Search

9543 Background: mMCC is a rare, aggressive neuroendocrine cancer which often occurs in older patients (pts) with multiple comorbidities. While initial response rates to ICI are high, optimal treatment duration, durability of response after treatment cessation and response to retreatment with ICI is unknown. Methods: mMCC pts from 12 international centres who received at least one dose of ICI and subsequently stopped treatment without progression for a minimum of 12 weeks were studied. Demographics, disease characteristics and treatment course were examined. Results: 40 pts with mMCC were included. Pt characteristics are summarised in Table. Median time on treatment was 13.5 months (range 1 to 35). Median time to best response was 4.5 months (range 1 to 17) and median time receiving treatment after best response was 8 months (range 0 to 29). 25 pts (63%) stopped primarily due to being in a complete or partial response (CR or PR), 9 (23%) due to toxicity and 6 (15%) due to other reasons, primarily pt choice or comorbidities. At time of discontinuation, 30 pts (75%) were in a CR, 8 (20%) in a PR and 2 pts (5%) had stable disease (SD). After a median follow up of 12 months from discontinuation, 14 pts (35%) have progressed (PD); 5 (36%) at a previous site, 5 (36%) at a new site and 4 (29%) at both. PD occurred after a median of 5.5 months (range 4 to 29) off treatment. 4 pts (29%) had a CNS recurrence, none of whom previously had CNS involvement. Pts in CR at time of discontinuation were less likely to progress (CR: 26% PD vs non-CR: 67% PD, p=0.044), but still had a considerable rate of PD (CR: 26%, PR: 57%, SD: 100%). Those who progressed had numerically less cycles of ICI prior to treatment cessation (17 vs 32, p>0.05). Baseline disease factors, time to best response and duration of treatment after best response were not associated with PD. ICI was restarted in 8 of 14 pts (57%) with PD, with response rate to retreatment of 75% (4 CR, 2 PR, 1 SD, 1 PD – pt with leptomeningeal disease). Median time to best response at retreatment was 3 months (range 2 to 7), with all responses ongoing after a median of 10 months back on treatment. 3 pts had an isolated site of PD successfully treated with radiation therapy and remain in remission off ICI. Conclusions: ICI responses in mMCC do not appear as durable off treatment as in other cancers, including in patients who achieve a CR. Ongoing treatment should be considered, though initial data on response to retreatment is promising.[Table: see text]

e14029 Background: A significant delay in oncology patient journey through emergency department (ED) due to various reasons such as multiple specialists involved, difficulty in accessing timely advice from extremely busy inpatient/outpatient oncology teams, etc. In order to streamline admissions and discharges for oncology patients, a new model of care was created with the introduction of oncology nurse practitioner (ONP) at Calvary Mater Newcastle ED. This model operated during business hours three days a week with an aim to improve continuity of care, to enhance patients’ experience and meet organisations key performance indicators (KPIs). Limited research into the impact of these services on patient care and patient experience, particularly from service users’ perspective. Methods: A retrospective audit (6 months) has been undertaken to determine the impact of this model of care on time to specialty transfer, number of admissions versus discharges and patients representations through ED when ONP was available versus standard care. Results: During the audit period, ONP reviewed 149 patients. Fifty-four (36%) patients were discharged and of those 6 (11%) returned (within 28 days) with same or related issues. There was an average reduction in time to disposition planning for ED oncology patients of approximately 83 (193 vs 110) minutes when ONP was present at ED (one month review). Using a raw bed day costing, this resulted in a significant financial saving. Further cost analysis of this model is underway. Conclusions: The introduction of ONP into an acute care hospital ED has proven to be effective in terms of continuity of patient care, financial savings and assisted ED in meeting KPIs. The perception within the senior emergency management team is that this new model of care has been an unqualified success. ONP has rapidly and effectively joined emergency team and has seamlessly adjusted practice to the new environment. ED remains highly supportive of this new model of care. This model of care is one that could be translated easily to other specialities. Further analysis will be presented at the time of ASCO meeting.

e20630 Background: Baseline high NLR predicts poorer outcome in stage IV NSCLC; post-treatment variation in NLR and potential impact on overall survival (OS) is not clear in this group. Prognostic implications of PLR and LMR are not well studied for stage IV NSCLC. We aimed to assess the prognostic role of NLR, LMR and PLR in stage IV NSCLC at diagnosis and post-treatment. Methods: A retrospective descriptive study of 279 patients with Stage IV NSCLC treated at our centre over five year period (2010 to 2015). NLR, PLR and LMR calculated at diagnosis and post first cycle chemotherapy/targeted treatment. Demographic variables summarized. Estimates of Kaplan-Meier survival distributions for OS were generated. Cox regression used to derive OS hazard ratios of predictive variables. Approval from ethics committee obtained. Results: Baseline NLR, PLR and LMR showed strong association with OS. A five-unit increase at baseline (treatment start date) in NLR was associated with an 11% increase in the hazard of death (HR = 1.115, 95% CI: 1.077-1.148) while the same increase in PLR was associated with 0.5% increase in the hazard of death (HR = 1.005, 95% CI:1-1.005). A five-unit increase in LMR at baseline was associated with a 50% reduction in the hazard of death (HR = 0.50, 95% CI:0.260-0.956). Post-treatment NLR, PLR and LMR were examined in 221 patients. Fitted models incorporating adjustment for baseline values demonstrated that increasing NLR correlated with a shorter OS (HR = 1.574, 95% CI:1.295-1.917) but no statistically significant relationship could be demonstrated for PLR nor LMR. Conclusions: While NLR, PLR and LMR showed significant associations with OS prior to treatment, only NLR showed an association with OS after treatment. OS was shorter for high NLR and high PLR at baseline compared to low NLR and low PLR at baseline. OS was longer for high LMR at baseline compared to low at baseline. An increase in NLR post-treatment correlated with a shorter OS. This is the first study examining the prognostic significance of all three ratios in patients with untreated and treated stage IV NSCLC.