Sena Ece Davarcı

Background and Objectives: Functional impairment is common in older adults with cancer and may influence treatment outcomes. This study aimed to evaluate the prognostic value of objectively measured functional mobility, with gait speed as the primary analytical variable, for survival, treatment response, and chemotherapy-related toxicity in geriatric cancer patients. Materials and Methods: In this single-center prospective study, 102 patients aged 65 years and older who were chemotherapy-naive were enrolled. Before treatment initiation, functional mobility was assessed using a 3-m gait-speed test at the patient’s usual pace. Gait speed was analyzed primarily as a continuous variable; the sample-median cutoff was retained for secondary descriptive analyses, and 0.8 m/s was evaluated in a sensitivity analysis. Associations with survival, treatment response, and toxicity were evaluated using survival and regression analyses. Results: The mean gait speed was 0.481 ± 0.176 m/s. Among patients with metastatic disease, higher continuous gait speed was associated with lower mortality in univariable analysis (HR = 0.752, 95% CI: 0.605–0.934, p = 0.010) and after adjustment for age, sex, and ECOG performance status (adjusted HR = 0.647, 95% CI: 0.490–0.853, p = 0.002). Gait speed was not significantly associated with metastatic PFS, non-metastatic OS or DFS, or grade ≥ 3 toxicity. The 0.8 m/s sensitivity analysis was limited by marked group imbalance. Conclusions: Higher baseline gait speed was associated with lower mortality in metastatic geriatric cancer patients, whereas statistically significant associations were not detected for PFS, non-metastatic survival outcomes, or grade ≥ 3 toxicity. These exploratory findings require validation in larger and more homogeneous cohorts.

Background and Objectives: FLOT is a highly effective first-line treatment for metastatic gastric cancer and offers a favorable safety profile. Clinical studies investigating the FLOT regimen have reported varying outcomes depending on the infusion duration and have highlighted possible differences in complication rates and the efficacy of neoadjuvant therapy. The choice between 24 h or 48 h infusion durations for fluorouracil can be influenced by several factors, such as the patient’s overall health status, their tolerance to treatment, and the specific treatment protocol determined by the medical team. In this study, we aimed to evaluate the effects of different infusion durations (24 and 48 h) on clinical response, toxicity, and survival in patients with gastric and gastroesophageal junction (GEJ) adenocarcinoma. Materials and Methods: This retrospective multicenter study included 113 patients with gastric or gastroesophageal junction adenocarcinoma who received neoadjuvant FLOT chemotherapy (24 h infusion: n = 28; 48 h infusion: n = 85). Propensity score matching (PSM) was performed to balance baseline characteristics, yielding a matched cohort of 90 patients. The primary endpoints were the pathologic complete response (pCR) and toxicity. Secondary endpoints included disease-free survival (DFS) and overall survival (OS). Results: Significant baseline imbalances existed (cT stage p < 0.001). After PSM, the balance improved (cT stage p = 0.009). In the matched cohort, pCR 11.1% (24 h) vs. 12.1% (48 h), p > 0.99. The median DFS was 27.4 mo (24 h) vs. NR (48 h), p = 0.847. The median OS was 32.8 mo in both, p = 0.797. Multivariate analysis (baseline variables) indicates that infusion duration is not prognostic (DFS HR = 0.77, p = 0.453; OS HR = 0.72, p = 0.328). Power was ~10% for a 1% pCR difference. Conclusions: The 24 h infusion protocol was associated with similar outcomes to the 48 h protocol after PSM adjustment. However, residual confounding persists (cT stage p = 0.009 despite PSM), and the combination of this study’s retrospective design and severe underpowering (~10%) precludes definitive conclusions. As a result, the findings are hypothesis-generating.

OBJECTIVE: Colorectal cancers are the leading cause of cancer-related deaths and usually occur in advanced age. Since geriatric patients are often excluded from most clinical trials, there is insufficient data on the treatment of these patients in the literature. In this study, we aimed to retrospectively evaluate the treatment outcomes of colorectal cancer patients over 75 years of age.MATERIAL AND METHODS: 160 patients aged 75 years and older who were diagnosed between 01.01.2009 and 01.06.2024 and admitted to Afyonkarahisar Health Sciences University Medical Oncology Clinic were included. The files of the patients were retrospectively reviewed and statistical analyses were performed with SPSS program.RESULTS: The median follow-up period was 17.2 months. In stage 2 patients, there was no difference in overall survival (OS) and disease-free survival (DFS) between the group with and without adjuvant therapy (p values 0.133 and 0.937, respectively). In stage 3 patients, adjuvant treatment did not contribute to DFS (p=0.069), but OS (p=0.037). Adding oxaliplatin to adjuvant treatment did not contribute to OS (p=0.692). No OS difference was observed between metastatic first-line treatment regimens (p=0.609). Addition of anti-VEGF or anti-EGFR in the first-line treatment was shown to contribute to PFS (0.009). Addition of anti-VEGF in the right colon and anti-EGFR in the left colon numerically contributed to OS in first-line treatment.CONCLUSIONS: Since most patients over the age of 75 cannot be included in clinical studies due to their comorbidities, the absolute necessity of giving treatment to these patients and which treatment regimens to choose if treatment is given makes clinicians think. This study showed that patients in the geriatric population had treatment outcomes consistent with the literature and concluded that treatment in geriatric patients, who are expected to have a low risk of toxicity, should be planned in accordance with current guideline recommendations.

