Agarwal, Muskan

8019 Background: Neoadjuvant and perioperative chemo-immunotherapy studies report 15%-20% of pts initiating NACT-I do not undergo surgical resection. Methods: Real-world data of pts who initiated NACT-I was collected retrospectively for January 1 st 2022 till September 30 th 2024. Pts and treatment details, reason for not undergoing resection (as assessed by the clinicians) and later treatments and outcomes were recorded. Total number of pts who initiated NACT-I in this period was identified from each center's records. Missing data was not imputed. Results: Data was collected from 10 centers in 4 countries (USA, Israel, Switzerland, France). Out of 330 pts that started NACT-I 43 pts (13%; range 4-33% in different centers) did not undergo surgical resection. Of these 43 pts, 34.9% became unresectable due to disease progression (PD). 20.9% in retrospect were non-resectable and did not regress as expected. 11.6% in retrospect were non-operable. 11.6% suffered toxicity and became unfit for surgery. 7% of pts refused surgery, 14% were not resected for other reasons (Table). Of the non-resected pts, 9.3% died prior to any second-line treatment. As a second line, 44.2% of the non-resected pts were treated with chemo-radiation, 14% with radiation alone, 7% chemotherapy and immunotherapy, 4.7% immunotherapy alone and 2.3% chemotherapy alone. 7% received palliative radiation followed by chemo or immunotherapy, 7% had follow-up alone. Conclusions: The rate of no surgical resection in this real-world multi-national cohort was 13%, in line with the rate in reported studies. Most un-resected pts underwent appropriate staging. Most were male, with high rate of T3/T4. Survival rate at 12 months was 73.7%. The most common causes for no surgery were PD or being upfront unresectable. The patients with the worst outcome were those who experienced PD during NACT-I. N (% out of 43 non-resected) Male (%) Age (median) PET Done prior to any therapy (%) Brain MRI staging (%) Documented MDT decision of NACT-I (%) Documented surgeon evaluation prior to NACT-I decision (%) T3-4 (%) N2a/b (9th V TNM; %) Survival rate at 12 month (95% CI) 43 (100.0) 69.8 71 95.3 95.0* 96.6* 86.2* 69.8 40.5 73.7% (50.5-87.2%) PD 15 (34.9) 80.0 67 93.3 100.0* 100.0* 92.3* 80.0 40.0 68.2% (14.2-89.7%) In retrospect not resectable 9 (20.9) 55.6 69 100.0 100.0 100.0* 50.0* 77.8 33.3 76.2% (33.2-93.5%) In retrospect not operable 5 (11.6) 80.0 71 100.0 60.0 100.0* 33.3* 40.0 20.0 100.0% (100.0-100.0%) Toxicity 5 (11.6) 80.0 72 100.0 100.0 100.0* 100.0* 80.0 80.0 80.0% (20.4-96.9%) Patient refusal 3 (7.0) 0.0 72 100.0 100.0 100.0 100.0 66.7 33.3 100% (100.0-100.0%) Other ** 6 (14.0) 83.3 75 83.3 100.0* 75.0* 100.0 50.0 40.0* 50.0% (11.1-80.4%) Percentages relate to the total of each row, besides 1st column relating to total of 43. *% of available data. **Death (n=3), intra-operative decision (n=2), additional malignancy (n=1).

Although anti-thyroid drugs (ATDs) are the most common cause of drug-associated anti-neutrophil cytoplasmic antibody (ANCA) vasculitis (AAV), many other classes of drugs can lead to drug-associated AAV. We present a unique case of rivaroxaban-associated AAV. A 76-year-old female with a past medical history of atrial fibrillation on rivaroxaban presented with fatigue, bilateral lower extremity purpura, and hemoptysis to an outside hospital. Investigations revealed a positive cytoplasmic-ANCA (c-ANCA) titer of 1:320 and a positive anti-myeloperoxidase (anti-MPO), and negative perinuclear-ANCA (p-ANCA) and anti-proteinase 3 (anti-PR3). In addition, chest imaging demonstrated bilateral ground-glass opacities which raised suspicion for diffuse alveolar hemorrhage (DAH). A lung biopsy revealed acute and ongoing DAH with focally active capillaritis and characteristic pathological findings, which strongly suggested that was likely secondary to rivaroxaban. Rivaroxaban was discontinued, and the patient received pulses of intravenous glucocorticosteroids and rituximab. Her symptoms improved. She continued immunosuppressive therapy with rituximab for 2 years. She presented to our hospital for a second opinion regarding the discontinuation of rituximab, and we decided to discontinue rituximab. After discontinuation, the patient remained stable after 1.5 years of follow-up and did not have any relapses. This is a unique case of rivaroxaban-associated AAV. Clinicians should consider drug-associated AAV in all patients who present with an atypical clinical presentation and/or pathological findings of AAV. Given the broad and rapidly increasing use of novel anticoagulants, it is important to raise awareness of this potential complication. Prompt discontinuation of the drug and initiation of immunosuppressant treatment in severe cases may be lifesaving.

