e17623 Background: Endometrial cancer (EC) is the most common gynecological cancer worldwide. The understanding of clinicopathological characteristics has changed within the last years. Limited data are available regarding the long-term survival of EC patients. Methods: Clinical data and survival data for patients with EC diagnosed in Germany between 2010 and 2020 were gathered from the German national center for population-based cancer registry. Differentiated by histological subtype, 5- and 7-year survival rates were calculated. Results: 49,808 patients with newly diagnosed EC between 2010 and 2020 were included in the analysis. Median age at diagnosis was 68.1 years (IQR 59.0;76.4). 5-year and 7-year overall survival was 67.5% and 56.7%, respectively, and decreased with increasing FIGO-stage: 83.7% and 72.6% for FIGO IA, 71.0% and 56.3% for FIGO IB, 59.8% and 47.3% for FIGO II, 48.2% and 38.7% for FIGO IIIA , 32.5% and 20.7% for FIGO IIIB, 40.0% and 30.6% for FIGO IIIC, 13.3% and 8.2% for FIGO IVA, 16.4% and 13.9% for FIGO IVB, respectively. Regarding histological subtype, endometrioid carcinoma showed the best 5-year and 7-year overall survival rates with 72.5% and 61.3%, respectively, followed by clear cell carcinoma with 41.2% and 34.0%, serous carcinoma with 35.5% and 24.8%, and lastly carcinosarcoma with 28.5% and 23.0%. Of 3,765 patients with known cause of death, 53.8% were due to endometrial cancer. 19.0% died of cardiovascular disease and 18.8% of other malignancies. Conclusions: Our data represents deeper insight in the characterization of long-term survival patients of this tumor entity.

e24120 Background: In recent years, the understanding of endometrial cancer shifted, leading to a change in therapy strategies including targeted therapies. For a successful conduction of therapy, a patient’s expectations, preferences, and needs should be considered. The aim of this study was to define these factors. Methods: We conducted an international 80 item survey in paper-form and via the internet for endometrial cancer patients. The data recorded were demographics, tumor stage, therapy, recurrence status, comorbidities, preferences and expectations concerning therapy modalities. Results: Between 12/2021 and 12/2022, 568 endometrial cancer patients could be recruited from seven different countries – with the majority being from Germany (54.3%) and Switzerland (44.0%). Median age was 66.0 [58.0; 73.0] years. While most patients (79.7%) were in follow-up care with no current anti-cancer therapy, 20.3% were still receiving treatment, of which 6.2% were due to cancer recurrence. In total, 14.6% of all patients suffered a relapse. More than two thirds were concomitantly suffering from high blood pressure (39.6%) and/or joint pain (arthrosis, arthritis) (30.5%) – a fifth (21.3%) did not have any pre-existing illnesses. On average, the patients took 2.9 (±3.0) different drugs regularly for their comorbidities. The distribution of initial tumor status was 62.5% for FIGO I, and 16.6%, 15.1% and 5.8% for FIGO II-IV, respectively. A third of the patients (34.7%) reported that their tumor was tested for molecular classification, more than half (56.9%) did not know if this had occurred. After first being diagnosed, most patients (96.6%) underwent an operation, 39.5% received radiation therapy, 27.6% chemotherapy, 7.1% hormonal treatment and 3.6% immunotherapy. More than a third (38.1%) of all patients would be interested in participating in clinical studies, less than half (43.6%) were offered this option. To receive information about their disease, 36.8% use the internet, but most (91.5%) think that the doctors’ expertise is the most important source of information. More than half (55.0%) see a need for more information material. To improve treatment, patients would like doctors to spend more time on explanations (31.2%), to better cooperate with each other (21.0%) and for the therapy not to lead to hair loss (20.6%). The maximum time of therapy, that most patients are willing to tolerate if everything goes well is 6-12 months (41.3%) followed by the time period until recurrence (34.4%). Conclusions: Women with endometrial cancer would benefit from significant improvement in the management of endometrial cancer, including the provision of information and educational materials and access to clinical trials. Clinical trial information: DRKS00025954 .

