A novel prognostic biomarker in progression free survival for patients with cervical cancer, glucose to c-reactive protein ratio (GCR).

BACKGROUND: Cervical cancer is a tumor with high morbidity and mortality. The importance of inflammatory and metabolic parameters affecting progression-free survival (PFS) and overall survival (OS) has been investigated more intensively recently. We aimed to investigate the effect of glucose/c-reactive protein (CRP) ratio [GCR], which shows these two parameters together, on PFS in cervical cancer. METHODS: We retrospectively included 90 patients with adenocarcinoma and squamous cell carcinoma of the cervix. The effects of clinical variables, inflammatory and glycemic parameters on PFS and OS were analyzed by Kaplan-Meier method. The data were compared with the healthy control group of 90 individuals using the independent t test. The effect of parameters on mortality was analyzed using ROC curves and cut off values were determined. RESULTS: Glucose, CRP, CRP/lymphocyte ratio (CLR) and GCR were statistically significant in predicting mortality (p < 0.05). Disease stage, glucose, CRP, CLR and GCR were associated with overall survival. CRP, CLR and GCR were associated with progression-free survival (p < 0.05). In multivariate analysis, GCR was prognostic for PFS (p = 0.025). GCR was statistically significant while compared with the patient and healthy control group (p < 0.001). CONCLUSION: In cervical cancer, GCR rate was found to be prognostic independent of stage. Higher GCR rate was associated with longer PFS duration.

The value of pretreatment glucose-to-lymphocyte ratio for predicting survival of metastatic gastric cancer.

Aim: To demonstrate the prognostic importance of glucose-to-lymphocyte ratio (GLR) in metastatic gastric cancer (mGC). Methods: Retrospectively, 159 mGC patients were enrolled. Kaplan-Meier curve and Cox regression analysis were used to determine the prognostic value of the systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI) and GLR. Results: Progression-free survival (PFS) and overall survival (OS) were associated with NLR, PNI, SII and GLR by univariate analysis. Moreover, OS was associated with Eastern Cooperative Oncology Group performance status and the chemotherapy regimen. In multivariate analysis, only GLR was found to be independently prognostic for both PFS and OS. Conclusion: In mGC, GLR may be a new prognostic marker for both OS and PFS.

Gastric cancer (GC) is the fourth cause of cancer-related deaths. Although different treatment algorithms, including immunotherapy, are applied in patients with unresectable or disseminated (metastatic) GC (mGC), survival results are not yet at the desired level. Different markers are being investigated to measure the response of cancer to treatment in these patients. Many studies have been conducted in this direction with the thought that the prognosis of these cancers will be affected by the patient's own immune response and nutritional status. Despite this, standard markers have not been established to predict cancer-related survival. Studies have shown a relationship between GC and glucose metabolism processes. Recently, a fasting blood glucose-to-lymphocyte count ratio (GLR) marker was developed that simultaneously evaluates both glucose metabolism and the patient's immune response. GLR was found to be effective in predicting survival time in cancers such as gallbladder cancer and hepatocellular carcinoma. However, the effect of GLR on survival in mGC is unclear. In this study, the authors investigated the prognostic significance of GLR in mGC. They found that low GLR was associated with longer survival in mGC. GLR may be a prognostic marker for survival in patients with mGC.

Lipegfilgrastim may cause hyperleukocytosis.

