BackgroundRadiotherapy for metastatic bone pain can induce a transitory increase in pain known as pain flare. Several studies have described the use of prophylactic corticosteroids to prevent pain flare. However, the role and efficacy of corticosteroids to prevent pain flare remain unclear.PurposeTo summarize the available evidence with regard to the efficacy and toxicity of prophylactic corticosteroids for the prevention of pain flare.MethodsThis was a systematic review (PROSPERO protocol CRD42018090351) of peer‐reviewed studies published in the Cochrane, Medline, and Scopus databases through September 2018. Studies carried out in adult patients treated with radiotherapy for bone metastases who received prophylactic corticosteroids to prevent pain flare were eligible for inclusion. The Cochrane Collaboration tool was used to assess risk of bias. The evidence grade was determined according to the GRADEpro tool.ResultsA total of 4,407 studies were identified. Of these, 4 clinical trials (CT) and 1 prospective cohort study met the inclusion criteria. The overall incidence of pain flare was 28%, and 21% vs. 37% in the prophylaxis vs. non‐prophylaxis groups; the relative risk reduction was 43%. In the 3 studies that compared corticosteroids to placebo, the relative risk reductions were 25%, 67%, and 72%. The most common treatment regimen was oral dexamethasone at 8 mg once daily from the first day of radiotherapy for 5 days. One study administered methylprednisolone. No severe toxicity was reported in any of the studies.ConclusionsOverall, the findings of this systematic review indicate that glucocorticoids appear to be an effective prophylactic treatment to prevent pain flare in patients undergoing radiotherapy for bone metastases. New CT are needed to confirm these results and to determine the optimal dose of dexamethasone.

Next Generation Sequencing (NGS) on clinical decision making. We evaluated whether information on mutational profiles modified clinical practice and care for patients with non-metastatic and metastatic cancer in an observational impact study. Methods: This study was a multicentric observational decision impact analysis conducted in seven sequencing platforms and 117 hospitals working with these platforms. The platforms were certified by the French National Cancer Institute (INCa). All NGS analyses performed between October 2013 and September 2016 for adult patients treated for lung, colorectal cancer or melanoma, both metastatic and non-metastatic, were included. We excluded analyses on constitutional mutations, somatic mutations for other cancers or NGS analysis with exclusive research purpose. Patients' pathways and referral patterns were obtained from NGS prescription forms and interviews with biomolecular biologists and clinicians. We extracted anonymized data on NGS results from the platforms. Results: 1213 patients from more than 117 centres were analyzed. Even if panels used were relatively homogeneous -less than 20kb (97%) and commercial kits (80%) -, we observed significant variability among practices. Depending on the initial structure of care and on the platform to which it was related, patients benefited from an NGS analysis at diagnostic (2 platforms) or later on (5 platforms), of a review of the medical file by a multidisciplinary meeting or not and of an unequal access to medical innovation on the national territory. Conclusions: We observed an important variability among practice on national territory. Thus patient equality of treatment is questionable. In a healthcare and economic perspective, important topics still need to be assessed to get a better understanding of the global impact of NGS. Among the outstanding questions: how can disutility of care, such as avoided complications and toxicities, limitation of diagnostic wavering, be evaluated? Funding: INCa. Disclosure: All authors have declared no conflicts of interest.42P Comparison of expression of microRNAs which regulate metastasis genes in breast cancer stem cells and primary breast cancer tissues

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BACKGROUND Glioblastoma (GB) is the most aggressive primary brain tumour. Despite the survival benefit associated with adjuvant therapy, most of patients (pts) relapse after initial therapy. Nitrosoureas (NU) are the standard treatment at relapse in Europe. Both fotemustine (FM) (Addeo schema) and lomustine (LM) (administered orally every 6 weeks) are used in this context. MATERIAL AND METHODS This retrospective cohort study included pts diagnosed with GB treated with NU at relapse in four Catalonia hospitals from 2010 to 2020. Clinical and pathological data were collected from medical records. We analysed 6months-progression-free survival (6m-PFS), progression-free survival (PFS) and overall survival (OS) from the start of NU to progression or death respectively. Differences in toxicity grade using CTCAE v5.0 were analysed globally as ‘non-toxicity’, ‘mild toxicity (grade 1 or 2)’ and ‘high toxicity (grade 3 or 4)’. RESULTS We identified 236 GB pts with a median age of 58 years old. 29% of the pts presented MGMT promotor methylation and only 3%(n=7) had IDH mutation. After a median follow-up of 20 months, 94% of the pts were dead at the time of the analyses. At first line, 83 pts were treated with FM and 18 with LM. Pts treated with FM had better performance status (PS) than those treated with LM (p=.010). Median PFS was 2 months and 6m-PFS was 12% vs 6% in FM and LM group respectively (p=.87). Median OS was 3 months with LM vs 6 months with FM, with no statistically significant differences even adjusted for prognostic factors (p=.79 HR:0.9 CI 95% 0.41–1.96).At second line, 78 were treated with FM and 24 with LM, no differences between groups. Median PFS was 2 months in both groups and median OS was 3 vs 5 months for pts treated with LM vs FM respectively, with no significant differences. 6m-PFS was 13% for LM vs 0% for the FM group (p=.39).Pts received a mean of 1.7 cycles (every 6 weeks) and 4.1 cycles (every 2 weeks) in LM and FM group, respectively. Thrombocytopenia was the most common serious side-effect, with a higher proportion of grade 1–2 toxicity in the FM group (p=.03) that also required more treatment delays (p=.01). CONCLUSION Despite being retrospective study and a few pts were treated with LM, there were no differences neither in PFS nor in OS in pts treated with LM vs FM at first or second line. Higher G1-2 thrombocytopenia was shown in the FM group probably due to a higher number of hematology samples collected.