Comparison of the Efficacy and Safety of 3 Months of CAPOX Followed by 3 Months of Capecitabine and 6 Months of CAPOX/FOLFOX in the Adjuvant Treatment of Low-Risk Stage III Colon Cancer Treated Surgically.

INTRODUCTION: In the adjuvant treatment of low-risk stage III colon cancer treated surgically, 3 months of CAPOX followed by 3 months of capecitabine is not a common clinical practice. Since there are no data on this practice in the literature, we have no idea how often it is used. However, it should be noted that this application is used in some centers due to the cumulative neurotoxicity of oxaliplatin but there are insufficient data in the literature on its efficacy. METHODS: The data of patients with colon cancer treated surgically who were followed up in 12 different oncology centers in Turkey between November 2004 and June 2022 were analyzed retrospectively. RESULTS: The study included 194 patients. The treatment arms were as follows: 3 months of CAPOX followed by 3 months of capecitabine = arm A and CAPOX/FOLFOX (6 months) = arm B. There were 78 patients (40.2%) in arm A and 116 patients (59.8%) in arm B. The median age and sex distribution were similar between the treatment arms. The median follow-up period of all patients was 34.4 months (95% confidence interval, 29.1-39.7). When arm A was compared with arm B, 3-year disease-free survival (DFS) was 75.3% versus 88.4% and 5-year DFS was 75.3% versus 82.8%, respectively. There were similar DFS outcomes between the treatment arms (p = 0.09). Rates of any grade of neuropathy were numerically lower in arm A, but the difference between the treatment arms was not statistically significant (51.3% vs. 56.9%; p = 0.44). The frequency of neutropenia was similar between the treatment arms. CONCLUSION: In this study, the efficacy and safety of the 3 months of CAPOX followed by 3 months of capecitabine chemotherapy regimen in the adjuvant treatment of low-risk stage III colon cancer treated surgically were proven. This result may also support the discontinuation of oxaliplatin at 3 months while continuing fluoropyrimidines, which is a common clinical practice but lacks sufficient data.

The effect of concomitant proton pump inhibitor use on survival outcomes of Nivolumab-treated renal cell carcinoma patients: a multicenter study.

AIM: We aimed to evaluate the effect of concomitant proton pump inhibitors (PPI) use with nivolumab on survival outcomes in metastatic renal cell carcinoma (mRCC) in second-line setting. METHODS: The study was designed as a multicenter and retrospective involving patients with metastatic renal cell carcinoma receiving second-line nivolumab therapy. One hundred and nine patients with mRCC were divided into two groups based on whether they use PPI concomitantly with nivolumab: concomitant PPI users and non-users. Overall survival (OS) and progression-free survival (PFS) were compared between the groups with and without concurrent PPIs. RESULTS: Of 109 patients in our study, 59 were not using PPI concomitantly with nivolumab and 50 were using PPI concomitantly. The median PFS was 6.37 (5.2-7.5) months in the concomitant PPI group and 9.7 (4.5-15) months in the non-users (p = 0.03). The median OS was 14.6 (7.1-22.1) months in patients on PPI concurrently with nivolumab and 29.9 (17.1-42.7) months in the non-users (p = 0.01). Accordingly, PPI use for PFS (Non-use vs. Use = HR: 0.44, 95%Cl 0.28-0.96, p = 0.014) and PPI use for OS (Non-use vs. Use = HR: 0.68, 95%Cl 0.22-0.88, p = 0.01) were found to be as independent risk factors. CONCLUSIONS: Concomitant use of PPIs is associated with worse survival outcomes in patients with mRCC treated with nivolumab. Clinicians should carefully consider the concomitant use of PPIs in such patients.

Prognostic impact of platelet/lymphocyte and neutrophil/lymphocyte ratios in patients with gastric cancer: a multicenter study.

BACKGROUND: Increasing amounts of evidence suggest patient-related systemic inflammatory response (SIR) as a powerful prognostic factor in cancer and applicability of SIR as a prognostic factor has been investigated. AIM: To evaluate the prognostic significance of SIR, which is among routinely analysed blood parameters in patients with all stages of gastric cancer (GC). METHODS: A total of 245 patients with gastric cancer who were followed up and treated in four clinics of medical oncology were included in the study. At first admission of the patients, from routinely determined whole blood cell counts in medical oncology clinics, their neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) values were estimated and recorded before initiating chemo- or radiotherapy. A univariate non-parametric analytical method and chi-square test examined the correlation between prognostic factors, and survival rates. Survival curves were estimated using the Kaplan-Meier method. RESULTS: Sixty-eight (27.8%) female and 177 (72.2) male patients (total n=245) were included in the study. When NLR was used as an indicator of SIR, 108 (44.1%) patients were SIR negative and 137 (55.9%) patients were SIR positive. When PLR was used as an indicator of SIR, SIR negativity and positivity were detected in 93(38%) and 152 (62%) patients, respectively. A statistically significant correlation was found between status of lymph node metastasis, stage of the disease and NLR (P=0.001, P=0.017). SIR determined with PLR was found to be correlated with the depth of tumor invasion and stage of the disease (P=0.016, P=0.033). A significant correlation was not detected between PLR and survival (P=0.405). CONCLUSION: According to our study, parameters of NLR and PLR calculated preoperatively from peripheral blood samples can be used in patients with various sizes of tumours in different disease stages. Still based on our results, NLR calculated during diagnostic workup is a parameter with a prognostic value. In addition, NLR is a determinative factor in the selection of surgical method and chemotherapeutic modalities, which also functions as a potential contributory marker in effective immunotherapeutic strategies.