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TPS5632 Background: Concurrent chemoradiation therapy (CCRT) is the standard of care for locally advanced cervical cancer (LACC); however, outcomes remain suboptimal in patients with high-risk disease. Recent studies suggest that integration of immunotherapy (IO) with definitive chemoradiation, or induction chemotherapy prior to CCRT improves outcomes. Whether treatment intensification with induction systemic therapy and IO prior to CCRT and IO further improves disease control remains unknown. Induction chemotherapy may reduce tumor burden, eradicate micrometastatic disease, and improve tumor immunogenicity prior to definitive CCRT. Preclinical and clinical data support synergy between systemic therapy or radiotherapy and immune checkpoint blockade, providing the rationale for evaluating an induction strategy incorporating chemotherapy and immunotherapy before standard CCRT with immunotherapy, followed by maintenance immunotherapy. Optional tumor tissue and blood samples will be collected for exploratory correlative analyses, including immune and molecular biomarkers associated with response, resistance, and patterns of failure. Methods: NRG-GY037 is a prospective, multi-institutional phase III randomized trial conducted through NRG Oncology. A total of 336 patients will be enrolled (168 per arm). Patients will be stratified by FIGO stage (III vs. IVA) and presence or absence of para-aortic lymph nodes (N2). The primary endpoint is progression free survival (PFS). The study has 90% power to detect PFS hazard ratio of 0.65 in the experimental arm. Treatment: Patients with previously untreated, high-risk LACC are randomized to receive either induction chemotherapy with pembrolizumab for 6 weeks followed by CCRT with pembrolizumab and pembrolizumab maintenance, or standard CCRT with pembrolizumab followed by pembrolizumab maintenance. Major Eligibility Criteria: Eligible patients have histologically confirmed cervical carcinoma (squamous, adenocarcinoma, or adenosquamous), TNM T3 and T4 disease, N0-2, ECOG performance status 0–1, and no prior definitive therapy for cervical cancer. Current Enrollment Status: The trial is actively accruing patients. No efficacy or safety data are available at the time of submission. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT07061977. Clinical trial information: NCT07061977 .

TPS1147 Background: Due to dramatic improvements in neoadjuvant and adjuvant HER2-directed therapy (tx), most patients (pts) with early HER2+ breast cancer are cured. As a result, over half of pts newly diagnosed with HER2+ metastatic breast cancer (MBC) now present with de novo stage IV disease. Anti-HER2 tx has also significantly extended survival for pts with HER2+ MBC, with a subgroup of exceptional responders alive many years (yrs) after diagnosis. However, the paradigm for HER2+ MBC remains non-curative, and pts receive tx indefinitely with significant toxicities and costs. The SAPPHO study is investigating whether an intensification approach of sequential, non-cross resistant anti-HER2 tx followed by tx discontinuation is associated with long-term disease control in pts with HER2+ MBC. Methods: SAPPHO is an open-label, phase II, single-arm trial testing a sequential regimen of non-cross resistant, HER2-targeted tx with curative intent in pts with de novo HER2+ MBC. Eligible pts must have biopsy-proven, de novo MBC with high HER2 expression (3+ by immunohistochemistry). Pts with brain metastases are eligible upon receipt of local tx. Treatment consists of an induction regimen (trastuzumab-pertuzumab-taxane [THP] x 4 cycles, followed by trastuzumab deruxtecan [TDXd] x 6 cycles, followed by trastuzumab emtansine [TDM1]-tucatinib x 4 cycles), followed by a maintenance regimen (HP-tucatinib for 1 yr). Given results from DESTINY-Breast09, the sequence of TDXd-P x 6 cycles followed by THP x 4 followed by TDM1-tucatinib x 4 can be chosen as alternative induction tx per investigator and patient choice. Pts who remain progression-free after completing maintenance will stop all anti-HER2 tx. Endocrine tx will be continued for pts with hormone receptor+/HER2+ tumors. Tumor specimens from breast and a metastatic site are collected at baseline and the end of induction. Serial plasma samples for ctDNA analysis are collected at baseline, during treatment, and during follow-up. The primary endpoint is the probability of being progression-free and off anti-HER2 tx 4 yrs from the start of induction. With a sample size of 72 pts, the study is designed to have 91% power to reject the null hypothesis that the probability of being off anti-HER2 tx and progression-free is less than 24%, with an alternative hypothesis of 40%. Key secondary endpoints are overall survival, overall response rate by modified RECIST 1.1 after induction, and safety. Correlative endpoints include the relationship between ctDNA dynamics and outcomes. Patient-reported outcomes will be analyzed, including quality of life, illness intrusiveness, financial toxicity, anxiety, distress about cancer progression, perception of benefit and risk of progression. SAPPHO began enrollment in Q3 2024, and the study is open at 4 US sites within the Translational Breast Cancer Research Consortium (NCT05721248). Clinical trial information: NCT05721248 .

