The efficacy of palbociclib and ribociclib in the first-line treatment of metastatic hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer in male patients: a Turkish oncology group (TOG) study.

INTRODUCTION: Male breast cancer, comprising approximately 1% of all breast cancer cases, often leads to the exclusion of male patients as a criterion in clinical trials. While the efficacy of Cyclin-dependent kinases 4 and 6 (CDK 4/6) inhibitors has been established in metastatic hormone receptor-positive (HR +) and human epidermal growth factor receptor 2-negative (HER2 -) breast cancer in women, limited data exist on their effectiveness in male patients. We aimed to evaluate the efficacy and safety of palbociclib or ribociclib in male patients with breast cancer. METHODS: This study is a multicenter, retrospective study. We included male patients with HR + and HER2-metastatic breast cancer who received palbociclib or ribociclib as first-line treatment. Our primary endpoints were progression-free survival (PFS), overall response rates (ORR), and drug-related adverse effects. RESULTS: A total of 46 male patients from 27 institutions were enrolled. The median age at initiation of CDK 4/6 inhibitors was 63.64 ± 13.69 years, with a median follow-up of 21.33 (95% CI 14.92-27.74) months. The ORR were 84% for palbociclib and 76.2% for ribociclib. The mPFS for the entire cohort was 28.06 months (95% CI 18.70-37.42). No significant difference in PFS was observed between palbociclib and ribociclib (mPFS: 24.46 months (95% CI 11.51-37.42) vs 28.33 months (95% CI 14.77-41.88), respectively, p = 0.211). No new adverse events were reported. DISCUSSION: This study demonstrates that palbociclib and ribociclib are effective and safe options for first-line treatment in male patients with HR + /HER2 - metastatic breast cancer. However, further prospective studies are warranted to establish their efficacy in this population.

Total Lesion Glycolysis Obtained by FDG PET/CT in Diagnosing Solitary Pulmonary Nodules.

OBJECTIVE: To evaluate the diagnostic performance of total lesion glycolysis (TLG) obtained by 18F-FDG PET/ CT to differentiate malignant solitary pulmonary nodules (SPNs) from benign ones. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Nuclear Medicine, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey, from January 2018 to April 2022. METHODOLOGY: Eighty patients, who were found to have SPNs and underwent PET/CT imaging, were enrolled in this retrospective study. Parameters of PET-CT such as metabolic, volumetric, and metabolovolumetric were assessed concerning diagnostic value. Moreover, maximum standard uptake value (SUVmax) and TLG were combined and compared to improve diagnostic accuracy. RESULTS: The number of the detected benign and malignant SPNs was 38 and 42, respectively. Compared to the benign lesions, the malignant nodules presented significantly higher values in terms of SUVmax, TLG, and the volumes of metabolic tumour (MTV) and CT. Considering all parameters, the highest area under the curve (AUC) was occupied by TLG and SUVmax. The values for the sensitivity, specificity, and accuracy of SUVmax, TLG, and SUVmax combined with TLG were as follows respectively: 97.6%, 63.2%, and 81.2%; 85.7%, 92.1%, and 88.7%; and 85.7%, 94.7%, and 90%. CONCLUSION: The conventional value of SUVmax does not yield satisfactory results in order to separate the malignant nodules from the benign ones. The SUVmax value could be more valuable if it is used with TLG measurement in diagnosing SPNs. KEY WORDS: 18F-FDG PET/CT, SUVmax, TLG, Pulmonary nodule.

Deficient Mismatch Repair and Lymphocytic Response to Tumor as Prognostic Markers in Stage II Colon Cancer Patients.

OBJECTIVE: To investigate the relationship between colon cancer (CC) subtypes defined by the status of tumor-infiltrating lymphocytes (TIL) and mismatch repair (MMR) combination with clinicopathological features and survival. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Medical Oncology, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey, from July 2010 to March 2020. METHODOLOGY: Eighty-three patients with operated stage II colon cancer were included in the study. Pathology, surgery and oncological treatment and follow-up information were obtained from patient files; and statistical analyses were performed on overall survival (OS). Tumor-infiltrating lymphocytes and mismatch repair status was determined with the help of immunohistochemistry. RESULTS: TIL-high and deficient MMR (dMMR) status were detected in 26 patients (31.3%) and 21 patients (25.3%), respectively. Tumors were divided into four subgroups according to TIL and MMR status. TIL-high/dMMR tumors had the most favourable prognosis, while TIL-low/proficient MMR tumors exhibited poor OS. CONCLUSION: The combination of TIL and MMR could enable us to differentiate patients' survival outcomes in more details. Therefore, considering that the TIL and MMR status, evaluated by IHC, may be a cost-effective and effective option for risk classification in patients with stage II colon cancer. Key Word: Lymphocytic response, Mismatch repair, Prognosis, Tumor-infiltrating lymphocytes, Stage II cancer, Colon cancer.

