It has been almost three years since the COVID-19 outbreak, yet evidence of its impact on the cancer care landscape remains scant. The present single-center study examines patterns in gynecological cancer diagnoses before and during the pandemic. All female patients diagnosed in our academic hospital with gynecological cancer, between January 2017 and December 2020, were retrospectively identified. Pre-defined subgroup analyses were performed in patients who had been newly diagnosed during 2020 and in the pre-pandemic 3-year period. The study was approved by the Institutional Ethical Committee and was conducted in accordance with the Declaration of Helsinki and the International Conference on Harmonization for Good Clinical Practice. In total, 1,193 women were included in this case-control study; 1,001 (83.91%) were identified in the pre-pandemic period as a control, while 192 (16.09%) cases were allocated in the pandemic group. The two cohorts were similar regarding demographic and clinical characteristics. For the pre-pandemic period, the mean yearly number of patients with newly identified cancer was highest for endometrial (149; 44.61%), followed by ovarian (92; 27.5%) carcinomas. During the first year of the pandemic, the number of new diagnoses significantly decreased by 42.5% (from 334 to 192) for all types of malignancies combined (one sample t-test p-value= 0.014). Declines ranged from 36.96% to 49% for ovarian and endometrial cancer, respectively. This is the first study to appraise a timely snapshot of the effect of COVID-19 on newly diagnosed gynecological tumors in a European Society of Gynaecological Oncology (ESGO)-certified center in Greece, demonstrating an alarmingly sharp decline in the number of new cases during the pandemic. It is of utmost importance the gynecologic oncologists to ensure the continuum of care for their patients.Table: 77PDemographic data for patients with newly diagnosed gynecological cancer, by time periodCancer typePre-pandemic period (01-12/2017)Pre-pandemic period (01-12/2018)Pre-pandemic period (01-12/2019)Pandemic period (01-12/2020)TotalCervical73 (19.89%)61 (19.68%)56 (17.28%)39 (20.31%)229 (19.20%)Endometrial174 (47.41%)129 (41.61%)145 (44.75%)76 (39.58%)524 (43.92%)Ovarian84 (22.89%)92 (29.68%)101 (31.17%)58 (30.21%)335 (28.08%)Vulvar30 (8.17%)21 (6.77%)20 (6.17%)14 (7.29%)85 (7.12%)Other6 (1.63%)7 (2.26%)2 (0.62%)5 (2.60%)20 (1.68%)Total367 (100%)310 (100%)324 (100%)192 (100%)1,193 (100%)Pearson chi2 (12) = 13.1806; Pr= 0.356 Open table in a new tab

Αim of this study is to evaluate the incidence of fungal infections in COVID-19 intensive care unit (ICU) patients, to identify potential risk factors and to investigate whether differences in patients’ outcomes are depicted. Material-Methods: This prospective observational study included critically ill patients diagnosed with COVID-19 that were admitted from 1/9/2020 to 1/11/2021 in ICU of the 1st Respiratory Department of Sotiria Chest Diseases Hospital. Epidemiologic characteristics, severity of disease, medication, outcome and complications were recorded. Results: Out of 300 patients included (213 men, 60,4±13,23 (mean±SD) years-old), 22 (7,3%) developed fungal infections (16 COVID-19 Associated Pulmonary Aspergillosis, 5 COVID-19 Associated Candidemia and 1 both). They were 6 female & 16 male, 55,73±13,28 years-old. Most patients had co-infections with multi-drug resistant bacteria. Patients with fungal infections were statistifically more on high dose of corticosteroids, invasive mechanical ventilation and renal replacement treatment (p<0.05). They had statistically more positive blood and bronchial secretion cultures, as well as more incidents of septic shock, venous thromboembolism and varotrauma (p<0.05). Their PaO2/FiO2 ratio on admission was statistically lower (p<0.05). Finally, after adjustment for confounfing factors and ICU days, they were at higher risk of dying (50% mortality). Conclusions: Fungal infections are a significant co-infection in critically ill COVID-19 patients. Those patients seem to have more severe respiratory failure on admission, be on higher doses of corticosteroids and in need of organ failure support. They also seem to develop more complications of COVID-19 and be at a higher risk of dying.

