BACKGROUNDPaclitaxel has unique activity in angiosarcomas of the face and scalp, but its activity in angiosarcomas originating at other sites is less well defined. Paclitaxel and pegylated‐liposomal doxorubicin (PLD) are highly effective in Kaposi sarcoma (KS). Because of the efficacy of PLD in soft tissue sarcoma in general, and in KS in particular, coupled with potential similarities in KS and angiosarcoma, and the apparent activity of paclitaxel in angiosarcomas, the authors treated patients with angiosarcoma with either paclitaxel or PLD as initial chemotherapy.METHODSTo better define the efficacy of these agents in angiosarcoma, the authors reviewed their experience with paclitaxel and PLD in patients with angiosarcoma treated between 1994 and 2004.RESULTSThey identified seven patients with angiosarcoma treated with paclitaxel, and six treated with PLD. Only one patient in the series had an angiosarcoma of the scalp. Two patients receiving paclitaxel had received previous therapy with PLD, and four of six patients treated with PLD had previously received paclitaxel. Of the eight patients treated with paclitaxel, five had major responses (three had partial responses [PR] and two had complete disease remission [CR]) and three had progressive disease (PD). Of the 6 patients who received PLD, 3 had a PR for 6, 19, and >20 months, respectively, 2 had stable disease for 7 and 11 months, respectively, and 1 had PD.CONCLUSIONSThe current study demonstrated the activity of PLD (five of six patients experienced clinical benefit) and extended the data on paclitaxel in angiosarcoma, both of the face and scalp, as well as angiosarcoma originating at other sites. Cancer 2005. © 2005 American Cancer Society.

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Introduction: PINKTCL is a less common presentation of extranodal, extranasal NK/T-cell lymphoma which arises along any segment of the gastrointestinal tract. PINKTCL is a rare and rapidly progressive disease with a poor prognosis. It is commonly associated with EBV infection and displays angiotropism and necrosis. PINKTCL affects younger adults and is not associated with pre-existing enteropathy. We conducted this exploratory analysis to delineate key disease characteristics and clinicopathologic determinants of survival in this rare NK/T-cell entity. Methods: To study the demographic characteristics, molecular and immunohistochemical signatures, therapeutic interventions, survival, and prognostic factors, we compiled a pooled database of 126 cases. Kaplan-Meier survival curves were constructed. Cox proportional-hazards model and Log-rank tests were used to assess the influence of demographic and clinicopathologic factors on overall survival (OS). Results: A total of 126 patients with confirmed PINKTCL were identified and analyzed. The median age of the sample was 39 years, with a peak incidence occurring between ages 34 and 48. Males were predominantly afflicted with an M:F ratio of 2.7. The colorectum and ileocecum were the most involved sites. The median overall survival (OS) of the whole group was 6 months. PINKTCL commonly presented with abdominal pain, GI bleeding, and perforation. The majority of cases were at stages I&IE (56%). The median duration of symptoms prior to diagnosis was 6 months. The median OS of surgery alone, chemotherapy alone, and surgery and chemotherapy were 2, 6, and 10 months respectively (p=0.002). OS was not impacted by age, sex, presentation with obstruction, anatomic site involvement, or stage. While constitutional symptoms, perforation, non-ileocecal GI involvement, EBER+, and CD56+ seemed to impact OS negatively, they did not reach statistical significance. Surprisingly, CD4 expression despite CD56+ conferred a significantly longer overall survival (18 vs. 6 months), raising the possibility of a separate and less aggressive entity. Conclusions: This study presents an updated clinicopathologic data from a pooled cohort of patients with PINKTCL. It identifies CD4+ status and surgical resection in conjunction with chemotherapy as major determinants of OS in this rare disease. Disclosures No relevant conflicts of interest to declare.

