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Aim: Compare healthcare resource utilization and costs among patients with HER2+ metastatic breast cancer (MBC) with and without central nervous system (CNS) metastases. Methods: Retrospective matched cohort study using IQVIA's PharMetrics® Plus claims database. Results: Patients with CNS metastases (n = 753) experienced more outpatient, emergency room and inpatient visits versus controls (n = 753; all p

Limited real-world information exists on the characteristics or treatment patterns of patients with peripheral T-cell lymphoma (PTCL). We reported demographics, treatments and direct healthcare resource utilization (HRU) in a large cohort of US patients newly diagnosed with PTCL. Patients aged ≥18 years with a PTCL diagnosis between January 2011 and December 2016 were identified from the Inovalon MORE2 Registry. Continuous medical/pharmacy enrollment 6-months prior to and ≥1-month after the first PTCL diagnosis was required. The main focus of this study was on newly diagnosed patients receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) versus other chemotherapy. A total 2971 patients with PTCL and chemotherapy information were included in the study; 1706 (57%) received CHOP and 1265 (43%) other chemotherapy. A majority of patients (51.7%) were female; mean (standard deviation) age at index was 61.0 (±16.0), Charlson score was 4.1 (±2.9), and follow-up time was 24.6 (±16.7) months. During the variable follow-up period, HRU was similar for the CHOP and other chemotherapy cohorts; 58.1% and 59.3% had ≥1 all-cause hospitalizations, respectively. The proportion of patients with ≥1 PTCL-related hospitalizations was higher in the CHOP than in the other chemotherapy cohort (40.3% vs. 9.7%, respectively) and mean length of stay was longer (4.6 vs. 3.7 days per patient per month, respectively). This retrospective analysis of patients with PTCL revealed high levels of comorbidity and HRU; novel interventions that improve patient outcomes and reduce the HRU burden of PTCL are needed.

A cross-sectional online survey, including a discrete choice experiment (DCE), was used to investigate first-line treatment preferences in patients with classical Hodgkin lymphoma (cHL) in the United States; 141 patients (median age 35.0 years) participated. In the DCE, risk of progression at 2 years (progression free survival) had the highest relative importance to patients (31.3%) when considering first-line treatments, followed by 2-year overall survival (OS; 26.9%), on-treatment pulmonary toxicity (23.3%), and on-treatment peripheral neuropathy (18.5%). Marginal rate of substitution analyses demonstrated that a 0.44% and 0.09% increase in 2-year OS was required for patients to accept a 1% increase in the risk of disease progression at 2 years and peripheral neuropathy, respectively. A 2.6% increase in 2-year OS was needed to accept a 7% rather than a 2% risk of pulmonary toxicity. In summary, patients with cHL rated survival attributes as more important than drug-related toxicity when considering first-line treatments.

Background: There is limited information on the burden of metastatic breast cancer (mBC) with a central nervous system (CNS) metastasis in the literature. The objective of this study was to quantify the total all-cause healthcare resource utilization (HCRU) and costs among adult mBC patients administered HER2-targeted therapy with/without a CNS metastasis. Methods: Retrospective study included continuously enrolled patients with a diagnosis (ICD-9 / ICD-10 codes) of BC and mBC (stage III/IV metastasis) and a pharmacy claim of anti-HER2 therapy (index date) between 1/1/12-9/30/17 identified from IQVIA’s Real World Adjudicated Claims – US Database. After excluding patients with breast-related surgery and radiation procedure in the 6-month baseline period, 3 mutually exclusive treatment groups were created: trastuzumuab (T), T + chemotherapy (TC [including capecitabine or taxanes]) and lapatinib group (L [with or without chemotherapy]), each further stratified by presence/absence of CNS metastasis (identified by diagnosis codes/brain radiation procedures). Overall treatment groups were propensity score matched 1:1:1. All-cause HCRU and costs were evaluated over the 1-year follow-up period. Results: 5,895 HER2-targeted therapy patients were initially identified with 172 patients in each of the 3 treatment groups post-matching. Among these patients, 56.4%, 57.6% and 59.3% patients had a CNS metastasis in T, TC and L groups, respectively. The mean overall age of patients was 52.8, 52.3 and 52.6 years in T, TC and L groups, respectively, with a higher proportion of patients in the 55-64 age group. Majority of patients had arthritis/pain and cardiovascular diseases or were de novo metastatic in the baseline period. Baseline mean all-cause total costs were $77,069 among T group (CNS: $83,164; no CNS: $69,186), $62,164 among TC group (CNS: $66,906; no CNS: $55,733) and $81,007 among L group (CNS: $95,803; no CNS: $59,447). Costs were mainly driven by pharmacy (Rx)/outpatient (OP) setting. Over the 1-year follow-up period, mean total Rx costs were $115,453 (mean visits: 86.3), $81,091 (mean visits: 127.1) and $119,319 (mean visits: 83.3) among T, TC and L groups, respectively. This was followed by OP costs with $45,498 (mean visits: 189.2) in T, $62,263 (mean visits: 259.8) in TC and $69,654 (mean visits: 196.6) in L group. Inpatient (IP) costs were $13,319 (average hospital length of stay (LOS): 2.9 days), $18,177 (LOS: 2.2 days) and $10,239 (LOS: 1.4 days) among T, TC and L groups, respectively. CNS patients had higher mean total costs compared to the no CNS group among these treatment groups (T: $192,252 vs $153,784; TC: $237,376 vs $221,647 amd L: $205,637 vs $191,219). Conclusions: Costs among mBC patients administered HER2-targeted therapy were highest for Rx, followed by OP and then IP over the 1-year follow-up period. Among each of the treatment groups, CNS metastasis patients incurred higher costs compared to patients without a CNS metastasis. Table 1: HCRU and CostsCosts/HCRU (Mean (SD))T TC L Overall (172)CNS (97)No CNS (75)Overall (172)CNS (99)No CNS (73)Overall (172)CNS (102)No CNS (70)Total costs ($)175,479 (110,859)192,252 (117,801)153,784 (97,728)230,700 (118,127)237,376 (104,470)221,647 (134,688)199,769 (128,546)205,637 (123,428)191,219 (136,112)Rx visits86.3 (59.9)91.4 (66.0)79.6 (50.6)127.1 (51.4)130.5 (52.9)122.4 (49.3)83.3 (60.0)83.7 (60.5)82.6 (59.6)Total Rx costs ($)115,435 (90,443)118,388 (93,686)111,616 (86,543)149,609 (87,173)149,154 (84,852)150,226 (90,814)119,319 (99,587)119,754 (95,819)118,687 (105,539)OP visits189.2 (107.8)213.0 (119.0)158.4 (82.4)259.8 (97.5)269.6 (99.0)246.5 (94.5)196.6 (109.9)197.7 (102.1)195.0 (121.1)Total OP costs ($)45,498 (36,510)54,805 (41,792)33,462 (23,539)62,263 (40,151)69,685 (40,531)52,198 (37,607)69,654 (67,930)74,504 (68,010)62,588 (67,676) Citation Format: Andres Forero-Torres, Vamshi Ruthwik Anupindi, Jason Yeaw, Mitch DeKoven, Joseph Feliciano, Akshara Richhariya. The economic burden of HER2-targeted therapy among metastatic breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-18-17.