Background: The impact of pretreatment factors on immune checkpoint inhibition in platinum-refractory advanced urothelial cancer (aUC) deserves further evaluation. The aim was to study the association of Bellmunt risk factors, time from last chemotherapy (TFLC), previous therapy and PD-11 expression with atezolizumab efficacy in platinum-refractory aUC. Patients and methods: This was a post-hoc analysis of patients who had received prior cisplatin or carboplatin in the prospective, single-arm, phase IIIb SAUL study (NCT02928406). Patients were treated with 3-weekly atezolizumab 1200 mg intravenously. The primary outcome was overall survival (OS). Relationships were analysed using Cox regression and long-rank test. Results: Of 997 patients in SAUL, 969 were eligible for this analysis. The number of Bellmunt risk factors was associated with OS (P < 0.001); median OS (mOS) for 0, 1 and 2-3 risk factors was 17.9, 8.9 and 3.3 months, respectively. Significant associations were also observed between OS and TFLC (P < 0.001), programmed death-ligand 1 (PD-L1) expression (P 0.002), and prior perioperative chemotherapy (P 0.013); mOS was 6.97 versus 11.63 months for TFLC <= 6 versus >6 months, 7.75 versus 11.6 months for PD-L1 expression on <1% of tumour-infiltrating immune cells (ICs) (IC0)/expression on 1% to <5% of tumour-infiltrating ICs (IC1) versus expression on >= 5% of tumour-infiltrating ICs (IC2/3) and 10.2 versus 7.8 months for prior versus no prior perioperative chemotherapy, respectively. The type of platinum compound and number of previous treatment lines were not associated with outcomes. Conclusions: Post-platinum atezolizumab is active in aUC, irrespective of previous platinum compound and lines of therapy. Bellmunt risk stratification, PD-L1 expression, TFLC and perioperative chemotherapy were identified as prognostic factors for OS with second-line atezolizumab, indicating the need for novel prognostic signatures for immunotherapy-treated patients with aUC.

BACKGROUND:Utilization of neoadjuvant chemotherapy for the treatment of muscle invasive bladder cancer in everyday practice differs from that of clinical trials. We describe the patterns of referral for "neoadjuvant chemotherapy", treatment and outcomes in a multidisciplinary tumor board.METHODS:This was an observational study. Patients referred for neoadjuvant chemotherapy received 4 cycles of dose-dense gemcitabine/cisplatin and were then assessed for definitive local therapy. Patients had a minimum follow-up of 2 years. Primary objective was a 3-year disease-free survival rate.RESULTS:Forty-six patients (clinical stages II: 28, IIIA: 9, IIIB: 4, IVA: 3, missing: 2) were included. Following chemotherapy, 30 underwent radical cystectomy, 8 radiotherapy and 8 no further therapy. Pathological downstaging was observed in 14 (46.6%) of the 30 patients who underwent radical cystectomy; clinical TNM staging was correlated with disease-free survival in the whole population, while clinical and pathological stages, as well as pathological downstaging, were correlated with disease-free survival in patients undergoing radical cystectomy. Three-year disease-free survival rates for the whole cohort and for patients undergoing radical cystectomy were 67.3% (95% confidence interval [CI]: 51-79.2) and 65.2 (95% CI: 44.9-79.6), respectively.CONCLUSION:Real-world muscle invasive bladder cancer patients who receive neoadjuvant chemotherapy are characterized by more advanced diseases and less frequent radical surgery than those included in clinical trials. Nevertheless, outcomes were comparable and, therefore, offering patients with stage II-IVA muscle invasive bladder cancer neoadjuvant chemotherapy after assessment by multidisciplinary tumor boards should be strongly encouraged.

BACKGROUND:Venous thromboembolic events (VTEs) frequently occur in cancer patients. Risk assessment models (RAMs) for cancer-associated thrombosis have been proposed. However, advanced urinary tract cancer (aUTC) was not adequately represented in these models. We studied the incidence of VTEs, the risk factors, and the applicability of recently described RAMs.PATIENTS AND METHODS:Data from 335 patients with aUTC treated with chemotherapy between April 1995 and September 2015 in a single institution were analyzed.RESULTS:A total of 95.2% received platinum-based first-line chemotherapy. Twenty-nine patients (8.7%) experienced VTEs. The 6-, 12-, and 24-month VTE incidence was 7.4% (95% confidence interval [CI], 4.8-10.6), 8.1% (95% CI, 5.4-11.5) and 9.4% (95% CI, 6.4-13.1), respectively. No significant association of VTE incidence with the Khorana risk score was observed. History of vascular event (VTE and/or arterial thromboembolic event) was significantly associated with the development of VTE. Patients with such history had a 6-, 12-, and 24-month VTE incidence of 16.2% (95% CI, 6.6-29.7), 19.2% (95% CI, 8.4-33.3), and 25.2% (95% CI, 12.5-40.1) compared to 6.2% (95% CI, 3.7-9.4), 6.6% (95% CI, 4.1-10), and 7.1% (95% CI, 4.4-10.6) of those who did not. The discriminatory ability of this factor adjusted for leucocyte count, sex, Eastern Cooperative Oncology Group performance status, and type of chemotherapy reached 0.79 (95% CI, 0.71-0.87) compared to the 0.58 (95% CI, 0.49-0.66) for the Khorana risk score.CONCLUSION:Development of tumor-specific algorithms for the risk of VTEs is advisable. Patients with aUTC and a history of vascular events are at high risk for VTE development, and prophylaxis should be prospectively studied in this group.