Introduction: MEITL is a rare and rapidly progressive extranodal T-cell lymphoma that arises from the intestinal intraepithelial T lymphocytes. Established in the 2016 WHO classification, this entity was carved out of what was previously known as type 2 enteropathy-associated T-cell lymphoma. MEITL usually affects the young-old and is not associated with celiac disease. We conducted this analysis to explore the clinicopathologic determinants of survival in this newly established T-cell entity. Methods: In order to study the demographic characteristics, molecular and immunohistochemical signatures, therapeutic interventions, survival, and prognostic factors, we compiled a pooled database of 116 cases. Kaplan-Meier survival curves were constructed. Cox proportional-hazards model and Log-rank tests were used to assess the influence of demographic and clinicopathologic factors on overall survival (OS). Results: A total of 116 patients with confirmed MEITL were identified. The median age was 59.5 years with a peak incidence between ages 56 and 68. There was a male predominance with M:F ratio of 2. The jejunum was the most commonly involved site (71%). Median OS of the whole group was 11 months. The most common presentations were abdominal pain, followed by perforation, diarrhea, and weight loss. The majority presented at stages I&II (78%). The median duration of symptoms prior to diagnosis was 4 months. Compared to no treatment, combination chemotherapy and stem cell transplant (SCT) were statistically superior with a median OS of 2, 9, and 34 months respectively (p=0.0005). Further analysis revealed that surgical resection imparted a survival advantage on its own and in conjunction with combination chemotherapy and SCT. When surgical resection was incorporated in the analysis, median OS amounted to 2, 5, 7, 11, 13, 24 months for no treatment, surgery alone, chemotherapy, surgery+chemotherapy, SCT, and surgery+SCT respectively (p=0.0015). The quality of response to treatment also seemed to impact the outcome (p=0.0005) with median OS of 6, 36, and 60 months for none/transient, PR, and CR respectively. OS was not impacted by sex, presentation with obstruction or perforation, or anatomic site involvement. While older age, weight loss, and TCRγδ seemed to negatively impact OS, they did not reach statistical significance. Conclusions: This study presents an updated clinicopathologic data from a pooled cohort of patients with MEITL. It identifies quality of response, treatment modalities as well as surgical resection as major determinants of OS in this rare disease. Disclosures No relevant conflicts of interest to declare.

20506 Background: Vascular endothelial growth factor (VEGF) plays an important role in many tumors including SAR. Because of the known efficacy of PLD in SAR and the presumed importance of VEGF in SAR, we have treated SAR patients with PLD-B. It is possible that the addition of B to PLD might alter the toxicity profile. The toxicities of this combination are not well described. Methods: To better define the toxicity of the combination of PLD-B in SAR, we reviewed our experience with PLD-B in patients treated between 2004 and 2006. Results: We identified 20 patients with SAR treated with PLD-B at our institution. There were 9 men and 11 women, with a median age of 47.5 years (range 23–77). Ten patients initiated therapy with PLD q28 days at a median dose of 45 mg/m2 (range 45–50), and 10 q14 days at a median dose of 21.2 mg/m2 (range 20–25), in combination with B at 5 mg/kg q14 days. A median of 5 cycles was given (range 1–15). Dose delay was required in 3 patients for the second cycle, and dose reduction was required in 9 patients by cycle 3. Of the 10 patients starting with monthly PLD, 7 were changed to q14 day PLD by cycle 4. Mucositis and skin toxicity were the dose limiting toxicities (DLT) in 14/20 patients, and myelosuppression was the DLT in 1/20 patients. Nine patients were felt to have clinical benefit; 3 had a PR and 6 had SD. Notably, 2/4 recurrent Ewing sarcoma patients had symptomatic improvement and at least SD for 10 and 11 months, respectively, with minor toxicity allowing a good quality of life. Conclusions: This report describes the toxicity profile of PLD-B in 20 patients with SAR. The toxicities observed were similar to those seen with PLD alone, however, these toxicities appeared more pronounced with the addition of B. Since VEGF is important for wound healing, the known effects of B on this process may contribute to more skin and mucosal toxicity of PLD at a given dose. Future studies of PLD-B should consider the potential of increased mucosal and skin toxicity. The use of q14 day PLD to allow more control over toxicity is suggested; a maximal starting dose of 20 mg/m2 is reasonable, although dose reduction will be common due to skin or mucosal toxicity. This combination can be given with limited toxicity, and meaningful responses were observed in recurrent sarcomas, including 2/4 Ewing sarcomas. No significant financial relationships to disclose.

