- Email: [email protected]
Annual cost of bevacizumab in the adjuvant treatment of ovarian cancer to the U.S. Medicare system
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Abstracts / Gynecologic Oncology 125 (2012) S3–S167
261 CA125 surveillance and second-line intraperitoneal platinumbased therapy increases second line progression-free survival for epithelial ovarian cancer M. Boisen1, J. Lesnock1, W. McBee2, S. Richard1, J. Kelley1, K. Zorn1, T. Krivak1, R. Edwards1. 1Magee Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, 2Heiskell, King, Burns and Tallman Surgical Associates, Morgantown, WV. Objective: Previous studies have suggested that only 3% of patients with epithelial ovarian cancer (EOC) have a longer progression-free survival (PFS) after second-line intravenous (IV) platinum chemotherapy than with front-line IV therapy (Markman, 2004). We examined what impact second-line intraperitoneal (IP) platinum might have on the ratio of second-line to first-line PFS in patients treated with IP platinum chemotherapy for first recurrence after front-line IV therapy. Methods: A retrospective, descriptive, single-institution analysis of women who received IP chemotherapy for recurrent EOC between January 2005 and March 2011 was conducted. Study patients were identified from the tumor registry and office records from a large Gynecologic Oncology practice. The records were reviewed for demographic factors including age, ethnicity, primary tumor histology, stage, grade, and the cytoreduction volume after primary and secondary surgeries. The first and second PFSs were defined as the time from the end of previous platinum-based therapy to the start of next the therapy. Results: Fifty-nine women received IP chemotherapy for their first EOC recurrence after IV chemotherapy. The mean age was 56 years (range 43–79). All patients had previously undergone primary surgical cytoreduction (80% optimally cytoreduced) followed by IV platinum-based chemotherapy. All patients underwent biopsy, and when necessary cytoreduction at the time of IP port placement. Because many of these women were identified by rising CA125 with small volume recurrent disease (mean CA125 133 IU/ml, range 4– 792), few women required extensive surgery. The majority (70%) of patients were considered optimal (b1 cm residual disease) at the completion of their second surgery. In 15 patients (25%) we observed longer PFS after IP chemotherapy than after primary IV chemotherapy. In this patient population, 85% had papillary serous histology of primary tumor; other histologies include clear cell, endometrioid, and carcinosarcoma. For these 15 patients, the median PFS for primary response was 8 months (range 5–56), while median PFS after IP chemotherapy for recurrent disease was 24 months (range 10–75). Conclusions: For EOC patients with limited peritoneal recurrence, there appears to be a significant increase in the number that can be expected to have their second-line IP-platinum PFS exceed their firstline IV-platinum PFS as compared to published data with IV therapy for recurrence. doi:10.1016/j.ygyno.2011.12.262
262 Downstream effects of first line bevacizumab (bev) on outcomes after recurrence in advanced ovarian cancer E. Bishop1, L. Perry1, R. Previs2, A. Alvarez-Secord2, K. Moore1. 1 University of Oklahoma, Oklahoma City, OK, 2Duke University Medical Center, Durham, NC. Objective: Bevacizumab has been shown to improve PFS in advanced epithelial ovarian cancer (OC), but long term effects of incorporating bev into first-line treatment remains controversial. The goal of this study was to assess the prognostic effect of first-line bev on response at the time of treatment for recurrence in advanced OC. Methods: Retrospective data was collected for 160 pts from 2 institutions from 2001 to 2010. All pts had stage II–IV OC, underwent
