tbuckley/cabot-search huggingface dataset:
Characteristics of patients with metastatic malignant melanoma in Colombia: Results of the Epidemiologic Registry of Malignant Melanoma REMMEC ACHO.
Authors: Aylen Vanessa Ospina Serrano, Juan David Ortiz Diaz, Fernando Contreras, Isabel Munevar, Paola Jimenez, William Armando Mantilla, Henry Idrobo, Pedro Ramos, Ray Manneh Kopp, Natalia Arango Acevedo, Daniel Andres Santa, Giovanna Patricia Rivas Tafurt, Alicia Quiroga, Claudia Vargas, Andres Yepes, Carmen Marcela Alcala Castro, Mauricio Lema, Isabel Chinchia, July Andrea Russi Noguera, Ivan Camilo Triana
Journal: Journal of Clinical Oncology (2024)

e21530 Background: The features and prognostic factors of patients with metastatic malignant melanoma are not well established in our country. Our objective is to collect and analyze the characteristics of a cohort of Colombian patients. Methods: Analytical cohort study based on the Epidemiologic Registry of Malignant Melanoma in Colombia (REMMEC). Data were collected between January 2011 and December 2023. Patients older than 18 years with a confirmed diagnosis of advanced melanoma were included. Descriptive analysis of demographic and clinical characteristics and survival analysis using Cox regression and Kaplan-Meier models were performed. Results: 322 patients were included. Median age was 66.5 years (range 55-76), 56% (180) of patients were men, 87% (280) had advanced disease at diagnosis, most (82%) with non-brain metastases and 51% (164) with multiple organ involvement. Table 1. For first-line treatment, patients received single-agent immunotherapy (37.26%), doublet immunotherapy (10.25%), targeted therapy (9%), and chemotherapy (7.14%), while 29% received best supportive care BSC. In the second line, single agent immunotherapy 9.32%, targeted therapy (4.34%), doublet immunotherapy 3.42%, chemotherapy (5%) and 77% received BSC. In the third line, only 9% (29) of patients were able to receive any therapy. Median follow-up was 16 months (IQR 7-32), median progression-free survival (PFS) was 8 months (IQR 4-35) and median overall survival (OS) was 23 months (IQR 9-66). OS in the first-line setting with immunotherapy as monotherapy was 23 months (IQR 12-40) HR 0.40 P 0.035 and with doublet immunotherapy 16 months (IQR 8-28) HR 0.16 P 0.005 Clinical characteristics associated with lower median OS were brain metastasis (HR 1,95 P 0.001), ECOG 3-4 (HR 5,49 P 0.001) and multiple metastatic disease (HR 2,15 P 0.001). According to acral vs. non-acral histologic type, the median OS was 26 vs. 44 months, respectively (HR 1.30 P 0.26). Conclusions: In our cohort of patients with metastatic melanoma, we found clinical outcomes similar to those reported in the worldwide literature. It is necessary to continue the registry and follow-up of patients to identify specific prognostic factors. [Table: see text]
Mapping incidence and survival of non-small-cell lung cancers stratified by mutation type in southern Appalachia: A single center retrospective study.
