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Secondary hematologic malignancy mortality in older survivors of gastrointestinal cancer.
e18611 Background: Improved survival following gastrointestinal (GI) cancers has increased the population at risk for second hematological malignancies (SHMs), including leukemia, lymphoma, and myelodysplastic syndromes. However, demographic, geographic, and urban–rural disparities related to SHMs among older GI cancer survivors at the national level remain insufficiently described. Methods: We conducted a nationwide cross-sectional mortality analysis using the CDC-WONDER Multiple Cause-of-Death database from 1999 to 2023. Deaths among individuals aged ≥65 years with both GI malignancies (ICD-10 C15–C26) and SHMs (ICD-10 C81–C96) listed on death certificates were included. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated using the 2000 U.S. standard population. Temporal trends were evaluated using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC) with 95% CIs. Results: A total of 22,668 SHM-related deaths among older adults with GI malignancies were identified. The overall AAMR increased from 21.88 in 1999 to 25.55 in 2023. Nationally, mortality declined from 1999 to 2018, followed by a significant rise from 2017 to 2023 (APC 5.49; 95% CI 3.63–8.61). Males had a substantially higher average AAMR than females (31.07; 95% CI 28.40–33.74 vs. 14.10; 95% CI 12.65–15.58). Among males, AAMRs declined till 2017, before increasing sharply from 2017 to 2023 (APC 5.63; 95% CI 3.57–9.03). Females showed a decline till 2015, followed by an increase from 2015 to 2023 (APC 3.58; 95% CI 2.15–5.78). Age-stratified analyses demonstrated rising mortality with advancing age: CMRs were lowest among those aged 65–74 years (10.56; 95% CI 9.25–11.88) and highest among those aged ≥85 years (45.71; 95% CI 40.03–51.39). Recent increases were observed across all age groups, most pronounced in adults aged ≥85 years (APC 6.88; 95% CI 3.51–14.55 from 2017–2023). Non-Hispanic White individuals had the highest average AAMR (22.35; 95% CI 20.76–23.93), followed by Black or African American individuals (18.84; 95% CI 14.51–23.98), with both groups exhibiting significant post-2016 increases. Regionally, the Midwest recorded the highest average AAMR (25.65; 95% CI 22.42–28.88). Non-metropolitan areas consistently showed higher mortality than metropolitan areas (23.37; 95% CI 19.89–26.85 vs. 19.98; 95% CI 18.46–21.50). Conclusions: SHM-related mortality among older adults with GI malignancies has risen significantly in recent years, following nearly two decades of decline. Marked disparities by sex, age, race/ethnicity, geography, and urbanization persist. These findings highlight an urgent need for enhanced survivorship surveillance, equitable access to oncology care, and targeted public health interventions to address the growing and uneven burden of secondary hematological malignancies.
Real-world outcomes of trastuzumab plus chemotherapy in HER2-positive biliary tract cancers from a high-incidence region.
e16234 Background: Biliary tract cancers (BTCs), particularly gallbladder carcinoma (GBC), are aggressive malignancies with a disproportionately high burden in Northern India. HER2 overexpression or amplification is a clinically actionable alteration in a subset of BTCs. However, prospective randomized data for HER2-directed therapy in BTC are limited. We evaluated the real-world effectiveness of trastuzumab combined with chemotherapy in patients with HER2-positive BTC. Methods: We conducted a retrospective cohort study of 67 consecutive patients with HER2-positive BTC (IHC 3+ or IHC 2+ with amplification) treated between 2019 and 2024. Clinical and pathological characteristics were summarized descriptively. Patients received standard platinum- or fluoropyrimidine-based chemotherapy with or without trastuzumab. The primary endpoints were progression-free survival (PFS) and overall survival (OS), estimated using the Kaplan–Meier method and compared using the log-rank test. Results: The median age was 51 years (range, 28–74), with 69% female patients. Gallbladder carcinoma comprised 97% of cases, and 88% had HER2 IHC 3+ expression. Metastatic disease at presentation was present in 75% of patients. Trastuzumab was administered to 35 patients (52%), including 24 (69%) in the first-line setting. At a median follow-up of 12.6 months, median PFS was 6.0 months (95% CI, 4.9–6.4) in the trastuzumab group compared with 1.8 months (95% CI, 1.4-3.8) in the non-trastuzumab group (p < 0.001), representing an approximately 3-fold improvement. Median OS was 8.5 months (95% CI, 6.4-9.4) with trastuzumab versus 2.1 months (95% CI, 1.5-2.7) without trastuzumab (p < 0.001). The 6-month OS rate was 83.9% in the trastuzumab cohort compared with 16.6% in the control cohort. Conclusions: In this real-world cohort from a high-incidence region, the addition of trastuzumab to chemotherapy resulted in a clinically and statistically significant improvement in PFS and OS in patients with HER2-positive BTC. These data support routine HER2 testing and integration of HER2-targeted therapy into standard treatment algorithms for this molecularly defined subgroup.
Association of KRAS variant subtypes with survival and recurrence in patients with surgically treated colorectal liver metastases.
e16245 Background: KRAS mutations are common in colorectal cancer and associated with poor outcomes after colorectal liver metastases (CRLM) resection. However, the relationship between specific KRAS subtypes and survival/recurrence in CRLM patients post-resection is not well-defined. Methods: We retrospectively analyzed 1389 CRLM patients undergoing curative-intent hepatectomy (2020–2022). KRAS variants were determined by targeted sequencing with Sanger confirmation. OS and PFS were analyzed by Kaplan–Meier/log-rank tests, and prognostic factors were evaluated using Cox regression. Results: KRAS mutations were detected in 28.0% (389/1389) of patients. KRAS mutation prevalence was higher in females (32.8% vs 25.8%; P = 0.008), CEA-positive (29.8% vs 24.2%; P = 0.030), CA19-9-positive (31.0% vs 25.6%; P = 0.030), and patients with multiple liver metastases (31.4% vs 23.9%; P = 0.002; Table 1). KRAS mutations were more frequent in right-sided colon primaries (34.9%) compared to left hemicolon (24.5%). Among KRAS-mutant patients (n = 389), codon 12 variants accounted for 62.7%, predominantly G12D (32.1%) and G12V (12.9%) (Supplementary Table 1). Univariate Cox analysis showed that KRAS mutations were associated with shorter PFS (HR = 1.48; P < 0.001) and OS (HR = 2.18; P < 0.001), with the largest hazard ratios for G12V (PFS: HR = 2.06; OS: HR = 3.61; both P < 0.001; Table 2). KRAS-mutant tumors had shorter mPFS and mOS compared to WT tumors (mOS: 43 months vs not reached; mPFS: 15.87 vs 23.93 months; both P < 0.001) (Figure 1A). Codon 12 mutations, particularly G12V, conferred the worst survival outcomes (Figure 1B and 1C). Baseline characteristics were similar between codon 12 and non-codon 12 KRAS-mutant groups, except codon 12 variants were more common in males (66.0% vs 55.3%; P = 0.049; Table 3). In the codon 12–mutant subgroup (n = 244), G12V tumors were more frequent in CEA-positive than CEA-negative patients (25.4% vs 9.3%; P = 0.003) and in those with multiple liver metastases (25.2% vs 13.9%; P = 0.036; Table 4). Conclusions: KRAS mutations were frequent and independently predicted worse OS and PFS after curative hepatectomy. Prognostic impact varied across KRAS subtypes, with G12V indicating a high-risk subgroup. Incorporating codon-specific KRAS information into risk stratification and perioperative decision-making may refine patient selection and trial design.
