Testing In Cancer Patients Research Articles

1580P Impact of social determinants of health (SDOH) on disparities in next-generation sequencing (NGS) testing in cancer patients (pts) in the US

1580P Impact of social determinants of health (SDOH) on disparities in next-generation sequencing (NGS) testing in cancer patients (pts) in the US

Targeted gene panel sequencing of liquid and tissue biopsies reveals actionable genomic alterations in Ghanaian metastatic breast cancer cases

PurposeBreast cancer is a major cause of cancer-related mortality among African women. The adoption of molecular genomic technologies in the management of cancer cases is limited in Africa. To provide much-needed insights on the feasibility and utility of such precision medicine paradigms in Africa, we conducted a prospective, non-interventional study involving combined tissue and plasma Next-generation sequencing (NGS)-based testing in cancer patients in Ghana. MethodsWe recruited 20 newly diagnosed, histologically confirmed, treatment-naïve women with metastatic breast cancer at the Cape Coast Teaching Hospital in Ghana. Tissue (NGS) and cell-free DNA (cfDNA) liquid biopsy analysis were ordered on all 20 patients. ResultsAll 20/20 (100 %) liquid biopsy samples were acceptable for analysis, whereas only 6/20 (30 %) passed quality control for tissue NGS testing. Liquid biopsy detected 42 cfDNA mutations in 17/20 patients. Of the 17 patients, 3 (17.6 %) had mutations previously associated with African ancestry, including BRCA1 p.K719E, ARAF p.S262I and GATA3 p.G125dup. Eight potentially actionable alterations specific to breast cancer were found in 6/17 (35.3 %) liquid biopsy samples, while potentially actionable mutations non-specific to breast cancer were detected in 12/17 (70.6 %). Tissue biopsy analysis detected mutations in all 6 patients tested, with 3/6 (50 %) patients presenting potentially actionable mutations relevant to breast cancer. ConclusionLiquid biopsy detected multiple additional actionable variants in Ghanaian women with breast cancer. Plasma cfDNA analysis featured fewer variations in sample preparation which is a key consideration in resource-limited settings. Liquid biopsy presents a great opportunity to improve cancer care in Africa.

Abstract 4066: Generation of tumor targeted self-assembling split IL-12 subunits for the treatment of cancer

Abstract A major milestone in immuno-oncology was the development of immune checkpoint inhibitors, resulting in significant benefits for numerous patients. However, many patients are not responsive, become refractory, or cannot tolerate the treatment due to toxicity or side effects, demonstrating the need for additional immunotherapies. Cytokines are a class of promising immunomodulatory proteins being explored as therapeutics, but their success has been limited due to their rapid clearance or pleiotropic properties. Classically known as ‘signal 3’ of an endogenous immune response, IL-12p70 is a heterodimeric cytokine comprising p35 and p40 subunits. When administered exogenously, IL-12 is a potent stimulator of the immune system and can have profound anti-tumor activity; however, the clinical use of IL-12 has been limited due to poor systemic tolerability. Therefore, developing an immunotherapy that can be systemically administered and improve the therapeutic index could capitalize on the potential clinical benefit of IL-12. Mural Oncology has developed an innovative approach to mitigate the toxicity of IL-12 by splitting the heterodimer into inactive p35 and p40 monomers. The individual subunits are separately fused to two non-competitive antibody fragments targeting a highly expressed tumor-associated antigen. The goal of this approach is to conditionally activate IL-12 preferentially in the tumor microenvironment (TME). This is achieved by sequential administration of the targeted subunits, which will drive assembly and activity of the IL-12 heterodimer primarily at the tumor site, reducing systemic exposure and thereby potentially reducing associated toxicities. To engineer the split IL-12 subunits, a structure-based rational design approach was used to remove the natural intra-molecular disulfide bond and generate variants that maintained affinity between the p35 and p40 monomers. The engineered subunits were characterized using analytical methods and screened for the pair with the strongest affinity. Additionally, the candidate pair was assessed for receptor binding and functional activity on human T cells through phosphorylation of STAT4 and secretion of IFN-γ. Pharmacokinetics and pharmacodynamics were evaluated in mouse models with and without tumors demonstrating that dual targeting led to an increase in tumor retention, rapid clearance from circulation, and dose dependent release of IFN-γ. The results thus far demonstrate that the innovative approach of tumor targeted self-assembling split IL-12 has the potential to enhance the overall therapeutic potential of this cytokine. A development candidate will be identified and moved into clinical testing in cancer patients to enable us to fully understand if this design approach holds true in the clinical setting. Citation Format: Joshua Heiber, Pinar Gurel, Robert G. Newman, Kristiana Dreaden, Yanchun Zhao, Chunhua Wang, Su-Ping Pearson, Jean Chamoun. Generation of tumor targeted self-assembling split IL-12 subunits for the treatment of cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4066.