Authors: Arjun Natarajan, Erica Marie Roman Hernandez, SriVyshnavi Ramineni, Jieying Liu, Brad Sackfield, Dipsa Shastri, Patrick Costello, Kanishka Chakraborty, Nicole Lewis
Journal: Journal of Clinical Oncology (2024)

e20568 Background: Non-small cell lung cancer (NSCLC) is often a mutation-driven disease with variability in incidence and survival depending on location as seen in population-based cohort studies. Our study aims to delineate these differences based on molecular testing for these mutations in our study cohort at East Tennessee State University - Quillen College of Medicine, which is based on patients from east Tennessee, western North Carolina, and southwestern Virginia. Methods: We obtained pathology results of 294 patient samples with advanced/metastatic NSCLC from our cancer center/health system database over a 5 year period. PDL-1 was tested in all patients. Fluorescent in-situ hybridization (FISH) testing for common pathogenic driver mutations such as EGFR, ALK, ROS1, RET, MET and PTEN were performed as is standard of care. Molecular sequencing was performed and included over 40 genetic mutations and 2 biomarkers, several of which today are considered targetable for advanced NSCLC, per standard of care. Incidence of different mutations was measured in our patient population. Overall survival was calculated with date of diagnosis available based on pathology report and date of patient expiration obtained from electronic medical records. Data analysis was performed to ascertain which mutations carried an increased risk of death. Results: The TP53 mutation was very common, seen in 85% of squamous cell carcinoma (SCC) histology and 55% of adenocarcinoma. Similarly, incidence of PTEN deletion by FISH was noted to be 52% in SCC and 31% in adenocarcinoma. EGFR mutations were rare, seen in only 3% of tested patients. We had an incidence of KRAS G12C mutations at 11% overall, but it was present in up to 18% of adenocarcinomas. BRAF was seen in 4.8% of all cases, 8% of adenocarcinomas and 2% of SCC. Since there were more than 2 predictors, Cox proportional-hazards regression model was fit. Due to either having all negative values or very few positive values, the variables CCND1, CDKN2B, ERBB2, ERBB4, FGFR, FGFR2, MET, MSI, NRAS, PDGFRA, RET, RS01, SCR were excluded from analysis. A total of 156 samples were used in final analysis. After model building, it was found that BRAF and KRAS G12C mutation were significant predictors of survival by hazard ratios for death. Conclusions: In our unique patient population, there was a greater incidence of deleterious TP53 mutations and PTEN deletions compared to the general North American advanced/metastatic NSCLC population. Although BRAF and KRAS G12C mutations were not at a greater incidence in comparison to the rest of North America, they were notably significant predictors of survival, conferring nearly 3.4 and 2.7 times increased risk of death in our study. [Table: see text]
Long-term follow up for adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma: Final results of the COMBI-AD study.
Authors: Axel Hauschild, Reinhard Dummer, Mario Santinami, Victoria Atkinson, Mario Mandala, Barbara Merelli, Vanna Chiarion-Sileni, Andrew Mark Haydon, Jacob Schachter, Dirk Schadendorf, Thierry Lesimple, Elizabeth Ruth Plummer, James Larkin, Monique Tan, Sachin Bajirao Adnaik, Paul Burgess, Tarveen Jandoo, Georgina V. Long
Journal: Journal of Clinical Oncology (2024)

9500 Background: Dabrafenib plus trametinib, a standard-of care adjuvant treatment for patients with BRAF-mutated AJCC-stage III melanoma, has significantly improved the primary endpoint, relapse-free survival (RFS). Further to published interim assessments, we present updated and final results for RFS, distant-metastasis-free survival (DMFS) and overall survival (OS). Methods: In the COMBI-AD phase 3 study, patients received dabrafenib (150 mg BD) plus trametinib (2 mg OD; n=438) or matching placebos (n=432). Treatment continued for up to 12 months or until disease relapse, unacceptable toxicity, withdrawal of consent, or death. OS, RFS, and DMFS were summarized using Kaplan–Meier estimates. OS was compared between study arms using stratified log-rank test. Hazard ratio (HR) was calculated using Pike estimator. Safety data were summarized descriptively. Results: At final analysis, median duration of follow up was 100.0 months in the treatment arm and 82.5 months in the placebo arm. Median OS was not attained in the two arms (HR: 0.80; 95% CI: 0.62, 1.01; P=0.063). Consistent OS benefits were seen across most prespecified subgroups including patients with BRAFV600E mutation (n=397; HR: 0.75; 95% CI: 0.58, 0.96). Estimated RFS (HR: 0.52; 95% CI: 0.43, 0.63) and DMFS (HR: 0.56; 95% CI: 0.44, 0.71) favored the dabrafenib plus trametinib arm. In both arms, patients received salvage immunotherapies (29% each) and targeted therapy (21% vs. 37% for treatment and placebo arms, respectively). Safety profile was consistent with previous reports. Conclusions: COMBI-AD presents the longest follow-up data (over 10 years) in adjuvant treatment of stage III melanoma in the modern era. OS was improved with dabrafenib plus trametinib over placebo for adjuvant treatment of stage III melanoma with a 20% risk reduction for death. However, this difference was not statistically significant. Consistent with published results at 3 and 5 years, RFS and DMFS were more favorable in the treatment vs. placebo arm. Clinical trial information: NCT01682083 . [Table: see text]
Tracking the information-seeking patterns and preferences of US-based medical oncologists (MOs): A 2-year longitudinal assessment.
