Abstract Background[ 18 F]-Fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) may sometimes be suboptimal for imaging gastric adenocarcinoma. The recently introduced [ 68 Ga]Ga-FAPI-04 (FAPI) PET/CT targets tumor stroma and has shown considerable potential in evaluating the extent of disease in a variety of tumors.MethodsWe performed a head-to-head prospective comparison of FAPI and FDG PET/CT in the same group of 13 patients with gastric adenocarcinoma who presented for either initial staging (n = 10) or restaging (n = 3) of disease. Lesion detection and maximum standardized uptake value (SUV max ) were compared between the two types of radiotracers.ResultsAll ten primary gastric tumors were FAPI-positive (100% detection rate), whereas only five were also FDG-positive (50%). SUV max was not significantly different, but the tumor-to-background ratio was higher for FAPI (mean, median, and range of 4.5, 3.2, and 0.8-9.7 for FDG and 12.9, 11.9, and 2.2-23.9 for FAPI, P = 0.007). The level of detection of regional lymph node involvement was comparable. FAPI showed a superior detection rate for peritoneal carcinomatosis (100% vs. none). Two patients with widespread peritoneal carcinomatosis underwent a follow-up FAPI scan after chemotherapy: one showed partial remission and the other showed progressive disease.ConclusionsThe findings of this study suggest that FAPI PET/CT outperforms FDG PET/CT in detecting both primary gastric adenocarcinoma and peritoneal carcinomatosis from gastric cancer. FAPI PET/CT also shows promise for monitoring response to treatment in patients with peritoneal carcinomatosis from gastric cancer, however, larger trials are needed to validate these findings.
Abstract Background Clinical trials are an essential source for advances in oncologic care, yet the enrollment rate is only 2-4%. Patients' reluctance to participate is an important barrier. This study evaluates patients' level of understanding and attitudes towards clinical trials. Methods This cross-sectional study was conducted in the oncology department and day care unit at the oncology division Tel Aviv Sourasky Medical Center, Israel. From January 2015 to September 2016. Two-hundred patients’ currently receiving active anti-cancer therapy at a large tertiary hospital completed an anonymous questionnaire comprised of demographic information, past experience in clinical research and basic knowledge on clinical trials. Results The majority of respondents did not meet the minimum knowledge level criteria. In those who replied they would decline to participate in a clinical trial, concern were related to potential assignment to the placebo arm, provision of informed consent and trust issues with their oncologist. Those with sufficient knowledge were significantly more interested in participating. Patients with past experience in clinical trials had a higher level of academic education, were less religious, had a better understanding of medical research and were inclined to participate in future research. Conclusions Misperceptions of clinical trials may contribute substantially to the unwillingness to participate in them.
e18725 Background: Healthcare data sharing is important for the creation of diverse and large data sets, supporting clinical decision making, and accelerating efficient research to improve patient outcomes. This is especially vital in the case of real world data analysis. However, stakeholders are reluctant to share their data without ensuring patients’ privacy, proper protection of their data sets and the ways they are being used. Homomorphic encryption is a cryptographic capability that can address these issues by enabling computation on encrypted data without ever decrypting it, so the analytics results are obtained without revealing the raw data. The aim of this study is to prove the accuracy of analytics results and the practical efficiency of the technology. Methods: A real-world data set of colorectal cancer patients’ survival data, following two different treatment interventions, including 623 patients and 24 variables, amounting to 14,952 items of data, was encrypted using leveled homomorphic encryption implemented in the PALISADE software library. Statistical analysis of key oncological endpoints was blindly performed on both the raw data and the homomorphically-encrypted data using descriptive statistics and survival analysis with Kaplan-Meier curves. Results were then compared with an accuracy goal of two decimals. Results: The difference between the raw data and the homomorphically encrypted data results, regarding all