Search

Simple Summary: Over the past eight years, the addition of the cyclin-dependent kinase (CDK) 4/6 inhibitors in the management of patients with metastatic hormone receptor-positive breast cancer has dramatically improved clinical outcomes. Nevertheless, early progression may occur in a notable percentage of patients, and biomarkers that can predict treatment failure have not yet been precisely defined. Progesterone receptor (PgR) status is recognized as a significant biomarker for predicting prognosis in hormone-positive breast cancer; however, its impact on the efficacy of CDK 4/6 inhibitors remains a matter of debate. The aim of this study was to investigate the impact of PgR status on the prognosis of patients receiving first-line CDK4/6 inhibitors in combination with endocrine therapy. The expression level of PgR might be used as a cost-effective and accurate indicator for assessing the efficacy of CDK4/6 inhibitors. Background/Objectives: CDK4/6 inhibitors have changed the landscape of hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (BC) management. It is essential to identify predictive and prognostic factors for the efficacy of CDK4/6 inhibitors. We aimed to investigate the differences in characteristics and outcomes of patients receiving first-line CDK4/6 inhibitors according to PgR status. Methods: This multicenter retrospective study included 351 patients treated with first-line CDK 4/6 inhibitors for HR-positive/HER2-negative metastatic BC. Patients were categorized based on their PgR expression levels, including the PgR-low (<20%) and PgR-high (≥20%) groups, and baseline characteristics, treatment responses, and survival outcomes were analyzed. Results: The median age was 57 years (range: 26–85). A total of 99 patients were premenopausal, and 252 patients were postmenopausal. There were 115 (32.8%) patients in the PgR-low group, while 236 (67.2%) were in the PgR-high group. The majority of patients (56.7%) presented with de novo metastatic disease. Visceral metastases presented in 44.2% of patients. Low PgR expression was significantly associated with lower estrogen receptor levels (p = 0.031), elevated Ki-67 levels (p = 0.002), a higher incidence of visceral metastases (p = 0.035), and recurrent disease (p = 0.019). In the multivariate analysis, low PgR expression was a significant independent predictor of worse progression-free survival (PFS) and overall survival (OS). Conclusions: We demonstrated that low PgR expression is independently and significantly correlated with shorter PFS and OS. These findings support low PgR expression as a valuable prognostic biomarker in metastatic BC patients treated with first-line CDK4/6 inhibitors. [ABSTRACT FROM AUTHOR]

Simple Summary: Real-world studies comparing TNT and CRT are vital for advancing the treatment of LARC. Our study provides valuable insights reflecting the diverse patient populations and varied clinical practices encountered and demonstrates the advantage of TNT, providing a superior alternative to standard CRT and potentially enhancing treatment outcomes and quality of life. Total neoadjuvant therapy (TNT) has emerged as a promising approach for managing locally advanced rectal cancer (LARC), aiming to enhance resectability, increase pathological complete response (pCR), improve treatment compliance, survival, and sphincter preservation. This study compares the clinical outcomes of TNT, with either induction or consolidation chemotherapy, to those of the standard chemoradiotherapy (CRT). In this retrospective multi-institutional study, patients with stage II-III LARC who underwent CRT or TNT from seven oncology centers between 2021 and 2024 were retrospectively analyzed. The TNT group was categorized into induction or consolidation groups based on the sequence of chemotherapy and radiotherapy. Clinical and pathological data and treatment outcomes, including pCR, event-free survival (EFS), and overall survival (OS), were analyzed. Among the 276 patients, 105 received CRT and 171 underwent TNT. The TNT group showed significantly higher pCR (21.8% vs. 2.9%, p < 0.001) and lower lymphatic (26.3% vs. 42.6%, p = 0.009), vascular (15.8% vs. 32.7%, p = 0.002), and perineural invasion rates (20.3% vs. 37.6%, p = 0.003). Furthermore, 16.9% of TNT patients opted for non-operative management (NOM), compared to 0.9% in the CRT group (p < 0.001). The median interval between the end of radiotherapy and surgery was longer in the TNT group (17.6 weeks vs. 8.8 weeks, p < 0.001). The 3-year EFS was 58.3% for CRT and 71.1% for TNT (p = 0.06). TNT is associated with higher pCR, lower lymphatic and vascular invasion rates, and higher rates of NOM compared to CRT. This supports the use of TNT as a viable treatment strategy for LARC, offering potential benefits in quality of life. [ABSTRACT FROM AUTHOR]