Aims: The aim of the study was to investigate the association between type-2 diabetes mellitus, other underlying diseases and obesity with the outcomes of critically ill Covid-19 patients in Greece. Methods: In this retrospective observational multi-centre study, data and outcomes of 90 RNA 2109-nCoV confirmed critically ill patients from 8 hospitals throughout Greece, were analysed. All reported information stand through April 13th 2020. Results: The median age of the patients was 65.5 (IQR 56-73), majority were male (80%) and obesity was present in 34.4% of patients most prevalent to younger than 55 years. Hypertension was the prevailing comorbidity (50%), followed by cardiovascular diseases (21.1%) and type-2 diabetes (18.9%). At admission, common symptoms duration had a median of 8 (IQR 5-11) days. A 13.3% of the patients were discharged, 53.4% were still in the ICUs and 28.9% deceased who were hospitalised for fewer days than the survivors [6 (IQR 3-9) vs. 9 (IQR 7-14.5) respectively]. Aging was not a risk factor but diabetes deteriorates the outcomes. Obesity poses a suggestive burden as it was more notable in deceased versus survivors. Conclusions: Type 2 diabetes and obesity may have contributed to disease severity and mortality in COVID-19 critically ill patients in Greece. (C) 2020 Elsevier B.V. All rights reserved.

SAUL, a phase IIIb study reported real-world data on atezolizumab used for mUC relapsing after 1st-line therapy (Sternberg et al, Eur Urol 2019). Hb<10 g/dL, liver mets, ECOG> 0 and time from last chemotherapy (TFLC) are associated with worse outcomes in 2nd-line chemotherapy but their significance in the immunotherapy setting is unknown. We studied the association of the above factors, previous use of cis- or carbo-platin and PD-L1 expression with outcomes using the SAUL database. We excluded patients who did not receive cis or carbo. Patients who received both were categorized as cis-treated. The major outcome measure was overall survival (OS). 969 pts were included. Selected baseline characteristics and subgroup efficacy outcomes are shown in the table. 551 pts (56.9%) had ECOG PS>0, 265 (27.3%) liver mets, 152 (15.7%) Hb< 10. Median OS (mOS) and median progression-free survival for the whole population were 8.6 (7.6-9.7) and 2.2 (2.1-2.4) mos. The prognostic significance of ECOG PS, anaemia, liver mets and Bellmunt risk score was confirmed. The number of previous lines of therapy was not associated with outcomes. There was a strong correlation of mOS with TFLC: 6.7 mos (5.4-7.8) for <3 vs. 14.2 (10-NR) for >9 mos and PD-L1 expression: 7.8 (6.5-9) for IC 0/1 vs.11.6 (8.8-18.8) mos for IC2/3. No interaction of PD-L1 expression with other prognostic factors was observed. There was a trend for better outcome after previous cisplatin vs. carboplatin (p=0.056). Nevertheless, further analyses, stratified for other significant factors did not confirm a significant association of previous therapy with OS.Table 748PnMedian OS (95% CI)Median PFS (95% CI)ORR (%)Bellmunt Risk factors 0 1 2-3296 383 26517.9 (12.7-NR) 8.9 (7.5-10.9) 3.3 (2.7-4)4.1 (3.5-4.4) 2.3 (2.1-2.8) 2 (1.9-2.1)18.6 13.8 6.8Previous therapy Cis-based Carbo-based581 3889.4 (8.1-10.9) 7.5 (6.4-9.2)2.3 (2.1-2.5) 2.2 (2.1-2.4)14.8 11.1Previous Lines 0 1 2-3369 531 699.7 (7.5-11.9) 8.3 (7.2-9.7) 7.4 (4.5-NR)2.2 (2.1-2.9) 2.2 (2.1-2.4) 2.1 (2-2.6)15.7 11.5 14.5PD-L1 expression 0-1 2-3647 2577.8 (6.5-9) 11.6 (8.8-18.8)2.1 (2.1-2.3) 2.6 (2.1-4.1)10.2 20.6Time from last Chemo in months 0-3 3-6 6-9 >9353 240 172 2046.7 (5.4-7.8) 7.5 (5.7-9.9) 10.6 (8.4-18) 14.2 (10-NR)2.1 (2.1-2.2) 2.1 (2.1-2.3) 2.5 (2.2-4.1) 4 (3.1-4.9)8.2 11.7 19.2 19.1 Open table in a new tab Post-platinum atezolizumab is active in mUC, irrespective of previous lines of therapy or previous platinum compound. In addition, to the established Bellmunt risk stratification, PD-L1 expression and TFLC were strongly correlated with OS, indicating the need for novel prognostic algorithms for immunotherapy-treated patients with mUC.

