A Comprehensive Ontology of

Hematology/Oncology Regimens

Jeremy L. Warner MD, MSJune 12, 2018

NAACCR Annual Meeting

Chemotherapy regimens

• Systemic cancer treatment is context specific, with complex multidrug regimens in many cases.

• We have been building a comprehensive, freely available website containing such information, HemOnc.org, since 2011.

• 84% of the distinct regimens on HemOnc.org have more than one antineoplastic component.

• While some chemotherapy regimen information is captured in standard ontologies (e.g., the NCI Thesaurus, SEER*Rx), this area of oncology is mostly non-standardized.

HemOnc.org

The case for a new ontology derived from HemOnc.org

NCI Thesaurus:

Incomplete: many other treatment settings

Underspecified: • Context for accepted use• Supportive medications• Substitutions (e.g., prednisolone)• Supportive evidence (i.e., references)

Are these the same?

HemOnc.org Ontology version 2018-05-08

• 171,865 axioms• 25,406 individuals (drugs, regimens, authors, etc.)

o 1,275 distinct treatment regimenso 2,827 referenceso 20,778 authors

Availability

http://ascopubs.org/doi/abs/10.1200/CCI.17.00142

Anti-CD20 antibodies

Drug example: Rituximab

29 classifications16 alias concepts1 standard mapping (to RxNorm)

Published in: Andrew M. Malty; Sandeep K. Jain; Peter C. Yang; Krysten Harvey; Jeremy L. Warner; JCO Clinical Cancer Informatics 2018, 2, 1-11.Copyright © 2018 American Society of Clinical Oncology

Regimen example: R-CHOP

4 alias concepts16 classifications20 treatment components42 references

Published in: Andrew M. Malty; Sandeep K. Jain; Peter C. Yang; Krysten Harvey; Jeremy L. Warner; JCO Clinical Cancer Informatics 2018, 2, 1-11.Copyright © 2018 American Society of Clinical Oncology

Even a concept as seeminglysimple as R-CHOP is quitecomplex!

Regimens by class(May 2018)

Class of regimen No. of distinct regimensChemotherapy 1,029Chemoimmunotherapy 26Chemoradiotherapy 79Endocrine therapy 37Growth factor therapy 10Immunosuppressive therapy 25Immunotherapy 29Radiotherapy 31Other 103

Drug annotations(May 2018)

Annotation Number of instancesRxNorm 343Drug_Code_Name 253Drug_Generic_Name 283Drug_Brand_Name 1,107Drug_Brand_Name_Preferred 246Drug_Alias 2,796

Regimen annotations(May 2018)

Annotation Number of instancesregimen 1,275biomarker 102empty 97historical 126Regimen_Alias 418

Next steps

• Complete the elimination of duplicative regimen names

• Classify “other regimens” to the extent possible

• Add a preferred name term to all individual entities

• Add expected duration of treatment property

• Add an annotation for regimens that are not stand-alone (i.e., they’re a component of a multipart treatment protocol under certain circumstances)

• Store cooperative group information separately, when it occurs (e.g., ECOG, CALGB, Intergroup, etc.)

Acknowledgements

18

• Collaborators– Krysten Harvey, BS– Sandeep Jain, MD– Andrew Malty– Peter Yang, MD

• DeepPhe and CLAMP teams– Hua Xu, PhD (MPI)– Ergin Soysal, PhD– Liwei Wang, MD PhD– Elizabeth Sigworth, BS– Chenjie Zeng, PhD

• Licensees– Boston Children’s– Dana-Farber– EMBL-EBI– Mayo Clinic– Northwestern Univ.– OHDSI– UAMS– Univ. of Illinois– Univ. of Pennsylvania

• Grant Funding– L30 CA171123– U24 CA184407– U24 CA194215– GM10331601