BackgroundBreast cancer is the most common cancer worldwide, and despite remarkable progress in its treatment, the survivors’ quality of life is hampered by treatment-related side effects that impair psychosocial and physiological outcomes. Several studies have established the benefits of physical exercise in breast cancer survivors in recent years. Physical exercise reduces the impact of treatment-related adverse events to promote a better quality of life and functional outcomes.AimThis study aims to provide an overview of systematic reviews and meta-analyses on the effect of physical exercise on the health-related quality of life, cardiorespiratory fitness, muscle strength, and body composition of breast cancer survivors.MethodsPubMed and Cochrane databases were searched for systematic reviews and meta-analyses from January 2010 to October 2022. The main focus was ascertaining the effectiveness of physical exercise in breast cancer survivors undergoing curative treatment (surgery and/or radiotherapy and/or chemotherapy). Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies.ResultsA total of 101 studies were identified, and 12 were yielded for final analysis. The eligible studies included nine systematic reviews/meta-analyses, one meta-analysis/meta-regression, and two systematic reviews. The number of randomised clinical trials included in each review varied from 11 to 63, and the number of participants was from 214 to 5761. A positive and significant effect of different physical exercise interventions on health-related quality of life was reported in 83.3% (10 studies) of the eligible studies. Physical exercise also improved cardiorespiratory fitness (3 studies; 25%) and showed to be effective in reducing body weight (3 studies; 25%) and waist circumference (4 studies; 33.3%).ConclusionsOur results suggest that physical exercise is an effective strategy that positively affects breast cancer survivors’ quality of life, cardiorespiratory fitness, and body composition. Healthcare professionals should foster the adoption of physical exercise interventions to achieve better health outcomes following breast cancer treatments.Systematic review registrationhttps://inplasy.com/inplasy-2022-11-0053/, identifier INPLASY2022110053.

<b><i>Introduction:</i></b> Febrile neutropenia (FN) is a potentially life-threatening complication of systemic chemotherapy (CT) that often requires hospital admission. Delay in diagnosis and treatment are associated with higher morbidity and mortality. <b><i>Objective:</i></b> We aimed to determine the factors that influence FN episodes outcomes in the emergency room (ER). <b><i>Methods:</i></b> This was a retrospective study of all FN episodes (with a collected blood culture [BC]) that occurred between 2012 and 2016 at our institution. FN was defined as a temperature ≥38°C and an absolute neutrophil count (ANC) &#x3c;1,000/μL, expected to decrease to &#x3c;500/μL in the following week. <b><i>Results:</i></b> Between 2012 and 2016, there were 173 FN episodes in 153/1,947 patients treated with intravenous CT. Most of these episodes (<i>n</i> = 121, 70%) were diagnosed in the ER, 29 in the outpatient clinic, and 23 as inpatients. In the ER, the median time was 36 min from hospital nurse triage to medical observation, and 52 min from medical observation to complete blood count specimen collection. There was a positive BC in 33 FN episodes, 72% with Gram-negative bacteria. A total of 160 FN episodes led to hospital admission and 13 were treated as outpatients. Mortality associated with the FN episode was 15% and an ANC &#x3c;100/μL was predictive of increased mortality. <b><i>Conclusion:</i></b> This study confirms that FN is a serious and common complication of IV CT which must be diagnosed and treated promptly. Profound neutropenia was the only predictive factor of mortality.

Anaemia is highly prevalent in cancer patients, adversely affects quality of life and impacts survival. The pathogenesis is multifactorial, with iron deficiency being a major and potentially treatable contributor. This study aimed to assess the effectiveness and economic impact of ferric carboxymaltose in chemotherapy-induced anaemia. This prospective cohort study between 2015–2016 of chemotherapy-treated patients for solid tumours, grade ≥2 anaemia and iron deficiency evaluated hematopoietic response four weeks after ferric carboxymaltose treatment. Transfusion rate of all cancer patients treated at our ambulatory unit during the two-year study period (2015–2016) was compared to a retrospective cohort (2013–2014) who received blood transfusion only. Between 2015–2016, 99 patients were included and treated with ferric carboxymaltose, the majority of whom (n = 81) had relative iron deficiency. Mean haemoglobin concentrations improved from 9.2 [6.7–10.8] g/dL to 10.6 [7.8–14.2] g/dL four weeks after treatment. A 26% reduction in the transfusion rate was observed from control retrospective to the prospective study group including ferric carboxymaltose treated patients [relative risk 0.74 (95% CI:0.66–0.83)]. The cost analysis showed a benefit for the use of ferric carboxymaltose in chemotherapy-induced anaemia. This study shows that ferric carboxymaltose is an effective, cost-saving support treatment, reducing the need for allogeneic transfusions saving blood units which are a limited resource.

Introduction Ovarian cancer is a leading cause of death among women with gynecologic malignancies. The relapse rate is high after platinum-based therapy, with the effectiveness of subsequent treatment lines decreasing over time. Recent data suggest the benefit of maintenance therapy with niraparib in platinum-sensitive recurrent disease. Case Presentations We report a case series of five women with advanced ovarian cancer and BRCAness phenotype who responded favorably, and in some cases with long-term response, to maintenance therapy with niraparib. Toxicities were as expected and generally manageable. Two patients developed grade 2/3 hematological toxicity, which resolved with treatment suspension and subsequent dose reductions, and one patient reported a rare skin toxicity while responding to full-dose niraparib treatment, which was controlled with photoprotection and sunscreen. Discussion and Conclusions This case series highlights the role of PARP1/2 inhibitors as a new standard of care as maintenance therapy for recurrent platinum-sensitive high-grade ovarian cancer, irrespective of BRCA status.

