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Supportive care prescribing: A real-world comparison of community vs. academic oncology practices.

e23438 Background: The majority of US cancer patients are treated in community settings, which differ from academic centers in patient populations and resources. These differences may influence supportive care (SC) prescribing, but large-scale, real-world data is lacking. We analyzed a large chart audit database to quantify these prescribing patterns. Methods: A retrospective analysis of the Ipsos Oncology Monitor - a physician-reported patient record database - was conducted. Data were collected online between November 2024 - October 2025 from 1,167 cancer-treating physicians in the US who were screened for specialty and caseload, and reported on 56,001 anti-cancer drug treated patients (aggregate) across all tumor types. We compared the proportion of patients prescribed SC agents in community versus academic practices across all cancer types and within specific breast cancer (BC) subtypes and treatment regimens. Results: As detailed in Table 1 , the proportion of reported patients receiving SC between community and academic settings is statistically significant across overall cancers (66% and 55%, respectively); the magnitude of this difference varied notably by clinical context. The disparity was most pronounced for G-CSF use in eTNBC (43% vs. 7%). In contrast, for the HR+ HER2- mBC patients on CDK4/6i inhibitors (n > 1,500), prescribing patterns showed both moderate differences (Bisphosphonate use: 23% vs. 12%) and near-parity (Denosumab use: 32% vs. 29%). Conclusions: Real-world data from a large sample of patient charts in this study demonstrate a general trend of higher supportive care utilization in community oncology. However, this trend is not uniform, with patterns ranging from dramatic disparities to near-parity depending on the specific clinical scenario. These findings highlight the complex interplay of factors influencing prescribing decisions and underscore the need for further research to tease apart the drivers (e.g., patient characteristics, physician habits, guideline interpretation) behind these varied practice patterns. Supportive care (SC) use in community vs. academic practice (n = patient record forms). Patient Group / Treatment Supportive Care Agent Comm. (n) Acad. (n) Comm. (%) Acad. (%) All Cancers (Overall) Any SC 36508 19493 66% 55% eTNBC G-CSF 172 33 43% 7% HR+ HER2- mBC w/ CDK4/6i Bisphosphonate 935 584 23% 12% Denosumab 32% 29% eTNBC: early-stage triple-negative breast cancer; mBC: metastatic breast cancer.

Comparative outcomes of squamous and non-squamous penile cancers: Insights from SEER database.

e17031 Background: Penile cancer is a rare neoplasm in Western countries and is typically of squamous cell carcinoma (SCC) origin. Nonsquamous cell carcinomas (NSCC) constitute approximately 5% of penile malignancies, however, their clinicopathologic characteristics and prognostic implications remain poorly defined. Penile cancers are positively associated with human papillomavirus (HPV) infection and inversely associated with circumcision. Limited studies are done to see demographic patterns and population based survival outcomes in penile cancer. Our study aims to evaluate the trends, clinicopathologic differences, and survival outcomes between squamous and non-squamous penile cancers using the SEER database. Methods: A retrospective analysis was performed using SEER 17 registries (2000–2022). Adult patients (≥18 years) with histologically confirmed penile cancer (ICD-10 C60) were included. Variables analyzed included age, race, tumor site, stage, and treatment modality (surgery, chemotherapy, radiation). Survival was assessed using Kaplan–Meier estimates and log-rank testing using Graphpad Prism. Statistical significance was set at P < 0.05. Results: Among 7,719 patients (median age 68 years), 7,216 (93.5%) had SCC and 503 (6.5%) had NSCC. The cohort was predominantly White (62.9%), followed by Hispanic (21.8%), Black (8.7%), Asian/Pacific Islander (4.9%), and American Indian/Alaska Native (0.9%) patients. Median overall survival (OS) varied significantly by race (P < 0.0001), highest among Asian/Pacific Islanders (108 M) and lowest among Black patients (56 M). In terms of primary site, prepuce had the longest median OS (86 M), followed by glans (70M) and shaft (68M).Median OS was 73 M for SCC versus 43 M for NSCC (P < 0.0001). Median OS was 101 M for in situ/localized, 43 M for regional, and 8 M for distant disease (P value-0.0001). Surgery was associated with improved OS in both SCC (78M) and NSCC (89M), while chemotherapy or radiation demonstrated shorter survival, likely reflecting more advanced disease at presentation. Conclusions: Histologic subtype significantly impacts survival in penile cancer, with NSCC showing poorer outcomes than SCC. Surgical management remains the cornerstone of therapy and improves survival irrespective of histology. Chemotherapy and radiation were associated with worse outcomes, highlighting the need for early detection, individualized surgical strategies, and prospective studies for non-squamous variants.

Insurance and racial disparities in CAR T-cell therapy outcomes: A National Inpatient analysis.

11172 Background: To understand equity gaps for Chimeric antigen receptor T-cell (CAR-T) therapy, we conducted an analysis examining insurance-based and racial disparities in CAR-T cell therapy. Methods: Using the National Inpatient Sample (2020-2022), we identified CAR-T recipients via ICD-10-PCS procedure codes (XW0 series) with FDA-approved indications including diffuse large B-cell lymphoma (DLBCL), B-cell acute lymphoblastic leukemia (B-ALL), multiple myeloma, follicular lymphoma, and mantle cell lymphoma. The primary outcome was in-hospital mortality. Secondary outcomes included cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and ICU utilization. Multivariable logistic regression estimated adjusted odds ratios (aOR) controlling for age, sex, race, insurance status, and disease indication. Access disparities were assessed by comparing racial composition of CAR-T recipients to US Census population estimates. Results: Among 10,610 weighted CAR-T hospitalizations (mean age 59.4 years; 62.1% male; 97% at academic centers), the most common indications were DLBCL (46.9%), multiple myeloma (25.0%), and B-ALL (12.7%). Overall in-hospital mortality was 8.6%, CRS occurred in 42.3%, and ICANS in 19.7%. Compared to privately insured patients (mortality 5.5%), both Medicare (11.5%; aOR 1.59, 95% CI 1.32-1.92, p < 0.0001) and Medicaid patients (10.7%; aOR 1.89, 95% CI 1.45-2.47, p < 0.0001) experienced significantly higher mortality after adjustment for demographics, comorbidities, and indication. This disparity persisted across the study period, with the Medicare-to-Private mortality ratio increasing from 1.9x (2020) to 2.2x (2022). Black (9.1% of CAR-T recipients vs 13.6% US population) and Hispanic patients (13.7% vs 18.9%) were significantly underrepresented, receiving CAR-T at only 67% and 72% of expected rates based on population demographics, respectively. Black patients demonstrated significantly higher ICANS risk (aOR 1.38, 95% CI 1.16-1.64, p = 0.0003) but lower CRS risk (aOR 0.79, 95% CI 0.68-0.91, p = 0.001) compared to White patients. Black patients also experienced higher rates of ICU-level care (23.8% vs 16.6%) and mechanical ventilation (12.4% vs 8.1%). No significant sex-based disparities were observed in mortality (aOR 0.90, 95% CI 0.78-1.04, p = 0.17). Conclusions: We identified insurance-based mortality gaps with 60-90% higher adjusted mortality compared to privately insured patients. Concurrent access disparities result in Black and Hispanic patients being underrepresented by approximately one-third. Black patients who do receive CAR-T demonstrate distinct toxicity phenotypes with higher neurotoxicity and ICU utilization. These findings support the need to address barriers to CAR-T access and optimize outcomes across all patient populations.