Authors: Neil Love, Douglas Paley, Jennifer Dvorkin, Wendy Cerenzia
Journal: Journal of Clinical Oncology (2024)

e21012 Background: The rapid pace of scientific advancement demands that community-based MOs continually access new information and effectively apply it in their clinical practices to improve long-term patient outcomes. A variety of dissemination vehicles are currently available to facilitate the transfer of knowledge, including continuing medical education (CME) activities. Despite the significant resources allocated for the development of these modalities, little definitive data is available documenting MOs’ preference for, utilization of and perspectives on the benefits and limitations of CME. This longitudinal assessment sought to establish a baseline understanding of MOs’ patterns of engagement with CME activities following the upheaval caused by COVID, and gauge if and/or how this has shifted as the pandemic has subsided further. Methods: In April 2022 a 56-question online survey was distributed to 4,623 US-based MOs from a proprietary database. A small honorarium was offered for participation. Responses were collected from 83 MOs. A 2-year follow up assessment is planned for April 2024 to track changes in preferences and participation. Results: 83% of MOs “agree” or “strongly agree” that the pace of oncology advancements is quicker now than it was in the past yet only 25% spend more time accessing CME. On average, MOs dedicate 6 hours a week to seeking oncology-related information, in which utilization of CME activities is included. MOs believe CME activities are useful for helping to stay up to date with advances in oncology (3.5 on a 1-5 scale) and 55% believe the application of new and emerging therapies within oncology would be slower if CME was no longer available. MOs are most interested in CME activities featuring practically oriented topics including recently presented clinical trial findings , molecular testing and analysis and treatment sequencing . Notably, the highest-ranking MO consideration for participation in a CME program was the topic, followed by faculty and then the length of the activity. In terms of length, MOs preferred 30-to-60-minute programs rather than shorter (15 minutes or less). All surveyed MOs utilize some form of CME with preferences varying for different virtual, live in-person and enduring formats. Despite its wide-scale proliferation, only 34% of MOs use social media for professional purposes including accessing oncology education. Conclusions: MOs value CME activities and utilize both in-person and virtual programs on a regular basis. As concerns over COVID have diminished, it is predicted that established interest in asynchronous forms of education will wane with an increased shift toward in-person meetings. The results of this longitudinal study are critical to ensure that oncology CME resources are designed to effectively convey needed information and in turn positively affect patient care.
Effect on patient empowerment through the EPEP program.
Authors: Aicha Diallo, Tracy T. Rode
Journal: Journal of Clinical Oncology (2024)

e21009 Background: There is a critical need to support oncology providers seeking to empower their patients and care partners by connecting them to trusted resources. To fill this gap, the Patient Empowerment Network (PEN) created the Empowering Providers to Empower Patients (EPEP) program to improve physician-patient communication and shared decision-making by creating a clear path to support providers in empowering their patients and care partners. Methods: The EPEP program, developed by an interdisciplinary team of experts for oncology health care professionals, launched in March 2023 with a focus on lung cancer resources. The program includes digital resources such as Roundtables (30-minute webinars + segments with leading experts, clinicians, and peers), an HCP Portal (a system that informs and collates vetted resources), a Resource Guide (resource guide for HCPs), and a Roundup Blog (article with key takeaways summarizing program). Following two roundtables in March 2023, we assessed initial provider engagement with EPEP using digital engagement metrics and a five-item questionnaire. Results: Since the launch, 212 oncology providers have access to the suite of digital resources. The content has been viewed and downloaded almost 13,595 times. Surveys conducted following the roundtables indicated that the program was well-received. Of 21 respondents, n=18 (86%) rated their experience as very positive; agreed or strongly agreed that the program gave them the confidence to better facilitate shared decision-making with their patients; and said they found relevant resources to share with their patients and their families. Sample feedback included, “I would say it gave me the confidence to raise the flag on timing. Sometimes we test and are not doing this in a timely way. Thanks for this program.” And “These conversations are so critical. Thank you for a great program.” And, “I thought the conversation was excellent; we need more of this. I thought the tips were spot-on and very helpful.” Providers wanted communication tools focused on the “timing of testing following the initial workup,” “pathology conversations” and “anxiety and fear after the cancer diagnosis, long-term side effects, screening and early detection of lung cancer.” Conclusions: The EPEP program serves as a trusted digital space for providers to objectively share and recommend resources to their oncology patients. The program now includes removing practice barriers that may be caused by a lack of awareness and outdated practices. The long-term goal is to improve physician-patient communication and shared decision-making while also empowering cancer patients and family members to ask informed questions based on where they are in their cancer journey.
