Medical Oncology Department Research Articles

Self-Medication with Herbal Medicine Among Young Adult Cancer Patients: A Prospective Monocentric Study.

Objective: The aim of this study was to determine the incidence of the self-use of plants in cancer patients and its impact on overall survival (OS). Methods: This was a prospective study including young adult patients collected between January 15, 2018 and January 15, 2019 in the department of medical oncology at the Habib Bourguiba University Hospital. All patients were questioned about the concept of taking herbs. We compared OS among those who received plants versus the nonusers. Results: A total of 223 patients were included. The average age was 35 ± 4 years. Ninety-seven patients had taken plants. Sixty patients had consumed alenda (61.8%), and 36 patients had received graviola (37.1%). Ten patients have had diarrhea (10.3%), 10 cytolysis (10.3%), 11 cholestasis (11.3%), 15 thrombocytosis (15.4%), 17 leukocytosis (17.5%), and 13 anemia (13.4%). OS at 5 years was 67.1%. It was lower in patients consuming the plants (54% vs. 83%, p = 0.023). Conclusion: Factors associated with a decrease in the 5-year OS were metastatic stage and plant consumption.

HEALTH-RELATED QUALITY OF LIFE AND ASSOCIATED FACTORS IN BREAST CANCER PATIENTS IN ABIDJAN (IVORY COAST)

ObjectiveThe main objective of this study was to assess health-related quality of life, and to investigate associated factors in breast cancer patients living in Ivory Coast. MethodsWe conducted a cross-sectional, descriptive and analytical study that took place from August 1, 2022 to October 31, 2022 in the Medical Oncology Department of the Treichville University Hospital. Seventy-six breast cancer patients participated in the study. Quality of life was assessed using the EORTC QLQ-C30 and QLQ-BR23 EORTC questionnaires. ResultsThe mean score for overall quality of life was 69.3 ± 21.9. Among the functional scales, emotional functioning, social functioning, sexual functioning, and sexual pleasure were the most affected, with 21.1 respectively; 23.7; 78.9, and 86.8% of patients who had a bad score. Nausea/vomiting, loss of appetite, and hair loss are the symptoms that most affected the QoL of our patients with respectively 19.7; 21.1, and 52, % of patients who had a bad score. Financial difficulties also negatively affected the QoL of our patients (55.3% had a poor score). The factors significantly associated with QoL deterioration were the metastatic stage, the presence of anemia, and the triple-negative immunohistochemical subtype. ConclusionThe overall quality of life of our patients was good. The psychosocial factors that were most affected in our patients were emotional functioning, social functioning, sexual functioning, and financial difficulties. The physical factors that most negatively affected the QoL of our patients were nausea/vomiting, loss of appetite and hair loss, presence of anemia, metastatic stage, and triple negative immunohistochemical type.

Clinical diagnostic reference levels and image quality metrics for CT in oncology patients

Background: In CT, the volumetric CT dose index (CTDIvol), dose-length product (DLP) and patient’s size-specific dose estimates (SSDE) are used as diagnostic reference level (DRL) metrics.Objectives: To develop clinical local DRL values for CT chest-abdomen-pelvis (CAP) examinations using the CTDIvol, DLP and SSDE, and to determine the image quality achieved.Method: In total, 201 cancer patients were included in the study. The scanning parameters, dose metrics from the CT unit and participants’ body mass index (BMI) were documented. The local CT DRL values for CAP examinations were defined as the median and 75th percentiles of the dose distribution.Results: The local DRL values given in terms of median CTDIvol ranged between 8.4 mGy and 12.7 mGy for the different types of cancers. The median DLPs ranged from 848 to 1173.4 mGy.cm for the various cancers. Generally, the radiation dose was directly proportional to the BMI and number of scan phases. Significant differences were observed between the DRLs for the various size-related parameters, number of scan phases and BMI classifications. The image quality was clinically satisfactory.Conclusion: No baseline data for clinical DRL values were available for this medical oncology department. The achieved DRLs were similar to published size-specific DRLs. The image quality was maintained during CT imaging. Dose optimisation and image quality assessment should be implemented to ensure optimal scanning parameters for different cancers in CT CAP examinations.Contribution: The first size-specific local DRL values for CT CAP investigations carried out on oncology patients in South Africa have been established.