INTRODUCTION: Granulocyte colony-stimulating factors (G-CSF) are utilized both in the treatment and prophylaxis of chemotherapy-induced neutropenia. Lipegfilgrastim is a long-acting G-CSF. Albeit it provides ease of administration compared to short-acting GCSFs, some lipegfilgrastim-related adverse events may occur. Bone pain, widespread body pain, and feeling of fever are among common adverse effects, while rare but more serious adverse effects such as leukocytosis, spleen rupture, interstitial pneumonia, acute respiratory distress syndrome, capillary leak syndrome, hypokalemia, and glomerulonephritis may occur as well. CASE REPORT: We reported a case of hyperleukocytosis that developed due to prophylactic administration of lipegfilgrastim following the first course of neoadjuvant pertuzumab (840-420 mg), trastuzumab (8-6mg/kg), and docetaxel (75 mg/m2) in a 45-year-old female patient with a diagnosis of breast invasive ductal carcinoma. The patient, who presented with weakness, loss of appetite, and oral intake disorder, had elevated white blood cell (WBC), lactate dehydrogenase (LDH), and uric acid levels in her test results. Peripheral smear (PS) had a left shift. MANAGEMENT AND OUTCOME: Intravenous 0.9% NaCl and peroral allopurinol were started to be administered to the patient. On the ninth day of hospitalization, the patient's clinical manifestation improved, and her WBC, LDH, uric acid, and PS returned to normal. Besides, the progression to tumor lysis syndrome (TLS) was prevented by appropriate hydration and allopurinol treatment. In subsequent chemotherapies (CTs), lipegfilgrastim was discontinued and filgrastim was started. The patient whose hyperleukocytosis did not recur was operated on following neoadjuvant CT. The patient's routine follow-up continues without any problems. DISCUSSION: Although lipegfilgrastim-induced hyperleukocytosis has not been reported in the literature, it should be borne in mind that hyperleukocytosis and related complications may occur, as in our case.

Efficacy and Safety of Trastuzumab Emtansine in Her2 Positive Metastatic Breast Cancer: Real-World Experience.

AIM: The aim of this study is to evaluate the efficacy and toxicity of trastuzumab emtansine (T-DM1) in cases with metastatic breast cancer (mBC) in different lines of treatment. METHOD: Retrospective analysis of T-DM1 results of human epidermal growth factor receptor 2 (Her2) positive 414 cases with mBC from 31 centers in Turkey. FINDINGS: Except 2, all of the cases were female with a median age of 47. T-DM1 had been used as second-line therapy in 37.7% of the cases and the median number of T-DM1 cycles was 9. Progression-free survival (PFS) and overall survival (OS) times were different according to the line of treatment. The median OS was found as 43, 41, 46, 23 and 17 months for 1st, 2nd, 3rd, 4th and 5th line, respectively (p = 0.032) while the median PFS was found as 37, 12, 8, 8 and 8 months, respectively (p = 0.0001). Treatment was well tolerated by the patients. The most common grade 3-4 adverse effects were thrombocytopenia (2.7%) and increased serum gamma-glutamyl transferase (2%). DISCUSSION: The best of our knowledge this is the largest real-life experience about the safety and efficacy of T-DM1 use in cases with mBC after progression of Her2 targeted treatment. This study suggests and supports that T-DM1 is more effective in earlier lines of treatment and is a reliable option for mBC.

Colorectal cancer in Lynch syndrome associated with PMS2 and MSH6 mutations.

BACKGROUND: It is known that colorectal cancers (CRC) are frequently seen and constitute an important part of cancer-related deaths. Lynch syndrome (LS) is responsible for 3-5% of CRCs and develops due to mutations in DNA mismatch repair (MMR) genes. The most important MMR genes are MutL homolog1 (MLH1), mutS homolog 2 (MSH2), mutS homolog 6 (MSH6) and postmeiotic segregation increased 2 (PMS2). PMS2 and MSH6 mutations are very rarely seen in LS. CASE PRESENTATION: We present a case that developed metastatic CRC, which we diagnosed as LS in association with a very rarely seen PMS2 and MSH6 germline mutation. Genetic counseling was recommended for the family, and screening programs were initiated for the family of the patient whose chemotherapy was continued after the diagnosis. CONCLUSION: With the increase in daily use of next-generation sequencing (NGS) technology, it is thought that detection rate of both combined mutations and rare mutations will be increased.

The Significance of Controlling Nutritional Status (CONUT) Score as a Novel Prognostic Parameter in Small Cell Lung Cancer.

