4579 Background: Intravesical Bacillus Calmette-Guerin (BCG) induction + maintenance (I+M) is the standard of care for high-risk NMIBC. Disease recurrence and progression is common. The studies investigating programmed cell death-1/programmed death-ligand 1 (PD-[L]1) inhibitors + BCG aim to enhance treatment outcomes and reduce burden in BCG naïve high-risk NMIBC. There is limited evidence on patient preferences for these combination regimens. Methods: A discrete choice experiment quantified preferences for attribute levels related to BCG and PD-(L)1 inhibitors. Attributes and levels were informed by a literature review, patient interviews, regulatory scientific advice, clinical experts and a patient advocate. Patients completed hypothetical choice tasks describing administration mode and frequency for PD-(L)1 inhibitors and BCG (induction [I]; I+M), median event-free survival (EFS) and adverse events (AEs: bladder AEs; chronic endocrine conditions; serious immune AEs). Hierarchical Bayesian modelling estimated preference weights (PWs) for attribute levels. PWs identified level combinations with the lowest choice probability. Relative importance (RI) was calculated by systematically varying attribute levels and capturing the gain in choice probability. Results: 150 patients (77 BCG-naïve; 73 BCG-experienced) in the United States completed the survey. Clinician-confirmed diagnosis (17%) and/or self-reported ongoing or planned BCG I+M (99%) was obtained. The sample was 51% male, had a median age of 63 years (49-74) and diverse by race (Caucasian 46%; African American/Black 27%; Other 27%) and ethnicity (Hispanic/Latino/Spanish 21%). EFS was the most important attributes to patients (RI 17.2), followed by bladder AEs (RI 16.4) and serious immune AEs (RI 14.0). Administration attributes were important (RI 9-9.9), but less important than other attributes. PWs show that short duration ( < 1 minute) subcutaneous (SC) injections was the most preferred PD-(L)1 route and shorter BCG schedule was preferred. Conclusions: Findings highlight the value of prolonging EFS, effective clinical management of BCG AEs and reducing administration burden in future BCG + PD(L)1 regimens. Attribute Level Mean PW 95% CI (±) RI*(%) EFS (months) 362722 3.46-1.03-2.43 0.280.110.22 17.2 Bladder AEs (%) 03575 2.98-0.10-2.88 0.290.120.26 16.4 Serious immune AEs (%) 01020 1.40-0.09-1.31 0.220.090.18 14.0 Chronic endocrine conditions (%) 0510 0.99-0.08-0.91 0.150.080.16 12.6 PD-(L)1 frequency (weeks) 643 0.45-0.10-0.35 0.100.100.06 9.9 PD-(L)1 administration route and time SC <1 minuteSC 7-10 minutesIV 30-60 minutes 0.150.06-0.21 0.090.100.08 9.5 BCG schedule II+M 0.25-0.25 0.140.14 9.0 *Sums to 88.7. The remaining 11.3 corresponds to an attribute used for analysis only. CI: confidence interval; IV: intravenous infusion.
S-band Synthetic Aperture Radar (SAR) offers advantages in foliage, ground penetration, and weather tolerance. However, it is comparatively underutilized for object classification due to the preference for higher band frequencies. This paper presents the first application of deep learning to $S$-band Synthetic Aperture Radar (SAR) data for local object classification. Our method of extrapolating the $2 D$ SAR image to a 3D Radar Cross Section (RCS) response differs from previous work that uses targets physical 3D point clouds. We also present a novel preliminary $2 D-3 D$ fusion method for $S$-band SAR to demonstrate the effectiveness of ensemble methods on this type of data. We combine a lightweight custom convolutional neural network (CNN) with a PointNet-based network, enhancing feature extraction from image and point cloud domains. Our method is more precise and robust to clutter compared to singlemodality techniques.
