tbuckley/cabot-search huggingface dataset:
Pathologic complete response in patients with localized soft tissue sarcoma treated with neoadjuvant therapy and its correlation with clinical outcomes: A systematic review.
Authors: Anastasios Kyriazoglou, Anna Boulouta, Ioannis Kotsantis, Panagiota Economopoulou, Maria Kirkasiadou, Maria Anastasiou, Anastasios Pantazopoulos, Myrto Moutafi, Niki Gavrielatou, Evangelos Zazas, Chrysanthi Nasiadi, George John Kavourakis, Amanda Psyrri
Journal: Journal of Clinical Oncology (2024)

e23529 Background: Soft tissue sarcomas (STS), comprising approximately 1% of adult solid malignancies, are primarily treated with surgery, with the choice of perioperative treatment being a challenging and highly individualized decision. Clinical trials assessing neoadjuvant modalities in STS predominantly use clinical outcomes or radiologic response as endpoints, with pathologic complete response (pCR) typically not being employed as a designated study endpoint. There is a growing inclination towards neoadjuvant treatment for STS. While pCR serves as a crucial marker guiding treatment decisions in other neoplasms like breast cancer and urothelial cancer, it is not yet used in a similar setting for STS. Our systematic review aimed to assess the rates of pCR in clinical trials of different neoadjuvant modalities for STS and its correlation with patient clinical outcomes. Methods: A systematic literature search was conducted, with eligibility criteria being prospective or retrospective, phase I, II or III trials testing neoadjuvant treatments for STS. Neoadjuvant treatments were chemotherapy, radiotherapy, TKIs or combinations of the above. 23 studies were included, from which data regarding rates of pCR with each treatment, as well as the correlation of pCR with clinical outcomes, were retrieved. Results: Of the 23 trials included, seven did not assess pCR. In the remaining 16 trials, pCR was defined by either ≥90% or ≥95% pathologic necrosis in the tumor specimen. The percentage of patients who achieved pCR ranged from 8 to 58%. Most of these trials did not assess an association between pCR and clinical outcomes. However, among those investigating this correlation, a positive association was identified between pCR and both 5-year disease-specific survival (DSS) and 5-year overall survival (OS). Table 1 summarizes the eight trials that sought to correlate rates of pCR with clinical outcomes. Conclusions: Our findings indicate pCR variability across different neoadjuvant treatments for STS and a possible positive correlation with patient outcomes. Consequently, we propose considering pCR as a surrogate endpoint in future prospective trials for STS that might guide further treatment decisions. [Table: see text]
Primary localized malignant PEComa treated with surgery: A report of a large series of patients treated in a referral institution.
Authors: Roberta Sanfilippo, Rosalba Miceli, Chiara Fabbroni, Marco Fiore, Chiara Colombo, Stefano Radaelli, Dario Callegaro, Carlo Morosi, Elena Fumagalli, Paola Collini, Paolo Giovanni Casali, Alessandro Gronchi
Journal: Journal of Clinical Oncology (2024)

11582 Background: Perivascular Epithelioid Cell Tumors (PEComa) are mesenchymal neoplasms with a characteristic myomelanocytic immunophenotype. These tumors exhibit a broad anatomic distribution, and aggressive clinical behavior has been correlated with histological features such as tumor size and increasing mitotic activity. PEComas arising from the kidney are referred to as angiomyolipomas and usually lack metastatic potential, whereas epithelioid angiomyolipomas do have metastatic potential. Until now, only case reports or a limited number of patients have been documented in the literature, resulting in a lack of data regarding their clinical behavior. In this study, we present the outcomes of a large series of patients (pts) with primary localized malignant PEComa. Methods: This is a retrospective study involving all consecutive pts of any age affected by primary and localized malignant Pecoma surgically treated with curative intent at our institution from January 2000 to December 2023. Eligible pts had a pathologically confirmed diagnosis of malignant Pecoma. We present the outcome results in terms of Disease-Free Survival (that includes Local Recurrence (LR), Distant Metastases (DM), or death as first events) and Overall Survival (OS). Due to the low number of events only univariable analyses were performed. Results: 48 patients (19/48 M; 29/48 F) were identified. Median age at surgery was 50 yrs (range 18-80). Primary site was extremity and trunk in 19/48 pts, retroperitoneum in 13/48 pts and other in 16/48; median size of tumor was 11 cm (range 1-30 cm). At a m-FU of 57 mos (IQR:22-116), 8 pts died. Five- and 10-yr OS was 81.6% [95% Confidence Interval (CI): 70.1-94.9%)] and 77.3% (CI: 64.2-93.0%), respectively. One patient developed LR as first event, 9 developed DM and 3 died without any LR and DM; 3 and 1 patients developed DM as 2 nd and 3 rd event, respectively. Five- and 10-yr DFS was 69.4% [CI: 56.3-85.6%] and 65.1% (CI: 50.9-83.1%). Predictors of higher risk of DFS were age (&gt;64 yrs old) and site of origin [p=0.5; HR trunk and arms: 1.2 (CI: 0.38-3.81) vs. retroperitoneum and 3.49 (CI: 0.43-28.37) vs other]. Conclusions: In this series PEComas have a 30% risk of recurrence at 5 years. While age and the site of origin are associated with the natural history of the disease, better pathologic criteria are needed to stratify their risk.