Background There are limited data on the treatment patterns, health care resource utilization (HRU), survival outcomes, and medical costs among Medicare beneficiaries newly diagnosed with peripheral T-cell lymphoma (PTCL). Patients and Methods This was a retrospective analysis of data from the Medicare Fee-For-Service claims database using the 100% sample of the Medicare research identifiable files. Patients identified for analysis were aged ≥ 65 years and had received a PTCL diagnosis between January 2011 and December 2017. Outcomes included patient characteristics, HRU, direct all-cause and PTCL-specific health care costs, treatment patterns, and overall survival. Patients were followed until disenrollment, death, or end of the study period. Results Overall, 2551 patients with PTCL were included, among whom 37% had ≥ 1 emergency department visit and 42% had ≥ 1 hospitalization during the pre-index period. During follow-up (median, 2.0 years), 70% of patients were hospitalized at least once (mean length of stay, 1.34 days); 22% advanced to hospice care. A total of 1593 patients received ≥ 1 identifiable treatment regimen post index, of whom 26% received CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and 3% CHOEP (CHOP plus etoposide), whereas 71% received other regimens. The median overall survival among patients receiving identifiable therapy was 4.6 years. The mean adjusted per-person-per-month all-cause costs among the overall PTCL cohort during follow-up were $5930; the mean disease-related costs were $2384. Costs were driven primarily by hospitalizations (38%) and outpatient services (28%). Conclusions Medicare beneficiaries newly diagnosed with PTCL have high HRU and cost burden, with no evident standard of care in real-world practice.

Purpose Hodgkin lymphoma (HL) survivors face long-term, elevated risk of treatment-related sequelae, including psychosocial distress associated with poor health outcomes. The magnitude and sources of distress are not well described in the routine care of HL outside of clinical trials. Methods We conducted a retrospective cohort study of patients visiting a tertiary-care center for treatment or long-term follow-up of HL. Patient-reported distress was documented using the National Comprehensive Cancer Network Distress Thermometer (DT) and Problem List. Three survivor groups were compared using descriptive methods: on treatment, surviving

Along with reducing spleen size, relieving symptom severity is a key objective of the treatment of myelofibrosis (MF). Several questionnaires have been developed for patient self-report of MF symptoms in clinical trials and each includes unique instructions, items, and/or response scales. This variability in questionnaire content increases uncertainty; it is unclear which questionnaire is the most appropriate for assessing MF symptoms and it makes comparisons across trials difficult. The Patient-Reported Outcome (PRO) Consortium's MF Working Group (WG) was established to review existing MF symptom questionnaires and to develop a harmonized, consensus-based PRO questionnaire for use in future MF trials. The WG focused on the seven core symptoms of MF: fatigue, night sweats, pruritus, abdominal discomfort, pain under the ribs on the left side, early satiety, and bone pain. The resulting Myelofibrosis Symptom Assessment Form version 4.0 (MFSAF v4.0) asks respondents to report symptom severity at its worst for each of the seven items on a 0 (Absent) to 10 (Worst Imaginable) numeric rating scale. The MFSAF v4.0, for which there are 24-h and 7-day recall formats, will be maintained and licensed by the Critical Path Institute and made publicly available for use in future clinical trials.

Background: Brentuximab vedotin was approved for adult patients with CD30-expressing cutaneous T-cell lymphoma treated with prior systemic therapy based on improved response rates and progression-free survival with brentuximab vedotin (1.8 mg/kg once every 3 weeks; ≤16 cycles) versus physician's choice (methotrexate/bexarotene; ≤48 weeks) in the phase III ALCANZA study. Quality of life (QoL) in ALCANZA patients was also examined. Methods: QoL measures in ALCANZA were based on the Skindex-29, Functional Assessment of Cancer Therapy-General (FACT-G) and European QoL 5-dimension (EQ-5D) questionnaires. Results: Mean maximum reduction from the baseline Skindex-29 symptom domain score (key secondary end-point) was greater with brentuximab vedotin than physician's choice (–27.96 versus –8.62); the difference, –18.9 (95% confidence interval –26.6, –11.2; adjusted p < 0.001), exceeded the study-defined minimally important difference (9.0–12.3). Mean changes from baseline to end-of-treatment visit total FACT-G scores were similar with brentuximab vedotin and physician's choice (0.15 versus –2.29). EQ-5D changes were also comparable between arms. Among brentuximab vedotin-treated patients with peripheral neuropathy (PN), mean maximum reduction in Skindex-29 symptom domain was –35.54 versus –11.11 in patients without PN. PN had no meaningful effect on FACT-G and EQ-5D QoL scores. Conclusions: In summary, brentuximab vedotin produced superior reductions in symptom burden compared with physician's choice, without adversely impacting QoL. QoL was unaffected by the presence of PN in brentuximab vedotin-treated patients. Clinical trial registration: NCT01578499.

