tbuckley/cabot-search huggingface dataset:
Is circulating tumor DNA the best surveillance tool for detecting post-adjuvant relapse in stage I-III breast cancer patients?
Authors: Vaishnavi Singh, Julie A. Cupp, Prakash Peddi
Journal: Journal of Clinical Oncology (2025)

e12505 Background: Despite advances made in breast cancer management, sensitive methods to detect relapse are limited to clinical examination and imaging. In this retrospective study, we evaluated the role of circulating tumor DNA (ctDNA) in detecting relapses in breast cancer patients on routine surveillance after completing definitive treatments. Methods: We analyzed data from a cohort of 298 stage I-III breast cancer patients (all subtypes) undergoing routine surveillance (on observation only or patients on adjuvant therapies) at our institution. These patients were followed with serial quarterly or semiannual ctDNA analysis using Signatera assays, which utilize multiplex PCR-based next-generation sequencing to identify 16 unique single nucleotide variants in a patient's tumor through whole-exome sequencing. True positives were defined as two or more serially positive ctDNA (+ctDNA) results with radiologic confirmation of relapses within 12 months. Demographic, clinical, radiological, and laboratory data were collected for patients with disease progression observed during surveillance. Results: Among the 298 patients included in our analysis, 289 patients had negative ctDNA results. These patients did not experience relapses on standard surveillance, thus resulting in a negative predictive value of 100%. Nine patients had a +ctDNA test (Table 1), among which seven were true positives. The median time from the +ctDNA test to radiologic relapse was 7 weeks. The two false positive cases had no radiological relapse and repeat ctDNA testing was negative. Therefore, in our analysis, sensitivity was 100%, specificity was 99.3%, with a positive predictive value of 99.9%. Notably, only one true-positive patient exhibited clinical symptoms during ctDNA positivity, while the remainder were clinically asymptomatic. Conclusions: Our study reveals that serial ctDNA analysis is a highly sensitive and specific method for detecting disease relapses in stage I-III breast cancer patients during routine surveillance compared to standard surveillance. Future prospective studies are warranted to better understand the role of ctDNA in advocating personalized surveillance. ctDNA positive patients with disease progression. Patient Age (years) Staging Time to radiologic relapse (weeks) 1 76 III 33 2 46 II 1 3 81 III 30 4 36 III 11 5 # 49 II 7 6 75 I 3 7 62 II 5 8* 54 II NA 9 * 53 II NA *: False positives; #: Clinically symptomatic; NA: Not applicable.
Association between glycemic index and glycemic load of the diet, insulin, and breast cancer: A case-control study.
Authors: Jordana Godinho-Mota, Larissa Vaz Gonçalves, Leonardo Ribeiro Soares, Wiviane Dias Lopes, Karine Anusca Martins, Luciana Bronzi, Ruffo Freitas-Junior
Journal: Journal of Clinical Oncology (2025)

e12515 Background: Despite advances in studies regarding the association between diet and the diagnosis of breast cancer, there is still controversy regarding the association between dietary patterns with high glycemic index (GI) and glycemic load (GL). Therefore, the objective of the study was to investigate the association between GI and GL of the diet and blood insulin levels with the diagnosis of BC, according to menopausal status, in women from the Central-West region of Brazil. Methods: Case-control study with 114 cases and 220 controls. The groups were matched by age, body mass index and menopausal status. Body composition was measured by dual-energy X-ray absorptiometry (DXA), food consumption was assessed through three 24-hour dietary recalls, fasting blood glucose and insulin after 12 hours of fasting. Multivariate logistic regression analysis was performed, considering significant associations when p &lt;0.05. Results: Energy and fat intake increased the chances of developing BC. Premenopausal women were more likely to develop the disease with increased intake of insoluble fiber (ORadj=1.08, p=0.044) and GL (ORadj=1.05, p=0.030). In the postmenopausal group, higher intake of total CHO, GI, GL, fats and proteins increased the chance of BC diagnosis. Conclusions: Dietary GL was positively associated with increased BC risk in the total sample. In premenopausal women, higher intake of insoluble fibers and dietary GL were associated with the disease. In postmenopausal women, total CHO, proteins and fats showed similar trends. Serum insulin showed no association with the diagnosis.
