Which factors help to determine the long-term response to first-line tyrosine kinase inhibitors in patients with metastatic renal cell carcinoma: A Turkish multi-centre study.

Many developing countries lack access to recommended first-line treatments for metastatic renal cell carcinoma (mRCC), such as immune checkpoint inhibitors (ICIs) or ICI-tyrosine kinase inhibitor (TKI) combinations. As a result, predictive markers are necessary to identify patients who may benefit from single-agent TKIs for long-term response. This study aims to identify such parameters. This was a multi-centre, retrospective study of patients with mRCC who were undergoing first-line treatment with sunitinib or pazopanib. Patients who had been diagnosed with mRCC and had not experienced disease progression for 36 months or more were deemed to have achieved a long-term response. Predictive clinical and pathological characteristics of patients who did not experience long-term disease progression were investigated. A total of 320 patients from four hospitals were included in the study. The median age of the patients was 60 years (range 20-89 years). According to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk classification, 109 patients were classified as having favourable risk and 211 were in the intermediate-poor risk group. The median progression-free survival (PFS) and overall survival (OS) for all patients were 12.5 months and 76.4 months, respectively. In the long-term responder's group, the median PFS was 78.4 months. Among all patients, prior nephrectomy, the Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) <1, and the absence of brain metastasis were predictive factors for long-term response. For patients in the favourable risk group, the lack of brain metastasis was a predictor of long-term response. In the intermediate-poor risk group, prior nephrectomy and ECOG PS <1 were predictive factors for long-term response. Some individuals with mRCC may experience a durable response to TKIs. The likelihood of a long-term response can be determined by factors such as nephrectomy, ECOG PS < 1, and the absence of brain metastases.

Efficacy of adjuvant capecitabine in residual triple negative breast cancer: a multicenter observational Turkish Oncology Group (TOG) study.

BACKGROUND: Triple negative breast cancer (TNBC) is characterized by high rates of recurrence, especially in patients with residual disease after neoadjuvant chemotherapy (NAC). Capecitabine is being used as standard adjuvant treatment in residual TNBC. We aimed to investigate the real-life data regarding the efficacy of capecitabine in residual TNBC. DESIGN AND METHODS: In this retrospective multicenter study, TNBC patients with residual disease were evaluated. Patients, who received standard anthracycline and taxane-based NAC and adjuvant capecitabine were eligible. Overall survival (OS), disease free survival (DFS) and toxicity were analyzed. RESULTS: 170 TNBC patients with residual disease were included. Of these, 62.9% were premenopausal. At the time of analysis, the recurrence rate was 30% and death rate was 18%. The 3-year DFS and OS were 66% and 74%, respectively. In patients treated with adjuvant capecitabine, residual node positive disease stood out as an independent predictor of DFS (p = 0.024) and OS (p = 0.032). Undergoing mastectomy and the presence of T2 residual tumor was independent predictors of DFS (p = 0.016) and OS (p = 0.006), respectively. CONCLUSION: The efficacy of capecitabine was found lower compared to previous studies. Selected patients may have further benefit from addition of capecitabine. The toxicity associated with capecitabine was found lower than anticipated.

Efficacy of first-line CDK 4-6 inhibitors in premenopausal patients with metastatic breast cancer and the effect of dose reduction due to treatment-related neutropenia on efficacy: a Turkish Oncology Group (TOG) study.

