tbuckley/cabot-search huggingface dataset:
SAINT: Results of an expanded phase II study using safe amounts of ipilimumab (I), nivolumab (N), and trabectedin (T) as first-line treatment of advanced soft tissue sarcoma [NCT03138161].
Authors: Erlinda Maria Gordon, Victoria S. Chua-Alcala, Katherine Kim, Paul Stendahl Dy, Micaela Kristina Paz, Nicole Angel, Ania Moradkhani, Doris Quon, Steven Wong, Omid Jafari, Sant P. Chawla
Journal: Journal of Clinical Oncology (2020)

11520 Background: Sarcoma cells are most immunogenic earlier in the disease. Hypothesis: Immune checkpoint inhibitors would be most effective when given as first-line therapy. Methods: Eligible patients include previously untreated male or female patients, ≥ 18 years of age with locally advanced unresectable or metastatic soft tissue sarcoma (STS), with measurable disease by RECIST v1.1. Immune checkpoint inhibitors I (1 mg/kg i.v. q 12 weeks) and N (3 mg/kg i.v. q 2 weeks) were given with T (1.2 mg/m2 i.v. q 3 weeks), a tumoricidal agent that depletes growth-promoting macrophages in the tumor microenvironment. Primary endpoint: Objective response rate by RECIST v1.1; Secondary endpoints: (1) Progression-free survival (PFS) at 6 months, (2) Overall survival (OS) at 6, 9, 12, 24, and 48 months, and (3) Incidence of adverse events. Results: Efficacy analysis: There were forty-one evaluable subjects. Best overall response rate was 19.5%; disease control rate 87.8%. The median OS was &gt;12.5 months; median PFS was &gt;6.0 months (6-month OS rate: 75%; 6-month PFS rate: 50%). Safety analysis: Grade 3 TRAEs include fatigue (n = 5), increased TSH (n = 3), decreased TSH (n = 1), adrenal insufficiency (n = 1), hyperglycemia (n = 1), dehydration (n = 1), hyponatremia (n = 2), bipedal edema (n = 2), increased AST (n = 8), increased ALT (n = 19), increased ALP (n = 2), increased CPK (n = 3), port site infection (n = 2), psoriasis exacerbation (n = 1), anemia (n = 6), thrombocytopenia (n = 2), and neutropenia (n = 2). Grade 4 TRAES include neutropenia (n = 1), thrombocytopenia (n = 2), and increased CPK (n = 2). Conclusions: These data suggest that combinatorial therapy with Ipilimumab, Nivolumab and Trabectedin (1) may have synergistic activity in achieving disease control, and (2) is safe with manageable toxicity for patients with previously untreated STS. Clinical trial information: NCT03138161 . [Table: see text]
Dose-dense carboplatin and paclitaxel versus three weekly regimen in the first-line treatment of ovarian carcinoma.
Authors: Rafaela Pirolli, Felipe Leonardo Estati, Viviane Alencar, Mariana Romero de Oliveira, Adriana Regina Goncalves Ribeiro, Glauco Baiocchi, Andrea Paiva Guimaraes, Alexandre Andre B. A. Da Costa
Journal: Journal of Clinical Oncology (2020)

e18059 Background: The benefit of dose dense chemotherapy (ddCT) in the adjuvant treatment of ovarian carcinoma (OC) is not clear. There is one positive Japanese trial and two negative trials in non-Asian patients, which differed from the JGOG 3016 trial for the use of bevacizumab in one of them and the use of neoadjuvant CT (NCT) in half the patients in the other. In this study, we aimed to compare progression free survival (PFS) of ddCT to conventional regimen. Methods: We did a retrospective review of medical records from patients with OC treated in a Brazilian cancer center from 2007 to 2018. All patients treated with ddCT or conventional carboplatin and paclitaxel regimen (3wCT) in the first line setting were included. PFS and overall survival (OS) were compared. To address selection bias we performed a second analysis in a propensity score matched cohort. Patients were matched according to age, ECOG performance status, CA 125, stage, residual disease and histological subtype, in a 1:2 ratio. Results: A total of 615 cases were enrolled for analysis, 62 were treated with ddCT. Patients treated with ddCT presented better ECOG and more frequently presented advanced stage, high-grade serous carcinoma and residual disease ≤ 1cm. Only 10% of patients were treated with NCT in both groups. In the multivariate analysis ddCT showed a non-significant benefit over conventional CT (PFS HR 0.646, 95% CI 0.384–1.087, p = 0.10). In the propensity score matched cohort 186 patients were included, 62 treated with ddCT and 124 3wCT. Groups were well balanced. After a median follow-up of 48.1 months, median PFS was 32 (18-45.9) versus 22.7 (18.8-26.6) months, favoring dose dense treatment (p = 0.059). In the multivariate cox regression ddCT showed a 45% lower risk of progression (HR 0.55, 95% CI 0.35–0.88, p = 0.01). Overall survival data is immature, but suggested better outcomes for ddCT (NR versus 76.1 months; p = 0.02). Conclusions: There is no prospective study in a Western population with the same design as the JGOG 3016 trial. In our study, in a population with the same treatment schedules of the Japanese trial, ddCT was associated with longer PFS. This finding suggests that a weekly regimen of paclitaxel might still be a reasonable option for first-line treatment for women with advanced ovarian cancer, and should be further prospectively evaluated.
阿卡波糖对2型糖尿病合并高血脂患者餐后血脂的影响
Authors: 陈少华, 冯丽, 张伟, 岳峰
Journal: BMJ (2006)

