2026 Accepted Abstracts
Complete response to talimogene laherparepvec and cetuximab in a renal transplant recipient with metastatic cutaneous squamous cell carcinoma
Background
Cutaneous squamous cell carcinoma (cSCC) is associated with a significant risk of recurrence and metastasis in solid organ transplant recipients, for whom immune checkpoint inhibition is often avoided due to allograft rejection risk. Talimogene laherparepvec (T-VEC) is approved for use in melanoma, however evidence supporting its use in cSCC, immunocompromised patients, and combination regimens remains limited.
Methods
An 81-year-old renal transplant recipient on chronic immunosuppression presented with recurrent, metastatic cSCC following multiple prior surgical resections and adjuvant radiation therapy. Concern for disease progression during cetuximab monotherapy prompted the addition of off-label intralesional T-VEC.
Results
The patient received seven T-VEC injections and cetuximab over three months and achieved a complete clinical and radiographic response, with resolution of dermal and nodal metastases. Treatment was well tolerated, with only transient flu-like symptoms following the initial T-VEC administration. No evidence of allograft rejection, disseminated herpes infection, or treatment-related nephrotoxicity was observed. The patient remains free of clinical and radiographic evidence of disease as of July 7, 2026.
Conclusions
To our knowledge, this represents the first reported use of combined cetuximab and T-VEC in a renal transplant recipient with metastatic cSCC. Therapy was associated with complete clinical and radiographic response without compromising allograft function, notably including regression of dermal metastases typically associated with unresectable disease and poor prognosis. Additionally, T-VEC may potentially induce a systemic immune effect as a non-injected lymph node demonstrated response. Further investigation of T-VEC for patients with advanced cSCC and contraindications to immune checkpoint inhibition is needed.
Additional Notes
Dr. Singh, an active NNECOS member, was your research mentor for this project, which will satisfy the sponsorship requirement
Direct oral anticoagulants for venous thromboembolism in patients with brain metastases: A scoping review of intracerebral hemorrhage risk
Background
Direct oral anticoagulants (DOACs) are first-line agents for cancer-associated venous thromboembolism (VTE). However, no consensus exists on routine use in patients with brain metastases due to intracranial hemorrhage (ICH) risk, both spontaneously and with anticoagulation. This review characterizes the literature on ICH risk with DOACs in this population.
Methods
A scoping review was conducted per Joanna Briggs Institute (JBI) methodology. Ovid MEDLINE, Ovid EMBASE, Cochrane Library, Web of Science, OAIster, GoogleScholar, Proquest Dissertations and Theses, and ClinicalTrials.gov were searched through 2024. Included studies met pre-specified protocol criteria, evaluating DOACs for cancer-associated VTE and discussing ICH in brain metastases. Two reviewers independently screened studies and extracted data. Cohort studies underwent quality assessment using the revised JBI tool.
Results
Of 7458 abstracts screened, 177 required full-text review and 22 were included. Six were retrospective cohort studies, the remainder were meta-analyses or reviews. One study focused exclusively on brain metastases but did not compare ICH by anticoagulant class. Several studies reported significantly less ICH with DOACs versus LMWH in primary brain tumors. ICH incidence in brain metastases ranged from 4.9-27.8% with DOACs and 2.3-52.9% with LMWH across studies, with no statistically significant differences. Fatal ICH was infrequently discussed. Four cohort studies were rated high risk and two moderate risk of bias, due to dissimilar cohorts and unadjusted baseline differences.
Conclusions
Limited, retrospective evidence suggests no significant increase in ICH with DOACs compared with LMWH in patients with brain metastases when used for treatment of VTE. Prospective studies are needed to define ICH risk for these patients.
Warburg Effect Masquerading as Septic Shock in Hepatosplenic T-Cell Lymphoma
Background
The Warburg effect, aerobic glycolysis persisting despite adequate oxygenation, is well established in solid tumors but rarely recognized as a clinical emergency in hematologic malignancy. When present, it can produce lactic acidosis and hypoglycemia that closely mimic septic shock, an overlap increasingly reported in aggressive lymphomas such as hepatosplenic and natural killer/T-cell lymphoma.
Methods
A 52-year-old man with newly diagnosed hepatosplenic T-cell lymphoma, and a history of urethral carcinoma treated with chemoradiation, diabetes, and hypertension, presented with weakness, anorexia, nausea, and mild dyspnea. He was hypotensive (86/66 mmHg) and tachypneic, with suprapubic tenderness but no peritoneal signs.
Results
Labs showed severe leukopenia (WBC 1.2×10³/μL), thrombocytopenia (35×10³/μL), hyponatremia (Na 128 mEq/L), low bicarbonate (17 mEq/L), elevated lactate (2.4 mmol/L), and transaminitis (AST/ALT 389/121 IU/L). Given his hypotension, recent UTI, and cytopenias, he was initially treated for septic shock. However, his lactate and glucose trends did not track with an infectious course, and hypoglycemia persisted despite dextrose supplementation, raising suspicion for tumor-driven aerobic glycolysis. Despite maximal supportive care, he deteriorated rapidly and progressed to multiorgan failure.
Conclusions
Fulminant lactic acidosis and refractory hypoglycemia in a patient with an aggressive lymphoma should raise suspicion for the Warburg effect, not just sepsis. The distinction matters clinically: sepsis calls for antimicrobials and source control, while a Warburg-driven metabolic crisis calls for urgent cytoreductive therapy. Delayed recognition likely contributed to this patient\’s rapid decline.
Bi-specific T-cell engagers as a bridge to ciltacabtagene autoleucel in Relapsed/Refractory multiple myeloma: Real-world outcomes in an underserved urban population
Background
Ciltacabtagene Autoleucel (cilta-cel), a BCMA-directed CAR-T therapy, and bispecific T-cell engagers (BiTEs) produce durable responses in relapsed/refractory multiple myeloma (RRMM), but data in underserved populations are limited. We report real-world outcomes of BiTE bridging before cilta-cel at an urban academic center.
Methods
Single-center retrospective review of adults with RRMM who underwent leukapheresis and received cilta-cel. Leukapheresis preceded BiTE initiation in all cases. The primary endpoint was safety with versus without BiTE bridging; secondary endpoints included overall response rate (ORR) and disease progression. Groups were compared using two-sided Fisher’s exact tests.
Results
From September 2023 to March 2025, 49 patients received cilta-cel, with follow-up through April 2026. Median age was 65 years. 38.9% patients identifying as non-Hispanic Black and 44.9% as Hispanic. Most were triple-class (36.7%) or penta-drug refractory (57.1%); 14.3% had extramedullary disease. Seventeen patients received BiTE (Talquetamab n=12, Teclistamab n=3, others n=2). CRS occurred in 59% (BiTE) versus 81% (non-bridged p=0.17). ICANS was not observed in the BiTE group but occurred in 4 non-bridged patients (p = 0.29). Prolonged cytopenias were comparable (52.9% vs 50%, p=1.0). ORR was 95.6% (43/45 evaluable) with identical ≥CR rates between BiTE- and non-BiTE-bridged groups (66.7% vs 66.7%, p=1.00). Six deaths occurred during follow-up (3 BiTE, 3 non-bridged). At a median follow-up of 18.4 months, 12-month PFS was 87.4% (BiTE) and 83.9% (non-bridged); median PFS was not reached.
Conclusions
In one of the few studies of BiTE bridging before cilta-cel in an underserved population, bridging was feasible, safe, and did not compromise CAR-T efficacy.
Hidden Hemolysis: DAT-Negative Autoimmune Hemolytic Anemia Complicated by HLH
Background
Autoimmune hemolytic anemia (AIHA) is typically characterized by a positive direct antiglobulin test (DAT), though 10% of cases are DAT-negative1, creating diagnostic challenges. Severe cases may be complicated by hemophagocytic lymphohistiocytosis (HLH), reflecting profound immune dysregulation with high morbidity/mortality.
Methods
A man with history of remote hepatitis C and EBV-associated DAT-positive AIHA presented with severe anemia and hemolysis, without clear intravascular features. Despite a persistently negative DAT, he was managed for an AIHA flare. Viral studies, including EBV, and flow cytometry were unremarkable. CT demonstrated splenomegaly with suspected infarcts and peri-splenic lymphadenopathy. Bleeding risk precluded biopsy.
Results
Prednisone and transfusional support were initiated, but severe transfusion-refractory anemia (hemoglobin nadir 3.4 g/dL) required \>25 units of packed red blood cells, prompting rituximab and IVIG administration. Progressive hyperferritinemia, elevated inflammatory markers, liver dysfunction, and an H-Score of 241 supported HLH. Steroids were escalated, and anakinra was initiated. Ongoing transfusion dependence led to splenectomy on hospital day 8, with subsequent improvement in bilirubin and ferritin. Respiratory failure ensued, requiring intubation, then pulseless electrical activity arrest despite thrombolysis for suspected pulmonary embolism.
Conclusions
DAT-negative AIHA often presents with severe disease and is less responsive to first-line therapy2. Although rare, the coexistence of AIHA and HLH has been described3, likely reflecting shared underlying triggers rather than a direct causal relationship. In this case, splenic pathology excluded lymphoma, and no unifying diagnosis was identified. DAT-negative AIHA can present with severe hemolysis and HLH. Early recognition is essential to facilitate prompt immunosuppression and multidisciplinary management.
Additional Notes
References: Berentsen, Sigbjørn, and Wilma Barcellini. “Autoimmune Hemolytic Anemias.” The New England Journal of Medicine, vol. 385, no. 15, Oct. 2021, pp. 1407–19. PubMed, https://doi.org/10.1056/NEJMra2033982. Barcellini W, Fattizzo B, Zaninoni A, Radice T, Nichele I, Di Bona E, Lunghi M, Tassinari C, Alfinito F, Ferrari A, Leporace AP, Niscola P, Carpenedo M, Boschetti C, Revelli N, Villa MA, Consonni D, Scaramucci L, De Fabritiis P, Tagariello G, Gaidano G, Rodeghiero F, Cortelezzi A, Zanella A. Clinical heterogeneity and predictors of outcome in primary autoimmune hemolytic anemia: a GIMEMA study of 308 patients. Blood. 2014 Nov 6;124(19):2930-6. doi: 10.1182/blood-2014-06-583021. Epub 2014 Sep 16. PMID: 25232059. Fattizzo B, Ferraresi M, Giannotta JA, Barcellini W. Secondary Hemophagocytic Lymphohistiocytosis and Autoimmune Cytopenias: Case Description and Review of the Literature. J Clin Med. 2021 Feb 20;10(4):870. doi: 10.3390/jcm10040870. PMID: 33672504; PMCID: PMC7923749.
Outcomes by Molecular Classification in Clinically High-Risk DLBCL
Background
The International Prognostic Index (IPI) is widely used for risk stratification in diffuse large B-cell lymphoma (DLBCL), yet substantial outcome heterogeneity persists within IPI risk groups. As the IPI incorporates only clinical variables, it does not account for genomic disease biology. We evaluated the prognostic value of LymphGen classification among patients with clinically high-risk (IPI ≥3) DLBCL.
Methods
DLBCL specimens underwent targeted exome and transcriptome sequencing. Genomic alterations were characterized using AUGMET, and molecular subtypes were assigned using the Bayesian LymphGen algorithm. Of 45 patients with LymphGen classification and evaluable progression-free survival (PFS), 37 with IPI ≥3 comprised the analysis cohort. Patients were categorized as having adverse molecular subtypes (MCD, A53, N1; n=17) or non-adverse molecular subtypes (BN2, EZB, ST2, other; n=20). PFS was compared using log-rank testing and Cox proportional hazards modeling.
Results
Mean age was 70.2 years, and median follow-up was 9.9 months. Mean IPI scores were similar between adverse and non-adverse groups (3.76 vs 3.80), while mean lines of therapy were 1.59 and 1.25, respectively. Progression occurred in 58.8% (10/17) versus 40.0% (8/20). Adverse-subtype classification was associated with numerically shorter PFS (HR, 1.99; 95% CI, 0.72–5.48; p=0.19), although not statistically significant.
Conclusions
Among patients with clinically high-risk DLBCL, adverse LymphGen subtypes were associated with a numerically higher risk of progression despite similar IPI scores. Although limited by small sample size and short follow-up, these findings suggest that molecular classification may further refine risk stratification among clinically high-risk DLBCL patients. Validation in larger cohorts with longer follow-up is warranted.
Reassessing Inpatient Requirements for Bispecific T-Cell Engager Therapy to Expand Access in Maine
Background
Bispecific T-cell engagers carry FDA labeling recommending hospitalization for early doses, enforced by REMS certification for some agents, given cytokine release syndrome (CRS) and neurotoxicity (ICANS) risk. Requirements ease with step-up completion, and shifting subsequent doses outpatient is an institution-specific decision. Maine Medical Center is the state\’s only site for these therapies and bed limitations can constrain access.
Methods
This multidisciplinary retrospective medication use evaluation includes adult patients who received blinatumomab, glofitamab, talquetamab, tarlatamab, or teclistamab at Maine Medical Center since 2024. We abstracted CRS and ICANS incidence, severity, and timing by dose number during labeled hospitalization windows, length of stay, inpatient versus outpatient administration costs, and home-to-hospital driving distance.
Results
CRS and ICANS occurred predominantly with initial doses across agents, with lower incidence and severity on subsequent administrations. Patients traveled substantial distances for treatment and outpatient bag changes. Projected inpatient costs exceeded modeled outpatient costs.
Conclusions
These findings support selective outpatient administration of later bispecific antibody doses at experienced centers. As Maine\’s sole provider of these therapies, defining and expanding safe outpatient pathways may improve statewide access without compromising safety, though limited infusion access outside the Portland-Brunswick corridor constrains step-down options for our largely rural population. We will discuss what has and has not worked at our institution and propose a path forward. We look forward to comparing approaches with other NNECOS sites.
COVID-19 Vaccination, Immune-Related Adverse Events, and Survival in ICI-Treated Cancer Patients: An Immortal Time Bias-Corrected Analysis
Background
COVID-19 vaccines activate immune pathways overlapping with immune checkpoint inhibitor (ICI) activity. Prior studies reported improved overall survival (OS) with vaccination, but potential immortal time bias remains a concern. We evaluated associations between COVID-19 vaccination, OS, and immune-related adverse events (irAEs) among ICI-treated patients.
Methods
We performed a single-center retrospective cohort study of patients receiving ≥1 ICI dose (2015–2025). Vaccination was obtained from electronic health records and irAEs from ICD-10 codes and free-text extraction. OS was analyzed using Kaplan-Meier and multivariable Cox regression. Immortal time bias was addressed using time-varying vaccination and 6- and 12-month landmark analyses.
Results
Among 2,715 patients, 1,308 (48.2%) were vaccinated. Time-fixed analysis associated vaccination with improved OS (adjusted HR 0.51, 95% CI 0.46–0.56; p\<0.0001). However, 25% received their first vaccine after ICI initiation (median 545 days). Time-varying analysis attenuated the association (adjusted HR 0.71, 95% CI 0.63–0.79), while landmark analyses were nonsignificant (6-month HR 0.92, p=0.25; 12-month HR 1.03, p=0.75). Time-fixed survival benefits across cancer types and ICI classes similarly attenuated after immortal-time correction. irAEs were modestly more frequent among vaccinated patients (19.1% vs 16.0%, p=0.034), without significant organ-specific differences.
Conclusions
In this real-world cohort, the survival benefit associated with COVID-19 vaccination among ICI-treated patients was substantially attenuated after accounting for immortal time bias. Despite a modest increase in irAE incidence, vaccination was not associated with increased organ-specific immune-related toxicity. These findings underscore the need for prospective, time-updated exposure studies to determine whether vaccination independently influences ICI outcomes.
