tbuckley/cabot-search huggingface dataset:
Current impact of ureteral carcinoma amongst racial minorities: Analysis of the National Cancer Database.
Authors: Christopher Edwards, Navid Leelani, Katiana Vazquez Rivera, Michael West, Benjamin Shpeen, Ariel Schulman
Journal: Journal of Clinical Oncology (2025)

675 Background: Upper tract cancer is a relatively uncommon type of genitourinary cancer. Lower socioeconomic status and racial disparities have long been associated with worse cancer related outcomes for various types of cancer. Our objective was to determine if racial minorities in the United States were more likely to present with ureteral cancer of stage II or greater. Methods: The National Cancer Database (NCDB) Hospital Comparison Benchmark Reports (HCBR) for ureter cancer from 2013 to 2022 were reviewed. Demographic and clinical data was compared between various races and ethnicities affected to determine any significant differences related to age, stage, insurance status, distance traveled, and education at presentation. Patients were stratified into two groups of patients with stage II or greater and those with less than stage II ureteral cancer. Fischer’s exact test was used to compare the proportion of Caucasian patients with stage II or greater ureteral cancer against patients of other ethnicities. Statistical significance was defined as p&lt;0.05. Results: Within the NCDB HCBR database, there were 26,153 patients with ureter carcinoma spanning 1,238 hospitals, with males comprising 16, 435 (62.8%) and females 9,718 (37.2%). Caucasian patients included most cases at 22,314 (86%), followed by African American patients 1,072 (4.17%), Hispanic patients 1,047 (4.08%), Asian and Pacific Islander patients 871 (3.39%), and Native American patients 73 (0.28%). Overall stage distribution included—0: 9,342 (36.38%); I: 3,711 (14.45%); II: 2,443 (9.51%); III: 2,724 (10.61%); IV: 3,636 (14.16%). A higher proportion of Asian and Pacific Islander patients were more likely to present with Stage II or greater ureteral cancer compared to Caucasian patients (43% vs 33.9%, p&lt;0.001). Furthermore, Asian and Pacific Islander patients were more likely to present with invasive disease (73.6% vs 63.9%, p&lt;0.001). A higher proportion of Asian and Pacific Islander patients were found to be uninsured or have Medicaid, be from a less educated household, and were less likely to travel longer distances for care when compared to Caucasian patients (all p&lt;0.001). Regarding presenting at stage II or greater, there was no significant difference found when comparing Caucasian patients versus African American, Hispanic, or Native American patients. Conclusions: Asian and Pacific Islander patients were more likely to present with stage II or greater ureteral cancer compared to their Caucasian counterparts. Future directions exploring the factors affecting these at-risk groups is vital to properly redirecting resources and improving disparities.
Patient characteristics and survival in primary prostate sarcomas: An analysis of the SEER database.
Authors: Ayush Kaushish, Hyun Lee, Joseph Han, Bohdan Baralo, Asit KR Paul
Journal: Journal of Clinical Oncology (2025)

271 Background: Primary prostate sarcoma (PPS) is a rare neoplasm of prostate and is associated with poor survival outcome. Methods: We conducted an analysis of patients with PPS in the Surveillance, Epidemiology, End Results (SEER) database from year 2000 to 2020. Patients were identified by using the primary cancer site codes for prostate as well as histological codes (ICD-O-3) that matches the list of sarcoma histology found in the NCCN soft tissue sarcoma and bone cancer guidelines. Data for demographics, disease extent and median overall survival (OS) were obtained. Sarcomas mixed with carcinomas, so-called carcinosarcomas, were included in the analysis. OS data of prostate adenocarcinoma from same database were obtained for a comparison. Results: During the period analyzed, a total of 1,120,527 patients with primary prostate neoplasms were identified. Among them, 239 patients (0.0002%) had PPS. Majority were Caucasian (67.8%) followed by Hispanics (13.4%) and African Americans (8.8%). The most common histology was rhabdomyosarcoma (28.5%), followed by leiomyosarcoma (21.8%), carcinosarcoma (16.7%), and unspecified sarcomas (8.8%).Among 221 patients with known extent of disease, 29.4%, 37.1% and 33.5% had localized, locoregional and distant metastatic disease, respectively. Overall, PPS was associated with worse OS than prostate adenocarcinoma (28 months vs. 183 months, P&lt;0.01). OS for patients with localized, regional, and distant diseases were 54, 39, and 18 months, respectively (P=0.04). Patients with carcinosarcomas had worse OS than those with pure sarcomas (15 months vs. 34 months, P&lt;0.001). Among patients with locoregional disease, 19 (14.2%) received chemotherapy only, 84 (62.7%) received surgery only, and 31 (23.1%) received both chemotherapy and surgery. Median OS was not reached in those with locoregional disease who did not receive surgery while it was 44 months in those who received surgery (P=0.055). As for those with distant metastasis, 37 (56.1%) received chemotherapy only, 13 (19.7%) received surgery only, and 16 (24.2%) received both chemotherapy and surgery. Median OS for those with metastatic disease who received chemotherapy versus no chemotherapy was 9 months versus 19 months (P=0.063). Conclusions: PPS was rare and associated with worse survival outcome compared with prostate adenocarcinomas. Carcinosarcomas were less common than pure sarcomas and were associated with worse survival than pure sarcomas.