PURPOSE: The immuno-nutritional status is closely related to the prognosis in many cancers. Controlling nutritional status (CONUT) score is a new parameter that reflects the immuno-nutritional status and is prognostic in some cancers. However, the prognostic significance of the CONUT score in small cell lung cancer (SCLC) is unknown. We aimed to demonstrate the prognostic significance of the CONUT score in patients with SCLC. METHODS: Two hundred sixteen patients who were followed up with SCLC were included in the study retrospectively. According to the receiver operating characteristic (ROC) curve analysis, the optimal cutoff values were determined for the CONUT score, and the patients were divided into low (< 2) and high (≥ 2) CONUT groups. Neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and prognostic nutritional index (PNI) were grouped based on a cutoff point 2.84, 626, and 46.1, respectively. Cox regression analyses were used to assess their prognostic values for progression-free survival (PFS) and overall survival (OS). RESULTS: The high CONUT group had significantly worse PFS and OS than the low CONUT group (p < 0.001, p < 0.001). In univariate analysis, stage, prophylactic cranial irradiation, extrapulmonary lesion, PNI, body mass index, CONUT score were found to be significant for both PFS and OS. In multivariate analysis, only CONUT score and stage were found as independent prognostic factors for both PFS (p: 0.018, p: 0.046) and OS (p: 0.038, p: 0.006). CONCLUSION: The CONUT score at the time of diagnosis is an independent prognostic parameter that predicts recurrence and survival times in SCLC.

Possible atezolizumab-associated acute kidney injury and immune thrombocytopenia.

INTRODUCTION: The immune checkpoint inhibitors (ICIs), which are used to activate the immune system and stimulate anti-tumor activity, are preferred in many cancers. Atezolizumab acts by blocking programmed cell death ligand (PD-L1) and may cause immune hyperstimulation in healthy tissues like other ICIs, resulting in immune-related adverse events (irAEs). Hepatitis, colitis, pneumonitis, hypophysitis, hypothyroidism, rash, musculoskeletal problems are the most common irAEs, and on the other hand, acute kidney injury (AKI) and immune thrombocytopenic purpura (ITP) are infrequent. CASE REPORT: We present a case with non-small cell lung cancer (NSCLC) treated with atezolizumab 1200 mg every three weeks for third-line treatment. The patient was admitted with fatigue and back pain. The patient's complaints started one week after the first dose of atezolizumab. The patient had renal injury and thrombocytopenia and was diagnosed with drug-induced AKI and ITP. MANAGEMENT AND OUTCOME: After platelet replacement, intravenous immunoglobulin (IVIG), and steroid therapy, the patient whose platelet count was normalized and creatinine level regressed was discharged, and routine follow-up continues. DISCUSSION: Here, we present a case with NSCLC treated with atezolizumab and with drug-induced ITP and AKI association. Given that atezolizumab and other immune checkpoint inhibitors are being utilized in the treatment of cancers, physicians should be aware of the irAEs, including the AKI and ITP.

The Effect of C-Reactive Protein/Lymphocyte Ratio (CLR) on PFS in Metastatic Breast Cancer Patients Treated with CDK4/6 Inhibitors: A Novel Biomarker.

Objective: Hormone positive breast cancer is a tumor with high mortality. Combining antihormonal therapy with cyclin dependent kinase 4/6 inhibitors (CDK4/6i) has resulted in longer survival. The effect of inflammatory parameters such as c-reactive protein and c-reactive protein/lymphocyte ratio (CLR) on efficacy and survival in CDK4/6i treatment is unknown. In our study, we aimed to investigate the role of CLR and some parameters in predicting progression-free survival (PFS) with CDK4/6i. Methods: This retrospective cohort study included 78 patients with denovo and recurrent metastatic breast cancer treated with CDK4/6i. Cut off values for the prediction of mortality by various numerical parameter scores were performed by ROC Curve analysis. The effect of clinical variables, inflammatory and histopathological parameters on survival was analyzed by Kaplan-Meier method. Results: Neutrophil/lymphocyte ratio (NLR) and CLR were statistically significant in predicting mortality (p < 0.05). Ki67 and CLR were correlated with PFS. Age and CLR were correlated with OS (p < 0.05). CLR was statistically significant for both PFS (p = 0.022) and OS (p = 0.006). Conclusion: In patients with metastatic hormone-positive breast cancer using CDK4/6i, low CLR and low Ki67 were correlated with longer PFS duration.

Inflammatory parameters in NSCLC with driver mutation.

