Abstract Background: Black women with breast cancer (BC) have a 40% higher mortality rate compared to Non-Hispanic White (NHW) women. Among women with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) BC, Black women have worse outcomes than NHW despite comparable systemic therapies. Gene expression profiling assays have been used in early-stage BC to provide prognostic and sometimes predictive information beyond standard immunohistochemical classifications. The 80-gene molecular subtype signature (BluePrint) with the 70-gene risk of distant recurrence signature (MammaPrint®) (Agendia, Irvine, CA) further classify HR+/HER2- BC into luminal A-type, luminal B-type, HER2-type, and basal-type tumors. Luminal B, HER2, and basal-type tumors (non-luminal A) are more aggressive with worse survival outcomes and are overrepresented among Black women. In the metastatic setting, the role of molecular subtype signatures in guiding therapeutic decisions has not yet been determined. We hypothesize that patients with metastatic HR+/HER2- non-luminal A-type BC post-progression on endocrine therapy +/- CKD4/6 inhibition will derive more benefit from chemotherapy than standard-of-care endocrine therapy in the second line setting. We also hypothesize that the impact of the intervention will be more pronounced in Black women compared to NHW women. Methods: This is a randomized phase II study that will evaluate the anti-tumor effect of capecitabine compared to physician’s choice endocrine therapy as second line therapy for adult ( >18 years) patients with non-Luminal A HR+/HER2- metastatic or unresectable locoregional invasive carcinoma (NCT 05693766). The study plans to enroll up to 62 patients. This trial enriches for racial/ethnic minority patients through collaborations with the University of Texas Southwestern and the University of Alabama at Birmingham, two health systems that serve a large minority population. Eligible patients who have received prior endocrine therapy with a CDK4/6 inhibitor will have their tumor tissue analyzed using the MammaPrint® and BluePrint assays. Patients with Luminal A tumors will receive standard of care and will be followed for survival only. Patients with non-Luminal A tumors will be randomized (1:1) to receive physician’s choice endocrine therapy versus capecitabine (dosed at 2000mg twice daily for 7 days on, 7 days off) with stratifications by molecular subtype and race. Patients will be evaluated for response every three cycles using the Response Evaluation Criteria in Solid Tumors. Therapy will be continued until evidence of disease progression or unacceptable major toxicity. The primary endpoint is progression free survival; secondary endpoints are overall response rate, clinical benefit rate, overall survival, and patient reported outcomes. The study will have 80% power to detect a minimal hazard ratio of 0.5 at one-sided significance level of 0.05. Cell-free DNA will be collected at baseline and at three times post-baseline to investigate potential genetic markers of disease response and resistance. Enrollment opened on June 1, 2023. We anticipate opening the trial at the external sites before the end of 2023. Citation Format: Moriah Forster, Jennifer Whisenant, Ben Park, Erica Stringer-Reasor, William Audeh, Andrea Menicucci, Fei Ye, Heather McArthur, Sonya Reid. Integrating gene signatures to guide HR+ MBC therapy in a diverse cohort (INSIGHT) [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 PO1-19-09.
The human papillomavirus causes a variety of genital lesions: condyloma acuminatum, bowenoid papulosis (carcinoma in situ), and squamous cell carcinoma. Only condylomata have been documented to be sexually transmitted. We report clinical and histopathologic evidence of suspected female to male transmission of bowenoid papulosis to the penis from a woman with condylomata acuminata, squamous cell carcinoma in situ, and focally invasive squamous cell carcinoma of the vulva. These findings indicate a need for thorough clinical and histopathologic evaluation of any anogenital lesions resembling condylomata and occurring in sexual partners. Conservative yet thorough destruction of bowenoid papulosis and squamous cell carcinoma in situ appears to be the treatment of choice.
BACKGROUND:Urine pregnancy tests are usually performed by women at home and also by healthcare professionals. However, there are several conditions that may cause a false-positive urine pregnancy test, including trophoblast tumors, malignancy, nephrotic syndrome, adenomyosis, tubo-ovarian abscess, and paraneoplastic syndromes. A case is presented of a false-positive urine pregnancy test in a 28-year-old woman with a history of tubal ligation, who had a delayed diagnosis of obstructive pyelonephritis due to renal calculus. CASE REPORT:A 28-year-old woman had previously been sterilized by tubal ligation. She presented with acute pyelonephritis associated with a left staghorn renal calculus and was found to have a false-positive urine pregnancy test, which delayed the diagnosis and management of her acute pyelonephritis. On follow-up, she had a negative serum pregnancy test. Abdominal computed tomography (CT) identified a left-sided staghorn calculus resulting in partial ureteric obstruction and hydronephrosis. She was treated with antibiotics, including cefazoline, and a left nephrostomy tube was sited to treat her hydronephrosis. Her pain was initially managed with acetaminophen and hydrocodone. Four days after her initial hospital admission, the patient was stable enough to go home on oral levofloxacin and pain medication. CONCLUSIONS:This case of a false-positive urine pregnancy test in a 28-year-old woman with a history of tubal ligation highlights that this association may result in the delay in the diagnosis and treatment of acute pyelonephritis.
