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e24196 Background: Radiation-induced edema and necrosis are common, dose-limiting toxicities. Corticosteroids remain first-line therapy but are associated with significant morbidity and limited long-term tolerability. Dietary and herbal agents with antioxidant, anti-inflammatory, and neurovascular protective properties are suggested as adjunct or steroid-sparing agents, yet systematic analysis of their overall efficacy is unclear. Methods: A systematic search of PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov was conducted from inception through December 2025. Eligible studies included randomized trials and observational studies evaluating non-traditional dietary or herbal interventions for radiation-induced cerebral edema or injury. The primary outcome was radiographic improvement of cerebral edema on MRI, harmonized as any MRI-documented reduction or resolution of edema or necrosis. A random-effects comparative meta-analysis was performed for controlled studies with extractable binary outcomes, excluding case reports. A secondary random-effects, single-arm meta-analysis of proportions was conducted for Boswellia serrata , including observational cohorts and case series. Studies without MRI-based cerebral toxicity endpoints were synthesized qualitatively. Results: Eleven studies encompassing more than 400 patients met the inclusion criteria. Boswellia serrata was the most frequently evaluated intervention, followed by dl-3-n-butylphthalide, vitamin E, omega-3 fatty acids, melatonin, multi-herbal formulations, and integrative multi-compound regimens. In a comparative meta-analysis of two controlled studies, dietary and herbal interventions were associated with a significantly higher likelihood of radiographic improvement in cerebral edema compared with standard therapy or placebo (pooled risk ratio 1.60, 95% CI 1.12–2.30; I² = 0%). In a secondary, single-arm, meta-analysis of five Boswellia serrata studies, the pooled radiographic response rate was 56.2% (95% CI 45.0%–67.1%). Across other studies, neurologic and cognitive improvement and steroid-sparing effects were commonly reported, while serious treatment-related adverse events were uncommon. Integrative oncology approaches combining Boswellia serrata with other natural compounds were also associated with improved survival and reduced steroid dependence in longitudinal observational studies. Conclusions: Dietary and herbal interventions, particularly Boswellia serrata , are associated with meaningful radiographic and clinical improvement in radiation-induced cerebral edema and brain injury, with favorable safety profiles. These findings support further prospective randomized trials and suggest a potential adjunctive role for non-pharmacologic therapies in managing radiation-related neurotoxicity.

e24182 Background: Cancer therapy-related cardiac dysfunction (CTRCD) is a clinically significant complication of anticancer treatments, including anthracyclines and trastuzumab, often necessitating dose reduction or discontinuation of potentially life-saving therapy. While angiotensin receptor-neprilysin inhibitors (ARNI) have demonstrated mortality and hospitalization benefits in heart failure with reduced ejection fraction, their efficacy in preventing chemotherapy-induced cardiotoxicity remains controversial due to conflicting results and a lack of large-scale data. Therefore, we performed a meta-analysis to evaluate the efficacy of ARNI for the prevention of cardiotoxicity in patients receiving chemotherapy. Methods: We searched PubMed, Embase, and Cochrane Central from intercept till 17 December 2025 for studies evaluating the benefit of ARNI in preventing CTRCD among patients undergoing cardiotoxic cancer therapy. The primary outcomes assessed were changes in left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), N-terminal pro-brain natriuretic peptide (NT-proBNP), and troponin T. Statistical analysis was performed using Review Manager, and heterogeneity was assessed using the I2 statistic. The study protocol was registered with PROSPERO (CRD420251266270). Results: A total of 442 patients from four RCTs were included, with follow-up periods ranging from 6 to 18 months. The analysis of changes in LVEF showed a trend toward improvement (mean difference 1.18; 95% CI -0.04 to 2.40; p = 0.06), though this did not reach statistical significance. There were no statistically significant differences observed in changes in GLS (mean difference -0.94; 95% CI -2.43 to 0.55; p = 0.14), NT-proBNP (mean difference -0.94; 95% CI -9.57 to 7.70; p = 0.69), or troponin T (mean difference 0.06; 95% CI -1.13 to 1.26; p = 0.92). Conclusions: In conclusion, prophylactic treatment with ARNI in patients undergoing cardiotoxic cancer therapy did not result in statistically significant changes in LVEF, GLS, or cardiac biomarkers (NT-proBNP and troponin T), although a non-significant trend toward preserved LVEF was observed. The lack of statistical significance may be attributable to limited statistical power due to small sample sizes and heterogeneity across cancer therapies. Given the observed trend in LVEF preservation, further adequately powered, large-scale RCTs focusing on specific chemotherapy regimens are needed.

