Our understanding of prognostic and predictive factors in the context of nivolumab combined with chemotherapy remains limited. In our multicenter study conducted across 16 centers, data from 153 patients with metastatic gastric adenocarcinoma and a PD-L1 CPS score ≥ 5, who received nivolumab in combination with chemotherapy as first-line treatment, were retrospectively analyzed for the period between 2021 and 2024. The study aimed to investigate the prognostic and predictive significance of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Systemic Immune-Inflammation Index (SII), as well as various clinical parameters. The estimated median progression-free survival (PFS) was 11.06 months while the estimated median overall survival (OS) was 16.03 months. Patients who were initially diagnosed with metastatic disease had a significantly worse prognosis, as was those with lung metastases. Lower NLR, PLR, and SII values were associated with longer PFS and OS in the univariate analysis; however, their statistical significance was not mantained in the multivariate analysis. SII and PD-L1 CPS score were determined as independent predictive factors for nivolumab plus chemotherapy treatment response. Our study is the only one to date that sheds light on prognostic and predictive factors in patients with metastatic gastric or GEJ adenocarcinoma and a PD-L1 CPS score ≥ 5, who received nivolumab in combination with chemotherapy.

Background/Objectives: Extrapulmonary neuroendocrine carcinomas (EP-NECs) are rare, aggressive malignancies with no standardized treatment approach. Although platinum-based chemotherapy is considered the first-line therapy, overall survival (OS) and progression-free survival (PFS) remain limited. This study aims to evaluate the clinical and pathological characteristics of EP-NEC patients, their treatment responses, and survival outcomes. Methods: This retrospective observational study included 29 EP-NEC patients diagnosed and followed between 2015 and 2024. Clinical and demographic data, tumor localization, disease stage, administered treatments, and survival outcomes were analyzed. Kaplan–Meier survival analysis was used to assess OS and PFS, with subgroup comparisons performed via the log-rank test. Results: The most common primary tumor sites were the pancreas (21%), prostate (17%), and cervix (14%). At diagnosis, 55.2% of patients had metastatic disease. First-line platinum-based chemotherapy achieved an objective response rate of 82.1%, with a median PFS of 8.16 months and a median OS of 14.16 months. Surgical intervention significantly improved survival (p = 0.020), while a high Ki-67 proliferation index (>80%) was associated with worse PFS (p = 0.032). Other factors, including smoking status and liver-directed therapies, had no significant impact on survival. Conclusions: EP-NECs present with a poor prognosis despite platinum-based chemotherapy achieving high response rates. Surgical resection improves survival outcomes, whereas high Ki-67 expression is associated with a worse prognosis. These findings highlight the need for further research into novel therapeutic strategies for EP-NECs.

Background/Objectives: ABO/Rh blood groups and systemic inflammation are each linked to cancer biology and prognosis, yet their combined and interactive prognostic value has not been clarified in small-cell lung cancer (SCLC). We investigated the distribution of ABO/Rh blood groups in SCLC, their association with baseline complete blood count (CBC)–derived inflammatory indices, and the prognostic significance of blood group–inflammation interactions for treatment response and survival outcomes. Methods: This retrospective study included 158 patients with SCLC with available ABO/Rh typing and pretreatment CBC data. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune–inflammation index (SII), and systemic inflammation response index (SIRI) were calculated using standard formulas. Treatment response was assessed according to RECIST v1.1 and categorized as response (CR/PR) versus non-response (SD/PD). Progression-free survival (PFS) and overall survival (OS) were analyzed using Cox regression models incorporating interaction terms. Results: Patients with blood group O exhibited consistently lower baseline inflammatory indices compared with non-O blood groups. Non-O blood group status and higher SIRI independently predicted chemoradiotherapy non-response. Among the evaluated indices, SIRI demonstrated superior diagnostic performance compared with SII, NLR, and PLR. Similarly, non-O blood group status and higher SIRI were independently associated with increased risks of progression and mortality. In joint analyses, compared with blood group O and low SIRI (reference), the highest risk of progression was observed in patients with blood group AB × high SIRI (HR 14.67), followed by blood groups A × high SIRI (HR 10.38) and B × high SIRI (HR 7.95). A similar pattern was observed for mortality, with the highest risk in patients with blood group AB × high SIRI (HR 22.76), followed by blood groups A × high SIRI (HR 13.93) and B × high SIRI (HR 12.41). Conclusions: ABO blood group is associated with distinct inflammatory profiles in SCLC. Elevated SIRI independently predicts treatment non-response and adverse survival, and its prognostic effect varies by blood group, underscoring the role of host biology in modulating systemic inflammation.

