Board Decisions Research Articles

Impact of metadata in multimodal classification of bone tumours

The accurate classification of bone tumours is crucial for guiding clinical decisions regarding treatment and follow-up. However, differentiating between various tumour types is challenging due to the rarity of certain entities, high intra-class variability, and limited training data in clinical practice. This study proposes a multimodal deep learning model that integrates clinical metadata and X-ray imaging to improve the classification of primary bone tumours. The dataset comprises 1,785 radiographs from 804 patients collected between 2000 and 2020, including metadata such as age, affected bone site, tumour position, and gender. Ten tumour types were selected, with histopathology or tumour board decisions serving as the reference standard.MethodsOur model is based on the NesT image classification model and a multilayer perceptron with a joint fusion architecture. Descriptive statistics included incidence and percentage ratios for discrete parameters, and mean, standard deviation, median, and interquartile range for continuous parameters.ResultsThe mean age of the patients was 33.62 ± 18.60 years, with 54.73% being male. Our multimodal deep learning model achieved 69.7% accuracy in classifying primary bone tumours, outperforming the Vision Transformer model by five percentage points. SHAP values indicated that age had the most substantial influence among the considered metadata.ConclusionThe joint fusion approach developed in this study, integrating clinical metadata and imaging data, outperformed state-of-the-art models in classifying primary bone tumours. The use of SHAP values provided insights into the impact of different metadata on the model’s performance, highlighting the significant role of age. This approach has potential implications for improving diagnostic accuracy and understanding the influence of clinical factors in tumour classification.

“All Eyes on McMinn:” Book Banning Discourse in the Age of Social Media

ABSTRACTThis project explores the intersection of local and online discourse around book bannings using the McMinn County School Board's decision in 2022 to remove Art Spiegelman's graphic memoir, Maus, from their school curriculum as a case study. Through interviews with McMinn County residents and data collected from Twitter, I argue that social media has altered book banning discourse. I interviewed 10 residents and asked them to discuss their experiences when Maus was removed by the school board and to reflect on how the local community responded amidst worldwide scrutiny online. Discourse on Twitter involved collecting over 2000 tweets mentioning the @McMinnCountySch account and tweets discussing Maus to understand online responses to the board's decision. I use Danielle Allen's discourse flow model as the theoretical framework for this project. In my initial findings, discourse began at the local level before traveling online and then back into the local space. Ongoing data analysis has shown that locally, residents were concerned with the board's decision along with the perception of their community once news of the banning spread. This is supported by Twitter discourse, where many tweets cast the McMinn County community in a negative light based on the school board's actions.

Skull Base Chordoma in a Young Lady - A Tale of Mismanagement and Redemption: A Case Report and Review of Literature.

Skull base chordomas are a rare entity that requires multidisciplinary decision-making for management. We report a case wherein the patient was initially mismanaged at a peripheral centre, and was then redeemed by a multidisciplinary tumor board decision-making and specialized surgical procedures. We also present a brief review of the therapeutic options.

Mind bylaws when confronting board term limit issues

With all of the disruption in nonprofit operating environments during the pandemic, it may have escaped your board's attention that one or more members of the board have termed out. In fact, it's even possible that the terms of entire boards actually ended during the pandemic and associated lockdowns, without anyone noticing. But does that mean the board's decisions since then are all moot and void? Not necessarily, according to Benjamin Takis, co‐founder of Sustainability Education 4 Nonprofits.