False-Reactive Fourth-Generation Human Immunodeficiency Virus Testing in Cancer Patients.

The fourth-generation (4th-gen) human immunodeficiency virus (HIV)-1/2 antibody/antigen (Ab/Ag) combination immunoassay currently used for HIV screening offers greater sensitivity than previous assays, but false-reactive results occur in up to 20% of patients. Large-scale observations in cancer patients are lacking. We conducted a retrospective study of cancer patients seen at the University of Texas MD Anderson Cancer Center (March 2016-January 2023) who had reactive 4th-gen ARCHITECT HIV-1/2 Ab/Ag combination immunoassay results. We analyzed characteristics of patients with true-reactive and false-reactive results, defined based on Centers for Disease Control and Prevention criteria. A total of 43 637 patients underwent 4th-gen HIV screening, and 293 had reactive 4th-gen HIV test results. Twenty-one patients were excluded because they did not have cancer. Among the remaining 272 patients, 78 (29%) had false-reactive results. None of these patients experienced delays in their cancer treatment, but 26% experienced mental distress. Multivariate logistic regression analysis identified 5 predictors of having false-reactive results: age >60 years (adjusted odds ratio [aOR], 6.983; P < .0001), female sex (aOR, 6.060; P < .0001), race/ethnicity (Black: aOR, 0.274; Hispanic: aOR, 0.236; P = .002), syphilis coinfection (aOR, 0.046; P = .038), and plant alkaloids therapy (aOR, 2.870; P = .013). False-reactive 4th-gen HIV test results occur in almost one-third of cancer patients. Physicians should be aware of the high rates of false-reactive HIV screening results in this patient population. These findings may have implications for counseling regarding testing, especially among those at low risk for HIV infection.

Tumour immune escape via P2X7 receptor signalling.

While P2X7 receptor expression on tumour cells has been characterized as a promotor of cancer growth and metastasis, its expression by the host immune system is central for orchestration of both innate and adaptive immune responses against cancer. The role of P2X7R in anti-tumour immunity is complex and preclinical studies have described opposing roles of the P2X7R in regulating immune responses against tumours. Therefore, few P2X7R modulators have reached clinical testing in cancer patients. Here, we review the prognostic value of P2X7R in cancer, how P2X7R have been targeted to date in tumour models, and we discuss four aspects of how tumours skew immune responses to promote immune escape via the P2X7R; non-pore functional P2X7Rs, mono-ADP-ribosyltransferases, ectonucleotidases, and immunoregulatory cells. Lastly, we discuss alternative approaches to offset tumour immune escape via P2X7R to enhance immunotherapeutic strategies in cancer patients.