Machaon Bonafede,1 Joseph Feliciano,2 Qian Cai,1 Virginia Noxon,1 Nicole Princic,1 Akshara Richhariya,2 David J Straus3,4 1IBM Watson Health, Cambridge, MA, USA; 2Seattle Genetics, Inc., Bothell, WA, USA; 3Memorial Sloan Kettering Cancer Center, New York, NY, USA; 4John P Leonard Department of Medicine, Weill Cornell Medicine, New York, NY, USA Purpose: The purpose of this study was to evaluate the economic burden of frontline failure (FLF) among classical Hodgkin lymphoma (HL) patients during and after treatment.Patients and methods: The population consisted of adult HL patients identified from January 2010 through September 2015 without any other primary cancer prior to HL diagnosis, who also had a frontline (FL) regimen indicative of curative intent. Patients were characterized as FLF (those who restart, switch to any chemotherapy; had a hematopoietic stem cell transplant; or newly initiated radiation therapy [RT] after discontinuing FL) or non-FLF (those not considered as FLF). Direct health care utilization and expenditures were measured over both fixed and variable length follow-up periods and during FL therapy.Results: There were 77 FLF and 602 non-FLF patients who met the final inclusion criteria. FLF and non-FLF patients were demographically similar with mean age 38.5 years and 47.5% females. Average per patient per month (PPPM) costs were significantly higher for FLF patients during all follow-up (US$20,266 vs US$7,772, P

Objectives: Multi-agent chemotherapy including bleomycin, doxorubicin, dacarbazine, and vinblastine has been the standard of care for initial treatment of Hodgkin Lymphoma (HL) for over 40 y. The study objective was to estimate the rate of new pulmonary events in HL patients exposed to bleomycin. Methods: A retrospective cohort study supplemented by chart abstraction included newly diagnosed adult HL patients from the US DOD military healthcare system between 1/1/2005 and 12/31/2013 and followed until death, disenrollment on 6/30/2016. Patients with concurrent primary malignancies and those receiving

Background: Peripheral T-cell lymphomas (PTCL) are a rare and heterogeneous group of lymphoid malignancies characterized by a clinically aggressive course with poor prognosis. A majority of PTCL patients are ≥60 years of age and typically present with advanced stage disease and multiple comorbidities. There remains no consensus standard of care for patients with most PTCL subtypes. Multi-agent chemotherapy, consisting of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or CHOP with etoposide (CHOEP), are guideline recommended options for nodal subtypes. Limited contemporary real-world data exist on the treatment patterns and overall survival (OS) of PTCL patients treated with CHOP or non-CHOP regimens in the United States before the FDA approval of brentuximab vedotin in combination with chemotherapy in November 2018 based on the ECHELON-2 trial. Objective: To evaluate treatment patterns and OS prior to the approval of brentuximab vedotin among Medicare Fee-for-Service (FFS) beneficiaries newly diagnosed with PTCL. Methods: The 100% sample of Medicare FFS claims (Parts A/B/D) was used to identify patients aged ≥65 years with ≥1 inpatient or ≥2 distinct outpatient diagnosis claims for PTCL (index event) from January 2011 to December 2017. Patients were required to have a least 6 months prior and 12 months post-index continuous Medicare enrollment, and were followed until disenrollment, death, or the end of the study period, whichever occurred first. OS, defined as the time from initial episode or treatment start date to the validated date of death, was measured using the Kaplan-Meier method; patients without a death date were assumed to be alive at the time of analysis and were censored. Results: A total of 2551 Medicare FFS beneficiaries with a PTCL diagnosis met study criteria and were included for analysis. The majority of patients were white (86.9%), over half were male (52.9%), and mean age was 75 years. Patients had multiple comorbidities at diagnosis (Charlson Comorbidity Index (CCI) score 4.47), including hypertension (77.3%), diabetes (32.9%), and chronic obstructive pulmonary disease (28.1%). Among the 2551 patients in the study cohort, 62.4% (n=1593 of 2551) received at least one identifiable drug regimen; 25.5% of treated patients received CHOP (n=407), 3.1% CHOEP (n=50) and 71.2% (n=1134) other regimens. Of patients treated with other regimens, 37.7% (n=427) received steroids only, 22.4% (n=254) steroids with unidentifiable chemotherapy, 6.9% (n=78) cyclophosphamide, 6.2% (n=70) methotrexate, 4.6% (n=52) brentuximab vedotin, 3.6% (n=41) bendamustine, 3.5% (n=40) romidepsin, and 15.2% (n=172) other therapy combinations. Among patients who were treated with CHOP, 16.6% (n=66) received an identifiable second line of therapy (LoT), 48.7% (n=194) an unidentifiable second LoT, and the remainder (34.7%, n=138) had no evidence of further anti-cancer treatment. The median time from CHOP initiation to a subsequent LoT was 5.6 months. The mean baseline CCI score for patients treated with CHOP was 4.33 (±2.93) compared with 4.76 (±2.97) for patients treated with other therapies (p=0.0118). In patients receiving an identifiable first LoT, median OS among CHOP and non-CHOP recipients was 4.8 years (95% CI 3.0-6.1) and 4.4 years (95% CI 3.0-4.9), respectively (Table). The 5-year OS estimate was 49% in patients receiving CHOP compared with 46% for non-CHOP recipients. Conclusions: Fewer than 30% of Medicare beneficiaries newly diagnosed with PTCL were treated with intensive chemotherapy as first LoT. Acknowledging a possible selection bias for more fit PTCL patients receiving CHOP, this group had increased OS compared with patients receiving non-CHOP therapy. However, the 5-year OS across all cohorts was less than 50%. New therapies such as brentuximab vedotin may fill the need for PTCL Medicare beneficiaries who may not be able to tolerate CHOP or CHOP-based regimens. Disclosures Shah: Avalere Health, An Inovalon Company: Employment. Petrilla:Avalere Health, An Inovalon Company: Employment. Rebeira:Seattle Genetics: Employment. Feliciano:Seattle Genetics: Employment, Equity Ownership. LeBlanc:Astra Zeneca: Consultancy, Research Funding; Duke University: Research Funding; Jazz Pharmaceuticals: Research Funding; Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees; Helsinn: Consultancy; Agios: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; NINR/NIH: Research Funding; Amgen: Membership on an entity's Board of Directors or advisory committees; AbbVie: Membership on an entity's Board of Directors or advisory committees; Otsuka: Consultancy, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Research Funding; CareVive: Consultancy; Celgene: Honoraria; Flatiron: Consultancy; American Cancer Society: Research Funding; Heron: Membership on an entity's Board of Directors or advisory committees; Medtronic: Membership on an entity's Board of Directors or advisory committees; Pfizer Inc: Consultancy. Lisano:Seattle Genetics, Inc.: Employment, Equity Ownership.

