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OBJECTIVE Breast cancer is the most diagnosed cancer in females. Cancer screening programs increase the detection of early-stage breast cancer. This study aimed to assess the long-term outcomes and the effect of adjuvant therapies for recurrence in stage I breast cancer patients. METHODS We recorded clinicopathological and treatment features of the stage I breast cancer patients and evaluated long-term outcomes retrospectively. Kaplan-Meier analysis and Cox regression analysis were used for recurrence and overall survival. RESULTS 308 patients with stage I breast cancer were involved in the study. The average age was 52 (range 21-81). The median follow-up was 99 (12-380) months. Forty-three (14%) patients were aged over 65, and 162 (52.7%) patients were postmenopausal. ER, PR, and HER2 receptor positivity were 78.9%, 60.8%, and 14.3%, respectively. Lumpectomy plus adjuvant radiotherapy was performed in 82.1% of the patients, and mastectomy in 10.7% of the patients for primary treatment. The patients received adjuvant chemotherapy (42.5%) and adjuvant hormonal therapy (79.9%). Recurrence (local-47.8%, metastatic-52.2%) occurred in 23 (7.5%) patients. In multivariate Cox regression analysis, we found that primary treatment (lumpectomy + adjuvant RT or mastectomy) (p=0.614), surgical margin status (p=0.495), adjuvant chemotherapy (p=0.259), and adjuvant hormonal therapy (p=0.289) were not statistically significant factors for recurrence. However, aged over 65 years (p=0.002) was statistically significant. CONCLUSION In this study, we showed long-term outcomes in stage I breast cancer patients. It was shown that the primary treatment type (lumpectomy + adjuvant RT or mastectomy) was not different in terms of recurrence. In addition, it was determined that adjuvant chemotherapy did not provide benefit for recurrence in stage I breast cancer patients in our results. For this reason, in patients with stage I cancer, more care should be taken in the decision of adjuvant therapy. [ABSTRACT FROM AUTHOR]

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OBJECTIVE This study assessed the efficacy of chemotherapeutic agents used in combination with bevacizumab in patients with metastatic ovarian cancer who could not receive platinum. METHODS The study is a retrospective observational study. Kaplan-Meier and Cox regression methods were used for statistical analysis. RESULTS The most common metastatic sites among the 60 patients were the peritoneum (91.7%), liver (51.7%), and lung (20%). As a single agent combined with bevacizumab, 29 (48.3%) patients received paclitaxel, 16 (26.7%) received liposomal doxorubicin, and 15 (25%) received gemcitabine. The median progression- free survival was 7.5 months (95% CI, 3.4-11.4), and the median overall survival was 14.4 months (95% CI, 9.3-19.4). Among the factors that affected overall survival, the number of metastasis sites (p=0.01) was statistically significant. The type of chemotherapy used with bevacizumab (p=0.55), age (p=0.057), liver metastasis (p=0.28), lung metastasis (p=0.19), bone metastasis (p=0.13), and brain metastasis (p=0.12) were not statistically significant. CONCLUSION Single-agent chemotherapy drugs used with bevacizumab demonstrated similar efficacy against ovarian cancer. Patients' performance scores, previous treatment regimens, and side effect profiles should be considered before administering any specific chemotherapy agent in combination with bevacizumab. [ABSTRACT FROM AUTHOR]

Objectives: The adrenal gland is one of the most common metastatic sites in lung cancer. The anatomical localization and symmetrical nature of the glands provided the concepts of laterality and resectability of adrenal gland metastasis (AGM) in lung cancer. In this trial, we aimed to investigate the clinical features and prognosis specific to ipsilateral AGM and compare them with contralateral AGM in lung cancer patients from a single tertiary center. Methods: Data of 135 lung cancer patients with AGM were retrospectively collected. The patients were divided into two groups as ipsilateral AGM and contralateral AGM. Clinicopathological features and survival outcomes were compared. Results: 57 lung cancer patients (42.2%) had ipsilateral AGM. Isolated AGM was significantly more prevalent in patients with ipsilateral AGM than those with contralateral AGM (29.4% vs. 14.1%; p=0.026). Patients with ipsilateral AGM have a survival advantage compared to contralateral AGM (The median OS: 11.6 months vs. 7.8 months; p=0.008). In multivariate analysis, ipsilateral AGM had a favorable independent prognostic factor (Hazard Ratio=0.61; %95Confidential interval: 0.40-0.92; p=0.018). Conclusion: In patients with lung cancer, ipsilateral AGM is more likely to be isolated and is associated with a better prognosis compared to contralateral AGM. [ABSTRACT FROM AUTHOR]

