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TPS631 Background: HCC is increasing rapidly in incidence worldwide driven by a rise in chronic liver disease including non-alcoholic steato-hepatitis (NASH). Most pts are not suitable for curative or loco-regional treatments and may be candidates for systemic therapies. Immune checkpoint inhibitors combined with VEGF inhibition is a standard of care in HCC. However, a meta-analysis of 3 phase III randomised trials of PD-1 or PDL-1 inhibitors (n > 1,600 pts) with HCC suggests that pts with NASH-related HCC treated with PD-1/PDL-1 inhibitors had reduced overall survival compared with other aetiologies. Neutrophils expressing the chemokine receptor CXCR2, crucial to neutrophil recruitment in acute-injury, are highly represented in NASH-HCC. In NASH-HCC murine models, lacking response to immune-checkpoint inhibitors, AZD5069 (CXCR2 inhibitor) in combination with anti-PDL-1 suppressed tumor burden and extended survival, accompanied by an increase in tumor-associated neutrophils which switched from a pro-tumor to anti-tumor progenitor-like neutrophil phenotype. We propose that inhibition of CXCR2 may potentiate the efficacy of anti-PDL-1 inhibition in pts with HCC. Methods: In this multi-centre (n = 10) study, pts with biopsy-confirmed HCC, PS ECOG < 1, Child-Pugh A, < 1 prior systemic therapies, receive 1 of escalating doses of AZD5069 (bid, po daily) with Durvalumab (1.5 gm iv on day 1) in 28-day cycles for up to 2 years to determine the recommended phase II dose using a Keyboard design, followed by an additional cohort of pts to determine the anti-tumor efficacy of this combination using a Simon’s two-stage design (min 18, max 35 pts; target objective response rate > 30%; unacceptable response rate < 10%). Dose limiting toxicities (DLTs) are assessed during cycle 1. Disease assessments are performed 8-weekly (12-weekly after 1 year). The 1st dose cohort has been completed with no DLTs. The 2nd dose cohort opened to recruitment in September 2022. Exploratory studies (blood; pre- & on-treatment tumor and non-malignant liver biopsies) include biomarkers of CXCR2 inhibition (blood); proof-of-mechanism (tumor: expression of CXCR2, PD-L1, PD-1, CD8, CD4, CD66b, CD69); proof-of-mechanism (blood: ctDNA); drug-induced changes of mRNA expression, CXCR2 ligands & signalling pathway genes, T-cell and myeloid cell pathways, neutrophil-associated genes; predictive biomarkers (blood and tumour) include biomarkers of the CXCR2/PD-L1 immune axis; aberrant CXCR2 signalling pathways; proliferation biomarkers and CD10 (neutrophils), CD68 (macrophages), CD103 (T-regs); tumour mutational status. This study is funded by a grant from Cancer Research UK (A29287) and is co-sponsored by University of Glasgow and NHS Greater Glasgow & Clyde. Study sites are supported by the Experimental Cancer Medicine Centre Network. AZD5069 and Durvalumab are provided by Astra Zeneca. Clinical trial information: 2020-003346-36 .

TPS460 Background: A major challenge of lower incidence cancer types is that to make significant advances a network approach is required to coordinate research, generate greater clinical capacity and recruit sufficient patients. This is particularly the case for pancreatic cancer (PC). To address this, we established Precision-Panc, a synergistic and dynamic platform aligning “discovery”, “preclinical” and “clinical” therapeutic development. Methods: Central to the clinical development is the Precision-Panc Master Protocol, a multi-centre “portal” protocol recruiting patients with known or suspected PC, to enable enrolment into PRIMUS (Pancreatic canceR Individualised Multi-arm Umbrella Study), examining different treatment regimens and/or biomarker development. Eligible patients are identified prior to the diagnostic biopsy to obtain Stage 1 (Screening) Consent for extra tissue to be taken in the same biopsy setting. Patients who already have a diagnosis are asked to provide additional research biopsy. Once the PC diagnosis is made, Stage 2 (Registration) Consent is obtained for molecular profiling at the central reference laboratory using Precision-Panc NGS Diagnostic (bespoke clinical grade assay), including germline testing of 12 PC predisposition genes. The results may inform eligibility for a PRIMUS study. There is no sample size calculation due to the nature of the Master Protocol; however, individual PRIMUS studies will be appropriately powered according to their study design and primary endpoint. Results: Adults (aged >16 years) with either a hypodense pancreatic mass highly suspicious of PC (+/- distant metastases) or histologically/cytologically confirmed PC and its variants; willing and able to undergo tumour biopsy to obtain sufficient tissue for molecular profiling; deemed suitable to receive chemotherapy and/or radiotherapy and/or surgery pending stage of disease; must give both Stage 1 and 2 informed consent. Conclusions: The study opened on 28 Dec 2017; by 25 Sep 2018, 67 patients have been screened for Precision-Panc, 43 of whom have gone on to be registered and 19 have then been randomised to the PRIMUS-001 study (first-line metastatic). Clinical trial information: ISRCTN14879538.