e19060 Background: The most common frontline treatment for peripheral T-cell lymphoma (PTCL) is cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or a CHOP-like regimen. In the recently reported phase 3 ECHELON-2 trial, brentuximab vedotin (BV) in combination with CHP (A+CHP) demonstrated significant improvement in progression-free survival (PFS) and overall survival (OS) compared to CHOP, with a manageable safety profile. The objective of this analysis was to evaluate the cost-effectiveness of A+CHP in the frontline setting for CD30-expressing PTCL. Methods: A partitioned survival model consisting of 3 health states (PFS, post progression survival, and death), was constructed using clinical and quality of life data from ECHELON-2 from a US payer perspective over a lifetime time horizon. PFS and OS observed from ECHELON-2 were extrapolated using standard parametric distributions. The best-fitting distributions (log-normal for both arms) were selected based on statistical goodness of fit and clinical plausibility of the long-term projections. Health utilities were derived from the European Quality of Life 5-Dimensions (EQ-5D) data collected in ECHELON-2. The average utility scores for the pre- and post-progression periods were estimated via a repeated-measures mixed-effects model. Medical resource use and costs were from literature. Results: The model predicted A+CHP extended undiscounted PFS by 2.92 and OS by 3.38 years over CHOP. These survival gains drive the value in the model. After adjusting for quality of life and discounting, A+CHP was associated with 1.79 quality-adjusted life years (QALYs) gained at an incremental cost of $176,842, yielding an incremental cost-effectiveness ratio (ICER) of $98,987. Sensitivity analyses of alternative model assumptions provided ICERs from $64,000 to $154,000. The estimated probability that A+CHP is cost-effective compared with CHOP was 75% at a willingness-to-pay threshold of $150,000. Conclusions: Based on the ECHELON-2 trial data, this analysis showed for patients with previously untreated CD30-expressing PTCL, treatment with BV in combination with CHP is likely to be cost-effective in comparison to CHOP.

A fourth arm during robotic retroperitoneal partial nephrectomy may provide optimal traction on target tissues and may decrease complications and positive margins secondary to impaired exposure., Introduction: Robotic partial nephrectomy is an effective alternative to laparoscopic partial nephrectomy. The 3-arm and 4-arm transperitoneal robotic approaches are well described in the literature. However, a retroperitoneal robotic technique has yet to be fully described. We report our technique and initial experience with robotic retroperitoneal partial nephrectomy with a novel 4-arm approach. Materials and Methods: We reviewed our current experience with the robotic retroperitoneal approach. Descriptive statistics on patient characteristics, operative parameters, and oncologic outcomes are reported. Results: A total of 67 robotic-assisted partial nephrectomies were performed by one surgeon between October 2009 and October 2010. The 4-arm retroperitoneal approach was used in 8 patients (12%) with no complications. Median tumor size was 2cm. All were posterior renal tumors, with 5 located in the upper pole. The median operative time, warm ischemia time, estimated blood loss, and length of stay were 202 minutes, 18 minutes, 100cc, and 2 days, respectively. Pathology indicated renal cell carcinoma (RCC) in 7 patients with negative margins. Conclusion: The 4-arm robotic approach to retroperitoneal partial nephrectomy is safe, reproducible, and easily used. The fourth arm provides optimal traction on target tissues in key maneuvers and may decrease complications and positive margins secondary to impaired exposure.

