Aim: To evaluate the immunogenicity and safety of the CoronaVac vaccine in patients with cancer receiving active systemic therapy. Methods: This multicenter, prospective, observational study was co... Tweetable abstract Immunogenicity developed with CoronaVac in 25 (59.5%) of 42 patients who received at least one cytotoxic drug and in all patients (n = 5) who received monoclonal antibody or immu...

BACKGROUND The hemoglobin-to-red cell distribution width ratio (HRR) is a recently introduced, easily accessible marker that provides insights into inflammation and the tumor vascular microenvironment. It has been suggested to have prognostic value for overall survival in various types of cancer, including urothelial carcinoma, lung cancer, and hepatocellular carcinoma. It has not yet been sufficiently investigated in colorectal cancers (CRC). AIM To investigate the prognostic significance of the HRR and other inflammation-based hematological markers in patients with metastatic CRC. Additionally, the study evaluated the impact of surgical interventions, particularly metastasectomy, and multiple clinical and laboratory parameters on overall survival. By identifying low-cost, accessible prognostic indicators, this research seeks to support clinicians in optimizing treatment strategies and risk stratification for patients with CRC. METHODS In this retrospective study, patients diagnosed with CRC between January 2020 and December 2024 were analyzed. The impact of HRR in conjunction with inflammatory markers and a total of 22 different clinical and laboratory parameters on overall survival were evaluated using univariate Cox regression and a multivariate model. Survival curves were visualized using Kaplan-Meier analysis. RESULTS A total of 155 patients with CRC were included in the study. The median age was 60 years, and 61.9% presented with de novo metastasis. In the receiver operating characteristic curve and area under the curve analysis performed to determine the optimal cutoff, the values were found to be 6.10 for carcinoembryonic antigen (CEA) (P = 0.036), 18.85 for platelet-to-red cell distribution width ratio (P = 0.028), and 10.87 for platelet distribution width-to-lymphocyte ratio (P = 0.028). For neutrophil-to-lymphocyte ratio, systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, HRR, and carbohydrate antigen 19-9, an optimal cutoff could not be determined using the receiver operating characteristic-area under the curve analysis. Therefore, the median values were adopted as the cutoffs (3.09, 835.96, 177.50, 0.380, 0.824, and 21.6, respectively). Univariate analysis identified male gender (P = 0.045), being under 65 years of age (P = 0.001), history of metastasectomy (P = 0.001), low serum CEA level (P = 0.010), low PLR (P = 0.024), low SII (P = 0.010), and high HRR (P = 0.025) as favorable prognostic factors for overall survival. In the multivariate model, being under 65 years of age [hazard ratio (HR) = 1.59, 95% confidence interval (CI): 1.06-2.39, P = 0.025], metastasectomy (HR = 0.49, 95%CI: 0.29-0.85, P = 0.011), CEA (HR = 1.51, 95%CI: 1.0-2.28, P = 0.048), and PLR (HR = 1.63, 95%CI: 1.09-2.44, P = 0.018) emerged as independent prognostic factors for overall survival, whereas gender, SII, and HRR did not retain statistical significance. CONCLUSION In conclusion, low HRR alone was a prognostic indicator. However, when modelled with other inflammatory and clinical parameters, it did not provide a sufficiently strong marker feature.

Objective: To investigate the prognostic value of clinical and inflammatory markers predicting response to nivolumab in patients with metastatic non-small cell lung cancer (NSCLC). Materials and Methods: Clinical, demographic and laboratory data of stage 4 NSCLC patients who were treated between February 2021 and November 2024 were analyzed. Before nivolumab treatment, inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), prognostic nutritional index (PNI), hemoglobin-albumin-lymphocyte-platelet score (HALP), neutrophil-to-eosinophil ratio (NER) and C-reactive protein-to-albumin ratio (CAR) were calculated. Factors affecting overall survival (OS) were determined by Cox regression analysis, and ROC curve analysis was used to calculate the ideal cut-off. Results: The study included 229 NSCLC patients and the median age of the patients was 63 years. The majority were male (84.3%) and had right lung localization (56.8%). Median overall survival was calculated as 21.2 months (95% CI: 17.4– 25.0). In univariate cox-regression analysis, the presence of brain metastases (HR: 2.08; p=0.004), liver metastases (HR: 1.85; p=0.014) and adrenal metastases (HR: 1.64; p=0.045) negatively affected the treatment response. Inflammatory markers such as high NLR (HR: 2.04; p< 0.001), high SII (HR: 1.96; p< 0.001), high CAR (HR: 1.84; p=0.001), high PLR (HR: 1.60; p=0.009) and high SIRI (HR: 1.51; p=0.021), low PNI (HR: 0.48; p< 0.001), low HALP (HR: 0.49; p< 0.001) and low LMR (HR: 0.65; p=0.016) were associated with poor prognosis. In multivariate analysis, the presence of brain metastasis (HR: 2.84; p< 0.001), adrenal metastasis (HR: 1.64; p=0.046) and low PNI (HR: 0.44; p< 0.001) together predicted poor prognosis and formed a statistical model on treatment response. Conclusion: In patients with metastatic NSCLC, nivolumab treatment response is predicted by inflammatory markers and the presence of brain and adrenal metastases. It was concluded that low PNI among inflammatory markers is a strong prognostic indicator in this patient group.

