Beverly Hills Cancer Center

Patients treated with a 1726-nm laser showed significant improvement in moderate-to-severe acne for ≥6 months in a prospective study. One-year follow-up data are presented. In this prospective institutional review board-approved study, patients underwent 3 treatments with a 1726-nm laser, 2-5 weeks apart. Inflammatory lesion counts and Investigator's Global Assessment scores were assessed at baseline, 3 months, and 1 year after treatment. Adverse events, treatment satisfaction, and self-confidence were assessed. Of 104 patients with Fitzpatrick skin types II-VI and moderate-to-severe acne, 89 and 71 patients, respectively, attended 12- and 52-week visits. At 12 weeks, 79.8% demonstrated ≥50% improvement in inflammatory lesion counts, which increased to 91.5% at 52 weeks. The proportion of patients with clear or almost clear Investigator's Global Assessment scores increased from 36.0% at 3 months to 66.2% at 52 weeks. Treatment was well tolerated: Mild erythema and edema occurred in 100% and 98.1% of patients, respectively. No blistering, crusting, or hypo- or hyperpigmentation were observed. Patient satisfaction and self-confidence improved at both follow-up timepoints. No control group; reliance on image assessment; open-label design. The seboselective 1726-nm laser is an effective and well-tolerated therapy for reducing moderate-to-severe facial acne for at least 1 year.

2661 Background: Immune checkpoint inhibitors (ICIs) have transformed cancer treatment but are associated with toxicity in the form of immune-related adverse events (irAEs). We previously reported a genetic signature predicting anti-PD1 irAEs in a retrospective analysis of a heavily pretreated melanoma cohort, which validated in a pan-cancer cohort. Here we investigate the applicability of that signature in a prospectively collected cohort of GU, breast, and NSCLC cancer patients. We evaluated clinical and genetic differences between the original training set and this cohort and leveraged the expanded dataset to develop novel models for timing-specific anti-PD1 toxicity. Methods: We analyzed clinical and genetic differences in the melanoma training cohort (n=58) and the new cohort of patients, all treated with single agent anti-PD1/PDL1 therapy (n=137). Clinical and genetic differences were assessed using Fisher’s exact test for categorical variables: pre-treatment, concurrent radiation, and SNP genotype across 165 loci. Kruskal-Wallis tests were used for age, toxicity timing, and severity of toxicity. Predictive genetic models were constructed using elastic net, random forest, and boosted tree algorithms and evaluated using leave-one-out cross-validation (LOOCV) metrics. Outcomes included cycle-specific toxicity (early ≤5 cycles, late ≥15 cycles). SNPs were pre-filtered for inclusion in genetic models using Fisher or Jonckheere-Terpstra p-values (<0.2) for relevance to outcomes. Results: The training and current cohort were different in their toxicity timing, with earlier toxicity onset in the new cohort (median 5 cycles vs. 20 cycles in melanoma, Kruskal p = 0.00018). Genetic analysis identified 12 significantly different SNP genotypes (Fisher p < 0.05) between cohorts, including mir146A rs2910164 (Fisher p = 0.0005). This SNP was associated with early toxicity overall and within data subsets. Refining our model to account for cycle-specific toxicity events significantly enhanced performance. For late toxicity (≥15 cycles), the refined model achieved a LOOCV AUC of 0.793 (genetics + clinical). A newly developed early toxicity model (≤5 cycles) using genetics alone demonstrated robust predictive accuracy with an AUC of 0.753. Conclusions: These findings emphasize the importance of defining clinical and genetic diversity in refining predictive models for anti-PD1/PDL1 outcomes. The development of an early toxicity model offers significant clinical utility. Next steps will be to use time to event (toxicity) versus cycle number. This study provides a foundation for the application of personalized genetic tools to predict the safety of ICIs for currently treated patient cohorts. New LOOCV performance metrics in expanded PD1 data (n=234). Outcome Covariates Sensitivity Specificity PPV NPV F1 AUC Late Toxicity (>= 15 cycles) SNPs + Clin 0.692 0.894 0.450 0.959 0.545 0.793 Early Toxicity (<=5 cycles) SNPs Only 0.600 0.907 0.486 0.939 0.537 0.753