e24122 Background: Using multiple channels and theory-based recruitment messaging are strategies to enroll diverse audiences in cancer clinical trials (CCTs) and reducing sociodemographic health disparities. 1-7 Customizing recruitment content to participants, such as including race-concordant images (i.e., images that match participants race/ethnicity) and translating information to a community-level (i.e., message framing) is linked to positive health-seeking behavior among minorities and their intention to enroll in clinical trials. 8,9 Drawing on Communication Accommodation Theory and social identity theories, this paper evaluated recruitment channels used to successfully enroll underrepresented participants in CCTs, and preferences for race-concordant images and message framing. Methods: Social media ads, flyers, and postcards were used to recruit rural, African American/Black, and Hispanic adults interested in cancer prevention and screening. Participants ( N = 430, M = 40 years old, SD = 14.47, range 18-85) were recruited to the study with unique links to track the stimuli they viewed, and demographics were collected. Participants viewed one of four images and one of two motivational recruitment message frames. Specifically, given our interest in recruiting rural, African American/Black, and Hispanic populations to CCTs, three images were selected to feature each population, and a fourth Inclusive image featuring all three. Additionally, the person-centered message frame conveyed participating in research is motivated by one’s own benefit, whereas the other-centered frame conveyed motivation for other people’s benefit. Results: In social media ads, across a three-week campaign there were 2,653 clicks on recruitment stimuli ads, resulting in a 6.17% response rate of recruited and enrolled. Across all recruitment channels, enrolled participants engaged with the Inclusive (n = 202) and Black/African American (n = 130) recruitment stimuli the most. In the case of framing, person- (n = 174) and other-centered (n = 199) had similar engagement. Investigating within-race preferences, a chi-square analyses revealed Black/African American participants preference for Inclusive (n = 172) and Black/African American (n = 109) visuals over Hispanic (n = 13) and Rural (n = 17), X 2 (30, N = 419) = 194.94, p < .001; as well as preference for other-centered (n = 180) vs person-centered (n = 129) framing, X 2 (30, N = 419) = 183.95, p < .001. Conclusions: Our findings indicate that Black/African American participants are more likely to interact with race-concordant or sociodemographic inclusive stimuli, and a preference for other-oriented framing. To reduce health disparities in CCT participation, recruitment must avoid monolithic approaches and instead segment outreach by sociolinguistic and social identity factors.

