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Background Cervical cancer, caused by human papillomavirus infection, is the source of significant personal and societal burden, and robs more than one hundred thousand Indian women and their families of the chances of a healthy and productive life each year. As outlined by the World Health Organization, the three-pronged approach of screening, vaccination, and reduction in mortality by early treatment presents the possibility of the elimination of cervical cancer as a public health problem in the next decade. 1 Unfortunately, these approaches are all associated with significant barriers in India. Objectives Given that the main mandate of palliative care practitioners to prevent and relieve suffering, here we make the case for these practitioners to offer education around vaccination and screening to female relatives of women encountered with cervical cancer. Conclusion Offering prevention strategies for human papillomavirus aligns with the idea of preventing suffering and is within the scope of palliative care clinicians.

Allogeneic hematopoeitic cell transplantation (allo-HCT) is the only curative treatment for myelofibrosis (MF). We evaluate the impact of various factors on survival outcomes post-transplant in MF. Data of 89 consecutive MF patients (primary 47%) who underwent allo-HCT between 2005 and 2018 was evaluated. Fifty-four percent patients had received JAK1/2 inhibitors (JAKi) pre-HCT. The median CD34 count was 7.1x106 cells/kg. Graft failure was seen in 10% of the patients. Grade 3-4 acute GVHD (aGVHD) and moderate/severe chronic graft versus host disease (cGVHD) occurred in 24% and 40% patients, respectively. Two-year overall survival (OS) and relapse free survival (RFS) were 51% and 43%, respectively. Cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) at 2 years were 11% and 46%, respectively. Higher CD34 cell dose (≤5 × 106 cells/kg vs 5-9 or ≥9 × 106 cells/kg) and lower pre-HCT ferritin (

Introduction Cancer care during the coronavirus disease 2019 (COVID-19) pandemic is challenging as the patients are at an increased risk of developing complications compared with the general population. Objectives This study was conducted to assess the impact of COVID-19 pandemic and nationwide lockdown on systemic cancer care. Materials and Methods This comparative descriptive study was conducted in the Department of Medical Oncology and Haematology in a tertiary care center in India. The study compared and analyzed the consecutive patient data of two different units in the Department of Medical Oncology in the pre-COVID phase (PCP) and post lockdown relaxation phase (PLRP). We represented the categorical data in frequency and percentage, and chi-squared test was used to analyze the variables. Results Patients were categorized based on demographic, disease-related, and hospital visit-related parameters and a significant drop noted in patients who utilized a prebooking facility (p = 0.0001), in the number of patients aged >50 years (p = 0.004), number of patients who presented with hematological malignancies (p = 0.006), and who came for follow-up (p = 0.0001). The other parameters remained statistically insignificant. Conclusions During PLRP, active systemic cancer care seems to have been less affected, whereas follow-up of patients and visits of elderly patients were significantly reduced. If the pandemic remains under control, cancer care may not get compromised. This shows the importance of flattening the curve for quality management of other diseases during a pandemic.

Cervical cancer is one of the most common cancers in the world both in terms of incidence and mortality, more so important in low- and middle-income countries. Surgery and radiotherapy remain the backbone of treatment for non-metastatic cervical cancer, with significant improvement in survival provided by addition of chemotherapy to radiotherapy. Survival as well as quality of life is improved by chemotherapy in metastatic disease. Platinum-based chemotherapy with/without bevacizumab is the mainstay of treatment for metastatic disease and has shown improvement in survival. The right combinations and sequence of treatment modalities and medicines are still evolving. Data regarding the molecular and genomic biology of cervical cancer have revealed multiple potential targets for treatment, and several new agents are presently under evaluation including targeted therapies, immunotherapies and vaccines. This review discusses briefly the current standards, newer updates as well as future prospective approaches in systemic therapies for cervical cancer.