277. FLUORESCENCE-GUIDED ANASTOMOSIS DURING SINGLE-PORT VATS IVOR LEWIS ESOPHAGECTOMY

Abstract Background Minimally Invasive Esophagectomy (MIE) is the standard approach for esophageal cancer. The thoracic part is performed using multiple ports during video or robotic approach with CO2 inflation of 8-10 mmHg. There are recent publications of successful lung & thymic surgeries utilizing single port. This video describes our technique for performing ICG-guided intrathoracic anastomosis during single-port Ivor Lewis (IL) esophagectomy. Methods The surgery was performed on a 58-year-old male patient with Siwert type 1 adenocarcinoma (cT3, N0 M0). The patient underwent 4 cycles of neoadjuvant FLOT chemotherapy following a Multidisciplinary tumour board decision. Single-port Ivor Lewis (IL) esophagectomy was planned after three weeks of last cycle. Results Following the laparoscopic abdominal phase with extracorporeal gastric conduit formation and feeding jejunostomy, the patient was placed in a semiprone position. The thoracic phase was performed through single-port (4 cm in the 6th intercostal) VATS without CO2. The intrathoracic anastomosis was performed with a linear stapler in side-to-side manner under 1.5 ml indocyanine green (ICG) guidance. Thoracic phase time was 65 minutes. There were no intraoperative and postoperative complications. The pain score was three without opioid use. The patient was allowed orally on day five and discharged home on the eighth postoperative day. Conclusion Single port VATS IL MIE is a quick and safe surgical technique. Optics, instrumentations and surgical stapler maneuvering through a single port require a learning curve but are not difficult in our experience. A larger cohort and long-term follow-up are necessary for wider utilization of this approach. https://wetransfer.com/downloads/21555d68e61e7f962f2c33ed061b72dc20240319163828/b0b0feeea6f7a7ba47a04bb26ac96c2220240319163854/83de2d

Detection of liver metastases in patients with pancreatic adenocarcinoma: MRI versus CT

Introduction. Detection of liver metastases is important to guide therapeutic management of pancreatic cancer. Data suggest that magnetic resonance imaging (MRI) is more sensitive than computed tomography (CT) for the diagnosis of liver metastases from pancreatic cancer. However, MRI is currently not recommended in several guidelines. Purpose. To compare the performance of CT vs MRI in detection of liver metastases in patients with pancreatic adenocarcinoma. Methods. This was a retrospective single-center study over 24 months from January 2020 to December 2021 of patients suspected of having PDAC. All patients underwent contrast-enhanced triple phase CT and contrast-enhanced MRI/MRCP. The CT and MRI assessment of resectability and detection of metastases were performed according to NCCN version 1.2024 criteria by one observer based on clinical report. Composite reference standard based on decision of operability (based on multidisciplinary tumor board decision), surgical findings (delay of 2 to 3 weeks after imaging) and histopathologic findings. Results. 117 patients (M/F 52/65, mean age 62±11y) were included. The mean tumor size was 43.6±15.2mm (add range). 42/46 patients (34.2%/39.3%) were diagnosed with metastatic disease on CT/MRI, 40/36 patients (34.2%/30.8%) were resectable, 20/16 patients (17.1%/13.7%) were borderline resectable and 15/19 patients (12.8%/16.2%) were locally advanced. The detection of liver metastases on CT and MRI was compared with surgical findings in 45 patients (38.5%). The analysis showed that MRI had superior performance to CT, with sensitivity at 100% vs 60% and specificity at 97.1% vs 97.1%, PPV at 90.9% vs 85.7% and NPV 100% vs 89.5% (MRI/CT). Conclusion. MRI is more sensitive than CT in detection of liver metastases in patients with pancreatic adenocarcinoma.

Digital Health Applications (DiGAs) on a Fast Track: Insights From a Data-Driven Analysis of Prescribable Digital Therapeutics in Germany From 2020 to Mid-2024.

