Intended Treatment Plan Research Articles

Practice patterns in prostate cancer therapy among healthcare professionals: Comparison with expert recommendations from an online tool.

e13549 Background: The treatment landscape of prostate cancer (PC) is complex, and recent approvals of new agents and regimens further challenge healthcare professionals (HCPs) to select optimal therapy for patients with PC. We sought to identify practice patterns among community HCPs for PC by comparing HCP and key opinion leader (KOL) treatment recommendations using an online decision support tool. Methods: The online decision support tool was developed with 5 KOLs who provided therapy recommendations for 96 patient case scenarios encompassing mHSPC, nmCRPC, and mCRPC based on factors including disease volume and symptoms, comorbidities, previous therapy, and biomarker status. HCPs entered specific patient and disease factors into the tool along with their intended treatment plan and were shown the 5 individual KOL recommendations for the patient case. An analysis of HCP selected therapy compared with KOL recommendations was performed. Results: Between September 2023 and January 2024, 286 patient cases were entered by 100 HCPs. KOL consensus defined as ≥3 in agreement. HCP therapy selection discordance with KOL recommendations was 69% for nmCRPC (n = 64 cases), 42% for mHSPC (n = 125 cases), and 46% for mCRPC (n = 97 cases). The level of discordance was 63% (n = 43 cases) for nmCRPC with a PSADT <10 months and 81% (n = 21 cases) with a PSADT ≥10 months (Table). Regardless of PSADT, selection of therapy for nmCRPC without listed comorbidities was highly discordant 82% (n = 34 cases). In mHSPC, the highest level of discordance was seen in cases with de novo, symptomatic, high-volume disease, and diabetes at 73% (n = 11). Discordance was 54% for de novo mHSPC with symptomatic disease (n = 52 cases). HCP selection of 1L, 2L, or 3L therapy for mCRPC was 44% to 47% discordant with KOL recommendations regardless of prior therapy. Selection of therapy for mCRPC with HRR mutations including BRCA (n = 29) was 48% discordant. Among HCPs who initially selected treatment options that diverged from expert recommendations or were uncertain about therapy selection, 48% (n/N = 75/157) intend to change their therapy selection to align with the experts. Detailed data analysis with KOL recommendations will be presented. Conclusions: This analysis suggests differences in clinical practice between HCPs and KOLs for multiple case scenarios in PC and suggests that use of the decision tool may lead to increased alignment of treatment choices with KOLs. [Table: see text]

Superiority of 18F-FAPI-42 PET/CT in the detection of primary tumor and management of appendiceal neoplasm to 18F-FDG PET/CT and CE-CT

BackgroundIn the present study, we investigated the value of 18F-fibroblast-activation protein inhibitor (FAPI) positron emission tomography/computed tomography (18F-FAPI-42 PET/CT) to preoperative evaluations of appendiceal neoplasms and management for patients.MethodsThis single-center retrospective clinical study, including 16 untreated and 6 treated patients, was performed from January 2022 to May 2023 at Southern Medical University Nanfang Hospital. Histopathologic examination and imaging follow-up served as the reference standard. 18F-FAPI-42 PET/CT was compared to 18F-fluorodeoxyglucose (18F-FDG) PET/CT and contrast-enhanced CT (CE-CT) in terms of maximal standardized uptake value (SUVmax), diagnostic efficacy and impact on treatment decisions.ResultsThe accurate detection of primary tumors and peritoneal metastases were improved from 28.6% (4/14) and 50% (8/16) for CE-CT, and 43.8% (7/16) and 85.0% (17/20) for 18F-FDG PET/CT, to 87.5% (14/16) and 100% (20/20) for 18F-FAPI-42 PET/CT. Compared to 18F-FDG PET/CT, 18F-FAPI-42 PET/CT detected more regions infiltrated by peritoneal metastases (108 vs. 43), thus produced a higher peritoneal cancer index (PCI) score (median PCI: 12 vs. 5, P < 0.01). 18F-FAPI-42 PET/CT changed the intended treatment plans in 35.7% (5/14) of patients compared to CE-CT and 25% (4/16) of patients compared to 18F-FDG PET/CT but did not improve the management of patients with recurrent tumors.ConclusionsThe present study revealed that 18F-FAPI-42 PET/CT can supplement CE-CT and 18F-FDG PET/CT to provide a more accurate detection of appendiceal neoplasms and improved treatment decision making for patients.

Added Value of [18F]PSMA-1007 PET/CT and PET/MRI in Patients With Biochemically Recurrent Prostate Cancer: Impact on Detection Rates and Clinical Management.

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) can change management in a large fraction of patients with biochemically recurrent prostate cancer (BCR). To investigate the added value of PET to MRI and CT for this patient group, and to explore whether the choice of the PET paired modality (PET/MRI vs. PET/CT) impacts detection rates and clinical management. Retrospective. 41 patients with BCR (median age [range]: 68 [55-78]). 3T, including T1-weighted gradient echo (GRE), T2-weighted turbo spin echo (TSE) and dynamic contrast-enhanced GRE sequences, diffusion-weighted echo-planar imaging, and a T1-weighted TSE spine sequence. In addition to MRI, [18F]PSMA-1007 PET and low-dose CT were acquired on the same day. Images were reported using a five-point Likert scale by two teams each consisting of a radiologist and a nuclear medicine physician. The radiologist performed a reading using CT and MRI data and a joint reading between radiologist and nuclear medicine physician was performed using MRI, CT, and PET from either PET/MRI or PET/CT. Findings were presented to an oncologist to create intended treatment plans. Intrareader and interreader agreement analysis was performed. McNemar test, Cohen's κ, and intraclass correlation coefficients. A P-value <0.05 was considered significant. 7 patients had positive findings on MRI and CT, 22 patients on joint reading with PET/CT, and 18 patients joint reading with PET/MRI. For overall positivity, interreader agreement was poor for MR and CT (κ = 0.36) and almost perfect with addition of PET (PET/CT κ = 0.85, PET/MRI κ = 0.85). The addition of PET from PET/CT and PET/MRI changed intended treatment in 20 and 18 patients, respectively. Between joint readings, intended treatment was different for eight patients. The addition of [18F]PSMA-1007 PET/MRI or PET/CT to MRI and CT may increase detection rates, could reduce interreader variability, and may change intended treatment in half of patients with BCR. 3 TECHNICAL EFFICACY: Stage 3.