SHAP analysis of predictive factors for pathologic complete response in breast cancer patients undergoing neoadjuvant chemotherapy.
Authors: Yoshihiko Kamada, Naoko Takigami, Kentaro Tamaki, Kanou Uehara, Nobumitsu Tamaki
Journal: Journal of Clinical Oncology (2025)

e12527 Background: Pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) is a key predictor of long-term outcomes in breast cancer. This study employs SHAP (SHapley Additive exPlanations) to interpret a Random Forest model predicting pCR based on clinical and treatment factors, providing insights for personalized treatment. Methods: A dataset of 158 patients was split into 80% for training and 20% for testing. SHAP analysis evaluated feature impacts on pCR prediction (pCR=1). Key features were analyzed, and unexpected findings explored for future investigation. A final predictive model will be presented in subsequent publications. Results: Key features, ranked by importance, included Ki67, Trastuzumab, Total RDI (Relative Dose Intensity), Subtype, Age, cT (tumor size), and cN (lymph node involvement). • Ki67: Higher values strongly correlated with pCR, reflecting its role in tumor proliferation. • Trastuzumab: Showed strong positive contributions, particularly in HER2-positive subtypes. • Total RDI: Lower values unexpectedly correlated with pCR, challenging the paradigm that higher RDI improves outcomes. This highlights the need to explore confounding factors such as dose reductions, patient tolerance, or regimen effects. • Age: Higher values correlated positively with pCR, possibly reflecting favorable tumor biology or effective treatments in older patients. • Subtypes Luminal B and HER2-Enriched: Displayed distinct and sometimes counterintuitive contributions, emphasizing tumor biology complexity. • Tumor size (cT): Larger tumors correlated positively with pCR, likely due to subtype-specific responses. Conclusions: SHAP analysis revealed key factors influencing pCR in NAC-treated breast cancer patients. The inverse relationship between TotalRDI and pCR warrants further investigation, challenging reliance on dose intensity as a predictor. These findings demonstrate machine learning’s potential to uncover nuanced relationships and improve treatment personalization. Key predictive features and their contribution to Pathologic Complete Response (pCR) prediction in breast cancer patients. Predictive Feature Average Contribution Impact on Prediction 1 Ki67 0.094592 Higher values increase pCR 2 Trastuzumab 0.091794 (same) 3 TotalRDI 0.061163 (same) 4 Subtype_Luminal B 0.051591 (same) 5 Subtype_HER2_Enriched 0.037895 (same) 6 Age 0.032980 (same) 7 Subtype_Luminal A 0.016545 (same) 8 cT 0.013637 (same) 9 cN 0.011557 (same) 10 Regimen_TC4 0.010680 Higher values increase pCR SHAP (SHapley Additive exPlanations) analysis was used to evaluate the impact of individual features on pCR prediction. The “Average Contribution” reflects the mean SHAP value for each feature, and “Impact on Prediction” indicates whether higher feature values were associated with an increased or decreased likelihood of achieving pCR.
Association between cost and insurance on receipt of guideline-concordant mammography.