Objectives: Osteosarcoma has worse prognosis in adult patients but cure is possible even in the metastatic stage. Survival rates have been significantly improved with systemic chemotherapy. We aimed to investigate the effects of clinicopathological factors on overall-survival (OS) and disease-free-survival (DFS) in 77osteosarcoma who received neoadjuvant treatment and were treated in our center. Methods: The patients were 18 years of age and over, applied to the Marmara University of Medical Oncology outpatient clinic between 2001-2022. Results: The overall 5-year DFS rate is 35.5%. Patients with primary tumor location in the pelvis had 5-year DFS rate of 20.0%, whereas patients with a primary location outside the pelvis had a DFS rate of 36.6%. After neoadjuvant therapy, patients with a necrosis rate of 90% or more had a 5-year DFS rate of 54.0%, while patients with a necrosis rate of less than 90% had rate of 31.6%. Conclusion: Significant prognostic indicators for DFS were found to be female gender, primary pelvic location, and completion of adjuvant therapy in patients who underwent surgery after neoadjuvant therapy. The completion of adjuvant chemotherapy in patients who underwent surgery after neoadjuvant therapy and a necrosis rate of 90% or more in the pathology report were discovered to be significant prognostic markers for OS. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the effects of demographic characteristics and clinicopathologic factors on survival in patients with metastatic non-small cell lung cancer (mNSCLC). Methods: We enrolled 320 patients treated for mNSCLC between January 2012 and December 2023. Progression free survival (PFS) and overall survival (OS) were evaluated. Univariate and multivariate analysis were performed for all parameters for prognostic evaluation. Results: Among 320 patients; median age was 63 years. Either presence of bone metastasis (p=0.005), brain metastasis (p=0.024), liver metastasis (p=0.08) and the number of metastasis is 3 or more (p=0.02) were associated with better PFS in univariate analysis. ECOG performance status 0-1 (p=0.001), de novo metastatic disease (p=0.05), bone metastasis (p=0.001), brain metastasis (p=0.016), liver metastasis (p=0.00), also the number of metastasis 3 or more (p=0.001) and use of immunotherapy (p=0.00) were related with longer OS. In multivariate analysis, either presence of brain metastasis (HR:1.50, 95% CI:1.13-1.99, p=0.004), liver metastasis (HR: 1.53, 95% CI: 1.06-2.21, p=0.02), number of metastatic site (HR:0.72, 95% CI: 0.54-0.97, p=0.03) and use of immunotherapy (HR:0.37, 95 % CI: 0.26-0.52, p=0.00) remained significant predictors of OS. Conclusion: Our results showed that liver and brain metastasis, number of metastatic site and use of immunotherapy were assosiated with survival and these can be used as stratification factors when designing randomized clinical trials. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Oncology / Türk Onkoloji Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ortadogu Medical Journal / Ortadogu Tip Dergisi is the property of Bastas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: CDK 4/6 inhibitors are effectively utilized among patients with hormone-positive, HER-2-negative metastatic breast cancer. The dose reduction for these patients varies between 35% and 57% across multiple trials. We aim to clarify the characteristics of patients who had dosage reduction and the effect of this reduction on survival outcomes. Materials and Methods: The study was designed as a retrospective, multicenter study. Patients who received CDK 4/6 inhibitors in the first-line and subsequent treatment settings were grouped based on dose reductions. Progression-free survival was compared between these groups, and factors influencing dose reduction were analyzed. Results: Multivariate logistic regression study demonstrated that patients aged 65 and older, with a Charlson CI score of 2 or higher, having metastases in three or more sites, and classed as normal weight, had greater dosage reductions. Dose reduction had no impact on progression-free survival (PFS) ( p = 0.114 for first-line treatment, p = 0.528 for second and subsequent-line treatment; p > 0.05). Conclusions: Regarding the absence of disparity in progression-free survival between patients with dose reduction and those without, dose reduction should not be avoided in certain patient groups to ensure therapy continuity and mitigate potential adverse effects.

