Hallak, Mohammed Najeeb Al

e13730 Background: Financial toxicity, the burden of treatment cost, affects up to half of people with cancer and can affect survival. Financial toxicity is a health equity issue, disproportionately affecting Black patients. This cross-sectional study used baseline data from the Discussions of Cost (DISCO) Trial, an RCT to improve patient-provider treatment cost discussions and, in turn, mitigate financial toxicity, to examine whether Black and White patients differed in patient-provider communication perceptions and financial toxicity correlates. Methods: Data were collected from 2021-2025 at an NCI-designated comprehensive cancer center. Participants were Black or White patients diagnosed with solid tumor cancers. At baseline, patients completed demographic measures; communication measures of self-efficacy in patient-provider interactions (e.g., “I am confident I know what questions to ask a provider”); self-efficacy in managing cancer treatment costs (e.g., “I am confident I can understand treatment costs”); and whether they have a provider- or patient-centered approach (e.g., “the provider should decide what gets talked about”); and financial measures including economic burden (e.g., “it’s difficult to live on my income”); treatment cost distress (e.g., “worries about paying for my cancer treatment keep me up at night”); and anticipated material hardship (e.g., “I worry about the financial problems I will have in the future as a result of my treatment”). Comparisons were conducted by patient race. Results: A total of 202 patients participated (116 Black patients, 86 White patients). White patients were more likely to have advanced degrees, a higher annual income, and less likely to have Medicaid compared to Black patients. Black patients reported higher self-efficacy for managing treatment costs ( p = .002) and a higher provider-focused orientation to the patient-provider relationship ( p = .001), than White patients. Black patients reported greater levels of financial burden ( p < .001), cost distress ( p = .005), and anticipated material hardship ( p = .003). There was no difference in self-efficacy for interacting with providers. Conclusions: These results suggest that a communication intervention for patients may help mitigate the experience of financial toxicity, especially for Black patients. Clinical trial information: NCT04766190 . Patient characteristics. Black Patients White Patients p -value Race 116 86 Education < High School High School/GED Some College 2 or 4-year College Degree Graduate/Professional College Trade/Technical/Vocational School 10352626712 0141631187 < .001 Annual Household Income 0 - $19,999 $20,000 - 39,999 $40,000 - 59,999 $60,000 - 79,999 $80,000 - 99,999 $100,000 - 149,999 $150,000 + 53201611431 51215991716 <.001 Insurance Type* Medicaid Medicare Medicare supplement Private None 604911330 113726393 <.001>.99<.001.20.15 *Patients could select more than one

e13729 Background: Financial toxicity, the burden of treatment cost, affects up to half of people with cancer and can affect survival. Financial toxicity is a health equity issue, disproportionately affecting Black patients. Patient education about cost and patient-provider cost discussions are recommended to mitigate financial toxicity but occur infrequently. The Discussions of Cost (DISCO) App, designed to mitigate financial toxicity through a tailorable education and communication intervention, was assessed for efficacy in an RCT with Black and White patients. Here we describe the DISCO App's feasibility and acceptability. Methods: Data were collected from 2021 to 2025 at an NCI-designated comprehensive cancer center. Participants were Black or White patients diagnosed with solid tumor cancers. While waiting to see their provider, patients randomized to the intervention arm used the DISCO App on a tablet. The DISCO App includes a video about treatment costs, ways to manage costs, and the importance of discussing costs with providers. Once patients enter their socio-demographic information (e.g., employment) and financial concerns, they receive a tailored list of cost questions to ask their provider. Patients responded to measures immediately after using the DISCO App. Feasibility was assessed by patient reports of how much time they needed to use the DISCO App and if they were able to use the DISCO App before the provider entered the exam room. Acceptability was measured by items assessing patient perceptions of the DISCO App (1 = strongly disagree; 5 = strongly agree). Descriptive statistics summarized results and mean comparisons were used to assess perceptions by patient self-identified race. Results: Of the 202 patients recruited, 124 were randomized to the intervention arm (67 Black patients; 57 White patients). All patients completed using the DISCO App prior to their provider entering the exam room and 80% of patients needed 15 minutes or less to use the DISCO App, with no difference by patient race. Black patients ( M = 4.4) reported finding the DISCO App more helpful than White patients ( M = 3.9; p = .02) and it brought up cost issues they had not considered (Black patients = 3.5; White patients = 3.0; p = .05). Patients reported the questions were easy to understand ( M = 4.4), helped them feel it was okay to talk with their provider about cost ( M = 4.0), that it prompted cost questions ( M = 3.3), that they learned what costs to consider (55%), and learned ways to manage cost (62%) with no differences by patient race. Conclusions: The DISCO App was feasible and acceptable to Black and White patients with cancer, with Black patients reporting more favorable perceptions than White patients. Next steps include assessing effectiveness in improving outcomes including prompting patient-provider treatment cost discussions and related financial toxicity outcomes (e.g., treatment adherence). Clinical trial information: NCT04766190 .

