tbuckley/cabot-search huggingface dataset:
Investigating communication barriers impacting postoperative decision regret in patients with pancreatic ductal adenocarcinoma.
Authors: Judy Li, Thomas M Li, Adam Geffner, Sophie Neugarten, Camilo Correa, Umut Sarpel, Daniel M Labow, Ganesh Gunasekaran, Myron E. Schwartz, Parissa Tabrizian, Spiros P Hiotis, James O Park, Noah A Cohen
Journal: Journal of Clinical Oncology (2025)

698 Background: Patient communication barriers are associated with worse quality of care and clinical outcomes. However there are limited data exploring their impact on shared decision-making (SDM) in the preoperative setting, especially for pancreatic ductal adenocarcinoma (PDAC). This study investigates the impact of patient communication barriers on patient-physician communication surrounding the decision to pursue pancreatectomy. Methods: This cross-sectional study investigates the impact of communication barriers on the degree of decisional regret (DR) in patients with PDAC who have undergone curative-intent resection at least 6 months prior to study recruitment. Patients completed validated surveys assessing communication preferences, SDM participation, and DR. Health literacy was assessed by the BRIEF Health Literacy survey. Groups were stratified by presence or absence of DR, assessed by the Decisional Regret Scale (DRS). Characteristics and survey scores were compared by chi-square and independent t-test. Given significant findings, results of this interim analysis are reported below. Results: 45 patients met inclusion criteria and completed all questionnaires. 19 (42.2%) patients expressed regret about their decision to pursue surgery with 5 patients expressing moderate to severe regret (DRS ≥25). Baseline characteristics were similar between groups. There were no significant differences in neoadjuvant or adjuvant treatments, or operative characteristics. Both groups reported high participation in preoperative SDM (average score 34.47 ± 9.67 in DR group vs 36.08 ± 8.88, P=0.567). Despite similar levels of education between groups, those expressing regret had a lower level of health literacy (14.68 ± 4.10 vs 17.35 ± 2.07, P=0.016). Fewer patients also identified English as their primary language in the DR group (78.9% vs 100%, P=0.026). While most patients preferred an active role in the final decision making process, fewer patients in the DR group reported this happening in actuality (ƙ= 0.635 vs ƙ=0.934). Conclusions: Almost half of patients expressed some regret pursuing surgery for PDAC. Despite similar educational backgrounds, a higher proportion of those expressing regret did not identify English as their primary language and had lower health literacy. While there was high participation in SDM, there was greater discordance between preferred and actual roles in the final decision making process. This identifies an important disparity to address in future preoperative discussions.
Chemoimmunotherapy plus radiotherapy in advanced esophageal squamous-cell carcinoma.
Authors: Keke Nie, Xiang Han, Ling Zhang, Qiuyu Hou, Youxin Ji
Journal: Journal of Clinical Oncology (2025)

437 Background: Chemotherapy plus Immune checkpoint inhibitors (ICIs) have improved survival outcomes of patients with advanced or metastatic esophageal squamous-cell carcinoma in both first- and second-line settings. However, the benefit of additional radiotherapy for the residual esophageal lesion after chemo-immunotherapy remains unclear. Methods: We conducted a one-arm, three-center, open label study involving patients who were treatment naïve, radiological and histological confirmed advanced or metastatic squamous-cell esophageal carcinoma. Enrolled patients were expected the survival time was three months or longer; and ECOG performance status score was 0 or 1. In induction phase, patients received four cycles of TP regimen chemotherapy (docetaxel, 75/mg 2 , iv on day 1 and cisplatin, 75mg/m 2 , iv on day 1) combined with PD-1 inhibitor (sintilimab, 200mg intravenous infusion on day 1) every 21 days. Patients who finished four cycles of chemo-immunotherapy with stable disease (SD) or partial response (PR) were initiated 50Gy/25f irradiation for residual tumors. 3-4weeks after radiotherapy, maintenance sintilimab therapy was administered every 21 days for another 31 cycles or until disease progression or intolerable toxicity. Results: Total of 39 patients were enrolled in this study, 30 of them could be evaluated in efficiency and toxicities. All of them were male and were squamous-cell carcinoma in histology. 