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Understanding real-world treatment patterns and proportions of eligible patients in each line of treatment is imperative to inform future clinical trial designs and multi-line treatment algorithm development.We conducted a retrospective observational cohort study of adult women who received first-line (1 L) therapy for r/mCC between 01 September 2014 and 31 December 2019, using The US Oncology Network electronic health records and chart review data. Patients were followed to 31 December 2020. Patient demographic and clinical characteristics, treatment patterns, and clinical outcomes were assessed descriptively.A total of 262 patients with r/mCC met study inclusion criteria (mean age = 53 years). The majority of patients in 1 L received platinum-based chemotherapy doublet plus bevacizumab (66%) or chemotherapy doublet alone (24%). Nearly half the patients (48%) completing 1 L received 2 L therapy. Among these patients, there was no consistent 2 L treatment of choice. Overall median time to treatment discontinuation was 3.5 months from 1 L treatment initiation, and median overall treatment-free interval was 2.1 months from 1 L discontinuation. Besides elevated serum creatinine, abnormal BMI indicated a directional trend for lower likelihood of receiving 2 L. Other predictors may include no prior bevacizumab, worse ECOG, and earlier disease prevention.50% of the patients who initiated 1 L treatment did not receive 2 L therapy, highlighting the need for novel and effective treatment options. As the treatment landscape continues to evolve, we anticipate that more patients will live longer with more treatment options across multiple lines of therapies in the r/mCC setting.

This article serves to highlight both the common nature and severity of postpartum hemorrhage (PPH). Identification of etiologies and management of each is reviewed. In addition, the evaluation and administration of proper blood component therapies and massive transfusion are also explained to help providers become comfortable with early administration and delivery of blood component therapies.

Objectives: The GOG240 trial introduced a doublet chemotherapy with bevacizumab as the new standard of care for first-line (1L) recurrent or metastatic cervical cancer (r/mCC). While this regimen has been shown to prolong survival compared with chemotherapy alone in this advanced population, there is no standard systemic treatment for r/mCC after failure of 1L. The objectives of this study were to characterize the real-world patient characteristics, treatment patterns, and clinical outcomes of patients who initiated second-line (2L) therapy for r/mCC in the US community oncology setting. Methods: This was an observational study of women with r/mCC who initiated 2L systemic therapy within the US Oncology Network (USON) between 2014 and 2019. USON's electronic health record was used to identify eligible patients and abstract data. Overall survival (OS), time to treatment discontinuation (TTD), and time to first subsequent treatment (TFST) were estimated using Kaplan-Meier methods. Results: A total of N=130 patients were identified (mean age: 52.8 years). At initiation of 2L systemic therapy, over 60% of patients had ECOG score of 0 or 1. Cytotoxic monotherapy was the most frequently prescribed regimen (N=60, 46%) in 2L, followed by combination therapies that included platinum doublet chemotherapy, or bevacizumab doublet or triplet combination therapy (N=45, 35%), pembrolizumab monotherapy (N=19, 15%), and bevacizumab monotherapy (N=6, 5%). Majority of patients initiating 2L had prior bevacizumab exposure in 1L (N=81, 62%), mostly as a triplet or doublet combination therapy. Median OS was 9.1 months (95% confidence interval (CI): 7.2-12.2) after initiation of 2L treatment. Median TTD was 2.8 months (95% CI: 2.5, 3.3), and median TFST was 4.9 months (95% CI: 4.2, 5.7). No statistically significant difference in the outcomes were found when stratified by 2L treatments, although sample sizes were small. Conclusions: Diverse treatment patterns were observed in the 2L r/mCC setting. Clinical outcomes in these patients were suboptimal and they did not vary significantly by 2L regimen. Additionally, many patients received combination therapies in 2L after having received similar treatments in 1L, even though there is no evidence to support this practice. These findings demonstrate the unmet medical need for new effective treatment options in this setting.

DNA damage response and repair (DDR) is responsible for ensuring genomic integrity. It is composed of intricate, complex pathways that detect various DNA insults and then activate pathways to restore DNA fidelity. Mutations in this network are implicated in many malignancies but can also be exploited for cancer therapies. The advent of inhibitors of poly(ADP-ribose) polymerase has led to the investigation of other DDR inhibitors and combinations to address high unmet needs in cancer therapeutics. Specifically, regimens, often in combination with chemotherapy, radiation, or other DDR inhibitors, are being investigated. This review will focus on 4 main DDR pathways-ATR/CHK1, ATM/CHK2, DNA-PKcs, and polymerase θ-and the current state of clinical research and use of the inhibitors of these pathways with other DDR inhibitors.

Background The Dominican Republic (DR) ranks among nations with the highest burden of HIV in the Caribbean. Cultural and gender roles in rural areas of the DR may place women at increased HIV risk. However, little is known about sexual health and HIV testing behaviors among women in the rural DR. Methods We conducted a needs assessment among a systematic sample of adult women in a rural DR community in 2016. Demographic and behavioral attributes related to HIV testing, sexual health, and healthcare utilization were evaluated. Poisson regression analysis was used to identify demographics and behaviors associated with having had a previous HIV test. Significance was defined as a p-value Results Among 105 women evaluated, 77% knew someone with HIV and 73% of women reported that they would be very or extremely likely to take an HIV test if offered. Only 68% reported a previous HIV test, including 47% who were tested over 2 years prior. Barriers to HIV testing included low risk perception (23%), distance or requisite travel (13%), and discomfort being tested (11%). Women who had never been tested for HIV were more likely than those who had been tested to be older (p = 0.03), to have a lower level of education (p = 0.04), and to have never been tested for other sexually transmitted infections (STI; p p = 0.03). Conclusions In the rural DR, numerous barriers contribute to low prevalence of HIV testing among women. Most women report willingness to have an HIV test and many engage in routine health care, indicating that this population may benefit from incorporating HIV testing and other sexual health promotion activities into routine medical care.

Background Zika virus is associated with substantial infant morbidity and mortality. Promising Zika vaccines for pregnant women are currently in clinical trials. To prepare for public availability, the acceptability of a hypothetical Zika vaccine was assessed among pregnant women. Methods A 16-question, 10-point Likert-scale survey was administered to a convenience sample of 100 pregnant women receiving routine prenatal care at the University of Kansas Medical Center from 07/07/2016 to 9/29/2016. The primary outcome, hypothetical vaccine acceptability, was evaluated by calculating the proportion of respondents who strongly agreed (responded 10/10) with the statement “If a vaccine for Zika virus was available, I would get this vaccine while pregnant.” Multivariable analyses were conducted to examine characteristics associated with Zika vaccine acceptability. Results Nearly half of the 100 patients surveyed (48%) expressed strong agreement to getting a hypothetical Zika vaccine while pregnant. Among these women, 98% n = 47 strongly agreed that a recommendation from their prenatal provider would be very important to them. Among the other 52% who did not demonstrate strong agreement to getting a Zika vaccine while pregnant, only 63% n = 33 of them strongly agreed that a recommendation from their prenatal provider would be very important to them. Women indicating strong acceptance of a hypothetical Zika vaccine were also more likely to feel strongly about the importance of children being up to date on all their vaccinations (97% vs. 83%, P = 0.01) and the importance of getting recommended vaccinations during her pregnancy (97% v. 79%, P = 0.003). Conclusion A Zika vaccine may be acceptable to pregnant women but would benefit from strong provider support and education about the risks and consequences of Zika infection and the benefits of vaccination. Disclosures All authors: No reported disclosures.