The only phase 3 study on the effectiveness of CDK 4-6 inhibitors in first-line treatment in premenopausal patients with hormone receptor (HR) positive, HER2 negative metastatic breast cancer is the MONALEESA-7 study, and data on the effectiveness of palbociclib is limited. Data are also limited regarding the effectiveness of CDK 4-6 inhibitors in patients whose dose was reduced due to neutropenia, the most common side effect of CDK 4-6 inhibitors. In our study, we aimed to evaluate the effectiveness of palbociclib and ribociclib in first-line treatment in patients with premenopausal metastatic breast cancer and the effect of dose reduction due to neutropenia on progression-free survival. Our study is a multicenter, retrospective study, and factors affecting progression-free survival (PFS) were examined in patients diagnosed with metastatic premenopausal breast cancer from 29 different centers and receiving combination therapy containing palbociclib or ribociclib in the metastatic stage. 319 patients were included in the study. The mPFS for patients treated with palbociclib was 26.83 months, and for those receiving ribociclib, the mPFS was 29.86 months (p = 0.924). mPFS was 32.00 months in patients who received a reduced dose, and mPFS was 25.96 months in patients who could take the initial dose, and there was no statistical difference (p = 0.238). Liver metastasis, using a fulvestrant together with a CDK 4-6 inhibitor, ECOG PS 1 was found to be a negative prognostic factor. No new adverse events were observed. In our study, we found PFS over 27 months in patients diagnosed with premenopausal breast cancer with CDK 4-6 inhibitors used in first-line treatment, similar to post-menopausal patients. We did not detect any difference between the effectiveness of the two CDK 4-6 inhibitors, and we showed that there was no decrease in the effectiveness of the CDK 4-6 inhibitor in patients whose dose was reduced due to neutropenia.

The real-world outcomes of Lutetium-177 PSMA-617 radioligand therapy in metastatic castration-resistant prostate cancer: Turkish Oncology Group multicenter study.

Metastatic castration-resistant prostate cancer (mCRPC) remains a challenging condition to treat despite recent advancements. This retrospective study aimed to assess the activity and tolerability of Lutetium-177 (Lu-177) PSMA-617 radioligand therapy (RLT) in mCRPC patients across multiple cancer centers in Turkey. The study included 165 patients who received at least one cycle of Lu-177 PSMA-617 RLT, with the majority having bone metastases and undergone prior treatments. Prostate-specific antigen (PSA) levels were assessed before each treatment cycle, and the biochemical response was evaluated in accordance with the Prostate Cancer Work Group 3 Criteria. The PSA decline of ≥50% was classified as a response, while an increase of ≥25% in PSA levels was indicative of progressive disease. Neither response nor progression was considered as stable disease. The Lu-177 PSMA-617 RLT led to a significant PSA response, with 50.6% of patients achieving a >50% decrease in PSA levels. Median overall survival (OS) and progression-free survival were 13.5 and 8.2 months, respectively. Patients receiving Lu-177 PSMA-617 RLT in combination with androgen receptor pathway inhibitors (ARPIs) had a higher OS compared to those receiving Lu-177 PSMA-617 RLT alone (18.2 vs 12.3 months, P = .265). The treatment was generally well-tolerated, with manageable side effects such as anemia and thrombocytopenia. This study provides real-world evidence supporting the effectiveness and safety of Lu-177 PSMA-617 RLT in mCRPC patients, particularly when used in combination with ARPIs. These findings contribute to the growing body of evidence on the potential benefits of PSMA-targeted therapies in advanced prostate cancer.

Prognostic role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, and pan-immune-inflammation value in metastatic castration-resistant prostate cancer patients who underwent 177Lu-PSMA-617.

This study is aimed to investigate the prognostic significance of inflammation indices, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and pan-immune-inflammation value (PIV) in metastatic castration-resistant prostate cancer (mCRPC) patients who had received lutetium labeled prostate-specific membrane antigen (177Lu-PSMA-617) therapy. Sixty-one mCRPC patients who received 177Lu-PSMA-617 treatment and followed up in Kocaeli University were included. The relationship between overall survival (OS) and progression-free survival (PFS) and clinical and laboratory parameters was analyzed by multivariate analyses. The mean age was 69.8 ±â€…6.9 years. The mean follow-up time was 53.2 ±â€…24 months. The median OS was 14 (95% CI: 8.8-18.1) and the median PFS was 10.4 (95% CI: 4.7-17.2) months. NLR ≥ 2.7, PLR ≥ 134.27, SII ≥ 570.39, PIV ≥ 408.59 were considered as elevated levels. In the multivariate analysis for OS, baseline ECOG performance score (HR: 1.92, 95% CI: 1.01-3.65, P = .046), high albümin (HR: 0.36, 95% CI: 0.16-0.82, P = .015), primary resistant total prostate-specific-antigen (PSA) (HR: 4.37, 95% CI: 1.84-10.35, P = .001), high NLR (HR: 3.32, 95% CI: 1.66-6.65, P = .001), high MLR (HR: 2.53, 95% CI: 1.35-4.76, P = .004), high PLR (HR: 2.47, 95% CI: 1.23-4.96, P = .01), and high SII (HR: 2.17, 95% CI: 1.09-4.32, P = .027) were associated with shorter OS. However, PIV was not associated with survival (P = .69). No factor other than the primer-resistant PSA could be identified as having an impact on PFS (for the PSA, HR: 4.52, 95% CI: 1.89-10.76, P = .001). In this study, pretreatment NLR, MLR, PLR, and SII demonstrate as powerful independent prognostic indices predicting survival in patients with mCRPC receiving 177Lu-PSMA-617 therapy.

