Predictive and Prognostic Factors in Ovarian and Uterine Carcinosarcomas

Background: Prognostic factors and the standard treatment approach for gynaecological carcinosarco-mas have not yet been clearly defined. Although car-cinosarcomas are more aggressive than pure epithelial tumours, they are treated similarly. Serous/clear cell and endometrioid components may be predictive fac-tors for the efficacy of adjuvant chemotherapy (CT) or radiotherapy (RT) or RT in patients with uterine and ovarian carcinosarcomas. Heterologous carcino-sarcomas may benefit more from adjuvant CT.Aims: We aimed to define the prognostic and predic-tive factors associated with treatment options in ovar-ian (OCS) and uterine carcinosarcoma (UCS).Study Design: Retrospective cross-sectional studyMethods: We retrospectively reviewed the medical re-cords of patients with ovarian and uterine carcinosar-coma from 2000 to 2013, and 127 women were includ-ed in this study (24 ovarian and 103 uterine). Patients admitted to seventeen oncology centres in Turkey be-tween 2000 and December 2013 with a histologically proven diagnosis of uterine carcinosarcoma with FIGO 2009 stage I-III and patients with sufficient data ob-tained from well-kept medical records were included in this study. Stage IV tumours were excluded. The pa-tient records were retrospectively reviewed. Data from 104 patients were evaluated for this study.Results: Age (>=70 years) was a poor prognostic factor for UCS (p=0.036). Pelvic±para aortic lymph node dis-section did not affect overall survival (OS) (p=0.35). Macroscopic residual disease was related with OS (p<0.01). The median OS was significantly longer in stage I-II patients than stage III patients (p=0.03). Adjuvant treatment improved OS (p=0.013). Adju-vant radiotherapy tended to increase the median O

Küçük hücreli akciğer kanserinde yıkıcı bir durum: Ektopik cushing sendromu

Ektopik adrenokortikotop (ACTH) salınmasına bağlı Cushing sendromu, küçük hücreli akciğer kanserli hastalarda diğer birçok paraneoplastik sendromlara göre daha sık görülür. Bu hastalarda hücresel bağışıklık sisteminin baskılanması hem hekimler hem de hastalar için önemli bir sorundur. Ek olarak kemoterapi, bu hastalarda şiddetli ve daha yüksek oranda hematolojik toksisiteye neden olmaktadır. Biz ektopik ACTH salınması ile ilişkili Cushing sendromuna bağlı humoral ve hücresel bağışıklık sistemi baskılanmış çok kötü seyirli bir küçük hücreli akciğer vakası sunduk. Ayrıca, bu özel vaka ve literatür ışığında Cushing sendrom olan küçük hücreli akciğerli hastalar için tedavi stratejileri önerdik.Ectopic secretion of adrenocorticotropic hormone (ACTH) related Cushing's syndrome (CS) is more frequently observed than many other paraneoplastic syndromes in patients with small cell lung cancer. Suppression of the cellular immune system in these patients is severe problem for both patients and physicians. In addition, the chemotherapy has been caused to severity and higher rate of hematological toxicity. We present a case of small cell lung cancer having a very poor prognosis, with a compressed humoral and cellular immune system due to an ectopic secretion of ACTH related CS. We report a rare case of combined immunosuppression in a case with small cell lung cancer in this paper. In addition, in the light of this special case and literature, we suggest treatment strategies for small cell lung cancer patients with CS

KRAS Mutation in Small Cell Lung Carcinoma and Extrapulmonary Small Cell Cancer

Background: Lung cancer is one of the most lethal cancers. It is mainly classified into 2 groups: non-small cell lung can-cer (NSCLC) and small cell lung cancer (SCLC). Extrapul-monary small cell carcinomas (EPSCC) are very rare. The Ras oncogene controls most of the cellular functions in the cell. Overall, 21.6% of human cancers contain a Kirsten Ras (KRAS) mutation. SCLC and EPSCC have several similar features but their clinical course is different.Aims: We investigated the KRAS mutation status in SCLC and EPSCC.Study design: Mutation research.Methods: Thirty-seven SCLC and 15 EPSCC patients were included in the study. The pathological diagnoses were confirmed by a second pathologist. KRAS analysis was performed in our medical genetic department. DNA isola-tion was performed with primary tumor tissue using the QIAamp DNA FFPE Tissue kit (Qiagen; Hilden, Germany) in all patients. The therascreen KRAS Pyro Kit 24 V1 (Qia-gen; Hilden, Germany) was used for KRAS analyses. Results: Thirty-four (91.9%) of the SCLC patients were male, while 11 (73.3%) of the EPSCC l patients were fe-male. SCLC was more common in males, and EPSCC in females (p=0.001). A KRAS mutation was found in 6 (16.2%) if SCLC patients. The most common mutation was Q61R (CAA>CGA). Among the 15 EPSCC patients, 2 had a KRAS mutation (13.3%). When KRAS mutant and wild type patients were compared in the SCLC group, no differ-ence was found for overall survival (p=0.6).Conclusion: In previous studies, the incidence of KRAS mutation in SCLC was 1-3%; however, it was 16.2% in our study. Therefore, there may be ethnic and geographical differences in the KRAS mutations of SCLC. As a result, KRAS mutation should not be excluded in SCL

