Trofosfamide is an alkylating agent that is derived from the oxazaphoshorines. It has found application in a broad spectrum of malignancies in the last three decades. The main indications for application were in the palliative situation and as maintenance therapy. Good results were reported from the treatment of non-Hodgkin’s lymphomas and soft tissue sarcomas. A lot of small studies and casuistic contributions are available giving treatment results of several solid carcinomas (malignant gliomas, ovarian, lung and prostate cancer, and others). Due to its oral formulation and good tolerability trofosfamide is an attractive candidate for the palliative situation because treatment on an outpatient basis is possible. However, there is still a lack of randomized clinical studies with trofosfamide. Thus, evidence-based conclusions on the therapeutic value of the drug cannot be drawn. In the future, phase III trials should be untertaken.

Background: With increasing numbers of patients subjected to total body irradiation and bone marrow transplantation for treatment of several systemic malignancies more and more patients with second malignancies were observed. Case Report: We report the case of a 29- year-old man who developed breast cancer 13 years after treatment for acute lymphoblastic leukemia. Therapy for leukemia included total body irradiation (TBI) and bone marrow transplantation (BMT). Breast cancer was treated with mastectomy and irradiation of the left chest wall. 17 months later the patient developed malignant pleural effusion and died despite chemotherapy and hormonal therapy due to further tumor progression. Conclusion: The increased risk for secondary solid cancers after TBI and BMT and the greater risk among younger patients indicate the need for lifelong careful follow up.

5513 Background: The prostate-specific antigen (PSA) test can lead to under- and over-diagnosis of prostate cancer and has not been recommended for population screening. A fast MRI scan might overcome the limitations of PSA. IP1-PROSTAGRAM is the first study to evaluate the performance of a 15-minute non-contrast MRI for prostate cancer screening in comparison to PSA. Methods: IP1-PROSTAGRAM was a prospective, population-based, screen-positive paired-cohort study. Men aged 50-69 years in the UK were invited for prostate cancer screening through seven primary care practices or community-based recruitment. Participants underwent a PSA and MRI scan (T2-weighted and diffusion). MRI was scored using PIRADS version 2.0 without knowledge of PSA; screen-positive MRI (defined as either PIRADS score 3-5 or 4-5) were compared against a screen-positive PSA defined as ≥3ng/ml. If any test was screen-positive, a systematic 12-core biopsy was performed with MRI-ultrasound image-fusion targeted biopsy to MRI suspicious areas, as appropriate. Clinically-significant cancer was defined as any Gleason score ≥3+4. The primary outcome was the proportion of screen-positive MRI at different scores; important secondary outcomes were the number of clinically-significant and insignificant cancers detected. Results: 2034 men were invited to participate of whom 408 consented and 406 were screened by both PSA and MRI (10/Oct/2018-15/May/2019). The proportion with a screen-positive MRI (score 3-5) was higher than the proportion with a screen-positive PSA (17.7% [95%CI 14.3-21.8] vs. 9.9% [95%CI 7.3-13.2]; p < 0.001). A screen-positive MRI (score 4-5) was similar to a screen-positive PSA (10.6% [95%CI 7.9-14.0] vs. 9.9% [95%CI 7.3-13.2], p = 0.71). An MRI score 3-5 or 4-5 used to denote a screen-positive MRI, compared to PSA alone, detected 14, 11 and 7 clinically-significant cancers, respectively. There were 7, 5 and 6 clinically-insignificant cancers detected, respectively. No serious adverse events occurred. Conclusions: When screening the general population for prostate cancer, MRI using a score of 4-5 to define a screen-positive test, compared to PSA alone at ≥3ng/ml, could lead to more men diagnosed with clinically-significant cancer without increasing the number of men biopsied or diagnosed with clinically-insignificant cancer. Clinical trial information: NCT03702439 .

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