PURPOSE: Malignant bowel obstruction (MBO) is a common and distressing complication in women with advanced gynecologic cancer. A pilot, interprofessional MBO program was launched in 2016 at a large Canadian tertiary cancer center to integrate these patients’ complex care needs across multiple disciplines and support women with MBO. METHOD: Retrospective analysis to evaluate the outcomes of women with advanced gynecologic cancer who were admitted to hospital because of MBO, before (2014 to 2016: baseline group) and after (2016 to 2018) implementation of the MBO program. RESULTS: Of the 169 women evaluated, 106 and 63 were in the baseline group and MBO program group, respectively. Most had ovarian cancer (n = 124; 73%) and had small-bowel obstruction (n = 131; 78%). There was a significantly shorter cumulative hospital length of stay (LOSsum) within the first 60 days of MBO diagnosis in the MBO program group compared with the baseline group (13 v 22 days, respectively; adjusted P = .006). The median overall survival for women treated in the MBO program was also significantly longer compared with the baseline group (243 v 99 days, respectively; adjusted P = .002). Using the interprofessional MBO care platform, a greater proportion of patients received palliative chemotherapy (83% v 56%) and less surgery (11% v 21%) in the MBO program group than in the baseline group, respectively. A subgroup of women (n = 11) received total parenteral nutrition for longer than 6 months. CONCLUSION: Implementation of a comprehensive, interprofessional MBO program significantly affects patient care and may improve outcomes. Unique to this MBO program is an integrated outpatient model of care and education that empowers patients to recognize MBO symptoms for early intervention.

Introduction POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes) syndrome is a rare multisystem paraneoplastic syndrome characterized by peripheral neuropathy and monoclonal plasmacytosis. Retrospective institutional experiences from the Mayo Clinic as well as Chinese, European, and Japanese series have provided important insights into the characteristics and treatment of this disease, but Indian data are extremely limited. We retrospectively analyzed 49 cases from our institute including 10 patients who underwent autologous stem-cell transplantation (ASCT). Patients and Methods We analyzed clinical and laboratory characteristics, treatment details and outcome of all patients diagnosed with POEMS syndrome between 1993 and 2017. Results Complete medical records were available for 49 patients with a median age of 44 years. Male/female ratio was 38:11. Twenty patients (40.8%) had Eastern Cooperative Oncology Group performance status of 4. Before 2012, melphalan/prednisolone was the most common regimen provided, while bortezomib/dexamethasone and lenalidomide/dexamethasone were used later. Hematologic response was available for 40 patients, 15 (37.5%) of whom experienced complete response, 13 (32.5%) partial response, and 11 (27.5%) stable disease. The median modified Rankin score at baseline was 4 (range, 1-5), which improved to 3 (range, 1-5). Ten patients underwent consolidation ASCT after a median of 4 cycles of induction. Median melphalan dose was 140 mg/m2. Engraftment syndrome was observed in 4. After ASCT, all 10 patients experienced hematologic complete response and clinical improvement. Conclusion This retrospective analysis provides important information on the clinical characteristics of POEMS syndrome in Indian patients, which will help the clinician’s decision-making process.

Background Despite the growing integration of mandatory biopsies for correlative endpoints within oncology clinical trials, there are sparse data on patient-reported outcomes, perceptions, and preferences. Objective This study aimed to prospectively assess the impact of research biopsies on the quality of life in patients with gynecologic cancer, evaluate patient-reported outcomes, and determine factors associated with patients’ willingness to undergo sequential biopsies. Study Design We conducted a prospective study in patients with gynecologic malignancies undergoing research biopsies between 2015 and 2019 at Princess Margaret Cancer Centre ( ClinicalTrials.gov Identifier: NCT02334761 ). Here, we report the results of the paper-based surveys performed before and 1 week after biopsy. Although the questionnaires each assessed the impact of anxiety using a modified version of the Hospital Anxiety and Depression Scale, the postbiopsy questionnaire specifically assessed the likelihood of future biopsies, postbiopsy symptoms, complications, and perceptions. Results A total of 129 patients were enrolled, of which 91 (70.5%) completed at least 1 questionnaire. These patients had either ovarian (89%; 81 of 91) or endometrial cancer (11%; 10 of 91). Of all biopsies taken, 75% were from the abdomen or pelvis (67 of 89). There was 1 clinician-reported complication, a perihepatic hematoma (1%). Pain during the biopsy and physical discomfort were experienced by 60.3% (41 of 68) and 61.8% (42 of 68), respectively. Embarrassment and loss of dignity were experienced by 13.2% (9 of 68) and 11.8% (8 of 68), respectively. Although the mean Hospital Anxiety and Depression Scale score was in the normal range before and after biopsy, there was a significant decline in the total score after the biopsy (prebiopsy, 5.3 [standard deviation, 4.7] vs postbiopsy, 3.7 [standard deviation, 4.5]; P=.005); 84% of subjects (58 of 69) stated that they would definitely or likely consent to another biopsy. There was no impact on patients’ willingness for future biopsies based on Eastern Cooperative Oncology Group status, biopsy site, age, number of cores, and pain during the biopsy; however, subjects who reported feeling physically uncomfortable (odds ratio, 0.14; P=.005), embarrassed (odds ratio, 0.03; P=.004) or experienced loss of dignity (odds ratio, 0.05; P=.01) during the biopsy and those who experienced flu-like symptoms (odds ratio, 0.2; P=.018) or felt feverish (odds ratio, 0.2; P=.035) 1 week after biopsy, were less likely to undergo a sequential biopsy. Similarly, those with higher Hospital Anxiety and Depression Scale scores before biopsy (odds ratio, 0.83; P=.008) and after biopsy (odds ratio, 0.8; P=.003) were less likely to consent for another biopsy. Conclusion Research biopsies were generally well accepted. Most patients (83%) were willing to undergo serial biopsies if necessary. Addressing the potentially modifiable psychosocial aspects of the procedure may improve the experience with research biopsies for patients with gynecologic cancers.