e24165 Background: Taxanes are associated with a higher incidence of immediate hypersensitivity reactions (HSRs) compared to other classes of chemotherapeutic agents, even with adequate premedication. This study evaluates whether a titrated infusion protocol reduces the rate of first-dose HSRs to taxanes. Methods: This was a retrospective cohort study conducted at a single site hematology/oncology infusion center. The fixed-rate arm consisted of patients from January 2022 to July 2023 who received a fixed infusion rate for their first dose. The titration arm comprised patients from August 2023 to July 2024 who underwent a three-step titration protocol for their first dose. The primary endpoint was the rate of immediate HSRs during the first lifetime dose of docetaxel or paclitaxel. Secondary endpoints included HSR severity, HSRs during the first or second dose, and rate of treatment discontinuation due to HSRs. Results: Of 479 patients included (240 fixed-rate; 239 titration), HSRs occurred in 7.1% of the fixed-rate group and 11.3% of the titration group (OR 1.67, 95% CI 0.89-3.15; p= 0.1104). There were no differences in the severity of HSRs or in the rate of treatment discontinuation among both groups. Conclusions: The use of a titrated infusion protocol for first lifetime dose taxanes did not significantly reduce the incidence or severity of immediate HSRs. These findings suggest that a titration protocol may not confer additional benefits over fixed-rate in this setting. Primary and secondary endpoints. Fixed (N=240) Titration (N=239) OR 95% CI p-value Primary Endpoint Rates of immediate HSR 17 (7.1%) 27 (11.3%) 1.67 0.89- 3.15 0.110 Secondary Endpoints Severity of immediate HSR N=17 N=27 Grade 1 10 (58.8%) 8 (30.8%) 0.637 Grade 2 6 (35.3%) 12 (46.2%) 0.157 Grade 3 1 (5.9%) 6 (23.1%) 0.059 Rates of immediate HSR with first or second dose combined N=471 infusions N=453 infusions 26 (5.5%) 37 (8.2%) 1.52 0.91-2.56 0.111 Taxane administration time (min) N=239 N=232 1-hour infusion 71.8 92.8 3-hour infusion 187.6 201.6 Rates of medication discontinuation due to immediate HSR N=26 N=37 1 (3.8%) 8 (21.6%) 6.90 0.81-59.17 0.069

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.

e24089 Background: Pancreatic cancer is associated with high symptom burden and frequent acute care utilization. Although early palliative care improves quality of life in advanced malignancies, real-world data describing its timing and downstream impact in pancreatic cancer remain limited. Methods: We conducted a retrospective cohort study using Epic Cosmos (2015–2025). Adults (≥18 years) with pancreatic cancer were identified using ICD-10 code C25.*. Early palliative care was defined as a documented palliative care encounter (ICD-10 Z51.5) within 0–2 months of cancer diagnosis. Patients were categorized as early palliative care versus not-early palliative care (late or no palliative care). A landmark approach was applied, with outcomes assessed beginning 2 months after diagnosis to mitigate immortal time bias. Outcomes included opioid use, antiemetic use, occupational/physical therapy (OT/PT) utilization, emergency department (ED) encounters resulting in inpatient admission, and inpatient length of stay. Results: Among 4,641 patients with pancreatic cancer, 464 (10.0%) received early palliative care, 365 (7.9%) received palliative care later, and 3,812 (82.1%) had no documented palliative care encounter. Compared with patients without early palliative care, early palliative care recipients demonstrated higher utilization of symptom-directed interventions, including opioids (40.6% vs 22.5%), antiemetics (37.2% vs 20.3%), and occupational/physical therapy services (6.2% vs 3.2%). Early palliative care was associated with a higher proportion of emergency department encounters resulting in inpatient admission (52.5% vs 23.6%), consistent with earlier consolidation of symptom-driven care. Mean inpatient length of stay was similar between groups (6.0 vs 6.2 days). Overall survival appeared comparable between groups; however, survival estimates in EHR-based analyses are limited by residual confounding and timing constraints. Conclusions: In a large national EHR cohort, early palliative care within two months of pancreatic cancer diagnosis was infrequently used but was associated with greater engagement in symptom-directed medications and supportive services, as well as a distinct downstream pattern of acute care utilization. These findings suggest that earlier integration of palliative care may improve coordination of symptom-focused care and represent an actionable quality-of-care target in pancreatic cancer.