The applications of artificial intelligence (AI) are evolving, offering new opportunities to enhance patient care. To determine whether the use of AI platforms for translating patient education materials (PEMs) improves their readability for patients seeking information on facial plastic and reconstructive surgery (FPRS) procedures. Text from 25 PEMs on topics such as rhytidectomy, rhinoplasty, and blepharoplasty was extracted. ChatGPT 4.o, ChatGPT 3.5, Microsoft Copilot, and Google Gemini were prompted to translate AAFPRS PEMs to the 6th-grade reading level, the accepted readability standard for PEMs. Readability was determined using Flesch Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), and Flesch Kincaid Reading Ease (FKRE). Statistical analysis was performed. A total of 125 PEMs were reviewed. Original PEMs had a mean FKGL, GFI, and FKRE of 10.7, 13.48, and 50.8 respectively, which exceed the recommended level. The translated AI-generated PEMs had a mean FKGL, GFI, and FKRE of 8.41, 10.62, and 64.43 respectively, representing an improvement in readability (p < 0.001). With physician supervision, AI platforms can improve the readability of PEMs for common FPRS procedures. This strategy may increase the accessibility of educational resources for diverse patient populations.

This chapter will delve into what makes the Developer Experience (DevEx) tick: well-crafted documentation. Think of this chapter as a compass guiding you through the intriguing landscape of creating, managing, and optimizing documentation to create a delightful and efficient developer environment.

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BackgroundPancreatic tumors demonstrate high mortality due to their insidious presentation and subsequent tendency to be locally advanced at the time of diagnosis. Due to involvement of critical structures in this region the percentage of patients who are surgical candidates is low, and the morbidity of surgical resection is high. Additionally, the tumors tend to recur after resection resulting in a dismal 5-year overall survival. Neo-adjuvant and adjuvant systemic therapy does not fare much better, with complete response and long-term survival being the exception rather than the rule. The advent of immunotherapy for cancer has resulted in a paradigm shift, with many systemic immunotherapy pharmaceuticals becoming first-line for various cancers. Pancreatic cancer, however, tends to respond poorly to immunotherapy, possibly due to its propensity to exhibit an ‘immune desert’ tumor microenviornment (TME) phenotype. This refers to a lack of tumor infiltrating lymphocytes and other resident immune cells residing within the tumor, critical to initiate immunologic tumor elimination.MethodsCT-guided pulsed electrical field (PEF) ablation for pancreatic tumors with adjuvant intra-tumoral immunotherapy injection was performed. The ablations were sub-total, and the immunotherapy administered included ipilimumab, nivolumab, and other medications known to elicit an immune response. Medications were administered via the PEF (Galvanize Theraputics, Inc., Redwood City, California, USA) probe outer cannula immediately post-ablation in a gel-matrix for local retention, with contrast for visibility. No immediate complications related to the treatment were observed.ResultsWe present five patients who underwent PEF ablation plus intratumoral immunotherapy injection for locally advanced and metastatic pancreatic tumors. These patients had exhausted/failed curative treatment options and were receiving palliative treatments for their malignancies. All patients were able to continue with treatment throughout the described treatment regimen. All five patients achieved a response to treatment, with evidence of long-term remission in some cases. Durable radiologic and biochemical responses were seen. All patients continued to have good performance statuses throughout and after the treatment regimen. There were no immediate treatment-related complications. A trans-gastric approach to pancreatic tumors is possible with the low-profile PEF probe, which can also be used to administer the immunotherapy cocktail after ablation. Non-treated tumors were seen to resolve after this treatment, known as the abscopal effect.ConclusionsPEF plus intratumoral immunotherapy is safe and effective for palliation of locally advanced and metastatic pancreatic tumors. Patients may benefit from the abscopal effect when there is diffuse metastatic disease present. Further investigation, including randomized clinical trials may be warranted.

