Advanced Gynecologic Cancer Research Articles

Analysis of inactivating TSC1 and TSC2 alterations in a real-world patient population with advanced gynecologic cancers in the Foundation Medicine genomic database

Analysis of inactivating TSC1 and TSC2 alterations in a real-world patient population with advanced gynecologic cancers in the Foundation Medicine genomic database

Outcomes of patients with advanced gynecologic cancers enrolled in a single-center, phase I clinical trial program, compared with other advanced, solid tumors

Outcomes of patients with advanced gynecologic cancers enrolled in a single-center, phase I clinical trial program, compared with other advanced, solid tumors

Meta-analysis on Effectiveness of Palliative Care versus Conventional Care amongst Advanced Gynaecological Patients with Cancer and Caregivers

In cancer patients, physical and psychological issues are very common. There is a need for family support and high utilisation of healthcare resources commonly. Palliative care (PC) has grown in popularity to better fulfil of needs of patients and their families and potentially lowering hospital costs. Given that the majority of patients still die in hospitals, there is a need for an effective model of PC for advanced gynaecological cancer, as well as the wise allocation of scarce resources. The main aim of this study was to compare the efficacy of PC to conventional treatment for adults with cancer, including gynaecological cancers, and their caregivers. Four randomised controlled trials (RCTs) were identified by searching PubMed, PubMed Central, Clinical Key, Embase and other grey literature from a duration of 2011–2021. Cochrane criteria were used to calculate the risk of bias, and the Grade Profiler Guideline Development Tool was used to check the quality of the included studies. Standardised mean differences (SMDs), I2 value and forest plot were prepared by using Review Manager 4.0. A total of four RCTs were extracted by following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and found to have a high risk for bias and low to poor quality of evidence. Included study sample sizes ranged from 22 to 104 participants, including 670 people in total, including 289 patients with advanced cancer patients, including gynaecological cancer and 381 unpaid caregivers. Results also showed that PC enhances patients’ quality of life (SMD = 0.26; 95% confidence interval [CI] = −0.29–0.80; I2 = 76%), lowered symptom burden amongst patients (SMD = −0.75, 95% CI = −1.75–0.25; I2 = 89%), reduces patient depression (SMD = 0.08, 95% CI = −0.19–0.34; I2 = 0%) and decreases depression in unpaid caregivers (SMD = −0.16, 95% CI = −0.56–0.24; I2 = 59%). PC treatment increases patients’ quality of life and lowers their symptom burden. In comparison to conventional care, it also reduces depression among patients and caregivers. We believe that the findings should be viewed with care until more recent exclusive RCTs are available.

720MO IBI354 (anti-HER2 antibody-drug conjugate [ADC]) in patients (pts) with advanced gynecological cancers (Gynecol C): Results from a phase I study

720MO IBI354 (anti-HER2 antibody-drug conjugate [ADC]) in patients (pts) with advanced gynecological cancers (Gynecol C): Results from a phase I study

713MO Nivolumab and ipilimumab combination treatment in advanced gynaecological clear cell cancers: Results from the phase II MoST-CIRCUIT trial

713MO Nivolumab and ipilimumab combination treatment in advanced gynaecological clear cell cancers: Results from the phase II MoST-CIRCUIT trial

Symptom burden, palliative care knowledge, and palliative care needs in advanced gynecological cancer patients in Korea.

Advanced gynecological cancer patients endure numerous symptoms resulting from both the disease itself and the treatments they undergo. This symptom burden significantly impacts the quality of life for both patients and their caregivers, as well as escalating medical costs. Palliative care presents a solution to alleviate these challenges. However, in Korea, there exists a low level of awareness regarding palliative care and consequently, a low utilization rate. Providing timely palliative care to advanced gynecological cancer patients in Korea necessitates a comprehensive understanding of their symptom burden, palliative care knowledge, and palliative care needs. However, no previous studies have addressed this critical issue. The purpose of this study is to determine the impact of advanced gynecological cancer on palliative care needs in Korea according to patient demographic and clinical characteristics, symptom burden, and palliative care knowledge. This study was a descriptive cross-sectional study of data from 115 participants with stage III or IV gynecological cancer, collected through an online questionnaire. The main variables were symptom burden (Functional Assessment of Cancer Therapy-General), palliative care knowledge (Palliative Care Knowledge Scale), and palliative care needs (Problems and Needs in Palliative Care questionnaire-short version). Multiple hierarchical regression analyses were used to determine the relationships between variables. Palliative care needs were divided into perceived problems and requests for professional support. The most common perceivedproblems were financial problems, psychological issues, and physical symptoms, and the most frequent requests for professional support were financial problems, psychological issues, and the need for information. The perceived problem score increased with age, not having surgical experience, and significant symptom burden. Additionally, the requests for professional support score rose in cases of ovarian cancer, not having surgical history, substantial symptom burden, and limited palliative care knowledge. Advanced gynecological cancer patients have palliative care needs that differ according to patient characteristics, symptom burden, and palliative care knowledge. Identifying factors influencing palliative care needs can aid clinicians in identifying target groups in need of palliative care and providing them with professional palliative care.

