The updated SIOG COVID-19 working group recommendations on COVID-19 vaccination among older adults with cancer

Background: Older patients with cancer remain at high risk for negative outcomes from COVID-19 infection, particularly those who have multimorbidities and on immunosuppressive therapy. These patients have been excluded or underrepresented in pivotal COVID-19 vaccine clinical trials and there are ongoing concerns that they may not acquire the same level of protection from the available vaccines as the immunocompetent adults. Moreover, the level of protection wanes over time making them more susceptible to emerging COVID-19 novel variants of concern. Despite the implementation of global vaccination campaigns which have successfully reduced COVID-related hospitalisations and deaths in many parts of the world, there remains many unresolved issues and challenges to address as the pandemic ensues. With aging, concerns for age-related dysregulation and immune dysfunctions called immunosenescence may lead to potentially lower immunogenicity to vaccines. Despite receiving the primary vaccination, real-world evidence showed that both patients aged > 65 years and those with cancer have a higher risk of developing breakthrough COVID-19 infections and related complications. Subsequent booster doses are found to be effective at improving immune response, particularly against the novel variants, and the vulnerable population should be given the priority in booster campaigns. Method(s): Since the beginning of the pandemic in 2020, The International Society of Geriatric Oncology set up a COVID-19 Working Group comprised of multidisciplinary specialists by developing recommendations, advocacy, and action plans based on expert opinion and evidence related to older adults with cancer. Result(s): The table below summarises the updated recommendations from the SIOG COVID-19 Working Group. Conclusion(s): The SIOG COVID-19 Working Group supports ongoing public health interventions, continued mass immunisations, and booster campaigns targeting the most vulnerable members of the society, including older adults with cancer (Table Presented).

Early prediction of efficacy of endocrine therapy (ET) in metastatic breast cancer (MBC): Pilot study with [18F]fluoro-estradiol-17β (18F-FES) PET/CT

Background: Estrogen receptors (ER) are predictive of endocrine responsiveness. However, 30% of ER+ BC patients will relapse despite adjuvant ET and 10 to 20% of metastatic lesions loose the expression of ER. The early identification of endocrine resistant patients may help to improve treatment strategies, especially in the light of innovative drugs recently approved. In the ET-FES trial we evaluated 18F-FES CT/PET as a prediction tool for endocrine responsiveness in ER+ MBC. The ET-FES study was funded by the ERANET-Transcan project. Methods: MBC patients with ER+/HER2- disease, were eligible for the ET/FES study. All patients underwent a baseline [18]F-FES PET/CT in addition to conventional procedures. Patients were classified as endocrine sensitive if overall Standardized Uptake Value (SUV) ≥ 2 and received ET;patients with SUV <2 were randomized to receive ET or chemotherapy (CT). The prognostic role of [18]F-FES PET/CT was assessed for PFS and OS by univariate and multivariate analyses. The primary endpoint was disease progression rate (DPR) at 6 months. Results: From April 2015 to October 2020 146 patients, from 7 EU centers were enrolled: of them, 115 with a mean SUV >2 received ET and 30 with SUV <2 were included in the randomized study. Median follow up was 18.4 months (range 8.0 to 38.3 months) in endocrine sensitive patients (SUV > 2) versus 10.1 months (range 8.0 to 36.8) in patients with SUV <2. Overall, at the time of this analysis 67 patients (45.9%) had disease progression and 37 (25.3%) died. DPR at 6 months was 57% in patients with SUV >2 vs 50% in SUV <2 randomized to ET and 57% in case of CT. DPR at 12 months was 35% vs 17% and 14%, respectively. Median PFS was 7.3 months (IQR 3.8 – 17.3) vs 5.2 (IQR 3.1 – 9.4) vs 7.7 months (IQR 3.0 – 14.0), respectively. OS rate at 12 months was 31% versus 17% versus 14%. Conclusions: The ET-FES clinical trial was prematurely interrupted, due to COVID-19 pandemic. The discriminating ability of this assay was high, leading to a personalized endocrine approach;a considerable proportion of patients with a mean SUV >2 is still on ET. Clinical trial identification: EudraCT 2013-000287-29. Legal entity responsible for the study: Alessandra Gennari - Università del Piemonte Orientale. Funding: AIRC. Disclosure: All authors have declared no conflicts of interest.

