Purpose: Previous studies have reported that blood-based inflammatory markers are associated with prognosis in patients with various solid tumors, including colorectal cancer (CRC). The pan-immune inflammation value (PIV) is a novel prognostic biomarker based on blood count. Here, we aimed to study the association between PIV and survival following transarterial radioembolization (TARE) in patients with liver-dominant metastatic colorectal cancer (CLM). Methods: A total of 49 patients with CLM who underwent TARE at the Ankara University Department of Medical Oncology were retrospectively analyzed. The relationship between clinical and laboratory parameters with post-TARE overall survival (OS) was analyzed by multivariate analyses. Results: The median age was 60 years and 71.4% of patients had received at least two lines of chemotherapy. The objective response rate (ORR) was 59.1% following TARE. Patients with hepatic response after TARE treatment demonstrated significantly longer survival compared to non-responders (p: 0.033). The optimal PIV threshold value was calculated as 629 in ROC analyses. This PIV value had 81% sensitivity and 80% specificity for OS prediction (AUC 0.86; 95% CI: 0.75–0.98, p = 0.008). Patients with elevated PIV > 629 had significantly shorter OS (p = 0.002). In the multivariate analysis, adjusted for ECOG PS, TARE response, presence of extrahepatic disease, number of chemotherapy lines, CEA levels and post-TARE NLR and PIV, only low PIV level was associated with longer OS (>629 vs. ≤629; HR: 4.87; 95% CI: 1.32–17.92; p = 0.017). Conclusions: PIV, a blood-based inflammatory score, may reflect the host’s immune response following TARE and serve as a novel predictor of survival.

Ewing sarcoma (ES) mainly affects children and adolescents; thus, treatment protocols for adult patients are adapted from pediatric protocols. Long treatment durations often lead to treatment discontinuation for adults. This single-center retrospective study evaluated real-world outcomes and compliance with standard chemotherapy regimens in adult patients with localized ES. Adult patients diagnosed with localized ES who underwent curative intent treatment between 2007 and 2022 were retrospectively analyzed. Patients who were intended to receive the vincristine, adriamycin, and cyclophosphamide (VAC)/(ifosfamide, etoposide) regimen, consisting of 18 cycles along with local treatment, were included in this study. Adherence to the treatment protocol and outcomes were evaluated. Event-free survival (EFS) and overall survival were calculated, and predictors of treatment completion were assessed. A total of 31 patients were analyzed. Median age was 28 years (range, 18–71 yr); 17 patients were male (54.8%) and 14 were female (45.2%). Fourteen (45.1%) patients underwent surgery, 10 (32.3%) received radiotherapy, and 7 (22.5%) received both treatments. Eighteen (58.1%) patients completed 18 chemotherapy cycles. Patients undergoing surgical resection were likelier to complete all the chemotherapy cycles (odds ratio: 0.117, 95% confidence interval: 0.016–0.835). The estimated 5-year EFS and overall survival rates were 37% and 58%, respectively. Multivariate analysis identified a neutrophil-lymphocyte ratio ≥ 5 as an independent predictor of EFS (hazard ratio: 4.50, 95% confidence interval: 1.52–13.30, P = .006). Compliance with the 51-week-long vincristine, adriamycin (doxorubicin), and cyclophosphamide/ifosfamide and etoposide chemotherapy regimen remains a critical issue for adult patients. Our findings suggest that surgical resection may be associated with better compliance with the chemotherapy protocol, and a neutrophil-lymphocyte ratio of ≥5 may be linked to poorer outcomes.

Are Changes in PET/CT SUVmax Associated with Pathologic Complete Response in Breast Cancer Patients Receiving Neoadjuvant Therapy? - Acta Haematologica Oncologica Turcica