e13677 Background: The development of AI led to the emergence of tools such as AIS, which have been increasingly adopted in medicine. However, formal evaluation of barriers and clinical care gaps in HemOnc is limited, particularly regarding treatment plan complexities and toxicity documentation. Methods: Structured investigator-developed surveys about AIS availability, adoption, benefits, and challenges were developed on Qualtrics and approved by the IRB. HemOnc faculty physicians (FP), advanced practice providers (APP), and trainees (HOT) were surveyed between 11/14/25-1/16/26. Surveys were distributed in the USA via email, social media (on X), and ASCO myConnection. Descriptive statistics were used for analysis. Results: 132 participants responded to the survey: 55 FP (42%), 14 APP (11%), and 63 HOT (48%). 80% of them reported having AIS at their institutions, and 54% of those reported using these tools in their clinical practice. Among FP and APP, 72% practiced in academic settings, 14% in community, and 13% in hybrid centers. Among those not using AIS, identified barriers were issues with note formatting (56%), lack of training (25%), and concerns that the note content is incorrect or inadequate (25%). 60% are willing to use AIS if note formatting matched their preference, and 42% would try it if contents better reflected the patient encounter. Table 1 details the proportion of encounters using AIS, the portion of documentation it was used for, and the perceived challenges with these tools. Among AIS users, the average satisfaction score was 5.3 on a 7 point scale, corresponding to participants being somewhat satisfied. Participants agreed slightly that AIS had reduced their feeling of work-related burnout, with an average score of 3.6 on a 5 point scale. Overall, participants felt neutral about how well-suited AIS are for HemOnc, with an average score of 4.0 on a 7 point scale. Conclusions: Despite AIS being widely available, 46% of the surveyed HemOnc workforce do not use them in clinical practice. Those who do reported decreased time spent on documentation outside work hours and a slight reduction in the feeling of burnout. Formatting issues and record integration remain barriers, with substantial concerns about AIS not adequately describing HemOnc treatment plans. To bridge the last mile of integration into HemOnc, partnership between AIS developers and the clinical workforce is essential to meet clinical needs, while prioritizing patient safety and data privacy. FP + APP % HOT % Patient encounters where AIS is used 62 44 Used AIS for the subjective portion of note 68 96 Used AIS for the assessment/plan portions of note 40 25 AIS decreased the time on clinical documentation outside work hours 96 93 AIS note formatting needs improvement 68 57 Issues integrating AIS and outside records 46 71 AIS note contents about the plan are suboptimal 32 61

e13121 Background: Triple-negative breast cancer (TNBC) lacks reliable prognostic biomarkers beyond standard clinical staging, limiting individualized risk stratification and treatment planning. The neutrophil-to-lymphocyte ratio (NLR), a readily available marker of systemic inflammation, has been proposed as a prognostic indicator in TNBC; however, existing evidence remains inconsistent. We performed an updated systematic review and meta-analysis to evaluate the prognostic value of pretreatment NLR in the contemporary treatment era. Methods: PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov were systematically searched from database inception through January 1, 2026, for randomized and observational studies reporting associations between pretreatment NLR and survival outcomes in TNBC. Two reviewers independently screened studies and extracted data with discrepancies resolved by consensus. Outcomes included overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS). Hazard ratios (HRs) were pooled using random-effects models. Risk of bias was assessed using ROBINS-I tool. Prespecified subgroup and sensitivity analyses were performed based on NLR cut-off values, follow-up duration, geographic region, and risk of bias. Results: Twenty-three retrospective studies comprising 4,731 patients with TNBC were included. On multivariate analysis, elevated pretreatment NLR was independently associated with poorer OS (HR 2.21, 95% CI: 1.56–3.13) and DFS (HR 1.97, 95% CI: 