Ng, Wern Lynn

e12707 Background: Anthracycline-based chemotherapy remains a cornerstone of breast cancer treatment but is limited by dose-dependent cardiotoxicity. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardioprotective effects across diverse populations. Preclinical models suggest they may mitigate anthracycline-induced cardiotoxicity. However, clinical data evaluating this association remain limited. Methods: We conducted a retrospective cohort study using the TriNetX real world data platform, including adults with breast cancer who received anthracycline within one year of diagnosis. Patients were stratified by SGLT2i use within one year of diagnosis into the SGLT2i group and the non-SGLT2i group. Propensity score matching (PSM) was performed to balance baseline demographics and comorbidities. Outcomes included 3-year all-cause mortality, heart failure, myocardial infarction, atrial fibrillation, mean left ventricular ejection fraction (LVEF), mean Troponin I, and mean brain natriuretic peptide level (BNP), analyzed using risk ratios (RR) and Kaplan-Meier survival analysis. Results: After PSM, 2912 patients were included in each group, with a mean follow-up of 630.3 days in SGLT2i group and 756.7 days in non-SGLT2i group. Mean age was 61.5 years vs 62.3 years (SGLT2i group vs non-SGLT2i group), with more than 98% of females in both groups. Most patients were White (49.0% in SGLT2i group and 48.6% in non-SGLT2i group), followed by African American (23.7% vs. 23.4%), unknown races (14.0% vs 14.0%), and Asian (9.5% vs. 9.8%). At baseline, the SGLT2i group had lower mean LVEF (53.4% vs 61.9%), higher mean Troponin I (0.992 vs 0.0849), and higher mean BNP levels (778 vs 240). SGLT2i group was associated with significantly lower 3-year all-cause mortality (Hazard ratio 0.52, 95% CI 0.44–0.61). Heart failure incidence (9.5% vs 6.0%; p = 0.0005) was significantly higher in the SGLT2i group. Mean LVEF in SGLT2i group was significantly lower (51.7% vs 58.9; p < 0.0001) and mean BNP level was significantly higher in SGLT2i group (685.5 vs 383.0; p = 0.0336). No significant differences were observed in myocardial infarction (3.9% vs 3.4%; p = 0.4459), atrial fibrillation (3.4% vs 4.5%; p = 0.0799), and mean troponin I (0.085 vs 0.113, p = 0.5191). Conclusions: In this real-world cohort, SGLT2i use was associated with lower 3-year all-cause mortality despite higher rates of heart failure. Notably, patients receiving SGLT2i had worse baseline cardiac function yet demonstrated more favorable trends in cardiac biomarkers, including smaller declines in LVEF, reductions in BNP, and lower mean troponin I levels, suggesting a slower progression of cardiac dysfunction. These findings support a potential cardioprotective and survival benefit of SGLT2i in patients with breast cancer receiving anthracycline therapy and warrant confirmation in future studies.

8598 Background: Immune checkpoint inhibitors (ICI) have become a cornerstone of treatment for lung cancer. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have been associated with improved outcomes in cancer patients in prior studies; however, their impact on outcomes among lung cancer patients receiving immunotherapy remains limited. Methods: We conducted a retrospective cohort study using the TriNetX real-world data platform. Adult patients with lung cancer treated with ICIs, including PD-1, PD-L1, or CTLA-4 inhibitors, were included. Patients were stratified based on exposure to GLP-1 RA. Propensity score matching (1:1) was performed to balance baseline demographics and comorbidities, including type 2 diabetes mellitus and body mass index. Primary outcomes included all-cause mortality, intensive care unit (ICU) admission, and hospitalization. Secondary outcomes included immune-related pneumonitis, colitis/enteritis, cachexia, and major adverse cardiovascular events (MACE). Results: After matching, 2,013 patients were included in each group, with a median follow-up of 372 days in the GLP-1 RA group and 383 days in the non-GLP-1 RA group. Mean age was 66.8 and 67.2 years, respectively, and approximately 50% of patients were male. Most patients were White (77.2% vs 71.8%), followed by Black (14.1% vs 14.0%) and Asian (2.1% vs 1.8%). GLP-1 RA use was associated with a significantly lower all-cause mortality rate compared with non-use (35.7% vs. 53.4%; p < 0.0001), with a hazard ratio of 0.65 (95% CI, 0.59–0.71). Significant reductions were also observed in ICU admissions (22.8% vs 29.0%; p = 0.0001), hospitalizations (64.1% vs 71.8%; p = 0.0001), pneumonitis (5.2% vs 6.8%; p = 0.0457), and MACE (19.9% vs 25.3%; p = 0.0026). No significant differences were observed in colitis/enteritis (9.3% vs 9.4%; p = 0.9704) or cachexia (8.0% vs 9.8%; p = 0.0650). In a subgroup analysis of lung cancer patients not receiving ICI, GLP-1 RA use was similarly associated with lower mortality, ICU admission, hospitalization, and MACE, without differences in immune-related toxicities. Conclusions: GLP-1 RA use among lung cancer patients was associated with improved survival, reduced healthcare utilization, and fewer selected adverse events in patients receiving ICI therapy. These associations likely reflect established metabolic and cardiovascular benefits of GLP-1 RA and may also involve antitumor mechanisms suggested in prior studies. Residual confounding related to healthcare access and socioeconomic factors cannot be fully excluded and should be considered when interpreting these findings. Prospective studies are warranted to validate these observations and clarify underlying biological mechanisms.