血脂代谢异常是2型糖尿病的重要危险因子,如何降低脂毒性的危害作用越来越得到重视.有研究认为,阿卡波糖(拜唐苹)可明显影响2型糖尿病患者的血脂水平,但由于这些临床研究的多数指标是在空腹状态下测定,而人体大部分时间处于餐后状态,采用空腹血脂很难准确反映血脂在体内的代谢过程及致病机制,为此我们重点对2型糖尿病患者进行餐后血脂检测和分析,报告如下。
ASCEND: Phase III, Randomized Trial of Acalabrutinib Versus Idelalisib Plus Rituximab or Bendamustine Plus Rituximab in Relapsed or Refractory Chronic Lymphocytic Leukemia
Authors: Paolo Ghia, Andrzej Pluta, Malgorzata Wach, Daniel Lysak, Tomas Kozak, Martin Simkovic, Polina Kaplan, Iryna Kraychok, Arpad Illes, Javier de la Serna, Sean Dolan, Phillip Campbell, Gerardo Musuraca, Abraham Jacob, Eric Avery, Jae Hoon Lee, Wei Liang, Priti Patel, Cheng Quah, Wojciech Jurczak
Journal: Journal of Clinical Oncology (2020)

PURPOSE Acalabrutinib, a highly selective, potent, Bruton tyrosine kinase inhibitor, was evaluated in this global, multicenter, randomized, open-label, phase III study in patients with relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL). METHODS Eligible patients, aged ≥ 18 years with R/R CLL, were randomly assigned 1:1 centrally and stratified by del(17p) status, Eastern Cooperative Oncology Group performance status score, and number of prior lines of therapy. Patients received acalabrutinib monotherapy or investigator’s choice (idelalisib plus rituximab [I-R] or bendamustine plus rituximab [B-R]). The primary end point was progression-free survival (PFS) assessed by an independent review committee (IRC) in the intent-to-treat population. Key secondary end points included IRC-assessed overall response rate, overall survival, and safety. RESULTS From February 21, 2017, to January 17, 2018, a total of 398 patients were assessed for eligibility; 310 patients were randomly assigned to acalabrutinib monotherapy (n = 155) or investigator’s choice (n = 155; I-R, n = 119; B-R, n = 36). Patients had received a median of two prior therapies (range, 1-10). After a median follow-up of 16.1 months (range, 0.03-22.4 months), median PFS was significantly longer with acalabrutinib monotherapy (PFS not reached) compared with investigator’s choice (16.5 months [95% CI, 14.0 to 17.1 months]; hazard ratio, 0.31 [95% CI, 0.20 to 0.49]; P &lt; .0001). Estimated 12-month PFS was 88% (95% CI, 81% to 92%) for acalabrutinib and 68% (95% CI, 59% to 75%) for investigator’s choice. Serious adverse events occurred in 29% of patients (n = 44 of 154) treated with acalabrutinib monotherapy, 56% (n = 66 of 118) with I-R, and 26% (n = 9 of 35) with B-R. Deaths occurred in 10% (n = 15 of 154), 11% (n = 13 of 118), and 14% (n = 5 of 35) of patients receiving acalabrutinib monotherapy, I-R, and B-R, respectively. CONCLUSION Acalabrutinib significantly improved PFS compared with I-R or B-R and has an acceptable safety profile in patients with R/R CLL.
John Deelun Somauroo
Authors: Rob Cooper, Derick Todd
Journal: BMJ (2020)