This study aimed to analyze the rapidly evolving ecosystem of digital health applications (Digitale Gesundheitsanwendung; DiGAs) in Germany, spurred by the 2019 Digital Healthcare Act. With over 73 million people in Germany now having access to DiGAs, these prescribable digital health apps and web-based applications represent a substantial stride in health care modernization, supporting both patients and health care providers with digital solutions for disease management and care improvement. Through a data-driven approach, this research aimed to unpack the complexities of DiGA market dynamics, economic factors, and clinical evidence, offering insights into their impact over the past years. The analysis draws from a range of public data sources, including the DiGA directory, statutory health insurance reports, app store feedback, and clinical study results. As of July 1, 2024, there are 56 DiGAs listed by the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte), divided into 35 permanently and 21 preliminarily listed applications. Our findings reveal that a majority of DiGAs extend beyond the intended 1-year period to achieve permanent listing, reflecting the extensive effort required to demonstrate clinical efficacy. Economic analysis uncovered a dynamic pricing landscape, with initial prices ranging from approximately €200 to €700 (€1=US $1.07), averaging at a median of €514 for a 3-month DiGA prescription. Following negotiations or arbitration board decisions, prices typically see a 50% reduction, settling at a median of €221. Prescription data offer valuable insights into DiGA acceptance, with total prescriptions jumping from around 41,000 in the first period to 209,000 in the latest reporting period. The analysis of the top 15 DiGAs, representing 82% of the total prescriptions, shows that these best-performing apps receive from a minimum of 8 to a maximum of 77 daily prescriptions, with native apps and early market entrants achieving higher rates. Clinical evidence from all 35 permanently listed DiGAs indicates a uniform preference for randomized controlled trials to validate primary end points, with no noteworthy use of alternative study designs encouraged in the Digital Healthcare Act and related regulations. Moreover, all evaluated DiGAs focused on medical benefits, with health status improvement as a key end point, suggesting an underuse of patient-relevant structural and procedural improvement in demonstrating health care impact. This study highlights the growth and challenges within the DiGA sector, suggesting areas for future research, such as the exploration of new study designs and the potential impact of patient-relevant structural and procedural improvements. For DiGA manufacturers, the strategic advantage of early market entry is emphasized. Overall, this paper underscores the evolving landscape of digital health, advocating for a nuanced understanding of digital health technology integration in Germany and beyond.

Synchronous Breast and Colorectal Malignant Tumors-A Systematic Review.

Our aim is to describe the main diagnostic and therapeutic challenges for synchronous breast and colorectal tumors. We performed a systematic review of the literature for cases or case series, using established keywords (synchronous breast and colon tumor and synonyms) for the period of 1970-2023. Five reviewers independently screened the literature, extracted data, and assessed the quality of the included studies. The results were processed according to the PRISMA 2020 guidelines. A total of 15 cases were included in the study, including 2 males (age 50 and 57) and 13 females (median age 60, with range from 40 to 79). In a vast majority of the cases, the diagnosis of synchronous tumor was prompted by the first tumor's workup. The first diagnosed tumor was colorectal in nine cases and a breast tumor in six cases. The most common histopathological type of breast tumor was invasive ductal carcinoma, and the colon tumors were exclusively adenocarcinomas. All cases had a surgical indication for both breast and colorectal tumor, except one case, in which the breast tumor had multiple metastasis. In four cases, the surgery was performed concomitantly (colectomy and mastectomy). In three cases, surgery was initially carried out for the breast tumor, followed by colon surgery. Oncological treatment was indicated depending on the tumor stage. For the treatment of synchronous tumors, the Tumor Board (T.B) decision is mandatory and must be personalized for each patient. Developing new methods of treatment and investigation may play an important role in the future for understanding synchronous tumor development, incidence, and outcome.

Vertical interlocking and decision making in national and provincial/territorial non-profit sport organization boards

ABSTRACT This study explains the impact of vertical interlocking on national (NSO) and provincial/territorial (P/TSOs) non-profit sport organization board decision making in a federated sport model. Data were collected from six boards in Canada (two NSOs, four P/TSOs) via 36 meeting observations, 18 semi-structured interviews, and over 900 documents. Sixty-six decisions were categorized based on vertically interlocked and non-interlocked boards (three per group). Data were analyzed via an independent sample t-test (derived from a structured observation sheet to score decisions quantitatively) and a codebook thematic analysis. Results demonstrated interlocked boards differed from their non-interlocked counterparts when making decisions regarding the length, delays, interactions, and information sources (i.e., acquisition and use). Theoretically, results provide insights into vertical interlocking’s multi-dimensional impact on decision-making constructs. Practically, NSO and P/TSO boards should perceive vertical interlocking positively, given the ability to access and use information sources not available in non-interlocked boards.