Real-World Outcomes of Faricimab Treatment for Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema.

The purpose of this study was to assess preliminary real-world outcomes in neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) treated with intravitreal faricimab. This was a retrospective, observational consecutive-case real-world study of patients with nAMD or DME initiated on intravitreal faricimab between November 2022 and April 2023. Treatment-naïve patients and patients previously treated with alternate anti-vascular endothelial growth factor (anti-VEGF) agents were initiated on an intended treatment plan of four monthly faricimab injections as a loading regime. Efficacy was assessed across four treatment groups. Primary outcomes assessed for both cohorts were changes in best corrected visual acuity (BCVA) and central subfield thickness (CST) on optical coherence tomography (OCT). Secondary outcomes were alterations in OCT-defined structural features. From 127 patients, 146 eyes received at least one dose of faricimab. Mean BCVA, measured in Early Treatment of Diabetic Retinopathy Study (ETDRS) letters, from baseline to fifth visit increased from: 59.0±12.8 to 62.2±14.3 in treatment-naïve nAMD; 61.1±17.6 to 63.5±14.8 in previously-treated nAMD; 61.1±13.0 to 72.8±11.5 in treatment-naïve DME; and 60.8±14.6 to 63.3±15.6 in previously-treated DME. Mean CST reduced in all four treatment groups between initiation to final loading dose, from: 442.8±172.0µm to 305.2±117.0µm (p<0.0001) in treatment-naïve nAMD; 355.2±115.1µm to 297.9±92.54µm (p<0.0001) in previously-treated nAMD; 465.8±109.1µm to 343.1±100.3µm (p<0.0001) in treatment-naïve DME; and 492.5±133.1µm to 388.5±131.4µm (p<0.0001) in previously-treated DME. Real-world outcomes showed some improvement in BCVA and CST for nAMD and DME following faricimab administration, including in patients previously treated with other anti-VEGF agents. Further work involving larger cohorts over longer periods is required to determine whether improvement is maintained, and if intervals can be extended to match those observed in clinical trials.

Clinical Practice Gaps in Managing Patients with Myelofibrosis: Comparison of Healthcare Professional and Expert Treatment Choices Provided to an Online Decision Support Tool

Background: Myelofibrosis (MF) is a rare hematologic malignancy for which treatment has evolved considerably in recent years, with 3 JAK inhibitors now approved in the United States to manage this disease. With numerous therapeutics in phase III trials, the complexity of treatment selection is likely to increase in the coming years. To assist hematology/oncology healthcare professionals (HCPs), we developed an online decision support tool designed to provide case-specific treatment recommendations from 5 MF experts. Here, we report an analysis of cases entered into the tool by HCPs, comparing their planned treatment with expert recommendations to determine differences in clinical practice and areas of educational need. Methods: In February 2023, 5 MF experts provided evidence-based treatment recommendations for 45 distinct MF case scenarios that were defined by multiple key factors, including the presence of MF symptoms, splenomegaly, or anemia; platelet count; prognostic risk group; and previous JAK inhibitor therapy. To use the tool, HCPs entered their patients' characteristics and their intended treatment plan; recommendations from each of the 5 experts based on those same characteristics were then provided. In this analysis, the intended treatment plans of HCPs were compared with expert recommendations to determine areas of discordance and agreement. Results: In May/June 2023, 91 cases were entered into the tool (84% of cases by physicians); 72% of respondents reported treating 1-4 patients with MF per month (n = 32), and 61% sought recommendations for a specific patient in their practice (n = 28). A lack of concordance between HCP and expert treatment choices was observed for many case scenarios (Table). For example, for case patients with lower prognostic risk and MF signs/symptoms, experts most frequently recommended ruxolitinib (85%) in contrast to HCPs, who recommended ruxolitinib for 38% of these cases. Similarly, discordance was noted for several case scenarios of patients with higher-risk MF who were not suitable for transplant and required a treatment change following initial therapy with ruxolitinib. Of note, subtle variance was observed among experts for specific second-line case scenarios, including when to add on to current therapy vs switching to a new JAK inhibitor, which may reflect the burgeoning area of clinical practice in defining JAK inhibitor failure and determining subsequent second-line treatment paradigms with several JAK inhibitors now available. Of the 23 HCP cases seeking recommendations for patients with higher prognostic risk, 74% sought recommendations in the post-ruxolitinib setting. Overall, after reviewing expert recommendations, 81% of HCP respondents indicated that they would change their treatment approach or that the recommendations confirmed their treatment strategy (n = 32). Conclusions: Analysis of data from an online decision support tool indicates differences among experts and HCPs in contemporary management of patients with MF, and data suggest that a decision support tool can affect HCP treatment decisions in a rapidly evolving therapeutic landscape, potentially improving patient care. In-depth analyses with additional HCP cases will be presented.

Socio-economic, education, and insurance-related factors associated with the treatment completion rates in patients with nonmetastatic urinary bladder cancer: A Retrospective cohort study.

