family CGs and examined themes of informal caregiving. Eligible CGs were ≥18 years old and identified by pts; eligible pts were ≥60 years old and on systemic treatment for BCLC stage B or C HCC. CGs completed the Zarit Burden Interview (ZBI). Participants completed semi-structured interviews focused on pt and CG experiences and needs, which were transcribed and analyzed using an inductive approach by at least two investigators. Results: Transcripts (n=16) from 11/2021-11/2023 of interviews with CGs (n=8) and pts (n=8) were analyzed. CGs were 87.5% female. Their median ZBI score was 20/88, indicating little or no burden, although scores ranged from 2-64; higher scores indicate greater burden. Four themes emerged: CG tasks, sources of burden, sources of support, and views of palliative care. CG tasks included coordinating medical appointments and transport, attending appointments, advocating for pt interests, and helping with household chores. Two sources of burden most commonly identified were logistics of medical visits and supporting pts through physical and emotional symptoms. CGs recognized multiple sources of support, including spouses, family, friends, church groups, and therapists. Pts were 87.5% male, median aged 70, 25% Black, 50% non-Hispanic white, and 25% Hispanic. Their responses about caregiving, in contrast to the CGs interviewed, showed strong themes of independence. Representative quotes include, “I don’t need any help,” “I am independent..so far,” and “I live alone, I’ve got my own place, I do the best I can for myself.” Some shared that the support of CGs is more spiritual or emotional, “I feel stronger because you’re there,” which was needed mostly with new diagnoses or disease progression. Conclusions: Levels of burden varied among CG participants; pt participants felt independent for the most part while receiving their treatments, consistent with improved functional status and quality of life experienced by those receiving combination therapy. The task of juggling logistics for numerous medical visits between multiple subspecialties emerged as a major challenge. Strategies to optimize care coordination, including increased use of navigation for those with advanced HCC, may help pts and their CGs live better as they live longer on improved treatments.
Cross-cultural differences in diet and quality of life between Taiwanese and American women during breast cancer treatment.
Authors: Kristin Yung, Maya Thomas, Yu-Chen Liu, Grace Sander, Caroline Pawlow, Jacqueline Chen, Judy Huei-yu Wang, Suin Jeong, Fei-Hsiu Hsiao, King Jen Chang, Chiao Lo, Wen-Hung Kuo, Chiun-Sheng Huang
Journal: Journal of Clinical Oncology (2024)

e23187 Background: Limited research has examined the role of different food types (vegetables, fruits, meat, fat, and whole grains) on quality of life (QoL) among cancer patients undergoing active treatment. This study aimed to examine what different food intakes are associated with QoL among American and Taiwanese women who are newly diagnosed with breast cancer (BC). Methods: This ongoing observational study enrolled 77 American (Black, Latina, and non-Hispanic White) adult women from MedStar Georgetown University Hospital and 79 Taiwanese women from National Taiwan University Hospital. They were diagnosed with stage 0-III primary BC within six months prior to enrollment, were undergoing surgery, chemotherapy, and radiation, with no other cancers. Patient-reported overall health and QoL were assessed using the two global health items from the EORTC-QLQ30. Three random 24-hour diet recalls (two weekdays and one weekend) were administered using the NIH-developed ASA24 program. Linear regression was conducted to examine the associations between food categories and QoL outcome, adjusting for nationality, age, cancer stage, treatment type, body mass index, physical activities, financial problems, and appetite loss. Results: American and Taiwanese patients displayed differing food intake during BC treatment. Taiwanese patients consumed less starchy vegetables and total fat (both p &lt; .01) than American patients, on average. Multivariate results indicated that QoL was positively associated with higher total vegetable intake (excluding starchy vegetables and legumes; β = 5.38, 95% CI: 0.22, 1.20), controlling for other food types and covariates. Starchy vegetables and legumes showed non-significant negative effects on QoL. QoL was positively associated with total fat intake (β = 0.11, 95% CI: 0.02, 0.21). Total meat, fruit, and whole grain intakes were not significantly associated with QoL. Conclusions: The associations between food intakes and QoL were not affected by nationality, regardless of food type. Non-starchy vegetables and adequate total fat intakes may support BC patients undergoing treatments. More research is needed to verify the identified associations and explore how cancer treatment affects the digestion of certain food types and their potential impact on QoL. This study provides cross-cultural insights into potential nutritional influence on QoL among patients undergoing cancer treatment.
Efficacy and safety of anthracycline combined with alkylating agent for treatment of advanced leiomyosarcoma.
Authors: Huijing Tan, Lijie Zuo, Yuting Sun, Yihebali Chi
Journal: Journal of Clinical Oncology (2024)