Preoperative and postoperative platelet-lymphocyte ratio as a prognostic marker for patients with soft tissue sarcoma treated with curative resection.
Authors: Inhee Lee, Jihyun Na, Soo Jung Lee
Journal: Journal of Clinical Oncology (2024)

e23568 Background: In cancer development and progression, systemic inflammation has been implicated. Inflammatory markers have been identified as prognostic indicators in numerous malignancies. In this study, we explored the prognostic relevance of initial and postoperative systemic inflammatory markers (neutrophil -lymphocyte ratio, platelet -lymphocyte ratio) on relapse-free survival (RFS) and overall survival (OS) in patients with soft -tissue sarcoma (STS) who underwent curative resection. Methods: We included a total of 89 patients with STS who underwent extensive and radical resection at the Kyungpook National University Chilgok Hospital (Daegu, Korea,) between 2004 and 2018. Kaplan-Meier curves and RFS and OS were calculated using multivariate Cox proportional models. Results: The median age of the patients was 55 years (range 27 - 86) and the ratio of male-to-female ratio was approximately 1:1. A total of 67 (75.3%) patients demonstrated a high initial neutrophil-lymphocyte ratio(NLR) (≥4.1) and 65 (75.3%) showed a high initial platelet-lymphocyte ratio(PLR) (≥231). After curative resection, the number of patients with high NLR and PLR was 16(18.0%) and 17 (29.3%). In both the NLR and PLR groups, including the postoperative NLR and postoperative PLR subgroups, no significant differences were observed in terms of age, sex, histologic type, tumor site, tumor size, tumor depth, or American Joint Committee on Cancer staging when stratified into high and low subgroups. In the univariate and multivariate analyses, an elevated initial PLR ratio was significantly associated with a decreased RFS (hazard ratio[HR]: 2.120; 95% confidence interval[CI]: 1.021 - 4.883, p = 0.017) and OS (HR: 5.073; 95% CI: 1.731 - 14.87, p = 0.003). Patients with a high PLR (PLR &gt; 231) had a median RFS of 24 months, whereas those with a low PLR (PLR ≤231) had a median RFS of 96 months. The median OS was 50 and 298 months for the high PLR and low PLR groups, respectively. Furthermore, a high postoperative PLR ratio was significantly associated with a decreased RFS (HR: 3.921; 95% CI: 1.738 - 8.845, p = 0.001) and OS (HR: 5.702; 95% CI: 1.099 -29.576, p = 0.038). Conclusions: The present results suggest that the preoperative and postoperative PLR ratio can be used as a cost- effective prognostic marker for oncologic outcomes in patients with STS who underwent surgery.
MetaAnalysisOnline.com: A new easy-to-use bioinformatic tool for the meta-analysis of clinical trials.