Can we improve the management of inoperable malignant bowel obstruction? Results of a feasibility study of elemental diet as an alternative to parenteral nutrition in patients with advanced gynaecological cancer

PurposeNutrition support in inoperable bowel obstruction (IBO) remains challenging. Parenteral nutrition (PN) is recommended if the prognosis is > 2 months. An elemental diet (ED) is licensed for strictures in Crohn’s disease but has not been used in malignant bowel obstruction. The aim of this study was to evaluate the use of ED in patients with IBO and provide a proof of concept of ED as an acceptable feeding option.MethodsThis was a mixed-methods single-arm feasibility study. The primary endpoint was to provide a ‘proof of concept’ of ED as an acceptable feeding option for patients with IBO. Secondary endpoints included taste acceptability, incidences of vomiting and pain, the proportion of women who tolerated ED, the number of cartons drunk, quality of life (QOL) and the number of women treated with chemotherapy. Patients (> 18 years) with CT-confirmed IBO who could tolerate 500 ml of liquid in 24 h remained on the trial for 2 weeks.ResultsA total of 29 patients were recruited; of those, 19 contributed to the analysis for the primary endpoint; 13 (68.4%) participants tolerated the ED; 26 patients contributed to MSAS and EORTC QLQ questionnaires at baseline to allow for the assessment of symptoms. At the start of the study, 18 (69%) of patients experienced vomiting, reducing to 4 (25%) by the end of day 15 of the study; 24 (92%) of patients reported pain at consent, reducing to 12 (75%) by the end of day 15. QOL scores improved from 36.2 (95% CI 27.7–44.7) at baseline to 53.1 (95% CI 40.3–66) at the end of day 15; 16 (84%) participants commenced chemotherapy within the first week of starting ED. The number of cartons across all participants showed a median of 1.3 cartons per day (range 0.8 to 2.5).ConclusionED is well tolerated by patients with IBO caused by gynaecological malignancies and may have a positive effect on symptom burden and QOL.

PARP inhibition with rucaparib alone followed by combination with atezolizumab: Phase Ib COUPLET clinical study in advanced gynaecological and triple-negative breast cancers

BackgroundCombining PARP inhibitors (PARPis) with immune checkpoint inhibitors may improve clinical outcomes in selected cancers. We evaluated rucaparib and atezolizumab in advanced gynaecological or triple-negative breast cancer (TNBC).MethodsAfter identifying the recommended dose, patients with PARPi-naive BRCA-mutated or homologous recombination-deficient/loss-of-heterozygosity-high platinum-sensitive ovarian cancer or TNBC received rucaparib plus atezolizumab. Tumour biopsies were collected pre-treatment, during single-agent rucaparib run-in, and after starting combination therapy.ResultsThe most common adverse events with rucaparib 600 mg twice daily and atezolizumab 1200 mg on Day 1 every 3 weeks were gastrointestinal effects, fatigue, liver enzyme elevations, and anaemia. Responding patients typically had BRCA-mutated tumours and higher pre-treatment tumour levels of PD-L1 and CD8 + T cells. Markers of DNA damage repair decreased during rucaparib run-in and combination treatment in responders, but typically increased in non-responders. Apoptosis signature expression showed the reverse. CD8 + T-cell activity and STING pathway activation increased during rucaparib run-in, increasing further with atezolizumab.ConclusionsIn this small study, rucaparib plus atezolizumab demonstrated acceptable safety and activity in BRCA-mutated tumours. Increasing anti-tumour immunity and inflammation might be a key mechanism of action for clinical benefit from the combination, potentially guiding more targeted development of such regimens.Clinical trial registrationClinicalTrials.gov (NCT03101280).

