Reactivation risk of Hepatitis B Virus in both HBsAg negative and HBcIgG positive patients with solid malignancy. Is antiviral prophylaxis really necessary?

Prophylactic antiviral treatment is controversial due to a lack of studies in both HBsAg negative/HBcIgG positive patients who treated conventional chemotherapy with solid malignancy, unlike HBsAg positive. In this cross-sectional and retrospective study, we analyzed that the reactivation risk of Hepatitis B Virus (HBVr) of totally 457 HBcIgG positive patients with solid cancer in archives records between 2011 and 2018 years of two different centers. Totally 217 HBcIgG positive patients with solid cancer were included in the study. Anti-HBs positive and negative patients were 119 (54.8%) and 98 (45.2%), respectively. Frequent diagnosis of the patients was lung (28.1%), colorectal (19.4%), breast (17.5%) and hepatobiliary tract cancers (8.3%), respectively. Most of the study population had stage 4 disease (48.8%) and received palliative chemotherapy. When the patients were stratified due to American Gastroenterological Association Institute (AGA) guideline, HBVr risk of chemo regimen was moderate in 21 patients (17.5%), low in 8 patients (3.7%). The majority of the patients were undefined risk group (78.8%). We did not determine any HBVr in the patients who have received different conventional chemotherapy regimens and have different primer tumor site despite all the patients did not receive the prophylactic antiviral drug. [Med-Science 2019; 8(2.000): 418-21

Oxaliplatin induced acute immune-mediated thrombocytopenia; a case report

Oxaliplatin is a third-generation platinum anti-neoplastic agent, which is used in the treatment of colorectal, gastric, and biliary tract cancers with combination other chemotherapy drugs. In rare cases, thrombocytopenia may occur suddenly in approximately 24 hours due to immune-mediated reactions. This reaction is usually seen after long term usage of oxaliplatin-based chemotherapy. Here, we present our case of immune-mediated thrombocytopenia associated with oxaliplatin. A 56 years old man who had stage IV rectum cancer with liver metastasis, had palliative surgery due to bowel obstruction after initial diagnostic approach. After failure of first line treatment, mFOLFOX6 plus Cetuximab (Cetuximab: 500mg/m2 on day 1, Oxaliplatin: 85 mg/m2 day 1, Leucovorin (LV): 400 mg/m2 day 1, 5-FU 400 mg/m2 IV bolus on day 1 followed by 2400 mg/m2 on day 1 infused over 46 hours every two weeks) regimen was started. Before the 21st cycle of oxaliplatin plus cetuximab regimen, the patient had normal thrombocyte, haemoglobin and neutrophile count. Approximately 8 hours after the chemotherapy patient had been taken to the emergency service with petechia, vigorous gastrointestinal and nasal bleeding. The thrombocyte levels were 3000 at μl. The patient was given methylprednisolone for three days. The thrombocyte levels recover quickly in 24 hours. After this reaction, oxaliplatin stopped and the chemotherapy was changed to capesitabine plus cetuximab regimen. In conclusion, oxaliplatin induced immune-mediated thrombocytopenia is a rare side effect but a life threatening complication. A physician who uses oxaliplatin as a treatment option should keep in mind the possibility immune-mediated thrombocytopenia which may cause life-threatening bleeding. Especially the long term use of oxaliplatin (median >10 cycles) may alert the physician for immune-mediated adverse effects

Real-Life Analysis of Efficacy and Safety of Everolimus Plus Exemestane in Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor-2-Negative Metastatic Breast Cancer Patients: A Turkish Oncology Group (TOG) Study

© 2021 Taylor & Francis Group, LLC.Purpose: This study evaluated the efficacy and safety of everolimus (EVE) plus exemestane (EXE) in hormone-receptor positive (HR+), human epidermal growth factor receptor-2-negative (HER2−) metastatic breast cancer (MBC) patients in real-life settings. Methods: Overall, 204 HR+, HER2− MBC patients treated with EVE + EXE after progressing following prior endocrine treatment were included. Overall survival (OS) and progression-free survival (PFS) and safety data were analyzed. Results: The objective response rate, median PFS, and median OS were 33.4%, 8.9 months, and 23.4 months, respectively. Multivariate analysis revealed that negative progesterone receptor status was a significant determinant of poor treatment response (p = 0.035) and PFS (p = 0.024). The presence of bone-only metastasis was associated with better treatment response (p = 0.002), PFS (p < 0.001), and OS (p = 0.001). Conclusion: We confirmed the favorable efficacy and safety profile of EVE + EXE for HR+, HER − MBC patients

Adrenocortical cancer in the real world: A comprehensive analysis of clinical features and management from the Turkish Oncology Group (TOG)