e23000 Background: ACGME and internal surveys performed at the University of North Carolina (UNC) demonstrate that IM residents have historically been dissatisfied with their inpatient oncology experience. Other institutions have demonstrated that a resident oncology video library is feasible and effective in improving clinical knowledge, but formal protected time for module use limited engagement. We created an oncology video library targeted to the resident learner. To enhance impact, we incorporated dedicated time during elective rotations to access the modules. Methods: We performed a pre-survey using a Likert scale to assess resident knowledge perception of solid tumor cancers. We designed a curriculum based on the ABIM blueprint and those cancers frequently encountered on service. We filmed 21 videos of UNC oncologists discussing content they selected for the resident learner. To improve engagement, we provided a half-day of independent study during their outpatient oncology elective. As this study is ongoing, we plan to conduct a post-survey and post-test to evaluate long-term knowledge acquisition. Results: Twenty-seven of the 85 IM residents completed the pre-survey. Eleven (40.8%) reported feeling extremely or somewhat satisfied with inpatient oncology teaching; the remainder felt neutral (29.6%), somewhat (25.9%) or extremely dissatisfied (3.7%). Among oncologic emergencies, most residents felt comfortable managing hypercalcemia (88.9%) and cord compression (55.6%), but not SVC syndrome (29.6%). Prior to implementation of the videos, most reported little/no knowledge gain from their clinical rotations alone across nearly all 20 domains assessed. The only domain in which a majority (65.39%) reported some or significant knowledge gain was chemotherapy toxicities. These domains were selected as video lecture topics. In the five months since their release, each video has been viewed an average 21.5 times. The most viewed video (39 views) was on traditional chemotherapy pharmacology; the least viewed video (9 views) was on pancreas cancer. 28% of residents surveyed reported utilizing the videos, and for those who did access them, half (56.2%) felt that the time for the videos was sufficient, while the other half (43.8%) wished for more dedicated time. Conclusions: IM residents may benefit from an online video library to improve knowledge acquisition and perception of oncology rotations. However, to maximize impact, residents must be given adequate time separate from their service requirements to access the modules. This is a study in progress, and while initial data regarding video utilization appears promising, we await additional information to ascertain knowledge improvement.
9003 Background: Hematology/oncology (HO) is a complex, fast-paced specialty. Similarly, the approach to medical education continues to evolve, with a shift to electronic educational resources, which was accelerated by the COVID-19 pandemic. Limited studies exist to evaluate what resources trainees utilize to learn HO topics. Here, we evaluate how HOF utilize supplemental resources for self-directed education and clinical decision making. Methods: We included HOF from 27 HO fellowship programs in the US from September to October, 2023. Each fellow received an invitation from a local site coordinator to complete an optional anonymous survey via REDCAP. The survey contained a series of questions to better understand the HOF baseline knowledge of various HO topics, how they utilize supplemental resources when approaching new disease topics, and how they rate these resources for clinical decision-making using a 7-point Likert scale (“1-extremely unhelpful”, “4-neutral”, “7-extremely helpful”). Pairwise chi-squared analysis was used to assess differences by PGY status. Results: A total of 222 HOF completed the survey (53% response rate) including 82 PGY4 (37%), 72 PGY5 (32%), and 68 PGY6 and above (31%), The most utilized resources were reference websites (92%), such as UpToDate and Medscape, and National Comprehensive Cancer Network (NCCN) guidelines (92%). The majority also utilized question banks (q-banks, 72%), faculty lecture slides (66%), and online review series videos (videos, 65%). Over half integrated journal articles (60%) and podcasts (55%). The least utilized platforms include textbooks (25%), social media (23%), and online discussion boards (5%). Upper year HOF used videos and q-banks more than PGY4 (p<0.001). There were no statistically significant differences in utilization of other resources by PGY status. Amongst HOF who trialed each resource for clinical decision-making at any time, the most helpful resources (Likert mean ± SD) were reference websites (6.2 ± 0.9), NCCN guidelines (6.1 ± 1.0), videos (5.8 ± 1.1), and q-banks (5.8 ± 1.1). HOF found journal articles (5.4 ± 1.2), podcasts (5.2 ± 1.3), and faculty lecture slides (5.1 ± 1.3) moderately helpful. HOF found little utility in textbooks (4.2 ± 1.4), social media (Twitter, 4.0 ± 1.6), and discussion boards (3.8 ± 1.4). Conclusions: To our knowledge, this is the first large-scale analysis to identify what resources HOF use to study and aid in clinical decision making. Reference websites and NCCN guidelines are frequently used to study by HOF and are most helpful for clinical decision-making. The least utilized and least helpful resources are social media sites and online discussion boards. Prospective multi-institutional randomized research studies in medical education are necessary to assess effective and preferred learning modalities and identify ways to improve and standardize educational opportunities for all trainees.
Epstein-Barr virus mucocutaneous ulcers (EBV MCU) are B-cell lymphoproliferative disorders associated with immunosuppression. We report EBV MCU in a multiple myeloma patient on lenalidomide maintenance after stem cell transplant that resolved with decreased immunosuppression. Furthermore, the subsequent development of classical Hodgkin lymphoma suggests an underlying predisposition to EBV-driven lymphoproliferative disorders.
Timely lung cancer surgery is a metric of high-quality cancer care and improves survival for early-stage non-small-cell lung cancer. Historically, Black patients experience longer delays to surgery than White patients and have lower survival rates. Antiracism interventions have shown benefits in reducing racial disparities in lung cancer treatment.
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