tbuckley/cabot-search huggingface dataset:
Real-world (RW) risk of recurrence among patients (pts) diagnosed with stage II-III HR+/HER2− early breast cancer (EBC) treated with endocrine therapy (ET) in the US.
Authors: Pedram Razavi, Mehnaj Ahmed, Ashley Roush, Rohan Parikh, Abigail Hitchens, Sherry Shen, Anton Safonov, Komal L. Jhaveri, Mark E. Robson, Nancy Walker Peacock, Yanjun Ma, Elizabeth Chertow Santarsiero, Vaidyanathan Ganapathy, Rohan M. Shah, Adaeze Q. Amefule, Agnes Lteif, L. Johnetta Blakely
Journal: Journal of Clinical Oncology (2024)

e12533 Background: Despite improved management of HR+/HER2− EBC, pts experience recurrences while on or up to decades after ending standard-of-care (SOC) ET. Addition of adjuvant (adj) cyclin-dependent kinase 4/6 inhibitors (CDK4/6is), ribociclib and abemaciclib, to SOC ET resulted in significant improvement of outcomes in pts with HR+/HER2− EBC at risk of recurrence. In NATALEE, ribociclib showed invasive disease-free survival (iDFS) benefit in a broader population, including select node-negative (N0) disease. This RW study describes short-term recurrence in pts with HR+/HER2− stage II-III EBC treated with SOC adj ET ± chemotherapy (CT) in the last decade in the US, prior to use of adj CDK4/6is. Methods: A medical record review from large academic (Memorial Sloan Kettering Cancer Center) and community (Tennessee Oncology) oncology practices was conducted. Adult women with stage II-III HR+/HER2− BC (AJCC 8) who underwent surgical resection and initiated adj ET between Jan 2012 and Dec 2018 were included. Pts were randomly selected for equal distribution by year of adj ET initiation. Study measures were summarized descriptively. Kaplan-Meier method was used to estimate 3-, 5-, and 7-y iDFS and distant disease–free survival (DDFS). Results: Medical charts of 992 pts were analyzed (median follow-up from initiation of adj ET, 6.3 y). Median age was 58 y. Most pts (76.7%) had stage II disease at diagnosis, 64.0% received CT, and 34.2% were premenopausal. In total, 35.8% of pts were N0. Among all N0 pts, ≈41.4% had high-risk tumor features, as defined by NATALEE: &gt;5 cm, 9.3%; 2-5 cm with G3, 25.9%; 2-5 cm with G2 + high genomic risk, estimated at 6.2%. N1(1-3) and N2/N3 (≥4) involvement was seen in 46.8% and 17.4% of pts, respectively. Analyses of iDFS/DDFS showed cumulative risk of invasive disease recurrence, predominantly distant disease, over 7 y in 21.4% across all stage II/III pts and 25.7% among the N0 pts meeting NATALEE criteria. Conclusions: This RW analysis from 2 major academic and community centers in the US confirms pts with stage II-III HR+/HER2− EBC, including select pts with N0 disease, experience considerable risk of recurrence, as early as during the adj treatment period cumulating over time. These findings warrant the consideration for tolerable treatment escalation for pts with stage II-III HR+/HER2− EBC.
A pilot study evaluating exercise intervention and body composition changes in patients with breast cancer and survivors.