Survival trends and disparities in indolent and aggressive non-Hodgkin lymphoma.

e23109 Background: Overall survival (OS) in non-Hodgkin lymphoma (NHL) has improved with therapeutic advances. Whether these improvements have occurred uniformly across lymphoma subtypes and sociodemographic groups remains uncertain. We evaluated temporal changes in 5-year OS and examined associations of race/ethnicity and socioeconomic factors with outcomes in indolent and aggressive NHL. Methods: Using Surveillance, Epidemiology and End Results (SEER) 21-registry data, we identified adults diagnosed with NHL from 2000–2017 (N = 108,041) and grouped them into two eras (2000–2010 vs 2011–2017). OS was censored at 60 months. Kaplan–Meier methods estimated 5-year OS by era and subtype, with comparisons by log-rank testing. Multivariable Cox proportional hazards models were fitted separately for indolent and aggressive NHL, adjusting for age, sex, race/ethnicity, era, median household income (per $10,000 increase) and living area (urban/rural). Statistical significance was set at p < 0.05. Results: In Kaplan–Meier analyses of all NHL, 5-year OS was higher for patients diagnosed in 2011–2017 than in 2000–2010 (64.7% vs 56.6%, p < 0.001). Subtype-specific analyses showed similar trends in both indolent (73.8% vs 64.6%, p < 0.001) and aggressive NHL (54.7% vs 47.0%, p < 0.001). Multivariable modeling in indolent NHL indicated that older age was associated with higher mortality (hazard ratio [HR] 1.05 per year; 95% CI, 1.049–1.052; p < 0.001), while female sex was associated with improved survival (HR 0.68; 95% CI, 0.66–0.70; p < 0.001). Compared with White patients, mortality was higher among Black (HR 1.51; 95% CI, 1.43–1.60; p < 0.001), Hispanic (HR 1.21; 95% CI, 1.15–1.27; p < 0.001), and Asian/Pacific Islander (HR 1.11; 95% CI, 1.04–1.19; p = 0.004) patients. Diagnosis in 2011–2017 (HR 0.69; 95% CI, 0.67-0.71; p < 0.001) and higher income (HR 0.95 per $10,000; 95% CI, 0.937-0.953; p < 0.001) were independently associated with lower mortality. In aggressive NHL, increasing age (HR 1.03 per year; 95% CI, 1.032–1.034; p < 0.001) was associated with higher mortality. Compared with White patients, mortality was higher among Black (HR 1.62; 95% CI, 1.56–1.69; p < 0.001), Hispanic (HR 1.18; 95% CI, 1.13–1.22; p < 0.001), and Asian/Pacific Islander patients (HR 1.11; 95% CI, 1.06–1.17; p < 0.001). Female sex (HR 0.79; 95% CI, 0.77–0.81; p < 0.001), diagnosis in 2011–2017 (HR 0.76; 95% CI, 0.74–0.78; p < 0.001) and higher income (HR 0.96 per $10,000 increase; 95% CI, 0.95–0.97; p < 0.001) were associated with improved survival. Living area was not associated with OS in either subtype. Conclusions: Five-year OS for both indolent and aggressive NHL improved in the contemporary era; however, notable racial and socioeconomic disparities persist. Despite overall survival gains, minority racial groups and lower-income communities continue to experience higher mortality, emphasizing the need for strategies to address inequities in lymphoma care.

Efficacy, tolerability, and outcomes of generic palbociclib in metastatic HR-positive, HER2-negative breast cancer: An ambispective study from a tertiary cancer center in South India.

e13034 Background: CDK4/6 inhibitors have transformed outcomes in hormone receptor (HR)-positive, HER2-negative metastatic breast cancer (MBC). In India, generic palbociclib has markedly improved accessibility at approximately 5–10% of the cost of the innovator formulation (INR 5,000–8,000 vs INR 95,000 per month), yet real-world data are limited. We evaluated indications, tolerability, and survival outcomes of generic palbociclib + endocrine therapy (ET) at a tertiary oncology center. Methods: Ambispective cohort study (Department of Medical Oncology, Amala Institute of Medical Sciences, Kerala). Retrospective: January 2022–June 2024; prospective: July 2024–September 2025. Only one patient initiated palbociclib in 2022 (switched to generic formulation in 2023); all others received generic palbociclib from treatment start. Adults with HR-positive, HER2-negative MBC receiving generic palbociclib + ET were eligible. Primary endpoints: treatment patterns, tolerability, dose modifications. Secondary endpoints: progression-free survival (PFS), overall survival (OS), objective response rate. Kaplan-Meier estimates and Cox regression were used. Results: Ninety-seven patients (median age 59 years [IQR 53–69]; 82.5% postmenopausal; 72.2% ECOG 1). Palbociclib was first-line in 63.9% and second-line in 27.8%; endocrine partner letrozole 79.4%, fulvestrant 15.5%. Starting dose: 125 mg (22.7%), 100 mg (50.5%), 75 mg (26.8%). Median follow-up 16 months; 31 progressions (32%) and 22 deaths (22.7%) occurred. Median PFS and OS not reached. One-year PFS 74.3% (95% CI 65.3–84.6); one-year OS 87.0% (95% CI 80.1–94.5). Neutropenia (any grade) 93.8% (grade 3–4 ,19.6%); non-hematologic grade ≥3 events <2%. Multivariate analysis: ECOG 3 (HR 9.27, P=0.042) and second-line use (HR 4.95, P<0.001) independently predicted inferior PFS; similar trends for OS. ER Allred score ≤4 trended toward poorer outcome (P=0.055). Conclusions: Generic palbociclib combined with ET demonstrated favorable efficacy and manageable tolerability in HR-positive, HER2-negative MBC, with outcomes comparable to global registration trials despite frequent upfront dose reductions and at >90% lower drug acquisition cost versus the originator. Poor performance status, later-line use, and low ER expression were associated with inferior survival. These findings strongly support the real-world effectiveness and value of generic palbociclib in resource-constrained settings; larger multicenter studies with longer follow-up are warranted.