Background: Psoriatic arthritis (PsA) affects both sexes equally, however there seem to be significant differences in disease expression between the genders. Objectives: To investigate gender differences in disease manifestations, patient-reported outcomes and comorbidities among patients with PsA. Methods: This cross-sectional study of patients with PsA followed at an academic rheumatology outpatient clinic between 1/6/2017 and 1/12/2019. We compared clinical characteristics, patient-reported outcomes, disease activity and comorbidities in male and female patients with PsA. All patients were over 18 years of age and fulfilled the CASPAR criteria for PsA. Differences between gender in values of continuous variables were assessed by T-tests or Mann-Whitney tests. The association between categorical variables and gender was assessed by Pearson chi-square test or Fisher’s exact test. Results: 135 patients, 83 (62%) women and 52 (38%) men were included. Factors studied for gender differences are shown in Table 1. Women had significantly more tender (11 vs 3 p 0.001) and swollen (10 vs 3, p 0.013) joints, worse VAS (Visual Analogue Scale 0-10) pain (6 vs 5, p <0.001), higher ESR (20 vs 11, p 0.001) and worse DAPSA(Disease Activity in Psoriatic Arthritis) (33 vs 18 p 0.006) and presented with more enthesitis (32.5% vs 13.5%, p 0.013). In contrast, men achieved Minimal Disease Activity (MDA) more frequently (26.9% vs 3.6% p<0.001)and had significantly more comorbidities than women. Polyarthritic disease was more frequent in women (62% vs 31%), although at non-significant levels. Conclusion: Male patients with PsA have more comorbidities, while female patients have greater disease activity, worse patient reported outcomes and achieve MDA less frequently. References: [1]Determinants of Patient-Reported Psoriatic Arthritis Impact of Disease: An Analysis of the Association with Gender in 458 Patients from 14 Countries. [2]Orbai AM, Perin J, et al Arthritis Care Res (Hoboken). 2019 Oct 14. doi: 10.1002/acr.24090. Factor Women (n=83) Men (n=52) P value Median (25th-75 th percentile ) Age 55.1 (46.8-63) 56.6 (50-65.7) 0.419* BMI 27.9 (24.9-35) 30.1 (26.8-33.3) 0.181 # Pso duration/ PsA duration (years) 8.3 (3.9-24.5)/ 2.4 (0-5.7) 14.3 (4.7-22.7)/ 2.8 (0-6.4) 0.451 # /0.605 # Smoking (Packyears) 15 (5-30) 27.5 (0-46) 0.002 # TJC/SJC 11 (4-16)/ 10 (5-17) 3 (0-13)/ 3 (0-14) 0.001 # /0.013 # VASPain/ VASGA 6 (5-8)/ 5 (3-6) 5 (1-6)/ 4 (2-5) <0.001*/ 0.121* CRP/ ESR 1.4 (0.4-3.2)/20(11-33) 1.1 (0.2-2.7)/ 11 (7-18) 0.398 # / 0.001 # BSA/PASI 0 (0-2)/0(0-2) 2 (0-6)/1(0-4.8) 0.139 # /0.258 # DAPSA 33 (24.1-45) 18 (9.3-45) 0.006 # n (% ) Enthesitis/ Dactylitis 27 (32.5)/ 20 (24.1) 7 (13.5)/ 10 (19.2) 0.013 ***/ 0.508*** Dyslipidemia 33 (40.2) 31 (59.6) 0.029*** Liver 3 (3.6) 7 (13.5) 0.046** Eyes 0 (0) 3 (5.8) 0.055** Uricemia 3 (3.6) 8 (15.4) 0.023** Depression or anxiety 16 (19.3) 11 (21.1) 0.817*** CAD 2 (2.4) 12 (23.1) <0.001** DM 14 (16.9) 12 (23.1) 0.392 MDA 3 (3.6) 14 (26.9) <0.001 *: T-test with unequal variances; # : Mann-Whitney test; **: Fisher’s exact test; ***: Pearson chi2 test; Pso: Psoriasis; PsA: Psoriatic arthritis; BMI: Body mass index; TJC: Tender joint count; SJC: Swollen joint count; VASPain: Visual analogue scale 0-10 for pain; VASGA: Visual analogue scale 0-10 for general assessement; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; BSA: Body surface area; PASI: Psoriasis area severity index; DAPSA: Disease activity in psoriatic arthritis; CAD: Coronary artery disease; DM: Diabetes mellitus; MDA: Minimal disease activity; Disclosure of Interests: ALEXANDROS GRIVAS: None declared, IRENE KAPNIARI: None declared, KIMON TZANNIS: None declared, Dimitrios Tseronis: None declared, Michail Aggelakos: None declared, Dimitra Kassara: None declared, KATERINA HAVATZA: None declared, Sofia Flouda: None declared, Dionysis Nikolopoulos: None declared, Theofanis Karageorgas: None declared, EVAGELIA PAPADAVID: None declared, DIMITRIOS BOUMPAS Grant/research support from: Unrestricted grant support from various pharmaceutical companies, PELAGIA KATSIMPRI: None declared