Optimal Prevention Strategies for Oral Mucositis in the Setting of Myeloablative Stem Cell Transplant
Background
Myeloablative hematopoietic stem cell transplant is a viable treatment option for certain hematologic malignancies which otherwise would be life-threatening. A significant toxicity from myeloablative conditioning regimens is oral mucositis, which can lead to systemic infections, need for parenteral or enteral nutrition, analgesics, prolonged hospital stays, and death. There are limited interventions for effective oral mucositis management.
Methods
A literature search was performed in the CINAHL and PubMed databases using the search terms mucositis, oral care, mouth care, oral hygiene, hematopoietic stem cell transplantation, bone marrow transplant, hsct, hct. 178 articles were found.
Results
In 2004, Multinational Association for Supportive Care in Cancer established evidence-based clinical practice guidelines for mucositis. These guidelines were updated in 2007, 2014 and 2019. They covered the prevention strategies: basic oral care, photobiomodulation, cryotherapy, natural and miscellaneous agents and growth factors/cytokines. MASCC completed systematic reviews of literature on each of these five (5) interventions.
Conclusions
There is no consensus on a standard oral care regimen for patients undergoing myeloablative HSCT. No studies were found that studied the effect of nursing interventions on OM and patient adherence in the adult myeloablative HSCT population.
Additional Notes
After a thorough review of the literature, the following needs have been identified: Development of effective nursing interventions to decrease the incidence and/or severity of mucositis. QI/QA projects measuring the effect of nursing interventions on basic oral care and patient adherence in the adult myeloablative HSCT population. Collaboration with inpatient nursing teams to educate the patients on importance of oral care during HSCT hospitalization.
A Diagnosis in the Pleural Space — A Rare Extramedullary Involvement of Acute Myeloid Leukemia
Background
Extramedullary Acute Myeloid Leukemia (AML) arises from a site outside of the bone marrow. Approximately 2% of newly diagnosed AML present with extramedullary disease.
Methods
A 76 year old woman with a past medical history of congestive heart failure, hypertension, atrial fibrillation status post Watchman with history of a stroke, and normocytic anemia with a persistent history of shortness of breath and dyspnea. These symptoms were originally suspected to be recurrent subacute/acute congestive heart failure, with a chest x-ray showing a persistent right sided pleural effusion. She underwent thoracentesis.
Results
Pathology was concerning for a CD34 positive myeloblastic population. Findings were most consistent with an extramedullary manifestation of an underlying high grade myeloid neoplasm, most consistent with AML with monocytic features. Her bone marrow biopsy was also consistent with 70% blasts with monocytic features and trilinear dysplasia at the time of diagnosis. She also had a notable DNMT3A VAF 46% and TET2 VAF 48%.
Conclusions
Pleural involvement by AML is a rare extramedullary manifestation, and presenting as the initial clue is exceedingly uncommon. Extramedullary involvement can complicate disease assessment and management, but prognosis remains driven by the biologic features of AML and response to therapy.
Making Every Citation Traceable: Provenance-Grounded Retrieval for Genomic Tumor Board Preparation
Background
Genomic tumor board (GTB) preparation requires synthesizing evolving evidence to guide treatment decisions. Large language models (LLMs) can accelerate this but may respond with hallucinated (fabricated) citations, an unacceptable risk when outputs inform patient care. Preventing this requires preserving each source document\’s identity during data indexing, something LLMs are not designed to do.
Methods
We indexed 6,312 oncology publications spanning twenty cancer domains into a knowledge graph, propagating a level-specific provenance header into every text unit, carrying document identity, source system, and authority level. Citations were injected deterministically from that provenance rather than generated during synthesis of LLM responses. A separate verification pass re-derived every identifier appearing in generated output against the source corpus, removing those that could not be confirmed. We measured provenance retention across all indexed text units and validation outcomes across all generated community reports, the system\’s machine-generated topic summaries.
Results
Provenance metadata was retained across all 11,940 indexed text units, confirming document identity survives graph construction and chunking at corpus scale. Of 5,646 generated community reports, 5,617 passed citation validation (99.5%). Verification identified and removed ungrounded PMIDs, confirming that deterministic injection alone is insufficient and that an independent scrubbing pass improves performance.
Conclusions
Provenance-grounded citation is achievable at production scale, and the remaining ungrounded identifiers demonstrate why verification must be independent of injection. This architecture establishes traceability as a precondition for clinical evaluation; blinded subject-matter-expert assessment of answer quality is ongoing and reported separately.
Additional Notes
Authors: Jacob J. Choi1, Jennifer Bourne M.S.2, Alexander Berger B.S.2, Lindsey Kelley M.S.2, Johannes Fischer M.D2, Leah Graham PhD2, Vivek Philip PhD2, Jens Rueter M.D.2 1Colby College 2The Jackson Laboratory
Synoptic Reporting in Melanoma Ultrasound Surveillance: A Single-Institution Implementation Study
Background
Nodal ultrasound (U/S) surveillance is standard for sentinel lymph node biopsy-positive (SLNB+) melanoma. Prior studies demonstrated inconsistent reporting of Multicenter Selective Lymphadenectomy II (MSLT-II) criteria and clinical recommendations. A synoptic U/S report template previously developed and implemented among radiologists improved documentation and provider satisfaction. We evaluated this synoptic template within a clinical practice setting.
Methods
The U/S synoptic report template was implemented from December 2025 – February 2026. Outcomes included template utilization, documentation of MSLT-II criteria, and clinical recommendations. Reporting outcomes were compared with a pre-implementation period (June 2025-November 2025). For patients with synoptic reports, the preceding pre-implementation U/S report was reviewed. Independent radiologic review of archived U/S images was compared with clinician interpretation using Cohen’s weighted kappa analysis.
Results
Among 17 eligible post-implementation U/S examinations in SLNB+ patients, 9 (52.9%) utilized the template. Across 41 pre-implementation U/S reports, 4 reports (9.8%) contained at least one MSLT-II criterion (mean of 0.12 criteria per report). Of the 13 patients with paired pre- and post-implementation reports (8 SLNB+ patients and 5 non-SLNB+ high-risk patients), reporting of MSLT-II criteria increased from 30.8% to 100%. Agreement between radiology and surgical recommendations was fair: 53.8% (weighted κ = 0.27, 95% CI −0.14 to 0.68).
Conclusions
Implementation of a U/S synoptic reporting template improved documentation of MSLT-II criteria. Fair agreement between surgeon and radiologic interpretation suggests a need to improve interrater reliability. This template may be most useful in clinical settings for improving documentation of clinical reasoning and supporting actionable recommendations when clinical uncertainty exists.
Additional Notes
This research was supported by a NNECOS training grant (medical student: Julia Geaghan-Breiner) As the submitting physician, I am a current physician member of NNECOS.
A Community-Based Model for Safe Bispecific Therapy Administration
Background
Bispecific therapies are transforming cancer treatment, with expanded indications for hematologic malignancies and solid tumors. Implementation in community oncology settings is challenging due to risks of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS); both require intensive monitoring. Historically, Southcoast Health patients are referred to academic centers for the step-up portion of treatment, creating barriers to care continuity.
Methods
A multidisciplinary team evaluated inpatient and outpatient treatment models; a hybrid approach was chosen. Bispecific therapies are administered in the outpatient cancer center, then patient is admitted to an inpatient oncology unit for post-treatment monitoring. Implementation required collaboration among oncology, pharmacy, hospitalists, ER, neurology, intensive care, nursing, and education teams. Staff education, standardized workflows, escalation pathways, and treatment protocols were developed. Patient education visits were expanded to include toxicity recognition/symptom reporting. Patients received home monitoring equipment, educational materials. Electronic health record enhancements improved treatment visibility, toxicity documentation, and patient identification across care settings.
Results
Long-term outcomes are still being evaluated, but early implementation has demonstrated feasibility. The program has expanded local access to bispecific therapies, reduced travel burden, improved continuity of care, and increased patient satisfaction. Standardized workflows, staff education, monitoring tools, and EHR enhancements have improved organizational readiness for future program growth.
Conclusions
A hybrid inpatient/outpatient bispecific therapy model can safely expand access to advanced cancer therapies in the community setting. This allows patients to remain within their local healthcare system while maintaining safety and quality of care.
Background
Historically, cancer care focused primarily on treating the disease. Over time, with advances in oncology, attention has been shifted toward supporting patients in living well throughout their cancer journey. This qualitative project explored how oncology nurses perceive their role in helping patients live well rather than simply treating cancer.
Methods
Drawing from ethnographic and narrative inquiry methods, data was collected through clinical observations and semi-structured interviews with oncology nurses. Observations provided insight into nursing practices that supported patients’ physical, emotional, and psychosocial well-being during treatment. The interviews filled in for the gaps in the data and allowed for a further dive into anything I wanted to dive further into different decisions made by the nurses.
Results
Three primary themes emerged. First, oncology nurses emphasized building meaningful relationships with their patients by learning details about patients beyond their diagnosis. Second, nurses adapted their communication, tone, and the care environment to meet patients’ emotional needs for that day, recognizing that they can significantly influence the patient experience. Third, nurses took time to address the psychosocial needs and social determinants of health of the patients by identifying resources and interventions that would reduce the burdens affecting patients’ overall well-being.
Conclusions
Collectively, these findings demonstrate that oncology nurses view their role as extending beyond providing treatment to supporting the whole person throughout the cancer experience. These findings reinforce the importance of wholistic oncology nursing care. This project sparked suggestions on strengthening nursing education, continued integration of interdisciplinary resources, and standardized quality-of-life evaluations.
Additional Notes
This project was an extension of the Flynn Fellowship of Oncology at Wentworth-Douglass Hospital in Dover, NH. I am a rising senior, honors nursing at the University of New Hampshire.
Tell Me More: The Culture, Resources, and Metrics Needed to Sustain Patient-Reported Outcomes in Transplant and Cellular Therapy
Background
Patient-reported outcomes (PROs) and agenda-setting tools can support person-centered care in transplant and cellular therapy (TCT); however, sustaining their integration into routine practice is challenging. PROs have been embedded in routine TCT care at our rural NCI-designated comprehensive cancer center since 2021. We examined factors perceived to influence the sustainability of the program and metrics needed to demonstrate value from provider and health system administrative leader perspectives.
Methods
We conducted 25 semi-structured interviews with TCT providers (n=12) and health system administrative leaders (n=13) between June and October 2025, using an appreciative inquiry approach. Interviews covered a range of topics including implementation resources, leadership and system culture, value, and sustainability. Qualitative analysis was conducted using a hybrid inductive-deductive approach to identify themes across both groups.
Results
Sustaining PRO implementation requires a supportive organizational culture. Both groups emphasized the need for adequate resourcing, including staff with data expertise, EHR infrastructure, and social support services (e.g., social work, transportation, and food assistance). Other key themes included leadership that champions PRO use and sharing of findings across the system. Administrators and providers differed in some respects, with providers focusing on clinic-level workflows and needs, while administrators emphasized system-wide obstacles, burden, and resource strain. To measure long-term value, both groups identified metrics spanning implementation, patient experience, clinical outcomes (mainly providers), and costs (mainly administrators).
Conclusions
PROs can be sustained when supported by specific organizational factors, including adequate resourcing, engaged leadership, and sharing of findings. Future analysis will measure value using quantitative metrics.
Improving precision oncology delivery through genomic eConsults: a one-year evaluation of genetic testing and immunotherapy recommendations.
Background
Precision oncology holds promise for transforming cancer care, yet the growing number of FDA-approved targeted therapies makes it challenging for oncologists to stay current. Since 2016, the Maine Cancer Genomics Initiative (MCGI) has supported oncologists through Genomic Tumor Boards (GTBs), which help interpret complex genomic data and translate it into actionable treatment recommendations. However, GTBs are time-intensive, and require several people to convene in real time. To improve efficiency, MCGI introduced asynchronous Genomic eConsult at Maine General Medical Center (MGMC) in February 2024. This study analyzes the first year of Genomic eConsults to assess its effectiveness.
Methods
The MCGI team provided Genomic eConsults for 155 patient cases between 2/2/2024 to 2/26/2025. Data regarding prescribed treatment, additional biomarker testing, and germline testing after the Genomic eConsult were collected and analyzed.
Results
Overall, 27.45% of all patients were recommended for genetic testing after their eConsult while 6.67% of patients received testing without recommendation. Breast, prostate and gynecologic cancers showed the highest germline referral completion. Additionally, 16.03% of patients received new immunotherapy medication and 14.93% changed their medication after their eConsult review.
Conclusions
The Genomic eConsult model increased the quantity of patients receiving genetic testing and prescriptions to immunotherapy medications.
Additional Notes
I have no additional notes at this time,
Association Between Immune Checkpoint Inhibitor Infusion Timing and Survival Outcomes in Cutaneous Melanoma: A Propensity Score Matched Real-World Study
Background
Circadian regulation of antitumor immunity raises interest in whether immune checkpoint inhibitors (ICIs) infusion timing influences outcomes, but findings remain inconsistent. We evaluated the association between induction ICIs timing and survival in cutaneous melanoma.
Methods
We retrospectively identified patients with cutaneous melanoma treated with ICIs in adjuvant or advanced-disease settings between 2015 and January 2026. Early administration was defined as a mean induction infusion start time before noon. Morning-predominant treatment was defined as \> than 50% of evaluable infusions beginning before noon. One-to-one propensity score matching incorporated age, sex, race, ECOG performance status, smoking history, melanoma stage, and academic versus community treatment site. Kaplan-Meier and Cox models estimated survival. The primary endpoint was overall survival (OS); progression-free survival (PFS) was secondary. An advanced unresectable/metastatic subgroup was evaluated.
Results
Among 153 patients, 119 received early and 34 late treatments; matching yielded 34 pairs. Median OS was not reached in either group (HR, 1.51; 95% CI, 0.57-3.97; P=.40). Median PFS was 47 months with early versus 44 months with late treatment (HR, 1.13; 95% CI, 0.59-2.20; P=.70). Among 72 patients with advanced disease (56 early and 16 late), matching yielded 16 pairs. Neither OS (28 vs 36 months; HR, 1.40; 95% CI, 0.52-3.78; P=.50) nor PFS (4.5 vs 5.0 months; HR, 1.00; 95% CI, 0.44-2.29; P=1.00) differed significantly.
Conclusions
Earlier induction ICI administration was not associated with improved OS or PFS in the overall cohort or advanced-disease subgroup. These findings do not support preferential morning scheduling, although wide confidence intervals preclude excluding modest effects.
Additional Notes
Study was supported by the UVM Cancer Center Summer Fellowship
Clonal CD5/CD10 negative EBV+ B-cell Lymphoma Arising During Treatment of a nTFH Lymphoma
Background
Nodal T-follicular helper (TFH) cell lymphoma (nTFHL) is a subtype of aggressive peripheral T-cell lymphomas that arise from neoplastic transformation of T-follicular helper cells. Dysregulated immune function of malignant helper T cells can result in unchecked proliferation and clonal expansion of EBV-infected B lymphocytes resulting in a secondary EBV+ B-cell process complicating existing nTFHL.
Methods
A 57-year-old male presented to the hospital with two months of progressive B symptoms. He was found to have diffuse lymphadenopathy and pancytopenia. Excisional lymph node and bone marrow biopsies demonstrated nTFHL. He was treated with one cycle of CHOP and two cycles of CV-CHP. Interval PET demonstrated primary refractory disease for which he was subsequently started on salvage therapy with romidepsin/duvelisib. He soon after developed a rapidly progressive peripheral lymphocytosis, worsening lymphadenopathy, and cytopenias. Flow cytometry of peripheral blood revealed a new clonal CD5/CD10 negative EBV-positive B-cell population. Repeat excisional lymph node and bone marrow biopsies demonstrated co-occuring clonal T and B cell populations identified by sequencing for IgH rearrangements and T-cell NGS.
