Objectives To assess the combined role of tumor vascularity, estimated from perfusion MRI, and MGMT methylation status on overall survival (OS) in patients with glioblastoma. Methods A multicentric international dataset including 96 patients from NCT03439332 clinical study were used to study the prognostic relationships between MGMT and perfusion markers. Relative cerebral blood volume (rCBV) in the most vascularized tumor regions was automatically obtained from preoperative MRIs using ONCOhabitats online analysis service. Cox survival regression models and stratification strategies were conducted to define a subpopulation that is particularly favored by MGMT methylation in terms of OS. Results rCBV distributions did not differ significantly (p > 0.05) in the methylated and the non-methylated subpopulations. In patients with moderately vascularized tumors (rCBV < 10.73), MGMT methylation was a positive predictive factor for OS (HR = 2.73, p = 0.003, AUC = 0.70). In patients with highly vascularized tumors (rCBV > 10.73), however, there was no significant effect of MGMT methylation (HR = 1.72, p = 0.10, AUC = 0.56). Conclusions Our results indicate the existence of complementary prognostic information provided by MGMT methylation and rCBV. Perfusion markers could identify a subpopulation of patients who will benefit the most from MGMT methylation. Not considering this information may lead to bias in the interpretation of clinical studies. Key Points • MRI perfusion provides complementary prognostic information to MGMT methylation. • MGMT methylation improves prognosis in glioblastoma patients with moderate vascular profile. • Failure to consider these relations may lead to bias in the interpretation of clinical studies.

Background. Despite the causal relationship between obesity and colon cancer being firmly established the effect of obesity on the course of cancer calls for further elucidation. The objective was to assess differences in clinicalpathological and psychosocial variables between obese and non-obese individuals with colon cancer. Patients and Methods. Prospective, multicentric, observational study conducted from 2015-2018. The sample comprised patients with stage II-III, resected colon cancer about to initiate adjuvant chemotherapy with fluoropyrimidine in monotherapy or associated with oxaliplatin and grouped into non-obese (BMI <30kg/m 2) or obese (≥30kg/m 2). Subjects completed questionnaires appraising quality of life (EORTC-QLQ-C30), coping (M-MAC), psychological distress (BSI-18), perceived social support (MSPSS), personality (BFI-10), and pain (BPI). Toxicity, chemotherapy compliance, 12-month recurrence and mortality rate data were recorded. Results. Seventy-nine of the 402 individuals recruited (19.7%) were obese. Obese subjects exhibited more comorbidities (≥2 comorbidities, 46.8% vs 30.3%, p=0.001) and expressed feeling slightly more postoperative pain (small size-effect). There was more depression, greater helplessness, less perceived social support from friends, and greater extraversion among the obese versus non-obese subjects (all p<0.04). The non-obese group treated with fluoropyrimidine and oxaliplatin suffered more grade 3-4 hematological toxicity (p=0.035), whereas the obese had higher rates of treatment withdrawal (17.7% vs 7.7%, p=0.033) and more recurrences (10.1% vs 3.7%, p=0.025). No differences in sociodemographic, quality of life, or 12-month survival variables were detected. Conclusion. Obesity appears to affect how people confront cancer, as well as their tolerance to oncological treatment and relapse. The Oncologist 2021;9999:• • Implications for Practice: Obesity is a causal factor and affects prognosis in colorectal cancer. Obese patients displayed more comorbidities, more pain following cancer surgery, worse coping, more depression, and perceived less social support than the non-obese. Severe hematological toxicity was more frequent among non-obese

Introduction Most cancers occur in older individuals, who are more vulnerable due to functional impairment, multiple comorbidities, cognitive impairment, and lack of socio-familial support. These can undermine patients’ sense of dignity. This study seeks to compare dignity scores in older patients with advanced cancer on sociodemographic and clinical variables and analyze the predictive value of anxiety, depression, functional limitations, and social support on dignity scores. Methods A prospective, multicenter, observational study conducted with participation of 15 hospitals in Spain from February 2020 to October 2021. Patients with newly-diagnosed, advanced cancer completed the dignity (PPDS), anxiety and depression (BSI), Social Support (Duke–UNC-11), and functional limitations (EORTC-C30) scales. Lineal regression analyses explored the effects of anxiety, depression, functional status, and social support on dignity, adjusting for sociodemographic and clinical variables. Results A total of 180 subjects participated in this study. The results of the correlation analysis revealed that dignity correlated negatively with anxiety, depression, and sex, and positively with social support, functional status, and longer estimated survival. Thus, women, and more anxious and depressed individuals scored lower on the dignity scale, whereas patients with more social support, fewer functional limitations, and longer estimated survival scored higher. Conclusion In conclusion, being female, having a lower educational level, lower estimated survival, depression, anxiety, less social support, and limited functionality are correlated with less dignity in the elderly with advanced cancer. It is a priority to manage both physical and psychological symptoms in patients with unresectable advanced cancer to mitigate psychological distress and increase their sense of dignity.