<i>HSD3B1</i> and overall survival (OS) in high-risk non-metastatic (M0) and metastatic (M1) prostate cancer starting androgen deprivation therapy (ADT) in the enzalutamide (ENZ) and abiraterone acetate plus prednisolone (AAP) STAMPEDE phase 3 trial.
Authors: Nima Sharifi, Mahaz Kayani, Laura Murphy, Robert Diaz, Emily Grist, Zsofia Kote-Jarai, Ros A. Eeles, Gianmarco Leone, Noel W Clarke, Mahesh K. B. Parmar, Louise C. Brown, Nicholas David James, Gerhardt Attard
Journal: Journal of Clinical Oncology (2025)

234 Background: The HSD3B1 gene encodes for the 3βHSD1 enzyme which regulates the rate-limiting step in potent androgen synthesis from non-gonadal precursors. The missense-encoding adrenal-permissive form of HSD3B1 generates a hyperactive 3βHSD1 enzyme compared to the adrenal-restrictive form. We aimed to test associations with OS for HSD3B1 genotyped patients randomized 1:1 to ADT vs. ADT+ENZ+AAP in the STAMPEDE platform protocol. Methods: HSD3B1 genotype was performed in germline DNA using a validated melting assay. We included patients who donated saliva or white blood cells for translational studies and were not planned for “triplet therapy with” docetaxel. Association between HSD3B1 gene and overall survival was estimated using Cox survival models adjusted for randomised group, age at randomization, WHO performance status, regular aspirin or NSAID use, planned radiotherapy and metastatic disease status. Predictive effect was estimated with the addition of an interaction term. We pre-specified M1 low volume as of primary interest given prior associations in the CHAARTED trial. Results: Germline HSD3B1 genotype was obtained for 259 men in the ADT arm and 335 men in the ADT+ENZ+AAP arm (594 total). 319 (54%) men were adrenal-permissive and 275 were adrenal-restrictive. Adrenal-permissive HSD3B1 was associated with shorter OS (HR, 1.32 [1.04-1.67, p=0.025]), which by pre-specified sub-group analysis was most strongly prognostic in low volume (N=185, HR 1.70 [1.12-2.59], p=0.012) versus M0 (N=248, HR 1.21 [0.74-1.96], p=0.442) or M1 high volume (N=161, HR 1.14 [0.78-1.67] p=0.490) Although, there was no evidence of an interaction between treatment arm and genotype (p=0.800, 0.231 and 0.480 for M0, M1 LV and M1 HV, respectively), the treatment effect in the M1 LV restrictive group was 0.37 [0.19, 0.71] versus 0.7 [0.41, 1.21] in the permissive group. Conclusions: Adrenal-permissive HSD3B1 inheritance is associated with increased risk of death in men starting long-term ADT ± ENZ+AAP in STAMPEDE. This result is consistent with prior analyses of the CHAARTED trial and prostatectomy cohorts. This effect is most notable in M1 LV and not overcome by addition of ENZ+AAP to ADT.
Muscle invasive bladder cancer treatment selection in an emerging treatment era: A patient preference study.