Background:Cisplatin-based combination chemotherapy is the standard treatment of advanced urinary tract cancer (aUTC), but 50% of patients are ineligible for cisplatin according to recently published criteria. We used a multinational database to study patterns of chemotherapy utilization in patients with aUTC and determine their impact on survival.Patients and methods:This was a retrospective study of patients with: UTC (bladder, renal pelvis, ureter or urethra); advanced disease (stages T4b and/or N+ and/or M+); urothelial, squamous or adenocarcinoma histology. Primary objective was overall survival (OS). Eligibility-for-cisplatin was defined by Eastern Cooperative Oncology Group performance status ≤ 1, creatinine clearance ≥ 60 ml/min, no hearing loss, no neuropathy and no heart failure. Cox regression multivariate analyses were used to establish independent associations of cisplatin versus noncisplatin-based chemotherapy on OS.Results:1794 patients treated between 2000 and 2013 at 29 centers were analyzed. Median follow-up was 29.1 months. About 1333 patients (74%) received first-line chemotherapy: the use of first-line chemotherapy was associated with longer OS: [hazard ratio (HR): 1.91, 95% confidence interval (CI): 1.67-2.20]. Type of first-line chemotherapy received was: cisplatin-based 669 (50%), carboplatin-based 399 (30%) and other 265 (20%). Cisplatin use was an independent favorable prognostic factor (HR: 1.54, 95% CI: 1.35-1.77). This benefit was independent of baseline characteristics or comorbidities but was associated with eligibility-for-cisplatin: eligible patients treated with cisplatin lived longer than those who were not (HR: 1.74, 95% CI: 1.36-2.21), while such benefit was not observed among ineligible patients. About 26% of patients who did not receive cisplatin were eligible for this agent. Median OS of ineligible patients was poor irrespective of the chemotherapy used.Conclusions:The importance of applying published criteria of eligibility-for-cisplatin was confirmed in a multinational, real-world setting in aUTC. The reasons for deviations from these criteria set targets to improve adherence. Effective therapies for cisplatin-ineligible patients are needed.

INTRODUCTIONIt has been reported that overexpression and altered compartmentalization of γ-tubulin may contribute to tumorigenesis and tumor aggressiveness in a variety of human malignancies. We have shown that γ-tubulin expression and cellular distribution pattern is also altered in non-small cell lung cancer (NSCLC) (Histol. Histopathol. 2012; 27: 1183-1194). In the present study we examined the relationship between γ-tubulin expression and patient overall survival (OS).MATERIAL AND METHODSImmunohistochemistry was performed, with well-characterized anti-γ-tubulin antibodies, on 109 formalin-fixed, paraffin-embedded NSCLC specimens (p-TNM stage I-III). γ-Tubulin labeling indexes (LIs) were determined, and the association of γ-tubulin expression with clinicopathological parameters was evaluated. To analyze OS rates according to γ-tubulin LIs, patients were categorized into three groups: those with low (0-30%), intermediate (31-69%) or high (70-100%) γ-tubulin LI. Association of clinicopathological parameters and γ-tubulin with survival were examined using univariate and multivariate Cox regression analysis.RESULTSNo statistically significant association was seen between γ-tubulin overexpression and histological type, tumor differentiation, p-TNM stage and adenocarcinoma subtyping. Longer survival was observed in the high γ-tubulin LI group of patients with p-TNM stages II+III when compared to intermediate or low γ-tubulin LI groups, but the difference was not statistically significant (p=0.066). On the other hand, when combined low and intermediate γ-tubulin LI groups (p-TNM stages II+III) where compared to high γ-tubulin LI group, statistically significant longer survival was observed in high γ-tubulin group (p=0.021).CONCLUSIONOur findings suggest that level of γ-tubulin expression may have an impact on patient survival at more advanced NSCLC stages.