Assessing the scientific quality and reliability of YouTube videos about chemotherapy.

No studies have evaluated the interaction, quality, and reliability of chemotherapy-related videos published on YouTube. The aim was to evaluate the content of YouTube videos about chemotherapy using 5 different scoring tools. In this cross-sectional register-based study, popular videos on YouTube about the following keywords were examined; "chemotherapy," "what is chemotherapy," "types of chemotherapy," "chemotherapy side effects" and "chemotherapy treatments." Quality and reliability of video content were measured using the modified DISCERN (mDISCERN), the Journal of the American Medical Association (JAMA), the Global Quality Score (GQS), the Video Information Quality Index (VIQI), and Health on the Net code (HONcode) scores. A total of 108 videos were analyzed in the study. The median duration was 200 (30-2020) seconds and the median total number of views was 17500 (61-8615000). Among the video publishers, private hospitals were the most (n = 36, 33%). The most (n = 71, 66%) populer category of videos were patient education videos. Half (n = 55, 51%) of the narrators in the videos were only oncology professionals. Mean DISCERN, JAMA, GQS, VIQI, and HONcode scores were 2.73 ± 1.18, 1.97 ± 1.05, 2.94 ± 1.08, 14.03 ± 3.73, and 4.68 ± 2.46, respectively. A positive correlation was found between the 5 scoring points (P < .001 for all pairwise comparisons). There was a significant difference between video quality scores according to video categories and video publishers (P < .001 for both). Although most YouTube videos about chemotherapy were helpful to patients, content quality and reliability were moderate-low. Cancer patients looking for information on chemotherapy may find YouTube videos beneficial, but clinicians must be cautious to clear up any misunderstandings.

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.

NUTRISCORE Compared to NRS-2002 for Detection of Malnutrition in Hospitalized Cancer Patients; A Cross Sectional Study.

The most commonly recommended screening test for determining the nutritional status of hospitalized cancer patients is Nutrition Risk Screening-2002 (NRS-2002). NUTRISCORE, on the other hand, is an outpatient cancer patient-specific nutritional screening test that is easier to administer than NRS-2002 and queries tumor location and treatment information received from the patient. We aimed to investigate the validity of NUTRISCORE, in hospitalized cancer patients. In total, 112 patients were enrolled in this study. The NRS 2002 and NUTRISCORE screening tests were performed. The data obtained with NUTRISCORE were compared to the reference test NRS-2002 using the κ test and ROC curve analysis. The NRS-2002 identified 45.5% of patients as being at risk of malnutrition, while the NUTRISCORE test identified 48.2% (k = 0.516, p < 0.005). The AUC value was 0.759 (95% CI:0.67-0.85) as shown in the ROC analysis. Using the NRS-2002 as a reference test, the sensitivity (S), specificity (SP), Positive Predictive (PPD), and Negative Predictive (NPD) values for the NUTRISCORE test were 76.5% (95% CI:63.7-86.6), 75.4% (95.CI:63.7-85), 72.2% (95% CI:59.4-83), 79%, (95% CI:67.7-88.3) respectively. NUTRISCORE can be used for screening of malnutrition in hospitalized cancer patients.

Treatment efficacy of ribociclib or palbociclib plus letrozole in hormone receptor-positive/HER2-negative metastatic breast cancer.