Telemedicine in oncology: Impact on clinical outcomes, access to care, and future oncology practice.
e13539 Background: The COVID-19 pandemic accelerated the adoption of telemedicine in oncology to maintain continuity of care while minimizing infection risk. Although in-person care has largely resumed, tele oncology remains embedded in routine practice. Ongoing evaluation is needed to understand its impact on clinical outcomes, healthcare utilization, patient experience, and health equity in the post–COVID-19 era. Methods: We conducted a narrative review of published literature evaluating telemedicine across the cancer care continuum, including diagnosis, active treatment, survivorship, and palliative care. Outcomes of interest included treatment adherence, symptom control, healthcare utilization, patient and provider satisfaction, and equity considerations. Results: Evidence suggests that telemedicine is comparable to in-person care for selected oncology visits, particularly follow-up encounters, symptom management, oral therapy monitoring, survivorship care, and palliative services. Tele oncology is associated with improved access to care, reduced travel burden, and high patient satisfaction. Remote patient monitoring and electronic patient-reported outcome (ePRO) systems have demonstrated improved symptom control and, in some studies, reductions in emergency department visits and hospitalizations. Provider satisfaction is mixed, reflecting perceived efficiency gains alongside concerns about limited physical examination and digital fatigue. Importantly, disparities in telemedicine utilization persist, with lower uptake among patients with limited digital access, lower socioeconomic status, or language barriers. Conclusions: Telemedicine has emerged as a durable component of oncology care with demonstrated benefits in access, convenience, and continuity of care. While outcomes are comparable to in-person care for appropriately selected visits, intentional, equity-focused implementation is critical to avoid widening disparities. Future tele oncology models should emphasize hybrid care approaches, supportive policy frameworks, and prospective evaluation of clinical outcomes, cost-effectiveness, and equity.
Late-stage prostate cancer in Syria: A call for decentralized and early detection systems.
e23211 Background: The Syrian conflict, ongoing since 2011, has significantly disrupted healthcare delivery, particularly in oncology. With the destruction of many regional cancer centers, access to care has become centralized in Damascus, home to Al Bairouni University Hospital—the nation’s primary cancer referral facility. This study examines the geographic distribution and stage at diagnosis of prostate cancer patients, highlighting post-conflict disparities in access and outcomes. Methods: We conducted a retrospective chart review of all prostate cancer patients diagnosed at Al Bairouni University Hospital between January 2022 and December 2024. Data on age, residency, and stage at diagnosis were extracted and analyzed descriptively. Results: A total of 859 patients were included, with a mean age of 69 years (SD 9). Only 47% (n = 405) of patients resided in Damascus or its suburbs (Rif-Dimashq), while the majority (53%, n = 462) traveled from other governorates—most notably Aleppo (8.5%), Hama (9.1%), Homs (8.4%), and Al-Hasakah (6.2%). This geographic pattern reflects the collapse of regional oncology services due to prolonged conflict.Alarmingly, 65% of patients (n = 507) were diagnosed with metastatic disease (stage IV), while only 16% and 19% presented with localized and regional stages, respectively. This contrasts sharply with global trends and suggests systemic gaps in early detection. Contributing factors may include the absence of structured screening programs, weak insurance system and primary care infrastructure, low prostate cancer awareness, fear of cancer diagnosis, financial barriers, and limited healthcare access in rural areas. Conclusions: This study reveals the deep, lingering effects of war on prostate cancer care in Syria. The centralization of oncology services places undue burden on patients traveling long distances for care, while the predominance of advanced-stage diagnoses underscores the need for robust early detection efforts. These findings support urgent investment in rebuilding regional cancer infrastructure, expanding community-based health services, and improving access to timely diagnosis and treatment as the country enters a phase of reconstruction.
Characteristics of cancer patients undergoing molecular residual disease testing with a tumor-informed assay.
568 Background: Detection of circulating tumor DNA (ctDNA) is strongly associated with recurrence across a variety of cancers. The use of ctDNA testing to measure molecular residual disease (MRD) is still in its infancy, and understanding sample characteristics may help set expectations for oncologists and their patients. Methods: For the first thousand patients with MRD testing in Exact Sciences’ commercial laboratory, the tumor and first plasma sample were used to record tumor type, tumor sample type (biopsy/surgical), tumor stage, MRD assay panel size (up to 200 variants), cfDNA levels, and ctDNA status (qualitative and quantitative), and, when data were available, presence of targetable alterations (TAs) were recorded. Results: A total of 1088 samples with valid results were included. Patients were mostly female (N=703, 64.6%) with a median age of 64 (range 17–97) years, and most had either breast (N=380, 34.9%) or colorectal (N=335, 30.8%) cancer. Most (N=632, 58.1%) tumor samples were surgical, and average number of variants for MRD assays from 86 in ovarian cancer to 189 in melanoma. Plasma cfDNA yield ranged from 15 ng (the minimum required) to 10,709 ng and was significantly higher in 412 ctDNA+ (median 86.1 ng, mean 239.7 ng) compared to ctDNA– (median 73.5 ng, mean 114.6 ng) samples (p<0.001). In 13 cancers with at least 10 patient samples, only breast cancer showed a difference in the average number of identified variants between sample types (biopsy: 129.1 versus surgical: 101.5), stage IV cancers had more cfDNA than stage I, range of ctDNA+ samples was from 27% in melanoma to 65% in gastroesophageal cancers, and ctDNA+ proportion tended to increase with stage: 26 (14.2%) of 183 stage I, 84 (32.1%) of 262 stage II, 140 (38.9%) of 360 stage III, and 140 (65.1%) of 215 stage IV. ctDNA+ samples had levels between 2.6 and ≥352,000 parts per million (PPM), with 27 (6.6%) samples below 15 PPM, 40 (9.7%) between 15 and 50 PPM, and 345 (83.7%) above 50 PPM. Genomic profiling was performed on 158 samples, most from breast (N=50, 31.6%) and colorectal (N=17, 10.8%) cancer patients. The mean number of TAs per sample was 4.6, with little difference between the 114 ctDNA+ patients (mean = 4.4, range 0–24) and 44 ctDNA– patients (mean = 5.1, range 1–29). TAs were present in 83 (72.8%) and 36 (81.8%) tumors in ctDNA+ and ctDNA– patients, respectively. Of note, both high microsatellite instability and high tumor mutational burden tumors had numerically higher proportion in ctDNA– (15.9% and 9.1%, respectively) compared to ctDNA+ (5.3% in both) patients. Conclusions: ctDNA+ frequency varied by cancer type and cfDNA yields and ctDNA+ proportion increased numerically with stage, though where patients were in their treatment cycles was unknown. Of patients with profiling results, a large proportion of patients had TAs regardless of ctDNA status, indicating a potential for immediate consideration of matched therapies in ctDNA+ patients.