e18001 Background: Head and neck squamous cell carcinoma(HNSCC) and its treatments affect health-related quality of life. This study aimed to describe patient and clinician views on the most impactful disease- and treatment-related symptoms. Methods: In this qualitative study, patients (aged ≥18 years with pathologically-confirmed recurrent and/or metastatic HNSCC) and experts (clinicians identified based on their experience treating patients with HNSCC) participated in a one-hour semi-structured interview. Interviews focused on identifying and assessing the importance of disease- and treatment-related symptom and impact concepts through an open-ended discussion of the disease and treatment experience. Concepts that were identified by patients and experts as unique characteristics of HNSCC were organized and presented as separate conceptual models. Results: Thirteen patients (mean age [standard deviation], 56.4 [11.5] years; male, 69.2% [9/13]) were interviewed. At the time of the interviews, 69.2% (9/13) of patients were receiving first-line chemo-, immune-, and/or targeted therapy after relapse or progression and 30.8% (4/13) of patients were receiving second-line therapy. A total of 16 disease-related signs and symptoms were reported. The most common were difficulty swallowing (53.8% [7/13]), throat, neck or mouth lumps (53.8% [7/13]), mouth pain (46.2% [6/13]) and voice changes (46.2% [6/13]), with mouth pain reported as most bothersome (38.5% [5/13]). Overall, 40 treatment-related concepts were reported across treatments (radiation, chemotherapy, surgery, and immunotherapy); skin burns (84.6% [11/13]), nausea (76.9% [10/13]), fatigue (69.2% [9/13]), difficulty swallowing (61.5% [8/13]) and pain (53.8% [7/13]) were most common. Patients named 30 disease- and treatment-related concepts as important to improve. Impaired speaking ability (38.5% [5/13]), fatigue and swelling (30.8% [4/13] each) were most important to improve. Four clinician experts were interviewed: two HN surgeons, one physician’s assistant in medical oncology, and one medical oncologist. Their experience ranged from 7.5–>30 years. Experts identified 15 disease-related sign and symptom concepts; all identified difficulty swallowing, throat, neck or mouth lumps, mouth/throat pain, weight loss, and voice changes. Difficulty swallowing was identified as the most important to improve (75.0% [3/4]). All experts identified burns, difficulty swallowing, dry mouth, fatigue and pain from 28 treatment-related concepts. Conclusions: This qualitative study highlights the heavy symptom burden associated with HNSCC and/or its treatment. Difficulty swallowing and throat, neck or mouth lumps were the most impactful disease-related symptoms reported by patients and clinicians. This study highlights symptoms of interest that should be carefully considered by new treatment options.
Background First-line nivolumab plus chemotherapy (NIVO + CHEMO) and nivolumab plus ipilimumab (NIVO + IPI) improves overall survival for patients with advanced esophageal squamous-cell carcinoma (ESCC). This analysis aimed to use quality-adjusted time without symptoms or toxicity (Q-TWiST) analyses to assess the overall risk–benefit profile of these treatments in the CheckMate 648 study. Materials and methods A post hoc analysis of CheckMate 648 assessed the association of quality-adjusted survival with treatment types (first-line NIVO + CHEMO, NIVO + IPI, or CHEMO alone) using the Q-TWiST methodology. The analysis included all randomized patients and those with tumor cell programmed death-ligand 1 (PD-L1) ≥1% at baseline, with a minimum follow-up of 45 months. Health-related quality of life was assessed using the EuroQoL 5-Dimension 3-Level (EQ-5D-3L) questionnaire. Differences in Q-TWiST exceeding 1.5 months were deemed clinically important. Results The analysis included 970 patients in the all-randomized population. Q-TWiST values were 12.8 and 12.9 months for NIVO + CHEMO and NIVO + IPI, respectively, compared with 10.8 months for CHEMO alone, showing gains of 2.0 and 2.1 months, respectively. In patients with tumor cell PD-L1 ≥1% (473 patients), Q-TWiST values were higher for NIVO + CHEMO (13.0 months) and NIVO + IPI (13.3 months) compared with CHEMO alone (9.1 months), with gains of 3.9 and 4.2 months, respectively. All gains surpassed the clinically important threshold. Conclusion These findings support NIVO + CHEMO and NIVO + IPI as first-line treatments for patients with advanced ESCC, particularly those with tumor cell PD-L1 ≥1%.
