PURPOSE Limited information exists regarding outcome severity among gynecologic cancer patients with SARS-CoV-2 infection. The objective of this study was to describe patient, cancer, and COVID-19 characteristics, and to identify factors associated with COVID-19 severity. METHODS Gynecologic cancer patients with SARS-CoV-2 infection were identified from the international COVID-19 and Cancer Consortium registry. We estimated odds ratios (ORs) for associations with severity of COVID-19 outcomes. Multivariable models included adjustment for age, race, cancer status, and time period of COVID-19 diagnosis. RESULTS Of 920 patients, 438 patients (48%) had endometrial, 249 (27%) had ovarian, 198 (22%) had cervical, and 44 (5%) had vulvar/vaginal cancers. Most were from the United States (86%) and non-Hispanic White (48%). Median age was 62 years (IQR, 52-71). When diagnosed with COVID-19, 457 (49%) patients were in remission and 343 (37%) had active disease. Outcomes included hospitalization in 452 patients (49%), intensive care unit admittance in 107 patients (12%), mechanical ventilation in 70 patients (8%), and death within 30 days of testing positive for SARS-CoV-2 in 91 patients (10%). In multivariable models, increasing age (adjusted OR, 1.35 [95% CI, 1.23 to 1.49]) and non-Hispanic Black race (adjusted OR, 1.75 [95% CI, 1.24 to 2.48]) were associated with increased COVID-19 severity, as were cardiac (adjusted OR, 1.85 [95% CI, 1.36 to 2.52]), pulmonary (adjusted OR, 1.58 [95% CI, 1.12 to 2.22]), and renal (adjusted OR, 2.18 [95% CI, 1.48 to 3.19]) comorbidities. Patients in remission <5 years had decreased COVID-19 severity (adjusted OR, 0.60 [95% CI, 0.42 to 0.87]). Other cancer characteristics associated with increased severity included progression (adjusted OR, 2.91 [95% CI, 1.92 to 4.40]), stage (adjusted OR, 1.57 [95% CI, 1.11 to 2.22]), and metastatic disease (adjusted OR, 1.60 [95% CI, 1.10 to 2.34]). CONCLUSION Patients with gynecologic cancer experience significant morbidity and mortality related to infection with SARS-CoV-2. Age, race, cancer status, comorbidities, and COVID-19 complications were associated with more severe COVID-19 outcomes.

This study compared Intraneural Facilitation (INF ® ) therapy and standard physical therapy (PT) in preventing chemotherapy-induced peripheral neuropathy (CIPN) in women with newly diagnosed breast and gynecologic cancer. Thirty-eight women undergoing platinum and/or taxane-based chemotherapy, without prior peripheral neuropathy, were randomized into INF ® therapy (n = 20) and PT (n = 18). Treatments lasted 45 minutes, twice weekly, for 6 weeks. Neuropathy severity was evaluated using the Pain Quality Assessment Scale. Assessments were at baseline, 3 weeks, 6 weeks, and 3 months post-intervention. Acceptability, burden, and satisfaction were evaluated after 6 weeks. Among 38 patients, 12 (32%) experienced CIPN, with mean pain scores remaining mild (≤3) and no pharmacotherapy required until week 6. No adverse events were reported from the interventions. The INF ® therapy arm showed significant changes in numbness ( F = 6.030, P = .001, partial η 2 = 0.262) after week 6, while the PT arm showed significant changes in numbness ( Z = −2.39, P = .017), tingling ( Z = −2.84, P = .004), cramping ( Z = −2.120, P = .034), surface pain ( Z = −2.75, P = .006), and deep pain ( Z = −1.99, P = .046) between weeks 3 and 6. Nearly 80% of patients completed chemotherapy cycles with an average relative dose intensity of 90.4% (INF ® therapy: 87.73% vs PT: 73.44%). Ninety-four percent of patients were satisfied with their care, accepted the treatments, and perceived them as a low burden. The results demonstrated that INF ® therapy and PT are feasible options for CIPN, improving treatment adherence, outcomes, and quality of life for women with newly diagnosed breast and gynecological cancers. Trial Registration - The study was pre-registered on ClinicalTrials.gov (NCT03272919). August 8, 2017.