Aim: The tumor microenvironment of NSCLC with driver mutations, such as EGFR, ALK and ROS, is less inflammatory. Materials & methods: This retrospective study included 38 patients with NSCLC driver mutations. The relationship between clinical and inflammatory markers concerning progression-free survival and overall survival was analyzed based on Kaplan-Meier curves. Results: The mean age of the patients was 59.8 ± 11.9. Progression-free survival and overall survival were significantly longer in patients under 65 years of age and with low neutrophil-lymphocyte ratio, low systemic immune-inflammation index and high lymphocyte count (p < 0.05). Conclusion: Unlike tumor biology, peripheral inflammatory parameters, such as neutrophil-lymphocyte ratio, systemic immune-inflammation index and lymphocyte count may be associated with survival in NSCLC patients with driver mutations.

Lung cancer is the most common cancer worldwide and has a high mortality rate. Overall survival expectancy in metastatic NSCLC has increased from 11 months to 18 months. The detection of targeting mutations and the introduction of targeted treatments are the factors that increase overall survival. The contribution of immunotherapy to NSCLC is indisputable. The contribution of immunotherapy is low in NSCLC with driver mutation. We found that survival was associated with peripheral parameter indicators of inflammation despite the less inflamed tumor microenvironment. For immunotherapy to be effective in NSCLC, where there are not many treatment options, investigating different immune checkpoints or escape mechanisms and treatment planning for these will further improve survival.

Peripheral inflammatory parameters may be associated with survival in driver mutation NSCLC, in contrast to a less inflammatory tumor microenvironment.

Adjuvant chemoradiation for gastric cancer: multicentric study of the Anatolian Society of Medical Oncology.

BACKGROUND/AIMS: The aims of this study were to report the clinical outcomes of adjuvant chemo-radiotherapy after curative resection in 637 patients with gastric cancer. METHODOLOGY: The retrospective analysis included 637 patients with resectable gastric cancer and stage IB-IV (M0) from 8 medical centers between 2003 and 2010. The patients were treated with 5FU-leucovorin and radiotherapy according to Schema for INT-0116. RESULTS: Of the 637 patients, the median of overall survival (OS) was 43.7 months and relapse free survival (RFS) was 36.6 months. OS rates were 84%, 45%, 40% while RFS rates were 81%, 45% and 35% at 1, 3 and 5-years, respectively. Hematological and gastrointestinal toxicities (grade 1-4) were observed in 35% and 36.5% of patients, respectively. In univariate analysis, according to the Lauren classification, tumor grade, T stage, N stage, type of operation (total gastrectomy or subtotal) and surgery resection margin (R0 or R1) were found as prognostic factors on RFS and OS (p<0.05). In multivariate analysis, T stage, N stage and surgical margins were found as effective factors on OS. T stage, N stage and Lauren classification were factors affecting RFS. CONCLUSIONS: Adjuvant chemo-radiotherapy after curative resection of gastric cancer was feasible, with acceptable toxicities in the Turkish population.

Characteristics of Newly Diagnosed Hepatocellular Carcinoma Patients Across Turkey: Prospective Multicenter Observational 3K Registry Study.

AIMS: To evaluate patient profile for epidemiological and clinicopathological characteristics and potential risk/prognostic factors in newly diagnosed hepatocellular carcinoma (HCC) patients across Turkey. METHODS: A total of 547 patients (mean (SD) age 62.6 (10.3) years, 81.9% were males) were included in this registry study. Data on patient characteristics, etiologies of HCC, laboratory values, and tumor characteristics and stages were recorded at study enrollment. RESULTS: HBV infection (68.2%) was the leading etiology, followed by HCV infection (17.2%), HDV infection (5.5%), alcohol (6.4%), and NAFLD (3.5%), as the major etiologies. Considering that 51.6% of the patients had >5 cm HCC, 44% were Child-Pugh B/C and 57% were BCLC B-D, it appears that a significant group of HCC patients were diagnosed at advanced stages. Of 540 patients, 271 (50.2%) were referred or applied with the diagnosis of HCC. Patients with HCC at presentation had larger tumor size (median (min-max) 6.6 (0-30) vs. 4.8 (0-90) cm, P < .001) and more advanced BCLC stage (Stage C-D in 40.8% vs. 26.4%, respectively, P = .005), compared to patients who were diagnosed during follow-up. CONCLUSIONS: Our findings revealed that HBV infection was the leading etiology and a moderate-to-advanced disease was evident in more than half of patients at the time of diagnosis. HCC patients diagnosed at follow-up had smaller tumor size and earlier BCLC stage.

