(P 307) ADOLESCENT AND YOUNG ADULT SARCOMA TREATMENT HARMONIZATION: AYA MAP FOR OSTEOSARCOMA

Objective: Several identified factors have led to suboptimal outcomes in cancer care for adolescents and young adults (AYAs), defined as individuals between the ages of 15 to 39 years by the National Cancer Institute. These include low clinical trial enrollment, inconsistencies in treatment approaches, decreased adherence to therapy or therapy intolerance and decreased provider familiarity with AYA cancer care. The AYA Sarcoma Treatment Paradigm Working Group was created at Memorial Sloan Kettering Cancer Center (MSK) to harmonize therapy for the prototypical sarcomas affecting AYAs across the pediatric and medical oncology services using evidence-based methods.

Methods: The MSK AYA Sarcoma Treatment Paradigm Working Group, an interdisciplinary group of medical and pediatric oncologists, advanced practice providers, clinical pharmacy specialists and hospital administrators, began meeting in August 2020 to harmonize treatments between medical and pediatric sarcoma care. Treatment harmonization is performed by identifying areas of discrepancies in clinical practice (e.g., disease and toxicity monitoring, chemotherapy dosing and administration and supportive care, etc.) between medical and pediatric sarcoma providers. Once inconsistencies are identified, a comprehensive literature review is performed by members of the working group to establish consensus on best practice for AYA patients. If limited evidence is available to support current practice, expert opinion is utilized to standardize care. Evidence-based recommendations are then translated into clinical care through creation of AYA treatment recommendations and guidelines that are circulated to medicine and pediatric sarcoma services, as well as nursing and pharmacy leads for feedback. Subsequently, AYA-specific treatment order sets are created to facilitate treatment harmonization.

Results: Osteosarcoma was the first disease to undergo treatment harmonization since there was consensus, supported by literature review, that methotrexate, doxorubicin and cisplatin (MAP) chemotherapy is the standard of care for AYA patients with newly diagnosed osteosarcoma. Despite general agreement on the regimen, there were several discrepancies in clinical care that required standardization, including: frequency and timing of echocardiograms; use of the cardioprotectant dexrazoxane with doxorubicin; antiemetic guidelines; hydration practices with methotrexate and cisplatin; use of mannitol with cisplatin; one versus two day administration of cisplatin; methotrexate dose capping; and outpatient versus inpatient administration of high-dose methotrexate. Once literature review was completed and consensus reached, treatment recommendations were translated into a treatment guideline circulated to the medical and pediatric sarcoma services. An AYA-specific osteosarcoma order set is in development and will be available for use institutionally across services. It is expected that AYA patients with osteosarcoma will be able to receive standardized care per harmonized treatment recommendations in the fourth quarter of 2022.

Conclusion: Treatment harmonization for AYA patients is critical to improve outcomes and ultimately serve as the backbone on which to build future clinical trials. The AYA Sarcoma Treatment Paradigm Working Group was developed as an interdisciplinary approach to standardize care for AYA patients at MSK based on available literature. Future directions of this group include expanding harmonization approaches to other disease states, including Ewing sarcoma and rhabdomyosarcoma, as well as across institutions. Importantly, after treatment implementation, outcomes related to cancer care before and after harmonization approaches will be analyzed to assess for changes in patient- and disease-specific outcomes.