Citations

Abstract Background: TTFields are non-invasive and novel treatment modality that utilizes low intensity, alternating, and intermediate frequency electrical fields to inhibit cancer cell proliferation through a multitude of mechanisms. These include inhibition of mitosis, disruption of cancer cell membranes, metabolomic dysregulation of cancer cells, and immunogenic activation of the tumor microenvironment (TME). TTFields are approved in glioblastoma multiforme, non-small cell lung cancer and malignant mesothelioma. The PANOVA2 trial demonstrated promising efficacy for TTFields when applied together with chemotherapy in patients with PDAC. Mechanisms of TTFields in PDAC need further delineation. We sought to investigate the efficacy of TTFields in vitro and in vivo in PDAC cell lines and mouse models. Preclinical studies were conducted in concert with an going clinical trial (NCT04605913). Experimental Procedures: Utilizing the inovitro apparatus we studied the effect of TTFields (150kHz, intensity 2.9+0.2 V cm RMS, 37ċ, over 72 hrs) in an array of PDAC (Panc1, KPC, Panc2, and AsPC1) and human pancreatic stellate cells (hPSC) cell lines, alone or together with cisplatin (Cis, 0.1μM) or gemcitabine (Gem, 0.01μM), compared to control. Cell viability analysis was conducted in each of the groups. In addition, cell lysates from Panc1 cells from concomitant treatment of TTFields plus Gem were probed for STAT3 and α-SMA to analyze stromal proteins and RAS pathway components (KRAS, P38, P42, and others) were performed via Westen Blot. We also performed RNA sequencing for the different groups to analyze gene expression levels. We further assessed the effect of TTFields (150kHz, intensity 1.8-2 V/cm RMS, over 2 weeks) using the inovivo system with and without chemotherapy (Cis, 0.25 mg/Kg per dose (i.p.) 3 times a week) compared to control in C57BL6 orthotopic murine models (6-7 weeks old C57BL6 mice). Summary of Results: Our analysis revealed statistically significant abrogation of PDAC cancer cell lines for the different groups and hPSC cell viability when compared to control for TTFields monotherapy (p <0.001) and TTFields concomitantly with Gem or Cis (p <0.0001). Western blot analysis demonstrated that TTFields alone and when combined with chemotherapy alters both the stroma and RAS pathways with confirmed downregulation of pSTAT3 and α-SMA and KRAS, P-P38, and P-P42. In vivo analysis revealed significant decrease in tumor volume and weight for the concomitant effect of TTFields + Cis. Conclusion: Our preclinical studies demonstrated the efficacy of TTFields as monotherapy and concomitantly with chemotherapy in PDAC and hPSC cell lines and mouse models. Mechanistic insights from the pre-clinical studies will inform the design of future TTFields studies in PDAC. Citation Format: Hani M. Babiker, Santanu Bhattacharya, Douaa Albelal, Shamit Kumar Dutta, Enfeng wang, Debabrata Mukhopadhyay. umor treating fields (TTFields) plus chemotherapy abrogates pancreatic ductal adenocarcinoma (PDAC) proliferation and alters the tumor microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 1834.

OBJECTIVE The optimal dose for triazoles in pediatric patients may substantially vary given the dynamic changes in pharmacokinetics and pharmacodynamics, based on disease severity. Therapeutic drug monitoring has been a valuable tool to help guide management and avoid potential toxicities associated with treatment of invasive fungal infections (IFIs). Goal azole serum concentrations are based on specific drug, indication, and minimum inhibitory concentration when known. This study aimed to determine the optimal pediatric azole doses needed to achieve targeted serum concentrations of isavuconazole, itraconazole, posaconazole, and voriconazole. METHODS This is a single center, retrospective chart review of pediatric patients who received isavuconazole, itraconazole, posaconazole, or voriconazole between January 1, 2011, and August 31, 2021. RESULTS A total of 273 pediatric patients received isavuconazole, itraconazole, posaconazole, or voriconazole in the inpatient or outpatient setting during the study period. Of the 273 patients, only 122 met criteria for inclusion in the analysis. Eighty-three percent of patients reached a goal serum concentration. Patients younger than 12 years required a higher dose (mg/kg/day) to achieve goal serum concentrations. Patients who received an azole in the form of an oral tablet or intravenously were more likely to reach a goal concentration than those not receiving these formulations. Median time to goal concentration occurred at 20 days for isavuconazole, 34 days for itraconazole, 11 days for posaconazole, and 10 days for voriconazole. CONCLUSIONS Higher starting azole doses are needed to obtain goal concentrations quickly, especially for children younger than 12 years.