Objectives: The aim of this study was to assess the impact of research biopsies on quality of life of patients (pts) with gynecologic malignancies, and determine which factors are associated with the pts willingness to undergo future biopsies. Methods: We conducted a prospective study on pts with gynecologic malignancies undergoing research biopsies between 2015 and 2020 at a tertiary Canadian cancer centre. Eligible pts were ≥18 years old and had an ECOG status of ≤2. Pts completed the questionnaires prior to the biopsy (Q1) and 1 week after the biopsy (Q2). Q1 collected general information, perceived risks and the modified Hospital Anxiety and Depression Scale (HADS; range 0-21, normal Results: 129 pts were enrolled, 88 were evaluable and completed Q1/Q2. The site of biopsy was abdomen/pelvis 78%, liver 16%, other 6%. Pts had predominantly recurrent disease (99%), 91% had ovarian and 9% endometrial cancer. Median age was 61.5 years (32-80). Ethnicity was White in 79%, Asian 15%, and others in 6% of pts. 92% of pts were involved in interventional clinical trials. Mean time from biopsy request to biopsy was 10.4 days (standard deviation [sd] 13.9). The mean HADS score was within normal ranges in Q1 and Q2, with a significant decline in the total score after the biopsy (Q1 5.3 [sd 4.7] and Q2 3.7 [sd 4.5]; p=0.005). Figure 1 describes the pts reported post-biopsy symptoms and perceptions in Q2. At Q2, 83% of pts reported that they would definitely or likely consent for another research biopsy. We then correlated each of the factors with pts willingness to undergo future research biopsies. There was no significant difference according to ECOG status (p=0.74), site of biopsy (p=0.99), age (p=0.56). None of the post-biopsy reported symptoms showed a significant impact in pts willingness to undergo future biopsies, including feverish feeling (OR:0.33, p=0.12), nausea/vomiting (OR:0.51, p=0.3), pain in biopsy area (OR:0.4, p=0.19), flu-like symptoms (OR:0.3, p=0.06). In terms of biopsy related perceptions, we did not detect a significant correlation with pain during procedure (OR:0.3 p=0.23). Whereas, pts with higher HADS scores in Q2 (OR:0.83, p=0.005), those who felt physically uncomfortable (OR:0.1, p=0.02), felt embarrassed (OR:0.03, p=0.005), or felt loss of dignity during the biopsy (OR:0.05, p=0.015) were less likely to consent for future research biopsies. Download : Download high-res image (244KB) Download : Download full-size image Conclusions: Research biopsies were generally well accepted in pts that underwent a biopsy, and 83% of pts reported willingness to undergo subsequent research biopsies. The mean HADS level was within normal ranges before the biopsy and decreased significantly post-procedure. Higher HADS scores, embarrassment, loss of dignity and physical discomfort during the procedure significantly influenced the likelihood of obtaining serial biopsies. A better understanding of the impact of research biopsies in pts is vital to improve their experience.

