immunofluorescence, and immunohistochemistry (IHC). MA activity was assessed by LC3B flux assay and CMA activity using a photo- activatable fluorescent reporter. CMA was inhibited using RNA interfer- ence against LAMP-2A, the CMA lysosomal receptor. Changes in protein expression between knockdown cells and control were assessed. Cell proliferation and cell viability were measured using standard assays to analyze changes in susceptibility to chemotherapy. Results: Tumor IHC revealed significantly increased expression of LAMP-2A for all ovarian cancer stages, while LC3 was decreased in all stages compared to control. MA activity was comparable in control and platinum-sensitive cell lines, but it was reduced in the platinum- resistant cell line. CMA markers and activity were increased in the ovarian cancer cells compared to control but most notably in the platinum-resistant cell line. Blockage of CMA by LAMP-2A knock- down decreased proliferation rates of both cancer cell lines and partially restored cisplatin sensitivity in the platinum-resistant cell line. We are currently investigating the molecular changes induced by the blockage of CMA in the platinum-resistant cells that contributed to their increased sensitivity. Conclusions: Inhibition of chaperone-mediated autophagy may be a novel approach to increase chemotherapy susceptibility of platinum- resistant ovarian cancers. doi:10.1016/j.ygyno.2014.03.218 199 — Poster Session A The management of peritoneal surface malignancies: Single-center initial experience M.A.F. Seoud, F. Jamali, A. Shamesseddine, M.J. Khalifeh. American University of Beirut Medical Center, Beirut, Lebanon. Objectives: Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease, with median survivals reported in the literature of 6 to 12 months. Cytoreductive surgery (CRS) and hyper- thermic intraperitoneal chemotherapy (HIPEC) have gradually gained acceptance as the standard of care in the management of selected cases of PC. Excellent results have been achieved in well-selected patients, but there is a very steep learning curve when starting a new program. Methods: A program for the multidisciplinary treatment of perito- neal surface malignancies of gastrointestinal or gynecologic origin was initiated in January 2010 at the American University of Beirut Medical Center. Patients enrolled in the program were treated using multimodality therapy with combinations of systemic therapy, cytoreductive surgery (CRS), and HIPEC. We present the results of our initial experience using a retrospective review of a prospectively collected database. Results: Twenty-three patients were treated with CRS and HIPEC. There were 10 male and 13 female patients. The most common indication (35%) was PC of colorectal origin, followed closely by pseudomyxoma (30%), ovarian malignancies (22%), gastric cancer (8%), and mesotheli- oma (4%). The mean duration of surgery was 480 min. Mean Peritoneal Cancer Index was 26. Twenty-one (91%) patients had a complete cytoreduction. Major morbidity and mortality rates were 35% and 4.3%, respectively. Mean hospital stay was 16 days. At a mean follow-up of 18 months, median survival has not been reached. Conclusions: We report the successful establishment of an active peritoneal surface malignancy multidisciplinary treatment program with excellent early results that are comparable to those published by reputable centers in the literature. Careful patient selection, a multidisciplinary approach, and proper surgical training and tech- nique are essential for the success of such a program. doi:10.1016/j.ygyno.2014.03.219 200 — Poster Session A The mTOR inhibitor RAD001 exhibited more efficacy against ovarian cancer ascites after pharmacologic inhibition of Mirk kinase X. Deng 1 , J. Hu 1 , M.J. Cunningham 2 , E.A. Friedman 1 . 1 Upstate Medical University, Syracuse, NY, USA, 2 GYN Oncology of CNY, PC, East Syracuse, NY, USA. Objectives: The PI3K/PTEN/Akt/mTOR pathway is one of the most frequently deregulated signaling pathways in ovarian cancer and is often responsible for the chemoresistance characterizing recurrent ovarian cancers. Several inhibitors of this pathway have shown limited clinical responses due to upregulation of other survival pathways in complex feedback loops. Because pharmacologic inhibition of mTOR causes Akt or PI3K upregulated expression of Mirk/dyrk1B kinase, we determined whether pharmacologic inhibi- tion of Mirk kinase would enhance the toxicity of mTOR inhibitors toward ovarian cancer ascites taken from patients. Mirk is expressed in most ovarian cancers, and depletion or pharmacologic inhibition of Mirk forces ovarian cancer cells to enter the cycle with elevated reactive oxygen species (ROS) levels, leading to cell death. Methods: Ascites were maintained as nonadherent multicellular aggregates or spheroids by culture in serum-free spheroid media in ultralow-attachment dishes. Specimens were obtained from eight patients with newly diagnosed epithelial ovarian cancer. Results: A Mirk/dyrk1B kinase inhibitor increased the sensitivity of three ovarian cancer cell lines to the mTOR inhibitor RAD001 (everolimus). Spheroids from these lines, like ascites spheroids, were largely quiescent, mostly in G0/G1, and enriched in Mirk/dyrk1B kinase and the quiescence proteins p130/Rb2 and the CDK inhibitor p27. Inhibition of Mirk/dyrk1B kinase led to a decrease in spheroid quiescence markers, an increase in ROS levels, and up to a sevenfold decrease in spheroid volume and viable cell numbers. Significantly, treatment of eight of eight patient-derived ovarian cancer ascites with a Mirk/dyrk1B kinase inhibitor together with the mTOR inhibitor RAD001 led first to an induction of apoptosis markers, then to a disruption of spheroid structure, and finally to loss in viable tumor cells. The Mirk inhibitor, at the concentration that killed patient-derived ovarian cancer ascites cells in vitro, had no detectable toxicity in mice, but reduced the size of xenografts up to threefold. Conclusions: The mTOR inhibitor RAD001 was more effective against ovarian cancer ascites when Mirk/dyrk1B kinase was inhibited. doi:10.1016/j.ygyno.2014.03.220 201 - Poster Session A The usefulness of ovarian cancer risk scoring in the discrimination of an isolated pelvic mass L.R. Eiriksson 1 , H.C. Millar 2 , G.K. Lennox 2 , C.J.M. Reade 2 , F. Leung 2,3 , E.P. Diamandis 2,3,4 , V. Kulasingam 2,4 , K.J. Murphy 5 , S.E. Ferguson 5 , M.Q. Bernardini 5 . 1 Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada, 2 University of Toronto, Toronto, ON, Canada, 3 Mount Sinai Hospital, Toronto, ON, Canada, 4 University Health Network, Toronto, ON, Canada, 5 Princess Margaret Hospital, Toronto, ON, Canada. Objectives: Treatment by a gynecologic oncologist improves survival for women with ovarian cancer. When patients present with a pelvic mass, risk-scoring systems are commonly applied to predict the likelihood of benign vs malignant disease based on menopausal status, tumor markers, and ultrasound findings. The objective of this study was to determine the usefulness of the Risk of Malignancy Index (RMI) to guide appropriate referral in patients with an isolated pelvic mass using a prospective population-based cohort. Methods: All patients presenting to our institution from February 2011 through November 2012 with known ovarian cancer, BRCA Abstracts / Gynecologic Oncology 133 (2014) 2–207 82