5th ECOP, European Conference of Oncology Pharmacy

The proceedings contain 130 papers. The topics discussed include: frequency of measuring body weight in (sub)populations of patients with cancer treated with chemotherapy;simple approach to enhance green tea epigallocatechin gallate stability in aqueous solutions and it bioavailability: experimental and theoretical approaches;incidence of cisplatin-induced nephrotoxicity and associated risk factors: single-center experience;impact of the 2019 coronavirus pandemic on cancer treatment in the Calabria Region, Italy;Palbociclib associated neutropenia in clinical practice;successful introduction of a point mutation into the genome of a primary colon cancer cell line using CRISPR base editing technology;incidence of cisplatin-induced nephrotoxicity and associated risk factors: single-center experience;real world data of alk-inhibitors in patients with advanced or metastic non-small cell lung cancer;pembrolizumab in non-small-cell lung cancer: a systematic review of real life data in Spain;gynecomastia in a male after imatinib treatment for chronic myeloid leukemia;and results after discontinuation of pembrolizumab in metastatic melanoma or lung cancer patients: real-word experience.

Case series of extra cardiac findings with increased perfusion during clinical 15O-H2O PET myocardial perfusion imaging

Aim/Introduction: Multiple extra cardiac findings with increased perfusion have been reported as coincidental findings during myocardial perfusion imaging (MPI) with various radiotracers. At our facility, 15O-H2O-PET MPI was implemented in daily clinical routine in May 2020, and we therefore anticipated similar findings using this radiotracer. The aim of this is therefore to share a case series of our initial experience regarding extra cardiac findings characterized by increased blood flow on 15O-H2O-PET. Material(s) and Method(s): Patient cases with extra cardiac findings observed during clinical 15O-H2O PET MPI scans were collected. All patients were scanned according to facility standards and international guidelines on a GE Discovery MI Digital Ready PET/CT (GE Healthcare, Waukesha, Wisconsin, USA). In contrast to the parametric myocardial 15O-H2O images, summed and gated retention images were used for assessment of extra cardiac perfusion. Biopsy histopathological diagnosis was used as reference standard in all malignant lesions and in some benign lesions. In the remaining patients, other imaging modalities were used as reference standard. Result(s): A variety of malignant lesions with increased perfusion appeared during the scans, including primary tumours of breast cancer, lung cancers, large-celled neuroendocrine tumours, lymphomas and metastases from colonic carcinomas and renal cell carcinomas. Furthermore, a number of benign conditions with increased perfusion were observed: Healing rib fractures, gynecomastia, atelectasis, acute pneumonia (disappeared on subsequent FDG-PET/CT), lung infiltrate with biopsy-verified chronic inflammation and fibrosis (FDG-positive), biopsy-verified benign lung nodulus, chronic diffuse lung infiltrates, pleural plaques and sequelae after recent COVID-19 infection (scan 12 days after positive test). In general, the benign findings were either inflammation or hyperplastic tissue, which are conditions known to be characterized by increased perfusion. Conclusion(s): Both malignant and benign extra cardiac coincidental findings with increased perfusion are readily visible and frequently encountered on 15O-H2O-PET MPI. In most cases, the coincidental findings are also visible on the low-dose attenuation correction CTscan. However, we did observe a 15O-H2O avid breast cancer tumour located outside the CT field of view, underlining the importance of evaluating the entire field of view of the retention 15O-H2O-PET and not just the reconstructed parametric myocardial images.

May Hepatic Steatosis Be Associated with Gynecomastia and Epicardial Fat? A Retrospective Study of 599 Male Patients

Objective: There is no study in the literature investigating the association of hepatic steatosis both gynecomastia and epicardial fat thickness together. We determined the correlations between hepatic steatosis through liver density, gynecomastia and epicardial fat thickness in patients undergoing computed tomography (CT) scans due to suspected coronavirus disease-2019 (COVID-19) symptoms. Methods: A total of 599 male patients who underwent chest CT scans because of a presumed diagnosis of COVID-19 in our radiology clinic were included in the study. Patients’ age, diameters of the subareolar glandular tissues of the right and left breasts, the right retroareolar fatty tissue, liver and spleen density, epicardial fat thickness and biochemical parameters were recorded and analyzed. Laboratory analyses were performed according to the standard methods. Results: The mean age of the patients was 47.21±15.00 years. The left subareolar tissue thickness and the right retroareolar fatty tissue thickness that are used to indicate gynecomastia were significantly correlated with liver density in the negative direction (r=-0.137, p<0.001;r=-0.172, p<0.001;respectively). Epicardial fat thickness was statistically significantly correlated with right subareolar tissue thickness (r=0.085, p=0.037), left subareolar tissue thickness (r=0.101, p=0.014) and right retroareolar fatty tissue thickness (r=0.148, p<0.001). Conclusion: The results of this study showed that gynecomastia was significantly correlated with both age and hepatic steatosis. Epicardial fat thickness is also associated with hepatic steatosis. We demonstrated the significant correlations between epicardial fat thickness and gynecomastia for the first time. Nevertheless, our results need to be confirmed by further comprehensive studies.

