Survival results according to Oncotype Dx recurrence score in patients with hormone receptor positive HER-2 negative early-stage breast cancer: first multicenter Oncotype Dx recurrence score survival data of Turkey

BackgroundThe Oncotype Dx recurrence score (ODx-RS) guides the adjuvant chemotherapy decision-making process for patients with early-stage hormone receptor-positive, HER-2 receptor-negative breast cancer. This study aimed to evaluate survival and its correlation with ODx-RS in pT1-2, N0-N1mic patients treated with adjuvant therapy based on tumor board decisions.Patients and methodsEstrogen-positive HER-2 negative early-stage breast cancer patients (pT1-2 N0, N1mic) with known ODx-RS, operated on between 2010 and 2014, were included in this study. The primary aim was to evaluate 5-year disease-free survival (DFS) rates according to ODX-RS.ResultsA total of 203 eligible patients were included in the study, with a median age of 48 (range 26-75) and median follow-up of 84 (range 23-138) months. ROC curve analysis for all patients revealed a recurrence cut-off age of 45 years, prompting evaluation by grouping patients as ≤45 years vs. >45 years. No significant difference in five-year DFS rates was observed between the endocrine-only (ET) and chemo-endocrine (CE) groups. However, among the ET group, DFS was higher in patients over 45 years compared to those aged ≤45 years. When stratifying by ODx-RS as 0-17 and ≥18, DFS was significantly higher in the former group within the ET group. However, such differences were not seen in the CE group. In the ET group, an ODx-RS ≥18 and menopausal status were identified as independent factors affecting survival, with only an ODx-RS ≥18 impacting DFS in patients aged ≤45 years. The ROC curve analysis for this subgroup found the ODx-RS cut-off to be 18.ConclusionThis first multicenter Oncotype Dx survival analysis in Turkey demonstrates the importance of Oncotype Dx recurrence score and age in determining treatment strategies for early-stage breast cancer patients. As a different aproach to the literature, our findings suggest that the addition of chemotherapy to endocrine therapy in young patients (≤45 years) with Oncotype Dx recurrence scores of ≥18 improves DFS

Survival outcomes and prognostic nutritional index in very elderly small-cell lung cancer patients: importance of active treatment and nutritional support

AbstractBackground Small-cell lung cancer (SCLC) is a highly aggressive tumor with a high metastatic potential, particularly affecting current or former heavy smokers. Treatment typically involves chemotherapy, often combined with radiotherapy, and immunotherapy for extensive disease. Prophylactic cranial irradiation is recommended to reduce brain metastases. Elderly SCLC patients face unique challenges due to frailty and comorbidities, leading to increased risks of treatment-related toxicity and malnutrition. The prognostic nutritional index (PNI), a composite marker of nutritional and immune status, has shown promise in predicting outcomes in various malignancies. However, the optimal treatment approach for very elderly SCLC patients remains unclear, as they are often excluded from clinical trials.Aims This study aimed to evaluate the survival outcomes of SCLC patients aged 75 years or older and their correlation with PNI.Study design Retrospective cohort study.Methods The study retrospectively analyzed data from 71 SCLC patients aged ≥75 years, focusing on age, gender, smoking status, chronic diseases, performance status, clinical stage, treatment modality, and pretreatment PNI. Survival estimates were calculated using the Kaplan–Meier method, and multivariate Cox regression analysis was performed to identify independent predictors of overall survival (OS).Results The results demonstrated that 26.8% of very elderly SCLC patients received no active treatment, resulting in a significantly shorter median survival time of 1.3 months. In contrast, patients who underwent aggressive treatment, such as palliative chemotherapy or chemotherapy plus radiotherapy, had significantly longer median survival times. Multivariate analysis revealed that receiving chemotherapy plus radiotherapy was associated with a significant survival benefit compared to no treatment. Furthermore, low PNI (≤40) was independently associated with decreased OS.Conclusion This study highlights the importance of active treatment and nutritional support in improving survival outcomes for very elderly SCLC patients. The findings suggest that low PNI and lack of oncological treatment are associated with worse survival outcomes. Therefore, integrating nutritional assessment, interventions, and appropriate treatment strategies are crucial in managing lung cancer patients. Larger, multicenter studies are needed to validate these findings and explore potential interventions to optimize nutritional status and improve outcomes for elderly patients with SCLC

