Mustafa Benekli

Objective: Cytokines have been the mainstay of treatment in metastatic renal cell cancer (mRCC) for decades before the introduction of tyrosine kinase inhibitors (TKIs), which dramatically changed the therapeutic landscape in these patients. This observational study was designed to evaluate use of TKIs in the treatment of cytokine-intolerant mRCC patients. Methods: A total of 151 cytokine-intolerant mRCC patients who were treated with TKIs (sunitinib, pazopanib and sorafenib) were enrolled in this prospective, non-interventional, multi-center observational study at 16 oncology centers across Turkey. Mean (SD) age was 61.3 (11.1) years and 74.8% were males. Data on duration of TKI treatment was the primary outcome measure. Additionally, overall response rate (ORR), progression free survival (PFS), overall survival (OS) and safety data were recorded. Results: Median duration of treatment was 8.2 months at a median follow up of 17.9 months. ORR and disease control rate were 12.5% and 70.8%, respectively. Median PFS and OS were 7.5 months (95%CI: 6.4–10.4) and 27.3 months (95%CI: 17.6–27.3) with no significant difference among three TKI agents in terms of treatment duration, ORR, PFS and OS. The most common adverse events excluding progression-which was the protocol requirement were diarrhea (13.6%), asthenia (13.6%) and hand-foot syndrome (12.6%). Dose modifications were required in 30.5% of the patients and 15% discontinued TKIs because of toxicity. Conclusions: Our findings confirm the efficacy and safety profile of TKIs in the first-line treatment of mRCC patients intolerant to cytokine treatment. There was no significant difference among three TKI agents in terms of treatment duration, ORR, PFS and OS. Trial registration: TURCOS ClinicalTrials.gov Identifier: NCT01585974. Registered April 25, 2012.

Challenging decision: ICU admission of critically ill elderly solid tumor patients

Soft tissue sarcomas, which originate from the mesenchymal tissue, represent a rare disease group with more than 100 subtypes. Primary treatment is surgical excision. In locally-advanced or metastatic cases, systemic treatment is the only therapeutic approach. Because of their heterogeneity, prognosis and response to the chemotherapy may be relatively different. Monotherapy with doxorubicin and its combination with ifosfamide continue to be the standard approach in the first-line treatment of advanced disease. Histology-directed therapy has become popular with the introduction of novel cytotoxic agents. Successful results have been achieved with recent developments in the field. Currently, the median overall survival rate in advanced stage disease barely exceeds 12 months in spite of the novel treatment options. In this review, our objective was to summarize the current data on cytotoxic treatments in the metastatic soft tissue sarcomas

Membraneous nephropathy (MN) is the most commonly occurring nephrotic syndrome in adults as well as the most common paraneoplastic nephropathy associated with solid tumors, and it is mostly associated with gastrointestinal system and lung carcinomas. Accurate diagnosis is important as the treatment of paraneoplastic glomerulonephritis is very varied from that of idiopathic ones. In the current report, a case of a patient that was referred with proteinuria and edema and was diagnosed with lung cancer, and responded markedly to treatment of malignancy, with improvement of MN, is presented. Active cancer is present in all patients with paraneoplastic MN. In numerous patients, the paraneoplastic MN and cancer diagnoses are made within one year of each other. The treatment of paraneoplastic syndromes is usually associated with the treatment of primary malignancy. There are conflicting data on which treatment modality is more suitable. In conclusion, further studies are required in order to determine the actual incidence of cancer in patients with nephropathy, explain the physiopathological association between cancer and nephropathy and to determine the most suitable treatment approaches.

The last decade has witnessed dramatic improvements in the diagnosis, classification and treatment of renal cell cancer (RCC). Besides improvements in surgical techniques in early stages, introduction of novel targeted agents has resulted in improved outcomes in advanced RCC for which no effective treatment existed until recently. This article reviews epidemiology, pathology and pathogenesis, diagnosis, clinical staging, prognostic factors and treatment modalities of early stage and advanced RCC. Expert commentary: Although treatment options are expanding rapidly, practicing physicians face considerable challenges in the decision-making process. Therapeutic agents may have unique side effects and unexpected drug interactions. RCC represents one of the major success stories of clinical oncology in recent years and the progress appears to be far from having reached a plateau. We aim to present a comprehensive in-depth review of RCC in an attempt to provide evidence-based recommendations and future perspectives for practicing oncologists.

