tbuckley/cabot-search huggingface dataset:
Total neoadjuvant therapy for rectal cancer in the rural community oncology setting.
Authors: Heidi Ann McKean, James Nordstrom, Sam Gaster, Emily Whiting, Jesse Guardado, Sabina Choudhry, Thomas Johnson, Matthew Casey, Charles Murphy, Heidi Ann McKean, Joel Grow, Raed Sulaiman, Erin Quist, Elizabeth O'Neill, Kelci Stoltenberg, Jill Schultz
Journal: Journal of Clinical Oncology (2024)

41 Background: The treatment of localized rectal adenocarcinomas with Total Neoadjuvant Therapy (TNT) has become the national standard. Data on the efficacy of TNT in a predominantly rural community oncology setting is limited. Methods: This ongoing retrospective analysis included 94 patients with proficient MMR Stage II or III rectal adenocarcinoma treated with traditional neoadjuvant treatment of chemoradiation followed by surgical resection +/- adjuvant chemotherapy, or Consolidation (chemoradiation upfront) TNT versus Induction (chemotherapy upfront) TNT followed by surgical resection, diagnosed between 2017 and 2022 and treated at the Avera Cancer Institute in Sioux Falls, South Dakota. The primary objectives were to compare the pathologic response and treatment completion rates in patients with rectal cancer treated with TNT to patients treated with traditional neoadjuvant treatment. The secondary objective was to compare the pathologic response rate for TNT at different tumor locations. Results: Of 94 patients assessed, 54 patients received traditional neoadjuvant treatment and 40 patients received TNT. For patients treated with traditional neoadjuvant treatment, 43% (n=23) completed all recommended treatment, with 63% (n=34) achieving a partial response (PR) and 19% (n=10) a complete pathologic response (CR). For patients treated with TNT, 93% (n=37) completed all recommended treatment, and 68% (n=27) achieved a PR and 15% (n=6) achieved a CR. For patients that received Consolidation TNT (n=21), 66% (n=12) achieved a PR and 21% (n=4) achieved a CR. For patients that received Induction TNT (n=19), 68% (n=13) achieved a PR and 11% (n=2) achieved a CR. For patients with high tumor location (n=4) treated with TNT, 50% (n=2) achieved a PR and one patient achieved a CR (25%). For patients with mid tumor location (n=18) treated with TNT, 67% (n=12) achieved a PR and 22% (n=4) achieved a CR. For patients with low tumor location (n=18) treated with TNT, 72% (n=13) achieved a PR and one patient (6%) achieved a CR. Conclusions: The treatment of rectal adenocarcinoma with TNT in the rural community cancer center setting is achievable with a higher completion rate compared to traditional neoadjuvant treatment. Our results also show a trend toward a higher complete pathologic response rate in Consolidation compared to Induction approach and in high/mid rectal tumors compared to low rectal tumors. Future work will be conducted to assess for any differences in recurrence and survival.
Colorectal Cancer Alliance: Promoting prevention and early detection with screening navigation and a personalized recommendation via a digital screening quiz tool for colorectal cancer.
Authors: Kim Newcomer, Alex Guevara, Marianne Pearson, Lisa Hall
Journal: Journal of Clinical Oncology (2024)

71 Background: Evaluating the effectiveness of a Colorectal Cancer screening navigation model delivered in a digital platform offered by a patient advocacy organization. Designed as a digital screening quiz tool and live navigation to promote CRC screening, the Colorectal Cancer Alliance’s Screening Quiz is a risk stratification tool that connects respondents to live certified cancer care navigators delivering evidence-based interventions to increase CRC screening, education and patient and family support. The framework utilizes small and mass media, one-on-one education and patient navigation services to help address and reduce barriers to care. Critical interventions which research shows that on-time screening for CRC leads to better outcomes. Methods: The Screening Quiz has been promoted through social sharing, community outreach, media, including influencer campaigns to increase outreach to at-risk communities. Questions assess personal and family history, hereditary syndromes, and demographics to provide a CRC screening recommendation based on current USPSTF guidelines. Respondents overdue for screening who opt in, are triaged to the Alliance’s patient navigation team for follow-up. This interaction includes phone calls and emails for symptomatic individuals or at high risk for CRC, telephonic and email for average-risk uninsured, and emails for average-risk insured. At-risk individuals are connected to resources, such as financial assistance, free at-home screening tests, and colonoscopy scheduling services. Results: July 2022 to August 2023, the Screening Quiz provided over 30,000 screening recommendations. The median age of respondents was 48; 33% of the respondents were between the ages of 45 to 64. Of the respondents, 29% were male and 71% were female. Most were White (74.3%), but nearly half of those who opted into navigation identified as BIPOC, including 14.4% Black/AA, 17.8% Hispanic or Latino, 7.7% Asian, and 2.5% AI/AN. Most respondents were symptomatic (65.5%) but 7.3% were asymptomatic high-risk. These two groups represented 88% of 1,851 respondents triaged to patient navigation. Conclusions: This digital screening tool and live navigation framework may serve as a key solution in driving CRC screening compared to other interventions. Providing access to live navigation, educational resources, and support services for CRC screening and diagnosis.The Alliance is uniquely positioned with its national network of volunteers, partners, and community presence to effectively reach at-risk communities. Aligning with the science of evidence-based interventions, the Alliance will continue to leverage the Screening Quiz in partnership with healthcare and community stakeholders to close Colorectal Cancer screening gaps.