Breast Cancer in Women Aged 75 Years and Older

Objective: Breast cancer is the most common cancer in women, with incidence and mortality increasing dramatically with age. Applying data ofyounger patients to the geriatric age group indicates ‘‘evidence biased medicine’’. Therefore, this study aimed to present the clinical and pathologicalfeatures of breast cancer and treatment choices in older patients.Materials and Methods: This study included 72 patients aged 75 years and older with breast cancer who were admitted to our medical oncologyclinic between 2005 and 2013. Clinicopathological and demographic features, progression-free survival and overall survival and adjuvant andpalliative treatments were recorded retrospectively. Categorical variables were presented as number (n) and percentage (%) and continuous variablesas median and minimum-maximum. Survival curves were drawn using the Kaplan-Meier method. P<0.05 was considered as statistically significant.Results: The study population consisted of 72 patients, with a median age of 78 (minimum-maximum: 75-88). The most common pathologicaltype of breast cancer was invasive ductal carcinoma, followed by infiltrative lobular carcinoma. Steroid receptor positivity rates were high, and thecerbB2 status was mostly negative; older patients had favourable tumours. Endocrine therapy was the most preferred option in this geriatric patientgroup, and aromatase inhibitors were the most commonly chosen hormonotherapy. Endocrine therapy is the first choice in palliative treatment;however, chemotherapy was preferred in second- and third-line treatment in metastatic diseases.Conclusion: According to available literature, geriatric patients show similarities in histologic and intrinsic subtypes with postmenopausal women,except for frailty and comorbidities. However, in geriatric patients, endocrine therapy is preferred as adjuvant and/or metastatic treatment becausethey are more susceptible to chemotherapeutic agents. Oncologists should consulate every older patient to geriatric medicine, and comprehensivegeriatric assessment should be done to decide and continue treatment. Age should not be the only factor in decision-making

Chemotherapy Choice in Neoadjuvant Dual Her2 Blockade: Is it Really Essential to Add Anthracycline?

Objectives: Addition of trastuzumab and pertuzumab to neoadjuvant chemotherapy in Human epidermal growth factor receptor 2 (HER-2) positive breast cancer is the current clinical standard. We aimed to determine whether anthra- cycline-containing neoadjuvant chemotherapy yields beneficial effects alongside dual HER-2 blockade, and to assess cardiotoxicity with this treatment. Methods: Fifty-two patients with HER-2-positive breast cancer who received neoadjuvant chemotherapy were ret- rospectively evaluated at three tertiary health-care centers. The effects of chemotherapy regimen and several other factors such as age, stage, menopause status, lymph node positivity, and hormone receptor positivity on pathological complete response (pCR) were evaluated. Results: The mean age at diagnosis was 46±9 years. The pCR rate was similar between those with and without anthra- cycline-containing regimens (71.4% vs. 70%). Subgroup analyses also showed similar pCR values for those with nega- tive and positive hormone receptors (64.7% vs. 74.3%), those with Ki67 levels 20% and >20% (60% vs. 73.8%), and when premenopausal patients were compared with postmenopausal patients (76.9% vs. 65.4%). Conclusion: It appears that adding anthracycline to dual HER-2 blockade for neoadjuvant therapy did not yield addi- tional benefits in terms of pCR. Further studies are needed to assess anthracycline-containing regimens in patients who will use the neoadjuvant pertuzumab-trastuzumab combination

Contribution of complete response to treatment to survival in patients with unresectable metastatic colorectal cancer: A retrospective analysis