e15543 Background: In the last two decades, colorectal cancer (CRC) mortality has been decreasing in the United States (US). However, the mortality trends for the different subtypes of CRC, including different sides of colon, rectosigmoid, and rectal cancer remain unclear. Methods: We analyzed death certificate data from CDC WONDER from 1999 to 2020. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals of CRC and its different subtypes and examined the trends over time by estimating the average annual percent change (AAPC) using the Joinpoint Regression Program. Results: From 1999 to 2020, 1,166,099 deaths were attributed to CRC, of which 957,182 deaths (82.08%) were due to colon cancer, 148,862 deaths (12.77%) from rectal cancer, and 60,055 deaths (5.15%) from rectosigmoid cancer. The overall CRC rates decreased significantly from 26.42 (95% CI, 26.20-26.64) to 15.98 (95% CI, 15.84-16.12) per 100,000 individuals, with AAPC of -2.41 (95% CI, -2.55, -2.27). However, the AAMR of rectosigmoid cancer increased significantly from 0.82 (95% CI, 0.78 -0.86) to 1.08 (95% CI, 1.04-1.11) per 100,000 individuals and the AAMR of right-sided colon cancer increased from 0.57 (95% CI, 0.54-0.60) to 0.70 (95% CI, 0.67-0.73) per 100,000 individuals, with AAPC of +1.10 (95%, 0.21-2.00) and +2.06 (95% CI, 0.85 - 3.27) respectively. Men had higher AAMR of CRC than women (23.90 [95% CI, 23.84-23.96] vs. 17.03 [95% CI, 16.99-17.08] per 100,000 individuals). African Americans had the highest AAMR of CRC (26.93 [95% CI, 26.79-27.07]), followed by Whites (19.60 [95%, 19.56-19.64] per 100,000 individuals), American Indians (14.53 [95%, 14.15-14.92] per 100,000 individuals), and Asians (13.04 [95%, 12.89-13.19] per 100,000 individuals). The overall AAMR of CRC decreased for those aged ≥ 50 years but increased significantly from 1.02 to 1.58 per 100,000 individuals for those aged 15-49 years, with an AAPC of +0.75. The AAMR from CRC was the highest in the Midwest (21.04 [95% CI, 20.96-21.12] per 100,000 individuals), followed by the South (20.51 [95% CI, 20.44-20.57]), the Northeast (20.30 [95% CI, 20.22-20.38] per 100,000 individuals), and the West (18.03 [95% CI, 17.95-18.10] per 100,000 individuals). Rural populations had higher AAMR than urban populations (22.40 [95% CI, 22.30-22.49] vs. 19.60 [95%, 19.56-19.64] per 100,000 individuals). Conclusions: Although overall CRC mortality declined, there were rising trends in young-onset CRC, rectosigmoid cancer, and right-sided colon cancer. Disparities persist in terms of sex, race, geographic region, and urbanization level, emphasizing the need for targeted public health measures.