Authors: Nicole E. Caston, Lisa P. Spees, Stephanie B. Wheeler
Journal: Journal of Clinical Oncology (2025)

11078 Background: Many organizations offer mammography guidelines with slight differences, which can serve as a barrier to receiving a mammogram. Furthermore, it is unknown how both cost and insurance serve as a barrier to receiving a mammogram. Therefore, our study explored the associations between cost and insurance on guideline-concordant mammography. Methods: This cross-sectional study used 2023 National Health Interview Survey data. Inclusion criteria included women eligible for a mammogram. The outcome was receipt of guideline-concordant mammography and was based on women following 2016 US Preventive Services Task Force or current American Cancer Society guidelines for age and frequency requirements. The exposures of interest included report of at least one healthcare-related cost issue (yes, no) and insurance status (uninsured, insured). Questions for healthcare-related cost issue included: in the past 12 months did you, 1) have problems paying or were unable to pay medical bills, 2) delayed medical care due to cost, &amp; 3) did not get necessary medical care due to cost. We estimated odds ratios (OR) and 95% confidence intervals (CI) using logistic regression to assess the interaction between cost issues and insurance status on receipt of guideline-concordant mammography. The model controlled for age at survey completion, race and ethnicity, Rural-Urban Classification Scheme, income to poverty ratio, and personal &amp; family history of breast cancer. Results: A total of 13,529 women were included. Mean age was 55 years, 63% were non-Hispanic White, 10% were in poverty. About 1 in 4 had not received guideline concordant mammography. When compared to those who had received a guideline-concordant mammogram, individuals who did not have a mammogram were younger (p-value: &lt;.0001), uninsured (&lt;.0001), and had reported at least one cost issue (&lt;.0001). In our adjusted analysis, we found that the uninsured, regardless of cost issue, had lower odds of receipt of guideline-concordant mammography (Table). Among insured individuals, those who did vs did not report a cost issue had 0.68 (95% CI 0.59-0.77) times the odds of receipt of a guideline-concordant mammogram. Conclusions: By interacting cost issues and insurance status, we found that individuals with health insurance and issues paying for care had low prevalence of guideline-concordant mammography. This is important when determining how best we can provide screening for those in need. We recommend that screening services that offer free or low-cost mammograms include women who have health insurance and report healthcare-related cost issues. Model results (N=13529). OR(95% CI) Healthcare-related cost issue Uninsured vs insured 0.59 (0.43-0.81) No healthcare-related cost issue Uninsured vs insured 0.46 (0.35-0.60) Uninsured Healthcare-related cost issue vs none 0.87 (0.60-1.27) Insured Healthcare-related cost issue vs none 0.68 (0.59-0.77)
Volume and acuity trends in geriatric patients with cancer: Insights from a comprehensive cancer center.
Authors: Patricia A. Brock, Denise Manon Langabeer, Valda D Page, Sarah Dendy, Jayne M Viets, Ziyi Li, Aiham Qdaisat
Journal: Journal of Clinical Oncology (2025)

e13852 Background: The risk of cancer increases with age, and with the continuous advancement of the use of novel cancer therapies and improved survival outcomes of cancer patients, the number of geriatric cancer patients is projected to rise. In 2020, of the 19.3 million new cancer cases worldwide, 64% occurred in individuals aged 60 and above, contributing to 71.3% of cancer-related deaths. Our study examined the trends in the volume and acuity of geriatric patients presenting to an oncologic emergency department (ED). Methods: All consecutive patients who presented to the ED at The University of Texas MD Anderson Cancer Center between January 1, 2018, and December 31, 2023, were identified using data from the institution's warehouse. Age at the time of visit was used to categorize the patients into geriatric (≥65 years) and non-geriatric ( &lt; 65 years) age groups. Descriptive statistics were used to summarize the main characteristics and acuity of the geriatric group. The Cochran-Armitage test was used to assess the trend in the volume and acuity (based on the Emergency Severity Index [ESI] 5 levels) of geriatric patients presenting to the ED over the study period. Results: A total of 165,616 ED visits occurred during the study period, of which 40.9% (n = 67,678) visits were patients ≥65 years old, representing 29,591 unique geriatric patients. The median age for these unique patients at the time of their ED visit was 72 years (interquartile range = 68–77 years). Most patients were White/Caucasian (76.0 %) or Black/African American (11.2%). Emergent (31.0%) and urgent (66.2%) acuity levels (i.e., ESI levels 2 and 3 respectively) accounted for the majority of the geriatric ED visits. The number of ED visits by geriatric patients showed a significant upward trend (P &lt; 0.001), increasing from 39.2% in 2018 to 43.0% in 2023. In addition, these ED visits demonstrated a significant increase (P &lt; 0.001) in acuity level, as the proportion of emergent cases (ESI level 2) grew from 19.3% in 2018 to 38.6% in 2023, and the urgent cases (ESI level 3) decreased from 76.8% in 2018 to 59.2% in 2023. Conclusions: In this study we observed a growing trend in oncologic ED visits by patients 65 and older, along with a rise in the acuity level of these visits. As aging trends within the cancer population are expected, tailored healthcare approaches for geriatric cancer patients in the ED are essential to address the unique and changing needs of this population.
Bridging the gender gap in cancer care at a resident-led federally qualified health center: Retrospective insights and strategies for improvement.
