Compass Oncology

Newberg, OR, United States

Compass Oncology

Newberg, OR, United States
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Sonpavde G.,Comprehensive Cancer Center | Bhor M.,Health-U | Hennessy D.,Sanofi S.A. | Bhowmik D.,Health-U | And 5 more authors.
Clinical Genitourinary Cancer | Year: 2015

Background Optimal sequencing of cabazitaxel (C) and abiraterone acetate (A) after docetaxel (D) for metastatic castration-resistant prostate cancer (mCRPC) is unclear. We assessed treatment patterns and outcomes in patients with mCRPC receiving different sequences of A or C, or both, after administration of D. Methods Retrospective analysis was conducted of US Oncology Network iKnowMed (iKM) electronic health record (EHR) data to assess patients with mCRPC who received treatment with D and were subsequently treated with C or A, or both, between April 2011 and May 2012. Patients received 2 or 3 drugs: DA, DC, DAC, or DCA. Overall survival (OS) and time to treatment failure (TTF) were analyzed by the Kaplan-Meier method from the start to the end of second-line therapy after administration of D (TTF1) and to the end of combined second- and third-line therapy (TTF2) for 3-drug sequences. Multivariable Cox proportional hazard models evaluated the impact of baseline clinical prognostic factors and treatment sequence on OS and TTF. Results Of 350 patients who were treated with D and subsequent therapies, 183 (52.3%) received DA, 54 (15.4%) received DC, 77 (22.0%) received DCA, and 36 (10.3%) received DAC. In a multivariable analysis, adjusted comparisons suggested that 3-drug sequences were associated with improved OS versus 2-drug sequences (hazard ratio [HR], 0.21; 95% confidence interval [CI], 0.092-0.476; P =.0002). There were no statistically significant differences in OS and TTF for DC versus DA, and OS was significantly greater for DCA versus DAC (HR, 0.13; 95% CI, 0.022-0.733; P =.0210). More cycles of C were administered in DCA than in DAC (median 6 vs. 4; t test P <.0001), whereas the duration of A treatment was similar. Conclusion Administration of 3 agents in the DCA sequence was more optimal for treating mCRPC in this hypothesis-generating study.


Gill S.E.,University Medical Center | Savage K.,Greenville Hospital System University Medical Center | Wysham W.Z.,Oregon Health And Science University | Blackhurst D.W.,Greenville Hospital System University Medical Center | And 2 more authors.
Gynecologic Oncology | Year: 2013

Objective The objective of this study was to determine the cardiac safety of high cumulative doses of pegylated liposomal doxorubicin (PLD) in patients with gynecologic malignancies and the need for routine evaluation of left ventricular ejection fraction (LVEF). Methods Data were collected for all patients treated with PLD with at least one evaluation of LVEF with either Multi-Gated Acquisition (MUGA) scan or echocardiogram from January 2006 to May 2012. Evaluation of LVEF was used to detect PLD-related cardiac toxicity (defined as a decline in LVEF of greater than 10% compared to baseline measurements). Results A total of 141 patients were included. Twenty-two patients were treated with a cumulative dose of 500 mg/m2 or more, and five patients with 1000 mg/m2 or more. Ten patients (7%) had a reduction in LVEF of greater than 10%, 38 had no significant change or increase in LVEF throughout the duration of treatment, and 93 did not require a follow-up evaluation of LVEF. The LVEFs of two patients dropped below 50% at cumulative doses of 1110 mg/m2 and 1670 mg/m2; one began with a baseline of 52%. Conclusions Only one patient had a clinically significant decrease in LVEF at a cumulative dose of 1670 mg/m2, suggesting that PLD does not carry a significant risk of cardiotoxicity, as evidenced by the stability of LVEF even after treatment with large cumulative doses. Routine surveillance of LVEF does not seem to be necessary or cost effective in the absence of other risk factors. © 2013 Elsevier Inc.


Troxell M.L.,Oregon Health And Science University | Griffiths R.,Oregon Kidney and Hypertension Clinic | Schnadig I.,Compass Oncology | Houghton D.C.,Oregon Health And Science University
American Journal of Kidney Diseases | Year: 2013

Clinical diagnosis of amyloidosis may be very challenging because signs, symptoms, and laboratory study results can be highly variable and may overlap with other disease entities. Amyloid has characteristic features on kidney biopsy, involving glomeruli, vessels, and/or interstitium as typically amorphous waxy material that is periodic acid-Schiff pale and Congo Red birefringent under polarized light. Electron microscopy demonstrates characteristic randomly oriented fibrils. However, in rare cases, amyloid may present with atypical morphologic features on kidney biopsy, closely mimicking other histopathologic diagnoses. We present a case of light chain (AL) κ amyloidosis with an unusual inflammatory infiltrate including prominent multinucleated giant cells in the interstitium and at the glomerular hilus. Amyloid was apparent within giant cells on Congo Red staining, as well as on ultrastructural evaluation. Together with prior studies of tumoral nonrenal amyloid and renal amyloid A, we suggest that the amyloid fibril constituents κ and serum amyloid A have some predilection for inciting the rare multinucleated giant cell reaction. © 2013 National Kidney Foundation, Inc.