690 Background: Most patients with pancreatic cancer (PC) present with late-stage (unresectable or metastatic) disease. Certain high-penetrance germline variants increase PC risk, for which there are imaging-based guidelines for screening to potentially diagnose patients earlier. This study aims to describe the screening compliance of patients with germline Pathogenic/Likely Pathogenic variants (PVs) at high-risk for developing PC. Methods: Patients who underwent genetic testing between 2021-2024 were identified from prospectively maintained Breast and Gastroenterology clinic databases. Genes with PVs for PC included ATM, BRCA2, CDKN2A, STK11, BRCA1 or PALB2 . After the date of genetic testing, abdominal imaging was reviewed including the modality (magnetic resonance imaging [MRI], computed tomography [CT], endoscopic ultrasound [EUS]), and whether imaging was for screening (intentional) or another reason unrelated to screening (incidental) based on the indication for ordering the study. The detection of PC and subsequent outcomes were longitudinally tracked. Results: Of 1,525 patients that underwent genetic testing, 192 had PVs for PC. Of those with PVs, 130 (68%) had subsequent imaging and 43 (33%) were screened intentionally to look for PC. The most common PVs included BRCA2 (63, 48%) ATM (13, 10%), BRCA 1 (68, 52%), CDKN2A (6, 4.6%), and PALB2 (8, 6.1%). The most commonly used modality was CT in 88 patients (68%), followed by MRI (41, 32%), and no patients underwent EUS. Three patients developed PC after genetic testing, however, none had PVs. Discussion: Our findings highlight a critical gap in guideline-recommended screening for patients with a genetic predisposition to PC. Despite 192 patients with PVs meriting PC screening, only a third were intentionally screened. Although MRI and EUS have a higher sensitivity for detection, CT scans were the most used modality. Conclusions: This large single center study supports the need for a more systematic, coordinated approach to pancreatic cancer screening in genetically high-risk patients. Future work will investigate costs related to pancreatic cancer screening as well as strategies for more effectively identifying patients at risk that may benefit from a screening program.

539 Background: The APT trial shifted adjuvant management of small HER2-positive breast cancer towards paclitaxel-trastuzumab, yet real-world uptake and outcomes of de-escalated single-agent chemotherapy (SC) plus anti-HER2 therapy (H) vs multi-agent chemotherapy (MC) plus H remain uncertain. Methods: Using NCDB (2013-2022), we identified patients with invasive HER2-positive pT1a-pT1c, pN0/N1mi, M0 disease treated with surgery without neoadjuvant therapy. We compared treatment patterns pre-APT (2013-2014) vs post-APT (2016-2022), excluding 2015 as a washout. Regimens were grouped as local therapy only, H only, chemo only, SC + H, or MC + H. Predictors of SC + H were assessed with multivariable logistic regression in post-APT chemo + H recipients. OS was evaluated using time-varying Cox models (time zero surgery; treatment exposure starting at recorded systemic therapy initiation), adjusted for demographic, tumor, and facility factors. In the overall cohort, each regimen (H only, chemo only, SC+H, and MC+H) was compared with local therapy only. For pT1a tumors, comparisons were limited to H only, chemo only, and any chemo + H vs local therapy. To evaluate whether de-escalation was associated with similar OS, SC + H vs MC + H was compared in separate Cox models restricted to chemo + H recipients in pT1b and pT1c. Results: Among 56,455 patients, SC + H use increased from 12.5% pre-APT to 40.3% post-APT, while MC + H decreased from 46.6% to 24.8% ( p < 0.001). In the post-APT era among chemo + H recipients (N = 24,867), SC + H use increased with age (per 10-year OR 1.32, 95% CI 1.27-1.36) and hormone receptor-positive (HR-positive) status (OR 1.37, 95% CI 1.27-1.49), and less common with pT1c (OR 0.47, 95% CI 0.43-0.51) and N1mi (OR 0.21, 95% CI 0.17-0.24) tumors. In OS analyses of the entire cohort with available systemic start dates (N = 51,078; deaths = 3,246), SC + H (HR 0.62, 95% CI 0.57-0.67) and MC + H (HR 0.63, 95% CI 0.58-0.68) were associated with improved OS vs local therapy only. Additional independent predictors of mortality included Black race, older age, and higher tumor burden (T1c and N1mi), while HR-positive was linked to better OS. In pT1a cohort (N = 10,212; deaths = 461), any chemo + H was associated with improved OS vs local therapy (HR 0.83, 95% CI 0.70-1.00, p = 0.049), while H only (HR 0.85, 95% CI 0.51-1.42) and chemo only (HR 1.14, 95% CI 0.74-1.74) were not. Among chemo + H recipients, OS was similar for SC + H vs MC + H in pT1b (HR 0.96, 95% CI 0.80-1.16) and pT1c (HR 1.09, 95% CI 0.97-1.24) cohorts. Conclusions: Since APT, real-world care has shifted towards de-escalated SC + H regimens. Among treated pT1b and pT1c patients, OS was similar with SC vs MC backbones, supporting the feasibility of de-escalation in selected patients. In pT1a disease, the OS association for chemo + H was marginal ( p = 0.049) and should be interpreted cautiously given non-random treatment selection and low event rates.