Evolving Patient-Centred Therapies for Metastatic NSCLC

The metastatic non-small cell lung cancer (mNSCLC) treatment landscape has vastly expanded over the past two decades as a result of advancements in biomarker testing. However, unmet needs remain both in terms of treatment options for some patient groups, and patient support throughout the treatment journey. In this symposium, Jarushka Naidoo, Consultant Medical Oncologist, Beaumont RCSI Cancer Centre, Dublin, Ireland; Terri Conneran, KRAS Kickers, Charlotte, North Carolina, USA; Luis Paz-Ares, Chair of the Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; and Alexander Drilon, Chief of Early Drug Development and Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, USA, focused on patient-centric approaches to mNSCLC treatment, starting with a patient and patient advocacy group perspective on what patients want from their care team during their treatment journey. The panel also discussed both immuno-oncology (I-O) monotherapy and combination therapy, including dual I-O therapies for patients with programmed death-ligand 1 (PD-L1) tumour expression <1%, as well as the treatment landscape for KRASG12C-mutated mNSCLC, and ongoing trials of KRAS-targeted agents. In addition, the latest data on tyrosine kinase inhibitors (TKI) for patients with alterations in ROS1 and NTRK genes were discussed, focusing on next-generation TKIs. Finally, the panel discussed patient cases, taking into account specific considerations and how to best approach treatment decisions.

Gestational Trophoblastic Tumours: Experience of the Oncology Department of the Moulay Ismail Military Hospital in Meknes (10 Cases)

Gestational trophoblastic tumors (GTTs) are the malignant forms of gestational trophoblastic diseases. They always follow a pregnancy, most often molar. The diagnosis of GTT is based on an abnormal course of HCG (chorionic gonadotropin hormone) and/or signs of ultrasound invasion and/or histological confirmation. We report a retrospective series of 10 cases of GTT collected at the Medical Oncology Department of the Moulay Ismail Military Hospital in Meknes over an 8-year period from January 2012 to January 2020. The analysis of our series led to the conclusion that: The average age of onsetis 42 years. 90% of our patients were pauciparic. The causal pregnancy was in 90% of the cases a molar pregnancy. The extension assessment was mainly based on the TAP CT identifying the lung as the main metastatic site in 40% of cases. 5 patients (50% of cases) underwent hysterectomy with post operative chemotherapy. 60% of our patients were classified as low risk according to the FIGO score and received methotrexate mono-chemotherapy. 4 patients were classified as high-risk and were treated with poly chemotherapy, the main protocol of which was EMA-CO. All our patients benefited from clinical and biological monitoring, before each chemotherapy session; then weekly and monthly after negativation, up to 12 months in case of good prognosis GTT, and up to 18 months in case of bad prognosis GTT. One case of MTX relapse (the case of IPTT) was reported and for which a 2nd line CMT with a favourable evolution was indicated. This study allowed us to analyze the cure rate, which was 100% for patients who were treated and had completed their monitoring.

Double Anti-Her2 Blockade in Metastatic Breast Cancer: Experience of the Oncology Department of the Moulay Ismail Military Hospital in Meknes

Metastatic breast cancer is recognized as an incurable disease and whose management is palliative, but in recent years there has been an increase in the overall survival of patients with metastatic Her2 + breast cancer, this is thanks to the development new, particularly targeted therapies. Our study aims to assess the value of the double combination pertuzumab to the reference dual therapy (trastuzumab + chemotherapy) in patients with metastatic breast cancer and its impact on overall survival. This is a retrospective study spread over a period of 2 years (2018- 2019) carried out in the medical oncology department of the Moulay Ismail military hospital in Meknes.

Rasch analysis of the perceptions of palliative care instrument (PPCI) in patients with advanced cancer.

The Perceptions of Palliative Care Instrument (PPCI) is a tool used to access perceptions towards palliative care in patients with advanced cancer. However, its psychometric properties have not been widely tested using modern psychometric methods. This study aimed to examine the psychometric properties of the PPCI in patients with advanced cancer using Rasch analysis. Four hundred and forty four Participants were recruited from the Department of Medical Oncology at a tertiary care hospital in Xinxiang City, Henan Province, China, between October 2020 and February 2021. Participants completed the PPCI. Rasch analysis procedures were conducted, including assessment of unidimensionality, model-date fit, rating scale function, differential item functioning, item-person map, and person and item reliability. The unidimensionality of the PPCI was confirmed, although two items (18 and 21) did not fit the Rasch model. The degree of fit of each item to its respective dimension was excellent, with Infit MNSQ and Outfit MNSQ values ranging from 0.73 to 1.33. The PPCI demonstrated high reliability, with an item reliability of 0.99 and a person reliability of 0.77. The PPCI is a valid and reliable instrument for assessing perceptions of palliative care in advanced cancer patients. However, to further improve the quality and applicability of the PPCI, the deletion of items 18 and 21 is recommended, as they did not fit the Rasch model.