Context: The COVID-19 pandemic continues to be a major socioeconomic disruptor in the U.S. and around the globe. The only intervention that has a far-reaching impact is the adoption of an efficient large-scale vaccination campaign with the highly effective COVID-19 vaccines. While the success of this strategy is predicated on the presence of adequate healthcare systems capacity, it also hinges on the trust and acceptance of the public. Vaccine hesitancy, which varies by the geosocial context, is considered a top obstacle. Objective: The Overton Brooks VA embarked on a survey to explore the demographic patterns and reasons for COVID-19 vaccination hesitancy among cancer patients. Study Design: phone survey. Setting: five Hematology-Oncology clinics across the ArkLATX. Population: random sample of 240 veterans with cancer. Intervention: Veterans were asked whether they are interested in getting vaccinated and to state the reason if they declined. They were asked to categorize the reason as relating to safety, efficacy, inadequate Information, aversion to any vaccine, not wanting to be the first, or other/explain. Outcome Measures: 1. Descriptive statistics of those who want and those who decline the vaccine. 2. Determine the impact of demographic factors on COVID19 vaccine hesitancy. Results: The median age was 71 years. The participants were 92% males and 40% Black vs 59% White. Seventy nine percent wanted to get vaccinated. Among the veterans that declined (21%), the reasons were due to concerns about safety (33%), not wanting to be the first (33%), anti-vaxxer stance (14%), and inadequate information (8%). No one cited concerns about efficacy as a reason. Other reasons (12%) included seeing no reason for the vaccination, citing severe reactions to prior vaccines, and voicing mistrust of the government. There were no statistical differences between veterans that approved or declined the vaccine with respect to demographic characteristics. Conclusions: This survey indicates that the majority of ArkLATX veterans with cancer are willing to be vaccinated against COVID-19. The major reasons behind vaccine hesitancy seem to be information problems consisting of questions about safety, inadequate information, and seeing no reason for the vaccine. Such barriers can be potentially circumvented by providing the appropriate information and counseling.

Introduction: PCNSL is a rare diffuse large B-cell lymphoma (DLBCL) confined to the central nervous system accounting for approximately 2-5% of all primary brain tumors. Although there is no standard combination of chemotherapy, high-dose methotrexate is considered the backbone of all PCNSL chemotherapy regimens. Rituximab, an anti-CD20 antibody, has been a standard component of non-CNS DLBCL combinations since it improves progression-free (PFS) and overall survival (OS). However, the role of Rituximab in the treatment of PCNSL has been controversial with contradictory results. A meta-analysis conducted in 2019 found no associated survival advantage for Rituximab when added to chemotherapy. However, this meta-analysis was small and included only 2 studies. The purpose of this meta-analysis is to evaluate in a more comprehensive way the impact of Rituximab-based chemotherapy combinations on the clinical outcomes of patients with PCNSL incorporating all available comparative studies. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of PCNSL diagnosis, English language, and studies reporting OS and PFS with hazard ratios (HR) or Kaplan-Meier curves that compared similar regimens with and without Rituximab. A meta-analysis using an inverse variance method with a random-effects model was conducted. Results: Four comparative studies with a total of 467 patients were included in this meta-analysis. Two of these studies were retrospective comparative studies and two were randomized phase II trials. When added to chemotherapy, Rituximab was found to significantly improve the OS and PFS (HROS 0.75, 95%CI: 0.59-0.96, p=0.02; HRPFS 0.67, 95%CI: 0.53-0.85, p=0.001) with a heterogeneity estimate, I2=0%. Conclusions: This is the first meta-analysis to show that adding Rituximab to chemotherapy is associated with OS and PFS in patients with PCNSL. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the routine use of Rituximab combinations in PCNSL. Disclosures No relevant conflicts of interest to declare.

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