Endocrine therapy (ET) is a cornerstone of treatment for hormone receptor-positive (HR+ ) breast cancer but has been linked to metabolic toxicities, including nonalcoholic fatty liver disease (NAFLD). Hispanic individuals are disproportionately affected by metabolic comorbidities, yet data on ET-associated NAFLD risk in this population are limited. We retrospectively analyzed 465 women with early-stage HR+ breast cancer who initiated adjuvant ET between 2010 and 2023 at a single academic center. Eligible patients had baseline and follow-up imaging for NAFLD assessment. Exclusion criteria included pre-existing liver disease, significant alcohol use, ET duration <6 months, or missing ethnicity data. Patients were stratified as Hispanic or non-Hispanic. Time to clinically detected, imaging-confirmed NAFLD was assessed using Kaplan-Meier analysis and Cox proportional hazards modeling. Overall, 64 of 465 patients (13.8%) developed clinically detected, imaging-confirmed NAFLD during follow-up. The cumulative occurrence was significantly higher among Hispanic compared with non-Hispanic patients (20.6% vs. 11.7%, p = 0.02). In multivariable analysis, Hispanic ethnicity (HR: 1.75, 95% CI: 1.01–3.02, p = 0.04), overweight (HR: 2.91, 95% CI: 1.32–6.46, p = 0.008), and obesity (HR: 3.15, 95% CI: 1.42–6.97, p = 0.005) were associated with a higher observed risk of clinically detected, imaging-confirmed NAFLD after adjustment for available metabolic and treatment-related factors. Hispanic ethnicity was associated with a higher observed risk of clinically detected, imaging-confirmed NAFLD in this retrospective cohort, even after adjusting for metabolic risk factors. These findings highlight the need for proactive hepatic monitoring and tailored metabolic interventions to support metabolic health and equitable survivorship care in diverse breast cancer populations.