Effectiveness and Safety of Cell-Free and Concentrated Ascites Reinfusion Therapy in the Treatment of Gynecological Malignancy-Related Ascites: A Systematic Review and Meta-Analysis

Introduction: Gynecological malignancy-related ascites (GMRA) cause discomfort symptoms in advanced gynecological cancer patients, especially in ovarian cancer. Cell-free and concentrated ascites reinfusion therapy (CART) is a palliative treatment for GMRA. Methods: Literature was searched from PubMed, CENTRAL, and Web of Science for relevant studies in all languages through May 31, 2024. The effectiveness of CART for GMRA was identified from data provided by full articles, brief reports, and conference abstracts. Results: Seven studies, comprising 166 patients with GMRA and 387 CART procedures, were examined in this study. The mean volume of GMRA obtained and reinfused after concentrating was 3.95 L (95% confidence interval [CI] 3.25–4.26 L) and 0.51 L (95% CI 0.38–0.65), respectively. Total protein and albumin reinfused were 98.6 g (95% CI 75.4–121.8 g) and 44.8 g (95% CI 37.2–52.5 g) on average, respectively. The mean CART-CART interval was 26.9 days (95% CI 24.2–29.7). No severe adverse events were observed during the CART procedures. Conclusions: CART is considered one of the palliative therapies for GMRA with proven safety and effectiveness.

Risk-stratified multidisciplinary ambulatory management of malignant bowel obstruction (MAMBO) program in women with advanced gynaecological cancers: A prospective study.

Risk-stratified multidisciplinary ambulatory management of malignant bowel obstruction (MAMBO) program in women with advanced gynaecological cancers: A prospective study.

Prevalence of HER-2 expression and correlation with clinicopathological features in gynecological cancer: A single-center retrospective study in China.

e17500 Background: Targeted therapy for human epidermal growth factor receptor 2 (HER2) has become a standard of care in several HER2-expressing solid tumors. Nonetheless, there remains an unmet need for effective treatment, for instance, anti-HER2 antibody-drug conjugates (ADCs), in advanced stage gynecological cancer. In this context, we presented a retrospective study on the incidence of HER2 expression in primary gynecological cancer based on a single-center data from southwestern China. Methods: Paraffin-embedded tumor tissue blocks, clinicopathological, and survival data of gynecological cancer patients were collected from Chongqing University Cancer Hospital. HER2 IHC scoring was carried out according to the updated ASCO/CAP guidelines for breast and gastroesophageal adenocarcinoma by two pathologists independently. Data analysis was performed using SPSS v.24. Results: A total of 104 cases of cervical cancer, 102 cases of endometrial cancer and 103 cases of ovarian cancer were included between 2019 and 2023. HER2 expression was detected in 31.7% samples, with scores of 1+, 2+, and 3+ in 23.9% (74/309: 36/104, 16/102, 22/103), 5.8% (18/309: 7/104, 7/102, 4/103), and 1.9% (6/309: 2/104, 1/102, 3/103) of patients, respectively. Notably, ultra-low HER2 expression with incomplete and faint staining in ≤10% of tumor cells was observed in 41.1% (127/309: 37/104, 53/102, 37/103) of patients. Metastasis and lymphovascular invasion were associated with elevated HER2 expression in endometrial cancer (p=0.037, 0.040, respectively), while a larger tumor size was associated with elevated HER2 expression in cervical cancer (p=0.004). However, no positive association between HER2 status and overall survival (OS) was found in cervical, endometrial or ovarian cancer. In our cohort, metastasis was the only risk factor related to reduced OS of gynecological cancer patients by COX regression analysis (HR=14.00, 95%CI=1.32-148.21, p=0.028). Conclusions: Our data revealed a considerable number of patients with HER2-low and ultra-low gynecological cancer. It might represent a significant portion in real-world scenarios and warrant more consideration in selecting candidates for HER2-targeted ADCs, especially for those with relapsed or refractory conditions. Given the inherent challenge in interpretation, the study highlights the necessity for a consensus on evaluating HER2 immuno-staining results in gynecological cancer. Clinical trial information: MR-50-23-019676 . [Table: see text]

IL-2-free tumor-infiltrating lymphocyte therapy with PD-1 blockade demonstrates potent efficacy in advanced gynecologic cancer