Background: Ribociclib, palbociclib and abemaciclib are currently approved CDK4/6 inhibitors along with aromatase inhibitors as the first-line standard-of-care for patients with hormone receptor-positive, HER2-negative metastatic breast cancer. Methods: The authors report retrospective real-life data for 600 patients with estrogen receptor- and/or progesterone receptor-positive and HER2-negative metastatic breast cancer who were treated with ribociclib and palbociclib in combination with letrozole. Results & conclusion: The results demonstrated that the combination of palbociclib or ribociclib with letrozole has similar progression-free survival and overall survival benefit in real life for the patient group with similar clinical features. Specifically, endocrine sensitivity may be a factor to be considered in the treatment preference.

Impact of COVID-19 lockdown on mood status: A comparison of hemodialysis and oncology patients.

INTRODUCTION: Coronavirus related lockdown measures had a severe psychological toll. We investigated the effects of population-wide infection control measures on hemodialysis (HD) and oncology patients' mood statuses. METHODS: An electronic survey was used to collect data. We used the Profile of Mood States (POMS) and the Hospital Anxiety and Depression Scale (HADS) to measure the mood statuses. RESULTS: The study groups composed of 400 HD, 234 oncology patients, and 276 controls. HADS anxiety and total POMS scores were significantly higher in the control group than that of both HD and oncology patients, a finding consistent with a worse mood status. In multivariate models, the male gender and the perception of having received appropriate medical support during the pandemic period were independent predictors of better POMS and HADS-anxiety and depression scores. CONCLUSION: HD and oncology patients appear to be less affected by the psychological stress induced by social distancing and lockdown periods.

Perceptions and acceptance of telemedicine among medical oncologists before and during the COVID-19 pandemic in Turkey.

BACKGROUND: As a result of technological developments in healthcare services, telemedicine is becoming widespread. We aimed to determine the effect of COVID-19 on Turkish medical oncologists' opinions of telemedicine through a survey. METHODS: This study was conducted using an online questionnaire linked to an invitation e-mail sent to the members of the Turkish Medical Oncology Association mailing group between May and July 2020. RESULTS: Of the 110 (73 males and 37 females) medical oncologists who answered the questionnaire, the average age was 43.9 ± 7.29 (range: 31-64) years, and the majority of the respondents were academics. The most commonly used telemedicine method was store and forward (69.7%). Telemedicine use during clinical visits and multidisciplinary councils increased significantly during the COVID-19 pandemic (p < 0.001 in both cases). CONCLUSION: The use of telemedicine increased during the COVID-19 pandemic, and the pandemic has led oncologists to view telemedicine more positively.

Anterior Segment Parameters in Patients With Wilson Disease.

PURPOSE: To investigate anterior segment parameters in patients with Wilson disease (WD). METHODS: In this cross-sectional study, 22 patients with WD (study group) and 22 healthy subjects (control group) were enrolled. Each participant underwent a comprehensive ophthalmic assessment including best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, and intraocular pressure. Anterior segment parameters were measured by the Sirius anterior segment analyzer system (Costruzione Strumenti Oftalmici, Florence, Italy). RESULTS: Mean central corneal thickness was 522 ± 47 µm in the study group and 568 ± 37 µm in the control group (P < 0.001). Mean flat keratometry was 42.4 ± 1.7 diopter (D) in the study group and 41.5 ± 1.16 D in the control group (P = 0.011); mean steep keratometry was 43.4 ± 2.0 and 42.4 ± 1.4 D in the study and control groups, respectively (P = 0.025). The anterior corneal elevation value was 5.5 ± 3.2 µm in the study group and 4.08 ± 2.2 µm in the control group (P = 0.029); the mean posterior corneal elevation value was 15.1 ± 6.0 and 10.1 ± 4.1 µm in the study and control groups, respectively (P = 0.002). The mean anterior chamber depth was 2.97 ± 0.3 µm in the study group and 3.16 ± 0.3 µm in the control group (P = 0.01); the mean horizontal visible iris diameter was 11.9 ± 0.4 and 12.2 ± 0.4 µm in the study and control groups, respectively (P = 0.001). CONCLUSIONS: This study indicates that patients with WD have differences in the anterior segment parameters including central corneal thickness, keratometric values, anterior and posterior elevations, horizontal visible iris diameter, and anterior chamber depth when compared with healthy controls.