tbuckley/cabot-search huggingface dataset:
Travel-associated carbon emissions of patients receiving cancer treatment from an urban safety net hospital.
Authors: Hasiya Yusuf, Rajvi Gor, Roha Saeed Memon, Abhishek Kumar
Journal: Journal of Clinical Oncology (2024)

e13812 Background: Climate change is one of the grand challenges of the 21 st century. The U.S. currently emits 11% of the annual global greenhouse gases, and 8-10% of its emissions result from the healthcare industry. Studies on the contribution of patients' commute for cancer treatment to healthcare-associated CO 2 emissions remain limited. This study aims to determine the CO 2 emissions of patients’ commute for cancer treatment among patients with malignancies at an urban safety net hospital. Methods: We conducted a retrospective study of patients seen at an oncology clinic from July 1, 2022 - June 30, 2023. Demographic data, data on visit diagnosis and indication (e.g., laboratory, infusion, or follow-up visits), and patients' home addresses were collected from the EMR. Distance between patients’ homes and the hospital was calculated using a Google Map API and a macro for distance. Total CO 2 emissions from patients’ travel in miles were estimated at 400 grams of CO 2 per mile based on the Environmental Protection Agency’s estimate of the average CO 2 emissions for a passenger vehicle. The primary outcome was CO 2 emissions from patients’ round-trip travel. The total estimated CO 2 emissions were converted to equivalents of coal burned, smartphones charged, and gallons of gasoline used based on the EPA equivalencies calculator. Results: Of the 8,235 visits, 5,095 (61.8%) were follow-up/laboratory visits, and 3,137 (38.1%) were chemotherapy infusion visits. Of the 1,080 patients who attended the clinic, the mean age was 63.8 years, 700 (64.8%) were males, 379 (35.1%) were females, 525 (48.6%) were black or African American, 139 (12.9%) were whites. Breast cancer was the most common diagnosis, with 423 (39.2%) of patients. Each patient traveled an average of 9.6 miles round trip (Range = 0.7-298.6 miles) to receive cancer care. An estimated 1,520 grams of CO 2 was emitted for each patient’s visit. A total of 79,582 round trip miles was made in 8,235 visits, which corresponds to 31,832 kg of CO 2 emissions, equivalent to 35,658 pounds of coal burned, 1,462 propane cylinders used for a home, or 3,872,250 smartphones charged. Conclusions: Cancer care is associated with significant CO 2 emissions. Efforts to decrease the overall carbon footprint of cancer treatment through adoption of telemedicine and alternative treatment schedules, are needed to reduce the effect of cancer treatment on the climate. [Table: see text]
Efficacy and biomarker analysis of carboplatin plus taxanes neoadjuvant chemotherapy in triple-negative breast cancer: A prospective multicenter cohort study.
Authors: Xi Chen, Meng Xiu, Hua Kang, Yan Zhang, Hua Yang, Xueyan Cheng, Qiao Li, Qing Li, Jiayu Wang, Bo Lan, Shanshan Chen, Min Xiao, Xiaoyan Qian, Bin Hua, Binghe Xu, Pin Zhang
Journal: Journal of Clinical Oncology (2024)

e12619 Background: The efficacy and survival data of carboplatin plus taxane (anthracycline-free) neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC) was lack of a large-sample study. The predictive biomarker of efficacy based on cell-free DNA (cfDNA) whole-methylome sequencing (WMS) has not been reported yet. Methods: The prospective multi-center cohort study was conducted in four hospitals of Chinabetween 2016 and 2023. Stage II-III TNBC patients were enrolled to receive NAC of carboplatin (AUC 5) every 3 weeks or carboplatin (AUC 4) every 2 weeks plus taxane(standard dose) for 4-6 cycles. Primary study endpoint were pathological complete response (pCR) and relapse-free survival (RFS). Plasma samples were prospectively collected at baseline (T1) and after NAC(T2). Chromosomal aneuploidy of featured fragments (CAFF),fragment size index (FSI) and methylation density score (MD) of cfDNA were detected with WMS. Results: A total of 267 patients were included in the study. The median age was 49 years, 156 patients (58.4%) were stage III disease. 147 patients (55.1%) received the triweekly NAC. 263 patients underwent breast surgery after NAC and 106 patients (40.3%) achieved pCR. The pCR were similar in biweekly or triweekly groups (39.8% vs 40.7%, P=0.89). The 3-year RFS and overall survival (OS) were 77.9%, 87.6%, respectively. Patients who achieved pCR had a significant better RFS (95.5%) and OS (97.7%) than those non-pCR (76.6%, P&lt;0.001; 81.2%, P&lt;0.001). A total of 66 patients with 120 plasma samples (64 samples at T1, 56 samples at T2) were included in WMS analysis. Patients with CAFF, FSI or MD positive at T1 had a higher tumor burden (stage III or cN2-3, all P values &lt;0.05). The proportion of patients with FSI negative at T2 was significantly higher in pCR group compared to non-pCR(86.2% vs 59.3%, P=0.034). There is a similar tendency in patients with CAFF negative. Patients with MD positive at T1 was significantly associated with poor RFS compared to MD negative (HR = 7.36, 95% CI: 0.93-58.75, Log-rank P=0.028). A linear SVM model based on FSI, CAFF, combining with immune cell (effector memory CD8 T cells, immature B cells) and clinical features was developed to predict pCR, with AUC = 0.90 for training dataset and AUC = 0.86 for testing data. Conclusions: Our large-sample study further confirmed that carboplatin plus taxanes (anthracycline-free) NAC in TNBC is an effective option with clinical applicability. Biomarkers based on cfDNA WMS may offer some predictive and prognostic value which needed to be further investigated.
Immunological profiling of glioblastoma cellular composition to predict response to dendritic cell vaccination.
Authors: Guilherme Lepski, Nataly Peres, Patricia Bergami Santos, Mariana Pinho, Nadia Chauca-Torres, Gabriela Coeli Evangelista, Sarah Teixeira, Elizabeth Flatow, Jaqueline Vaz de Oliveira, Carla Fogolin, Analía Leonora Arévalo, Venâncio A Alves, Alexandre Barbuto
Journal: Journal of Clinical Oncology (2024)

e14037 Background: Glioblastomas are the most common primary malignant brain tumors, comprising 2% of all adult cancers. Despite recent advancements in genetic classification and targeted therapies for specific mutations, there has been no significant improvement in overall life expectancy for the majority of patients. Last year, our research group reported promising results from a phase II prospective trial involving allogeneic dendritic cell vaccination. To date, six out of 37 reported cases remain alive without tumor recurrence, exhibiting a performance status of 90 to 100% according to the Karnofsky Performance Scale (KPS) three years after the initiation of vaccination. Methods: In this study, we focused on the immune cell infiltration observed at the time of tumor excision in enrolled patients. We utilized flow cytometry to quantify cells expressing membrane CD86, CD45, HLA-DR, PD-L1, CD11b, and CD14, in addition to assessing IDH-1 status, age, gender, KPS, gender, ECOG, symptomatology, and the number of vaccines administered during the trial. Our goal was to predict responsiveness in terms of overall survival using a neural network prediction algorithm with three hidden nodes and five seeds for improved reproducibility. We employed the random holdback method for algorithm validation. Results: From the 37 enrolled patients, we successfully obtained viable tumor cells from 19 frozen samples. The model achieved an RSquare value of 0.71 after training and 0.66 after validation (where 1 indicates a perfect model and 0 implies no improvement over a constant model). Similar RSquare values in both training and validation sets indicate strong predictive power. Positive predictors of overall survival included HLA-DR positivity, PD-L1 positivity, IDH-1 mutation status, the presence of focal deficits, and higher KPS scores, while negative predictors were CD86 expression, older age, symptoms of intracranial hypertension (ICH), and higher ECOG performance status. Conclusions: In conclusion, the neural network algorithm described herein enables the prediction of responsiveness to dendritic cell vaccination in terms of overall survival, based on clinical features and the profile of immune cell infiltration observed at the time of tumor excision.
Exploratory phase I study of HF1K16 for the treatment of patients with refractory/recurrent advanced glioma: Preliminary efficacy and mechanism as a monotherapy.
Authors: Ruofan Huang, Anjie Zheng, Yuhong Xu, Xiaochen Zhang, Jinsong Wu
Journal: Journal of Clinical Oncology (2024)

e14030 Background: The absence of I.O success in advanced glioma treatment suggests that a deeper understanding of the brain tumor and the immune microenvironment is critical. It is well-documented that refractory/recurrent glioma has an immunosuppressive nature. One frequent observation is the high level of circulating myeloid-derived suppressor cells (MDSCs). We conducted a exploratory study to assess an immunomodulatory approach for relieving immune suppression employing HF1K16, a liposome all-trans retinoic acid (ATRA) suspension. Methods: This Phase I study (NCT05388487) comprise a conventional 3+3 dose escalation plus an advanced glioma-specific expansion arm. Eligible patients had prior confirmed advanced solid tumor and failed standard treatment. HF1K16 infusions were administered in 21-day cycles (q.o.d days 1-14). Prior to and during treatment, peripheral blood mononuclear cells were collected and analyzed with flow cytometry to monitor the changes in myeloid cell phenotype and T cell composition. Survival data were calculated as it is difficult to determine the timing of progression for immunotherapies owing to pseudoprogression. Results: As of Feb 2th, 2024, 14 recurrent/refractory glioma patients including 6 males and 8 females had been enrolled in this study. 2 of them withdrew before finished 1st cycle. 7 had received treatment for at least 3 cycles and 1 had achieved CR after 15 cycles. For the 8 primary diagnosed grade IV glioma patients, the mOS is 7.8m, and 6 (75%) are alive. The mOS for the primary dignosed grade II/III is 13.7m and 100% patients are alive (n=4). There is 1 recurrent GBM patent who had received 5 cycles of treatment. MRI showed an enlargement of tumor lesion while KPS score remained &gt;90. A surgical resection was performed and we subsequently studied the posttreatment tumor specimens (window of opportunity). IHC and flow cytometry analysis revealed prominent perivascular and intratumoral inflammatory infiltrate, containing CD8+CTL cells and HLA-DR expressing cells. Conclusions: While the interpretation of our data is limited by the small sample size, the results provide an encouraging signal and warrants further assessment. Patient recruitment continues with anticipated completion in 2024. Clinical trial information: NCT05388487 . [Table: see text]
Descriptive analysis of brain metastases (BM) of solid neoplasms in an academic hospital from a low- and middle-income country (LMIC) with a Hispanic population.
Authors: Victor Antonio Dominguez-Porras, Ildefonso Roberto Roberto De La Pena Lopez, Christian Haydeé Flores-Balcázar
Journal: Journal of Clinical Oncology (2024)

e14015 Background: Multidisciplinary management of BM of solid cancers integrates different combinations of treatment modalities. The scarcity of SRS centers has prevented widespread adoption of this therapy for appropriately selected patients. Methods: One-hundred eighteen (51.7% female, 48.3% male, median age 59 years) BM patients from a National Health Institute from Mexico (INCMNSZ) were included and analyzed. Results: The most common primary tumors were lung and breast cancers (25 cases each, representing 21% of the whole cohort), kidney cancer (14%), male germ cell tumors (10%), metastatic carcinoma of unknown primary (CUP) (5%), upper- and lower- gastrointestinal cancers (5%), thyroid differentiated cancers (5%), followed by melanoma, prostate, ovarian, hepatobiliary cancers and sarcoma (3% each of them) and urothelial carcinoma (2%) being the least common. No biopsy was reported for only one case. The most common histomolecular tumors were adenocarcinoma of the lung (17 cases), renal cell carcinoma (17), triple negative (TN) breast cancer (BC) (9), HER-2+ BC (7), Nonseminomatous germ cell tumor (7), CUP (6), ER+/HER-2+ BC (5), Germ cell tumor with choriocarcinoma (5), small-cell lung cancer (SCLC) (5), melanoma (5), prostate adenocarcinoma (5), thyroid differentiated cancer not otherwise specified (NOS) (5). Rectal adenocarcinoma, high-grade serous ovarian cancer, ER+/PR+ BC, sarcomas and NSCLC (3 cases, each) and urothelial carcinoma (2). Rare tumor subtypes, with one case, each included hepatocellular carcinoma, PR+/HER2+ BC, follicular thyroid cancer, esophageal, gastric and colonic adenocarcinomas, neuroendocrine prostate, neuroendocrine gallbladder, endometrial, large cell neuroendocrine lung carcinomas and cholangiocarcinoma. A solitary BM was present in 44 patients (37.3%), 2-3 BM in 30 (25.4%) and &gt;3 BM in 44 patients (37.3%). 18 patients (15.2%) were not symptomatic at the time of diagnosis. 79 patients were treated with Whole-Brain Radiotherapy (WBRT), ten with a combination of surgery and adjuvant WBRT, seven with surgical resection without radiotherapy, only five included SRS as part of their treatment and seventeen received only supportive care. There was no difference in overall survival (OS) between treatment modalities excluding supportive care (p=0.05). Conclusions: Our experience from a LMIC with Hispanic population highlights that more than 50% of BM metastasize from solid tumors different from lung and breast cancers. Even though SRS has been included in recent guidelines from ASCO and ESMO, WBRT is the option most commonly included in multimodality treatments.
Socioeconomic disparities impact on the outcome of patients with diffuse and anaplastic astrocytoma: A SEER analysis of pediatric and adult populations.
Authors: Neveen Mostafa, Mohamed Amin Ahmed, Salwa Amin Abd Elhameed, Zyad Kafri
Journal: Journal of Clinical Oncology (2024)

e14024 Background: Astrocytoma is a rare form of brain tumors that affects both pediatrics and adults. In this study we assessed the effect of socioeconomic disparities on the outcome of patients diagnosed with astrocytoma in the pediatric and adult settings. Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) registry for patients diagnosed with diffuse and anaplastic astrocytoma between 2000 and 2020. Data were collected on age at diagnosis, tumor site, annual household income, urban/rural residence and time of death. The chi-squared test was used to assess the association between two categorical variables, the Mann-Whitney U test and the Kruskal-Wallis test were used for continuous data that were non-normally distributed. The Kaplan-Meier method was used for survival analysis. Statistically significant differences between the curves were estimated using the 2 tailed log-rank test. Results: Among 27,438 patients (males: 55.4%), 9.5% were under 18, 36.5% were 19-45, 23.7% were 45-60, and 30% were over 60. Ethnicity was 14.3% Hispanic, 6.7% Black, and 73.7% White. Common tumor sites were frontal lobe (30.4%), temporal lobe (20.4%), and parietal lobe (10.6%). 39% had income &gt;$75K and 11.2% lived in rural areas. Median survival was the highest in patients under 18 (15.8 years), declining with age to 2.8 years for those over 60 (P&lt;0.0001). Surgery improved outcomes across all ages. Pediatric patients who had surgery lived 2.7 years longer on average (12.8 vs 10.1 years, p&lt;0.001), while adults who had surgery saw a 4.1 year gain (8.8 vs 4.7 years, p&lt;0.001). Higherhousehold income (&gt;$75k) improved survival across ages. The median OS for pediatric patients with higher income is 16.4 years compared to 15.5 years for patients with lower income with p= 0.02. For adult patients mean survival was 8.9 years for those who had higher income compared to 8 years for patients with lower income with p&lt;0.001. Location didn't impact pediatric outcomes (15.8 vs 15.8 years), but adults in non-metropolitan areas had lower survival (6.9 vs 8.5 years, p&lt;0.001). Conclusions: Age, surgery, household income and geographic location influenced the survival of patients with diffuse and anaplastic astrocytoma. Surgery was a key factor positively impacting both pediatric and adult populations. Household income similarly affects outcomes across age groups, with younger patients generally experiencing better outcomes.
Pineal gland: Sleep, malignancy and statistics.
Authors: Kristal Pereira, Hassan Ali, Rajesh Thirumaran, Krishna Desai
Journal: Journal of Clinical Oncology (2024)

e14042 Background: The pineal gland is a neuroendocrine gland located deep in the middle brain that regulates the circadian rhythm through Melatonin. Pineal parenchymal tumors arise from pineocytes, have no sexual predominance, occur most frequently in the pediatric population and result in melatonin level disruptions.Pineal region tumors can spread via CSF to other areas in the CNS. The first treatment for pineal region tumors is surgery. Treatments after surgery may include radiation, chemotherapy or clinical trials. Methods: Data was collected from Surveillance, Epidemiology and End Result database Research Plus Data, 17 Registries, Nov 2022 Sub (2000-2020). Pineal gland tumor cases that were labeled as the primary site were extracted from the data base. Further selection was made using the ICD Code D75.3 for neoplasm of pineal gland-primary site labelled. The data was stratified based on age, sex, race and survival curves were compared using the Log-Rank test (GraphPad Prism). Results: A total of 416 pineal gland tumor cases were found, of which ~ 50.48% were males. These tumors were most commonly seen in White (51.68%) patients followed by Hispanic (23.32%), Black (16.10%), Asians/Pacific Islander (6.97%) and Alaskans/Native American (0.96%) patients. The median age of diagnosis was 24.5 years. The incidence rate (per 1,000,000 population) for the general population has increased from 0.69 in 2000 to 0.73 in 2020. As of 2020, the incidence was noted to be higher in males, although overall the incidence among females has been ion the rise. Incidence rate was highest among the Native Americans/Alaskans population followed by Hispanics, Asians/Pacific Islanders, Blacks and Whites. Within the races, incidence was noted to be increasing in the Native Americans/Alaskans &amp; Hispanic populations, stable in the Asians/Pacific Islanders &amp; Black populations and decreasing amongst the White population over the period of 20 years. When the survival curves were compared on the basis of gender and race, the data was clinically significant only for gender. The median of survival (mOS) for males was 146 months but was undefined for females (CI:5.344-12.55, HR: 8.191, p &lt;0.0001) mostly likely due to zero death events being recorded for females. Conclusions: Pineal gland tumors are rarely encountered malignancy with only 416 case reported in the last two decades. It has an almost equal predilection for males and females, more common in the younger population. The incidence is higher among males, although being relatively constant since 2000, and is trending up in females. Overall survival was superior in females with no reported death events. Native Americans/Alaskans are more affected overall survival is independent of the race.
