Good Samaritan Hospital

Abstract Effective cathodic protection (CP) design must account for spatial and temporal variability in soil resistivity and coating condition, both of which critically influence protection performance. However, current practices often overlook site variability, particularly variation of soil temperature and moisture driven by climatic factor change, which alter soil electrical properties and result in inappropriate cathodic protection design. To address this gap, this study develops a simulation-driven framework based on an extended transmission line model (LTM) to replicate Close Interval Potential Survey (CIPS) responses. Within this framework, users can customize site and pipeline parameters, design protection scenarios, and obtain simulated CIPS observations. The model supports sensitivity analyses and evaluates environmental impacts on CP design and CIPS monitoring, thereby guiding adaptive rectifier control strategies and providing complementary explanations for the CIPS monitoring. Furthermore, the framework can work as an interactive training tool, where users can visualize potential distributions under customized soil and coating conditions, explore simulated CIPS responses, and experiment with rectifier settings. By linking spatial and temporal site variability with field-applicable CP metrics, the framework provides both a research testbed and an education resource for CP design and CIPS method.

Abstract Background: Latin American (LA) women are more likely to be diagnosed with aggressive early-stage breast cancer (EBC) compared to Non-Hispanic White (NHW) women, yet population-specific tumor biology remains underexplored. Previously, we reported elevated immune gene expression in BluePrint® (BP) Luminal B tumors in LA patients (pts) with EBC and obesity compared to Black and NHW cohorts. Here, we present updated clinical comparisons between LA, NHW and Black pts with EBC and whole transcriptome analysis (WTA) between BP Luminal B and Basal BC in pts with obesity. Methods: Clinical and WT data were analyzed from 15,577 EBC pts self-identified as LA, Black, or NHW enrolled in FLEX (NCT03053193), a prospective observational study with MammaPrint® risk of recurrence and BP molecular subtyping assays, and WT profiles. ImPrint, 53-gene immune signature, results (+/-) were generated for pts with hormone receptor positive (HR+) EBC. Chi-square and t-tests were conducted on clinical groups using arsenal R package. For WT comparisons, 215 obese LA pts with BP Luminal B and 77 with BP Basal EBC were matched to corresponding NHW and Black pts by age, T and N status. Differentially expressed genes (DEGs) were evaluated using limma, and pathway enrichment was performed using gene set enrichment analysis with Hallmark gene sets. Significant results were reported with adjusted p < 0.05. Results: Compared to Black and NHW pts, LA pts were younger and more often premenopausal (Table). Both LA and Black pts had statistically significantly higher rates of obesity compared to NHW pts. Significantly higher rates of MP High Risk 2, BP Basal and ImPrint+ tumors were observed in LA and Black pts vs NHW. WT comparisons among the obese subpopulations revealed that metabolic pathways, including adipogenesis, angiogenesis, epithelial-mesenchymal transition, and oxidative phosphorylation were significantly downregulated in EBC in LA pts vs NHW and Black cohorts. Conversely, immune-related pathways such as allograft rejection and interferon gamma response were enriched among LA pts with Basal cancers compared to NHW and Black groups. These coordinated pathway alterations suggest unique metabolic and immune profiles in LA EBC subtypes with a median absolute fold change of 1.3 among DEGs. Conclusion: The data suggest that signals from metabolic pathway alterations from modest immune-related gene upregulation may contribute to more aggressive tumor behavior in obese LA pts with EBC. Clinical and transcriptomic analyses demonstrated differences in Luminal B and Basal EBC biology among self-identified LA pts compared to NHW and Black cohorts, consistent with prior research. With further research, these findings may offer treatment targets which may enhance outcomes and reflect the importance of including racially and ethnically diverse pts in clinical trials to characterize population-specific differences in EBC outcomes. Citation Format: M. Mazo Canola, A. Santillan, J. Alberty-Oller, E. Dias, V. Kaklamani, A. Elkhanany, K. Hoskins, M. Habibi, R. Hampton, J. L. Barone, N. M. Johnson, N. Gordon, N. Sookhan, T. Bah, P. John, E. Aponte, S. Diab, V. Klimberg, N. Stivers, C. Page, S. Uygun, W. Audeh, J. O'Shaughnessy. Distinct Immune and Metabolic profiles in Latin American breast cancer patients with obesity enrolled in FLEX [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-09-09.