Evaluation of concomitant medications in advanced prostate cancer patients receiving apalutamide: TITAN and SPARTAN post-hoc analysis.

5087 Background: Apalutamide (APA) is an androgen receptor pathway inhibitor (ARPI) approved for use with androgen-deprivation therapy (ADT) in patients with metastatic castration-sensitive prostate cancer and nonmetastatic castration-resistant prostate cancer based on data from the phase 3 TITAN and SPARTAN trials. APA induces cytochrome (CYP) 3A4/2C19 and P-glycoprotein, which may alter the pharmacokinetics of commonly used medications, raising the possibility for adverse events (AEs) or serious adverse events (SAEs) due to drug-drug interactions (DDIs). Methods: A post-hoc analysis was conducted to evaluate the incidence of AEs associated with select concomitant medication classes—antihypertensives, antidiabetics, statins, proton pump inhibitors (PPIs), and corticosteroids, among patients treated with APA + ADT or placebo + ADT in the TITAN and SPARTAN trials. The selected drug classes include some of the most frequently prescribed agents with significant CYP 3A4/2C19 activities. This analysis was also done in comparison to non-recipients of concomitant medications. Results: See Table. Conclusions: In this exploratory post-hoc analysis of >2,200 patients from TITAN and SPARTAN, concomitant use of commonly prescribed medications (antihypertensives, antidiabetics, statins, PPIs, and corticosteroids) was frequent and reflected routine real-world practice. Across medication classes, we observed no clinically meaningful increase in serious or loss-of-efficacy adverse events among apalutamide-treated recipients compared with placebo or with non-recipients of the class. These findings suggest that co-administration of apalutamide with routine concomitant therapies is safe and feasible under standard clinical monitoring. Clinical trial information: NCT02489318 and NCT01946204 . Incidence of side effects for selected classes of concomitant medications by study and treatment actually received. Medication Class Treatment TITANRecipients(%) TITANTEAS(%) TITANTE SAEs(%) SPARTANRecipients(%) SPARTANTEAEs(%) SPARTANTE SAEs(%) Antihypertensives APA+ADT (PBO+ADT) 41 (34.3) 41.9 (39.2) 1.9 (1.7) 42.8 (41) 49.4 (36.8) 0.9 (0.6) Antidiabetics APA+ADT (PBO+ADT) 12.2 (10.8) 34.4 (33.3) 1.6 (1.8) 12.2 (9.3) 42.9 (27) 3.1 (0) Statins APA+ADT (PBO+ADT) 23.9 (15.6) 12 (11) 0 (0) 33.9 (31.7) 10.7 (6.3) 0 (0) PPIs APA+ADT (PBO+ADT) 17.6 (14.6) 6.5 (1.3) 0 (0) 26 (21.6) 8.6 (9.3) 0 (1.2) Corticosteroids APA+ADT (PBO+ADT) 14.9 (11.2) 12.8 (18.6) 1.3 (0) 10.7 (8.3) 18.6 (15.2) 1.2 (0) Treatment-emergent AEs (TEAEs) and SAEs deemed attributable to the pharmacologic class of the concomitant medication are classified as class-related side effects and included in the analysis. Percentages of TEAEs and SAEs are calculated based on recipients of a given class of concomitant medication.

Prevalence of germline cancer predisposition pathogenic variants in cancer cohorts.

e22667 Background: Clinical practice guidelines recommend germline genetic testing for a broadening scope of incident adult malignancies. The objective of this study was to identify the frequency of germline pathogenic variants (PVs) in cancer cohorts. Methods: We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of the proportion of individuals with incident cancer who harbor cancer germline predisposition PVs. We searched MEDLINE, Embase, and CENTRAL from inception through August 2025. The primary outcome evaluated was the percentage of those with incident malignancy who harbor a germline cancer predisposition PV. Meta-analysis was conducted using R software (Version 4.4.2 (6/14/2024)). Random effects models were reported. Risk of bias was evaluated using tools from the Joanna Briggs Institute. Publication bias was assessed by evaluating funnel plots. Results: In mixed cancer cohorts, 8 heterogeneous moderate-quality studies without significant evidence of publication bias revealed a pooled population of 40,436 individuals with 15.6% [95% CI 12 – 21] harboring a germline cancer predisposition PV and BRCA 2 (21%) BRCA 1(16%), CHEK2 (10%), and ATM (8%) PVs being most common. PV stage distribution was Stage 0 3.4% [95% CI 1.0-5.8], Stage I 5.5% [95% CI 1.0-25], Stage II 12.2% [95% CI 0.5-80], Stage III 37% [95% CI 1.0-90], and Stage IV 38.1% [95% CI 2.6-94]. Approximately 29% [95% CI 4.5%-79] of those with PVs did not meet NCCN criteria for germline cancer genetic testing. Variants of unknown significance were found in 43% [95% CI 26-62] and negative test results in 54% [95% CI 34-72%]. Where demographics were reported, mean age was 55 years, 14.9% of participants were non-Hispanic White, 2.7% Black, 4.3% Hispanic, 0.3% Asian, and the remaining classified as “other/unknown.” Approximately 64% of participants were women. Prevalence of PV in publications that reported on a singular cancer type was as follows: ovarian [14.1% 95% CI 6.4 -28] (3 studies, 4130 participants); colorectal cancer [13.1% 95% CI 9.7 -17] (3 studies 1899 participants); prostate [12% 95% CI 9.0-15] (12 studies 36,839 participants); endometrial cancer [11% 95% CI 5.1-20] (4 studies 1884 participants); pancreatic [10% 95% CI 5.3-18] (7 studies, 5087 participants); breast [9.1% 95% CI 7.0-12] (11 studies of 112,110 participants). Single cancer studies were heterogeneous, of low/moderate quality, and with no evidence of publication bias. Conclusions: Approximately 16% of those in a mixed-cancer cohort harbor cancer germline pathogenic variants, with trends towards increased prevalence by cancer stage. PV prevalence in select single cancer cohorts ranged from 9 – 14%.

