27th Hellenic Conference of Clinical Oncology

5th Hellenic Congress of Oncology

25th Hellenic conference of Clinical Oncology

6th Hellenic Congress of Oncology

<abstract><title style='display:none'>Abstract</title>Immunotherapy is considered to be the most important breakthrough in cancer management in the past few years. This success was based on the scientific understanding of immune mechanisms due to improvement in preclinical science and the introduction of new methods of investigation. Immune checkpoint inhibitors (ICIs) are among the most promising drugs in the field of immune-oncology; they represent monoclonal antibodies that modulate the effects of immune checkpoints, such as cytotoxic T lymphocyte Antigen 4 (CTLA-4) and Programmed Cell Death protein 1 (PD-1), which are co-inhibitory signals responsible for immune suppression. Despite clinical benefits, ICIs are immune activating agents that are associated with a number of important side effects (immune-related adverse events-irAEs), attributed to organ-specific inflammation. Herein, we review the toxicities of ICIs, highlighting the importance of early identification and management.</abstract>

Overview and management of toxicities of immune checkpoint-blocking drugs

<abstract><title style='display:none'>Abstract</title>Past decade has seen the advent of several prognosticators for oral squamous cell carcinoma (OSCC). Although TNM staging is still considered as the prognostic gold standard, it is not possible to obtain all the necessary information for a pathological TNM staging until excisional biopsy. Thus, it is necessary to identify features from the initial biopsy, which could aid in early prognostication.<sec><title style='display:none'>Aim</title>To compare neutrophil elastase immuno-expression in oral squamous cell carcinoma patients with and without lymph node metastasis.</sec><sec><title style='display:none'>Materials and Methods</title>Archival specimens of 50 oral squamous cell carcinoma consisting of 25 cases with and 25 cases without lymph node metastasis were immuno-stained for neutrophil elastase.</sec><sec><title style='display:none'>Results</title>Statistically, a significant difference was noted in the neutrophil elastase staining between the 2 groups. 18 of the 25-oral squamous cell carcinoma cases with lymph node metastasis were positive and only 5 of the 25-oral squamous cell carcinoma cases without nodal involvement were positive.</sec><sec><title style='display:none'>Conclusion</title>Presence of neutrophil elastase in the lesional tissue is strongly associated with a lymph node involvement, and thus could serve as a prognostic factor for oral squamous cell carcinoma.</sec></abstract>

Assessing the potential role of neutrophil elastase as a prognostic indicator in oral squamous cell carcinoma

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<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
Lung cancer is one of the leading causes of cancer-related mortality worldwide. It frequently metastasizes to bone, brain, lung, and liver, causing a shorter survival. Unusual metastasis also occurs. A few reports have been published, and the majority of described metastatic sites involved the gastrointestinal system and, occasionally, the thyroid gland. Gastrointestinal metastasis from primary lung cancer is rare; however, metastasis to the gastrointestinal tract as an event is frequent. However, distant metastasis to the thyroid gland is a rare event for all types of tumors.
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<sec><title style='display:none'>Case presentation</title>
In the present study, we report two cases of primary lung carcinoma with isolated colonic and thyroid metastases. The first one was a patient with lung cancer who presented with an acute abdomen and underwent right hemicolectomy, which revealed moderately differentiated adenocarcinoma of lung origin. The second one was a patient who presented with thyroid swelling that was preoperatively diagnosed as a metastatic thyroid carcinoma to the lung. So, the patient underwent total thyroidectomy with bilateral neck dissection. But the microscopic examination showed a picture of metastatic adenocarcinoma with mucoid activity, which was of pulmonary origin.
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<sec><title style='display:none'>Conclusion</title>
Thyroid and gastrointestinal metastases from lung cancer are rare, but they should be put into consideration. Clinical and radiologic evaluations are mandatory to help reach the diagnosis, but pathologic confirmation is inevitable.
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Lung cancer with thyroid and colon metastases: a report of two cases