An Observational Study of Risk Factors for SARS-CoV 2 Infection in Patients with Cancer

Introduction: Cancer patients are regarded as a highly vulnerable population in Coronavirus Disease 2019 (COVID-19) pandemic due to their systemic immunosuppressive state. The aim of the study was to investigate the prevalence of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection in asymptomatic cancer patients attending the oncology clinic. Methods: We conducted a retrospective observational study from May- November 2020. The patients who tested positive for SARS-CoV-2 RT PCR were followed up to study the risk factors, clinical presentation, and outcome. The ethical approval from institutional review board was done. Chi-square test was used to compare qualitative variables and logistic regression model was used to estimate the odds ratio (OR) of having COVID-19 infection. Results: We included 334 cancer patients who were tested for COVID-19 infection. The prevalence of SARS-CoV-2 infection was 28.4%. COVID-19 infection was more common in solid organ malignancy than hematological cancer (29.2% vs. 26.1%). The risk of COVID-19 infection was associated with comorbidity (p = 0.002). Time since diagnosis of malignancy and the type of anticancer treatment received did not increase the risk of COVID-19 infection. However, patients receiving anticancer therapy in the last 4 weeks of testing positive for SARS-CoV-2 RT PCR had a higher risk for COVID-19 infection (p&lt;0001). The oncological treatment was continued after resolution of symptoms and with negative RT-PCR. The multi variable regression model revealed that females, patients having both hypertension and diabetes mellitus and patients receiving chemotherapy within the last 4 weeks had higher odds of COVID-19 infection (p&lt;0.05). Conclusion: We observed that active oncologic treatment does not represent a risk factor for SARS-CoV-2 infection in cancer patients. However delaying anticancer treatment to avoid SARS-CoV-2 transmission may lead to malignancy related complications. The approach of routine COVID 19 testing in cancer patients seems preferable in detecting asymptomatic virus carriers.

Positive direct antiglobulin tests in cancer patients on immune checkpoint inhibitors: A case series from India.

Tumour cells activate immune checkpoints such as programmed death receptor-1 (PD-1) and cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) signalling pathways to inhibit T lymphocyte activation and thus escape from immune surveillance. Immune checkpoint inhibitors (ICPis) reactivate T lymphocytes to recognize cancer cells by blocking CTLA-4 or PD-1. Autoimmune haemolytic anaemia is a rare, but often severe, complication of ICPis. Therefore, we performed a retrospective clinical case review, including serologic, haematology, and biochemistry laboratory results, of three patients who developed autoantibodies to erythrocytes following treatment with pembrolizumab, an anti-PD-1 inhibitor. Serologic testing of blood samples from these patients showed their red cells were positive for direct antiglobulin test (DAT+for IgG in two cases and IgG with C3d in one case). Antibody detection test was negative. No patient had clinical and laboratory features of haemolysis. There were no additional immune-related adverse events. IgG antibodies coating red cells were neither IgG1 nor IgG3 in class and elution was found negative in all. In conclusion, immunohaematology laboratories should be aware of the possibility of erythroid autoantibodies and their nature in cancer patients receiving ICPis. The result of a positive DAT should be interpreted carefully in these patients to exclude other possible causes of anaemia.

Unveiling the diagnostic enigma of D-dimer testing in cancer patients: Current evidence and areas of application.

Cancer is a well-known risk factor for venous thromboembolism (VTE). A combined strategy of D-dimer testing and clinical pre-test probability is usually used to exclude VTE. However, its effectiveness is diminished in cancer patients due to reduced specificity, ultimately leading to a decreased clinical utility. This review article seeks to provide a comprehensive summary of how to interpret D-dimer testing in cancer patients. In accordance with PRISMA standards, literature pertaining to the diagnostic and prognostic significance of D-dimer testing in cancer patients was carefully chosen from reputable sources such as PubMed and the Cochrane databases. D-dimers have not only a diagnostic value in ruling out VTE but can also serve as an aid for rule-in if their values exceed 10-times the upper limit of normal. This threshold allows a diagnosis of VTE in cancer patients with a positive predictive value of more than 80%. Moreover, elevated D-dimers carry important prognostic information and are associated with VTE reoccurrence. A gradual increase in risk for all-cause death suggests that VTE is also an indicator of biologically more aggressive cancer types and advanced cancer stages. Considering the lack of standardization for D-dimer assays, it is essential for clinicians to carefully consider the variations in assay performance and the specific test characteristics of their institution. Standardizing D-dimer assays and developing modified pretest probability models specifically for cancer patients, along with adjusted cut-off values for D-dimer testing, could significantly enhance the accuracy and effectiveness of VTE diagnosis in this population.

