BackgroundESR1 mutation has recently emerged as one of the important mechanisms involved in endocrine resistance. The incidence and clinical implication of ESR1 mutation has not been well evaluated in heavily pretreated breast cancer patients.MethodsWe conducted a retrospective review of advanced breast cancer patients with tumors who underwent next-generation sequencing genomic profiling using Foundation One test at Cancer Treatment Centers of America® regional hospitals between November 2012 and November 2014.ResultsWe identified a total of 341 patients including 217 (59%) estrogen receptor (ER)+, 177 (48%) progesterone receptor (PR)+, 30 (8%) hormone receptor+/HER2 positive, and 119 (32%) triple negative patients. ESR1 mutation was noted in 27/222 (12.1%) ER+ or PR+ breast cancer patients. All ER+ patients received at least one line of an aromatase inhibitor. All 28 patients were found to harbor ESR1 mutations affecting ligand-binding domain with the most common mutations affecting Y537 (17/28, 60.7%) and D538 (9/28, 32.1%). In this cohort, 19 (67.9%) patients carried three or more, seven (25%) patients had one or two additional genomic alterations and one (3.6%) patient had an ESR1 mutation only. Of 28 patients, three patients were treated with fulvestrant immediately before and two patients were treated after next-generation sequencing testing; only one patient achieved stable disease for 8 months and the other four patients had progression of disease. In all, 3/3 (100%) patients before testing and 2/4 (50%) after testing treated with exemestane and everolimus achieved stable disease for at least 6 months.ConclusionESR1 mutation was found in 12.1% of a large cohort of advanced breast cancer patients. Exemestane in combination with everolimus might be a reasonable option. Prospective studies are warranted to validate these findings.

53 Background: Pain is experienced by a majority of cancer patients, often having a significant negative impact on their quality of life. Effective documentation of pain scores and plan of care provide care teams with data for decision-making to improve pain management. In Q2 of 2021 documentation deficiencies were identified. Process improvement interventions were initiated through the remainder of 2021 to support clinical teams. Methods: Over the course of twelve months our practice sought to improve documentation of pain management through a multi-pronged approach. Execution began with initiation of the Quality and Safety Committee early in 2021 to engage key stakeholders. Our Chain of Command Project identified strategic members of the administrative and clinical leadership teams at the individual clinic level who initiated monthly meetings to promote quality awareness and engagement. Quality measures associated with pain management, MIPS 143 and 144, were examined with assistance from our Value Based Care Transformation Team. Monthly provider scorecard distribution commenced Q2 to identify documentation inconsistencies related to pain management. Providers, medical assistants, and scribes were provided education and training related to appropriate pain management documentation workflows. Follow up audits were performed by the Quality team. In Q3 and Q4 the Quality team collaborated with Human Resources to identify new employees and facilitate education on quality metric capture within a month of hire. Results: The data above is a representation of all clinics and patients treated. The interventions resulted in improved metrics from 2020 to 2022 YTD: MIPS 143 +5.5%, MIPS 144 +27.3%, and PIMSH4 +6.3%. Conclusions: Effective change management occurred from the top down with additional engagement of administrative and clinical members. Analysis of the internal structure and deficiencies was needed with implementation of metric training. Data transparency helped with engagement and managing documentation of MIPS 143 and 144. Next steps include leveraging the current documentation processes to improve PIMSH4, ultimately improving the quality of life for patients.[Table: see text]

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