John Deelun Somauroo was a keen sportsman from his school days at King’s College Taunton. After medical school in Nottingham he undertook junior doctor posts in Plymouth and Leicester. His cardiology training was on the Mersey rotation, and while training he published on cardiac screening in young professional footballers. It was from here that his interest and …
The impact of tumor hypoxia on the clinical efficacy of anti-PD-1 mAb treatment in recurrent/metastatic HNSCC patients (R/M).
Authors: Dan Paul Zandberg, Maria A Velez, Ashley V. Menk, Angen Liu, Heath Devin Skinner, Umamaheswar Duvvuri, James Ohr, Simion I. Chiosea, Marci Lee Nilsen, David Anthony Clump, Robert L. Ferris, Greg Delgoffe
Journal: Journal of Clinical Oncology (2020)

6546 Background: Anti-PD-1 mAbs have changed the landscape of R/M HNSCC treatment, but physical, immunologic, and metabolic barriers present in the tumor microenvironment are likely drivers of low response rates. Hypoxia is a well-established feature of the tumor microenvironment and may act as a barrier to T cell infiltration and function. We evaluated the effect of hypoxia on the efficacy of anti-PD-1 mAb treatment in R/M HNSCC patients. Methods: We conducted a retrospective analysis of R/M patients treated with anti-PD-1 mAb that had consented to the UPMC Hillman tissue banking protocol (HCC 99-069). Pre-treatment archival FFPE samples were analyzed via immunofluorescent imaging for number of CD8+ T cells (CD8), Tregs, and the percent area (% CAIX) and mean intensity (Int) of carbonic anhydrase IX, a well-described marker of hypoxia. Tissue sections stained with PanCK, CAIX, CD8, Foxp3, and DAPI were imaged with an Olympus IX 83 microscope. ImageJ software and custom software plugins were used to determine %CAIX, Int, CD8, and Treg. PD-L1 by IHC was reported as a combined positive score (CPS) defining positive as CPS &gt; 1. We compared non-responders (NR) i.e. PD to responders (R) i.e. PR or SD, and analyzed OS, PFS. All data were analyzed using GraphPad Prism software. Two-tailed unpaired t test was used when comparing 2 groups, 1-way ANOVA was used for multiple comparisons, and log-rank test was used for survival analysis. Results: The 36 patients included were 69% male, median age 59, 58% smokers. 61% were platinum failure. Primary site included 39% OC, 22% OPC (38% HPV positive), 17% Larynx, 17% other, 5% hypopharynx. Low %CAIX/Int, high CD8, and high CD8/Treg were all significantly associated with R. Patients with low %CAIX/Int (12 month OS Low: 75% vs. Mid: 17% vs. High:8%, p = 0.02) and high CD8/Treg had a significant increase in OS. Only high CD8 was associated with significantly higher PFS. Low %CAIX alone showed a non-significant trend towards increased R and no difference in PFS/OS. There was no difference in CD8, CD8/Treg, PD-L1 and Treg between %CAIX/Int groups. Conclusions: To our knowledge this is the first evaluation of tumor hypoxia as a predictive biomarker in anti-PD-1 mAb treated R/M HNSCC patients. Lower hypoxia by %CAIX/Int was associated with significantly increased response and OS. While further analysis in a larger dataset is needed to confirm, the lack of significant difference in CD8, Treg, PD-L1, and CD8/Treg between %CAIX/Int groups (Low, Mid, High) suggests that hypoxia may be an independent predictive marker.
Use of quality of life scales in evaluation of life quality in patients with asthma
Authors: 李凡, 蔡映云, 李海玲, 徐晓雯, 罗艳蓉
Journal: BMJ (2005)

目的 了解支气管哮喘生命质量量表(AQLQ)在评估支气管哮喘患者生命质量时的效果,并与非特异性生命质量量表SF36量表比较.方法采用4周非双盲定群研究方法,分别以7分制、5分制支气管哮喘生命质量量表(7-AQLQ、5-AQLQ)和SF36量表对48例支气管哮喘患者在初诊、治疗2周和4周时进行生命质量评估,随访期间患者每日监测呼气峰流速(PEF)并记哮喘日记.结果 48例支气管哮喘患者呼气峰流速平均值占预计值百分比(PEF占预计值%)从初诊的55%,提高到治疗2周后的63%和4周后的66%(P 0.05);AQLQ总均分与PEF占预计值%的相关系数明显高于SF36量表与PEF占预计值%的相关系数.结论在评估支气管哮喘患者生命质量时,AQLQ比SF36量表灵敏。
Clinical manifestations of pyogenic liver abscesses of cryptogenic origin
Authors: Jian Gong, Wei Dai
Journal: BMJ (2013)

