(1) Background: Metastatic L-type sarcomas (liposarcoma and leiomyosarcoma) are rare and have a poor prognosis. Trabectedin is an effective agent that can be used after anthracyclines. This study was designed to evaluate the real-life effectiveness and safety of trabectedin. (2) Methods: A retrospective multicenter study was conducted on patients who were treated with trabectedin for metastatic L-type sarcomas at ten tertiary oncology centers between 2015 and 2023. The objective response rate (ORR), disease control rate (DCR), time to treatment failure (TTF), and overall survival (OS) were evaluated in the cohort. Cox regression analysis was used to determine prognostic factors for survival. (3) Results: A total of 98 patients (52% liposarcoma and 48% leiomyosarcoma) were included in the study. The median treatment line was three (range: 1 to 6). Thirteen patients (13.3%) underwent local treatment due to oligoprogression, and dose reduction was required in seventeen patients (17.3%) due to toxicity. The ORR and DCR were 16% and 42%, respectively. The median TTF was 3 months, and the median OS was 10 months. In univariate analysis, a significantly longer median TTF was observed in patients who underwent local treatment (p = 0.008), obtained objective responses (p < 0.001), and underwent dose reduction (p = 0.002). No statistical differences were observed according to the histologic subtype and metastatic site. In the multivariate analysis for OS, it was found that obtaining an objective response was a good prognostic factor (p = 0.003), while the presence of liver metastases was associated with a poor prognosis (p = 0.016). (4) Conclusion: Trabectedin is a suitable option for L-type sarcoma after doxorubicin-based treatments. Survival was not worse in patients who underwent dose reduction. The use of local therapies simultaneously with trabectedin can be effective.

Introduction: Hyperprogression is a specific type of response seen with immunotherapy that is observed in all malignancies with a frequency of 9% - 29%, characterized by a rapid increase in tumor burden. Many possible related factors and possible markers have been evaluated but a clinical or laboratory parameter associated with hyperprogression has not yet been established. For renal cell carcinoma, hypercalcemia is known to be a poor prognostic factor but it has not been linked to hyperprogression. Case report: We retrospectively evaluated 52 patients diagnosed with renal cell carcinoma who had nivolumab treatment in any line. 3 of 9 patients who had hyperprogression were noticed to have hypercalcemia preceding hyperprogression. Here we present those 3 cases who developed hypercalcemia after nivolumab and had hyperprogression at follow-up. Management and outcome: All cases had less than 4 courses of nivolumab and showed hyperprogression in assessment. Nivolumab was discontinued. However, patients’ survival was extremely poor, as expected. Discussion: The development of hypercalcemia may help predict hyperprogression in patients with renal cell carcinoma who receive immunotherapy. In such cases, early evaluation of progression and cessation of nivolumab may be considered.

Background and Objectives: Advanced solid organ tumors, particularly breast, lung, and prostate cancers, frequently metastasize to bone, leading to debilitating skeletal-related events (SREs). Denosumab, a RANKL inhibitor, is crucial in preventing SREs. This study aimed to comparatively evaluate the efficacy and adverse effect profiles of denosumab in patients with bone metastases originating from these three common cancer types. Materials and Methods: This retrospective study included 146 patients treated with denosumab for bone metastases. Data on demographics, SREs before and during denosumab treatment, serum creatinine, calcium, and magnesium levels (at baseline, 3, and 6 months), other adverse effects, and survival were analyzed. Results: Before denosumab, SREs were present in 36.3% of patients (breast: 43.4%, prostate: 28%, lung: 33.8%). During denosumab treatment, SRE rates markedly decreased across all groups (breast: 9.4%, prostate: 16.0%, lung: 8.8%), with no significant intergroup difference in on-treatment SREs. Significant decreases in serum calcium levels were observed at 3 and 6 months post-denosumab initiation in breast (p < 0.0001) and lung cancer patients (p = 0.001). Mean creatinine levels significantly decreased in lung (p < 0.0001) and prostate (p = 0.020) cancer patients at 3 and 6 months. Overall survival significantly differed, with lung cancer patients having the shortest median survival (p < 0.005). Conclusions: Denosumab effectively reduces the incidence of SREs in patients with bone metastases from breast, lung, and prostate cancer. However, clinicians must diligently monitor for hypocalcemia, a notable adverse effect, particularly at 3 and 6 months after starting denosumab, with specific caution warranted in patients with lung cancer.

