Background/Objectives: CDK4/6 inhibitors have changed the landscape of hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (BC) management. It is essential to identify predictive and prognostic factors for the efficacy of CDK4/6 inhibitors. We aimed to investigate the differences in characteristics and outcomes of patients receiving first-line CDK4/6 inhibitors according to PgR status. Methods: This multicenter retrospective study included 351 patients treated with first-line CDK 4/6 inhibitors for HR-positive/HER2-negative metastatic BC. Patients were categorized based on their PgR expression levels, including the PgR-low (<20%) and PgR-high (≥20%) groups, and baseline characteristics, treatment responses, and survival outcomes were analyzed. Results: The median age was 57 years (range: 26–85). A total of 99 patients were premenopausal, and 252 patients were postmenopausal. There were 115 (32.8%) patients in the PgR-low group, while 236 (67.2%) were in the PgR-high group. The majority of patients (56.7%) presented with de novo metastatic disease. Visceral metastases presented in 44.2% of patients. Low PgR expression was significantly associated with lower estrogen receptor levels (p = 0.031), elevated Ki-67 levels (p = 0.002), a higher incidence of visceral metastases (p = 0.035), and recurrent disease (p = 0.019). In the multivariate analysis, low PgR expression was a significant independent predictor of worse progression-free survival (PFS) and overall survival (OS). Conclusions: We demonstrated that low PgR expression is independently and significantly correlated with shorter PFS and OS. These findings support low PgR expression as a valuable prognostic biomarker in metastatic BC patients treated with first-line CDK4/6 inhibitors.

Background and Objectives: Obesity is a significant risk factor for the development of breast cancer (BC) and associated poorer outcomes. A pathological complete response (pCR) with neoadjuvant chemotherapy (NACT) correlates with improved long-term prognosis in BC patients. In this study, we aimed to investigate the predictive effect of obesity on achieving pCR following NACT. Methods: This single-center retrospective study included patients with operable BC who were treated with NACT. Patients were categorized based on their pre-chemotherapy body mass index (BMI), including non-obese (<30 kg/m²) and obese (≥30 kg/m²) groups, and pathological responses to NACT were compared. Results: A total of 191 female patients were included in this study; of these, 83 (43.4%) were obese and 108 (56.6%) were in the non-obese group. Obesity was more common in postmenopausal patients, and the median age of obese patients was significantly higher compared to non-obese patients. Patients in the obese group demonstrated significantly lower pCR rates compared to the non-obese group (30% vs. 45%, p = 0.03). The histological subtype assessment indicated that only in the HR-positive/HER2-negative patients was the pCR rate significantly lower in the obese group compared to the non-obese group (11% vs. 27%, p = 0.05). According to menopausal assessment, a significant difference in pCR rates was observed only among postmenopausal patients, with rates of 29% in the obese group compared to 52% in the non-obese group (p = 0.03). In logistic regression analysis, obesity (OR: 0.52, 95% CI: 0.28–0.97; p = 0.04) and a low Ki-67 score (HR: 2.7, 95% CI: 1.37–5.53; p = 0.003) were independently associated with a decreased rate of pCR. Conclusions: The impact of obesity on achieving pCR in BC patients undergoing NACT remains controversial. Our study revealed that obesity was an independently significant negative predictive factor for achieving pCR.

Background and Objectives: Breast cancer is a leading cause of cancer-related mortality, particularly in aggressive subtypes such as HER2-positive and triple-negative breast cancer (TNBC). Achieving a pathological complete response (pCR) after neoadjuvant therapy is strongly associated with improved survival outcomes in these subgroups, making the prediction of pCR a clinical priority. Sarcopenia, a progressive loss of skeletal muscle mass and strength, is increasingly recognized in cancer patients and has been linked to chemotherapy toxicity and poorer survival. However, its specific impact on pCR in HER2-positive and TNBC patients remains unclear. This study aimed to evaluate the association between radiologically defined sarcopenia, or a low skeletal muscle index (SMI), and pathological response in these subtypes, and to explore its potential as a predictive biomarker. Materials and Methods: This retrospective study included patients with HER2-positive or TNBC who received neoadjuvant therapy between January 2015 and October 2023. SMI was assessed using pre-treatment positron emission tomography images at the L3 vertebral level, with values < 38.5 cm²/m² considered as low. Univariate and multivariate logistic regression analyses were performed to identify factors associated with pCR. Results: A total of 85 patients were included, with low SMI present in 35 (41.2%). In univariate analysis, clinical stage and low SMI were associated with pCR. However, in the multivariate model, only low SMI remained an independent predictor. Patients without low SMI had higher odds of achieving pCR (odds ratio [OR] 4.13; 95% confidence interval [CI] 1.55–10.95; p = 0.004). Low SMI was also associated with higher rates of treatment-related toxicity (42.9% vs. 20.0%, p = 0.023). Conclusions: Pre-treatment low SMI is strongly associated with lower pCR rates in patients with HER2-positive and TNBC undergoing neoadjuvant therapy. These findings underscore the importance of early identification and management of radiologically defined sarcopenia to optimize treatment response and improve clinical outcomes.