BackgroundTumor-infiltrating lymphocyte (TIL) therapy has been restricted by intensive lymphodepletion and high-dose intravenous interleukin-2 (IL-2) administration. To address these limitations, we conducted preclinical and clinical studies to evaluate the safety, antitumor activity, and pharmacokinetics of an innovative modified regimen in patients with advanced gynecologic cancer.MethodsPatient-derived xenografts (PDX) were established from a local recurrent cervical cancer patient. TILs were expanded ex vivo from minced tumors without feeder cells in the modified TIL therapy regimen. Patients underwent low-dose cyclophosphamide lymphodepletion followed by TIL infusion without intravenous IL-2. The primary endpoint was safety; the secondary endpoints included objective response rate, duration of response, and T cell persistence.ResultsIn matched patient-derived xenografts (PDX) models, homologous TILs efficiently reduced tumor size (p < 0.0001) and underwent IL-2 absence in vivo. In the clinical section, all enrolled patients received TIL infusion using a modified TIL therapy regimen successfully with a manageable safety profile. Five (36%, 95% CI 16.3–61.2) out of 14 evaluable patients experienced objective responses, and three complete responses were ongoing at 19.5, 15.4, and 5.2 months, respectively. Responders had longer overall survival (OS) than non-responders (p = 0.036). Infused TILs showed continuous proliferation and long-term persistence in all patients and showed greater proliferation in responders which was indicated by the Morisita overlap index (MOI) of TCR clonotypes between infused TILs and peripheral T cells on day 14 (p = 0.004) and day 30 (p = 0.004). Higher alteration of the CD8+/CD4+ ratio on day 14 indicated a longer OS (p = 0.010).ConclusionsOur modified TIL therapy regimen demonstrated manageable safety, and TILs could survive and proliferate without IL-2 intravenous administration, showing potent efficacy in patients with advanced gynecologic cancer.Trial registrationNCT04766320, Jan 04, 2021.

Alpelisib for PIK3CA-mutated advanced gynecological cancers: First clues of clinical activity

ObjectiveRecurrent gynecological tumors (e.g., endometrial, and ovarian cancers) are incurable diseases; therefore, new treatment options are urgently needed. The PTEN-AKT-PI3K pathway is frequently altered in these tumors, representing a potential treatment target. Alpelisib is an α-specific PI3K inhibitor approved in PIK3CA-mutated advanced breast cancer. We report outcomes from a large series of patients with PIK3CA-mutated gynecological cancers prospectively treated with alpelisib within a controlled program. MethodsFrom April 2021 to December 2022, 36 patients with PIK3CA-mutated advanced gynecological cancers received alpelisib 300 mg orally once daily. Objective response (ORR) and disease control (DCR) rates provided measure of the antitumor activity of alpelisib, the primary objective of the study. ResultsIncluded patients had endometrial (17/36 [47%]), ovarian (10/36 [28%]), or other gynecological cancers (9/36 [25%]). Most patients had received 2–3 prior systemic treatments (endometrial, 47·2%; ovarian, 60%; other, 56%), and presented with visceral metastases at baseline (82%, 70%, and 56%, respectively). Overall, 17 different PIK3CA mutations were found, including 53% in the kinase domain (most commonly H1047R) and 36% in the helical domain (most commonly E545K). Overall, the ORR was 28% and DCR was 61%, with the greatest benefit observed in patients with endometrial cancer (35% and 71%, respectively). ConclusionAlpelisib represents an active treatment option in patients with recurrent gynecological cancers harboring a PIK3CA mutation. These findings support the need of biomarker-driven randomized trials of PI3K inhibitors in gynecological cancers.

Pelvic exenteration: a retrospective study in a tertiary referral cancer center in the UK.

Pelvic exenteration (PE) is an extensive surgery that is indicated in cases of recurrent advanced gynecological cancer with curative and sometimes palliative intent. The procedure is associated with both high morbidity and mortality and as such is considered a highly specialist procedure. The aim of the study was to analyze surgical outcomes in women who underwent PE for advanced gynecological malignancy in a tertiary cancer referral center over 11 years. This is an observational retrospective single-center study. There were 17 patients included who underwent PE in Hull Royal Infirmary Hospital (Hull, UK) between 2010 and 2021. The main outcome measures were the perioperative complications, overall survival (OS), and recurrence free survival (RFS). Cumulative survival rates were reported at 1, 3 and 5 years. Univariate Cox regression analysis was undertaken to analyze factors that are prognostic for OS and RFS. Hazard Ratios (HR) with 95% confidence intervals (95% CI) were computed from the results of the Cox regression analyses. Kaplan-Meier survival curves were generated to visually display estimates of OS and RFS over the follow-up period. The median age at the time of surgery was 63.0 (IQR: 48.0-71.0). All patients received surgery with curative intent and complete tumor resection (R0) was achieved in 94.1% of cases. An overall 5-year survival was achieved in 63.7% of patients. Mean overall survival (OS) was 8.4 years (95% CI: 7.78-9.02). The RFS was 5.0 years (95% CI: 4.13-5.87). Both OS and RFS were significantly negatively affected by the hospital stay (P=0.020 and P=0.035, respectively), but not by the type of surgery (P=0.263 and P=0.826, respectively). The results of the study demonstrated stable and comparable outcomes in patients undergoing pelvic exenteration.