An NCDB analysis on the demographic, treatment, and survival of ovarian papillary mucinous cystadenocarcinoma.
e17540 Background: Ovarian papillary mucinous cystadenocarcinoma (OPMC) originates from the germinal epithelium by metaplasia with slow development accompanied with harmful impacts. Given that OPMC often presents with vague or nonspecific symptoms and shares overlapping histologic characteristics with other tumors of the ovary, the diagnostic process is particularly challenging. While literature is limited on the mortality rate in OPMC, 5-year mortality rates for other mucinous papillary lesions stand at 60%. Due to the rarity of OPMC, this study leverages the NCDB to analyze trends in patients that could present information of OPMC’s epidemiology. Methods: Utilizing the 2004-2020 NCDB, a retrospective cohort analysis was conducted of patients with a histologically-confirmed diagnosis of OPMC using the ICD-O-3 code 8471 (N = 218). Descriptive statistics were used to characterize demographic (age, sex, race, Hispanic status) and socioeconomic factors (income, insurance, etc). Incidence trends and survival analysis were conducted using regression and Kaplan-Meier statistics. Results: Our cohort identified 218 patients with a confirmed diagnosis of OPMC, with a strong decline in annual incidence between 2004 and 2020 (R^2 = 0.866). Most patients were diagnosed at stage I (43.6%) with the ovary as the primary site (70.2%). Most patients were non-Hispanic (85.3%), White (83.0%), and female (89.0%), and had a Charlson-Deyo co-morbidity score of 0 (79.8%). The mean age at diagnosis was 57.4 (SD = 17.0). Socioeconomically, patients were primarily privately insured (48.2%) or using Medicare (35.3%) with more than half of patients (55.5%) living in counties in metropolitan areas with a population of >1 million. For primary treatment, the majority of patients (91.3%) received surgery, while 40.4% also received chemotherapy, and 6% also received radiation therapy. The 30-day mortality rate was 2.3% with a 90-day mortality rate of 5.5%. The surgical margin of primary site was majority (61.9%) no residual tumor. The 2-year, 5-year, and 10-year survival rates were 90.2% (SE = 0.020), 76.8% (SE = 0.03) and 59.9% (SE = 0.04) respectively, with the mean survival time being 125.3 months (SD = 6.2). Conclusions: This study represents the first NCDB analysis of OPMC, addressing a substantial gap in literature. Patients are usually diagnosed in middle adulthood with the primary site being the ovary area, this is consistent with prior literature. This analysis is the first to exhibit that the majority of surgery performed on the primary site resulted in no residual tumor. The extent of impact that demographic and socioeconomic factors have on the diagnosis, treatment, and overall survival rate of PMC patients warrants further studies.
Socioeconomic and racial disparities in receipt of treatment among early-stage ER+/PR+ HER2- breast cancer: Insights from invasive breast cancer OncoDX recurrence score database.
520 Background: Oncotype DX Recurrence Score (RS) predicts recurrence risk and potential benefit from chemotherapy (CT) in early-stage ER+ and HER2- breast cancer (BC). However, real-world CT decision patterns remain poorly understood. This work evaluated how socioeconomic, racial and clinical factors influence CT decisions beyond RS-guided recommendations. Methods: We analyzed patients with early-stage ER+/PR+, HER2- BC in SEER OncoDX RS Database (2004-2019). Variables included age, rurality, poverty status, socioeconomic status (SES), RS, histology, tumor grade, nodal status, PR status, and CT receipt. Treatment disparities among patients with similar RS were evaluated using chi-square tests. Multivariable logistic regression model (MVA) identified independent predictors of CT utilization among patients with similar RS. Results: A total of 208,674 patients were included (median age 60). Median follow up was 4.9 years. Among postmenopausal (post-M, ≥50yrs) women with RS≥26 (CT indicated), lowest SES (60.6% vs 66.5% [highest], P<0.001) and Hispanic ethnicity (63.2% vs 63.3% [White], P=0.016) were associated with lower rate of CT. When CT was not indicated in post-M women (RS<26), Black patients were more likely to receive treatment (9.0% vs 7.9% [White], P<0.001). Among premenopausal (pre-M, <50yrs) women with N0 disease and RS>15, highest SES (41.0% vs 44.2% [lowest], P=0.032) and White race (41.2% vs 46.8 [Black], P<0.001) received less CT. Among pre-M women with N1-3 disease, rural residence (42.9% vs 47.1 [urban], P = 0.004) and White race (44.6% vs 50.1% [Black], P = 0.042) were associated with less CT. MVA showed that invasive ductal carcinoma, grade III tumor, PR-negative status and Black race increased the likelihood of CT irrespective of RS (Table 1). Conclusions: CT decisions were frequently influenced by socioeconomic, racial and clinicopathological factors beyond genomic guided recommendations. Our data highlights a gap between clinical guidelines and real-world practice. Future research should focus on understanding the underlying reasons for deviations in treatment selection and examining changes in practice patterns in the post-RxPONDER era. MVA for CT decision by RS (OR, 95%CI). Pre-M, N0, ≤15 Pre-M, N0, >15 Pre-M, N1-3 Post-M, <26 Post-M, ≥26 SES (highest vs lowest) - 0.88 (0.78-0.99) - - 1.34 (1.22-1.49) Race (B vs W) - - - 1.10 (1.01-1.19) 1.14 (1.03-1.26) Histology (IDC vs ILC) - 1.22 (1.11-1.33) 1.16 (1.01-1.32) 0.84 (0.80-0.88) 1.19 (1.09-1.28) Grade (III vs I) 4.89 (3.72-6.42) 7.13 (6.42-7.93) 5.91 (4.96-7.04) 4.07 (3.80-4.36) 2.44 (2.21-2.71) PR (pos vs neg) - 0.49 (0.43-0.56) 0.44 (0.32-0.60) 0.53 (0.50-0.57) 0.82 (0.77-0.87) Not statistically significant.