Tang K.Y.,Legacy Health System | Gardiner S.K.,Devers Eye Institute | Gould C.,Legacy Health System | Osmundsen B.,Legacy Health System | And 2 more authors.
American Journal of Obstetrics and Gynecology | Year: 2012

OBJECTIVE: To compare surgical outcomes for robotic vs laparotomy staging in obese endometrial cancer patients. STUDY DESIGN: This was a retrospective cohort study of patients with body mass index ≥30 kg/m 2 staged in a community gynecologic oncology practice. Patients undergoing robotic staging were compared with historic laparotomy controls. RESULTS: One hundred twenty-nine patients underwent robotic staging, compared with 110 laparotomy patients. The robotic cohort had fewer abdominal wound complications (13.9% vs 32.7%, P <.001), but more vaginal cuff complications (4.7% vs 0%, P =.032). Blood loss was lower in the robotic group (P <.001), as was length of stay (P <.001). Surgical times were longer in the robotic group (P <.001). There was no difference in terms of percentage of patients undergoing pelvic or paraaortic lymph node dissection. CONCLUSION: Robotic staging for endometrial cancer is feasible in obese women, with fewer abdominal wound complications, but more vaginal cuff complications. © 2012 Mosby, Inc.


Dao K.H.T.,Oregon Health And Science University | Solti M.B.,Compass Oncology | Maxson J.E.,Oregon Health And Science University | Winton E.F.,Emory University | And 4 more authors.
Leukemia Research Reports | Year: 2015

Mutations in CSF3R (colony-stimulating factor 3 receptor) are frequent oncogenic drivers in chronic neutrophilic leukemia (CNL) and atypical chronic myeloid leukemia (aCML). Here we describe a 75 year old man who was diagnosed with CSF3R-T618I-positive atypical CML. He presented with leukocytosis, anemia, and thrombocytopenia and developed massive splenomegaly and severe constitutional symptoms. Hydroxyurea was given over a 6 month period but failed to provide any measureable clinical benefit. Eventually, he was treated with ruxolitinib, an FDA-approved JAK1/2 inhibitor, which resulted in dramatic improvement of his blood counts. He also had significant reduction of spleen volume and constitutional symptoms. This case highlights the need for a clinical trial to interrogate JAK1/2 as a potential molecular target in CNL and aCML in patients with or without CSF3R mutation. A clinical trial evaluating the safety and efficacy of ruxolitinib for this patient population is registered at ClinicalTrials.gov (NCT02092324). © 2014 The Authors.


PubMed | Eisai Inc, Yakima Valley Memorial Hospital North Star Lodge Cancer Center, Compass Oncology, Texas Oncology Baylor Charles mmons Cancer Center and 3 more.
Type: Clinical Trial, Phase II | Journal: Clinical breast cancer | Year: 2016

The present phase II, open-label, multicenter study explored the feasibility, safety, and tolerability of eribulin, a novel non-taxane microtubule inhibitor, plus capecitabine as adjuvant therapy.Postmenopausal women with early-stage, human epidermal growth factor receptor 2 (HER2)-negative, estrogen-receptor (ER)-positive breast cancer received four 21-day cycles of treatment with eribulin mesylate (1.4 mg/m(2) intravenously on days 1 and 8 of each cycle) combined with capecitabine (900 mg/m(2) orally twice daily on days 1-14 of each cycle [standard schedule] or 1500 mg orally twice daily using a 7-days on/7-days off schedule [weekly schedule]). Feasibility was determined by the relative dose intensity (RDI) of the combination using prespecified criteria for 80% of patients achieving an RDI of 85%, with a lower 95% confidence boundary > 70%.The mean RDI was 90.6%, and the feasibility rate was 81.3% among women (n = 67, mean age, 61.3 years) receiving the standard schedule and 95.6% and 100% among women (n = 10, mean age 62.3 years) receiving the weekly schedule. Dose reductions, missed doses, and withdrawals due to adverse events (most commonly hand-foot syndrome) ascribed to capecitabine led to a higher RDI (93.5% vs. 87.8%) and feasibility rate (82.8% vs. 71.9%) for eribulin than for capecitabine using the standard dosing schedule. The most common adverse events were alopecia and fatigue.Eribulin plus capecitabine with standard or weekly dosing schedules is feasible in patients with early-stage, HER2-negative, ER-positive breast cancer. Full-dose eribulin (1.4 mg/m(2) on days 1 and 8) with capecitabine (1500 mg orally twice daily, 7 days on/7 days off) is recommended as a regimen for further evaluation.


