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Purpose Metastatic breast cancer (mBC) patients with DPYD genetic variants linked to loss of dihydropyrimidine dehydrogenase (DPD) activity are at risk of severe capecitabine-associated toxicities. However, prospective DPYD genotyping has not yet been implemented in routine clinical practice. Following a previous internal review in which two patients underwent lengthy hospitalisations whilst receiving capecitabine, and were subsequently found to be DPD deficient, we initiated routine DPYD genotyping prior to starting capecitabine. This study evaluates the clinical application of routine DPYD screening at a large cancer centre in London. Methods We reviewed medical records for consecutive patients with mBC who underwent DPYD genotyping before commencing capecitabine between December 2014 and December 2017. Patients were tested for four DPYD variants associated with reduced DPD activity. Results Sixty-six patients underwent DPYD testing. Five (8.4%) patients were found to carry DPYD genetic polymorphisms associated with reduced DPD activity; of these, two received dose-reduced capecitabine. Of the 61 patients with DPYD wild-type, 14 (23%) experienced grade 3 toxicities which involved palmar–plantar erythrodysesthesia (65%), and gastrointestinal toxicities (35%); no patient was hospitalised due to toxicity. Conclusions Prospective DPYD genotyping can be successfully implemented in routine clinical practice and can reduce the risk of severe fluoropyrimidine toxicities.

Background/aim Subcutaneous (s.c.) trastuzumab was introduced in the (neo)adjuvant setting, based on the non-inferiority results and patient preference. In the advanced setting, preliminary safety data have only been reported. We conducted an observational study of s.c. trastuzumab in combination with i.v. pertuzumab and docetaxel in the first-line setting of human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer. Patients and methods In this single-institution study, patients received 600 mg s.c. trastuzumab in combination with 840 mg pertuzumab for the first cycle and 420 mg for the following cycles, and 75-100 mg/m2 docetaxel, followed by maintenance with s.c. trastuzumab and pertuzumab until disease progression or unacceptable toxicity. Endpoints were efficacy and safety. Results Forty patients were enrolled. The median number of cycles with docetaxel was six, while the median number of maintenance cycles was 21. With a median follow-up of 37 months, median progression-free survival and overall survival were 24 and 35 months. Conclusion Subcutaneous trastuzumab in combination with pertuzumab and docetaxel is well tolerated and effective in HER2-positive advanced breast cancer.

Background/aim During recent years, a survival advantage was reported for first-line treatment of advanced pancreatic cancer with two new regimens, FOLFIRINOX and gemcitabine/nab-paclitaxel, over gemcitabine monotherapy. Gemcitabine/nab-paclitaxel administration on days 1, 8 and 15 of a 4-week cycle is associated with some practical disadvantages. We adopted a biweekly regimen with the same dose density. Patients and methods Patients with Eastern Cooperative Oncology Group performance status 0-2 diagnosed with advanced histologically or cytologically confirmed pancreatic cancer and no prior treatment were included in the study. Study combination included 1.5 g/m2 gemcitabine and 175 mg/m2 nab-paclitaxel given every 2 weeks. Survival analysis was performed using the Kaplan-Meier method. Results Forty-six patients were treated with this regimen. Adverse events were similar to those of the original regimen. Median progression-free and overall survival were 5 and 10 months, respectively. Conclusion Biweekly gemcitabine/nab-paclitaxel seems to have a similar safety and efficacy profile as the original regimen.

90 Background: ASCO guidelines suggest patients > 65 should have a formal geriatric assessment [1]. We set up a new service in a London Cancer Centre. Cancer patients > 65 were reviewed in a one-stop GOLD clinic. Their focus was to provide a holistic approach to improve the oncology management. Nevertheless, not all cancer patients are fit to receive SACT. The aim of this study was to retrospectively review this group of patients. Methods: From October 2016 to April 2018, 596 patients were reviewed by GOLD. We analysed data for 298 (50%), including GOLD interventions and oncology management. In this cohort, 73% were between70-84 years (median 78). While most patients had SACT, 36 (12.4%) were deemed unfit by the oncology teams and had best supportive care only. These patients had a median age of 78.7 (64-93) and 20 (55.5%) were between 70-84. We also collected data on palliative care referral. Results: The main referrers were GI (10, 28%) and Urology (9, 25%). The rest included haematology (7, 19.4%), lung (5, 13.9%), gynaecology (3, 8.3%), melanoma and H&N (1, 2.8%) each. Referrals came mainly from the oncology teams (22, 61.1%). The remainder were identified from screening due to age (10, 27.8%) or following inpatient admission/Acute Oncology attendance (4, 11.1%). Co-morbidities and borderline performance status for systemic treatment were the two most common reasons for GOLD reviews (47.2% each), 8.3% involved polypharmacy and 2 (5.5%) cases involved social issues. Medication changes were advised for 52.8%. 41.6% did not have any changes to their management. One patient (2.8%) was referred to AHP and one (2.8%) to community palliative care. Fifteen (41.7%) had been referred to the Palliative Care team at the time of their review by GOLD. Conclusions: Despite multi-professional input, there are patients who remain unfit for SACT. It remains unclear whether a one-stop GOLD review added to the management of this group. Further evaluation is required to correctly identify patients who do not require multiple reviews. [1] Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology Hurria et al.