e12524 Background: NAFLD is a metabolic comorbidity increasingly recognized in oncology populations.Hormone receptor-positive (HR+) breast cancer (BC) is typically treated with endocrine therapy (ET). Both aromatase inhibitors (AIs) and tamoxifen are linked to metabolic side effects, including NAFLD, which complicate treatment outcomes and impact long-term health. Ethnic differences in the prevalence of NAFLD among women receiving ET for BC remain underexplored. Methods: We conducted a retrospective single-center analysis of adult female patients with HR+ early-stage BC (carcinoma in situ to stage III) between January 2012 and December 2022. Baseline demographic and clinicopathologic characteristics were collected. All patients received adjuvant ET for at least 6 months. Patients with baseline NAFLD, viral/autoimmune/alcoholic hepatitis, heavy alcohol use, or concurrent malignancies were excluded. Incidence and time to onset of NAFLD by imaging was measured. Primary analysis was restricted to patients who self-identified as Hispanic (H) or Non-Hispanic (NH). Chi-square or Fisher’s exact tests were used for categorical variables, and Mann-Whitney U tests for continuous variables. Multivariate Cox regression models were used to identify risk factors for NAFLD and analyze its impact on patient outcomes. Results: A total of 246 patients were analyzed, comprising 54 (22%) H and 192 (78%) NH. H patients were younger (median age 51.5 vs. 61 years, p < 0.0001), more frequently pre-menopausal (42.6% vs. 20.8%, p = 0.001) with lower prevalence of hypertension (27.8% vs. 44.8%, p = 0.025). No differences were noted between the two groups in BMI (median 29.1 vs. 27.4, p = 0.52), diabetes (14.8% vs. 12.5%, p = 0.66), or hyperlipidemia (31.5% vs. 36.4%, p = 0.5).Cancer stage at diagnosis and pathologic tumor characteristics did not significantly differ between the two groups.Treatment patterns showed more ovarian suppression (27.8% vs. 8.9%, p = 0.0003) and less chemotherapy use (14.8% vs. 33.3%, p = 0.008) in H vs. NH. No significant differences in recurrence-free survival ( p = 0.28) or overall survival ( p = 0.41) were noted. NAFLD incidence post-ET was significantly higher in H (22.2% vs. 11.5%, p = 0.043). Time to onset of NAFLD was also shorter in H compared to NH patients (HR 2.46, 95% CI 1.21–5.00, p = 0.01), with median durations not reached in either group. Multivariate analysis identified Hispanic ethnicity (HR 2.34, 95% CI 1.06–5.19; p = 0.036) and BMI (HR 1.10, 95% CI 1.04–1.17; p = 0.0015) as independent NAFLD risk factors. Conclusions: This study highlights the higher incidence and early onset of NAFLD in Hispanic women with early-stage breast cancer receiving ET, underscoring the unmet need for targeted screening, hepatic monitoring, and early lifestyle interventions for this high-risk population.

Data on COVID-19 outcomes in Asian Americans and Pacific Islanders (AAPI) are lacking. We analyzed data from 6,244 patients from the COVID-19 and Cancer Consortium, including 6.0% AAPI patients, to examine disparities in outcomes following acute COVID-19. Despite AAPI patients having lower median BMI than non-Hispanic White (NHW) patients and higher diabetes rates, both groups showed similar 30-day mortality and COVID-19 outcomes. In multivariable analyses, morbid obesity (BMI >35 kg/m2) in AAPI patients was associated with significantly higher 30-day mortality (OR 4.96; 95% CI 1.78 - 13.88) and COVID-19 severity (OR 2.6; 95% CI 1.26 - 5.35); underscoring the differential impact of obesity in AAPI patients.

450 Background: Pancreatic cancer (PC) remains one of the deadliest malignancies, due to late-stage presentation and limited risk-reduction strategies. Certain high-penetrance germline variants increase pancreatic cancer risk, and the NCCN recommends screening for this unique population. As genetic testing becomes more common, mutations predisposing to pancreatic cancer can be detected. This study aims to describe the screening compliance of patients at a single center with germline pathogenic variants (PVs) at high-risk for developing pancreas cancer. Methods: Patients who underwent genetic testing between 2010-2024 were identified from a prospectively maintained Breast and Gastroenterology clinic database. Patients without confirmed genetic testing documentation were excluded. High-penetrance PVs for pancreatic cancer include ATM, BRCA2, CDKN2A and STK11, as well as a family history of PC with BRCA1 or PALB2 PVs. After the date of genetic testing, abdominal imaging was reviewed including the modality (MRI, CT, EUS), and whether imaging was for screening (intentional) or another issue unrelated to screening (incidental) based on the indication for ordering the study. The detection of pancreatic cancer and outcomes were additionally tracked. Results: Of 194 patients who had relevant genetic testing results, 128 (65.98%) underwent abdominal imaging, while 66 (34.02%) did not. Among those who underwent imaging, 86 (67.19%) had incidental imaging and 42 (32.81%) had intentional screening. The most used modality was CT in 69 patients (76.67%), followed by MRI in 21 (23.33%). Five patients developed PC, however, all underwent genetic testing after their diagnosis. Discussion: Our findings highlight a critical gap in guideline-recommended screening for patients with a genetic predisposition to pancreatic cancer. Despite having confirmed mutations, only 65% underwent imaging and only one-fifth were intentionally screened for pancreas cancer. Although MRI and EUS have a higher sensitivity for detection, CT scans were the most used imaging modality. Conclusions: This study reveals the need for a more systematic, coordinated approach to pancreatic cancer screening in genetically high-risk patients. Our institution has launched a high-risk pancreas screening program to address this gap and will follow the outcomes of this effort in future work.