Efficacy and Safety of Oral Metronomic Chemotherapy in Recurrent Refractory Advanced Gynaecological Cancer: An Experience From the Regional Cancer Centre of Eastern India.

The outcome of recurrent/metastatic gynaecological malignancy has drastically improved with the introduction of poly(ADP-ribose) polymerase inhibitors and immunotherapy, but the use of these drugs in routine practice is complicated due to access barriers and their high cost in developing countries. The purpose of this study is to present the clinical response, outcome and safety of oral metronomic chemotherapy (OMCT) in resource-limited, financially constrained populations. This is a retrospective study on patients with advanced gynaecological cancer treated at Chittaranjan National Cancer Institute, Kolkata, India, from 2021 to 2023. The patients were treated with one of these two regimens: a split-dose course of cyclophosphamide (50 mg orally once daily for 21 days) and capecitabine (500 mg twice daily continuous) or a fixed-dose combination (capecitabine 1800 mg and cyclophosphamide 80 mg orally for 14 days in every 21 days) until disease progression or unacceptable toxicities occurred. All data was captured from the hospital's medical records until June 2023. Toxicity data was reported per the Common Terminology Criteria for Adverse Events (CTCAE) v5.1, and progression-free survival (PFS) was estimated using Kaplan-Meier methods. Among 34 screened patients, 10 were excluded due to noncompliance. This study analysed 24 patients with a median age at diagnosis of 56 years (IQ range 44-75). Sixteen (67%) patients were at stage IV disease with an Eastern Cooperative Oncology Group (ECOG) performance status of 3. Ovarian and cervical cancers were 80% and 20%, respectively; among them, 16 (67%) patients were platinum-refractory. Forty-two per cent of patients received three lines of chemotherapy before OMCT. A split course versus fixed dose was given to 67% versus 33% of the population; the best responses per the Response Evaluation Criteria in Solid Tumours v1.1 were complete response in 12%, partial response in 67% and stable disease in 21%. The most common toxicities were grade I anaemia (54%), grade I chemotherapy-induced nausea and vomiting (46%), grade I fatigue (42%) and grade I neutropenia (21%). Twenty-five per cent of patients were offered next-line systemic therapy after progression. The entire cohort had a median PFS of nine months (95%, CI: 5.2-12.7). Cox regression analysis identified a median PFS of 12 months (95%, CI: 6.2-17.7) among platinum-refractory groups. OMCT was a well-tolerated, affordable regimen with durable clinical response and survival outcome (median PFS of nine months) in recurrent, refractory advanced gynaecological cancer and can be offered to patients at resource-limited centres.

The Cost of Care: Describing the Financial Needs and Preferences of Patients with Advanced Gynecologic Cancer

The Cost of Care: Describing the Financial Needs and Preferences of Patients with Advanced Gynecologic Cancer

Language-concordant, patient-centered gynecology oncology symptom screening.

85 Background: Patients with advanced gynecologic cancer experience symptoms at diagnosis, on treatment, at recurrence, and at the end of life. There is no standardized screening or interventions for these symptoms. Further, little is known about how primary language affects the screening and treatment of symptoms. Our aim was to understand patients’ preferences when screening for symptoms. The secondary aim was to explore patients’ attitudes using symptom screening tools and to understand obstacles in communication. Methods: Patients with advanced or recurrent gynecologic cancer (ovary, cervix, uterus, vulva), who speak Spanish or English, participated in focus groups facilitated by research staff in a semi-structured discussion on a virtual platform for 1 hour. Spanish language groups were led by native Spanish-speaking research staff. Transcripts of the discussions were translated by certified translators. A validated symptom screening tool and focused gynecologic symptoms screening tool were administered, and feedback elicited. Transcripts were independently reviewed by 3 investigators to identify common themes. Discrepancies were reconciled via consensus. Results: There was a total of 21 participants, 14% were Spanish primary speakers and 85% English speaking. Twenty-nine percent of participants were Black, half of whom identified as Afro-Latinas, 14% Asian, and 5% American Indian. Most patients had ovarian (65%) or uterine cancer (20%). Most patients had recurrent disease (57%), 33% were stage III, 10% were stage IV. Eighty-one percent completed a web-based symptoms survey. Using a symptom screening tool was readily accepted by Spanish- and English-speaking patients. Participants highlighted four important themes: 1) Education and attention to symptoms for early detection of recurrence; 2) mental health and support groups with a noted disparity in access for the Spanish-speaking patients; 3) palliation of treatment-related symptoms; and language concordance between patient; and 4) care team identified by the Spanish-speaking group. Conclusions: Clear communication and education about symptoms are important to patients. Patients experience many mental health symptoms and desire therapy and support groups. Patients want to be screened for symptoms, and there is a strong desire for bilingual resources. Next steps include conducting focus groups with physicians and staff who provide care for this patient population and implementing a screening tool in our clinics.