Abstract Background: The optimal approach for treating elderly patients (age ≥70) with HER2-positive breast cancer is uncertain, especially when balancing the benefits of combination chemotherapy with HER2-targeted agents versus targeted therapy alone. Given the increased risk of treatment-related toxicities in older adults, it is crucial to understand real-world outcomes and risks associated with these regimens in this population. Methods: We conducted a retrospective, real-world cohort study using the TriNetX platform. We identified two cohorts of patients aged ≥70 years with HER2-positive breast cancer. Cohort A (n=4,178) included patients who received HER2-targeted therapy (trastuzumab or trastuzumab deruxtecan) without concurrent chemotherapy (excluding docetaxel/paclitaxel). Cohort B (n=7,607) included those treated with HER2-targeted therapy in combination with chemotherapy (docetaxel or paclitaxel). Propensity score matching was performed, yielding 3,595 patients per cohort for comparative analyses. Outcomes were assessed with Kaplan-Meier survival curves and hazard ratios (HR) for mortality and major toxicities. Results: After 1:1 propensity score matching, 3,595 patients were included in each cohort. Mortality was slightly higher in the HER2-only group (25.96%) compared to the combination group (23.91%) (HR 1.136, 95% CI: 1.036-1.247, p=0.007). Hospitalization occurred more frequently in the combination group (36.2%) compared to the HER2-only group (30.3%; HR 0.830, 95% CI: 0.749-0.919, p=0.001). Outpatient visits were more frequent in the HER2-only group (56.1% vs. 32.6%; HR 1.649, 95% CI: 1.072-2.537, p=0.016). Rates of cancer progression were similar between groups (24.6% combination vs. 23.8% HER2-only; HR 1.004, p=0.951). Cardiomyopathy was more frequent in the combination group (12.7% vs. 10.4%; HR 0.834, p=0.012), while heart failure showed a non-significant trend towards higher frequency in the combination group (15.5% vs. 13.6%; HR 0.886, p=0.060). Treatment-related toxicities were consistently higher in the combination group, including neutropenia (16.3% vs. 6.0%; HR 0.359, p<0.001), anemia (35.1% vs. 24.9%; HR 0.661, p<0.001), thrombocytopenia (12.3% vs. 10.0%; HR 0.829, p=0.010), peripheral neuropathy (32.3% vs. 16.2%; HR 0.461, p<0.001), nausea/vomiting (33.0% vs. 21.7%; HR 0.608, p<0.001), mucositis (8.2% vs. 3.9%; HR 0.485, p<0.001), and diarrhea (32.1% vs. 20.9%; HR 0.598, p<0.001). Infections such as pneumonia, as well as heart failure with reduced ejection fraction (HFrEF) and severe sepsis, were also more frequent in the combination group, although not all differences reached statistical significance.The combination therapy cohort featured more complex, multi-agent treatment pathways, with nearly all patients receiving both HER2-targeted therapy and chemotherapy either concurrently or sequentially, and a small minority lacking documented treatment sequences. The HER2-only cohort showed simple, single-agent HER2-targeted therapy pathways. Conclusions: Among elderly patients with HER2-positive breast cancer, combination chemotherapy plus HER2-targeted therapy provided a modest but statistically significant improvement in survival compared to HER2-targeted therapy alone. However, this benefit was accompanied by substantially higher rates of hematologic, cardiac, neurologic, and gastrointestinal toxicities. Importantly, the risk of cancer progression was not significantly different between regimens. These results suggest that HER2-targeted therapy alone may be a reasonable and safer alternative in select elderly patients who are frail and have significant comorbidities, offering similar cancer control with significantly less toxicity. Citation Format: F. Khan, M. Zafar, B. Singeltary. Outcomes and Toxicity of Combination Chemotherapy and HER2-Targeted Therapy Versus HER2-Targeted Therapy Alone in Elderly Patients with HER2-Positive Breast Cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-01-11.