Diversity of patients enrolled in SWOG gastrointestinal cancers therapeutic trials.
Authors: Rachael A Safyan, Sarah Colby, Colmar Figueroa-Moseley, Katherine A. Guthrie, E. Gabriela Chiorean, Philip A. Philip
Journal: Journal of Clinical Oncology (2024)

726 Background: Racial/ethnic minorities, elderly, and rural populations are underrepresented in clinical trials. Globally, gastrointestinal (GI) cancers represent more than a quarter of all cancers, and socioeconomic and lifestyle factors impact their incidence. Additionally, racial/ethnic disparities exist across GI tumor types, including early-onset colorectal cancer, and are associated with survival outcomes. Here we examine the proportion of women and minority participants with GI malignancies enrolled on SWOG Cancer Research Network therapeutic trials. Methods: We analyzed data on participants enrolled to SWOG phase I-III GI cancers treatment trials launched and completed between 2011-2021 according to sex, age (&lt; 70 years vs ≥ 70 years), ethnicity (Hispanic vs not Hispanic), Race (Black vs Asian/Pacific Islander (PI) vs Native American vs White), insurance type (Medicaid or no insurance vs other), and residence types (classified as urban, large rural, small rural, and isolated small rural) using Rural-Urban Commuting Area (RUCA) codes based on zip codes. Participants reporting any category of Black, Asian/PI, Native American, or Hispanic were considered minority. Results: In total, n=1486 participants from 10 trials (S1005, S1115, S1201, S1310, S1313, S1406, S1505, S1513, S1613, S1815) conducted in 5 different GI cancers categories were enrolled, of whom 696 (46.8%) were women and 313 (21.1%) were minority. The five cancer types represented were biliary tract (34.0%), colorectal (10.8%), esophageal (4.8%), gastric/gastroesophageal junction (GEJ) (14.5%), and pancreatic (35.9%). Overall, 696 (46.8%) were female, 94 were Black (6.3%), 83 (5.6%) were Asian/PI, 5 (0.3%) were Native American, 132 were Hispanic (8.9%), 349 (23.5%) were ≥ 70 years, 1263 (85.0%) lived in an urban area, and 155 (10.4%) had Medicaid or no insurance. Minority participants were younger on average than non-minority participants (mean 58.7 vs 63.1, p&lt;0.001), more likely to live in urban settings (92.7% vs. 82.9%, p&lt;0.001) and have Medicaid or no insurance (26.5% vs. 6.1%, p&lt;0.001). Over one-third (37.9%) of Hispanic, 22.3% of Black, and 13.3% Asian/PI participants vs 8.0% of White participants had Medicaid or no insurance. Women’s participation varied according to cancer type, ranging from 8.3% for esophageal to 56.2% for biliary tract, as did minority participation, ranging from 5.6% for esophageal to 36.6% for gastric/GEJ. Conclusions: Our findings suggest that racial/ethnic minorities, the elderly, and those residing in non-urban settings were less likely to enroll in SWOG GI cancers treatment trials than were whites, younger patients, and urban residents. Efforts are needed to enhance diverse enrollment, to break down barriers preventing minority participation, and to improve trial access to minimize disparities.
Body composition and postoperative outcomes after minimally invasive esophagectomy.