e23558 Background: Leiomyosarcoma(LMS) accounts for 12-14% of all soft tissue sarcomas(STSs) and this STS subtype has high metastatic potential. We evaluated the efficacy and safety of epirubicin combined with temozolomide(EPI-TMZ) for treatment of advanced LMS. Methods: Oral TMZ(200 or 300 mg) was administered each day on days 1-5, and intravenous EPI(60 mg/m2) was administered on days 1-4, with even distribution over these 96h within a 21‐day cycle. After 8 cycles of intensive chemotherapy, monodrug maintenance therapy consisted of TMZ alone(dosing as in the primary therapy, most choices, stop taking medication after 1 year control), and two-drug maintenance therapy consisted of TMZ with thalidomide(only 3 patients). All patients-initiated EPI-TMZ treatment between January 2018 and January 2024. Results: We examined 31 patients who received EPI-TMZ. There were 25 females and 6 males, with average age 50.5 years old. All were unresectable patients derived from abdominal retroperitoneum, uterus, inferior vena cava, mesentery, small intestine, stomach, thighs, elbows, wrists, pancreas, nasal cavity, meantime with distant metastasis. Average Ki67 is above 40%. This was a first-line treatment in 16 patients, a second- or third-line in 13, and a fourth-line in 2. At the time of data cutoff (January 31, 2024), the median PFS was 12.6 months, 1 patient had cCR, 9 PR and 20 SD. The ORR was 32.3%(10/31) and DCR was 96.8%(30/31). The only patient who progressed after two cycles of medication had PMS2 deficiency, and studies have reported that it may have a primary resistance mechanism. Even the shortest disease control period is also 5 months, indicating this regime has significant clinical benefit. Some patients have undergone tumor reduction surgery to improve quality of life after achieving significant tumor relief. The current longest PFS is 42 months up to now and under continuous tumor control. Previous retrospective studies indicated the best mPFS was 9.2 months and the best ORR was 30.9%. 2023 ESMO declared prospective doxorubicin with trabectedin obtained mPFS of 12.19 months. The most common treatment-related adverse effects were leukopenia, neutropenia, thrombocytopenia, anemia, nausea, vomiting, fatigue, and oral mucositis. Two patients had severe febrile neutropenia, but there were no treatment-related deaths, survival data follow-up. Conclusions: EPI-TMZ is potentially effective for treatment of advanced LMS, and the adverse effects appear tolerable. EPI-TMZ may provide better outcomes than reported in previous studies of other treatments for advanced LMS, worth further prospective research.
In-hospital outcomes and mortality of drug-induced pneumonitis and radiation pneumonitis in patients with thoracic cancer.
Authors: Yi Lee, Kim Abbegail Tan Aldecoa, Keisuke Shirai
Journal: Journal of Clinical Oncology (2024)

12042 Background: Pneumonitis is one of the challenging adverse events in thoracic oncology patients undergoing cancer therapy. The cancer treatments, including targeted agents, systemic chemotherapy, immune-checkpoint inhibitors, and radiation therapy have recently advanced, however, the data on incidence of drug-induced and radiation pneumonitis (DP and RP) and their association with in-hospital outcomes is limited. Methods: Data from the National Inpatient Sample Database from 2016 to 2019 were analyzed. Adult patients with primary lung cancer were included and categorized into three groups: (1). Patients without pneumonitis, (2). Patients with DP, (3). Patients with RP. Outcomes included in-hospital mortality, intensive care unit (ICU) admission, and hospital length of stay (LOS). Data were extracted using ICD-10 codes. Results: Our analysis included 1,631,940 hospitalized primary lung cancer patients (based on a weighted sample). Among all, 4,515 patients had DP, and 16,905 patients had RP. Overall, 69.3% had smoking history, however, no significant difference between DP and RP. There was a higher prevalence of chronic obstructive pulmonary disease (COPD) in RP than DP (66.5% vs 53.2%; p&lt;0.05) (Table). The in-hospital mortality rate was highest in DP compared to other groups. Coarsened exact matching method was used to balance covariates between non-pneumonitis and pneumonitis patients (DP and RP). Multivariate logistic regression showed that pneumonitis patients had higher odds of intubation (OR: 1.57; 95% CI: 1.24-1.99; p&lt;0.05) and mortality (OR: 1.48; 95% CI: 1.28-1.71; p&lt;0.05) than non-pneumonitis. Pneumonitis patients also had 23% longer length of stay than non-pneumonitis patients. We then compared the outcomes between DP and RP using the same matching algorithm, however, there was no significant difference in the outcomes between the two groups. Over the study years, the trend for DP significantly increased, whereas the RP trend was stable. Conclusions: Hospitalized pneumonitis patients had relatively poor clinical outcomes compared to patients without pneumonitis. The trend of hospitalized drug-induced pneumonitis is increasingly common. [Table: see text]
Off-label use of fam-trastuzumab deruxtecan-nxki with early activity in a cohort of patients with desmoplastic small round cell tumor.
Authors: Emily K Slotkin, Chelsey Burke, Meera Hameed, Cristina R. Antonescu, Narasimhan P Agaram, Umesh Bhanot, Gerald Behr, Anita Price, Neeta Pandit-Taskar, Dylan Domenico, Julia Lynne Glade Bender, Filemon S Dela Cruz, Damon R. Reed
Journal: Journal of Clinical Oncology (2024)