Background: Achieving no evidence of disease (NED) in HER2-positive metastatic breast cancer (MBC) has been proposed as a response-state marker for durable disease control. However, its clinical significance and predictive factors are not yet well established. Methods: In this multicenter retrospective study at 13 oncology centers in Turkey, we analyzed 118 patients with stage IV HER2-positive MBC who received trastuzumab-based first-line therapy and remained progression-free for at least 36 months. Patients were stratified by radiologically defined NED status according to RECIST v1.1. Clinicopathological features were compared between groups, and predictors of NED were identified using logistic regression. Progression-free survival (PFS) was estimated by Kaplan–Meier analysis and assessed with Cox regression. Results: Of the 118 patients, 55 (46.6%) achieved NED. Compared with patients who did not achieve NED, those attaining NED were younger (median 46 vs. 53 years, p = 0.013), had better ECOG performance status (p = 0.005), were more likely to have HER2 IHC 3+ status (p = 0.015), and higher histologic grade tumors (p = 0.013). In multivariable logistic regression, ECOG PS 0 (vs. 1 ; OR = 5.99, p = 0.005), HER2 IHC 3+ (vs. IHC 2+/ISH+; OR = 4.79, p = 0.035), and histologic grade ≤2 (vs. grade 3 ; OR = 0.25, p = 0.011) were independently associated with NED attainment. Patients who achieved NED had experienced significantly longer PFS than those who did not (median 131 months vs. 66 months; p < 0.005). In multivariate Cox regression, NED remained independently associated with prolonged PFS (HR = 0.24, p = 0.003). Metastasis-directed local therapy and treatment regimen (trastuzumab vs. trastuzumab + pertuzumab) were not independently associated with NED attainment or PFS. Conclusions: In this multicenter cohort of pre-selected long-term responders, nearly half of HER2-positive MBC patients achieved radiologic NED. Radiologic NED was independently associated with prolonged PFS within this enriched population. Factors associated with NED attainment included favorable ECOG performance status, HER2 IHC 3+ expression, and high tumor grade; given the wide confidence intervals, these estimates should be interpreted cautiously as exploratory and hypothesis-generating.

Background: Treatment options for metastatic unresectable osteosarcoma are limited, and there is no standard approach after the failure of first-line chemotherapy. Conventional chemotherapy in the second and subsequent lines typically yield a median progression-free survival (PFS) of less than 4 months, with objective response rates ranging from 3 to 29%. The activity of anti-vascular endothelial growth factor receptor multi-tyrosine kinase inhibitors (TKIs) in bone sarcomas has been demonstrated. We present a case of metastatic osteosarcoma exhibiting a durable response to regorafenib treatment. Case: We discuss a 30-year-old male with metastatic osteosarcoma who had extensive bone and lung metastases and was ineligible for metastasectomy. The patient had received all active chemotherapy regimens in the early and metastatic stages except ifosfamide. Next generation sequencing analysis of resected tumor tissue revealed a possibly pathogenic missense mutation (P.G472E) in NOTCH1 gene. Due to the presence of heart failure with a reduced ejection fraction, chemotherapy was not considered, and regorafenib was initiated. After four cycles of regorafenib, a partial metabolic response was achieved. The patient was followed up without progression under regorafenib for 15 months, without requiring dose reduction. Unfortunately, the treatment had to be interrupted for an extended period due to challenges with recurrent tumor infection and the necessity for repeated surgeries. Following successful wound site control, we restarted full-dose regorafenib and achieved a metabolic partial response again. Conclusion: To our knowledge, this case represents the longest achieved PFS with regorafenib in metastatic osteosarcoma. TKIs can provide a durable clinical response in metastatic osteosarcoma patients. Clinical and molecular biomarkers are required to determine which patients are most likely to benefit from these treatments.

Triple-negative breast cancer (TNBC) is an aggressive subtype with limited treatment options and poor prognosis. Effective prognostic tools are essential to guide risk-adapted strategies following neoadjuvant chemotherapy (NACT). In this multicenter retrospective study, we evaluated 690 patients with locally advanced TNBC treated between 2010 and 2023 across 25 oncology centers. Patients were stratified into CPS-EG risk groups: low (0–1), intermediate (2–3), and high (≥4). The CPS-EG score was strongly associated with pathological complete response (pCR), recurrence, disease-free survival (DFS), and overall survival (OS). Five-year DFS rates were 80.6%, 53.2%, and 31.5% in the low-, intermediate-, and high-risk groups, respectively, while OS rates were 76.7%, 53.2%, and 48.8% (p<0.001). Multivariate analysis confirmed CPS-EG as an independent predictor of both DFS and OS after adjusting for clinicopathological factors. These findings highlight the CPS-EG score as a simple, cost-effective, and widely applicable prognostic tool that may improve post-NACT risk stratification and support treatment decisions, especially in resource-limited oncology settings.