Background: Mucosal malignant melanoma (MMM) is a rare and aggressive malignancy with a dismal prognosis. While the Systemic Immune-Inflammation Index (SII) has emerged as a prognostic marker in various solid tumors, its specific value in MMM remains undefined. This study investigated the association between pretreatment SII and overall survival (OS) in patients with MMM. Methods: We retrospectively analyzed 106 adults with histologically confirmed MMM treated at six oncology centers in Turkey between 2005 and 2025. The baseline SII was calculated as platelet × neutrophil/lymphocyte counts obtained before definitive treatment. A receiver operating characteristic (ROC) analysis identified an optimal SII cutoff of 776 for overall survival (OS), defining low (<776) and high (≥776) SII groups. Results: Gastrointestinal and head and neck mucosa were the most frequent primary sites, and one-third of patients presented with metastatic disease. The median OS for the entire cohort was 23.3 months. Patients with a high versus low SII had a shorter OS (16.2 vs. 35.2 months; HR 2.71, 95% CI 1.67-4.40; p < 0.001). In multivariable analysis, a high SII (HR 1.88, 95% CI 1.12-3.14; p = 0.016), gastrointestinal primary site (HR 1.99, 95% CI 1.23-3.23; p = 0.005), and metastatic disease at diagnosis (HR 4.01, 95% CI 2.32-6.94; p < 0.001) independently predicted a worse OS. Conclusions: The SII is a novel, independent prognostic biomarker in MMM. Elevated pretreatment SII correlates with aggressive clinicopathologic features and inferior survival. As a readily accessible and cost-effective marker, SII may facilitate improved risk stratification in routine clinical practice for MMM patients.

ObjectiveIn this study, we aimed to investigate the prognostic significance of the expression of lymphocyte activation gene 3 and CD73 in advanced or metastatic hepatocellular carcinoma as well as its predictive effect on disease control rates in patients receiving sorafenib.MethodsData from 79 patients diagnosed with hepatocellular carcinoma in 3 different oncology centers between 2012 and 2021 were analyzed. Of these patients, 67 were included in this study based on the inclusion and exclusion criteria. The correlation between the expression of lymphocyte activation gene 3 and CD73 and clinical features was analyzed.ResultsOf the 67 patients included in the study, 80.6% were males, and the median age at diagnosis was 65 (55-73) years. A baseline alpha-fetoprotein level of <400 ng/mL and the presence of lymphocyte activation gene 3 expression were correlated with better survival (p = 0.001 and p = 0.049, respectively). CD73 expression was observed in 45.8% of patients whose disease was under control with sorafenib, while 80% of patients who did not respond to sorafenib showed CD73 expression (p = 0.02).ConclusionsPositive lymphocyte activation gene 3 expression was correlated with better survival in patients with advanced or metastatic hepatocellular carcinoma. In addition, CD73 expression in patients with advanced or metastatic hepatocellular carcinoma was a negative predictive factor in those receiving sorafenib.

Background/Objectives: The prognostic nutritional index (PNI) has been associated with outcome in metastatic breast cancer, but studies in CDK4/6 inhibitor-treated patients have used cohort-derived thresholds and examined only the pretreatment value. We assessed the PNI as a continuous variable, compared it with inflammatory indices, and examined whether repeated measurement added information. Methods: We reviewed 192 consecutive patients with hormone receptor–positive, HER2-negative metastatic breast cancer treated with a CDK4/6 inhibitor and endocrine therapy at a single centre. We calculated the PNI, neutrophil-to-lymphocyte ratio (NLR), and systemic inflammation response index (SIRI) before treatment and recalculated them before cycles 2 and 3. The Cox models were adjusted for age, liver metastasis and line of therapy; no threshold was derived from these data. Results: The median follow-up was 44.9 months. Each one-point increase in the baseline PNI was independently associated with lower hazards of progression (HR 0.952, 95% CI 0.923–0.983) and death (HR 0.919, 95% CI 0.884–0.956), corresponding to HR 0.782 (95% CI 0.670–0.918) and HR 0.656 (95% CI 0.540–0.799) per five-point increase. For overall survival, in formal comparisons on identical patient sets, neither the NLR nor the SIRI added prognostic information to a model containing the PNI (likelihood ratio p = 0.383 and p = 0.335), whereas the PNI added information to models containing either ratio (p < 0.001 and p = 0.004). In exploratory landmark analyses, change in the PNI added little to the baseline value; apparent associations between increases in the NLR or SIRI by cycle 3 and overall survival did not persist after winsorisation of extreme change scores. Conclusions: Baseline PNI, analysed as a continuous variable and without a data-derived threshold, was independently associated with progression-free and overall survival in this cohort. For overall survival, neither baseline inflammatory ratio added detectable prognostic information beyond the index, and repeated measurement during treatment added little to the baseline value, although the confidence intervals do not exclude modest effects. Because all patients received a CDK4/6 inhibitor and no comparator arm was available, these findings support a prognostic rather than a predictive interpretation, and external validation is required before the index can inform clinical decisions.

PURPOSEHepatitis B virus (HBV) and hepatitis C virus (HCV) infections are clinically significant in patients with cancer, as chemotherapy can trigger viral reactivation, leading to liver failure, treatment interruption, or death. Despite this risk, routine viral screening in patients with solid tumors remains inconsistent across institutions and guidelines. The purpose is to determine the frequency of viral screening and the prevalence of HBV, HCV, and HIV infections—and to assess the rate of viral reactivation—in a large cohort of newly diagnosed adult patients with cancer receiving chemotherapy.MATERIALS AND METHODSA retrospective, multicenter cohort study was conducted across 15 oncology centers in Turkey. Data from 15,942 adults with solid tumors receiving parenteral chemotherapy between January 2018 and December 2022 were analyzed. Patients with primary liver cancer or those receiving non-immunosuppressive therapies were excluded.RESULTSAmong 15,942 patients (median age, 58 years [range, 16-94]; 51.4% male), hepatitis B surface antigen (HBsAg) testing was performed in 90.3%, anti-HCV in 71.7%, and anti-HIV in 64.0%. HBV infection was identified in 4.5% (n = 645), with only 42.9% receiving antiviral prophylaxis. HBV reactivation occurred in 4.0% of HBsAg-positive patients (n = 26). Anti-HCV positivity was found in 0.4% (n = 46), of whom 17.4% had detectable HCV RNA and received treatment. HIV infection was rare (0.06%; n = 6), and no cases of viral reactivation were observed.CONCLUSIONThis large multicenter study highlights persistent gaps in viral screening and prophylaxis among patients with solid tumors. Despite lower HBV reactivation rates—likely due to partial prophylaxis—preventable complications still occurred. Despite increases in vaccination and prophylaxis, reactivation rates remain a significant problem. Standardized national protocols for prechemotherapy viral screening and timely antiviral therapy are essential to improve patient safety and treatment outcomes.

Introduction Trastuzumab deruxtecan (T-DXd)-induced interstitial lung disease/pneumonitis (ILD) represents a clinically significant and potentially fatal toxicity. Discrepancies exist regarding its reported frequency and severity between clinical trials (CTs) and real-world data (RWD). This meta-analysis aims to evaluate the incidence of T-DXd-related ILD and investigate its differences between CTs and RWD. Methods A systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Databases were searched from their inception through January 2026. CTs and real-world studies reporting T-DXd-related ILD were included in the analysis. Pooled incidences for all-grade, grade ≥3, and fatal ILD were calculated using random-effects models. Subgroup analyses comparing CTs and RWD, and meta-regression analyses for relevant outcomes were performed. Results Thirty-five studies (19 CTs, 16 RWD) including 6840 patients were analyzed. The pooled incidence was 8.8% for all-grade ILD, 1.6% for grade ≥3 ILD, and 0.26% for fatal ILD. RWD was independently associated with lower reported rates of all-grade and fatal ILD, while prior lines of therapy were the main predictor of grade ≥3 ILD. Conclusion ILD risk with T-DXd differs by severity and data source. Vigilant monitoring is essential, particularly in heavily pretreated patients.

Background Germline BRCA1/2-mutated (gBRCAm) hormone receptor-positive/HER2-negative (HR+/HER2−) metastatic breast cancer (MBC) represents a biologically distinct subset in which the efficacy of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors remains incompletely characterized. Given the interplay between DNA damage repair deficiency and cell-cycle regulation, BRCA-associated tumors may demonstrate differential therapeutic sensitivity. We evaluated real-world outcomes, safety, and prognostic factors in a multicenter cohort. Methods This multicenter retrospective cohort study included patients with pathogenic germline BRCA1 and/or BRCA2 mutations treated with a CDK4/6 inhibitor plus endocrine therapy for HR+/HER2 − MBC (June 2020–September 2025) at participating centers in Turkey. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan–Meier methods and compared by log-rank testing. Cox proportional hazards models were used for univariable and multivariable analyses. Results Among 121 patients, 30 (24.8%) had BRCA1, 88 (72.7%) BRCA2, and 3 (2.5%) dual BRCA1 + BRCA2 mutations; 66.9% received CDK4/6 inhibitors as first-line therapy. Ribociclib was used in 69.4% and palbociclib in 29.8%. Objective response rate was 69.4% and clinical benefit rate 82.6%. Median PFS was 17.0 months and median OS was 47.0 months. PFS differed significantly by BRCA subtype (25.0 months for BRCA1, 14.0 months for BRCA2, and 6.0 months for BRCA1 + 2; log-rank p = 0.013). Median OS also differed (57.0, 49.0, and 11.0 months, respectively; log-rank p = 0.016). PFS did not differ between ribociclib and palbociclib (p = 0.192); OS favored ribociclib at a borderline level (p = 0.050), not confirmed in Cox regression. In multivariable analysis, ECOG ≥ 1 (HR 1.846; p = 0.010) and fulvestrant-based therapy (HR 1.735; p = 0.041) predicted shorter PFS; fulvestrant predicted worse OS (HR 2.389; p = 0.008). Dose reductions occurred in 16.5% and discontinuation in 2.5%. Conclusions CDK4/6 inhibitor–based therapy demonstrates clinically meaningful activity in gBRCAm HR+/HER2 − MBC; however, survival outcomes differ by BRCA subtype, suggesting underlying biological heterogeneity. These findings support further investigation of BRCA subtype–specific tumor biology and its implications for therapeutic sequencing in this molecularly defined population.

Background: Vandetanib and cabozantinib are the approved first-line antiangiogenic multikinase inhibitors (aaMKIs) for metastatic medullary thyroid carcinoma (MTC); however, real-world data on their comparative efficacy, optimal sequencing, and outcomes beyond the first-line setting remain limited. We report multicenter real-world outcomes from a large Turkish cohort. Methods: In this retrospective multicenter cohort study, we analyzed data from 24 oncology referral centers across Türkiye. Patients with histologically confirmed metastatic MTC who received systemic therapy between December 2011 and December 2024 were included. The primary endpoint was progression-free survival (PFS), assessed separately for first-line (PFS1) and second-line (PFS2) therapy. Overall survival (OS) and prognostic factors were evaluated using Kaplan-Meier and Cox proportional hazards analyses. Results: A total of 115 patients were included (median age 47.4 years; 63.5% male). In the first-line setting, vandetanib (47.8%) and cabozantinib (30.4%) were the most frequently used agents. Median PFS1 was 40.8 months with vandetanib and was not reached with cabozantinib; both were significantly superior to chemotherapy (median PFS1 4.9 months; log-rank p < 0.001). In the second-line setting, median PFS2 was not reached with cabozantinib and was 32.5 months with vandetanib. Sequential use of cabozantinib and vandetanib across the first two lines was associated with a median time to second progression of 114 months, compared with 39 months in patients receiving any other TKI combination (p = 0.003). Second-line use of cabozantinib or vandetanib was independently associated with improved OS (HR 0.40, 95% CI 0.16-0.98; p = 0.046). On multivariate analysis, younger age (HR 0.16, 95% CI 0.03-0.72; p = 0.017) and bone metastasis (HR 0.29, 95% CI 0.11-0.73; p = 0.009) were independent prognostic factors for OS. Conclusions: In this real-world cohort of patients with metastatic MTC, cabozantinib and vandetanib demonstrated durable efficacy across treatment lines, substantially outperforming alternative TKIs and chemotherapy. Sequential use of both approved aaMKIs was associated with prolonged disease control. These findings suggest a potential association between access to both agents and improved outcomes. They are consistent with their central role in treatment sequencing, particularly in settings with limited access to selective RET inhibitors. Given the retrospective design and small subgroup sizes, these results should be interpreted as exploratory and hypothesis-generating.

Limited-stage small cell lung cancer (LS-SCLC) is characterized by rapid proliferation and a high propensity for early relapse, resulting in poor prognosis. For decades, the standard of care has remained concurrent chemoradiotherapy followed by prophylactic cranial irradiation. The advent of immune checkpoint inhibitors has recently stimulated investigation into novel therapeutic strategies for this patient population. This review summarizes the biological rationale, feasibility, and current clinical evidence regarding the use of immunotherapy in LS-SCLC. In early-phase studies, the use of immunotherapy as a neoadjuvant approach has predominantly been evaluated through Phase II or retrospective trials with limited sample sizes; nonetheless, the achieved response rates have been found clinically promising. Studies concerning immunotherapy administered concurrently with chemoradiotherapy present heterogeneous outcomes, necessitating further advanced-phase clinical trials to definitively establish the efficacy and safety of this approach. In contrast, consolidation immunotherapy has yielded data with the highest level of evidence in LS-SCLC, primarily driven by the ADRIATIC trial. The results of the ADRIATIC study support the adoption of consolidation durvalumab following concurrent chemoradiotherapy as a new standard of care in the management of LS-SCLC. However, reliable biomarkers capable of predicting the clinical benefit of neoadjuvant, concurrent, and consolidation immunotherapies, as well as the specific patient subgroups that would derive the greatest benefit, have yet to be clearly defined. Consequently, prospective large-scale trials remain critical to addressing existing uncertainties regarding the optimal timing of immunotherapy and patient selection.

In EGFR T790M-mutant lung adenocarcinoma, the strong and early clinical responses achieved with osimertinib may be limited by the emergence of diverse resistance mechanisms over time. In this case report, we describe an acquired CD74-ROS1 fusion that developed during osimertinib therapy in a patient who had an EGFR exon 20 T790M mutation detected in the treatment-naive setting. The fusion, identified through a tissue biopsy performed at the time of progression, suggests that the tumor had activated an alternative oncogenic driver under therapeutic pressure. The combination of osimertinib and crizotinib resulted in a marked clinical and metabolic response, was well tolerated, and the patient remained in remission. This rare case highlights that acquired CD74-ROS1 fusions may contribute to osimertinib resistance and suggests that combination targeted therapy may represent a potential therapeutic approach in selected patients.

Mucosal malignant melanoma (MMM) is a rare, aggressive malignancy with poor prognosis in the advanced setting. Although the Royal Marsden Hospital (RMH) score is widely used in advanced malignancies, its utility in advanced MMM remains insufficiently characterized. We aimed to develop a composite prognostic score and compare its performance with RMH. We analyzed 80 patients with advanced MMM (metastatic or unresectable) from a multicenter database. Pretreatment inflammatory indices and clinical variables were evaluated. The CLIP-M score (Clinical and Inflammatory Prognostic Score in Mucosal Melanoma) was derived from independent predictors in multivariable Cox regression and internally validated by bootstrap resampling. Predictive accuracy was compared with RMH using time-dependent AUCs, Harrell’s C-index, and Kaplan–Meier estimates. During a median follow-up of 65.2 months, 63 deaths occurred. SII was selected as the biological component. CLIP-M integrated high SII (≥ 789; derived by 12-month time-dependent ROC analysis), age ≥ 65 years, and non–head neck primary location. Time-dependent AUCs numerically favored CLIP-M over RMH at 12 months (0.731 vs. 0.613), 24 months (0.824 vs. 0.680), and 36 months (0.863 vs. 0.697), with a nominal 36-month between-model difference that did not remain significant after correction for three time horizons (ΔAUC = 0.166; nominal p = 0.039). Bootstrap internal validation showed moderate discrimination, with apparent and optimism-corrected C-indices of 0.648, and acceptable 12-month calibration. CLIP-M stratified patients into low-risk (score 0–1) and high-risk (score 2–3) groups with divergent median overall survival (24.8 vs. 6.4 months; HR 4.03, 95

Background: Effective management of hypertension (HT) and adherence to antihypertensive therapy are essential for maintaining quality of life in cancer patients. This study aimed to assess medication adherence and quality of life in cancer patients diagnosed with HT. Methods: This prospective descriptive study was carried out from January to September 2024 in the outpatient chemotherapy (CT) unit of a tertiary care research hospital in Istanbul. Participants were adults over 18 years old undergoing CT with a pre-existing diagnosis of HT. Each patient completed the Turkish versions of the Functional Assessment of Cancer Therapy - General (FACT-G) and the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCHBPT) through face-to-face interviews. Results: Sixty-two cancer patients with HT (mean age 63.0 ± 8.2 years; 65% female) were included, with gastrointestinal cancers being the most common (40%). Median baseline blood pressure (BP) was 125/73 mmHg, with most patients achieving target BP. Older age and longer HT duration were associated with lower diastolic BP. Medication adherence, measured by the HBCHBPT Scale (Cronbach’s alpha = 0.644), was positively correlated with baseline systolic BP and differed by cancer type and therapy, with lower adherence observed in patients with hematologic cancers and those receiving targeted therapies. Quality of life, assessed with the FACT-G, was generally lower in physical, functional, and emotional well-being subscales. Male patients had higher physical well-being scores than females, while other subscale and total scores were not significantly affected by demographic or clinical factors. Conclusion: Although a trend suggesting an association between higher adherence and better quality of life was observed, it did not reach statistical significance. These results indicate a possible link that should be explored in further studies, with attention to identifying factors that negatively influence adherence and quality of life and developing targeted interventions that enhance medication adherence and overall well-being in this population. Cite this article as: Yılmaz F, Tezcan S, Köstek O. Treatment adherence and quality of life in hypertensive cancer patients receiving chemotherapy. Trends in Pharmacy, 2026, 3, 0001, doi: 10.5152/TrendsPharm.2026.26001.

Although bone metastases (BMs) are uncommon in colorectal cancer (CRC), they are a clinically significant problem. BMs are associated with a poor prognosis, and depending on the location, skeletal complications may occur. This study aims to evaluate the characteristics, treatment modalities, and prognostic factors affecting survival in patients with bone-metastatic CRC treated at a single institution. This retrospective study included 59 patients diagnosed and followed up with bone-metastatic colorectal cancer at Marmara University Pendik Training and Research Hospital between January 2014 and December 2024. Demographic and clinical variables, including age, sex, tumor location, grade, mutation status, and metastatic spread, were examined. Bone Metastasis Progression-free survival (BM-PFS) and Bone Metastasis spesific overall survival (BM-OS) were assessed using the Kaplan-Meier method, and prognostic factors were assessed using Cox proportional hazard regression in univariate and multivariate models. Median age of the patients was 59 years and 64.4

Objective: Tumor-associated edema has been implicated as a marker of aggressive tumor biology in gliomas, yet most existing evidence is derived from preoperative imaging and glioblastoma-focused cohorts. The prognostic significance of postoperative edema in non-glioblastoma diffuse gliomas remains insufficiently characterized. Material and Methods: This retrospective cohort study included patients with histologically confirmed non-glioblastoma diffuse gliomas who underwent surgical intervention at a single tertiary center between October 2010 and January 2024. Postoperative edema was assessed using routine magnetic resonance imaging and classified as present or absent. Overall survival (OS) was defined as the time from diagnosis to death from any cause or to last follow-up. Survival analyses were performed using Kaplan-Meier methods and Cox proportional hazards regression models. Multivariable models were constructed using clinically relevant covariates selected a priori, with sensitivity analyses incorporating performance status and comorbidity burden. Results: A total of 79 patients were included. Postoperative edema was present in 34 patients (54.8%). Median OS was significantly shorter in patients with postoperative edema compared with those without edema (69 vs. 108 months; log-rank p=0.007). In multivariable Cox regression analysis, postoperative edema was independently associated with worse OS (hazard ratio: 2.86; 95% confidence interval: 1.41-5.88; p=0.004), after adjustment for tumor grade, tumor location, surgical procedure, and adjuvant treatment. Tumor grade and non-supratentorial location were also independently associated with poorer survival. The association between postoperative edema and OS remained significant in sensitivity analyses that included Eastern Cooperative Oncology Group performance status and the Charlson Comorbidity Index. Conclusion: Postoperative edema is a independently associated with OS in patients with non-glioblastoma diffuse glioma. These findings suggest that routine assessment of postoperative edema may provide clinically meaningful prognostic information beyond established clinicopathological factors and may support its potential role in postoperative risk stratification.

The integration of digital health technologies into oncology care has accelerated dramatically, yet the relationship between technology access and health literacy remains insufficiently characterized. This study examined information and communication technology (ICT) usage patterns and health literacy levels among cancer patients receiving active treatment, investigating whether a gap exists between technology ownership and meaningful digital health engagement. We hypothesized that higher health literacy levels would be associated with increased ICT utilization for health information seeking. We conducted a cross-sectional study of 267 cancer patients at Marmara University Medical Oncology Clinic between January and September 2025. Participants completed a comprehensive 28-item questionnaire assessing sociodemographic characteristics, ICT usage patterns, and attitudes toward digital health applications. Health literacy was measured using the validated Turkish Health Literacy Scale-32 (TSOY-32). Statistical analyses included ANOVA for continuous variables and chi-square tests for categorical variables, with significance set at p < 0.05. The mean age of participants was 53.01 ± 13.60 years, with 64.8

Background and Objectives: This study aimed to evaluate the prognostic impact of baseline body composition measurements and changes in muscle and adipose tissue during treatment on overall survival (OS) in metastatic non-small cell lung cancer (NSCLC) patients treated with nivolumab. Materials and Methods: Eighty-eight metastatic NSCLC patients who were initiated on nivolumab between January 2022 and December 2024 were retrospectively analyzed. Body composition parameters were derived from baseline and 3-month 18F-FDG PET/CT scans at the L3 level, including psoas muscle index (PMI), skeletal muscle index (SMI), intramuscular adipose content (IMAC), and subcutaneous fat density (SFD). Treatment-related changes in body composition were evaluated, and survival analyses were performed using Kaplan–Meier estimates and Cox regression models. Results: Overall, 34.1% (n = 30) of patients were classified as sarcopenic. Median OS was significantly longer in non-sarcopenic patients (19 months vs. 5 months, p < 0.001). In univariate analysis, older age, higher comorbidity burden, liver metastasis, baseline sarcopenia, and adverse treatment-related changes in muscle and nutritional parameters were found to be associated with OS. In multivariate analysis, only unfavorable changes in skeletal muscle (ΔSMI; HR 3.39, p = 0.003) and subcutaneous fat radiodensity (ΔSFD; HR 2.45, p = 0.02) remained independent adverse prognostic factors. Baseline body composition parameters did not maintain their independence in multivariate models. Conclusions: Our study demonstrates that muscle loss or insufficient gain and unfavorable changes in subcutaneous fat radiodensity during nivolumab treatment more strongly predict overall survival compared to baseline measurements. These findings highlight the clinical importance of monitoring dynamic body composition throughout treatment, rather than static assessments, in NSCLC patients receiving immunotherapy.

Capecitabine is an oral fluoropyrimidine prodrug widely used in the treatment of various malignancies, including colorectal cancer. While it is generally well-tolerated, rare and life-threatening toxicities can occur. Pneumonitis is an exceedingly rare complication associated with capecitabine monotherapy. A 36-year-old male with pT3N0 (stage IIA) colon adenocarcinoma underwent curative resection and was started on adjuvant capecitabine monotherapy. During the second cycle, the patient developed a cough and exertional dyspnea. Symptoms progressed during the third cycle, leading to hospitalization. Imaging revealed diffuse ground-glass opacities, and pulmonary function tests showed a severely reduced diffusion capacity of the lung for carbon monoxide (38% of predicted). Dihydropyrimidine dehydrogenase deficiency was ruled out. Based on clinical and radiological findings, a diagnosis of capecitabine-induced pneumonitis was made. Capecitabine was discontinued, and intravenous methylprednisolone (1 mg/kg) was initiated. The patient showed rapid symptomatic improvement and was discharged with a tapered steroid regimen. Follow-up imaging at 1 month showed complete resolution of pulmonary opacities. The patient remains in remission at a 3-year follow-up. Although capecitabine-induced pneumonitis is remarkably rare, it carries a risk of significant morbidity. Clinicians should maintain a high index of suspicion for drug-induced pulmonary toxicity in patients presenting with new respiratory symptoms during capecitabine therapy, as early recognition and treatment are crucial for recovery.

Background The integration of digital health technologies into oncology care has accelerated dramatically, yet the relationship between technology access and effective utilization remains poorly understood. This study examined information and communication technology (ICT) usage patterns and health literacy levels among cancer patients receiving active treatment, exploring the paradox of high technology ownership but limited health literacy. Methods We conducted a cross-sectional study of 267 cancer patients at Marmara University Medical Oncology Clinic between January and September 2025. Participants completed a comprehensive 28-item questionnaire assessing sociodemographic characteristics, ICT usage patterns, and attitudes toward digital health applications. Health literacy was measured using the validated Turkish Health Literacy Scale-32 (TSOY-32). Statistical analyses included ANOVA for continuous variables and chi-square tests for categorical variables, with significance set at p < 0.05. Results The mean age of participants was 53.01 ± 13.60 years, with 64.8% female and 80.8% married. Despite high smartphone ownership (91.6%), limited health literacy was prevalent, with 68.6% of patients classified as having inadequate (31.5%) or problematic-limited (37.1%) health literacy. Healthcare professionals remained the primary information source (50% always consulted), followed by the internet (33.5% regular users). Significant associations emerged between health literacy levels and ICT usage patterns, including internet use for health information (p < 0.001), mobile application use (p = 0.002), and medication research frequency (p = 0.031). Notably, 93.2% of patients expressed willingness to use health applications if recommended by their physician, yet only 51.4% currently had health-related applications installed, and merely 22% would definitely pay for such applications. Conclusions This study reveals a critical digital health paradox in cancer care: while technology access is nearly universal, limited health literacy creates substantial barriers to effective digital health engagement. The strong influence of physician recommendations on application adoption suggests that healthcare provider-endorsed, integrated digital health solutions may be more effective than consumer-market applications. Our findings underscore the urgent need for health literacy-informed design of digital health interventions and systematic integration of these tools into oncology practice. Future digital health strategies must address not only technological access but also the capacity to critically evaluate and effectively utilize digital health information.

We aimed to evaluate the efficacy and safety of a combination of nab-paclitaxel and gemcitabine as a second-line treatment, after first-line treatment with FOLFIRINOX regimen, for metastatic or locally advanced unresectable pancreatic cancer. This national multicenter retrospective study included patients with metastatic or unresectable locally advanced pancreatic cancer treated with FOLFIRINOX in the first-line setting. After progression with first-line treatment, all patients were treated with nab-paclitaxel and gemcitabine as second-line treatment. This study included 180 patients across 15 centers with a median age of 60 years. The median overall survival (OS) of all patients was 17.9 months. The median progression-free survival (PFS) following first-line chemotherapy was 8.4 months, whereas the median PFS achieved with nab-paclitaxel plus gemcitabine treatment was 5.5 months. Regarding treatment-related adverse events (TRAEs), all grades of non-hematologic adverse events (AEs) occurred at expected rates. However, the incidence of hematologic TRAEs was lower than anticipated. Grade 5 TRAEs were not observed. Patients who responded well to first-line FOLFIRINOX demonstrated a trend toward better outcomes with NG, although this did not reach statistical significance. The combination of nab-paclitaxel and gemcitabine is safe and effective as second-line treatment for locally advanced unresectable or metastatic pancreatic cancer after FOLFIRINOX.

Background/Objectives: This study aimed to evaluate the prognostic value of 18F-FDG PET/CT-based secondary lymphoid organ metabolic ratios-spleen/liver (SLR), bone marrow/liver (BLR), and ileocecal region/liver (ILR)-and hematological inflammation markers (neutrophil/lymphocyte ratio [NLR] and systemic immune-inflammation index [SII]) obtained before nivolumab treatment in relation to survival in patients with advanced non-small cell lung cancer (NSCLC). Methods: This retrospective single-center study included 79 advanced NSCLC patients who were treated with nivolumab monotherapy at Marmara University Faculty of Medicine Hospital between 2022 and 2024. Pretreatment SLR, BLR, and ILR ratios were calculated from 18F-FDG PET/CT examinations; NLR and SII values were obtained from hematological data. Survival outcomes were analyzed using the Kaplan-Meier method, and prognostic factors were assessed using Cox proportional hazards regression analysis. In a subset of patients, an exploratory longitudinal analysis was performed using early follow-up PET/CT to assess follow-up-to-baseline changes in immune-organ metabolic ratios in relation to overall survival. Results: High NLR and SII levels were significantly associated with shorter progression-free survival and overall survival. In contrast, no significant associations were observed between PET/CT-derived metabolic ratios (SLR, BLR, and ILR) and survival. Multivariate analysis identified the presence of liver metastases and a high NLR as independent adverse prognostic factors for overall survival. Conclusions: In this homogeneous real-world cohort treated exclusively with single-agent nivolumab, PET/CT-derived secondary lymphoid organ metabolic ratios showed limited prognostic value at baseline and during early on-treatment assessment. In contrast, hematological inflammation markers, especially high NLR levels, are strong prognostic indicators of survival and may complement established clinical factors in risk stratification.

218 Background: Brain metastases from colorectal cancer (CRC) are rare but clinically significant events with limited data available. This study aimed to evaluate the clinicopathological and molecular features, as well as survival outcomes, of CRC patients who developed brain metastases across multiple centers. Methods: We retrospectively reviewed CRC patients treated at eight oncology centers. Clinical variables (age, sex, tumor location, timing of brain metastasis), molecular markers (MSI, KRAS, NRAS, BRAF, HER2), and survival outcomes were analyzed. Overall survival (OS) was calculated from CRC diagnosis, and post-brain metastasis survival from the time of cranial involvement. Results: Among 5617 CRC patients, 94 (1.7%) were identified with brain metastases. The cohort included 57 men (60.6%) and 37 women (39.4%), with a median age of 60 years (range, 26.9–81.3). Primary tumor location was rectum in 42 patients (44.7%), left colon in 31 (33.0%), and right colon in 21 (22.3%). Brain metastases occurred significantly more frequently in left-sided and rectal primaries compared with right-sided tumors (77.7% vs 22.3%, χ²=28.8, p<0.001). Molecular profiling revealed: MSI-H 6.1% (5/82), KRAS mutation 46.3% (38/82), NRAS mutation 2.7% (2/75), BRAF mutation 8.1% (6/74), and HER2 positivity 10.8% (8/74). Notably, HER2 positivity appeared higher than the expected prevalence reported in unselected metastatic CRC cohorts. Brain metastases developed after a median of 1.8 years (range, 0–7.4); 8 patients (13.6%) had de novo brain metastasis, while 51 (86.4%) developed interval metastases. At last follow-up, 83.7% of patients had died. Median OS from diagnosis was 31.2 months, while median survival after brain metastasis was only 4.8 months. Conclusions: Our multicenter analysis demonstrates that CRC brain metastases occur most often in left-sided and rectal tumors, with an unexpectedly high rate of HER2 positivity and left-sided BRAF mutations. This pattern may reflect a unique molecular biology that distinguishes CRC patients at risk of cranial involvement and could inform future strategies for surveillance and targeted therapy. To our knowledge, this represents one of the largest multicenter series investigating CRC patients with brain metastases.