A case of gastric adenocarcinoma with rectal metastasis in the form of linitis plastica presenting as primary rectum carcinoma

Gastrointestinal sistemde linitis plastika şeklindeki metastazlar nadir olup sıklıkla primer tümörün mide olduğu bildirilmektedir. Biz rektuma linitis plastika şeklinde metastaz yapan mide adenokarsinom olgumuzu ender rastlanması ve primer lokal ileri rektum kanseri şeklinde karşımıza çıkması sebebiyle literatür bilgileri ışığında, gastrik adenokarsinomaların intestinal metastazlarının klinik, radyolojik ve patolojik özelliklerini de tartışarak sunmayı amaçladık.It is often reported that metastases in the form of linitis plastica developed in the gastrointestinal system are rare cases and frequently the primary tumor is located in the stomach. We presented a case of gastric adenocarcinoma developing a metastasis in the rectum in the form of linitis plastica, which appeared as a primary local advanced rectum cancer. We discussed the clinical, radiological, and pathological characteristics of the intestinal metastases of gastric adenocarcinomas

Turkish national consensus on breast cancer management during temporary state of emergency due to COVID-19 outbreak

Objective: Cancer care is excessively influenced by the COVID-19 outbreak for various reasons. One of the major concerns is the tendency for delayed surgical treatment of breast cancer patients. The outbreak has urged clinicians to find alternative treatments until surgery is deemed to be feasible and safe. Here in this paper, we report the results of a consensus procedure which aimed to provide an expert opinion-led guideline for breast cancer management during the COVID-19 outbreak in Turkey. Material and Methods: We used the Delphi method with a 9-scale Likert scale on two rounds of voting from 51 experienced surgeons and medical oncologists who had the necessary skills and experience in breast cancer management. Voting was done electronically in which a questionnaire-formatted form was used. Results: Overall, 46 statements on 28 different case scenarios were voted. In the first round, 37 statements reached a consensus as either endorsement or rejection, nine were put into voting in the second round since they did not reach the necessary decision threshold. At the end of two rounds, for 14 cases scenarios, a statement was endorsed as a recommendation for each.Thirty-two statements for the remaining 14 were rejected. Conclusion:There was a general consensus for administering neoadjuvant systemic therapy in patients with node-negative, small-size triple negative, HER2-positive and luminal A-like tumors until conditions are improved for due surgical treatment. Panelists also reached a consensus to extend the systemic treatment for patients with HER2-positive and luminal B-like tumors who had clinical complete response after neoadjuvant systemic therapy

Bintrafusp Alfa Versus Pembrolizumab in Patients With Treatment-Naive, Programmed Death-Ligand 1–High Advanced NSCLC: A Randomized, Open-Label, Phase 3 Trial