P2 Clinical utility of universal genetic predisposition testing in cancer patients and impact on patients with gynecologic malignancies

P2 Clinical utility of universal genetic predisposition testing in cancer patients and impact on patients with gynecologic malignancies

Germline variants of uncertain significance, their frequency, and clinico-pathological features in a cohort of Sri Lankan patients with hereditary breast cancer

BackgroundNext-Generation Sequencing (NGS)-based testing in cancer patients has led to increased detection of variants of uncertain significance (VUS). VUS are genetic variants whose impact on protein function is unknown. VUS pose a challenge to clinicians and patients due to uncertainty regarding their cancer predisposition risk. Paucity of data exists on the pattern of VUS in under-represented populations. This study describes the frequency of germline VUS and clinico-pathological features in Sri Lankan hereditary breast cancer patients.MethodsData of 72 hereditary breast cancer patients who underwent NGS-based testing between January 2015 and December 2021 were maintained prospectively in a database and analyzed retrospectively. Data were subjected to bioinformatics analysis and variants were classified according to international guidelines.ResultsGermline variants were detected in 33/72(45.8%) patients, comprising 16(48.5%) pathogenic/likely pathogenic variants and 17(51.5%) VUS. Distribution of VUS in breast cancer predisposing genes were :APC:1(5.8%), ATM:2(11.7%), BRCA1:1(5.8%), BRCA2:5(29.4%), BRIP1:1(5.8%), CDKN2A:1(5.8%), CHEK2:2(11.7%), FANC1:1(5.8%), MET:1(5.8%), STK11:1(5.8%), NF2:1(5.8%). Mean age at cancer diagnosis in patients with VUS was 51.2 years. Most common tumour histopathology was ductal carcinoma 11(78.6%). 50% of tumours in patients having VUS in BRCA1/2 genes were hormone receptor negative. 73.3% patients had family history of breast cancer.ConclusionsA significant portion of patients had a germline VUS. Highest frequency was in BRCA2 gene. Majority had family history of breast cancer. This highlights the need to undertake functional genomic studies to determine the biological effects of VUS and identify potentially clinically actionable variants that would be useful for decision-making and patient management.

Next generation sequencing (NGS) testing for cancer patients at a safety NET hospital.

e18563 Background: Next Generation Sequencing (NGS) testing is gradually becoming an essential aspect of cancer care. However, numerous studies have shown that non-White patients are under-represented in both precision oncology clinical trials and molecular testing. Highland General Hospital (HGH) is a community safety-net hospital in Oakland, California serving primarily Black, Hispanic and Asian patients. In an effort to increase health equity, in August 2020 we began to offer NGS testing with Tempus Labs, Inc. for our cancer patients. The purpose of this study is to document this experience and highlight the genomic profile of our patient population. Methods: This is a retrospective chart review study. Patients were included if their tumor biopsy was sent for NGS testing from August 2020 to December 2022. A total of 165 patients had their samples sent for NGS, of which 148 were included in this study and 17 were excluded due to lack of sufficient tissue. Patient demographic data and predictive biomarkers were collected. For the purposes of this study, we defined predictive biomarkers as those that predict likelihood of response or lack of response to therapy as recommended by National Comprehensive Cancer Network guidelines. Results: The racial distribution of our patient sample is shown in the table below. Consistent with the patient population of HGH, our sample included mostly Black (32.4%), Hispanic (26.4%), and Asian (21.6%) patients. Non-Small Cell Lung Cancer (NSCLC) and colorectal cancer (CRC) were the two most common malignancies sequenced at 34.5% and 25.7%, respectively. For NSCLC patients, 54.9% had predictive biomarkers, with EGFR and KRAS being the most common driver mutations. For CRC patients, 60.5% had predictive biomarkers, with 73.9% of those being NRAS/KRAS and 13.0% being high tumor mutational burden. Full results to be presented. Conclusions: Based on our experience, it is feasible and informative to provide NGS testing for patients at safety-net hospitals. NGS testing allows for the most appropriate treatment selection for each patient, which can translate into better outcomes. Moreover, due to the unique demographics of patients from these hospitals, NGS tests can provide valuable information about the tumor genomic profiles of these underrepresented patients. This data can help improve drug development research and close the health equity gap. [Table: see text]