e24088 Background: Chemotherapy-induced nausea and vomiting (CINV) significantly affects treatment tolerance and quality of life. ASCO guidelines recommend a NK-1 receptor antagonist with a 5-HT3 receptor antagonist and corticosteroid for patients receiving highly emetogenic chemotherapy (HEC). Olanzapine has emerged as an alternative antiemetic, with evidence suggesting noninferiority in triple regimens. Given its favorable cost profile, we performed a pooled analysis comparing olanzapine- versus aprepitant-based triple antiemetic regimens for CINV prevention. Methods: This PRISMA-compliant review was prospectively registered in PROSPERO (CRD420261284983). Five databases were systematically searched to identify studies comparing olanzapine (OLZ) versus aprepitant (APR) based triple antiemetic regimens. The primary endpoint was complete response (CR) for prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in adult patients receiving HEC. Statistical analyses were performed in R (version 2025.05.0+496; Posit). Results: 13 studies were included in the final synthesis, comprising 1,557 patients (OLZ: n = 779; APR: n = 788). CR was comparable between groups (RR 1.02, 95% CI 0.95–1.09; I² = 55.8%). Exclusion of Mehta et al. (2017) reduced heterogeneity to zero (I² = 0%). In the acute phase ( < 24 h), CR was also similar between OLZ and APR (RR 1.09, 95% CI 0.98–1.20; I² = 82.7%); however, OLZ demonstrated superior CR in the 10-mg dose subgroup (RR 1.08, 95% CI 1.03–1.14; I² = 74%). For delayed-phase CR (24-120 h), the pooled effect estimate was RR 1.11 (95% CI 0.98–1.27; I² = 84.3%). Control of nausea was significantly improved in the OLZ group compared with APR (RR 1.19, 95% CI 1.01–1.40; I² = 72.8%), particularly in anthracycline–cyclophosphamide–based regimens (RR 1.30, 95% CI 1.09–1.54; I² = 62.9%) and the 10-mg OLZ dose subgroup (RR 1.22, 95% CI 1.01–1.49; I² = 75.2%). Nausea control was also superior in both the acute phase (RR 1.13, 95% CI 1.01–1.27; I² = 76.5%) and the delayed phase (RR 1.31, 95% CI 1.05–1.65; I² = 93.3%). Control of vomiting was comparable between OLZ and APR (RR 0.99, 95% CI 0.92–1.07; I² = 0%), with no significant differences observed in the acute ( < 24 h) phase (RR 1.03, 95% CI 0.97–1.10; I² = 49%) or the delayed (24–120 h) phase (RR 1.00, 95% CI 0.97–1.04; I² = 0%). Conclusions: OLZ-based triple antiemetic regimens provide comparable CR and vomiting control to APR, with superior nausea control, particularly in anthracycline–cyclophosphamide regimens and at the 10-mg dose.

e24087 Background: Radiotherapy-induced nausea and vomiting (RINV) negatively impacts adherence and quality of life. Multiple antiemetic strategies exist, but comparative effectiveness and ranking across regimens remain unclear, particularly regarding olanzapine-containing combinations. Methods: We conducted a systematic review and network meta-analysis of randomized and comparative studies evaluating antiemetic prophylaxis for RINV. Databases included MEDLINE, Embase, CENTRAL, and clinical trial registries. Interventions were categorized into clinically interpretable nodes (e.g., 5-HT3 antagonist ± dexamethasone, NK1-based combinations, olanzapine-containing regimens). The primary outcome was complete response (no emesis, no rescue therapy) during acute and delayed phases. Secondary outcomes included no nausea, severity, sedation, and discontinuation. Random-effects network meta-analysis was performed with treatment ranking using SUCRA probabilities. Results: Twenty-two studies encompassing 3,145 patients were included. Olanzapine-containing regimens ranked highest for complete response during both acute (SUCRA 92%) and delayed phases (SUCRA 89%), outperforming standard 5-HT3 + dexamethasone (SUCRA 64%). NK1-based triple therapy showed intermediate efficacy (SUCRA 78%). Olanzapine regimens had modest increases in sedation (RR 1.14, 95% CI 1.01–1.29) but no significant differences in discontinuation rates. Subgroup analyses indicated consistent benefits across radiation sites, fractionation schedules, and emetogenic risk. Conclusions: Olanzapine-based antiemetic regimens provide superior prevention of RINV compared with standard therapies, with acceptable tolerability across radiotherapy settings. Clinical Takeaway: Incorporating olanzapine into prophylactic antiemetic strategies can optimize symptom control, improve patient adherence, and enhance quality of life during radiotherapy.