Authors: Balazs Gyorffy, Janos Tibor Fekete
Journal: Journal of Clinical Oncology (2024)

e23012 Background: A meta-analysis is a formal, quantitative study design in epidemiology and clinical medicine that systematically assesses and consolidates previous research findings to derive comprehensive conclusions on a specific topic. Here, we aimed to establish a new tool for the visualization options useful for conducting a meta-analysis specifically designed for oncology trials. Methods: A meta-analysis can be based on binary data, continuous data, or time-to-event data. The most crucial statistical models, including the random effect model and the fixed effect model, are outlined alongside their respective statistical methods. Furthermore, we implemented graphical representations such as the forest plot, funnel plots, and Z-scope plots. While the forest plot effectively illustrates heterogeneity and pooled results, a funnel plot can reveal potential publication bias, and a Z-score plot shows the robustness of the used sample number. Results: The models and visualization options outlined have been integrated into a new, online web portal which can be accessed without the need for registration. The web application operates on an Ubuntu server running Apache and enables users to conduct meta-analyses using results typically used in oncology trials including binary (total and event numbers), continuous (mean and standard deviation data), and time-to-event data (hazard rate and CI data). Study results from common spreadsheet applications like Excel can be directly input into the system. The online platform utilizes the meta and metafor packages in the R programming environment (R version 4.2.2) for calculations and plots. The Shiny user interface is powered by shinyjs, shinydashboard, and rhandsontable R packages. The portal generates a forest plot to summarize meta-analysis results, a funnel plot for visual detection of potential bias, and a Z-score plot showing the sufficiency of the cumulative sample number. The analysis results of the tool were validated using IBM SPSS v28. The new bioinformatic tool is available at www.metaanalysisonline.com and requires no programming knowledge or command line use. Conclusions: Our platform aims to provide a user-friendly meta-analysis tool for epidemiological studies and oncology clinical trials, offering a swift and reproducible way to integrate the results from multiple studies.
Treatment patterns and outcomes in patients with early onset cholangiocarcinoma: A large database analysis.
Authors: Udhayvir Singh Grewal, Srija Manchkanti, Naomi Fei, Chandrikha Chandrasekharan
Journal: Journal of Clinical Oncology (2024)

e23294 Background: Although the average age of onset of cholangiocarcinoma (CCA) is ≥ 65 years, recent data have demonstrated an alarming rise in incidence of CCA in the United States (US) among people younger than 50 years of age. However, robust data regarding the characteristics and outcomes of CCA among young patients are lacking. Methods: We used TriNetX, a national database comprising approximately 74 million patients across 54 healthcare organizations in the US, to perform the current analysis. We retrospectively identified patients with CCA (using ICD-10 code C22.1) from Jul 2009 to Jan 2022. We then performed comparative analysis between patients ≤ 49 years (early-onset CCA or EOCCA) and ≥ 50 years old (average-onset CCA or AOCCA). We performed a comparative analysis of baseline characteristics, treatment patterns and overall outcomes. We used the Chi-square test for the comparative analysis and Kaplan-Meier estimates were plotted for survival analysis. A p-value of &lt; 0.05 was considered statistically significant. Results: We included a total of 1,343 patients with EOCCA. Compared to AOCCA, patients in the EOCCA group were more likely to be females (51% vs 48%, p &lt; 0.0001), African Americans (13% vs 9%, p &lt; 0.0001) and have a history of primary sclerosing cholangitis (7% vs 1%, p &lt; 0.0001). Patients in the EOCCA group were more likely to undergo surgical resection (9.7% vs 8%, p = 0.007), liver transplant (4.5% vs 1.6%, p &lt; 0.0001) and adjuvant chemotherapy (39.2% vs 33.5%, p &lt; 0.0001). Young patients were also more like to receive palliative chemotherapy (16.7% vs 12.6%, P &lt; 0.00001) and FGFR-directed targeted therapy (1.5% vs 0.3%, p &lt; 0.00001). Compared to older patients, we noted a significantly higher overall survival among young patients undergoing surgical resection (85 months vs 43 months, p = 0.008) and patients with advanced disease (28 months vs 15 months, p &lt; 0.0001), however, no difference in overall survival was noted between young and older patients undergoing liver transplant (88 months vs 117 months, p = 0.6). Conclusions: We present a large real-world analysis highlighting treatment patterns and outcomes in patients with EOCCA. Young patients received more surgical resections, both adjuvant therapies and palliative therapies, and had a significantly longer overall survival than their older counterparts. Although more patients underwent liver transplant in the EOCCA group, post-transplant survival was not significantly better compared to their older counterparts. Prospective clinical studies tailored to assess surgical and systemic therapeutic approaches specific to EOCCA patients are warranted.