Background Allogeneic hematopoietic cell transplantation (HCT) outcomes may be predicted by published risk scores; however, the ideal system has not been identified for acute leukemias. Patients and Methods We retrospectively examined the Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI), modified European Group for Blood and Marrow Transplantation (mEBMT), EBMT-Alternating Decision Tree (ADT), and others on 231 patients with acute leukemia. Results Acute myeloid leukemia was diagnosed in 200 patients, and acute lymphocytic leukemia was diagnosed in 31 patients. For HCT-CI, patients were grouped as 0 to 1, 2 to 3, and > 3. For mEBMT, patients were grouped as 0 to 2, 3, and > 3. For EBMT-ADT, the 100-day mortality was calculated and grouped as ≤ 4.1%, 4.1% to 11.5%, and > 11.5%. Higher HCI-CI demonstrated inferior overall survival (P = .04; c-statistic, 0.57), whereas mEBMT and EBMT-ADT did not stratify well. A new weighted score was developed that assigned 1 point for age ≥ 60 years, acute lymphocytic leukemia diagnosis, mismatch unrelated or haploidentical donor, cardiovascular comorbidity, and pre-transplant diabetes, whereas arrhythmia received 2 points. The new weighted score assigned 0 points to 88 (38%), 1 to 2 points to 121 (52%) and ≥ 3 points to 22 (10%) patients, and demonstrated improved prognostic capability compared with the other scores (P = .0001; c-statistic, 0.61). Conclusions The HCT-CI stratifies patients with leukemia for overall survival but is inferior to our single-center score, which is influenced by cardiac comorbidity and arrhythmia. Differences in pre-transplant risk scores may be related to different transplant practices.

Introduction: Poly adenosine diphosphate-ribose polymerase (PARP) inhibitors (PARPi) are evolving as one of the most promising therapies in ovarian cancers, especially for patients with a BRCA1/2 or Homologous Recombination Repair (HRR) defect. Rucaparib is one of the three PARPi approved for use in ovarian cancer. Recent research has opened an expanded indication for PARPi beyond germline BRCA1/2 (gBRCA1/2) mutation. This increases the number of patients eligible for PARPi from around 15–20% of high grade serous ovarian cancers (HGSOC) with BRCA1/2 mutations to around 50%.Areas covered: This review focuses on Rucaparib, its pharmacology and salient preclinical and clinical data. The significance of a companion diagnostic test, which helps in selection of patients for Rucaparib, the upcoming trials, future directions and challenges are also discussed.Expert opinion: In germline or somatic BRCA1/2 (g/sBRCA1/2) mutated ovarian cancer patients, Rucaparib is found to have a tolerable side effect profi...

Ovarian cancer has the highest mortality rate among all gynecologic cancers. The standard treatment for over 40 years has been surgery and chemotherapy; however, over the last decade, targeted therapies are increasingly proven effective. Poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi) are molecules that competitively block one of the DNA repair pathways by binding to PARP, and thus push the repair process to the homologous recombination pathway. In patients with a BRCA1/2 mutation, this pathway is deficient and ultimately leads to apoptosis. Patients who harbor a BRCA1/2 mutation are at higher risk of developing certain cancers such as breast and ovarian, rendering prophylactic strategies attractive in this subset of patients. PARPi have been found to be beneficial in this group of patients; recently, various international regulatory agencies have approved this class of agents as maintenance therapy or as monotherapy in the relapsed setting. Contemporary trials are ongoing in the relapsed as well as first-line setting, monotherapy and maintenance therapy or even in combination with other agents. This review focuses on the mechanisms involved in DNA repair pertinent to BRCA1/2 mutation and PAPR inhibitor therapy, the prophylactic and therapeutic advances in this field, and the opportunities available.

Background & objectives: Studies have shown that immunohistochemical (IHC) staining using epidermal growth factor receptor (EGFR) mutation specific antibodies, is an easy and cost-effective, screening method compared with molecular techniques. The purpose of present study was to assess the percentage positivity of IHC using EGFR mutation specific antibodies in lung biopsy samples from patients with primary lung adenocarcinoma (ADC). Methods: Two hundred and six biopsies of primary lung ADC were subjected to EGFR mutation specific antibodies against del E746-A750 and L858R. Detection of EGFR mutation done by high resolution melting analysis (HRM) was used as gold standard. A concordance was established between molecular and IHC results. Frequency of IHC positivity was assessed. Results: Of the 206 patients, 129 were male and 77 were female patients, with a mean age of 54.1 yr. Fifty five (26.6%) patients (36 men; 19 women) showed positivity for IHC of del E746-A750 (33) and L858R (22). HRM results were available in 14 patients which showed EGFR mutations in correspondence with del E746-750 or L858R in 64.2 per cent cases. Positive cases on HRM were further confirmed by DNA sequencing and fragment analysis. Three patients showed exon[20] variation. Two cases were negative for mutation. The genotype of del E746-750 mutation was more common than L858R. A concordance was established between molecular mutation and IHC in 85.7 per cent cases. Interpretation & conclusions: In this preliminary study from India mutation specific IHC was used for assessment of mutation status of EGFR. Although the number tested was small, a good concordance was observed between molecular EGFR mutation and IHC expression. IHC methodology is a potentially useful tool to guide clinicians for personalized treatment in lung ADC, especially where facilities for molecular analysis are not readily available and for use in small biopsies where material is scant for molecular tests.