Pancreatic cancer (PC) remains one of the deadliest malignancies, due to late-stage presentation and limited risk-reduction strategies. Certain high-penetrance germline variants increase pancreatic cancer risk, and the NCCN recommends screening for this unique population. As genetic testing becomes more common, mutations predisposing to pancreatic cancer can be detected. This study aims to describe the screening compliance of patients at a single center with germline Pathogenic/Likely Pathogenic variants (PVs) at high-risk for developing pancreas cancer. Patients who underwent genetic testing between 2010-2024 were identified from a prospectively maintained Breast and Gastroenterology clinic database. Patients without confirmed genetic testing documentation were excluded. We included patients with moderate and high-penetrance PVs for pancreatic cancer (ATM, BRCA2, CDKN2A and STK11), as well as a family history of PC with BRCA1 or PALB2. After the date of genetic testing, abdominal imaging was reviewed including the modality (magnetic resonance imaging [MRI], computed tomography [CT], endoscopic ultrasound [EUS]), and whether imaging was for screening (intentional) or another issue unrelated to screening (incidental) based on the indication for ordering the study. The detection of pancreatic cancer and outcomes were additionally tracked. The most common mutation found through genetic testing was BRCA2 which was found in 13 (1.88%) of patients, however other mutations found included ATM (n=9, 1.3%), BRCA 1 (n=9, 1.3%), CDKN2A (n=4, 0.58%), and PALB2 (n=2, 0.29%). For all patients who received genetic testing, 285 (41.36%) had incident imaging done while (39) 5.66% were intentional for PC screening and 365 had no imaging. Patients received follow-up imaging in 49.06% of patients. The most used modality was CT in 163 patients (87.17%), followed by MRI in 22 (11.76%), and 2 patients who underwent EUS (1.07%). Of the 53 patients with mutations associated with pancreatic cancer, 39 had abdominal imaging; 7 were intentional and 32 incidentals. 26/39 had follow-up abdominal imaging while 13 patients did not. All 39 patients are PC free; however, from the entire cohort studied, there was 1 diagnosis of pancreatic cancer in a patient with no PV. Discussion: Our findings highlight a critical gap in guideline-recommended screening for patients with a genetic predisposition to pancreatic cancer. Despite 53 patients having confirmed mutations, only 26 underwent imaging and only 7 were intentionally screened for pancreas cancer. Although MRI and EUS have a higher sensitivity for detection, CT scans were the most used imaging modality. This study supports the need for a more systematic, coordinated approach to pancreatic cancer screening in genetically high-risk patients. Our institution has launched a high-risk pancreas screening program to address this gap and will follow the outcomes of this effort in future work. Pranati D. Shah, Alexander Gavralidis, Liang Ji, Jordan Klaassen, Enxi Chen, Derek Tai, Kevin Bera, Joseph Hemry, Harrison Jennings, Sumaia G. Khoury, Mina Batros, Skey Balang, Timothy Yen, Gayathri Nagaraj, Raja R. Narayan. Impact of germline pathogenic variants on pancreatic cancer screening and outcomes [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research—Emerging Science Driving Transformative Solutions; Boston, MA; 2025 Sep 28-Oct 1; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2025;85(18_Suppl_3):Abstract nr B064.