BACKGROUND:The impact of cisplatin use on long-term survival of unselected patients with advanced urinary tract cancer (aUTC) has not been adequately investigated. We used a multinational database to study long-term survival and the impact of treatment type in unselected patients with aUTC. MATERIALS AND METHODS:A total of 1,333 patients with aUTC (cT4bN0M0, cTanyN+M0, cTanyNanyM+), transitional-cell, squamous, or adenocarcinoma histology who received systemic chemotherapy and had available survival data were selected. Long-term survival was defined as alive at 3 years following initiation of first-line chemotherapy. Conditional overall survival (COS) analysis was employed to study change in prognosis given time survived from initiation of first-line chemotherapy. RESULTS:Median follow-up was 31.7 months. The combination of cisplatin use and cisplatin eligibility accurately predicted long-term survival. Eligible patients treated with cisplatin conferred a 31.6% probability of 3-year survival (95% confidence interval [CI]: 25.1-38.3), and 2-year COS for patients surviving 3 years after initiation of cisplatin-based chemotherapy was 83% (95% CI: 59.7-93.5). The respective probabilities for patients who were ineligible for cisplatin or not treated with cisplatin despite eligibility were 14% (95% CI: 10.8-17.6) and 49.3% (95% CI: 28.2-67.4). Two-year COS remained significantly different between these two groups up to 3 years after chemotherapy initiation. CONCLUSION:Cisplatin-based therapy was associated with the highest likelihood of long-term survival in patients with aUTC and should be used in patients who fulfill the established eligibility criteria. Novel therapies are necessary to increase long-term survival in cisplatin-ineligible patients. IMPLICATIONS FOR PRACTICE:Long-term, disease-free survival is possible in one in four eligible-for-cisplatin patients with advanced urinary tract cancer (aUTC) treated with cisplatin-based combination chemotherapy. Therefore, deviations from eligibility criteria should be avoided. Consolidation surgery should be considered in responders. These data provide benchmarks for the study of novel therapies in aUTC.

Background: Cisplatin-based chemotherapy is the treatment of choice in aUTC. Nevertheless, about 50% of patients are unfit for this treatment. Long-term survival of patients with aUTC has not been adequately studied outside the context of clinical trials. In addition, the impact of cisplatin utilization on long-term survival has not been adequately addressed. We used a multinational database to study long-term survival and the impact of treatment type in unselected aUTC patients as well as to provide benchmarks for future trials. Methods: Selection criteria: Diagnosis of aUTC, non small-cell histologies, administration of 1st-line chemotherapy, survival data available. Major end point: Overall survival (OS). Fitness-for-cisplatin (FFC) was defined according to Galsky et al (2011). Landmark and conditional survival analysis was used to study the change of prognosis with time from initiation of 1st-line chemotherapy. Results: 1361 patients (median fup: 31 months) were analysed. Survival analyses are shown in the table.Table866PProbability of surviving (y) (%)345Received Cisplatin (n = 689) Did not receive cisplatin (n = 672)28 1323 1019 6FFC (n = 421) Unfit (n = 550)28 1322 1018 8Received Cisplatin/Fit (n = 295) Did not receive cisplatin/unfit (n = 368)34 1128 1028 6Probability of surviving 2 more years having lived (y) (observed/predicted) (%)123Received Cisplatin Did not receive cisplatin44/43 30/3254/62 48/4762/67 43/57FFC Unfit45/43 31/3264/60 56/5364/69 61/66Received Cisplatin/Fit Did not receive cisplatin/unfit49/49 29/3267/65 57/5582/74 58/68 Open table in a new tab Cisplatin therapy and FFC were associated with improved long-term survival. FFC patients have a 28% probability of 5-year survival, which is increased to 74% for the 34% of patients who survive 3-years after initiation of cisplatin-based chemotherapy. Conclusions: Published criteria for FFC accurately predict for long-term survival of aUTC patients, following cisplatin-based chemotherapy, while patients not treated with cisplatin have inferior outcome. Probability of long-term survival was increased with time after initiation of 1st-line (cisplatin or no-cisplatin) therapy. Legal entity responsible for the study: RISC investigators Funding: None Disclosure: Y-N. Wong: The author was at Fox Chase Cancer Center at the time the study was conducted but is now a Janssen Scientific Affairs employee. All other authors have declared no conflicts of interest.