76. Automating immunogenomic tumor board decision-making for neoantigen cancer vaccine design

76. Automating immunogenomic tumor board decision-making for neoantigen cancer vaccine design

Board Characteristics and Quality of Integrated Reporting of Firms Listed Nairobi Securities Exchange

Companies that opt for integrated reporting are in a favorable position to enhance a range of benefits,whether internal or external in nature. It encompasses improvements in resource allocation, shareholderengagement, and reputation. On the other hand, external advantages pertain to investors who rely ongovernance disclosure, as well as compliance with regulations, frameworks, standards, and guidelines setby stock exchanges. The expansion and adoption of integrated reporting are broadening its scope, with anincreasing number of companies showing willingness to adopt this approach. The diffusion and adoptionof reporting practices stem from diffusion theory, which has evolved from institutional theory,encompassing institutional factors that influence organizational behavior. The positive and statisticallysignificant relationships between board characteristics highlight how crucial it is for publicly tradedcorporations to work to improve the independence of their boards of directors while also includingmembers with financial expertise to facilitate the disclosure of both financial and non‐financial information.The findings are significant especially in the implementation of board decisions, strategic planning, and inmanaging corporate governance attributes in the attempts to enhance information disclosure through theimplementation of integrated reporting.

Optimalisasi Penerapan Prinsip Transparansi Dalam Pengelolaan Perum Perhutani

Juridically, the implementation of transparency principles as part of Good Corporate Governance in Perum Perhutani has been initiated, though not yet fully optimized. Perum Perhutani has provided easy access to information and strives to maintain good relationships with stakeholders through various activities and media, in compliance with OJK Regulation No. 31/POJK.04/2015 on Disclosure of Material Information by Issuers or Public Companies. Transparency in material information builds public trust in a company's performance, necessitating specific regulations governing Annual Reports, as outlined in Chairman of the Capital Market Supervisory Board and Financial Institution Decision No. KEP-431/BL/2012 regarding Submission of Annual Reports by Issuers or Public Companies. Public access to information enables understanding and monitoring of management activities, fostering professional and ethical implementation of corporate vision and mission, considering all stakeholders. Ultimately, optimal application of Good Corporate Governance serves as a collective commitment to professional and ethical company conduct, minimizing conflicts of interest and legal issues, thereby enhancing product quality, company management, corporate value development, and reputation improvement in the long run.

On stare decisis in criminal law

The article considers the place of the principle of stare decisis and the effect of its key parameters in the context of modern criminal law. The author proceeds from the fact that the precedent character of criminal law positions of the highest court directly follows from the constitutional requirements of equality of all before the law and the court, describes the basis of this principle in Russian realities. The author shows the groundlessness of the explanations of the Supreme Court of the Russian Federation and the chaotic formation of its quarterly reviews. The author proposes not to consider the explanations of the Plenum of the Supreme Court of the Russian Federation as precedent, leaving among them only the decisions of the Supreme Court regardless of their inclusion in the review of practice. Based on the research of the own telegram channel “Ugolovnaya practica VS RF” and more than 800 judicial acts for the last 3 years, it has been proved that there is a trend of precedent justice, as the courts of first instance actively motivate their decisions by elaborated positions and references to the decisions of the criminal board in specific cases.

Tumor Board Practice and Current Approach of Oncologists in Türkiye

Objective: Interdisciplinary cooperation is essential in treating and following up cancer disease. The primary objective of multidisciplinary tumor councils (MDTCs) is to identify the most suitable and effective treatment strategies for cancer patients through the collective decision-making of experts in oncology. MDTC plays a key role in breaking traditional taboos, providing the most up-to-date approach to the patient, sharing responsibility and accountability, and encouraging interdisciplinary communication and collaboration. Material and Methods: In this study, the perspectives, expectations, and experiences of medical oncologists regarding tumor boards were evaluated. The survey consisted of 10 questions and was conducted as an online survey at the '7th National Immunotherapy and Oncology Congress'. This study was cross-sectional and online. While those who were actively working as medical oncologists and those who wanted to voluntarily participate in the survey were included in the study, those who were not medical oncologists, those who were not actively working, and those who worked in private clinics were not included in the study. Participants were asked various questions about multidisciplinary tumor boards. They were asked about the specialties they most needed on the boards, the other clinics participating in the boards, and the clinics they felt were essential. The necessity of genetic clinics and molecular boards in shaping the future of oncology through molecular assessments was also assessed. The impact of board decisions on patient treatment and management was investigated. Results: A total of 624 oncologists participated in the survey. The majority of the participants were young oncologists. Most participants worked in tertiary healthcare units, including university hospitals and training and research hospitals. Almost all of the participants stated that they did MDTC. The most frequent and regular councils are; thoracic cancers and gastrointestinal cancers. The most needed and hard to reach branch was the medical genetics department. Conclusion: Cancer treatment is a complex process that cannot be confined to a single expertise. Multidisciplinary tumor boards (MDTB) are one of the cornerstones of a comprehensive approach to cancer treatment. In multidisciplinary tumor boards, various topics such as medical treatment planning for patients, diagnosis, surgical and radiotherapy planning, side effect management, and palliative care can be examined. MDTB not only provides effective treatment for cancer patients from a broad perspective but also ensures rapid and comprehensive solutions in case of potential complications.