BACKGROUND:Oncology providers often lack the confidence to make clinical recommendations about medical cannabis (MC). This study aimed to develop and evaluate the feasibility of implementing an educational curriculum on the use of MC in patient care for oncology trainees. METHODS:A multidisciplinary team designed an educational curriculum for MC use in oncology. The curriculum was piloted as a 1-hour interactive webinar across 8 United States-based hematology/oncology fellowship programs between 2022 and 2023. Incentivized surveys measuring feasibility outcomes, including cultural attitudes/norms, acceptability, compatibility, and self-efficacy (a composite index of self-confidence in discussing MC efficacy, risks, modes of use, and role in symptom management), were distributed before, immediately after, and 12 weeks post-webinar. RESULTS:Of 103 trainees, 75 (72.8%) completed the pretraining survey and 66 (64.1%) completed the posttraining survey. Most respondents believed discussions about the role of MC in symptom management were valuable (n=56; 74.7%), though few (14.7%) believed trainees were expected to engage in such discussions. Most participants rated the curriculum as helpful (92.4%), beneficial for oncology trainees (84.8%), and likely to be recommended to colleagues (87.9%). Post-webinar, 78.8% of participants reported an increased likelihood of initiating discussions with patients regarding MC. There were significant improvements in the composite self-confidence index from pre- to post-webinar (2.7% vs 65.2%; P<.001), which persisted in the follow-up surveys (n=36; response rate, 34.9%). CONCLUSIONS:This multisite study demonstrates the feasibility of implementing a novel curriculum focused on MC for oncology trainees. These findings can guide the design of a prospective, multi-institutional study to evaluate knowledge expansion, retention, and behavioral changes resulting from the intervention.

BACKGROUND:COVID-19 can have a particularly detrimental effect on patients with cancer, but no studies to date have examined if the presence, or site, of metastatic cancer is related to COVID-19 outcomes. METHODS:Using the COVID-19 and Cancer Consortium (CCC19) registry, the authors identified 10,065 patients with COVID-19 and cancer (2325 with and 7740 without metastasis at the time of COVID-19 diagnosis). The primary ordinal outcome was COVID-19 severity: not hospitalized, hospitalized but did not receive supplemental O2, hospitalized and received supplemental O2, admitted to an intensive care unit, received mechanical ventilation, or died from any cause. The authors used ordinal logistic regression models to compare COVID-19 severity by presence and specific site of metastatic cancer. They used logistic regression models to assess 30-day all-cause mortality. RESULTS:Compared to patients without metastasis, patients with metastases have increased hospitalization rates (59% vs. 49%) and higher 30 day mortality (18% vs. 9%). Patients with metastasis to bone, lung, liver, lymph nodes, and brain have significantly higher COVID-19 severity (adjusted odds ratios [ORs], 1.38, 1.59, 1.38, 1.00, and 2.21) compared to patients without metastases at those sites. Patients with metastasis to the lung have significantly higher odds of 30-day mortality (adjusted OR, 1.53; 95% confidence interval, 1.17-2.00) when adjusting for COVID-19 severity. CONCLUSIONS:Patients with metastatic cancer, especially with metastasis to the brain, are more likely to have severe outcomes after COVID-19 whereas patients with metastasis to the lung, compared to patients with cancer metastasis to other sites, have the highest 30-day mortality after COVID-19.