Background Intravenous high-dose melphalan has a short half-life, and application of this single drug in MM transplant favors the use of stem cells without cryopreservation, for wider use in general and in resource-limited settings in particular. Patients and Methods Ninety-two patients with MM were given high-dose melphalan and rescued with granulocyte colony stimulating factor (G-CSF) mobilized noncryopreserved autologous PBSC, in our hospital during the past 18 years. Stem cells were mobilized with 4 days of G-CSF, harvested (median CD34 dose, 2.9 × 10 6 /kg) and then stored at 4°C in a refrigerator for a median of 2 days (range, 1-5 days) before reinfusion. Results Median time to neutrophil (> 500/mm 3 ) and platelet (> 20,000/mm 3 ) engraftment were 10 and 14 days respectively. There was no graft failure. Mucositis grade 3/4 was seen in 66 patients (72%). Transplant-related mortality at 100 days was 3.2%. The overall response to transplant was 88% and improvement compared with pretransplant status was seen in 48%. The median overall survival (OS) and progression-free survival (PFS) were 61.7 months and 35.4 months respectively; independent predictors of survival were Eastern Cooperative Oncology Group Performance Status and hemoglobin for OS and chemosensitive disease and remission status after transplant for PFS. Conclusion We conclude that high-dose chemotherapy and autologous transplant with noncryopreserved PBSC is a simple, effective, and safe method for MM with equivalent results, and that cryopreservation is not necessary. It reduces the cost of transplant and avoids dimethyl sulfoxide toxicity.

Background Allogeneic Stem Cell Transplantation (SCT) is potentially curative for many hematological diseases, however carries a high risk of mortality and morbidity. Multiple scoring systems has been developed to predict SCT outcomes and one of the more popular one id the Hematopoeitic Cell Transplantation - Co-Morbidity Index (HCT-CI). This study evaluates the value of HCT-CI score in predicting the outcomes of patients undergoing SCT at Princess Margaret Cancer Centre (PMCC). We also looked at the impact of the individual elements of HCT-CI in predicting SCT outcomes. Methods Two experienced physicians prospectively calculated the HCT-CI score for all patients transplanted at our center. Prospective calculation was performed during the patient's pre-transplant assessment before transplant admission using a pre-prepared form. All other patient and transplant characteristics were retrospectively collected from the EPR. Non-Relapse Mortality (NRM) and Overall survival (OS) were calculated to assess the prognostic power of the scores. This was correlated with the major SCT outcomes of Non-relapse mortality (NRM) and Overall survival (OS). Separately the impact of each components of HCT-CI was assessed in Univariate and multivariable analysis for NRM and OS. Results From August 2014 to April 2017, 299 patients underwent allogeneic HCT at the Princess Margaret Cancer Centre (PMCC), Toronto. Base line characteristics of the patients are shown in Table 1. HCT-CI scores were grouped as 0-2 as group 1 and ≥3 as group 2. Nearly two thirds belonged to group 1. (Table 1) The 2 year OS for the whole cohort was 51% (45%-56%) and NRM at 2 years was 25.1% (20%-31%). For the HCT-CI scores 0-2 vs ≥3, 2-year OS was 53% vs 46% respectively (p=0.29). The NRM at 2 years was 34% (29%-39%) for the whole cohort. For the HCT-CI scores 0-2 vs ≥3, 2-year NRM was 33% vs 35% respectively (p=0.75). (Figure 1) Univariate analysis of the impact of the independent components of HCT-CI score on OS and NRM was done. A p value of 0.2 was taken as cut off for selection for multivariable analysis. For NRM, cardiac co-morbidity, Diabetes and cerebrovascular accident were considered for multivariable analysis, where as cardiac co-morbidity, diabetes, severe pulmonary comorbidity, arrythmia and cerebrovascular accident were considered for OS multivariable analysis. On multivariable analysis, diabetes was the only factor found independently impacting both NRM [HR 2.2 (95%CI 1.4-3.4), p=0.0005] and OS [HR 1.6 (95%CI 1.1-2.4), p=0.025]. Conclusion HCT-CI was not found to predict OS or NRM accurately in our cohort of patients. Among the components of HCT-CI, diabetes was the only co-morbidity that significantly impacted both OS and NRM. Future prognostic scorings should incorporate only significant elements of comorbidities along with other transplant and disease related elements while developing prognostic scores. Disclosures Mattsson: Therakos: Honoraria; Celgene: Honoraria; Gilead: Honoraria. Michelis:CSL Behring: Other: Financial Support.