Among urological malignancies, the diagnosis and treatment of urinary bladder cancer (UBC) incurs the highest cost per patient. Our objective was to broaden the current understanding of how demographic, socioeconomic, education, and insurance-related factors influence UBC management. Between January 2017 and December 2019, all patients with nonmetastatic bladder cancer were included. The demographic, treatment, and follow-up details were retrieved from a prospectively maintained database, and the Modified Kuppuswamy Index was used to evaluate the patients' socioeconomic level. Patients were divided into the completed treatment group, or the incomplete treatment group based on adherence to the initially intended treatment plan. Patients who presented with benign disease or metastases were not included. Eighty-nine patients did not complete the initially intended course of treatment out of 132 patients who needed additional management after the initial transurethral resection. Comparable risk factors and demographic profiles existed in both groups. Patients with intermediate-risk disease are more likely to fail to adhere to the initial intended treatment (odds ratio [OR] = 0.09; 95% confidence interval [CI]: 0.02-0.30). On logistic regression analysis, upper socioeconomic status (OR = 6.8; 95% CI: 0.35-132.1) patients and patients with higher educational status of graduation or above (OR = 3.62; 95% CI: 0.75-17.43) had higher chances of treatment completion. Education status significantly impacted treatment completion on multivariate analysis (P = 0.01). Patients who utilized employer-funded insurance had better treatment compliance (OR = 4.1; 95% CI: 0.90-18.7). The compliance was unaffected by smoking, occupation, or other demographic factors. Patients with low economic status, low levels of education, and who need adjuvant intravesical therapy had considerably greater treatment dropout rates.

Advanced cervical cancer therapy: Comparison of contemporary expert and healthcare professional recommendations from an online treatment decision tool.

5528 Background: Practice patterns for the management of advanced cervical cancer are rapidly evolving given the emergence of novel treatment options. We developed an online Interactive Decision Support Tool (IDST) for advanced cervical cancer to provide expert guidance to healthcare professionals (HCPs). Methods: With input from 5 experts, an IDST was developed for patient scenarios with newly diagnosed (ND) and recurrent/second-line (2L) advanced cervical cancer. The IDST included expert insights on 352 scenarios based on criteria such as adenopathy, disseminated disease status, previous therapy, and actionable biomarkers (PD-L1, MMR/MSI, TMB). Users were asked to enter specific patient criteria and their intended management approach. The IDST then showed the 5 expert recommendations for that specific scenario and HCPs were asked to indicate whether the recommendations changed their intended treatment plan. Expert recommendations vs user-selected therapy for different scenarios were analyzed. We present self-reported practice patterns in this disease setting and the impact of expert recommendations on treatment choice. Results: At this interim analysis, 141 unique learners used the IDST, entering 232 unique patient scenarios. Data from the IDST also showed areas of consensus and controversy in treating patients with advanced cervical cancer. For locally advanced, ND, no adenopathy and no metastases, all experts recommended pelvic chemoradiation with or without brachytherapy vs only 61% of HCPs; 16% and 3% of those entering cases for the locally advanced ND setting indicated expert recommendation changed their treatment choice and that barriers impeded the recommendations, respectively. For advanced ND, with adenopathy, metastatic, PD-L1–positive cervical cancers, all experts vs 50% of HCPs chose an immunotherapy-containing platinum-based chemotherapy regimen with/without bevacizumab; 9% of those indicated barriers to implementing expert recommendations. In 2L recurrent disease, all experts chose either single-agent immunotherapy (if PD-L1 positive) or tisotumab vedotin (if PD-L1 negative) vs 45% and 40% of HCPs, respectively; 19% of those selecting 2L therapy in the recurrent setting said the expert recommendations had changed their intended choice. Conclusions: Analysis from this IDST indicates differences in practice patterns between experts and HCPs for various case scenarios of advanced cervical cancer. Online decision support tools may increase the number of HCPs making optimal treatment decisions for advanced cervical cancer, particularly when new data, indications, and guideline updates must be considered. Updated and detailed analyses from the IDST will be presented.

State-of-the-art management of HER2-negative early breast cancer: Treatment patterns among healthcare professionals and concordance with expert recommendations.

553 Background: The management of high-risk HER2-negative early-stage breast cancer (EBC) has recently evolved with the addition of newer agents including abemaciclib, olaparib, and pembrolizumab as (neo)adjuvant therapy options for appropriate patients. To aid healthcare professionals (HCPs) in the recommended implementation of these agents, we developed an online treatment decision support tool providing case-specific treatment guidance from 5 breast cancer experts. Here, we report an analysis of cases entered into the tool by HCPs, comparing their planned treatment with expert recommendations. Methods: Expert therapy recommendations for 10 case scenarios in high-risk HER2-negative EBC based on 3 pivotal clinical trials (KEYNOTE-522, OlympiA, and monarchE) were obtained in March 2022. Patient and disease characteristics included hormone receptor (HR) status, BRCA mutational status, lymph node positivity, presence of residual disease after resection, and additional criteria based on the 3 practice-changing trials. HCPs entered specific patient and disease factors into the tool along with their intended treatment plan and were shown 5 individual expert treatment recommendations for the unique case scenario. Results: From June 2022 to January 2023, 547 HCPs entered 982 patient case scenarios into the tool. A comparison of treatment recommendations by experts and HCPs showed divergence for several case scenarios. For patients with high-risk HR-positive/HER2-negative EBC and no BRCA mutation, all 5 experts recommended adjuvant abemaciclib plus endocrine therapy. By contrast, 64% of HCPs’ therapy choices were discordant with the experts, with 49% choosing chemotherapy followed by endocrine therapy. For patients with triple-negative breast cancer (TNBC) who received neoadjuvant chemotherapy and have no residual disease, all 5 experts recommended observation, whereas 36% of HCPs recommended additional adjuvant therapy. In the setting of BRCA-mutated TNBC with residual disease after neoadjuvant pembrolizumab plus chemotherapy, 4 of 5 experts recommended adjuvant pembrolizumab plus olaparib, but just 33% of HCPs chose this combination. One third of HCPs who initially selected treatment options that diverged from expert recommendations or who were uncertain about treatment choice intend to change their therapy selection to align with the experts. Conclusions: Analysis of data from this tool suggests differences in clinical practice between experts and HCPs for multiple case scenarios of high-risk EBC, including examples of potential overtreatment. Moreover, our data demonstrate that this decision support tool may lead to better alignment of HCP treatment choices with experts, with the potential to improve clinical management of patients.