The sit to stand test in cancer patients and survivors.

e24058 Background: The sit to stand test in 30 seconds has been used to measure power, strength, endurance, and balance. It has also been described as a useful tool in identifying presence of sarcopenia. Methods: Retrospective chart review of cancer patients and survivors referred to cancer rehabilitation clinic over a 5-year period from 1/1/2018-12/31/2022 at a large cancer institute in the southeastern part of the United States. Patients were assessed at their initial evaluation using the sit to stand test in 30 seconds (STS-30). Scoring for the sit to stand score was divided into 2 groups (impaired and good scores) based on age and gender specific normative data. Data was also collected for patients/survivors with different body mass index (BMI) ranges: underweight: (BMI &lt; 18.5); normal weight (BMI 18.5-24.99); overweight (BMI: 25.-29.99), obese ( &gt; 30) as well as stages of cancer (stage 0-4). Results: 1406 cancer patients and survivors underwent STS-30 at their initial evaluation in cancer rehabilitation clinic. This included cancers of breast, GI, GU, lung, gynecologic, brain/spine, hematologic, head and neck, musculoskeletal, endocrine and skin. 749/1406 (53.27%) had impaired STS-30 with an average score of 6.45 repetitions in 30 seconds and 657/1406 (46.73%) had good scores with an average of 14.75 repetitions in 30 seconds. BMI and STS-30: 1,298 patients had BMI data available. 912/1298 (70.3%) were overweight or obese. 501/912 (54.93%) had an impaired STS-30 with an average of 6.76 repetitions in 30 seconds. 411/912 (45.07%) had a good STS-30 with an average of 14.66 repetitions in 30 seconds. 386/1298 (29.7%) had a normal BMI or were underweight. 173/386 (44.82%) had an impaired STS-30 with an average of 6.57 repetitions in 30 seconds. 213/386 (55.18%) had a good STS-30 with an average of 15.06 repetitions in 30 seconds. Stage of cancer and STS-30: The stage of cancer was known for 647 patients/survivors. 462/647 (71.4%) had stage 0-3 cancer. 218/462 (47.2%) had an impaired STS-30 with an average of 6.91 repetitions in 30 seconds.244/462(52.8%) of them had a good STS-30 with an average of 14.54 repetitions in 30 seconds. 185/647 (28.6%) had stage 4 cancer. 114/185 (61.62%) had an impaired STS-30 with an average of 6.04 repetitions in 30 seconds. 71/185 (38.38%) had a good STS-30 score with an average of 14.27 repetitions in 30 seconds. Conclusions: The STS-30 was impaired in a significant percentage of cancer patients and survivors across all stages, implying the possible presence of sarcopenia in this population. Stage 4 cancer patients and overweight/obese patients were at especially high risk of having an impaired STS-30. Clinicians should utilize the STS-30 to screen cancer patients and survivors and if scores are impaired, further assess for presence of sarcopenia and introduce interventions to address it.