The Effect of FDG-PET/CT on Clinical Prognostic Staging of Breast Cancer Patients being Planned Neoadjuvant Treatment.

OBJECTIVE: To evaluate the effect of FDG-PET/CT in the radiological imaging of breast cancer (BC) patients planned for neoadjuvant treatment (NAT), on the clinical prognostic stage (CPS). STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey, between June 2014 and September 2020. METHODOLOGY: Consecutive patients with stage I-III breast cancer (BC) who were planned for neoadjuvant treatment (NAT). The distribution of CPS detected by both conventional radiological methods (c-CPS) and FDG-PET/CT (PET-CPS) were compared. RESULTS: Significant upstaging on CPS was detected with the addition of FDG-PET/CT to conventional imaging methods in 25/121 (20.7%) patients (p <0.001). In the c-CPS stage, IB, IIA, IIB, IIIA, IIIB patients, the stage change rate was 22.7%, 28.6%, 37.5%, 50%, and 9.1%, respectively. There was no change in patients with c-CPS stage IA and IIIC. There was a significant change in the cN stages (p <0.001), while no significant change was detected in the cT stages of the patients (p = 0.180). Upstaging was detected in 5/16 (6.3%, p=0.034), 14/71 (19.7%, p <0.01), 15 / 30 (50%, p <0.01) of initially cN 0, 1, 2 patients, respectively (p<0.001). CONCLUSION: The change in CPS was due to nodal upstaging. The effectiveness of including FDG-PET/CT in the initial radiological imaging in patients planned for NAT should be evaluated with prospective studies evaluating treatment choices to be used in NAT. Key Words: PET scan, Breast cancer, Positron emission tomography, Neoadjuvant treatment, Cancer staging, Staging system, TNM.

The Role of FDG PET/CT to Evaluation of Axillary Lymph Nodes after Neoadjuvant Chemotherapy in Breast Cancer.

OBJECTIVE: To determine the diagnostic value of breast and axillary maximum standard uptake (SUVmax) values for predicting ypT0 and ypN0 separately. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of Medical Oncology, Haydarpasa Numune Training and Research Hospital, between May 2017 and September 2020.  Methodology: Consecutive patients with operated breast cancer (BC) after neoadjuvant chemotherapy (NAC) were evaluated. SUVmax on FDG-PET/CT after NAC at both primary tumour (postSUVmax-T) and axillary lymph nodes (postSUVmax-N) were assessed to predict the ypT0 and the ypN0, respectively.  Results: Clinically meaningful correlation was detected between postSUVmax-N with ypN0 in patients with human epidermal receptor-positive (Her2+) and triple-negative (TN) BC (in Her2+ BC: r=0.596, p <0.001, in TN BC: r=0.782, p = 0.001). The postSUVmax-N predicted ypN0 with 90.5% positive predictive value (PPV) and 85.7% negative predictive value (NPV) in patients with Her2+ and TN BC. The postSUVmax-T predicted ypT0 with 87.5% PPV and 100% NPV in patients with TN BC (AUC: 0.938, P <0.01) Conclusion: According to this study's findings, the FDG-PET/CT may be an alternative to sentinel lymph node biopsy (SNB) to protect patients from axillary lymph node dissection when the expected FNR of the SNB is high in patients with Her+ and TN BC. Key Words: Breast cancer, FDG PET/CT, Neoadjuvant therapy.

A case of primary squamous cell carcinoma of the breast with pathologic complete response after neoadjuvant chemotherapy.

BACKGROUND: Primary squamous cell carcinoma (SCC) of the breast is a metaplastic carcinoma subtype which includes fibromatosis-like and sarcomatoid features. This is a very aggressive tumor with poor prognosis. Other sites of primary SCC should be ruled out first to classify these tumors as primary SCC of the breast. Here we present a case of locally advanced primary SCC of the breast. CASE REPORT: A 72 years old woman presented with a right axillary lump. Trucut biopsy was performed, it showed squamous cell carcinoma. Estrogen receptor had poor immunoreactivity, negative for both progesteron receptor and HER 2 in immunohistochemistry staining. PETCT imaging were conducted to showing only 6 × 6.5 cm mass in right breast adjacent to axilla, multiple lymphadenomegaly in right axillary. We planned neoadjuvant chemotherapy consisting of weekly paclitaxel followed by epirubicin and cyclophosphamide combination. Postoperative pathology revealed wide necrosis, no viable tumor cell. We started adjuvant anastrozole treatment of 1 mg/day. No evidence of disease was detected after 1 year follow up. CONCLUSION: Primary squamous cell carcinoma of the breast is a very rare disease with no standard treatment approach. Our case achieved pathologic complete response after neoadjuvant chemotherapy.