e24014 Background: Cardio-oncology traditionally focuses on cardiotoxicity prevention and acute cardiovascular-events. However, the functional, vocational, and mental health challenges that define daily survivorship remain largely hidden, representing a critical gap in holistic care. Methods: Utilizing the 2024 National Health Interview Survey (NHIS), we analyzed a nationally representative cohort of U.S. adults (≥18 years) across four groups: (1) Controls (no cancer or CVD), (2) CVD only, (3) cancer only, and (4) cardio-oncology. We evaluated five patient-centered metrics reflecting quality of life: functional and work limitations, assistive equipment use, personal assistance needs, and overall disability. Multivariable regression models, using Taylor series linearization for complex survey weighting, were adjusted for age, sex, race, hypertension, diabetes, hyperlipidemia, smoking, psychological distress (K6 score), and insurance status. Results: Among 32,599 adults (Weighted N = 259.7M), 2.9% lived with cardio-oncology multi-morbidity (weighted N = 5.34M; mean age 73y). After multivariable adjustment, functional limitations were highest in the cardio-oncology (63.6%, OR 2.34 [95%CI 1.89-2.88]), exceeding both CVD only (OR 1.99) and cancer only (OR = 1.26) groups. This population was also at the highest risk of disability (OR 2.74) and work limitations (31.7%, OR = 2.53). One in five cardio-oncology survivors reported severe mobility impairment (difficulty walking/steps), with a need for assistive equipment (OR = 2.86) and personal assistance (OR = 1.38). Conclusions: Cardio-oncology survivors face a functional and vocational burden significantly exceeding that of cancer or CVD alone. Care models must expand beyond event prevention to integrate routine functional screening and early rehabilitation to preserve quality of life in this high-risk population. Adjusted odds ratios by disease phenotype. Outcome CVD Only (vs. Control) Cancer Only (vs. Control) Cardio-Oncology (vs. Control) OR (95% CI) OR (95% CI) OR (95% CI) Functional limitation 1.99 (1.75–2.28) 1.26 (1.14–1.39) 2.34 (1.89–2.88) Uses special equipment 2.56 (2.20–2.98) 1.26 (1.08–1.46) 2.86 (2.32–3.53) Needs assistance 1.51 (1.17-1.94) 0.84 (0.64-1.12) 1.38 (0.99-1.92) Work limitation 2.12 (1.88-2.39) 1.19 (1.07-1.33) 2.53 (2.11-3.03) Disability 2.20 (1.90–2.56) 1.11 (0.96–1.29) 2.74 (2.26–3.32) Note: Models adjusted for age, sex, race, hypertension, diabetes, hyperlipidemia, smoking status, psychological distress, and insurance type. Reference group = Adults with no history of cancer or CVD. CVD = Cardiovascular disease; OR = Odds Ratio; CI = Confidence Interval.