Abstract Background and Objective: Bladder cancer is the 9th most diagnosed cancer worldwide with high incidences reported in Europe and the United States. Here, we evaluated the real-world performance of a commercially available multiplex immunoassay Oncuria-Detect that detects bladder cancer by simultaneously measuring a panel of 10 biomarker proteins in naturally voided urine samples. Methods: We tested prospectively collected urine samples from a real-world cohort of 1, 002 patients presenting to five USA centers, one European center and one Japanese center with hematuria. Assay results were collated with patient clinical data and a cancer diagnosis was defined by biopsy and pathology. The prevalence of bladder cancer in the cohort was 15.9%. Results: In a training set (n=684), the Oncuria-Detect assay correctly identified bladder cancer in 94/109 cases, representing a sensitivity of 91.8%, specificity of 71.6% (AUC 0.885; 95% CI 0.843 - 0.927) and with improved performance for high-grade bladder cancer and muscle-invasive bladder cancer (sensitivity 93.6% and 92.1%, respectively). In a test cohort of n =339 the AUC for detecting bladder cancer was 0.850 (95% CI 0.779-0.920). Conclusions and Implications: The multiplex Oncuria-Detect assay identified bladder cancer with high sensitivity and NPV, for low-grade and high-grade tumors alike. Oncuria-Detect’s high NPV could effectively rule out 66% of patients from requiring subsequent cystoscopy. Citation Format: Ian Pagano, Zhen Zhang, Sergei Tikhonenkov, Florence Le Calvez-Kelm, Steve Goodison, Toru Sakatani, Kaoru Murakami, Takashi Kobayashi, Howard Kim, Riko Lee, Sunao Tanaka, Charles J. Rosser, Hideki Furuya. Performance of the Oncuria-detect bladder cancer test for evaluating patients presenting with hematuria: results from a real-world clinical setting [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 5919.

Abstract Background: Despite recent advances in the treatment of triple negative breast cancer (TNBC) many patients are still suffering from early recurrence, therapy resistance, and organ metastasis 1 to 3 years post-chemotherapy. TNBC cells with stem cell-like properties are resistant to standard of care chemotherapy and are responsible for early tumor relapse and poor outcome. Up-regulation of PD-L1 expression in Cancer Stem Cells (CSCs) has been associated with immune evasion capacity and promotion of their stem-like properties. In this study we identify two druggable stemness target, Aurora-A Kinase (AURKA) and NOTCH3, with positive feedback on intra-tumoral PD-L1 expression and cancer cell plasticity. Methods: MDA-MB 231, MDA-MB 231 LM and SUM149-PT TNBC cells were used both in 2D and 3D environment. Unique TNBC cells were established from metastatic PDX models. TNBC cells were treated with Alisertib (AURKA inhibitor, 50nM) or AV353 (NOTCH3 inhibitor, 200ng). Immunofluorescence and immunoblot were used to compare different biomarker expression. ALDH was measured using Aldefluor kit. Apoptotic cells were quantified in real-time using IncuCyte S3. In vivo studies; 1x106 MDA MB 231/LM cells were injected into the mammary fat pad of NSG-female mice and treated with Alisertib or AV353. Control groups were treated with pacebo. Results: Our study shows that AURKA and NOTCH3 pharmacological blockade reduced nuclear/undruggable PD-L1, that is not achieved clinically by using FDA-approved immune checkpoint inhibitors (ICIs). Significantly, following stemness-targeted therapy with alisertib or AV353, reduction of intra-tumoral PD-L1 resulted in inhibition of tumor growth, decreased levels of CD44 expression, increased CD8+ T-cell tumor infiltration, impairment in the enrichment of ALDHhigh CSCs and enhanced