primary surgical cytoreduction (CRS), received platinum based chemotherapy (CT) with or without bev, and have developed recurrent disease. Pts were stratified based on bev exposure and on response to, and PFS following, 2nd line chemotherapy (CT2). The primary endpoint was 2nd progression free interval (PFI2) defined as time from starting CT2 until start of third line CT, or date of last follow up for those who did not have a 2nd recurrence. Univariate and multivariate analysis identified prognostic factors for PFI2. Secondary endpoint was evidence of clinical benefit (CB) defined as complete or partial response to CT2 or stable disease. Results: Of the 160 pts, 25% received first-line bev (bev + platinum and/or bev maintenance) while the remainder received platinumbased CT. Following CRS 66% had b1 cm residual disease. 70% of pts were platinum sensitive. Following 2nd line therapy, 16% remain disease free, and 84% had a 2nd disease recurrence. With a median follow up of 38 months, mean primary PFI after initial platinum based therapy was 17.4 months and mean PFI2 was 10.6 months. In pts with platinum sensitive recurrent disease, there was no difference seen in mean PFI2 between pts who received first line bev and those who did not (8 vs. 7 months). Multivariate analysis of prognostic factors for response to CT2 included residual disease following CRS, CT2 agent, and front line bev use. Primary bev exposure was an independent predictor of CB during CT2 (p = 0.007). This improvement in CB was not seen in the platinum resistant subset of pts and similarly, there was no difference in PFI2 (5 vs. 5 months). Conclusions: These results suggest that advanced OC pts treated with first line bev do not have worse response to therapy for recurrent disease than pts treated with platinum-based CT. In fact, in pts with platinum sensitive OC, treatment with first line bev may actually result in improved clinical benefit following therapy for recurrent disease. If these results are confirmed, this raises the question of the true effect of bev on tumor microenvironment. doi:10.1016/j.ygyno.2011.12.263
263 Annual cost of bevacizumab in the adjuvant treatment of ovarian cancer to the U.S. Medicare system A. Walter, J. Geisler, K. Manahan. University of Toledo Medical Center, Toledo, OH. Objective: To determine the potential annual cost of adding bevacizumab to the adjuvant treatment of ovarian cancer (EOC). Methods: A decision model was developed based on Gynecologic Oncology Group (GOG) protocol 218. Arm 1 is 6 cycles of carboplatin/ paclitaxel (CP). Arm 2 is 1 cycle of CP, 5 cycles of CP + bevacizumab (B), and 16 cycles of B alone (CPB + B). Actual and estimated costs of treatment plus the potential costs of complications based on Medicare reimbursement and published data were established for each regimen. An acceptable willingness to pay was considered $50,000 per person per life year gained. Results: Of the nearly 22,000 women who will develop EOC yearly, approximately 85% (18,598) will need chemotherapy after surgery. The cost of chemotherapy agents and infusion of them was $3,138.72/ person for CP and $190,630.47/person for CPB + B. Annual cost to the U.S. economy for infusion of medications alone would be $27 million versus for CP versus N$13.5 billion dollars for CPB + B, respectively. If cost per quality adjusted progression free life year (PFLY) is examined per person, it would be $14,656/PFLY versus $184,306/PFLY giving an incremental cost effectiveness ration (ICER) of $727,183/PFLY. This is well above an accepted level of $50,000 per life year gained. Thus, to increase on average 1 year of PFL (not survival) for each woman with EOC, the U.S. healthcare expenditure would have to increase spending on EOC alone by N$13 billion.