Survival implications and radiographic predictors of prognosis in patients with IDH-mutant astrocytoma with CDKN2A/b homozygous deletion: An international, multi-centered study.
Authors: Ethan A. Wetzel, Annie Lee Hsieh, Amin Nohman, David Reuss, Ilker Eyupoglus, Lingyang Hua, Gilbert Youssef, Patrick Y. Wen, Daniel P. Cahill, Christine Jungk, Tareq A. Juratli, Julie J. Miller
Journal: Journal of Clinical Oncology (2024)

e14035 Background: Isocitrate Dehydrogenase (IDH) 1 or 2 mutations are associated with improved prognosis in glioma patients. Despite their less aggressive clinical course when compared to IDH-wild type gliomas, molecularly-defined IDH-mutant glioma subtypes with poor prognosis have been identified. Among these, CDKN2A/B homozygous deletion represents the strongest negative genetic predictor of prognosis yet identified in IDH-mutant astrocytoma. With the WHO 2021 classification recognizing CDKN2A/B homozygous deletion as sufficient for the designation of astrocytoma, IDH-mutant, WHO Grade 4, the translational implications and potential for therapies targeting CDKN2A/B homozygous deletion are an area of active investigation. We sought to further characterize overall (OS) and progression-free survival (PFS) of CDKN2A/B deleted patients within a large, multi-centered, international cohort and identify clinical characteristics that predict survival for patients with CDKN2A/B deletion. Methods: Patients with IDH-mutant glioma with CDKN2A/B homozygous deletion were retrospectively identified across four institutions (Massachusetts General Hospital, USA; University Hospital Heidelberg, Germany; University Hospital Dresden, Germany, and Foudan-Shanghai, China). IDH-mutation status was determined by immunohistochemistry or next-generation sequencing. CDKN2A/B status was determined by hybridized DNA capture or FISH. Results: We identified 75 patients with IDH-mutant astrocytoma with CDKN2A/B homozygous deletion. The cohort had a median follow-up time of 5.0 years, was 56% male, and had an average age of 38.8 years. Patients were treated with chemotherapy and radiation following initial surgery in 77% of cases. Preoperative contrast enhancement and T2 FLAIR mismatch were identified in 56 and 44% of cases, respectively. Compared to a cohort of 51 patients with CDKN2A/B intact, grade 4, IDH-mutant astrocytoma, those with CDKN2A/B-deleted tumors had significantly shorter median OS and PFS (OS: 4 vs 13.5 years, HR = 6.8, HR 95% CI = 3.1, 14.6, p &lt; 0.0001; PFS: 2.8 vs 5.9 years, HR = 3.0, HR 95% CI = 1.7, 5.2, p = 0.0001). Within the CDKN2A/B deleted cohort, preoperative contrast enhancement predicted worse OS, but not PFS (OS: HR = 2.7, 95% CI = 1.1, 7.4, p = 0.04; PFS: HR = 1.17, 95% CI = 0.7, 3.7, p = 0.24). Conclusions: These data reinforce the strong negative prognostic impact of CDKN2A/B homozygous deletion on OS and PFS and identify a novel association between preoperative contrast enhancement and shorter OS in patients with CDKN2A/Bdeleted, IDH-mutant astrocytoma.