OBJECTIVES:To evaluate the prevalence and its clinical characteristics of psoriatic arthritis (PsA) in a specialized psoriasis clinic of a University Hospital.METHODS:In this retrospective study, 278 patients with psoriasis were evaluated between 2011 and 2013.RESULTS:The study included 278 patients with psoriasis: 144 (52%) were male and 134 (48%) female. Their median age was 51.41 with median psoriasis presenting age of 34.52 years. Referring to the type of psoriasis, 86% presented with plaque psoriasis, 5% guttate, 2% palms and soles, 2% inverse, 1% pustular and 4% with psoriasis of more than one type. Nail disease appeared in 121 patients (43.5%) and scalp disease in 175 (63%). Of these patients, 85 (30%) had PsA, whereas 51% of patients with PsA had psoriatic nail disease. With reference to the PsA type, 43 (51%) patients presented with polyarthritis, 10 (12%) with oligoarthritis, 7 (8%) with axial arthritis, whereas the rest 25 of them (31%) had PsA of more than one type. The subgroup of patients with PsA had significantly higher rates of comorbidities including arterial hypertension, diabetes and hypercholesterolaemia compared to non-PsA patients with 41% vs. 17% (P = 0.001), 20% vs. 8% (P = 0.021) and 41% vs. 19% (P = 0.004), respectively.CONCLUSION:The prevalence of PsA among patients with psoriasis was relatively higher in Greece compared to other ethnic-based studies. Comorbidities related to life expectancy were more frequent. As there is a high percentage of undiagnosed cases with active arthritis among patients with psoriasis, dermatologists should be aware of PsA clinical signs in order to recognize it earlier and provide successful treatment.

Advanced ovarian cancer (AOC) is one of the leading lethal gynecological cancers in developed countries. Based on the important role of angiogenesis in ovarian cancer oncogenesis and expansion, we hypothesized that the development of an "angiogenic signature" might be helpful in prediction of prognosis and efficacy of anti-angiogenic therapies in this disease. Sixty-nine samples of ascitic fluid- 35 from platinum sensitive and 34 from platinum resistant patients managed with cytoreductive surgery and 1st-line carboplatin-based chemotherapy- were analyzed using the Proteome ProfilerTM Human Angiogenesis Array Kit, screening for the presence of 55 soluble angiogenesis-related factors. A protein profile based on the expression of a subset of 25 factors could accurately separate resistant from sensitive patients with a success rate of approximately 90%. The protein profile corresponding to the "sensitive" subset was associated with significantly longer PFS (8 [95% Confidence Interval {CI}: 8-9] vs. 20 months [95% CI: 15-28]; Hazard ratio {HR}: 8.3, p<0.001) and OS (20.5 months [95% CI: 13.5-30] vs. 74 months [95% CI: 36-not reached]; HR: 5.6 [95% CI: 2.8-11.2]; p<0.001). This prognostic performance was superior to that of stage, histology and residual disease after cytoreductive surgery and the levels of vascular endothelial growth factor (VEGF) in ascites. In conclusion, we developed an "angiogenic signature" for patients with AOC, which can be used, after appropriate validation, as a prognostic marker and a tool for selection for anti-angiogenic therapies.

Anti vascular endothelial growth factor (aVEGF) agents represent the standard 1st-line therapy for mRCC. Monotherapy with agents blocking VEGF, mTOR or PD1/PD-L1 interaction are approved therapies. Since post progression blockade of VEGF may be of value, we studied the combination of BEV + TEM in mRCC patients relapsing after 1st-line treatment. A prospective, phase II, multicenter, trial evaluating the combination of BEV(10mg/kg, every 2 weeks) withTEM(25 mg weekly), until progression of the disease or unacceptable toxicity, was conducted in patients with mRCC who failed first-line aVEGF treatment. No previous therapy for relapsed disease was allowed. % of 6-month progression-free survival (PFS) was the primary end point. 39 patients were enrolled and 37 of them were evaluable for response. 1st-line therapy included: sunitinib (16), bevacizumab/interferon (12), pazopanib (10), sorafenib (1). The median age was 67 (40-80) years. Clear cell histology was present in 97% of patients, while 69% had PS 0. 51% of patients were progression-free at 6 months (95% CIs: 34-66) and 20% (95% CIs: 9-34) at 12 months. The median time to progression was 6.8 months (95%CI 5.5-9.2) and the overall survival 18.2 months (95%CI 12.9-27.2). Best responses were: complete-1 (2.7%), partial-9(24.3%), stable disease-20 (54.1%), progression-7(18.9%). Worst toxicities were of grade: 1 in 1 case (3%), 2 in 20 (51%), 3 in 15 (38%), 4 in 2 (5%), 5 in 1 (3%). The most common adverse evets (AEs) were metabolic (44%), gastrointestinal (11%) and myelotoxicity (9%). The most common grade 3 and 4 AEs were infection (10%), hypertension (5%), hypertriglyceridemia (5%) and mucositis (5%).Toxicity was the most frequent cause of treatment discontinuation (33%). The combination of BEV and TEMis active in mRCC patients relapsing after a VEGF 1st-line treatment. Our study confirms recent encouraging data of another anti-VEGF/anti-mTOR combination in this population. Nevertheless, toxicity was considerable leading to the discontinuation of therapy in 1/3 of patients.

