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Precision medicine is playing an increasingly important role in cancer management and treatment. Specifically in the field of oncology, circulating tumor cells (CTCs) hold significant promise in enabling non-invasive prognostication and near real-time monitoring to individualize treatments. In this study, we present strong associations between CTC subtype counts with treatment response and tumor staging in lung, nasopharyngeal and breast cancers. Longitudinal analysis of CTC count changes over short-time windows further reveals the ability to predict treatment response close to real-time. Our findings demonstrate the suitability of CTCs as a definitive blood-based metric for continuous treatment monitoring. Robust processing of high-throughput image data, explainable classification of CTC subtypes and accurate quantification were achieved using an in-house image analysis system ‘CTC-Quant’, which showed excellent agreement with expert opinion upon extensive validation.

e21516 Background: The utility of a liquid biopsy test for diagnosis and treatment is determined by its accuracy, molecular target coverage and timeliness to a clinically informative result. We describe our clinical experience of providing comprehensive next-generation sequencing (NGS) plasma testing for advanced lung cancer cases, including parallel testing with allele-specific PCR (AS-PCR) for rapid EGFR mutation detection. Methods: Plasma cell-free DNA (cfDNA) from advanced lung cancer patients (n = 374) underwent real-world testing with an amplicon-based NGS assay, in a CAP and ISO15189 accredited central laboratory. The assay covers 51 genes, including 8 guideline recommended biomarkers- EGFR, BRAF, MET, ALK, RET, ROS1, ERBB2 and KRAS. 168 cases (44.9%) were treatment-naïve (baseline) and 206 cases (55.1%) had received one or more lines of treatment. Parallel testing with AS-PCR for 10 specific EGFR mutations was done for 151 cases (90 baseline, 61 non-baseline). Concordance of EGFR mutation detection by the two methods, and the frequency of detection of clinically actionable (driver) mutations by NGS were assessed. Turnaround time (TAT) was calculated from sample receipt. Results: An overall concordance of 97.4% was observed for EGFR mutations between AS-PCR and NGS. When restricted to baseline cases, concordance was 100%. Among baseline cases which were concordant with AS-PCR for EGFR negativity (n = 63), driver mutations were identified in EGFR (n = 7 rarer mutations), KRAS, ERBB2, MET, NRAS, BRAF and ALK (n = 16 total) by NGS, providing an additional 37% diagnostic yield (23/63 cases). Among all baseline cases tested by NGS, a driver gene mutation was found in 64.28% of cases, including EGFR (36.9%) and KRAS mutations (11.9 %). Among non-baseline cases which were EGFR-negative by NGS and by AS-PCR, added diagnostic yield provided by NGS was 33.3% (10 of 30 cases), and included 16.7% rarer EGFR mutations. Overall, detection rate of ALK, RET, ROS1 fusions was 2.4% (n = 5, 3 and 1, respectively). Median TAT for EGFR results by AS-PCR was 1 day (range 1-2 days), while median TAT for NGS results was 10 days (range 4-13 days). Conclusions: We report excellent real-world performance of blood-based liquid biopsy testing for detecting recommended biomarkers in lung cancers, including an approach combining two orthogonal platforms for quick decision making. Clinically meaningful diagnostic yields can be obtained using a timely comprehensive NGS assay, either individually or in parallel with rapid AS-PCR testing.

Aim: Cancer genetic risk assessment clinics represent the primary prevention arm in oncology in identifying high-risk patients for screening and prevention, but deals with the taboo subject of cancer risk prediction. Low knowledge level and traditional beliefs may pose significant barriers to its acceptance in Asia. Methods: We conducted a questionnaire survey to evaluate the acceptance of breast cancer genetic counseling. Results: More than 70% of the 438 respondents indicated interest and perceived potential benefits. Higher education level and use of English were associated with greater acceptance. Learning about cancer risk and cancer detection, helping the family, and the doctor's recommendation, were important motivators, while misperception that cancer patients could not gain personally, concerns of not understanding the information, cost issues, and fears of bad news, were important barriers. Conclusions: Singaporean women were receptive to cancer genetics counseling. Education to correct misperceptions may optimize utilization of a cancer genetics service.