Compensation for radiotherapy treatment interruptions due to a cyberattack: An isoeffective DVH‐based dose compensation decision tool

Unscheduled interruptions to radiotherapy treatments lead to decreased tumor control probability (TCP). Rapid cell repopulation in the tumor increases due to the absence of radiation dose, resulting in the loss of TCP. Compensation for this loss is required to prevent or reduce an extension of the patient's overall treatment time and regain the original TCP. The cyberattack on the Irish public health service in May 2021 prevented radiotherapy treatment delivery resulting in treatment interruptions of up to 12 days. Current standards for treatment gap calculations are performed using the Royal College of Radiologists (RCR) methodology, using a point‐dose for planning target volume (PTV) and the organs at risk (OAR).An in‐house tool, named EQD2VH, was created in Python to perform treatment gap calculations using the dose–volume histogram (DVH) information in DICOM data extracted from commercial treatment planning system plans. The physical dose in each dose bin was converted into equivalent dose in 2‐Gy fractions (EQD2), accounting for tumor cell repopulation. This EQD2‐based DVH provides a 2D representation of the impact of treatment gap compensation strategies on both PTV and OAR dose distributions compared to the intended prescribed treatment plan. This additional information can aid clinicians’ choice of compensation options. EQD2VH was evaluated using five high‐priority patients experiencing a treatment interruption when the cyberattack occurred. Compensation plans were created using the RCR methodology to evaluate EQD2VH as a decision‐making tool.The EQD2VH method demonstrated that the comparison of compensated treatment plans alongside the original intended treatment plans using isoeffective DVH analysis can be achieved. It enabled a visual and quantitative comparison between treatment plan options and provided an individual analysis of each structure in a patient's plan. It demonstrated potential to be a useful decision‐making tool for finding a balance between optimizing dose to PTV while protecting OARs.

Variance in Practice between Experts and Oncology Healthcare Professionals for Follicular Lymphoma: Analysis of an Online Treatment Decision Tool

Variance in Practice between Experts and Oncology Healthcare Professionals for Follicular Lymphoma: Analysis of an Online Treatment Decision Tool

Variance between Experts and Oncology Healthcare Providers in Managing Polycythemia Vera and Myelofibrosis: Analysis of an Online Treatment Decision Support Tool

BackgroundThe management of patients with the Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) polycythemia vera (PV) and myelofibrosis (MF) is evolving. US clinical practice guidelines for MF were published for the first time in late 2016, and those for PV (and essential thrombocythemia) are in development. Clinicians still face substantial challenges in selecting therapy for patients with PV and MF. To assist with patient care and to help healthcare providers (HCPs) make informed decisions in this complex treatment landscape, an online treatment decision support tool was developed. Here we report data comparing expert treatment recommendations from the tool with the intended treatment entered by HCPs using the tool.MethodsIn February 2017, 5 experts in MPN patient care provided specific treatment recommendations for numerous distinct PV and MF case scenarios. These scenarios were defined by key patient and disease characteristics, including the presence of disease symptoms or anemia, previous response to treatment, and eligibility for transplantation and other therapeutic modalities. To use the tool, participating HCPs entered specific patient and disease factors along with their intended treatment plan for their case. When the case entry was completed, the expert treatment recommendations for that specific patient case were shown, followed by a short survey designed to determine if the expert recommendations had changed the HCP's planned course of treatment.ResultsFrom March 20, 2017, to June 9, 2017, 369 patient cases (n = 172 for PV; n = 197 for MF) were entered into the tool by 270 HCPs (83% MDs). Although there was expert consensus (≥ 3 of 5 experts choosing the same treatment course) for the majority of PV and MF cases (table), variance among the experts did exist in select areas: for example, the treatment of anemic patients with intermediate-2-risk/high-risk MF who had significant disease symptoms or splenomegaly but were not candidates for transplantation. A comparison of expert and tool user treatment choices showed substantial variability for several different patient case scenarios (table). For example, compared with expert recommendations for the PV cases, many tool users would potentially overtreat patients at low risk for thrombosis and underuse peginterferon (pegIFN) and ruxolitinib for high-risk patients. Approximately one half of the PV cases entered into the tool involved patients with prior intolerance/inadequate response to hydroxyurea (HU), and the intended treatment for these patients indicated by the majority of HCPs did not match consensus expert recommendations. Compared with expert recommendations for the MF cases, many tool users would potentially overtreat asymptomatic low-risk/intermediate-1-risk patients and underuse ruxolitinib for higher-risk patients. Among the HCPs who reported that their intended treatment plan differed from the experts, 73% indicated that the recommendations provided by the tool would change their previous management plans.ConclusionsAnalysis of cases and intended treatment plans entered into an online PV/MF treatment decision support tool indicated variance in expert and HCP treatment choices for many case scenarios. Expert recommendations in this online tool changed the intended treatment plan of many HCPs and, as such, suggest that online treatment decision tools developed by respected experts can help optimize the care of patients with PV and MF. A full analysis of all cases entered into the tool-including a detailed report of expert and HCP practice trends for PV and MF management-will be presented. [Display omitted] DisclosuresDeininger:Ariad Pharmaceuticals, Bristol Myers Squibb, CTI BioPharma Corp, Gilead, Incyte, Novartis, Pfizer, Celgene, Blue Print, Galena: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Research Funding; ARIAD: Consultancy; Incyte: Consultancy; Celgene: Research Funding; Novartis: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Pfizer: Consultancy. Mascarenhas:Promedior: Research Funding; Incyte: Other: Clinical Trial Steering Committee , Research Funding; CTI Biopharma: Research Funding; Janssen: Research Funding; Merck: Research Funding; Novartis: Other: DSMB member , Research Funding. Mesa:Incyte Corporation: Research Funding; Ariad: Consultancy; Promedico: Research Funding; Celgene Corporation: Research Funding; Galena Biopharma, Inc.: Consultancy; Gilead Sciences, Inc.: Research Funding; CTI BioPharma Corp.: Research Funding; Novartis Pharmaceuticals Corporation: Consultancy. Stein:Incyte: Consultancy. Verstovsek:Lilly Oncology: Research Funding; Promedior: Research Funding; Astrazeneca: Research Funding; Pfizer: Research Funding; Incyte: Research Funding; Bristol Myers Squibb: Research Funding; Pfizer: Research Funding; Gilead: Research Funding; Roche: Research Funding; Astrazeneca: Research Funding; NS Pharma: Research Funding; Galena BioPharma: Research Funding; CTI BioPharma Corp: Research Funding; Bristol Myers Squibb: Research Funding; Seattle Genetics: Research Funding; Gilead: Research Funding; NS Pharma: Research Funding; Celgene: Research Funding; Promedior: Research Funding; Roche: Research Funding; Seattle Genetics: Research Funding; CTI BioPharma Corp: Research Funding; Lilly Oncology: Research Funding; Genentech: Research Funding; Celgene: Research Funding; Genentech: Research Funding; Blueprint Medicines Corp: Research Funding; Blueprint Medicines Corp: Research Funding; Galena BioPharma: Research Funding; Incyte: Research Funding.