Introduction: Patients with HER2-positive metastatic breast cancer are at risk for developing brain metastases. Different anti-HER2 treatments can be used in the management of the disease. In this study, we aimed to evaluate the prognosis and the factors affecting the prognosis in brain metastatic patients with HER2-positive breast cancer. Methods: Clinical and pathological features of HER2-positive metastatic breast cancer patients and magnetic resonance imaging features at the onset of brain metastasis were recorded. Survival analyses were performed using Kaplan-Meier and Cox regression methods. Results: Analyses of the study were performed by including 83 patients. The median age was 49 (25–76). All patients had HER2 receptor-positive tumors. Thirty-five (42.2%) patients had a hormone-positive disease. Thirty-two (38.6%) patients had de novo metastatic disease. Brain metastasis sites were found to be bilateral – 49.4%, right brain – 21.7%, left brain – 12%, and unknown – 16.9%, respectively. The median brain metastasis largest size was 16 mm (range 5–63). The median follow-up time from the post-metastasis period was 36 months. Median overall survival (OS) was found as 34.9 months (95% CI, 24.6–45.2). In multivariate analysis for factors affecting OS, estrogen receptor status (p = 0.025), number of chemotherapy agents used with trastuzumab (p = 0.010), number of HER2-based therapy (p = 0.010), and the largest size of brain metastasis (p = 0.012) were found to be statistically significant. Conclusions: In this study, we demonstrated the prognosis in brain metastatic patients with HER2-positive breast cancer. When the factors affecting the prognosis were evaluated, we determined that the largest size of brain metastasis, estrogen receptor positivity, and the use of TDM-1 and lapatinib plus capecitabine consecutively during the treatment process affected the prognosis of the disease. [ABSTRACT FROM AUTHOR]

Simple Summary: Despite advances in treatment generated by clinical trials in metastatic breast cancer (MBC), their impact on routine daily practice and the reflection of the outcome within the community remains unclear. This study evaluates time-related differences in treatment patterns and outcome in a real-world patient population with MBC over a ten-year timeframe. Except for the HER2+ subgroup, which showed a significant survival benefit with the incorporation of novel agents, we failed to identify significant variations in outcomes for the remaining subgroups. A consistent feature we observed was the challenge in treating TNBC, which had the worst prognosis in both time-related cohorts. Elucidation of biologic characteristics to identify novel treatment options remains an unmet need to improve outcomes in TNBC. The favorable survival attained with routine endocrine agents in the luminal A subgroup suggests that barriers in access to CDK inhibitors may not have a negative impact on the outcome in subgroups of hormone receptor-positive patients, constituting an appealing strategy for communities with limited resources. This multicenter registry study aims to analyze time-related changes in the treatment patterns and outcome of patients with metastatic breast cancer (MBC) over a ten-year period. Correlations between demographic, prognostic variables and survival outcomes were carried out in database aggregates consisting of cohorts based on disease presentation (recurrent vs. de novo) and the diagnosis date of MBC (Cohort I: patient diagnosed between January 2010 and December 2014; and Cohort II: between January 2015 and December 2019). Out of 1382 patients analyzed, 52.3% patients had recurrent disease, with an increased frequency over time (47.9% in Cohort I vs. 56.1% in Cohort II, p < 0.001). In recurrent patients, 38.4% (n = 277) relapsed within two years from initial diagnosis, among which triple-negative BC (TNBC) was the most frequent (51.7%). Median overall survival (OS) was 51.0 (48.0–55.0) months for all patients, which was similar across both cohorts. HER2+ subtype had the highest OS among subgroups (HER2+ vs. HR+ vs. TNBC; 57 vs. 52 vs. 27 months, p < 0.001), and the dnMBC group showed a better outcome than recMBC (53 vs. 47 months, p = 0.013). Despite the lack of CDK inhibitors, luminal A patients receiving endocrine therapy had a favorable outcome (70 months), constituting an appealing approach with limited resources. The only survival improvement during the timeframe was observed in HER2+ dnMBC patients (3-year OS Cohort I: 62% vs. Cohort II: 84.7%, p = 0.009). The incorporation of targeted agents within standard treatment has improved the outcome in HER2+ MBC patients over time. Nevertheless, despite advances in early diagnosis and treatment, the prognosis of patients with TNBC remains poor, highlighting the need for more effective treatment options. [ABSTRACT FROM AUTHOR]