Epidemio-Clinical, Anatomopathological, Computed Tomography Aspects from Breast Cancer to Imaging and Medical Oncology Departments at Chu – Mother-Child “Luxembourg”

Introduction: Cancer results from an anarchic proliferation of abnormal cells of the mammary gland and is the most common cancer in women in developed countries with 50,000 new cases in 2008. Objectives: The aim of our work was to describe the sociodemographic characteristics of patients, to determine the different sites and the frequency of metastases; and to describe the CT and histological aspects in the diagnosis of extension, therapy and assessment. Methods: Our study was retrospective descriptive over a period of 12 months from January 2020 to December 2020 in the radiology and medical oncology department of CHUME Luxembourg. It concerned all patients with histologically confirmed cancer who had undergone a scan before, during treatment or during therapeutic monitoring. The examinations were carried out with a HITACHI SUPRIA 16 BARRETTES CT scanner installed in 2015. Results: During the period of our study, the frequency of breast cancer was 10.7% (130 cases) out of 1204 scans carried out with a female predominance of 98%, an average age of 52 years and extremes of 12 to 90 years. The main metastases were: pulmonary (59%), followed by lymph node metastases (66%), bone (51%), liver (29%) and brain (2%). The association of pulmonary, lymph node, liver and bone metastasis represented 27% of the most frequent associations. As for the histological aspect, non-specific invasive carcinoma grade II SBR and TNM was the most frequent.

Progression of vertebral fractures in metastatic melanoma and non-small cell lung cancer patients given immune checkpoint inhibitors

IntroductionThe immune system mediates important effects on bone metabolism, but little has been done to understand immunotherapy’s role in this interaction. This study aims to describe and identify risk factors for the occurrence and/or exacerbation of vertebral fractures (vertebral fracture progression) during immune checkpoint inhibitors (ICIs). MethodsWe conducted an observational, retrospective, monocentric study. We collected data on melanoma and NSCLC patients, treated with first-line ICIs at the Medical Oncology Department ASST Spedali Civili of Brescia, between January 2015 and November 2021, and with a median follow-up of 20.1 (6–36) months. We collected data on patients, diseases, immune-related adverse events, and cortico-steroid therapy initiated on concomitant ICIs. ResultsWe identified 135 patients, 65 (48.2 %) with locally advanced/metastatic melanoma and 70 (51.8 %) with locally advanced/metastatic non-small cell lung cancer (NSCLC). Twenty-one (15.6 %) patients already had an asymptomatic vertebral fracture at baseline before starting ICIs in monotherapy. A total of ten patients, or 7.4 %, had a vertebra fracture progression defined as a new vertebral fracture or a worsening of a previous fracture. There was a strong relation between the steroid therapy and irAEs with vertebra fracture progression [OR (95 % CI) 8.1 (3.7–17.8) p-value < 0.001] in univariable analysis. However, only steroid therapy resulted to be an independent risk factor [8.260 (95 % CI 0.909–75.095); p-value 0.061] at the multivariable analysis. ConclusionConcurrent steroid therapy in patients receiving immunotherapy exposes them to a high risk of fractures due to skeletal fragility. The use of bone resorption inhibitors should be considered in these patients to prevent these adverse events.

Breast cancer: do the current policies mean anything?