chemosensitivity. In vivo pharmacological blockade of AURKA and NOTCH3 signaling pathways induced inhibition of tumor growth, apoptosis, and impairment of organ metastases. Conclusions: This study demonstrates that selective AURKA and NOTCH3 pharmacological blockade results in the inhibition of cancer cell plasticity that is linked to reduction of undruggable nuclear PD-L1 in TNBC cells. Our findings provide the strong preclinical rationale to develop novel clinical trials for patients with advanced TNBC that are refractory to chemotherapy and show limited response to FDA-approved ICIs. Citation Format: Antonino Bonaventura D'Assoro, Matthew Goetz, Carol Lange, Roberto Leon-Ferre, Tufia Haddad, James Ingle, Annapaola Montagner, Andrew Takchi, Ellie Babadi, Lucio Miele, Urban Lendahl, Urban Lendahl. Pharmacological blockade of AURKA and NOTCH3 oncogenic pathways to inhibit cancer cell plasticity in triple negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 5978.

Abstract Circulating tumor cells (CTCs) are cancer cells that detach from tumors, enter the blood and seed distant sites. CTCs spread as single cells, or cluster aggregates, and can be heterogenous with differing biological phenotypes, i.e. epithelial, mesenchymal, progenitor, & stem cell. Three clinically relevant CTC subtypes are often described in patients (pts) 1) CTCs with normal epithelial traits (strong filamentous cytokeratin (CK+ & CD45-/CD14-), 2) Epithelial-mesenchymal CTCs (EMTs), cancer cells with downregulated epithelial & upregulated mesenchymal traits (low diffused CK+, CD45-/CD14-) and 3) tumor-macrophage fusion cells (TMFCs), cancer cells that fuse with macrophages (polynucleated DAPI+, diffuse CK+ and CD14+/CD45+). To better elucidate the biological and clinical importance of the 3 CTC subtypes, we isolated CTCs by a marker agnostic method from the blood of n=49 metastatic cancer pts. We then enumerated and phenotypically subtyped CTCs comparing clinical utility of clustering and CTC heterogeneity over 2 years. Peripheral blood samples were collected from 49 metastatic cancer pts, breast (n=38), pancreatic (n=9), colon (n=3), lung (n=1), and prostate (n=1). Whole blood (7.5mL) was filtered by size exclusion using CellSieve microfilters and fluorescently stained for CD45, CD14, CK, and DAPI to identify CTCs, EMTs and TMFCs. Cells were imaged, enumerated and fluors quenched by the QUAS-R technique; followed by re-stained for CD44, CD24, CD133, CD144, N-Cadherin, EpCAM, and Vimentin. Markers were categorized as negative, low, medium, or high. A heterogeneity biomarker score was developed as high, 2-3 log deviations between marker expression, or low 0-1. Pt progressive free survival (PFS) and overall survival (OS) were analyzed over 2 years. CTCs were found in 40% of pts, EMTs in 51%, & TMFCs in ∼93%. For subtyping, CD44 was in CTCs 88%, EMTs 59%, & TMFCs 91%; CD24 in CTCs 40%, EMTs 41%, & TMFCs 6%; CD133 in CTCs 100%, EMTs 8%, & TMFCs 100%; CD144 in CTCs 100%, EMTs 77%, & TMFCs 82%; N-cadherin in CTCs 100%, EMTs 0%, & TMFCs 45%; Vimentin in CTCs 51%, EMTs 100%, & TMFCs 83%; EpCAM in CTCs 74%, EMTs 12%, & TMFCs 20%. CTCs and EMTs were found to have high heterogeneity in 30% of samples in both individual cells and clusters, with a high biomarker heterogeneity significantly correlated with poorer outcomes (PFS: HR=15.4, p=0.0014, CI=3.4-68.9; OS: HR=12.4, p=0.0056, CI=2.6-59.1). TMFCs were found to have high heterogeneity, 40% of samples, but this was not correlated with outcomes. In this pilot study, it appeared that isolated CTC, EMTs and TMFCs subtypes have differing heterogenous expressions of epithelial, mesenchymal, progenitor, and stem cell markers. Further, high rates biomarker heterogeneity in CTCs and EMTs, but not TMFCs, correlated with faster rates of progression & death. Larger validation experiments with biomarker stratification is ongoing. Citation Format: Alexis B. Duffy, Massimo Cristofanilli, Carolina Reduzzi, Cha-Mei Tang, Saranya Chumsri, Susan Tsai, Mohammed Aldakkak, Daniel L. Adams. Heterogeneity of epithelial, mesenchymal, progenitor, and stem cell phenotypes on CTCs correlates to clinical outcomes in metastatic cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 1989.