Abstract Background Immune checkpoint inhibitor combined with platinum‐etoposide is the standard first‐line therapy for patients with extensive‐stage small cell lung cancer (ES‐SCLC). The phase 3 clinical trials that led to the approval of chemoimmunotherapy in ES‐SCLC excluded patients who had an Eastern Cooperative Group (ECOG) performance status (PS) of 2–3. Therefore, data on the efficacy of chemoimmunotherapy in patients with an ECOG PS of 2–3 are limited. Methods A retrospective analysis was performed on patients diagnosed with ES‐SCLC who received chemoimmunotherapy (atezolizumab or durvalumab) within the Mayo Clinic Health System between January 2016 and January 2021. The objective of this study was to compare the overall survival (OS), progression‐free survival (PFS), and best clinical response to therapy in patients with an ECOG PS of 0–1 vs. patients with an ECOG PS of 2–3 who received chemoimmunotherapy for newly diagnosed ES‐SCLC. Results In total, 82 patients were included in the study. The mean ± standard deviation age was 68.1 ± 8.3 years. Of these, 56 patients were identified with an ECOG PS of 0–1, and 26 patients were identified with an ECOG PS of 2–3. The median PFS was similar regardless of ECOG PS (5.8 months [95% CI, 4.3–6.0 months] in the ECOG PS 0–1 group vs. 4.1 months [95% CI, 3.8–6.9 months] in the ECOG PS 2–3; p = .2994). The median OS was also similar regardless of ECOG PS (10.6 months [95% CI, 8.4–13.4 months] in the ECOG PS 0–1 group vs. 9.3 months [95% CI, 4.9–12.8 months]; p = .2718) in the ECOG PS 2‐3 group. Conclusions The study results demonstrated no significant difference in PFS or OS among the ECOG PS 2–3 and ECOG PS 0–1 groups. Therefore, chemoimmunotherapy should be considered for patients who have ES‐SCLC with an ECOG PS of 2–3.

Objectives Somatostatin receptor (SSTR) PET imaging is utilized with increasing frequency in the clinical management of neuroendocrine tumors. Incidental PET-avid CNS lesions are commonly noted and presumed to be meningiomas. However, SSTR PET lacks specificity for meningioma identification. This study aimed to clarify the role of SSTR-based imaging in the classification of incidental CNS lesions based on current clinical practice. Methods Patients who underwent both Ga-68-DOTATATE PET and brain MRI and had an incidental CNS lesion identified with a radiographic prediction of meningioma via one (discordant prediction) or both (concordant prediction) imaging modalities were retrospectively analyzed. Imaging indication, semiquantitative measures, and clinical history were recorded. Results Among 48 patients with a CNS lesion identified on both imaging modalities, most scans were performed for a history of neuroendocrine tumor (64.6%). Cases with concordant lesion-type prediction of meningioma between imaging modalities (N = 24) displayed a significantly higher SUV max (median 7.9 vs. 4.0; P = 0.008) and Krenning score (median 3.0 vs. 2.0; P = 0.005) on Ga-68-DOTATATE PET compared with cases with a discordant prediction of meningioma (N = 24). In cases with lower SUV max values, Ga-68-DOTATATE was more likely to discordantly predict meningioma without agreement by the corresponding MRI. Prior cranial radiation or use of somatostatin mimetics did not affect quantitative radiographic measures, and MRI-based tumor size was similar across groups. Conclusion Lesions with increased avidity may be more confidently predicted as meningioma in Ga-68-DOTATATE PET scans, whereas there is more discrepancy in prediction among low SUV cases.