Immunotherapy in stage IV non-small cell lung cancer according to racial characteristics and community of residence.
Authors: Annie Chang, Matthew Untalan, Raja Michael Flores, Emanuela Taioli
Journal: Journal of Clinical Oncology (2024)

e20621 Background: Non-small cell lung cancer (NSCLC) remains the leading cause of cancer mortality worldwide. The advent of immunotherapy has transformed treatment paradigms for NSCLC. However, the use and effectiveness and immunotherapy may differ across racial groups and other sociodemographic factors, including sex, comorbidities, and community of residence. Our study analyzed disparities in immunotherapy receipt and overall survival among patients with stage IV NSCLC. Methods: Patients diagnosed with stage IV NSCLC from 2014 through 2016 were identified using the Surveillance Epidemiology, and End Results (SEER)-Medicare linked dataset. Immunotherapy receipt was compared across racial groups: non-Hispanic Whites, Blacks, Asians, Hispanics, and Native Americans. A multivariable logistic regression model evaluated associations between immunotherapy receipt and demographic and clinical variables including age, sex, marital status, Charlson comorbidity index, and histology. A multivariable Cox proportional hazards model assessed associations between these variables and overall survival. Results: Among 21,444 patients, the majority (78.6%) were White, while 10.7% were Black, 4.9% were Asian, 1.6% were Hispanic, and 0.2% were Native American. The efficacy of immunotherapy treatment was present across races, associating with better overall survival versus no immunotherapy (adjusted HR: 0.54, 95% CI: 0.49-0.59). After accounting for community of residence, race remained a significant factor in immunotherapy receipt (type 3 p-value: 0.028). Further adjustment for other covariates revealed that Black patients had significantly lower odds of receiving immunotherapy than White patients (adjusted OR: 0.64, 95% CI: 0.47-0.87). While Hispanics and Asians also had lower rates of receiving immunotherapy, these differences were not statistically significant. Asian patients exhibited higher overall survival compared to other races (adjusted HR: 0.88, 95% CI: 0.82-0.95). Conclusions: Use of immunotherapy for stage IV NSCLC is substantially lower among Blacks and other minority groups compared to Whites, indicating racial disparities in access to novel lung cancer treatments. Patients treated in urban areas are more likely to receive immunotherapy, underscoring the need to expand consistent access to efficacious treatments for advanced NSCLC. Ensuring equal access to effective treatments such as immunotherapy, regardless of race or community of residence, has the potential to improve outcomes and reduce racial disparities in lung cancer survival.
Assessing clinician familiarity with integrative oncology and uptake of an electronic medical record–based education resource.
Authors: Joshua Jiang, Nikko Gonzales, Sidharth Anand
Journal: Journal of Clinical Oncology (2024)

e21001 Background: Integrative oncology is the practice of incorporating complementary and alternative medicine (CAM) into the conventional care of cancer. CAM encompasses a broad realm of treatment modalities, ranging from nutrition and exercise to acupuncture, supplements, and behavioral therapy. Few oncologists discuss CAM with their patients while patients under-report their usage of these treatments to their oncologists. Our project aim was to assess clinician familiarity with integrative oncology and to improve education on the topic using a clinician-facing tool accessible through the electronic medical record (EMR). Methods: We distributed a survey from May through July 2023 to assess attitudes towards CAM and practice patterns at an academic oncology department. Respondents used a five-point Likert scale to rate their understanding of CAM, role in counseling patients on CAM, and factors affecting their discussion of such topics. We created EMR-accessible clinician guides which reviewed the evidence base for common complementary treatments in breast, colon, and lung cancer. Results: Fifteen of 64 (23%) affiliated oncologists completed the survey. Eleven (73%) respondents agreed or strongly agreed that it is their responsibility to learn about CAM. Fourteen (93%) respondents agreed or strongly agreed that it is their responsibility to ask patients about CAM usage, although two-thirds of respondents initiated conversations about CAM “sometimes” or less. Six (40%) felt comfortable providing resources on CAM to their patients. Respondents reported greatest awareness of the evidence for exercise and psychotherapy (average rating 3.8 out of 5; higher is more familiar) and least awareness for supplements (average 3.2). The factors most strongly affecting respondents’ practices of discussing CAM with patients were a lack of credible resources and fear that supplements might replace conventional cancer treatment. Ten (67%) respondents reported that patients undergoing active treatment often or always ask about CAM and nine (60%) reported that survivors often or always ask about CAM. Three practicing oncologists and two fellows had added our clinical guides to their EMR shortcuts six months after their introduction. Conclusions: Certain forms of CAM remain controversial within oncology practice. Although oncologists in our department reported a sense of responsibility to understand and counsel patients on CAM, multiple barriers impeded physician comfort with the topic and uptake of a novel educational resource was limited. Patients undergoing active treatment and survivors alike asked clinicians about CAM, which suggests it is an important area of competence for oncologists regardless of treatment phase.
Longitudinal circulating tumor DNA kinetics and correlation with patient outcomes in metastatic melanoma.
Authors: Ramya Tummala, Sirisha Tummala, Timothy Kuzel, Alan Tan
Journal: Journal of Clinical Oncology (2024)

e21538 Background: Previous studies have shown circulating tumor DNA (ctDNA) to be an accurate noninvasive method for detecting minimal residual disease and predicting therapeutic response. This study aims to investigate if positive ctDNA and subsequent clearance kinetics may be used as a predictive and prognostic tool in patients with stage IV metastatic melanoma. Non-clearance of ctDNA may be associated with poorer outcomes for progression-free survival (PFS) and overall survival (OS). Methods: In this retrospective analysis of preexisting data from a cohort of 27 patients with stage IV melanoma treated at Rush University, longitudinal ctDNA plasma samples collected between 05/01/2020 and 01/01/2024 were analyzed. A tumor-informed ctDNA assay (SignateraTM, reported in mean tumor molecules per mL (MTM/ml), low limit of detection of 0.01% variant allele frequency) was used for detection and quantification of ctDNA in plasma samples. Progression was determined based off of radiographic studies, overall survival was determined by time from stage IV diagnosis to patient death. Results: A total of 192 ctDNA timepoints were analyzed. The median number of ctDNA timepoints per patient was 5 (range 1-26). 8 patients were identified whose initial ctDNA result was negative and remained negative throughout their treatment course; 5/8 of these patients had baseline negative values available prior to the initiation of treatment. 19 patients had at least 1 positive ctDNA result at any given time; 1/19 of these patients was ctDNA-negative at baseline, 7/19 were positive at baseline, and 11/19 did not have baseline values available. The PFS rate was higher for ctDNA-negative patients compared to ctDNA-positive patients (62.5% vs. 57.9%). The OS rate was also higher for ctDNA-negative patients compared to ctDNA-positive patients (75% vs. 52.6%). Of the ctDNA-positive patients, those who achieved persistent clearance or had decreasing values of ctDNA had higher PFS rates when compared to ctDNA-positive patients who neither downtrended nor achieved clearance (71.4% and 66.7% vs. 22.9%). Patients who achieved persistent clearance or had decreasing values of ctDNA also had higher OS rates when compared to ctDNA-positive patients who neither downtrended nor achieved clearance (71.4% and 100% vs. 33.3%). Conclusions: Within the limitations of a small sample size, our data suggests that for patients with stage IV melanoma, a positive ctDNA result is associated with poorer outcomes for PFS and OS, when compared to patients with negative ctDNA results. Additionally, ctDNA-positive patients who achieved persistent clearance or downtrending ctDNA values showed more favorable outcomes for PFS and OS than ctDNA-positive patients who did not. [Table: see text]