Prescribers of opioids for head and neck cancer (HNC) survivors.
Authors: Talya Salz, Akriti Mishra Meza, Patrick T Bradshaw, Sankeerth Jinna, Natalie Moryl, Anuja Kriplani, Kathryn Ries Tringale, James Flory, Deborah Korenstein, Allison Lipitz-Snyderman
Journal: Journal of Clinical Oncology (2024)

12085 Background: Older HNC survivors often experience post-treatment pain, and they have concerningly high rates of unsafe opioid prescribing per CDC guidelines (e.g., high doses, concurrent benzodiazepines). Because interventions to improve opioid safety should target providers who prescribe opioids to HNC survivors, we aimed to identify post-treatment opioid prescriber specialty. Methods: Using the national linked Surveillance, Epidemiology, and End Results (SEER) registry and Medicare claims data, we identified adults age &gt;65 diagnosed 2014-2017 with stage I-III HNC and who had ≥6 months treatment-free follow-up prior to censoring at further treatment, new cancer, hospice, death, or end 2019. Each opioid fill was assigned to a prescriber specialty: oncology (medical, radiation), surgery, primary care (internal medicine, family practice, geriatrics), pain, or other. Prescriber patterns (number of fills, duration of fill, annual opioid receipt) were summarized across follow-up and stratified by year. Multinomial logistic regression models captured trends in prescribing, accounting for clinical and sociodemographic characteristics. Results: Among 5547 HNC survivors, 2951 (53%) had ≥1 opioid fill (median 2.1 years follow-up). Primary care providers (PCPs) prescribed 49% of all fills (46%-53% each year). PCPs prescribed opioids to 49% of survivors with ≥1 opioid fill, a greater share than other specialties. PCPs prescribed longer supplies of opioids (median 30 days/fill and median 45 days/year) than oncologists or surgeons. The likelihood of an opioid being prescribed by an oncologist or surgeon was ≥5 times lower than by a PCP. Over follow-up, rates of opioid prescribing by oncologists decreased relative to rates of prescribing by PCPs (Table). Conclusions: Primary care involvement in opioid prescribing remains high over post-treatment HNC survivorship. Interventions to address unsafe opioid prescribing for HNC survivors should target the primary care setting, as is typical for opioid-reduction efforts in the non-cancer population. [Table: see text]
A single institution review of immunotherapy use, adverse events, and outcomes in early-onset cancer.
Authors: Michael Daunov, Chaim Domb, Matthew M. Mirsky, Jennifer Elizabeth Murphy, Jamie Abraham Perez, Jennifer Cullen, Kate Daunov, Melissa Amy Lumish
Journal: Journal of Clinical Oncology (2024)

e23320 Background: A significant portion of cancer patients are treated with immune checkpoint inhibitors (ICI) and many experience immune related adverse events (irAE) which impact treatment and outcomes. A paucity of data exists related to use of ICIs in Early Onset Cancers (EOC), their irAE, and its correlation to outcomes. Methods: A single institution database of immunotherapy use from an NCI-designated cancer center (NCI-CC) was reviewed with patients treated from 2010-2019. Two cohorts were examined: EOC (age ≤50 at diagnosis), and age &gt; 50. Clinically significant irAEs were defined as those requiring hospitalization (≥grade 3). Pearson's Chi-squared test and Fisher's exact test were used for analysis. Significance was defined as p &lt; 0.05. Results: A total of 1067 patients were identified, 173 were EOC. Race and ethnicity were similar between groups, the EOC group had significantly higher proportion of females, private insurance, working, single, treated at main campus, and ECOG 0. Main cancer types in EOCs were skin cancers (38.2%), lung (16.2%), and heme malignancies (11.6%); those &gt; 50 were lung (46.6%), skin cancer (21.6%), and GU malignancies (11.2%). Stages of cancer were not statistically different nor was type or doses of ICI. EOCs were more likely to get a greater number of ICIs. IrAE requiring hospitalization were similar between groups; 20 (11.6%) in EOC vs 95 (10.6%) in &gt; 