The prognostic significance of hemoglobin-to-red cell distribution width ratio in muscle-invasive bladder cancer.

Aim: To investigate the prognostic significance of pretreatment hemoglobin (HB)-to-red cell distribution width (RDW) ratio (HRR) in patients with muscle-invasive bladder cancer (MIBC). Materials & methods: The neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), prognostic nutritional index, HRR, HB and RDW were analyzed to assess their prognostic value using the Kaplan-Meier curves and Cox-regression analysis in 152 patients with MIBC. Results: Univariate analysis showed that the progression-free survival (PFS) was associated with NLR, SII, HRR, RDW, whereas overall survival (OS) was associated with NLR, SII, prognostic nutritional index, HRR, HB, RDW. In multivariate analysis, HRR was found to be an independent prognostic factor for both PFS and OS. Conclusion: HRR is a new prognostic factor that can be used to predict PFS/OS in MIBC.

The ratio of hemoglobin to red cell distribution width predicts survival in patients with gastric cancer treated by neoadjuvant FLOT: a retrospective study.

BACKGROUND: Hemoglobin (HB) and red cell distribution width (RDW) are known to be prognostic in many cancer types. The HB-RDW ratio (HRR) is a new biomarker that has been shown to be predictive in some cancer types. However, the prognostic significance of HRR in patients with gastric cancer (GC) is unknown. AIMS: In this study, we aimed to demonstrate the prognostic importance of HRR in GC patients treated with neoadjuvant fluorouracil, leucovorin, oxaliplatin, docetaxel (FLOT). METHODS: Eighty-five GC patients who were treated with neoadjuvant FLOT in our center were included in the study, retrospectively. Associations between clinical and histopathological parameters with disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier curves and compared by the log-rank test. The optimal cutoff values were determined by a receiver operating characteristic (ROC) curve analysis. Neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and HRR were grouped based on a cutoff points 3.05, 802, and 0.89, respectively. Univariate and multivariate analyses were used to assess their prognostic values for DFS and OS. RESULTS: Low NLR, low SII, and high HRR were found to be associated with longer DFS/OS. In univariate analysis, Eastern Cooperative Oncology Group performance status, grade, stage, response to neoadjuvant treatment, NLR, SII, and HRR were found to be significantly associated with DFS and OS. But in multivariate analysis, only HRR was demonstrated as an independent prognostic factor for DFS/OS (p 0.001, p 0.037, respectively). CONCLUSIONS: HRR is a new biomarker that can predict DFS and OS in GC patients treated with neoadjuvant FLOT.

Serum adiponectin levels in patients with esophageal cancer.

OBJECTIVE: The aim of the study was to investigate a possible relationship between serum levels of adiponectin and clinicopathological characteristics in esophageal cancer. This is the first report evaluating serum adiponectin levels in patients with esophageal cancer. METHODS: Sixty-two patients with esophageal cancer and thirty healthy subjects were included in the study. Adiponectin levels were determined by an enzyme-linked immunosorbent assay kit. RESULTS: The mean serum adiponectin level in the cancer group was significantly low compared with the adiponectin level in the healthy control group. Furthermore, adiponectin levels of the patients gradually decreased with increase in tumor stage. The patients with adenocarcinoma of the esophagus had significantly lower values of serum adiponectin than patients with squamous cell carcinoma. CONCLUSION: We concluded that decreased circulating adiponectin levels may play a role in the progression and/or development of esophageal cancers. However, for clinical use of serum adiponectin in terms of early diagnosis and treatment, further studies should be performed.

Protective effect of mirtazapine on indomethacin-induced ulcer in rats and its relationship with oxidant and antioxidant parameters.

