Noa Popovits‐Hadari

Advances in cancer care have led to a growing number of cancer survivors globally. As cancer increasingly affects women and people of reproductive age, more individuals will be experiencing pregnancy after completing cancer treatment. This Best Practice Advice manuscript describes the epidemiology of pregnancy after cancer, recommended clinical evaluation before pregnancy, key components of pregnancy care for cancer survivors, considerations for delivery planning and postpartum care, and suggested steps for future health and prevention.

AIMS: To present our Institute's experience with intraoperative radiotherapy in this selected population by collecting and analyzing clinical data, including long-term follow-up. BACKGROUND: Breast-conserving therapy is the standard treatment for early-stage breast cancer. The treatment includes tumor resection and a whole breast irradiation. Intraoperative radiotherapy is a single dose of irradiation given to the tumor bed immediately after it is removed. This treatment is suitable for a selected population of patients with early stage breast cancer, which constitutes about 20% of all breast cancer patients and is supposed to replace the standard whole breast radiation treatment. METHODS: Between the years 2006-2017, 737 women with early breast cancer were treated in Carmel Medical Center with intraoperative radiotherapy. We herein report the results of the first 500 patients who were treated until 2015. RESULTS: In 13.8% of the patients, additional breast treatment was recommended due to poor pathological characteristics of the disease in final pathological examination. During a median follow-up period of 74 months (1-136), recurrence was observed in 22 patients (4.4%), and in 7 patients (1.4%) recurrence was observed in regional lymph nodes; 13 patients (2.6%) developed metastatic disease. Risk factors for regional recurrence were identified: tumor size greater than 2 cm, lack of adjuvant therapy and poor genetic profile of the disease. CONCLUSIONS: Intraoperative radiotherapy is feasible and may offer an alternative to the standard whole breast radiotherapy, in low risk early breast cancer patients. The patients should be selected according to known risk factors.

e19120 Background: mNSCLC pts benefit from EGFR tyrosine kinase inhibitors (TKIs) but also from chemotherapy; the optimal sequencing of these treatments in not known. Methods: mNSCLC pts that received systemic treatment for stage 4 disease were eligible. De-identified data was retrieved from medical records of 6 cancer departments. Overall survival (OS) from diagnosis of metastatic disease was the primary outcome. Multivariate analyses included first line of treatment for metastatic disease (chemotherapy vs. TKI), EGFR mutation type, age, sex, stage at diagnosis, histologic subtype, smoking and performance status (PS). Based on our pilot study, to demonstrate OS HR ≥ 2.0 between pts treated with chemotherapy vs. TKI as first treatment, with significance level of 5% and power of 90%, we needed at least 88 events. Results: 287 pts were eligible, median age 66 years, 38% male, 76% stage 4 at diagnosis, 89% adenocarcinoma, 37% ever smokers, 79% PS 0-1. TKI was first treatment in 83%. Only stage at diagnosis (HR 3.15; 95% C.I. 2.02-4.92) and PS (HR 2.0; 95% C.I. 1.16-3.44) were prognostic. Median OS (mOS) was 26.8 months (95% C.I. 24.1-29.5). Among patients with exon 19 deletion, OS trended to be longer for pts that started chemotherapy first (HR 0.50; 95% C.I. 0.24-1.019, p = 0.056). For patients with L858R, the opposite trend was seen (HR 2.24; 95% C.I. 0.89-5.67, p = 0.088). Interaction of first treatment and mutation type was not significant. Patients ≥ 72 y were unlikely to receive chemotherapy first (p = 0.009). Conclusions: Type of EGFR mutation was neither prognostic nor predictive for OS in this cohort, but may influence the most effective treatment sequence. Further studies are required. All patients TKI first Chemotherapy first N (%) mOS (months, 95% C.I.) N mOS (months, 95% C.I.) N mOS (months, 95% C.I.) All pts 287 (100) 26.8 (24.4-29.2) 237 26.6 (23.2-29.9) 50 37.1 (14.9-59.3) Deletion 19 157 (55) 27.0 (25.4-28.5) 136 27.0 (23.7-30.2) 21 37.1 (7.7-66.5) L858R 67 (23) 24.3 (17.8-30.7) 57 26.7 (20.7-32.7) 10 19.5 (8.1-30.9) Other 10 (3.5) 14.7 (0-39.9) 8 25.6 (4.5-46.7) 2 2.56 (-_) Unknown 53 (18.5) 27.2 (14.6-39.8) 36 17.6 (9.7-25.6) 17 47.8 (21.4-74.2)

e21685 Background: ALKi represent the standard 1 st - and 2 nd -line treatment (Tx) for ALK+ aNSCLC patients (pts). The value of ALKi in the 3 rd -line setting is unclear. We retrospectively assessed the real-world impact of a 3 rd -line ALKi vs. non-ALKi Tx in ALK+ aNSCLC pts. Methods: Consecutive ALK+ aNSCLC pts were identified in the working databases of 7 Israeli oncology centers; pts receiving any systemic Tx beyond 2 different ALKi were selected for the comparative analysis. Pts whose immediate next Tx line (post-2 nd -ALKi) was a 3 rd ALKi (Group (Gr) A) were compared to pts whose immediate next Tx line (post-2 nd -ALKi) was non-ALKi Tx (Gr B), in terms of overall survival (OS) and time to next Tx line (TNT). Results: 158 consecutive ALK+ aNSCLC pts diagnosed in January 2011 - March 2019 were included, median follow up from diagnosis of aNSCLC was 41 months (mo) (IQR 8-45). Median OS from aNSCLC diagnosis was 56 mo (95% CI 36-66). Post-2 nd -ALKi line was a 3 rd ALKi for 23 pts (Gr A) and a non-ALKi Tx for 10 pts (Gr B). 7 of Gr B (70%) received ALKi as a later line Tx. Median OS after initiation of post-2 nd -ALKi Tx was 27 mo (95% CI, 7-NA) for Gr A vs. 16 mo (95% CI, 7-NA) for Gr B; p-non-significant (NS) with or without adjustment for sex, age, brain metastases. TNT on post-2 nd -ALKi Tx was 6 mo (95% CI, 2-27) for Gr A vs. 2.5 mo (95% CI, 0-NA) for Gr B; p-NS. Conclusions: Following progression on a 2 nd ALKi, OS and TNT were numerically higher for pts receiving a 3 rd ALKi, but statistically NS. Extensive exposure of pts in the non-ALKi Tx Gr to an ALKi at a later stage might have impacted these results. Further studies are required to identify patients likely to benefit from ALKi after progressing on 2 or more ALKi Tx lines. [Table: see text]