Results
Rituximab was added for treatment of the clonal B-cell population in addition to romidepsin/duvelisib for his T-cell lymphoma. Unfortunately, his disease continued to progress, and he ultimately passed away.
Conclusions
This case highlights an example of clonal CD5/CD10 negative EBV+ B-cell lymphoma arising during the treatment of a NTFH lymphoma. Further research is needed to better understand how to best sequence therapy in such cases.
Metastatic Endometrial Adenocarcinoma Harboring A De Novo ESR1 Mutation with dMMR/MSI-H Phenotype
Background
Mismatch repair deficiency (MMRd) is one of four molecular subgroups of endometrial carcinoma. MMR deficiency is associated with PD-L1 expression resulting in benefit from first-line chemo-ICI; however, dMMR from MLH1 methylation has demonstrated lower response compared to dMMR from germline/somatic mutations. Additionally, ESR1 mutations are a well-established mechanism of resistance to endocrine therapy in breast cancer; however, their clinical significance in endometrial adenocarcinoma remains less well defined.
Methods
An 83 year-old female was diagnosed with endometrial adenocarcinoma and underwent TAH/BSO. Final pathology showed FIGO grade 1A (pT1a, PN0, cM0), and no adjuvant therapy was recommended. Eleven months later she presented with hemoptysis and was found to have new multifocal pulmonary nodules. Biopsy confirmed metastatic recurrence of endometrial cancer. IHC showed loss of MLH1/PMS2 staining consistent with dMMR/MSI-H disease; NGS showed a de novo ESR1 mutation and activating FGFR2 mutation.
Results
She was treated with six cycles of carboplatin, paclitaxel, and pembrolizumab and had a partial response before progressing shortly after on pembrolizumab maintenance. She was treated with abemaciclib and fulvestrant given the presence of ESR1 mutation. Her disease unfortunately continued to progress, and she was referred for enrollment in a phase I ADC trial.
Conclusions
This case highlights a unique example of a metastatic endometrial adenocarcinoma harboring a de novo ESR1 mutation co-occurring with an FGFR2 alteration with dMMR/MSI-H phenotype. An evidence gap currently exists in how to best treat these patients.
Durable Clinical and Radiographic Response to Tarlatamab in DLL3-High Metastatic High-Grade Neuroendocrine Carcinoma of Pulmonary Origin
Background
Delta-like ligand 3 (DLL3) is aberrantly surface-expressed in most small-cell lung cancers (SCLC) and across high-grade neuroendocrine carcinomas (NEC). Tarlatamab, a DLL3×CD3 bispecific T-cell engager, improved overall survival versus chemotherapy in relapsed SCLC (DeLLphi-304: 13.6 vs 8.3 months; HR 0.60).\[1\]\[2\] Emerging data suggest DLL3×CD3 engagers are active beyond SCLC—in DLL3-high pulmonary carcinoid (73% response), extrapulmonary NEC and LCNEC (obrixtamig), and DLL3+ neuroendocrine prostate cancer—but experience in non-SCLC high-grade NEC remains limited.\[3\]\[4\]\[5\]
Methods
A 53-year-old man presented with a scalp lesion and periauricular nodule. Biopsies showed metastatic NEC (TTF-1+, synaptophysin+, INSM1+; Ki-67 \~15%, focally 80–90%), probable pulmonary origin, with widespread metastases (lungs, pleura, nodes, liver, adrenals, pancreas, omentum, soft tissue). NGS through TEMPUS xT CDx: PD-L1 TPS \<1, KRAS p.G12C, KEAP1, \[NF1\](/rare-disease/neurofibromatosis-type-1), CDKN2A/B and MTAP loss; TMB 8.4. After progression on carboplatin/etoposide/atezolizumab, DLL3 was diffusely positive (100%), and tarlatamab was started per the DeLLphi-304 regimen with protocolized CRS/ICANS monitoring
Results
By cycle 2 he had resolution of dyspnea, 22-lb weight gain, and regression of cutaneous/nodal disease, without documented CRS or ICANS. Eight-week restaging CT showed a very impressive response: resolved pleural effusions; decreased adenopathy; markedly improved hepatic metastases; smaller renal, adrenal, and pancreatic lesions; regressed intramuscular implants; no new disease. The scalp lesion rapidly evolved and crusted after C1 (see photos)
Conclusions
Conclusion: This case demonstrates a rapid, radiographically confirmed response to tarlatamab in DLL3-high, immunochemotherapy-refractory high-grade NEC, supporting DLL3 immunohistochemistry as a selection biomarker and prospective study in non-SCLC high-grade NEC.\[1\]\[5\]\[6\]
Additional Notes
Refer to attached document for clinical photos and PET/ct before and after images
MOSAIC: Methylation-Oriented Site Analysis and Information Classifier for Robust Epigenomic Classification of Acute Leukemia in Clinical Cohorts with Variable Tumor Purity
Background
DNA methylation-based classification offers a diagnostic complement to conventional molecular workflows in acute leukemia. However, existing classifiers are trained on array-derived reference cohorts that favor specimens with high tumor content. Performance in clinically representative low-purity specimens remains poorly characterized. We developed MOSAIC to improve molecular subtype classification in specimens with limited tumor content.
Methods
MOSAIC (Methylation-Oriented Site Analysis and Information Classifier) is a neural network classifier designed to maintain classification accuracy across a range of tumor purities. MOSAIC was trained using publicly available array-based methylation data augmented with native methylation calls from Oxford Nanopore sequencing. Performance was evaluated using independent held-out specimens not used for model training.
Results
In 10 acute leukemia specimens with \<25% blasts, including one with 1.4% blasts, MOSAIC achieved 100% (10/10) concordance with expert review, compared with 70% (7/10) for MARLIN and 50% (5/10) for ALMA. MOSAIC correctly identified leukemia subtypes despite markedly diluted disease-associated methylation signals. Gradient-based saliency analysis demonstrated that MOSAIC relied on a partially distinct set of discriminative CpG probes when classifying low-blast specimens, suggesting adaptation to methylation patterns present at low disease burden.
Conclusions
MOSAIC demonstrates the feasibility of accurate methylation-based acute leukemia subtype classification in specimens with limited tumor content. Augmenting training data with clinically representative methylation profiles may improve classification of low-purity specimens that remain challenging for existing approaches. These findings support further validation of MOSAIC as a diagnostic complement to conventional molecular testing across clinically encountered tumor purities.
Hypermethylation signature is associated with pretreatment resistance to Azacitadine-Venetoclax in acute myeloid leukemia
Background
In the last decade, Azacitadine and Venetoclax combination (Aza-Ven) has become the standard of care treatment for elder AML patients unfit for more intensive chemotherapies. Despite its clinical efficacy, a subset of patients exhibits primary refractory disease, and the biological mechanisms underlying Aza-Ven resistance remain incompletely understood. In this study we investigated differential methylation between Aza-Ven sensitive and refractory bone marrow samples to identify a candidate epigenetic signature associated with refractory disease and explore its potential utility for pretreatment response stratification.
Methods
Pretreatment bone marrow samples from 23 AML patients treated with Aza-Ven were collected and profiled using Oxford Nanopore long-read sequencing. Comparisons were performed in an Aza-Ven cohort with 14 sensitive and 9 refractory patients. Methylation regions were examined for 0.15 absolute difference in mean methylation between response groups suggestive of possible contribution to resistance or susceptibility.
Results
A candidate hypermethylation signature associated with Aza-Ven refractory AML was identified and included loci annotated to NRGN, ARHGAP35, TNRC6C, HOXB4, HOXA6, HOXB3, SLC2A14, and LINC01347 with mean methylation difference between response groups of these loci ranged from 0.15 to 0.26 (15-26% increase) with an adjusted P value of \<0.05.
Conclusions
Pretreatment Aza-Ven refractory AML was associated with a candidate hypermethylation signature involving genes related to hematopoietic developmental regulation, stem/progenitor-associated biology, cellular signaling, and transcriptional control. These findings suggest that pretreatment methylation profiling may help distinguish patients at increased risk of refractory disease.
Access Barriers Associated With Receipt of Single-Fraction Stereotactic Body Radiation Therapy in Rural Vermont: A Retrospective Study
Background
Stereotactic body radiation therapy (SBRT) is an established treatment modality for those with inoperable lung cancer, or who decline surgical treatment. Despite studies demonstrating that single-fraction (SF) treatments have similar outcomes to multi-fraction (MF), use of the former still lags. SF-SBRT may be most advantageous when patients travel long distances to treatment facilities. We describe treatment selection, outcomes, toxicities and travel burden for SF versus MF SBRT in a rural setting.
Methods
A retrospective cohort study of 71 consecutive patients treated with lung SBRT from 2022 — 2026 was conducted (24 SF, 34Gy x1, 47 MF, 50-55 Gy in 3-5 fractions). Baseline characteristics, overall survival (OS), CTCAE toxicities and round-trip travel were compared (Kaplan-Meier/log-rank, Fisher exact, Wilcoxon).
Results
Median follow-up was 13 months. SF patients were younger (median 66.5 vs 71.0, p=0.002), with no differences in sex, performance status, staging, insurance, travel needs or median travel distance (19 vs 16 miles, p=0.95), though squamous was more common with SF. OS did not differ (log-rank p=0.86). 12-month OS was 83% (SF) vs 90% (MF); 24-month 83% vs 77%. Grade \>=2 toxicity was 8.3% (SF) vs 6.5% (MF, p=1.0), with no grade \>=4 events. Median round-trip distance was 38 (SF) vs 140 miles (MF, p\<0.001); SF spared nearly 4,600 patient travel-miles.
Conclusions
In a rural setting, SF-SBRT demonstrates survival and toxicity equivalent to MF-SBRT in a clinically comparable population. SF-SBRT reduced per-course travel by 75%, supporting wider use in rural health settings where travel burden presents a meaningful barrier to care.
Background
Central diabetes insipidus (CDI) has been reported in \<0.6% of acute myeloid leukemia (AML) cases, typically due to pituitary gland infiltration, which is not always apparent upon imaging.1,2 Given the severity of AML relapse and the subtlety of imaging findings with pituitary involvement, awareness of this presentation is crucial for prompt recognition and management.
Methods
We discuss a 66-year-old male with a history of AML previously on Azacitidine and Venetoclax in remission. He was diagnosed with CDI after initial presentation with pancytopenia, lower extremity tremors, polyuria, and hypernatremia. MRI demonstrated AML invasion into the pituitary sella. Bone marrow biopsies confirmed AML relapse.
Results
Patient presented for an outpatient bone marrow biopsy due to fatigue and pancytopenia, and was found to have significant lower-extremity tremors, no loss of consciousness, and normal CK. Upon admission for monitoring, hypernatremia and polyuria were noted. Urine osmolality was 191, and copeptin was 4.1, indicating CDI. MRI pituitary demonstrated AML invasion into the pituitary stalk and sella. Bone marrow biopsy confirmed relapsed AML. Next-generation sequencing indicated mutations in TP53, DNMT3A, and GATA2, which are poor prognostic indicators without additional therapeutic targets. A goals-of-care conversation was held, leading to hospice care.
Conclusions
In this case, MRI findings were consistent with AML relapse-induced CDI; however, this is not typical, and clinical suspicion must remain high in such instances. Polyuria and hypernatremia in patients with AML in remission should always prompt consideration of relapse in the differential. Rapid endocrinologic workup permits early identification and treatment of relapsed AML.
Additional Notes
References Wojeck, Brian, et al. “Acute Myeloid Leukemia Leading to Central Diabetes Insipidus.” Journal of the Endocrine Society, vol. 5, no. Suppl 1, May 2021, pp. A570–71. PubMed Central, https://doi.org/10.1210/jendso/bvab048.1163. Ladigan, Swetlana, et al. “Acute Myeloid Leukemia with Central Diabetes Insipidus.” Blood Cells, Molecules & Diseases, vol. 76, May 2019, pp. 45–52. PubMed, https://doi.org/10.1016/j.bcmd.2019.01.005.
Impact of Rurality on Screening and Prevention Strategies for Patients with Hereditary Breast and Ovarian Cancer Syndrome
Background
Patients with germline BRCA1/2 pathogenic variants have high breast cancer risk and require guideline-based imaging surveillance. Although rurality is a known barrier to healthcare access, its impact on surveillance adherence in this population is poorly understood. We evaluated breast imaging adherence by rurality among BRCA1/2 carriers at a regional cancer genetics program.
Methods
We enumerated a cohort of patients with pathogenic BRCA1/2 variants previously seen by the Cancer Genetics Program at the University of Vermont Cancer Center. Adherence to guideline-based mammography and breast MRI was assessed among patients without prior risk-reducing mastectomy. Rurality was classified from residential ZIP codes using Rural-Urban Commuting Area (RUCA) codes: metropolitan (≤3), micropolitan (4-6), and rural (\>7). Risk ratios (RR) were estimated with modified Poisson models adjusted for age, BRCA1/2 gene, and longitudinal follow-up participation.
Results
Among 492 natal females (46% metropolitan, 22% micropolitan, 32% rural) adherence was 64% for mammography. Compared with metropolitan patients, rural patients had lower mammography adherence (RRadj = 0.77; 95% CI: 0.60, 0.99) and a trend toward lower breast MRI adherence (RRadj = 0.80; 95% CI: 0.60, 1.1). Micropolitan patients showed similar reductions. Restricting to longitudinal follow-up participants attenuated but did not eliminate the imaging disparity.
Conclusions
Rural and micropolitan BRCA1/2 carriers had lower adherence to breast cancer imaging surveillance than metropolitan patients. Sustained engagement with genetics care may help mitigate rural disparities in surveillance. Further work is needed to identify modifiable barriers and develop strategies to improve surveillance adherence among rural patients.
Fostering Connection and Purpose Through a Facilitated Interprofessional Storytelling Event: A Pilot Evaluation in Radiation Oncology
Background
Burnout and diminished sense of purpose are prevalent among oncology professionals. Structured, narrative-based gatherings may offer a low-cost intervention to strengthen interprofessional connection and meaning in work. We evaluated a facilitated evening event for radiation oncology staff hosted by the Northern New England Clinical Oncology Society (NNECOS).
Methods
A single-session, off-site event was held in May 2026, facilitated by a palliative care physician and structured around small-group sharing of positive patient care experiences. Attendees (N=26) represented six professional roles, including nurses, radiation therapists, physicists/dosimetrists, administrative staff, and physicians. Evaluation included a post-event survey using 5-point Likert scales, open-ended responses, and a pre/post \”mood board\” capturing emotional states at arrival and departure.
Results
Fourteen participants completed the survey (54% response rate). Mean overall experience was 4.71/5.00, with 71% rating the event 5/5. Participants reported reconnecting with their sense of purpose (M=4.64), improved understanding of colleagues\’ roles (M=4.64), increased connection to colleagues (M=4.64), and comfort participating (M=4.57). Willingness to attend again was high (M=4.93; 93% strongly agreed). Mood-board data demonstrated a shift from arrival states (\”tired,\” \”frazzled\”) to departure states (\”fulfilled,\” \”inspired\”). Qualitative feedback emphasized gratitude, renewed career meaning, and appreciation of cross-role contributions. Most respondents (57%) preferred quarterly recurrence.
Conclusions
A brief, facilitated interprofessional storytelling event was feasible and highly rated, with participants reporting enhanced purpose and connection. Findings support recurring implementation and controlled evaluation of effects on burnout and team cohesion.
The cost-effectiveness of neoadjuvant FOLFIRINOX vs. gemcitabine based chemoradiotherapy (CRT) for resectable or borderline-resectable pancreatic ductal adenocarcinoma
Background
PREOPANC-2 showed no significant survival improvement in treating resectable/borderline-resectable pancreatic ductal adenocarcinoma (PDAC) with neoadjuvant FOLFIRINOX (FFX) vs. gemcitabine-based chemoradiotherapy (CRT). However, it is unclear whether differences arise when considering treatment toxicity and costs.