European Society for Medical Oncology (ESMO)/International Society of Geriatric Oncology (SIOG) Joint Working Group (WG) survey on management of older patients with cancer

Background: ESMO and SIOG created a joint WG in 2019. Their goals are to improve management of the older cancer patients through education, dedicated resources and guidelines and to raise awareness on their specific needs and requirements. Therefore, the WG initiated a survey to describe the practice patterns worldwide. Methods: All ESMO and SIOG members received a request by email to complete the survey online on 17 Feb 2020 with subsequent reminders. Questions were focused on clinical practices, perception of geriatric oncology (GO), use of screening tools such as geriatric-8 (G8), education and knowledge of guidelines. The survey was closed on 5 Apr 2020. Results: A total of 168 participants fully completed the survey. Most of them were female (65%), aged 30-39 (58%), medical oncologists (70%) and from Europe (50%). Professionals predominantly in charge of front-line care of older patients with cancer were medical oncologists (68%);however, only 19% had a physician coordinating a GO programme at their institution. According to respondents, GO brings to oncology: detection of frailty (83%), prediction of toxicity (77%), integrative management (70%), improving older patient’s understanding of treatment and adherence (64%), providing practice guidelines (46%) and prediction of survival (41%). Most of the respondents (95%) felt the need for other scales than ECOG Performance Status, 66% knew about the G8 scale and 52% used it in their clinical practice. Non-SIOG members were significantly less aware of the G8 screening tool (56% vs 97% for SIOG members;p<0.001) and less prone to use it in clinical practice (50% vs 61% for SIOG members;p=0.002). G8 use (or knowledge) was not affected by place of work nor region of the world. Finally, 76% felt that “all oncologists should be geriatric oncologists” and 96% that they needed more information and education in GO. Conclusions: The care of older patients with cancer is very heterogeneous. Despite the low number of responses, probably affected by the first lockdown of COVID-19 pandemic, there is a clear need for training in GO and information about the screening tools. Legal entity responsible for the study: ESMO/SIOG WG. Funding: Has not received any funding. Disclosure: C. Baldini: Financial Interests, Personal, Invited Speaker: BMS;Financial Interests, Personal, Invited Speaker: AZ;Financial Interests, Personal, Invited Speaker: Sanofi;Financial Interests, Institutional, Research Grant: BMS;Financial Interests, Institutional, Principal Investigator: Seattle Genetics;Financial Interests, Institutional, Principal Investigator: Iteos;Financial Interests, Institutional, Principal Investigator: Tahio. E.G.C. Brain: Financial Interests, Personal, Invited Speaker: Lilly;Financial Interests, Personal, Advisory Board: BMS;Financial Interests, Personal, Advisory Board: Pfizer;Financial Interests, Personal, Advisory Board: G1 Therapeutics;Financial Interests, Personal, Advisory Board: TLC PharmaChem. L. Biganzoli: Financial Interests, Personal, Invited Speaker: Lilly;Financial Interests, Personal, Advisory Board: AZ;Financial Interests, Personal, Advisory Board: Daiichi;Financial Interests, Personal, Advisory Board: Eisai;Financial Interests, Personal, Advisory Board: Genomic Health;Financial Interests, Personal, Advisory Board: Pierre Fabre;Financial Interests, Personal, Advisory Board: Novartis;Financial Interests, Personal, Advisory Board: Pfizer;Financial Interests, Institutional, Research Grant: Celgene;Financial Interests, Institutional, Research Grant: Genomic health;Financial Interests, Institutional, Research Grant: Pierre Fabre. V. Goede: Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker: Janssen;Financial Interests, Personal, Invited Speaker: Gilead;Financial