Wee, Christopher Eing

AbstractIntroductionChemotherapy in combination with immunotherapy has a proven survival benefit compared to chemotherapy alone in extensive stage small cell lung cancer (SCLC) and is the new standard of care. Since extrapulmonary small cell carcinomas (SCCs) are less common, treatment paradigms are reasonably extrapolated from SCLC regimens. We examined our institution's experience utilizing the combination of chemotherapy and immunotherapy (as used in SCLC) for SCC and neuroendocrine carcinoma of the prostate.MethodsUtilizing an institutional database search tool, we queried the electronic medical record to identify patients with SCC or neuroendocrine carcinoma of the prostate who had been treated with atezolizumab and chemotherapy. We recorded patient characteristics, including age, pathology, and disease extent. Treatment characteristics included number of prior treatments, use of concominant androgen deprivation, number of cycles of immunotherapy, and prior systemic therapies (including those for adenocarcinoma of the prostate). Progression free survival (PFS) and overall survival (OS) were the primary outcomes.ResultsWe identified seven men who received atezolizumab for metastatic prostate cancer with a small cell or neuroendocrine component. In six of the seven patients, the combination of carboplatin, etoposide, and atezolizumab was the first‐line of treatment after diagnosis of small cell or neuroendocrine carcinoma. Two of the seven patients had de novo small cell/neuroendocrine pathology, while the other five had transformation from a preexisting adenocarcinoma. In the patients who received chemotherapy plus immunotherapy in the first‐line setting, at a median follow‐up of 6.5 months (range: 1.5–15.1) the median PFS was 3.4 months and median OS was 8.4 months.ConclusionSmall cell or neuroendocrine carcinoma of the prostate was associated with poor survival outcomes despite adding immunotherapy (atezolizumab) to chemotherapy (carboplatin and etoposide). To our knowledge, there has been no demonstrable benefit of adding immunotherapy to chemotherapy in this setting.

PURPOSE: The benefit of routine pre-emptive screening for severe acute respiratory syndrome coronavirus 2 infections in patients with cancer before cancer-directed therapies is unclear. Herein, we characterize the outcomes of a cohort of patients with cancer who were diagnosed with COVID-19 by routine screening (RS) in comparison with those diagnosed on the basis of clinical suspicion or exposure history (nonroutine screening [NRS]). METHODS: A multisite prospective observational study was conducted at three major and five satellite campuses of the Mayo Clinic Cancer Center between March 18 and July 31, 2020. The primary outcome was COVID-19–related hospital admission. Secondary outcomes included intensive care unit admissions and all-cause mortality. RESULTS: Five thousand four hundred fifty-two patients underwent RS in the outpatient setting only, and 44 (0.81%) were diagnosed with COVID-19. RS detected 19 additional patients from the scheduled inpatient admissions for surgical or interventional procedures or inpatient chemotherapy. One hundred sixty-one patients were diagnosed with COVID-19 on the basis of NRS. COVID-19–related hospitalization rate (17.5% v 26.7%; P = .14), intensive care unit admission (1.6% v 5.6%; P = .19), and mortality (4.8% v 3.7%; P = .72) were not significantly different between the RS and NRS groups. In the multivariable analysis, age ≥ 60 years (odds ratio, 4.4; P = .023) and an absolute lymphocyte count ≤ 1.4 × 109/L (odds ratio, 9.2; P = .002) were independent predictors of COVID-19–related hospital admission. CONCLUSION: The COVID-19 positivity rate was low on the basis of RS. Comparing the hospital admission and mortality outcomes with the NRS cohort, there were no significant differences. The value of routine pre-emptive screening of asymptomatic patients with cancer for COVID-19 remains low.