Introduction: The standard of care for previously untreated classical Hodgkin lymphoma (HL) in the United States has been combination chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) alone or with radiotherapy depending on clinical characteristics. Other treatment programs exist, including intensified chemotherapy regimens, and substitution of brentuximab vedotin for bleomycin recently received FDA approval as first-line therapy for advance stage HL. The objective of this study was to understand how specific treatment attributes impact preferences among patients and physicians for choice of first-line treatment of HL. Methods: An online survey including a discrete choice experiment (DCE) was administered both to oncologists who manage patients with HL and to patients diagnosed within HL within the last two years in the United States. Participants were identified via online research panels. The attributes and levels of the hypothetical treatments presented in the DCE were informed by targeted literature review and physician and patient interviews. For physicians, six attributes were included: two-year overall survival (OS); two-year progression free survival (PFS); risk of side effects requiring hospitalization; risk of peripheral neuropathy (PN); risk of pulmonary toxicity; and patient out-of-pocket cost. The patient DCE included four attributes: OS, PFS, risk of PN and risk of pulmonary toxicity. DCE scenarios were developed using a d-efficient design. Participants reviewed 10 scenarios, and selected their preference between two hypothetical treatments. Patients considered themselves when selecting their preference; physicians considered four different advanced HL patient profiles that differed in age (30 or 65 years), smoking status, and the presence of baseline PN. The DCE data were analyzed using a mixed logit model (MXL). The relative importance of each attribute was calculated by determining the differences between the maximum and minimum coefficients of each attribute. These were then normalized and presented as percentages. Results: A total of 200 physicians and 141 patients were included in the analysis. Physicians had a mean of 15 years' experience and 71% practiced in a community setting. Patients had a median age of 35 years (range 19 to 69), 60% were male, and 34% were diagnosed with advanced stage HL. In the DCE, the most important attributes to both patients and physicians were OS and PFS. Based on the coefficients from the MXL model, a 1% increase in OS was more important to both groups than a 1% increase in PFS. The coefficients and level ranges for each attribute were used to calculate preference weights (see methods). Based on preference weights, PFS was the most important attribute for patients, followed by OS, risk of pulmonary toxicity, and risk of PN (Table 1). Compared to male patients, there was a trend for female patients to have a lower preference for a 1% decrease in risk of progression (p=0.077). Patients above the median age of 35 years had a significant preference (p=0.048) for a lower risk of pulmonary toxicity, and a trend for a higher preference for a 1% increase in OS (p=0.059) was observed. OS was also marginally more important to patients diagnosed with advanced stage HL versus those diagnosed in earlier stages. For physicians, preferences for treatment attributes differed based on the patient profile presented. PFS outweighed OS for a healthy 35 year-old patient (Table 2), whereas OS had a higher relative preference weight for a 35 year old smoker and older patients. For smokers, physicians ranked pulmonary toxicity as the most important attribute. Among older patients, side effects requiring hospitalization were more important to physicians' preferences than both OS and PFS. There were no major differences in preferences between academic and community oncologists. Conclusion: Patients are willing to accept treatments with worse short and long-term side effects in exchange for improved OS or PFS. Physicians' treatment preferences are patient-specific, with age and comorbidities impacting both the relative weight of OS and PFS attributes and the importance of pulmonary toxicity and short-term side effects. These results underscore the importance of assessing and sharing patient and physician preferences in creating a treatment plan for the management of newly diagnosed Hodgkin lymphoma. Disclosures Feliciano: Seattle Genetics: Employment, Equity Ownership. Mueller:ICON plc: Employment. Korol:ICON plc: Employment. He:ICON plc: Employment. Matasar:Seattle Genetics: Honoraria.

Introduction: Treatment of relapsed or refractory classical Hodgkin lymphoma (R/R cHL) in patients considered ineligible for stem cell transplant (SCT) in the United States (US) has evolved since 2011. It is important to understand the current treatment landscape and the outcomes associated with current standards of care as new treatment options have been introduced. This analysis provides recent real-world evidence on patient characteristics, treatment patterns, and outcomes in R/R cHL patients in the US who are initially considered ineligible for SCT and are treated with or without brentuximab vedotin (BV). Methods: Hematologists and oncologists (N=205) from the US retrospectively identified patients diagnosed with R/R cHL who received at least two lines of therapy and received their most recent line of therapy between January 2014 and May 2018. The physicians were responsible for abstracting data and completing response forms for variables of interest. The current analysis focused on patients who were considered ineligible for SCT by their physician: descriptive statistics on patient demographics/clinical characteristics, treatment patterns, and outcomes by line of therapy; bivariate analyses (chi-square) comparing treatment modalities by line of therapy. Results: Physicians retrospectively identified 297 patients that they considered ineligible for SCT. Mean (SD) age at initial cHL diagnosis was 53.0 (18.5), most patients were male (69.4%) and Caucasian (61.3%). The most common cHL subtype at diagnosis was nodular sclerosis HL (40.4%), and patients had either Stage I/II (45.8%) or Stage III/IV (54.2%) cHL at initial diagnosis. Median follow-up time for the cohort included here was 15.96 months from initiation of 1L treatment. The majority of the cohort (N = 297) received systemic therapy alone (84.5%) compared to those who received systemic therapy in combination with radiation therapy (RT) (15.5%) in 1L. 1L systemic regimens included regimens that contained ABVD alone or ABVD in combination with other regimens (69.4%). Of those who used ABVD alone or in combination with another regimen (N = 206), 24.8% used a PET adapted approach and deescalated to AVD (N = 51) and 11% escalated to be BEACOPP (N = 18). Other systemic regimens included AVD (10.1%), BEACOPP (7.4%) and ICE (5.7 %). The majority of patients achieved a complete response (CR) or partial remission (PR) after 1L therapy (41.4%, 38% respectively) while 34.1% (N = 61) failed to achieve remission or progressed while on therapy. The most common systemic regimens in 2L (N = 293) were BV monotherapy or in combination with bendamustine (34.6%), salvage regimens [including ICE, DHAP, ESHAP or gemcitabine based combinations] (33%), re-challenge with a previous 1L regimen (19.5%), and PD-1 inhibitors (10.8%). Very few patients received systemic therapy in combination with RT (6.7%) in 2L.The most common systemic regimens used in 3L (N = 21) for the selected cohort of patients not eligible for SCT were BV monotherapy (28.6%) and PD-1 inhibitors (33.3%). Median (range) number of cycles in 2L and 3L was four (1-18) and two (1-14), respectively. Treatment outcomes were variable for patients in 2L and 3L. In 2L, 27.6% achieved a CR, 25.6% achieved a PR, while 24.2% and 15.8% were refractory or progressed on treatment. There were no CRs reported in 3L (N = 21). 26 patients died in 2L and 3L combined. Conclusion/Summary: Given the rapid evolution of therapies used to treat R/R cHL, these findings fill a crucial data gap in real-world evidence on patient characteristics, treatment patterns, and outcomes of patients deemed SCT ineligible in the US. Disclosures Feliciano: Seattle Genetics: Employment. Way:Kantar Health: Employment; Seattle Genetics: Research Funding. Engley:Seattle Genetics: Employment. Ghosh:Juno: Consultancy, Research Funding; SGN: Consultancy, Research Funding, Speakers Bureau; PCYC: Consultancy, Research Funding, Speakers Bureau; Celgene: Consultancy; Spectrum: Consultancy; Gilead: Consultancy, Speakers Bureau; Pharmacyclics, an Abbvie Company: Consultancy, Research Funding, Speakers Bureau; Genentech: Research Funding; F. Hoffman-La Roche Ltd: Research Funding; Abbvie: Consultancy, Speakers Bureau; Forty seven Inc: Research Funding; TG Therapeutics: Honoraria, Research Funding.