Authors: Angela Smith, John L. Gore, Stephanie Chisolm, Patrick Squires, Haojie Li, Sonia Franco, Caroline Vass, Xiaoying Liu, Carol Mansfield
Journal: Journal of Clinical Oncology (2025)

753 Background: Patients with muscle invasive bladder cancer (MIBC) face a preference-sensitive choice among various treatment alternatives. MIBC is typically treated with radical cystectomy (RC) or bladder-sparing chemoradiation, but systemic therapy also plays a conjunctive role in reducing recurrence rates. This study elicited preferences for available and emerging systemic treatments among MIBC patients in the United States. Methods: Patients with self-reported MIBC participated in an online survey. A discrete-choice experiment elicited preferences for attributes of existing and emerging systemic treatments that could be administered with either RC or bladder-sparing approaches. Evidence-based attributes (and levels) included timing and duration of therapy (3 months before and/or 9-12 months after primary treatment); time in delaying cancer recurrence (20-64 months); overall survival (OS) rate at 5 years (40%-85%); chance of treatment-related adverse events (AEs), including fatigue (from none to moderate-severe), neuropathy (from none to moderate-severe), and risk of immune-related AEs that require oral steroid treatment (0%-25%). Conditional relative importance of attributes and risk tolerance were calculated from random-parameters logit models. In addition, direct-elicitation questions offered choices between fixed profiles of bladder-sparing treatment and RC with adjuvant and neoadjuvant systemic treatments. The Shared Decision Making (SDM) Questionnaire (SDM-Q-9) was also included, revealing patients’ levels of satisfaction with previous real-world choices. Responses to the fixed-profile questions and SDM-Q-9 were analyzed descriptively. Results: 202 participants completed the survey. Of the treatment attributes and levels evaluated, improvements in efficacy were most important (OS at 5 years, followed by delaying cancer recurrence). The average patient was tolerant of AEs and willing to accept high levels of risks (greater than those presented in the survey) and severity for any of the OS improvements offered. Two-thirds of respondents (66.8%) preferred RC plus neo- and adjuvant intravenous treatment in a profile with a 25-percentage-point increase in OS at 5 years, a 40-month delay in recurrence, and a 15% risk of immune-related AEs, mild fatigue, and nerve damage over a bladder-preserving treatment with chemoradiation and no AEs. Almost 20% of respondents disagreed with the statement “My doctor asked me which treatment option I prefer” when reflecting on their SDM experiences. Conclusions: Improving OS and delaying recurrence were the most important attributes to patients in this sample, and patients were willing to accept clinically relevant treatment-related AEs for the improvements in efficacy. Patients demonstrated heterogeneous preferences; efforts to promote shared decision-making are therefore warranted.
Survival of patients with metastatic renal cell carcinoma with or without brain metastases.
Authors: Michael E. Hurwitz, Bryden Considine, Nitzan Hasson, Noam Savion Gaiger, Melanie Nelson, Veronica Chiang, Harriet M. Kluger, David A. Braun, David Aaron Schoenfeld, Mario Sznol, Michael Leapman
Journal: Journal of Clinical Oncology (2025)

476 Background: Brain metastasis (BM) is an adverse prognostic indicator and associated with poor survival for patients with metastatic renal cell carcinoma (mRCC). Although immune checkpoint inhibitor (ICI) therapy has significantly improved survival in patients with metastatic renal cell carcinoma, the prognostic significance of BM in the ICI era is unclear. Methods: We performed a retrospective cohort study of patients diagnosed with clear cell RCC (ccRCC) between 2012-2023 at the Yale Cancer Center. We examined the association between brain metastasis and overall survival among patients by treatment type (with or without ICI in any line of therapy). We compared overall survival (mOS) using Kaplan-Meier analyses and multivariable Cox proportional hazards models. Results: We identified 338 patients diagnosed with metastatic ccRCC between 2012 and 2023, of whom 96 (28.4%) had BM, 39 of which were detected by screening versus 57 detected by symptoms. BM detected on screening MRI were smaller than those identified for cause (mean 13.9 versus 20.8 mm, respectively, p=0.002). The mOS from the time of metastatic ccRCC diagnosis was 54.0 months (95%CI 41-76) in patients without BM versus 37.0 (27-52) months in patients with BM (p=0.03). Among patients who received ICI therapy, mOS was 66 months (95% CI, 50-91) in those without BM versus 37 months (95% CI, 29-63) in those with BM (p=.01). In patients who did not receive ICI therapy, mOS was 31.5 months (95% CI, 23-80) in those without BM versus 17 months (95% CI, 14-NR) in those with BM (p=0.4). Among patients with BM, the mOS from the development of BM was 17.0 months (95% CI, 13-30). Median overall survival was 62 (95% CI: 17-NR months) versus 12 months (95% CI: 5-25 months) from the time of metastatic cancer diagnosis for those who underwent screening versus those who did not (p=0.0001). Conclusions: In our ccRCC population, there is a higher prevalence of brain metastases than previously thought. Overall survival for patients with metastatic ccRCC and brain metastases has improved in the era of ICI therapy. Brain metastases remain associated with poor prognosis and were frequently detected during asymptomatic screening. Patients with brain metastases discovered on screening had improved overall survival compared to those with brain metastases discovered because of symptoms.