Abstract Abstract Importance: The benefit of routine screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in patients with cancer before cancer-directed therapies is unclear. Herein, we characterize the outcomes of a cohort of cancer patients diagnosed with Coronavirus Disease 2019 (COVID-19) by routine screening in comparison with those diagnosed based on clinical suspicion or exposure history (non-routine screening). Objective: To describe and compare the outcomes of cancer patients diagnosed with COVID-19 on routine screening vs. non-routine screening at a multi-site tertiary cancer center. To identify risk factors for COVID-19-related hospital admission. Design: A multi-site prospective observational study was conducted between March 18 and July 31, 2020. Setting: Three major and 5 satellite campuses of the Mayo Clinic Cancer Center. Participants: Adult patients diagnosed with active cancer within the past five years and confirmed SARS-CoV-2 infection were included. Primary Outcomes and Measures: Clinical and laboratory data were assessed as independent variables. The primary outcome was COVID-19-related hospital admission. Secondary outcomes included intensive care unit (ICU) admissions and all-cause mortality. Results: Between March 18 and July 31, 2020, 5452 patients underwent routine screening in the outpatient setting, 44 (0.81%) were diagnosed with COVID-19. Routine screening detected additional 19 patients from inpatient and pre-procedural settings; 161 patients were diagnosed with COVID-19 based on non-routine screening. The median age of the entire cohort at diagnosis was 54 years, and 95 patients (42.2%) were female. COVID-19 related-hospitalization rate (17.5% vs. 26.7%, p=0.14), ICU admission (1.6% vs. 5.6%, p=0.19), and mortality (4.8% vs. 3.7%, p=0.72) were not significantly different between routine screening and non-routine screening groups. In the multivariable analysis, age ≥ 60 years (odds ratio: 4.4, p=0.023) and an absolute lymphocyte count ≤1.4 × 109/L (odds ratio: 9.2, p=0.002) were independent predictors of COVID-19-related hospital admission. Conclusions and Relevance: The COVID-19 positivity rate was low based on routine screening. Comparing the outcome with the non-routine screening cohort, there was no significant difference. These results led to an important practice change at our cancer center. We currently follow a testing strategy based on symptoms, exposure, risk factors, and clinical judgment. Citation Format: Zhuoer Xie, Antoine N. Saliba, Jithma Abeykoon, Umair Majeed, Daniel Almquist, Julia Wiedmeier-Nutor, Evandro Bezerra, Xavier Andrade-Gonzalez, Ashley Hickman, Karl Sorenson, Sagar Rakshit, Christopher Wee, Sri Tella, Anuhya Kommalapati, Nadine Abdallah, Joshua Pritchett, Mariza De Andrade, Dipesh Uprety, Andrew Badley, Joleen Hubbard, Naseema Gangat, Carrie A. Thompson, Thomas Witzig, Robert R. McWilliams, Konstantinos Leventakos, Thorvardur R. Halfdanarson. Outcomes of COVID-19 in patients with cancer: Results of a prospective observational comparison of routine screening strategy versus testing based on clinical suspicion [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S06-03.