Head and neck cancer (HNC) treatment’s toxicities impact several health domains. Exercise training (ET) may be beneficial. This prospective observational study (NCT04996147) aimed to analyse the acute impact of HNC curative multimodal treatment on health-related quality of life (HRQoL), nutritional status, physical and cognitive functions, and ET preferences. Eighteen patients with stage III/IV HNC were evaluated at baseline (T0), and 10 patients were evaluated at the end of treatment (T1), 7 of them after radical chemoradiotherapy (rCRT). At T0, the majority referred a good HRQoL on the EORTC QLQ-C30 questionnaire (median score: 70.8), were moderately malnourished or at risk of malnutrition (78%), recognized the benefits of an ET program, and were willing to participate (78%). After rCRT, there was worsening in HRQoL (75 vs. 50 score, p = 0.014), dysphagia severity (Eating Assessment Tool: 7 vs. 31, p = 0.027; Functional Oral Intake Scale: 6 vs. 4, p = 0.041), handgrip strength (dominant: 40.9 vs. 35.8 kgf, p = 0.027; nondominant: 37.2 vs. 33.9 kgf, p = 0.043), and nutritional status (Patient-Generated Subjective Global Assessment: 7 vs. 18, p = 0.028). HNC patients subjected to radical treatment represent a vulnerable population that might benefit from multimodal supportive care strategies including an ET program.

BACKGROUND Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine neoplasia, with high risk of recurrence and metastasis and poor survival. Immune checkpoint inhibitors, like the anti-programmed death-ligand 1 agent avelumab, were recently approved for the treatment of advanced MCC. We, herein, report the first case of advanced MCC with oligoprogression managed with avelumab and local radical treatment. CASE SUMMARY A 61-year-old man was presented to the hospital with sporadic fever and an exudative malodorous mass (10 cm of diameter), located on the right gluteal region. The final diagnosis was MCC, cT4N3M1c (AJCC, TNM staging 8 th edition, 2017), with invasion of adjacent muscle, in-transit metastasis, and bone lesions. Patient started chemotherapy (cisplatin and etoposide), and after six cycles, the main tumor increased, evidencing disease progression. Two months later, the patient started second line treatment with avelumab (under an early access program). After two cycles of treatment, the lesion started to decrease, achieving a major response. Local progression was documented after 16 cycles. However, as the tumor became resectable, salvage surgery was performed, while keeping the systemic treatment with avelumab. Since the patient developed bilateral pneumonia, immunotherapy was suspended. More than 2.5 years after surgery (last 19 mo without systemic therapy), the patient maintains complete local response and stable bone lesions. CONCLUSION This report highlights the efficacy and long-term response of avelumab on the management of a chemotherapy resistant advanced MCC, with evidence of oligoprogression, in combination with local radical treatment.

e16104 Background: Portugal has the highest gastric cancer incidence in western Europe. In our institution, FOLFIRI/XELIRI is the standard second line (2L) chemotherapy (CT) in advanced gastroesophageal adenocarcinoma (aGEA). Other treatment option is paclitaxel/ramucirumab combination. There is no prospective trial comparing these regimens. Our global aim was to investigate efficacy and safety of FOLFIRI/XELIRI after failure of a fluoropyrimidine/platinum (FP) regimen in patients with aGEA. Methods: Single center, retrospective cohort study of all patients with aGEA who failed FP regimen and received > 1 cycle of FOLFIRI/XELIRI between 2015-2020. Failure of a FP regimen defined as: 1) progression after first line (1L) palliative CT; 2) progression < 6 months after a curative intent strategy. Kaplan-Meier method was used to estimate median overall (mOS) / progression free survival (mPFS) and multivariate Cox regression analysis to assess PFS predictors. Results: Thirty-three patients analyzed. FOLFIRI/XELIRI regimen was used as 1L palliative CT (after failure of curative intent CT) in 48.5% of patients and as 2L palliative CT in 51.5%. Median age was 63 years (IQR 54–68.5), 72.7% were men. ECOG performance status (ECOG-PS) was 0-1 in 84.8%. Primary tumor site was stomach (87.9%), gastroesophageal junction (9.1%), esophagus (3.0%). All but one patient had metastatic disease (57.6% ≥2 metastatic sites; 42.4% peritoneal disease). Histology subtypes identified were diffuse and intestinal (14 patients each). Signet ring cell features were present in 12,1% of cases. 6 had HER2 positive tumors and in 1 there was microsatellite instability. 30,3% of patients had surgery of the primary tumor. Median number of cycles was 12 (IQR 5–17.5). Tumor response was accessed in 27 patients. Disease control rate was 74,1% (1 complete response, 8 partial responses, 11 stable disease). With a median follow-up of 9.4 months, mPFS was 5.1 months (95%CI 4.3-5.9) and the mOS 9.8 months (95%CI 6.6-13.0). 6-month overall survival was 69.7%. In multivariate analysis ECOG-PS (HR 6.20, p = 0.002), age (HR 0.94, p = 0.011), pre-treatment level CEA (HR 1.01, p = 0.011) and FOLFIRI/XELIRI as 1L palliative CT (HR 0.25 p = 0.004) were predictors of PFS. Treatment was discontinued in 31 patients (20 disease progression, 10 worsening of ECOG-PS). The main treatment-related grade 3 or 4 adverse events were neutropenia (12.1%), mucositis (9.1%) and anemia (6.6%). No treatment-related deaths occurred. Fifteen patients initiated a subsequent treatment line (7 taxane, 2 ramucirumab, 5 taxane/ramucirumab, 1 Tas102). Conclusions: FOLFIRI is an active and well tolerated regimen after failure of a FP regimen in patients with aGEA. Population with poor prognostic features was well represented. Efficacy outcomes were similar to the ones reported for the paclitaxel/ramucirumab combination RAINBOW trial.

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