1.65–2.37. Similar associations were observed on univariate analysis (OS: HR 1.70, 95% CI: 1.07–2.72; DFS: HR 1.84, 95% CI: 1.14–2.98). No statistically significant or consistent association was observed between NLR and PFS. Associations between high NLR and adverse OS and DFS remained robust across prespecified subgroup and sensitivity analyses, representing the largest contemporary synthesis of multivariable-adjusted outcomes in TNBC. Key pooled outcome associations are summarized in Table 1. Conclusions: Elevated pretreatment NLR is independently associated with worse OS and DFS in patients with TNBC, supporting its potential role as a low-cost tool for clinical risk stratification and treatment planning. Given its availability from routine blood tests, NLR may assist in identifying high-risk patients who could benefit from intensified surveillance or therapeutic strategies. Prospective validation in the modern chemo-immunotherapy era is warranted. Summary of pooled associations between pretreatment NLR and survival outcomes in TNBC. Outcome Studies (n) Interpretation Overall survival 14 Worse survival Disease-free survival 15 Worse survival Progression-free survival 3 Inconclusive

e12697 Background: Postpartum-associated breast cancer (PABC) has been defined clinically as breast cancer (BC) diagnosed within the first 5 years of the most recent birth. Though generally rare, incidence rates are increasing in conjunction with delayed childbearing and older maternal age at first birth. Currently, there are limited data regarding serial patient-reported outcomes in this patient population compared to non-PABC patients. Methods: Patients with PABC from the Mayo Clinic Breast Disease Registry who completed baseline, 2, and 4-year surveys were matched 1:1 to BC patients whose cancers occurred more than 5 years after their most recent birth (or in the setting of nulliparity) based on age, clinical stage, treatment received, and tumor subtype. Survey results from the Patient Health Questionnaire-2 (PHQ-2), Patient-Reported Outcomes Measurement Information System-10 (PROMIS-10), and Impact of Event Scale-Revised (IES-R) collected at approximately two and four years after diagnosis were compared between PABC and non-PABC patients. Univariable analyses used Wilcoxon rank sum tests, whereas multivariable analyses employed linear regression models adjusting for potential confounding effects. Results: A total of 222 individuals were included (111 with PABC). A higher proportion of individuals in the PABC cohort were married compared to the non-PABC cohort (80% vs. 42%, p < 0.001); otherwise, the groups were well-balanced across multiple categories, including age, gender, race/ethnicity, menopausal status, and germline mutation status. In univariable analyses, the Year 2 composite PHQ-2 score was significantly worse among individuals with non-PABC (p = 0.04), and the non-PABC cohort reported greater difficulty with sleep (p = 0.03) as measured by IES-R at Year 4. Both associations attenuated in a multivariable analysis controlling for marital status. In marital status-adjusted analyses of Year 4 survey results, PABC participants reported greater difficulty in carrying out social activities but were less likely to report emotional distress as evaluated by PROMIS-10 (compared with non-PABC participants). No other variables were significant univariably or multivariably (p > 0.05). Conclusions: In general, quality of life is similar among survivors of PABC compared to those diagnosed with breast cancer outside the postpartum period (or when nulliparous). However, our findings reveal that individuals with PABC are less likely to experience emotional distress 2 and 4 years after the BC diagnosis, which is unexpected, given that postpartum patients typically report higher levels of distress compared to their non-postpartum counterparts. Further investigation into these findings is warranted.