Spatial pathology–driven graph neural network modeling for predicting response to neoadjuvant immunotherapy in non–small cell lung cancer.
e20024 Background: Neoadjuvant immunotherapy has significantly improved outcomes in patients with resectable NSCLC; however, substantial heterogeneity in therapeutic response remains, and robust predictive biomarkers are lacking. Spatial pathology enables high-resolution characterization of the tumor immune microenvironment beyond conventional cell density metrics. Integrating spatial cellular organization with graph-based learning may provide a scalable and generalizable strategy for predicting response to neoadjuvant immunotherapy. Methods: This multicenter retrospective cohort study included NSCLC patients who received neoadjuvant immunotherapy after diagnostic biopsy between 2019 and 2025 across four institutions(GDPH,SYSUCC, GYFYY,FAHZZU). Pretreatment biopsy H&E whole-slide images were analyzed using a spatial pathology pipeline incorporating cell instance segmentation, spatial organization modeling, and graph neural network learning. The model was developed to predict major pathological response (MPR) and was evaluated in independent external validation cohorts. Results: A total of 1,002 NSCLC patients receiving neoadjuvant immunotherapy from four centers were included, all with pretreatment biopsy H&E whole-slide images available. The spatial pathology–based graph neural network model showed stable performance across multicenter cohorts. In independent external validation, the model achieved an area under the receiver operating characteristic curve (AUC) of 0.72 for predicting major pathological response, demonstrating good generalizability across institutions. Conclusions: This spatial pathology-based graph neural network provides a scalable and generalizable approach for predicting response to neoadjuvant immunotherapy in NSCLC using routine biopsy specimens, with potential clinical utility for preoperative risk stratification and treatment decision-making.
Efficacy and safety of commercial CD19 CAR-T (inaticabtagene autoleucel) in relapsed/refractory extramedullary B-ALL: A large multicenter real-world study.
e23343 Background: Adult patients with relapsed/refractory (R/R) extramedullary B-ALL have a dismal prognosis with conventional therapies. Despite the success of CD19 CAR-T in hematologic relapse, its efficacy in extramedullary disease remains underexplored, as pivotal trials often excluded these high-risk pts. This large, multicenter, real-world study aims to define the outcomes of Inaticabtagene autoleucel (Inati-cel) in this challenging population. Methods: Eligible patients had R/R extramedullary B-ALL, underwent apheresis for Inati-cel following its approval (November 7, 2023), and completed at least 30 days of follow-up. The primary endpoints were overall survival (OS) and relapse-free survival (RFS). Secondary outcomes included the complete remission (CR) rate, minimal residual disease (MRD) negativity rate, and toxicity profiles. CR was defined as ≤5% bone marrow blasts morphologically, no circulating lymphoblasts, and resolution of extramedullary disease. MRD was evaluated via flow cytometry, RQ-PCR, and/or NGS. CRS and ICANS were graded according to ASTCT criteria. Results: As of the data cutoff (December 31, 2025), a total of 50 patients with R/R extramedullary B-ALL from over 20 centers across China received Inati-cel therapy. The median age was 39.5 years (range, 14–79), and 60% were male. Extramedullary disease involved the central nervous system (CNS) in 64%(32/50) of pts, non-CNS disease in 28%(14/50), and both in 8%(4/50). Following infusion, 41 of 48 evaluable pts (85.4%) achieved CR in both bone marrow and EM disease, with 100% of responders achieving bone marrow MRD negativity. Among pts with CNS involvement, the CR rate was 93.3% (28/30), compared with 78.6% (11/14) in those with non-CNS EM disease and 50% (2/4) in pts with both CNS and non-CNS EM disease. After a median follow-up of 7.2 months, the median OS and RFS had not been reached; Notably, the 1-year OS and RFS rates were 86.8% and 61.9%, respectively. Compared to their Ph-positive counterparts, patients with Ph-negative disease had significantly worse OS (100% vs 76.4%; P = 0.026) and RFS (81.2% vs 45.6%; P = 0.039). Similarly, IKZF1 deletion was associated with significantly poorer OS (89.4% vs 66.7%; P = 0.044) and RFS (67.1% vs 33.3%; P = 0.004). Regarding safety, any-grade CRS occurred in 66% of pts (4% Grade 3–4), and ICANS occurred in 14% (4% Grade 3). All toxicities were manageable and reversible, with no treatment-related deaths. Conclusions: This largest real-world study demonstrates that commercial CD19 CAR-T therapy with Inati-cel induces high response rates and durable survival in adult patients with high-risk R/R extramedullary B-ALL, exhibiting a manageable safety profile. These findings establish Inati-cel as an effective standard-of-care option for this population and support its use even in settings typically excluded from clinical trials.
Phase I/II study of concurrent intrathecal toripalimab and pemetrexed (PM) for leptomeningeal metastases (LM) from solid tumors.