50. There was no difference in the incidence of specific irAEs. Further stratification of EOC cohort by age group 13-30, 31-40, and 41-50 demonstrated no difference in experience of an irAE. Ipilimumab had the highest incidence of irAE in EOC; 12 (75.0%) vs 52 (33.1%), as did receiving 2+ ICIs: 11 (68.8%). The number of doses of a specific ICI was not correlated to irAE in EOC. EOC patients without an irAE were more likely to have a disease response; either stable disease, partial response, or a complete response: 21 (70.0%) vs 1 (12.5%); there was no difference in mortality. Conclusions: In a single NCI-CC review of ICI use, EOC had no difference in ≥grade 3 irAEs or in specific irAEs relative to older adults. Within EOCs, those who experienced a significant irAE were more likely to have received Ipilimumab or 2+ ICIs and were less likely to obtain a response to treatment, although mortality was not different. [Table: see text]
Head and neck cancer survivors: Long-term nutrition impact symptoms, eating problems, and barriers to care impact psychosocial health.
Authors: M Claire Saxton, Richa Ruwala, Alyssa Jaisle, Kirstin Fearnley, Elif Andac-Jones
Journal: Journal of Clinical Oncology (2024)

12044 Background: Head and neck cancer (HNC) survivors experience significant long-term side effects of their treatment, and health-related quality-of-life (HRQoL) assessments of HNC survivors are still early in development. This survey captured long-term nutrition impact symptoms, eating problems, psychosocial impact, and barriers to accessing health care of HNC survivors. Methods: The Cancer Support Community (CSC) conducted an online survey with participants from CSC, Head and Neck Cancer Alliance, and Support for People with Oral and Head and Neck Cancer (SPOHNC). 172 “long-term survivors” (LTS), at least 2 years past initial diagnosis completed the survey. Most respondents were white (94%) &amp; female (58%). The average age was 64. The most common treatments reported were radiation (93%), surgery (66%), and chemotherapy (59%). Results: Physical and psychosocial issues are prevalent and persistent among LTS. Almost all (99%) LTS reported experiencing eating problems since diagnosis, and 92% had symptoms persist into the last 7 days. Dry mouth (85% ever/68% in last week) and problems swallowing (82%/62%) were most common. Prevalence of side effects was independent of stage of cancer and time since initial diagnosis. 42% of LTS reported still not eating a solid food diet (30% “soft” food; 9% feeding tube; 4% liquid or pureed food). 63% ever used a feeding tube. For those no longer using a feeding tube, 71% used it for ≤6 months. Current users had feeding tubes for a median of 39 months. Weaning from a feeding tube was most likely before 14 months. 62% of LTS reported still feeling self-conscious when eating, 45% feeling embarrassed about their eating habits, 44% having their daily activities affected by eating problems, 37% said they avoid going out in public when it involves eating or drinking. Despite this, 27% reported never seeing a health care professional (HCP) or mental health professional (MHP) to manage their eating problems &amp; psychosocial impact. Only 11% of LTS ever met with MHPs to address their distress. Female LTS of younger age and those with Medicare insurance were more likely to meet with HCPs (except dentists for Medicare recipients) and MHPs. Financial, transportation, &amp; logistical concerns were top barriers to receiving care. 19% reported cost of care as a moderate to great barrier to cancer treatment. LTS reported difficulty paying for dental work (29%), supplemental nutrition drinks (11%), and other products to manage eating problems (9%). Conclusions: Although HNC’S are generally considered “curable,” the nature of the disease and the required aggressive treatment regimens leave LTS with a broad range of common physical and psychosocial issues that are rarely addressed. Survey data highlight almost universal, long-term persistence of eating and nutrition problems which cause significant psychosocial impact over LTS’s lifetime.