Abstract Introduction: The success of CAR-T in multiple myeloma suggests potential in other challenging plasma cell disorders like systemic AL amyloidosis (AL) and plasma cell leukemia (PCL). CAR-T experience in these indications is limited by the rarity of these diseases. Methods: A systematic review examined publications and clinical trials from 2014 to 2024 to gauge clinical outcomes and safety of CAR-T in AL and PCL. Studies of plasma cell-directed CAR-T with safety and efficacy outcomes were included. Results: We identified a total of 21 AL patients from 6 publications and 23 PCL patients from 5 publications. All patients were treated with anti-BCMA CAR-T; 9 different products were administered. Among AL patients, 12 had cardiac amyloidosis, and 6 had at least stage 3. At a median follow-up of 9 months (2.5-26.4), 16 of 21 AL patients (76%) had a response of VGPR or better: 2 had MRD-negative sCR with organ response, 8 CR, 6 VGPR, 1 PR, and 3 not evaluable. From a safety standpoint, CRS occurred in 71%, with 57% experiencing grades 1-2 and 14% grade 3. ICANS occurred in 2 patients (10%): one grade 1, one grade unknown. Of 11 patients treated with HBI0101, 5 patients died of cardiac disease within 1 year of CAR-T (3 PD, 1 VGPR, 1 PR). Hematologic events were common, with neutropenia in 76% (52% grades 3-4), anemia in 38% (19% grade 2-3, 5% grade 1), and thrombocytopenia in 24% (10% grade 2, 5% grade 3, and one grade 4 worsening thrombocytopenia). Infections were also seen, including BK virus hemorrhagic cystitis, SARS-CoV-2 pneumonia, severe respiratory infection, respiratory viral infection, and sepsis, each affecting 5-14%. A review of CAR-T in PCL included 6 patients with primary PCL and 17 with secondary PCL, with a median of 4.5 (range: 0-15) prior lines of therapy. Overall response at a median follow-up of 6.5 (range: 0-15) months was 17/23 (78%): 2 patients with sCR, 2 CR, 7 VGPR, and 7 PR. Adverse events were only described in 20 of the 23 PCL patients. CRS was frequent, with any grade CRS occurring in 18 of 20 (90%); CRS grade was only reported in 10 (4 grade 1, 3 grade 2, 1 grade 3, 2 grade 4, 8 grade unknown). ICANS grade 1 was reported in 4 patients (20%), and infection (any grade) in 8 (40%). Hematologic events of any grade were frequent: neutropenia in 90% of patients (35% grade ≥ 3), anemia in 80% (40% grade ≥ 3), and thrombocytopenia in 70% (40% grade ≥ 3). Three deaths were reported, two due to infection (pneumonia and pulmonary aspergillosis) and one due to GI hemorrhage. Conclusions: BCMA-directed CAR-T has been used in AL and PCL with encouraging responses, though the durability of these responses is unknown. Our review suggests that CAR-T may be safe in AL in patients without significant cardiac disease. Patients with PCL may be at an increased risk of serious adverse events, especially in the setting of active progressive disease. Careful patient selection and potential dose adjustment may be warranted in these orphan indications. Citation Format: Heather T. Morgan, Benjamin Derman, Hong Ma, Shaji K. Kumar. CAR-T in high-risk plasma cell dyscrasias: A systematic review of AL amyloidosis and plasma cell leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3180.

