Oncology Commons^™

Ethnic Differences In Germline Genetic Testing For Breast Cancer, Kathryn Dent, Rebecca J. Jaslow, Md

Phase 1

Introduction: Ethnic variations in uptake of genetic testing and differences in findings of germline mutations within ethnic groups, are not well understood. The goal of this research is to assess for any such differences or similarities within a genetic counseling and testing program at an urban Cancer Center.

Methods: This is a non-comparative, descriptive epidemiology study assessing individuals with a diagnosis of breast cancer undergoing genetic counseling at the TJUH Sidney Kimmel Cancer Center in Philadelphia between 2014 and 2019. Data were compiled onto Research Electronic Data Capture (REDCAP) and analyzed statistically.

Results: Patients with Breast Cancer (n=1075) were included …

The Financial And Psychosocial Impact Of Medicinal Cannabis, Chris Ahmed, Andrew Lee, Amanda Campbell, Gregory Garber, Msw, Lcsw, Neil D. Palmisiano, Md, Brooke Worster, Md

Phase 1

Introduction: Therapeutic utilization of medicinal cannabis for symptom management in oncology patients is a burgeoning area of research focus. We hypothesize that medicinal cannabis use can result in subjective improvements in quality of life (QOL) metrics for cancer patients.

Methods: Adult palliative care patients at a medical oncology clinic are consented to the study after being certified to access medicinal cannabis. After three months, subjective changes in QOL, including well-being, financial burden, pain, chemotherapy induced nausea and vomiting (CINV), and other categories are recorded via telephone interview. Responses are documented with a numerical Likert scale (from 1-5, with a score …

The Financial And Psychosocial Impact Of Medicinal Cannabis, Andrew Lee, Chris Ahmed, Amanda Campbell, Gregory Garber, Msw, Lcsw, Neil D. Palmisiano, Md, Brooke Worster, Md

Phase 1

Introduction: The use of medicinal cannabis for symptom management in cancer patients is a growing area of clinical interest. Past studies have demonstrated cannabis’s potential as an antiemetic and analgesic, but there is still much research to be done on its clinical efficacy. Our study hypothesizes that cancer patients using medicinal cannabis experience subjective improvements in pain, chemotherapy-induced nausea and vomiting (CINV), and quality of life (QOL) that justify related out-of-pocket costs.

Methods: Cancer patients are surveyed by phone three to six months after certification for access to medicinal cannabis. The survey assesses patient-reported changes in pain, CINV, QOL, and …

Pre-Clinical Models Of Small Cell Lung Cancer And The Validation Of Therapeutic Targets, Jane S.Y. Sui, Petra Martin, Steven G. Gray

Articles

Introduction: Small-cell lung cancer (SCLC) is an aggressive form of lung cancer that has a dismal prognosis. One of the factors hindering therapeutic developments for SCLC is that most SCLC is not surgically resected resulting in a paucity of material for analysis. To address this, significant efforts have been made by investigators to develop pre-clinical models of SCLC allowing for downstream target identification in this difficult to treat cancer.

Areas covered: In this review, we describe the current pre-clinical models that have been developed to interrogate SCLC, and outline the benefits and limitations associated with each. Using examples …

The Effects Of Autophagy And Senescence On Sensitivity To Cisplatin In Head And Neck Cancer, Zara H. Siddiqui

Theses and Dissertations

While current treatments in cancer, such as chemotherapy and radiation, can generally be effective in eliminating disease in patients, there also exists the possibility of recurrence of cancer cells over time. In patients diagnosed with locally advanced head and neck carcinoma, about 50-60% develop a loco-regional recurrence within two years, and 20-30% of patients develop metastatic disease at distant sites in the body [5]. On a cellular level, one mechanism for this survival may be that natural mechanisms such as autophagy and senescence play a role in allowing cells to survive after undergoing treatment. One standard of care chemotherapy for …

An Outcome Assessment Of A Single Institution's Longitudinal Experience With Uveal Melanoma Patients With Liver Metastasis., Rino S. Seedor, David J. Eschelman, Carin F. Gonsalves, Robert D. Adamo, Marlana Orloff, Anjum Amjad, Erin Sharpe-Mills, Inna Chervoneva, Carol L. Shields, Jerry A. Shields, Michael Mastrangelo, Takami Sato

