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16 Background: Randomized clinical trials have demonstrated the survival benefit provided by the addition of biologic drugs to chemotherapy (biochemotherapy) in patients with metastatic colorectal cancer (mCRC). However, Hispanic patients are underrepresented in trial populations with limited data on treatment efficacy in them. We aim to compare effectiveness of chemotherapy vs biochemotherapy among Hispanic population in the US with mCRC. Methods: This study includes two cohorts of patients: 1. age ≥ 65 years mCRC diagnosed from 2004 to 2011 who had received at least 1 dose of chemotherapy and had complete Medicare claims data using the Surveillance, Epidemiology, and End Result (SEER)–Medicare linked database, and 2. local Hispanic population from two hospitals in Bronx, New York, from 2006- 2020. Patient data were classified according to whether they received chemotherapy (oxaliplatin, irinotecan, and 5-fluorouracil or capecitabine) or biochemotherapy (bevacizumab, cetuximab, panitumumab, ramucirumab, or aflibercept, started within 3 months of chemotherapy). Overall survival (OS) was defined as the time from starting chemotherapy to death or last follow-up. A weighted Cox regression model was used to assess differences in survival. Results: A total of 188 patients with mCRC were identified. Fifty three (28.2%) received chemotherapy and 135 (71.8%) received biochemotherapy. Median ages were 69 and 68 years, respectively. There were no differences based on median income, marital status, primary site or sidedness, tumor differentiation grades or Charlson Comorbidity Score between both groups. Among patients who received only chemotherapy, 9% received second or greater lines of chemotherapy when compared to 51% in the biochemotherapy group (p st year. Patients receiving biochemotherapy are more likely to receive further lines of chemotherapy upon disease progression.

e15512 Background: While more aggressive clinical/pathological features have been consistently described in between patients with early-onset (EO) and standard-onset (SO) colorectal cancer (CRC), survival data have been conflicting. While some studies report better survival rates for EO-CRC; others found that outcomes among groups are not different. In a prior study, using the Surveillance, Epidemiology and End Results (SEER), we reported that cancer-related survival did not differ between EO-CRC and SO-CRC; however, a main limitation was the lack of molecular status and treatment details among groups. This study aims to compare the survival of EO-CRC and SO-CRC patients at Montefiore Medical Center. Methods: Retrospective cohort among 690 patients diagnosed with metastatic colorectal cancer (CRC) at Montefiore Medical Center between 2010 and 2018. Patients were identified using the software Clinical Looking Glass and charts were reviewed manually to gather information about demographics (race/ethnicity defined as Non-Hispanic White [NHW], Non-Hispanic Black [NHB] and Hispanic [H], gender, comorbidity index, calculated using the Charlson comorbidity score), clinicopathological features (grade, tumor sidedness, K-ras mutation) and treatment-related characteristics (metastatectomy, lines of chemotherapy and use of biologics). EO-CRC was defined as CRC diagnosis before age 50 and SO-CRC as CRC diagnosed at 50 years or older. Overall survival was compared between EO-CRC and SO-CRC using Kaplan Meier and Cox regression analyses. Stata v15.1 was used for statistical analysis. Results: Of 690 patients with CRC, 139 (20.1%) had EO-CRC and 551 (79.9%) had SO-CRC. Participants with EO-CRC had a higher frequency of poorly-differentiated tumors (35.5% vs. 23.8%, p = 0.02), a lower comorbidity index (6 vs. 7, p < 0.001). and a higher use of biologics (70.5% vs. 60.8%, p = 0.03) compared to SO-CRC. K-ras mutation was available for 377 (54.5%) of cases and did not differ among groups (45.9% vs. 45.9%, p = 0.99). In a model adjusted for race/ethnicity, gender, comorbidity index, sidedness, use of biologics and metastatectomy, there was no difference in mortality among groups (HR:0.9, 95%CI: 0.58 – 1.43, p = 0.68). This result remained unchanged in a model restricted to patients with available K-ras-status (n = 75), adjusted for all these variables. Conclusions: Despite more aggressive clinical/pathological features in patients with EO-CRC, survival does not differ compared to SO-CRC.