Methods
We constructed a decision-tree using utilities and costs-per-month from the literature, and probabilities from PREOPANC-2. Overall survival (OS) (time between randomization and death from any cause), was assumed as 30 months for resectable disease, 8 months for FFX or CRT without surgery (non-resectable), and 3-6 months for treatment-refractory PDAC. FFX treatment lasted 3 months, 6 months for CRT, and 3 months for adverse events. Utilities include 0.8 for progression-free survival, 0.73 for survival with progression (metastatic/unresectable disease) before surgery, 0.58 for progression after surgery, and 0.526 for adverse events. Costs of FFX, CRT, and surgery were assumed as \$101,518, \$59,900, and \$99,157, respectively. Treatment costs of adverse events were \$7,868 (diarrhea) and \$6,324 (neutropenia).
Results
When assuming equal toxicity of FFX and CRT, FFX resulted in more quality-adjusted life months (QALMs) (18.98 vs. 18.02), but with an additional cost of \$36,697.02. If CRT toxicity is improved relative to FFX to a utility of 0.7, CRT becomes preferred (19.22 vs. 18.98 QALMs, -\$36,697.02).
Conclusions
Treatment of PDAC with neoadjuvant FFX vs. CRT results in minimal differences in QALMs that are dependent on the toxicity of treatment. However, the cost of FFX exceeds most definitions of societal willingness-to-pay (\$440,364 per additional quality-adjusted life year). Moreover, if CRT is considered less toxic, it becomes the dominant strategy.
Transcriptomic Cell-of-Origin Classification in DLBCL Using an IHC Trained Expression Model
Background
Cell-of-origin (COO) classification in diffuse large B-cell lymphoma (DLBCL) is commonly performed by immunohistochemistry (IHC)/Hans algorithm to determine germinal center B-cell (GCB) type or non-GCB type status, but these incompletely classify cases. Our group evaluated a multi-omic classifier (COOrigin) to address these limitations.
Methods
59 DLBCL (29 GCB, 30 non-GCB by IHC) cases underwent IHC, whole exome and whole transcriptome sequencing. COOrigin was developed using IHC determined GCB and non-GCB labels as the truth set. Differentially expressed transcripts were selected with PyDESeq2 and used for model training with a 75%/25% train–validation split; the deployed model applies feature selection, expression transformation, PCA, and LogisticRegressionCV classification. Transcript weights comprised 247 features, including 85 GCB-directed and 162 non-GCB-directed features. COOrigin output was compared with IHC/Hans and gneSeqCOO calls in the context of their genomic profiles.
Results
COOrigin was concordant with IHC in all cases. In contrast, gneSeqCOO, a bulk RNA expression-based classification was concordant in 48/59 cases, unclassified in 9/59, and discordant in 2/59. 6/9 unclassified cases were BN2-like, TP53-altered, or with mixed genomic features consistent with indeterminate cases. 3/9 unclassified cases called by COOrigin (2 GCB, 1 non-GCB), were supported by genomic findings. The two cases unresolved by genomic profiling — a borderline gneSeqCOO call and a low-confidence COOrigin call — likely represent edge cases.
Conclusions
These findings support the use of this COOrigin as a companion method with potential utility delineating GCB/non-GCB classes that fall within the indeterminate class by genSeqCOO. Further assessment is needed to explore the classifier’s utility in a real-world setting.
A Case of a De Novo JAK2 V617F Myeloproliferative Neoplasm Presenting After Treatment of Core Binding Factor Acute Myeloid Leukemia
Background
A 45-year-old female without significant co-morbidities was diagnosed with acute myeloid leukemia (AML) with CBFB/inv(16)(q22) rearrangement after presenting to her PCP with night sweats, spontaneous bruising, and labs revealing 32% circulating blasts. She underwent induction with daunorubicin, cytarabine, and one dose of gemtuzumab ozogamicin followed by three cycles of high dose cytarabine consolidation. Bone marrow biopsy after induction and one cycle of consolidation showed no evidence of disease and no measurable residual disease (MRD) for Inv16 by PCR. Post-consolidation bone marrow biopsy returned MRD negative for AML, but revealed a new JAK2 V617F mutation without morphologic evidence of myeloproliferative neoplasm (MPN). Reexamination of molecular sequencing completed at the time of diagnosis of AML revealed a single cell positive for a JAK2 variant, well below the threshold of reportability for this assay. The patient experienced molecular relapse eight months after consolidation and was treated with azacitidine and venetoclax, achieving MRD negative remission after four cycles. She subsequently underwent a matched related myeloablative allogeneic stem cell transplant. Pre-transplant bone marrow aspiration and biopsy showed no evidence of leukemia, but molecular and morphological evidence of JAK2 positive essential thrombocytosis.
Methods
n/a
Results
n/a
Conclusions
Development of MPN after treatment for AML is rare, reported only 3 times in the last decade. A driver mutation for MPNs can develop decades prior to disease presentation. This case queries whether chemotherapy for an unrelated malignancy may exert selective pressures to hasten the development of an MPN in patients with pre-existing driver mutations.
Predictors and outcomes of genomic tumor boards for a rural statewide genomics initiative
Background
Precision oncology promises improved outcomes through genome-matched treatment (GMT), but delivery gaps are especially pronounced in rural and community settings, where genomic testing infrastructure, tumor board access, and clinical trial availability are limited. The Maine Cancer Genomics Initiative (MCGI), an initiative from The Jackson Laboratory, aims to address these gaps by providing free genomic tumor testing (GTT), genomic tumor boards (GTBs), and education to Maine oncologists.
Methods
We analyzed 1,241 patients enrolled in MCGI (2017–2021) who received GTT results. Mixed-effects logistic regression evaluated patient- and clinician-level predictors of GTB case presentation. Logistic regression analysis assessed the association between GTB presentation and GMT receipt.
Results
Most patients were rural-dwelling (72.8%), had incomes under \$50,000 (56.1%), and relied on Medicare/Medicaid (64.4%). Of 1,241 patients, 40.1% (n=498) had cases presented at a GTB across 509 sessions, generating 584 treatment recommendations. Stage IV disease and breast cancer diagnosis significantly predicted GTB presentation for patients, while no clinician-level factors were associated with presentation. Patients discussed at GTBs received GMT nearly twice as often as those not discussed (22.3% vs. 12.1%, OR 2.19, 95% CI 1.53–3.13, p\<0.001). However, only 13.2% of GTB recommendations were delivered to patients.
Conclusions
GTBs were associated with increased GMT delivery in a predominantly rural, low-income population, and rurality did not independently limit GTB access within this program. Substantial gaps between recommendation and treatment receipt persist, underscoring the need for structural supports, such as clinical trial navigation and off-label drug acquisition assistance, to translate GTB recommendations into care for rural and underserved patients.
Trends in High Grade Prostate Cancer at Diagnosis in the United States from 2004-2022
Background
Prostate cancer is a heterogeneous disease, ranging from indolent to aggressive. High-grade prostate cancer (Gleason score ≥8/Grade Group ≥4) carries worse prognosis. This study examined US trends in prostate cancer grade over time.
Methods
Using the 2025 National Cancer Data Base, we identified men diagnosed with prostate cancer from 2004–2022, defining high-grade disease as biopsy Gleason Score ≥8.
Results
Of 2,259,526 men diagnosed with prostate cancer, 423,953 (18.8%) had high-grade disease. The proportion of newly diagnosed high-grade cases rose from 11.9% in 2004 to 24.9% in 2022. Univariate analysis linked increasing age, Black race (vs. White), and non-academic diagnosis (vs. academic) to higher odds of high-grade disease. In multivariate analysis, increasing age at diagnosis (OR 1.058/year, 95% CI 1.058–1.059), diagnosis at an academic center (OR 1.038, 95% CI 1.03–1.05), and Black (OR 1.25, 95% CI 1.24–1.27) or American Indian/Alaskan Native identifying patients (OR 1.27, 95% CI 1.19–1.36) versus White identifying patients were all associated with increased likelihood of high-grade disease (all p\<0.001). By era, the incidence of high-grade disease rose from 12.2% (2004–2007) to 24.7% (2018–2022).
Conclusions
High-grade prostate cancer incidence has risen continuously. This rise may partly reflect improved diagnostics (e.g., MRI-targeted biopsy), but the steady increase—paralleled by more metastatic disease—may also signal a concerning shift in prostate cancer biology warranting further investigation.
Additional Notes
Aparna Krishnan (Dartmouth medical student) will be presenting the abstract.
The Final Transfusion: Use of Exagamglogene autotemcel (exa-cel) to achieve a functional cure of Transfusion-dependent β-thalassemia (TDT) and Sickle cell disease (SCD)
Background
TDT and SCD are inherited, β-globin blood disorders affecting 4,000 and 100,000 people in the US, respectively. Exa-cel, a CRISPR-CAS9 base-editing gene therapy, is FDA approved and provides a ‘functional cure’ for both diseases by increasing protective fetal hemoglobin (HbF). Here, we describe two patients treated with exa-cel at Boston Medical Center, an academic, safety-net hospital: a 41-year-old woman with TDT and a 29-year-old man with SCD.
Methods
Retrospective chart review.
Results
A 41 year old woman with TDT and baseline transfusion requirement of two units of red blood cells every 2 weeks requiring chelation. Autologous CD34+ hematopoietic stem cells (HSCs) were mobilized using granulocyte-colony stimulating factor, and plerixafor. The 29 year old male with HbSS, whose course was complicated by frequent pain episodes and hip avascular necrosis, required five HSC collections using plerixafor alone. Both underwent busulfan myeloablative conditioning complicated by grade 3 pancytopenia, neutropenic fever, and grade 3 mucositis requiring parenteral nutrition. All complications were secondary to busulfan. The TDT patient achieved neutrophil and platelet engraftment on days 15 and 40, respectively. At discharge, hemoglobin was 7.7g/dL and HbF 13.9%; at 1 year, hemoglobin was 11.9g/dL, HbF 83.1%, and she remains transfusion-independent. The SCD patient achieved neutrophil and platelet engraftment on days 18 and 20; at 8 months, hemoglobin was 13.1g/dL and HbF 45.7%, with no admissions for SCD-related complications.
Conclusions
These cases highlight the life-changing potential of GT for TDT and SCD, with rapid HbF induction and ultimate independence from chronic transfusions, severe pain episodes, and other disease-related complications.
Understanding Demographic and Geographic Trends in DECIPHER Genomic Scores
Background
The Decipher GC score (GC) is a 22-gene genomic classifier that correlates with aggressive prostate cancer. Our study aims to clarify the trends in GC scores by patient age, race, practice setting and practice rurality.
Methods
We utilized the NIH SEER Decipher Prostate GC Database, including patients with a numerically reported GC score (n=8,796). The first GC score was used for patients with multiple GC scores. Patients were stratified by age (\<50, 50-59, 60-69, 70-79, 80+), race (White, Black, Other; excluded Unknown race n=295), setting (academic, community), and rurality. Kruskal-Wallis was used to compare GC scores for age and race. Wilcoxon rank-sum was used to compare GC scores for practice setting and rurality. Multivariate analysis estimated marginal means via the emmeans R package to compare race, practice setting and rurality, adjusting for age category.
Results
On univariate analysis, median GC scores significantly increased with age (\<50: 0.46, 50-59: 0.50, 60-69: 0.54, 70-79: 0.56, 80+: 0.58, p\<0.01). There were significant differences in median GC by practice (Academic: 0.55, Community: 0.47, p\<0.01) and rurality (Rural: 0.56, Urban: 0.54, p\<0.01) setting, but not by race (White: 0.54, Black: 0.54, Other: 0.54, p\>0.05). Differences in age-adjusted estimated marginal means by practice and geographic setting remained significant (Rural: 0.56, Urban 0.53, p\<0.01; Academic: 0.54, Community: 0.47, p\<0.01). Differences in age-adjusted estimated marginal means by race remained insignificant (White: 0.53, Black: 0.54, Other: 0.53, p\>0.05).
Conclusions
Older prostate cancer patients at academic and rurally located centers seem to present with more aggressive disease.
Additional Notes
Presenter will be Mathew Lin (Medical student)
Neuroendocrine Transformation from Endometrial Cancer
Background
Neuroendocrine transformation from gynecological cancers is very rare. A 41 years old female patient diagnosed with FIGO stage II endometrioid adenocarcinoma of the right ovary arising in a background of endometriosis. Genomic profiling revealed a KRAS mutation, low tumor mutational burden (TMB), microsatellite-stable disease, negative folate receptor alpha (FOLR1) expression, and equivocal HER2 expression (2+). Patient completed six cycles of adjuvant carboplatin and paclitaxel. Post-treatment imaging a new lytic lesion involving the left iliac bone extending into the superior acetabulum. Biopsy of the lesion demonstrated metastatic poorly differentiated high-grade carcinoma with morphologic features distinct from those of the primary ovarian tumor. Immunohistochemical evaluation demonstrated synaptophysin positivity, supporting neuroendocrine differentiation. Comprehensive genomic profiling of the metastatic lesion revealed a strikingly different profile, including (TMB-high) and microsatellite instability-high (MSI-high).
Methods
Case report
Results
The significant morphologic and molecular discordance between the primary ovarian tumor and the metastatic lesion raised two competing diagnostic considerations: an occultun second primary high-grade neuroendocrine carcinoma or histologic transformation of the original ovarian endometrioid carcinoma into a high-grade neuroendocrine carcinoma. Given the aggressive clinical behavior and neuroendocrine features, the patient was initiated on carboplatin, etoposide, and atezolizumab. Follow up imaging has demonstarted a favorable response to therapy.
Conclusions
This case highlights the possibility of neuroendocrine transformation in gynecologic malignancies and underscores the potential role of repeat genomic profiling in detecting clonal evolution and informing therapeutic decision-making.
Treatment Response to Combination Chemotherapy and Immunotherapy in a Patient with High PD-L1 Expressing Adenosquamous Cell Carcinoma of the Pancreas
Background
Adenosquamous carcinoma of the pancreas is an uncommon and aggressive malignancy associated with poor prognosis and limited treatment options. To date, no standard therapeutic strategy has been established. Although immunotherapy has transformed the treatment landscape of many cancers, its role in pancreatic cancer remains limited, even in PD-L1 high adenocarcinomas.
Methods
Case report.
Results
We report a case of locally advanced, initially unresectable pancreatic adenosquamous carcinoma that progressed on first-line neoadjuvant FOLFIRINOX. Following the discovery of high PD-L1 expression (tumor proportion score, TPS 55%), the patient received combination therapy with gemcitabine, nab-paclitaxel (Abraxane), and pembrolizumab, resulting in marked tumor regression and successful curative resection. The patient remains disease-free 25 months after his initial diagnosis, compared to historical median OS 4-5 months for unresectable patients.
Conclusions
This case illustrates a potentially meaningful role for chemoimmunotherapy in PD-L1–high adenosquamous carcinoma of the pancreas and underscores the need for further exploration of immunotherapy in this rare subtype.
Understanding Patient and Caregiver Experience of Outpatient CAR T-Cell Therapy: Preliminary Themes
Background
Chimeric antigen receptor T-cell (CAR-T) therapy has expanded the cellular therapy repertoire to offer a potential cure for patients with hematological malignancies. Greater expertise with CAR-T has shifted care to the outpatient setting, transferring responsibility from trained inpatient staff to patients and their caregivers. This work explores the patient and caregiver experience of predominantly outpatient CAR-T therapy to identify gaps in patient and caregiver support.