Background: The Lung Immune Prognostic Index (LIPI) has recently emerged as a novel prognostic biomarker in several malignancies, particularly in patients receiving immunotherapy. However, its role in renal cell carcinoma (RCC), especially in non-metastatic and tyrosine kinase inhibitor (TKI)-treated patients, remains unclear. Methods: In this retrospective cohort study, 153 patients diagnosed with RCC between 2012 and 2024 were analyzed. Prognostic scores including LIPI, International Metastatic RCC Database Consortium (IMDC), and Memorial Sloan Kettering Cancer Center (MSKCC) scores were calculated. The patients were stratified into risk groups (good, intermediate, and poor) based on these scores. Survival analyses were performed using Kaplan–Meier and Cox regression methods. Correlations between scoring systems were assessed using Pearson’s correlation. Results: The median follow-up was 29.1 months. A total of 55 (35.9%) patients had metastases at diagnosis. LIPI was significantly associated with overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) (p < 0.05). In the multivariate Cox analysis, LIPI remained an independent prognostic factor for OS and PFS. Strong positive correlations were found between LIPI and both IMDC and MSKCC scores (r > 0.6, p < 0.001). Notably, LIPI demonstrated prognostic relevance even in patients treated with TKIs. Conclusions: LIPI is a simple and accessible prognostic tool that provides significant survival stratification in RCC patients. Its predictive utility extends beyond immunotherapy cohorts, indicating potential value in broader RCC management. Integration of LIPI into current prognostic models may improve individualized treatment approaches.

OBJECTIVE: Isocitrate dehydrogenases (IDHs) are rate-limiting enzymes in the intracellular tricarboxylic acid (TCA) cycle. IDH1/2 mutation may have an oncogenic effect and has also enabled the discovery of new therapeutic approaches for treating changes caused by this mutation. Genetic alterations and changes in DNA methylation are known to contribute to the pathogenesis of endometrial cancer. Still, there is no information yet about a relationship between IDH 1 mutation and endometrial cancer. In this study, aimed to evaluate the frequency of IDH1 mutations in endometrial cancer and its effect on prognosis. MATERIAL AND METHODS: For this study, we reviewed the files of 150 patients diagnosed with endometrial cancer who were treated and monitored between January 2012 and December 2020. 104 patients had adequate tumor tissue available in the pathology laboratory. The IDH-R132H mutation was assessed using immunohistochemistry. The primary endpoints were defined as overall survival (OS) and event-free survival (EFS). RESULTS: The study included 104 patients diagnosed with endometrial cancer. The patients expressing mutant IDH had a significantly higher rate of stage 4 disease (p=0.008), distant metastasis (p=0.034), and recurrence (p=0.037). The 3-year and 5-year event-free survival rates were significantly shorter in this group, with a p-value of 0.044. CONCLUSIONS: This is the first study showing that the IDH1-R132H mutation can be detected in patients with endometrial cancer. Our findings indicate that this mutation is a poor prognostic factor for these patients. We believe that the results of our study will form the basis of treatment studies targeting this mutation in endometrial cancer patients with the IDH1-R132H mutation.

Purpose We aimed to evaluate whether brain metastases, which are one of the most critical factors that have a poor prognostic value and make treatment difficult in breast cancer cases, differ in HER2-low breast cancer and to evaluate the prognosis of HER2-low breast cancer. Method This retrospective study included 1134 female patients diagnosed with breast cancer between June 2012 and June 2023 from two tertiary healthcare centers in Türkiye. Molecular groups were examined in six categories according to hormone receptor (HR) and human epidermal growth factor receptor (HER2) status (HR(+) HER2(−), HR(+) HER2-low, HR(+) HER2(+), HR(−) HER2(−), HR(−) HER2-low, and HR(−) HER2(+)). Results The median follow-up period was 56.6 months (IQR 29.9–90.5). We detected HER2-low disease in 155 (13.7%) cases. Among the six molecular groups, the highest brain metastasis rate was observed in the HR(−) HER2-low group (22.2%) (p = 0.001). In the HR(+) HER2-low group, the brain metastasis rate was 3.8%, with no statistically significant difference (p = 0.13). In the multivariate binary logistic regression model, there was a 32.4-fold increase in the risk of brain metastasis for the HR(−) HER2-low group compared to the HR(+) HER2(−) group (OR: 12.4, 95% CI 6.70–156.2, p < 0.001). The analysis reveals no significant increase in risk for the HR(+) HER2-low group (OR: 1.68, CI: 0.42–6.67, p = 0.46). In the Cox's regression model, the highest risk for poor BMFS was found in the HR(−) HER2-low group compared to the HR(+) HER2(−) group, with a 32.8-fold increased risk (HR: 32.82, CI: 7.80–138.3, p < 0.001). In the Cox's regression model, the highest risk for poor DFS was detected in the HR(−) HER2-low group compared to the HR(+) HER2(−) group, with a fourfold increase in risk (HR: 4.05, CI 1.34–12.30, p = 0.013). Shorter BMSS times were observed in the triple-negative and HR(−) HER2-low groups (1.33 and 3.9 months, respectively; p = 0.001). Conclusion Our study found that the risk of brain metastasis and disease recurrence increased significantly in the HR(−) HER2-low group, and contrary to some literature data, the risk of brain metastasis in the HR(+) HER2-low group did not differ from the HR(+) HER2(−) group. Both in our study and in many existing studies in the literature, it seems that the HR(+) HER2-low group has a similar prognosis with the HR(+) HER2(−) group, and the HR(−) HER2-low group is in an intermediate form between the HR(−) HER2(+) and HR(−) HER2(−) groups. Recurrence with brain metastasis and general disease recurrence were more common in the HR(−) HER2-low group. The study's retrospective design and the limited number of patients, especially in the HR(−) HER2-low group, along with potential underreporting in 1 + HER2 cases, are notable limitations.

Kaposi sarcoma (KS) is an endothelial originated angio-proliferative disease. There are four main types of KS; classic, endemic, iatrogenic (transplantation associated KS) and HIV-associated. Even if the disease mostly occurs in mucocutaneous sites; face, trunk, the skin of the lower extremities, and genitalia frequently involved. Even KS is mostly seen in the penis in the urogenital system, the scrotal disease is rare. A 68-year-old male was admitted to the dermatology clinic with blue-purple lesions on the scrotum. He was referred to our medical oncology clinic when tissue biopsy was resulted as ‘Classical Kaposi Sarcoma’. His serologic test was negative for HIV Human Herpes Virus but (HHV-8) test was not available at our center. The patient received curative radiotherapy daily 300 cGy for ten days. Localize dermatitis and minimal lymphocele developed on the treatment field as a complication. These lesions recovered in a few days with local symptomatic treatment. There was no residual KS after the three months completed the therapy. The patients’ follow-up continues as free of recurrence. Although epidemic and HIV-associated KS frequently involved urogenital tract, classic KS is rarely seen. The KS is mostly seen in the penis while scrotum localization is very rare. In the literature, a total number of 9 patients which are composed by HIV positive and negative patients is reported. To the best our knowledge, our case is 4th scrotal KS patient described in an HIV-negative patient.

Aim: Hormone receptor (HR)-positive, human epidermal growth factor 2 (HER2)-negative breast cancer which represents the most common subgroup of metastatic breast cancer (MBC). Recently, further subclassification for HER2-negative tumors has emerged as HER2-low. There is limited knowledge regarding the effect of HER2-low expression on outcomes of patients with HR-positive and HER2-negative MBC treated with CDK 4/6 inhibitors plus hormonal therapy. Therefore, we evaluated survival parameters according to HER2-low status for this patient group in this study. Material and Methods: As the Turkish Oncology Group (TOG) Project, retrospectively collected data from 423 patients with HR-positive/HER2-negative MBC treated with ribociclib and palbociclib plus letrozole therapy was assessed. Included patients had metastatic first-line therapy and endocrine-sensitive disease. Survival outcomes were compared between HER2-negative and HER2-low patient groups. Conclusion: HER2-low status had no statistically significant impact on survival in patients treated with palbociclib or ribociclib plus letrozole.