Association between specific cancer types and polyarteritis nodosa among hospitalized patients in the United States.

e18631 Background: Since immunization programs drastically reduced Hepatitis-B associated polyarteritis nodosa (PAN), the correlation between PAN and cancer has become more essential yet cancer types strongly linked with PAN remain poorly defined. We aim to quantify the association of specific cancer types with PAN. Methods: Adults admitted between 2016-2022 were recruited via the National Inpatient Sample, excluding COVID-19 cases. We identified myelodysplastic syndrome, Hodgkin lymphoma, non-Hodgkin lymphoma, chronic lymphocytic leukemia, hairy cell leukemia, chronic myelomonocytic leukemia, multiple myeloma, angioimmunoblastic T-cell lymphoma, gastric, lung, colon, renal cancers, cholangiocarcinoma, and PAN. Multivariable logistic regression estimated associations of each cancer versus controls without malignancy for PAN, reported as adjusted odds ratios (aOR), 95% confidence intervals (CI), and p-values, adjusted for age, sex, race, insurance, hospital characteristics, admission year, and comorbidities including hepatitis B/C, HIV/AIDS, autoimmune conditions, diabetes, hypertension, dyslipidemia, peripheral vascular disorders, heart failure, chronic kidney disease, liver disease, and COPD. Results: We evaluated over 199 million hospitalizations. Angioimmunoblastic T-cell lymphoma demonstrated the strongest association with PAN (aOR 8.146, 95% CI 2.471-26.855, p=0.001). Chronic myelomonocytic leukemia was also significantly associated (aOR 2.646, 95% CI 1.080-6.487, p=0.033). Lung cancer showed significant inverse association (aOR 0.634, 95% CI 0.445-0.902, p=0.011). Several hematologic malignancies showed elevated but non-significant associations: hairy cell leukemia (aOR 2.712, 95% CI 0.373-19.717, p=0.324), myelodysplastic syndrome (aOR 1.767, 95% CI 0.657-4.754, p=0.260), Hodgkin lymphoma (aOR 1.379, 95% CI 0.570-3.340, p=0.476), chronic lymphocytic leukemia (aOR 1.143, 95% CI 0.647-2.018, p=0.646), non-Hodgkin lymphoma (aOR 1.021, 95% CI 0.726-1.435, p=0.906). Multiple myeloma showed non-significant inverse association (aOR 0.748, 95% CI 0.426-1.314, p=0.312). Solid tumors showed non-significant inverse associations: gastric cancer (aOR 0.304, 95% CI 0.043-2.156, p=0.233), colon cancer (aOR 0.666, 95% CI 0.336-1.319, p=0.244), renal cancer (aOR 0.377, 95% CI 0.133-1.066, p=0.066), cholangiocarcinoma (aOR 0.752, 95% CI 0.173-3.259, p=0.703). Conclusions: Certain hematologic malignancies like angioimmunoblastic T-cell lymphoma and chronic myelomonocytic leukemia were most strongly linked with PAN supporting immune dysregulation in PAN pathogenesis. Lung cancer showed reduced association suggesting variability in immune response among cancer subtypes. Further studies should explore the cancer-PAN link.

Impact of pain on functional status, quality of life, and cognition in older adults with prostate cancer.

e23084 Background: Pain is a common symptom in patients with cancer that can be compounded by aging. Studies of its multidimensional impact on functional status, physical and cognitive function, and health-related quality of life (HRQOL) in older patients with prostate cancer are limited. Methods: Patients with prostate cancer ≥50y harmonized across three single-institution prospective registries: Cancer and Aging Resilience Evaluation (CARE), Web-enabled CARE (WeCARE), and Cognition in Advanced Prostate Cancer Patients Treated with Androgen Blockers (CAPITAL) completed a self-reported geriatric assessment (GA) at baseline (time of presentation to a medical oncologist). Pain was measured on a 10-point Likert scale ("In the past 7 days, how would you rate your pain on average?"), and based on prior literature moderate-severe pain defined as ≥ 4. Functional status was measured by Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL). Physical function was measured by self-reported ECOG performance status and ability to walk one block, perform vigorous activities, and climb one flight of stairs. HRQOL measured using PROMIS 10-item Global Health questionnaire; social activity by 2 items from MOS Social Support survey; and cognition by PROMIS Cognitive Function Short Form 4a. Multivariable logistic regression models assessed associations between pain and GA impairments adjusting for age, race, education, marital, and employment status. Results: We included 175 patients, median age 70yrs (range: 51-93), 69% White, 23% Black, 63% married, 57% disabled, retired, or unemployed, and 53% with college education or above. A total of 45% of patients reported moderate-severe pain. Table 1 reports adjusted odds ratios and 95% confidence intervals of associations of pain and GA impairments. Conclusions: Pain is highly prevalent among patients with prostate cancer at time of presentation and associated with significant impairments in functional status, physical and cognitive function, social activity and HRQOL. These findings underscore the importance of routine pain assessment and identifying strategies to reduce pain and minimize its impact on patient well-being. Future work needs to assess impact of cancer treatment and stage, comorbidities, and age-related conditions that may compound pain. Association of moderate-severe pain with GA impairments. Variables Adjusted odds ratio (aOR) 95% Confidence interval (CI) P value IADL 4.09 2.09-7.96 ≤0.001 ADL 5.81 2.01-16.84 0.001 Walking 1 block 1.98 1.05-3.76 0.04 Climbing 1 flight of stairs 2.31 1.15-4.63 0.02 Vigorous Activities 4.32 1.77-10.52 0.001 Self-rated ECOG Performance Status 5.23 2.27-12.06 ≤0.001 Health-Related Quality of Life (HRQOL) 3.88 2.02-7.47 ≤0.001 Cognitive Function 1.89 0.97-3.69 0.06 Social Activities 2.80 1.35-5.78 0.005