Abstract Background: Ad5/3-E2F-D24-hTNFa-IRES-hIL-2 (TILT-123) is an oncolytic adenovirus armed with TNFa and IL-2. The cytokine pairing demonstrated superior tumor immunomodulation in preclinical studies. Subsequent studies supported evaluation of TILT-123 in PROTA, a phase 1 study of TILT-123 in combination with pembrolizumab in platinum resistant or refractory ovarian cancer patients. Biomarker analysis is ongoing. Experimental procedures: In this phase 1a dose escalation trial (NCT05271318), 15 patients received an initial single intravenous dose of TILT-123 ranging from 3x1011 to 4x1012 VPs, followed by intratumoural and/or intraperitoneal injections ranging from 1x1011 to 5x1011 VPs. Patients also received i.v. pembrolizumab (200mg) every three weeks starting on day 36. The primary endpoint was safety by day 92, while efficacy by RECIST1.1 and overall survival (OS) were secondary endpoints. Collection of tumour biopsies and blood, including PBMCs and serum, enabled evaluation of MoA and identification of preliminary biomarkers. Summary of data: ORR was 7.1% in evaluable patients (1/14). Disease control rate was 64% in evaluable patients (n = 14) and median OS was 190 days (n =15). Patients with disease control and no disease control by 92 achieved a median OS of 571 days and 138 days respectively. Correlations of complete blood count with differential to OS (n =15) and imaging response (n = 14) revealed a greater drop in lymphocyte count after treatment, as well as baseline lymphocyte count positively correlated with OS and disease control (PR/SD vs PD). Correlation of prothrombin INR to OS revealed patients with a slower blood-clotting rate at baseline and post-treatment positively correlated with OS. Analysis of anti-adenovirus neutralizing antibody (nAb) titer revealed 77% of all patients were positive for nAbs prior to treatment. All patients developed nAbs in blood and ascites (ascites n = 3). Patients presenting with nAbs at baseline achieved longer OS than those not positive. Additionally, a higher titer post-treatment positively correlated with OS and disease control. Percentage and fold change increase in IgM expression on plasma cells on day 36 positively correlated with OS. In addition, a higher expression of IgM on the surface of plasma cells at baseline was observed in patients achieving disease control. Conclusion: These preliminary results identify a key role of circulating lymphocyte re-distribution and humoral immune response as markers of treatment benefit. Initial phenotyping implicates IgM producing plasma cells as a potentially relevant immune cell population. Additionally we observed a correlation between the coagulation cascade and OS. Citation Format: James H. Clubb, Matthew Block, Johanna Mäenpää, Victor Arias, Mirte van der Heijden, Santeri Pakola, Dafne C. Quixabeira, Tatiana Kudling, Elise Jirovec, Lyna Haybout, Tuomo Alanko, Daniel Adamo, Susan Ramadan, Jorma Sormunen, Juha Kononen, Michael J. Chisamore, Julia W. Cohen, Nadena Singh, John Goldfinch, Suvi Sorsa, Riikka Havunen, Claudia Kistler, João M. Santos, Víctor Cervera-Carrascon, Akseli Hemminki. Clinical-immunological correlates in platinum resistant or refractory ovarian cancer patients treated with chimeric oncolytic adenovirus encoding TNFa and IL-2 (TILT-123) in combination with pembrolizumab [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 2035.