Authors: Luisa Ladel, Yasser Abouelkheer, Wan Ying Tan, Nishan Pokhrel, Shira Rosoph, Vivan Sohal, Huseyin Ozer, Maria Hernandez, Kevin Hess, Cristina Smina
Journal: Journal of Clinical Oncology (2025)

e13841 Background: Federally Qualified Health Centers (FQHCs) are nonprofit organizations with federal funding which play a vital role in the United States health care system by providing affordable and accessible outpatient care, particularly to those facing socioeconomic, language, geographic and cultural barriers to healthcare. Prior studies have indicated differences in cancer screening participation based on gender and gender identity. This study aims to explore gender disparities in cancer care among FQHC patients. Methods: We conducted retrospective data analysis using a cancer registry at a FQHC in Connecticut. This registry was curated from March 2021 to March 2024 and included alive patients over the age of 18 with a diagnosis of cancer were included in this registry. Statistical analysis was performed with chi-squared test or Fisher’s exact test where applicable. Results: In the observed population, a trend was noted for men to present at more advanced stages of cancer (70.6% stages 0-III vs 29.4% stages III-IV) when compared to women (78.1% stages 0-III vs 21.9% stages III-IV). Regardless of whether screening occurred before or after their cancer diagnosis, 5.5% of female patients had not undergone age-appropriate cancer screening, compared to 41.9% of males. All unscreened females were uninsured, whereas the majority (53.8%) of unscreened male patients did have insurance. Interestingly, while women had slightly higher screening rates when they spoke English (100% vs 89.5%), there was no major difference in cancer screening rates based on language for male patients (57.9% English speakers vs 53.8% non-English speakers). Male cancer patients also exhibited a higher number of comorbidities (40% had 2 or less vs 60% had 3 or more comorbidities) than females (61.4% had 2 or less vs 38.6% had 3 or more comorbidities). Remarkably, male cancer patients were more likely to have undergone cancer screening if they had 3 or more comorbidities compared to 0-2 comorbidities (72.2% vs 27.8%) whereas for women there was no significant difference. Conclusions: Our findings suggest a gap in cancer care affecting males in medically underserved populations. Not only do male cancer patients face higher number of comorbidities complicating their treatment options, they also appear to have lower cancer screening rates and tend to present at later stages of disease. Subgroup analysis indicates that other variables beyond socioeconomic factors influence the disparities in cancer care for male compared to female patients in FQHCs. Efforts in improving cancer care in FQHCs should consider the influence of gender differences when devising new strategies.
Association of Claudin18.2 expression, PD-L1, and prognostic implications in gastric and gastroesophageal junction cancers.
Authors: Dani Ran Castillo, Mengni Guo, Kyung-il John Kim, Hannah Zhong, Gagandeep Brar, Shengyang Wu, Rifat Mannan, S. Cecilia Lau, Yan Xing, S.Peter Wu
Journal: Journal of Clinical Oncology (2025)

e16094 Background: CLDN18.2-targeted therapies and immune checkpoint inhibitors (ICIs) are promising approaches for gastric and gastroesophageal junction cancers (GC/GEJ). CLDN18.2 expression and PD-L1 CPS serve as potential biomarkers, yet their interplay and joint prognostic impact remain unclear. Methods: We retrospectively analyzed 56 patients with metastatic GC or GEJ cancer who progressed after 1L treatment. CLDN18.2 IHC expression was classified as positive (≥75%) or negative (&lt; 75%), while PD-L1 CPS was evaluated using cutoffs of &lt; 10 and ≥10. Relationships between CLDN18.2 expression, PD-L1 CPS, histological subtypes, molecular features, and metastasis patterns were examined. Progression-free survival (PFS) and overall survival (OS) were analyzed using log rank tests and Cox multivariable models. Categorical variable associations were assessed using chi-square test. Results: CLDN18.2-positive tumors were identified in 57% (32/56) of patients. CLDN18.2-positivity was associated with younger age (median 55 vs. 66.5 years, p = 0.008), increased non-regional lymph node-only metastases, and fewer liver-only metastases. The CLDN18-ARHGAP26/6 