Even though there are many drugs for the treatment of gastric ulcers, these drugs sometimes cannot succeed. Since the 1950s, antidepressant drugs have been used for several non-psychiatric indications. A lot of antidepressant drugs have been shown experimentally to produce antiulcer activity in various ulcer models. This study aimed to investigate the antiulcer effects of mirtazapine and to determine its relationship with antioxidant mechanisms. The antiulcer activities of 15, 30, and 60 mg/kg mirtazapine have been investigated on indomethacin-induced ulcers in rats, and the results have been compared with that of the control group. Mirtazapine decreased the indomethacin-induced ulcers significantly at all doses used. Mirtazapine significantly increased the glutathione (GSH) level, which decreased in the control group given only indomethacin. All doses of mirtazapine significantly decreased the catalase (CAT) level in stomach tissue compared to the control. Additionally, all doses of mirtazapine reversed the decrease in the superoxide dismutase (SOD) level in the stomach tissue of control rats. And finally, all doses of mirtazapine decreased malondialdehyde (MDA) and myeloperoxidase (MPO) levels significantly compared to the control. In conclusion, the activation of enzymatic and non-enzymatic antioxidant mechanisms and the inhibition of some toxic oxidant mechanisms play a role in the antiulcer effect mechanism of mirtazapine. This new indication of mirtazapine will make it the first-choice drug in depressive patients with gastric ulcers.

Immunological Agents Used in Cancer Treatment.

Immune checkpoint inhibitors (ICI) are monoclonal antibodies targeting cytotoxic T lymphocyte antigen-4 (CTLA-4), programmed cell death protein-1 (PD-1), or PD-1 ligand (PD-L1). ICI are approved for the treatment of malign melanoma, non-small cell lung cancer, classical Hodgkin lymphoma, head and neck squamous cell carcinoma, urothelial carcinoma, and renal cell carcinoma. They can lead to long-term anti-tumor responses by deactivating the brake mechanism in the immune system. Ipilimumab, tremelimumab, pembrolizumab, nivolumab, atezolizumab, durvalumab, and avelumab are examples of ICI. CTLA-4 is a brake mechanism in immune response. Ipilimumab and tremelimumab are antibodies against CTLA-4. PD-1 is another important immune checkpoint co-inhibitor receptor that is expressed by activated T cells in the peripheral tissue. As a result of blockage of the PD-1/PD-L1 pathway, local tumor-specific immune response augments, and long-term tumor control can be achieved. In recent years, ICI are approved for the treatment of various malignities. They may be responsible for specific toxicities called immune-related adverse events (irAEs). irAEs are a consequence infiltration of normal tissues by activated T lymphocytes that are responsible for autoimmunity. Corticosteroids and anti-tumor necrosis factor agents, such as infliximab and mycophenolate mofetil, are effective in the treatment of irAEs. Immune checkpoint inhibition with monoclonal antibodies against CTLA-4 and/or PD-1/PD-L1 by single agent or combination treatments became a new option in various solid tumors. However, ICI have unique adverse events, and these adverse events should be considered in any new onset clinical situation and should be managed properly. Future prospective randomized clinical trials will clarify recent questions.

A novel predictor in patients with gastrointestinal stromal tumors: Systemic immune-inflammation index (SII).

PURPOSE: Systemic inflammation and immune response are associated with tumors'prognosis. However, there is little information about inflammatory indexes in patients with gastrointestinal stromal tumor (GIST). In this study, we aimed to determine the prognostic significance of inflammation indexes such as neutrophil to lymphocyte ratio (NLR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI) and Glasgow prognostic score (GPS) in GIST patients. METHODS: Forty-five patients diagnosed with GIST between 2003 and 2018 were included in the study. The effects of NLR, SII, PNI and GPS on progression-free survival (PFS) and overall survival (OS) estimated based on clinicopathological and laboratory data were evaluated by Kaplan-Meier and Cox regression analysis. RESULTS: The optimal cut-off values for NLR, SII and PNI were 2.54, 940, and 37.5, respectively. Low SII and higher PNI values were associated with longer PFS (p=0.041, p=0.018, respectively). In terms of OS, patients with high NLR, high SII and low PNI had a shorter lifespan. In multivariate analysis, only SII was found to be independent prognostic factor. CONCLUSION: In cases with GIST, SII may predict recurrence and survival.

Relationship between 18-FDG-PET/CT and Clinicopathological Features and Pathological Responses in Patients with Locally Advanced Breast Cancers.

