Unusual region for pericardial malignant mesothelioma: cutaneous manifestation in a Turkish woman

Malignant mesothelioma is a disease that originates from mesenchymal cells. It is related to the occupational or environmental exposure to asbestos. The treatment remains controversial because it is commonly diagnosed at a very late stage, and the prognosis is very poor. In this report, we present a 37-year-old female patient who was admitted with shortness of breath, palpitation and inability to sleep on her back for the previous 10 days. A large pericardial effusion was detected on echocardiography. Pericardiocentesis was performed and the patient’s symptoms were alleviated. However, approximately 7 months later, she was readmitted to the clinic with complaints of a mass at the incision site. Pathological examination of the mass yielded a diagnosis of pericardial malignant mesothelioma. Malignant mesothelioma is a rare occurrence, and to our knowledge, there are no reports in the English literature of pericardial malignant mesothelioma local invasion to an incision site

Effectiveness and Tolerability of FOLFIRINOX Regime in Metastatic Pancreas Cancer Disease

Amaç: Metastatik pankreas kanseri tedavisinde FOLFİ-RİNOX rejiminin kullanımı hem progresyonsuz sağ kalımıhemde genel sağ kalım süresini uzatmıştır. Türk popülasyonundametastatik pankreas kanserli hastalarda birinciseride FOLFİRİNOX rejimi kullanımının etkinlik ve güvenilirliğiniretrospektif olarak araştırmak istedik.Gereç ve Yöntem: Çalışma retrospektif çok merkezli olarakdizayn edilmiştir. 2012-2016 yılları arasında birinci seriFOLFİRİNOX rejimi ile tedavi edilen metastatik pankreaskanserli hastalar dahil edilmiştir.Bulgular: Çalışmaya 44 metastatik pankreas kanserli hastaalındı. Hastalardan 30’u erkek (%68,2), 14’ü kadındı(%31,8). Hastaların yaş ortalaması 58,7 (34-73) yıldı. Mediantakip süremiz 14 ay idi. Hastaların metastaz bölgelerinebakıldığında %72,7 karaciğere, %18,2 akciğere, %18,2peritona, %4,5 lenf nodlarına ve %4,5 kemiklere metastazyapmıştı. Tedaviye yanıt oranlarına bakıldığında %40,9hastada parsiyel yanıt, %13,6 hastada stabil yanıt, %45,4hastada progresyon mevcuttu. Median progresyonsuz sağkalım süresi 8 ay (%95 CI 4-12) olarak bulundu. Mediangenel sağ kalım süresi 14 ay (%95 CI 10.3-17.7), 6 aylıkgenel sağ kalım %76,2, 12 aylık genel sağ kalım %57,5, 24aylık genel sağ kalım %6 olarak bulundu. Toksisite oranlarınabakıldığında grade 3-4 Nöropeni %36,4 (grade 3%27,3, grade 4 %9,1), grade 3-4 trombositopeni %13,6hastada görüldü. Grade 3-4 anemi %14,6 hastada görüldü.Hematolojik dışı yan etkilerden grade 1-2 ishal %68olmasına rağmen grade 3-4 ishal %4,5 oranında görüldü.Grade 1-2 periferik duysal nöropati %72,7 oranında görülürkengrade 3-4 duysal nöropati tespit edilmedi.Sonuç: Metastatik pankreas kanserinde FOLFİRİNOX rejimikullanılarak 12 ayın üzerine çıkan bir genel sağkalımaulaşılmıştır. Fakat grade 3-4 hematolojik yan etki oranı%49’lara kadar çıkmıştır.Objective: The use of the FOLFIRINOX regimen in thetreatment of metastatic pancreatic cancer prolonged bothprogression-free survival and overall survival. We wantedto retrospectively investigate the efficacy and safety of firstlineFOLFIRINOX regimen use in patients with metastaticpancreatic cancer in the Turkish population.Material and Methods: The study was designed as retrospectivemulticenter. Patients with metastatic pancreaticcancer treated with the first series FOLFIRINOX regimenbetween the years 2012-2016 were included.Results: Forty-four patients with metastatic pancreaticcancer were included in the study. 30 patients were male(68.2%) and 14 were female (31.8%). The mean age of thepatients was 58.7 (34-73) years. Our median follow-up was14 months. When the metastatic sites of the patients wereexamined, 72.7% had liver, 18.2% lung, 18.2% peritoneal,4.5% lymph nodes and 4.5% bones metastases. There was40.9% partial response, 13.6% stable disease and 45.4%progression disease in the patients. The median progression-free survival time was 8 months (95% CI 4-12). Medianoverall survival time was 14 months (95% CI 10.3-17.7), 6months overall survival was 76.2%, 12 months overall survivalwas 57.5% and 24 months overall survival was 6%.Grade 3-4 neuropeni was found in 36.4% (grade 3, 27.3%,grade 4 9.1%) and grade 3-4 thrombocytopenia was foundin 13.6% of the patients. Grade 3-4 anemia was seen in14.6% of the patients.Grade 3-4 diarrhea was seen in 4.5%of cases, although grade 1-2 diarrhea was 68% with nonhematologicside effects. Grade 1-2 peripheral sensory neuropathywas observed in 72.7% of the cases, whereas grade3-4 sensory neuropathy was not detected.Conclusion: Patients with metastatic pancreatic cancerachieved a overall survival of over 12 months using theFOLFIRINOX regimen. However, grade 3-4 hematologicside-effects were up to 49%