Authors: Van Christian Sanderfer, Alexis Holland, Erin E. Donahue, Reilly Shea, Ella Schwarzen, Kunal C. Kadakia, Jonathan C. Salo
Journal: Journal of Clinical Oncology (2024)

300 Background: Esophagectomy is a complex operation associated with significant morbidity for even fit, healthy patients. Prior studies have utilized hand grip strength or muscle mass to predict postoperative esophagectomy outcomes. This study however, used skeletal muscle gauge (SMG), a CT-derived body composition measure, along with age, to classify patients into groups to summarize perioperative surgical mortality after minimally invasive esophagectomy. Methods: A total of 396 patients undergoing minimally invasive esophagectomy between 2010 and 2022 were identified. Preoperative CT scans at the L3 vertebral level were analyzed to calculate skeletal muscle gauge (SMG) as the product of skeletal muscle area and skeletal muscle density. Patient demographics, histology, treatment, and outcomes including anastomotic leak, pneumonia, prolonged ventilation, discharge destination, 30-day readmission, and 90-day mortality were collected. Patients were grouped into quartiles of SMG and by age (≥75 and &lt;75 years). 90-day postoperative mortality for the high risk group in the bottom SMG quartile (Q1) was compared to the low-risk group in the top 3 quartiles (Q234). Results: Mean age was 62.8 years (SD 10.4). Patients were 84.4% male with 87.4% White, 10.6% Black, 1.8% Hispanic, and 0.3% Asian. Histologically, 86.4% of patients had adenocarcinoma while 11.4% had squamous cell carcinoma. Anastomotic leak occurred in 8.1%, pneumonia in 16.7%, ventilation greater than 48 hours in 20.7%, and discharge to home in 82.1% of patients. 30-day readmission occurred in 16.4% and 90-day mortality in 6.1% of patients. 8 patients did not have CT scans available. Analysis of 90-day mortality as a function of age &gt;75 and SMG risk group showed 33.3% mortality among patients &gt;75 in Q1 for SMG, 9.6% for patients &lt;75 in Q1 for SMG, 5.6% for patients &gt;75 in Q234 for SMG, and 2.2% in 264 patients &lt;75 in Q234 for SMG for subjects who had available scan data (n = 388). Conclusions: As expected, patients with older age and lower SMG have higher mortality after esophagectomy compared to younger patients with higher SMG. Patients who are &gt;75 years old and in the bottom SMG quartile represent a small group (27/388 = 7% of the total) which are identified as a high-risk group with a mortality of 33.3%. This study identifies a small subset of patients whose risk of surgery may outweigh the benefit, particularly in patients already treated with chemoradiation. Preoperative body composition, as measured by SMG, in combination with age can be used to predict postoperative mortality after minimally invasive esophagectomy and guide treatment decisions. [Table: see text]
Patient-reported outcomes (PROs) &lt;65 or ≥ 65 years old (yo) from CARES-310 camrelizumab + rivoceranib vs sorafenib as first-line treatment for patients with unresectable hepatocellular carcinoma (uHCC).
Authors: Stephen Lam Chan, Ahmed Omar Kaseb, Wei Shi, Laura Alexander, Xianzhang Meng, CheolHee Park, Kristin Ryan, Arndt Vogel
Journal: Journal of Clinical Oncology (2024)

456 Background: CARES-310 (NCT03764293) evaluated the combination of the anti-PD-1 inhibitor, camrelizumab (cam), and the VEGFR-2 tyrosine kinase inhibitor, rivoceranib (rivo), compared to sorafenib (sor) for the treatment of uHCC. Cam + rivo significantly improved OS and PFS compared to sor (OS, 22.1 months [mo] [95% CI 19.1-27.2] vs 15.2 mo [13.0-18.5] HR 0.62 [95% CI 0.49-0.80]; one-sided p&lt;0.0001); PFS, 5.6 mo [95% CI 5.5-6.3] vs 3.7 mo [2.8-3.7]; HR 0.52 [95% CI 0.41-0.65]; one-sided p&lt;0.0001). The most common (≥20%) grade ≥3 treatment-related adverse events for cam + rivo were hypertension (37.5%) and increased AST (16.5%) vs palmar-plantar erythrodysesthesia syndrome (15.2%) for sor. This analysis evaluated PROs stratified by age: &lt;65 yo (baseline, overall cam + rivo n=191, sor n=210) or ≥65 yo (baseline, overall cam + rivo n=81, sor n=61). Methods: Patients completed EORTC QLQ-C30 and EORTC QLQ-HCC18 at baseline, each visit, and post-last-dose follow-up periods. Endpoints included time to deterioration (TTD) with a ≥10-point decrease from baseline of patient reported QoL, physical functioning, role functioning, and patient-reported symptoms. Results: Mean completion rates across questionnaires were 98.56% and 96.78% for cam + rivo and 98.91% and 98.75% for sor in the &lt;65 and ≥65 yo groups, respectively, from baseline through ≥121 weeks of treatment. In the &lt;65 yo group, cam + rivo vs sor had improved TTD in fatigue measured by EROTC-QLQ-C30. In the ≥65 yo group, cam + rivo had significantly longer median TTD of pain measured by EROTC-QLQ-HCC18 and QLQ-C30, respectively. The median TTD of appetite loss in the ≥65 yo group favored cam + rivo. Median TTD for jaundice was significant for sor in both &lt;65 yo and ≥65 yo group. Median GHS/HRQoL in the ≥65 yo group favored cam + rivo. Conclusions: Cam + rivo was associated with improvement in varied QoL aspects in both patient groups. These PRO results support the clinical benefit and use of cam + rivo in patients with uHCC who have not received prior systemic therapy. Clinical trial information: NCT03764293 . [Table: see text]
Peri-hilar cholangiocarcinoma (phCCA): A comparative comprehensive genomic profiling study.