Phase 2 trial of immuno-ablation with intrabladder injection of N-803 or intravesical N-803 plus BCG for intermediate-risk non-muscle invasive papillary bladder cancer.
Authors: Sandeep Bobby Reddy, Max Kates, Megan Huang, Bhavya Ravi, Paul Bhar, Patricia R Spilman, Bruce Brown, Leonard S. Sender, Patrick Soon-Shiong
Journal: Journal of Clinical Oncology (2025)

TPS905 Background: Response rates (55-65%) with bacillus Calmette-Guerin (BCG) monotherapy in papillary non-muscle invasive bladder cancer (NMIBC) are lower than rates (70-75%) for carcinoma in situ (CIS) disease, pointing to an unmet need for efficacious treatment of papillary NMIBC. We previously reported a complete response (CR) rate of 71% with combined intravesical use of the interleukin-15 (IL-15) superagonist fusion molecule N-803 (nogapendekin alfa inbakicept, NAI; ANKTIVA) and BCG in QUILT 3.032 cohort A study participants with BCG-unresponsive bladder CIS +/- Ta/T1 papillary disease and a disease-free survival (DFS) probability of 55.4% at 12 months for cohort B participants with BCG-unresponsive high-grade Ta/T1 papillary NMIBC. Based on these and other findings, the combination of N-803 plus BCG was recently approved by the FDA for BCG-unresponsive bladder CIS +/- Ta/T1 papillary disease. In a planned study, the efficacy of intrabladder N-803 immunoablative monotherapy by peritumoral injection of N-803 will be compared to intravesical N-803 plus BCG in patients with intermediate-risk BCG-naïve papillary NMIBC. The rationale for injection is based on findings from pre-clinical murine tumor models, the hypothesis that N-803 half-life will be extended by injection, and the suitability of injection for papillary disease. Methods: In the open-label phase 2 randomized study QUILT-215, adult participants with histologically-confirmed BCG-naïve intermediate-risk papillary Ta/T1 NMIBC will be enrolled into either Arm A or B. Up to 20 participants will be enrolled in each arm. In the first treatment period, Arm A participants will receive 400 µg N-803 monotherapy every 3 weeks by peritumoral intrabladder delivery and Arm B participants will receive 400 µg N-803 plus 50 mg BCG weekly for 6 weeks by intravesical delivery. The initial response assessment will be at 3 months. The second treatment period would commence at the end of month 3 and continue through month 15, with treatment depending upon the month 3 response. The primary endpoint is the CR (absence of any grade papillary NMIBC or CIS disease) rate at month 3 as determined by Investigator assessment of cystoscopy, cytology, and biopsy. The CR rate will be summarized by the number and percent and exact 95% CI using the Clopper-Pearson method. Secondary endpoints are progression-free survival (PFS), time to disease progression, overall survival (OS), disease-specific survival (DSS), duration of response (DOR) and cystectomy avoidance rate, to be analyzed using Kaplan-Meier methods. Safety will be assessed, including adverse events (AEs) and serious AEs (SAEs).
Radical cystectomy in female patients: Does the urinary diversion type affect postoperative complications?