Authors: Lindsey Merifield, Chloe Asato, Kirsten Baron, Matthew Toyama, Paulette Yamada, Cheri Teranishi-Hashimoto, Jami Aya Fukui
Journal: Journal of Clinical Oncology (2024)

e12527 Background: In breast cancer patients and survivors, higher weight and adipose tissue levels have been associated with cardiovascular disease, diabetes, osteoporosis, and cancer recurrence. Additionally, various breast cancer treatments can increase body weight, adipose tissue, and inflammatory markers, raising multiple health concerns for breast cancer patients. Recent studies have found exercise programs alongside breast cancer treatment decreased adipose tissue; however, the weight loss and lifestyle results were not maintained following the exercise program. It remains unclear what strategies are effective in implementing long term lifestyle changes. Methods: In this pilot study, breast cancer patients and survivors (N=24, individual=12, group=12) followed an exercise program for 6 months, followed by 6 months of follow up. Participants ranged from ages 36 to75. Participants were randomized into group and individual exercise sections. Anthropometric measurements were taken at baseline, 3 months and 1 year. One-year measures were used to indicate continued lifestyle changes. Results: Significant differences in fat % body composition were found between baseline and 3 months in both group and individual with an average change of 1.12% (5.9% max) and 1.32% (5.4% max) respectively (P=0.0090). In addition, the baseline and 1-year average change of both group 2.8% (8.8% max) and individual 1.5% (9.6% max) sections was also seen and statistically significant (P=0.0040). Patients in individual and group exercise sections had up to 9.6% and 8.8% decrease in adipose tissue over 1 year, respectively.However, no significant difference was found between the individual and group exercise sections (P=0.3244). Conclusions: Patients from both the individual and group exercise sections continued to decrease adipose tissue composition throughout the 1-year study period, including after formal exercise course cessation at 6 months. This indicates that both group and individual exercise courses may offer similar health benefits to breast cancer survivors. We are continuing long term data collection to evaluate sustainability of the intervention benefits and to monitor breast cancer recurrence rates. Clinical trial information: NCT04013568 . [Table: see text]
An overview of psychological analysis of patients with breast cancer undergoing total mastectomy and breast conservation surgery and its impact on objectified body consciousness at a tertiary care cancer centre.
Authors: S.P. Somashekhar, Richa Jaiswal, Ashwin K. Rajgopal, Aaron Marian Fernandes, Rohit Kumar C. Chandrashekar
Journal: Journal of Clinical Oncology (2024)

e12537 Background: Breast cancer is the most common cancer among females, and surgery plays a central role in its treatment. Surgical treatments may have a negative psychological impact on women’s mental health regarding their body image. The purpose of this study was to compare the psychological health insights pertaining to objectified body consciousness scores before and after the surgery and also to observe whether these scores were comparable across the surgery types. Methods: This retrospective qualitative study included 706 breast carcinoma patients who underwent either Breast Conservation Surgery or Total Mastectomy at Manipal Cancer Centre, between the years 2020-2021. A validated questionnaire of Objectified Body Consciousness was used to obtain responses at diagnosis and at 6 months postsurgery and final scores were calculated for both instances. Two sample t- tests/analysis of variance and Chi-square tests were used to compare continuous and categorical variables respectively. Results: Out of total 706 breast cancer patients, 402 patients underwent Breast Conservation Surgery and 304 underwent Total Mastectomy procedure. A statistically significant change was seen in the mean Objectified Body Consciousness Score (14.22±15.44) for all patients when compared pre-operatively (72.72±11.38) and postoperatively (60.15±17.58). This change was higher in the Total Mastectomy group (29.38±11.53). Also, statistically significant rise in scores was seen with increasing age. There was a statistically significant difference between BCS and Total Mastectomy groups with respect to the distribution of age group, marital status, types of cancer, stage and grade of cancer, NACT administration and postoperative mean objectified body consciousness scores of patients (p-value &lt;0.05). Conclusions: We could affirmatively conclude in our study that younger breast cancer patients and all patients who underwent a total mastectomy, had more psychological apprehension with the body image post-surgery, signifying these groups should be encouraged by healthcare professionals to reach out for counselling at the earliest. Knowing the pre-operative Objectified Body Consciousness scores and the type of surgery the patient is going to undergo, will help us to streamline categorical psycho-educational programs for each group and personalise our healthcare professionals to encourage women to reach out to social support groups and directed counselling at the earliest. This will help women adapt to their transformed life and be mentally prepared for the changes that are expected post-surgery.
MRI-Linac radiation therapy outcomes in patients with prostate, breast and other advanced malignancies.