TPS4589 Background: First-line cisplatin-based chemotherapy (70 mg/m2) is the standard of care for LA/mUC patients (pts). However, about 50% will be ineligible for Cisplatin according to Galsky´s criteria. Moreover, a significant proportion of cisplatin-fit pts will receive carboplatin based on physician criteria. s-GC represents a feasible alternative in such situations, and could improve response rate compared to carboplatin regimens. Atezo is a programmed death-ligand 1 (PD-L1) inhibitor that is approved as first line treatment for cisplatin-ineligible LA/mUC pts with PD-L1 expression ≥5% (Ventana SP142). We present the study design of a phase II single arm trial of Atezo +s-GC in previously untreated pts with LA/mUC (NCT04602078). Methods: This single arm, open-label, multicenter study evaluates the efficacy and safety of Atezo +s-GC in previously untreated pts with LA/mUC. 66 pts will be enrolled and receive s-GC x 6 cycles (Cisplatin 35mg/m2 + Gemcitabine 1000mg/m2 on days 1 and 8 Q3W) and Atezo (1200 mg IV Q3W), followed by Atezo (1200 mg IV Q3W) until disease progression, toxicity or absence of clinical benefit. Eligibility criteria include histologically confirmed unresectable LA/mUC, measurable disease per RECIST 1.1 and adequate organ and marrow. Pts must be unfit for full cisplatin dose based on: age > 70 years, PS ECOG 0-2, creatinine Clearance >30 and <60 mL/min per Cockroft-Gault formula or by 24-hour urine collection. Other reasons for cisplatin ineligibility as considered by investigator, including those uncovered by Galsky´s criteria, will be allowed, prior discussion with PI. Exclusion criteria include prior systemic therapy for LA/mUC (adjuvant/neoadjuvant allowed if finished > 12 months prior to inclusion), prior autoimmune disease and uncontrolled significant illnesses. The primary endpoint is ORR per RECIST 1.1 assessed by investigator; the secondary endpoints are DoR, OS, PFS and safety. Biomarker analysis, including PD-L1 expression and microbiome relationship, will be an exploratory objective. The first two patients were enrolled in February 2021. Clinical trial information: NCT04602078.

Purpose: Cancer and its treatments changes patients’ quality of life. The aim was to analyze quality of life, psychological distress, and life satisfaction in patients with resected versus unresectable cancer.Methods: Two prospective, multicenter (15 medical oncology departments), studies with consecutive patient recluitment were conducted, NEOetic, in individuals with unresectable advanced disease (2020-2021) and NEOcoping, in subjects with resected non-metastatic cancer (2016-2018). Participants completed quality of life (EORTC QLQ-C30), emotional distress (Brief Symptom Inventory, BSI), and life satisfaction (Satisfaction with Life Scale, SWLS) questionnaires before systemic antineoplastic treatment and after treatment. A descriptive, bivariate chi-square analysis and t-tests were performed to ascertain the differences between localized and advanced cancer.Results: A total of 1450 patients were recruited, 941 (65%) with a resected cancer and 509 with unresectable advanced cancer with a mean age of 59.0 and 64.9 years, respectively. The most common cancers were colorectal (42%) and breast (34%) in resected group and bronchopulmonary (29%), colorectal (17%), and pancreatic (11%) in unresectable advanced cancer group. Subjects with advanced disease exhibited worse scores on functional scales (physical, cognitive, emotional, and social), and had more symptoms than those with resected disease prior to initiating systemic treatment. Individuals with advanced cancer displayed better functional status and fewer symptoms, but more fatigue and nausea and those with resected cancer presented worse physical and cognitive function, more psychological distress, and more symptoms post-treatment. Conclusion: This sample reveals how antineoplastic treatment can enhance quality of life for people with unresectable advanced disease and negatively affect individuals with resected, non-metastatic cancer.Structured Abstract: Our study shows the potential quality of life benefit of systemic antineoplastic treatment in patients with unresectable advanced cancer. In addition, it shows the deterioration of quality of life in patients with resected non-metastatic cancer after completion of adjuvant treatment.

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