Background Several studies have suggested that sarcopenia is associated with an increased treatment toxicity in patients with cancer. The aim of this study is to evaluate the relationship between sarcopenia and anthracycline-related cardiotoxicity. Methods Patients who received anthracycline-based chemotherapy between 2014 and 2018 and had baseline abdominal CT and baseline and follow-up echocardiography after anthracycline treatment were included. European Society of Cardiology ejection fraction criteria and American Society of Echocardiography diastolic dysfunction criteria were used for definition of cardiotoxicity. Sarcopenia was defined on the basis of skeletal muscle index (SMI) and psoas muscle index (PMI) calculated on CT images at L3 and L4 vertebra levels. Results A total of 166 patients (75 men and 91 women) were included. Sarcopenia was determined in 33 patients (19.9%) according to L3-SMI, in 17 patients (10.2%) according to L4-SMI and in 45 patients (27.1%) according to PMI. 27 patients (16.3%) developed cardiotoxicity. PMI and L3-SMI were significantly associated with an increased risk of cardiotoxicity (L3-SMI: HR=3.27, 95% CI 1.32 to 8.11, p=0.01; PMI: HR=3.71, 95% CI 1.58 to 8.73, p=0.003). Conclusions This is the first study demonstrating a significant association between CT-diagnosed sarcopenia and anthracycline-related cardiotoxicity. Routine CT scans performed for cancer staging may help clinicians identify high-risk patients in whom closer follow-up or cardioprotective measures should be considered.

Immune checkpoint inhibitors (ICIs) are widely used in clinical practice. The primary objective of this study is to evaluate the safety and efficacy of ICIs in patients diagnosed with cancer who also have chronic hepatitis B virus (HBV) infection. We reviewed the charts of patients who received an ICI between 2016 and 2023 at three tertiary cancer centers. We included those who had known chronic HBV infection. Of the 1352 patients screened, we identified 65 (4.8%) with concurrent hepatitis B. Of the 65 patients, 8 (12.3%) experienced irAEs (immune-related adverse events) of any grade, with 1 (1.5%) having grade 3 pneumonitis. No cases of reactivation were seen except for one patient (1.5%) with poor compliance with his antiviral drug developed hepatitis B reactivation 9 months after discontinuation of ICI. ICIs appear safe in patients with chronic hepatitis B, especially when antiviral treatment is given. We believe these patients should not be deprived of the potential benefits of ICIs solely because of chronic viral infection, neither in daily practice nor in clinical trials.