2621 Background: Intrathecal (IT) programmed death-1 (PD-1) inhibitors have demonstrated safety and feasibility in leptomeningeal metastases (LM) from melanoma or lung cancer. However, no studies have yet reported on the combination of IT PD-1 inhibitors with IT chemotherapy for LM from solid tumors. This study evaluated the feasibility and potential clinical benefit of combining IT toripalimab with pemetrexed (PM) in this patient population. Methods: Phase I followed a 3+3 dose de-escalation design to determine the dose-limiting toxicity (DLT) and the recommended phase II dose (RP2D). Patients received IT PM (15 mg flat dose) twice weekly for 2 weeks (induction), then weekly for 4 weeks (consolidation), followed by monthly maintenance. The administration of IT toripalimab (40 mg initial dose) was initiated concurrently with the fourth dose of IT PM, on an every-two-week schedule for 6 weeks (induction/consolidation), switching to monthly dosing during the maintenance phase. Continuation of previously administered systemic therapies was permitted during the study. The primary endpoints were RP2D and safety. Secondary endpoints included clinical response rate (CRR), disease control rate (DCR) and overall survival (OS). Results: From June 2024 to September 2025, 45 patients were enrolled (40 non-small cell lung cancer, 4 breast cancer, and 1 small cell lung cancer). Median age was 52 years (range 30–69), and 35 patients were female. In phase I, no DLTs were observed; the RP2D was established as toripalimab 40 mg plus PM 15 mg. All patients completed induction therapy, 42 completed consolidation therapy, and 41 received maintenance therapy. No treatment-related deaths occurred. All grade ≥3 adverse events (AEs) were attributable to IT PM, with an overall incidence of 55.6% (25/45), including leukopenia (n = 16), thrombocytopenia (n = 10), decreased hemoglobin (n = 7), and elevated hepatic aminotransferases (n = 5). Immune-related AEs were limited to grades 1-2, occurring in 24.4% (11/45) of patients, and included rash (n = 5), fever (n = 3), hypothyroidism (n = 3), and pneumonia (n = 1). According to Response Assessment in Neuro-Oncology (RANO) criteria, the CRR was 66.7% (30/45), including 11 patients with neurological dysfunction improvement, 16 with CSF cytological response, and 18 with neuroimaging improvement. The DCR was 93.3% (42/45). As of January 20, 2026, 19 patients had died. Median follow-up was 11.1 months (95% CI: 7.7–17.0). Median OS was 13.1 months (95% CI: 9.9–not applicable). Conclusions: IT toripalimab combined with PM showed a manageable safety profile and promising clinical activity in patients with LM from solid tumors. Based on the encouraging interim OS observed, further clinical investigation of intrathecal immunotherapy is warranted for patients with LM. Clinical trial information: NCT06462222 .
Class-specific clinical and molecular features of <i>SMARCA4</i> alterations in non–small cell lung cancer.
8033 Background: SMARCA4 mutations occur in 5–10% of non-small cell lung cancers (NSCLCs) and are associated with poor overall survival, especially class I SMARCA4 alterations (truncating mutations, fusions, and homozygous deletion), which often result in SMARCA4 loss. However, the biological and clinical significance of SMARCA4 alteration classes and their distribution among pan-cancers in Asians remain unclear. Methods: We analyzed pan-cancer across solid tumors patients enrolled in Center for Cancer Genomics and Advanced Therapeutics (C-CAT) database (approval number CDU2021-001N) between June 2019 and October 2025 and patients with surgically resected NSCLCs at our hospital between 1999 and 2023 (approval number 2005-109) were performed by whole exome sequencing. Somatic mutations were annotated using Annovar and OncoKB. SMARCA4 mutations were classified into two groups: class I or class II (missense or other). Copy number alterations were detected using facets and GISTIC2. Transcriptomic differences were assessed using RNA sequencing with DESeq2 and gene set enrichment analysis (GSEA). Tumor immune cell composition was assessed using CIBERSORTx. Results: In the C-CAT pan-cancer dataset (N=10,155), SMARCA4 mutations were frequently identified in NSCLC (NSCLC vs. others; 12.3% vs. 4.0%). In NSCLC, TP53 was the most frequent co-altered gene in patients with class I and class II mutation (73.0% vs. 63.0%). Other major genes did not show clear class-associated differences. In our NSCLC cohort (N=1,166), the frequency of SMARCA4 class I and II mutation was 2.3% (all truncating) and 2.3% (all missense), respectively. The class I SMARCA4 alterations were associated with significantly poorer survival outcomes compared with wild- type tumors (OS: HR = 2.04, 95% CI = 1.24–3.12, p = 0.007; RFS: HR = 2.09, 95% CI = 1.28–3.20, p = 0.005), whereas class II alterations were not significantly different in survival (OS: HR =0.50, 95% CI =0.40-0.61, p =0.17; RFS: HR = 0.46, 95% CI = 0.42–0.76, p =0.12). Regarding transcriptomic analysis and genomic profiling, class I tumors showed activation of ASCL1 -related transcriptional programs, suppression of squamous/basal lineage differentiation, increased CD8⁺ T-cell infiltration, and recurrent copy number loss of SMARCA2 and CDKN2A/B compared with wild type tumors. In contrast, class II tumors showed limited transcriptomic divergence from wild-type tumors, downregulating SPRR2E , KRT5 , and KRT13 without a significant CD8⁺ T-cell difference. Conclusions: In NSCLC, class I SMARCA4 altered tumors are associated with poor survival outcomes, and an immune-active molecular phenotype with recurrent copy number loss of SMARCA2 and CDKN2A/B , whereas class II tumors lack these features and do not show adverse survival compared to wild-type tumors. This highlights the distinct clinical implications of SMARCA4 alteration class.
Efficacy of adjuvant anti–PD-1/anti–PD-L1 immunotherapy in resected renal cell carcinoma (RCC): An updated systematic review and meta-analysis.
e16508 Background: To systematically review and meta-analyze randomized controlled trials (RCTs) evaluating adjuvant immunotherapy (atezolizumab, pembrolizumab, ipilimumab plus nivolumab, or nivolumab alone) in patients with locally advanced, non-metastatic clear cell renal cell carcinoma (RCC). Adjuvant immunotherapy aims to reduce recurrence risk in high-risk RCC post-nephrectomy, but conflicting trial results necessitate synthesis. Methods: We searched MEDLINE, EMBASE, LILACS, and CENTRAL up to December 2025. Overall survival (OS) and disease-free survival (DFS) were assessed. Effect estimates were pooled as hazard ratios (HR) or risk ratios (RR) with corresponding 95% confidence intervals (95% CI), using fixed- and random-effects models as appropriate. Results: Of 49 records screened, 5 RCTs (IMmotion010, KEYNOTE-564, CheckMate 914 [part A], CheckMate 914 [part B], and PROSPER) comprising 4,232 patients status post nephrectomy were included. Adjuvant immunotherapy improved DFS versus placebo/observation (fixed effect: HR=0.85, 95% CI=0.76 to 0.94; p=0.002), with moderate heterogeneity (Chi2=5.43, df=4 [p=0.25]; I2=26%). A random-effects model yielded consistent results (HR=0.86, 95% CI=0.76 to 0.97; p=0.02). In subgroup analyses, immunotherapy was associated with longer DFS among patients with PD-L1 expression (≥1% IHC SP142 or combined positive score ≥1 IHC 22C3) (fixed effect: HR=0.73, 95% CI=0.62 to 0.87; p=0.0004), without heterogeneity (Chi2=1.58, df=2 [p=0.45]; I2=0%). Patients with sarcomatoid features also derived DFS benefit (fixed effect: HR=0.62, 95% CI=0.45 to 0.83; p=0.002), without heterogeneity (Chi2=3.75, df=4 [p=0.44]; I2=0%). OS data were immature, with no statistically significant difference between groups (fixed effect: HR=0.88, 95% CI=0.71 to 1.08; p=0.23). Conclusions: This is the first meta-analysis to include all five available RCTs of adjuvant immunotherapy in resected RCC. Adjuvant immunotherapy significantly improved DFS overall. In subgroup analyses, patients with PD-L1 expression or sarcomatoid features experienced DFS benefit without heterogeneity. These findings support adjuvant immunotherapy in selected high-risk subgroups, pending mature OS data.