Methods
Community-engaged qualitative research methods utilized a “Partnership Academy” (n=4 participants), followed by five CAR-T patient or caregiver interviews, and four co-design sessions with providers (n=3), patients and their caregivers (n=2), medical student (n=1), and research partners (n=2).
Results
Barriers associated with undergoing CAR-T therapy include challenges of daily symptom monitoring, future uncertainty, financial hardship, emotional turmoil, interference with daily-life and routine, and caregiver burden. Facilitators for support include tailored communications with targeted education, referral to appropriate resources (e.g., lodging, travel), and peer support.
Conclusions
Outpatient CAR-T administration may identify new areas of need, among patients, caregivers, and care teams when compared to patients receiving inpatient therapy. Patients and caregivers report highly variable and person-specific needs, knowledge gaps, and preferences during preparation. These preliminary data stress the need for ongoing investigation to identify patient and caregiver needs in real time, and for a dynamic, tailored process to address gaps throughout the CAR T cell treatment course.
Adverse cardiac outcomes in breast cancer patients treated with accelerated partial breast irradiation
Background
Conventionally-fractionated radiotherapy for breast cancer can increase the risk of cardiac disease. Cardiac risk from accelerated radiotherapy is not well characterized. Our study examined the incidence of adverse cardiac events (ACE) in patients treated with accelerated partial breast irradiation (APBI).
Methods
We queried records of 73 patients treated between 2006-2026 on 2 prospective clinical trials, VCC0601 and NRG-BR007. 67 patients received 4000 Gy in 10 fractions and 6 received 3000 Gy in 5 fractions. Coronary artery calcification (CAC) was assessed on simulation CT using 130 HU threshold. ACE included arrhythmias, conduction abnormalities, valvular disease, myocardial infractions (MI), ventricular dysfunction, and pericarditis.
Results
Median age was 71 years (range 59-89). 54% of patients were smokers, 26% had preexisting cardiac disease, and 67% had CAC prior to radiation. Mean heart dose (MHD) was low, median 0.65 Gy. With median follow-up of 12.9 years, 37 patients experienced ACE including 10 MI. MHD was not associated with ACE (HR 0.72 per Gy, 95% CI 0.45-1.16, p = 0.18). Preexisting cardiac disease (HR 3.8, 95% CI 1.8-8.0, p \< 0.001) and age (HR 1.07 per year, p = 0.015) were associated with ACE.
Conclusions
In patients receiving APBI with long term follow-up, there was a high rate of ACE. Patients in the cohort received low MHD and dose was not associated with ACE. Instead, in this cohort that was elderly with comorbidities, age and history of cardiac disease were associated with ACE. A study limitation is small sample size.
Additional Notes
I am submitting on behalf of medical student Holden Lofaro who is the first author
Integrated DNA methylation and flow cytometric immune profiling identifies signatures associated with recurrence after CAR-T therapy: a pilot study
Background
Chimeric antigen receptor T-cell (CAR-T) therapy has significantly improved outcomes in relapsed and refractory hematologic malignancies; however, durable remissions remain limited in patients with high-risk features. Resistance mechanisms include CAR-T exhaustion, impaired expansion, antigen loss, and inadequate tumor infiltration. DNA methylation-based immune deconvolution offers a scalable, low-input alternative to serial flow cytometry. We evaluated whether methylation-derived immune signatures recapitulate flow cytometry and whether immunologic signatures are associated with CAR-T outcomes.
Methods
In a pilot cohort of 10 patients (7 remission, 3 recurrence) receiving lymphodepletion followed by CAR-T therapy, peripheral blood was collected at Day -5, Day 0 (infusion), and Day +28. Multiparameter flow cytometry, CBC with differential, and methylation-based immune deconvolution were performed. Outcomes were compared using Mann-Whitney U tests and assay concordance using Spearman correlation.
Results
Methylation-derived proportions correlated with CBC lymphocytes (r=0.96) and neutrophils (r=0.94; both p≤0.001) and flow-derived NK (r=0.89), CD3+ T (r=0.84), and CD4+ T cells (r=0.69; all p\<0.05). T-cell reconstitution was greater in remission, while myeloid-skewed profiles tracked recurrence. Pre-treatment methylation-derived myeloid burden and Day +28 monocyte-to-lymphocyte ratio were higher in recurrence (p=0.017–0.033). Flow cytometry identified higher LAG-3 expression across M-MDSCs, monocyte subsets, and B cells, maximally separated at Day 0 (p=0.017) as well as increased VISTA expression at Day 0 (p=0.033) in patients who later had recurrence, without significant changes in overall circulating immune cell frequencies.
Conclusions
DNA methylation recapitulated flow and CBC immune composition, supporting scalable CAR-T immune monitoring. Pre-infusion LAG-3, myeloid skewing and impaired T-cell reconstitution were identified as immunologic signatures associated with recurrence.
Additional Notes
N. Mangena is a medical student who is co-first author with submitting author (Zarina Brune – resident).
When Tumor Activity Drives Muscle Injury: Chemotherapy-Responsive Rhabdomyolysis in Metastatic Pancreatic Neuroendocrine Neoplasm
Background
Rhabdomyolysis is an uncommon manifestation of a paraneoplastic phenomenon. A temporal decline in creatine kinase (CK) and creatinine following tumor-directed therapy, particularly after insufficient response to supportive care, may suggest an association between tumor activity and muscle injury.
Methods
A 38-year-old woman with metastatic pancreatic neuroendocrine neoplasm, previously treated with pancreatectomy, and targeted lymph-node radiation presented with one month of progressive generalized pain and myalgias, and concurrent constitutional symptoms including nausea, vomiting, chills, and subjective warmth. During hospitalization, an expedited evaluation for aggressive disease progression or transformation was undertaken. Bone-marrow biopsy demonstrated an atypical CD45-negative/CD56-positive population consistent with neuroendocrine neoplasm. Subsequent endobronchial ultrasound-guided biopsy of a station 7 lymph node similarly identified atypical CD56-positive cells
Results
Her hospitalization was complicated by severe rhabdomyolysis, with CK exceeding 20,000 U/L despite aggressive intravenous hydration. Additional complications included acute kidney injury, hyperuricemia requiring rasburicase, lactic acidosis, encephalopathy, transaminitis, thrombocytopenia, and transfusion-dependent anemia. Because of progressive malignancy and persistent laboratory abnormalities despite supportive treatment, inpatient FOLFOX chemotherapy was initiated. CK declined precipitously following chemotherapy, and renal function normalized within several days.
Conclusions
This case highlights the importance of considering active or transforming malignancy when severe rhabdomyolysis remains refractory to conventional supportive management. Although causality cannot definitively be established, the temporal improvement in CK and renal function following chemotherapy suggests that treatment of the underlying disease may contribute to recovery when supportive measures alone are insufficient.
Beyond the Criteria: Diagnosing Hemophagocytic Lymphohistiocytosis With Multiple Competing Inflammatory and Malignant Processes
Background
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that occurs in the setting of profuse immune dysregulation. Diagnosis becomes challenging when multiple precipitating factors coexist and can independently account for the clinical and laboratory features of HLH.
Methods
An 82-year-old patient with chronic lymphocytic leukemia (CLL), steroid-refractory warm autoimmune hemolytic anemia (wAIHA), and metastatic melanoma previously treated with nivolumab presented with melena and diarrhea. Despite an extensive negative infectious evaluation, and broad-spectrum antibiotic therapy, he continued to demonstrate persistent fevers with lymphadenopathy, and progressive splenomegaly. His clinical course rapidly progressed to encephalopathy, neutropenia with coagulopathy, and distributive shock complicated by multiorgan failure.
Results
Laboratory evaluation demonstrated hyperferritinemia (\>33,500 ng/mL), hypofibrinogenemia, progressive cytopenias, undetectable haptoglobin, and elevated soluble interleukin-2 receptor level (77,516 U/mL). Although he fulfilled six HLH-2004 criteria with an HScore of 99%, diagnosis was confounded by overlapping manifestations of CLL, wAIHA, disseminated intravascular coagulation, and infection, all of which independently accounted for several diagnostic criteria, and were equally plausible drivers of secondary HLH. Given progressive decline, HLH-directed therapy was initiated before histological confirmation, and resulted in marked clinical improvement.
Conclusions
This case illustrates how HLH may arise from the convergence of multiple concurrent inflammatory and malignant processes, which can obscure the diagnosis and delay recognition of HLH. Integrating the evolving clinical context with laboratory findings, rather than relying on diagnostic criteria alone, is critical to timely initiation of life-saving therapy.
Identifying Gaps in Colorectal Cancer Screening Among Veterans: Baseline Characterization and Prospective Evaluation of Barriers to FIT Completion
Background
Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality despite the availability of effective screening. Fecal immunochemical testing (FIT) provides a noninvasive screening option; however, its effectiveness depends on successful completion. Noncompletion of an ordered FIT represents a potentially modifiable gap in the CRC screening pathway.
Methods
Veterans eligible for CRC screening with outstanding FIT orders were identified through the electronic health record. Baseline characteristics, including age, sex, and time since FIT ordering, were collected. Patients will undergo standardized outreach to prospectively identify patient, healthcare, and system-level barriers to FIT completion. Barriers will be categorized to identify potentially modifiable factors and inform future interventions.
Results
As of June 26, 2026, 135 Veterans with outstanding FIT orders met the study inclusion criteria. The mean time elapsed since the index FIT order was 70 days. Prospective assessment of barriers to FIT completion is ongoing.
Conclusions
Noncompletion of ordered FIT represents an important gap between CRC screening eligibility and successful screening. Veterans are an important population in which to examine this gap because of their distinct clinical characteristics, burden of comorbid disease, and receipt of care within an integrated healthcare system. Characterizing barriers may identify actionable opportunities to improve FIT completion and reduce missed opportunities for CRC prevention.
Are Medical Grade Weighted Blankets in Radiation and Infusion Oncology Worth Their Weight
Background
Clinicians can improve oncology patients\’ treatment experience by reducing anxiety through non-pharmacological interventions. Medical-grade weighted blankets (MGWB) reduce anxiety in various settings, but evidence during oncology treatment is limited. Prior work examined MGWB during early infusions but was not longitudinal, and their benefit during radiation is unstudied. Because MGWB are expensive and more cumbersome to use, clean, and store than traditional blankets, their value must be weighed. This longitudinal feasibility study addressed these gaps by including radiation patients and using repeated measures over time.
Methods
This multidisciplinary community hospital study enrolled patients receiving initial radiation for lung, brain, or head and neck diagnoses, or initial anticancer infusions. After consent, participants reported prior anxiety/depression history and weighted-blanket experience. Anxiety was self-assessed before and after three consecutive treatments using the MGWB, with nurse assistance. A final survey asked whether they would use the blanket again.
Results
Anxiety scores improved, and most participants would use the weighted blanket again. Participants with higher baseline anxiety showed greater pre-to-post improvement. The team determined MGWB were a feasible, valuable adjunct that improved the patient experience.
Conclusions
Reducing anxiety with sustainable, non-pharmacological methods should be prioritized while balancing cost and practicality. For patients with anxiety during radiation and infusion treatments, MGWB are another tool to improve the oncology treatment experience.
A Patient Centered Approach to the Case Study
Background
The aim of this work was to transform the case study paradigm and deconstruct the traditional case study approach, placing the patient, instead of the disease, at the center of the narrative. This case study method intercalates the clinicians’ presentation of the case with the patient’s commentary on the lived experience.
Methods
The unique approach to this case study method is the addition of the patient’s and caregiver’s voices. The lived experience is embedded within the case study format. Employing Interpretive Phenomenology, patients and caregivers shared their stories about the transplant journey. Seeking a more holistic approach, the method aligns with the Relationship-Based Care (RBC) model and Jean Watson’s Theory of Human Caring.
Results
Including the patient’s story in the case study provides authenticity by outlining the clinical significance of the disease process and its treatment with the thoughts and feelings of the patient and caregiver included. The lived experience of the pair is illuminated in parallel with the evolving physical care and experiences of the transplant journey. The reader has the opportunity to have a window into those experiences which can help guide and improve care.
Conclusions
Further research needs to be completed to determine if this type of case study provides an effective tool to educate nurses. We offer these patient centered case studies to provide an exemplar for clinical nurses in all areas of specialization who can adopt this method and use it to describe individual experiences and bring more patient stories to life.
Background
Ocular adnexal lymphoma (OAL) makes up about 8% of extranodal lymphomas and 1-2% of all non-Hodgkin lymphomas. With a small predominance for females, who present with a slowly growing painless, unilateral ocular mass. Marginal zone ocular lymphoma is the most common subtype of OAL.
Methods
Patient is a 78 year old who presented to her optometrist with worsening double vision. She was given prisms for her glasses which initially improved her symptoms but symptoms returned 6 months later. She underwent MRI which showed bilateral orbital masses (L\>R) of intraconal and extraconal fat, encompassing rectus muscles and optic nerve.
Results
Biopsy of the L orbital mass showed a diffuse infiltrate of small CD20+/CD43+ B lymphocytes with kappa light-chain restriction and a Ki67 of \<10%, consistent with extranodal marginal zone lymphoma. PET/CT showing mild uptake in non-enlarged lymph nodes, likely reflecting isolated orbital disease.
Conclusions
Here we present a rare case of bilateral primary orbital marginal zone lymphoma. Presenting with vague visual symptoms that initially improved with changes to corrective lenses, our patient was diagnosed nearly one year after her initial symptoms began with localized disease. Overall survival is excellent however risk of recurrence over lifetime is present and disease may present at other extranodal sites.
Food Insecurity and Psychosocial Wellbeing Screening in Adolescent and Young Adult Cancer Survivors
Background
Food insecurity is prevalent among cancer survivors, especially those in the adolescent and young adult (AYA) population. In addition, this group faces unique psychosocial challenges navigating cancer care. This study aimed to identify strategies to decrease rates of food insecurity (FI) and examine the number of providers who screened for psychosocial symptoms among AYA cancer survivors.
Methods
This study employed a cross-sectional research design through the administration of an online survey between November 2025 and May 2026 (n = 53). Participants included oncologists, social workers, dietitians, nurses, and physician assistants who were recruited via email and flyer postings.
Results
Most participants cited appointment time as the largest barrier to screening for FI, represented by time spent discussing other health issues (60.4%, n=32) or a general lack of time (47.2%, n=25). Participants also reported feeling unprepared to have these conversations due to not receiving appropriate training (45.3%, n=24) or inadequate knowledge on local resources (54.7%, n=29). 62.7% (n=32) of participants believed that nutritional counseling would be an effective strategy for those struggling with FI. 66% (n=40) of participants screened for overall well-being and 60.4% (n=32) screened for physical functioning and pain management, respectively.
Conclusions
FI screening in AYA cancer survivors is hindered by a lack of time and relevant training. Psychosocial screening was commonly performed, opening the opportunity to add in FI screening alongside it. Further research is needed on the efficacy of participant recommended interventions and the availability of in-clinic support staff.
Navigating A Rare Case of Burkitt Lymphoma in the Third Trimester of Pregnancy
Background
Cancer is diagnosed in 1/1000 pregnancies annually, with non-Hodgkin lymphoma occurring in only 4% of those. Diagnosis and treatment are complicated by fetal risks from imaging and therapy and low incidence, which precludes larger clinical trials to guide treatment.
Methods
We present a 33-year-old G4P2 with a history of Tetralogy of Fallot, repaired in infancy, who presented at 30w5d with a palpable right breast mass.
Results
Ultrasound was performed at that time and was most consistent with a lactating adenoma or galactocele, measuring 3cm. At 34w5d, the mass had palpably increased in size, prompting an ultrasound-guided biopsy at 37w0d. Five days later, she presented to the emergency department with scapular pain and lower extremity weakness. Preliminary biopsy resulted at that time and was consistent with Burkitt lymphoma, and she underwent urgent Cesarean section to initiate treatment. At presentation, she had widely disseminated disease, including a large pelvic mass, spinal column involvement causing cord compression, bilateral breast masses, diffuse intraabdominal disease, and lymphadenopathy. She was treated with 4 cycles of R-CODOX-M/R-IVAC, with PET-CT demonstrating a favorable treatment response.