Bintrafusp alfa; NSCLC; PD-L1Bintrafusp alfa; NSCLC; PD-L1Bintrafusp alfa; NSCLC; PD-L1Introduction Bintrafusp alfa, a first-in-class bifunctional fusion protein composed of the extracellular domain of TGF-βRII (a TGF-β “trap”) fused to a human immunoglobulin G1 monoclonal antibody blocking programmed death-ligand 1 (PD-L1), has exhibited clinical activity in a phase 1 expansion cohort of patients with PD-L1–high advanced NSCLC. Methods This adaptive phase 3 trial (NCT03631706) compared the efficacy and safety of bintrafusp alfa versus pembrolizumab as first-line treatment in patients with PD-L1–high advanced NSCLC. Primary end points were progression-free survival according to Response Evaluation Criteria in Solid Tumors version 1.1 per independent review committee and overall survival. Results Patients (N = 304) were randomized one-to-one to receive either bintrafusp alfa or pembrolizumab (n = 152 each). The median follow-up was 14.3 months (95% confidence interval [CI]: 13.1–16.0 mo) for bintrafusp alfa and 14.5 months (95% CI: 13.1–15.9 mo) for pembrolizumab. Progression-free survival by independent review committee was not significantly different between bintrafusp alfa and pembrolizumab arms (median = 7.0 mo [95% CI: 4.2 mo–not reached (NR)] versus 11.1 mo [95% CI: 8.1 mo–NR]; hazard ratio = 1.232 [95% CI: 0.885–1.714]). The median overall survival was 21.1 months (95% CI: 21.1 mo–NR) for bintrafusp alfa and 22.1 months (95% CI: 20.4 mo–NR) for pembrolizumab (hazard ratio = 1.201 [95% CI: 0.796–1.811]). Treatment-related adverse events were higher with bintrafusp alfa versus pembrolizumab; grade 3-4 treatment-related adverse events occurred in 42.4% versus 13.2% of patients, respectively. The study was discontinued at an interim analysis as it was unlikely to meet the primary end point. Conclusions First-line treatment with bintrafusp alfa did not exhibit superior efficacy compared with pembrolizumab in patients with PD-L1–high, advanced NSCLC.The trial was sponsored by the healthcare business of Merck KGaA, Darmstadt, Germany (CrossRef Funder identification: 10.13039/100009945) and was previously part of an alliance between the healthcare business of Merck KGaA, Darmstadt, Germany, and GlaxoSmithKline. The healthcare business of Merck KGaA, Darmstadt, Germany provided the trial drugs. The investigators worked with the healthcare business of Merck KGaA, Darmstadt, Germany on the trial design, collection and analysis of data, and interpretation of results. The authors thank the patients and their families, investigators, co-investigators, and the study teams at each of the participating centers and the healthcare business of Merck KGaA, Darmstadt, Germany. The medical writing support was provided by Joyce Lee, PhD, ClinicalThinking, which was funded by the healthcare business of Merck KGaA, Darmstadt, Germany, and was previously part of an alliance between the healthcare business of Merck KGaA, Darmstadt, Germany, and GlaxoSmithKline in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3)

Cutaneous metastasis to the thigh from rectal adenocarcinoma: A case report

Yetmiş iki yaşındaki erkek hastada, rektum 1/3 alt kısmını dolduran ve anal kanala uzanan adenokarsinom nedeniyle Miles ameliyatı yapıldı. Adjuvan radyoterapi uygulanan hasta, ameliyattan 54 ay sonra sağ supraklaviküler 2 cm çaplı fikse lenfadenopati, sağ bacakta şişlik yakınmalarıyla tekrar başvurdu. Klinik ve patolojik değerlendirmede sağ supraklaviküler lenf nodu, akcişğr, kemik ve pelvik lenf nodu metastazları bulunan hastaya palyatif radyoterapi ve kemoterapi uygulandı. Kemoterapinin dördüncü kürü sonunda, sağ uyluk 1/3 orta ön kısım cildinde papüler lezyonların geliştiği görüldü. Cilt biyopsisinde karsinom metastazı belirlendi. Kemoterapi rejimi değiştirilen ve cilt lezyonlarına yönelik palyatif radyoterapi uygulanan hasta, nüks belirmesinden sekiz ay sonra hastalığın ilerlemesi sonucu kaybedildi.A 72-year-old man underwent Miles operation for curative excision of adenocarcinoma infiltrating 1/3 distal part of the rectum and extending to the anal canal. He received adjuvant radiotherapy postoperatively. Fifty-four months after the operation, he presented with right supraclavicular lymphadenopathy 2 cm in diameter and a swelling in the right lower extremity. Clinical and pathological evaluations showed metastatic involvement of the right supraclavicular lymph node, lung, bone, and pelvic lymph nodes. Chemotherapy and palliative radiotherapy were initiated. Papular skin lesions were noted in the 1/3 middle part of the right thigh after the fourth cycle of chemotherapy. Pathologic examination of the skin lesions showed metastasis of adenocarcinoma, for which second-line chemotherapy and palliative radiotherapy were initiated. The patient died of disease progression eight months after recurrence

Ramucirumab plus docetaxel versus placebo plus docetaxel in patients with locally advanced or metastatic urothelial carcinoma after platinum-based therapy (RANGE): a randomised, double-blind, phase 3 trial

Few treatments with a distinct mechanism of action are available for patients with platinum-refractory advanced or metastatic urothelial carcinoma. We assessed the efficacy and safety of treatment with docetaxel plus either ramucirumab-a human IgG1 VEGFR-2 antagonist-or placebo in this patient population

Demographic, pathologigal and clinical features of patients with hormon receptor negative and her?2 negative breast cancer compared with patients with hormon receptor negative and her?2 positive breast cancer