Authors: Parth J Sampat, Dean C. Pavlick, Jeffrey S. Ross, Alina Basnet
Journal: Journal of Clinical Oncology (2024)

542 Background: CCA is a heterogenous group of malignancies that arise from epithelium of the biliary tree. The comparison of the genomic landscapes that can influence therapy selection of phCCA from other types of intra- and extra-hepatic CCA (ih/ehCCA) are not well-known. We queried differences in comprehensive genomic profiles (CGP) of CCAs and comparing genomic alterations (GA) in phCCA and other types of CCA. Methods: DNA extracted from 110 cases of phCCA, 743 cases of common bile duct CCA (cbdCCA) and 9178 cases of intrihCCA underwent hybrid capture-based CGP to evaluate GA, MSI status, TMB levels, genomic ancestry, genomic signature, HRD score and germline status. phCCA cases were confirmed at surgery and pathology as originating from either the left, right or common hepatic ducts. cbdCCA cases were confirmed either by CBD biopsies or Whipple procedures. PD-L1 expression was determined by IHC using the Dako 22C3 assay using the tumor proportional score (TPS) system. Results: Patient characteristics were similar (Table). The GA/tumor and frequencies of European ancestry were similar. Both phCCA and cbdCCA featured significantly greater frequency of ERBB2 GA than ihCCA (P=.002) and lower frequencies of FGFR2 GA (P=.001) and IDH1 GA (P=.006). ihCCA featured significantly higher frequencies of FGFR2 (11.7%) and IDH1 (13.9%; P=.006) GA than either phCCA or cbdCCA. cbdCCA had a significantly higher frequency of KRAS GA than phCCA (P=.015) and ihCCA (P&lt;.001). The KRAS G12C frequency reached 5.9% of KRAS mutated ihCCA. GA in BRAF, PIK3CA, CDKN2A and MTAP were not significantly different. TP53 GA were higher in cbdCCA than phCCA (P=0.011) and combined phCCA and cbdCCA (ehCCA) were higher than ihCCA (P=.071). MSI status, TMB levels and PD-L1 expression was similarly low in all 3 groups. Positive homologous recombination deficiency (HRD) scores based on %gLOH and high frequencies of MMR genomic signatures were similar in all 3 groups. Conclusions: phCCA appears to be a distinctive form of ehCCA featuring significantly higher frequencies of potentially targetable ERBB2 and lower frequencies of targetable FGFR2 and IDH1 mutations, when compared to ihCCA. Predictive IO markers were similarly low in both ihCCA and ehCCA.[Table: see text]
A novel image-guided laparoscopic liver resection with integrated fluorescent imaging and artificial intelligence: A preliminary study.
Authors: Yoshihiko Tashiro, Takeshi Aoki, Nao Kobayashi, Yuta Kumazu, Kodai Tomioka, Kazuhiko Saito, Tatsuya Yamazaki, Takahito Hirai, Hideki Shibata, Hiromi Date, Ryohei Watanabe, Kazuhiro Matsuda, Tomokazu Kusano, Kimiyasu Yamazaki, Makoto Watanabe
Journal: Journal of Clinical Oncology (2024)

568 Background: Technology innovations improve surgical techniques. ICG fluorescence imaging is beneficial for real time navigation tool during surgery and enables accurate surgery. Recently, the prediction of anatomical structures by artificial intelligence (AI) is expected to support surgeons as navigation tool. We developed a visual-support AI system to perform the laparoscopic liver resection (LLR) using ICG fluorescence imaging and AI technology. Methods: Procedure: ICG fluorescence imaging was used for liver mapping and securing surgical margin. AI model development and evaluation: Over 430 images extracted from 13 videos of LLR for hepatocellular carcinoma and colorectal liver metastasis was used to develop and evaluate the AI algorithm at Anaut Inc. The annotation was performed on video frames capturing a LLR performed by 2 surgeons for hepatic vein and Glisson sheath. The performance of AI on unlearned LH videos was evaluated quantitatively using Intersection-Over-Union (IOU) and Dice coefficients, and qualitatively on a five-point scale (from 1 to 5) by 10 hepato-biliary-pancreatic surgeons using 35 randomly extracted still images from the analyzed videos. Results: ICG fluorescence imaging could visualize the demarcation line and clarified the boundaries of the liver transected surface. The hepatic veins and Glisson sheath were appeared in the parenchymal transection plane during segmentectomy and securing surgical margin, and this AI system enabled to recognize and display these vascular structures through color-coding under bleeding and ICG fluorescent imaging without visual discrepancies. The AI model accurately recognized vascular structures of any size (IoU=0.33, Dice=0.44) in real-time (&lt;0.12 s) In the qualitative evaluation by surgeons, the mean sensitivity score was 4.10 ± 0.92 (range 3.61–4.76). Additionally, this AI system also recognized vascular structures during robot-assisted liver resection. Conclusions: This is the first study demonstrating that AI can precisely identify vascular structures during LLR. Novel image-guided LLR using ICG fluorescent imaging and artificial intelligence is expected to provide safer and more accurate LLR, thereby contributing to reduce complications and improve survival rates.
Oncologic safety of transverse colon cancer surgery without central vessel ligation.
Authors: Kyung-ha Lee, Ji Yeon Kim, In Jun Yang, Seung-Hwan Yoon
Journal: Journal of Clinical Oncology (2024)

108 Background: Transverse colon cancers (TCC) have mixed embryological and molecular characteristics of right and left colon cancers and they are difficult to classified to right or left colon cancer due to the ambiguity of their location. Therefore, there is a lack of research about TCC alone, and it tended to be excluded in previous large clinical trials. Also, the optimal surgical procedure for each TCC varies depending on the location and stage of the tumor and anatomic structure of the patient. Consequently, standardization of surgery for TCC has not been established, and the oncologic benefits of central vessel ligation (CVL) with complete mesocolic excision and D3 dissection are unclear yet. The aim of the study is to evaluate oncologic safety of TCC surgery without CVL of middle colic artery. Methods: It is a retrospective, observational study. The clinical, surgical, and pathological characteristics were investigated retrospectively and statistical analyses were performed using chi-square test, independent samples T-test, and Kaplan-Meier analysis. Mid TCC was defined as tumor arising in the middle third of transverse colon and determined by intraoperative exploration. Hepatic and splenic flexure colon cancer, which were defined as tumor is adjacent to liver or spleen, were excluded. Radical resection was conducted along the embryological surgical plane, following D2 or D3 dissection. Central vessel ligation was defined as ligation of root of middle colic artery. Results: The numbers of proximal, mid, and distal TCC were 48 (45.3%), 32 (30.2%), and 26 (24.5%), respectively. The numbers of right hemicolectomy, transverse colectomy and left hemicolectomy were 57 (53.8%), 28 (26.4%) and 21 (19.8%). The numbers of No CVL group and CVL group were 47 (44.3%) and 59 (55.7%). The numbers of stage I, II and III were 24 (22.6%), 45 (42.5%), 37 (34.9%), and 49 patients underwent adjuvant treatment. The most frequent organ of recurrence was peritoneum (N=6, 5.6%). There was no statistically significant difference of stage, mean number of retrieved lymph node (24.12 vs. 22.36 p=0.464), mean number of metastatic lymph node (1.53 vs. 0.74, p=0.163), mean proximal margin (19.2 cm vs. 16.7 cm, p=0.139), mean distal margin (9.6 cm vs. 9.9 cm, p=0.753), adjuvant chemotherapy, and the rate of recurrence with lymph node metastasis. Also, there was no statistically significant difference of 6-year DFS survival and OS in stage II and III. Conclusions: When following oncologic plane and adequate lymph node dissection, resection without CVL for TCC is considered to have equal surgical and oncologic outcomes comparing to resection with CVL. Therefore, it is considered that CVL would not be always mandatory for TCC surgery, and a branch of middle colic artery could be preserved, if necessary.