BACKGROUND: Allogeneic hematopoeitic cell transplant (HCT) is potentially curative for a variety of hematological diseases. It is however associated with significant morbidity and mortality. Numerous pre-transplant risk scores have been developed to predict outcomes, such as the Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI). This study assesses the value of the HCT-CI and related scores on a single center population, in comparison with other potential parameters influencing outcomes. A similar methodology was later applied to a different cohort of patients' data from Oslo University Hospital, Norway. METHODS: Two experienced physicians prospectively calculated the HCT-CI score for all patients transplanted at our center. The age-adjusted HCT-CI score and the augmented HCT-CI score were calculated retrospectively. Prospective calculation was performed during the patient's pre-transplant assessment before transplant admission using a pre-prepared form. The HCT-CI/age and the augmented HCT-CI (which includes ferritin, albumin and platelet count) were calculated using additional data retrospectively collected from the electronic patient records (EPR). All other patient and transplant characteristics were retrospectively collected from the EPR. Non-Relapse Mortality (NRM) and Overall survival (OS) were calculated to assess the prognostic power of the scores. We also looked at the impact of major transplant and patient related parameters in our patient population. A similar methodology was later applied to a different cohort of patients' data from Oslo University Hospital, Norway. RESULTS: From August 2014 to April 2017, 299 patients underwent allogeneic HCT at the Princess Margaret Cancer Centre (PMCC), Toronto. A similar analysis was performed in a cohort of 455 patients from Oslo University Hospital who underwent HCT between 2012 and 2018. Comparative patient characteristics are described in Table 1. On univariate analysis, 2-year OS of the PMCC cohort was 51% (95% CI 45-56%). For the HCT-CI scores 0-2 vs ≥3, 2-year OS was 53% vs 46% respectively (p=0.29). For the HCT-CI/age scores 0-2 vs ≥3, it was 56% vs 44% respectively (p=0.03). For the augmented HCT-CI scores 0-2 vs ≥3, it was 55% vs 46% respectively (p=0.05). Among other variables, age group ( We then developed a weighted score that would better reflect risk groups in our population. Age CONCLUSION: A simple, weighted score involving donor HLA mismatch and age predicts survival and NRM better than the HCT-CI score for patients transplanted at our center with good replicability as shown from Oslo data. Efforts should continue to strive for the development of a widely applicable pre-transplant outcome predictive scoring system. Disclosures Mattsson: Gilead: Honoraria; Therakos: Honoraria; Celgene: Honoraria. Michelis:CSL Behring: Other: Financial Support.

5580 Background: Immunomodulation through check point inhibition is an important treatment strategy in many cancers. In ovarian cancer (OC) response rates with immune checkpoint inhibitors (ICI) alone are around 10%. Chemotherapy antitumoural effect is driven by cytotoxicity and immunomodulatory effect. ICI treatment reduces tumour induced immune-tolerance improving immunocompetence, essential for chemotherapy effect. We chose to investigate clinical outcomes of chemotherapy post ICI in women with OC. Methods: The Tumor Immunotherapy Program (TIP) database at the Princess Margaret Cancer Centre identified patients with OC treated with chemotherapy after ICI from 2011 to 2018. Evaluation of clinical outcomes including response rate (RR), progression free survival (PFS) and overall survival (OS) was assessed for pre ICI, ICI and post ICI. Results: 40 women with OC were treated with chemotherapy after ICI. 90% had high grade serous histology, 7.5% carcinosarcoma and 2.5% low grade serous. Median number of pre ICI treatment lines was 3 (1-8) and 2 (1-6) in the post ICI setting. Median time of ICI initiation from diagnosis was 3 years. At ICI all patients had PS 0-1 and treated in clinical trials. 2% of the patients had platinum refractory disease, 88% had platinum resistant disease and 10% platinum sensitive disease. 50% were treated with ICI single agent, 16% were treated with ICI combined with chemotherapy, 14% ICI combo and 17% ICI in combination with other agents. Patients were treated for a median of 3 cycles (1-26). 8% experienced PR, 18% SD, no CR were seen. 67% of the patients discontinued treatment due to PD, 25% due to toxicity. Last treatment in pre ICI RR was 35%. First treatment in post ICI RR was 30%. RR for each treatment used in post ICI was 9% for liposomal doxorubicin, 25% for single agent platinum, 29% for weekly paclitaxel and 67% for chemotherapy with bevacizumab. Median PFS in the last pre ICI treatment was 6.5m and 5m in the first post ICI treatment. Median PFS and OS for all the population was 53m and 54m respectively. Conclusions: ICI are associated with modest activity in OC, planned clinical trials exploring systematic sequential therapy integrating ICI, targeted agents and chemotherapy are needed.