Abstract Background: Glucagon-like peptide-1 receptor agonists (GLP-1a), commonly used for type 2 diabetes and obesity, have shown potential anti-cancer effects in preclinical models. However, their impact on outcomes in patients with estrogen receptor-positive (ER+) metastatic breast cancer (MBC) remains unclear. This study evaluates the association between GLP-1a use and survival & metabolic outcomes in a real-world cohort of patients with ER+ MBC. Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network. Two cohorts were defined: (1) ER+ MBC patients treated with GLP-1a (tirzepatide, dulaglutide, semaglutide, or liraglutide) and aromatase inhibitors (letrozole, anastrozole, or exemestane), excluding metformin users; and (2) ER+ MBC patients treated with aromatase inhibitors without GLP-1a or metformin. Cohorts were matched 1:1 using propensity scores based on demographics, comorbidities including type 2 diabetes mellitus and Obesity; and concurrent medications, including endocrine therapies (letrozole, anastrozole, exemestane) and other systemic treatments such as CDK4/6 inhibitors, mTOR inhibitors, and HER2-targeted agents. Kaplan-Meier survival analyses were performed for overall survival and adverse outcomes over a 2-year follow-up. Results: After propensity score matching, each cohort included 1,793 patients. GLP-1a use was associated with significantly improved 2-year overall survival (HR 0.612, 95% CI: 0.484-0.773, p<0.001). Risk of hospitalization was also lower in the GLP-1a group (HR 0.559, 95% CI: 0.412-0.759, p<0.001). GLP-1a use was associated with reduced risk of Anemia (HR 0.769, 95% CI: 0.601-0.983, p=0.035), Thrombocytopenia (HR 0.682, 95% CI: 0.487-0.955, p=0.025) and Severe sepsis (HR 0.633, 95% CI: 0.411-0.975, p=0.037). No significant differences were observed for Neutropenia (HR 0.712, 95% CI: 0.501-1.012, p=0.057), Nausea/vomiting (HR 1.204, 95% CI: 0.958-1.512, p=0.111), Outpatient visits (HR 0.795, 95% CI: 0.159-3.970, p=0.779), Heart failure (HR 1.150, 95% CI: 0.818-1.616, p=0.421), Cardiomyopathy (HR 0.777, 95% CI: 0.460-1.312, p=0.344), Diarrhea (HR 0.998, 95% CI: 0.773-1.288, p=0.987), HFrEF (HR 0.881, 95% CI: 0.505-1.537, p=0.656), Pneumonia (HR 0.925, 95% CI: 0.680-1.258, p=0.620), Peripheral neuropathy (HR 0.893, 95% CI: 0.677-1.178, p=0.423). Conclusions: This large retrospective cohort analysis provides evidence suggesting that GLP-1a use in patients with ER+ metastatic breast cancer may offer survival benefits beyond their established metabolic indications. The association between GLP-1a use and improved two-year overall survival, as well as reduced hospitalizations and lower incidence of several treatment-related adverse events, is clinically significant and suggests a possible dual role for GLP-1a in addressing both metabolic and oncologic challenges in this population. Importantly, GLP-1a therapy was not associated with increased gastrointestinal or cardiac toxicity, reinforcing its safety profile when used alongside standard endocrine and targeted cancer therapies. These findings align with emerging data that metabolic interventions can impact tumor biology and patient outcomes, and they highlight the value of a multidisciplinary approach that addresses both oncologic and comorbid metabolic conditions. Future prospective studies and randomized clinical trials are needed to validate these results and further elucidate the underlying biological mechanisms by which GLP-1a may exert anti-tumor effects in ER+ MBC. This study signifies the evolving landscape of cancer care, where holistic, patient-centered strategies are increasingly recognized as essential for optimal outcomes. Citation Format: F. Khan, M. Zafar, B. Singeltary. Impact of Glucagon-like peptide-1 receptor agonists Use on Survival and Metabolic Outcomes in Metastatic Estrogen Receptor Positive Breast Cancer: A Real-World Cohort Study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-10-12.

Introduction: Orolingual angioedema is a recognized adverse effect of thrombolytic treatment for acute ischemic stroke (AIS). Although it is generally mild with a relatively low incidence (1–5%), orolingual angioedema may trigger life-threatening airway occlusion necessitating rapid intubation. This population-based, retrospective study is the first to examine differences in complications, management, and outcomes of AIS in patients with and without thrombolysis-induced angioedema. Methods: The National Inpatient Sample (NIS) was queried by International Classification of Disease Ninth and Tenth Revision diagnostic and procedural codes (ICD-9-CM/ICD-10-CM) to identify AIS patients treated with thrombolysis who experienced subsequent angioedema. Baseline characteristics, treatment, complications, and functional outcomes were analyzed through multivariate regression and compared through a propensity-score matching (PSM) analysis. Results: We examined 99,935 patients diagnosed with AIS and administered thrombolytics between 2010 and 2019. AIS patients with thrombolytic-induced angioedema were younger (67.44 years vs. 69.32 years, p < 0.01), less likely to be white (53.83% vs. 66.48%, p < 0.01), and presented with higher acute stroke severity scores (0.69 vs. 0.63, p < 0.01) than non-angioedema AIS patients. Following PSM analysis, patients with angioedema had higher rates of tracheostomy (5.7% vs. 0.49%, p < 0.01) and lower rates of endovascular mechanical thrombectomy (4.72% vs. 9.63%, p < 0.01). Though patients who developed angioedema were observed to have longer length of stay (LOS) (7.34 days vs. 5.41 days, p < 0.01), they demonstrated similar rates of adverse complications, poor functional outcome (p = 0.25), and in-hospital mortality (p = 0.32) compared to their non-angioedema AIS counterparts. Conclusion: Although angioedema increased the likelihood of tracheostomy and prolonged hospitalization, outcomes were comparable to those of patients without this complication. These findings are hypothesis-generating and may help guide discussions with families when angioedema occurs, demonstrating that while the need for airway intervention is more likely, the overall prognosis remains reassuring. Future studies should further clarify acute management strategies and long-term outcomes in this patient population.