Amaç: Erken evre meme kanserinde (MK) primer ve adjuvan tedavilerdeki gelişmelere rağmen hala birçok hastada uzak metastaz gelişmektedir. Özellikle son on yılda metastatik meme kanseri (MMK) tedavisinde kaydedilen önemli gelişmelere rağmen tam kür sağlanamayan bir hastalık olmaya devam etmektedir. Çalışmamızda metastatik meme kanserli hastalarda birinci basamak tedavi sonuçlarının değerlendirmeyi amaçladık. Gereç ve Yöntemler: Çalışmamıza 263 metastatik meme kanseri hastası dâhil edildi. Hasta verileri retrospektif olarak analiz edildi. Bulgular: Medyan takip süresi 48.3 ay (interquartile range-IQR: 26.5-79.3) olup; 126 (%47.9) hastada de novo metastaz, 137 (%52.1) hastada ise takipte metastaz saptandı. Birinci basamak tedavi sonrası; 39 (%14.8) hastada tam yanıt, 150 (%57) hastada parsiyel yanıt, 6 (%2.3) hastada stabil hastalık ve 35 (%13.3) hastada ise progresif hastalık şeklinde sonuçlandı. Hormon reseptör (HR) ve insan epidermal büyüme faktörü (HER2) durumuna göre hasta moleküler grupları arasında birinci basamak tedavi sonrası progresyonsuz sağ kalım (PFS1) ve genel sağ kalım (OS) sürelerinde anlamlı fark saptanmamıştır ancak HER2 (+) olan gruplarda literatüre kıyasla daha uzun OS süreleri (HR- HER2+ grupta 108 ay) saptandı. Birinci basamakta uygulanan tedavi kategorilerine göre hasta grupları arasında anlamlı bir PFS1 farkı saptanmıştır (p=0.01). PFS1’de en uzun süre kemoterapi ile başlanıp hormonoterapi ile devam edilen grupta (17.8 ay), en kısa süre ise sadece kemoterapi alan grupta saptandı (4.2 ay). Birinci basamak tedavi kategorilerine göre gruplar arasında medyan OS’ de anlamlı fark saptandı (p=0.025). HR+ HER2- olgularda CDK4/6 inhibitörü temelli tedavide diğer tedavilere gör daha OS elde edilmiştir. Birinci basamak CDK4/6 inhibitörü temelli hormonoterapi alanlarda medyan OS’ ye ulaşılamadı. Sonuç: Hasta moleküler grupları arasında genel sağ kalım ve progresyonsuz sağ kalım farkı saptanmazken, literatür ile kıyaslandığında HR-HER2+ grupta genel sağ kalım süresi daha uzun, diğerlerinde benzerdi. CDK4/6 inhibitörü alanlarda medyan OS’ye ulaşılamamıştır. Birinci basamak tedavilere göre hasta gruplarında PFS1 süreleri literatüre benzer bulunmuştur.

There are conflicting data regarding the prognostic effect of microvascular density (MVD) in breast cancer and its molecular subtypes. It is thought that high levels of FOXP3 + T cells in breast cancer are associated with poor prognosis. However, data regarding FOXP3 show significant variability in the literature. In our study, we aim to measure MVD and FOXP3 + T cells in breast cancer cases and investigate their relationship with each other and their effects on breast cancer patients’ clinical and prognostic features. In our study, the results of 207 female breast cancer patients whose excisional tumoral tissue was obtained are presented. The study evaluated the findings under a light microscope using antibodies against CD34 for measuring MVD and FOXP3 for measuring FOXP3-positive T cells. CD34 ≥ 17 was categorized as high MVD, and CD34 < 17 was classified as low MVD. FOXP3 + cell count ≥ 20/mm2 was categorized as high FOXP3 positivity and < 20/mm2 as low FOXP3 positivity. The SPSS program (version 22) was used to evaluate the results statistically, and p < 0.05 was considered significant. The median age was 54.0 (27–86) years, and the median follow-up period was 60.0 (IQR: 42.6–86.5) months. In the high MVD group, a higher progesterone receptor (PR) positivity rate was detected (p = 0.035). High FOXP3 positivity was significantly associated with high nuclear grade (p = 0.003). High FOXP3 positivity was significantly associated with PR negativity and high Ki67 values ​​(p = 0.009, p = 0.012, respectively). No statistically significant correlation was found between MVD elevation and FOXP3 positivity (r = 0.063, p = 0.36). A weakly significant positive correlation was detected between high Ki67 and FOXP3 positivity (r = 0.0146, p = 0.04). A weak inverse correlation was detected between high FOXP3 positivity and PR percentage values ​​(r=-0.182, p = 0.01). While there was no significant difference in disease-free survival in cases with high MVD and high FOXP3 + T cells compared to groups with low levels, the results were not mature enough because the median values ​​in overall survival could not be reached. A significant correlation was found between high FOXP3 positivity and some aggressive tumor features; no effect on survival was detected. In contrast to literature data on luminal A breast cancer, high MVD in the luminal B (HER2-) subgroup was associated with a lower risk of recurrence. Our study is the first in the literature to evaluate the relationship between MVD measured using CD34 and FOXP3 positive T cells in breast cancer. Our study found no correlation between MVD and FOXP3 positivity, while literature data show significant correlations in some other cancers.