Personalized Palliative and Survivorship Care for Patients With Metastatic Cancer Treated With Radiation Therapy

While the benefits of early palliative care for patients with metastatic cancer are well established, cancer survivorship remains inadequately integrated into the care of patients with distant metastases. Moreover, the optimal model of care delivery is poorly defined. A prognostic model previously developed and validated at Good Samaritan University Hospital identified four groups of patients with metastatic solid tumor malignancy having very favorable, favorable, standard or unfavorable prognoses with median survival of 31, 14, 4 and 1 month, respectively. This framework holds promise for the personalized delivery of supportive, palliative and survivorship care services in the context of radiation therapy. We review the published literature providing the rationale for a novel multidisciplinary care model where the radiation oncology Clinical Nurse Specialist identifies and coordinates interventions to address unmet physical and emotional issues faced by survivors with metastatic cancer with the goal of improving quality of life and overall survival

Technology Pipeline for Large Scale Cross-Lingual Dubbing of Lecture Videos into Multiple Indian Languages

Cross-lingual dubbing of lecture videos requires the transcription of the original audio, correction and removal of disfluencies, domain term discovery, text-to-text translation into the target language, chunking of text using target language rhythm, text-to-speech synthesis followed by isochronous lipsyncing to the original video. This task becomes challenging when the source and target languages belong to different language families, resulting in differences in generated audio duration. This is further compounded by the original speaker's rhythm, especially for extempore speech. This paper describes the challenges in regenerating English lecture videos in Indian languages semi-automatically. A prototype is developed for dubbing lectures into 9 Indian languages. A mean-opinion-score (MOS) is obtained for two languages, Hindi and Tamil, on two different courses. The output video is compared with the original video in terms of MOS (1-5) and lip synchronisation with scores of 4.09 and 3.74, respectively. The human effort also reduces by 75%

A prospective pilot study of genome-wide exome and transcriptome profiling in patients with small cell lung cancer progressing after first-line therapy

<div><p>Background</p><p>Small cell lung cancer (SCLC) that has progressed after first-line therapy is an aggressive disease with few effective therapeutic strategies. In this prospective study, we employed next-generation sequencing (NGS) to identify therapeutically actionable alterations to guide treatment for advanced SCLC patients.</p><p>Methods</p><p>Twelve patients with SCLC were enrolled after failing platinum-based chemotherapy. Following informed consent, genome-wide exome and RNA-sequencing was performed in a CLIA-certified, CAP-accredited environment. Actionable targets were identified and therapeutic recommendations made from a pharmacopeia of FDA-approved drugs. Clinical response to genomically-guided treatment was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1.</p><p>Results</p><p>The study completed its accrual goal of 12 evaluable patients. The minimum tumor content for successful NGS was 20%, with a median turnaround time from sample collection to genomics-based treatment recommendation of 27 days. At least two clinically actionable targets were identified in each patient, and six patients (50%) received treatment identified by NGS. Two had partial responses by RECIST 1.1 on a clinical trial involving a PD-1 inhibitor + irinotecan (indicated by <i>MLH1</i> alteration). The remaining patients had clinical deterioration before NGS recommended therapy could be initiated.</p><p>Conclusions</p><p>Comprehensive genomic profiling using NGS identified clinically-actionable alterations in SCLC patients who progressed on initial therapy. Recommended PD-1 therapy generated partial responses in two patients. Earlier access to NGS guided therapy, along with improved understanding of those SCLC patients likely to respond to immune-based therapies, should help to extend survival in these cases with poor outcomes.</p></div

Summary of treatment received and response.

<p>Summary of treatment received and response.</p

Clinical characteristics for the eligible patients.

<p>Clinical characteristics for the eligible patients.</p

NGS sequencing metrics.

<p>NGS sequencing metrics.</p

Representative example.

<p>(A) Circos plot for SCLC0008, with potentially actionable alterations listed in red font. (B) Summary of the type and number of genomic aberrations detected for SCLC0008. Level 1 corresponds to alterations viewed as potentially clinically actionable. (C) A representative baseline radiographic image (top image) and a response evaluation scan at 11 months (bottom image) for SCLC0008, with the red circle surrounding tumor burden in the retroperitoneum and left adrenal gland. The overall tumor burden decreased from 10.8 cm to 2.3 cm, with CEA tumor marker decreasing from 94.8 to 7.8.</p