12/30 (40.0%) patients were in stage III, and 18/30 (60.0%) were in stage IV. 29/30 (96.7%) patients completed four cycles chemo-immunotherapy, the complete response (CR) rate was 6.7% (2/30), the partial response (PR) rate was 53.3% (16/30) and disease control rate (DCR) was 86.7% (26/30). The median depth of response (DpR) was 34.5% for chemoimmunotherapy and was 64.0% after radiotherapy. The progression-free survival (PFS) was 16.4 months and the overall survival (OS) was not reached. The most common grade 3 or worse adverse event was neutropenia and occurred in 3 (10.0%) patients. Conclusions: Four cycles sintilimab plus cisplatin and docetaxel followed by radiotherapy for residual tumors and maintained sintilimab had high response rate, prolonged PFS and tolerable toxicities as first line treatment in patients with advanced or metastatic esophageal squamous-cell carcinoma. Longer OS is promising and more patients enrolled in this study is needed in future. Clinical trial information: NCT06138028 . Clinicopathological features and patient factors. Factors No. of patients (n=30) (%) Gender Male 30 (100.0) Female 0 (0) Age (year) &lt; 65 27 (43.3) ≥ 65 17 (56.7) PD-L1 (CPS) &lt; 5 9 (30.0) ≥ 5 21 (70.0) Clinical Stage III 12 (40.0) IV 18 (60.0) Metastatic Pattern Regional lymph node 12 (40.0) Cervical &amp; Supraclavicular 4 (13.3) Abdomen 5 (16.7) Lung 6 (20.0)
Real-world excess costs associated with hematologic adverse events (hAEs) during first-line (1L) treatment of metastatic pancreatic adenocarcinoma (mPDAC) with FOLFIRINOX (FFX), FFX without 5FU bolus, and gemcitabine+nab-paclitaxel (GnP).
Authors: Syvart Dennen, Marty Masek, Paul Cockrum, Ravi Kumar Paluri
Journal: Journal of Clinical Oncology (2025)

693 Background: During 1L treatment of mPDAC with FFX and GnP, hAEs can harm patients (pts) and accrue excess costs to the health system, i.e., costs beyond those of a treated pt without the hAE. This study examined excess total cost of care (TCoC) and components (total inpatient; outpatient transfusion, granulocyte colony-stimulating factor [G-CSF], and thrombopoietic growth factor [TGF]) for three key hAEs (anemia, neutropenia, thrombocytopenia) during 1L FFX, FFX without 5FU bolus (FFXnb), and GnP. Methods: This retrospective observational study utilized Optum Market Clarity claims + EHR linked data. Inclusion criteria were: adult pts diagnosed with mPDAC between 1/1/2015 and 5/31/2023; initiated 1L FFX, FFXnb, or GnP within -14 to +90 days (index date); ≥6 months pre-index enrollment. hAEs during 1L were detected from lab values and grouped all grades combined. Pts were divided into “hAE groups” and “ref. groups” with and without any of the three hAEs of interest, respectively. Pts were matched 1:1 without replacement based on follow-up time. Costs were measured from the day a lab value indicated an hAE until 30 days later and during the corresponding times for ref. pts, then standardized to per-pt-per-month (PPPM). This study did not adjust for differences in pt characteristics. Results: Means and differences (95% CI) in TCoC following hAE detection for each regimen and hAE of interest are presented (Table). PPPM TCoC was greater for all three regimens and hAEs, driven by 1.6–4.9 times higher inpatient costs. Inpatient costs were $5,614 and $5,665 higher for FFX and FFXnb neutropenia pts vs. ref. groups. Use of outpatient G-CSF at any time during 1L was lower for FFX and FFXnb neutropenia pts, at 76% and 63% vs. 83% and 75% in the ref. groups, respectively. Outpatient TGF and transfusions were rare. Conclusions: All hAEs showed excess PPPM TCoC across regimens, driven by inpatient costs. FFX and FFXnb neutropenia pts had lower overall utilization of outpatient G-CSF but higher inpatient costs following detection of neutropenia, which may represent an opportunity for improved pt management. Excess TCoC of hAEs. AE (any grade) FFX, hAE group(N=199, 127, 157) FFX, ref. group(N=199, 127, 157) Diff. (95% CI) FFXnb, hAE group(N=202, 106, 137) FFXnb, ref. group (N=202, 106, 137) Diff. (95% CI) GnP, hAE group (N=406, 268, 270) GnP, ref. group (N=406, 268, 270) Diff. (95% CI) AnemiaTCoC, mean 30,561 22,310 8,251 (4,396–12,106) 31,866 23,380 8,487(4,007–12,966) 32,662 27,697 4,965(1,320–8,610) NeutropeniaTCoC, mean 30,382 24,952 5,430(-31–10,891) 26,588 22,571 4,017(-1,288–9,322) 32,975 31,051 1,924(-4,629–8,477) ThrombocytopeniaTCoC, mean 30,566 22,535 8,031 (3,895–12,166) 31,434 22,958 8,476(2,962–13,991) 33,863 30,751 3,113(-3,310–9,536)
An organ-preserving strategy in patients with esophageal squamous cell carcinoma treated with immunochemotherapy.
Authors: Bo Zhang, Yijia Guo, Xiaoge Kou, Wu Zhuang, Huangyang Ye, Mudan Yang, Yunpeng Liu, Guohua Yu, Xiao Qi, Qingyu Wang, Jing Huang
Journal: Journal of Clinical Oncology (2025)

424 Background: This study evaluated the strategy of dose-dense chemotherapy plus a PD-1 inhibitor with selective organ-preservation in patients with advanced esophageal squamous cell carcinoma (ESCC). Methods: Patients with locally advanced or metastatic (confined to the supraclavicular lymph nodes) ESCC were enrolled to receive treatment with a PD-1 inhibitor plus albumin bound-paclitaxel, cisplatin and 5-FU every two weeks. After six cycles of treatment, patients with clinical complete response (cCR) confirmed by computed tomography (CT), endoscopy and biopsy underwent an organ-preserving strategy with continuation of immunochemotherapy. The primary endpoint was cCR rate in the intention-to-treat population. A post hoc analysis was also conducted in patients with advanced ESCC who had a best response of CR after immunochemotherapy from three prospective studies we previously reported. Consecutive patients who had not received esophagectomy prior to immunochemotherapy, and had durable CR as confirmed by imaging, endoscopy with or without biopsy were identified to provide supporting evidence for the organ-preserving strategy. Results: A total of twenty patients were enrolled. At data cut-off (September 12, 2024), eight patients fulfilled the criteria of cCR (40%), while six patients actually adopted the organ-preserving strategy. 75% of the patients experienced ≥ grade 3 treatment-related adverse events (TRAEs), most commonly neutropenia and leukopenia. All TRAEs were managed with appropriate medical care. In the post hoc analysis, out of 71 patients who had a best response of CR to immunochemotherapy in three previous trials, sixteen consecutive patients who had not received esophagectomy before immunochemotherapy, and remained CR assessed with CT at data cut-off were identified. Although endoscopy was not mandatory during follow-up, twelve patients underwent endoscopic exams, and none of them had suspected tumor with endoscopic visualization. Biopsies were taken for eight patients, and were all negative for tumor. The median follow-up for these twelve patients reached 42.7 months, suggesting a long-term disease-free survival after immunochemotherapy. Conclusions: Dose-dense nab-paclitaxel, cisplatin and 5-FU combined with a PD-1 inhibitor showed encouraging cCR rate and manageable safety, making organ-preservation a possible subsequent approach in patients with advanced ESCC. Clinical trial information: ChiCTR2300072992.
Ethnic and socioeconomic disparities in cancer-free and all-cause survival in cholangiocarcinoma patients under 60: A population-based study.
Authors: Adit Dharia, Abdulah Amer Mahayni, Rahul Borra, Supriya Peshin, Haik Ser-Manukyan, Sainarayana Mangu, Dharmik M Patel, Salman Muddassir
Journal: Journal of Clinical Oncology (2025)

527 Background: Cholangiocarcinoma in individuals under 60 years of age is rare, and survival outcomes can vary based on ethnic and socioeconomic factors. While previous studies have examined these disparities in other cancers, little is known about their impact on cancer-free and all-cause survival in younger cholangiocarcinoma patients. This study investigates the role of race and income in survival outcomes for this population. Methods: Data for individuals under 60 diagnosed with cholangiocarcinoma were extracted from the Surveillance, Epidemiology, and End Results (SEER) 22 registry. Kaplan-Meier curves were constructed to assess overall and cancer-free survival. Median survival times were calculated for each racial and income group, and log-rank tests were used to compare survival differences across the groups. Results: A total of 11,214 individuals under 60 years of age diagnosed with cholangiocarcinoma were included. Median all-cause survival was 12.0 months for Asian patients, 11.0 months for White patients, and 9.0 months for both Black and Hispanic patients. Significant differences were observed between Asian vs White (p &lt; 0.005), Asian vs Black (p &lt; 0.005), Asian vs Hispanic (p &lt; 0.005), White vs Black (p &lt; 0.005), and White vs Hispanic (p &lt; 0.005), with no significant difference between Black and Hispanic patients (p = 0.859). For cancer-free survival, the median was 13.0 months for Asians, 12.0 months for Whites, 11.0 months for Blacks, and 10.0 months for Hispanics, with significant differences between Asian vs Black (p &lt; 0.005), Asian vs Hispanic (p &lt; 0.005), and White vs Black (p = 0.017). The difference between Asian vs White was not statistically significant (p = 0.052), and no significant difference was observed between White vs Hispanic (p = 0.418) or Black vs Hispanic (p = 0.418). By income, patients with an income &gt;$75,000 had significantly longer all-cause survival (12.0 months vs 9.0 months, p &lt; 0.005) and cancer-free survival (13.0 months vs 11.0 months, p &lt; 0.005) compared to those with an income of $0-$75,000. Conclusions: Significant disparities in cancer-free and all-cause survival were found based on ethnicity and income. Asian and White patients had longer survival compared to Black and Hispanic patients, and higher-income patients experienced better outcomes. These findings highlight the need for targeted efforts to address healthcare inequalities in cholangiocarcinoma care.