Aim Breast cancer remains one of the most prevalent malignancies globally with a high mortality rate. South Africa has a number of policies in place designed to ensure that minimum delays are experienced by patients from first symptom to initial treatment. This study was initiated to determine where the longest delays occurred during the patient’s journey, from the first symptom to the first treatment. This information, combined with the existing policy, identifies shortfalls in the breast cancer diagnostic and treatment pathways that must be addressed. Methods A cross-sectional study was undertaken in the Department of Medical Oncology, University of Pretoria/Steve Biko Academic Hospital between April 2020 and August 2021, analysing six timelines from first symptom to first treatment in patients with newly diagnosed breast cancer. Data was obtained by the researchers from the patients on their first visit relating to the delays experienced from first symptom to final biopsy. Clinical information was obtained from the patients’ source records once a treatment decision had been reached and treatment started where applicable. Results The longest delays experienced were between the patients’ first visit to any medical facility to date of diagnostic biopsy. Delays due to COVID-19 were in the minority with 13/79 (16.4%) patients reporting having experienced COVID-19 related delays. Key Area 2 of the Breast Cancer Prevention and Control Policy makes provision for patients to be referred directly to a regional/tertiary/quaternary medical facility for further screening, diagnosis and treatment within 21-60 days from the first visit. In the study’s cohort, a mean of four months from first visit to diagnostic biopsy was recorded. Overall delays of longer than 12 months due to non-representative biopsies (range 1-3) were recorded in three patients. Twenty-nine patients (36.7%) presented to three medical facilities prior to diagnostic biopsy with 10/79 (12.6%) and 1/79 (1.2%) presenting to four and five institutions, respectively, before the diagnostic biopsy. Conclusions The delays patients experienced highlights the lack of knowledge about the urgency and correct referral of suspected malignancy cases. Despite the number of promulgated policies relating to fast track systems via specialist breast units, fiscal and human capital deficiencies negatively impact the attempts to diagnose and treat patients timeously and increase survival.

Effect of training based on Orem's self-care deficit theory on breast cancer patients' management of chemotherapy-related side effects and self-care behaviors: A randomized controlled trial

PurposeTo examine the effects of training based on Orem's self-care deficit theory on breast cancer patient's physical, social, and psychological well-being and self-care behaviors during chemotherapy. MethodsThis randomized controlled trial was based on a pretest–posttest experimental design. The study sample consisted of 62 breast cancer patients (n = 31 for each of the intervention and control groups) receiving cyclophosphamide–epirubicin or cyclophosphamide–adriamycin treatment in the medical oncology department of a university hospital in Tekirdağ, Turkey. The breast cancer patients in the intervention group received training based on Orem's self-care deficit theory regarding physical, social, and psychological well-being and self-care behaviors during chemotherapy. The researcher conducted two face-to-face follow-ups (during the second and third chemotherapy cycles, 3 weeks apart) and a posttest assessment. Pretest and posttest symptom scores and self-care survey results were compared for both groups. ResultsThe Nightingale Symptom Assessment Scale (N-SAS) first follow-up, second follow-up, and posttest scores showed that the intervention group experienced fewer negative changes in quality of life than the control group based on the physical, social, and psychological subdimension and total scale scores (p < .05). The most positive changes in the intervention group's self-care behaviors were observed for items about caring for and protecting hair, using protective gloves when doing chores, monitoring weight, and limiting social meetings when blood values were low to protect against possible infection. ConclusionTraining based on Orem's self-care deficit theory positively influenced breast cancer patients' management of chemotherapy-related side effects and self-care behaviors. Chemotherapy-related side effects should be evaluated frequently. Moreover, patients' needs should be determined, and training should be tailored to their needs.

Prognostic Factors for Survival in Patients with Metastatic Colon Carcinoma

Colorectal cancers are the most common cancers of the gastrointestinal system. They rank third after prostate and lung cancer in men and after breast and lung cancer in women. In Turkiye, colon cancer is the third most common among all cancers. In such cancer, beyond the stage of the disease, there are many biological, molecular, genetic, and tissue-related factors that determine the prognosis. Among these, vascular invasion, the number of affected regional lymph nodes, and the levels of preoperative carcinoembryonic antigen (CEA) are prominent factors. In this study, we investigated the personal, clinical, tumoral, metastatic, and treatment characteristics of metastatic colon cancer (MCC) that may be associated with long survival. This study included the data of 103 patients diagnosed with MCC who were followed at the Medical Oncology Department of Karadeniz Technical University Faculty of Medicine between 2010 and 2016. In univariate analyses, primary surgery (p&lt; 0.001), targeted therapy (p= 0.01), being less than 65 years old (p=0.02), having normal CEA levels (p= 0.03), and not having elevated platelet counts (p= 0.001) were significant factors associated with prolonged survival. Multivariate analysis indicated that survival was longer in patients who underwent primary surgery (p= 0.001, 95% CI: 0.07–0.52) and had normal or low platelet levels at the time of diagnosis (p= 0.001, 95% CI: 1.77–9.16), regardless of other factors. In patients diagnosed with MCC, those who had primary tumor surgery and had normal or low platelet levels at the time of diagnosis had a better prognosis regardless of other factors. Therefore, prognostic factors are important in MCC, and more comprehensive studies are needed on this subject. Keywords: Metastatic colorectal cancer, Survival, Prognostic factors

Effectiveness of Hospital Fit on Physical Activity in Hospitalized Patients: A Stepped-Wedge Cluster-Randomized Trial and Process Evaluation.