Pilot study of remote electronic patient-reported outcomes (ePRO) symptom monitoring of palliative care needs among outpatients with advanced solid cancers.

250 Background: Early specialty palliative care for patients with advanced cancer is an evidence-based practice that improves health outcomes, yet patients do not receive timely referrals. ePRO symptom monitoring provides a ready care delivery platform to monitor patients for unmet palliative care needs and direct palliative care referral based on patient report. This study sought to obtain feasibility data for ePRO symptom monitoring of palliative care needs. Methods: We conducted a single-arm pilot study of longitudinal ePRO symptom monitoring of multidimensional palliative care needs among outpatients with advanced breast, gastrointestinal, and gynecologic cancers at an academic oncology practice. Adult patients on active treatment with a prognosis &gt; 6 months were approached consecutively. Patients completed baseline measures and enrolled on a third-party symptom monitoring platform for 12 weeks. Patients received weekly monitoring of 14 common symptoms using the National Cancer Institute's PRO version of the common terminology criteria for adverse events (PRO-CTCAEs). Patients received monthly monitoring of palliative needs using 11 PRO items from validated measures and a clinician-developed item for patient request for palliative care. Weekly symptom alerts and monthly palliative care PRO assessments were reported to the primary oncology team for interdisciplinary clinical management. Acceptability and appropriateness of the intervention were assessed using the Acceptability of Intervention Measure (AIM) and Intervention Appropriateness Measure (IAM). Results: From May 2022 to April 2023, 29 of 37 eligible patients (78%) consented to the study, of which 25 completed baseline measures and enrolled on the platform (68% enrollment rate; most common reason for refusal was not enough time). Median age was 53 years (range 29-77), 18 (72%) female, 12 (48%) non-Hispanic White, 32% reported an ECOG-PRO score 2-3. 96% of patients met pre-defined ePRO adherence thresholds and 92% completed study end measures (1 patient censored for death). Completion of the palliative PRO items was &gt; 94% for 9 of 11 items. Two PRO items for spiritual distress screening were skipped most often. 80% of patients reported a severe score for at least one palliative PRO symptom during the study period. Mean AIM and IAM scores were 3.92 and 4.26, respectively (range 3.25 – 5; best possible total score 5). Conclusions: Expanding evidence-based ePRO symptom monitoring to include monthly palliative care needs assessment is highly feasible, acceptable, and appropriate to patients. Adherence to PRO items was high, and most patients had at least one area of need. Future work will refine the ePRO palliative assessment with attention to spiritual distress screening and determine severity thresholds to develop a PRO-directed referral system to specialty palliative care.

313P Efficacy and safety of oral metronomic chemotherapy in recurrent refractory advanced gynaecological cancer: Experience from regional cancer center of eastern India

313P Efficacy and safety of oral metronomic chemotherapy in recurrent refractory advanced gynaecological cancer: Experience from regional cancer center of eastern India

Describing Self-Advocacy in Underrepresented Women With Advanced Cancer.

To describe the self-advocacy experiences of women from underrepresented groups who have advanced breast or gynecologic cancer. To be eligible for the study, participants had to self-identify as vulnerable, which was defined as a member of a group considered at risk for poor cancer outcomes and underrepresented in clinical research. This descriptive, longitudinal, qualitative study consisted of one-on-one interviews of women within three months of an advanced breast or gynecologic cancer diagnosis. 10 participants completed 25 interviews. The average age of participants was 60.2 years (range = 38-75 years). Three major themes emerged: (a) speaking up and speaking out, (b) interacting with the healthcare team, and (c) relying on support from others. Women with advanced cancer who are from underrepresented groups self-advocated in unique ways, learning over time the importance of how to communicate their needs and manage their healthcare team. Future research should incorporate these findings into tailored self-advocacy interventions.