Abstracts / Gynecologic Oncology 125 (2012) S3–S167
Conclusions: Unless costs are significantly reduced, or overall survival is significantly increased, the U.S. would have difficulty absorbing the cost of CPB + B to only improve PFLY by an average of 3.8 months/per patient. doi:10.1016/j.ygyno.2011.12.264
264 Beta blocker use and ovarian cancer survival: A retrospective cohort study R. Eskander1, L. Randall1, L. Bessonova1, K. Ward2, H. Anton Culver1, T. Harrison3. 1University of California, Irvine Medical Center, Orange, CA, 2 University of California, San Diego Moores Cancer Center, La Jolla, CA, 3 Kaiser Permanente Medical Group, Los Angeles, CA. Objective: Beta-blockers have been shown to have a potential beneficial impact on survival in melanoma, breast and prostate cancer. These effects may be mediated through β-2 adrenergic blockade. We examined the association between beta-blocker use and ovarian cancer-specific overall survival (OS). Methods: After institutional review board approval, a retrospective study of patients diagnosed with stage I–IV epithelial ovarian cancer from 2007 to 2010 at Kaiser Permanente Southern California was performed utilizing a universal electronic medication record. Betablocker users for at least 30 days prior to diagnosis were matched 1:4 to non-users. Sample size calculation indicated that 115 users and 415 non-users would provide an 80% power to detect a 30% difference in OS. Statistical analysis was performed using Kaplan–Meier and Cox proportional hazards models. Results: A total of 680 patients were evaluated, including 144 beta-blocker users and 536 non-users. The mean age of beta-blocker users (67.8 years) was statistically greater than that of non-users (60.7 years, P=b 0.001). The mean OS was 23 months for all patients. Median OS was similar for beta-blocker users and non-users (23 months vs. 20 months respectively, P=0.0787), independent of age and stage. Long-term beta-blocker use (≥2.5 years of use prior to diagnosis) resulted in a hazard ratio (HR) of death of 0.711 (95% CI 0.315–1.608). After adjusting for age and stage, the HR for ovarian cancer-specific death was 0.529 (95% CI 0.233–1.200) for long-term users. Post-hoc power analysis showed 21% power to detect a HR of 0.70 with this subgroup sample size at α=0.05. This trend was not seen for short-term users (HR 1.101, 95% CI 0.803–1.510). Conclusions: In this patient cohort, long-term beta-blocker use was associated with a 47% reduction in risk of death, though this did not reach statistical significance. This provocative trend supports further study of long-term beta-blocker use in a larger patient cohort. doi:10.1016/j.ygyno.2011.12.265
265 Mullerian inhibiting substance (MIS) pathway as a therapeutic target in ovarian cancer: Deciphering the necessary components T. Ayeni, W. Sullivan, A. Weaver, W. Cliby. Mayo Clinic, Rochester, MN. Objective: Activation of mullerian inhibiting substance type II receptor (T2R) leads to dimerization with one of three candidate type I receptors (T1R) and growth inhibition of mullerian tissues. While T2R is commonly expressed in epithelial ovarian cancer (EOC), the prevalence of T1R is unknown; this data is critical because our in vitro studies suggest that biologic response is dependent upon which candidate T1R is involved in signaling. The aims of this research were to characterize the frequency of candidate T1R expression in EOC and determine if clinical outcomes are dependent on receptor expression.
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Methods: Tissue microarrays (TMA) were created from 323 consecutive patients with primary EOC. Expression of T1R (ALK2, ALK3, ALK6) and T2R was assessed with immunohistochemistry. Associations between T2R status and clinical characteristics were assessed using the chi-square test. The logrank test was used to evaluate associations between clinicopathologic features and recurrence-free survival (RFS, limited to patients disease-free after completion of chemotherapy) and overall survival (OS), respectively. Results: Analysis was restricted to 262 patients with serous, endometrioid, clear cell, mucinous or mixed histology and known status for at least one of the four receptors. The most common receptor combinations were: T2R-/Alk2,3,6 (16; 6%); T2R-/ALK2,3 (43; 16%); T2R+/ALK2,3 (81; 31%); and T2R+/ALK2,3,6 (84; 32%). There was no difference among these receptor combinations regarding survival (RFS p = 0.91; OS p = 0.89). Patients without T2R were more likely to have advanced stage disease (p = 0.04) and an inability to be cytoreduced to microscopic disease (p = 0.01), compared to patients with T2R present. The ALK6 protein was the least represented form of type I receptor and its expression was associated with death in early stage disease (p = .03), but not in late stage (p = 0.42). Conclusions: The downstream effect of therapy targeting the MIS pathway is dependent upon specific receptor pairing in EOC. We demonstrate for the first time that the majority of human EOC (70%) expresses the necessary candidate receptors for growth inhibition via the MIS pathway. We show that expression of specific receptors is associated with worse clinical outcomes. These results will facilitate future in vitro and in vivo investigations. doi:10.1016/j.ygyno.2011.12.266