Medulloblastoma (MB) is rarely seen in adults. For adjuvant therapy in adults the same therapy protocols used in pediatric cases are used. The present study retrospectively evaluated the data of MB patients who were treated in different Oncology Centers in Turkey. The data of 60 adult patients with MB from 8 Oncology Centers diagnosed between 2005 and 2012 were retrospectively analyzed. The median patient age was 28.8 years (range 16-54). The administered chemotherapy included procarbazine+lomustin+vincristine (group A, N=31) and cyclophosphamide/ifosfamide+vincristine+cisplatin (group B, N=13). Median chemotherapy courses were 4 (range 1-8). Median progression free survival (PFS) was 76 months and median overall survival (OS) has not been reached in both groups. In young female patients and in those who received adjuvant chemotherapy, median PFS and OS were longer but without statistical significance. Mean PFS and OS were 65.9 months and 101.2 months in group A and 113.6 months and 141.6 months in group B, respectively. Improved survival results were obtained in women, in patients aged below 25 years, in those who underwent gross total excision (GTE) and in those who received adjuvant therapy with cyclophosphamide/ifosphamide.

E23135 Background: Neoadjuvant chemotherapy has been accepted as standart treatment in locally advanced breast cancer recently. 18-FDG-PET/CT is frequently used method for the staging of disease before treatment. We aimed to investigate the role of PET/CT in staging and detection of distant metastasis in addition the relationship of PET/CT with demographic and histopathologic characteristics. Methods: In 6 centers of the different cities of our country, the patients scanned with PET/CT before NAC were evaluated. The SUV of the primary tumor and axilla, age, menopausal status, performance status, clinical stage, tumor localization, hormonal receptor status, presence of Her2 expression, and molecular subtypes of the patients were recorded. ″Mean SUV″ was accepted as mean of the SUVmax of the primary tumor and axilla. Mann-Whitney U ve Kruskall-Wallis H tests were used to investigate the relationship between mean SUV and demographic and histopathologic characteristics. Results: In this study 317 patients were evaluated. Median age was 49(20-82). Of the patients 10.4% was below 35 years, 52% was premenopausal, 89% had ECOG PS:0, 84.5% had stage III disease. In 45.1% of the patients tumor localization was on the right breast. Endocrine sensitivity was 80.1%, Her2 positivity was 42.9% and triple negative molcular subtype was 8.2% of the patients. Mean SUV was found to be significantly higher in patients without hormone sensitivity (ER and PR negative)(p = 0.033). There was a statistically trend between clinical stage and molecular subtype with mean SUV (p = 0.098 and 0.063 respectively). Mean SUV was found to be higher in stage III and triple negative patients. There was no significant relationship between Mean SUV and other parameters(p > 0.05). Conclusions: Taking into consideration of the demographic and histopathological characteristics will increase the success of the treatment in breast cancer patients. Furthermore, PET/CT findings and high level of mean SUV may guide the agressiveness of the tumor.

E12539 Background: Pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) has been shown to provide survival advantages in breast cancer. Here, we investigated the role of 18-FDG-PET/CT and other possible factors in predicting pCR after NAC. Methods: The patients who had 18-FDG-PET/CT before NAC in 6 different centers enrolled in this study. SUV max values of the primary tumor and axilla, age, menapousal status, postoperative histopathological characteristics as hormonal receptor status, presence of Her2 expression, vascular, lymphatic and perineural invasion, grade and molecular subtypes of the tumor of the patients were recorded. Receiver-operating curve (ROC) analysis was done to find out the cut-off SUV value for predicting pCR. The effects of all these factors on pCR were determined by chi-square test. Results: In this study, 317 patients were evaluated. Ten percent of the patients were below 35 years of age, 52% was premenapousal, 89% had ECOG performance status 0, 42.9% had Her2 positive disease. Triple negative subtype was detected in 8.2% of the patients. ORR was 87.1% while pCR was achieved in 29.7% of the patients. The predictive cut-off SUV value of 18-FDG-PET/CT for pCR was found as 7.7 by ROC analysis. The sensitivity and specificity for this value were 57% and 64% respectively (AUC = 0.606; p = 0.0018). There was no significant association between pCR and menapousal status, performance status, perineural invasion or grade (p > 0.05). The pCR was found to be significantly higher in patients with hormone receptor negative tumors, patients with Her2 positive tumors, patients with triple negative tumors , patients without vascular and lymphatic invasive tumors and in patients with mean SUV values over 7.7 (p = 0.009, 0.038, 0.047, 0.000, 0.001 respectively). Conclusions: High levels of mean SUV value 18-FDG-PET/CT and some histopathologic parameters may have a role in predicting pCR after NAC in breast cancer patients, and thus give us the clues about the survival of the patients