Department of Medical Oncology Faculty Papers

There is no FDA-approved treatment for metastatic uveal melanoma (UM) and overall outcomes are generally poor for those who develop liver metastasis. We performed a retrospective single-institution chart review on consecutive series of UM patients with liver metastasis who were treated at Thomas Jefferson University Hospital between 1971–1993 (Cohort 1, n = 80), 1998–2007 (Cohort 2, n = 198), and 2008–2017 (Cohort 3, n = 452). In total, 70% of patients in Cohort 1 received only systemic therapies as their treatment modality for liver metastasis, while 98% of patients in Cohort 2 and Cohort 3 received liver-directed treatment either alone …

Individual And Joint Effects Of Metformin And Statins On Mortality Among Patients With High-Risk Prostate Cancer., Xiang-Lin Tan, Jian-Yu E, Yong Lin, Timothy R Rebbeck, Shou-En Lu, Mingyi Shang, William K Kelly, Anthony D'Amico, Mark N Stein, Lanjing Zhang, Thomas L Jang, Isaac Yi Kim, Kitaw Demissie, Anna Ferrari, Grace Lu-Yao

Department of Medical Oncology Faculty Papers

BACKGROUND: Pre-clinical studies suggest that metformin and statins may delay prostate cancer (PCa) metastases; however, data in humans are limited. To the best of our knowledge, this is the first human study aimed to quantify the individual and joint effects of statin and metformin use among patients with high-risk PCa.

METHODS: This population-based retrospective cohort study identified patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Exposure to metformin and statins was ascertained from Medicare Prescription Drug Event files. The association with all-cause and PCa mortality were evaluated using Cox proportional hazard model with competing causes of death, …

Caring For Young Adults With Cancer: A Systematic Review, Sarah M. Pelletier

All Graduate Theses, Dissertations, and Other Capstone Projects

Young adulthood is unique period of life in which critical developmental milestones are achieved amid dynamic physical, emotional, and social changes. During this period of life, young adults are charged with establishing personal and social independence. When challenged with a cancer diagnosis, the already turbulent late teens, twenties, and thirties are dramatically and permanently altered. Hence, the needs of young adults vary from that of their pediatric and older adult counterparts. The aim of this systematic review of the literature was to identify what age-specific needs must be addressed by healthcare professionals to enhance quality of care and outcomes for …

The Effect Of Interventions On Radiotherapy-Induced Skin Toxicity: A Systematic Review, Claudia R. Figueroa

Honors Undergraduate Theses

Various studies show a variety of interventions for radiotherapy-induced skin toxicity. Radiotherapy-induced skin toxicity is the most common side effect for women with breast cancer who undergo radiotherapy sessions. Intervention agents include topical creams, barrier films, oral agents, as well as laser therapy. However, despite the variety of intervention agents available, there is still a lack of accepted guidelines to manage radiotherapy-induced skin toxicity. This thesis aims to conduct a systematic review and meta-analysis of published randomized controlled trials with the primary purpose of exploring the available intervention methods to prevent radiotherapy-induced skin toxicity and evaluate the effects of different …

The Impact Of Age On Survival In Cll Patients Receiving Ibrutinib As Initial Therapy., Chaitra Ujjani, Anthony Mato, Brian T Hill, John N Allan, Frederick Lansigan, Ryan Jacobs, Alan Skarbnik, Hande Tuncer, John M Pagel, Danielle Brander, Bruce Cheson, Paul Barr, Lindsey E Roeker, Jeffrey Pu, Nirav N Shah, Andre Goy, Stephen J Schuster, Nicole Lamanna, Alison Sehgal, Constantine S Tam, Mazyar Shadman

Articles, Abstracts, and Reports

Introduction: Recent randomized trials have demonstrated the efficacy of ibrutinib-based therapy in the treatment of patients with CLL. In Alliance A041202, a higher than expected number of unexplained deaths were reported with front-line ibrutinib in a patient population aged at least 65 years compared to ECOG 1912, which included patients up to 70 years of age.

Methods: Therefore, we conducted a retrospective analysis to investigate whether ibrutinib was associated with a greater mortality in older patients outside of a clinical trial setting. This multicenter analysis was performed by investigators at 20 academic and community practices.