Cisplatin-based chemotherapy is the treatment of choice in metastatic urothelial cancer (mUC). Nevertheless, about 50% of patients do not receive this treatment. Recently, specific criteria for unfitness-for-cisplatin (UFC) have been published. We used a multinational database to study the impact of adherence to UFC criteria in the outcome of unselected mUC patients Selection criteria: diagnosis of mUC, transitional, mixed, squamous and adeno histologies, survival data available. Major end point: Overall survival (OS). UFC was defined according to Galsky et al (2011). From 1828 mUC patients 441 (24%) did not receive any chemotherapy. These patients had a significantly shorter median OS (Table). 1361 patients (median fup: 31 months) were included in the analysis of the following treatment types: cisplatin-based (689;50%), carboplatin-based (404;30%), no cis- or carbo-platin [other (268;20%)]. Cisplatin therapy was associated with longer OS (Table). 971 patients had full data regarding UFC. The following deviations from the UFC criteria were noted: 21% and 32% of the carboplatin and the other groups were fit-for-cisplatin, while 38% of the cisplatin-treated patients fulfilled at least one UFC criterion. UFC patients had inferior outcome. This effect was significant only in cisplatin-treated patients (Table), while the benefit from cisplatin was also more pronounced within the fit-for-cisplatin patients. This cisplatin therapy-UFC interaction was significant (p = 0.0343)Tabled 1Median OS (months)95% CIp1st-line chemotherapy Yes (n = 1499) No (n = 475)14.6 5.113.4-15.5 4.2-6.2<.001Treatment Group Cisplatin (n = 689) Carboplatin (n = 404) Other (n = 268)16.7 10.5 9.714.8-18.5 9.3-11.7 7.9-11.8<.001Unfit-for-cisplatin Yes (n = 550) No (n = 421)15.8 9.814.1-18.7 8.6-10.8<.001Cisplatin-treated Fit-for-cisplatin (n = 295) Unfit-for-cisplatin (n = 182) Non-cisplatin treated Fit-for-cisplatin (n = 126) Unfit-for-cisplatin (n = 368)19.4 11.9 12.2 8.615.9-22.4 10.8-14.2 9.4-14.1 7.2-9.6<0.001 0.150 Open table in a new tab A sizable proportion of fit-for-cisplatin patients do not receive cisplatin-based chemotherapy. Use of cisplatin for those patients may have potential to improve outcomes. On the contrary, unfit-for-cisplatin patients have a worse outcome and more efficient therapies should be sought.

Transurethral resection of bladder tumor (TURBT), radiotherapy, chemotherapy, or combinations can be used in patients with muscle-invasive bladder cancer (MIBC) not undergoing cystectomy. Nevertheless, unfitness for cystectomy is frequently associated with unfitness for other therapeutic modalities. We report the outcome of patients with MIBC who did not undergo cystectomy and did not receive cisplatin-based chemotherapy. Selection criteria for the study were nonmetastatic MIBC, no cystectomy, no cisplatin-based chemotherapy. Chemotherapy and/or radiotherapy should have been used aside from TURBT. Forty-nine patients (median age 79), managed between April 2001 and January 2012, were included in this analysis. Median Charlson Comorbidity Index was 5, while 76% were unfit for cisplatin. Treatment included radiotherapy (n = 7), carboplatin-based chemotherapy (n = 25), carboplatin-based chemotherapy followed by radiotherapy (n = 10), and radiochemotherapy (n = 7). Five-year event-free rate was 26% (standard error [SE] = 7) for overall survival, 23% (SE = 7) for progression-free survival, and 30 (SE = 8) for cancer-specific survival (CSS). Patients who were treated with combination of radiotherapy and chemotherapy had significantly longer CSS compared to those treated with radiotherapy or chemotherapy only (5-year CSS rate: 16% [SE 8] vs. 63% [SE 15], P = 0.053). Unfit-for-cystectomy patients frequently receive suboptimal nonsurgical treatment. Their outcome was poor. Combining chemotherapy with radiotherapy produced better outcomes and should be prospectively evaluated.