This study investigates the effectiveness of using Hospital Fit as part of usual care physiotherapy on the physical activity (PA) behavior of hospitalized patients compared to patients who received physiotherapy before implementation of Hospital Fit. In addition, a process evaluation is conducted. A prospective, multi-center, mixed-methods stepped wedge cluster randomized trial was performed at the cardiology and medical oncology departments of two Dutch university medical centers. Patients were included in the non-intervention or intervention phase. During the non-intervention phase, patients received usual care physiotherapy. During the intervention phase, Hospital Fit was additionally used. Mean time spent walking, standing, lying/sitting per day and the number of postural transitions from lying/sitting to standing/walking positions were measured using an accelerometer and analyzed using linear mixed models. A process evaluation was performed using questionnaires and semi-structured interviews with patients and focus-group interviews with healthcare professionals. A total of 77 patients were included, and data from 63 patients were used for data analysis. During the intervention phase, the average time spent walking per day was 20 min (95% confidence interval: -2 to 41 min) higher than during the non-intervention phase (p = 0.075). No significant differences were found for mean time spent standing per day, mean time spent lying/sitting per day, or the number of postural transitions per day either. During the intervention phase, 87% of patients used Hospital Fit at least once, with a median daily use of 2.5 to 4.0 times. Patients and healthcare professionals believed that Hospital Fit improved patients' PA behavior and recovery. Insufficient digital skills and technical issues were described as challenges. Although patients and healthcare professionals described Hospital Fit as an added value, no statistically significant effects were found.

Endocrine Adverse Events Related To Immune Checkpoint Inhibitor Treatment: Relationship Between Antibodies and Severity of Thyroid Dysfunction.

The purpose of this study was to identify predictive and risk factors for the development of immune-related endocrinopathies and to analyze the incidence and characteristics of immune-related endocrinopathies in our population. A retrospective, single-centre cohort carried out at Gregorio Marañón Hospital between January 2018 -December 2019. A total of 163 patients were enrolled. In January 2018 and December 2019, we treated patients who underwent ICI treatment in the Medical Oncology Department of General University Hospital Gregorio Marañón, a tertiary care public hospital in Madrid, as part of an observational, retrospective, single-center cohort study. Endocrinopathies were diagnosed in 19.5% of the patients (n = 32). The tumours with the highest incidence of endocrinopathies were non-small cell lung cancer (25,9%), kidney cell cancer (25%) and hepatocarcinoma (20%). Among the 32 patients who developed endocrinopathy, 18,8%, 19,13%, and 21,28% received anti-CTLA-4, anti-PD-1 and anti-PDL-1, respectively. Thyroid dysfunction was the most frequent endocrinopathy (12,8%). A higher percentage of patients with negative antiTPO and antiTG antibodies developed G1 hypothyroidism compared to patients with positive antibodies who developed a higher proportion of G2 hypothyroidism. The presence of an initial phase of thyrotoxicity was not related to greater severity. We observed longer progression-free survival in patients who developed thyroid dysfunction. Pre-existing antibodies were independently associated with endocrinopathies. Moreover, our study let us conclude that the presence of thyroid autoantibodies may be related to its severity. It is important to determine anti-thyroid antibodies prior to the start of immunotherapy as a risk factor for thyroid dysfunction, which in turn is a prognostic marker.

