Development of second primary multiple myeloma five years after treatment for limited-stage small cell lung cancer: a rare case report

Introduction. The development of a second primary malignancy (SPM) following small cell lung cancer (SCLC) has been previously reported in the literature. Especially smoking-related malignancy coupling is well known. The development of multiple myeloma (MM) in long-term survivors after treatment for SCLC is unknown. Here, we report the first case in the literature who developed MM 5 years after treatment for limited-stage SCLC. Case report. A 67-year-old male patient was diagnosed with limited-stage SCLC. After he received chemotherapy and radiotherapy, he was followed up without medication. He was admitted to the hospital with back pain and dyspnea 5 years after the diagnosis of small cell lung cancer. MRI revealed osteolytic lesions in the vertebrae. Laboratory testing revealed a markedly elevated serum IgA and an elevated serum beta-2 microglobulin level. Serum immunofixation revealed IgA lambda-type M-protein. Lambda excretion in urine immunofixation electrophoresis was observed. Bone marrow aspiration revealed the frequency of plasma cells to be 80% of all nucleated cells. Hence, the final diagnosis revealed IgA lambda free light chain MM. Treatment was given for multiple myeloma. In the follow-up, the patient experienced increased dyspnea and developed bilateral pleural effusion. The cytology sent from thoracentesis sampling was reported as plasmocyte-rich material. The patient fell into a coma and died in an intensive care unit. Conclusion. We presented the development of MM 5 years after treatment in a patient with SCLC who were treated for one year and then followed up with stable findings. It should be kept in mind that a patient with SCLC who is a long-term survivor and presents with back pain may have developed a primary malignancy originating from bone marrow rather than a bone metastasis. Patients should be advised smoking cessation after the treatment and diagnosis of SCLC. Also, the patients with SCLC who are long-term survivors should be closely monitored for the development of SPM

Which chemotherapy regimen might be the best for the second-line treatment of patients with small-cell lung cancer?

Introduction. Small-cell lung cancer (SCLC) is an aggressive disease. Despite the first-line (1L) chemotherapy, almost all patients need the second-line (2L) treatment within a year. However, there is no general agreement on standard 2L treatment. This study aimed to determine outcomes obtained with different treatment regimens, factors affecting the results, and standard approach in the 2L treatment of SCLC. Material and methods. This was a singlecenter, retrospective, cross-sectional, cohort study. The inclusion criteria were age ≥ 18, histologically or cytologically proven SCLC, progressive disease after 1L treatment, and receiving 2L chemotherapy. Results. A total of 89 patients were assessed in this study. The patients were classified into three groups: 35 patients received the combination of doxorubicin, cyclophosphamide, and vincristine (CAV), 24 patients received single-agent topotecan (TPT), and 30 patients received numerous different treatment schemes. The overall response rate (ORR), disease control rate (DCR), median progression-free survival (PFS), and median overall survival (OS) were 19.1%, 46.1%, 3.5 months, and 6.4 months, respectively. Although no statistically significant difference was found between the three groups in PFS (p = 0.195) and OS (p = 0.286), there were numerically better outcomes with CAV. In univariate analyses, the comorbidity was related to decreased PFS (p = 0.044). However, this relationship could not maintain its statistical significance in multivariate analysis (p = 0.224). Conclusions. It is still impossible to make a standard recommendation for the 2L treatment of patients with SCLC. However, the numerical difference in favor of CAV may be clinically meaningful

Jak2v617f Mutation in Patients with Myeloproliferative Diseases and Those with Ischemic Heart Disease with Normal Coronary Angiography