Conclusions
This case illustrates a rare presentation of Burkitt lymphoma in pregnancy, in which nonspecific initial symptoms made early diagnosis challenging. Fortunately, the patient was full-term by the time urgent treatment was required, as many chemotherapies are contraindicated during pregnancy depending on gestational age, adding complexity for both treating physicians and the patient and family. Because treatment began postpartum, breastfeeding also required consideration; ultimately, she had to pump and discard her breast milk.
Beyond Deli Meat: A Novel Case of Listeria-Triggered Autoimmune Hemolytic Anemia
Background
Approximately 50% of warm autoimmune hemolytic anemia (AIHA) cases are idiopathic/primary. Secondary AIHA typically arises in the setting of lymphoproliferative disorders, autoimmune diseases and infections (particularly viral). Listeria monocytogenes, a pathogenic bacterium causing invasive disease in immunocompromised patients is a heretofore unknown trigger of AIHA.
Methods
We present a 69-year-old man with minimal healthcare engagement, whose only notable history was extensive chronic tobacco use. In the months before presentation, he developed weakness, exertional dyspnea, fatigue, and jaundice.
Results
Initial labs showed hemoglobin of 3.1 g/dL, MCV 145.1 fL, undetectable haptoglobin, low C3/C4, and a positive IgG DAT, consistent with warm AIHA. Further work-up ruled out active viral infection, malignancy, or an underlying auto-immune process. Two sets of blood cultures grew Listeria monocytogenes, identified as the likely trigger for his AIHA in the absence of any other explanation. He also manifested reduced LVEF (39%), attributed to high-output heart failure from severe anemia, which normalized within 11 days of anemia treatment. He received ampicillin for his infection. His AIHA was initially managed with steroids and Rituximab weekly x4, plus prednisone, but hemolysis persisted for several weeks. He then received two doses of IVIG without benefit, prompting initiation of daratumumab. His hemoglobin stabilized three weeks later, with sustained remission thereafter.
Conclusions
This case illustrates an atypical case of AIHA—apparently triggered by Listeria bacteremia, not previously reported in the literature. Notably, this proved refractory to initial standard AIHA therapy and treatment of the infection, though was ultimately responsive to novel therapy.
Relapsed T-Cell Prolymphocytic Leukemia with Hypercalcemia, Encephalopathy, and Suspected CNS Involvement Complicated by Respiratory Failure Before Planned Allogeneic Transplant
Background
T-cell prolymphocytic leukemia (T-PLL) is a rare, aggressive mature T-cell neoplasm with median overall survival of 1-2 years. Intravenous alemtuzumab produces response rates \>80%, but responses are transient and relapse is nearly inevitable without consolidative allogeneic hematopoietic cell transplantation (allo-HCT). CNS involvement is uncommon and highly lethal, and the prolonged immunosuppression required for disease control predisposes to fatal infection.
Methods
We report a case of relapsed T-PLL with suspected CNS involvement culminating in fatal respiratory failure before planned allo-HCT.
Results
A 70-year-old woman with prior stage IA HER2-positive breast cancer presented with pruritus, ascites, edema, and thrombocytopenia. Flow cytometry and marrow biopsy diagnosed T-PLL, with FISH showing TCL1A and TRA/D rearrangement. She responded to alemtuzumab; a mid-treatment WBC rise to 120k prompted salvage pentostatin and steroids. Two weeks before planned allo-HCT, she relapsed with hypercalcemia and encephalopathy and started ruxolitinib and duvelisib. MRI showed parietal dural enhancement concerning for CNS involvement; lumbar puncture was deferred for thrombocytopenia. She was hospitalized for multifocal pneumonia and influenza A, then returned with progressive hypoxemic respiratory failure and atrial fibrillation with rapid ventricular response. Despite ICU care, antibiotics, and oseltamivir, she deteriorated; her family elected comfort measures and she died of acute hypoxic respiratory failure related to T-PLL.
Conclusions
This case underscores the aggressive biology of T-PLL, the dual burden of chemoresistant relapse and treatment-related immunosuppression, highlighting the diagnostic challenge of CNS involvement the therapeutic dilemma when relapse precludes curative transplant, and the central role of infection in T-PLL mortality.
Evaluating the Feasibility and Clinical Utility of a Graphic Narrative Education Guide (CEBRE) in Breast Radiotherapy: A Quality Improvement Pilot
Background
Standard patient education for external‑beam radiotherapy is usually delivered as a text‑heavy booklet, leaving many patients feeling overwhelmed and anxious. Evidence shows that visual, picture‑based tools improve comprehension and engagement, yet they are rarely incorporated into routine oncology workflows. To close this gap, we piloted the Communicating the External‑Beam Radiotherapy Experience (CEBRE) discussion guide, a concise, image‑rich conversation aid.
Methods
We conducted a prospective, single-arm, mixed-methods quality improvement pilot at Dartmouth Hitchcock Medical Center (DHMC) enrolling breast cancer patients (N=20). The CEBRE graphic narrative guide was distributed by a physician during initial consultation and/or nurses during CT simulation (post-consent, pre-procedure). Anonymous patient surveys include three 5-point Likert items (approachability, comprehension, preparedness) plus open-ended prompts; staff surveys assess implementation friction, perceived patient value, and long-term viability. Analysis used descriptive statistics with top-two box scores and thematic analysis of open-ended feedback.
Results
Patient top-two box scores were high: approachability (89.5%), comprehension (89.5%), and preparedness (94.4%; n=20). Patients reported visuals aided understanding and comfort. All staff (n=5) rated implementation as seamless and the guide very helpful; 60% endorsed long-term use as-is, 40% with changes, including removing the prone-position image and clarifying arms-up duration.
Conclusions
CEBRE boosts patient readiness for radiation therapy – patients report visuals help them understand and feel more comfortable. Nurse-led distribution at CT simulation provides a smooth touchpoint without extending appointment times.
Real-world outcomes of atezolizumab versus durvalumab in extensive-stage small cell lung cancer
Background
Landmark trials IMpower133 and CASPIAN demonstrated improved progression-free survival (PFS) and overall survival (OS) with atezolizumab- or durvalumab-based chemotherapy, respectively, versus chemotherapy alone in ES-SCLC. Two retrospective single-center academic studies subsequently reported improved OS with durvalumab versus atezolizumab without PFS differences. We compared these regimens in a real-world academic and community population using an intent-to-treat approach.
Methods
We retrospectively identified adults with ES-SCLC receiving ≥1 cycle of first-line platinum-etoposide plus atezolizumab or durvalumab from 2018–2025 at the University of Vermont Medical Center and affiliated community centers. The study was IRB-exempt. Demographic, clinical, treatment, immune-related adverse event (irAE), and survival data were manually abstracted. Propensity score matching incorporated baseline laboratory values, demographics, performance status, and treatment setting. Missing values underwent multiple imputation. OS was measured from treatment initiation to death and PFS to progression/death. Kaplan-Meier and Cox proportional hazards models evaluated survival; Fisher’s exact test compared baseline characteristics and irAEs.
Results
Of 96 patients, 78 remained after matching (39/group). Baseline characteristics were balanced except treatment setting; academic practice favored durvalumab (p=0.019). OS was similar with atezolizumab versus durvalumab (9.96 vs 11.61 months; HR 1.07; 95% CI 0.62–1.84; p=0.80), as was PFS (6.61 vs 4.41 months; HR 1.22; 95% CI 0.73–2.04; p=0.44). irAEs were comparable (8 vs 9; p=0.66).
Conclusions
No statistically significant differences in OS, PFS, or irAEs were observed between regimens. Despite treatment-setting imbalance, these findings support comparable real-world effectiveness and safety, suggesting selection may be guided by access, institutional preference, and patient-specific factors.
Closing the Gap: Universal Germline Screening for Hereditary Predisposition in AML/MDS
Background
Myeloid neoplasms with germline predisposition are increasingly recognized as a distinct diagnostic category, with implications for treatment selection, donor eligibility, and cascade testing of at-risk relatives. Current testing strategies at our institution rely on the treating physician\’s referral to a genetic counselor. Our institution does not routinely perform skin fibroblast culture for germline confirmation. We hypothesized that selective testing is missing a substantial proportion of AML/MDS patients who carry pathogenic germline variants.
Methods
We retrospectively reviewed bone marrow biopsy NGS results for 37 adult patients diagnosed with AML/MDS in 2024. Cases with a variant allele fraction (VAF) of 40% or greater in TP53, CEBPA, or RUNX1, genes associated with hereditary myeloid malignancy syndromes, were flagged as possible germline candidates.
Results
Of 37 bone marrow biopsies reviewed, 9 (24%) demonstrated a VAF of 40% or greater in TP53, CEBPA, or RUNX1. None of these patients underwent germline confirmatory testing or genetic counseling referral, as no institutional pathway for reflex fibroblast testing currently exists.
Conclusions
Nearly one in four AML/MDS patients diagnosed in 2024 had sequencing findings suggestive of possible germline predisposition that went unrecognized and unreferred. These findings support implementation of universal, VAF-based reflex germline screening for all AML/MDS patients to ensure timely genetic counseling, informed donor selection, and cascade testing for at-risk relatives.
Insurance-Based Disparities in Patterns of Care for Brain Metastases
Background
Immuno-oncology (IO) and stereotactic radiosurgery (SRS) have improved outcomes for patients with brain metastases (BM) from non-small cell lung cancer (NSCLC) and melanoma, offering intracranial control with less neurocognitive toxicity than older treatments like whole-brain radiation (WBRT). However, IO and SRS are costly and resource-intensive, raising concern that non-clinical factors may shape accessibility. We characterized insurancebased variation in BM patterns of care.
Methods
Using the National Cancer Database (\~75% of U.S. cancer patients), we identified patients with BM from NSCLC or melanoma diagnosed 2016-2022. Logistic regression assessed no treatment/hospice versus any treatment, adjusting for age, sex, race/ethnicity, rurality, income, education, Charlson comorbidity, and facility type. Multinomial regression modeled receipt of four treatment groups—WBRT/traditional radiation, IO alone, SRS alone, or IO plus SRS—relative to no treatment/hospice. Medicare, private, and other government insurance were grouped as \”Other-insured.\”
Results
Medicaid/uninsured patients had higher odds of no treatment/hospice than Otherinsured patients (OR 1.34, 95% CI 1.29–1.40; p\<0.001). Among treated, Medicaid/uninsured status was associated with greater relative use of WBRT/older radiation and lower use of SRS monotherapy and dual IO/SRS (Table 1). Consistent associations were observed for lowest versus highest area income (OR 1.15, 1.09–1.22; p\<0.001) and education (OR 1.20, 1.13-1.27; p\<0.001), indicating broader socioeconomic influences in treatment decision-making.
Conclusions
In this national cohort, Medicaid/uninsured patients with BM from NSCLC or melanoma were more likely to receive no treatment and, when treated, less likely to receive IO and SRS than older radiation. These insurance-based disparities may represent a modifiable barrier to modern BM therapy.
Additional Notes
Faith Ryu will present the abstract at the meeting. She is a Dartmouth medical student and will apply for trainee registration.
Caught Between Worlds — A Case of Plasmablastic Lymphoma
Background
Plasmablastic lymphoma (PBL) is a rare CD20 negative, aggressive B-cell lymphoma which is most classically most often associated with immunodeficiency, particularly Epstein-Barr virus and HIV infection. We describe an atypical case of PBL in an HIV-negative patient with mixed connective tissue disease and a remote history of anal carcinoma.
Methods
A 65-year-old woman with mixed connective tissue disease on long-term hydroxychloroquine, and anal carcinoma treated with chemoradiation in 2014, was admitted for bulky lymphadenopathy, progressive lower-extremity swelling, and a mass-like lesion at prior anal cancer site. The initial concern was for anal cancer recurrence; however biopsy demonstrated PBL. Further workup for immunodeficiency noted markedly low CD4 count (210) with negative HIV testing. Germline genetic testing identified a pathologic variant in CHEK2 gene, which is increasingly reported in lymphoid malignancies, and six variants of uncertain significance, three of which are associated with immune deficiency syndromes for which she has been referred to immunology .
Results
The patient was treated with six cycles of dose-adjusted EPOCH, daratumumab, and intrathecal methotrexate prophylaxis. Post-treatment PET demonstrated likely CR with one area of FDG avidity in the spleen requiring additional imaging. She is planned for autologous stem cell transplantation for consolidation.
Conclusions
PBL should remain in the differential diagnosis of rapidly progressive extranodal disease in patients without HIV, particularly in the setting of underlying autoimmune disease or long-term immunosuppression. This case highlights the importance of tissue diagnosis when lymphoma mimics recurrent malignancy and demonstrates the clinical and molecular heterogeneity of PBL.
Microplastics and Human Health: Emerging Implications for Carcinogenesis and Malignancy
Background
Microplastics and nanoplastics (MNPs) are increasingly recognized environmental contaminants with widespread human exposure through food, beverages, synthetic textiles, and inhalation. MNPs have now been detected in blood and multiple human tissues, raising concern regarding their potential contribution to human disease, including malignancy.
Methods
We performed a narrative review of the emerging literature evaluating sources of human MNP exposure, methods of detection, human biomonitoring studies, proposed mechanisms of toxicity, and associations between MNP accumulation and malignancy
Results
Human biomonitoring studies demonstrate widespread MNP accumulation across multiple organ systems. Preclinical studies suggest several biologically plausible mechanisms of toxicity, including oxidative stress, inflammation, cellular injury, disruption of intestinal barrier function, and transport of environmental pollutants and plastic-associated chemicals. Studies across several solid tumors, including colorectal, gastric, breast, genitourinary, gynecologic, lung, and pancreatic cancers, have reported greater MNP concentrations in tumor tissue compared with adjacent nonmalignant tissue. Epidemiologic data are limited but include associations between higher fecal microplastic concentrations and colorectal cancer. Evidence in hematologic malignancies is sparse, but there is evidence to support MNP concentration impacting allogenic bone marrow graft success.
Conclusions
MNP exposure is ubiquitous, and accumulating evidence demonstrates associations between MNP burden and human disease, including malignancy. However, current studies cannot establish causality, and substantial limitations in exposure assessment, detection methodology, and study design remain. Standardized prospective studies are needed to determine whether MNPs contribute directly to carcinogenesis or preferentially accumulate in diseased tissues.
EGFR-Mutated Lung Adenocarcinoma Presenting as Miliary Lung Disease and Successful Osimertinib Rechallenge After Pneumonitis with Combination Therapy: A Case Report
Background
Lung cancer remains the leading cause of cancer deaths in the U.S. Miliary lung metastasis, defined as over 20 bilateral round pulmonary nodules (\<5 mm), is more common in adenocarcinoma and strongly associated with epidermal growth factor receptor (EGFR) mutations (78.8%), extrapulmonary metastasis, female sex, and non-smokers. Treatment options for stage IV EGFR mutated lung adenocarcinoma include Osimertinib, Osimertinib with chemotherapy, and Lazertinib with Amivantamab. Osimertinib-induced pneumonitis is an uncommon, but life-threatening side effect; standard treatment includes drug discontinuation and high-dose corticosteroids. Data on the safety of re-challenging with Osimertinib remains limited.