Total 118 patients with pyogenic liver abscess admitted to Zhongshan Hospital were classified into pypgenic liver abscesses of cryptogenic origin (PLAC, n=54), pyogenic liver abscesses of biliary origin (PLAB, n=48) and pyogenic liver abscesses of hemagenous origin (PLAH, n=16) according to the causes. The clinical features of three groups were compared and analyzed. The results showed that no statistically significant difference existed among three groups in clinical manifestation and signs. Compared to PLAB, the abscesses in right lobe of liver were more common in PLAC, diabetes mellitus was more prevalent in PLAC, but the co-existing diseases including chronic liver disease, non biliary malignant tumor and ALP elevation were less in PLAC. Klebsiella pneumoniae was frequently detected in PLAC, but there was no significant difference comparing to other two groups. No significant difference was found among three groups in the choice of therapeutic methods, the course of antibiotics, length of hospital stay and the days from admission to diagnosis.


Key words: 
Liver abscess, pyogenic; Clinical features
Optimizing medication strategies in elderly patients
Authors: Xuelian Yan, Xiaohong Liu
Journal: BMJ (2018)

老年人不合理用药问题普遍，易导致疗效降低、药物不良反应增加，相关住院率及病死率增加等多种不良后果。面对老年人共病、多重用药等复杂情况，优化药物治疗是对临床工作者的一个挑战。文章从避免多重用药、药物重整、结合老年综合评估等多个方面阐述优化老年人药物治疗的策略。
眼上静脉血栓性静脉炎一例
Authors: 姜鹏飞, 孙英, 李元彬
Journal: BMJ (2010)

患者男,66岁,因突发左眼眼胀、眼红3 d于2009年1月27日就诊.无发热、头痛等症状.既往曾患甲状腺功能亢进症(甲亢),近期复查促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)均正常.无高血压、糖尿病、冠心病、脑血管等疾病。
Financial toxicity in patients with multiple myeloma participating in clinical trials: A U.S. Food and Drug Administration pooled analysis.
Authors: Bellinda King-Kallimanis, Ting-Yu Chen, Bindu Kanapuru, Vishal Bhatnagar, Paul Gustav Kluetz
Journal: Journal of Clinical Oncology (2020)

e19370 Background: Financial toxicity (FT) is a major concern for patients receiving standard cancer treatment, and FT can lead to worse cancer outcomes. However, little is known about the FT of patients enrolled in clinical trials (CT). While investigational treatment may be provided by sponsors free of charge, patients are subject to increased clinic visits (ie, missed workdays, travel costs) and still bear the cost of usual care. This analysis evaluates patient-reported FT in multiple myeloma (MM) trials submitted to US FDA and explores the relationship between baseline FT and overall response rate (ORR). Methods: We pooled data from 9 MM registration CTs submitted to the FDA that included the EORTC Quality of Life questionnaire (QLQ-C30). The QLQ-C30 includes an item asking patients “Has your physical condition or medical treatment caused you financial difficulties?”. We looked at proportion of patients at baseline reporting any FT and their ORR. We also report prevalence, incidence and change from baseline FT at 3 and 6 months. Results: 5,667 patients answered the FT item. Mean age of patients was 65 years, 55% were male, 85% were white and 6% were enrolled in the US. Approximately a third of patients reported experiencing any FT at baseline, 3 and 6 months. When compared to their baseline, 69% of patients had unchanged FT and 14% had worse FT at both 3 and 6 months. The incidence of new cases of FT at 3 months was 17% and at 6 months 7%. The ORR in patients who reported any FT at baseline was 69% compared to 72% in patients with no baseline FT, and was similar regardless of the degree of FT. Conclusions: Few studies have investigated FT in a large sample of CT participants. In this pooled analysis of patients enrolled in MM CTs, approximately a third of patients reported FT associated with their physical condition or medical treatment at baseline and throughout the trial. A small percentage of patients experienced worsening FT during the trial and a small percentage went from no FT to reporting any FT. The impact of baseline FT on ORR was small. Limitations of this preliminary analysis include missing patient level or group level insurance status, socio-economic status and other important determinants of health.
Application of stair climbing test in preoperative evaluation for patients of lung cancer with lower pulmonary function
Authors: 朱勇, 杜贾军, 陈景寒
Journal: BMJ (2007)

