Introduction Serious Acute Respiratory Syndrome Coronavirus 2 (SARSCoV2) has led to COVID 19 pandemic a year ago and it has not been globally taken under control yet. COVID 19 tends to have poorer prognosis in cancer patients. Additionally, we have no well-established guidelines for management of these patients during pandemic, in terms of treatment of ‘cancer’ and treatment of ‘COVID 19’. Tyrosine kinase inhibitors (TKIs) are given without any break in cancer patients to have better survival outcomes in daily routine. However, there is no well-established data to continue or delay ALK inhibitors in lung cancer patients infected with SARS-CoV2. Concomittant use of ALK inhibitors and COVID 19 antiviral treatment is a dilemma because of the lack of data in this area. Case Report A 47-year old female metastatic ALK positive nonsquamous cell lung cancer patient on alectinib, a second generation ALK inhibitor was diagnosed with symptomatic COVID 19. She was given favipiravir for COVID 19 while continuing alectinib. Management and outcome: The patient continued alectinib during COVID 19 antiviral treatment without any break. She tolerated ‘concomittant’ alectinib & favipiravir. She had partial remission after three months of alectinib without any dose adjustment despite active COVID 19 medication. Discussion To best of our knowledge, this is the first case who continued alectinib without dose adjustment during antiviral COVID-19 medication without clinically worsening. There is limited data about ‘concomittant’ use of TKIs and antiviral COVID 19 medication in the literature. There are some case reports, but they generally tended to delay or suspend TKIs during COVID 19 antiviral medication. Our case differs from them in terms of continuation of alectinib without any break or additional side effects during favipiravir for symptomatic COVID 19. We consider that our case might contribute to the literature in terms of management of cancer patients on targeted therapy during COVID 19 antiviral treatment. However, clinical trials are needed in this area.

Purpose:Role of neoadjuvant chemotherapy(NAC) & modified preoperative endocrine prognostic index (mPEPI) score after NAC is unclear in locally advanced HER2(-) breast cancer(LA-HnLBC).We evaluated prognostic & predictive factors for NAC in LA-HnLBC retrospectively. Methods:All had doxorubicin+/-taxane as NAC.They were grouped as pCR/non-pCR & categorized for PR/ki67/ki67 decline/mPEPI score. Ki67 cut-offs were as 20 & median values in our study. Results:142 LA-HnLBC pCR( n:26) & non-pCR(n:116) patients were included.Median age was 53 years. pCR rate was 18.3%. Median ER/PR/ki67 were as 90/40/40 %. Median ki67 was 40 for basal & postoperative. pCR group had more T2(73%), grade 3(69%) & non-pCR had more T3(21%), grade 2(46%) tumors (p=0.03,p=0.03). pCR group had lower mPEPI score (3.5 vs 5,p=0.05). 5y-DFS was 69% (93.8% vs 63.4%, p=0.012). 5y-OS was 77% (100% vs 72%, p=0.018). In univariate analysis, high basal/postoperative ki67 levels, ki67 decline & mPEPI score were significant poor prognostic factors for DFS (p=0.01, p< 0.001, p=0.017, p<0.001) & OS (p=0.006, p=0.003, p=0.05, p=0.001) in non-pCR goup. Prognostic cut-offs were as 40 for basal ki67 (DFS & OS), 20 for postoperative ki67 (DFS), 4 for mPEPI (DFS) & 30 for ki67 decline (OS). Conclusion: Favorable prognostic factors were defined as lower basal ki67 level (<40%) & higher ki67 decline (ki67 <30%) for OS; lower basal ki67 (<40%), po ki 67 (<20%) & mPEPI score (<4) for DFS after NAC in LA HnLBC. Different prognostic cut-offs for basal & postoperative ki 67 is striking. mPEPI score may also have prognostic significance after NAC, T in LA-HnLBC pts.