Exploratory Analysis Of Epidemiological, Clinicopathological Characteristics And Prognostic Factors Of Stage IV Epithelial Ovarian Cancers: A Single Institutional Study In Chennai

Background: Ovarian cancer (oc) is the 3rd most common cancer (ca) in females in India (globocan 2020)1 , epithelial ovarian cancer consists of 90% of all oc. More than 70% of ovarian ca patients diagnosed at advanced stage due to its asymptomatic nature and insidious onset of the disease. Metastases(mets) remained a major cause of mortality in ovarian cancer patients. This study is being undertaken to identify prognostic and predictive factors associated with the survival of patients with metastatic ovarian cancer. Materials and methods: It is a retrospective study. Patients diagnosed with stage IV epithelial ovarian cancer (treatment naive), who attended the department of medical oncology, Govt Royapettah Hospital (GRH), Chennai during 2013- 2018 with regular follow up included. 5 years follow-up data collected till dec, 2023. Aim of this study is to identify the epidemiological, clinicopathological characteristics, treatment outcome and other prognostic factors predicting overall survival (os) and progression free survival (pfs) in patients with stage IV ovarian cancer. Results: In this study 85 patients with stage IV epithelial ovarian ca were analysed. In our study median os is 27 months, pfs is 13 months. Overall survival (os) rate at 2 years (yr)= 0.5647, overall survival (os) rate at 5 years = 0.105. Progression free survival (pfs) rate at 2 years = 0.1765, progression free survival (pfs) rate at 5 years = 0.0471. Kaplan Meier (KM) survival curves have shown response after 1 st line treatment, surgery vs no surgery, platinum sensitive recurrence have significant association with 2 year, 5 year os and pfs (p&lt;0.05). Hpe (high grade serous vs less common ovarian cancers) has showed significant correlation with 5 year survival (p&lt;0.05), univariate cox regression analysis has shown, number of mets (single site vs multiple site) significantly associated with improved 2 year survival (p=0.02) and pfs (p=0.005). Both univariate and multivariate analysis showed age (&lt;=56 vs&gt;56) as independent factor correlating with 5 year survival (p=0.02), (p=0.01), multivariate cox regression analysis showed pretreatment ca 125 is an independent variables for pfs (p=0.04). Conclusion: In our study KM survival curves have shown if patients could undergo cytoreductive surgery, had response after 1 st line treatment (surgery and chemo) , significant improvement in 2 year, 5 year os and pfs can be achieved, though not established in regression analysis. Recurrence rate remained very high in advanced stage, in our study KM survival curve has shown platinum sensitive recurrence has significantly better 2 year, 5 year os and pfs rate. Cox regression analysis showed patients with single site of mets have significantly better 2 year survival and pfs than patients with multiple site of mets. Pre treatment raised ca 125 found to be an independent factor which can predict poor pfs. Higher age is an independent factor found to impact 5 year os

A retrospective single institutional analysis of outpatient chemotherapy in patients with cancer during the COVID-19 pandemic.

Providing treatment to patients with cancer, even during the coronavirus disease (COVID-19) pandemic, is essential. In collaboration with infectious disease specialists, we established guidelines for the management of patients with cancer receiving ambulatory treatment during the pandemic on April 8, 2020. This study examined the practice and management of ambulatory chemotherapy under emergency conditions. Following the guidelines, our Breast and Medical oncology department developed a chemotherapy strategy for the phases. Additionally, to distinguish fever during chemotherapy, we developed a flow chart for fever. As part of a fact-finding survey, the status of outpatient chemotherapy was investigated: (1) whether there was any change in the number of chemotherapies before and after the declaration of a state of emergency by the Tokyo Metropolitan Government and (2) the frequency and severity of febrile neutropenia (FN) cases. Compared to before the first declaration of the state of emergency, the number of chemotherapies decreased except after the declaration, but no decrease was observed during the rest of the period; no difference was observed in the frequency or severity of FN outbreaks or in the use of pegfilgrastim for primary prevention before and after the epidemic. With appropriate treatment guidelines, routine chemotherapy can be performed in an outpatient setting during an outbreak.

Prognostic value of a novel myeloid-to-lymphoid ratio biomarker in advanced gastric cancer.