PubMed | Texas Oncology The U.S. Oncology Network, Rocky Mountain Cancer Centers, Compass Oncology, Health-U and McKesson
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

99 Background: Patients, families and healthcare providers can be apprehensive about having end-of-life (EOL) conversations. However, asking patients about personal values regarding their healthcare goals may create a platform for more in depth conversations. A quantitative instrument to assess patient values and ACP readiness was developed and validated to complement a process for identifying patients appropriate for ACP.Recruitment was conducted at seven cancer center sites in The US Oncology Network over a 90-day pilot study period. Of 871 identified patients, 301 Texas Oncology patients engaged in ACP. A cross-sectional descriptive design was used in 301 metastatic cancer patients. Sixty-three participants completed the questionnaire. The 13-item instrument was created after an extensive literature review regarding EOL choices and interventions using a 5-point Likert scale. Descriptive statistics were examined, in addition to analysis of the relationships between items using Pearsons r correlations.Participants were primarily female (59%) and Caucasian (95%); with a mean age of 66 years. Sixty-eight percent reported it Very Important to be told they were dying. There was a significant association between willingness to discuss feelings about dying and being told by their physician when dying, (r= 0.373, p<0.01). Sixty-two percent reported it Very Important to be able to choose their EOL care location. EOL care location and level of burden for caregivers were significantly associated (r= 0.315, p<0.05). Also, 76% reported being able to select the person who makes EOL decisions for them as Very Important.Recent studies have shown the importance of assessment of patient healthcare values in the metastatic oncology population. The values and readiness instrument allows healthcare providers to understand the patients wishes early in the course of care. ACP can be guided through review of the validated instrument in the adult metastatic population. This provides appropriate weight to both sides of the care equation and is a major step toward creating patient-centered care. Further development of the instrument is needed in this population.


PubMed | Rocky Mountain Cancer Centers, Compass Oncology, Health-U, McKesson and Texas Oncology
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

243 Background: Comprehensive cancer care embraces the concept of having timely discussions with patients about end of life care preferences regarding treatment interventions. Physicians and healthcare teams are frequently challenged with identifying patients who are clinically appropriate for these discussions and subsequent management of ACP work within the context of clinic resource capacity. A data extraction process is needed to systematically identify cancer population subsets for ACP based on clinical data elements maintained within an EHR database.Seven cancer center sites of service participated in a 90-day pilot study for delivering ACP services to discrete patient populations who it was believed would most benefit from ACP. Electronic methodology was developed and tested through the pilot process to systematically identify those patients having documented evidence of designated clinical criteria, including metastatic disease status. Metastatic status was determined using five clinical data elements. EHR technology enabled further targeting by cancer diagnoses and allowed this program to be scalable to individual practice capacity. Additional filtering capability was incorporated to exclude non-applicable patient records.On a weekly basis, each pilot site received a report of eligible patients based on clinical criteria and practice-specific diagnoses. During the 90-day pilot period, sites collectively identified an average of 871 patients per week who met clinically-based selection criteria. Once a patient was identified, physicians were able to determine if the patient was appropriate for ACP introduction. The systematic patient identification process allowed ACP to be easily integrated into mainstream practice workflow.EHR technology is invaluable for strategically identifying cancer patient population subsets for clinically appropriate delivery of ACP services. Automated notification of eligible patients and the ability to filter the population enabled practices to engage the ACP process wholly within the scope of comprehensive cancer care delivery.


PubMed | Texas Oncology The U.S. Oncology Network, Rocky Mountain Cancer Centers, Compass Oncology, Health-U and Texas Oncology
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

22 Background: Addressing advance care planning (ACP) early in metastatic disease is a challenge for providers across oncology. Providing a systematic method to engage providers and patients in these discussions offers opportunities to improve end of life outcomes, improve patient quality of life and engage in shared decision making that supports effective transition to appropriate palliative care and hospice.A multidisciplinary group of oncology providers developed a framework for ACP which included defining a target population for early introduction, utilizing a standard patient-centered measurement tool (Values Assessment), reviewing practice workflow to schedule ACP conversations, and incorporating documentation elements embedded in the electronic health record. The model included physician referral of patients to a nurse practitioner or social worker who scheduled meetings with patients to assess values, assist patients with advance directives (AD), and explore patient end-of-life wishes based on disease. Seven cancer center sites of service engaged in the pilot study for a 90-day period to test tools, workflow and effectiveness of implementation methods. Documented values assessments, code status, and advance directives were pilot outcomes measures.All sites in the pilot study implemented the framework and participated for 90 days. Workflows were validated to support scheduling of ACP conversations. Use of the values assessment tool was slow to be incorporated in ACP process as was physician referral for introduction.Engaging in a systematic approach to gather and assimilate information provides an opportunity to comparatively assess adoption of an ACP program. Providers are not inherently experienced in basic ACP introduction or deeper ACP discussions. Communications training, including conversations for values assessment and ACP, is in development for use with pilot and new practices engaging in the program, which supports program scalability. [Table: see text].


