IntroductionStandard treatment for locally advanced cervical cancer (LACC) includes concomitant chemoradiotherapy (CRT) that typically controls localized disease. However, most patients develop distant metastasis, ultimately leading to death.ObjectiveTo determine the role of adjuvant carboplatin and paclitaxel for clinical outcomes in patients with LACC.MethodsBetween 2010 and 2017, 109 patients with LACC were retrospectively evaluated. All patients received cisplatin (40 mg/m2) with concurrent external-beam radiotherapy (up to 50.4 Gy), followed by intra-cavitary brachytherapy. Forty-six of 109 patients received a median of six cycles (range 3–6 cycles) of adjuvant chemotherapy consisting of paclitaxel (175 mg/m2) and carboplatin (CRT + chemotherapy group; area under the curve 5). The remaining 63 patients did not receive adjuvant chemotherapy (CRT group).ResultsDisease-free survival and overall survival after a median follow-up of 24.5 months (range 2.6–94.75 months) were 93.5% and 95.7% and 69.8% and 82.5 % for the CRT + chemotherapy and CRT groups, respectively (p = 0.001, p = 0.012, respectively). No acute grade 3/4 gastrointestinal or genitourinary toxicities were seen during CRT. During adjuvant chemotherapy, the most troublesome side effects were hematologic and neurologic toxicities; however, most were manageable. No chronic grade 3/4 genitourinary toxicities were seen.DiscussionAdjuvant chemotherapy in patients with LACC significantly improved both disease-free survival and overall survival without increasing unmanageable toxicity. Future larger prospective trials are warranted to verify these findings.
202 Background: The optimal treatment for metastatic colorectal cancer (mCRC) after the second line is still controversial. Regorafenib (Reg) revealed promising results by improving overall survival compared to best supportive care. However, in real-world practice rechallenge chemotherapy (CTr) is often preferred even though supporting evidence is not enough. We aim to compare the efficacy of regorafenib and 5-fluorouracil-based (5-FU) rechallenge treatment in the third line setting of mCRC. Methods: In this retrospective multi-institutional trial, mCRC patients from 21 centers in Turkey progressing after 2 lines of chemotherapy between 2012-2020 were analyzed. Patients who were treated with Reg or rechallenge therapy in the third-line setting were eligible. Rechallenge chemotherapy was identified as the re-use of the 5-FU based regimen which was administered in one of the previous treatment lines. Overall survival (OS), objective response rate (ORR), progression free survival (PFS) and toxicity were analyzed. Chi-square, Kaplan-Meier method and Cox regression analysis were used for analysis. Results: The clinical data of 441 mCRC patients were analyzed. Of these, 284 received regorafenib while 156 received rechallenge chemotherapy. The mean age was 57 and 56% was male. Median OS since the diagnosis was better with CTr than with Reg (48 months (95% CI, 43.4–52.6) vs. 39 months (95% CI, 35.4–42.5), p<0.001). Median OS after the third-line treatment was 12.0 (95% CI, 9.9–14) and 9.0 months (95% CI, 7.5–10.4) for CTr and Reg groups, respectively (p<0.001). PFS was 6 months for patients receiving CTr and 4 months for those treated with Reg (p = 0.139). ORR was significantly higher in CTr group than Reg (p<0.001). BRAF status, MSI status and treatment type (CTr vs. Reg) are factors found associated with OS in Cox regression analysis (p<0.001, p=0.021 and p<0.001, respectively). Adverse effects were seen in 82% and 68.2% of patients receiving Reg and CTr, respectively. Discontinuation of treatment due to adverse effects was higher in patients treated with Reg (10% vs. 2.5%). Conclusions: Our analysis revealed that rechallenge is an appreciated option, in both efficacy and toxicity, when the limited treatment options for mCRC is considered. Although regorafenib treatment contributes to survival, CTr shows better disease control. Our study has the highest number of patients in the literature. Still, prospective studies are mandatory for validation of CTr in the third-line treatment of mCRC.
Introduction Cyclin-dependent kinase 4/6 inhibitors are new generation drugs that have recently been used in patients with hormone receptor-positive and human epidermal growth factor receptor 2-negativenegative metastatic breast cancer. Recent studies have shown that the use of cyclin-dependent kinase 4/6 inhibitors significantly improves the outcomes of these patients. The most common side effects of cyclin-dependent kinase 4/6 inhibitors are hematological toxicity, gastrointestinal side effects, and fatigue. We aimed to present a case of metastatic breast cancer who was treated with ribociclib and developed vitiligo-like lesions after treatment. Case report A 56-year-old female patient was diagnosed with locally advanced hormone receptor (+)/human epidermal growth factor receptor 2 (−) breast cancer in May 2000. She was followed up with hormonal therapy after adjuvant chemotherapy and radiotherapy. The patient progressed with lung metastases in 2012. Ribociclib, anastrozole, and leuprolide acetate were started in November 2021 after multiple-line chemotherapy. After six cycles of ribociclib, vitiligo-like lesions that developed in the last 1 month were detected on the upper extremities, both hands, neck, chest, and upper back. Management and outcome The patient was referred to dermatology. Topical immunosuppressive therapy and oral corticosteroids were recommended. At the first and third-month follow-up examinations, vitiligo-like lesions were observed to persist. Discussion Vitiligo-like lesions are not a life-threatening side effect. However, it significantly affects the quality of life and disrupts the patient's compliance with treatment. Cyclin-dependent kinase 4/6 inhibitors can inhibit cell division or cause premature cell death by acting on the melanocyte cell cycle.
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