Safety and efficacy of nivolumab therapy in patients with metastatic renal cell carcinoma and impaired kidney function.

INTRODUCTION: Patients with renal insufficiency, usually defined as those with creatinine clearance < 40 mL/min, were excluded from pivotal clinical trials, especially in studies involving nivolumab therapy in patients with renal cell carcinoma (RCC). The aim of the study is to evaluate the efficacy and safety of nivolumab in patients with metastatic RCC (mRCC) stratified according to creatinine clearance. MATERIAL AND METHODS: Data from mRCC patients treated with nivolumab were retrospectively analyzed. Patients were classified into two categories according to their estimated glomerular filtration rate (eGFR); the first category (C1) included patients with eGFR < 40 mL/min/1.73 m2 and the second category (C2) included those with eGFR ≥ 40 mL/min/1.73 m2. RESULTS: Of the 95 patients enrolled, 1. group included 26 patients (27.4%) and 2. group included 69 patients (72.6%). None of the pts in category 1 were on hemodialysis. Overall incidence of adverse events was not statistically different between the two groups (P = .469). The overall response rate ORR was 50% in the first group and 42.0% in the second group (P = .486). Median overall survival (OS) was longer with 23.3 months in the 2. group versus 11 months in the 1. group (P = .415). CONCLUSION: Renal insufficiency is a common problem in patients with advanced renal cancer since they often undergo nephrectomy and their renal function may also worsen while receiving tyrosine kinase inhibitor therapy. We found that there is no significant difference in the safety and efficacy of nivolumab treatment between two groups. Nivolumab appears to be a safe and effective agent in patients with renal impairment.

Adequacy of surgical margins, re-excision, and evaluation of factors associated with recurrence: a retrospective study of 769 basal cell carcinomas

Abstract Background: Achieving adequate surgical margins and preventing recurrence are important in the treatment of basal cell carcinoma (BCC). Objectives: The objectives of this study were to evaluate the adequacy of surgical margins and the re-excision rates in patients with primary BCC who underwent standard surgical treatment using our proposed algorithm and to define the risk factors in patients with recurrent BCC. Methods: The medical records of patients who were histopathologically diagnosed with BCC were reviewed. An algorithm created based on previous literature was used to determine the distribution of optimal surgical margins adequacy and re-excision rates. Results: Statistically significant differences were observed between the cases with and without recurrence in age at diagnosis (p = 0.004), tumor size (p = 0.023), tumor location in the H zone of the face (p = 0.005), and aggressive histopathological subtype (p = 0.000). When the tumors were evaluated for adequacy of deep and lateral surgical margins and re-excision rates, higher rates of adequate excision (457 cases, 68.0%) and re-excision (43 cases, 33.9%) were noted for tumors in the H or M zone. Study limitations: Inadequate follow-up of newly diagnosed patients in terms of recurrence and metastasis and the retrospective application of our proposed algorithm are the limitations of the present study. Conclusions: Our results showed that if BCC was detected at an early age and at an early stage, recurrence was lower. The H and M zones were the regions with the highest rates of optimal surgical outcomes.

Pertuzumab, trastuzumab and taxane-based treatment for visceral organ metastatic, trastuzumab-naïve breast cancer: real-life practice outcomes.

PURPOSE: In this study, we aimed to describe the real-life practice outcomes of pertuzumab-trastuzumab-taxane (PTT) combination in visceral organ metastatic, trastuzumab-naive breast cancer (BC) patients. METHODS: This study was conducted by Turkish Oncology Group and included 317 patients' data from 36 centers. RESULTS: Median age was 51 (22-82). Median PFS was 28.5 months, while median OS was 40.3 months. Patients with brain metastases (n: 13, 4.1%) had worse PFS (16.8 m vs. 28.5 m; p = 0.002) and OS (26.7 m vs. 40.3 m; p = 0.009). Patients older than 65 years of age (n: 42, 13.2%) had significantly lower OS results (19.8 m vs. 40.3 m; p = 0.01). Two hundred sixty-eight patients (86.7%) received docetaxel while 37 patients (11.7%) received paclitaxel. PFS and OS were similar between taxane groups. In eight patients (2.5%), 5-40% ejection fraction decrement from baseline was detected without any clinical sign of heart failure. CONCLUSIONS: Our RLP trial included only visceral metastatic, trastuzumab-naïve BC patients including cases with brain involvement who received PTT combination in the first-line treatment. Regardless of negative prognostic characteristics, our results are in parallel with pivotal trial. Further strategies for brain metastasis should be developed to improve outcomes despite encouraging results with PTT treatment. Taxane selection can be personalized and endocrine maintenance may further improve outcomes after taxanes were discontinued. To our knowledge, this is the largest scale real-life clinical practice study of pertuzumab-trastuzumab-taxane therapy to date.

Benign metastasizing leiomyoma of bone and lung in postmenopausal women: two rare case reports and review of the literature.

Benign metastasizing leiomyoma (BML) is a rare disease that mostly occurs in women of reproductive age. Patients usually have a history of uterine leiomyoma and/or myomectomy. Although lung is the most common site of metastasis, bone involvement is rarely occurred. Here the authors report two rare cases of BML with lung and bone metastasis in postmenopausal women that were successfully treated with surgery and anti-estrogen approach.

The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer.

