Hyperprogression after immunotherapy: A comprehensive review

Immune checkpoint inhibitors have revolutionized cancer treatment with patient improved survival, quality of life, and a longer response. However, up to 30% of patients experience paradoxical accelerated tumor progression early after immune-checkpoint blockade therapy. This phenomenon is also known as hyperprogression (HP). Unlike other responses, such as pseudoprogression or natural progression, HP causes worse survival outcomes in patients. Older age, higher meta-static burden, and previous radiation have been independently associated with HP. Even though the exact molecular mechanism underlying HP after immune-checkpoint blockade therapy remains unknown, oncogenic signaling activation including MDM2 amplification or EGFR alterations, the modification of tumor microenvironment by radiotherapy with immune checkpoint inhibitors, and alterations in immune landscape of tumors have been hypothesized as the biological mechanisms behind HP. Patients with HP have been presented with poor prognosis and increased deleteri-ous mutations in cancer genes, along with alterations in the tumor microenvironment. As immune checkpoint inhibitors have been more widely accepted by oncologists, proper assessment of this unique tumor response remains challenging in clinical practice. This work documents the recent findings on epidemiology, biological and clinicopathological factors of HP after immunotherapy

Hyperprogression after immunotherapy: A comprehensive review

Immune checkpoint inhibitors have revolutionized cancer treatment with patient improved survival, quality of life, and a longer response. However, up to 30% of patients experience paradoxical accelerated tumor progression early after immune-checkpoint blockade therapy. This phenomenon is also known as hyperprogression (HP). Unlike other responses, such as pseudoprogression or natural progression, HP causes worse survival outcomes in patients. Older age, higher meta-static burden, and previous radiation have been independently associated with HP. Even though the exact molecular mechanism underlying HP after immune-checkpoint blockade therapy remains unknown, oncogenic signaling activation including MDM2 amplification or EGFR alterations, the modification of tumor microenvironment by radiotherapy with immune checkpoint inhibitors, and alterations in immune landscape of tumors have been hypothesized as the biological mechanisms behind HP. Patients with HP have been presented with poor prognosis and increased deleteri-ous mutations in cancer genes, along with alterations in the tumor microenvironment. As immune checkpoint inhibitors have been more widely accepted by oncologists, proper assessment of this unique tumor response remains challenging in clinical practice. This work documents the recent findings on epidemiology, biological and clinicopathological factors of HP after immunotherapy

Rarely seen rectum tumor with bad prognosis: A case of large cell neuroendocrine carcinoma

Large cell neuoendocrine carcinoma forms an extremely aggressive and poor prognostic subset of neuroendocrine tumors with a tendency to early metastasis. However palliative chemotherapy in patients with metastatic disease may provide longer progression-free survival but the important issue is to detect and surgically treat the disease at an early stage. In this article, we  present a case of  large cell neuroendocrine carcinoma of the rectum which was admitted to our hospital with a complaint of rectal bleeding for about a month and multiple dsitant metastases at the time of diagnosis. The patient received palliative chemotherapy with cisplatin plus etoposide and zoledronic acid and an overall 6 month survival time was achieved. Generalizing the screening programs for colorectal cancers and facilitating access to colonoscopy are essential for early diagnosis and therapy of rectal neuroendocrine tumors.</p

Second-line gemcitabine-based chemotherapy regimens improve overall 3-year survival rate in patients with malignant pleural mesothelioma: a multicenter retrospective study

In the present study, we aimed to evaluate the effectiveness of second-line gemcitabine-based chemotherapy regimens on overall survival (OS) in malignant pleural mesothelioma (MPM) patients receiving first-line pemetrexed-based regimens. A total of 73 patients with MPM from Akdeniz University, Acibadem Kayseri Hospital, Kayseri Training and Research Hospital, and Erciyes University were analyzed and evaluated retrospectively as two groups: second-line gemcitabine-based chemotherapy and no second-line chemotherapy. The median OS of patients who received second-line gemcitabine-based chemotherapy was 11.3 (5.1-17.5) months, while it was 9.9 (2.1-17.7) months in the patients who did not receive chemotherapy in the second-line setting (p = 0.056). When we evaluated the survival rate at the 6th, 12th, 18th, 24th, and 36th month, the OS rate of the 36th month was significantly higher in patients who received gemcitabine-based second-line chemotherapy (p = 0.041). When evaluating the OS from diagnosis to death, the median OS values were 20.8 (17.5-24.1) months for first-line pemetrexed-based regimens then second-line gemcitabine alone and 13.1 (9.0-17.1) months supportive care after first-line pemetrexed-based regimens (p = 0.005). According to our results, we may consider gemcitabine-based regimens as second-line chemotherapy after treatment with pemetrexed plus platinum in patients with MPM