Analysis of Healthcare Provider Practice Patterns from Individual Patient Cases Entered into an Online Treatment Decision Tool for Chronic Lymphocytic Leukemia (CLL)

BackgroundNew agent approvals and indications in CLL have changed treatment approaches and increased the complexity of managing CLL. Healthcare providers (HCPs), particularly those practicing in community settings with limited experience in caring for patients with CLL, can be challenged to make informed treatment decisions in this evolving treatment landscape. We report on an analysis of current CLL treatment patterns of HCPs using an online treatment decision tool developed by experienced CLL physicians from leading academic institutions and cancer centers (experts) to assist HCPs in their practice.MethodsSince 2016, CLL experts have developed and then twice updated (early 2016, late 2016, and 2017) an online treatment decision tool designed to provide specific recommendations for patient case scenarios entered by HCPs. For each iteration of the tool, 5 experts provided their treatment recommendations for hundreds of case variations based on key factors defined by the experts as those that guide treatment choices in their practice. Factors for newly diagnosed CLL included age, fitness (based on ECOG PS, CIRS, and renal function), cytogenetic abnormalities, and IGHV mutation status. Additional variables for patients with relapsed/refractory disease after first-line treatment included previous treatment, response duration, reason for switching therapy, burden of comorbidities, and disease-related symptoms. To use the tool, participating HCPs entered patient and disease factors along with their intended treatment plan for that case. When the entry of the case into the tool was completed, the 5 expert treatment recommendations for that specific patient case were shown, followed by a short survey designed to determine if the expert recommendations changed the HCPs' planned course of treatment. Our analysis includes a comparison of intended treatment of HCPs for 2198 cases entered into the tool (early 2016, n = 883; late 2016, n = 562; 2017, n = 753) with the expert recommendations for those patient cases.ResultsAlthough there was consensus among the experts (≥ 3 of 5 experts choosing the same treatment course) for 87% of cases included in the 2017 tool, there was substantial variation between the expert recommendations and the intended treatment of HCPs using the tool. In treatment-naive patients with del(17p) CLL in all 3 tool iterations, experts recommended ibrutinib as first-line therapy for 100% of cases regardless of any other variable, whereas only approximately 40% of HCPs planned to use ibrutinib for these patients.For young (< 65 years of age), fit patients with non-del(17p) CLL, the addition of IGHV mutation status as a factor in the late 2016 and 2017 tools changed expert recommendations. Experts recommended FCR for 60% (vs HCPs at 68%) and ibrutinib for 40% (vs HCPs at 14%) of cases with IGHV mutations. For cases without IGHV mutations, experts recommended FCR for 0% (vs HCPs at 53%), ibrutinib for 80% (vs HCPs at 18%), and BR for 20% (vs HCPs at 21%) of the cases. Similar treatment patterns are also seen with older or unfit patients with non-del(17p) CLL, where the expert recommended use of ibrutinib increased from early 2016 to 2017 (21% to > 65% of cases), whereas HCP use of ibrutinib remained consistent (15% to 20%).In patients with del(17p) CLL who progressed on first-line therapy, the approval of venetoclax changed treatment patterns among both experts and HCPs in the late 2016 and 2017 tools. In patient cases with del(17p) CLL who were discontinuing ibrutinib, experts consistently recommended venetoclax in 93% of cases (7% idelalisib + R for cases with intolerance to ibrutinib) vs HCPs using venetoclax for 59% and 69% of cases in late 2016 and 2017, respectively. For HCPs whose intended treatment differed from experts, 50% indicated that their treatment plan would change after using the tool (36% no/undecided and 14% reported barriers to change).ConclusionsPractice patterns between experts and HCPs differed substantially in their use of novel therapy for routine clinical practice. Expert recommendations in this online tool changed the intended treatment plan of HCPs using the tool and suggests that online treatment decision tools developed by respected experts can help optimize the care of patients with CLL. A full analysis of all cases entered into the tool, including a detailed report of expert and HCP practice trends, will be presented. DisclosuresCoutre:Gilead: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; AbbVie: Consultancy, Research Funding; Janssen: Consultancy; Pharmacyclics LLC, an AbbVie Company: Consultancy, Research Funding; Celgene: Consultancy, Research Funding. Sharman:Novartis: Research Funding; Genentech: Research Funding; Gilead Sciences, Inc.: Consultancy, Honoraria, Research Funding, Speakers Bureau. Zelenetz:Amgen: Consultancy; Celgene: Consultancy.