AIM: Identification of patient with increased risk of cardiotoxicity would allow not only prevention and early diagnosis of chemotherapy related cardiotoxicity but also administration of optimal dose and duration of chemotherapy. MATERIALS AND METHODS: Fifty-two women with HER2(+) breast cancer treated with trastuzumab were included in this study. Patients were prospectively followed with routine cardiac evaluation. Before and after administration of trastuzumab blood samples for NT-proBNP were also taken. RESULTS: The median age was 48.5 year (range: 26-74). Hypertension and obesity were two most common co-morbidities. The median duration application of trastuzumab was 52 weeks. During median 14.5 (3-33) months follow-up cardiac adverse events occurred in 5 (9.6%) patients and 2 out of 5 was grade III-IV heart failure. Both patients had preserved left ventricular ejection fraction and no symptom of heart failure before trastuzumab but older than 65 years old and had diabetes mellitus and obesity. High level of NT-proBNP (> 300 ng/ml) was observed in both patients and heart failure recovery was not observed. There was statistically significant difference regarding body mass index (p = 0.004) and diabetes mellitus (p = 0.002) between patients with and without cardiotoxicity. CONCLUSION: Although, cardiac biomarkers still cannot replace routine cardiac monitoring, natriuretic peptides may provide additional tool for detection of patients with high risk of cardiotoxicity and early detection of cardiotoxicity.

Perception about influenza and pneumococcal vaccines and vaccination coverage among patients with malignancies and their family members.

PURPOSE: Although influenza and pneumococcal vaccinations for high-risk populations are recommended by current guidelines, vaccination coverage rate (VCR) is still low in patients with malignancies and the family members living with them. METHODS: During the 2011-2012 seasonal influenza (SI), we surveyed 359 patients with solid or hematological malignancies Data were recorded in an especially designed questionnaire after face to face interview. RESULTS: The median patient age was 57 years (range 18-90) and 177 (49.3%) patients were female. Overall vaccination rate was 17% and 4.2% for influenza and pneumococcus, respectively. VCR among family members was 21.2%. The most common causes for not getting vaccinated were lack of knowledge for indication by the patients (33.5%), getting chemotherapy (22.1%), fear of side effects (12.5%), lack of efficacy (12.1%), and not advised by the attending physician (5.9%). CONCLUSION: VCR was very low among patients with cancer and their family members. To eliminate misconceptions and improve vaccination coverage in this population, educational programs for patients and for physicians focusing on safety and efficacy of vaccine are needed.

ABO and Rh blood groups frequency in women with HER2 positive breast cancer.

PURPOSE: The role of genetic factors in the development of cancer is widely accepted. Data on the role of ABO blood group and Rh factor in breast cancer is inconclusive. The aim of this study was to investigate the presence of a possible association between HER2 (+) breast cancer in Turkish women and ABO blood groups and Rh factor. METHODS: In 294 female patients with HER2 (+) breast cancer, ABO blood groups and Rh factor were examined. The relationship of blood groups with age, menopausal status, and family history of cancer, estrogen receptor (ER), progesterone receptor (PR) and HER2 status of these patients was evaluated. Blood groups distribution of 22,821 healthy blood donors was also assessed and compared with the patients' blood groups distribution. RESULTS: The median patient age was 47 years (range 20-80) and 56% of the patients were premenopausal. ER and PR were positive in 50 and 60% of the patients, respectively. Overall, the ABO blood group distribution of the 294 HER2 (+) breast cancer patients was similar to that of the healthy blood donors (p=0.36). Likewise there was no correlation between blood type and ER, PR and menopausal status. Rh (-) patients had more frequent family cancer history and this difference was significant for patients with blood group B Rh (-) and O Rh (-) (p = 0.04). CONCLUSION: In the present study we didn't find any relationship between HER2 status and ABO blood group and Rh factor. However, further studies with larger number of patients are needed to establish the role (if any) of blood groups in patients with breast cancer.

Primary extranodal non-Hodgkin's lymphoma presenting as painful gingival swelling.

Primary extra-nodal non-Hodgkin's lymphomas (NHL) constitute 25-40% of NHL but less than 1% arises in oral cavity. Here in 53-year-old man with stage IE gingival diffuse large B cell lymphoma who was treated successfully with chemotherapy and radiotherapy was presented.

Kikuchi--Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma.

AIM: Kikuchi - Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare disorder and often confused with lymphoma. PATIENT: There is presented a case of 28-year-old patient with cervical lymphadenopathy, who had history of lymphoma. RESULTS: On immunohistopathologic examination diagnosis of KFD was made and patient followed without any treatment. CONCLUSION: Patient's lymphadenopathy had almost resolved and he was completely asymptomatic after three months. In patient with cervical lymphadenopathy KFD should be considered in the differential diagnosis.

Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis.

UNLABELLED: Atypical metastasis, such as splenic and renal metastasis is rare in colorectal cancer. There have been case reports of colorectal cancer patients with isolated splenic metastasis, even after years of surgery in the literature. AIM: To report two colorectal cancer cases with atypical metastasis. RESULTS: The first patient was a 58-year old man who had isolated splenic metastasis after 20 months of surgery. The other one was a 51-year old male patient with both lung and renal metastasis at rectal cancer diagnosis. Splenic and renal metastases have been histopathologically documented in both of them. The first patient was given chemotherapy after splenectomy. The other one had also multiple lung metastases besides renal metastasis. He received palliative chemotherapy.