Background and Objectives: Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy with a poor prognosis. Identifying reliable prognostic factors is crucial for risk stratification and optimizing treatment strategies. This study aimed to evaluate the impact of clinicopathologic factors and systemic inflammatory markers on survival outcomes in patients with MPM. Materials and Methods: This retrospective, multicenter study included 217 patients diagnosed with MPM between January 2009 and March 2024. Data on age, gender, histology, disease stage, treatment modalities, and inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein/albumin ratio (CAR) were collected. Survival outcomes were analyzed using Kaplan-Meier methods, and prognostic factors were evaluated using Cox regression analysis. Results: CAR was identified as an independent prognostic factor for both overall survival (OS) and progression-free survival (PFS). Patients with CAR < 0.98 had significantly longer OS (87.0 months vs. 14.0 months, p < 0.001) and PFS (17.61 months vs. 8.96 months, p = 0.010). While NLR was significant in univariate analysis (OS: 25.0 months for NLR < 2.58 vs. 21.0 months for NLR ≥ 2.58, p = 0.040), it did not retain significance in the multivariate model ( p = 0.180). Epithelioid histology and early-stage disease were strongly associated with improved survival outcomes (OS: 32.0 vs. 11.0 months for epithelioid vs. non-epithelioid histology, p < 0.001; 32.0 vs. 12.0 months for early-stage vs. metastatic disease, p < 0.001). Conclusions: CAR is a strong independent prognostic factor in MPM, reflecting systemic inflammation and nutritional status. Epithelioid histology and early-stage disease are associated with significantly longer survival, underscoring the critical role of early detection in improving patient outcomes.

Background: We aimed to explore the correlation between anti-hypertensive treatment and survival rates in patients with metastatic non-small cell lung cancer (mNSCLC)., Objective: In this study, we analyzed the correlation between antihypertensive treatment and survival in 300 patients with mNSCLC., Design: Retrospective., Settings: Medical faculty hospital., Patients and Methods: We investigated the relationship between antihypertensive treatment and survival in 300 patients who were diagnosed with mNSCLC. We also examined the relationship between histological type, performance status, gender, age and type of antihypertensive medication used and survival., Main Outcomes and Measures: Survival difference between mNSCLC patients with and without antihypertensive treatment., Sample Size: 300 patients with mNSCLC., Results: Among patients receiving concomitant antihypertensive treatment, 107 (35.7%) were prescribed angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB), 64 (21.3%) beta-blockers and 36 (11%) calcium channel blockers. The study found that the overall survival rates for all patients at 36 and 60 months were 11.5% and 7%, respectively. However, the ACEi/ARB group had higher survival rates at 18.1% and 12% for 36 and 60 months, respectively, compared to the non-ACEi/ARB group with rates of 8.7% and 5% ( P <.05)., Conclusion: These results strongly suggest that renin-angiotension system (RAS) inhibitors hold great promise as potential adjunctive therapies for mNSCLC due to their significant inhibitory effects on cell proliferation, angiogenesis and tumor progression., Limitations: Retrospective and non-randomized nature. Additionally, the retrospective analysis did not allow for verification of the duration or regularity of drug use, which made it infeasible to examine dose-response relationships with reliability., Competing Interests: CONFLICT OF INTEREST: None.