Background: Hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer frequently involves liver metastases, which are linked to poor outcomes. The optimal first-line treatment strategy in this subgroup remains unclear. Methods: This multicenter, retrospective study evaluated 121 patients with HR-positive, HER2-negative breast cancer and liver metastasis who had not received prior systemic chemotherapy or cyclin-dependent kinase (CDK) 4/6 inhibitors (e.g., palbociclib, ribociclib). Patients were classified based on their initial treatment during the liver metastatic phase (CDK4/6 inhibitors or chemotherapy). Clinical characteristics, treatment patterns, and survival outcomes were assessed. Cox regression analysis identified independent prognostic factors. Results: The median age was 53 years; 62% were postmenopausal. Chemotherapy was administered to 36.4%, and CDK4/6 inhibitors to 63.6% of patients. Most cases (59.5%) were recurrent disease. Baseline characteristics were comparable, except for the use of local liver-directed therapies. Progression-free survival favored CDK4/6 inhibitors (10.9 vs. 4.8 months; p < 0.01), while overall survival favored chemotherapy (42.2 vs. 25.9 months; p = 0.042). In multivariate analysis, initial treatment modality, local liver-directed therapy, hormonal status, and the size of the largest liver lesion were independent predictors of survival. Conclusions: In patients with HR-positive, HER2-negative breast cancer and liver metastasis, first-line chemotherapy was associated with improved overall survival compared to CDK4/6 inhibitors. Local liver-directed therapies contributed to longer survival, while larger liver lesions and endocrine-resistant disease correlated with worse outcomes. These findings support considering chemotherapy as first-line treatment in selected patients with aggressive liver metastatic disease.

Objective: Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related death. Panimmune-inflammation value (PIV), a novel biomarker that reflects systemic inflammation and immune status, has been evaluated for prognostic efficacy in various cancer types. This study aimed to investigate theefficacy of PIV on survival outcomes in patients diagnosed with advanced NSCLC who were treated withnivolumab.Methods: The single-center, retrospective, and observational study included patients with metastatic NSCLCwho received nivolumab treatment. The receiver operating characteristic (ROC) curve analysis was performed to find the optimal PIV cutoff value for predicting outcomes, and patients were divided into 2groups: low-PIV and high-PIV.Results: The median age was 63 years. The patient cohort comprised 68 male and 20 female patients.Adenocarcinoma histology was identified in the majority of patients (56.8%). Nivolumab was administeredto 74% of patients as a second line of treatment and to 26% in the third line or later. In ROC analysis, theideal cutoff value for PIV was established at 652 (AUC: 0.691, 95% CI: 0.568-0.814, P = .013). No statistically significant differences were observed in the demographic and clinicopathological features of patientsbetween the low- and high-PIV groups. High PIV was independently associated with shorter progressionfree survival (HR: 0.47, 95% CI: 0.29-0.76; P = .002) and overall survival (HR: 0.54, 95% CI: 0.32-0.92;P = .023), independent of other factors affecting outcomes.Conclusion: The findings of the study indicate that PIV value may serve as a significant prognostic biomarkerfor predicting survival in metastatic NSCLC patients undergoing treatment with nivolumab.Cite this article as: Guliyev M, Alan Ö, Fidan MC, et al. Evaluating the prognostic role of pan-immune-inflammation value inpatients with advanced non-small cell lung cancer treated with nivolumab. Cerrahpaşa Med J. 2025, 49, 0038, doi:10.5152/cjm.2025.25038.

Ejmi Eurasian Journal of Medical Investigation