Authors: Lakhvir Kaur, Kim Mcmillin, Ashley Drokin, Amar J. Srivastava, Steven K. Seung, Matthew C. Solhjem, Stephen Blake Bader, Eric K. Hansen, Alice Wang Chesebro, Marka R. Crittenden, Kristina Hoot Young
Journal: Journal of Clinical Oncology (2024)

e13811 Background: MR-guided radiation therapy offers an innovative approach, providing superior soft tissue contrast that enables clinicians to deliver higher doses to the target site with fewer fractions. The objective of the study is to assess objective response rates and adverse effects related to a community-based single-institution experience with the ViewRay MRIdian. Methods: An IRB-approved registrational trial was conducted at the Providence Cancer Institute starting May 2020, with data cutoff of September 2023. All patients treated underwent MR screening, and the target site(s) were treated using hypofractionated radiation therapy in ≤5 fractions. The primary endpoint was to assess adverse effects attributed to radiation therapy. Secondary measures included local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), overall survival (OS), and change in prostate-specific antigen (PSA) for patients treated definitively for prostate cancer. The assessments were performed under the guidance of experienced radiation oncologists. Results: From May 2020 to September 2023, n=257 patients received treatment on the MRIdian with a median follow-up of 430 days [range 4-1221 days]. One and 2-year LRFS was 92% and 87%, and excluding prostate and breast cancer, 83% and 70%. Definitive prostatestereotactic body radiation therapy(SBRT) was delivered to 117 patients and significantly reduced PSA (mean difference -6.27, p&lt;0.0001), with no local failures to date. One and 2-year DMFS was 75% and 67%, though if excluding definitive prostate SBRT and partial breast irradiation, these were 48% and 33%. The OS rate at 1 and 2 years was 86% and 76%. Excluding prostate and breast cancer, the 1 and 2-year OS was 74% and 55%. Grade 3+ adverse events possibly or definitely attributable to radiation therapy were noted in 5% (n=13/257) of patients, including 2 possible treatment-associated deaths (bowel perforation following liver SBRT, and respiratory failure following lung SBRT and trastuzumab-deruxtecan systemic therapy). Conclusions: Our institutional experience with the MRIdian demonstrated high levels of local control, while overall survival was driven by out-of-field failures. Serious adverse events were infrequent, but more common in abdominal targets highlighting the need for careful planning and tight organs at risk (OAR) constraints, particularly if systemic therapy is delivered soon after radiation.
Tolerance and safety of adjuvant metronomic capecitabine in Indian patients with non-metastatic triple negative breast cancer (TNBC): An institutional experience.
Authors: Shruti Kate, Yasam Venkata Ramesh, Rohini Vyavahare, Rajnish Vasant Nagarkar
Journal: Journal of Clinical Oncology (2024)

e12530 Background: Triple-negative breast cancer (TNBC) subtype has a high risk of recurrence and overall poorer survival after standard treatment. SYSUCC-001 study presented in ASCO 2020 reported an increased disease-free survival after one year of metronomic capecitabine in operable TNBC patients after completion of local therapy. As per our clinical experience in metastatic breast cancer, many Indian patients are not able to tolerate capecitabine for longer duration. Hence, we wanted to assess the tolerance and safety of one year of daily dosing of capecitabine in our patients with Non-Metastatic TNBC. Methods: We performed a retrospective analysis of non-metastatic TNBC patients receiving adjuvant capecitabine 650 mg /m2 twice daily continuously for one year who took treatment from June 2020 to August 2022. The data extracted included patient socio-demographics, capecitabine information, side effects, and capecitabine treatment changes (dose reductions and dose interruptions). Statistical analysis was conducted using SPSS, version 24. Results: We analyzed 90 patients, out of which majority (62%) were stage II. Median age of the cohort was 48 years. Germline data was available for 64 patients, out which 8 patients were BRCA 1 positive and 8 patients had a variant of undetermined significance. Median duration of capecitabine in our patients was 230 days (IQR: 10 - 360). Twenty-six (28.8%) patients underwent dose reduction and 15 (16.6%) had reported grade 3 toxicity. Mean dose of capecitabine received was 535 mg / m2 twice daily. Treatment was interrupted due to toxicity in 20 (22%) of patients. The most common capecitabine-induced toxicity was hand foot syndrome, which was also the most common reason for dose reduction and treatment interruption. Dihydropyrimidine dehydrogenase (DPD) mutation status was known for 38 patients out of which only one (2.6%) was found to have DPD deficiency. Incidence of grade 3 toxicity was observed to be less in patients with age less than 50 years, ECOG performance status 0-1 and absence of comorbidities. Two-year disease free survival (DFS) and overall survival (OS) was estimated to be 79.3% and 80% respectively. Most common site of metastases was reported to be brain followed by lung. Conclusions: Continuous metronomic dosing of adjuvant capecitabine for 1 year is fairly well tolerated in Indian patients with non-metastatic TNBC, but may still require dose reduction in some patients due to toxicity.