Interests, Personal, Invited Speaker: Heel;Financial Interests, Personal, Advisory Board: Janssen;Financial Interests, Personal, Advisory Board: Gilead;Financial Interests, Personal, Advisory Board: Abbvie;Financial Interests, Pers nal, Advisory Board: Berlin-Chemie. R. Kanesvaran: Financial Interests, Institutional, Invited Speaker: Astellas;Financial Interests, Institutional, Invited Speaker: Johnson&Johnson;Financial Interests, Institutional, Invited Speaker: Ipsen;Financial Interests, Institutional, Invited Speaker: Amgen;Financial Interests, Institutional, Invited Speaker: BMS;Financial Interests, Institutional, Invited Speaker: MSD;Financial Interests, Institutional, Invited Speaker: Sanofi;Financial Interests, Institutional, Invited Speaker: Novartis;Financial Interests, Institutional, Invited Speaker: AZ;Financial Interests, Institutional, Advisory Board: Johnson&Johnson;Financial Interests, Institutional, Advisory Board: Pfizer;Financial Interests, Institutional, Advisory Board: Ipsen;Financial Interests, Institutional, Advisory Board: Amgen;Financial Interests, Institutional, Advisory Board: BMS;Financial Interests, Institutional, Advisory Board: MSD;Financial Interests, Institutional, Advisory Board: Bayer;Financial Interests, Institutional, Advisory Board: AZ;Financial Interests, Institutional, Advisory Board: Ferring;Financial Interests, Institutional, Research Grant: Sanofi;Financial Interests, Institutional, Research Grant: Eisai;Financial Interests, Institutional, Research Grant: Johnson&Johnson. E. Quoix: Financial Interests, Personal, Advisory Board: BMS;Financial Interests, Personal, Advisory Board: Chugai;Financial Interests, Institutional, Principal Investigator: Roche;Financial Interests, Institutional, Principal Investigator: BMS;Financial Interests, Institutional, Research Grant: Boehringer;Financial Interests, Institutional, Research Grant: OSE;Financial Interests, Institutional, Research Grant: UCPVax;Financial Interests, Institutional, Research Grant: Novartis;Financial Interests, Personal, Other: BMS;Financial Interests, Personal, Other: Roche;Financial Interests, Personal, Other: Takeda. C. Steer: Financial Interests, Personal, Invited Speaker: BMS;Financial Interests, Personal, Invited Speaker: Eisai;Financial Interests, Personal, Advisory Board: MSD;Financial Interests, Personal, Advisory Board: Janssen;Financial Interests, Personal, Advisory Board: GSK;Financial Interests, Personal, Advisory Board: Specialised therapeutics;Financial Interests, Personal, Advisory Board: AZ. D. Papamichael: Financial Interests, Institutional, Invited Speaker: Ipsen;Financial Interests, Institutional, Invited Speaker: Amgen;Financial Interests, Institutional, Advisory Board: Merck;Financial Interests, Institutional, Advisory Board: Ipsen;Financial Interests, Institutional, Research Grant: MSD. H. Wildiers: Financial Interests, Institutional, Advisory Board: AZ;Financial Interests, Institutional, Advisory Board: Biocartis;Financial Interests, Institutional, Advisory Board: Daiichi;Financial Interests, Institutional, Advisory Board: Eisai;Financial Interests, Institutional, Advisory Board: KCE;Financial Interests, Institutional, Advisory Board: Lilly;Financial Interests, Institutional, Advisory Board: Novartis;Financial Interests, Institutional, Advisory Board: Orion corp;Financial Interests, Institutional, Advisory Board: Pfizer;Financial Interests, Institutional, Advisory Board: PSI Cro AG;Financial Interests, Institutional, Advisory Board: Puma Biotechnology;Financial Interests, Institutional, Advisory Board: Roche;Financial Interests, Institutional, Advisory Board: Sirtex;Financial Interests, Institutional, Research Grant: Novartis;Financial Interests, Institutional, Research Grant: Roche;Financial Interests, Institutional, Other, Travel: Pfizer;Financial Interests, Institutional, Other, Travel: Roche. All other authors have declared no conflicts of interest.