e12691 Background: Breast cancer prognosis is influenced not only by tumor-specific factors but also by systemic inflammatory responses. Elevated circulating neutrophils after surgery may reflect one such systemic inflammatory response that promotes a pro-tumorigenic environment. Neutrophil extracellular traps (NETs) have been recognized as promoters of cancer activity. However, there have been no studies looking at neutrophil count alone as an independent inflammatory marker in cancer. Clinical prognostic significance of post-operative neutrophil counts remains incompletely understood. If proven significant, neutrophil count is a simple, widely available measure to predict post-operative outcomes in patients with breast cancer. Methods: Data from the Mayo Clinic Platform were retrospectively analyzed, including only breast cancer patients with normal BMI and neutrophil counts recorded within one week after breast surgery. Patients who underwent radical mastectomy were excluded. Patients were stratified into two groups based on neutrophil count: high (>7×10⁹/L) and normal (1.7–7×10⁹/L). Clinical outcomes assessed included age distribution and 5-year overall survival. Age differences were evaluated using Cohen’s D, and Kaplan-Meier survival curves and hazard ratio estimation were performed using the Mayo Clinic Platform's tool. Results: A total of 899 patients were included in the study cohort: 303 in the high neutrophil group (Cohort A) and 596 in the normal neutrophil group (Cohort B). Age distributions were comparable between groups (Cohort A mean 59.2 ± 13.1 years; Cohort B mean 59.1 ± 14.3 years; Cohen's d = 0.0079). High neutrophil counts were significantly associated with reduced 5-year survival (77.8% vs. 84.5%) and an increased risk of mortality (HR 1.63; 95% CI: 1.16–2.29; P = 0.0041). Conclusions: Recent literature supports that surgery-induced NET formation may drive metastatic progression. Findings from this retrospective analysis at Mayo Clinic suggest that elevated neutrophil counts after breast cancer surgery are associated with poorer survival and may reflect systemic inflammation. While markers like NLR and NPAR have prognostic value, neutrophil count alone is a practical, accessible biomarker for clinical use. Limitations of this study include potential confounding factors such as lifestyle and comorbidities, and lack of subgroup analysis by breast cancer type, stage, and other treatments in addition to surgery. Further prospective studies are still needed for validation. Five-year survival rate comparison. Statistic High Neutrophil counts Normal Neutrophil counts Patient Count 303 596 1 Month Survival 99% 99.8% 5 Month Survival 97% 99.3% 10 Month Survival 94.4% 97.3% 30 Month Survival 85.4% 91.9% 60 Month Survival 77.8% 84.5% Hazard Ratio* 1.63 (95% CI: 1.16–2.29) P = 0.0041.

Abstract Objectives Carbapenem resistance is a growing public health crisis with regional variability in incidence. We characterized the susceptibility of carbapenem-resistant Gram-negative rods (CR-GNRs) from the Pacific Northwest to five reserve beta-lactam agents including cefiderocol and aztreonam-avibactam. Methods A panel of 162 CR-GNRs from unique patients were tested against cefiderocol, aztreonam-avibactam, ceftazidime-avibactam, meropenem-vaborbactam and ceftolozane-tazobactam, with a subset of isolates derived from patients with bacteraemia (n = 55). Whole-genome sequencing (WGS) was performed on representative Stenotrophomonas maltophilia isolates displaying a range of cefiderocol MICs (n = 9). Results Among all isolates, the MIC50 and MIC90 to cefiderocol was 0.25 and 4 mg/L, respectively, compared with 4 and &gt;64 mg/L for aztreonam-avibactam. Overall, 98.3% of S. maltophilia (n = 60), 91.2% of Enterobacterales (n = 34) and 88.5% of Pseudomonas aeruginosa (n = 26) isolates were susceptible to cefiderocol, while 78.6% of other non-fermenters had MICs ≤4 mg/L. Aztreonam-avibactam and cefiderocol exhibited similar activity against Enterobacterales and S. maltophilia, but aztreonam-avibactam was less active against other organisms. WGS of S. maltophilia isolates with elevated cefiderocol MICs identified disruptive mutations in PBP-encoding genes (mrcB/PBP1b and pbpC/PBP1c) that were not observed in highly susceptible isolates. The bacteraemia cohort had many comorbidities and a 29% 30 day all-cause mortality. In this cohort, cefiderocol demonstrated the highest in vitro activity as extrapolated from MICs, followed by ceftazidime-avibactam, aztreonam-avibactam, meropenem-vaborbactam and ceftolozane-tazobactam, respectively. Conclusions Cefiderocol exhibited the greatest in vitro activity against various CR-GNRs species in a Pacific Northwest population enriched for severely ill patients. Susceptibility to other agents was more variable among tested organisms.