Background/Aims: The treatment of hepatocellular carcinoma (HCC), which accounts for 90% of all liver cancers, is highly varied. The use of second-line treatments following progression on first-line atezolizumab and bevacizumab (Atez/Bev) for advanced HCC remains controversial. The aim of this study was to analyze the real-world clinical results of second-line treatments in progression after Atez/Bev and to determine the factors affecting prognosis. Materials and Methods: Fifty-eight patients treated with second-line sorafenib, regorafenib, and cabozantinib for progression after first-line Atez/Bev for advanced/metastatic HCC from 20 centers in Türkiye between October 2020 and June 2024 were retrospectively analyzed. Responses were evaluated by Response criteria, specifically Response Evaluation Criteria in Solid Tumors (RECIST v1.1) criteria. Median overall survival (OS) and progression-free survival (PFS) were computed with the Kaplan–Meier method. The Cox regression model was utilized to analyze multivariate analyses. Results: About 82.8% of the patients were male and the median age of the whole group was 62 (range, 18-78) years. All patients progressed after first-line Atez/Bev and were given second-line treatment. The most commonly used second-line treatment option was sorafenib (70.7%), followed by regorafenib (12.1%) and cabozantinib (10.3%). Both median PFS (4.1 months) and median OS (7.8 months) were longer in patients treated with sorafenib compared to other treatments. In univariate analyses, Child–Pugh score B, alpha-fetoprotein (AFP) levels (>200 ng/mL), extrahepatic spread, and Prognostic Nutritional Index (PNI) < 47.6 substantially raised the risk of overall mortality. Multivariate analysis showed that extrahepatic spread (HR (Hazard ratio): 0.41, P = .012), PNI level (HR: 0.24, P =.005), and AFP level (HR:1.97, P = .049) were independent predictors of OS. Conclusion: Although second-line therapies after Atez/Bev show different degrees of efficacy, survival rates are consistent with the literature. Extrahepatic spread, AFP level, and PNI level are the main prognostic factors. In light of this information, personalized treatment strategies may improve outcomes for this challenging patient group. Cite this article as: Majidova N, Yaslıkaya S, Mıldanoglu MM, et al. Efficacy of second-line treatments after atezolizumab and bevacizumab in advanced hepatocellular carcinoma and related prognostic factors: A multicenter study by the turkish oncology group (TOG). Turk J Gastroenterol. 2025;36(5):293-301.

Background: Immune checkpoint inhibitors (ICIs) have become the standard first-line treatment for patients with metastatic non-small cell lung cancer (NSCLC) with high programmed death-ligand 1 (PD-L1) expression. However, the optimal selection between immunotherapy monotherapy and chemo-immunotherapy in patients with a PD-L1 tumor proportion score (TPS) ≥ 50% remains uncertain in routine clinical practice. Methods: We retrospectively reviewed patients with metastatic NSCLC and a PD-L1 TPS ≥ 50% who initiated first-line treatment with pembrolizumab monotherapy or pembrolizumab combined with platinum-based chemotherapy at the Istanbul Medipol University Department of Medical Oncology between July 2017 and December 2024. Survival outcomes, including progression-free survival (PFS) and overall survival (OS), were evaluated and compared according to PD-L1 expression levels and treatment strategy. Prognostic factors associated with survival outcomes were also explored. Results: A total of 65 patients were included, of whom 36 received pembrolizumab plus chemotherapy and 29 received pembrolizumab monotherapy. The estimated median PFS and OS for the entire cohort were 24.2 months (95% CI, 6.5–33.0) and 34.6 months (95% CI, 6.5–62.7), respectively. Patients with very high PD-L1 expression (TPS ≥ 90%) experienced significantly longer survival outcomes compared with those with a TPS of 50–89%, and a PD-L1 TPS ≥ 90% remained an independent prognostic factor for OS. When treatment strategies were compared across the entire cohort, no statistically significant differences in PFS or OS were observed between immunotherapy monotherapy and chemo-immunotherapy. Hypertension was identified as an independent negative prognostic factor for PFS. In patients with a PD-L1 TPS ≥ 90%, survival outcomes numerically favored pembrolizumab monotherapy, although this difference did not reach statistical significance. Conclusions: In this real-world cohort of patients with PD-L1 high metastatic NSCLC, PD-L1 expression, particularly very high TPS levels, was strongly associated with survival outcomes. While no survival differences were observed between treatment strategies in the overall population, pembrolizumab monotherapy may represent an appropriate first-line option in selected patients with a PD-L1 TPS ≥ 90%. Larger prospective studies are warranted to refine treatment selection in this setting.

Cytotoxic Lesion of the Corpus Callosum Associated with 5-Fluorouracil: A Case Report and Review of Literature - Journal of Oncological Sciences