e13054 Background: The last decade has seen a rapid increase in systemic treatment options for patients with HR+ ABC. The incorporation of CDK4/6 inhibitors in first line (1L) is now standard practice leading to improved survival. However, there is a paucity of data on uptake of standard therapies and associated toxicities in the real-world setting. Methods: ARORA is a secondary data use study of Australian patients with HR+ ABC capturing prospective data on patient characteristics, systemic therapy sequencing and treatment outcomes in routine clinical practice. Patients aged > 18 diagnosed after 1 Jan 2020 are eligible. Results: Data from 294 patients at 16 sites was analysed with a median follow up of 15 months. Mean age was 63 years; 23% > 75 years. 64% were ECOG 0, 5.4% had a familial syndrome, 61% had relapsed metastatic disease and 19.4% had bone only metastases at diagnosis. Of patients who relapsed, 14.6% and 52.8% received neoadjuvant and adjuvant chemotherapy respectively, and 77.5% received adjuvant endocrine therapy (ET). 41% relapsed on or within 12 months of stopping adjuvant ET. 5 patients (1.7%) did not receive any systemic therapy for ABC. Of those on 1L therapy, 223 (77%) received CDK4/6i + ET, 38 (13.1%) received ET alone and 26 (9%) received chemotherapy. Choice of 1L CDK4/6i was palbociclib (50.7%), ribociclib (34.5%) and abemaciclib (9.9%). Patients who received 1L ET alone were older (mean age 75 vs 62 years; 68.4 vs 16.6% > 75 years) with poorer performance status (34.2 vs 6.3% ECOG ≥2) and more comorbidities (76.3 vs 36.8% Charlson index > 2) compared to those who received 1L CDK4/6i + ET. Conversely, those on 1L chemotherapy were younger (mean age 54, 96.2% < 75years), with better performance status (69.2% ECOG 0-1) and fewer comorbidities (88.5% Charlson index < 2). Patients receiving 1L chemotherapy were more likely to have visceral metastases compared to those on CDK4/6i + ET (69.2 vs 43.1%, p = 0.01). The most common reported toxicities in patients receiving CDK4/6i were diarrhea (59% abemaciclib vs 3.9% ribociclib vs 2.7% palbociclib), neutropenia (38.1% palbociclib vs 32.5% ribociclib vs 22.7% abemaciclib) and nausea/vomiting (27.3% abemaciclib vs 22.1% ribociclib vs 12.4% palbociclib). Abnormal LFTs occurred in 9.1% of patients on abemaciclib (vs 3.9% ribociclib and < 1% palbociclib). 2 patients (1.8%) on palbociclib had pneumonitis whilst 1 (1.3%) on ribociclib had QTc prolongation. Survival data is immature. Conclusions: Despite CDK4/6i + ET being gold standard treatment in 1L HR+ ABC, only 3/4 of patients received this combination, with a substantial minority receiving ET alone or chemotherapy. Age, ECOG status, comorbidity burden and presence of visceral disease appear to be major determinants of treatment choice. Toxicity profile of the CDK4/6i agents were mostly in line with clinical trial results, although longer follow up is needed to confirm this.
e24127 Background: Patients with a rare cancer (RC) diagnosis face unique challenges affecting psychological wellbeing. Vast geographical distances further compound challenges in accessing RC sub-specialist expertise, clinical trials, research and non-reimbursed therapies. The Australian Rare Cancer (ARC) Portal is a novel model of care delivery that has a positive psychological impact on these patients. Methods: The ARC Portal is a national free online referral platform implemented to overcome barriers to accessing excellent care. It is funded by Omico, with support from BioGrid Australia, Rare Cancers Australia (RCA), and The WEHI Stafford Fox Rare Cancer Program (SFRCP). We have recorded 924 referrals for a diverse range of RC in early (30%) and late stages (70%). Our 162 referring clinicians derive from every Australian state and from both regional and metropolitan centres. Over 50 content experts from Australia and internationally have provided case advice. Referring clinical impact surveys and patient feedback surveys were analysed to identify psychosocial impacts of the ARC Portal. Results: Our model of care keeps patients with their primary oncologists by equipping referrers with increased expertise drawing from, on average, two to five experts. The entirely online consent process overcomes geographical barriers to enrolment, and is of particular importance in the context of the ongoing COVID-19 restrictions removing in person interaction. Provision of expertise and treatment recommendations meets informational needs and increased the patient confidence patients in their treating clinicians. Report recommendations directly altered the treatment delivered to patients in 20/48 of surveyed referrer respondents. Early stage patients are eligible for referral to guide neoadjuvant and adjuvant therapy, and those in remission for anticipatory identification of next lines of therapy. We identify appropriate access to investigator-driven research efforts to overcome financial barriers to genomic sequencing e.g. via the MoST Program funded by OMICO and the WEHI-SFRCP enabling access to molecularly-guided therapy. A lack of reimbursed therapeutic options in RC poses financial stress on patients. The ARC Portal expands patients’ treatment options via links with clinical trial networks, coordination with industry, and cross-referral to the charity, RCA, for fundraising assistance. We provide patients with the opportunity for involvement in research, which for many provides hope, either for themselves, or for others, as they can opt to provide access to biomarker and tumour specimens via the WEHI-SFRCP; the majority of patients (82.5%) have provided consent. Conclusions: The ARC Portal offers patients access to excellent rare cancer care resulting in positive impacts upon patients’ psychological wellbeing. These initial observations require more formal assessment.
e18581 Background: Rare cancers (RC) occur at incidence < 6/100,000 and accessing treatment and evidence-based care can be challenging. Australia’s geographical distance adds complexity when referring to RC sub-specialists, clinical trials or research. The Australian Rare Cancer (ARC) Portal aims to address this unmet need. Methods: The ARC Portal is a free online academic referral hub designed to facilitate rare cancer clinical care and research. Registered cancer specialists can request RC guidelines, expert advice and molecular testing/interpretation. Patient consent allows researchers access to de-identified clinical data, with optional consent for biospecimen access, for dedicated rare cancer research projects (Melbourne Health HREC/15/MH/396). Portal case reports are collated by research fellows with reference to published evidence and expert opinion to inform treating clinician decision making. Surveys are sent at 3 time points following case completion to assess the ARC Portal impact on patient management. The ARC Portal is funded by Omico, with support from BioGrid Australia, Rare Cancers Australia and the Stafford Fox Rare Cancer Program. Results: Over two years, 924 patients have been enrolled into the ARC Portal. Demographics include 73% females, 27% males, at different disease stages from initial diagnosis (23%), on relapse/ progression (48%) or with stable disease/in remission (29%). The spread of incidence of individual cancers varied from 6/100,000 to < 0.1/100,000. Primary tumour types include gynaecological (44.4%), gastrointestinal (19%), thoracic (6%), ocular (5.2%), soft tissue (3.8%), breast (3.6%), skin (3.0%), and CNS tumors (2.5%). Endocrine, head and neck, urological, and cancers of unknown primary comprised the remaining 12.5% of cases. Longer term follow up of 100 cases demonstrated ARC Portal reports impacted clinician decision making in at least 42%. This included subsequent lines of treatment, molecular testing access or clinical trial enrolment. Conclusions: The ARC Portal uses an online centralized streamlined approach to overcome challenges and inequities inherent in rare cancer care, by optimizing clinician access to RC expertise and clinical trials; and to facilitate future RC discoveries by enabling research through collection of clinical data and accessible annotated biospecimens.
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