Background The aim of the study is to reveal the contribution of complete response (CR) to treatment to overall survival (OS) in patients with unresectable metastatic colorectal cancer. In addition, to evaluate progression-free survival (PFS) in patients who attained CR to treatment and to examine the clinicopathologic features of the patient group with CR. Methods This article is a retrospective chart review. Patients diagnosed with metastatic colorectal cancer were divided into two groups. The systemic treatment was compared with the patients who received a full response according to the Response Evaluation Criteria in Solid Tumors (RECIST1.1) and those who did not attain CR (progression partial response and stable response) in terms of both PFS and OS data, and the effect of attaining CR to treatment on prognosis was evaluated. Results A total of 222 patients were included in the study. 202 of 222 patients could be evaluated in terms of complete response. All data from their files were tabulated and analyzed retrospectively. The mean age of diagnosis of the study group was 60.13 12.52 years. The total number of patients who attained CR to treatment was 31 (15.3%); 171 (84.6%) patients did not attain CR. Patients who had a CR had longer median PFS times than patients who did not have a CR (15.2 vs. 7.4 months, P<0.001). Patients who had CR had longer median survival times than patients who did not have a CR (39.2 vs. 16.9 months, P<0.001). In subgroup patients who underwent primary surgery, the number of patients who attained CR was statistically higher compared with the number of patients who did not attain CR (p<0.001). Complete response was less common in the presence of liver metastasis and bone metastasis (p = 0.041 and p = 0.046, respectively), had a negative prognostic effect. In other words, 89.1% of patients with liver metastasis, 100.0% of patients with bone metastasis, and 88.7% of those who died did not have a CR to the treatment. According to multivariate analysis, CR to treatment, primary surgery, first-line chemotherapy (combination compared with fluoropyrimidine), and no bone metastasis were found to be predictors for OS. Conclusion Providing CR with systemic treatment in patients with unresectable metastatic colorectal cancer (mCRC) contributes to prognosis. The primary resection in our secondary acquisitions from the study, the number of metastatic regions and the combination therapy regimens also contributed to the prognosis

Real-life experience of patients with sarcomatoid renal cell carcinoma: a multicenter retrospective study [2]

Sarcomatoid renal cell carcinoma (sRCC) is a rare variant of renal cell carcinoma (RCC) and is associated with a poor prognosis. We reviewed the outcomes of patients from oncology centers in Turkey. Our aim is to share our real-life experi-ence and to contribute to the literature. The demographic and clinical features, treatment, and survival outcomes of 148 patients with sRCC were analyzed. The median age at the time of diagnosis was 58 years (range: 19-83 years). Most patients (62.8%) had clear-cell histology. Most patients were in the intermediate Memorial Sloan-Kettering Cancer Center (MSKCC) risk group (67.6%) and were stage 4 at the time of diagnosis (63.5%). The most common sites of metastasis were the lung (60.1%), lymph nodes (47.3%), and bone (35.8%). The patients received a median of two lines (range: 0-6) of treatment. The most common side effects were fatigue, hematological side effects, hypertension, and hypothyroidism. The median follow-up was 20.9 months (range: 1-162 months). The median overall survival (OS) was 30.8 months (95% confidence interval: 24.9-36.7 months). In multivariate analysis, high MSKCC scores, sarcomatoid differentiation rates >50%, having stage 4 disease, and having lung metastasis at the time of diagnosis were independent factors for poor prognosis affecting OS. No difference was observed between patients who received tyrosine kinase inhibitor (TKI) as the first or second-line treatments. Similarly, no difference between TKI and immunotherapy as the second-line treatment. In conclusion, sRCC is a rare variant of RCC with a poor prognosis and response to treatment. Larger-scale prospective studies are needed to define an optimal treatment approach for longer survival in this aggressive variant.Financial support was received from the Mediterranean Oncology Association (Akdeniz Onkoloji Dernegi-AOD) for the statistical analysis of the study.Mediterranean Oncology Association (Akdeniz Onkoloji Dernegi-AOD