The purpose of this study was to evaluate the effect of prognostic factors on the outcome of patients with MM after ASCT.We analyzed results of 170 consecutive patients (121 male and 49 female) of MM who underwent ASCT. Patients' median age was 52 years (range, 26-68 years). High dose melphalan (200 mg/m(2)) was used for conditioning. One hundred thirty-two patients (77.6%) had evidence of chemosensitive disease before transplant. Response was assessed using European Group for Blood and Bone Marrow Transplantation criteria.Post ASCT 44.7% of patients achieved CR, 24.7% had very good partial response (VGPR), and 21.2% had partial response (PR). Presence of pretransplant chemosensitive disease (CR, VGPR, and PR) and transplant within 12 months of diagnosis for years before 2006 were associated with higher response rates on multivariate analysis. At a median follow-up of 84 months, median overall (OS) and event-free survival (EFS) is 85.5 and 41 months, respectively. Estimated OS and EFS at 60 months is 62 ± 0.04% and 41 ± 0.04%, respectively. Patients who responded to transplant (CR, VGPR, and PR) had a longer OS (P.001) and EFS (P.001). Additionally, patients who achieved CR post transplant had a longer OS (P.001) and EFS (P.001). Patients who received novel agents for induction pretransplant had a longer OS (P.001) and EFS (P.002).Outcome after ASCT is better for myeloma patients with pretransplant chemosensitive disease and those who achieve CR after transplant.

2539Background: Despite the increased inclusion of mandatory biopsies for clinical trials, there are scant data related to the perceptions and acceptability by pts. This study assessed the pre and ...

e17034 Background: Modest prospective data reports the impact of biopsies on patients (pts) with respect to adverse events (A/E) and anxiety. With increasing use of biopsies in clinical practice and trials, BIOPSY was designed to prospectively assess this. Methods: Pts undergoing a biopsy for diagnosis and/or research at Princess Margaret Cancer Centre were eligible. Surveys at 1 wk prior to biopsy and 1 wk and 1 mth post-biopsy assessed anxiety, A/E and pt experience. Anxiety was measured with a modified hospital anxiety and depression scale (HADS) score. Results: From 3/2015 to 1/2017, 51, 47 and 39 pts completed 1, 2 and 3 surveys respectively. Median age was 61 years. 40 biopsies were for research (78%) and 11 for diagnosis (22%). 46 pts were involved in a clinical trial (90%). 47 pts had a gynecological cancer (92%). 45 pts felt well-informed of the possible risks of the biopsy (88%). 23 pts noted the biopsy would not impact them directly (45%). 48 pts supported the use of tissue for future unrelated research (94%). Feelings of anxiety about the biopsy improved with time (table 1). 28 pts had pain 1 wk post-biopsy (60%) which was a moderate or major problem in 9 pts (19%). 2 pts reported reduced dignity with the biopsy (4%). 12 pts at 1 wk (26%) felt another biopsy would be a moderate-major issue. At 1 mth 3 of these pts reported a biopsy was now a mild problem. No significant A/E occurred. At baseline only 2 pts felt a biopsy would deter them from entering a clinical trial (4%). 42 pts at 1 wk (89%) and 30 pts at 1 mth (77%) felt they would consent to another biopsy for research. On univariate analysis pts with at least moderate pain post-biopsy at 1 wk or 1 mth (p=0.03) or an elevated HADS score at 1 mth (p=0.02) appeared less likely to agree to a further research biopsy but numbers were small. Conclusions: Anxiety and pain are potentially modifiable A/E that impact whether a pt will agree to a further biopsy. Overall, most pts tolerated their biopsy well, supported its use for future unspecified research and were open to further biopsies. [Table: see text]