Obligation to State Reasons: Clear Principle with (Still) Unclear Scope? In Search of an Adequate Standard of Reasoning for a Decision Based on Confidential Data (Joined Cases C???584/20 P and C???621/20 P Commission and SRB v Landesbank Baden-Württemberg)

This article provides an analysis of the judgment of the Grand Chamber of the Court of Justice (the Court) of 15 July 2021 delivered in Joined Cases C-584/20 P and C-621/20 P (Commission and SRB v Landesbank Baden-W??rttemberg), which offers valuable insights into the question of the scope of the obligation to state reasons. In particular, the judgment clarifies how that obligation should be weighed, if necessary, with the obligation to protect the confidential data within the EU decision-making process. While the judgment specifically pertains to a decision of the Single Resolution Board regarding the calculation of ex-ante contributions to the Single Resolution Fund, its implications extend to all areas of EU law where the EU administration relies on confidential information in order to adopt a decision. Additionally, the judgment holds particular significance for the National Resolution Authorities of the Member States non-participating in the Banking Union, since they are required to calculate ex‐ante contributions to their national resolution financing arrangement and must, for this purpose, rely on the methodology provided by the EU legislator, as interpreted by the Court. Finally, the authors argue that regardless of its significance, the judgment leaves several questions unanswered regarding the adequacy of the reasoning of an administrative decision based on confidential data.

Assessing the role of advanced artificial intelligence as a tool in multidisciplinary tumor board decision-making for primary head and neck cancer cases

BackgroundHead and neck squamous cell carcinoma (HNSCC) is a complex malignancy that requires a multidisciplinary approach in clinical practice, especially in tumor board discussions. In recent years, artificial intelligence has emerged as a tool to assist healthcare professionals in making informed decisions. This study investigates the application of ChatGPT 3.5 and ChatGPT 4.0, natural language processing models, in tumor board decision-making.MethodsWe conducted a pilot study in October 2023 on 20 consecutive head and neck cancer patients discussed in our multidisciplinary tumor board (MDT). Patients with a primary diagnosis of head and neck cancer were included. The MDT and ChatGPT 3.5 and ChatGPT 4.0 recommendations for each patient were compared by two independent reviewers and the number of therapy options, the clinical recommendation, the explanation and the summarization were graded.ResultsIn this study, ChatGPT 3.5 provided mostly general answers for surgery, chemotherapy, and radiation therapy. For clinical recommendation, explanation and summarization ChatGPT 3.5 and 4.0 scored well, but demonstrated to be mostly an assisting tool, suggesting significantly more therapy options than our MDT, while some of the recommended treatment modalities like primary immunotherapy are not part of the current treatment guidelines.ConclusionsThis research demonstrates that advanced AI models at the moment can merely assist in the MDT setting, since the current versions list common therapy options, but sometimes recommend incorrect treatment options and in the case of ChatGPT 3.5 lack information on the source material.