OBJECTIVE: We investigated the relationship between the maximum standardized uptake value (SUVmax) of whole-body positron emission tomography/computed tomography (PET/CT) performed before treatment and the demographical and histopathological features in locally advanced breast cancer (LABC), as well as the role of PET/CT in the evaluation of pathological complete response (pCR) after neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS: Fifty-one LABC patients who received NAC in our center between 2011 and 2015 were retrospectively analyzed. Basal PET/CT was performed in all the patients before NAC. The SUVmax levels and demographical and histopathological results were compared. The relationship between the SUVmax values after NAC and pathological responses were evaluated. RESULTS: The mean age of the patients was 49 (32-69) years. PET/CT performed after NAC showed complete response in 20 patients (39.2%), partial response in 28 patients (54.9%), stable disease in 2 patients (3.9%), and progressive disease in 1 patient (2%). There was no significant difference between the mean SUVmax values of the patients according to age (>50 and ≤50 years), menopausal status, tumor localization, clinical stage, and grade. The mean SUVmax value was higher in the triple-negative group than those in the HER2 positive and luminal groups. There was a significant difference in the SUVmax values between the group that achieved pCR after NAC and the group that could not achieve pCR (SUVmax value for breast 2.92 vs. 0.30; p=0.01; SUVmax value for axilla 1.5 vs. 0.0, p=0.02). CONCLUSION: The SUVmax values are independent of demographical features. There was a significant relationship between the pCR and SUVmax values after NAC. PET/CT could be useful in the evaluation of patients to predict the biological characteristics of tumors.

Evaluation of 22 Primary Gastrointestinal Lymphoma Patients.

OBJECTIVE: Primary gastrointestinal non-hodgkin lymphomas (PGI-NHL) are uncommon diseases with treatment modalities including chemotherapy, surgery, and radiotherapy. Our aim is to analyze the demographic and clinical features and treatment results of PGI-NHL. MATERIALS AND METHODS: 286 patients diagnosed with lymphoma who referred to Ataturk University Medical Faculty Hospital between July 2001 and April 2014 were surveyed retrospectively and 22 (7.6%) PGI-NHL cases whose primary lesions were in gastrointestinal system were included. RESULTS: Mean age was 47 (min.25-max.77) and 14 (63.6%) of them were men. The origin was determined as small intestines (50%), stomach (31.8%) and colon (18.2%), respectively. The most common complaint and pathologic subtype were abdominal pain (68.2%) and diffuse large B cell lymphoma (86.4%), respectively. The Lugano Classification was as follows: stage 1 (18.2%), stage 2 (59.1%), and stage 4 (22.7%). Surgery and chemotherapy were administered to 40.9% of patients. Complete and partial response and disease progression were established in 72.1%, 4.5% and 13.6% of the patients, respectively. Mean survival time was 99.6±16 months. Mean overall survival time was determined significantly longer in small bowel group than gastric group (119±15 vs. 50±24 months) (p=0.039). Age, gender, Eastern Cooperative Oncology Group performance status, International Prognostic Index, stage, histological type, tumor size, LDH level, albumin level, Hemoglobin level and treatment options were not associated with survival. CONCLUSION: Demographic and clinical characteristics of our series were similar with Middle Eastern and African countries. Optimal treatment options or prognostic factors for PGI-NHL are not clear. There is a need for randomized prospective studies including large number of patients and long follow-up period.

Creatinine kinase elevation and peripheral neuropathy during nivolumab treatment of a patient with metastatic renal cell carcinoma.

We report elevation of creatinine kinase (CK), which is an uncommon adverse event related to treatment with nivolumab. Nivolumab is a monoclonal antibody against programmed cell death-1 and an effective agent in metastatic renal cell carcinoma (RCCa). Here, we report a case of 58 year-old male receiving nivolumab as fourth-line treatment for metastatic RCCa. The patient was admitted to our clinic with pelvic pain and weakness in his legs. Elevated CK level was noted and he was hospitalized. About 1 mg/kg methylprednisolone was initiated and nivolumab was discontinued. On the second day of his hospitalization, left facial palsy occurred. After his neuropathy improved and CK level normalized, the patient was discharged. Neurological immune-related adverse events are very rare with nivolumab but can be serious.