Evolving Treatment Patterns of Healthcare Providers (HCPs) and Multiple Myeloma (MM) Experts from 2013-2017: Analysis of an Annually Updated Online Treatment Decision Tool

BackgroundExpanding availability of novel agents for treating MM has transformed management strategies, particularly for relapsed/refractory (R/R) disease. Since 2013, experienced MM physicians from leading academic institutions and cancer centers (experts) have annually updated an online tool designed to provide HCPs with treatment recommendations for specific patient cases. Previous reports from our tool analyses have shown yearly changes in treatment patterns among experts but a multiyear delay by HCPs in the adoption of many expert-recommended treatment strategies into their practice.MethodsTo develop the tool, 5 MM experts provided treatment recommendations for hundreds of case scenarios across induction, maintenance, and R/R disease settings. To use the tool, HCPs seeking treatment consultation entered patient and disease factors with a planned treatment for that specific patient using dropdown menus and received 5 expert recommendations for their case. HCPs were asked to indicate the impact of expert recommendations on their planned treatment. This report includes analysis and comparison of intended treatment of HCPs for 790 cases entered into the 2017 iteration of tool with expert recommendations for those patient cases. Treatment trends observed in 2017 will also be compared with those from previous years.ResultsConsensus (≥ 3 of 5 experts choosing the same treatment) among experts has been increasing for induction therapy since 2013. In ASCT-eligible patients, regardless of any other factors, experts recommended bortezomib/lenalidomide/dexamethasone (VRd) in 75% of tool cases in 2017, up from 58% in 2016 and 45% in 2013 and 2014. By comparison, HCPs used VRd for 44% of ASCT-eligible patient cases in 2017 and only 19% in 2016. Expert recommendation of VRd for 66% (vs 48% of HCPs) of ASCT-ineligible cases in 2017 also increased from 38% (vs 18% of HCPs) in 2016. Expert recommendations for induction therapy changed most for cases with varying comorbidities, and data from the 2017 tool are shown in the figure below. In patients without specific comorbidities or with cardiac dysfunction only, experts recommended VRd for 87% to 90% of these cases (vs 41% to 44% of HCPs). In cases involving peripheral neuropathy, experts recommended carfilzomib/lenalidomide/dexamethasone (KRd) for 60% and VRd for 30% compared with HCPs selecting KRd for 10% and VRd for 71% of those cases.In the R/R setting, the novelty and broad range of available regimens are reflected in the lack of consensus in treatment recommendations by both the experts as well as the planned treatment of HCPs. In 304 R/R case scenarios, only 36 cases (12%) had an exact expert treatment consensus and 63 cases (21%) had 2 pairs of experts agreeing on the same treatment recommendations. However, overall treatment strategies were similar among experts, with use of triplet regimens including novel agents increasing in 2017. Experts recommended Kd or daratumumab monotherapy for 40% of cases refractory to lenalidomide in 2016. In 2017, experts no longer recommended monotherapy or doublet therapy for R/R cases in this setting. In 2017, the experts recommended triplet regimen therapy for 87% to 97% of cases involving bortezomib-refractory or lenalidomide/bortezomib-refractory patients, and each of the recommendations included either carfilzomib, ixazomib, daratumumab, or elotuzumab compared with only 55% to 60% of their recommendations including triplet therapy with one of these agents in 2016. Again, variation was observed in the intended treatment of HCPs compared with the expert recommendations for R/R cases. In 2017, the intended treatment of HCPs did not match any of the experts' recommendations for 45% of the R/R cases entered into the tool.ConclusionsAnalysis of cases entered into our expert-developed treatment decision tool shows that a wide gap remains between expert treatment recommendations and the intended treatment plans of HCPs for many of the same MM case scenarios. Experts had nearly full consensus on choice of induction therapy; however, differences between expert recommendations in R/R MM are due to availability of multiple triplet-based treatment options in this setting. In addition, newly approved therapies continue to have a strong impact on experts' recommendations as they quickly integrate new agents into their treatment approaches. A detailed analysis of expert and HCP MM practice trends will be presented. [Display omitted] DisclosuresKumar:Celgene, Millennium, BMS, Onyx, Janssen, Noxxon, AbbVie, Amgen, Merck, Oncopeptides, Skyline Diagnostics, Takeda: Consultancy; Skyline: Honoraria; Celgene, Millennium/Takeda, Onyx, AbbVie, Janssen, Sanofi, Novartis, Amgen, Genentech, Merck, Oncopeptides, Roche, Skyline Diagnostics: Research Funding. Lentzsch:Caelum Biosciences: Other: leadership position and stock; BMS: Consultancy; Amgen: Consultancy. Anderson:Gilead Sciences: Membership on an entity's Board of Directors or advisory committees; Oncopep: Other: scientific founder; C4 Therapeutics: Other: scientific founder; Millenium Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees; MedImmune: Membership on an entity's Board of Directors or advisory committees.