variables analyzed was within the pre-determined accuracy range goal, as well as the practical efficiency of the encrypted computation measured by run time, are presented in table. Conclusions: This study demonstrates that data encrypted with Homomorphic Encryption can be statistical analyzed with a precision of at least two decimal places, allowing safe clinical conclusions drawing while preserving patients’ privacy and protecting data owners’ data assets. Homomorphic encryption allows performing efficient computation on encrypted data non-interactively and without requiring decryption during computation time. Utilizing the technology will empower large-scale cross-institution and cross- stakeholder collaboration, allowing safe international collaborations. Clinical trial information: 0048-19-TLV. [Table: see text]
e13622 Background: COVID19 pandemic expedited the use of telemedicine across nations. Oncology patients as at risk population especially needed the use of telemedicine to continue patient care. Evaluating patients' compliance and satisfaction with telemedicine is needed and might vary across nations and cultures. Experience from telemedicine during COVID might help shape oncology care in the future. Methods: A questionnaire that was locally validated in the Tel-Aviv Sourasky Oncology Division was distributed internationally using the BELONG.life digital health platform, a free and anonymous application (app) for cancer pts and caregivers. Results were compared between US pts replied through the app and Israeli patients. Results: The questionnaire was distributed to 232 Israeli patients and to 362 BELONG users in the US. The compliance was 74% and 35% pts respectively. Majority of users in Israel were male (54%) versus female in the US (77%). In the US 75% were Caucasian. More Israeli patients had a family member present in the call then in the corresponding US group (47% vs 64%). Both Israeli and US pts felt satisfied with the meeting and reported the willingness to continue with the same approach in the future regardless of the pandemic situation (84.9%, 63%, respectively). 95.9% of Israeli patients were attended by their regular doctor as opposed to 71% in the US. Call time duration was prolonging to 30-60 min and willingness to repeat the calls dropped to 47% when performed with a different doctor. In the US 76% of patients reported the telemedicine call saved them precious time. Conclusions: Patients' response to telemedicine meetings across countries was positive with oncology care visits being maintained successfully despite the ongoing COID19 pandemic. Most patients regardless of country of origin showed willingness to continue with telemedicine however maintaining the care with the patient's regular physician is important for the continued use of telemedicine in reducing visits time and improving the pts interaction and satisfaction. Clinical trial information: 0227-20.
[18F]-Fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) may sometimes be suboptimal for imaging gastric adenocarcinoma. The recently introduced [68Ga]Ga-FAPI-04 (FAPI) PET/CT targets tumor stroma and has shown considerable potential in evaluating the extent of disease in a variety of tumors.We performed a head-to-head prospective comparison of FAPI and FDG PET/CT in the same group of 13 patients with gastric adenocarcinoma who presented for either initial staging (n = 10) or restaging (n = 3) of disease. Lesion detection and maximum standardized uptake value (SUVmax) were compared between the two types of radiotracers.All ten primary gastric tumors were FAPI-positive (100% detection rate), whereas only five were also FDG-positive (50%). SUVmax was not significantly different, but the tumor-to-background ratio was higher for FAPI (mean, median, and range of 4.5, 3.2, and 0.8-9.7 for FDG and 12.9, 11.9, and 2.2-23.9 for FAPI, P = 0.007). The level of detection of regional lymph node involvement was comparable. FAPI showed a superior detection rate for peritoneal carcinomatosis (100% vs. none). Two patients with widespread peritoneal carcinomatosis underwent a follow-up FAPI scan after chemotherapy: one showed partial remission and the other showed progressive disease.The findings of this pilot study suggest that FAPI PET/CT outperforms FDG PET/CT in detecting both primary gastric adenocarcinoma and peritoneal carcinomatosis from gastric cancer. FAPI PET/CT also shows promise for monitoring response to treatment in patients with peritoneal carcinomatosis from gastric cancer; however, larger trials are needed to validate these preliminary findings.