Introduction: The majority of PTCL cases are pathologically heterogeneous, aggressive and chemorefractory; nearly 70% of patients who undergo induction chemotherapy develop RR disease. Data on how RR-PTCL patients are managed outside of clinical trials and academic settings have not been adequately studied. Understanding how PTCL patients are treated in the real world allows better design of future clinical trials and refined development of novel therapies. This study aimed to describe contemporary treatment patterns, clinical characteristics, and overall survival (OS) among RR-PTCL patients treated in the US community oncology setting. Methods: We conducted a retrospective, observational cohort study of RR-PTCL patients treated between 1/1/2010-12/31/2016. Data were collected from patient medical records abstracted from 30 community oncologists across all geographic areas in the US (38% South, 22% West, 7% Midwest, 26% Northeast, and 7% unknown). Patient characteristics, treatment patterns, adverse events (AEs), physician-reported response to first- and second-line (1L, 2L) treatments, and date of death were collected. Descriptive statistics were calculated to summarize patient characteristics and study outcomes. Median (95% confidence interval [CI]) OS from RR disease was calculated by the Kaplan-Meier method. Results: We analyzed 200 RR PTCL patients (71% received CHOP, 20% received CHOEP, and 9% received another regimen as 1L systemic therapy). The majority (58%) were PTCL not otherwise specified (NOS), 61% were males, and median age was 62 years (range: 20-90) (Table). Overall response rate (ORR) to 1L treatment was 80% (CR, 54%; PR, 26%), and ORR to 2L treatment was 55% (CR, 31%, PR, 24%). Among all PTCL patients and among those with PTCL NOS, the OS (95% CI) from RR disease was 13.0 months (95% 7.0-not estimable) and 9.0 months (95% 6.0-not estimable), respectively (Figure). Median time to RR disease from 1L initiation was 12.9 months. Median durations of 1L and 2L treatments were 4.4 months and 3.7 months, respectively. Among those who continued to 2L therapy, 27% received brentuximab vedotin (2% in combination), 19% received ICE (carboplatin/cisplatin, ifosfamide, etoposide), 13% received romidepsin (2% in combination with pralatrexate), 10% received pralatrexate monotherapy, 7% received GEMOX (gemcitabine, oxaliplatin), and the rest (22%) received other 2L regimens or an unknown regimen (2%). After 1L initiation, only 14/200 (7%) received hematopoietic stem cell transplant (HSCT) and 28/151 (19%) after 2L. AEs resulting in a dose reduction, discontinuation, or hospitalization during 1L treatment and occurring among ≥10% included anemia (39%), thrombocytopenia (27%), neutropenia (23%), mouth sores (16%), diarrhea (15%), neuropathy (14%), febrile neutropenia (13%), and vomiting (10%). Conclusions: While response to 1L treatment in this cohort was high (80%), all developed RR disease (or died), for whom the prognosis remains poor. Very few patients underwent HSCT in any line of therapy. Our data demonstrate the unmet medical need for RR-PTCL patients and the need for novel therapies in the 1L setting. It also underscores the need to better understand factors leading to treatment selection and optimal treatment sequencing in the real world. Disclosures Nabhan: Cardinal Health: Employment, Equity Ownership. Laney:Cardinal Health: Employment, Equity Ownership. Feliciano:Seattle Genetics: Employment, Equity Ownership. Lee:Cardinal Health: Employment. Klink:Cardinal Health: Employment, Equity Ownership.