Objectives: Arterial and venous thrombotic events are more commonly observed in patients with myeloproliferativediseases (MPDs). Arterial and venous thromboses are significant causes of mortality and morbidity in Philadelphia (Ph)chromosome-negative MPDs. The present study investigates the presence of the JAK2V617F mutation, which contributes to the early diagnosis of MPD, in patients with ischemic heart disease with a normal coronary angiography and inthose with a venous thrombosis in an atypical location. The goal in this regard is to determine the contribution of theJAK2V617F mutation to the development of thrombosis in Philadelphia chromosome-negative MPDs, and to identifypossible relationships between the JAK2 mutation and other clinical and laboratory characteristics.Methods: The study was conducted in the Division of Hematology of the Department of Internal Medicine in theTrakya University Faculty of Medicine between March 2008 and August 2009. Approval for the study was granted by theEthics Committee of the Trakya University Faculty of Medicine on February 21, 2008, and the study was supported bythe Trakya University Scientific Research Projects Fund. A total of 87 subjects were included in the study. The JAK2V617Fmutation was analyzed using a real-time PCR device and with a melting curve analysis. The demographic and medicaldata of the patients was retrieved from the medical charts. The statistical analysis was performed using SPSS 13.0 dataanalysis software.Results: The study included 31 patients diagnosed with myeloproliferative disease, 32 patients with ischemic heartdisease with a normal coronary angiography and four patients with a venous thrombosis in an atypical location, as wellas 20 healthy volunteers included in the control group. The JAK2V617F mutation was identified in 24 patients (77.4%)with myeloproliferative disease, in one patient (3.1%) with cardiovascular disease and in two patients (50%) with avenous thromboembolism in an atypical location. No JAK2V617F mutation was found in the healthy control group.There was no difference between myeloproliferative disease subgroups in terms of history of thrombosis. No significantrelationship was found between the presence of the JAK2V617F mutation, history of thrombosis and leukocyte count,or between leukocyte count and history of thrombosis (p=0.183, p=0.345, p=0.368, respectively).Conclusion: The identification of the JAK2V617F mutation in three patients with thrombosis with no diagnosis of myeloproliferative disease suggests that the detection of this mutation in patients with a venous thromboembolism in anatypical location and in some patients with an arterial thrombosis may contribute to the early recognition of patients withmyeloproliferative disease, and may give these patients the chance to begin the appropriate therapy. The rate of a historyof thrombosis was higher in the JAK2V617F-positive patients, although the difference did not reach statistical significanc

More sunlight exposure may improve the overall survival in patients with pancreas cancer

The protective effect of sun exposure on prognosis of cancer and cancer risk was previously reported in some studies except for melanoma and skin cancer. In presented study we aimed to compare the effect of sunlight exposure on prognosis of patients with pancreatic cancer (PC) in two regions with different sunlight exposure. Totally of 139 patients with PC from Akdeniz University from Antalya (n:103) and Kocatepe University (n:36) from Afyon were analyzed retrospectively. Antalya and Afyon state have different sunlight exposure. Two groups were compared in terms of overall survival (OS). The median OS values were 10,9 [95% CI: 7,8–14,0] and 6,9 [95% CI: 3,9–9,9] months for Antalya and Afyon groups, respectively and it was found a significant difference between groups for OS (p = 0.015). Also, the region and stage were an independent prognostic factor. In conclusion, the patients with PC had better OS in the region with more sunlight exposure

Real-world efficacy and safety data of immune checkpoint inhibitors in Turkish patients with metastatic melanoma: A Turkish oncology group study