Currently, immune checkpoint inhibitors (ICIs) have excellent performance in the clinical treatment of advanced gastric cancer (AGC). However, precisely selecting AGC patients who can benefit from immunotherapy is an urgent difficulty. In this study, we investigated the immunoprognostic role of myeloid-to-lymphocyte ratio (M:L) in AGC patients. We collected information on 268 AGC patients who were hospitalized in the Department of Medical Oncology of PLA General Hospital from December 2014 to May 2021. The patients were divided into low M: L group (< 3.76) and high M:L group (≥ 3.76). Survival differences between different M: L level groups at baseline and after treatment were analyzed by methods such as Kaplan-Meier, Cox or Logistic regression model. Progression free survival (PFS) (5.8months vs. 3.4months, p = 0.001) and overall survival (OS) (14.1months vs. 9.0months, p = 0.001) were significantly longer in the low M:L group than in the high M:L group. After analyses of Cox regression modeling it was concluded that M:L was an independent prognostic factor for PFS (HR 1.371 95%CI 1.057-1.777 p = 0.017) and OS (HR 1.352 95%CI 1.003-1.824 p = 0.048), respectively. Subsequent subgroup analyses performed across immunotherapy lines, regimens, PD-1 inhibitor agents, and age groups revealed a poorer prognosis in the high M:L group. Notably, an increase in the value of M:L after treatment significantly increased the risk of poor prognosis. M:L ≥ 3.76 is associated with poor prognostic outcomes in AGC patients receiving immunotherapy and may be a predictive biomarker of prognosis. This result needs to be confirmed by larger prospective studies.

Outcomes of EGFR, ALK, ROS1, BRAF, MET, and RET mutated non-small cell lung cancer with brain metastases (NSCLC BM).

201 Background: Non-small cell lung cancer (NSCLC) is a leading cause of brain metastases. Advances in gene-directed therapies have shifted the focus away from traditional platinum-based chemotherapies. Key targeted mutations in NSCLC include EGFR, ALK, BRAF, MET exon skipping, RET fusions, and ROS1 rearrangements. This retrospective study aims to explore overall survival (OS) and progression-free survival (PFS) in NSCLC BM patients with these gene mutations. Methods: In this retrospective study, conducted by the Department of Medical Oncology at Beijing Tiantan Hospital and the First Medical Center, PLA General Hospital, we reviewed 1526 patients with NSCLC brain metastasis from 2010 to 2022. Data collected included molecular marker status, systemic therapies, and dates of progression. The analysis focused on determining OS and PFS from the time of brain metastasis diagnosis to the last follow-up or death. Statistical analysis used the Cox proportional hazards model. Results: The study reviewed 1526 patients, identifying the following mutation distribution: EGFR mutations in 628 patients, ALK rearrangements in 207 patients, ROS1 rearrangements in 64 patients, BRAF mutations in 31 patients, MET exon skipping in 55 patients, and RET fusions in 42 patients. Significant variations in median OS (mOS) and median PFS (mPFS) were observed across these mutation groups. Patients with EGFR and ALK mutations demonstrated longer mOS and mPFS. Patients with RET and ROS1 mutations also showed better outcomes compared to those with BRAF and MET mutations. Conclusions: This study highlights the importance of molecular mutations in NSCLC BM as prognostic indicators and therapeutic targets. EGFR and ALK mutations were associated with more favorable outcomes, emphasizing the need for personalized medicine in managing NSCLC BM. The study suggests further research focused on specific mutation types is crucial to refine treatment strategies and improve patient care.

Drug Utilization Study of Anticancer Drugs in Breast Cancer Patients at a Tertiary Care Teaching Hospital

This study aimed to assess the drug utilization of anticancer drugs in breast cancer patients at a tertiary care teaching hospital. The objectives were to identify the most commonly prescribed chemotherapeutic drugs and to study the side-effect profile using the CTCAE grading. A prospective observational study was conducted in the medical oncology department. Data was collected from 93 patients and analyzed for prescribing patterns, drug utilization, and side-effects. The majority of patients were aged 46-55 years (48.38%) and in stage III cancer (62.36%). Luminal B was the most common molecular subtype (35.48%). Neoadjuvant therapy was administered to 59.13% of patients, while 40.86% received adjuvant therapy. Trastuzumab was the most frequently prescribed drug in both neoadjuvant (34.54%) and adjuvant (36.84%) therapies. Ondansetron, aprepitant, dexamethasone, and olanzapine were commonly used as supportive treatments. Side-effects were experienced by 76.34% of patients, with 71.83% having grade 1 and 28.16% having grade 2 side-effects. The most frequent side-effects were nausea, vomiting, and alopecia. The onset of side-effects was highest after the 3rd chemotherapy cycle (28.16%). The study provides valuable information about the prescribing patterns and side-effect profile of anticancer drugs in breast cancer patients

Under-representation of older Indian persons with cancer in clinical trials

ObjectiveOlder patients with cancer have traditionally been under-represented in global clinical trials. There are no data from India regarding this issue.Methods and analysisThis was a retrospective analysis done at our...