Introduction: Peripheral T-cell lymphomas (PTCL) are a rare heterogeneous group of lymphoid malignancies, which originate from post-thymic (or mature) T-cells. Although there are approximately 7,000 new cases of PTCL in the US annually, PTCL is extremely heterogenous and difficult to diagnose even in academic settings (Teras et al. 2016. CA Cancer J Clin 2016; 66:443-459). Prior research suggests a high rate of diagnostic revision among PTCL patients. The objective of this analysis was to describe the rate of diagnostic revision among patients with a PTCL diagnosis using 2 large, real-world US databases. Methods: This retrospective analysis used the IBM MarketScan Commercial and Medicare Supplemental administrative claims databases (claims) and the IBM Explorys Research Database, an electronic health record (EHR) database; both databases have national coverage but are fundamentally different in their structure and data sources. Adults (age ≥18 years) with a new diagnosis of PTCL between January 2010 and June 2017 were identified in each database. The prevalence of diagnostic revision was the primary outcome, defined as the diagnosis of a non-PTCL diagnosis before or after the PTCL diagnosis with the latest diagnosis serving as the index date. Other lymphomas included were Hodgkin's, diffuse large-B-cell (DLBCL) and marginal zone lymphoma. The presence of anaplastic large cell lymphoma, mature T/NK-cell lymphomas, and other subtypes of T/NK-cell lymphomas closely related to PTCL were described but were not classified as diagnostic revision. Patients were required to have 12 months of pre-index and one month of post-index continuous enrollment (claims) or evidence of database activity (EHR). Results: 2561 patients met the selection criteria for the claims database analysis (mean age 59.9 [SD=15.4]; 42.9% female) and 1,881 met the EHR criteria (mean age 64.3 [SD=15.2]; 47.0% female). Diagnostic revision was present among 29.3% of PTCL patients in the claims analysis and 21.6% of PTCL patients in the EHR analysis. Among patients with diagnostic revision, 51.4% revised to PTCL and 48.6% revised from PTCL in the claims analysis, while 56.0% revised to PTCL and 44.0% revised away from PTCL in the EHR analysis. Among patients with diagnostic revision from PTCL, 37.5% were revised to DLBCL, 17.0% revised to Hodgkin's disease, and 4.9% to marginal zone lymphoma in the claims analysis, and 42.5% revised to DLBCL, 10.6% revised to Hodgkin's disease, and 7.9% to marginal zone lymphoma in the EHR analysis. Among patients with diagnostic revision to PTCL, 32.0% revised from DLBCL, 14.9% revised from Hodgkin's disease, and 5.2% from marginal zone lymphoma in the claims analysis, and 34.6% revised from DLBCL, 11.1% revised from Hodgkin's disease, and 10.3% from marginal zone lymphoma in the EHR analysis. The average time from the first diagnosis to the final diagnosis in the 12-month baseline period was 150.9 [SD=128.2; median 122.5] days in the claims analysis and 167.4 [SD=127.6; median=128.5] days in the EHR analysis (Table 1). Baseline Deyo Charlson Comorbidity Index scores were higher among patients with diagnostic revision in both the claims (4.1 [SD=2.8] vs. 2.8 [SD=2.5]) and EHR (2.4 [SD=2.5] vs. 4.4 [SD=3.1]) analysis (both p Conclusions: This analysis reaffirms the need for appropriate diagnostic criteria and expertise when diagnosing PTCL and its subtypes. The analysis is limited to patients who meet the inclusion criteria for 1 of the 2 databases and generalizability of study results are subject to those same limitations. Differences in diagnostic revision rates between the databases may be due to underlying differences in patient populations in the data sources or potential coding differences in data contributors. Diagnostic revision is common among subtypes of PTCL and can serve as area for quality improvement in the field of hematology oncology to promote accurate diagnosis closer to when lymphoma presentation becomes apparent. Disclosures Feliciano: Seattle Genetics: Employment, Equity Ownership. Bonafede:Seattle Genetics: Other: I am an employee of IBM Watson Health (formerly Truven Health Analytics), which received a research contract to conduct this study with and on behalf of Seattle Genetics.. McMorrow:Seattle Genetics: Other: I am an employee of IBM Watson Health (formerly Truven Health Analytics), which received a research contract to conduct this study with and on behalf of Seattle Genetics.. Park:Seattle Genetics: Other: I am an employee of IBM Watson Health (formerly Truven Health Analytics), which received a research contract to conduct this study with and on behalf of Seattle Genetics.. Lisano:Seattle Genetics: Employment, Equity Ownership. Manley:Seattle Genetics: Employment, Equity Ownership.

Introduction Most existing cancer registries do not fully capture relapse or progression of cancer. Further, clinical trials for upfront treatment typically withdraw patients from study at the time of treatment failure and only collect minimal information about approaches to and outcomes with salvage therapy. As such, patient outcomes other than mortality often are available only through formal chart review, which is resource intensive. For HL, although many patients are successfully cured, a sizeable subset of patients experience treatment failure. Most of the data describing failure arises from prospective clinical trials, despite most patients receiving treatment in the community setting. Therefore, data from the community setting are needed to understand the experience of real-world patients and to inform and improve the quality of care in oncology practices. To facilitate observational research and quality improvement projects on HL treatment failure, we examined an EHR-based algorithm for identifying treatment failure in HL. Methods All HL patients who initially presented with advanced stages II-IV disease between 2007-2012 at Kaiser Permanente Southern California (KPSC) were identified using KPSC's cancer registry. An algorithm for identifying treatment failure was proposed by study oncologists. Treatment failure was defined as relapse after complete remission of > 60 days' duration or disease progression on active treatment. The algorithm was defined as meeting one of the following: (1) Initiation of any second chemotherapy regimen, including use of brentuximab vedotin, or PD-1 inhibitor beyond initial regimen; or (2) stem cell transplantation (SCT). Data needed to construct the algorithm were collected from KPSC's EHR, including the chemotherapy database and transplant registry. The algorithm was applied to all HL cases up to 4 years after diagnosis, as most HL relapses occur within this timeframe. Manual chart reviews were performed for all potential treatment failure cases identified by the algorithm, and for one-third of randomly-selected HL cases not captured by the algorithm. Each case was abstracted by trained study staffed and reviewed for quality control by two study oncologists. Results Of the 470 HL patients newly diagnosed during the study period (91% diagnosed at age 18 and older, 57% male), the algorithm identified 80 as potential treatment failure cases. Chart review confirmed 75 of 80 as actual treatment failure. The algorithm misclassified relapse for 5 cases who had emergence of a second malignancy for which therapy was instituted after the completion of initial therapy for HL. The positive predictive value (PPV) was 94% (95% confidence interval: 89%-99%). The negative predictive value (NPV) based on the review of 127 patients not captured by the algorithm was 100%. Based on the high PPV and NPV, our review suggested both a high sensitivity and specificity of the algorithm. Conclusion This EHR-based algorithm, based on receipt of second-line therapy beyond initial treatment and SCT, was highly effective in capturing relapse or disease progression cases among HL patients in this integrated health care delivery system. Application of this algorithm will allow for better long-term follow up for novel agents in observational studies, which is critical for understanding the cost-effectiveness of therapeutic agents in real-world patients. External validation using data from other health care settings or sources such as claims data will be useful to further confirm the generalizability of this algorithm. Altogether, this algorithm could assist practices in the identification and prospective tracking of the relapsed/refractory HL patient population for clinical and non-clinical outcomes, such as cost, health-related quality of life, and sequelae of treatment. Disclosures Chao: Seattle Genetics: Research Funding. Xu:Seattle Genetics: Research Funding. Cannizzaro:Seattle Genetics: Research Funding. Rodday:Seattle Genetics: Research Funding. Feliciano:Seattle Genetics: Employment, Equity Ownership. Kumar:Seattle Genetics: Research Funding. Evens:Seattle Genetics, Inc.: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics International DMC: Membership on an entity's Board of Directors or advisory committees; Tesaro: Research Funding; Abbvie: Consultancy; Janssen: Consultancy; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Affimed: Consultancy; Novartis: Consultancy; Acerta: Consultancy; Bayer: Consultancy. Parsons:Seattle Genetics: Research Funding.