Authors: Mazyar Zahir, Farshad Sheybaee Moghaddam, Seyedeh Sanam Ladi Seyedian, Gus Miranda, Jie Cai, Monish Aron, Mihir Desai, Inderbir Gill, Anne K. Schuckman, Siamak Daneshmand, Hooman Djaladat
Journal: Journal of Clinical Oncology (2025)

752 Background: Data is limited on the possible impact of urinary diversion (UD) type on post cystectomy complications, particularly in women. This study aims to investigate this issue and identify predictors of post-cystectomy complications in female population. Methods: We utilized our prospectively maintained IRB-approved radical cystectomy (RC) database (#HS-01B014) to identify all female patients who underwent RC between 2003 and 2021. Patients were categorized into three groups based on their UD type: ileal conduit (IC), neobladder (NB) and continence cutaneous diversion (CCD). Demographics, baseline characteristics and postoperative complications were compared across the three groups. A multivariate logistic regression analysis was used to assess the predictors of complications at 90 days postoperatively. Results: A total of 531 female patients were included: 263 (49.5%) with IC, 206 (38.8%) with NB, and 62 (11.7%) with CCD. The table outlines the patients' demographics and perioperative characteristics. The overall 30-day complication rates were comparable across groups: 54.9% for NB, 51.6% for CCD, and 61.6% for IC (p = .195). Similarly, 90-day complication rates were also comparable (NB = 65.5%, CCD = 64.5%, IC = 70.3%; p = .456). 90-day complication subgroups including cardiac, pulmonary, gastrointestinal, hematologic, infectious, and neurologic were comparable between different UDs. However, genitourinary complications were significantly higher in CCD (32.3%) compared to IC (13.3%) and NB (14.6%) (p &lt; .001). Multivariate analysis showed that patients with CCD had increased odds of 90-day genitourinary complications compared to NB (OR = 2.83 [95%CI: 1.38, 5.72], p= .001), while preoperative eGFR was protective (OR = 0.987 [95%CI; 0.977, 0.997], p = .010). Conclusions: Our results suggested that UD type has minimal influence on cumulative 30- and 90- day post-cystectomy complications. However, CCD was associated with an increased odds of 90-day genitourinary complications. Demographics and perioperative characteristics of patients stratified by urinary diversion type. Patient characteristics Neobladder(N = 206) Continent Cutaneous Diversion (N =62) Ileal conduit(N = 263) p Age (yrs.) 64.4 ± 9.8 64.2 ± 10.5 73.5 ± 10.4 &lt;.001 Charleson Comorbidity Index 0 80 (38.8%) 25 (40.3%) 41 (15.6%) &lt;.001 1 63 (30.6%) 11 (17.8%) 60 (22.8%) &gt;=2 63 (30.6%) 26 (41.9%) 162 (61.6%) Preoperative eGFR (mL/min) 73.2 ± 24.7 72.3 ± 32.0 63.8 ± 29.0 &lt;.001 Surgical Approach Open 196 (95.1%) 60 (96.8%) 177 (67.3%) &lt;.001 Robotic assisted 10 (4.9%) 2 (3.2%) 86 (32.7%) Pathological Staging OC (&lt; (y)pT2; pN0) 166 (80.6%) 44 (71.0%) 168 (63.9%) .002 EV (&gt; (y)pT2; pN0) 26 (12.6%) 9 (14.5%) 62 (23.6%) LN+ (pN+) 14 (6.8%) 9 (14.5%) 33 (12.5%)
State of the genitourinary medical oncology workforce in the United States, 2024.
Authors: David Joseph Benjamin, Arash Rezazadeh
Journal: Journal of Clinical Oncology (2025)

446 Background: There are approximately 13,400 oncologists engaged in patient care in the US as of 2022. As the field of medical oncology becomes subspecialized in not only academic but in community settings, it remains unclear unknown how many practicing oncologists identify as genitourinary medical oncologists. Methods: Using lists for the top fifty hospitals per state as ranked by US News &amp; World Report, we identified practicing medical oncologists. We then identified those with a primary (100%) or predominant (50% or greater) areas of clinical focus in genitourinary oncology. We collected data on gender, race/ethnicity, and medical education. Results: We identified a total of total of 451 genitourinary medical oncologists in the United States. Of these, 399 (88.5%) practice in academic settings while 52 (11.5%) practice in community-based hospitals. 327 (72.5%) genitourinary medical oncologists are male, while 124 (27.5%) are female. 17 GU oncologists (3.8%) are from underrepresented minority groups in medicine. 321 oncologists (71.2%) were trained at US medical schools. 76 (16.9%) identified a particular organ (prostate, bladder, kidney, or testicle) as a clinical or research area of focus. The Northeast US had the most GU oncologists (n=150), followed by the South (n=129), West (n=97), and Midwest (n=75). Seven US states have no genitourinary medical oncologist. Conclusions: Medical oncologists with a primary or predominant focus in genitourinary cancers make up 3.4% of the medical oncology workforce in the US. Seven (14%) of US states do not have a self-identified genitourinary medical oncology expert. Gender and racial/ethnic disparities are present among the genitourinary medical oncology workforce. State of the workforce among genitourinary medical oncologists in the US. Number Male Female Underrepresented Minorities Focus Academic 399 285 114 15 Prostate (39), bladder (14), renal (18), testicular (2) Community 52 42 10 2 Renal (1), Prostate (2) Total 451 327 124 17