Introduction: Mutations in the gene isocitrate dehydrogenase 2 (IDH2) occur in ~12-15% of patients with acute myeloid leukemia (AML). Enasidenib, an oral small molecule selective targeted inhibitor of IDH2 enzymes, was approved forIDH2mutated relapsed/refractory AML (RR-AML) in 2017 (Stein et. al., 2017). There is limited data regarding its efficacy and toxicity outside the context of clinical trials. Using Mayo Clinic's cohort of AML patients, we provide a real-world look at outcomes forIDH2mutated RR-AML patients treated with enasidenib. Methods: A total of 13 patients treated with enasidenib for RR-AML were identified, all of which experienced at least one relapse following induction chemotherapy. Response assessment was based on European Leukemia Net (ELN) 2017 response criteria.Complete blood counts including blast percentage and transfusion dependency were obtained at AML diagnosis, initiation of enasidenib, 2 months and 6 months following initiation of therapy. Transfusion dependency was defined by the need for either a red cell or platelet transfusion within 4 weeks of the designated time frame. We compared the clinical characteristics of patients who achieved complete response (CR) (n=4) to those not achieving CR (n=9), using the Mann-Whitney U test for numerical variables and the Fischer's Exact test for quantitative data. Results: The median age at diagnosis of our 13 patients was 68 years (range 60-82), with a male predilection (n=11) (Table 1). Cytogenetic and molecular genetic findings are provided in Table 2. Complete response (CR) was achieved in 4 (30.7%) patients by cycle 2 and 2 of those patients (50%) proceeded to an allogeneic hematopoietic stem cell transplant (AHSCT). The median time from diagnosis to initiation of treatment for patients in CR was 3.5 months (range 1-7), and for patients not achieving CR was 13 months (range 6-53; p=0.048), with median time of follow up after treatment initiation of 23.5 months (range, 5-36) and 7 months (range, 1-14), respectively. Among 8 patients who were transfusion dependent at baseline, all the CR patients (2/2) achieved red blood cell and platelet transfusion independence 6 months after treatment, instead only (3/6) 50% of those not in CR achieved transfusion independence (p=0.028). An initial trajectory of improvement in counts is noted from the time of diagnosis to the 2 month mark post treatment with 75% of the responder cohort showing improvement in counts which was durable through the 6 month mark, whereas 55% of those that did not respond had worsening counts at month 2 and died prior to 6 month follow up. At the time of data cut-off, the median duration of CR was 14 months (range, 2-33), with 3 of 4 (75%) of responders maintaining CR. Figure 1 details overall responses and outcomes in all 13 patients. None of the patients in our study experienced differentiation syndrome. Five patients were hospitalized in the course of treatment for infectious complications. Two patients were noted to have hyperbilirubinemia however there was no clear indication that this was secondary to enasidenib Median overall survival for all 13 patients was 21 months (range, 6-53 months) with leukemia free survival of 7 months (range, 5-19 months). Furthermore, median overall survival for patients in CR was 27 months (range, 6-42), and those not in CR was 16 months (range, 6-53) (p=0.20). In addition, we observed that 75% of patients who attained CR are alive compared to 11.1% of those not in CR (p = 0.052). Conclusion: We demonstrate a superior CR rate of 30.7% with enasidenib amongstIDH2mutated RR-AML patients compared with clinical trial data showing CR rate of 19.6% (Stein et. al., 2019) despite our patients being heavily pre-treated with median number of two prior therapies (range; 1-5) including prior AHSCT in 2 patients. Moreover, a subset of patients (2 of 4 in CR) were able to undergo ASCHT. Finally, the achievement of CR at 2 months after initiation of therapy serves as an appropriate time point for response assessment. Disclosures No relevant conflicts of interest to declare.

10503 Background: Gender bias can be reinforced through the use of gender-subordinating language and differences in the forms of address. We examined how professional titles were used during speakers’ introductions at the American Society of Clinical Oncology (ASCO) Annual Meeting. Methods: A retrospective observational study of video-archived speaker introductions at the 2017 and 2018 ASCO annual meetings was conducted. Data were extracted by mixed-gender coders. Professional address was defined as professional title followed by full name or last name. Multivariable logistic regressions were used to identify factors associated with the form of address. Results: 2511 videos were reviewed and 812 met inclusion criteria. Regarding speakers’ characteristics, 530 (65%) were non-Hispanic white (NHW), 743 (92%) held a MD or MD-PhD degree, and 484 (60%) were an associate or full professor. Female speakers were less likely to receive a professional address compared to male speakers (61% vs. 81%, p < 0.001). Female speakers were more likely to be introduced by first name only (17% vs. 3%, p < 0.001). Males were less likely to use a professional address when introducing female speakers compared to male speakers (53% vs. 80%, p < 0.01). No gender differences in professional address were observed for female introducers (p = 0.13). Male introducers were more likely to address female speakers by first name only compared to female introducers (24% vs. 7%, p < 0.01). In a multivariable regression including gender, race, degree, and academic rank, male speakers were more likely to receive a professional address compared to female speakers (OR: 2.67, 95%CI: 1.81-3.94, p < 0.01). Black speakers of both genders were less likely to receive a professional address compared to NHW (OR: 0.10, 95%CI: 0.01-0.53, p < 0.01). Female gender was a predictor for a non-professional form of address (first name only) (OR: 9.50, 95%CI: 4.38-20.62, p < 0.01). Conclusions: When introduced by men, female speakers were less likely to receive a professional address and more likely to be introduced by first name only compared to male speakers. Selective use of forms of address may strengthen gender bias; more research is needed to explore the causes of this disparity and its influence.