e22070Background: Multi-agent chemotherapy including bleomycin has been the standard of care for initial treatment of Hodgkin lymphoma (HL) for over 30 years. The incidence of pulmonary events asso...

Fluoroquinolones have been shown to decrease infective complications after prostate biopsy. However, fluoroquinolone resistance is emerging. We quantified contemporary rates of infective complications and the incidence of fluoroquinolone resistant infections after prostate biopsy under fluoroquinolone prophylaxis.We retrospectively evaluated the records of 1,273 patients who underwent prostate biopsy at New York Harbor Veterans Affairs Hospital from January 2004 to December 2006. Patients received levofloxacin or gatifloxacin. Using the Veterans Affairs computerized patient record system we reviewed all patient visits within 1 month after prostate biopsy. Visits were queried for infective symptoms. Positive cultures were evaluated for resistance patterns. The annual and overall incidence of infective complications and fluoroquinolone resistant infections was calculated.Of 1,273 patients 31 (2.4%) presented with infective symptoms after biopsy. The overall incidence of fluoroquinolone resistant infections was 1.2% (15 cases). When stratified by year, there were statistically significant increases in the incidence of infective complications and fluoroquinolone resistance from 2004 to 2006. Of the positive cultures those from 89% of patients yielded Escherichia coli and 90% were fluoroquinolone resistant. Fluoroquinolone resistant E. coli were also resistant to gentamicin in 22% of cases, trimethoprim/sulfamethoxazole in 44%, piperacillin in 72% and ampicillin in 94%. However, 100% sensitivity was demonstrated for amikacin, ceftazidime and ceftriaxone.Fluoroquinolones are still effective as antibiotic prophylaxis for prostate biopsies but there is an increase in infective complications and fluoroquinolone resistance. When patients present with post-prostate biopsy infective symptoms, almost 50% are associated with fluoroquinolone resistant pathogens. Empirical treatment with ceftriaxone, ceftazidime or amikacin should be initiated until culture specific therapy can be implemented.

e18260Background: Myelofibrosis (MF) patients often present with cytopenias related to disease progression or treatment. This retrospective study examined the prevalence and healthcare resource bur...

e18556Background: Pharmacologic and medical management of myelofibrosis (MF) in the real world is not well characterized. This retrospective study examined current MF treatment patterns in the Unit...

Introduction: Robot-assisted laparoscopic partial nephrectomy (RPN) is a safe and effective minimal invasive approach to nephron-sparing surgery (NSS).1–3 In an effort to preserve functional renal outcomes, techniques have been developed to minimize ischemia time during NSS. These include zero ischemia technique with hypotension4 and selective arterial clamping,5 but both are technically demanding and complex. To facilitate selective clamping during robotic NSS, we utilized the daVinci fluorescence video system (Intuitive Surgical Inc.) to assist in identifying target arterial branches and assess tissue perfusion of target areas for resection. Herein, we report our technique and initial experience with video fluorescence angiography and its application in selective arterial clamping during RPN. Materials and Methods: Included in this video are two cases in which we utilized the daVinci video fluorescence system with real-time indocyanine green (ICG) angiography during RPN. ICG is an optical contr...

Splenic laceration is a recognized complication of both open and laparoscopic renal surgery. Laparoscopic renal surgery continues to become the new standard of care, and this potentially problematic complication may be encountered during mobilization to gain access to the retroperitoneum. We present 2 cases of splenic injury managed with BioGlue, a new surgical adhesive, during one hand-assisted and one pure laparoscopic nephrectomy. Application of the BioGlue adhesive resulted in satisfactory hemostasis for both injuries without the need for further intervention. These preliminary observations suggest that BioGlue may be a useful addition to the urologic armamentarium to achieve hemostasis in laparoscopic surgery.

8042 Background: Ages > 80 represent the most rapidly growing segment of society. Incidence of NHL rises exponentially with age; however, sparse data exist among the > 80 pt group. Methods: We comp...