BackgroundDespite being the second leading cause of death in the United States, cancer disproportionately affects underserved communities due to multiple social factors like economic instability and limited healthcare access, leading to worse survival outcomes. This cross-sectional database study involves real-world data to explore the relationship between the Social Vulnerability Index (SVI), a measure of community resilience to disasters, and disparities in screening, incidence, and mortality rates of breast, colorectal, and lung cancer. The SVI encompasses four themes: socioeconomic status, household composition & disability, minority status & language, and housing type & transportation.Materials and methodsUsing county-level data, this study compared cancer metrics in U.S. counties and the impact of high and low SVI. Two-sided statistical analysis was performed to compare SVI tertiles and cancer screening, incidence, and mortality rates. The outcomes were analyzed with logistic regression to determine the odds ratio of SVI counties having cancer metrics at or above the median.ResultsOur study encompassed 3,132 United States counties. From publicly available SVI data, we demonstrated that high SVI scores correlate with low breast and colorectal cancer screening rates, along with high incidence and mortality rates for all three types of cancers. County level SVI has impact on incidence rates of cancers; breast cancer rates were lowest in high SVI counties, while colorectal and lung cancer rates were highest in the same counties. Age-adjusted mortality rates for all three cancers increased across SVI tertiles. After risk adjustment, a 10-point SVI increase correlated with lower screening and higher mortality rates.ConclusionIn conclusion, our study establishes a significant correlation between SVI and cancer metrics, highlighting the potential to identify marginalized communities with health disparities for targeted healthcare initiatives. It underscores the need for further longitudinal studies on bridging the gap in overall cancer care in the United States.

3149 Background: Understanding and addressing intratumor heterogeneity in breast cancer (BC) is crucial for advancing research and improving patient outcomes. The identification of biomarkers for targeted therapies is complex when dealing with heterogeneous tumors, and this heterogeneity complicates cancer outcomes since it affects treatment response, and the development of resistance. Methods: A single institution retrospective review of patients with BC who received neoadjuvant systemic therapy (NAST) followed by definitive surgical resection from 2008 to 2022 was performed. Initial tumor biopsies were tested for hormone receptors (HR) [estrogen receptor (ER) and progesterone receptor (PR)], and HER2 status and repeated on the residual tumor tissue after NAST. HER2 status was categorized into HER2-negative, HER2-low, and HER2-positive and HR status was categorized into ER and/or PR positive or negative based on the 2023 ASCO-CAP guidelines. HER2 and HR concordance and discordance rates were obtained and patients who had disease recurrence were identified and analyzed using descriptive statistics and Fisher’s exact test. Results: 480 patients with BC received NAST, and 143 patients with residual disease had pre and post treatment biomarker data available for analysis with a median post-surgery follow up of 15.2 months. Discordance in either HER2 or HR status was identified in 50% (72/143) of samples. Out of 143 patients, 44 patients had disease recurrence in which 50% (22/44) of tumors exhibited biomarker discordance. Among the changes in biomarker status, a shift in PR expression occurred most frequently in 27% of tumors (12/44). A change from HER2-low to HER2-negative status, as well as changes in ER expression occurred in 11% of tumors (5/44). 14% (6/44) of tumors had changes in both HER2 and HR. In patients who did not have recurrence, 51% (50/99) of tumors exhibited biomarker discordance. A HER2-low to HER2-negative status occurred most frequently in 18% (18/99). A change in ER expression occurred second most frequently, in 14% (14/99) of tumors. There was no statistical significance of discordance rates in the recurrence group and non-recurrence group (p-value=0.96). Conclusions: Tumor heterogeneity plays a role in shaping the distinct tumor biology of each patient. While the rates of biomarker discordance were comparable between samples with and without recurrence, the importance of HR discordance in this group requires extensive long-term monitoring. Our research highlights the importance of biomarker changes in a curative setting. Considering the implications for treatment, further investigation into additional biological and tumor-related factors associated with recurrence is warranted. [Table: see text]

Supplementary Fig. S2. Mutations in selected genes observed in this trial in contrast to that in COSMIC data

This is case of a 4 year 6 months old male child presented asAcute Flaccid Paralysiswith symptoms of hypokalaemia and paralysis which was initially mistaken for the Guillain-Barre syndrome, however it was later diagnosed as Distal Renal Tubular Acidosis.