Introduction/Background Endometrial cancer (EC) is commonly associated with cardiovascular risk factors such as obesity and metabolic diseases. Especially in type 1 cancer, strong correlation with these characteristics was demonstrated. For successful holistic conduction of therapy, the patient's wish for change and compliance must be understood better. The aim of this study was to define the status quo of patient needs and preferences. Methodology An 80 item survey in paper-form and via internet was distributed to patients with diagnosed EC in seven countries. General patient characteristics (comorbidities, tumor stage, therapy), monitoring of lifestyle before and after diagnosis and adherence to treatment modalities were recorded. Results Between 12/2021 and 04/2023, 656 patients with EC (median age: 65.0[20.0; 92.0] years) completed the survey. Major recruitment took place in Germany (56%) and Switzerland (41%). The most common comorbidities were hypertension (42%), diabetes (13%) and hypothyroidism (20%). 46% of patients reported not exercising before diagnosis of EC. Only 14% increased their activity after diagnosis, 39% did even less (49% of those due to weakness). The need for medical exercise programs was low – only 30% were interested - although 55% felt that more activity would benefit their disease. 62% reported that they had not changed their diet after diagnosis. 31% would be interested in a professional nutrition counseling program, 81% did not receive one during treatment. Regarding screening programs, 52% participated in the colonoscopy program, 61% in the cervical cancer program, 34% in the skin cancer program and 71% in mammography screening. Conclusion A majority of patients believe in a potential positive impact of lifestyle changes, such as exercising and diets. Nevertheless, physical activity appeared to be relatively low and most patients did not change their diet after diagnosis. There is a need for better support of patients in these aspects, to achieve the known benefits of holistic treatment. Disclosures Financial support by GlaxoSmithKline Research & Development Limited.

BACKGROUND/AIM:Lynch syndrome (LS) is the secondary cause of hereditary ovarian cancer (OC). Germline mutations in the DNA-mismatch repair (MMR) genes cause tumorigenesis and a high immunogenicity. Recent studies showed a promising use of immunotherapy in MMR deficient (MMRd) tumors. This is a case report of a patient with LS-associated OC and a complete response to pembrolizumab.CASE REPORT:A 44-year-old patient was admitted to the hospital with lower abdominal pain. The patient's history showed LS with a germline mutation in the MSH2-gene. Initial diagnostics showed a pelvic tumor mass and a highly elevated cancer antigen 125. After debulking surgery, histopathological findings showed a high-grade serous OC with mutations in the MSH2 and MSH6 genes. Only 5 weeks after operation with no residual tumor mass, a quick and significant intraabdominal progression of the disease was diagnosed. Adjuvant therapy with carboplatin and paclitaxel in a weekly course did not lead to sustainable response. An anti-PD-L1 antibody therapy with pembrolizumab was initiated. After only two courses of therapy, the laboratory results and clinical status of the patient improved tremendously. Shortly after, a complete response was detected, and therapy is still ongoing. The patient remains tumor free for 21 months now.CONCLUSION:The significance of germline compared to somatic mutations has not yet been sufficiently investigated. To our knowledge, this is the first case with complete response to checkpoint inhibition in OC associated with LS. Regarding LS-associated OC, immune checkpoint inhibition is an efficient therapy in tumors nonresponsive to standard therapy.

Introduction/Background The adjuvant treatment of endometrial carcinoma is constantly evolving. The introduction of checkpoint inhibitors in the therapy of recurrent endometrial carcinoma marked a milestone in the clinical outcome. Nevertheless, there is a need to develop possible treatment strategies to overcome a checkpoint inhibitor resistance. Methodology Results We present a case of 79-year-old patient diagnosed with endometrioid endometrial carcinoma in 2010. Laparoscopically assisted vaginal hysterectomy with salpingo-oophorectomy and systematic pelvic and paraaortic lymphadenectomy was performed, and the carcinoma was classified as pT1b G2 R0 L0 V0 FIGO IB. Two years later a vaginal stump recurrence was resected, macroscopically tumor free. Five years after initial diagnosis, the patient presented with pulmonary metastasis. Chemotherapy was started with weekly paclitaxel and carboplatin for twelve cycles. Moreover, the patient underwent combined radio-chemotherapy in June 2016. Six months later the patient was first diagnosed with cerebral metastasis, stereotactic radiation was followed by MPA for 10 months. In November 2017 due to the third local recurrence, a laparotomy with resection of the tumor from the pelvic wall and the iliac vessels was performed and letrozol therapy was initiated until January 2020. A pathological examination confirmed an EEC – p53 wt, hormone receptor positive and a microsatellite instability with loss of PMS2 and MLH1. In 2020 the patient presented infiltration of the bladder. Immunotherapy with checkpoint inhibitor was initiated but the tumor showed image morphological progression after 9 months. Due to the progression the addition of lenvatinib was recommended. Under this combination therapy the tumor showed a stable disease ever since in total of 21 months and with some lesions to partial response. Conclusion The combination of checkpoint inhibitor and a tyrosine kinase inhibitor is a potential approach to overcome checkpoint inhibitor resistance. Further clinical trials are warranted.