11584 Background: Desmoplastic small round cell tumor (DSRCT) is a rare and aggressive sarcoma occurring predominantly in pediatric, adolescent and young adult biologic males, and is molecularly characterized by the pathognomonic EWSR1-WT1 fusion. Despite aggressive multi-modality therapy outcomes for those with DSRCT remain poor, and more effective therapies are urgently required. Prior pre-clinical data and transcriptomic analyses of DSRCT patients has suggested the relevance of the ERBB2 pathway in this disease, prompting the off-label use of fam-trastuzumab deruxtecan-nxki (T-DXd) in the treatment of patients of DSRCT patient with relapsed and refractory disease. Methods: Patients with relapsed/refractory DSRCT received T-DXd 5.4 mg/kg intravenously in 21-day cycles. Whole body PET and CT of the chest, abdomen and pelvis were used for monitoring. Response was correlated with HER2 immunohistochemistry (IHC) status and transcriptomic analysis by RNA sequencing (RNAseq) when available. Results: Seven patients received the agent, and at the time of submission 3 patients had at least one follow up imaging test after receiving between 6 and 9 cycles of T-DXd. Treatment was overall well tolerated with the only grade 3 toxicity of transaminitis (in patients with known liver metastases), which self-resolved. All other toxicities including constipation, nausea, and fatigue were grade 2 or less. All 3 patients have experienced clinical benefit including one patient with a RECIST 1.1 partial response and two patients with stable disease. Additionally, favorable responses were noted by PET imaging. Four additional patients with relapsed/refractory DSRCT have initiated off-label treatment with T-DXd and are pending imaging responses. 7/7 and 4/7 patients have available IHC and ERBB2 RNA expression data available respectively. All ERBB2 RNA expression data is elevated when compared with the median across all evaluated pediatric tumors in our institutional series. Conclusions: The use of anti-HER2 therapy in a limited and unselected group of heavily pre-treated DSRCT patients is demonstrating an early signal of activity with minimal toxicity and suggests that formal assessment as monotherapy or in other relevant combinations in clinical trials is warranted. Further correlation with IHC and RNAseq expression data may help optimize correlatives and/or generate biomarkers for future clinical trials.
An NCDB analysis of patient treatment trends in soft tissue angiosarcoma.
Authors: Jasleen Kaur Chaddha, Maya Mary Samuel, Prachi Saldhi, Peter T. Silberstein, Marco Braaten
Journal: Journal of Clinical Oncology (2024)

e23563 Background: Angiosarcoma is a rare subtype of soft tissue sarcoma associated with a generally poor prognosis and high mortality rate. Median survival of patients with angiosarcoma typically ranges from 15 to 24 months, with a 5-year survival of 12-33%. Angiosarcomas have a high propensity for local recurrence, metastasis, and multiple organ involvement as they originate from vascular endothelial cells. Though surgical excision currently plays a central role in the treatment of angiosarcoma, no significant study has analyzed NCDB for treatment trends in these patients. This study aims to characterize the effect of different treatment modalities on overall survival of angiosarcoma patients. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with angiosarcoma from 2004 to 2020 using histology code 9120 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, Chi-Square, Cox Proportional Hazards and Logistic Regression tests were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05. Results: 3560 patients with angiosarcoma of the soft tissue were queried. The most common primary site for a tumor was the head, neck, or face (920 patients, 31.3%). Of the initial sample, 1889 ( 53.1%) patients received surgery alone, 450 ( 12.6%) patients received adjuvant chemotherapy, 55 ( 1.54%) received adjuvant radiation, and 30 ( 0.84%) patients received adjuvant chemoradiation. Surgery alone conferred the greatest median survival; no surgery conferred the least ( 31.4 months vs. 7.2 months; p &lt; 0.001). In the crude and adjusted logistic regression models, combined chemoradiation (OR = .210; 95% CI:.100-.400) and surgery alone were associated with the lowest odds of death (OR = .271; 95% CI: .224-.329) relative to no surgical procedure of the primary site. This finding persisted once the model was adjusted for age, stage, and tumor size. Surgery alone conferred the lowest hazard ratio (HR = .352; 95% CI: .323-.384) relative to no surgery. Conclusions: In angiosarcoma patients, surgical excision at the primary site alone was associated with the greatest median survival and the lowest hazard ratio. Additionally, angiosarcoma patients who did not receive surgery had the least median survival. Surgery with adjuvant chemoradiation and surgery alone had the lowest odds of death. These findings affirm that surgical excision at the site of the primary tumor plays a key role in increasing the survival of angiosarcoma patients. Further research is necessary in characterizing treatment trends in angiosarcoma patients to supplement current standardized treatment protocols and improve the mortality of this lethal cancer.