Amaç: Kanser, psikolojik sorunlara da sebep olan bir hastalıktır. Kanser hastalarında uyku bozukluğu, depresyon, anksiyete sık görülmektedir. Bu çalışmada, diğer kanser türlerine göre kür sağlanma olasılığı daha yüksek olan erken evre meme kanseri tanılı, hormonoterapi tedavisi almakta ya da tedavisiz izlemde olan hastalarda uyku bozukluğu, depresyon, anksiyete sıklığının belirlenmesini amaçladık. Gereç ve Yöntemler: Çalışma poliklinik ortamında, Pittsburgh Uyku Kalite İndeksi (PUKİ), Uykusuzluk Şiddeti İndeksi (UŞİ), Hastane Anksiyete ve Depresyon (HAD) Ölçeği kullanılarak yapıldı. Bulgular: Çalışmaya 80 hasta dâhil edildi. Hastaların medyan yaşı 55 idi. Tüm hastalar erken evre (Evre 1, Evre 2, Evre 3) meme kanseri tanısı ile takipteydi. Hiçbir hasta kemoterapi almıyordu. 22 (%27,5) hasta tedavisiz takipte, 58 (%72,5) hasta hormonoterapi [(26 (%44,8) hasta tamoksifen, 32 (%55,1) hasta aromataz inhibitörü, 12 (%20,6) hasta gonadotropin reseptör agonisti)] almaktaydı. Doğal ya da iyatrojenik menopozda olan 59 (%73,8) hasta, premenopozal 21 (%26,3) hasta vardı. Anket sonuçlarına göre uyku bozukluğu PUKİ ile %37,5, UŞİ ile %45,5; depresyon %35, anksiyete bozukluğu %58,8 sıklıkta saptanmıştır. Kullanılan hormonoterapi türü ve menopoz durumu ile anket sonuçlarına göre gruplar arasında fark saptanmadı. Sonuç: Erken evre meme kanseri tanılı hasta grubunda kemoterapi tedavisi tamamlanmış ve hastalar takibe alınmış olsa bile uyku bozukluğu, depresyon, anksiyete bozukluğu sıklığı yüksek saptanmıştır. Kanser tanılı tüm hastaların psikolojik değerlendirme ve gereğinde tedavi amacıyla yönlendirilmesi önem taşımaktadır.

Background: In non-small cell lung cancer (NSCLC), immunotherapy is a treatment option in patients without targetable mutations in second and later lines. Nevertheless, there is no validated test that can predict immunotherapy response. Material and Methods: Our study aimed to investigate the effect of radiotherapy (RT) on survival in patients with NSCLC receiving immunotherapy after first-line chemotherapy. Twenty-five patients diagnosed with NSCLC and received immunotherapy after at least one previous chemotherapy line were included in our study. Results: The median age of the patients was 61.7 (26.6-81.2) years. 19 (76%) patients were male. 11 (44%) of the patients had received immunotherapy in the second-line and 14 (66%) in ≥3 lines. Patients had received a median of 5 cycles (1-27) of immunotherapy. RT to immunotherapy interval was 6.4 months (1.0-11.8). Partial response was observed in 12 patients, stable disease in 8 patients, progression in 1 patient, and hyperprogression in 4 patients. Median progression-free survival (PFS) was 4.4 months (95% CI; 3.2-5.6), and median overall survival (OS) was 16.4 months (95% CI; 5.6-27.3). 14 (56%) of the patients had received RT. RT was administered to 12 patients before immunotherapy, and two patients received RT to bones during immunotherapy. The patients who received RT had statistically longer PFS (4.9 vs 3.9 months, p=0.012) and OS (18.7 vs 7.3 months, p=0.023) comparing those without RT. Conclusions: Our findings showed that RT significantly improved the survival in patients who received immunotherapy, pointing that RT may have an influential role in immunotherapy response.

Background: Neuroendocrine neoplasms (NEN) originate in many body parts, with 70% reported from the gastrointestinal system, 25% from the lungs. NENs of the breast account for < 1% of all NENs. The primary breast NEN nomenclature was changed in the most recent World Health Organization classification in 2019. Since the pathological classification has changed several times, there are no definitive data on treatment management. Methods: In this study, patients followed up in our clinic were pathologically reevaluated according to the latest classification. Results: The clinical characteristics, treatments, recurrence, and survival status of 36 patients with early stage primary breast NEN were examined. A statistically significant difference was determined in respect of overall survival (OS) for the Eastern Cooperative Oncology Group Performance Score (ECOG PS), type of surgery, age ≥ 70 years, PR positivity, and tumor size. A low ECOG PS, younger age, breast-conserving surgery (BCS), and small tumor diameter were associated with better survival. A low ECOG PS, early stage, BCS, and fewer than 4 malignant lymph nodes were associated with better disease-free survival. All the patients in this study were at an early stage and were treated for typical breast cancer, although some patients diagnosed with neuroendocrine carcinoma (NEC) received cisplatin and etoposide treatment. Conclusions: In our study, the prognosis of breast NEN patients was better than the literature data. Maybe the prognosis of patients evaluated as breast NEN according to the new classification is better than the older classification groups.