266 Survey of physician awareness of oocyte and embryo cryopreservation in women with hereditary breast ovarian cancer (HBOC) syndrome A. West1, N. Noyes2, B. Pothuri2. 1New York University School of Medicine, New York, NY, 2New York University Medical Center, New York, NY. Objective: Risk reducing salpingo-oophorectomy may be offered to women with hereditary breast ovarian cancer syndrome with reduction in ovarian cancer mortality. This study evaluated physician awareness of oocyte and embryo cryopreservation procedures in this population. Methods: Physicians at academic centers in 45 states and D.C. caring for women at risk of developing ovarian cancer were invited to participate in an anonymous online survey. Physicians were recruited using email addresses publicized on institutional websites. Physicians received an email link to the 5-minute, 28-question survey, which evaluated demographic information and knowledge of fertility preservation (FP). Results: One-thousand-ninety-six physicians were invited to participate and 109 completed the questionnaire: OB/GYN 34 (31%), GynOnc 25 (23%), MedOnc 26 (24%), REI 8 (7%), Surgery 6 (6%), and other 10 (9%). Ninety-four (86%) physicians indicated they regularly care for women at risk of developing ovarian cancer and 92 (84%) are concerned about child bearing. In the experience of 62 (57%) physicians, greater than 25% of their patient population is interested in learning about FP options. Eighty-six (79%) of the physicians speak to women about FP options. Physicians who speak to patients about FP introduce oocyte cryopreservation 23 (21%), embryo cryopreservation 40 (37%), or both 23 (21%). Sixty-eight (62%) have referred HBOC patients for embryo cryopreservation and 58 (53%) have referred for oocyte cryopreservation. Ninety-eight
Abstracts / Gynecologic Oncology 125 (2012) S3–S167
261 CA125 surveillance and second-line intraperitoneal platinumbased therapy increases second line progression-free survival for epithelial ovarian cancer M. Boisen1, J. Lesnock1, W. McBee2, S. Richard1, J. Kelley1, K. Zorn1, T. Krivak1, R. Edwards1. 1Magee Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, 2Heiskell, King, Burns and Tallman Surgical Associates, Morgantown, WV. Objective: Previous studies have suggested that only 3% of patients with epithelial ovarian cancer (EOC) have a longer progression-free survival (PFS) after second-line intravenous (IV) platinum chemotherapy than with front-line IV therapy (Markman, 2004). We examined what impact second-line intraperitoneal (IP) platinum might have on the ratio of second-line to first-line PFS in patients treated with IP platinum chemotherapy for first recurrence after front-line IV therapy. Methods: A retrospective, descriptive, single-institution analysis of women who received IP chemotherapy for recurrent EOC between January 2005 and March 2011 was conducted. Study patients were identified from the tumor registry and office records from a large Gynecologic Oncology practice. The records were reviewed for demographic factors including age, ethnicity, primary tumor histology, stage, grade, and the cytoreduction volume after primary and secondary surgeries. The first and second PFSs were defined as the time from the end of previous platinum-based therapy to the start of next the therapy. Results: Fifty-nine women received IP chemotherapy for their first EOC recurrence after IV chemotherapy. The mean age was 56 years (range 43–79). All patients had previously undergone primary surgical cytoreduction (80% optimally cytoreduced) followed by IV platinum-based chemotherapy. All patients underwent biopsy, and when necessary cytoreduction at the time of IP port placement. Because many of these women were identified by rising CA125 with small volume recurrent disease (mean CA125 133 IU/ml, range 4– 792), few women required extensive surgery. The majority (70%) of patients were considered optimal (b1 cm residual disease) at the completion of their second surgery. In 15 patients (25%) we observed longer PFS after IP chemotherapy than after primary IV chemotherapy. In this patient population, 85% had papillary serous histology of primary tumor; other histologies include clear cell, endometrioid, and carcinosarcoma. For these 15 patients, the median PFS for primary response was 8 months (range 5–56), while median PFS after IP chemotherapy for recurrent disease was 24 months (range 10–75). Conclusions: For EOC patients with limited peritoneal recurrence, there appears to be a significant increase in the number that can be expected to have their second-line IP-platinum PFS exceed their firstline IV-platinum PFS as compared to published data with IV therapy for recurrence. doi:10.1016/j.ygyno.2011.12.262