PCN35 Systematic and Structured Reviews of the Disease Burden in Patients with Microsatellite Instability High (MSI-H) or Mismatch Repair Deficient (DMMR) Colorectal Cancer (CRC)

Literature reviews were undertaken to assess global disease burden of MSI-H/dMMR CRC Medline®, Embase®, Cochrane, EconLit, CRD York databases and select conferences were searched for studies reporting burden of MSI-H/dMMR CRC globally. Evidence was searched during 2009-19 (economic burden) and 2014-19 (epidemiology, treatment patterns and humanistic burden). Of 41,296 records screened - epidemiology (N=41), economic (N=2) humanistic burden (N=2) and treatment patterns (N=4) studies were reported for MSI-H/dMMR CRC. Included evidence showed prevalence of MSI-H/dMMR CRC ranged from 5.8% to 22% across disease stages with rates higher in earlier stages, >50 years of age, females, and Caucasians. Three country-specific real world studies reported common use of 5-FU- based treatments with either irinotecan, or oxaliplatin and with or without an EGFR or VEGF inhibitor for 1L MSI-H CRC. In response to a 2018 survey of global healthcare practitioners on their intended treatment plan for various case scenarios, 43%(1st line), 62%(2nd line) and 54%(3rd line) indicated preference for use of an immune checkpoint inhibitor. In a single institution, non-randomized study of 5-FU-treated patients, overall symptom burden (OR 2.48; 95% CI, 1.29-4.74) pain (3.06 [1.61-5.84]), fatigue (2.78 [1.41-5.49]), sleep (2.52 [1.32-4.08]); and drowsiness (2.51 [1.32-4.78]) was greater among those with MSI-H versus microsatellite stable tumors. Published evidence on the disease burden of MSI-H/dMMR CRC is sparse. Given the recent approvals and increased clinical development of immune checkpoint inhibitors in this high unmet need area, real-world and economic studies could further help to assess the disease burden.

Evolving Treatment Patterns in Chronic Lymphocytic Leukemia Among Experts and Community Practitioners: Analysis of an Online Decision Support Tool

Evolving Treatment Patterns in Chronic Lymphocytic Leukemia Among Experts and Community Practitioners: Analysis of an Online Decision Support Tool

Utility of an Online CLL Treatment Decision Support Tool As a Resource for Patients and Caregivers

Introduction: The recent expansion of effective treatment options available for patients with chronic lymphocytic leukemia (CLL) has increased the need for patients to be informed and participate in their care. Patients with CLL, provided with reliable information and resources, as part of shared decision making, can collaborate with their healthcare providers (HCPs) to better ensure optimal care that is both effective and matches their treatment preferences. To help inform patients with CLL, we developed an online treatment decision support tool designed to provide case-specific treatment recommendations from 5 CLL experts. Here we report findings from an analysis of this project along with an associated survey on patient understanding and satisfaction with treatment planning. Methods: The online tool was developed with input from 5 experts who provided their treatment recommendations on October 2019 for hundreds of different case scenarios in the newly diagnosed and relapsed/refractory CLL settings. These unique case scenarios were defined by patient and disease factors that the experts considered critical to making treatment decisions, including age, fitness, cytogenetic abnormalities, and previous treatment. To use the tool, patients entered their information and, if known, their intended treatment plan based on discussions with their HCPs. After this, expert recommendations for their specific patient scenario were provided, followed by a survey designed to assess patients understanding and satisfaction with their treatment planning. Results: Between April 2020 and August 2020, 576 unique case scenarios were entered by patients or their caregivers into the tool. Most of the entered cases represented previously untreated patients (77%) followed by second-line cases (19%) and third-line cases (4%). Overall, in the treatment naive CLL setting, 65% of the cases entered were younger (&amp;lt; 65 yrs), fit patients and 20% had a del(17p) or TP53 mutation. Among those who indicated that they had discussed their treatment plan with their provider, there was good agreement between experts and HCP recommendations to patients on the use of a BTK inhibitor in treatment naive CLL with a del(17p) or TP53 mutation (70% vs 66%, respectively). In the absence of a del(17p) or TP53 mutation, there was a greater divergence of treatment recommendations with experts favoring venetoclax + obinutuzumab while HCPs continued to predominantly recommend a BTK inhibitor for these treatment-naive cases. Among patients who had discussed their treatment with their HCP, 80% indicated that their treatment options were adequately explained and 70% indicated that their goals and preferences were considered during the treatment planning process. Overall, 50% of patients indicated that their HCP recommendations agreed with the expert recommendations provided in the tool. Of those who used this online tool, 87% indicated that they would use this information as part of discussions with their HCP. Conclusions: This analysis suggests that an online tool designed for patients and their caregivers can provide easy access to CLL treatment recommendations by experts and may help inform patients about alternative treatment options. Moreover, these findings suggest that online tools for patients may improve patient satisfaction in their care by promoting educated discussions with their HCPs. A detailed analysis of the tool, including case entries and management recommendations along with patient satisfaction survey results will be presented. Disclosures Koffman: BMY: Speakers Bureau; TGTX: Speakers Bureau; AZN: Speakers Bureau.

Incidental findings detected on cone beam computed tomography in an older population for pre-implant assessment.

The aim of this retrospective study was to record incidental findings in CBCT scans taken in an older population for pre-implant assessment, and to examine whether these findings would influence the intended dental implant placement. 300 consecutive CBCT scans over the age of 40years was carried out. The incidental findings were grouped into regions as follows: dentoalveolar structures, maxilla and mandible, paranasal sinuses, temporomandibular joint (TMJ), naso/oral-pharyngeal airway, cervical spine and neurovascular canals. The incidental findings are further categories into their significance towards the intended treatment plan. Incidental findings were noted on all of the scans. 555 incidental findings (1.85 findings/scan) were identified. The highest number of incidental findings was in the sinuses (34%), followed by dentoalveolar structures (31%), nasal/oral-pharyngeal airway (12%), maxilla and mandible (10%), TMJ (6%), cervical spine (4%) and neurovascular canals (3%). A total of 37% of findings required follow-up. In 12% of cases detection of the incidental findings lead to amendment or abortion of the intended implant treatment plan. Incidental findings within and beyond the region of interest are common in CBCT scans. The numbers of incidental findings per scan in an older population is higher than in a younger population.