24 Background: Early onset colorectal cancer (EO-CRC, age < 50 years) is an emerging public health crisis, especially in minorities. We evaluated and compared the effects of Medicaid expansion on the incidence of EO-CRC among Hispanics, Blacks, and Whites across the United States. Methods: The National Cancer Data Base was used to collect data on newly diagnosed cases of EO-CRC (40-49 years) among the three races, across all stages, from 2010-2017. Data for 21 expansion states (ES) that expanded Medicaid in 2014, and 16 non-expansion (NES) states was analyzed, excluding the states which expanded after 2014.The yearly state-wise population of all three races was collected from the U.S Census Bureau for 2010-17. A segmented Poisson regression model with generalized estimating equations was used for statistical analysis. Results: Annual incidence (AI) of EO-CRC pre and post expansion, in ES was 6/100,000 and 9/100,000 in Hispanics; 17/100,000 and 21/100,000 in Blacks and 14/100,000 and 18/100,000 for Whites. In NES the AI, pre and post 2014 was 8/100,000 and 10/100,000 among Hispanics, 19/100,00 and 24/100,000 among Blacks and 16/100,000 and 20/100,000 among Whites. Rate of change in AI of EO-CRC among Hispanics was 4.3% per year (2010-14), and 9.8% (2014-17) for ES states; and 6.4% (2010-14), and 1% (2014-17) in NES; among blacks was 3.8 % per year (2010-14), and 1.3% (2014-17) for ES states; and 1.6% (2010-14), and 3.2% (2014-17) in NES. Among Whites, increase in AI was 4.3% per year (2010-14), and 6.3% (2014-17) for ES states; and 4.0% (2010-14), and 5.7% (2014-17) in NES. ES showed greater change in incidence after expansion compared to pre-expansion in the incidence of EO-CRC as compared to NES (p=0.03) in Hispanics, however no significant difference was noted among Blacks (p=0.33) and Whites(p=0.94). Racial groups did significantly differ with respect to the degree of change in pre and post expansion (2014) rates of incidence of EO- CRC in the ES, however, in the NES, there were significant difference between the Hispanics and Whites (p=0.01), but not between Blacks versus Whites. Conclusions: Medicaid expansion reduces racial disparities in detection of EOCRC.[Table: see text]

3547 Background: Early onset colorectal cancer (EO-CRC, age < 50 years) is an emerging public health crisis; especially in Hispanics. Access to healthcare is critical for timely detection and is tied to medical insurance. In 2010, the Affordable Care Act allowed for expansion of Medicaid eligibility across the country, however, states were permitted to opt out by the US Supreme Court ruling of 2012, which created an unintended experiment in the healthcare market. We evaluated the effects of Medicaid expansion on the incidence of EO-CRC among Hispanics with the hypothesis that it would lead to an increase in incidence and early detection EO-CRC. Methods: The National Cancer Data Base was used to collect data on newly diagnosed Hispanics with EO-CRC (40-49 years), across all stages, from 2010-2017. Data for 21 expansion states (ES) that expanded Medicaid in 2014, and 16 non expansion (NES) states was analyzed. The yearly state-wise Hispanic population was collected from U.S Census Bureau for 2010-17. Incidence was computed as number of new cases of CRC divided by size of the state’s Hispanic population. Segmented Poisson generalized linear mixed effects model was used to analyze rate of change in yearly incidence of EOCRC before and after 2014, in ES and NES. Results: Average annual incidence (AI) of EO-CRC in Hispanics was 6/100,000 and 8/100,000 pre and post expansion, in ES, and 8/100,000 and 9/100,000 pre and post 2014 in the NES, respectively. Increase in AI of EO-CRC was 3.6% per year (2010-14) (95% CI: -0.1% to 7.4%), and 9.8% (2014-17) (95% CI: 5.2% to 14.7%) for ES states; and 6.4% (2010-14) (95% CI: 2.1% to 10.8%), and 1% (2014-17) (95% CI: -3.8% to 6.1%) in NES. ES showed greater change in EO-CRC incidence post expansion (2014) vs. pre-expansion, as compared to NES (p=0.078) table. There was no difference in stage at diagnosis between pre- and pos- expansion periods between ES and NES. Conclusions: Increase in incidence of EO-CRC in ES is likely due to greater access to health care due to Medicaid coverage as compared to NES. Other potential factor is migration of Medicaid eligible persons from NES to ES. However we need data past 2017 to confirm the current trend.[Table: see text]