Background: It is well known that supportive care clinics are vital in medical oncology practice. This study aims to present a portrait of the supportive care clinic of a tertiary cancer center in a low-middle-income country. Methods: This study included patients admitted to our supportive care clinic between January 2019 and December 2023. This study included patients who attended the supportive care clinic. For patients who were readmitted more than once throughout the study period, only the first readmission was included in the analysis. The primary outcome of this study was a better understanding of the risk factors associated with hospital readmissions in cancer patients, which could lead to improved patient outcomes. In addition, the secondary objective was to identify the characteristics of patients and clinical decisions regarding follow-ups as inpatients or outpatients referred to the supportive care clinic. Results: This study included 477 patients; 300 (62.9%) were directed to oncology inpatient care, while 177 (37.1%) were treated as outpatients. The most common diagnoses were lung cancer (20.5%), colorectal cancer (13.6%), and breast cancer (8.4%). Most patients (71.5%) were evaluated for symptom palliation. In multivariate analysis, metastatic disease (OR: 2.52 95% CI 1.48–4.29 p = 0.001), Eastern Cooperative Oncology Group (ECOG) performance status (OR: 1.58 95% CI 1.04–2.42 p = 0.034), and a decrease in albumin levels (OR: 0.42 95% CI 0.29–0.61 < 0.001) were significantly related to hospitalization. In univariate analyses, albumin level (p < 0.001), disease stage (p = 0.007), and ECOG performance status (p = 0.025) were statistically associated with unplanned hospital readmission. Among these factors, a decrease in albumin levels was significantly associated with the outcome, with an odds ratio of 0.54 (95% CI 0.39–0.75, p < 0.001), indicating a protective effect of higher albumin levels. In univariate analyses, sex (p = 0.016), cancer treatment type (p = 0.010), albumin level (p < 0.001), disease stage (p < 0.001), unplanned hospital readmission (p < 0.001), ECOG performance status (p < 0.001), and hemoglobin (p = 0.008) were statistically related to overall survival. Among these factors, sex (HR: 1.28 95% CI 1.03–1.59 p = 0.025), a decrease in albumin levels (HR: 0.67 95% CI 0.56–0.82 p < 0.001), disease stage (HR: 1.52 95% CI 1.11–2.09 p = 0.008), unplanned hospital readmission (HR: 1.30 95% CI 1.03–1.63 p = 0.027), and ECOG performance status (HR: 3.45 95% CI 2.68–4.45 p < 0.001) remained significant in the multivariate analysis. Conclusions: This study shows that supportive care clinics are a key element of patient care. Early evaluation of patients in supportive care clinics may aid clinicians in identifying high-risk patients who may require closer follow-up or inpatient care. Several factors were identified as predisposing to hospitalization, unplanned hospital readmission, and overall survival. Further prospective studies are needed to determine the risk factors associated with hospitalization, readmission, and overall survival.

Introduction: Although, immune check-point inhibitors changed the course of many cancers, the outcomes in sarcomas were rather disappointing with less than 10% response rates. Ewing sarcoma is a poorly differentiated and aggressive tumor mostly seen in the children and adolescents. It’s a distinct type of sarcoma with prominent chemosensitivity in the early stages. However, the relapsing disease has a poor prognosis with limited treatment options. Case report: Herein, we represent a case of relapsed Ewing sarcoma treated with multiple lines of chemotherapy. Management & outcome: The patient had a very good response to salvage treatment with a combination of paclitaxel and nivolumab which lasted for twelve months after the cessation of treatment. Discussion: We think that chemotherapy plus immunotherapy can be an option for Ewing sarcoma patients treated with multiple lines of chemotherapy.

Background: Several studies have suggested that the serum albumin–creatinine ratio (sACR) is a useful marker for the early risk stratification of patients with cardiomyocyte injury. This study aims to evaluate the relationship between sACR and anthracycline-related cardiotoxicity. Methods: This study included patients who had received anthracycline-based chemotherapy between 2014 and 2023 and had undergone baseline and follow-up echocardiography after the treatment. The level of sACR was calculated using serum albumin and creatinine values obtained before the chemotherapy. The definition of cardiotoxicity was based on the criteria of the European Society of Cardiology (ESC) for ejection fraction and the American Society of Echocardiography (ASE) for diastolic dysfunction. The patients were categorized into either the high or low sACR group based on the cut-off value obtained from the receiver operating characteristic (ROC) curve analysis. Results: In total, 525 patients (159 males, 366 females) were included. Multivariate analysis after adjustment for age, body mass index (BMI), cardiovascular disease, hemoglobin, anthracycline dose, and gender showed that sACR (HR = 1.85% 95 CI 1.12 to 3.06 p = 0.016), cardiovascular disease (HR = 1.97% 95 CI 1.08 to 3.61 p = 0.027), BMI (HR = 1.86% 95 CI 1.12 to 3.10 p = 0.017), and age (HR = 1.02% 95 CI 1.001 to 1.04 p = 0.036) were significantly associated with an increased risk of cardiotoxicity. Conclusions: This study is the first to show a significant relationship between sACR and cardiotoxicity related to anthracycline use. Routine laboratory tests that are conducted before anthracycline therapy can aid clinicians in identifying high-risk patients who may require closer follow-up or cardioprotective measures.