Ivermectin use in patients with cancer over the past decade at an academic cancer center.
e23175 Background: Patient interest in ivermectin has increased over time, initially as potential treatment for COVID-19 and currently for purported anti-cancer effects. Scarcity of evidence-based medicine has limited translation to clinical practice, however the growing public dialogue has led providers to anecdotally note increased patient off-label use. This study sought to characterize ivermectin use among patients seen at a large, academic cancer center. Methods: All patients seen at a tertiary referral center from 2016-2025 with an active medication reconciliation were included. Foundry (an AI-powered analytic platform by Palantir) was used to query the electronic health record to identify patients with oral ivermectin (brand name stromectol) documented on their medication list (topicals were excluded). Descriptive statistics categorized patient characteristics; time trends were assessed by linear regression. Results: A total of 2,187 unique patients were identified with documented ivermectin use (0.05% of the 416,042 patients seen in the past decade). The median age was 63 years (IQR 52-70); most were White (79.9%), and non-Hispanic or Latino (83.6%); slightly more than half were male (55.9%), most were nonsmokers (60.9%). Patients lived a median of 145 miles from the center (IQR 24-412). Documented ivermectin use increased over time, from 66 patients in 2016 to 475 in 2025 (p < 0.001)75.8% of documented use in the past 10 years has been since 2021. There was a notable rise in 2021 (n = 379) followed by a slight decline in 2022 and consistent rise since then. The most common cancer diagnoses were leukemia and lymphoma (27% of use), followed by breast (13%), prostate (8%), and lung (5.5%). This has changed over time with 2016-2020 use dominated by patients with hematologic malignancies (62% of use) and then a shift 2021-2025 to solid tumors (89% of use). Between 2016-2020, 35% of ivermectin use was associated with an Infectious Diseases (ID) sub-specialty provider; this decreased sharply to 4.6% by 2025, with the majority of use being patient self-reported during medication reconciliation. Conclusions: Documented ivermectin use has rapidly increased in the past decade in patients with cancer, highlighting the essential role of full and accurate medication reconciliation. Our study likely underestimates the true frequency, as it relies on patient report and accurate documentation. These results underscore the importance of understanding patient off-label use, given 7-fold increase despite no change in FDA recommended indications. Further research is needed to understand patient beliefs and to evaluate clinical recognition and management of ivermectin-related interactions and complications (and/or potential benefits) based on specifics of cancer treatment and clinical course.
Plastic and single-use materials in breast cancer screening and diagnosis: A multi-center audit of modifiable resource use in oncology care.
e23159 Background: Breast cancer screening and diagnostic pathways are central to modern oncology care and rely on imaging, biopsy, and pathology workflows. These processes are increasingly resource-intensive and generate substantial single-use material waste, much of which is plastic-based. Plastics and waste-associated pollutants are implicated in environmental exposures relevant to cancer risk and public health. Quantifying material use within routine diagnostic workflows is a necessary first step toward identifying high-value opportunities to reduce unnecessary waste while preserving diagnostic quality and patient outcomes. Methods: We conducted a multicenter audit at three U.S. academic medical centers of materials in common breast cancer diagnostic steps, including ultrasound-guided (USG) fine-needle aspiration (FNA), stereotactic core-needle biopsy (CNB), USG CNB, MRI-guided (MRIG) CNB, and pathology processing of CNB and FNA samples. Per process step, supplies were cataloged by recording primary material composition, mass, and whether the item was single-use. We quantified the proportion and mass of plastic and single-use materials and compared consumption across diagnostic steps. Results: Plastic was the primary material in 27–50% of supplies used across biopsy modalities, while single-use items comprised the majority of supplies across evaluated steps (61–81%). Although plastics accounted for a smaller proportion of total material mass (4–16%), single-use items represented up to 27% of total material mass per process step. Stereotactic CNB had the highest total material mass per process step (7,255 g) but the lowest proportion of plastic by mass (4%). USG CNB had the highest plastic mass per biopsy step (410 g). Pathology processing of FNA specimens contributed substantial plastic mass (530 g). Conclusions: Breast cancer diagnostic workflows depend on single-use and plastic-based materials across imaging, biopsy, and pathology steps, which contribute to downstream harmful environmental pollutants. Our results identify clinically-relevant opportunities to reduce such material consumption. Integrating waste-reduction strategies into breast cancer screening and diagnostic pathways may help align high-quality oncologic care with critical environmental risk reduction. Process Step Supplies per Step (SpS) (n) % Plastic SpS (n) % Single-Use SpS (n) Total Mass of SpS (g) Mass of Single-Use SpS (g) Single-Use Mass pS (%) Mass of Plastic Material in SpS (g) Plastic Mass pS (%) USG FNA 18 50.0 61.1 2,460 242.4 9.9 393 16.0 Stereotactic CNB 20 45.0 80.0 7,255 1067.6 14.7 314 4.3 USG CNB 20 50.0 70.0 3,020 802.9 26.6 410 13.6 MRIG CNB 15 26.6 73.3 2,043 89.7 4.4 330 16.1 CNB Pathology 25 20.0 64.0 — — — 62 — FNA Pathology 26 23.1 80.8 — — — 530 — Mean ± SD — 42.9 ± 11.1 71.1 ± 7.3 3,944 ± 2,222 505.1 ± 407 13.9 ±9.5 362 ± 44 9.2 ± 2.1
Culmerciclib (CDK2/4/6 inhibitor) plus fulvestrant in HR+/HER2− advanced breast cancer after progression on CDK4/6i: Preliminary results from a phase II trial.