Study Design: Analysis of prospectively collected data. Objective: To assess if systemic illness severity affects cervical spondylotic myelopathy (CSM) surgery outcomes. Summary of Background Data: It remains unclear if CSM patients with poor physical status/severe systemic illness benefit as much from surgery as those in good condition. Methods: Using the Quality Outcomes Database CSM cohort and the American Association of Anesthesiology (ASA) grade as a surrogate for illness burden, we compared patients with (ASA 3–4) and without (ASA 1–2) severe systemic illness, including rates of readmission and 24-month minimal clinically important differences (MCID) achievement for patient-reported outcomes (PROs)—numerical rating score (NRS) arm and neck pain, neck pain-related disability (NDI), and quality of life (EQ-5D). Results: Of 1141 CSM patients, 1062 had ASA grades recorded. Of these 1062 patients, 70.2% had a 2-year follow-up for mJOA, and 81%–84% had a follow-up for NRS arm and neck, NDI, and EQ-5D. Five hundred twenty-one patients (49.1%) had mild (ASA 1–2) and 541 (50.9%) had severe systemic illness (ASA 3–4). The severe disease cohort was older (63.3±11.0 vs. 57.4±11.7), had higher BMI (31.4±7.0 vs. 28.9±5.6), had more comorbidities (diabetes, coronary artery disease, depression), and had less independent ambulation (71.3% vs. 90.6%) ( P <0.05). At baseline, severe disease patients had worse NRS arm (5.2±3.5 vs. 4.7±3.4) and neck (5.5±3.2 vs. 5.1±3.3) pain, NDI (40.5±20.1 vs. 36.8±21.0), and EQ-5D (0.53±0.22 vs. 0.59±0.22) scores ( P <0.05). Perioperatively, the severe disease cohort had longer hospitalizations (2.4±2.6 vs. 1.7±2.0 days) and increased nonhome discharges (17% vs. 5%) ( P <0.05). The severe disease cohort had higher 90-day readmissions (7.6% vs. 2.5%), including surgery-related (3.7% vs. 1.5%) and non–surgery-related reasons (3.9% vs. 1.0%) ( P <0.05). On multivariate analysis, increased ASA grade was significantly associated with 90-day readmissions (OR: 2.55 per 1-grade increase, 95% CI: 1.38–4.83). However, both severe and mild disease cohorts had similarly high rates of achieving 2-year MCID for mJOA (67.5% vs. 66.0%), NRS arm (72.0% vs. 74.1%), neck (69.5% vs. 69.4%) pain, NDI (63.1% vs. 68.1%), and EQ-5D (67.9% vs. 66.9%) ( P >0.05). Conclusion: Patients with severe systemic illness (higher ASA) have worse baseline PROs and higher 90-day readmissions. However, they achieve similar MCID rates for mJOA and all measured PROs 2 years postoperatively.