Effects of home-based exercise programs on physical fitness in cancer patients undergoing active treatment: A systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis aimed to investigate the effects of home-based exercise on physical fitness (cardiorespiratory fitness, muscle strength, and body composition) in cancer patients undergoing active treatment. Systematic review with meta-analysis and Grading Recommendations Assessment, Development, and Evaluation of the evidence. A comprehensive search of existing literature was carried out in four electronic databases: PubMed, Web of Science, Scopus, and PEDro. All databases were searched for randomized controlled trials assessing the effects of home-based exercise on physical fitness outcomes in cancer patients during active treatment. Multicomponent interventions (i.e., exercise plus diet/behavioral therapy) were excluded. The methodological quality of each study was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. Meta-analytical procedures were performed when appropriate and standardized mean differences (SMD) were calculated. Twenty-eight randomized controlled trials (n = 2424 cancer patients) were included. Most of the interventions were conducted in breast cancer patients (n = 13) during the adjuvant treatment period (n = 17); 18 studies included a walking component in their home-based protocol. Home-based exercise was effective at improving the distance of the 6-minute walk test (k = 6; SMD = 0.321, p = 0.010). However, the results were no longer significant when performing sensitivity analysis based on exclusively walking (k = 1) and non-exclusively walking interventions (k = 5; SMD = 0.258; p = 0.072). No effects were found for muscle strength and body composition outcomes (p > 0.05). Regular home-based exercise programs are an effective strategy to improve 6-minutes walk test in cancer patients undergoing active treatment. Conversely, no alterations were found in muscle strength and body composition.

Genomics-Driven Precision Medicine in Pediatric Solid Tumors

Over the past decades, several study programs have conducted genetic testing in cancer patients to identify potential genetic targets for the development of precision therapeutic strategies. These biomarker-driven trials have demonstrated improved clinical outcomes and progression-free survival rates in various types of cancers, especially for adult malignancies. However, similar progress in pediatric cancers has been slow due to their distinguished mutation profiles compared to adults and the low frequency of recurrent genomic alterations. Recently, increased efforts to develop precision medicine for childhood malignancies have led to the identification of genomic alterations and transcriptomic profiles of pediatric patients which presents promising opportunities to study rare and difficult-to-access neoplasms. This review summarizes the current state of known and potential genetic markers for pediatric solid tumors and provides perspectives on precise therapeutic strategies that warrant further investigations.

What is thyroid function in your just-diagnosed cancer patient?

The principal hormonal product of the thyroid gland, L-thyroxine (T4), is a prohormone for 3,3',5-triiodo-L-thyronine, T3, the major ligand of nuclear thyroid hormone receptors (TRs). At a cell surface thyroid hormone analogue receptor on cancer cell and endothelial cell plasma membrane integrin αvβ3, however, T4 at physiological concentrations is biologically active and is the major ligand. At this site in solid tumor cells, T4 nongenomically initiates cell proliferation, is anti-apoptotic by multiple mechanisms, supports radioresistance and enhances cancer-related angiogenesis. In contrast, hypothyroidism has been reported clinically to slow tumor growth. At physiological levels, T3 is not biologically active at the integrin and maintenance of euthyroidism with T3 in cancer patients may be associated with slowed tumor proliferation. Against this background, we raise the possibility that host serum T4 levels that are spontaneously in the upper tertile or quartile of the normal range in cancer patients may be a factor that contributes to aggressive tumor behavior. Recent observations on tumor metastasis and tumor-associated propensity for thrombosis due to T4 also justify clinical statistical analysis for a relationship to upper tertile hormone levels. That reverse T3 (rT3) may stimulate tumor growth has recently been reported and thus the utility of adding this measurement to thyroid function testing in cancer patients requires assessment. In summary, T4 at physiological concentrations promotes tumor cell division and aggressiveness and euthyroid hypothyroxinemia arrests clinically advanced solid tumors. These findings support the clinical possibility that T4 levels in the upper tertile of the normal range require examination as a tumor supporting factor.

Cancer patients with venous thromboembolism: Diagnostic and prognostic value of elevated D-dimers.