1082 Background: CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) have been the standard first line treatment for HR+/HER2- advanced breast cancer (ABC). However, there is currently no established standard treatment after progression on a CDK4/6i–based regimen. Culmerciclib (Culm), a novel potent CDK2/4/6 inhibitor, has shown significant PFS benefits when combined with Fulvestrant (Ful) in both first-line and later-line settings for HR+/HER2– ABC (ESMO 2025; CSCO 2024). Here we evaluated the combination in HR+/HER2- ABC following disease progression on prior CDK4/6i + ET. Methods: In this prospective, multicenter, single-arm phase II trial (TQB3616-II-04), eligible patients (pts) who had progressive disease on a CDK4/6i + ET as initial therapy for ABC or relapse on/after a CDK4/6i + ET as adjuvant therapy for early BC, previous up to 2 lines of ET and 1 line of chemotherapy for ABC, received Culm (180mg, qd) + Ful. The primary endpoint was ORR, and secondary endpoints included DCR, PFS, DOR, CBR and safety. Assuming a power of 0.9 to test the hypothesis that ORR would be 30.0% against the null hypothesis that it would be 8.0% or lower, with 0.025 as one-sided significance level; considering the dropout rate of 20%, a total of 33 pts was required. Results: 35 female pts were enrolled and treated, 31.4% were pre- or perimenopausal (received a concomitant GnRH agonist), 71.4% had visceral metastases (including 45.7% with liver metastases and 5.7% with brain metastases). All pts had received prior CDK4/6i +ET (AI and/or SERM) therapies, prior CDK4/6i was 68.6% palbociclib, 28.6% dalpiciclib, and 8.6% ribociclib (2 pts with dual CDK4/6i); 28.6% had received prior two lines endocrine therapy, also 37.1% had received prior chemotherapy for metastatic disease. As of data cutoff on Jan 17, 2026, median follow-up time was 7.3 months. Among 34 evaluable pts, the overall ORR was 29.4% (95% CI: 15.1, 47.5, p ＜0.0001 ), meeting the predefined primary endpoint, which significantly rejected the null hypothesis of ORR. The overall DCR was 88.2% (95% CI: 72.6, 96.7), and the CBR was 82.4% (95% CI: 65.5, 93.2). Median TTR was 3.7 months, mPFS and mDOR were not yet reached, while 6-month PFS rate was 72.5% (95% CI: 52.7, 84.7). Grade≥3 TRAEs and serious TRAEs were reported in 14 (40.0%), 3 (8.6%) pts, respectively. The most common TRAEs included diarrhea, neutropenia, vomiting etc. No new safety signals were observed, with findings consistent with the known safety profile of Culm. Dose reductions due to TRAEs occurred in 14.3% of pts, and no deaths or discontinuations related to TRAEs were reported. Conclusions: Culm combined with Ful demonstrated promising antitumor activity in HR+/HER2- ABC after progression on previous CDK4/6i + ET, offering a potential targeted therapeutic strategy for this population (NCT06702618). Clinical trial information: NCT06702618 .
Clinicopathological characteristics and survival outcomes of typical and atypical pulmonary carcinoid tumors: A 13-year single-center retrospective study.
e20090 Background: Pulmonary neuroendocrine neoplasms (NENs) range from low-grade typical and atypical carcinoids to high-grade, poorly differentiated tumors such as large-cell and small-cell lung carcinoma. Pulmonary NENs account for approximately 20–30% of all neuroendocrine tumors and are classified as typical or atypical carcinoids based on mitotic count per high-power field and the presence of necrosis. This study evaluated the association between clinicopathological features, treatment modalities, and prognostic outcomes in patients with NENs treated at the National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital. Methods: In this retrospective cross-sectional study, pathology records of patients diagnosed with pulmonary neuroendocrine tumors between 2007 and 2020 were reviewed. Demographic data, pathological features, treatment modalities, and survival outcomes were collected. P < 0.05 was considered significant. Results: A total of 186 patients were included, of whom 164 (88.1%) had typical carcinoid tumors, and 22 (11.9%) had atypical carcinoids. Patients with atypical pulmonary carcinoids experienced higher rates of disease progression and metastasis and worse observed survival outcomes than those with typical carcinoids (P-values 0.0004,0.0001 and 0.0001, respectively). Surgery alone was the most common treatment modality in typical carcinoids (89.1%), whereas combined surgical resection and chemotherapy was most frequently used in atypical carcinoids (16.7%). The 1-year survival rates for atypical and typical carcinoids were 95.2% and 98.2%, respectively, while the corresponding 3-year survival rates were 89.6% and 95.7%. Conclusions: Atypical pulmonary carcinoids are associated with significantly higher rates of disease progression and metastasis and demonstrate inferior survival outcomes compared with typical carcinoids. These findings highlight the importance of early diagnosis and tailored treatment strategies to improve outcomes in patients with atypical pulmonary carcinoids. Clinicopathological characteristics and outcomes of patients. Pathologic results P-Value Overall n(%) Typical Carcinoid Tumors(n=164,88.1%) Atypical Carcinoid Tumors Age (Mean±SD a ) 43.67±15.78 42.92 ±15.87 49.18±14.33 0.081 SexFemaleMale 100(53.8)86(46.2) 90(54.87)74(45.13) 10(45.45)12(44.55) 0.405 Smoking StatusSmokerNon-Smoker 10(504)176(9406) 7(4.3)157(95.7) 3(30)19(70) 0.067 Vital statusAliveDead 175(94.1)11(5.9) 158(96.3)6(3.7) 17(77.3)5(22.7) 0.0004 * MetastasisNoYes 181(97.3)5(2.7) 163(99.4)1(0.6) 18(81.8)4(18.2) <0.0001 * Disease ProgressionYesNo 24(12.9)162(87.1) 15(9.1)149(90.9) 9(40.9)13(59.1) <0.0001 * *Significant P-value. Abbreviation: a; SD: standard deviation.
FusionVAC22_02, a phase I clinical trial in progress: Adjuvant <i>DNAJB1-PRKACA</i> fusion transcript–based peptide T-cell activator for fibrolamellar hepatocellular carcinoma (FLC) and other tumor entities carrying the oncogenic driver fusion.