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<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI) are widely used to assess patient’s outcome in many types of neoplasms including breast cancer. The aim of this study was to select the best parameter with a high prognostic value by defining the optimal cutoff value for each parameter in patients undergoing mastectomy.
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<sec><title style='display:none'>Patients and Methods</title>
This is a retrospective monocentric study enrolling 59 patients. The receiver operating characteristic (ROC) curve was used for the obtention of the optimal cutoff values of NLR, PLR, MLR, SII, and SIRI. The Kaplan–Meier curve and log-rank test were used to assess recurrence-free survival (RFS), distant metastasis-free survival (DMFS), and overall survival (OS).
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<sec><title style='display:none'>Results</title>
Among the five parameters, we obtained the optimal cutoff values for NLR, MLR, SII, and NLR but not for PLR (AUC ≤0.5). To assess the RFS, the optimal cutoff values for NLR, MLR, SII, and SIRI were defined as 2.11, 0.16, 472, and 0.6888, respectively. High MLR (p= 0.0165), SII (p= 0.0368), and SIRI (p= 0.012) were associated to shorter RFS. For DMFS, the optimal cutoff values for NLR, MLR, SII, and SIRI were 1.60, 0.28, 472, and 0.6888, respectively. Interestingly, the Kaplan–Meier curve showed that patients with high MLR (p&lt; 0.0001), SII (p= 0.0345), and SIRI (p= 0.0255) exhibited shorter DMFS.
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<sec><title style='display:none'>Conclusions</title>
The MLR, SII, and SIRI indices would be the best indicators. They could constitute a promising predictive tool in the detection of locoregional and distant metastasis.
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Prognostic value of pro-inflammatory markers at the preoperative stage in Algerian women with breast cancer

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<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
Temporary prostate brachytherapy, in combination with external beam radiotherapy (EBRT), is an established and evolving treatment technique for non-metastatic, intermediate and high-risk prostate cancer. This study aimed to evaluate the outcomes of patients with localized intermediate and high-risk prostate cancer treated with combined EBRT and high-dose-rate brachytherapy boost (HDR-BT) at a single centre.
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<sec><title style='display:none'>Patients &amp; Methods</title>
A retrospective review of patients who underwent EBRT and HDR-BT treatment between January 2015 and December 2020. Patient and tumor characteristics, treatment outcomes (Kaplan-Meier analysis), and toxicities were analysed.
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<sec><title style='display:none'>Results</title>
127 patients with intermediate (28.3%) or high-risk (71.7%) prostate cancer were included. Median follow-up was 42 months. Five-year bDFS, CSS and OS rate was 77.5%, 98.1% and 93.0%, respectively, with no significant difference between risk groups. The most frequent toxicity was acute grade 1 urinary obstruction (7.9%). One patient experienced acute and late grade 3 urinary obstruction. No grade ≥4 were observed.
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<sec><title style='display:none'>Conclusions</title>
Combined EBRT and HDR-BT demonstrated favourable disease control rates and manageable toxicities in patients with localized intermediate and high-risk prostate cancer. The 5-year bDFS rate was consistent with previous studies, supporting the effectiveness of this treatment approach. The low incidence of toxicities highlights the conformality and biological efficiency of HDR-BT boost. This treatment strategy provides an effective, safe and convenient option for this group of patients. To the best of our knowledge, this is the first report of the use of helical tomotherapy based intensity-modulated radiation therapy in combination with prostate HDR-BT (81.1% of cases).
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Outcomes of patients with localized prostate cancer treated with combined external beam radiotherapy and high-dose-rate brachytherapy boost: A single-center retrospective study

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<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Objective</title>
We wish to investigate whether there is a known connection between prostate cancer and glomerulonephritis.
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<sec><title style='display:none'>Methods</title>
We present a case report of a patient whom we diagnosed with rapidly progressive glomerulonephritis as a result of prostate cancer relapse.
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<sec><title style='display:none'>Results</title>
In rare cases, prostate cancer is associated with crescentic glomerulonephritis.
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<sec><title style='display:none'>Conclusion</title>
Every patient with cryptic glomerulonephritis should be screened for cancer.
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</abstract>

Glomerulonephritis as a paraneoplastic event from prostate cancer relapse

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<title style='display:none'>Abstract</title>
Drug dosing based on the body surface area (BSA) has been the mainstay of oncological treatment over the last decades. Although this seems to be an adequate measure of an individual’s appropriate dose for traditional chemotherapeutic drugs according to their somatometric data, it is currently being questioned due to the delivery of novel treatments such as monoclonal antibodies. Most modern regimes require either a flat (fixed)-dosing model, independent of body weight, or a weight-based administration pattern, mainly depending on specific pharmacokinetic data. However, even in this case, some controversy exists about whether this model is sufficient. Given the recent findings from pharmacokinetic studies, perhaps we should reconsider the solid hypothesis that drug efficacy correlates with dose, as many molecules seem to be efficient even in the lowest doses administered, with minimum toxicity.
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Change of dosing paradigm in oncology