Background: Data regarding outcomes among patients with cancer and co-morbid cardiovascular disease (CVD)/ cardiovascular risk factors (CVRF) after SARS-CoV-2 infection are limited.Objectives: To compare Coronavirus disease 2019 (COVID-19) related complications among cancer patients with and without co-morbid CVD/CVRF.Methods: Retrospective cohort study of patients with cancer and laboratory-confirmed SARS-CoV-2, reported to the COVID-19 and Cancer Consortium (CCC19) registry from 03/17/2020 to 12/31/2021. CVD/CVRF was defined as established CVD or no established CVD, male & GE; 55 or female & GE; 60 years, and one additional CVRF. The primary endpoint was an ordinal COVID-19 severity outcome including need for hospitalization, supplemental oxygen, intensive care unit (ICU), mechanical ventilation, ICU or mechanical ventilation plus vasopressors, and death. Secondary endpoints included incident adverse CV events. Ordinal logistic regression models estimated associations of CVD/CVRF with COVID-19 severity. Effect modification by recent cancer therapy was evaluated.Results: Among 10,876 SARS-CoV-2 infected patients with cancer (median age 65 [IQR 54-74] years, 53% fe-male, 52% White), 6253 patients (57%) had co-morbid CVD/CVRF. Co-morbid CVD/CVRF was associated with higher COVID-19 severity (adjusted OR: 1.25 [95% CI 1.11-1.40]). Adverse CV events were significantly higher in patients with CVD/CVRF (all p<0.001). CVD/CVRF was associated with worse COVID-19 severity in patients who had not received recent cancer therapy, but not in those undergoing active cancer therapy (OR 1.51 [95% CI 1.31-1.74] vs. OR 1.04 [95% CI 0.90-1.20], pinteraction <0.001).Conclusions: Co-morbid CVD/CVRF is associated with higher COVID-19 severity among patients with cancer, particularly those not receiving active cancer therapy. While infrequent, COVID-19 related CV complications were higher in patients with comorbid CVD/CVRF. (COVID-19 and Cancer Consortium Registry [CCC19]; NCT04354701).

11013 Background: There is continued uptake in the use of medical cannabis (MC) among patients with cancer. Our group previously conducted a national study that showed that while a majority of oncology fellows discussed MC with patients, very few feel well informed in doing so. We hypothesized that an evidence-based curriculum on the use of MC for oncology trainees is feasible to develop and would be effective in improving confidence to discuss MC with patients. Methods: A multidisciplinary expert team designed an evidence-based educational curriculum in 5 modules specifically for MC in oncology populations that included pharmacology/history, symptom management, cancer-directed effects, toxicities and practical/logistic concerns. The curriculum was piloted as a one-hour webinar at three US hematology oncology fellowship training programs in 2022-2023. Anonymous incentivized survey instruments that were designed to assess self-perceived knowledge, attitudes and behaviors pertaining to MC (on a 5-point Likert scale; strongly agree to strongly disagree) were distributed anonymously via email at the pilot (t = 0) and immediately after (t + 7 days); additional delayed surveys (t+90 days) are in progress. Results: Of 35 eligible trainees, 31 completed the pre-training surveys (88.6%), and 26 (74.3%) completed the post-training surveys. Most trainees indicated that the curriculum is helpful (88.5%, 95% CI: 69.8-97.6) and that they would recommend it to their colleagues (80.8%, 95% CI: 60.6-93.4). Following the webinar, there was significant improvement in self-reported comfort with discussing MC for symptom management (3.2% vs. 92.3%, P < 0.001), risks of MC (9.7% vs. 76.9%, P < 0.001) and modes of MC use (16.1 vs. 80.8%, P < 0.001). The majority of participants (80.0%, 95% CI: 59.3-93.2) reported that they were more likely to initiate conversations about MC with their patients after attending the webinar. Conclusions: In this multi-center study, we demonstrate that it is feasible to develop and deliver a fellow-focused, evidence-based curriculum for MC use in patients with cancer. The webinar was well received and demonstrated significant improvement in fellow-reported attitudes surrounding MC efficacy, risks, and modes of use. Further work to assess durability of the curriculum on knowledge, attitudes, and behaviors is ongoing.

Supplementary Fig. S3 Immunohistochemistry (IHC) for PTEN expression on archival tumor specimens

Supplementary Fig. S1. Buparlisib dosing intensity by treatment cohorts