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4611 Background: Erlotinib is an EGFR TKI active in combination with gemcitabine in p with advanced pancreatic cancer (PC). The combination of gemcitabine and bevacizumab is also active in PC. A phase I of gemcitabine, bevacizumab and erlotinib in p with unresectable locally advanced or metastatic PC is being conducted. Methods: Two cohorts of 6 patients with advanced PC have been treated either with erlotinib (150 mg/day po), bevacizumab (5 mg/Kg iv, days 1 and 15, every 28 days), and either 10 mg/m2/min infusion of gemcitabine 850 mg/m2 or 1,000 mg/m2 days 1 and 15 every 28 days. P received a maximum of 6 cycles of 28 days. Cohort 1: Daily erlotinib 150 mg po + bevacizumab 5 mg/kg iv days 1 and 15 + gemcitabine 850 mg/m2 over 10 mg/m2/min infusion days 1 and 15. Cohort 2: daily erlotinib 150 mg po + bevacizumab 5 mg/kg iv days 1 and 15 + gemcitabine 100 mg/m2 over 10 mg/m2/min infusion days 1 and 15. Results: 12 p have been included in this study (6 cohort 1 and 6 cohort 2), being evaluable for toxicity. 11 p have concluded the study and 7 have received complete treatment as per protocol. Median age 62.6 yrs (range 38–71); male/female: 5/7 (42%/58%); stage III/IV: 3/9 (25%/75%); Karnofsky index 100%/80%: 2/10. 3 of 6 p in cohort 1 developed gr. 3 asthenia (50%), 2 p gr. 3 neutropenia (33.3%), whereas 1 p had grade 3 leucopenia and gr. 3 skin rash. In cohort 2, most severe adverse events were: 1 case of grade 4 GGT elevation, 1 p gr. 3 skin rash and 1 p. experienced asthenia gr. 3. No severe hematological toxicity in cohort 2 was reported. One p of each cohort required dose reduction of erlotinib, both due to skin rash. Mild diarrhea was reported in 11 of 12 p evaluated. No dose limiting toxicities has been reported. All p were available for response: 2 p reached partial response (both included in cohort 1) and 7 showed stabilization (3 and 4 in cohorts 1 and 2, respectively). No complete responses were observed. Overall disease control index was 75%. Conclusions: The combination of gemcitabine, erlotinib and bevacizumab is well tolerated. MTD has not been reached. Encouraging clinical activity in advanced pancreatic cancer has been observed. Phase I is still ongoing. Toxicity data for all the p will be presented. No significant financial relationships to disclose.

Background and Importance The opening of a pharmaceutical care service for onco-haematology patients (OHP) in the midst of the health care crisis caused by the COVID19 pandemic, made it possible to maintain the healthcare activity, avoid the collapse and provide the opportunity to implement Comprehensive Medication Management (CMM). Aim and Objectives To investigate the pharmacotherapeutic experience of OHP in outpatient therapy with CMM services; to know important aspects perceived for the identification of barriers/facilitators that determine the quality of the service and proposals for improvement. Material and Methods Descriptive observational design with a qualitative approach, using informal and semi-structured indepth interviews (participant observation and peer review) during January-June 2021. ATLAS.ti software was used for content analysis. Oncohaematology patients in outpatient therapy with any medication-related problem and who received CMM services were interviewed. Those who, due to cognitive limitation, could not be interviewed or who did not have a caregiver/family member available were excluded. Results 19 interviews were conducted: 57.89% patients and 42.10% caregivers; 57.89% were women. All patients were very satisfied with the care received, the vast majority preferred to be attended by a pharmacist, and valued telepharmacy as an alternative or complementary option. The vision of the pharmacy professional as an expert in medicines improves. They suggest improvement related to location, waiting times and greater accessibility of the pharmacist. After the researchers' reflective process, were identified as barriers: care pressure, limited time/resources, lack of interlevel coordination, and facilitators: prioritisation of interventions, integration of pharmacist in the multidisciplinary team, trust in the pharmacist and the new model of care. Improvement strategies: provision of human/material resources with release of pharmacist's time to provide the CMM, extension of hours, information management with the development of personal learning environment and use of programs for recording/integration of information and interventions. Conclusion and RelevanceDelving into patients' experiences can be key to improving the quality of care. In our case, the implementation of the CMM service in OHP has been a challenge and an opportunity in the current context of the COVID-19 pandemic. The pharmacy adapted to the needs and implemented a new model of care with excellent acceptance by users.

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Funding Acknowledgements Type of funding sources: None. Introduction and objectives The prevalence of left atrial (LA) thrombus in patients with atrial fibrillation (AF) or atrial flutter (AFL) on guideline-directed anticoagulation is nor well known, moreover, evidence on the presence of left atrial thrombus with different anticoagulation therapies provides heterogeneous results. Methods Ambispective, observational, single-center study that consecutively included 271 patients undergoing elective electrical cardioversion (ECV) for AF or AFL >48 hours of onset. A transoesophageal echocardiogram (TOE) was performed in all patients within 24 hours prior to ECV. Patients with <3 weeks of anticoagulation and those in sinus rhythm on admission were excluded, and the clinical characteristics and presence of atrial thrombus were analyzed in 172 patients. Results The main baseline characteristics are shown in Picture 1. A total of 66.5% of the patients were receiving treatment with direct oral anticoagulants (NOAC) dabigatran (15.9%); rivaroxaban (28.3%); apixaban (31.2%) and edoxaban (23.9%). The remaining 33.5% were anticoagulated with vitamin K antagonists (VKA). Eight thrombi were detected in the left atrial appendage (prevalence 4.7%), and on 2 occasions the presence of thrombus could not be ruled out, and CVE was also suspended. No statistically significant differences were observed between the prevalence of thrombus and the type of anticoagulant (NOAC vs VKA 4.5% vs 4.9%; p= 0.56) or between the different NOACs (p=0.61). Of the 8 patients with left atrial thrombus, anticoagulant treatment was modified in 3 of them. Control TOE was performed (median until new TOE 64 days), and resolution was verified in 3 cases (all under treatment with NOAC), of which 2 patients had maintained their previous anticoagulant treatment. Conclusions Anticoagulated patients scheduled for elective ECV present a prevalence of left atrial thrombus close to 5%. No differences were observed with respect to the anticoagulation treatment received.