260 Background: The patient-oncologist relationship is cultivated from the first clinic visit, trust and assurance established throughout the follow up period until the end of life. In March 2020, with the break of the COVID-19 pandemic, social distancing restrictions were implement throughout Israel. The adoptions of telemedicine services were incorporate as a response at our institution. Almost all ambulatory activity in the oncology division in Tel Aviv Medical Center was converted to telemedicine services. Several studies report favorable results regarding patient preference and cost effectiveness of telemedicine. Methods: We conducted a telephone interview questionnaire assessing patient satisfaction. Inclusion criteria included solid tumor patients over 18 years who utilized the telemedicine platform at Tel Aviv Sourasky Medical Center between March 2020 - May 2020. We aimed to evaluate patient's perspectives and preferences regarding telemedicine and assess whether this virtual communication affects the patient-doctor relationship. Results: Following the COVID-19 outbreak, 400 telephone calls were made to patients, 100 patients agreed to participate and surveyed. Fifty-two percent were female. The majority of patients independently downloaded the telemedicine application and did not encounter technical constraints (67%). Family members and friend attended 45% of telemedicine visits. Patients cancer diagnosis included colorectal cancer (47%), breast cancer (18%), genitourinary cancer (18%), sarcoma (9%) lung malignancies (6%), gynecological cancer (1%) and CNS tumors (2%). Visit intent included post-treatment follow up (40%), active treatment follow (53%), and first visit intake (7%). The majority of patients felt their emotional needs were met (88%) and felt that their treatment was not harmed due to absence of a physical visit (84%). Almost all patients (99%) felt their privacy was maintained. Ninety-five percent of patients affirmed that the virtual visit relieved their worries regarding treatment interruption. Importantly, 75% of patients affirmed their interest to continue telemedicine regardless of COVID-19 pandemic. Conclusions: Telemedicine is an acceptable platform that may replace follow up visits without comprising patients’ experience. Our data call for research and development of tools enabling long-term implementation of remote telemedicine and assess the patient-physician relationship and quality of care among oncology patients.
The COVID-19 epidemic is transforming the most basic component of communication between patients and physicians: the face-to-face meeting. This commentary addresses the challenges unique to the oncologist conducting appointments via telemedicine.
This letter to the editor responds to recent advice related to delivering difficult news via telemedicine, further encouraging productive discussions on this challenging topic.
e16222 Background: PDAC is one of the most lethal cancers, with 5-year overall survival (OS) ranging from 3-8%, and median survival of 6-11 months for patients with metastatic disease. We aimed to examine survival trends of PDAC patients treated over 10 years in a large tertiary center with unique ethnic characteristics. Methods: Survival data of all PDAC patients diagnosed at our institution between 2007 and 2016 was analyzed. Data regarding efficacy of chemotherapy combinations was further examined in a subset of patients diagnosed with upfront metastatic disease during 2015-2016. Results: A total of 1213 PDAC patients were treated in our institution during 2007-2016, representing ~20% of all Israeli PDAC patients. The 5-year OS was 17%. No change in OS was observed during all these years and was also identical before and after the introduction of FOLFIRINOX and Gemcitabine-Abraxane combinations. 232 patients (23%) underwent curative surgery and their 5-year OS was 23%. Among patients with upfront metastatic disease (n = 123) diagnosed during 2015-2016, 71% received any type of chemotherapy and their survival was 10.3 months, compared to only 2.2 months in the 29% of patients not receiving any treatment (p < 0.01). The untreated patients were older (median age 76.5 vs. 66 respectively) and their albumin was lower compared to those receiving chemotherapy. Survival among those treated with FOLFIRINOX as first line (n = 49, 40%) was 14.2 months, compared to 11.2 months for those receiving Gemcitabine as first line. Conclusions: The longer survival shown in real-life data compared to statistics of other countries may reflect unique genetic factors of the Israeli population. Importantly, we identified a relatively large group of metastatic PDAC patients not receiving any treatment and demonstrated an OS of 2.2 months. This group is neglected in the literature and clinical trials, and contributes to OS data.