2018Background: The poly(ADP-ribose) polymerase (PARP) inhibitor olaparib (O) has radio and chemosensitizing properties in GBM models. Clinical development of PARP inhibitor combinations has been r...

TPS4158Background: Platinum-containing regimens (e.g. FOLFIRINOX) have shown survival benefit for pancreatic cancer (PC), with some “exceptional responders”; biomarkers (BM) of response are not well defined. Tumors with mutations in BRCA1/2 and other Fanconi Anemia genes, are preferentially sensitive to DNA-damaging agents (e.g. platinum) through synthetic lethality mechanisms, as they are defective in DNA damage response (DDR). We have shown that DDR deficiency may be present in 20% of PC. PRIMUS-001 aims to exploit defective DDR as a therapeutic vulnerability, with integrated study of BM of DNA-damaging agent response. Methods: PRIMUS-001 will enroll patients who are profiled molecularly using Precision-Panc NGS Diagnostic (BM via bespoke clinical grade assay). It is a multicentre, randomized (1:1), open-label, phase II trial comparing FOLFOX-A (nab-paclitaxel 150mg/m2 IV, oxaliplatin 85mg/m2, folinic acid 350mg flat dose, fluorouracil infusion 2400mg/m2 continuous IV infusion) vs AG (nab-paclitaxel 125...

Background There are limited data on the cardiac effects of radiotherapy and chemo-radiotherapy on the heart in patients with non-small cell lung cancer (NSCLC). CART is a pilot study designed to investigate change in myocardial function and tissue properties where Patients will undergo cardiac magnetic resonance (CMR) at baseline, during treatment, at 6 weeks and at 6 months after treatment completion. Here we report our preliminary findings related to temporal changes in myocardial perfusion index (MPI). Methods CMR was performed on a Siemens MAGNETOM Verio (Erlangen, Germany) 3.0 Tesla scanner. First-pass myocardial perfusion was assessed by saturation recovery prepared dynamic contrast enhanced sequence during administration of 0.1 mmol/kg of gadoterate meglumine (Dotarem). Semiquantitative analysis was performed on segmented basal and mid-LV short axis slices to derive normalised upslopes of myocardial signal intensity profiles (myocardial perfusion index, MPI). The change in MPI over time was analysed statistically using a linear mixed effects model. Results 13 patients currently have undergone CMR at baseline and during treatment (mean age 66 years, SD: 9; 71% male), 8 patients have undergone CMR at 6 weeks post treatment initiation (5 patients lost to follow-up/ died), and 6 patients have undergone CMR at 6 months from baseline (n = 2 lost to follow-up/ died). Perfusion index (Figure 1) varies significantly with time (p = 0.0015). After adjustment for multiple testing, the increase from baseline is statistically significant at 6 weeks (p = 0.014) and approaches significance at 6 months (p = 0.074) post treatment. Conclusion Change in microvascular perfusion is most pronounced 6 weeks following the completion of treatment. This finding will be used in the design of future clinical studies, where measurement of MPI will provide a robust comparison of different existing and emerging treatment protocols for NSCLC with regard to their effects on myocardial physiology. Funding Beatson Oncology Centre Fund