Many developing countries lack access to recommended first-line treatments for metastatic renal cell carcinoma (mRCC), such as immune checkpoint inhibitors (ICIs) or ICI-tyrosine kinase inhibitor (TKI) combinations. As a result, predictive markers are necessary to identify patients who may benefit from single-agent TKIs for long-term response. This study aims to identify such parameters. This was a multi-centre, retrospective study of patients with mRCC who were undergoing first-line treatment with sunitinib or pazopanib. Patients who had been diagnosed with mRCC and had not experienced disease progression for 36 months or more were deemed to have achieved a long-term response. Predictive clinical and pathological characteristics of patients who did not experience long-term disease progression were investigated. A total of 320 patients from four hospitals were included in the study. The median age of the patients was 60 years (range 20-89 years). According to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk classification, 109 patients were classified as having favourable risk and 211 were in the intermediate-poor risk group. The median progression-free survival (PFS) and overall survival (OS) for all patients were 12.5 months and 76.4 months, respectively. In the long-term responder's group, the median PFS was 78.4 months. Among all patients, prior nephrectomy, the Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) <1, and the absence of brain metastasis were predictive factors for long-term response. For patients in the favourable risk group, the lack of brain metastasis was a predictor of long-term response. In the intermediate-poor risk group, prior nephrectomy and ECOG PS <1 were predictive factors for long-term response. Some individuals with mRCC may experience a durable response to TKIs. The likelihood of a long-term response can be determined by factors such as nephrectomy, ECOG PS < 1, and the absence of brain metastases.

Cutaneous metastases of bladder carcinoma are very rare. The rate of cutaneous metastasis in urologic malignancies is 1.3% and this rate was found to be 0.84% for bladder carcinomas. Cutaneous metastasis of bladder carcinoma can be confused with cellulitis. This case report presents a 60-year-old patient operated on for bladder carcinoma and undergoing treatment for cellulitis because of erythematous lesions appearing in the suprapubic region in the early postoperative period. As there was no response to antibiotic treatment, skin biopsy was performed and cutaneous metastasis was diagnosed. Subsequently, chemotherapy with carboplatin and gemcitabine was started. The prognosis of bladder carcinoma with cutaneous metastasis has been reported to be poor.

Background/aims: Studies concerning red cell distribution width (RDW) for use in the assessment of inflammatory bowel disease (IBD) activity are limited. We investigated whether RDW is a marker of active disease in patients with IBD., Methods: In total, 61 patients with ulcerative colitis (UC) and 56 patients with Crohn's disease (CD) were enrolled in the study group, and 44 age- and-sex-matched healthy volunteers were included as the control group. A CD activity index >150 in patients with CD indicated active disease. Patients with moderate and severe disease based on the Truelove-Witts criteria were considered to have active UC. In addition to RDW, serum C-reactive protein levels, erythrocyte sedimentation rates, and platelet counts were measured., Results: Twenty-nine (51.7%) patients with CD and 35 (57.4%) patients with UC had active disease. The RDW was significantly higher in patients with CD and UC than in controls (p<0.001 and p<0.001, respectively). A subgroup analysis indicated that for a RDW cut-off of 14%, the sensitivity for detecting active CD was 79%, and the specicity was 93% (area under curve [AUC], 0.935; p<0.001). RDW was the most sensitive and specific marker for active CD. However, it was not valid for UC, as the ESR at a cutoff of 15.5 mm/hr showed a sensitivity of 83% and a specicity of 76% (AUC, 0.817; p<0.001), whereas the RDW at a cutoff of 14% showed 17% sensitivity and 84% specicity for detecting active UC., Conclusions: RDW was elevated in IBD in comparison with healthy controls and increased markedly in active disease. RDW may be a sensitive and specific marker for determining active CD, whereas ESR is an important marker of active UC.