fusion occurred in 9% of CLDN18.2-positive tumors and 11% of diffuse-type tumors with signet-ring cell features. PD-L1 expression was significantly higher in CLDN18.2-negative tumors (41.7% vs. 9.4%, p = 0.005). CLDN18.2-negative status was linked to improved OS (median OS NR vs. 28 months; p &lt; 0.02), a finding which remained significant in multivariate models adjusting for PD-L1 (HR 0.19, 95% CI 0.04-0.85; p = 0.03). No significant PFS difference was seen between CLDN18.2-negative and -positive tumors (median PFS 9.5 vs. 8.5 months; p = 0.4). Conclusions: Our findings highlight biomarker complexity and heterogeneity in GC/GEJ cancers. The inverse relationship between CLDN18.2 and PD-L1 CPS suggests CLDN18.2-positive tumors may be less likely to engage PD-L1-mediated immune evasion mechanisms, providing a rationale for combining CLDN18.2-targeted therapies with ICIs. These results also underscore the potential of CLDN18.2 as a prognostic marker for overall survival in the setting of metastatic gastric cancer. Baseline characteristics. CLDN+ (n=32) CLDN- (n=24) p Age, median (range) 55 (38–82) 66.5 (42–84) 0.008 Male 16 (50%) 18 (75%) 0.06 Diffuse histology 27 (84.4%) 12 (50%) 0.006 ARHGAP26/6 Fusion 3 (9.4%) 0 0.26 PD-L1 expression PD-L1&gt;=10 3 (9.4%) 10 (41.7%) 0.005 Metastatic siteLung-onlyLiver-onlyPeritoneum-onlyNon-regional lymph node-onlyMulti-organ 3 (9.4%)1 (3.1%)16 (50%)4 (12.5%)8 (25.0%) 1 (4.2%)8 (33.3%)11 (45.8%)04 (16.7%) 0.02
Adherence of published randomized phase 3 cancer trials to principles proposed by common-sense oncology.
Authors: Omar Abdihamid, Bishal Gyawali, Christopher M. Booth, Wilma M. Hopman, Brian Shkabari, Dario Trapani, Haydee Cristina Verduzco-Aguirre, Brooke E Wilson, Ian Tannock
Journal: Journal of Clinical Oncology (2025)

11019 Background: Randomized clinical trials (RCTs) remain the gold standard for evaluating the efficacy and safety of novel cancer therapies. Some RCTs are well-designed and show meaningful improvements in patient outcomes while others are confounded by various types of bias, or do not reflect outcomes that matter to patients. Published RCTs should be designed, analyzed and reported to provide optimal, unbiased information for clinicians to enhance treatment decision-making Common-Sense Oncology (CSO) is an initiative of clinicians, patient advocates, researchers, and policymakers with the mission of ensuring that cancer care and research are focused on outcomes that matter to patients. CSO has published a checklist for the design, analysis and reporting of RCTs evaluating systemic treatments for cancer. In the present study, we have applied the checklists to a cohort of cancer drug trials to assess the extent to which CSO principles were incorporated in reports of RCTs published in 2023 in high-impact journals. Methods: We reviewed retrospectively phase 3 RCTs evaluating systemic therapies for adult solid tumors published in 2023 in The New England Journal of Medicine, Lancet, Lancet Oncology, JAMA, JAMA Oncology, Journal of Clinical Oncology, and Annals of Oncology . These journals were selected based on their high impact. For each trial we evaluated the trial design in the methodology, how the results were reported and the discussion section using the CSO RCT Checklist. Results: 50 RCTs evaluating systemic therapies for solid tumors were published in 2023. The most common tumor types were lung, liver, and prostate cancer. Progression-free survival and overall survival were the primary endpoints in 44% (22) and 42% (21) of trials, respectively. Only 36/50 trials justified the control arm, 25/50 justified the primary endpoint, and 18 included Quality-of-Life as a secondary endpoint. Only two trials addressed strategies to limit censoring and dropout; numbers of censored patients (with numbers at risk) were shown under Kaplan-Meier curves in only 21/50 trials, and sensitivity analysis to determine the potential effects of censoring was done in only 5 trials. Chronic toxicities were reported in only one trial, only 7 trials included patient-reported outcomes and only 3/50 trials mentioned cost of the drug. Conclusions: Our findings underscore the need for standardized methodologies, comprehensive design, and reporting in oncology RCTs. By identifying gaps in RCT design and reporting, CSO aims to improve the quality and consistency of future trials.