Methods
A 51-year-old woman with a remote seven pack-year smoking history presented with subacute dyspnea on exertion. Imaging revealed innumerable bilateral miliary lung nodules and mildly enlarged mediastinal and hilar lymph nodes. Biopsy and molecular testing confirmed lung adenocarcinoma with EGFR exon 19 deletion. She received Osimertinib and chemotherapy, but developed Osimertinib-induced pneumonitis, which improved after holding Osimertinib and initiating steroids. Osimertinib was subsequently resumed at half dose with prednisone 10mg daily.
Results
She has had no recurrent hypoxia since then. Three months later, imaging showed improvement in ground-glass opacities and pulmonary nodules, resolution of lymphadenopathy, and no new metastases. She remains on half-dose Osimertinib and chemotherapy and has discontinued the steroids.
Conclusions
This case highlights the importance of recognizing EGFR-mutated miliary intrapulmonary adenocarcinoma and the potential for Osimertinib rechallenge after Osimertinib-induced pneumonitis. Given the efficacy of targeted therapy, it is pertinent to consider lower dose Osimertinib rechallenge with a limited course of steroids for both efficacy and safety.
Navigating Unexpected Infectious Co-morbidities in Primary CNS Lymphoma (PCNSL)
Background
A 54-year-old previously healthy male presented with subacute sensory changes and acute right hand weakness. MRI showed widespread leptomeningeal enhancement without parenchymal lesions. He reported frequent outdoor activity and a remote travel history to the southeastern United States.
Methods
CSF analysis was notable for lymphocytic pleocytosis with a 6% population of monoclonal atypical lymphocytes (CD19+, CD20-, MYC rearranged) most consistent with large B-cell lymphoma. CSF Lyme Index was strongly positive at 77.4. PET/CT demonstrated no other sites of disease, consistent with PCNSL.
Results
He was concurrently initiated on IV ceftriaxone for neuroborreliosis and methotrexate, temozolomide, and rituximab for PCNSL. Given his travel history and plan for consolidative autologous stem cell transplant, broad pre-transplant infectious screening was pursued, including T. cruzi serology. Pre-transplant serology returned positive for Chagas antibodies, confirmed by ELISA and LFA. This was consistent with chronic, asymptomatic T. cruzi infection. Subsequent PCR tests remained negative pre-transplant, though a detectable but unquantifiable positive emerged 3 weeks post-transplant. This raised the question of early reactivation versus normal parasitic life cycle fluctuation. The patient remained clinically asymptomatic. A subsequent PCR remained undetectable, lending support to the latter hypothesis. He did not require antiparasitic therapy.
Conclusions
This case underscores the value of comprehensive infectious workup alongside oncologic evaluation in patients with leptomeningeal disease, as well as ongoing multidisciplinary collaboration while diagnosing and concurrently treating neuroborreliosis and PCNSL. Subsequent scans continue to demonstrate nerve root enhancement suspicious for residual infection-associated inflammation. Due diligence additionally identified a positive pre-transplant Chagas antibody that informed monitoring post-transplant.
Central Diabetes Insipidus in AML: A Case of Hypothalamic Involvement with Monosomy 7 and MECOM Rearrangement
Background
Central diabetes insipidus (CDI) is a rare complication of acute myeloid leukemia (AML) that has been associated with cytogenetic abnormalities involving chromosomes 3 and 7. CDI may occur with or without overt central nervous system (CNS) leukemic involvement.
Methods
A 60-year-old man with newly diagnosed AML was admitted for progressive nausea, vomiting, and malaise with acute kidney injury (serum creatinine 1.57 mg/dL; baseline 1.00 mg/dL) and hyperuricemia (9.1 mg/dL), concerning for spontaneous tumor lysis syndrome. Serum sodium was 153 mEq/L on admission, with persistent hypernatremia (145–159 mEq/L) documented over the preceding 2 weeks. Review of multiple recent emergency department visits and hospitalizations revealed 2 months of new onset polyuria, severe enough to disrupt sleep.
Results
Further questioning revealed intense thirst, nocturnal polydipsia, and persistent polyuria. Physical examination demonstrated dry mucous membranes. Laboratory evaluation showed elevated serum osmolality of 312 mOsm/kg with inappropriately dilute urine (urine osmolality 152 mOsm/kg; urine sodium \<25 mEq/L). A desmopressin challenge confirmed CDI. Brain MRI demonstrated abnormal hypothalamic enhancement, concerning for leukemic involvement of the hypothalamic-pituitary axis despite negative cerebrospinal fluid cytology and flow cytometry. Bone marrow studies revealed monosomy 7 and a MECOM (MDS1 and EVI1 complex locus) rearrangement involving chromosome 3. These adverse-risk cytogenetic findings, together with radiographic evidence of CNS involvement, informed treatment planning.
Conclusions
New onset polyuria, polydipsia, and hypernatremia in patients with AML should prompt evaluation for CDI and hypothalamic-pituitary involvement. Careful review of the clinical history and targeted laboratory evaluation are essential for recognizing this rare but clinically significant complication.
Molecular correlates of response to antibody-drug conjugate therapy in metastatic breast cancer: a real-world cohort study
Background
Antibody-drug conjugates (ADCs), including trastuzumab deruxtecan (T-DXd) and sacituzumab govitecan, have transformed treatment for metastatic breast cancer (MBC), yet biomarkers predicting durable benefit remain poorly defined. We evaluated real-world clinical outcomes following ADC therapy and performed exploratory genomic and transcriptomic analyses to identify candidate biomarkers associated with progression-free survival (PFS).
Methods
We retrospectively identified patients with MBC treated with an ADC who underwent next-generation sequencing (NGS). PFS was measured from ADC initiation to disease progression or last follow-up using Kaplan-Meier analysis. Durable benefit was defined as PFS ≥6 months. Associations between recurrent somatic alterations and PFS were evaluated using log-rank and Mann-Whitney tests. Exploratory differential gene expression analysis was performed using PyDESeq2 followed by pathway overrepresentation analysis against MSigDB canonical pathways.
Results
Among patients receiving T-DXd (n=20), median PFS was 9.1 months and 65% achieved durable benefit. With sacituzumab govitecan (n=8), median PFS was 6.9 months and 50% achieved durable benefit. All triple-negative breast cancer (TNBC) patients receiving T-DXd (4/4) achieved durable benefit (median PFS, 11.8 months). PFS was not associated with prior therapy number (p=0.79) or CDK4/6 inhibitor exposure (p=0.71). FGFR1 alterations (n=4) were associated with shorter PFS versus wild-type tumors (4.8 vs 10.8 months; p=0.05). In contrast, patients with durable benefit demonstrated higher expression of neuroendocrine- and hormone receptor-related genes, including CHGA, CHGB, PGR, and GRPR.
Conclusions
T-DXd demonstrated durable responses among TNBC patients. FGFR1/11q13 alterations and neutrophil/innate immune transcriptional programs emerged as resistance biomarkers. These findings warrant validation in larger cohorts to inform future biomarker-guided therapies.
Additional Notes
Please note D. Shirmer and Z. Brune are co-first authors. Z. Brune is submitting on behalf of D. Shirmer (a medical student).
Advanced HIV/AIDS with Progressive Multisystem Disease: Malignancy at the Center of Clinical Decline
Background
Kaposi sarcoma (KS) is an HHV-8–associated malignancy that can demonstrate visceral dissemination in advanced immunosuppression. It can be complicated by severe systemic inflammation, including KS herpesvirus–associated inflammatory cytokine syndrome (KICS), which may overlap with secondary hemophagocytic lymphohistiocytosis (HLH) and mimic sepsis.
Methods
We present a case of advanced HIV/AIDS with multisystem disease with review of clinical data, pathology, treatment, and autopsy findings.
Results
A 33-year-old man with newly diagnosed HIV on ART presented with persistent inability to tolerate oral intake, with endoscopic findings of nonspecific inflammation. Imaging demonstrated diffuse edema, mesenteric lymphadenopathy, and large bilateral pleural effusions. Thoracentesis revealed lymphocyte-predominant exudative effusions. Infectious evaluation for Tuberculosis and CMV was unrevealing. HIV viral load had become undetectable with ART, but CD4 count remained low (7 cells/mm3). Clinical status rapidly deteriorated with renal failure, respiratory failure, and shock. Repeat endoscopy with biopsy confirmed HHV-8–positive Kaposi sarcoma involving the gut. The course was further complicated by profound inflammation, ferritin \>100,000 ng/mL, liver dysfunction, coagulopathy, and escalating vasopressor requirements, concerning for KICS with an HLH-like phenotype. However, definitive HLH diagnosis was limited by an incomplete evaluation and inability to do a BM biopsy. Despite aggressive multidisciplinary management, the patient developed refractory shock and died. Autopsy revealed disseminated Kaposi sarcoma involving the gastrointestinal tract, lungs, and heart.
Conclusions
Disseminated KS in HIV can present as a fulminant malignancy-driven hyperinflammatory syndrome. This can resemble sepsis and may overlap with HLH. Early consideration of HHV-8–associated disease therapy may guide timely therapy.
Emergency Department Utilization After Chemotherapy at Southcoast Health Cancer Center (SCHCC): From CMS OP-35 Benchmarking to Action
Background
CMS OP-35 for outpatients evaluates rate of ED visits within 30 days of chemotherapy administration, to quantify/ reduce ED visits and admissions, and to improve their QOL. SCHCC sought to evaluate its OP-35 performance and identify opportunities to improve outpatient management of treatment-related symptoms. If a patient’s unmet needs are reduced and gaps in care diminished, then ED visits should be reduced. Potential cost savings for patient management in an outpatient setting exists. However, the increasing patient volumes and the growing complexity of cancer therapies further challenge outpatient management of treatment-related symptoms.
Methods
SCHCC evaluated CMS published data for ED visits for patients receiving chemotherapy (1/1/2023 thru 12/31/2023, published 2/19/2025). Staff looked at other institutions’ results (our area and Northern New England). Lastly, SCHCC evaluated six months (1/1/2026 thru 6/30/2026) of data looking at ED visits within 14 days of receiving chemotherapy, which was an internal quality-improvement analysis informed by OP-35.
Results
Common reasons for ED visits included: GI, weakness/fatigue, fever/infection, pain. Of 291 patients that visited the ED during our review period, 144 patients were admitted. 113 contacted the clinic prior to the ED. 204 patients who visited the ED did not have immediate communication with Oncology staff after ED visit.
Conclusions
Opportunities identified include increased utilization of NP/urgent care visits, standardized use of symptom-management algorithms, standardized post-ED follow-up, and enhanced patient education regarding treatment-related symptoms and when to contact the oncology team. Targeting these gaps may facilitate earlier management, improve continuity of oncology care, and reduce potentially avoidable ED visits.
A Quality Improvement Initiative to Enhance Multidisciplinary Cancer Conference Effectiveness
Background
Under standards established by the Commission on Cancer (CoC), multidisciplinary cancer case conferences review clinical staging, guideline-based treatment planning, genetic testing, clinical trials, and supportive care services. At Mercy Hospital, biweekly tumor boards are conducted to support coordinated patient care and improve patient outcomes. Under CoC Standard 7.3, this quality improvement initiative aimed to optimize conference preparation, clinical information availability, and promote multidisciplinary participation.
Methods
Following the DMAIC framework (Define, Measure, Analyze, Improve, Control), anonymous attendee surveys were used to identify areas for improvement. Four interventions were implemented: (1) a revised case submission form specifying the clinical question, relevant images, and ancillary support needs; (2) a reformatted agenda incorporating these elements; (3) quarterly provider presentation of new treatment guidelines; and (4) reminders for upcoming Dana-Farber Cancer Institute (DFCI) events. An anonymous post-intervention survey evaluated attendees\’ perception of the implemented changes.
Results
19 attendees completed the pre-intervention survey, recognizing the need for greater supportive care involvement and identifying concerns about radiology and pathology availability. 13 completed the post-intervention survey, reporting that relevant patient data were available for review and that ancillary services had adequate opportunity to contribute. More than 50% identified the interventions specifying clinical questions and periodic guideline presentations as positively impacting meeting quality.
Conclusions
Structured changes to case submission and agenda design were associated with improved perceptions of data availability and multidisciplinary participation. Given the near-universal role of multidisciplinary case conferences in cancer care, these structural interventions are readily adaptable by programs seeking similar quality improvement goals.
Normalizing Help-Seeking for Secondary Traumatic Stress Among Healthcare Workers: When Our Professional Identity Is to Care for Others
Background
Secondary traumatic stress (STS) is the emotional and psychological impact of repeated exposure to others\’ trauma through professional caregiving. In healthcare settings, STS contributes significantly to compassion fatigue, burnout, and moral injury. Healthcare workers care for individuals experiencing serious illness, death, trauma, and socioeconomic adversity, while facing high occupational stress. As a result, healthcare workers experience disproportionately high rates of mental health concerns, including depression, anxiety, PTSD and suicide.
Methods
A narrative review of literature examining STS and mental health outcomes among healthcare workers was conducted. Sources included publications from SAMHSA, CDC, the Betsy Lehman Center, the Emotional PPE Project, peer-reviewed journals, and other healthcare workforce mental health initiatives. Evidence regarding prevalence, barriers to help-seeking, risk factors, and intervention strategies was examined.
Results
Research consistently demonstrates substantial rates of psychological distress among healthcare workers. Untreated STS contributes to compassion fatigue, burnout, reduced job satisfaction, workforce attrition, and diminished personal well-being. Despite elevated need, significant barriers to help-seeking persist. Stigma, professional reputation, licensing and credentialing fears, normalization of inadequate self-care, and logistical challenges all contribute to treatment avoidance.
Conclusions
STS should be recognized as an occupational hazard of caregiving rather than a personal failure or weakness. Awareness, early identification, and accessible support systems are critical to preventing chronic psychological distress and workforce impairment. Addressing STS includes leadership engagement, stigma reduction, psychological safety, policy reform, workplace accountability, and innovative support programs.
Innumerable Non-Bone-Contiguous Hepatic Plasmacytomas in Relapsed Multiple Myeloma
Background
Extramedullary disease (EMD) in multiple myeloma (MM) definitionally occurs in tissues without para-skeletal disease. It portends a worse prognosis with poor response to traditional therapies. Notably, EMD is frequently associated with mutations in the MAPK pathways and gain of function mutations in chromosome 1q. This case is unique as EMD to the liver is uncommon, and numerous lesions of disease in the liver is rare.
Methods
An 83-year-old male with history of MM presented after new liver lesions were incidentally noted on outpatient ultrasound. He was previously treated with a fourteen-month course of daratumumab, lenalidomide, and dexamethasone and had recently reached remission. Prior Fluorescence in Situ Hybridization (FISH) analysis showed gain of function mutation at 1q22. During his admission for expedited evaluation of the lesions, computerized tomography showed innumerable liver lesions with accompanying hepatomegaly and a left hemipelvis lytic lesion. Lambda free light chains were measured showing a sharp increase. Biopsy of one of the liver masses ultimately resulted with plasma cell proliferation with histochemistry positive for lambda protein, consistent with MM relapse with EMD.
Results
He was restarted on daratumumab, lenalidomide, and dexamethasone. Unfortunately, he tolerated this regimen poorly and his health declined rapidly.
Conclusions
This case highlights a unique presentation of EMD in a patient with a high-risk mutation. There are no specific treatments for MM with EMD and first line agents are the same in patients without EMD. There is growing evidence that chimeric antigen T-cell (CAR-T) therapy with immunomodulators may show benefit in patients with EMD.
A low-touch physical activity intervention for breast cancer survivors in alignment with the National Standards for Cancer Survivorship Care
Background
Organizations tasked with developing programs to support cancer survivorship care uniformly agree on the benefits of physical activity and recommended guidelines (\>150 minutes of moderate-vigorous physical activity per week). Unfortunately, longitudinal studies show significant declines in physical activity engagement during the 12-months post-diagnosis, with most breast cancer survivors never fully returning to pre-diagnosis activity levels. To address low rates of activity engagement among breast cancer survivors, leaders in the field are calling for exercise counseling to become standard of care in oncology by 2029. To realize this vision, physical activity promotion strategies that can be delivered as part of routine follow-up care are needed.