Introduction/Background Lynch syndrome is a secondary cause for hereditary ovarian cancer after BRCA mutation. Germline mutations in the DNA-mismatch repair genes cause tumorigenesis and a high immunogenicity. Recent studies showed a promising use of immunotherapy in MMR deficient (MMRd) tumors. We present a case of a patient with LS associated OC and a complete response to pembrolizumab. Methodology x Results A 44-year old patient was admitted to the hospital with lower abdominal pain. The patient’s history showed LS with a germline mutation in the MSH2-gene. Initial diagnostics showed a pelvic tumor mass and a highly elevated cancer antigen 125. After debulking surgery, histopathological findings showed a high grade serous OC with a mutation in the MSH2 and MSH6-genes. Only 5 weeks after operation with no residual tumor mass a quick and significant intraabdominal progression of the disease was diagnosed. Adjuvant therapy with carboplatin and paclitaxel in a weekly course did not lead to sustainable response. An anti-PD-L1 antibody therapy with pembrolizumab was initiated. After only 2 courses of therapy the laboratory results and clinical status of the patient improved tremendously. Shortly after a complete response was detected and until today for 28 cycles immune checkpoint inhibition therapy is ongoing. The patient remains tumor free for 21 months now. Conclusion Recent studies suggest a promising effect of checkpoint inhibition within MMRd tumors. OC on the other hand does not seem to show an overall good response to immunotherapy. The significance of germline compared to somatic mutations has not yet been investigated in prior studies suffiently. To our knowledge, this is the first case with complete response to checkpoint inhibition in OC associated with LS. Comprehensive testing for germline mutations should be established. Regarding Lynch syndrome associated ovarian cancer, immune checkpoint inhibition is an efficient therapy in tumors nonresponsive to standard therapy.

Background/Aim: Angiosarcoma of primary gynecologic origin is an extremely rare and highly malignant tumor of endothelial origin with a 5-year survival rate of less than 35%. To date, only 61 cases have been described in the literature. The aim of this study was to present more cases and discuss potential therapy options. Case Report: The following case series presents three cases of gynecologic angiosarcomas that were under therapy at the Charite - University medicine of Berlin from June 2014 to February 2018. Results: Two of the cases deal with primary angiosarcomas of the uterus whereas the third case was diagnosed after the suspicion of a recurrence of a poorly differentiated squamous cell carcinoma of the cervix uteri. In case one a 75-year old patient with initial postmenopausal bleeding and a tumor mass of the uterus is described. After surgery a hemangiosarcoma of the uterus was confirmed. After two months the patient presented with a presacral peritoneal sarcomatosis. Chemotherapy of weekly paclitaxel was administered. Case two deals with a patient presenting with abdominal pain. A uterine sarcoma with infiltration of the parametry and angiosarcomatosis peritonei was diagnosed during an emergency laparotomy because of spontaneous peritoneal bleeding. Moreover, osseous metastasis was found. The patient underwent weekly paclitaxel. Due to tumor progression, chemotherapy was changed to doxorubicin and olaratumab and radiotherapy was induced. The patient died 33 months after initial diagnosis. Case three describes a 34-year old patient with suspected local recurrence of cervical cancer with infiltration of the bladder. During TURB an angiosarcoma was found. Following laparoscopy revealed peritoneal metastasis. The patient underwent weekly paclitaxel followed by a paclitaxel and pazopanib maintainance therapy which showed a regression. Due to progression afterwards, chemotherapy was changed to gemcitabine and docetaxel and gemcitabine monotherapy. The patient died 33 months after initial diagnosis. Conclusion: Even though there is no evidence on standard treatment of this extremely rare and aggressive tumor entity of the female genital tract the patients showed the longest stability of disease during chemotherapy with weekly paclitaxel.