Introduction: Adrenocortical carcinoma (ACC) is a rare yet highly malignant tumor associated with significant morbidity and mortality. This study aims to delineate the clinical features, survival patterns, and treatment modalities of ACC, providing insights into the disease's prognosis. Materials and Methods: A retrospective analysis of 157 ACC patients was performed to assess treatment methodologies, demographic patterns, pathological and clinical attributes, and laboratory results. The data were extracted from the hospital's database. Survival analyses were conducted using the Kaplan–Meier method, with univariate and multivariate analyses being performed through the log-rank test and Cox regression analyses. Results: The median age was 45, and 89.4% had symptoms at the time of diagnosis. The median tumor size was 12 cm. A total of 117 (79.6%) patients underwent surgery. A positive surgical border was detected in 26 (24.1%) patients. Adjuvant therapy was administered to 44.4% of patients. The median overall survival for the entire cohort was 44.3 months. Median OS was found to be 87.3 months (95% confidence interval [CI] 74.4-100.2) in stage 2, 25.8 (95% CI 6.5-45.1) months in stage 3, and 13.3 (95% CI 7.0-19.6) months in stage 4 disease. Cox regression analysis identified age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as significant factors associated with survival in patients with nonmetastatic disease. In metastatic disease, only patients who underwent surgery exhibited significantly improved overall survival in univariate analyses. Conclusion: ACC is an uncommon tumor with a generally poor prognosis. Understanding the defining prognostic factors in both localized and metastatic diseases is vital. This study underscores age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as key prognostic determinants for localized disease, offering critical insights into the complexities of ACC management and potential avenues for targeted therapeutic interventions. © 2024 Elsevier Inc

Efficacy of Palbociclib and Endocrine Treatment in Heavily Pretreated Hormone Receptor-positive/HER2-negative Advanced Breast Cancer: Retrospective Multicenter Trial

Background: The synthesis of CDK4/6 inhibitors with endocrine treatment in two series of treatment has been widely accepted as the standard for patients with estrogen receptor-positive metastatic breast cancer. In spite of this, the activity of CDK4/6 inhibitors in patients with metastatic breast cancer who have progressed despite receiving multiple lines of treatment is not well understood

Efficacy of first-line CDK 4-6 inhibitors in premenopausal patients with metastatic breast cancer and the effect of dose reduction due to treatment-related neutropenia on efficacy: a Turkish Oncology Group (TOG) study

The only phase 3 study on the effectiveness of CDK 4-6 inhibitors in first-line treatment in premenopausal patients with hormone receptor (HR) positive, HER2 negative metastatic breast cancer is the MONALEESA-7 study, and data on the effectiveness of palbociclib is limited. Data are also limited regarding the effectiveness of CDK 4-6 inhibitors in patients whose dose was reduced due to neutropenia, the most common side effect of CDK 4-6 inhibitors. In our study, we aimed to evaluate the effectiveness of palbociclib and ribociclib in first-line treatment in patients with premenopausal metastatic breast cancer and the effect of dose reduction due to neutropenia on progression-free survival. Our study is a multicenter, retrospective study, and factors affecting progression-free survival (PFS) were examined in patients diagnosed with metastatic premenopausal breast cancer from 29 different centers and receiving combination therapy containing palbociclib or ribociclib in the metastatic stage. 319 patients were included in the study. The mPFS for patients treated with palbociclib was 26.83 months, and for those receiving ribociclib, the mPFS was 29.86 months (p = 0.924). mPFS was 32.00 months in patients who received a reduced dose, and mPFS was 25.96 months in patients who could take the initial dose, and there was no statistical difference (p = 0.238). Liver metastasis, using a fulvestrant together with a CDK 4-6 inhibitor, ECOG PS 1 was found to be a negative prognostic factor. No new adverse events were observed. In our study, we found PFS over 27 months in patients diagnosed with premenopausal breast cancer with CDK 4-6 inhibitors used in first-line treatment, similar to post-menopausal patients. We did not detect any difference between the effectiveness of the two CDK 4-6 inhibitors, and we showed that there was no decrease in the effectiveness of the CDK 4-6 inhibitor in patients whose dose was reduced due to neutropenia

Efficacy and Safety of Trastuzumab Emtansine in Her2 Positive Metastatic Breast Cancer: Real-World Experience

Aim The aim of this study is to evaluate the efficacy and toxicity of trastuzumab emtansine (T-DM1) in cases with metastatic breast cancer (mBC) in different lines of treatment. Method Retrospective analysis of T-DM1 results of human epidermal growth factor receptor 2 (Her2) positive 414 cases with mBC from 31 centers in Turkey. Findings Except 2, all of the cases were female with a median age of 47. T-DM1 had been used as second-line therapy in 37.7% of the cases and the median number of T-DM1 cycles was 9. Progression-free survival (PFS) and overall survival (OS) times were different according to the line of treatment. The median OS was found as 43, 41, 46, 23 and 17 months for 1st, 2nd, 3rd, 4th and 5th line, respectively (p = 0.032) while the median PFS was found as 37, 12, 8, 8 and 8 months, respectively (p = 0.0001). Treatment was well tolerated by the patients. The most common grade 3-4 adverse effects were thrombocytopenia (2.7%) and increased serum gamma-glutamyl transferase (2%). Discussion The best of our knowledge this is the largest real-life experience about the safety and efficacy of T-DM1 use in cases with mBC after progression of Her2 targeted treatment. This study suggests and supports that T-DM1 is more effective in earlier lines of treatment and is a reliable option for mBC