Methods
Data were collected for a two-arm trial (NCT04903249) with N = 40 inactive stage 0-III breast cancer survivors within 5 years of completing primary treatment. All participants received a Fitbit smartwatch and three, remotely-delivered, 1:1 exercise counseling sessions with the study interventionist. All participants were given a personalized exercise prescription that emphasized sustaining a moderate intensity pace (standard practice) or feeling as good as possible during exercise (novel prescribing technique). Otherwise, the conditions were identical. At each counseling session, participants were shown a data visualization summary of their physical activity levels since the prior visit.
Results
Proof-concept-was demonstrated as average minutes of weekly moderate-vigorous physical activity exceeded the pre-specified threshold of 90minutes per week at 2-, 6-, and 12-weeks follow-up for greater than 50% of the sample.
Conclusions
A remotely delivered low-touch exercise intervention for breast cancer survivors was feasible and a subsequent fully-powered trial is justified.
Real-World Safety Profile of Isocitrate Dehydrogenase (IDH)-1 Inhibitors: A Pharmacovigilance Comparison of Olutasidenib and Ivosidenib Utilizing the FDA Adverse Event Reporting System (FAERS)
Background
Ivosidenib was first approved for the treatment of relapsed or refractory (R/R) acute myeloid leukemia (AML) in July 2018. More recently, another IDH-1 inhibitor, olutasidenib, was approved for the same indication. Comparisons of safety profiles between these agents may help guide their use in specific clinical scenarios.
Methods
We retrospectively queried real-world ivosidenib- and olutasidenib-associated adverse events (AEs) reported to the FAERS database from ivosidenib approval in 2018 until last submission on March 31, 2025. Proportional reporting percentages were calculated by comparing drug specific-AEs to total reported AEs in the database. Descriptive analysis compared the most commonly reported AEs.
Results
There were 1,555 ivosidenib-associated AEs and 163 olutasidenib-associated AEs reported to FAERS. For ivosidenib, 797 AEs were considered serious (51%), with 441 (28%) hospitalizations, and 113 (7%) reported deaths. Commonly reported AEs, with associated proportionality reporting percentages, included differentiation syndrome (10%), febrile neutropenia (0.13%), diarrhea (0.09%), and fatigue (0.04%). For ivosidenib AEs, 97 were considered serious (59%), with 74 (45%) hospitalizations, and 24 (14%) reported deaths. Commonly reported AEs, with associated proportionality reporting percentages, included differentiation syndrome (0.8%), febrile neutropenia (0.02%), and constipation (0.01%).
Conclusions
The real-world safety profile for the recently approved olutasidenib was similar to the experience with ivosidenib. No new serious AEs have been reported with olutasidenib. Close monitoring for patients receiving these treatments is warranted, given the continued association with differentiation syndrome. For patients with disease progression on ivosidenib, olutasidenib may be an alternative with a similar real-world safety profile.
Real-world study of upfront genomic testing utilization in newly diagnosed non–small cell lung cancer
Background
Comprehensive genomic profiling using tissue DNA next-generation sequencing (NGS) is essential for precision medicine in non-small cell lung cancer (NSCLC). Complementary liquid biopsy (LB), tissue RNA sequencing, and PDL1 testing may enhance detection of actionable alterations and inform treatment selection. Real-world use of upfront genomic testing remains poorly characterized.
Methods
We retrospectively studied adults with biopsy-confirmed stage IB-IV NSCLC diagnosed 4/2020- 9/2024 across the MaineHealth Cancer Center Network. Genomic test results were obtained from Tempus; demographic and clinical data from the tumor registry and EMR. Utilization was compared using Wilcoxon rank-sum, Chi-square tests, and multivariable logistic regression.
Results
Among 1,022 newly diagnosed NSCLC patients, 433 (42.4%) underwent upfront tissue and/or liquid NGS. Patients who received upfront NGS were more likely to be younger, female, former or never smokers, and have stage IV disease or adenocarcinoma. Rurality was associated with lower odds of receiving NGS (OR = 0.621, 95% CI \[0.449, 0.854\], p=0.004), whereas treating center was not. Of 419 evaluable patients, 47 (11.2%) had LB alone and 372 (88.8%) underwent tissue NGS, among whom 127 (34.1%) also underwent LB, 270 (72.6%) RNA sequencing, and 193 (51.9%) PDL1 testing. In early stage (IB-III) disease, RNA sequencing was more common at academic than community centers (67.6 vs. 32.4%, p=0.039).
Conclusions
Upfront NGS remains underused across a statewide network. Rural patients were less likely to receive upfront NGS regardless of treating center. Inconsistent use of complementary testing may limit identification of actionable alterations and treatment options. These findings highlight persistent disparities in access to precision oncology.
Small cell carcinoma of the anal canal with associated high titer AGNA-1 antibody positive paraneoplastic syndrome
Background
Small cell neuroendocrine carcinoma is a fast-growing, highly metastatic malignancy that most often originates in the lung. Very rarely, small-cell neuroendocrine carcinoma arises from a primary colorectal site, accounting for less than 1% of colorectal cancers. Small cell neuroendocrine carcinoma is associated with paraneoplastic syndrome, which can cause a variety of systemic symptoms.
Methods
We describe a 67-year-old male who presented with symptoms of confusion, amnesia, and personality changes, at which time he was diagnosed with high-titer anti-glial nuclear antibody type 1 (AGNA-1) antibody-positive paraneoplastic syndrome following positive AGNA-1 cerebrospinal fluid testing. Initial brain MRI, lumbar puncture, and PET/CT were negative for malignancy. Neurological symptoms continued, and eight months after initial workup, a repeat PET/CT showed uptake at the level of the anus. Biopsy revealed small-cell neuroendocrine carcinoma of the anal canal.
Results
The patient was started on Cisplatin and Etoposide, as well as radiation therapy, and neurological symptoms improved. Repeat biopsies showed no evidence of malignancy. A serum AGNA-1 paraneoplastic antibody was negative. An MRI showed no macroscopic anal abnormality. Overall, there was no evidence of disease.
Conclusions
To our knowledge, a case has not been reported where a paraneoplastic syndrome predated the diagnosis of small cell carcinoma of the anal canal. Our patient’s diagnosis of AGNA-1 antibody-positive paraneoplastic syndrome ultimately led to an early diagnosis of small-cell neuroendocrine carcinoma of the anal canal prior to metastatic involvement.
Patient Perceptions of Sustainability and Why Oncologists Should Care
Background
Cancer care is resource-intensive and longitudinal, creating opportunities to reduce environmental impacts through changes in treatment delivery and health-system operations. However, sustainability initiatives must remain aligned with patient priorities. We characterized patient perceptions of environmentally sustainable health care and examined implications for oncology practice.
Methods
We conducted a scoping review of PubMed and Web of Science for studies evaluating patient perceptions, attitudes, or knowledge regarding environmental sustainability in health care. We summarized study design, population, care setting, and key findings, with attention to oncology-relevant themes.
Results
Twenty-one studies met inclusion criteria: 14 cross-sectional surveys, five interview studies, one testimonial, and one data analysis. Common topics included medications (n=9), asthma/inhaler care (n=5), gynecology (n=4), surgery (n=3), anesthesia (n=2), and primary care (n=2). Only two studies addressed oncology, including one focused on cancer screening rather than active treatment. Across studies, patients generally supported environmentally sustainable care when clinical outcomes were maintained, although cost, convenience, ease of use, and comfort influenced acceptability. Patients also commonly viewed clinicians as having a role in advancing environmentally responsible health care.
Conclusions
Patient perspectives appear broadly compatible with sustainability initiatives that preserve clinical efficacy, safety, and patient-centeredness; however, oncology-specific evidence remains limited. Cancer centers should incorporate patient perspectives when designing and implementing lower-impact care pathways. This evidence gap is particularly relevant for geographically dispersed regions such as Northern New England, where patient-centered implementation may identify strategies that reduce environmental impact without increasing treatment burden.
Additional Notes
Change affiliation to: Lichter Lab not Lichter Greenhealth Lab
PD-L1 Expression and Intracranial(iC) Efficacy of Immune Checkpoint Inhibitors(ICI) in NSCLC Brain Metastases: A Real-World Cohort Study
Background
Patients with brain metastases and leptomeningeal disease(BMLM) from lung cancer(LCa) have historically been underrepresented/excluded from clinical trials. The role of PD-L1 expression as a predictive biomarker for iC outcomes remains uncertain.
Methods
Patients diagnosed with LCa +BMLM who received ICI at Dartmouth Cancer Center 01/01/2015-1/31/2025 were identified. Clinical and treatment data was obtained by manual review of electronic health records. iC progression free survival(iCPFS) was defined as time from BMLM diagnosis to radiographic/clinical progression. We compared continuous variables with Wilcoxon rank sum test; categorical variables with Fisher’s exact/Pearson’s Chi-squared. Association between iCPFS and PD-L1 \<1% and ≥1% was evaluated using univariate and multivariable Cox proportional hazards models estimating hazard ratios(HRs) with 95% confidence intervals(CIs).
Results
Of 1786 patients with NSCLC +BMLMs, 147 were included; 110 received ICI therapy. 73.6% had PD-L1 ≥1%. To treat BMLM, 56(50.9%) had stereotactic radiosurgery, 15(13.6%) whole-brain radiation, and 5(4.5%) both. Neurosurgical intervention was performed for 34(30.9%). Corticosteroids used for 77(70%). Pembrolizumab was the most used ICI. PD-L1 ≥1% was not significantly associated with longer icPFS in univariate/multivariable models: HR=0.8975; 95% CI(0.577-1.395); p=0.631 and HR=1.05; 95% CI(0.63-1.75); p=0.85.
Conclusions
Previous studies have demonstrated concordance of PD-L1 expression between primary tumor and iC metastases. However its utility in predicting intracranial response to ICI has been variable, consistent with findings in this initial analysis.
Paraneoplastic Nephrotic Syndrome Due to Minimal Change Disease in Pleural Epithelioid Mesothelioma
Background
Malignant pleural mesothelioma is a rare, aggressive malignancy typically linked to asbestos exposure, most often presenting with dyspnea and pleural effusion. Minimal change disease (MCD), a common cause of nephrotic syndrome in children, has rarely been reported as a paraneoplastic manifestation of solid tumors, including mesothelioma, posing unique diagnostic and management challenges in older, frail patients.
Methods
An 85-year-old man with hypertension, diabetes, and stage III-IV chronic kidney disease presented with progressive dyspnea. CT chest showed a large right pleural effusion; thoracentesis yielded 2.9 L of fluid, complicated by pneumothorax requiring chest tube placement. Cytology showed atypical mesothelial cells, and subsequent VATS pleural biopsy confirmed epithelioid malignant pleural mesothelioma. Oncologic treatment was deferred for elective hernia repair.
Results
He returned one week later with recurrent effusion, volume overload, worsening renal function, and new nephrotic-range proteinuria. Renal biopsy revealed diabetic nephropathy with superimposed minimal change disease and acute tubular injury, without amyloidosis or immune complex deposition. High-dose corticosteroids were initiated, but renal function continued to decline, necessitating hemodialysis. Given his poor prognosis and the limited benefit of immunotherapy without renal recovery, the patient elected to discontinue dialysis and transition to hospice, where he died peacefully weeks later
Conclusions
This case highlights minimal change disease as a rare paraneoplastic complication of mesothelioma. Renal biopsy is essential in unexplained nephrotic syndrome with underlying malignancy, and corticosteroids may be ineffective in paraneoplastic MCD associated with advanced cancer. Early goals-of-care discussions are critical when both renal and oncologic prognoses are poor.
Comparative Outcomes of Mohs Micrographic Surgery versus Superficial Radiation Therapy for Nonmelanoma Skin Cancer: A Retrospective Matched Cohort Study
Background
Mohs micrographic surgery (MMS) is the gold standard for treating nonmelanoma skin cancer because of margin control and low recurrence rates. Superficial radiation therapy (SRT) is a noninvasive alternative, though comparative data remain limited.
Methods
We conducted a retrospective matched cohort study of adults with basal cell or cutaneous squamous cell carcinoma treated with MMS or SRT at two cancer centers between October 2019-August 2025 (IRB #3664). SRT-treated tumors were matched 1:3 with MMS-treated tumors by treatment date, age, sex, and location per Mohs Appropriate Use Criteria. Continuous and categorical variables were analyzed using Student’s t-tests and Fisher’s exact tests, respectively. Recurrence-free survival was assessed using Kaplan-Meier methods and Cox proportional hazards models adjusted for age, sex, insurance status, Area Deprivation Index (ADI), immunosuppression, and Charlson Comorbidity Index (CCI).
Results
In all, 88 SRT-treated patients (109 tumors) and 315 MMS-treated patients (327 tumors) were included. Groups were similar in age, sex, immunosuppression, and CCI. SRT-treated patients had higher ADI scores (67.1 versus 48.1, P\<0.001) and differed in insurance status (P\<0.001). Recurrence occurred in 7/109 (6.4%) SRT-treated versus 3/327 (0.9%) MMS-treated tumors. Recurrence-free survival was significantly lower following SRT (log-rank P\<0.001), and SRT was associated with increased recurrence risk (adjusted HR 29.61, 95% CI: 5.15-170.13, P\<0.001).
Conclusions
MMS was associated with lower recurrence than SRT. SRT-treated patients had greater socioeconomic disadvantages and different insurance status, highlighting potential disparities in access to care and follow-up that may contribute to outcome differences. Further analyses will examine tumor characteristics associated with recurrence.
Additional Notes
Dear NNECOS, Please find my completed disclosure form attached. I am also happy to provide a PDF copy of the abstract if needed, and I can be reached at richard.zhang@med.uvm.edu. Thank you for your consideration. Sincerely, Richard Zhang
Real-world outcomes with atezolizumab versus durvalumab plus chemotherapy for extensive-stage small cell lung cancer: a TriNetX propensity-matched analysis
Background
First-line treatment for extensive-stage small cell lung cancer (ES-SCLC) consists of platinum-etoposide plus an immune checkpoint inhibitor (ICI), either atezolizumab or durvalumab. No head-to-head randomized trials have compared these regimens. We evaluated real-world outcomes associated with these ICIs using a large multi-institutional database.
Methods
We performed a retrospective cohort study using the TriNetX Global Collaborative Network. Adults with ES-SCLC treated with platinum-etoposide plus atezolizumab or durvalumab were included. The index date was initiation of platinum, etoposide, and ICI therapy. Cohorts were matched 1:1 using propensity scores based on age, sex, race, tobacco use, and comorbidities. The primary outcomes were overall survival (OS) and real-world progression-free survival (rwPFS), defined as time to second-line therapy or death. Survival was analyzed using the Kaplan-Meier method and log rank test.
Results
Among 750 eligible patients (677 atezolizumab, 73 durvalumab), 69 matched pairs were identified. Median follow-up was 13.4 months for atezolizumab and 8.6 months for durvalumab. Median OS was significantly longer with durvalumab compared with atezolizumab (23.2 vs 9.1 months; Hazard Ratio \[HR\] 0.58, 95% CI 0.47–0.93; p=0.021). No significant difference in rwPFS was observed (8.6 vs 6.7 months; HR 0.72, 95% CI 0.47–1.11; p=0.14).
Conclusions
We found that durvalumab-based first-line therapy was associated with longer OS compared to atezolizumab in patients with ES-SCLC, although no significant difference in rwPFS was observed. Interpretation is limited by shorter follow-up duration in the durvalumab cohort. Due to the observational study design, potential residual confounding, and limited sample size, these results should be regarded as hypothesis-generating.