Results: Amongst the 391 patients …

Cri Iatlas: An Interactive Portal For Immuno-Oncology Research., James A Eddy, Vésteinn Thorsson, Andrew E Lamb, David L Gibbs, Carolina Heimann, Jia Xin Yu, Verena Chung, Yooree Chae, Kristen Dang, Benjamin G Vincent, Ilya Shmulevich, Justin Guinney

Articles, Abstracts, and Reports

The Cancer Research Institute (CRI) iAtlas is an interactive web platform for data exploration and discovery in the context of tumors and their interactions with the immune microenvironment. iAtlas allows researchers to study immune response characterizations and patterns for individual tumor types, tumor subtypes, and immune subtypes. iAtlas supports computation and visualization of correlations and statistics among features related to the tumor microenvironment, cell composition, immune expression signatures, tumor mutation burden, cancer driver mutations, adaptive cell clonality, patient survival, expression of key immunomodulators, and tumor infiltrating lymphocyte (TIL) spatial maps. iAtlas was launched to accompany the release of the TCGA …

Incidence Of Female Breast Cancer In The United States By Race And Region, Tiffany Le

Scholarship in Medicine - All Papers

Objective: Assess the distribution and incidence of female breast cancer in the United States in different races and regions of the United States. Methods: Collect and analyze CDC WONDER data from the Center for Disease and Control to see if there are varying rates of female breast cancer incidence between races and in different regions of the United States. Results: The results are expected to show a significant difference in female breast cancer incidence between races and a non-significant difference in female breast cancer incidence among different regions of the United States.

Long-Term Survival Of Bladder Cancer Metastatic To Femoral Neck Treated With Chemotherapy, Radiation, And Arthroplasty: A Case Report, John Defant, Scott Huff, Joseph D. Henningsen, Anil Krishnamurthy

Scholarship in Medicine - All Papers

Case: A 64-year-old male suffered a pathologic left femoral neck fracture. Biopsy demonstrated metastatic urothelial cancer with a non-muscle invasive bladder cancer primary confirmed by cystoscopy. Patient underwent hemiarthroplasty, chemotherapy, radiation, and eventually, a conversion to total hip arthroplasty. Today, over a decade from initial surgery, the patient remains alive and highly functional. To our knowledge, this is the only report of bone metastatic bladder cancer with over 10-year survival. Conclusion: Bladder cancer metastatic to bone has a 5-year survival rate of 3%. Surgical resection of metastasis with reconstruction may confer a survival benefit in bony oligometastatic bladder cancer.

Diffuse Intrasinusoidal Hepatic Metastasis From Breast Cancer Presenting As Liver Failure: Effective And Rapid Treatment With Weekly Low-Dose Adriamycin, Thanh-Phuong N. Afiat, Timothy N. Hembree, Erin A. Dean, Cyrillo Araujo, Luis R. Pena, Marilin Rosa, Hyo S. Han, Kaitlin Hendrix, Asha Ramsakal

Oncologic Sciences Faculty Publications

Background: Hepatic metastasis is well known in breast cancer. Approximately 12–20% of breast cancer patients will develop liver metastasis, which usually presents as discrete mass lesions. Rarely, metastatic spread can be so diffuse that it is unidentifiable on imaging but can progress to fulminant hepatic failure. Our case report suggests that clinicians need to have a high index of suspicion when patients present with rapidly decompensating liver failure in the absence of discrete radiologic hepatic lesions, and that weekly Adriamycin should be considered as a first-line therapeutic option.

Case Report: A 28-year-old African American woman with a history of locally …

Observational Study Of Talimogene Laherparepvec Use In The Anti-Pd-1 Era For Melanoma In The Us (Cosmus-2), James Sun, Brian R. Gastman, Lucy Mccahon, Elizabeth I. Buchbinder, Igor Puzanov, Michele Nanni, James M. Lewis, Richard D. Carvajal, Shahnaz Singh-Kandah, Anupam M. Desai, Leon Raskin, Carrie M. Nielson, Rubina Ismail, Jonathan S. Zager

Oncologic Sciences Faculty Publications

Aim: Talimogene laherparepvec (T-VEC) is an intralesional therapy for unresectable, metastatic melanoma. T-VEC real-world use in the context of anti-PD1-based therapy requires further characterization.

Materials & methods: A retrospective review of T-VEC use from 1 January 2017 and 31 March 2018 for melanoma patients was conducted at seven US institutions.

