Background Genomic classifiers (GC) have been shown to improve risk stratification post prostatectomy. However, their clinical benefit has not been prospectively demonstrated. We sought to determine the impact of GC testing on postoperative management in men with prostate cancer post prostatectomy. Methods Two prospective registries of prostate cancer patients treated between 2014 and 2019 were included. All men underwent Decipher tumor testing for adverse features post prostatectomy (Decipher Biosciences, San Diego, CA). The clinical utility cohort, which measured the change in treatment decision-making, captured pre-and postgenomic treatment recommendations from urologists across diverse practice settings (n = 3455). The clinical benefit cohort, which examined the difference in outcome, was from a single academic institution whose tumor board predefined "best practices" based on GC results (n = 135). Results In the clinical utility cohort, providers' recommendations pregenomic testing were primarily observation (69%). GC testing changed recommendations for 39% of patients, translating to a number needed to test of 3 to change one treatment decision. In the clinical benefit cohort, 61% of patients had genomic high-risk tumors; those who received the recommended adjuvant radiation therapy (ART) had 2-year PSA recurrence of 3 vs. 25% for those who did not (HR 0.1 [95% CI 0.0-0.6], p = 0.013). For the genomic low/intermediate-risk patients, 93% followed recommendations for observation, with similar 2year PSA recurrence rates compared with those who received ART (p = 0.93). Conclusions The use of GC substantially altered treatment decision-making, with a number needed to test of only 3. Implementing best practices to routinely recommend ART for genomic-high patients led to larger than expected improvements in early biochemical endpoints, without jeopardizing outcomes for genomic-low/intermediate-risk patients.

No abstract

Purpose/Objective(s): Inflammatory breast cancer (IBC) is an aggressive subtype of breast cancer. The current treatment paradigm is trimodality approach with neoadjuvant chemotherapy, modified radical mastectomy (MRM), and post-mastectomy radiation therapy (PMRT). Advancements in systemic therapy have improved survival increasing the importance of locoregional control. Even with improving outcomes, survival rates remain unsatisfactory prompting the need to identify individuals that may benefit from treatment intensification. We report tumor characteristics, patient demographics, and oncologic outcomes of IBC in the modern era in order to identify subgroups with poor outcomes. Materials/Methods: We searched the Surveillance, Epidemiology, and End Results (SEER) database for women with breast cancer. This cohort was narrowed to women with non-metastatic [Adjusted AJCC 6 th M (1988+) M0] IBC [Adjusted AJCC 6 th T (1988+) T4d] with MRM [(1998+) Breast] with or without external beam PMRT. To be included, patients were treated with either ipsilateral MRM with or without reconstruction with the specified race, age, hormone receptor [ER/PR Status], grade, nodal stage [(1988+)], marital, and radiation data. A minimum of 5 years of follow-up was required. We report the actuarial 5-year cause-specific survival. Results: We identified a cohort of 4841 women treated between 1998 and 2007. The median age of diagnosis was 55. The actuarial 5-year CSS for the whole cohort was 56% (95% CI; 54.0-57.2). Black women made up 13% while white women, other races, and unknown represented 81%, 6%, and <1% respectively. Blacks, whites, and other had 5-year CSS of 42% (37.3-46.0), 58% (55.8-59.3), and 59% (51.8-64.9) respectively. Blacks had a statistically significant (SS) lower CSS than the other groups. PMRT (n Z 2903) had a SS benefit compared to no RT (n Z 1439) with 5-year CSS of 59% (57.3-61.3) and 49% (46.7-52.4) respectively. Women over 70 years of age had a SS lower CSS compared to women between 50-69, but not when compared to ages 20-49. Patients with high-grade histology had a SS lower CSS than intermediate and low-risk patients with CSS of 49% (47-51.8), 68% (64.6-70.8), and 82% (71.6-89.1) respectively. Negative hormone receptor status or being divorced/widowed was also associated with SS worse survival compared to receptor positive disease and being married respectively. Conclusion: Our study confirms that IBC has several tumor factors are associated with worse survival and suggests some patient factors are associated with health disparity. As such, select patients (e.g. black women) may benefit from individualized treatment intensification including additional adjuvant systemic therapy and/or dose escalated PMRT. Select patients may also benefit from more intense post-treatment surveillance and support. Long-term follow-up and prospective data, if feasible, is needed to confirm our findings and conclusions.

No abstract

Conclusion: In a large cohort of community and academic patients, we did not find an independent association between radiation treatment schedule and OS in early stage NSCLC patients. Our findings suggest that dose escalation beyond 100 Gy BED 10 may improve patient survival.