Low-dose aspirin to reduce recurrence rate in colorectal cancer patients with PI3K pathway alterations: 3-year results from a randomized placebo-controlled trial.
Authors: Anna Martling, Johan Lindberg, Ida Hed Myrberg, Mef Nilbert, Markus Mayrhofer, Henrik Gronberg, Bengt Glimelius
Journal: Journal of Clinical Oncology (2025)

LBA125 Background: Colorectal cancer (CRC) affects 1.9 million individuals globally each year. Among patients with stage II-III CRC, 20-40% develop metastatic disease. Aspirin lowers the incidence of adenomas and CRC in high-risk patients. In addition, observational studies suggest that post-diagnosis aspirin treatment improves disease-free survival (DFS) in unselected populations. Furthermore, retrospective findings indicate that somatic PIK3CA mutations predict treatment response, but requires validation in randomized trials. Methods: The ALASCCA trial was a randomized, double-blind, multicenter, placebo-controlled trial with two parallel arms, across 33 hospitals in Sweden, Denmark, Finland, and Norway. Patients with stage I-III rectal cancer or stage II-III colon cancer exhibiting somatic alterations in the PI3K signaling pathway were included. Patients were randomized to receive either 160 mg of aspirin daily or placebo, initiated within three months post-surgery and continued for three years. To detect a hazard ratio (HR) of 0.36 for the primary outcome of time to recurrence (TTR) assessed at 3 years, with 80% power and a two-sided alpha of 0.05, 150 patients with PIK3CA mutations in exon 9 and/or 20 (“Group A”) were required per arm. An additional 300 patients with other somatic PI3K pathway driver alterations (PIK3CA outside exon 9/20, PIK3R1, or PTEN; "Group B") were required for secondary analyses. A stratified Cox proportional hazards model was fitted for the primary efficacy analysis. Results: A total of 3508 patients were screened for somatic alterations in the PI3K pathway. Of the 2980 patients with conclusive genomic analyses, 1103 patients (37%) had an alteration in the PI3K pathway: 515 patients (17.3%) in Group A and 588 patients (19.7%) in Group B. In total, 626 patients were randomized. After three years of follow-up, the HRs for TTR comparing aspirin to placebo were 0.49 (95% CI; 0.24-0.98; p=0.044) in Group A and 0.42 (95% CI; 0.21-0.83; p=0.013) in Group B. For DFS, the HRs were 0.61 (95% CI; 0.34-1.08; p=0.091) in Group A, and 0.51 (95% CI; 0.29-0.88; p=0.017) in Group B. Three patients experienced aspirin-related severe adverse events (one GI-bleeding, one hematoma, one allergic reaction). Conclusions: Primary endpoint was met. Adjuvant treatment with 160 mg aspirin daily for three years reduced recurrence rate in CRC patients with somatic alterations in the PI3K signaling pathway. These findings could lead to immediate changes in clinical praxis for about a third of CRC patients. Clinical trial information: NCT02647099 .
Current status of physicians’ perception of HCC conversion/downstaging therapy: A nationwide survey in China.