e23554 Background: Radiographic imaging remains the standard of care for disease surveillance and response assessment in soft tissue sarcoma (STS). Circulating tumor DNA (ctDNA) has emerged as a potential biomarker in solid tumors; however, its feasibility and detectability in STS remain incompletely defined due to histologic heterogeneity and variable tumor DNA shedding. We evaluated ctDNA detectability and its relationship to radiographic disease status in the most common STS subtypes: undifferentiated pleomorphic sarcoma (UPS) and leiomyosarcoma (LMS). Methods: We retrospectively analyzed patients with UPS or LMS who underwent serial ctDNA testing using a personalized assay (Signatera) alongside routine radiographic surveillance between 2022 and 2025. Any detectable mean tumor molecules (MTM) >0 was considered positive. ctDNA results were paired with the closest imaging within ±30 days and assessed using radiology report–based determinations of disease status. Exploratory sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were estimated per paired assessment using radiographic progression or recurrence as the reference standard. Results: 13 patients were included (7 female, 6 male), with a median age of 62 years (range 28–75); 7 patients (54%) had LMS and 6 (46%) had UPS. A total of 59 ctDNA–imaging paired assessments were analyzed (median 4 per patient). Overall ctDNA detectability was low and histology-dependent. Baseline ctDNA was detectable in 2 of 13 patients (15%), both with LMS. During longitudinal follow-up, ctDNA remained persistently undetectable in 10 of 13 patients (77%), including all UPS patients and 4 of 7 LMS patients. Detectable ctDNA occurred almost exclusively in LMS and was often observed in association with radiographic disease progression. Across all paired assessments, 46 of 59 (78%) were concordant. Discordance included false-negative ctDNA (negative ctDNA with radiographic disease/progression; n=9) and transient ctDNA positivity without immediate radiographic progression (n=4). Where longitudinal follow-up was available, subsequent ctDNA or imaging assessments frequently demonstrated eventual alignment; lead-time analysis for transient positives was limited by sample size. Using radiographic progression as the reference standard, exploratory per-pair test characteristics demonstrated a sensitivity of approximately 64%, specificity of 88%, PPV of 80%, and NPV of 77%. Conclusions: In this real-world cohort, ctDNA detectability differed by histology and was observed predominantly in LMS. When detectable, ctDNA trends often aligned with radiographic disease progression or recurrence, supporting a potential complementary role in disease monitoring for selected patients. These findings require confirmation in larger, prospective studies.

e23510 Background: There is minimal data comparing the prognostic models (PM) developed to predict recurrence of Gastrointestinal stromal tumors (GIST). Current PM include tumor size, location, and mitotic index (MI) but lack genotypic data. This analysis compares the performance of the National Institute of Health, Armed Forces Institute of Pathology, and Memorial Sloan Kettering Cancer Center models for predicting tumor recurrence with and without adjustment for c-kit Exon 11 mutation status (MS). Methods: This is an IRB-approved single-institution retrospective analysis. Adults with GIST mentioned in their medical records from 2014 – 2025 at the authors’ institution were identified. 330 patients with documented biopsy-proven GIST were included. Data was collected by manual review. PM were evaluated using multivariate analysis, adjusting for surgical resection, systemic therapy, and c-Kit exon 11 MS. Predictive performance was measured by area under the curve (AUC) and receiver operating characteristics (ROC) analysis. Results: Mean age at diagnosis was 64.6 years (SD =13.1 years). 46.7 % of patients were male. Primary GIST was most common in the stomach (63.9%) and small bowel (23.6%). Primary tumors were an average of 6.5 cm (SD 5.6 cm) with a MI of 6.6/50 HFU (SD = 13.4 50/HFU). Patients received resection (80.9%) and first-line systemic therapy with imatinib (43.3%). Recurrence occurred in 17.9% of patients. 19.4% of patients completed genetic testing, of which 51.6% were c-Kit exon 11 mutation positive. The predictive performance of all PM was not statistically different with (p value = 0.16) or without (p value = 0.18) adjustment for c-Kit exon 11 MS (Table 1). However, adjusting for c-Kit exon 11 MS improved AUC for all PM. Conclusions: Adjusting PM for c-KIT exon 11 status improved the predictive performance of all PM, although the results were not significant. This study found no significant difference in the performance of PM that predict GIST recurrence, which aligns with the one other study on this topic. Lack of significance may be due to a small sample size, which also limited the multivariate analysis. Including genotypes in PM that predict GIST recurrence should be further explored with larger multi-center datasets that can adjust for multiple mutations. Multivariate analysis comparing prognostic models for gastrointestinal stromal tumors at predicting recurrence with and without adjustment for c-KIT exon 11 genotypes using receiver operating characteristic. Without c-Kit exon 11 AUC (95% Confidence Interval) P value NIH 0.86 (0.81,0.90) 0.18 AFIP 0.87 (0.82,0.91) MSKCC 0.89 (0.84,0.94) With c-Kit exon 11 genotype NIH 0.80 (0.67,0.93) 0.16 AFIP 0.84 (0.73,0.95) MSKCC 0.90 (0.80,0.99) NIH: National Institute of Health, AFIP: Armed Forces Institute of Pathology, MSKCC: Memorial Sloan Kettering Cancer Centre. AUC: Area under the curve.