262 Downstream effects of first line bevacizumab (bev) on outcomes after recurrence in advanced ovarian cancer E. Bishop1, L. Perry1, R. Previs2, A. Alvarez-Secord2, K. Moore1. 1 University of Oklahoma, Oklahoma City, OK, 2Duke University Medical Center, Durham, NC. Objective: Bevacizumab has been shown to improve PFS in advanced epithelial ovarian cancer (OC), but long term effects of incorporating bev into first-line treatment remains controversial. The goal of this study was to assess the prognostic effect of first-line bev on response at the time of treatment for recurrence in advanced OC. Methods: Retrospective data was collected for 160 pts from 2 institutions from 2001 to 2010. All pts had stage II–IV OC, underwent
primary surgical cytoreduction (CRS), received platinum based chemotherapy (CT) with or without bev, and have developed recurrent disease. Pts were stratified based on bev exposure and on response to, and PFS following, 2nd line chemotherapy (CT2). The primary endpoint was 2nd progression free interval (PFI2) defined as time from starting CT2 until start of third line CT, or date of last follow up for those who did not have a 2nd recurrence. Univariate and multivariate analysis identified prognostic factors for PFI2. Secondary endpoint was evidence of clinical benefit (CB) defined as complete or partial response to CT2 or stable disease. Results: Of the 160 pts, 25% received first-line bev (bev + platinum and/or bev maintenance) while the remainder received platinumbased CT. Following CRS 66% had b1 cm residual disease. 70% of pts were platinum sensitive. Following 2nd line therapy, 16% remain disease free, and 84% had a 2nd disease recurrence. With a median follow up of 38 months, mean primary PFI after initial platinum based therapy was 17.4 months and mean PFI2 was 10.6 months. In pts with platinum sensitive recurrent disease, there was no difference seen in mean PFI2 between pts who received first line bev and those who did not (8 vs. 7 months). Multivariate analysis of prognostic factors for response to CT2 included residual disease following CRS, CT2 agent, and front line bev use. Primary bev exposure was an independent predictor of CB during CT2 (p = 0.007). This improvement in CB was not seen in the platinum resistant subset of pts and similarly, there was no difference in PFI2 (5 vs. 5 months). Conclusions: These results suggest that advanced OC pts treated with first line bev do not have worse response to therapy for recurrent disease than pts treated with platinum-based CT. In fact, in pts with platinum sensitive OC, treatment with first line bev may actually result in improved clinical benefit following therapy for recurrent disease. If these results are confirmed, this raises the question of the true effect of bev on tumor microenvironment. doi:10.1016/j.ygyno.2011.12.263
263 Annual cost of bevacizumab in the adjuvant treatment of ovarian cancer to the U.S. Medicare system A. Walter, J. Geisler, K. Manahan. University of Toledo Medical Center, Toledo, OH. Objective: To determine the potential annual cost of adding bevacizumab to the adjuvant treatment of ovarian cancer (EOC). Methods: A decision model was developed based on Gynecologic Oncology Group (GOG) protocol 218. Arm 1 is 6 cycles of carboplatin/ paclitaxel (CP). Arm 2 is 1 cycle of CP, 5 cycles of CP + bevacizumab (B), and 16 cycles of B alone (CPB + B). Actual and estimated costs of treatment plus the potential costs of complications based on Medicare reimbursement and published data were established for each regimen. An acceptable willingness to pay was considered $50,000 per person per life year gained. Results: Of the nearly 22,000 women who will develop EOC yearly, approximately 85% (18,598) will need chemotherapy after surgery. The cost of chemotherapy agents and infusion of them was $3,138.72/ person for CP and $190,630.47/person for CPB + B. Annual cost to the U.S. economy for infusion of medications alone would be $27 million versus for CP versus N$13.5 billion dollars for CPB + B, respectively. If cost per quality adjusted progression free life year (PFLY) is examined per person, it would be $14,656/PFLY versus $184,306/PFLY giving an incremental cost effectiveness ration (ICER) of $727,183/PFLY. This is well above an accepted level of $50,000 per life year gained. Thus, to increase on average 1 year of PFL (not survival) for each woman with EOC, the U.S. healthcare expenditure would have to increase spending on EOC alone by N$13 billion.