目的 评价登楼试验在判断低肺功能肺癌患者能否承担手术治疗中的作用.方法 将需行肺叶切除术的418例肺癌患者按肺功能检查结果分为肺功能正常(NPF)组(357例)和低肺功能(LPF)组(61例).NPF组行手术治疗;LPF组行登楼试验,对90 s内可以登楼76级台阶、静息状态呼吸室内空气时动脉血氧饱和度＞90%的48例患者进行术前功能锻炼后行手术治疗,另外13例行保守治疗.观察术后两组的并发症情况,比较LPF组有、无并发症者的登楼试验结果.结果 手术治疗的405例患者术后出现并发症51例(12.6%),其中心律失常14例、心功能衰竭7例、心肌梗死1例、肺部感染16例、肺不张6例、肺动脉栓塞1例、呼吸衰竭6例(其中1例死亡).其中NPF组的并发症发生率为11.5%(41/357),低于LPF组的20.8%(10/48),但差异无统计学意义(P＞0.05).LPF组有无并发症患者的一氧化碳弥散量占预计值百分比、登楼前后心率变化值差异有统计学意义(P＜0.05),登楼时间和登楼前后动脉血氧饱和度变化值的差异无统计学意义(P＞0.05).结论 静态肺功能测定显示不宜行肺叶切除的肺癌患者,通过术前登楼试验筛选,可使部分患者重新得到手术治疗的机会。
Effect of metallic nanoparticles on tumor growth: In vivo study.
Authors: Elena Yu. Zlatnik, Elena I. Triandafilidi, Oksana V. Bykadorova, Oleg I. Kit, Galina V. Zhukova, Irina A. Goroshinskaya
Journal: Journal of Clinical Oncology (2020)

e15650 Background: The aim of the study was to assess the effect of metallic nanoparticles on growth of transplanted ascitic tumor sarcoma 37 in mice. Methods: Nanoparticles (NP) of transition metals were experimentally developed and kindly provided us by Prof. V.B. Borodulin. Ultradispersed metallic powders (NP Cu, NP Zn, NP Fe) 30-100 nm sized were dispersed by ultrasound in 0.85% NaCl before use and daily administrated intraperitoneally to tumor-bearing mice with ascitic sarcoma 37. Injections of NP 500 µl (10 µg/ml) were performed for 4 days, and 4 days after the completion of the course mice were sacrificed. The control group received 0.85% NaCl. Ascitic fluid volume was measured and living cells were counted. Results: In all the tumor-bearing mice the progression of ascites was noted: it was maximal in controls, less in animals having received NP Fe and NP Cu, minimal – in mice after injection of NP Zn. The volume of the latter was 0.78±0.31 ml in comparison with control data: 1.79±0.66 ml (p &lt; 0.05); it was also less than in mice after administration of NP Cu (2.16±0.68 ml) and NP Fe (3.3±1.3 ml). Similar difference was seen in the amount of tumor cells in ascitic fluid: (1.67±0.5)х10 6 /ml after the injection of NP Zn and (27.7±2.86)х10 6 /мл in the control group. Effect of NP Cu and NP Fe was less pronounced than of NP Zn though obvious in spite of the noted tendency of the increase of the ascitic fluid volume. The most significant changes were observed when absolute amount of living tumor cells was counted per one mouse – it was minimal after NP Zn administration (0.636±0.2)х10 6 /ml and maximal in the control group (23.98±10.5)х10 6 /ml), i.e. only 2.6% of tumor cells had survived after NP Zn injection. Conclusions: Our results demonstrate that metallic NP were able to produce antitumor in vivo without any supplements like laser or hyperthermia: the effect was likely to depend upon the metal and was the highest in NP Zn compared to NP Cu and Fe.
Circulating tumor DNA sequencing analysis of patients with metastatic renal cell carcinoma (mRCC).
Authors: Zeynep Busra Zengin, Nazli Dizman, Nicholas Salgia, Jeremy Jones, Jingbo Zhang, Yunchao Liu, Bing Xu, Fuwei Li, Yan Wang, Mengjian Li, Rong Du, Ye Zhou, Joann Hsu, Meghan Salgia, Lixin Yang, Sumanta K. Pal
Journal: Journal of Clinical Oncology (2020)