The conversion ofRASstatus in metastatic colorectal cancer patients after first-line biological agent treatment

Aim The aim was to investigate theRASdiscordance between initial and recurrent metastasectomy specimens in metastatic colorectal cancer (mCRC) patients treated with chemotherapy (CT) plus biological agents in a first-line setting. Methods Patients who had been treated with CT plus bevacizumab or cetuximab or panitumumab followed by R0 resection for potentially resectable colorectal cancer liver metastases were scanned. Among these, patients who developed resectable new metastases after a disease-free interval longer than 6 months were included in the study. We compared theRASmutation status between the first biopsy and the second metastasectomy specimen. Results A total of 82 mCRC patients treated with CT plus biological agents in a first-line setting were included in the study. The first biopsy assessment showed wild-typeRAStumours in 39 (47.6%) patients and mutantRAStumours in 43 (52.4%) patients. The mean time for new operable liver metastasis after R0 resection was 15.5 months. In the second metastasectomy specimens, the numbers of wild-type and mutantRAStumours were 30 (36.6%) and 52 (63.4%), respectively. The comparison with the first biopsy specimens showedRASstatus conversions in 17 (20.7%) patients. Univariate comparison between patients with and withoutRASstatus conversion revealed that grade, pathological T stage, wild-typeRAStumour and longer biological agent use time in the first-line treatment were significant factors forRASconversion. Conclusion Our results suggest that re-biopsy is needed for an optimal second-line treatment decision in mCRC patients regardless of backbone biological agent, especially in patients with wild-typeRASmCRC.Interdisciplinary Oncology Associatio

Cetuximab-induced rash is associated with overall survival in patients with recurrent/metastatic squamous cell carcinoma of head and neck

Purpose In this study, we looked for whether treatment-induced rash predicts treatment efficacy in patients with recurrent/metastatic HNSCC treated with Cetuximab and chemotherapy. Methods Patients who were treated with platinum-based chemotherapy and cetuximab for the first line treatment of recurrent/metastatic HNSCC were recruited. Presence of rash, hypomagnesemia, hypopotassemia, anemia, neutropenia, thrombocytopenia during treatment and treatment response, date of progression, date of last visit and death were recorded. Results A total of 138 patients' data were available for analysis. Any grade of rash was detected in 57 (44.5%) of the patients. The incidence of rash was significantly higher in patients with objective response than in patients with disease progression (%56.8 vs %14.3, p < 0.001). Progression free survival was 7.06 months (4.98-9.15) in patients treated with cetuximab and chemotherapy as first line treatment. In the multivariate analysis; rash was significantly correlated with longer PFS (HR 2.136; 95% CI 1.067-4.278; p = 0.032). Progression free survival was 9.65 months in patients who experienced rash, and 6.02 months in patients without rash, (p = 0.019, log-rank test). Overall survival was 11.24 months (9.65-12.82). In multivariate analysis, the survival of patients with rash was significantly longer than patients without rash (HR 1.954; 95% CI 1.162-3.285; p = 0.012). Overall survival was 15.08 months in patients who experienced rash, and 8.61 months in patients without rash (p = 0.05, log-rank test). Conclusion Cetuximab-induced rash is associated with better ORR and longer PFS and OS in patients with recurrent/metastatic HNSCC treated with Cetuximab and platinum-based chemotherapy

Real-life analysis of treatment approaches and the role of inflammatory markers on survival in patients with advanced biliary tract cancer