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<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
Breast cancer is a growing concern in Iraq, posing significant health challenges for Iraqi women. The objective of this study was to describe the demographic and clinical characteristics associated with breast cancer among Iraqi women, with a specific focus on age-related differences.
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<sec><title style='display:none'>Materials and Methods</title>
Medical records of 500 female patients diagnosed with breast cancer between 2017 and 2022 were retrospectively analyzed. Demographic information, clinical history, presentation details, treatment modalities, and outcomes were collected and analyzed.
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<sec><title style='display:none'>Results</title>
Among the studied cohort, 62.4% of breast cancer cases were diagnosed in women aged 50 and older. Marital status correlated significantly with age, with 89.9% of those diagnosed before 50 being married compared to 74.7% of those diagnosed after 50. Notably, 48% of patients diagnosed before 50 had breastfeeding duration of 1–3 months, contrasting with 28.5% of those diagnosed after 50. Diabetes mellitus, hypertension, hypercholesterolemia, heart disease, and vitamin D deficiency were significantly more prevalent among patients diagnosed after 50. Clinical presentation revealed 67.8% with tumor stage II. Metastasis to lymph nodes occurred in approximately 50% of patients. Among patients who were diagnosed after 50 years of age, 34% had metastasis, compared to 22.9% of those diagnosed before the age of 50. Mortality rates were higher in patients diagnosed after 50 (23%) compared to those under 50 (12.8%).
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<sec><title style='display:none'>Conclusion</title>
The findings emphasize the need for targeted public health campaigns, early detection initiatives, and treatment optimization to improve patient outcomes and mitigate the burden of breast cancer.
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</abstract>

Demographic and Clinical Characteristics of Females with Breast Cancer in Iraq with Respect to Age: A Single-Center Study

<abstract><title style='display:none'>Abstract</title>Purpose: Assessment of pain response in patients with bone metastasis after treating with two radiation schedules and to compare toxicity profile in both arms. Patients &amp; Methods: A prospective randomised study was designed to include 100 patients from May 2011 to May 2013. Patients with histopathologically proven primary malignancy having symptomatic secondary deposits to bone were selected for the study. Patients were randomised to 8 Gy in a single fraction (arm A) or 20 Gy in five fractions (arm B). Initial pain response was assessed using numeric rating scale, and compared using the same scale 3 months after completion of treatment. Acute toxicities were assessed using the radiation therapy oncology group criteria for adverse events Results: Arm A comprised 51 patients while 49 patients were enrolled in Arm B. Baseline patient characteristics were comparable. Twelve patients were lost to follow-up. So the 3-month pain score assessment was completed by 88 of the 100 patients; A complete response was observed in 20.4% (18 patients) of the 88 patients, and partial response was observed in 54.5% (48 patients), for an overall response rate of 75% (66 of 88 patients); only 10% (9 patients) of the 88 patients had progression of pain. Mild GI toxicity was noted in both arms but differences in two arms were not statistically significant (p = 0.45), no interruption of treatment was required because of side effects. Conclusions: In our study, we found both the radiation fractionation schedules for palliative bone metastasis treatment is equally effective in pain control.</abstract>

Single Fraction versus Multiple Fraction Radiotherapy for treatment of painful bone metastases: A Prospective Study; Mansoura experience

<abstract><title style='display:none'>Abstract</title>Background: Despite the documentation of addressing healthcare disparities in detection and treatment of cancer and health outcomes for cancer patients, the inequalities persist. Cancer patients of several vulnerable groups suffer disproportionally the effect of economic crisis on health and healthcare.Patients &amp; Methods: A cross sectional survey was carried out between July and October 2014 in order to assess the cancer patients’ barriers to healthcare access. A total of 426 cancer patients, members of cancer patient organization participated in the study. Data were collected by using an online, self reported questionnaire evaluating three main areas: healthcare access (7 items), economic status and financial burden of the disease (17 items) and the alteration on several aspects related to the disease (8 items) from 2009 to 2014.Results: Approximately 31% of cancer patients reported that they faced barriers to healthcare access for cancer treatment during the last 12 months. The main barriers included long waiting time for a medical appointment (51%) and inability to visit a private physician due to the incapability to pay the out of pocket cost (44%). One in four patient encountered obstacles in medication access which resulted to treatment delay (46%), worsened health status (96%) and increased out of pocket costs (39%).Conclusions: Results suggest that there are vulnerable groups among cancer patients in Greece who suffer disproportionally more the impact of economic crisis on health and healthcare. Healthcare reforms and targeted interventions should be implemented in order to effectively address the inequities in access for cancer patients.</abstract>

Healthcare access for cancer patients in the era of economic crisis. Results from the HOPE III study