TPS4270 Background: The DNAJB1-PRKACA fusion transcript was detected as the oncogenic driver of tumor pathogenesis in fibrolamellar hepatocellular carcinoma (FLC) and other cancers, e.g. oncocytic neoplasms of pancreas and bile duct. We and others have shown that the fusion protein can be targeted by T cell-based immunotherapy: Application of Fusion-VAC-XS15 a peptide-based T cell activator including the TLR1/2 agonist XS15 emulsified in Montanide ISA 51 VG in two FLC patients was well tolerated without systemic side effects and induced long-lasting T-cell response accompanied by disease remission with a progression-free survival of up to 80 months and 60 months in both patients (Bauer et al. Nat. Commun., 2022). Based on these promising data, Fusion-VAC-XS15 combined with Atezolizumab is currently under evaluation in the advanced or metastatic situation since October 2023 (Hackenbruch et al. Front Oncol., 2024; NCT05937295). For localized FLC, surgical resection still represents the only curative treatment option but shows high relapse rates which underscores the high medical need for adjuvant treatment options. We here present the FusionVAC22_02 trial, which evaluates Fusion-VAC-XS15 as an adjuvant therapeutic in FLC patients who have reached complete remission. Methods: FusionVAC22_02 is a Phase I open label, multicentric clinical trial evaluating immunogenicity along with safety, toxicity and first signs of clinical efficacy of Fusion-VAC-XS15 as adjuvant treatment, in 20 patients with FLC or other cancers with proven DNAJB1-PRKACA fusion protein, and lacking adjuvant treatment options. One key eligibility criterion is achievement of complete remission (e.g. due to surgery, radiotherapy, local intervention or systemic treatment) according to RECIST1.1. Of note, a history of liver transplantation or prior immune-mediated side effects (e.g. after treatment with checkpoint-inhibitors) are no exclusion criteria. Fusion-VAC-XS15 is applied twice in a 4-week interval, with an optional booster 56 days after the second application, followed by a 6-month follow-up. Primary objectives include assessment of immunogenicity in terms of peptide-specific T cell responses, as well as evaluation of safety and toxicity. Safety assessment is based on the frequency of adverse events according to CTCAE v5.0. Clinical efficacy is determined by RECIST1.1 assessment on imaging. Recruitment started in July 2025, nine FLC patients from various parts of the world have been included and treated so far, four of which have reached the primary endpoint. Clinical trial information: NCT06789198 .
Nivolumab plus ipilimumab combined with chemotherapy as first-line treatment for HER2-negative unresectable advanced or recurrent gastric/gastroesophageal junction cancer: A randomized phase 3 trial (ATTRACTION-6).
4006 Background: Anti-PD-1 antibodies combined with chemotherapy (Chemo) are established as a standard first-line (1L) treatment for HER2-negative gastric/gastroesophageal (G/GEJ) cancer. Nivolumab (NIVO) and ipilimumab (IPI), an anti-CTLA-4 antibody, have complementary mechanisms of action on tumor immunity. Combining NIVO plus Chemo with IPI is expected to suppress disease progression durably and prolong survival, as suggested in other types of tumors. Methods: ATTRACTION-6 is a randomized, phase 3 trial conducted in Japan, Korea, and Taiwan. Previously untreated patients with HER2-negative unresectable advanced or recurrent G/GEJ cancer were randomized 1:1 to receive NIVO 360 mg every 3 weeks, IPI 1 mg/kg every 6 weeks in addition to Chemo (S-1 plus oxaliplatin [SOX] or capecitabine plus oxaliplatin [CAPOX]) or Chemo alone. Randomization was stratified by PD-L1 (CPS≥5 or CPS < 5, indeterminate), ECOG PS (0 or 1), countries (Japan or Korea/Taiwan), and disease status (advanced or recurrent). Primary endpoint was overall survival (OS). Secondary endpoints included progression free survival (PFS), objective response rate (ORR) per RECIST v1.1 assessed by site investigator, and safety. Results: Between November 2021 and August 2023, 626 patients were randomized 1:1 to the NIVO + IPI + Chemo arm (N = 315) or the Chemo arm (N = 311). At the median follow-up of 31.3 months, the primary endpoint of OS was not met (HR 0.90; 95.8% CI 0.74-1.09; P = 0.267; median OS 15.7 vs 15.8 months). Median PFS was 8.9 vs 7.7 months (HR 0.83; 95% CI 0.69-1.00). Among patients with ≥1 measurable lesion at baseline, ORR was 57.9% vs 38.5%. Grade≥3 adverse events (AEs) and grade≥3 treatment-related AEs occurred in 80.0% and 64.8% in the NIVO + IPI + Chemo arm, respectively, and 62.4% and 42.9% in the Chemo arm, respectively. Treatment-related deaths occurred in 0.3% vs 0%, and the only observed event was gastroenteritis in the NIVO + IPI + Chemo arm. Conclusions: In ATTRACTION-6 study, NIVO + IPI + Chemo did not improve OS compared with Chemo as 1L treatment for patients with HER2-negative unresectable advanced or recurrent G/GEJ cancer. Although toxicity increased with the addition of NIVO and IPI, no new safety signals were observed. Clinical trial information: NCT05144854 .
Sociodemographic predictors of palliative care utilization across a mid-Atlantic healthcare system.
e13736 Background: Patients with advanced (Stage III, IV) cancer have high symptom burden that significantly impacts patients’ quality of life. American Society of Clinical Oncology Guidelines recommend referring all patients with advanced cancer to specialized interdisciplinary palliative care to provide symptom management alongside active treatment. However, palliative care is underutilized for patients with advanced cancer in the US (~35% receive inpatient palliative care). Prior research demonstrates that utilization of palliative care differs based on sociodemographic characteristics. The current study examined palliative care utilization during inpatient visits across a Mid-Atlantic healthcare system. Methods: We extracted data for all inpatient encounters from 2020-2023 for patients diagnosed with advanced cancer in the tumor registry (n=8,180 encounters among 4,296 patients). We used generalized linear mixed effects models controlling for insurance, cancer stage, and hospital to identify factors associated with the likelihood of a patient receiving a palliative care encounter. Results: A majority (63.63%) of patients in our sample had at least one palliative care encounter. Analyses indicated that Black OR=1.49, 95% CI [1.32, 1.67] and Other/Unknown racial group patients OR=1.65, 95% CI [1.33, 2.04] were more likely to have a palliative care encounter relative to White patients, though Hispanic patients did not have a significant difference in likelihood. Older age was related to lower likelihood of palliative care encounters OR=0.90, 95% CI [0.83, 0.96], and male patients were significantly less likely to have a palliative care encounter than female patients OR = 0.45, 95% CI [0.25, 0.81]. However, a significant interaction indicated that as patients increased in age, female patients’ palliative care encounter likelihood decreases. Conclusions: Our study found that almost two-thirds of patients with advanced cancer in our system received inpatient palliative care; this rate is ~1.8 times higher than other published studies among advanced stage cancer. Consistent with other studies, we found that female patients were more likely to receive palliative care than male patients. Our findings that older age was related to lower likelihood of palliative care utilization was contrary to other research. Limitations include the lack of comorbidity data and reliance on demographic data from electronic records vs. self-report. Future research is needed to understand mechanisms for differences based on racial group, sex, and age. Generalized linear mixed effects model. Variable Odds Ratio, 95% CI Racial Group Non-Hispanic White Reference Non-Hispanic Black* 1.49 [1.32, 1.67] Hispanic 1.32 [0.99, 1.77] Other/Unknown* 1.65 [1.33, 2.04] Age at encounter Age (continuous)* 0.90 [0.83, 0.96] Sex Female Reference Male* 0.45 [0.25, 0.81] *Indicates statistical significance at p < .05.