Abstracts / Gynecologic Oncology 125 (2012) S3–S167
Conclusions: Unless costs are significantly reduced, or overall survival is significantly increased, the U.S. would have difficulty absorbing the cost of CPB + B to only improve PFLY by an average of 3.8 months/per patient. doi:10.1016/j.ygyno.2011.12.264
264 Beta blocker use and ovarian cancer survival: A retrospective cohort study R. Eskander1, L. Randall1, L. Bessonova1, K. Ward2, H. Anton Culver1, T. Harrison3. 1University of California, Irvine Medical Center, Orange, CA, 2 University of California, San Diego Moores Cancer Center, La Jolla, CA, 3 Kaiser Permanente Medical Group, Los Angeles, CA. Objective: Beta-blockers have been shown to have a potential beneficial impact on survival in melanoma, breast and prostate cancer. These effects may be mediated through β-2 adrenergic blockade. We examined the association between beta-blocker use and ovarian cancer-specific overall survival (OS). Methods: After institutional review board approval, a retrospective study of patients diagnosed with stage I–IV epithelial ovarian cancer from 2007 to 2010 at Kaiser Permanente Southern California was performed utilizing a universal electronic medication record. Betablocker users for at least 30 days prior to diagnosis were matched 1:4 to non-users. Sample size calculation indicated that 115 users and 415 non-users would provide an 80% power to detect a 30% difference in OS. Statistical analysis was performed using Kaplan–Meier and Cox proportional hazards models. Results: A total of 680 patients were evaluated, including 144 beta-blocker users and 536 non-users. The mean age of beta-blocker users (67.8 years) was statistically greater than that of non-users (60.7 years, P=b 0.001). The mean OS was 23 months for all patients. Median OS was similar for beta-blocker users and non-users (23 months vs. 20 months respectively, P=0.0787), independent of age and stage. Long-term beta-blocker use (≥2.5 years of use prior to diagnosis) resulted in a hazard ratio (HR) of death of 0.711 (95% CI 0.315–1.608). After adjusting for age and stage, the HR for ovarian cancer-specific death was 0.529 (95% CI 0.233–1.200) for long-term users. Post-hoc power analysis showed 21% power to detect a HR of 0.70 with this subgroup sample size at α=0.05. This trend was not seen for short-term users (HR 1.101, 95% CI 0.803–1.510). Conclusions: In this patient cohort, long-term beta-blocker use was associated with a 47% reduction in risk of death, though this did not reach statistical significance. This provocative trend supports further study of long-term beta-blocker use in a larger patient cohort. doi:10.1016/j.ygyno.2011.12.265
265 Mullerian inhibiting substance (MIS) pathway as a therapeutic target in ovarian cancer: Deciphering the necessary components T. Ayeni, W. Sullivan, A. Weaver, W. Cliby. Mayo Clinic, Rochester, MN. Objective: Activation of mullerian inhibiting substance type II receptor (T2R) leads to dimerization with one of three candidate type I receptors (T1R) and growth inhibition of mullerian tissues. While T2R is commonly expressed in epithelial ovarian cancer (EOC), the prevalence of T1R is unknown; this data is critical because our in vitro studies suggest that biologic response is dependent upon which candidate T1R is involved in signaling. The aims of this research were to characterize the frequency of candidate T1R expression in EOC and determine if clinical outcomes are dependent on receptor expression.