<abstract><title style='display:none'>Abstract</title><sec id="j_fco-2016-0007_s_333_w2aab3b8b8b1b7b1aab1c13b1Aa"><title style='display:none'>Purpose</title>Adjuvant trastuzumab is currently an internationally standard for the treatment of localised breast cancer that over express HER2 with the most adverse effect being cardiotoxicity. We conducted this study to evaluate the cardiac safety of trastuzumab in clinical practice.</sec><sec id="j_fco-2016-0007_s_334_w2aab3b8b8b1b7b1aab1c13b2Aa"><title style='display:none'>Methods</title>This study is a retrospective observational single institutional study conducted in the Oncology Center of King Abdulla Medical City (KAMC), Makkah, Saudi Arabia, from June 2011 to January 2014. We evaluated the incidence of cardio toxicity and associated risk factors during adjuvant trastuzumab treatment.</sec><sec id="j_fco-2016-0007_s_335_w2aab3b8b8b1b7b1aab1c13b3Aa"><title style='display:none'>Results</title>Of 57 patients, 20 patients (35%) exhibited cardiotoxicity. About 14% of patients had drop of left ventricular ejection fraction (LVEF) below 50%, whilst 10% and 15% drop of LVEF below their baseline levels were found in 30% and 5% of patients, respectively. About 98.3% of our patients have completed treatment, of whom 21% had a provisional interruption because of a fall in LVEF. A definitive trastuzumab discontinuation has been made in 1.75% of cases because of a nonregressive reduction in LVEF. Analysis of risk factors related to trastuzumab cardio toxicity found that patients older than 40 years were more likely to develop cardio toxicity compared to those younger than 40 years. This difference was statistically significant (p = 0.042).</sec><sec id="j_fco-2016-0007_s_336_w2aab3b8b8b1b7b1aab1c13b4Aa"><title style='display:none'>Conclusion</title>In our study, the cardiac safety seems comparable with the literature data. Trastuzumab-related cardiotoxicity is manifested by an asymptomatic decrease in the LVEF and less commonly by clinical heart failure. Most instances are transient, asymptomatic and reversible.</sec></abstract>

Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Egypt, Mansoura,

Cardiology, King Abdulla Medical City Makkah, Kingdom of

Medical Oncology, Oncology Center of King Abdulla Medical City (KAMC), Makkah, Kingdom of

Cardiotoxicity of the adjuvant trastuzumab in a Saudi population: clinical experience of a single institution

<abstract><title style='display:none'>Abstract</title>The emergence of cyclin-dependent kinase (CDK) 4 and 6 inhibitors has brought a new approach in the treatment of advanced hormone receptor (HR) positive breast cancer and human epidermal growth factor (HER) 2 negative breast cancer. To date, three CDK 4/6 inhibitors, palbociclib, ribociclib, and abemaciclib, are approved by the Food and Drug Administration (FDA); the first two agents are approved by the European Medicines Agency (EMA) as well. The family of CDKs consists of key regulatory enzymes that play a significant role in cell cycle progression. The aim of this review is to give an overview of the mechanism of action and the efficacy of CDK4/6 inhibitors and to highlight the most serious adverse events and the drug interactions related to these agents.</abstract>

The Pharmacological Profile of Cyclin-dependent Kinase (CDK) 4/6 Inhibitors: Clinical Management of Toxicity and Drug Interactions Related to CDK 4/6 Inhibitor-based Treatment in Advanced/Metastatic Breast Cancer

<abstract><title style='display:none'>Abstract</title>Treatment personalisation plays a key role in the current management of patients with cancer. Several biomarkers have shown clinical utility and may guide therapeutic decisions. Amongst patients with lung cancer, the level of expression of programmed death ligand 1 (PD-L1) has both prognostic and predictive values in terms of response to the inhibition of programmed cell death protein 1 (PD-1). Depending on the clinical setting, the expression of PD-L1 ≥1% or ≥50% has been associated with improved outcomes amongst patients receiving pembrolizumab. Regarding patients with colorectal carcinoma, mutations in the KRAS oncogene predict the responsiveness to the inhibition of epidermal growth factor receptor (EGFR). Only patients with wild-type KRAS tumours derive benefit from cetuximab and panitumumab in terms of response and survival. In conclusion, future research should aim in the optimisation of the use of biomarker in the clinical practice in order to provide the optimal drug combination to each individual patient.</abstract>

Clinical biomarkers directing the management of patients with colon and lung cancer (beyond oncogene-addicted NSCLC)

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