Telephone triaging during the 1st wave of the COVID 19 Pandemic: Outcomes and proposed pathway for managing patients referred for breast pain

Introduction/Background• The sudden outbreak of the COVID 19 pandemic led to increased stress on healthcare systems across the globe. They struggled to continue to provide other essential clinical services whilst dealing with the rapid surge of COVID 19 cases. It was therefore essential to optimize patient-centred care safely in a risk adapted environment without compromising outcomes.• We present our experience of telephone triaging of new symptomatic patients referred to a single, tertiary, academic large volume breast unit. Based on our observed outcomes, we propose a novel pathway for management of patients referred with Breast Pain. Methodology• We conducted an audit of patients triaged for telephone consultation at Guy's and St Thomas' NHS foundation Trust, UK between 1st April 2020 to 30th June 2020. Data was collected retrospectively from hospital records following approval from the Trust Audit Committee. Two week wait (2WW) referrals determined to be of low index of suspicion for breast cancer were triaged to telephone consultation. Criteria for low index of suspicion was breast pain, non-suspicious skin changes, bilateral non pathological nipple discharge, gynaecomastia, patients < 30. Patients > 70 were initially offered telephone consultation for risk assessment to avoid potential exposure to COVID19 (shielding of vulnerable cohort). Follow up data was recorded up to October 2020. SResults• There were a total of 685 new 2WW referrals during this time. The total number of patients that were triaged to telephone consultation were 111. The median age of this cohort was 34. There were 105 women and 6 men in this cohort. When classified by symptoms, 47 were referred for breast pain, 46 for suspected breast lumps, 6 for nipple discharge and 12 for other miscellaneous reasons.• The total number of patients that were invited back for imaging or face to face (F2F) consultation or both were 67 (60%).Total number that came back for F2F consultation were 50, out of which 14 were purely for F2F. The total number of patients that came back for imaging were 53, out of which 17 came for imaging only. Total number that came back for F2F and imaging both were 36.• 44 patients were discharged without a F2F consultation or imaging (40%)• F2F consultations (50) when classified by symptoms, 70% presented with breast lump, 14% with breast pain, 6% with nipple discharge, 2% with breast infections and 8% with other benign causes.• Total number of biopsies performed were 9, out of which 2 were cancers and the rest were benign.• There were 3 patients that came back with new referrals after a few months of being discharged following a telephone consultation. They presented with the same symptoms, or their symptoms had worsened or they had new symptoms. However, none of them had any significant finding on F2F consultations or imaging and were reassured and discharged. Conclusion• Our audit (although a small cohort), some published data (Cancer Waiting Times data in the UK comparing 1st 6 months from 2019 with 2020) and literature support the effectiveness of this tool in unprecedented times.• Breast pain is not the most alarming symptom. None of the patients in our cohort with breast pain were found to have any significant finding on imaging or were diagnosed with breast cancer.• Any breast lump or pathological nipple discharge irrespective of age should undergo triple assessment as gold standard.• Our proposal is to design a separate pathway for patients with breast pain as they do not necessarily need a F2F consultation or imaging (can be elicited by the clinician and called only if deemed necessary). This will in turn decrease the strain of 2WW referrals and increased burden on radiology.

Impact of COVID pandemic on compliance with ABS Guidelines for Gynaecomastia

Background: Introduction: The ABS recommends that gynaecomastia in secondary care does not require all aspects of triple assessment. The COVID pandemic altered pathways for care delivery and triggered a review of practice. The audit is designed to assess the compliance of clinical practice with the ABS guidelines. Materials and Methods: Methods: Retrospective data collection of all male patients referred to a DGH Breast service from 1st August 2019 to 1st August 2020 using hospital data system. The cohort represents patients referred 6 months prior to COVID pandemic and 6 months after. The proforma design was based on ABS guidelines. Results: Results: Sample size 233. Clinical contact time increased due to the COVID pandemic, however there were less patient facing episodes. No patient referred was under 25 with a P3+ lesion in the breast. Just under 25% of the patients aged <25 with a clinical grade of P2 had no imaging. 44% of these were impacted by the COVID pandemic. Only 17% of patients presenting with bilateral benign gynaecomastia graded <P2 met the audit standard. Of these, only one patient had a face to face clinic appointment. 8 patients had P3+,M3+ or U3+ lesions, only 1 patient was not biopsied. Conclusions: Conclusion: Results demonstrate overprovision of care in two of the four standards assessed. The COVID pandemic has demonstrated that alterations can be made to the delivery of care in line with guidelines without compromising the quality of care. Some changes were implemented during the second lockdown based on these outcomes and will be re-audited.

Prevalence of Incidental Gynecomastia by Chest Computed Tomography in Patients with a Prediagnosis of COVID-19 Pneumonia.

OBJECTIVE: In this study, we aimed to determine the prevalence of gynecomastia by evaluating computed tomography (CT) images of male patients who were admitted to our hospital during the coronavirus disease-2019 (COVID-19) pandemic. MATERIALS AND METHODS: This study included a total of 1,877 patients who underwent chest CT for prediagnosis of COVID-19 pneumonia between March 15th and May 15th, 2020. All images were evaluated for the presence of gynecomastia. Gynecomastia patterns were evaluated according to morphological features, and diagnoses were made by measuring the largest glandular tissue diameter. Statistical analysis was performed with IBM SPSS software version 25.0. RESULTS: The prevalence of gynecomastia was 32.3%. In terms of pattern, 22% were nodular, 57% were dendritic, and 21% were diffuse glandular gynecomastia. A significant correlation was found between age and gynecomastia pattern (p<0.001). The incidence of nodular, dendritic, and diffuse glandular gynecomastia increased with advancing age. A significant difference was found in the analysis of the correlation between age groups and glandular tissue diameters (p<0.001). With an increase in glandular tissue diameter, the gynecomastia pattern changed from a nodular to a diffuse glandular pattern. CONCLUSION: In our study, gynecomastia diagnosis was made through axial CT images. Although CT should not replace mammography and ultrasonography for clinical diagnosis of gynecomastia, chest CT scans can be used to evaluate patients with suspected gynecomastia.