D-dimer testing is known to have a high sensitivity at simultaneously low specificity, resulting in nonspecific elevations in a variety of conditions. This retrospective study sought to assess diagnostic and prognostic features of D-dimers in cancer patients referred to the emergency department for suspected pulmonary embolism (PE) and deep vein thrombosis (DVT). In total, 526 patients with a final adjudicated diagnosis of PE (n= 83) and DVT (n= 69) were enrolled, whereas 374 patients served as the comparative group, in which venous thromboembolism (VTE) has been excluded. For the identification of VTE, D-dimers yielded the highest positive predictive value of 96% (95% confidence interval (CI), 85-99) at concentrations of 9.9mg/L and a negative predictive value of 100% at .6mg/L (95% CI, 97-100). At the established rule-out cut-off level of .5mg/L, D-dimers were found to be very sensitive (100%) at a moderate specificity of nearly 65%. Using an optimised cut-off value of 4.9mg/L increased the specificity to 95% for the detection of life-threatening VTE at the cost of moderate sensitivities (64%). During a median follow-up of 30 months, D-dimers positively correlated with the reoccurrence of VTE (p= .0299) and mortality in both cancer patients with VTE (p< .0001) and without VTE (p= .0008). Although D-dimer testing in cancer patients is discouraged by current guidelines, very high concentrations above the 10-fold upper reference limit contain diagnostic and prognostic information and might be helpful in risk assessment, while low concentrations remain useful for ruling out VTE.

Positive direct antiglobulin tests in cancer patients hospitalized with COVID-19: A brief report from India.

Positive direct antiglobulin tests in cancer patients hospitalized with COVID-19: A brief report from India.

Assessing the utility of universal preprocedure severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing at a cancer center.

We implemented preprocedure severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing for cancer patients. The overall positivity rate was 0.3%. Preprocedure testing may be limited to operative procedures as community rates of SARS-CoV-2 exceed 7%. Nonoperative aerosol-generating procedures may be performed without preprocedure testing, wearing the appropriate personal protective equipment.

Patient views on genetics and functional imaging for precision medicine: a willingness-to-pay analysis.

Purpose: Willingness-to-pay (WTP) analyses can support allocation processes considering the patients preferences in personalized medicine. However, genetic testing especially might imply ethical concerns that have to be considered. Methods: A WTP questionnaire was designed to compare preferences for imaging and genetic testing in cancer patients and to evaluate potential ethical concerns. Results: Comparing the options of imaging and genetics showed comparable WTP values. Ethical concerns about genetic testing seemed to be minor. Treatment success was the top priority irrespective of the diagnostic modality. In general, the majority of patients considered personalized medicine to be beneficial. Conclusion: Most patients valued personalized approaches and rated the benefits of precision medicine of overriding importance irrespective of modality or ethical concerns.

Markers of activation of coagulation in cancer patients.

Prothrombotic tendency is characteristic of tumors. The aim of the study is to investigate the changes in the laboratory parameters for coagulation and fibrinolysis, namely in fibrinogen, thrombin-antithrombin complex (ТАТ), tissue factor (ТF), prothrombin fragment (F1+2), antithrombin III (AT III), D-dimer and screening coagulation tests in cancer patients before initiation of chemotherapy. Levels of F1+2, fibrinogen, ТАТ, AT III, TF, D-dimer, PT, aPTT and TT were measured baseline in 80 patients with breast and lung cancer before systemic treatment. The same parameters were investigated in 65 healthy volunteers. TF, ТАТ, F1+2 were measured by ELISA; AT III, D-dimer, fibrinogen and screening coagulation tests were measured by automated coagulation system Sysmex CS 2000i. RESULTS: Levels of F1+2, fibrinogen, ТАТ, TF, and D-dimer in cancer patients were significantly higher than those in the control group, while the levels of ATIII activity were significantly lower (p < 0.001). The highest area under the ROC curve was for D-dimer, which made it a good marker for the risk of thrombosis. Higher levels of TF, ТАТ, F1+2, fibrinogen and D-dimer and lower activity of АТ III in cancer patients support our hypothesis of an association between malignant disease and coagulation disorders. Cancer patients are at an increased risk of thrombosis wherefore antithrombotic prophylaxis may be considered (Tab. 6, Fig. 2, Ref. 34). Text in PDF www.elis.sk Keywords: coagulation, fibrinolysis, cancer.