Trends in mortality due to heart failure and malignant neoplasms among adult patients in the United States: A 25-year nationwide retrospective analysis with 12-year future projections.

e24002 Background: Malignant neoplasms and heart failure (HF) are major contributors to morbidity and mortality in older adults. Although the interplay between cancer and HF has gained increasing attention, national patterns of HF-related mortality among individuals with malignant neoplasms remain insufficiently described. Understanding these trends is crucial, as HF represents a potentially preventable cause of death with important implications for prognosis, clinical management, and healthcare system planning. This study examines national trends in HF and malignant neoplasms-related mortality among patients across demographic and geographic subgroups in the United States from 1999 to 2023. Methods: A retrospective analysis of CDC WONDER mortality data from 1999 to 2023 was performed. Deaths related to malignant neoplasms (ICD-10 C00–C97) and HF (ICD-10 I50) were identified, and age-adjusted mortality rates (AAMRs) were calculated. Joinpoint regression was used to evaluate annual percent change (APC) in mortality trends, with stratification by age, sex, race/ethnicity, and geographic region, including census divisions and state-level patterns. 12 Year (2024-2035) future mortality trends were projected using an autoregressive integrated moving average (ARIMA) time-series model. Results: A total of 684,474 deaths occurred between 1999 and 2023. The majority occurred in inpatient medical facilities (33.15%) or at home (32.08%). National AAMRs declined from 1999 to 2012 but reversed thereafter, rising from 10.20 in 2012 to 14.60 in 2023. Forecasts predict a continued increase to 15.19 by 2035. Significant early declines were observed across demographic groups, followed by subsequent increases beginning in the mid-2010s. Males consistently exhibited higher AAMRs than females, and older adults (65–85+) experienced the highest mortality burden. Racial disparities revealed the highest AAMRs among Non-Hispanic Black and Non-Hispanic White populations. Geographic variation was substantial: the Midwest had the highest regional AAMR, while the Northeast had the lowest. State analyses revealed the highest AAMR in Mississippi (21.15) and the lowest in Arizona (6.95). States such as Mississippi, Nebraska, Oregon, North Dakota, and Oklahoma demonstrated the greatest mortality burdens. Conclusions: U.S. mortality related to HF and malignant neoplasms shows a concerning reversal of prior improvements, with rising AAMRs since 2012 and persistent sociodemographic and geographic disparities. Forecasted increases through 2035 highlight an urgent need for targeted public health strategies, equitable healthcare access, and intensified chronic disease prevention and management efforts. These findings highlight the importance of monitoring at-risk populations and addressing systemic factors.

Post-prophylaxis CMV in the letermovir era: Incidence, risk factors, and outcomes following HCT.

6561 Background: Cytomegalovirus (CMV) is a major infectious complication after allogeneic hematopoietic cell transplantation (HCT). Letermovir prophylaxis (ppx) effectively reduces clinically significant CMV infection (csCMVi) within 100 days, but csCMVi after ppx discontinuation occurs in 7–16%. Extended letermovir ppx has been proposed for high-risk patients, though optimal patient selection is uncertain. Our study aims to define the incidence, risk factors, and outcomes for post-ppx csCMVi to guide extended ppx strategies. Methods: We analyzed adult CMV-seropositive (+) HCT recipients at Cleveland Clinic who received ≥45 days of Letermovir primary ppx between 1/1/2018-12/31/2024. The primary outcome was post-ppx csCMVi, defined as CMV disease or asymptomatic viremia requiring preemptive therapy. Secondary outcomes included overall and non-relapse mortality. Patients with csCMVi during standard ppx were excluded. Associations with csCMVi were evaluated using competing-risk models accounting for mortality, with multivariable Cox analyses adjusting for age, sex, Karnofsky score. Results: Among 311 CMV+ recipients of HCT, 62% were donor-CMV negative and 50% were male. Median age was 59 (47-67) years. HCT was most commonly for AML (48%), with matched unrelated donors (54%), peripheral blood graft (76%), myeloablative conditioning (45%), and GVHD ppx with post-transplant cyclophosphamide (PTCy) (63%). Grade ≥2 acute GVHD (36%), chronic GVHD (53%), and relapse (22%) were common in the cohort. Post-ppx infection occurred in 64 patients (21%), including 8 (13%) with tissue-invasive disease. Median duration of Letermovir was 75 days, typically initiated on day 28 post-transplant. Median time to csCMVi was 123 days from transplant. Cumulative incidence of post-ppx csCMVi was 9% at 60 days, 11% at 90 days, and 12% at 180 and 360 days. Risk factors included older age (HR 1.04 per year, 95% CI=1.01-1.07, p=0.014), female sex (HR 3.3, 95% CI=1.5-7.1, p=0.003), chronic GVHD (HR 9.9, 95% CI=1.2-5.6, p=0.024), and GVHD treated with steroids (HR 9.86, 95% CI=1.4-71.5, p=0.024) or ruxolitinib (HR 2.8, 95% CI= 1.3-6.3, p=0.011). Primary disease, donor CMV status, donor relationship, graft source, conditioning intensity, ATG, and PTCy were not associated with csCMVi. All-cause mortality was high in the cohort (37%), particularly in the late csCMVi group (52%). Post-ppx csCMVi was associated with increased non-relapse (HR 2.36, 95% CI= 1.37-4.07, p=0.002) and overall mortality (HR 2.41, 95% CI= 1.43-4.06, p<0.001) in multivariable analysis adjusted for age and sex. Conclusions: Late csCMVi occurs in 12% of CMV+ HCT recipients after prophylaxis discontinuation and may confer additional mortality risk. These findings support risk-adapted surveillance and extended prophylaxis in high-risk groups, particularly recipients who are older, female, and have chronic GVHD requiring immunosuppression.

