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Background: Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) for assessing axillary lymph node status in clinically node-negative breast cancer patients. However, the approach to axillary surgery after neoadjuvant treatment is still controversial. In the present study, our objective was to predict the pathological nodal stage based on SLNB results and the clinicopathological characteristics of patients who initially presented with clinical N1 positivity but whose disease status was converted to clinical N0 after neoadjuvant chemotherapy (NAC). Materials and methods: After NAC, 150 clinically node-negative patients were included. The relationships between clinicopathologic parameters and the number of positive lymph nodes in SLNBs and ALNDs were assessed through binary/multivariate logistic regression analysis. Results: Among 150 patients, 78 patients had negative SLNBs, and 72 patients had positive SLNBs. According to the ALND data of 21 patients with SLNB1+, there was no additional node involvement (80.8%), 1–2 lymph nodes were positive in 5 patients (19.2%), and no patient had ≥ 3 lymph nodes involved. Following the detection of SLNB1 + positivity, the rate of negative non-sentinel nodes were 75% in the luminal A/B subgroup, 100% in the HER-2-positive subgroup, and 100% in the triple-negative subgroup. Patients with a lower T stage (T1-3 vs. T4), fewer than 4 clinical nodes before NAC (< 4 vs. ≥4), and a decreased postoperative Ki-67 index (< 10% vs. stable/increase) were included. According to both univariate and multivariate analyses, being in the triple-negative or HER2-positive subgroup, compared to the luminal A/B subgroup (luminal A/B vs. HER2-positive/triple-negative), was found to be predictive of complete lymph node response. Conclusion: The number of SLNB-positive nodes, tumor-related parameters, and response to treatment may predict no additional nodes to be positive at ALND. [ABSTRACT FROM AUTHOR]

Objectives: Androgen deprivation therapy (ADT) is used alone or in combination with docetaxel or androgen inhibitors in the initial treatment of metastatic PC (mPC). Enzalutamide is an androgen receptor inhibitor that is used orally and plays a role in different steps of the androgen receptor (AR) signal pathway. The aim of this study is to determine the real life data of patients using enzalutamide for metastatic PC. Methods: 118 patients from totally 6 centers using enzalutamide treatment were included in this retrospective analysis. Clinical information of patients were recorded from patient files or automation records. Results: Median OS was 71 months and median PFS was 5 months (4,1-5,9 months). There was no association of Gleason score with OS and PFS (p=0.5 and p=0.4, respectively). Although those who were metastatic at the time of diagnosis lived longer than those who developed metastases later, the difference was not statistically significant (p=0.9). Likewise, there was no relationship between the time of metastasis development and PFS (p=0.2). There was no difference in OS and PFS between patients with visceral metastasis and those without (p=0.3, p=0.5, respectively). Conclusion: Enzalutamide is an effective and safe agent in accordance with the literature in the patient group included in this study, although some patients may have an unresponsiveness to enzalutamide or develop progression under the enzalutamide treatment. More studies are needed to understand which patient group can benefit more from enzalutamide. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we aimed to investigate the utilization of 68Ga-FAPI PET/CT in comparison to 18FDG PET/CT to evaluate the peritoneal involvement of the gastrointestinal malignancies alongside primary lesions and other metastatic foci. Procedures: A total of 37 patients with various gastrointestinal malignancies with accompanying peritoneal involvement who underwent 68Ga-FAPI PET/CT and 18FDG PET/CT imaging between September 2020 and June 2021 were included in this retrospective study. SUVmax values of 68Ga-FAPI and 18FDG were compared according to lesion locations. Also, the lesion localization ability of both imaging was compared in patient basis. Results: Of the 37 patients with peritoneal involvement (23 males and 14 females; median age, 62.8 ± 12.7 years), 35.1% (n = 13) had colorectal cancer, 37.8% (n = 14) gastric cancer, and 27.0% (n = 10) pancreaticobiliary cancer. While 45.9% of them were operated, the remaining did not have surgery. The mean time interval between two studies was 3.2 days (range: 2–6 days). The mean SUVmax value of peritoneal metastases (p < 0.001) was significantly higher with 68Ga-FAPI PET/CT compared to that with 18FDG PET/CT, as in primary lesions (p < 0.001), lymph node metastases (p = 0.006), liver metastases (p = 0.002), and bone metastases (p = 0.018). A total of 185 lesions was detected in the initial assessment with 18FDG PET/CT. Of the total lesions detected with 18FDG PET/CT, 5 of them were evaluated as benign lesions with 68Ga-FAPI PET/CT also in accordance with the reference standard. In addition to 180 lesions detected with 18FDG PET/CT, a total of 37 additional malignant lesions, 12 of which were peritoneal metastases, were detected with 68Ga-FAPI PET/CT. Conclusion: 68Ga-FAPI PET/CT was determined to be superior to 18FDG PET/CT in terms of detection of peritoneal involvement with high image quality as well as primary tumor and other metastatic foci. Consequently, 68Ga-FAPI PET/CT can be used as a complementary imaging modality especially for inconclusive 18FDG findings due to the lack of accuracy of 18FDG PET/CT in some of the metastatic regions, especially in the liver. [ABSTRACT FROM AUTHOR]

Purpose: We compared the ability of 68Ga-FAPI PET//CT with 18FDG PET/CT imaging techniques to detect additional lesions in breast cancer patients that may affect further chemotherapy options.Methods: A total of 48 patients with breast cancer underwent concurrent 68Ga-FAPI-04 and 18FDG PET/CT regardless of whether they had received chemotherapy or not in the last month before imaging. Both modalities were compared according to various parameters: clinical/pathological features, number of lesions detected, activity uptake (SUVmax), and the effect on the evaluation of response to treatment in the post-chemotherapy group.Results: This retrospective study included 48 patients with breast cancer (mean age 53.3 ± 11.7 years; IDC 89.6%; ILC 10.4%). In the comparison of both modalities, no statistical significance was obtained in terms of the pathological characteristics of the patients. More lesions were demonstrated in all categorized regions in 68Ga-FAPI PET/CT imaging with higher uptake values compared to 18FDG PET/CT in this study. In the treatment response evaluation of the post-chemotherapy group, 12 cases (12/24) who were evaluated as PMR, CMR, or SD according to 18FDG PET/CT results were later accepted as PD due to newly detected lesions in complementary 68Ga-FAPI PET/CT imaging and treatment of patients was managed accordingly by clinicians.Conclusion: It was determined that 68Ga-FAPI PET/CT was superior to 18FDG PET/CT in terms of accuracy and it was thought that 68Ga-FAPI PET/CT could be utilized as an additional complementary imaging to 18FDG PET/CT. Moreover, 68Ga-FAPI PET/CT, with its significant theranostic potential, could become a key element in predicting the pathological response of breast cancer patients in further researches. [ABSTRACT FROM AUTHOR]

Background: Adenocancer pathologic subtype, smoking history, and women gender have been known to predict the parameters such as the sensitivity to epidermal growth factor receptor tyrosine kinase inhibitors in advanced non-small cell lung cancer (NSCLC); however, we need new predictive markers as well as driver mutations for better treatment options. The aim of this study is to investigate the predictive role of sarcopenia in lung adenocancer patients treated with erlotinib. Materials and Methods: This study was designed as retrospectively. Skeletal muscle index (SMI) was measured with a single cross-sectional area of the muscle at the third lumber vertebra (L3, cm2)/(height × height)(m2). Sarcopenia was defined by median cutoff values of SMI of women (<28.2 cm2/m2) and men (<32.7 cm2/m2). The predictive role of sarcopenia and other parameters was assessed by the cox-regression model. Results: The median age was 56 years (range, 36–84). Median progression-free survival (PFS) was 38 (95% confidence interval [CI]: 21.3–54.6) weeks in the sarcopenic group and 49 (95% CI: 0–101.4) weeks in the nonsarcopenic group (P = 0.053). In multivariate analysis, the presence of sarcopenia and number of metastatis were the independent predictive factors for PFS. Disease control rate and overall survival were not significantly different between sarcopenic and nonsarcopenic groups. Conclusion: We found that the presence of sarcopenia and number of metastasis were a predictive marker in NSCLC patients treated with erlotinib. It is important to recognize sarcopenia early and manage patients accordingly. [ABSTRACT FROM AUTHOR]

The article comments on the use of P-value as a metric of magnitude of clinical benefit in the KEYNOTE-394 study on pembrolizumab in patients with hepatocellular carcinoma compared to the similarly designed KEYNOTE-240 clinical trial. It argues that assessing clinical utility on the basis of median and delta overall survival values alone may be misleading and that the two studies have similar clinical implications considering their similar hazard ratios of death and P-values.

Introduction: Nivolumab is a human IgG4 programmed death-1 immune checkpoint inhibitor antibody. Immune-related toxicity may be associated with higher response even after interruption of nivolumab. Case report: We reported a case diagnosed with metastatic clear cell renal cell carcinoma and treated with nivolumab as fourth-line therapy. Although nivolumab treatment was stopped after two cycles due to grade 3 renal toxicity, progression-free survival rates of 11 months, that is quite a long time for fourth-line treatment of renal cell carcinoma was observed. Management and outcome: Therefore, we speculate that when renal toxicity develops, response may continue even after interruption of nivolumab in renal cell carcinoma. Discussion: Nivolumab was approved to be used for second-line treatment of renal cell carcinoma with 4.6 months of median progression-free survival benefit. Higher immune-related toxicity can produce higher efficacy for some instances such as malignant melanoma, lung cancer, and renal cell carcinoma. Renal disturbance during nivolumab treatment is extremely rare, and there are no data on survival after interruption due to renal toxicity of nivolumab without further treatment in renal cell carcinoma. In the present case, we obtained long duration of stable disease, with two cycles of nivolumab after the development of nephrotoxicity. Close follow-up without any treatment until progression may be a treatment choice, because nephrotoxicity can be a sign of benefit and durable response to nivolumab. [ABSTRACT FROM AUTHOR]