82 Background: Use of immune checkpoint inhibitors (ICI) in metastatic solid malignancies can occasionally result in a complete response (CR). There is limited long-term data regarding outcomes for patients who achieve a CR on ICIs. Methods: We screened the Mayo Clinic electronic medical record using an institutional database query program to identify patients whose records contained keywords such as “pembrolizumab” and “complete response” or “no evidence of disease.” Patients were included if they had measurable metastatic solid tumor disease prior to initiation of ICI and if they had a CR defined by two consecutive imaging studies at least twelve weeks apart. Exclusion criteria included oligometastatic disease treated with locoregional therapy or presence of a second confounding malignancy. Results: One-hundred four patients with a CR on pembrolizumab met criteria. Most (71.1%) patients had melanoma and 63/103 (61.2%) received had received the ICI during the first line of metastatic systemic therapy. Additional characteristics are in Table. At a median follow-up of 35.8 months (6.1-87.7), patients had received ICI for a median of 12.1 months (1.5-46.7). The vast majority of patients who stopped ICI did so electively (for reasons other than disease progression). Of 88 elective discontinuations, only 7 patients had disease recurrence after a median follow-up from start of ICI of 40.5 months. Conclusions: Patients with a metastatic solid malignancy who achieve a CR to pembrolizumab appear to maintain remissions off therapy, with low rates of relapse. Further outcomes will be explored, including analyzing and characterizing a sub-group of “hyper-responders” and patients receiving other ICI agents. [Table: see text]

Introduction: Several recent studies have shown a gender disparity in professional doctoral introductions at major medical conferences, with female speakers being less likely to be introduced with a professional title. We sought to examine whether a similar disparity existed at the American Society of Hematology (ASH) Annual Meeting. Methods: In this retrospective observational study, 8 investigators reviewed available presentations from video archives of the 2018 ASH Annual Meeting. Presentations were excluded if gender could not be identified and/or speaker did not have a doctoral degree. We collected data on speaker gender, speaker academic/non-academic rank, speaker geographic location, speaker training status, speaker session type and introducer gender were all collected. A "professional address" was defined as either "Dr. [First and Last Name]" or "Dr. [Last Name]." Descriptive statistics and regression modelling were used to analyze the data. Results:Of the videos reviewed, 645 presentations were eligible for analysis; 380 (59%) speakers were men and 264 (41%) were women. A comparison of male and female speaker cohorts is seen in Table 1. Forty-eight percent of both men and women held a Medical Doctor degree (MD), and the rest were MD/PhD or PhD graduates. Substantially more men (28%) were full professors compared to women (13%). Almost half (47%) of session types for both men and women speakers were designated as "basic science." In an adjusted analysis, more women (N=174, 66%) compared to men (N=225, 59%) received a professional address (P&lt;.01). 43% of women were introduced by a female introducer and 42% of men were introduced by a female introducer (P=.79). In addition, 48 of the introducers (19%) for women and 68 of the introducers (18%) for men had a PhD or MD/PhD. In a logistic regression model adjusting for session type, academic rank, degree, geographic location, trainee status, and gender of introducer, there were no significant gender-based differences in professional introduction [Table 1; Odds Ratio (OR) 0.71, P=.06]. In addition, speakers with MD introducers were more likely to have a professional introduction compared to PhD introducers (OR 2.15, P=.03) regardless of sex. Conclusions: Our study demonstrates that women were at least as likely as men to receive a professional address at the 2018 ASH Annual Meeting. These results differ from previous studies of other professional medical conferences. These findings may reflect the strong presence of PhD graduates as both speakers and introducers. Both forms of bias (gender and degree-based) merit further study and interventions including speaker training to ensure combatting unconscious bias. Disclosures Velazquez: Midatech: Other: Husband owns stock in this company; Portola Pharmaceuticals: Other: Husband owns stock in this company; Corbus Pharmaceuticals: Other: Husband owns stock in this company; Johnson & Johnson: Other: Husband is employed by this company.