Authors: Xinyu Bi, Xiao Liang, Guang Tan, Hai-Tao Zhao, Tao Huang, Ming Zhao, Jinzhang Chen, Xiao-Dong Zhu, Jianfeng Xue, Hui-Chuan Sun, Jianqiang Cai
Journal: Journal of Clinical Oncology (2025)

585 Background: Conversion or downstaging therapy for intermediate and advanced unresectable hepatocellular carcinoma (HCC) has emerged as a significant exploring area of clinical practice and research in recent years. Nonetheless, there exists considerable variability in both the selection criteria for patients undergoing conversion therapy and the regimens selected for conversion across different regions and medical institutions. The present study aims to elucidate the current clinical application of conversion therapy in China, as well as to identify the considerations that physicians take into account when selecting eligible patients for conversion therapy and determining the appropriate conversion modality. Methods: Physicians meeting predefined inclusion criteria were invited to complete an online questionnaire from January to July, 2024. The collected data were subsequently pooled and analyzed descriptively. Results: A total of 120 valid questionnaires were retrieved, mainly form surgical (69.2%, n=83) and interventional (30.8%, n=37) departments. Generally, the study showed that approximately 51% of stage Ib-IIIa patients will be selected for the treatment goal of conversion or downstaging, and the overall successful rate as meeting criteria for surgical resection after treatment was 36%. Three primary factors were prioritized by physicians for determination of conversion therapy: the type of portal vein tumor thrombus (PVTT) (97%, 116/120), the future liver volume (90%, 108/120), and Child-Pugh classification (90%,108/120). In the specific physician group who selected the following attributes, patients classified as Child-Pugh A (82%, 89/108) or Child-Pugh B7 (66%, 71/108), those with tumor diameter exceeding 5 cm (92%, 98/106) and Eastern Cooperative Oncology Group (ECOG) performance score of 0 to 1 (89%, 76/85) were most frequently selected for conversion therapy. Additionally, study showed that patients presenting with Vp1-2 (72%, 83/116) and Vp3 (71%, 82/116) could also be considered for conversion therapy. Currently, the prevalent treatment approach of conversion therapy involves a combination of local and systemic therapies, which is utilized in approximately 73% of cases. Among systemic treatment methodologies, the combination of Lenvatinib and immunotherapy is the most widely adopted by physicians. Besides, higher ORR was the foremost consideration for 83% (99/120) of physicians, followed by rapid response (68%, 82/120), adherence to guidelines and consensus (63%, 76/120), and lower tumor progression rate (58%, 70/120). Conclusions: This study elucidates the current status of conversion therapy for HCC in China. The findings underscore the necessity for optimizing conversion modalities and advancing standardized practices in the application of conversion therapy.
Racial disparities in secondary metastasis in patients with hepatocellular carcinoma: A 5-year National Inpatient Sample study.
Authors: Sakditad Saowapa, Natchaya Polpichai, Hector J Garcia Pleitez, Diego Olavarria Bernal, Chanakarn Kanitthamniyom, Pojsakorn Danpanichkul, Panat Yanpiset, Manasawee Tanariyakul, Chalothorn Wannaphut, Thanathip Suenghataiphorn, Narathorn Kulthamrongsri, Phuuwadith Wattanachayakul, Pharit Siladech, Kanak Das, Lukman Aderoju Tijani
Journal: Journal of Clinical Oncology (2025)

523 Background: Hepatocellular carcinoma (HCC), a primary liver malignancy, is one of the leading causes of cancer-related mortality worldwide. The incidence and outcomes of HCC vary significantly across racial groups. Secondary metastasis, a key factor in disease progression and prognosis, also appears to differ by race, though these disparities remain poorly understood. This study aims to explore how race influences the metastatic progression of HCC, providing valuable insights into potential racial differences in disease outcomes. Methods: A retrospective analysis of National Inpatient Sample (NIS) data from 2016 to 2020 was conducted, identifying adults with HCC using International Classification of Diseases, Tenth Revision (ICD-10) codes, and categorizing them based on the presence of metastasis. The primary outcome was racial differences in organ metastasis. Multivariable logistic regression models were used to adjust for potential confounders and to evaluate the impact of race on all metastatic patterns, with Caucasians as the reference category. Statistical significance was defined as p-values ≤ 0.05. Results: The study cohort included 236,985 adult patients with HCC, of whom 34,875 had secondary metastasis. The cohort was predominantly male (77.37%), with 22.63% female. The racial distribution was 52.61% Caucasian, 19.08% African American, 15.04% Hispanic, and 13.27% from other racial groups. After adjusting for confounders, African American patients had significantly higher odds of lung (aOR 1.42, P&lt;0.001), bone (aOR 1.51, P&lt;0.001), and brain metastasis (aOR 1.47, P=0.02), but lower odds of adrenal gland metastasis (aOR 0.74, P=0.003) compared to Caucasians. Asian/Pacific Islander patients demonstrated increased odds of lung (aOR 2.00, P&lt;0.001) and brain metastasis (aOR 1.95, P=0.02). In contrast, Hispanic patients had lower odds of abdominal lymph node (aOR 0.69, P=0.008) and bone metastasis (aOR 0.83, P=0.007). Conclusions: This study highlights significant racial disparities in the metastatic patterns of hepatocellular carcinoma, emphasizing the need to consider these differences in clinical management and treatment strategies for HCC patients. Further research is required to investigate the underlying causes of these disparities and their impact on long-term survival.