Impact of eftilagimod alfa, an APC activator via MHC class II, on lymphocyte activation and survival outcomes in metastatic cancer patients.

2569 Background: Immune activation is important for survival in cancer. Eftilagimod alfa (E), an antigen-presenting cell (APC) activator, binds to a subset of MHC class II molecules on APCs to mediate lymphocyte, e.g. T cell (CD4/CD8), recruitment/activation. Clinical studies of E in combination with a PD-1 antagonist (P) or chemotherapy (C) have shown promising results in phase 2 studies, and E is currently investigated in a phase 3 study in combination with P and C in first-line NSCLC (NCT06726265). We present cumulative correlation studies of immune activation in blood after administration of E with clinical efficacy in late-stage cancer patients (pts). Methods: Five (5) studies with 569 pts were evaluated. 30 mg E in combination with either P (pembrolizumab IV at 200 mg q3w or 400 mg q6w or 2 mg/kg q3w) or C (paclitaxel 80 mg/m 2 day 1, 8, 15, q4w) was administered SC biweekly for 6 months (mo), then every 2-4 weeks for 6-18 mo in pts with late-stage metastatic NSCLC, HNSCC, melanoma, or breast cancer. Absolute lymphocyte count (ALC) was taken before dosing (day 1 per cycle). ALC response was pre-defined as a change ≥0.2 x 10 9 /L in ≤3 mo on study. Samples for gene expression profile (GEP) were taken pre-dose / 3 mo in a subset (N=111). IFN-g and CXCL10 were assessed pre-dose / after 1 st E admin in a subset (N=79). Clinical efficacy was assessed by iRECIST and survival. Results: Treatment with E led to a rapid (3 mo) and sustained (~12 mo) stat. sign. (p=0.03) ALC gain versus control arm. 54.4% of all pts treated with E were ALC responders (53.6% for E+P; 55.1% for E+C). In ALC responders with E, overall survival (OS) was significantly improved (see Table 1) compared to non ALC responders. Effects were observed irrespective of the combination partner, P or C, with a median increase of 6.8 or 5.2 mo, respectively. In pts treated with P or C alone (control), 40.4% were ALC responders but with no sign. median OS gain. Clinical responders (iPR or iCR as BOR) exhibited consistent upregulation of immune pathways associated with T-cell functions, NK cell functions and cytotoxicity during treatment in GEP analysis. These functions were not upregulated in non-responders. IFN-g and CXCL10 concentrations increased quickly (~8h) and significantly post-first E dosing compared to baseline and levels remained elevated until next E dosing. This effect with E was consistent with P or C. Conclusions: E leads to immediate and sustained ALC increase and TH1 type reaction, which is associated with clinical efficacy in combination with P or C. Treatment Effects Results E (N=408) ALC Responder with E 54.4% (N=222/408) Impact on survival: ALC responder vs. ALC non-responder Median OS+ 7.7 mo(23.4 vs.15.7 mo)HR=0.69; p=0.002 Control arm (N=161) ALC Responder in control arm 40.4% (N= 65/161) Impact on survival: ALC responder vs. ALC non-responder Median OS+2.9 mo(20.4 vs. 17.4 mo)HR=0.98; p=0.93

Trilaciclib for myeloprotection in adjuvant and first-line chemotherapy for advanced gastric/gastroesophageal junction adenocarcinoma: A multicohort study.

12152 Background: Chemotherapy-induced myelosuppression (CIM) has become one of the important limiting factors in the treatment of gastric cancer, which significantly impairs patients' prognosis.Trilaciclib, a highly selective reversible CDK4/6 inhibitor, reduces chemotherapy-induced hematopoietic stem/progenitor cell (HSPC) damage via transient G1 arrest when administered intravenously pre-chemotherapy, while its transient T-cell suppression may modulate the tumor immune microenvironment.This study evaluates trilaciclib’s myeloprotective efficacy in adjuvant and first-line metastatic gastric/gastroesophageal junction adenocarcinoma (GA/GEJA) and explores immunomodulatory effects. Methods: This prospective multicohort study (ChiCTR2500097520) enrolled Cohort 1 (resectable GA/GEJA, T1-4bN0-3M0 post-D2/R0 resection; n = 75) and Cohort 2 (first-line metastatic GA/GEJA, including recurrence > 6 months post-adjuvant; n = 40). Regimens included SOX/XELOX/FOLFOX ± immune checkpoint inhibitors (ICIs) ± trastuzumab. Trilaciclib (240 mg/m²) was given on days 1 and 3 every 21 days for 6–8 cycles. Primary endpoints: incidence of grade ≥3 neutropenia and febrile neutropenia (FN); exploratory analyses included immune biomarkers and antitumor efficacy. Results: As of January 2026, 204 patients were enrolled (male: 158 ; female: 46; median age: 63 years [range: 31–82]). Cohort 1: 118 patients (primary prophylaxis [PP]: 98 ; secondary prophylaxis [SP]: 20 ). Cohort 2: 86 patients (PP: 48 ; SP: 38 ). Grade ≥3 CIM incidence: Cohort 1 vs. Cohort 2: 4.46% vs. 2.96%; grade ≥3 neutropenia: 3.24% vs. 1.73%; thrombocytopenia: 1.54% vs. 0.74%; anemia: 0.77% vs. 1.97%. Prophylaxis-stratified analysis showed superior myeloprotection with PP: overall grade ≥3 CIM (PP:3.35% vs. SP: 4.56%), neutropenia (PP: 2.75% vs. SP:1.83%), thrombocytopenia (PP: 0.6% vs. SP: 2.29%), and anemia (PP: 1.32% vs. SP: 0.91%). Furthermore, the collection and detection of immune cells from 97 patients before and after treatment revealed that: the total number of T cells in patients showed an increasing trend after prophylactic medication. The number of CD4+ T cells showed an increasing trend; the number of CD8+ T cells began to decline after more than 3 cycles of chemotherapy; the number of Treg T cells increased and returned to the pre-chemotherapy level after more than 4 cycles. Conclusions: Trilaciclib demonstrated effective myeloprotection and immunoregulation in GA/GEJA, with PP showing a favorable trend. Grade ≥3 CIM rates were ≤5.88% (adjuvant) and ≤3.49% (metastatic), with no new safety signals. The studies will continue to analyze the correlation between immune-related indicators and anti-tumor efficacy. Clinical trial information: ChiCTR2500097520.