Abstract Background: While cancer immunotherapies have revolutionized treatment, their efficacy remains limited for most patients, highlighting tumors' capacity to evade immune detection. Epigenetic modifications, particularly DNA methylation, play a pivotal role in silencing immune-related pathways, thereby facilitating immune escape. By modulating gene expression, methylation disrupts immune activation, contributing to reduced tumor immunogenicity. This study examines the methylation landscape of co-stimulatory and immune checkpoint genes across various cancers to elucidate how these changes influence immune responses. Methods: Using The Cancer Genome Atlas (TCGA), we analyzed methylation and gene expression profiles across diverse cancer types. Data from 8,186 solid tumors and 745 adjacent normal tissues were processed via t-distributed stochastic neighbor embedding (t-SNE) with 247 probes targeting 20 immune-related genes. Principal component analysis (PCA) was applied to capture methylation variability across 8,931 tumor and normal samples. To explore the effects of methylation on immune gene expression, we analyzed data from 26 epithelial cancer cell lines treated with 5-azacitidine, a demethylating agent, using the GSE57342 dataset. Post-treatment changes in gene expression were assessed, and survival analyses from prior studies were used to explore clinical correlations. Results: We identified distinct methylation patterns in immune synapse genes, differentiating tumors from adjacent normal tissues. Co-stimulatory genes such as CD40 were hypermethylated in tumors, correlating with decreased expression, whereas immune checkpoint genes like PDL1 and HHLA2 were hypomethylated, correlating with increased expression. This inverse relationship between methylation and gene expression underscores the transcriptional regulatory role of DNA methylation. Treatment with 5-azacitidine reversed hypermethylation in co-stimulatory genes, including CD40, potentially enhancing immune recognition. Methylation levels of these genes were also associated with T cell infiltration into the tumor microenvironment and predicted better outcomes in melanoma patients, underscoring their clinical relevance. Conclusion: This study demonstrates that DNA methylation of immune synapse genes contributes to tumor immune evasion by modulating immune gene expression. Targeting these epigenetic alterations represents a promising strategy to restore tumor immunogenicity and improve immunotherapy outcomes, particularly when combined with immune checkpoint inhibitors. Reversing methylation-driven immune suppression could strengthen the immune response and enhance clinical outcomes for cancer patients. Citation Format: Imene Hamaidi, Anders Berglund, Matthew Mills, Ryan M. Putney, James J. Mulé, Sungjune Kim. DNA methylation of immune synapse genes drives tumor immune evasion [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4831.

Abstract Background: Prostate cancer continues to disproportionately affect Black men, who face notonly higher incidence, but also more severe outcomes compared to other racial and ethnicgroups. While advancements in survivorship care have been made, significant disparities remain, highlighting the critical need for research that addresses the distinct challenges faced by Black men during their survivorship journey. In the face of these ongoing inequities, understanding the advocacy, resilience, and lived experiences of Black men post-treatment is essential. By exploring these factors, our study aims to uncover actionable strategies to enhance survivorship care and support, driving the development of targeted interventions that can close the gap in outcomes for this underserved population. Methods: We conducted a secondary analysis of qualitative interviews with 31 Black prostatecancer survivors participated in the CaPCaS study, aiming to explore their perspectives onsurvivorship and advocacy. A Grounded Theory approach was employed to rigorously analyze the participants' narratives. Through open and axial coding, we systematically identified key themes from the transcribed, verified, and deidentified audio recordings, ensuring a comprehensive exploration of their post-treatment experiences. Results: Our analysis revealed four central themes that highlight the evolving health behaviors and coping mechanisms of participants. First, Self-care and Health Management emerged, showcasing empowered decision-making around exercise, dietary improvements, and hydration. Second, Increased Awareness and Prioritization underscored the shift toward heightened health consciousness, with participants emphasizing the importance of personal health and prioritizing food quality. Third, the theme of Emotional and Social Support illustrated how shared experiences fostered comfort and perspective, reinforcing ongoing health maintenance. Finally, participants reframed Health Challenges, viewing them as minor nuisances rather than deterrents, bolstered by medical reassurance and a strong survivor mindset. Conclusion: These findings emphasize the importance of holistic health strategies in improving the quality of life for Black men during their post-treatment prostate cancer survivorship journey. By fostering empowered self-care, prioritizing health awareness, and leveraging emotional and social support, survivors can navigate ongoing health challenges with resilience and confidence. The reframing of health issues as manageable aspects of their lives further underscores the potential for interventions to enhance long-term well-being and reduce disparities in prostate cancer survivorship. Citation Format: Dottington Fullwood, Mary Ellen Young, Folakemi T. Odedina. Health maintenance reframed: Insights from Black prostate cancer survivors on prioritizing wellbeing [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4011.