Abstract Context Limited data are available on quality of life (QoL) and adrenal crises in patients with immune checkpoint inhibitor–induced secondary adrenal insufficiency (ICI-SAI). Objective To (1) characterize the presentation, management, and outcomes of patients with ICI-SAI; (2) compare outcomes of ICI-SAI with other etiologies of secondary adrenal insufficiency (oSAI); and (3) identify variables associated with QoL and adrenal crisis. Methods In this single-center cross-sectional study, adults with ICI-SAI or oSAI (2018-2025) completed questionnaires assessing symptoms, management, adrenal crises, and the Addison’s Disease–Specific QoL survey (AddiQoL); outcomes included AddiQoL score and adrenal crisis events. Results Patients with ICI-SAI (n = 109) were older (median age 66 vs 60 years), more often women (59% vs 43%), and more frequently diagnosed within 1 year of symptom onset (88% vs 42%, P &lt; .001), compared to patients with oSAI (n = 139). Patients with ICI-SAI had higher AddiQoL scores (median 87 vs 85, P = .020). In a multivariable analysis of age, sex, glucocorticoid dose and type, insurance support, and duration of SAI, ICI-SAI remained independently associated with higher AddiQoL (estimate 5.4, P = .010). The prevalence of reported adrenal crises within the prior year was similar between groups (15% vs 14%, P = .782). In a multivariable analysis, higher AddiQoL scores were independently associated with lower odds of adrenal crisis (OR 0.57; 95% CI 0.42-0.76). Conclusion Patients with ICI-SAI report better QoL compared with patients with other causes of SAI, despite similar adrenal crisis rates. These differences may be related to earlier diagnosis and differing clinical contexts, underscoring the importance of timeline recognition and patient-centered management.

7532 Background: BsAbs are highly effective, off-the-shelf T-cell engagers recently approved for relapsed/refractory multiple myeloma (MM) but remain underutilized in real-world settings. In partnership with the Florida Society of Clinical Oncology (FLASCO), a statewide initiative was launched to expand BsAb access through peer-led regional discussions focused on operational barriers, care transitions, and therapy management strategies. This study assessed the real-world impact of these interventions on BsAb utilization in FL. Methods: Multidisciplinary discussion forums were held in 4 FL metropolitan areas (Jan-Apr 2024). We conducted single and controlled interrupted time series (ITS) analyses using IQVIA eLAAD claims data (Apr 2023 - Sep 2025) including adult patients with a diagnosis of MM, evidence of claim activity, and provider state information. Fifth line or later (5L+) status was estimated as 3.3% of MM prevalence (Nikolaou et al.) BsAb utilization (% of MM 5L+ patients receiving a BsAb) was evaluated using segmented regression to estimate pre- and post-intervention trends, excluding the intervention period. We reported BsAb utilization by comparing FL with all other states, between community versus academic settings, and assessing the number of sites administering BsAb. Results: Before the intervention, BsAb utilization among MM 5L+ patients in FL rose from 8.2% (Apr 2023) to 11.2% (Dec 2023) (0.3 pp/mo; p=0.23), compared with a rise from 6.7% to 16.3% (1.3 pp/mo; p<0.0001) across all other states over the same time period. Post-intervention, BsAb utilization in FL increased from 22.8% (May 2024) to 35.9% (Sep 2025), reflecting a 7.0% immediate increase and 0.8 pp/mo sustained growth, exceeding the post-intervention trend observed across all other states (23.5% to 30.3%; 0.5 pp/mo). Overall, although pre-intervention BsAb utilization in FL was lower than all other states, FL demonstrated a 1.2 pp/month higher post-intervention utilization trend (p<0.001; Table). Post-intervention, FL community sites showed a 0.13 pp/mo higher BsAb utilization trend than academic sites, and the number of community sites administrating BsAb increased from 5 to 9, with no change among academic sites. Conclusions: This study suggests that the FLASCO-led, collaborative model increased BsAb utilization in FL community oncology sites and offers a framework for broader community adoption across other states. Parameter estimates from ITS model(s). FL (%) p-value Other US States (%) p-value Difference CITS:FL - Other US States (%) p-value Intercept (Apr 2023) 8.6 <.0001 7.7 <.0001 0.9 0.52 Monthly change pre-intervention 0.3 0.23 1.3 <.0001 -0.9 0.002 (Apr - Dec 2023) Immediate change post-intervention 7 0.01 0.2 0.87 6.8 0.01 (May 2024) Monthly change post-intervention 0.8 <.0001 0.5 <.0001 1.2 0.0003 (May 2024 – Sep 2025)