141 Background: Differences in incidence, clinical features, and survival between early-onset (EO) and standard-onset (SO) colorectal cancer (CRC) are well-established. Factors associated with longer survival have not been reported. We aim to determine clinical and treatment factors associated with longer survival in patients (pts) with metastatic EO and SO CRC. Methods: Pts with metastatic CRC diagnosed between 2010-2019 at two NYC hospitals were identified by tumor registry and classified as EO (diagnosis at < 50 years) or SO (diagnosis at ≥ 50 years). Median overall survival (OS) was calculated for each group using Kaplan Meier curves. Long-term survival was defined as OS > 2 years (EO-CTC median OS). Data was collected by chart review and compared between short vs long-term survivors in EO and SO CRC pts independently. Stata v15 was used for statistical analysis. Results: Of 646 pts, 144 (22.3%) had EO and 502 (77.7%) had SO. High grade tumors were more likely in EO (33.3% vs 24%, OR: 1.59, p = 0.04) than SO; whereas no differences were seen in gender, sidedness, KRAS mutation or chemotherapy. Biologics were used more frequently in EO than SO (OR = 1.7; p = 0.008]. Median OS was 2.1 and 1.9 years in EO and SO. There were 53 (36.8%) and 175 (35.1%) long-term survivors in EO and SO groups. In pts with SO, metastasectomy, irinotecan-based chemotherapy and use of biologics were significantly associated with long-term survival, whereas metastasectomy was the only associated factor in pts with EO. Conclusions: Metastatectomy was the only factor associated with longer survival in both EO and SO groups. Other clinical/pathological and treatment-related factors associated with long-term survival among SO-CRC were not associated with long-term survival among EO-CRC patients. [Table: see text]

21 Background: Globally, the incidence of early-onset colorectal cancer has risen. Racial disparities in colorectal cancer (CRC) are well-described, however data in EO by race/ethnicity is lacking. We aim to compare the presenting features, treatment, and survival features of patients with metastatic early-onset CRC (EO). Methods: Patients with metastatic CRC diagnosed between 2010-2019 at two NYC hospitals were identified by tumor registry (n = 646). Clinical/pathological features, treatment and survival data was collected by chart review and compared between Non-Hispanic Whites (NHW), Non-Hispanic Blacks (NHB) and Hispanics (H) using Chi-square or Fisher’s exact test. Kaplan Meier curves were plotted to compare overall survival (OS) among groups. Stata v15 was used for statistical analysis. Results: Of 646 CRC patients, 126 (21.5%) were NHW, NHB or H diagnosed with EO with a frequency ranging from 16.6% in NHW to 26.1% in H. Non statistically significant lower frequencies of male gender, low/moderate grade, left-sided tumors,and higher frequency of KRAS mutations were seen in NHB (Table). Metastectomy was performed in 20 patients (13.9%) and did not differ between groups. There was no difference in the use of chemotherapy or biologics in general (Table), but NHW were more likely to get cetuximab than NHB (OR:4.5, p = 0.02) and H (OR:4.7, p = 0.02).There were no differences in median OS (1.8 vs. 2.2 vs. 2 years, p = 0.9)or 1-year OS (72% vs 72.3% vs 70.8%) in NHW, NHB and H, respectively. A lower 5-year OS was seen in NBH (14.5%) and Hispanics (24.4%) compared to NHW (44%). Conclusions: EO-CRC is more frequently seen in minority racial/ethnic groups. Despite no differences in the use of chemotherapy or biologic treatment in general, NHB have a lower 5-year survival rate compared to NHW and H. [Table: see text]

8063 Background: Information on central nervous system (CNS) involvement with NA-ATLL is limited. In this study, we describe CNS involvement in ATLL patients at a tertiary hospital in New York City. Methods: We considered CNS involvement if one of the following criteria was met 1) cerebrospinal fluid (CSF) cytology or flow cytometry was positive 2) CNS imaging was positive for disease involvement or 3) Physical exam findings were compatible with neurologic involvement. Results: Of 94 NA-ATLL patients, 21 (22.3%) had CNS involvement by ATLL. CSF was involved in 13/21 and 5/21 patients at diagnosis and relapse respectively. At diagnosis, MRI showed CNS involvement in brain and spine in 5/21 (24%) and 3/ 21 (14%) cases respectively. At relapse, imaging revealed brain and spine involvement in 2 patients each. Neurological exam was abnormal in 7 (33%) and 3 (14%) cases at diagnosis and relapse respectively. Next generation exon targeted sequencing was performed in 9 cases. Table shows the mutations (mtn) and functional groups with frequencies. XPO1 E571K mutation was present in 2 patients with extensive CNS disease and refractory to conventional treatment with an overall survival (OS) of 2 months. To our knowledge, this is the first time that XPO1 E571K is reported in a T-Cell malignancy. We also describe here a second set of mutations with CNS involvement (KLF2 and PI3KCD) in 2 patients. Median OS was 8.5 months, Median RFS was 6.5 months in our series. In most cases, the lymphomatous phenotype appeared to have direct mass-like extension (5/21) with several cases of accompanying osteolytic spine or skull lesions, whereas cases with hematogenous involvement tends to spread to the CSF by traversing the brain blood barrier. Conclusions: In this report we describe patterns of CNS involvement in ATLL and the associated mtns. We also describe two unique cases of XPO1E571K mtn in a TCL. [Table: see text]