e23252 Background: The UPMC-Kline Health Center (KHC) in Harrisburg, PA, shows a lower cervical cancer screening rate compared to the general population in the USA (57.08% vs 78%, respectively, based on the Medical Group Fiscal Year 2023 Internal Quality Measures). To understand this gap, we distributed a comprehensive questionnaire to patients, aiming to pinpoint factors contributing to the lower screening rate and plan targeted interventions for improvement. Methods: We randomly distributed questionnaires to female patients aged 21 to 61 during appointment check-in at the KHC, considering our linguistically diverse patient population with surveys available in Spanish, English, and Nepali. Given the diverse linguistic landscape of our patient population, we prepared questionnaires in Spanish, English, and Nepali. The survey aims to identify and address specific clinic-related problems, with a follow-up assessment after a few months to gauge improvements following interventions targeting the underlying causes of screening gaps. Results: Over a three-month span, 65 questionnaires were completed. Among the participants, 38% (25 patients - 7 white/Caucasian, 11 black/African American, 1 Asian, 7 others; 12 Hispanic, 13 non-Hispanic) revealed that they had not undergone screening within the past three years. The analysis of this subgroup unveiled significant issues: 84% (21/25) did not receive paperwork to schedule the test, 88% (22/25) were not contacted to schedule the test, 76% (19/25) did not receive reminder notifications before appointments, and 72%(18/25) expressed concerns about the lack of insurance coverage for costs. Furthermore, 76% (19/25) indicated the requirement to pay a co-pay, and an equal percentage reported difficulties in obtaining the screening test. Additionally, 72%(18/25) mentioned that their healthcare providers did not discuss the screening's importance, while 76%(19/25) noted their providers did not explain the purpose of the test. Conclusions: These findings underscore critical gaps in communication, accessibility, and cost-related barriers to cervical cancer screening at KHC. This ongoing quality improvement project, scheduled for data recollection in a few months, encompasses proposed interventions such as automated reminders, technology integration for communication, and distributing flyers in clinic and waiting areas to foster open communication and address inadequate discussions about the importance of screening. The aim is to improve patient awareness, engagement, and ultimately prevent delayed cancer diagnoses. KHC is committed to enhancing the cervical cancer screening rate to minimize the likelihood of delayed cancer diagnoses.

e23244 Background: The UPMC-Kline Health Center (KHC) located in Harrisburg, PA, has a lower colon cancer screening rate compared to the general patient population in the USA (26.03% vs 78%, respectively, according to the Medical Group Fiscal Year 2023 Internal Quality Measures). To understand the reasons behind this disparity, a comprehensive questionnaire was conducted aiming to identify factors contributing to the lower colonoscopy screening rate and to implement targeted interventions to improve the situation. Methods: Surveys were distributed to eligible patients aged 45 to 75 at the clinic, considering linguistic diversity by preparing questionnaires in Spanish, English, and Nepali. Distribution, randomized and conducted by medical assistants, aims to identify and address specific clinic-related issues. Subsequent assessment, after a few months, will determine improvements resulting from interventions targeting the underlying causes of screening gaps. Results: Over a three-month period, a total of 77 questionnaires were completed and collected. We analyzed responses from 33 patients (42%, 14 females, and 19 males; 16 white/Caucasian, 14 black/African American, 2 Asian, 1 other; 8 Hispanic/Latino, 25 non-Hispanic/Latino) who had not undergone a colonoscopy in the past 10 years. Findings revealed that 72% (24/33) of patients reported not receiving paperwork for scheduling, while 72% (24/33) were not contacted to schedule the test. Additionally, 78% (26/33) of patients did not receive a reminder call or message before their scheduled appointments. 51% (17/33) of patients highlighted a lack of insurance coverage for costs, with 63% (21/33) indicating the need for a co-pay. 57% (19/33) of patients reported difficulties in obtaining the screening test. 51% (17/33) of patients mentioned that their healthcare provider discussed the importance of the screening test, and 54% (18/33) of patients noted that their providers explained the purpose of the test. Conclusions: The survey identifies scheduling, communication, and cost-related barriers to colon cancer screening at KHC. Proposed interventions, including the implementation of automated reminders, integrating technology to facilitate communication, and incorporating flyers within the clinic and patient waiting areas. This quality improvement project is ongoing, with data scheduled for recollection in a few months. These measures are anticipated to foster improvements, aiding more patients in preventing delayed cancer diagnoses. KHC aims to create a patient-friendly environment by addressing scheduling inefficiencies, improving communication, and tackling financial concerns for timely and accessible colon cancer screenings.

