Background/Objectives: Cancer patients using implanted venous access devices (ICVADs) for chemotherapy are at increased risk of venous thromboembolism (VTE), but the performance of risk assessment models (RAMs) in this setting is understudied. This study evaluated VTE incidence, risk factors, and the predictive performance of the Khorana, COMPASS-CAT, and ONKOTEV models. Methods: We retrospectively reviewed records of adult cancer patients treated with chemotherapy via ICVADs. The cumulative incidence (CI) of VTEs was estimated using the Fine–Gray method, and RAM performance was assessed by sensitivity, specificity, predictive values, accuracy, and AUC. Overall survival (OS) was analyzed using Kaplan–Meier and log-rank tests. Results: A total of 446 patients were included. The most common cancers were colorectal (29.6%), gastric (26%), pancreatic (18.4%), and breast (13.9%). During a median follow-up of 16.5 months, VTEs occurred in 82 patients (18.4%), including 43 (9.6%) that were ICVAD-related. Median time to VTE was 117 days and 68 days for ICVAD-related events. The CI of VTEs was 9% at 1 year and 18.4% at 2 years. ONKOTEV showed the best performance (accuracy of 74.4%, specificity of 85.7%, and AUC of 0.607), with 1-year incidence higher in the high-risk group (28.5% vs. 12.4%, p < 0.001). In contrast, all RAMs showed limited ability for ICVAD-related VTEs. VTE was independently associated with inferior OS (HR 1.39, p = 0.037). Conclusions: Cancer patients with ICVADs face a substantial risk of early VTEs. Among evaluated RAMs, ONKOTEV performed best for overall but not ICVAD-related events. Prospective studies are needed to guide prophylaxis strategies using validated RAMs.

Background/Objectives: In metastatic breast cancer (MBC) treated with CDK4/6 inhibitors, baseline neutrophil-to-lymphocyte ratio (NLR) is an established prognostic marker. On-treatment NLR dynamics have shown inconsistent associations with survival, and no prior study has decomposed change into neutrophil-driven and lymphocyte-driven components.Methods: We retrospectively analyzed 352 patients with HR+/HER2− MBC treated with ribociclib. Using paired neutrophil and lymphocyte counts at baseline and 4 months, a log-linear decomposition classified patients into four NLR-trajectory phenotypes by dominant driver of change. Associations with progression-free survival (PFS) and overall survival (OS) were assessed using a 4-month landmark approach with multivariable Cox models, with robustness evaluated across four thresholds, tertiles, and a continuous model. Secondarily, NLR change was related to discordance between 3-month and best overall response.Results: NLR trajectory was not associated with PFS in any specification (multivariable hazard ratio [HR] 1.15 per standard deviation [SD], 95% CI 0.97–1.37, p=0.12), but was independently associated with OS: each 1-SD increment carried an HR of 1.40 (95% CI 1.18–1.67, p< 0.001), confirmed on bootstrap resampling. Adding NLR trajectory to a baseline clinical model improved discrimination (C-index +0.04) and fit (likelihood-ratio p< 0.001). Proportional hazards was violated for the phenotype term, indicating a time-varying effect within two years post-landmark. NLR trajectory was unrelated to dose-limiting neutropenia or dose reduction (both p>0.24). Primary refractory patients showed blunted NLR decline versus responding or stable patients (p=0.008), independent of baseline NLR.Conclusions: On-treatment NLR trajectory is a PFS-independent, toxicity-independent correlate of OS in ribociclib-treated MBC, distinct from direct tumor control. Prospective external validation is warranted.