[No Abstract Available

Prognostic importance of the positive lymph node ratio in the gastric cancer

Bu çalışmada, evre 1-3 gastrik karsinomda (GK) metastatik lenf nodlarının toplam çıkarılan lenf nodu sayısına oranının (LNO) prognostik önemini değerlendirmeyi amaçladık. 2012-2019 yılları arasında opere edilen evre 1-3 GK’lı toplam 233 hasta retrospektif olarak değerlendirildi. Sağkalım eğrileri Kaplan-Meier yöntemi kullanılarak oluşturuldu. Medyan metastatik ve disseke lenf nodu sayısı sırasıyla 5 ve 27 idi, ortalama LNO 0.1 idi. Hastalar LNO <0.1 ve ≥0.1 olanlar olmak üzere iki gruba ayrıldı. Medyan LNO <0.1 ve ≥0.1 olan hastalarda medyan genel sağkalım 26.9 ay ve 76 ay idi (p <0.001). Tek değişkenli analizde cinsiyet, lenfovasküler invazyon (LVİ) ve perinöral invazyon (PNİ) medyan genel sağkalımda anlamlı bulundu (sırasıyla p=0.043, <0.001 ve <0.001). LNO ve LVİ, çok değişkenli analizde genel sağkalımın bağımsız prediktörleri olarak saptandı (sırasıyla p<0.01 ve 0.02). GK hastalarında artan LNO, opere edilen hastalarda azalmış genel sağkalım açısından prognostik bir öneme sahiptir. Bu nedenle, LNO, yetersiz lenf nodu diseksiyonu veya D1 diseksiyonu olan hastalarda patolojik nodal sınıflandırma yerine kullanılabilir.Herein, we aimed to evaluate the prognostic significance of the ratio of metastatic lymph nodes to the total number of removed lymph nodes (LNR) in Stage 1-3 operated gastric carcinoma (GC). A total of 233 patients with stage 1-3 GC operated between 2012 and 2019 were retrospectively evaluated. Survival curves were constructed using the Kaplan-Meier method. The median number of metastatic and dissected lymph nodes were 5 and 27, respectively, with a median LNR of 0.1. Patients were categorized into two groups as those with a LNR <0.1 and ≥0.1. Median OS in patients with a median LNR of <0.1 and ≥0.1 were 76 vs. 26.9 months (p<0.001). In univariate analysis gender, lymphovascular invasion (LVI), and perineural invasion (PNI) were found to be significant predictors of median OS (p=0.043, <0.001 and <0.001, respectively). LNR and LVI emerged as independent predictors of OS in the multivariate analyses (p<0.01 and 0.02, respectively). LNR has prognostic significance for OS in operated GC patients where increasing LNR is associated with reduced overall survival. Thus, LNR may be used as a substitute for pathological nodal classification in patients with insufficient lymph node dissection or D1 dissection

DENOSUMAB TÜRKİYE VERİLERİ: KRONİK BÖBREK HASTALIĞI’NIN DENOSUMAB SONLANIM NOKTALARINA ETKİSİ; TÜRK ONKOLOJİ GRUBU(TOG) ÇALIŞMAS

Amaç: Denosumab, kemik remodellingini düzenleyen önemli bir ligand olan NFkB ligandının (RANKL) reseptör aktivatörünü spesifik olarak bağlar ve inaktive eder. Tümör hücreleri tarafından uyarılan kemik yıkım döngüsünü azaltarak İİÖ’yü önlemede etkin bir ajandır. Denosumab, ağırlıklı olarak retiküloendotelyal sistem yoluyla temizlenen bir monoklonal antikordur. Denosumab böbrekler tarafından atılmadığından, böbrek fonksiyonunun izlenmesi ve önceden var olan böbrek yetmezliği için doz ayarlaması gerekli değildir ve önerilmemektedir. Gereç-Yöntem: Ocak 2011-Aralık 2021 tarihleri arası tüm solid organ malignitesi olan hastalarda denosumab kullanan hastaların, bu tedaviyi alma süresi, yan etkilerinin sıklığı ve derecesi retrospektif olarak incelendi.Türkiye Onkoloji Grubu(TOG) projesi kapsamında toplam 17 merkezden 266 hasta incelendi.11 hasta verileri ulaşılamadığı için çıkarıldı. Hastalar KBH’ı olanlar ve olmayanlar olarak iki gruba ayrılıp incelendi, yan etkileri, görülme sıklıkları, iskelet ilişkili olayların sıklığı ve sağkalıma etkileri incelendi. Bulgular: Çalışmaya alınan hastaların 157(%59.5)’si kadındı. Ortalama takip süresi 64.86(57.19-72.53) aydı. Grade 3 toksiste toplam 18 hastada görüldü. Bunların 15’inde hipokalsemi,2’sinde kreatinin artışı, 1’nde osteonekroz görüldü. GFR 60’ın altında olan hastalar ile grade 3 toksisite ilişkisi anlamlı olarak görüldü(18 grade 3 toksiste’nin 8’inde GFR 60’ın altındaydı.p&lt;0.001) Grade 3 toksiste sağkalım ilişkisine bakıldığında grade 3 toksiste gelişen hastalarda sağkalım oldukça kısaydı(36.4 ay v 165.38 ay, p&lt;0.001) Sonuç: Denosumab alan ve GFR’si 60’ın altında olan hastalarda grade 3 yan etki görülme oranı ve buna bağlı olarak iskelet ilişkili olay görülme sıklığı daha fazladır. Anahtar Kelimeler: denosumab, glomerüler filtrasyon hızı, hipokalsemi</p