Purpose/Objective: To determine if a weekly cone-beam CT (CBCT) is enough to evaluate the entire tumor inclusion and the reproducibility throughout the radiation course treatment in lung cancer. Materials and Methods: Thirty-six lung cancer patients were treated with image-guided radiotherapy (IGRT) on an Elekta Synergy Beam Modulator linear accelerator. The GTV included the tumor and the positive nodes in PET-CT and pathologic analysis. The PTV was configured with the GTV and a margin of 0.7 cm – 1 cm in all directions. In our protocol of lung cancer treatment, prior to each radiotherapy fraction we make one cone-beam CT every day on the first five days of treatment using automated softtissue registration. The positional errors of the reference image in relation to the acquired image (given in terms of translation movements) were obtained. No rotations were permitted. The average of these translational movements in the three axes (x, y, z) was calculated. This average was applied from the sixth day of treatment until the end. Weekly image guidance was registered resulting in at least 10 CBCT scans for each patient. The deviations in the three axes in every weekly CBCT with respect to the average were analyzed (Tx, Ty, Tz) Results: The graphics summarize the result of our analysis. In 29 patients (80.6%) the mean value of the difference between the positional errors compared to the average was: x = (0.19 ± 0.14) cm, y = (0.21 ± 0.14) cm, z = (0.27 ± 0.16) cm. All these values were less than 0.5cm and were considered correct for the suitable treatment of the patients. The shifts in the z axis showed more variability compared to the other axes mainly related to breathing movements. Nevertheless this z axis variability did not influence on the entire tumor inclusion and the set up reproducibility. In the other 7 patients (19.4%) we obtained a greater difference in either axes, and a CBCT more often than once a week was evaluated by the physician. Conclusions: Our preliminary results showed that in most lung cancer patients treated with IGRT, once an average is calculated after the first five days of treatment, a weekly cone-beam CT is enough to evaluate the entire tumor inclusion and the reproducibility throughout the radiation treatment.

430 Background: Two previous single arm trials have drawn conflicting conclusions regarding pazopanib in urothelial bladder cancers (UBC) after failure of platinum-based chemotherapy. PLUTO is a randomized phase II trial to compare the efficacy of pazopanib with paclitaxel in this setting. Methods: It was planned for 140 patients with progressive, advanced UBC (with at least a component of transitional cell carcinoma) who had previously received a single prior platinum containing chemotherapy regimen for advanced UBC to be randomised(1:1). Patients in arm A received weekly paclitaxel 80mg/m2 and those in arm B received pazopanib (800mg once daily) until progression. The primary endpoint was overall survival analysis of which would occur after 110 events. The efficacy was assessed by an independent data monitoring committee during the trial. Results: Between Aug 2012- Oct 2014, 131 patients were randomised. 74.0% of patients had visceral metastases. The study was terminated early by the IDMC due to futility of pazopanib. Final analysis after 110 deaths occurred in July 2015. The median number of cycles of paclitaxel received was 4 (12 weeks). The median time on pazopanib was 11 weeks. Median overall survival was 8.0 months for paclitaxel [80% confidence interval (CI) 6.9 to 9.7 months] and 4.7 months for pazopanib [80% CI 4.2 to 6.4 months]. The hazard ratio (HR) adjusted for baseline stratification factors was 1.25 [80% CI 0.96 to 1.63; 1-sided p = 0.86] in favour of paclitaxel. Median progression free survival was 3.2 months for paclitaxel [80% CI 2.9 to 5.0 months] and 3.1 months for pazopanib [80% CI 2.7 to 3.8 months]. The adjusted HR for PFS was 1.06 [80% CI 0.83 to 1.36; 1-sided p = 0.62] (in favour of paclitaxel). Discontinuations for toxicity occurred in 6.3% and 20.0% for paclitaxel and pazopanib respectively. VHL, HIF1alpha, VEGFR2 and PD-L1 expression were measured from archived tissue and correlated with outcome. Conclusions: Pazopanib does not have greater efficacy than paclitaxel in the second line treatment of UBC. There is a trend towards superior OS with paclitaxel. Clinical trial information: NCT00949455.

TPS4589 Background: Urothelial cancer (UC) is a chemosensitive disease. There is a clear role for first line, platinum-based chemotherapy in advanced disease, response rates being around 40-50%. Ho...