OBJECTIVE ROS1 positivity is seen in 1-2% of patients with metastatic lung cancer. Targeted drugs such as crizotinib, lorlatinib, and entrectinib are used in the treatment. We aimed to evaluate the efficacy of crizotinib and the prognosis of patients with ROS1 fusion-positive metastatic non-small cell lung cancer (NSCLC) in this study. METHODS We analyzed data of the advanced NSCLC patients with ROS1 mutation retrospectively. We determined the clinicopathological features of the patients. We evaluated the parameters affecting the prognosis with survival analyzes. RESULTS The research enlisted the participation of 21 patients. Median progression-free survival with crizotinib treatment was found 26.1 (95% Confidence interval [CI], 8.1-44.1) months. Median overall survival was 35.2 (95% CI, 13.5-56.9) months. Treatment-related Grade 1-2 adverse effects were observed in 9 (42.9%) patients and Grade 3-4 adverse effects were detected in 1 (4.8%) patient. Clinicopathological parameters affecting survival were evaluated; age (p=0.02) and liver metastasis (p=0.03) were defined as prognostic parameters. ROS1 positivity rate (p=0.08) was not found to be a prognostic factor. CONCLUSION In patients with ROS1 fusion-positive metastatic NSCLC, crizotinib was shown to be both efficacious and safe. We also found that in this patient group, age and the existence of liver metastases are prognostic factors. [ABSTRACT FROM AUTHOR]

The study's goal is to evaluate the effectiveness of erlotinib in patients with EGFR mutant metastatic non-small cell lung cancer (mNSCLC). The patient's medical data were analyzed retrospectively. Erlotinib's effectiveness was assessed by the radiological response. Survival analyzes were done for prognostic factors. Eighty-five patients were included in the study. 49 (57.6%) of the patients were female, and the average age was 60 (range, 33-85). Exon 19, exon, 21, and other mutations were detected in 62.4%, 24.7%, and 12.9%, respectively. Brain metastases were present in 25.9% and liver metastases in 17.6% of patients. Before erlotinib treatment, 25.9% of the patients received chemotherapy, and 43.5% received radiotherapy. With erlotinib treatment, complete response was found in 15.3%, partial response in 51.8%, and stable response in 10.6% of patients. Median PFS was 22.3 (95% CI, 11.0-33.5) months. Grade 1-2 side effects were observed in 29.1% of the patients, and grade 3-4 side effects in 7.1%. The median OS was found as 37.5 (95% CI, 22.6-52.4) months. The 5- years overall survival rate was found to be 32.2%. In this study, we showed outcomes of erlotinib therapy in patients with EGFR mutant mNSCLC. Erlotinib has been well-tolerated and effective in disease control. Age, number of metastases, and EGFR mutation type predict treatment-related prognosis. [ABSTRACT FROM AUTHOR]

The goal of this study was to evaluate the efficacy of crizotinib in patients with ALK-positive metastatic lung cancer. The patients' data were analyzed retrospectively. Cox regression and Kaplan-Meier methods were used to perform survival analyses. A total of 25 patients were involved in the study. Thirteen (52%) patients were male, and the average age was 55 (range, 30-80). 23 (92%) of the patients were de-novo metastatic. Brain metastases were present in 32% and liver metastases in 20% of the patients. Before crizotinib treatment, 64% of the patients had received chemotherapy, and 20% had received palliative radiotherapy. Progression-free survival was found as 16.8 (CI 95%, 5.7-27.9) months. Grade 1-2 side effects were detected in 36% of the patients, and grade 3-4 side effects were observed in 12%. After progression, 13 (52%) patients received 2nd series ALK inhibitors (alectinib, ceritinib, and lorlatinib) or chemotherapy. The median overall survival (OS) was found as 44.2 (95% CI, 28.5-59.9) months. The four-year OS rate was 37.4%. In the multivariate analysis, the ALK positivity ratio (p=0.02) was determined as a statistically significant factor affecting OS. We showed efficacy data of crizotinib in patients with ALK mutant metastatic non-small cell lung cancer. Crizotinib is an effective and safe therapy for patients with ALK mutant metastatic non-small cell lung cancer. Also, we found that the ALK positivity ratio was prognostic for OS. [ABSTRACT FROM AUTHOR]

Background: Metastatic and unresectable thymoma (T) or thymic carcinoma (TC) have limited treatment options, especially after first line. Methods: Patients with unresectable or recurrent thymic tumors who used minimum one dose of nivolumab at any line of treatment were evaluated retrospectively. Even though nivolumab was administered 3mg/kg dosage in PRIMER study, due to toxicity and financial concerns, we used low dose regimen mostly. Results: Among 46 unresectable and recurrent thymic epithelial tumors; 8 patients with TC (n = 3), T (n = 4) and mixt histology (n = 1) were reviewed. Three patients had myasthenia gravis history that had to be controlled before treatment. Four patients showed moderate (n = 2) or severe (n = 2) adverse events with nivolumab treatment. Interestingly, two severe adverse events were occurred at first dose even with 40 mg nivolumab and required cessation of treatment permanently. The median number of nivolumab received was four (range: 1–18). Best response was partial response. Two patients progressed at the 3rd and 5th month of treatment. Best duration of response for one patient with TC and one patient with T–B2 were 9 and 14 months, respectively. Median survival time after nivolumab was 7.4 months (range: 2–22.1). Conclusions: After the results of the previous study could be supported by randomized prospective studies with more number of patients, nivolumab may be considered as an option in patients with thymic epithelial tumors who have received multiple line treatments. However, given the high rate of severe toxicities, there is need to find out a reliable marker to prediction patients who will derive benefit or exhibit toxicity. [ABSTRACT FROM AUTHOR]

OBJECTIVE Astragalus membranaceus root extract (AMe) has been shown to have immunomodulatory effects on macrophages and Th1 type immune responses. Our goal was to determine whether AMe improves the overall survival (OS) of patients with metastatic non-small cell lung cancer (NSCLC). METHODS The medical charts of metastatic NSCLC were retrospectively reviewed. Histological subtype, performance status, age, gender, smoking status, comorbidities, chemotherapeutics, and erlotinib that were part of any type of treatment were recorded. RESULTS The median age of the patients was 61. The median follow-up period was longer for Group A (AMe users) than Group C (control group) (18 vs. 11 months, p<0.001). At the time of analysis, 83.8% of the patients had died. Univariate analysis showed that OS was significantly longer in Group A than Group C (21±4.2 vs. 11±0.9 months, p=0.004). In addition to AMe usage, female gender, smoking status, presence of hypertension, and erlotinib usage also had significant impacts on OS (p<0.05 for all variables). The multivariate analysis showed that only AMe (hazard ratio [HR]: 0.46, 95% CI: 0.27-0.76, p=0.003) and erlotinib (HR: 0.45, 95% CI: 0.22-0.89, p=0.02) usage were correlated with significantly longer OS. CONCLUSION Taking AMe during systemic anti-cancer treatment may significantly prolong OS of patients with meta- static NSCLC. [ABSTRACT FROM AUTHOR]

Lymphomas secondarily involving the breast are uncommon, although they do represent the largest group of tumors metastatic to breast. A 20-year-old female with lymphoblastic lymphoma (LBL) presented here with 3 month history of weight loss, night sweats, fatigue and a mass in her left breast. Her physical examination revealed a left breast mass, lympadenopathy, bilateral pleural effusion and hepatomegaly. WBC count was 17,710/mm 3 and LDH was mildly elevated. Breast ultrasound showed a 1.7 cm mass in the inner lower quadrant of left breast. Biopsy of the breast mass showed diffuse infiltration with small, round atypical cells which did not stain with CD20, CD43, CD34, cytokeratine and were positive for CD3. She was diagnosed as leukemic phase of a precursor T-cell LBL and treated with 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone), intrathecal methotrexate and cranial radiotherapy, achieving a complete response. She then was started on maintenance therapy. Four months later she returned with CNS involvement and was started on induction treatment. She had a very aggressive course of disease and died only 12 months after diagnosis. Breast involvement is very rarely seen in precursor T-cell LBL/ALL and in this patient occurred secondarily as part of widespread disease. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the distribution of metastatic lesions and their influence on survival, as well as other prognostic factors previously shown to have an impact on the outcome of patients with extensive small cell lung cancer (SCLC). Of the 207 patients were included and retrospectively analyzed; 124 patients had extended disease at initial presentation and the remaining 83 developed metastatic disease during follow-up. Patients who relapsed presented most frequently with distant metastases. The brain was the most frequent organ targeted for metastatic disease following the completion of chemotherapy (p<0.05). Serum LDH levels correlated significantly with the presence of liver metastasis (p<0.001). The site of involvement did not seem to have an impact on survival. Nevertheless, patients with multiple metastatic sites had a significantly poor survival rate (p=0.001). Weight loss, performance status, gender, clinical stage, serum LDH and albumin levels were all shown to correlate with survival (p<0.05). Response to chemotherapy was determined to be the most important prognostic factor. [ABSTRACT FROM AUTHOR]