Breast cancer recurrence rate after mastectomy in young females.
Authors: Hamsa Sahib, Waqas Azhar, Nitin Saini, Kathy J Robinson, Kristin Delfino, Krishna A. Rao
Journal: Journal of Clinical Oncology (2024)

e12591 Background: Breast cancer is the most commonly diagnosed female cancer worldwide and the most common cause of cancer mortality in women. Surgical treatment of early breast cancer includes lumpectomy or mastectomy with or without reconstruction. Despite the surgeon’s best effort to perform a radical resection of the breast tissue during mastectomy to achieve locoregional control, residual fibroglandular tissue was found in 20% of breasts on postoperative breast MRI, which carries a risk of recurrence. Younger women with breast cancer have inferior survival rates despite receiving more aggressive therapy. Tumors in young women are more likely to be poorly differentiated, hormone receptor-negative, have a high proliferation index, and more lymphovascular invasion, which is partially explained by patients’ genetic profile. Another factor that could contribute to poor outcomes is the advanced stage at the time of diagnosis, including larger tumor size and higher rates of axillary lymph node positivity. This knowledge has motivated us to conduct this study that is dedicated to looking at the recurrence rate in young females following mastectomy. Methods: This is a retrospective study that collected data from young female patients who were diagnosed with breast cancer between January 2010 and August 2018, had an age at diagnosis of 18-45 years old, and underwent unilateral or bilateral mastectomy with or without reconstruction. The study also looked at the patient’s risk factors and genetic profile. Results: A total of 115 patients were diagnosed with early-stage breast cancer between January 2010 and August 2018 and underwent mastectomy. 81.74% were Caucasian females, and 8.7% were African American females. The mean age of diagnosis was 36.9 years. The mean BMI was 30.5 kg/m2. 59.13% of patients had a family history of breast cancer. The most common genetic mutations were BRCA1 at 7.83% and BRCA2 at 8.7%. 71% of patients underwent a bilateral mastectomy. 76% of patients had reconstruction. 77% of tumors were ER-positive, 68% PR-positive, and 26% HER2-positive. 49.4% of tumors were Nottingham grade 3. 52% of patients had no nodal involvement, while 35% had N1 disease. 34.6% had lymphovascular invasion. We found that 18/115 patients had recurrence of breast cancer following mastectomy. 5/17 patients had locoregional recurrence, while 12/17 patients had a distant recurrence; 1 patient’s recurrence data was unavailable. The median time to recurrence was 1147.5 days (335 to 3107). The 5-year recurrence free survival rate is 86% ± 3%. Conclusions: Our study found that 15.65% of young females had recurrence after mastectomy. To our knowledge, this is the first dedicated study to look at the recurrence rate after mastectomy in this young, high-risk patient population. Our study aims to encourage larger studies in young females with breast cancer to help tailor the treatment plan in this population.
Clinical factors associated with response to neoadjuvant chemotherapy in women of Hispanic origin diagnosed with early-stage TNBC or HER2+ breast cancer in the United States.