Prospective study of an AI enabled online intervention to increase delivery of guideline compliant cancer care, on the ground.

2011 Background: Despite survival benefits of guideline compliant cancer care, under treatment and over treatment are prevalent. Navya is an AI enabled online intervention that matches a patient’s medical record with NCCN and NCG guidelines (National Cancer Grid, India) and layers live multidisciplinary expert review to recommend actionable treatment plans. It was developed to standardize care and mitigate morbidity and mortality, by delivering on-t ime, guideline based expert treatment plans. Methods: From July 2019 to January 2020, all patients who received a Navya treatment plan based on guidelines and live expert review were included. Intended treatment plans were prospectively collected from the patient. Compliance of intended plans with NCCN (including Resource Stratified Framework) or NCG was measured. Noncompliant intended plans were categorized as overtreatment or undertreatment. After delivery of Navya plan, prospective phone follow up assessed whether noncompliant intended plans were changed to guideline compliant care. Results: Of 1707 consecutive patients who received a Navya plan, 1549 intended plans were available. Patients were diverse with respect to geographic, socioeconomic, and primary tumor distribution: West of India: 28%, North: 26%, East: 21%, South: 15%, Central: 7%, International: 3%; 35% of patients with income &lt; $300/month; GI: 23%, Breast: 14%, Head &amp; Neck: 11%, Thoracic: 10%. Of the 1549 intended plans, 441 (28.47% (95% CI ± 0.26%)) were not compliant with NCCN or NCG. Undertreatment was 35%, overtreatment 26%, incomplete staging workup 28% and 11% could not be categorized. Of 441 patients with noncompliant intended plans, 80.19% (± 0.97%) shared the Navya plan with their treating oncologists and 50.40% (± 0.88%) changed their intended plan to receive the Navya treatment plan. Intervention with Navya increased on-the -ground guideline compliance by ~15% (from 71.53% ±0.42% to 85.87% ± 1.73%). Conclusions: Guideline compliant care ensures best achievable clinical outcomes with existing therapies. A technological earthshot that significantly increases adoption of guideline based care is the first step towards cancer moonshots.

Abstract P4-14-07: Treatment patterns for metastatic hormone receptor-positive breast cancer: Comparing expert and community practice

Abstract Background Endocrine therapies and CDK4/6 inhibitors have dramatically improved outcomes for patients with hormone receptor-positive (HR+) metastatic breast cancer (MBC). To help inform treatment decisions among healthcare providers (HCPs) caring for patients with MBC, we have developed and regularly updated an online treatment decision support tool that provides recommendations from multiple breast cancer experts for specifically defined patient scenarios. Here we report data for HR+/HER2- MBC cases entered into the tool since 2016, capturing self-reported practice trends from HCPs compared with matched treatment recommendations from experts. Methods For the most recent MBC treatment tool (published October 2018), 5 breast cancer experts provided treatment consultation for 549 unique MBC case scenarios based on a simplified set of variables: disease phenotype, previous systemic therapy, visceral crisis (yes/no), rate of disease progression, and the presence or absence of germline BRCA1/2 mutations. HCPs used selection menus to enter patient and disease factors based on these variables along with their intended treatment plan. When completed, the experts’ treatment recommendations for that specific patient case were shown to the HCPs at which time they were asked to indicate if the expert recommendations changed their planned treatment. Results From October 2018 through June 2019, 603 HCPs entered 1127 patient case scenarios, including 581 HR+/HER2- MBC cases, in the most recent online tool. A comparison of expert and HCP treatment choices for select HR+/HER2- MBC case scenarios from the October 2016 and October 2018 tool is shown in the Table. In the setting of HR+/HER2- MBC, among those HCPs whose planned treatment differed from the consensus expert recommendation, 55% indicated that they would change their original choice of treatment. Conclusions CDK4/6 inhibitors have had a large impact on expert treatment recommendations for patients with HR+/HER2- MBC. However, data from this online treatment decision support tool suggest ongoing differences in practice between experts and community HCPs in this setting. For many cases entered into the tool, the practice of the majority of HCPs differed from expert consensus (Table). Consensus expert recommendations in this online tool changed the intended treatment plan of many using it and, therefore, can help optimize the care of patients with MBC. A detailed analysis of overall community practice trends for HR+/HER2- MBC along with a comparison of expert and HCP practice for different case scenarios will be presented. HR+/HER2- MBC Case Scenarios (no visceral crisis)Expert Consensus Recommendation (%)Expert Consensus Recommendation (%)HCP Practice Matched Expert Consensus Recommendation, % (n)HCP Practice Matched Expert Consensus Recommendation, % (n)2016201820162018de novoCDK4/6i + AI (100)CDK4/6i + AI (100)23 (111)32 (188)Previous (neo)adjuvant AICDK4/6i + FULV (92)CDK4/6i + FULV (90)22 (54)17 (77)Previous CDK4/6i + AIFULV (82)FULV ± EVE (92)0 (14)18 (40)Previous AI and CDK4/6i + FulvEVE + EXE (87)EVE + EXE (73)63 (19)28 (18) Citation Format: Timothy Quill, Sara Hurvitz, Kathy D. Miller, Ruth O'Regan, Tiffany A. Traina, Rachael Andrie, Kevin L. Obholz, Mohammad Jahanzeb. Treatment patterns for metastatic hormone receptor-positive breast cancer: Comparing expert and community practice [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-14-07.

Analysis of an Online Treatment Decision Tool Reveals Variances in Practice between Experts and Oncology Healthcare Providers for Newly Diagnosed Follicular Lymphoma

Analysis of an Online Treatment Decision Tool Reveals Variances in Practice between Experts and Oncology Healthcare Providers for Newly Diagnosed Follicular Lymphoma