e14088 Background: The checkpoint inhibitor (CPI) immunotherapy class of drugs is redefining how we treat cancer. The US FDA has approved CPI drugs as 1st, 2nd or salvage line after progression on conventional chemotherapy (CTX) for multiple cancers including melanoma, lung, bladder and other cancers. However, many questions remain regarding optimal treatment post-progression. Indeed, it has been noted that the patterns of response and relapse to CPI agents are quite different from those of standard cytotoxic agents and that response to CTX AFTER CPI may be different than in the de novo setting. The purpose of this retrospective analysis is to evaluate the activity (response rate (RR), response duration (DOR) and progression free survival (PFS)) of subsequent CTX after disease progression following treatment with CPI. Methods: In this analysis, patients (pts) were enrolled under an IRB approved waiver of consent. We identified pts treated with CPI agents between Jan, 2011 and Dec, 2018 at a multi-site community cancer program who received subsequent CTX as a result of disease progression (PD). We assessed the RECIST RR to subsequent therapy, DOR from onset of response, and PFS from the onset of post CPI CTX, identifying index lesions from the most recent pre-treatment anatomic scan. Results: A total of 47 cases satisfying the above criteria were found; 31 NSCLC, 8 melanoma, 1 SCLC, 1 GEJ, 1 gastric, 2 head/neck, 1 large cell neuroendocrine tumor, 2 bladder cancer. 25 pts had PD as best response to post-CPI CTX. 9 pts (19%) achieved a partial response (PR) with a median DOR of 99 days. 22 pts achieved a PR or stable disease (SD) for a clinical benefit (CB) rate of 47%. The median duration of CB was 92 days. Of the 9 patients who achieved PR, 5/6 had achieved response to CTX prior to CPI . The median PFS for the entire cohort was 97 days. Conclusions: While an expected RR could not be calculated in this heterogenous group of pts, the number and degree of responses suggests CPI possible “priming” that may enhance response to CTX. Post-CPI CTX may be of value and in this retrospective study of a heterogenous group of pts, responses may be more frequent than expected. A larger further study is warranted.
663 Background: Infusional-5-fluorouracil (inf-5FU), administered over 48 hours every 2 weeks, is frequently prescribed for the treatment of gastrointestinal cancers. A portable infusion device (ID) may be used for this purpose to enable treatment at home. At our institution, patients are educated by an oncology nurse as to what to expect, and how to function once they leave the infusion center. However, there is no formal process in place to report their experience and to record and analyze the results. The intended goal of this study was to accomplish this, such that the data could improve the education and experience of future patients. Methods: After verbal consent, a sequential cohort of patients, who had received 2 or more treatments with inf-5FU for gastrointestinal cancer, was invited to complete a de-identified paper questionnaire concerning their experience. Eleven specific questions suggested by the GI group were included, with an opportunity to add comments. The surveys were then collated and reviewed. Results: See table. Conclusions: While most patients felt well prepared by their medical team as to what to expect from the ID (93.1%), ≥ 25% had issues with bathing (73.6%), sleep (37.5%), exercising (30.6%), intimacy (26.4%), social interactions (25%) and anxiety (25%). These insights will be used to improve the education of future patients and a second assessment will follow. 72/72 patients approached over 6 months completed the survey with results below: [Table: see text]
IntroductionGastric cancer (GC) is the fourth most common type of cancer and the second leading cause of cancer-related deaths in the world [1]. Most patients suffering from the advanced, inoperable or metastatic stage of the disease have 5-year survival rates and are approximately 30% (of the cancer population?) [2]. Validated chemotherapeutic regimens such as fluoropyrimidine and/or platinum-based therapies failed to improve the prognosis of advanced GC that remains poor, with a median overall survival (OS) being around 1 year [3,4]. AbstractHuman epidermal growth factor receptor 2 (HER2) is responsible for the pathogenesis and poor outcomes of several types of cancers, including advanced gastric and gastroesophageal junction cancer. Molecular-targeted drugs on the other hand, such as trastuzumab, prolong overall survival and progression-free survival in HER2-positive gastric cancer. The purpose of the case report is to evaluate the impact of delivering trastuzumab in advanced gastric cancer with concomitant HER2 mutation and amplification.Keywords: Gastric cancer; Human epidermal growth factor receptor 2; CT scan; Trastuzumab; Biopsy Therefore, there is an urgent need for targeted-driven approaches toward deregulated molecular signaling pathways in advanced GC such as phosphatidylinositol -4, 5-bisphosphate 3-kinase, catalytic subunit alpha (PIK3CA) pathway or epidermal growth factor receptor (EGFR) pathway. HER2 is the first validated treatment target in HER2-positive GC. HER2 amplification is reported in 7-34% of tumor cases [5,6]. Although anti-HER2 therapy such as Trastuzumab confers clinical benefit on GC patients, its efficacy was shown to be unsatisfactory due to primary or acquired resistance [7][8][9]. The ToGA trial [7] reported a prolongation of median OS by a modest 2.7 months (from 11.1 months to 13.8 months) with Trastuzumab.Fragments of DNA shed by cancers into the bloodstream can potentially be used as a non-invasively screening method for earlystage cancers, monitor responses to treatment and explains why some cancers are resistant to therapies. For most neoplasms, a tissue biopsy is quite challenging in that it is costly, painful, unreachable, insufficient amount of staining or potentially risky for the patient. All these are good reasons to learn about cancer through blood and to get excited about the possibility of carrying out liquid biopsies. The development of non-invasive methods to detect and monitor cancers continues to be a major challenge in oncology. Cell-free circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs) are plasma sources of tumor DNA that have been investigated for non-invasive detection and monitoring of patient tumors but have not been analyzed or directly compared across multiple tumor types. Although the current Food and Drug Administration (FDA)-approved liquid biopsy measures intact CTCs to give a prognosis of overall survival, the potential predictive value of ctDNA is much more exciting. ctDNA liquid biopsy allows us to understand specifically what ki...
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