Clinicopathologic Features and Molecular Subtypes of Breast Cancer in Young Women (Age ≤35)

Introduction: Breast cancer in young women is a relatively rare disease; however it tends to be more aggressive and is the leading cause of cancer death in this population. The aim of this study is to investigate the clinical and biological features of breast cancer arising in young Turkish breast cancer patients. Materials and Methods: Patients with breast cancer aged 35 or less (<= 35 years) were selected for the study. In total 211 cases were included. Pathologic features; histologic subtypes, grade, lymphovascular invasion, axillary involvement, and stage were recorded for each. Results: The most common subtype was luminal B (36.5%), followed by luminal A (30.8%), triple negative (23.2%) and HER2+(9.5%) subtypes. Twelve percent of the patients had stage 4, 32.7% had stage 3, 46.4% had stage 2, and 6.2% had stage 1 disease at the time of diagnosis. Mean tumour diameter was 3.87 cm (range 0.3-13 cm). The axillary lymph nodes were positive in 74.4% of the patients, while lympho-vascular invasion was seen in 56.4%. Some 9.5% of patients had grade 1, 51.2% had grade 2, and 31.8% had grade 3 tumors. Conclusions: Young women with breast cancer in Turkey are more likely to present with luminal B subtype. Tumors in young women are more likely to present with advanced disease, to be high grade and and to have more lymphovascular invasion. Further research should focus on whether we need new treatment strategies for young patients with breast carcinoma

Clinicopathologic Features and Molecular Subtypes of Breast Cancer in Young Women (Age <= 35)

Introduction: Breast cancer in young women is a relatively rare disease; however it tends to be more aggressive and is the leading cause of cancer death in this population. The aim of this study is to investigate the clinical and biological features of breast cancer arising in young Turkish breast cancer patients. Materials and Methods: Patients with breast cancer aged 35 or less (<= 35 years) were selected for the study. In total 211 cases were included. Pathologic features; histologic subtypes, grade, lymphovascular invasion, axillary involvement, and stage were recorded for each. Results: The most common subtype was luminal B (36.5%), followed by luminal A (30.8%), triple negative (23.2%) and HER2+(9.5%) subtypes. Twelve percent of the patients had stage 4, 32.7% had stage 3, 46.4% had stage 2, and 6.2% had stage 1 disease at the time of diagnosis. Mean tumour diameter was 3.87 cm (range 0.3-13 cm). The axillary lymph nodes were positive in 74.4% of the patients, while lympho-vascular invasion was seen in 56.4%. Some 9.5% of patients had grade 1, 51.2% had grade 2, and 31.8% had grade 3 tumors. Conclusions: Young women with breast cancer in Turkey are more likely to present with luminal B subtype. Tumors in young women are more likely to present with advanced disease, to be high grade and and to have more lymphovascular invasion. Further research should focus on whether we need new treatment strategies for young patients with breast carcinoma

Her-2 Positive Gastric Cancer Presented with Thrombocytopenia and Skin Involvement: A Case Report

Gastric cancer is the 5th most frequent cancer around the world and the 3rd most frequent reason of deaths due to cancer. Every year, about 1 million new cases are taking place, with varying geographical distribution. Gastric cancer is often metastatic to liver, lungs, and bones in hematogenous way, to peripheral lymph nodes in lymphogenous way, and to peripheral tissues in adjacency way, yet bone marrow (BM) and cutaneous metastasis are quite seldom. Pancytopenia is a more frequent finding identified in BM metastasis of solid organ cancers, and isolated thrombocytopenia is less often. The human epidermal growth factor 2 (HER-2) is positive in gastric cancer at a rate of 7–34%. Here, we have presented our HER-2 positive gastric cancer incident which presented with BM and cutaneous metastasis, and has no 18F-fluoro-2-deoxi-D-glucose (FDG) involvement except bone metastases