tbuckley/cabot-search huggingface dataset:
Is there a correlation between estrogen receptor expression level and early breast cancer survival? A retrospective study.
Authors: Ayman Rasmy, Ahmed Zeeneldin, Walid Abozeed, Shereef Elsamany
Journal: Journal of Clinical Oncology (2024)

e12574 Background: The optimal cut-off of estrogen receptor (ER) positivity is still debatable; however, adjuvant hormonal therapy is usually given if ER expression is ≥ 1%. The present study aims to assess the clinicopathological features and survival outcomes of patients with low compared to high ER expression levels. Methods: In this retrospective, we checked non-metastatic hormonal receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients who presented to three hospitals in Egypt and Saudi Arabia between 2016 and 2019. Different clinicopathological factors and data on relapse were checked in patients’ medical records. These data were compared in patients with ER-Low (1–10%) vs. ER-High (&gt;10%) expression levels. Results: We included 419 patients who met the eligibility criteria for the study. Only 3.3% of patients had ER-Low. Compared to the ER-high group, the ER-low expression group was more likely to have grade 3 tumours (64.3% vs. 21.0%, p = &lt;0.0001) and PR-negative tumors (64.3% vs. 16.3%, p = &lt;0.0001). Furthermore, younger age (≤ 50 years) was more frequent in the ER-Low group compared to ER-High patients (71.4% vs. 42.5%, respectively, p = 0.032). Likewise, ER-high patients were more likely to have high ER-staining intensity (74.1% vs. 0.0%, p&lt;0.0001). Disease-free survival (DFS) was numerically improved in patients with ER-high, but without statistical significance. After adjustment of different clinicopathological prognostic factors, the DFS benefit in the ER-high group was more definite (hazard ratio (HR) = 3.59, 95%, confidence interval (CI) = 1.11–11.55, and p value = 0.032). Conclusions: A lower estrogen receptor expression level (varying from 1 to 10%) in hormone-positive early breast cancer patients is an uncommon pattern associated with more aggressive disease features at diagnosis. This group of patients had a lower DFS than those with a higher degree of estrogen receptor expression, although there was no statistically significant difference in OS.
Examining emerging trends in palliative care utilization for malignant neoplasms with the highest mortality rates.
Authors: Kingsley Chinonyerem Nnawuba, Hanna Jensen, Divyaswathi Citla Sridhar
Journal: Journal of Clinical Oncology (2024)

e24066 Background: Lung, colorectal, pancreatic, breast &amp; prostate cancer account for the top 5 malignancies resulting in mortality in the US. The need for palliative care in patients with these malignancies continues to grow &amp; monitoring its utilization is crucial, especially among different racial groups &amp; ethnicities. Methods: In this study, the TriNetX database which is a collaboration between; pharmaceutical companies, research organizations &amp; HCOs was used. A total of 3,221,731 de-identified pts (pediatric, AYA &amp; adult) was analyzed. The impact of palliative care use vs absence between 2009-2023 was compared in 4-year cohorts, with univariate &amp; multivariate analyses. A p-value &lt; 0.05 was deemed significant. Chi-square was employed to assess palliative care utilization or absence through the years for each group. Results: Analyzing Table 1, palliative care utilization was greater among Non-Hispanics and Whites, as evidenced by the mean. White pts consistently exhibit a higher use compared to other racial groups, but it declined between 2019-2023. The lowest use of palliative care was among Native Hawaiians, Native Americans, &amp; Asians. Black, Latino, Other race, Unknown Race &amp; unknown ethnicity pts accounted for about 50% of its use. Similarly, in most racial &amp; ethnic groups a decline in its non-utilization was observed progressively. Based on the chi-square test, overall results show a significant P-value for all racial &amp; ethnic groups through the years, except for white pts with a p-value of 0.1847. Conclusions: The study highlights disparities that exist in palliative care utilization among racial &amp; ethnic groups. Despite increasing trend in its use, its utilization remains constant among minorities. These details are pivotal in advancing an inclusive healthcare that enhances end of life outcomes for all patients. [Table: see text]
Patterns of referral to supportive oncology (SO) practice embedded in a cancer center and impact of timing of referrals on end-of-life outcomes.
Authors: Fionnuala Crowley, Li Zeng, Tianxiang Sheng, Nadeem Bilani, Mollie Hobensack, Beth Popp, Debora Afezolli, Lauren Kelly, Winston Wey, Joanna Chen, Vanessa Austin, Aleena Bajwa, Eve Easton, Arlyn Pagala, Emily Kim, Cardinale B. Smith, Laura P. Gelfman
Journal: Journal of Clinical Oncology (2024)

e24064 Background: ASCO guidelines recommend early palliative care (PC) for patients with advanced cancer, defined as within eight weeks of diagnosis, to enhance survival and quality of life. It is unclear which subsets of patients are referred “late” to PC and how timing of referral impacts cancer outcomes and end-of-life care. Methods: Patients &gt;18 years with first SO consult between 01/01/2021-06/30/2023 were included. Data on patient demographics, acute healthcare and hospice utilization, cancer treatment and mortality was extracted from the electronic medical record (EMR) and claims database. Early referral to SO was defined as visit &lt; 3 months after diagnosis of advanced disease, delayed referrals &gt; 3 months and late consults as &lt; 30 days from death. We used descriptive statistics to describe patients’ sociodemographics, clinical characteristics and healthcare utilization. Multinomial logistic regression analysis was utilized to evaluate how patient characteristics influenced the timing of referrals. To examine the effects of late referral on inpatient (IP) and intensive care unit (ICU) stay durations, we applied a hurdle model. Results: Total sample included 1229 patients; majority had ECOG &lt; 2 and received one line of treatment at time of consult, 87% had solid tumors, of whom 74% had stage 4 disease. The solid tumors most referred were gastrointestinal cancers (25%), lung cancer (14%) and head and neck cancers (13%). Early referral rates across cancer groups differed significantly 53% Head and Neck, 48% GI, 46% Lung, 43% GYN, 29% GU, 11% Breast, and 31% Other (p &lt; 0.001). The most common reason for referral was physical symptom management (98%). The median ESAS symptom burden was 5 (range 0-10) symptoms. At time of analysis, 431 (35.1%) patients had died of which 256 (59%) were in-hospital deaths. Of the deceased patients, late referral ( &lt; 30 days from death) showed a trend, although not statistically significant, toward higher in-hospital mortality rates, (Odds Ratio: 1.13; 95% CI: 0.57-2.24), and a trend toward reduced likelihood of hospice enrollment(Odds Ratio: 0.73; 95% CI: 0.36-1.49). Notably, late referral significantly increased the duration of IP stays (p &lt; 0.001) and ICU stays (p = 0.004) in last 30 days of life, without change in admission to IP (p = 0.68) or ICU (p = 0.86). Conclusions: The delivery of the guideline-directed "early” consult among patients with advanced cancer is variable. Preliminary analysis showed a trend towards higher in-hospital mortality rates and lower hospice referral for patients referred &lt; 30 days from death among “late” consults. Further subgroup analysis is ongoing. [Table: see text]
Risk assessment of myelosuppression with PARP inhibitors in prostate cancer: Insights from FAERS.
Authors: Karan Jatwani, Mayur Sarangdhar, Venkatesh Kolli, Atulya Aman Khosla, Dharmesh Gopalakrishnan
Journal: Journal of Clinical Oncology (2024)

12144 Background: DNA damage repair defects are prevalent in 15% of Prostate cancer. FDA has approved four PARP inhibitors to be used for metastatic castration resistant prostate cancer (mCRPC). Based on the approvals, currently Olaparib, Niraparib, Rucaparib and Talazoparib have been approved alone or in combination with an Androgen receptor pathway inhibitor (ARPI). All these agents have myelosuppressive (MS) events . We aimed to assess the pharmacovigilance (PV), reporting rate, and reaction outcomes of different approved PARP inhibitors in the mCRPC setting reported to the United States Food and Drug Administration Adverse Event Reporting System (FAERS). Methods: We analyzed MS events in 2,137 patients on PARP inhibitors. MS event reports were submitted to FAERS between 2004-2023 and analyzed using the AERS Mine framework. MS incidences were analyzed within different PARP inhibitors utilized for prostate cancer. Our primary composite endpoint was the PV of MS caused by olaparib, rucaparib, niraparib and talazoparib for the treatment of mCRPC. PARP inhibitors were analyzed as mutually exclusive cohorts. Standard PV metrics were used to determine MS association with PARP inhibitors and two-way ANOVA testing was used to evaluate for statistical significance across the treatment groups. Results: 2,137 prostate cancer patients on PARP inhibitors were identified. MS events (n=677)– olaparib (227/831, 27.32%), rucaparib (n = 171/495, 34.55%), niraparib (63/111, 56.76%), and talazoparib (34/47, 72.34%). MS events were further categorized into five classes – anemia (n = 311, 45.94%), leukopenia (n = 123, 18.17%), thrombocytopenia (n = 107, 15.81%), pancytopenia (n = 102, 15.07%), and myelodysplastic syndrome (MDS) or Acute Myeloid Leukemia (AML, 34, 5.02%). Anemia rates across the four cohorts were identical (table). Leukopenia rates were highest in talazoparib cohort (27.66%). Thrombocytopenia rates were highest in niraparib cohort (24.32%). For pancytopenia, rates were highest in talazoparib 10.64%. MDS/AML rates were Talazoparib (2.13%), Olaparib (1.8%). The relative rates of MS events were significantly different across the PARP inhibitors (p &lt; 0.05, Table). Conclusions: This is the first study specific to prostate cancer analyzing the relative rates of MS events across different PARP inhibitors. Talazoparib exhibited the highest incidence of myelosuppression. This underscores the careful patient selection and vigilant monitoring needed in PARP inhibitors. Prompt recognition of myelosuppression is needed to optimize the safety and efficacy of PARP inhibitor therapies in prostate cancer. [Table: see text]
LC3AB protein-based gene (PbG) signatures as an indicator of relapse even after achieving pathological complete response.
Authors: Sandeep K. Singhal, Kevin Gardner
Journal: Journal of Clinical Oncology (2024)

e12552 Background: The application of tissue-based quantitative protein and morphological profiling of breast cancer tissues combined with RNA sequencing provides a flexible and generally applicable and scalable method to develop Protein-based Gene (PbG) signatures with significant prognostic value. Methods: A racially and subtype diverse breast cancer cohort (N=555) with available subset of RNA-seq data was used to develop gene expression-based signatures by stratifying patients according to protein expression (IHC) based on survival information and tumor lymphocyte infiltration (TILs) using survival-derived cutoff values. The predictive value of these signatures was then compared with other popular biomarkers scoring systems such as ROR.score, and OncotypeDx (Gene 21). Here we describe the predictive value of these signatures is evaluated by logistic regression modeling of publicly available gene expression data (N=996) from patients receiving neoadjuvant chemotherapy (anthracycline +/- taxane) with a final validation in an independent cohort (N=443) receiving similar therapy. Results: A model of PbG-derived signature from Kaiso, LC3A/B IHC and quantitative TIL-measurements together with ROR score, MAPK, PTEN, Immune and Gene21 signatures show significant prediction of distant metastasis-free survival in all patients: (DMFS, AUC= 0.737, 95% CI: 0.665- 0.819); and in non-pCR patients DMSF (AUC= 0.71, 95% CI: 0.633-0.773). When examining the role of all those markers among the patients who achieved the pCR and had relapse, the LC3A/B PbG-derived score was found to be highly predictive of those patients who would not achieve pCR and ultimately have recurrent disease. Conclusions: PbG-based signatures utilizing on LC3A/B protein values offer a novel and clinically relevant predictive biomarker of response to therapy and relapse in breast cancer patients.
Can narrative medicine methods improve well-being in patients with gastrointestinal malignancy?
Authors: Eve Louise Makoff, Rabia Rehman, Ming Li, Syma Iqbal
Journal: Journal of Clinical Oncology (2024)

e24091 A Pilot study - Can Narrative Medicine Methods Improve Well-being in Patients with Gastrointestinal Malignancy? Background: Patients with cancer often face profound physical and emotional challenges. Narrative medicine methods, involving discussions of and writing about creative texts, are utilized to help healthcare providers improve communication and process emotional experiences which, unexplored, may lead to poor well-being. We apply the narrative medicine method to patients with GI malignancies. Methods: The endpoints of this pilot study were feasibility - 7/10 participants completing 2 out of 3 sessions, and assessing the benefit of applying the practice to optimize well-being. 10 patients were identified by a single oncologist at USC/Norris cancer center to undergo three narrative medicine sessions. Sessions addressed themes relevant to well-being: Identity, Meaning making, and Finding joy. A survey with Likert scales (1-5) and free text answers, as well as interviews, were administered. Content analysis was done. ESAS scales were administered before sessions. Results: 7 of 10 patients have been assessed, completing all three sessions.Surveys were administered after session 3, interviews 1 month later. 5 was the most popular Likert choice. 7/7 chose a 5 for feeling comfortable and learning about themselves. In free text answers, 6/7 patient responses reflected themes of enhanced self-reflection, 2/7 improved perspective-taking, and 3/7 enhanced empathy for others. 1/7 said the sessions gave them hope for medical research, and 1/7 noted the sessions helped them tolerate chemotherapy. ESAS scores trending in a positive direction included pain, drowsiness, nausea, anxiety, and well-being. The interviews elicited the following themes: 7/7 noted the narrative medicine experience had been enjoyable, 6/7 noted enhanced meaning-making meaning and perspective-taking. 3/7 noted the sessions made them feel more positively about their healthcare experiences and helped them embrace their identities outside of cancer. 3/7 said the sessions improved their empathy for others. Other individual themes were: the sessions gave them hope, helped with self-reflection, encouraged seeking new experiences, helped them accept circumstances, enhanced connection to creativity and spirituality, and improved their ability to connect to others. Conclusions: This narrative medicine pilot project was feasible and patients were able to complete the assessment. The evaluative scores demonstrated that all participants felt comfortable participating. Additionally, the patients noted benefits related to well-being including but not limited to improved capacity for self-reflection, putting things in perspective, meaning-making, and noticing moments of joy. A larger study is planned to assess the benefits of this approach for patient well-being and clinical outcomes.
Cardio-Oncology Awareness: A multidisciplinary survey amongst health care trainees and practicing professionals at academic institutions.
Authors: Shruti Bansal, Shagun Misra, Rupali Khanna, Punita Lal, Satya Sadhan Sarangi, Aditya Kapoor, Shaleen Kumar
Journal: Journal of Clinical Oncology (2024)

e24023 Background: The awareness of cancer therapy-related adverse cardiac effects is incited by recent literature on cardiotoxicity incidence and detection strategies. Despite availability of guidelines, cardiotoxicity monitoring and treatment are not structurally performed across institutions. Aim: Assessing knowledge of health care professionals’ cardiac complications of cancer treatments, current perspectives on cardio-oncology ultimately to determine an agenda for improvements in practice. Methods: A web-based survey (Google Forms) was adapted from that of Ottawa Hospital Research Institute’s survey, consisting of 45 questions organized into 7 sections, modified according to our local needs and circulated to cardiologists, oncologists (radiation, medical) practicing or training in a multi-disciplinary setup and academic centers. Fortnightly reminders were sent for to receive a maximum response. The survey enquired about implementing respondent’s perception of cardio-oncology, availability of cardio-oncology services at the respondent’s institution, opinions towards current practice. A descriptive statistical analysis was carried out. Results: Fifty-five professionals completed the survey, of which 12 were cardiologists, 31 radiation oncologists, and 12 medical oncologists. Majority, 31 (54.5%) were trainees and only 1.8% had some formal training in cardio-oncology while 20% respondents reported to have a formal cardio-oncology training programme. Nearly 90% understood cardio-oncology as a stream to be able to identify side-effects and refer for treatment to the cardiologists while 84% felt that timely referral would improve outcomes.72% recognized follow-up and 67.3% felt patient education to be important component. Awareness of cardio-oncology guidelines was reported by 38.2% respondents. In the setting of metastatic cancer, there was a difference in risk tolerance for cardiotoxicity with the majority accepting 1-5% risk in curative setting and 56% accepting &gt; 5% risk of cardiotoxicity in the metastatic setting. None of the institutions reported on having a formal training programme. Limited infrastructure (54.5%) and limited interest (47.3%) were cited the most common reasons. Conclusions: This survey identified that professionals recognize cardio-oncology services to be an important component of cancer treatment. Lack of formal training and awareness about guidelines was reported. There is a felt need for collaboration between cardiologists and oncologists to improve cardiovascular outcomes of cancer patients.
Implementation of a palliative care service in a tertiary hospital in a developing country: Methods, strategies and results.
Authors: Cecilia Emerick Mendes, Daniela Chimeli, Merian Albuquerque, Tamina Ferreira, Simone Carvalho, Carolina Alves Ribeiro, Sarah Ananda Ananda Gomes
Journal: Journal of Clinical Oncology (2024)