Abstract Purpose: Pancreatic ductal adenocarcinoma (PDAC) remains a deadly disease urgently requiring new treatments. Overexpression of the protein transporter exportin-1 (XPO1) leads to mislocalization of tumor-suppressor proteins (TSP) and their inactivation. Earlier, we showed that blocking XPO1 by CRISPR/Cas9 validated Selective Inhibitor of Nuclear Export (SINE) compounds (selinexor and analogs) restores the antitumor activity of multiple TSPs leading to suppression of PDAC in vitro and in orthotopic models. Experimental Design: We evaluate the synergy between SINE compounds and standard-of-care treatments in preclinical models and in a PDAC Phase Ib trial. Results: SINE compounds synergize with gemcitabine (GEM) and nanoparticle albumin–bound (nab)-paclitaxel leading to suppression of PDAC cellular growth and cancer stem cell (CSC) spheroids disintegration. Label-free quantitative proteome profiling with nuclear and cytoplasmic enrichment showed superior enhancement in nuclear protein fraction in combination treatment. Selinexor inhibited the growth of PDAC CSC and two patient-derived (PDX) subcutaneous xenografts. Selinexor–GEM–nab-paclitaxel blocked PDX and orthotopic tumor growth. In a phase 1b study (NCT02178436), 9 patients were exposed to selinexor (60 mg oral) with GEM (1,000 mg/m2 i.v.) and nab-paclitaxel (125 mg/m2 i.v.) on days 1, 8, and 15 of 28-day cycle. Two patients showed partial response, and 2 had stable disease. An outstanding, durable objective response was observed in one of the responders with progression-free survival of 16 months and overall survival of 22 months. Conclusions: Our preclinical and ongoing clinical study lends support to the use of selinexor–GEM–nab-paclitaxel as an effective therapy for metastatic PDAC.

Abstract Abstract 3175 Background: Iron deficiency anemia (IDA) is an important entity in clinical practice. Distinguishing between IDA and other kinds of anemia is challenging in many situations. Various laboratory indices have been studied in relation to IDA including red cell distribution width (RDW), mean cell volume (MCV), transferrin saturation (TS), total iron binding capacity (TIBC), serum ferritin and erythrocyte protoporphyrin (EPP). Methods: We chose 8015 subjects in the National Health and Nutrition Examination Survey (NHANES) database between 2003–2008 who had the required hematologic values. After applying the Centers for Disease Control (CDC) definition for anemia, the number of anemic subjects became 627 (8%). After applying the IDA model as suggested by Cogswell et al using the log ratio of transferrin receptor to ferritin, 46.1% of the anemic subjects had IDA. Then we developed receiver operator (ROC) curves for MCV, RDW, erythrocyte protoporphyrin, TIBC, and percent transferrin saturation for those anemic subjects with and without iron deficiency. From these variables, the area under the curves (AUC), sensitivity, specificity, positive likelihood ratios (LR+), and negative likelihood ratios (LR-) along with their confidence intervals (CI) were calculated. Furthermore we investigated the performance of each available measure by sub-setting the subject group into variables. Data analysis was done using SAS (version 9.2), R version 9.2 with the ROCR library, and MedCalc (version 11.2; MedCalc Software, Mariakerke, Belgium). ROCR and MedCalc have slightly different but individually valuable approaches to ROC curve analysis. Confidence intervals for sensitivity, specificity, and the likelihood ratios were calculated. Results: For the 627 anemic subjects, median age was 26.1 year with 95% being females. Fifty four percent were African American (AA). The MCV showed an AUC of 0.666, sensitivity of 73.7, specificity of 58.8, LR(+) of 1.79, LR(−) of 0.45 with a criterion of <81.6. RDW showed an AUC of 0.803, sensitivity of 77.2, specificity of 69.2, LR(+) of 2.51, LR(−) of 0.33 with a criterion >13.9. For 535 subjects with anemia the EPP showed an AUC of 0.831, sensitivity of 66.4, specificity of 84.9, LR(+) of 4.41, LR(−) of 0.40 with a criterion >93. For 542 subjects with anemia the TIBC showed an AUC of 0.756, sensitivity of 80.3, specificity of 61.5, LR(+) of 2.09, LR(−) of 0.32 with a criterion >406. Finally for the same 542 subjects the TS showed an AUC of 0.869, sensitivity of 80.3, specificity of 78.8, LR(+) of 3.79, LR(−) of 0.25 with a criterion <10.4 [Figure 1]. Comparing the LR(+) and LR(−) between the indices in the setting of inflammation showed that the EPP is the least affected but all indicators are, to some extent, affected by inflammation. Comparing the LR(+) and LR(−) between the indices in the setting of pregnancy showed that TS is the strongest performer. Finally; comparing the LR(+) and LR(−) between the indices in the AA versus non-AA showed that AA ethnicity has a small impact on the LR(−) but reduces the clinical utility of the LR(+) somewhat. Conclusion: Alternative hematologic indices have diagnostic value in the diagnosis of IDA. Transferrin saturation (TS) is the most efficient alternative to ferritin in most circumstances. Erythrocyte proto-porphyrin (EPP) should be considered as an alternative tool in inflammatory conditions. Disclosures: No relevant conflicts of interest to declare.