Neoadjuvant darovasertib in uveal melanoma patients undergoing primary local therapy (OptimUM-10): Phase 3 trial.

TPS9608 Background: Uveal melanoma (UM) is the most common intraocular malignancy and has high risk of metastatic progression and poor long-term survival. Standard treatment of the primary tumor includes enucleation (eye-removal), and radiation therapy including plaque brachytherapy (PB) and proton beam therapy, which can result in vision loss or removal of the eye. No approved neoadjuvant therapies exist that shrink the tumor or improve visual outcomes. Almost all UM tumors harbor GNAQ/GNA11 initiating mutations with downstream constitutive activation of protein kinase C (PKC). Darovasertib, a first-in-class oral PKC inhibitor tested in study OptimUM-09, has demonstrated the ability to reduce UM tumor size resulting in enucleation sparing in patients with large tumors, and radiation reduction in patients with medium sized tumors requiring PB. In addition, visual improvements have been observed not only during neoadjuvant therapy but also in the predicted risk of legal blindness post PB using a vision prognostication tool. Methods: OptimUM-10 is an ongoing phase 3, randomized, multicenter, open-label trial enrolling patients with primary non-metastatic UM. Eligible patients must have high metastatic risk (class 2 gene-expression profile, monosomy 3, or AJCC stage 3). Additionally, for the PB cohort, moderate to high risk of vision loss (> 30Gy predicted radiation dose to key visual structures) is required for eligibility. Major exclusion criteria include metastatic disease or extraocular tumor extension, prior UM primary treatment, attributes necessitating immediate enucleation, and relevant ocular comorbidities. The trial has two cohorts: Cohort 1 (n=330) includes patients with medium UM tumors where PB is the standard treatment. Cohort 2 (n=120) includes patients with large UM tumors where enucleation is the standard treatment. In each cohort, eligible patients are randomized 2:1 to receive neoadjuvant darovasertib (300 mg twice daily for up to six 28-day cycles) or standard-of-care treatment with PB (cohort 1) or enucleation (cohort 2). The primary endpoint for cohort 1 is the proportion of patients with loss of Early Treatment Diabetic Retinopathy Study Best-Corrected Visual Acuity of ≥15 letters (%VL15) from randomization, while in cohort 2 it is eye preservation rate. Across cohorts, the key secondary objective is to evaluate response rate with neoadjuvant darovasertib. Additional secondary endpoints include event-free survival and safety, as assessed by treatment-emergent adverse events and serious adverse events. Enrollment is ongoing, and results will determine whether OptimUM-10 may establish darovasertib prior to definitive PB as the first neoadjuvant treatment for primary UM to meaningfully reduce tumor burden and expand vision- and eye-preserving treatment options for patients. Clinical trial information: NCT07015190 .

Phase II basket trial of brigatinib for <i>ALK</i> fusion–positive solid tumors: ALLBREAK trial (WJOG15221M).

3105 Background: ALK fusions occur in approximately 0.2% of solid tumors other than non-small cell lung cancer (NSCLC) and are associated with poor outcomes. Prospective evidence for ALK tyrosine kinase inhibitors in this rare condition is limited. Methods: This phase II basket trial evaluated brigatinib (90 mg once daily for 7 days, then 180 mg once daily) using a decentralized clinical trial platform. Eligible patients had advanced solid tumors other than NSCLC with ALK fusions detected in tumor tissue or circulating tumor DNA (ctDNA). The initial planned sample size was 14, with an objective response rate (ORR) of 50% considered promising and 12% unacceptable (one-sided α = 0.025; β = 0.09). Enrollment was expanded to 28 patients due to rapid accrual. ctDNA analyses were performed at baseline, cycle 2, and progressive disease (PD). Results: Twenty-eight patients from ten hospitals were enrolled from May 2022 to March 2025; one was excluded from the full analysis set (FAS) due to clinical deterioration before treatment initiation. The FAS (n = 27) included patients with biliary tract cancer (BTC), colorectal cancer (CRC), thyroid cancer (TC), inflammatory myofibroblastic tumor (IMT), or other solid tumors (n = 7, 5, 3, 3, and 9, respectively). ECOG PS was 0 or 1 (18/9). The number of prior lines of therapy was 0–2 and ≥3 in 20 and seven patients, respectively. ALK fusions were detected by next-generation sequencing (NGS) or fluorescence in situ hybridization (22/5). Among NGS-detected cases, fusion partners included EML4 (n = 8), STRN (n = 2), and others (including CEP44 , HOOK1 , TPM3 , and RRBP1 ; n = 12). The confirmed ORR in the FAS was 63.0% (95%CI, 42.4–80.6), with ORRs of 57% in BTC, 60% in CRC, and 67% each in TC, IMT, and other tumors. For the first 14 patients enrolled as per initial study design, the ORR was 57.1% (95% CI, 28.9–82.3%). In the FAS, the disease control rate was 92.6%, and the median progression-free survival, duration of response, and overall survival were 9.7, 14.4, and 19.5 months, respectively. At data cutoff, 11 patients remained on treatment. ORR varied with fusion partner: 38% for EML4 , 100% for STRN, and 75% for other partners. ORR was comparable between patients with and without baseline ctDNA detection of ALK fusions (67% vs. 64%). At PD, acquired ALK mutations (G1202R, E1028K, and L1502L) were detected in 23% (3/13) of patients; alterations in EGFR, KRAS, or MET were observed in 23% (3/13) of patients. The most common grade 3–4 adverse events were increased creatine phosphokinase (11%) and hypertension (11%). Interstitial lung disease occurred in 7% of patients (grade 1 only; no grade 3–4). No treatment-related deaths occurred. Conclusions: Brigatinib shows a high, durable response rate and manageable toxicity in non-NSCLC ALK fusion–positive solid tumors, supporting its use as a tumor-agnostic therapeutic agent in this rare molecular subset. Clinical trial information: jRCT2041210148.