S111
Methods: Tissue microarrays (TMA) were created from 323 consecutive patients with primary EOC. Expression of T1R (ALK2, ALK3, ALK6) and T2R was assessed with immunohistochemistry. Associations between T2R status and clinical characteristics were assessed using the chi-square test. The logrank test was used to evaluate associations between clinicopathologic features and recurrence-free survival (RFS, limited to patients disease-free after completion of chemotherapy) and overall survival (OS), respectively. Results: Analysis was restricted to 262 patients with serous, endometrioid, clear cell, mucinous or mixed histology and known status for at least one of the four receptors. The most common receptor combinations were: T2R-/Alk2,3,6 (16; 6%); T2R-/ALK2,3 (43; 16%); T2R+/ALK2,3 (81; 31%); and T2R+/ALK2,3,6 (84; 32%). There was no difference among these receptor combinations regarding survival (RFS p = 0.91; OS p = 0.89). Patients without T2R were more likely to have advanced stage disease (p = 0.04) and an inability to be cytoreduced to microscopic disease (p = 0.01), compared to patients with T2R present. The ALK6 protein was the least represented form of type I receptor and its expression was associated with death in early stage disease (p = .03), but not in late stage (p = 0.42). Conclusions: The downstream effect of therapy targeting the MIS pathway is dependent upon specific receptor pairing in EOC. We demonstrate for the first time that the majority of human EOC (70%) expresses the necessary candidate receptors for growth inhibition via the MIS pathway. We show that expression of specific receptors is associated with worse clinical outcomes. These results will facilitate future in vitro and in vivo investigations. doi:10.1016/j.ygyno.2011.12.266
266 Survey of physician awareness of oocyte and embryo cryopreservation in women with hereditary breast ovarian cancer (HBOC) syndrome A. West1, N. Noyes2, B. Pothuri2. 1New York University School of Medicine, New York, NY, 2New York University Medical Center, New York, NY. Objective: Risk reducing salpingo-oophorectomy may be offered to women with hereditary breast ovarian cancer syndrome with reduction in ovarian cancer mortality. This study evaluated physician awareness of oocyte and embryo cryopreservation procedures in this population. Methods: Physicians at academic centers in 45 states and D.C. caring for women at risk of developing ovarian cancer were invited to participate in an anonymous online survey. Physicians were recruited using email addresses publicized on institutional websites. Physicians received an email link to the 5-minute, 28-question survey, which evaluated demographic information and knowledge of fertility preservation (FP). Results: One-thousand-ninety-six physicians were invited to participate and 109 completed the questionnaire: OB/GYN 34 (31%), GynOnc 25 (23%), MedOnc 26 (24%), REI 8 (7%), Surgery 6 (6%), and other 10 (9%). Ninety-four (86%) physicians indicated they regularly care for women at risk of developing ovarian cancer and 92 (84%) are concerned about child bearing. In the experience of 62 (57%) physicians, greater than 25% of their patient population is interested in learning about FP options. Eighty-six (79%) of the physicians speak to women about FP options. Physicians who speak to patients about FP introduce oocyte cryopreservation 23 (21%), embryo cryopreservation 40 (37%), or both 23 (21%). Sixty-eight (62%) have referred HBOC patients for embryo cryopreservation and 58 (53%) have referred for oocyte cryopreservation. Ninety-eight