Abstract 58 Background: In 2011, an international panel of breast cancer experts developed the first Advanced Breast Cancer (ABC) Consensus Guidelines to provide standards and improved care for the multidisciplinary care of patients with this common disease. We sought to adapt the ABC guidelines for China, incorporating cultural standards and available Chinese resource, and identifying suitable formed guideline. Methods: We organized the Chinese Consensus Guidelines Conference for ABC (CABC) yearly from 2013 through 2015 in Beijing as a joint effort between the China Medical Women's Association, the Organization of Beijing Sunshine Great Wall Oncology Program, Peking University, The panel included 50 breast oncology and surgery experts from 20 provinces, as well as two external consultant oncologists from the U.S. and Singapore. Permission was obtained from the ABC Chair to use the guidelines as a basis for our discussion. All questions were presented and discussed in detail, including a review of current applicable data, and panel members voted on each question. Results: The main issues discussed included; 1. In China the patient treatment decision making generally by family members. 2. Use of sequential single agent chemotherapy for standard risk in China most experts still prefer combination therapy. 3. The trastuzumab are not covered by health insurance in China and/or pertuzumab is not yet available. 5. For hormone receptor positive ABC, some physicians in China prefer to start with chemotherapy . 7. Not well accepted by Chinese patients. Details of final voting and Chinese consensus will be presented. Conclusions: Standard guidelines are critical, but must be tailored to be used effectively in specific countries. The CABC has effectively discussed, modified and distributed guidelines for the treatment of ABC in China. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Huiping Li No relationship to disclose Hope S. Rugo Honoraria: Genomic Health Speakers' Bureau: Genomic Health Research Funding: Plexxikon, Macrogenics, OBI Pharma, Eisai, Pfizer, Novartis, Eli Lilly, GlaxoSmithKline, Genentech, Celsion, Nektar, Merck, Amgen Travel, Accommodations, Expenses: Novartis, Nektar, Roche/Genentech, OBI Pharma, Mylan Jin Zhang No relationship to disclose Zhimin Shao No relationship to disclose Zhenzhou Shen No relationship to disclose Binhe Xu No relationship to disclose Jiong Wu No relationship to disclose Zefei Jiang No relationship to disclose Erwei Song No relationship to disclose Yinhua Liu No relationship to disclose Xichun Hu No relationship to disclose Cuizhi Geng No relationship to disclose Bo Li No relationship to disclose Jinhai Tang No relationship to disclose Jifeng Feng No relationship to disclose Pin Zhang No relationship to disclose Junlan Yang No relationship to disclose Qingyuan Zhang No relationship to disclose Jian Liu No relationship to disclose Yuee Teng No relationship to disclose Yongsheng Wang No relationship to disclose Zhongsheng Tong No relationship to disclose Guohong Song No relationship to disclose Peng Yuan No relationship to disclose Hongmei Zhao No relationship to disclose Wuyun Su No relationship to disclose Tao Sun No relationship to disclose Seng-Weng Wong Consulting or Advisory Role: MSD Oncology, Novartis, Roche, Pfizer Speakers' Bureau: MSD Oncology, Bayer, Novartis Travel, Accommodations, Expenses: Bayer, Roche, Merck Serono, Boehringer Ingelheim Yanshen Lu No relationship to disclose Yongchang Zhou No relationship to disclose

Hepatocellular carcinoma (HCC) is a hypervascular tumour, which overexpresses vascular endothelial growth factor. Thalidomide is an antiangiogenic agent with activity in refractory multiple myeloma. The purpose of this multi-centre phase II study was to evaluate the efficacy and toxicity of thalidomide in patients with advanced HCC. From February 2000 to November 2001, 37 patients with histologically proven, bi-dimensionally measurable advanced, unresectable HCC were enrolled. The starting dose of Thalidomide was 100 mg per day and escalated weekly by 100 mg to a maximum dose of 800 mg/day according to individual patient tolerance. Radiological tumour response and treatment related toxicities were prospectively assessed. Thirty-seven patients were evaluable for toxicity and 24 patients were evaluable for response. The median Thalidomide dose was 400 mg/day. There was no complete response (CR). One patient had a radiological partial response (PR) (3%; 95% confidence interval [95% CI], 0% to 8%) and six (16%) patients had stable disease for more than 6 months. Somnolence and fatigue were the most common side effects, occurring in 84% and 73% of patients respectively. Thalidomide monotherapy is tolerable and associated with modest antitumour activity in advanced HCC.