5581 Background: Checkpoint inhibitors have shown to be effective in different tumors and are under investigation in HGSOC. Methods: INSPIRE (NCT02644369) is a prospective multi-cohort study investigating tumor genomic and immune landscapes in pts treated with Pembro at 200 mg IV Q3W. Patients underwent tumor biopsy pre, on-treatment and at progression for DNA/RNA sequence, immune-profile, and PD-L1 expression by immunohistochemistry (IHC). Serial blood samples for immunophenotyping were collected. Correlative data are available for 6 pts: 3 with shrinkage in target lesion and 3 with progressive disease (PD). Results: At interim analysis as of January 2017, 18 pts with HGSOC have been enrolled and 16 have platinum-resistant disease, with median 3 prior lines of treatment (range 1-7). Of 14 evaluable pts, best response by RECIST 1.1 was stable disease (SD) in 5 (36%) and PD in 9 (64%). Mean Tumor Proportion Score of PD-L1 by IHC (Qualtek) was 6.4% (range 0-30%). Grade 3/4 adverse events possibly related to Pembro were observed in 4/18 (22%) pts; none was fatal and the most common were fatigue and hyponatremia. Preliminary correlative data showed no significant change in CD4, CD8 and myeloid-derived suppressor cells in peripheral blood after Pembro treatment. Mean PD-1 expression on CD4 and CD8 T cells on baseline tumor tissue (measured as product of PD-1+ cells and the per cell expression of PD-1 [% of mean fluorescence intensity]) was significantly higher in pts with tumor shrinkage compared to pts with PD (CD4: 2658 vs 678, p = .02; CD8: 1999 vs 451, p = .048). Genomic analysis of baseline tumor tissue was available for 3 pts with tumor shrinkage and 2 with PD. Mean mutation burden was higher for pts with tumor shrinkage (2.38 vs 1.0 mutations/Mb covered). The pt with the longest SD in our cohort (6 months) had the highest mutation burden (2.72), including somatic POLE (c.6331-6C > G) and germline BRCA2mutations. Conclusions: In HGSOC, pts with higher PD-1 level on tumor CD4 and CD8 T cells and higher mutation burden at baseline may have a better outcome following treatment with Pembro. POLE mutation is rare in HGSOC but may correlate with checkpoint inhibitor activity. Clinical trial information: NCT02644369.

7082 Background: Data on B cell Acute Lymphoblastic leukemia (ALL) in the poor prognostic age group of > 9 years from India is minimal. Methods: This is an analysis of patients of above 9 years that were diagnosed and treated from January 2000 to December 2010 at a single institute . All patients who completed at least 4 weeks of induction therapy were analysed for various outcomes. Results: Of the 241 newly registered patients, the median age was 19 years (Range 10-78 years) with an M:F ratio of 1.9:1. Out of this 47%, 25% & 28% patients belonged to 10-18, 19-30 & > 31 years age group respectively. Twenty seven (11.6%) and 5(2%) had CSF and testicular involvement respectively. Thirty nine per cent had a total leucocyte count (TLC) of above 30x109/L. Philadelphia chromosome (Ph) positivity was seen in 27% and was equally distributed among the different age groups. Patients available for outcome analysis were 213(88.4%). Complete remission rate (CRR) was 66.6% and induction mortality was 26.3%.At a median follow up of 65.8 months 5 year leukemia free survival was 30.5%. Seventy eight (55%) patients relapsed (median relapse time of 13.5 months, range 1.7 to 53.4 months) , 55% during maintenance phase. The 5 year overall survival (OS) was 30.3% with a median OS of 15.8 months. The OS was similar in 10-18 and 19-30 age groups (5 year OS 35% vs. 27.5%, p=0.641) but it was significantly lower in >31 years (5year OS 21%, p=0.008). Apart from this, extramedullary disease, not attaining a CR in 1st induction, albumin at presentation below 3.5gm% and TLC of >100x109/L were significant poor prognostic markers for survival. Conclusions: This is a large study of B-ALL outcomes in patients above 9 years from a single center in India. Patients above 30 years had a worse prognosis while the prognosis of 10-18 and 19-30 years age group were similar. Induction mortality was higher mainly because of advanced disease and poor performance status at presentation.