Comparing the efficacy of regorafenib and 5-fluorouracil-based rechallenge chemotherapy in the third-line treatment of metastatic colorectal cancer

Abstract Background The optimal treatment for metastatic colorectal cancer (mCRC) after the second line is still controversial. Regorafenib has been the standard of care in this setting as it improved overall survival (OS) compared to placebo. In real-world practice chemotherapy rechallenge is also a preferred option even though supporting evidence is not enough. We aim to compare the efficacy of regorafenib and 5-fluorouracil-based (5-FU) rechallenge treatment in the third line setting of mCRC. Methods In this retrospective multi-institutional trial, mCRC patients from 21 oncology centers who progressed after 2 lines of chemotherapy were analyzed. Patients who were treated with regorafenib or rechallenge therapy in the third-line setting were eligible. Rechallenge chemotherapy was identified as the re-use of the 5-FU based regimen which was administered in one of the previous treatment lines. OS, disease control rate (DCR), progression free survival (PFS) and toxicity were analyzed. Results Three hundred ninety-four mCRC patients were included in the study. 128 (32.5%) were in the rechallenge, and 266 (67.5%) were in the regorafenib group. Median PFS was 5.82 months in rechallenge and 4 months in regorafenib arms (hazard ratio:1.45,95% CI, p = 0.167). DCR was higher in the rechallenge group than regorafenib (77% vs 49.5%, respectively, p =  < 0.001). Median OS after the third-line treatment was 11.99 (95% CI, 9.49–14.49) and 8.08 months (95% CI, 6.88–9.29) for rechallenge and regorafenib groups, respectively (hazard ratio:1.51, 95% CI, p < 0.001). More adverse effects and discontinuation were seen with regorafenib treatment. Conclusion Our study revealed that higher disease control and OS rates were achieved with rechallenge treatment compared to regorafenib, especially in patients who achieved disease control in one of the first two lines of therapy

Efficacy of Capecitabine and Temozolomide Regimen in Neuroendocrine Tumors: Data From the Turkish Oncology Group

INTRODUCTION: This study aims to report the efficacy and safety of capecitabine plus temozolomide (CAPTEM) across different lines of treatment in patients with metastatic neuroendocrine tumors (NETs). METHODS: We conducted a multicenter retrospective study analyzing the data of 308 patients with metastatic NETs treated with CAPTEM between 2010 and 2022 in 34 different hospitals across various regions of Turkey. RESULTS: The median follow-up time was 41.0 months (range: 1.7-212.1), and the median age was 53 years (range: 22-79). Our results across the entire patient cohort showed a median progression-free survival (PFS) of 10.6 months and a median overall survival (OS) of 60.4 months. First-line CAPTEM treatment appeared more effective, with a median PFS of 16.1 months and a median OS of 105.8 months (median PFS 16.1, 7.9, and 9.6 months in first-, second- and ≥third-line respectively, P = .01; with median OS values of 105.8, 47.2, and 24.1 months, respectively, P = .003) In terms of ORR, the first-line treatment again performed better, resulting in an ORR of 54.7% compared to 33.3% and 30.0% in the second and third or higher lines, respectively (P < .001). Grade 3-4 side effects occurred only in 22.5% of the patients, leading to a discontinuation rate of 9.5%. Despite the differences in outcomes based on treatment line, we did not observe a significant difference in terms of side effects between the first and subsequent lines of treatment. CONCLUSIONS AND RELEVANCE: The substantial superior outcomes in patients receiving first-line CAPTEM treatment highlight its potential as an effective treatment strategy for patients with metastatic NET