THE WOODLANDS, Texas--(BUSINESS WIRE)--US Oncology Research held its 15th Annual Science Forum earlier this fall. The annual meeting for all US Oncology Research affiliated investigators was held in Dallas and highlighted the importance of clinical trials as a treatment option for cancer patients. “A clinical trial saved my life,” said Rhonda Jenkins, breast cancer survivor, clinical trial participant and patient of Texas Oncology, an affiliate of US Oncology Research. Jenkins shared her story with the hundreds of clinical attendees, including investigators and research coordinators. “The best advice I can give to patients is to not turn down a clinical trial if one is available. I received a terminal diagnosis eleven years ago. Because of a trial, I have my life back. I no longer consider myself as having a terminal disease. Plus, participating in a trial allowed me to play a part in hopefully helping future patients fight this disease,” added Jenkins. The Annual Science Forum allows research investigators to discuss and exchange thoughts on the latest scientific approaches and novel treatment strategies. Topics of discussion included: immunotherapy; the oncology care model; early phase trials; proton therapy; genomics; precision medicine; and much more. "This Forum represents an important form of education for all of us in the cutting-edge, ongoing work in basic and clinical research against cancer,” said Daniel Von Hoff, MD, FACP, chief scientific officer, US Oncology Research. “It helps our team craft strategies for the best way to help our patients.” One strategy used by US Oncology Research is its Selected Trials for Accelerated Rollout, or STAR, method. This program quickly opens clinical trials for difficult-to-find patients. When a potential STAR trial patient has been identified, the practice is trained and the study is opened within a two-week timeframe at the location where the patient is expected to be seen. Ultimately, STAR provides the latest in clinical research to the practice where the patient has been identified. “We are truly delivering tomorrow’s treatments today,” said Michael Seiden, MD, chief medical officer, The US Oncology Network and McKesson Specialty Health. “The Annual Science Forum brings together the leadership of US Oncology Research as we both celebrate our accomplishments and look forward to building an even stronger culture of research across our national network of affiliated physicians and research staff.” During the Forum, investigators convened to hear from world renowned speakers on topics and trends in oncology research. The purpose is to continue to be at the cutting edge of research and provide patients in the community setting access to the latest treatments. Roy Herbst, MD, PhD, chief of Medical Oncology and associate director for Translational Research at Yale Cancer Center, was a keynote speaker at the Forum and spoke about novel therapies for lung cancer, including targeted and immuno-therapies. “Collaborating with research investigators across the country on the most recent trends in oncology treatment is extremely important,” said Dr. Herbst. “It is our responsibility as researchers and providers to constantly be in search for the latest and most effective treatment options to improve efficacy and decrease toxicity. It was an honor to be among such passionate and dedicated clinicians and researchers.” “This year's Annual Science Forum really put a charge into our passion for clinical research,” said David Cosgrove, MD, oncologist with Compass Oncology and associate chair of the US Oncology Research Gastrointestinal (GI) Committee. “We heard from impressive speakers involved in cutting-edge science, highlighted recent successes in our field and got great perspective regarding patient communication. The Forum highlighted some of the challenges we will face in clinical research in a community oncology setting in the years ahead, and also provided a robust framework for future success building upon the US Oncology Research model that leads the way in these endeavors. I am excited to be part of this group moving forward.” Supported by McKesson Specialty Health and The US Oncology Network, US Oncology Research draws from a network of experienced investigators and dedicated clinical staff who specialize in oncology clinical trials. US Oncology Research serves approximately 60 research sites and nearly 160 locations managing about 300 active trials at any given time. Physicians in the research network have enrolled more than 64,000 patients in more than 1,500 trials since inception in 1992 and have played a role in more than 60 FDA-approved cancer therapies, nearly one-third of all cancer therapies approved by the FDA to date. For more information about US Oncology Research visit https://www.usoncology.com/oncologists/us-oncology-research. To find clinical trials available through US Oncology Research visit http://trialfinder.usoncology.com.

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