Establishing Healthcare Discrimination: An Analysis of Scandinavian Equality Boards

Discrimination in healthcare is a pervasive issue faced by patients, affecting their access to treatment and overall well-being. This article examines the forms of healthcare discrimination recognised by Scandinavian equality boards through a comparative analysis of their decisions. While social science studies have established the existence of discrimination based on ethnicity, race, gender, sexuality, and age, proving such discrimination in legal terms poses significant challenges. An analysis of board decisions reveals that patients face barriers in establishing legally actionable discrimination, as perceived discriminatory conduct may not meet the criteria for legal claims. Additionally, equality boards are often hesitant to intervene in medical decision-making processes, further complicating the path to legal recourse. Lack of evidentiary support, especially in cases of unconscious bias, makes it difficult for some patients to substantiate claims of discrimination. The findings underscore the complexities of addressing healthcare discrimination through legal means. To effectively combat discrimination, there is a need to clarify the goals of discrimination law in the healthcare context and consider its future application within the broader context of human rights and equality.

Case report of the perinatal form of Nieman-Pick disease type С against the backdrop of pathogenetic off-label therapy

Background. Niemann–Pick disease type C is a multisystem orphan disease caused by mutations in the NPC1 and NPC2 genes and characterized by clinical polymorphism. The difficulties of managing such patients lie in the diagnosis and differential diagnostic search with other conditions with cholestasis, as well as the initiation of substrate-reducing therapy in young children. Case report. Previously, a case report of Niemann–Pick disease type C, with the manifestation of the disease in infancy and the appointment of off-label pathogenetic therapy was described. The article presents the results of dynamic monitoring of the child on this therapy, its effectiveness and safety. The leading syndromes in the clinical presentation of the disease were cholestasis, cytolysis, hepatosplenomegaly, as well as psychomotor retardation. An extensive differential diagnostic search was conducted with the exception of diseases such as toxic, viral hepatitis, alpha-1-antitrypsin deficiency, autoimmune liver diseases, aminoacidopathy, Alagille syndrome. Genetic testing on the “Cholestasis” panel revealed a mutation in the NPC1 gene. Biochemical diagnostics showed an increase in the concentration of lysosphingomyelin-509 and increased activity of chitotriosidase in dry blood spots. When sequencing the NPC1 gene by Sanger, the nucleotide substitution chr18:21131617G> A in the homozygous state was detected in the child. At 9 months, by the decision of the medical board, the child was prescribed pathogenetic therapy, the effectiveness of which was confirmed by clinical and laboratory relief of cholestasis, positive dynamics of neurological manifestations, in addition, the drug is satisfactorily tolerated by the patient, despite the preservation of an isolated increase in the level of aspartate aminotransferase. Conclusion. The presented case report confirms the need for a thorough differential diagnostic search with the inclusion of a wide range of diseases with the leading cholestasis for the timely detection of infants with Niemann- Pick disease type C, as well as the importance and effectiveness of early administration of pathogenetic therapy.

ChatGPT's Gastrointestinal Tumor Board Tango: A limping dance partner?

ObjectivesThis study aimed to assess the consistency and replicability of treatment recommendations provided by ChatGPT 3.5 compared to gastrointestinal tumor cases presented at multidisciplinary tumor boards (MTBs). It also aimed to distinguish between general and case-specific responses and investigated the precision of ChatGPT's recommendations in replicating exact treatment plans, particularly regarding chemotherapy regimens and follow-up protocols. Material and methodsA retrospective study was carried out on 115 cases of gastrointestinal malignancies, selected from 448 patients reviewed in MTB meetings. A senior resident fed patient data into ChatGPT 3.5 to produce treatment recommendations, which were then evaluated against the tumor board's decisions by senior oncology fellows. ResultsAmong the examined cases, ChatGPT 3.5 provided general information about the malignancy without considering individual patient characteristics in 19% of cases. However, only in 81% of cases, ChatGPT generated responses that were specific to the individual clinical scenarios. In the subset of case-specific responses, 83% of recommendations exhibited overall treatment strategy concordance between ChatGPT and MTB. However, the exact treatment concordance dropped to 65%, notably lower in recommending specific chemotherapy regimens. Cases recommended for surgery showed the highest concordance rates, while those involving chemotherapy recommendations faced challenges in precision. ConclusionsChatGPT 3.5 demonstrates potential in aligning conceptual approaches to treatment strategies with MTB guidelines. However, it falls short in accurately duplicating specific treatment plans, especially concerning chemotherapy regimens and follow-up procedures. Ethical concerns and challenges in achieving exact replication necessitate prudence when considering ChatGPT 3.5 for direct clinical decision-making in MTBs.