Treatment-related hypomagnesemia and pertuzumab discontinuation in HER2-positive breast cancer: A decade of Appalachian data.

e12677 Background: Breast cancer remains the most frequently diagnosed cancer among women. Intensive chemotherapy for early-stage HER2-positive breast cancer often causes side effects, including electrolyte disturbances. At our institution, treatment-related hypomagnesemia has become a notable concern, sometimes requiring interruption or adjustment of therapy. Despite the widespread use of these chemotherapy protocols, there are no established guidelines for routine magnesium monitoring. This study examined the frequency of hypomagnesemia, its association with specific chemotherapy regimens, and its impact on treatment completion. Methods: Our single-center retrospective study included adults with HER2-positive breast cancer treated from 2014 to 2024. We examined the frequency of hypomagnesemia during treatment for stage I-II HER2-positive breast cancer. Patients with preexisting hypomagnesemia were excluded. We also assessed the association between hypomagnesemia and standard chemotherapy regimens, including TCHP and TH. To minimize confounding, we adjusted analyses for diuretic and proton pump inhibitor (PPI) use. Secondary outcomes included rates and reasons for pertuzumab discontinuation in HER2-positive breast cancer, regardless of stage. Results: Among 138 early-stage HER2+ breast cancer patients without preexisting hypomagnesemia, 41.3% (57) developed hypomagnesemia during treatment. Hypomagnesemia was more common in patients receiving TCHP (docetaxel, carboplatin, trastuzumab, pertuzumab) than in those receiving TH (paclitaxel, trastuzumab) (45.5% vs 23.1%, p = 0.036). After adjusting for potential confounders, including age, BMI, performance status, diuretic and PPI use, TCHP remained associated with higher odds of hypomagnesemia (OR 2.8, 95% CI 1.04–7.46; p = 0.04). This association was mediated mainly by diarrhea, which was strongly associated with hypomagnesemia (OR 4.54, 95% CI 2.04–10.12; p &lt; 0.001). Across all stages of HER2+ breast cancer (134), the pertuzumab discontinuation rate was 46.3% (62), with diarrhea accounting for the majority of discontinuations (64%). Conclusions: TCHP therapy is associated with an increased risk of hypomagnesemia, primarily due to treatment-related diarrhea, which often leads to discontinuation of treatment. Larger prospective studies are needed to assess the clinical significance. Patients receiving pertuzumab-based therapy may benefit from regular magnesium monitoring and early intervention. Comparison of Hypomagnesemia and Diarrhea outcomes between TCHP and HP regimens. Outcome TCHP (112) TH (26) Estimate Hypomagnesemia, n (%) 45.5% 23.1% p = 0.036 Diarrhea, n (%) 56.3% 3.9% p &lt; 0.001 Median days to hypomagnesemia (IQR) 63 (41–92) 42 (14–73) p = 0.34 TCHP vs TH (adjusted OR, 95% CI) — — 2.79 (1.04–7.46) Diarrhea (adjusted OR, 95% CI) — — 4.54 (2.04–10.12)

Moisture-driven local strain development in ASR-damaged concrete

Although alkali–silica reaction (ASR) is widely recognized as one of the major concrete durability issues, the mesoscale response of pre-existing ASR products to moisture exposure remains poorly understood. In this study, neutron tomography combined with image registration is employed to non-destructively quantify moisture-induced local deformation in concrete specimens already affected by ASR damage. Three concrete mixes with different aggregate reactivities were imaged before and after 72 hours of water exposure. The resulting volumetric strain fields show that the largest localized expansions are concentrated within the crack network of the cement paste, where amorphous ASR products are expected to be prevalent. In contrast, cracks within aggregates, which typically contain crystalline ASR phases, exhibit substantially lower expansion. These observations provide direct experimental evidence supporting the hypothesis that amorphous ASR products possess a greater swelling potential than crystalline counterparts.

Engineering a surface reconstruction cascade via synergistic halide management for high-performance perovskite photovoltaics

The efficiency and stability of perovskite solar cells (PSCs) are limited by surface defect-induced non-radiative recombination and ion migration. Herein, we propose a cascading-cooperative reconstruction strategy based on synergistic post-treatment with methylammonium chloride (MACl) and phenethylammonium iodide (PEAI), which forms a uniform passivation layer on perovskite films via a two-step solution process. Unlike conventional single-step passivation, MACl treatment induces a dissolution-recrystallization process to enlarge the grain size, while subsequent PEAI treatment further passivates grain boundary defects through ion exchange and amine coordination. The synergistic post-treatment reduces the surface trap density of perovskite to 1/3 of the control sample, with an increase in the open-circuit voltage (Voc) to 1.15 V, and a champion power conversion efficiency (PCE) of 23.24%. Besides, the device retains over 90% of its initial PCE after 720 h. This strategy, by elucidating the mechanism of constructing robust interfaces through cascading passivation, provides a new design principle for fabricating highly stable inverted PSCs.

Modelling and simulation of bio-convective nanofluid flow under magnetic, porous, radiative, and chemical reaction effects using CCM and GWRM

Nanomaterial Integration at Liquid–Liquid Interfaces for Green Catalysis

ABSTRACT The assembly of functional nanomaterials at liquid–liquid interfaces offers a promising approach to address mass transfer and catalyst‐recovery limitations in conventional biphasic catalytic systems. This strategy exploits engineered colloidal particles serving dual roles as emulsion stabilizers and catalytic sites, creating platforms with high interfacial area‐to‐volume ratios. These systems can exhibit improved reaction kinetics with efficient phase separation and catalyst recyclability while potentially operating under milder conditions that reduce energy consumption and waste generation. This review analyzes recent developments in the design, synthesis, and surface engineering of interfacially active nanocatalysts. It is examined structure‐performance relationships governing catalytic efficiency and emulsion stability, assess industrial implementation challenges including scalability and economic viability, and evaluate prospects of Pickering emulsion‐based microreactor platforms as enabling technologies for sustainable chemical processes aligned with green chemistry principles and circular economy frameworks.