Results: Among 83 patients, three categories of T-VEC and anti-PD-1 therapy were identified: T-VEC used without anti-PD-1 (n = 29, 35%), T-VEC after anti-PD-1-based therapy (n = 22, 27%) and concurrent T-VEC and anti-PD-1-based therapy (n = 32, 39%). 25% of patients discontinued T-VEC therapy due to no remaining injectable …

High Lymph Node Positive To Sampled Ratio As A Potential Indication For Postoperative Radiation Therapy In Patients With Pn2 Non-Small-Cell Lung Cancer, Nikhil P Mankuzhy, Muayad F Almahariq, Craig W Stevens, Thomas J Quinn

Articles

Background: The role for postoperative radiation therapy (PORT) for patients with non–small-cell lung cancer (NSCLC) with mediastinal lymph node (LN) involvement (pN2 disease) is controversial. We performed a SEER analysis comparing surgery alone with PORT among patients with pN2 NSCLC. As we await the final results of the LUNG ART trial, a subset of patients with a high LN positive to sampled (LPR) ratio may benefit from PORT. Patients/methods: Patients with pN2 NSCLC, ranging from 1989-2016, were assessed from the Surveillance, Epidemiology and End Results (SEER) database. A propensity score (PS)-matched, inverse probability of treatment weighting (IPTW) analysis was conducted …

The Association Between Testicular Cancer And Female Reproductive Cancers: A Systematic Review, Alyssa Church

Honors Undergraduate Theses

The most common neoplasm found in young to middle-aged men is testicular cancer (TCa). This disease not only poses a risk of early death, but can also affect a male's fertility and testosterone levels and can diminish one's mental health and/or quality of life. One particular line of research that is emerging in the field is a possible genetic association of TCa with female reproductive cancers. We employed a systematic review to assess the methodological quality of articles that met the inclusionary criteria. To be selected for this review, articles had to go through a primary, secondary, and tertiary screening …

Treating Hematologic Malignancies During A Pandemic: Utilizing Telehealth And Digital Technology To Optimize Care., Adam F Binder, Nathan R Handley, Lindsay Wilde, Neil Palmisiano, Ana Maria Lopez

Department of Medical Oncology Faculty Papers

In late January 2020, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) was reported as an outbreak in Wuhan, China. Within 2 months it became a global pandemic. Patients with cancer are at highest risk for both contracting and suffering complications of its resultant disease, Coronavirus 19 (COVID-19). Healthcare systems across the world had to adapt quickly to mitigate this risk, while continuing to provide potentially lifesaving treatment to patients. Bringing care to the home through the use of telehealth, home based chemotherapy, and remote patient monitoring technologies can help minimize risk to the patient and healthcare workers without sacrificing quality …

Recent Advances In The Understanding And Management Of Primary Hyperparathyroidism., Melanie Goldfarb, Frederick R Singer

Articles, Abstracts, and Reports

Primary hyperparathyroidism is a hormonal disorder whose prevalence is approximately 1-2% in the United States of America. The disease has become more recognizable to clinicians in an earlier phase and, at present, patients can be diagnosed with "classic", "normocalcemic", "normohormonal", or "mild, asymptomatic" primary hyperparathyroidism. Surgery, with a focused parathyroidectomy when possible, or a four-gland exploration, is the only way to cure the disease. Cure is determined by use of intra-operative parathyroid hormone monitoring with long-term cure rates ranging from 90-95%. Newer adjuncts to surgery include CT or PET imaging and near-infrared immunofluorescence. This article highlights updates in parathyroid disease …

Aml Risk Stratification Models Utilizing Eln-2017 Guidelines And Additional Prognostic Factors: A Swog Report., Era L Pogosova-Agadjanyan, Anna Moseley, Megan Othus, Frederick R Appelbaum, Thomas R Chauncey, I-Ming L Chen, Harry P Erba, John E Godwin, Isaac C Jenkins, Min Fang, Mike Huynh, Kenneth J Kopecky, Alan F List, Jasmine Naru, Jerald P Radich, Emily Stevens, Brooke E Willborg, Cheryl L Willman, Brent L Wood, Qing Zhang, Soheil Meshinchi, Derek L Stirewalt

Articles, Abstracts, and Reports

Background: The recently updated European LeukemiaNet risk stratification guidelines combine cytogenetic abnormalities and genetic mutations to provide the means to triage patients with acute myeloid leukemia for optimal therapies. Despite the identification of many prognostic factors, relatively few have made their way into clinical practice.

Methods: In order to assess and improve the performance of the European LeukemiaNet guidelines, we developed novel prognostic models using the biomarkers from the guidelines, age, performance status and select transcript biomarkers. The models were developed separately for mononuclear cells and viable leukemic blasts from previously untreated acute myeloid leukemia patients (discovery cohort,

Results: Models …