Authors: Maria Herran, Saad Sabbagh, Ali Hijazi, Mohamed Mohanna, Barbara Dominguez, Zeina A. Nahleh
Journal: Journal of Clinical Oncology (2024)

e12535 Background: Neoadjuvant chemotherapy (NACT) has been strongly recommended for patients diagnosed with TNBC or HER2+ breast cancer. Hispanic populations are composed of a heterogenous group that include different racial and national backgrounds. This may account for differences in response to NACT. The aim of this study is to explore the factors associated with chemosensitivity among Hispanic women with early-stage TNBC or HER2+ breast cancer in the United States. Methods: This retrospective cohort study queried data from the National Cancer Database between 2010 and 2020 for women diagnosed with early-stage TNBC or HER2+ breast cancer who received NACT and identify as Hispanic (Mexican, Puerto Rican, Cuban, South or Central American and Dominican Republic). Patients were divided into two groups based on their response to NACT: sensitive (pTNM stage &lt; cTNM, including ypT0N0) and refractory (pTNM stage ≥ cTNM stage). Using chi-square, socio-demographic and clinical factors associated with response to NACT were identified. Significant variables (p&lt;0.05) were included in the multivariate logistic regression model predicting their response to NACT. Results: This study included N= 1,225 Hispanic women who met the inclusion criteria, 48.8% were Mexican, and 30.5% were from the Caribbean (Cuba, Puerto Rico, and Dominican Republic and 20.7% were from Central or South America). Within the overall group, n=769 (62.8%) were deemed sensitive to NACT, while n=456 (37.2%) were considered refractory. Significant variables associated with chemosensitivity at the multivariate level included age, tumor subtype, cN stage, and the use of multiagent NACT. Hispanic patients &gt;70 years were less likely to respond to NACT (OR 0.57 95% CI 0.35-0.94, p-value=0.027). Meanwhile, patients diagnosed with TNBC were more likely to respond to NACT compared to HER2+ tumors (OR 2.0 95%CI 1.6-2.6, p-value&lt;0.001). Patients with negative lymph nodes were 1.6 times more likely to have chemosensitive response compared to those with positive lymph nodes who tend to have more refractory disease (95%CI 1.6-2.6, p-value&lt;0.001). Patients receiving single agent were 63% less likely to respond than multiagent NACT (95%CI 0.23-0.61, p-value&lt;0.001). No major chemosensitive differences were found between individual Hispanic origin. Conclusions: In our nationwide Hispanic cohort, youngerage, TNBC, and cN0 were found to be significant predictors of neoadjuvant chemosensitive response in early-stage Breast Cancer. Further prospective inclusive studies are warranted to better delineate the heterogeneity in response to NACT among individual self-reported Hispanic ethnicities within the United States.
Rural palliative care in cancer: Using telemedicine to bridge the gap.
Authors: Danielle Noreika
Journal: Journal of Clinical Oncology (2024)

e13807 Background: Despite the rapid growth in palliative care (PC) services, many rural regions remain without access to specialty palliative care. Community-based telemedicine may offer solutions to underserved populations from rural areas within the United States. Methods: This is a retrospective review of the creation of 2 separate rural clinics attached to the VCU Massey Comprehensive Cancer Center at CMH in South Hill, VA in 2018 (with interruption related to the Covid-19 pandemic) and in Tappahannock, VA in 2021. In addition to operational descriptions a chart review was conducted of all encounters for these clinics. Care provided was coordinated by the University PC service and the oncology clinics, including nurses and oncologists. Regulatory, legal, Information Technology (IT), and systems logistics were developed in partnership for 6-9 months prior to each pilot. There were over 100 encounters from the two periods of care for CMH (2018 until paused for pandemic towards the end of 2020; and March of 2021 to current) and greater than 50 at Tappahannock. All visits were conducted in the rural oncology clinics with assistance of oncology nursing during the encounter. Results: The average patient age was 57, and over 90% had solid tumors. On average, patients had 1-2 telemedicine visits. The most common reason for referral was symptom management, predominantly pain. Edmonton Symptom Assessment scales were collected at all visits by oncology nursing. Physical exams were completed with electronic stethoscopes and supported by oncology nursing. Medications were prescribed to rural pharmacies electronically directly by the PC physician; for the periods of clinic over the course of the Covid-19 public health emergency this included prescriptions for controlled substances (almost exclusively long and short acting opioids). For patients requiring advance care planning documents were completed electronically or by trained interdisciplinary team members in clinic in partnership with the PC physician. Technological issues occurred rarely (less than 1% of visits) and resolved without IT involvement. Conclusions: Our pilot program integrated specialist palliative care into two rural oncology clinics providing supportive care, including symptom management and goals of care discussions. Further research should define optimal integration of PC telemedicine into rural oncology.