Objectives: Advanced-stage biliary tract cancers (BTC) are rare malignancies with poor prognosis. There are few prospective trials, but several retrospective studies regarding treatment options. In this study, we aimed to investigate the role of systemic inflammatory parameters (SIP) and other possible independent factors that may affect survival and treatment approaches and to determine the benefit of later-line treatments in these patients. Methods: A total of 284 patients, initially diagnosed with advanced stage or progressed after curative treatment of BTC, from different oncology centers in Turkey were included in this retrospective study. The prognostic significance of clinicopathological factors, SIPs and treatment options was analyzed. Results: At a median follow-up of 13 months, the median progression-free survival (PFS) was 6.1 months (95% CI:5.51–6.82), and the median overall survival (OS) time was 16.8 months (95% CI: 13.9–19.6). Treatment choice (p <.001 HR:0.70 CI95% 0.55–0.9), performance status (p <.001 HR:2.74 CI 95% 2.12–3.54) and neutrophil-to-lymphocyte ratio (NLR) (p =.02 HR:1.38 CI 95% 1.03–1.84) were independent prognostic factors for PFS. For OS, the independent prognostic indicators were determined as The Eastern Cooperative Oncology Group Performance Status (ECOG PS) (p <.001 HR:1.78 CI 95% 1.5–2.3), Systemic Immune-inflammation Index (SII) (p <.001 HR:0.51 CI95% 0.36–0.73) and stage at diagnosis (p =.002 HR:1.79 CI 95% 1.24–2.59). Furthermore, second and third line treatments significantly prolonged OS in advanced BTC (p <.001 HR:0.55 CI 95% 0.38–0.79; p =.007 HR:0.51 CI95% 0.31–0.83, respectively). Conclusion: SII and NLR are useful prognostic factors and may be helpful in making treatment decisions. Additionally, second and later-line treatments in advanced BTC have a significant impact on survival under real-life conditions

Real-world treatment outcomes from nationwide Onco-colon Turkey registry in RAS wild-type patients treated with biologics second-line mCRC

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Efficacy and safety profile of COVID-19 vaccine in cancer patients: A prospective, multicenter cohort study

Aim: To compare the seropositivity rate of cancer patients with non-cancer controls after inactive SARS-CoV-2 vaccination (CoronaVac) and evaluate the factors affecting seropositivity. Method: Spike IgG antibodies against SARS-CoV-2 were measured in blood samples of 776 cancer patients and 715 non-cancer volunteers. An IgG level >= 50 AU/ml is accepted as seropositive. Results: The seropositivity rate was 85.2% in the patient group and 97.5% in the control group. The seropositivity rate and antibody levels were significantly lower in the patient group (p < 0.001). Age and chemotherapy were associated with lower seropositivity in cancer patients (p < 0.001). Conclusion: This study highlighted the efficacy and safety of the inactivated vaccine in cancer patients. Clinical Trials Registration: ClinicalTrials.gov) Plain language summary Cancer patients are at high risk for infection with SARS-CoV-2 and of developing the associated disease, COVID-19, which therefore puts them in the priority group for vaccination. This study evaluated the efficacy and safety of CoronaVac, an inactivated virus vaccine, in cancer patients. The immune response rate, defined as seropositivity, was 85.2% in the cancer patient group and 97.5% in the control group. The levels of antibodies, which are blood markers of immune response to the vaccine, were also significantly lower in the patient group, especially in those older than 60 years and receiving chemotherapy. These results highlight the importance of determining the effective vaccine type and dose in cancer patients to protect them from COVID-19 without disrupting their cancer treatment.Oncological Clinical Research Association (ONKAD

Cisplatin plus paclitaxel and bevacizumab versus carboplatin plus paclitaxel and bevacizumab for the first-line treatment of metastatic or recurrent cervical cancer

OBJECTIVE: Cisplatin-paclitaxel and bevacizumab is a frequently used treatment regimen for metastatic or recurrent cervical cancer, and carboplatin-paclitaxel and bevacizumab are also among the recommended regimens. In this study we aimed to evaluate the efficacy of these two regimens for the treatment of metastatic or recurrent cervical cancer. METHODS: Patients with metastatic or recurrent cervical cancer treated with cisplatin-paclitaxel and bevacizumab or carboplatin-paclitaxel and bevacizumab were retrospectively evaluated in this study. The clinical and demographic characteristics of patients in each group were evaluated. Median overall survival, progression-free survival, and response rates between the two groups were compared. RESULTS: A total of 250 patients were included. Overall, the numbers of patients with recurrent disease and metastatic disease were 159 and 91, respectively. The most common histologic subtype was squamous cell carcinoma (83.2%). The median duration of follow-up was 13.6 (range 0.5-86) months. The median progression-free survival was 10.5 (95% CI 9.0 to 11.8) months in the cisplatin-paclitaxel and bevacizumab group (group 1), and 10.8 (95% CI 8.6 to 13.0) months in the carboplatin-paclitaxel and bevacizumab group (group 2) (HR 1.20; 95% CI 0.88 to 1.63; p=0.25). The median overall survival was 19.1 (95% CI 13.0 to 25.1) months in group 1 and 18.3 (95% CI 15.3 to 21.3) months in group 2 (HR 1.28; 95% CI 0.91 to 1.80; p=0.15). CONCLUSIONS: There is no survival difference between cisplatin or carboplatin combined with paclitaxel and bevacizumab in metastatic or recurrent cervical cancer

Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy.

Background There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based). Methods A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and >= 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy. Results The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0-14.0) months in the ET arm of group A, and 5.3 (3.9-6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8-7.7) months in the ET arm of group B, and 5.7 (4.6-6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5-8.0) months in the ET arm of group C and 4.0 (3.5-4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months. Conclusion Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET