Introduction and aim To investigate the effect of the prognostic nutritional index on treatment response and survival in patients with metastatic renal cell cancer. Methods We retrospectively analyzed the treatment modalities; the demographic, clinical and pathological features of 396 patients with RCC and prognostic nutritional index. Based on the median value, patients were grouped as having low and high prognostic nutritional index values. Kaplan-Meier method was used for survival analysis, and Cox-regression analysis was used for multivariate analysis. Results The median overall survival was 39 months (95% CI 26.1–51.8), 28 months (95% CI 17.9–38) and 7 months (95% CI 4.7–9.2) in patients with favorable, intermediate and poor International Metastatic Renal Cell Carcinoma Database Consortium risk group, respectively. The difference between the groups was statistically significant (p < 0001). Overall survival was 11 months (95% CI 7.5–14.5) in the low-prognostic nutritional index (prognostic nutritional index ≤38.5) group, and 41 months (95% CI 30.5–51.4) in the high prognostic nutritional index (prognostic nutritional index >38.5) group (p < 0.001). In Cox regression analysis, Eastern Cooperative Oncology Group performance score (HR: 2.5), time to systemic treatment (HR: 1.7) and prognostic nutritional index (HR: 1.8) were associated with overall survival. Conclusion In patients with renal cell cancer, prognostic nutritional index is closely related to survival and has prognostic significance.

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Background To describe the prognostic value of neutrophil–lymphocyte ratio and its effect on survival in in patients with advanced renal cell carcinoma. Methods We retrospectively analyzed 331 patients. The cut-off value of neutrophil–lymphocyte ratio was specified as “3” which is mostly close—and also clinically easily applicable—to the median neutrophil–lymphocyte ratio level of our study group. High group is identified as neutrophil–lymphocyte ratio >3 (n = 160) and low group is identified as neutrophil–lymphocyte ratio ≤3 (n = 163). Results A total of 331 (with 211 male and 120 female) patients were enrolled to study. The median age of the patients was 58. The International Metastatic RCC Database Consortium risk score is calculated for the 72.8% (n = 241) of the study group and among these patients, favorable, intermediate, and poor risk rates were 22, 45.2, and 32.8%. The total usage of tyrosine kinase inhibitors reached 78% of the patients. The median overall survival was 32 months versus 11 months in the neutrophil–lymphocyte ratio low and high groups, respectively (HR: 0.49 (95% CI 0.37–0.65), p < 0.001). Conclusion In conclusion, the pre-treatment value of elevated neutrophil–lymphocyte ratio might be a predictor of poor overall survival in advanced renal cell carcinoma patients.

Results: 72 patients were included: 52 received abemaciclib as first line, 20 as second line; in 49 patients abemaciclib was administer in combination with an aromatase inhibitor, in 23 with fulvestrant. 95.8% of patients experienced at least one adverse event. The most common was diarrhea (79.2%), mainly G1 (66.7% of cases). Other common toxicities were: neutropenia (56.9%), increased serum creatinine (38.9%), anemia (37.5%), nausea (34.7%), fatigue (23.6%) and hypertransaminasemia (22.2%). Toxicities were mainly low grade; 10.1% of adverse events where G3-4. 48.6% of patients required a temporary interruption of abemaciclib and 45.8% a dose reduction. All 17 patients aged 70 required a dose reduction. A concomitant palliative radiotherapy was administered in 16 patients: in all cases radiotherapy was regularly completed; a temporary interruption of abemaciclib was required in 3 patients due to hematologic toxicities. In patients with measurable disease, ORR was 55.7%, significantly higher in first line compared to second line (70.5% vs 17.7%, p<0.001). ORR was not significantly different between full and reduced dose (46.9% vs 65.5%, p¼0.143). At the time of the present analysis, 51 patients are still on therapy. Treatment discontinuations were due to disease progression in 17 patients, and to adverse events in 4 (G3 increased ALT in 1 patient and persistent G2-3 cutaneous toxicity in 3 patients).Conclusions: In a real-world population, abemaciclib was associated with a meaningful rate of objective response, with a favourable safety profile. Side effects were mostly low grade, manageable with temporary interruptions or dose reductions.Legal entity responsible for the study: The authors.

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Keywords• aromatase inhibitors • breast cancer • endocrine treatmentPatients with invasive breast cancers that estrogen receptor and/or progesterone receptor are positive should be treated with adjuvant endocrine therapy regardless of stage of the disease, patient age, prior chemotherapy and menopausal status [1]. In the adjuvant hormonal treatment of postmenopausal breast cancer patients, most of the trials have showed the superiority of aromatase inhibitors over tamoxifen. In a meta-analyses of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen, aromatase inhibitors significantly lower recurrence rates compared with tamoxifen treatment either as initial monotherapy or after 2-3 years of tamoxifen [2]. In a metanalyses of 31,920 postmenopausal patients, 5 years of an aromatase inhibitor reduces recurrence rates by about 30% and 10-year breast cancer mortality rates by about 15% compared with 5 years of tamoxifen [3]. Due to the better progression-free survival rate and lower recurrences with aromatase inhibitors compared with tamoxifen in early breast cancer, aromatase inhibitors have been accepted as first-line treatment in the adjuvant treatment of hormone receptor-positive postmenopausal breast cancer [4].Letrozole is a more potent inhibitor of aromatase than anastrozole at their conventionally used doses, and leads to more complete inhibition of whole-body aromatase. Geisler et al. reported that mean percentage aromatase inhibition with anastrozole was 97.1%, whereas more than 99.1% suppression of aromatase enzyme was observed with letrozole in standard treatment doses [5]. In postmenopausal patients, a randomized Phase II ACOSOG Z1031 trial (NCT00265759) showed that all three aromatase inhibitors; letrozole, anastrozole and exemestane have similar rates of clinical response in the neoadjuvant setting [6]. However, aromatase inhibitors have been accepted as first-line treatment of postmenopausal hormone receptor-positive early breast cancer, it is wondering that which aromatase inhibitor is better than another. Recent published trials investigated the clinical efficacy of aromatase inhbitors.In a randomized Phase III MA.27 trial (NCT00066573), the efficacy of steroidal aromatase inhibitor exemestane and nonsteroidal aromatase inhibitor anastrozole for 5 years in the adjuvant hormonal treatment of hormone receptor-positive postmenopausal early breast cancer was compared [7]. Total of 7576 patients were enrolled in this first comparison of steroidal and nonsteroidal