Meme kanseri heterojen bir hastalıktır ve halen bazı alt gruplar kötü klinik seyre sahiptir. Bu retrospektif çalışmanın amacı hormon reseptör negatif hastalar arasında HER?2 pozitif ve negatif meme kanserli hastaların farklı demografik, patolojik ve klinik seyire sahip olup olmadığını araştırmaktır. Bin dokuz yüz doksan dokuz ve 2006 yılları arasında, hormon reseptör negatif meme kanserli hastalara içinde HER?2 durumu bilinen 91 hastanın demografik, patolojik, klinik özellikleri ve sağkalım sonuçları incelendi. Yaş, çocuk doğurma yaşı, çocuk sayısı, menopoz yaşı ve beden kitle oranı gibi demografik özellikler iki grup arasında farklı değilken, HER?2 negatif hastalar HER?2 pozitif hastalardan daha fazla meme kanserli aile öyküsüne sahipti (sırasıyla, %13.2' karşı 0%, p=0.091). Sadece 3 hastada tanı sırasında ileri evre hastalık vardı. Altı hasta cerrahiden sonra başka tedavi seçeneklerine onay vermedi. Toplam 83 hasta neoadjuvan (n:9) ve adjuvan (n:83) kemoterapi aldı. Kırk bir (%46.6) hastada yineleme gelişti. Tümör çapı, tutulmuş aksiller lenf nodu sayısı erken evre meme kanserli hastalar arsında yinelemeyle anlamlı ilişkiye sahipti. HER?2, tümör gradı, lenfovasküler invazyon, perinöral invazyon ve menopozal durum yineleme ile ilişkili bulunmadı. Tümör çapı (p=0.042) ve tutulmuş aksiller lenf nodu sayısı (p=0.001) hastalıksız sağkalım için bağımsız prognostik faktörlerdi, diğer faktörler prognostik faktör olarak bulunmadı. İleri evre HER 2 pozitif hastalarda daha sık beyin metastazı oluşmasına eğilim vardı (p=0.052). Taksanlara objektif yanıt HER?2 pozitif hastalarda daha düşük olma eğiliminde idi (p=0.071). Genel sağkalım için çok değişkenli analizde bağımsız prognostik faktör saptanmadı. Tek değişkenli analizde tutulmuş aksiller lenf nodu sayısı (p=0.004) ve HER?2 durumu (p=0.043) genel sağkalım üzerine etkili 44 faktörler olarak bulundu. Sonuç olarak, hormon reseptör negatif meme kanserli hastalardan HER?2 pozitif ve negatif hastalar arasında bazı farklar vardır. Bu grup hastalar farklı stratejilerle takip ve tedavi edilmelidir. HER 2 negatif hastalar rutin genetik danışmanlık almalıdır. HER 2 pozitif hastalar profilaktik kraniyal radyoterapi için aday olabilir. HER 2 pozitif hastalar en az HER 2 negatif hastalar kadar sistemik tedavilere dirençlidir. Her iki grubun yeni etkin tedavi stratejilerine ihtiyacı vardır.Breast cancer is a heterogeneous disease and some subgroups have stili poor clinical coure. The aim of this retrospective study was to investigate whether HER-2 positive and negative patients among hormon receptor negative breast cancer patients have different demographic and pathologic features, and different clinical course. Demographics, pathologic and clinical features and survival results were reviewed in 91 hormon receptor negative breast cancer patients with known HER-2 status between 2001 and 2006. Sixty-eigth patients were HER-2 negative and 23 patients were HER-2 positive. While demograpfıcs such as age, childbearing-age, parity, menoposal age, body-massindex were not dififerent among groups, HER-2 negative patients have more family history with breast cancer than HER-2 positive patients (13.2% versus 0%, P = 0.091, respectively) Only three patients have advanced disease at diagnosis. Six patients did not give consent to other modalities after surgery. Totally 83 patients received neoadjuvant (n: 9) or adjuvant (n: 74) chemotherapy. Forty-one (46.6%) patients recurred. Tumor size and involved axillary lymph node number have a significant association with recurrence in early breast cancer patients (p=0.042 and p=0.001, respectively). HER-2, tumor grade, lymphovascular invasion, perineural invasion and menoposal status were not found associated with recurrence. involved 46 axillary lymph node number (p=0.04), but other factors were independent prognostic factors for disease-free survival. There was a trend for more brain metastasis in HER-2 positive patients than HER-2 negtive patients (p=0.052). There was a trend toward significantly low objective response to taxanes in HER-2 positive patients (p=0.071). independent prognostic factors were not obtained with multivariate analysis for overall survival; but involved axillary lymph node number (p=0.004) and HER status (p=0.043) were obtained as factors affecting on overall survivalin univariate analysis. In conclusion, there are some differences between HER-negative and HER positive breast cancer patients. These groups patients should be followed and treated with different strategies. ``Triple negative patients should be routinely received genetic counselling. HER-2 positive patients may be candidate for prophylactic cranial radiotherapy. HER-2 positive patients are at least as resistant as to systemic therapy in HER-2 negative patients. Both groups need to new effective therapy strategies