Abstract In the last two decades, colorectal cancer (CRC) mortality has been decreasing in the United States. However, the mortality trends for the different subtypes of CRC, including different sides of colon, rectosigmoid, and rectal cancer remain unclear. We analyzed the mortality trends of different subtypes of CRC based on Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research data from 1999 to 2020. We calculated age‐adjusted mortality rates (AAMR) per 100,000 individuals and examined the trends over time by estimating the average annual percent change (AAPC) using the Joinpoint Regression Program. Our study shows that the overall CRC rates decreased significantly from 26.42 to 15.98 per 100,000 individuals, with an AAPC of −2.41. However, the AAMR of rectosigmoid cancer increased significantly from 0.82 to 1.08 per 100,000 individuals, with the AAPC of +1.10. Men and Black individuals had the highest AAMRs respectively (23.90 vs. 26.93 per 100,000 individuals). The overall AAMR of CRC decreased for those aged ≥50 years but increased significantly from 1.02 to 1.58 per 100,000 individuals for those aged 15–49 years, with an AAPC of +0.75. Rural populations had a higher AAMR than the urban populations (22.40 vs. 19.60 per 100,000 individuals). Although overall CRC mortality declined, rising trends in young‐onset CRC and rectosigmoid cancer warrant attention. Disparities persist in terms of sex, race, and geographic region, and urbanization level, emphasizing the need for targeted public health measures.

Abstract Introduction: Chimeric antigen receptor T-cell (CAR-T) therapy is an established treatment modality for the management of refractory and/or relapsed non-Hodgkin lymphoma (NHL). Despite restrictions on granulocyte colony-stimulating factor (G-CSF) use in registration clinical trials due to potential worsening of cytokine release syndrome (CRS), G-CSF is often prescribed for neutrophil recovery post-CAR-T in clinical practice. We conducted a retrospective study to assess the association between G-CSF use and the safety and efficacy of CAR-T. Methods: Following Institutional Review Board approval, we retrospectively analyzed NHL patients receiving commercial CD19-targeted CAR-T across Mayo Clinic sites (Arizona, Florida, and Minnesota) between October 2017 and May 2023. Demographics, labs, and post CAR-T events were collected. Electronic medical records were reviewed for G-CSF exposure within Day 1 - 100 post-CAR T. Differences by G-CSF status were examined using a Chi-square test and Kruskal Wallis tests. Hazard ratios (HR) and 95% confidence intervals (CI) for overall survival (OS) were calculated using Cox model. Results: Among 270 CAR-T patients; 106 received G-CSF within 30 days and 164 did not. Median age was 56.9 with G-CSF and 58.3 without G-CSF. Most were male (75.2% G-CSF, 62.6% no G-CSF). Diffuse large B cell lymphoma was the predominant NHL subtype (67.0% G-CSF, 65.2% no G-CSF). G-CSF within 30 days was not associated with reduced incidence of neutropenic fever (11.7% G-CSF vs 9.9% no G-CSF, p = 0.6593) or documented infection (22.1% vs 18.3%, p = 0.4439). G-CSF correlated with decreased profound neutropenia duration (ANC &lt; 100 μL, 0 vs 2 days, p &lt; 0.0001) and incidence within 30 days ( 31.7% vs 60.4%, p &lt; 0.0001) as well as incidence of protracted profound neutropenia (&gt; 7 days, 3.8% vs 22.8%, p &lt; 0.0001). G-CSF was associated with a higher incidence of cytopenias between days 30 -100: severe neutropenia (ANC &lt; 500/uL, 28.8% vs 15.2%, p = 0.0075), severe anemia (Hb &lt; 8 g/dL, 21% vs 9.7%, p = 0.0114), and severe thrombocytopenia (Plt &lt; 50 g/L, 35.2% vs 20.9%, p = 0.0099). Logistic regression analysis showed that none of the examined covariates, including prior autologous stem cell transplant, ECOG PS score, and receipt of bridging therapy, were associated with severe neutropenia likelihood. G-CSF was associated with a higher CRS incidence (89.6% vs 79.9%, p = 0.0343), but grade 3 CRS or higher (4.7% vs 3.7%, p = 0.6675) was no different. No difference in complete response rates (66% vs 61.1%, p = 0.4707) or 2-year OS (p = 0.523) was observed between the 2 groups. Conclusion: G-CSF within 30 days was associated with reduced duration and incidence of profound neutropenia without a significant impact on incidence of neutropenic fever or documented infections. There was a signal of association between G-CSF and increased incidence of low-grade CRS and delayed cytopenias (day 30-100) that warrants confirmation in larger studies. Citation Format: Lay She Ng, Claire I. Yee, Radhika Bansal, Mohamed A. Kharfan-Dabaja, Grzegorz S. Nowakowski, Allison C. Rosenthal, Javier Munoz, Januario Castro, Wern Lynn Ng, Hemant S. Murthy, Yi Lin, Matthew R. Buras, Madiha Iqbal, Yucai Wang, Talal Hilal. Impact of G-CSF on safety and efficacy of CAR T-cell therapy in non-Hodgkin lymphoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6327.