Introduction Despite more robust attempts to deliver chemotherapy in the outpatient setting, certain regimens for hematologic malignancies require inpatient hospitalization for treatment and monitoring clinical status. Increased length of stay (LOS) for planned chemotherapy admissions leads to increased healthcare utilization and decreased patient satisfaction. We sought to identify potentially modifiable risk factors for increased LOS. Methods Planned chemotherapy admissions to the inpatient hematology services at Mayo Clinic (Rochester, MN) from October 2018 through March 2019 were reviewed. We included patients who had treatment plans based on four pre-specified common regimens for acute myeloid leukemia, relapsed non-Hodgkins lymphoma and multiple myeloma. Patients who remained in the hospital for lack of caregiver support were excluded. Patient characteristics, including age, malignancy type, and chemotherapy regimen were recorded. Encounter characteristics included day of week of admission, time of admission, time chemotherapy plan initiated, and whether or not all necessary procedures (labs, vascular access, chemo orders) were completed prior to admission. Primary outcome was LOS. Secondary outcome was time to treatment initiation (TTI) after admission. Results There were 100 planned admissions for patients receiving four regimens: cytarabine consolidation, EPOCH, ICE, VDT-PACE, during the six month review period. Thirty-six admissions did not occur as planned (regimen changed, rescheduled, or disease progression). Of the remaining 66 admissions, 11 outliers were excluded from primary analysis. Baseline characteristics are summarized in Table 1. Univariate analysis with independent t-test found no difference in LOS for patients who had physician chemotherapy orders in place prior to admission. To the contrary, we detected a non-significant trend toward longer mean length of stay for patients that were not seen in clinic on day of admission (Table 2). On ANOVA, there was a statistically significant difference in LOS when comparing Monday admissions 3.93 days (95% CI 3.07 to 4.79) vs Friday 5.25 days (95% CI, 4.86 to 5.64), but not between any other days. There were no statistically significant differences in TTI when comparing by day of week, physician order status, or chemotherapy regimen. Again, a non-significant trend toward increased TTI was observed for patients not seen in clinic on the same day as admission. Conclusions This study serves as a starting point towards identifying modifiable factors that are essential to delivery of safe, satisfying inpatient care to our hematological malignancy patients.Our noteworthy finding regarding patients who were admitted on Friday having a longer LOS than those admitted on Monday requires further exploration. This study is ongoing with mature data to be presented at the meeting. Disclosures No relevant conflicts of interest to declare.

PURPOSE In a professional setting, the introduction of female speakers without their professional title may have an impact on the public’s perception of the female speaker. We examined how professional titles were used during speakers’ introductions at the ASCO Annual Meeting. METHODS We conducted a retrospective, observational study of video-archived speaker introductions at the 2017 and 2018 ASCO Annual Meetings. A “professional address” was defined as the professional title followed by the speaker’s full name or last name. Multivariable logistic regressions were used to identify factors associated with the form of address. RESULTS Of 2,511 videos reviewed, 781 met inclusion criteria. Female speakers were addressed less often by their professional title compared with male speakers (62% v 81%; P < .001). Males were less likely to use a professional address when introducing female speakers compared with females when introducing male speakers (53% v 80%; P < .01). When women performed speaker introductions, no gender differences in professional address were observed (75% v 82%; P = .13). Female speakers were more likely to be introduced by first name only (17% v 3%; P < .001). Male introducers were more likely to address female speakers by first name only compared with female introducers (24% v 7%; P < .01). In a multivariable regression including gender, degree, academic rank, and geographic location of the speaker’s institution, male speakers were more likely to receive a professional address compared with female speakers (odds ratio, 2.43; 95% CI, 1.71 to 3.47; P < .01). CONCLUSION When introduced by men, female speakers were less likely to receive a professional address and more likely to be introduced by first name only compared with their male peers.