Background and Objectives: This study aimed to investigate the prognostic value of the hemoglobin–albumin–lymphocyte–platelet (HALP) score—a marker reflecting both inflammatory and nutritional status—in patients with metastatic non-small cell lung cancer (NSCLC) undergoing immunotherapy. We also sought to determine whether dynamic changes in the HALP score during treatment could predict therapeutic success and help distinguish between pseudoprogression and hyperprogression. Materials and Methods: A retrospective analysis was conducted on 160 patients diagnosed with metastatic NSCLC and treated with immunotherapy at the Ankara Atatürk Sanatorium Training and Research Hospital. Chemotherapy regimens, metastatic sites, baseline and third-month hemograms and biochemistry parameters, and survival data were recorded. Survival outcomes were analyzed using the Kaplan–Meier method with the log-rank test and the Cox proportional hazards regression model using IBM SPSS Statistics. Results: The median overall survival (OS) for the entire cohort was 15 months (95% CI: 11.88–18.12). HALP1 score (p = 0.048), HALP2 score (p = 0.026), and hyperprogression (p < 0.001) were statistically significant predictors of OS. Regarding progression-free survival (PFS), the HALP2 score (p = 0.031), line of immunotherapy (p = 0.046), and hyperprogression (p < 0.001) were found to be significant. When comparing patients with increasing versus decreasing HALP scores, those with increasing HALP scores demonstrated significantly better outcomes for both OS (p = 0.034) and PFS (p = 0.007). Conclusions: In patients with metastatic NSCLC undergoing immunotherapy, the HALP score and its dynamic alterations during treatment appear to be non-invasive, easily calculable biomarkers that may predict both OS and PFS.

Background: Immune checkpoint inhibitors (ICIs) targeting the PD-1 axis represent standard second-line therapy for metastatic non-small cell lung cancer (NSCLC). Emerging data suggest that SARS-CoV-2 mRNA vaccines may enhance antitumor immunity through innate immune activation and type I interferon signaling, potentially sensitizing tumors to PD-1 blockade. The clinical impact of patients initiating second-line nivolumab remains unclear. Methods: In this retrospective single-center cohort study, 88 patients with recurrent stage IV NSCLC who received second-line nivolumab between 1 January 2023 and 1 January 2026 were analyzed. Vaccination exposure was defined using a 6-month pre-treatment window prior to nivolumab initiation (T0). Patients were stratified according to receipt of ≥2 versus 0–1 mRNA COVID-19 vaccine doses within the 6 months preceding T0 (n = 45 and n = 43, respectively). The primary endpoint was progression-free survival from nivolumab initiation (PFS2). Survival outcomes were estimated using the Kaplan–Meier method and evaluated using Cox regression models. Results: With a median follow-up of 22.4 months, median PFS2 for the overall cohort was 11.1 months (95% CI, 9.4–15.1). Patients receiving ≥2 mRNA doses had significantly longer PFS2 than those receiving 0–1 dose (14.0 vs. 9.6 months; p = 0.04). In multivariable analysis, ≥2 doses were independently associated with reduced risk of progression or death (aHR 0.52, 95% CI 0.31–0.88; p = 0.01). Non-adenocarcinoma histology and baseline brain metastasis were independently associated with shorter PFS2. Conclusions: Receipt of ≥2 mRNA vaccine doses within 6 months before nivolumab initiation was independently associated with prolonged PFS2 in metastatic NSCLC. Prospective multicenter validation is warranted.