Abstract PO4-20-09: Successful outcome of locally advanced HR+HER2+ breast cancer treatment in a young female after pancreas-kidney transplantation. 3-year follow-up

Abstract Background Solid organs recipients with subsequent cancer comprise a group of patients with unmet medical needs: they lack any clinical trials or guidelines for treatment. There are only individual case reports in literature. Meanwhile their number is growing due to achievements in transplantology and improved cancer diagnosis. Case presentation А young 34-year-old female attended our center in September 2019 with a palpable mass and peau d'orange of the left breast. A core-needle biopsy of the left breast mass revealed invasive ductal carcinoma G3, estrogen receptor 7 (Allred), progesterone receptor 6 (Allred), HER-2 (3+), Ki-67 49%. Left axillary lymph node biopsy revealed metastatic breast cancer. After a complete examination the clinical stage was cT4bN1fM0, IIIB stage. The patient had a history of Type 1 diabetes mellitus since 2003 leading to multiple complications including terminal diabetic nephropathy, which required renal replacement therapy with the use of long-term hemodialysis since July 2014. The other complications consisted of severe retinopathy with corneal transplantation on the left eye in April 2013, an episode of right eye hemophthalmia in March 2016 with consequent loss of vision in the right eye, polyneuropathy, gastropathy and enteropathy. The patient underwent a simultaneous pancreas-kidney transplantation in April, 2016 and was on permanent immunosuppressive therapy with tacrolimus 8 mg daily and methylprednisolone 8 mg daily. The function of both transplants was satisfactory. This unique case was published by Pinchuk A. et al. in Transplant Proceedings, 2017 [doi: 10.1016/j.transproceed.2017.10.005]. A multidisciplinary approach was applied to tailoring treatment plan for this patient. Initially immunosuppressive therapy was modified: the patient discontinued methylprednisolone and started everolimus with simultaneous tacrolimus dose reduction (their doses adjusted according to blood concentrations). The tumor board decision was to start neoadjuvant therapy with regimen with the mildest and the most manageable toxicity profile and to avoid anthracyclines. From October to December 2019 the patient received 12 cycles of paclitaxel 80 mg/m2 day 1 weekly and 4 cycles of anti-HER2 dual blockade: trastuzumab 8 mg/kg day 1 followed by 6 mg/kg day 1 every 21 days + pertuzumab 840 mg day 1 followed by 420 mg day 1 every 21 days. Adverse events were: stomatitis grade 1, palmar-plantar erythrodysesthesia grade 1, diarrhea grade 2. Partial response was evaluated in the end of December 2019, but due to persistent skin edema, she was not a candidate for surgical treatment. The tumor board decision was to proceed with T-DM1 + pertuzumab based on the results of the KRISTINE trial [doi:10.1016/s1470-2045(17)30716-7]. From January to March 2020 the patient received 4 cycles of trastuzumab-emtansine 3,6 mg/kg day 1 every 21 days + pertuzumab 420 mg day 1 every 21 days. The patient tolerated this treatment with mild toxicity: ALT & AST increase grade 2 and diarrhea grade 2. Considering that the edema was significantly reduced, surgical treatment was planned. The patient underwent a modified radical mastectomy for left breast cancer on 14 of April 2020. The pathological stage was ypT1аN0 R0, RCB I. The patient continued trastuzumab emtansine until November 2020 (up to 1 year of anti-HER2 targeted therapy) in the adjuvant setting. In June 2020 she underwent locoregional radiation therapy. Tamoxifen with ovarian function suppression (LHRH agonists) for 5 years was started in June 2020. Fortunately, after 3 years of follow-up after surgery there is no evidence of disease and no delayed cancer treatment complications. Conclusion: Personalized multidisciplinary team decisions for cancer patients after organ transplantation are crucial to further improve the long-term outcome of these patients. Citation Format: Lyudmila Zhukova, Natalya Polshina. Successful outcome of locally advanced HR+HER2+ breast cancer treatment in a young female after pancreas-kidney transplantation. 3-year follow-up [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-20-09.