e17100 Background: Despite extensive work to characterize genomic alterations (GAs) in metastatic renal cell carcinoma (mRCC), GAs are not currently used for treatment sequencing or selection. Circulating tumor DNA (ctDNA) in both blood and urine may elucidate potential mRCC biomarkers through a minimally invasive approach. We aimed to validate previous blood-based ctDNA studies (Pal et al Eur Urol 2017) and compare detection rates of clinically relevant GAs in plasma and urine. Methods: From a single institution, patients (pts) with mRCC were recruited to provide a plasma and urine specimen. ctDNA next-generation sequencing was performed using an investigational 120-gene panel, and we limited our assessment to 7 GAs with biological relevance in RCC ( VHL, MTOR, PIK3CA, TSC2, MET, AKT1, TSC1). Further, only pathogenic alterations previously recognized in RCC and cited in the Catalogue of Somatic Mutations in Cancer (COSMIC) database were considered. Clinicopathologic variables, treatment type and response to therapy were collected from an institutional mRCC patient database. Concordance analysis was performed at the gene level between blood and urine using previously published approaches (Chae et al Oncotarget 2016). Results: 50 pts (40M:10F) were enrolled with a median age of 65. 40 pts (80%) had clear cell histology, while the remainder were papillary (12%), chromophobe (4%) or other (4%). Pts received a median of 1 line of therapy (range, 0-7). GAs were identified in 45 pts (90%) in blood and in 45 pts (90%) in urine . Applying the above criteria, the most frequently observed GAs in blood specimens were TSC2 (9%), MTOR (4%), and VHL (2%). The most frequently observed GAs in urine were VHL (4%) and MTOR (2%). The rate of concordance between blood- and urine-detected GAs was 93%. Of pts bearing mTOR pathway alterations in blood or urine, 3 received everolimus-based therapy. All 3 pts remain on therapy at 10.4, 13.8 and 14.0 months, respectively. Conclusions: Biologically relevant GAs can be detected in pts with mRCC using blood and urine. Our methodology showed high concordance between both platforms. Consistent with prior reports, ctDNA assessment of pts with pretreated mRCC shows a higher frequency of TOR pathway alterations and a lower frequency of VHL mutation.
Real-world adoption of PD-L1 testing in metastatic urothelial carcinoma.
Authors: Shilpa Gupta, Martine C Maculaitis, Andrew Bernstein, Anna Boudoures, Marija Tesic-Schnell, Brian S. Seal, Emily Mulvihill, Yunes Doleh
Journal: Journal of Clinical Oncology (2020)

e19184 Background: The role of PD-L1 testing in locally advanced (LA) or metastatic urothelial carcinoma (mUC) is not currently well-defined, except in cisplatin-ineligible patients (pts). IMVigor130 trial data are the first to suggest cisplatin-eligible PD-L1 positive pts may also benefit from immunotherapy (IO) (ESMO LBA14_PR, 2019). As clinical data accumulate on the influence of PD-L1 expression on LA/mUC pt outcomes with IO, we assessed medical oncologists’ (ONCs) PD-L1 testing perceptions and practices. Methods: ONCs completed a longitudinal, online self-report survey fielded from August 22 to September 23, 2019, prior to release of IMVigor130 data. Baseline results are reported. Descriptive statistics and bivariate comparisons by practice setting were conducted. Results: ONCs (N = 203) had a mean of 15 years in practice; a majority (64%) practice in the community. ONCs tested most LA/mUC pts, but initiated treatment for about a third before receiving results (Table). Half believe PD-L1 testing in LA/mUC will increase over time; this view was more common for ONCs who do not (n = 55) vs. do (n = 148) order PD-L1 testing as standard for LA/mUC pts (55% vs. 49%). Most ONCs reported that pts in an IO + chemotherapy trial arm should be stratified by PD-L1 status (74%), but not platinum agent (69%). Common barriers to more LA/mUC pts (n = 92) getting a PD-L1 test were limited biopsy sample (54%), lack of influence on treatment decisions (54%), and treatment initiation urgency (30%). ONCs varied little by practice setting. Conclusions: PD-L1 testing has been adopted by ONCs for most of their LA/mUC pts. However, ONCs report limited biopsy sample and lack of influence on treatment decisions as barriers to testing more LA/mUC pts, supporting their initiation of therapy prior to receipt of results and desire for trial data to be stratified by PD-L1 status. Results suggest PD-L1 expression is not yet a key driver in treatment decisions. Given the variability in self-reported responses, results should be interpreted with this limitation in mind. [Table: see text]