The Society of Thoracic Surgeons/American Society for Radiation Oncology Updated Clinical Practice Guidelines on Multimodality Therapy for Locally Advanced Cancer of the Esophagus or Gastroesophageal Junction

Outcomes for patients with esophageal cancer have improved over the last decade with the implementation of multimodality therapy. There are currently no comprehensive guidelines addressing multidisciplinary management of esophageal cancer that have incorporated the input of surgeons, radiation oncologists, and medical oncologists. To address the need for multidisciplinary input in the management of esophageal cancer and to meet current best practices for clinical practice guidelines, the current guidelines were created as a collaboration between The Society of Thoracic Surgeons (STS), American Society for Radiation Oncology (ASTRO), and the American Society of Clinical Oncology (ASCO). Physician representatives chose 8 key clinical questions pertinent to the care of patients with locally advanced, resectable thoracic esophageal cancer (excluding cervical location). A comprehensive literature review was performed identifying 227 articles that met the inclusion criteria covering the use of induction chemotherapy, chemotherapy vs chemoradiotherapy before surgery, optimal radiation dose, the value of esophagectomy, timing of esophagectomy, the approach and extent of lymphadenectomy, the use of minimally invasive esophagectomy, and the value of adjuvant therapy after resection. The relevant data were reviewed and voted on by the panel with 80% of the authors, with 75% agreement on class and level of evidence. These data were then complied into the guidelines document.

The Society of Thoracic Surgeons/American Society for Radiation Oncology Updated Clinical Practice Guidelines on Multimodality Therapy for Locally Advanced Cancer of the Esophagus or Gastroesophageal Junction

Outcomes for patients with esophageal cancer have improved over the last decade with the implementation of multimodality therapy. There are currently no comprehensive guidelines addressing multidisciplinary management of esophageal cancer that have incorporated the input of surgeons, radiation oncologists, and medical oncologists. To address the need for multidisciplinary input in the management of esophageal cancer and to meet current best practices for clinical practice guidelines, the current guidelines were created as a collaboration between The Society of Thoracic Surgeons (STS), American Society for Radiation Oncology (ASTRO), and the American Society of Clinical Oncology (ASCO). Physician representatives chose 8 key clinical questions pertinent to the care of patients with locally advanced, resectable thoracic esophageal cancer (excluding cervical location). A comprehensive literature review was performed identifying 227 articles that met the inclusion criteria covering the use of induction chemotherapy, chemotherapy vs chemoradiotherapy before surgery, optimal radiation dose, the value of esophagectomy, timing of esophagectomy, the approach and extent of lymphadenectomy, the use of minimally invasive esophagectomy, and the value of adjuvant therapy after resection. The relevant data were reviewed and voted on by the panel with 80% of the authors, with 75% agreement on class and level of evidence. These data were then complied into the guidelines document.

Abstract P2-14-03: Novel visualization tools to search ongoing clinical trials and track trial results for metastatic breast cancer

Metastatic breast cancer (MBC) remains a terminal illness and is the cause of virtually all breast cancer deaths. The median survival for patients with MBC in the US is approximately 3 years from time of stage IV diagnosis. People living with MBC are in urgent need of new treatment options once current therapies no longer keep the disease under control. Access to new treatments is often through clinical trials. We have developed a novel way to visualize active clinical trials and track trial results. Methods: Clinical trials were queried from Clinicaltrials.gov and the National Cancer Institute. Trials were categorized by breast cancer subtype, line of therapy, hallmark of cancer, sponsor, phase, sample size and compound. A bubble chart was created to display data triplets (x, y, z) corresponding to three continuous variables: x and y to define the position, and z, the radius of each bubble. In our example, x and y coordinates are optimized according to an algorithm that essentially balances the bubble's gravity (i.e., action of moving towards the center of the plot), friction (i.e., velocity decay) and charge (or repulsion/attraction force). This layout is frequently used for network visualization. In addition to x, y and z, it is possible to encode other information. Results: We identified 204 clinical trials actively recruiting patients with MBC. The current webpage (www.mbcalliance.org) displays clinical trial data from 204 clinical trials in six different ways. Trials actively recruiting patients will be updated quarterly. In addition to data triplets (x, y and z) we encoded other information about trials using a color code to add three additional dimensions: phase, breast cancer subtype and sponsor type. When a user hovers over a bubble, key information about the clinical trial extracted from Clinicaltrials.gov is displayed. When a user clicks on the bubble, the user is directed to the corresponding landing page at BreastCancerTrials.org to access detailed trial information. We are employing a similar coding scheme and display characteristics for completed clinical trials results. Conclusions: We have developed a user-friendly, web tool to quickly sort and visualize ongoing clinical trials and results for completed trials to benefit both MBC patients and research scientists.

Citation Format: Kumar M, Kissoon K, Abdulai AR, De La Torre K, Flowers M, Cohen E, Colen S, Mercier JB, Hurlbert M. Novel visualization tools to search ongoing clinical trials and track trial results for metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-14-03.