Background/Objectives: In metastatic breast cancer (MBC) treated with CDK4/6 inhibitors, baseline neutrophil-to-lymphocyte ratio (NLR) is an established prognostic marker. On-treatment NLR dynamics have shown inconsistent associations with survival, and no prior study has applied a dominant-driver decomposition to classify patients by whether NLR change is neutrophil- or lymphocyte-driven. Methods: We retrospectively analyzed 352 patients with HR+/HER2− MBC treated with ribociclib. Using paired neutrophil and lymphocyte counts at baseline and at approximately 12 weeks (before cycle 4), a log-linear decomposition classified patients into four NLR-trajectory phenotypes by the dominant driver of change. Associations with progression-free survival (PFS) and overall survival (OS) were assessed using a 4-month landmark approach with multivariable Cox models, with consistency evaluated across four thresholds, tertiles, and a continuous model. Secondarily, NLR change was compared across five response-trajectory groups. Results: NLR trajectory was not associated with PFS in any specification (multivariable hazard ratio [HR] 1.15 per standard deviation [SD], 95% CI 0.97–1.37, p = 0.12) but was independently associated with OS (HR 1.40 per SD, 95% CI 1.18–1.67, p < 0.001), confirmed on bootstrap resampling. Adding NLR trajectory improved discrimination (C-index +0.04) and fit (likelihood-ratio p < 0.001). The OS effect was time-varying, attenuating beyond 24 months. NLR trajectory was unrelated to dose-limiting neutropenia (p = 0.58) or dose reduction (p = 0.69). Primary refractory patients showed blunted NLR decline versus responding or stable patients (p = 0.005), independent of baseline NLR. Conclusions: On-treatment NLR trajectory is a correlate of OS, independent of PFS, dose-limiting neutropenia, and dose reduction, in ribociclib-treated MBC, distinct from direct tumor control. Prospective validation is warranted.

Background: Uveal melanoma (UM) is a rare malignancy. Despite effective local control, 10–50% of patients develop metastatic disease, which is associated with poor prognosis. Real-world data remain lacking. This study evaluated the clinical characteristics, treatment patterns, and survival outcomes of metastatic UM in a comprehensive cancer center in Jordan. Methods: This retrospective study included adult patients with metastatic UM treated and followed at King Hussein Cancer Center in Jordan (2006–2025). Baseline characteristics and treatment patterns were collected. Descriptive and inferential statistical analyses were performed in JASP v0.95.4 and R v4.5.3. A two-sided p < 0.05 was considered statistically significant. Results: Among 125 patients with followed UM, 31 (24.8%) had metastatic disease and were included in the analysis. Median age at diagnosis was 51 years, 61.3% were males, 61.2% had an ECOG PS 0–1, and 51.6% had hepatic-only metastases. Median time to distant metastasis was 25 months. Median OS from initial diagnosis was 35 months, while median post-metastatic OS (PM-OS) was 10 months. First-line immunotherapy was associated with improved PM-OS compared to Dacarbazine (median, 11 vs. 5 months; p = 0.034; 24-month PM-OS, 44.4% vs. 0%). In exploratory analysis, patients who continued immunotherapy beyond radiologic progression, consistent with pseudoprogression, had longer PM-OS than those who discontinued therapy (median, 32 vs. 6 months; Log-rank p = 0.020). Conclusions: In this real-world cohort, metastatic UM was associated with poor outcomes and limited access to novel therapies including Tebentafusp. First-line immunotherapy may be associated with favorable survival outcomes, and hypothesis-generating exploratory analysis suggested potential benefit from immunotherapy continuation beyond radiologic progression.

Background/Objectives: Cancer patients using implantable venous access devices for chemotherapy have an elevated risk of venous thromboembolism (VTE), but the utility of existing risk models in this group is understudied. This study aims to evaluate the VTE incidence, risk factors, and the predictive performance of the Khorana, COMPASS, and ONKOTEV models. Methods: Medical records of adult cancer patients who received chemotherapy via ICVADs were retrospectively reviewed. Cumulative incidence (CI) of VTEs was estimated using the Fine and Gray method. RAM performance was assessed by sensitivity, specificity, predictive values, and accuracy. Overall survival (OS) was analyzed using Kaplan-Meier and log-rank tests. Results: A total of 446 patients were included. The most common cancers were colorectal (29.6%), gastric (26%), pancreatic (18.4%), and breast (13.9%). Over a median follow-up of 16.5 months, VTEs occurred in 82 (18.4%) patients, with 43 (9.6%) being ICVAD-related. Median time to VTE was 117 days overall and 68 days for ICVAD-related events. The CI of VTEs at 30, 90, 180, 360, and 720 days was 0.9%, 5.8%, 8.1%, 9.0%, and 18.4%, respectively. ONKOTEV showed the best predictive performance (sensitivity 33.3%, specificity 85.7%, accuracy 74.4%). The 1-year VTE incidence was significantly higher in the ONKOTEV high-risk group (28.5%) versus low-risk (12.4%, p<0.001). VTE was independently associated with inferior OS (HR 1.39, p=0.037). Conclusions: Cancer patients with ICVADs have an increased risk of early VTEs. Among the RAMs, ONKOTEV showed superior predictive ability. Prospective studies are warranted to assess individualized VTE prophylaxis guided by validated RAMs.