e24056 Background: In Rio de Janeiro, only 11 palliative care facilities exist, creating challenges in meeting the complex needs of patients with metastatic cancer. Our study aims to implement a palliative care service within an existing oncology practice. This approach holds promise as a model that could guide similar practices in low- and middle-income countries, offering a blueprint for the implementation of palliative care services on a broader scale. Methods: This descriptive study spans from February to December 2023, involving the monitoring of 176 patients. Eligible patients met criteria such as a FAST scale for dementia syndrome ≥ 7A, stage IV disease, ranking 5 stroke, terminal organic failure, uncontrolled symptoms, or requiring end-of-life care. The PC team, denoted as “Continued Care”, comprises a medical leader, 3 routine doctors, and 1 nurse. Activities undertaken by the team encompass consults requested by internal medicine and intensive care unit (ICU) teams, outpatient care, continuous education, and daily monitoring of patients with advance care plan (ACP). Results: Among 176 patients initially enrolled, outcomes were completed for 171 patients. Remarkably, 80% of those receiving PC assistance had an ACP in place, with 78% opting for exclusive non-invasive support. The overall death rate was 38%. Notably, among patients enrolled in the PC program, the ICU death rate was 31%. Conclusions: Institutional PC policies associated with the integration of a dedicated team into the hospital's routine, and investments in disseminating knowledge about irreversible illness processes and comfort strategies, emerge as a pivotal component in establishing a comprehensive and integrated model of PC services. This approach appears to surpass the effectiveness of traditional consult or sectorized model, emphasizing the importance of an institutionalized and holistic framework for delivering quality PC.
Efficacy and safety of sacituzumab govitecan in HR+/HER2– advanced breast cancer: A comprehensive systematic review and meta-analysis.
Authors: Zaheer Qureshi, Abdur Jamil, Faryal Altaf, Rimsha Siddique
Journal: Journal of Clinical Oncology (2024)

e13085 Background: Breast cancer is the most commonly diagnosed cancer in women, with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2–) being the predominant subtype. Sacituzumab govitecan, a novel antibody-drug conjugate, has emerged as a promising treatment for metastatic HR+/HER2– breast cancer. The aim of this systematic review and meta-analysis was to evaluate its efficacy and safety. Methods: Adhering to PRISMA guidelines, a comprehensive search was conducted in PubMed, Scopus, and Cochrane databases up to December 2023. We included clinical trials and observational studies evaluating sacituzumab govitecan in patients with HR +/HER2–advanced breast cancer. The primary outcome was progression-free survival (PFS), while the secondary outcomes included overall survival (OS), objective response rate (ORR), clinical benefit rate (CBR), duration of response (DOR), and adverse event profiles. Various statistical models were used for the analysis. Results: Nine studies met the inclusion criteria, and three were suitable for meta-analysis. The pooled analysis showed a Hazard Ratio (HR) of 0.57 for PFS, indicating a significant reduction in disease progression, and an HR of 0.68 for OS, suggesting improved survival. The treatment also significantly increased the likelihood of tumor response and clinical benefit but was associated with a higher occurrence of adverse events. Conclusions: Sacituzumab govitecan demonstrated significant efficacy in treating HR+/HER2– advanced breast cancer, reducing disease progression and mortality. However, its use is associated with a high rate of adverse events. These findings highlight the potential of Sacituzumab govitecan as a valuable addition to breast cancer treatment regimens, warranting further investigation and long-term studies.