391 Background: Goserelin is a gonadotropin-releasing hormone agonist used for ovarian function suppression in the treatment of pre- and peri-menopausal patients with breast cancer. Goserelin, administered as a subcutaneous implant, is available in doses of 3.6 mg once monthly or 10.8 mg every three months; goserelin 3.6 mg is approved in the US, and both the 3.6 mg and 10.8 mg doses are approved by Health Canada and the European Medicines Agency. A study utilizing US real-world evidence was conducted to characterize treatment patterns of patients treated with goserelin 3.6 mg and/or 10.8 mg. Methods: Electronic health record data of adult patients with a history of breast cancer and with ≥2 prescriptions of goserelin between 1 January 2017 – 31 December 2022 were identified through TriNetX. Index date was the initiation of goserelin administration. Patients were followed until 15 March 2024. Patient demographics, treatment adherence, and healthcare resource utilization (HCRU) were examined and summarized using descriptive analytics. Results: Overall, 3,620 patients were identified: 2,870 treated with goserelin 3.6 mg, 410 with goserelin 10.8 mg, and 340 who switched from goserelin 3.6 mg to 10.8 mg. Peak utilization of goserelin 10.8 mg (36.6%) and peak dosage switching (26.5%) occurred in 2020. Across groups, mean age at index date was 42.2–44.4 years, and patients were white (64.1–67.6%), black (11.8%–13.9%), Asian (8.0%–11.8%), and American Indian and/or Alaskan native (0.3%–2.9%). Of patients with known BMI, BMI mostly ranged between 18.5–24.9 kg/m 2 in all groups. Patients who switched from goserelin 3.6 mg to 10.8 mg had the longest median treatment duration (776 days) (Table). Patients treated with goserelin 10.8 mg remained on treatment for a median of 426 days; 74.4% of these patients were treatment-adherent (Table). In comparison, patients treated with goserelin 3.6 mg had a shorter median treatment duration (226 days) and were less adherent (56.4%) (Table). HCRU during the 12 months after index date was broadly similar across groups. Conclusions: Treatment with goserelin 10.8 mg every three months is associated with greater adherence and longer treatment duration, compared with 3.6 mg once monthly, in patients with a history of breast cancer. Patients who switched from goserelin 3.6 mg to 10.8 mg were treatment-adherent for nearly two years, consistent with clinical recommendations. Goserelin 3.6 mg (n = 2,870) Goserelin 10.8 mg (n = 410) Switched from goserelin 3.6 mg to 10.8 mg (n = 340) Median duration of treatment (days) 264 429 776 Median time to switch (days) — — 218 Patients adherent* to dosing schedule 1,608 (56.4%) 306 (74.4%) — Status as of March 15, 2024 Discontinued goserelin 2,018 (70.8%) 261 (64.3%) 173 (50.9%) Death 88 (3.1%) 10 (2.5%) 3 (0.9%) *Defined as: ≤36 days between prescriptions (3.6 mg) or ≤108 days between prescriptions (10.8 mg).

Teprotumumab, a novel IGF-1R antibody, has been shown to significantly reduce the signs of acute and chronic Thyroid Eye Disease (TED). Light sensitivity is a reported symptom in patients with TED. There is a lack of a prospective study that has explored the effects on light sensitivity in a large cohort of patients with acute and chronic TED following treatment with teprotumumab. Consecutive patients who were diagnosed with TED and reported light sensitivity at baseline were considered for study eligibility. All patients had measurements of Visual Light Sensitivity Questionnaire-8 (VLSQ-8), proptosis, clinical activity score (CAS), and MRD1 (distance between the upper eyelid margin and corneal reflex, mm) and MRD2 (distance between the lower eyelid margin and corneal reflex, mm) before and after treatment. Ninety patients (41 acute, 49 chronic) met the inclusion criteria. The mean (SD) age was 47.3 (14.3). Eighty-six (95.6%) patients completed all 8 infusions. There was a significant reduction in the total score and across all categories of the VLSQ-8 (p< 0.01 for all). Seventy-two (80%) patients had a clinically significant improvement (≥2 reduction) in at least one category. There was no significant difference in the total VLSQ-8 score between the acute and chronic group (p= 0.8). Teprotumumab improves light sensitivity in patients with acute and chronic TED. The results of this study highlight that the improvements in light sensitivity following treatment are not directly related to the mechanical changes in TED, suggesting another underlying mechanism ispotentially involved.