BackgroundSeveral studies have suggested that sarcopenia is associated with an increased treatment toxicity in patients with cancer. The aim of this study is to evaluate the relationship between sarcopenia and anthracycline-related cardiotoxicity.MethodsPatients who received anthracycline-based chemotherapy between 2014 and 2018 and had baseline abdominal CT and baseline and follow-up echocardiography after anthracycline treatment were included. European Society of Cardiology ejection fraction criteria and American Society of Echocardiography diastolic dysfunction criteria were used for definition of cardiotoxicity. Sarcopenia was defined on the basis of skeletal muscle index (SMI) and psoas muscle index (PMI) calculated on CT images at L3 and L4 vertebra levels.ResultsA total of 166 patients (75 men and 91 women) were included. Sarcopenia was determined in 33 patients (19.9%) according to L3-SMI, in 17 patients (10.2%) according to L4-SMI and in 45 patients (27.1%) according to PMI. 27 patients (16.3%) developed cardiotoxicity. PMI and L3-SMI were significantly associated with an increased risk of cardiotoxicity (L3-SMI: HR=3.27, 95% CI 1.32 to 8.11, p=0.01; PMI: HR=3.71, 95% CI 1.58 to 8.73, p=0.003).ConclusionsThis is the first study demonstrating a significant association between CT-diagnosed sarcopenia and anthracycline-related cardiotoxicity. Routine CT scans performed for cancer staging may help clinicians identify high-risk patients in whom closer follow-up or cardioprotective measures should be considered.

Introduction Although, immune check-point inhibitors changed the course of many cancers, the outcomes in sarcomas were rather disappointing with less than 10% response rates. Ewing sarcoma is a poorly differentiated and aggressive tumor mostly seen in the children and adolescents. It’s a distinct type of sarcoma with prominent chemosensitivity in the early stages. However, the relapsing disease has a poor prognosis with limited treatment options. Case report Herein, we represent a case of relapsed Ewing sarcoma treated with multiple lines of chemotherapy. Management & outcome: The patient had a very good response to salvage treatment with a combination of paclitaxel and nivolumab which lasted for twelve months after the cessation of treatment. Discussion We think that chemotherapy plus immunotherapy can be an option for Ewing sarcoma patients treated with multiple lines of chemotherapy.

Karın ağrısı, nefes darlığı nedeniyle acil servise başvuran 83 yaşındaki kadın hastanın rektal tuşesinde melena saptanması üzerine yapılan endoskopide mide antrumundaki ülsere adeno kanser tanısı konuldu. Hastaya malignite evrelemesi amacıyla abdomen bilgisayarlı tomografi çekildi. Mide duvarı kalınlığı dışında, Chilaiditi belirtisi de saptandı. Chilaiditi belirtisi kolon ve/veya ince barsağın karaciğer ve diyafragma arasına transpozisyonu olarak adlandırılır. Toplumda görülme sıklığı %0.1-%1 arasındadır. Erkeklerde ve yaşlılarda daha sık görülür. Genelde tesadüfen saptanır ve hastalar çoğunlukla asemptomatiktir. Sağ üst kadran ağrısı, nefes darlığı, kabızlık gibi semptomlarla birlikteliğinde Chilaiditi sendromu olarak adlandırılır. En sık bilinen önemi diyafragma altındaki gaz görünümü nedeniyle  pnömoperitoneum ile karıştırılarak gereksiz cerrahi girişimlere neden olabilmesidir. Chilaiditi belirtisinin bazı hastalıklar ile birlikte olduğu da bildirilmiştir. Literatürde kolon volvulusu, kronik obstrüktif akciğer hastalığı, siroz, atrofik veya pitotik karaciğer varlığı, frenik sinir hasarı ve obezitenin Chilaiditi belirtisi ile beraber görüldüğü vaka sunumları mevcuttur. Chilaiditi belirtisinin kolon kanseri ile beraber görüldüğü vakalar bildirilmiştir. Bizim hastamızda mide kanseri ile birliktelik söz konusudur. Karaciğer pitozu, sirozu gibi bazı patolojilerdeki gibi neden-sonuç ilişkisi kurulamasa da, tümörle birlikte olabileceği de unutulmamalıdır.

Aim: The combination of cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitors plus endocrine therapy (ET) improved the survival outcomes and became standard of care in the treatment of metastatic hormone-positive breast cancer. However, these combinations increased the risk of neutropenia compared with ET alone. While the infection-related mortalities did not seem to be increased, the exact risk of infections with CDK 4/6 inhibitor and ET combinations is relatively understudied. Therefore, we performed a meta-analysis of CDK 4/6 inhibitor clinical trials to assess the infection risk of adding CDK4/6 inhibitors to ET.Material and Method: We systemically searched the PubMed database for relevant clinical trials. For each study, all grades and grade 3 or higher infections, upper respiratory tract infections (URTI), urinary tract infections (UTI), pneumonia and febrile neutropenia rates were recorded, whenever available. The hazard ratios (HR) with %95 con dence intervals (CI) of infection risk were calculated via the generic inverse-variance method with a random-effects model.Results: Nine eligible studies were included in the analyses (MONALEESA-2,3,7, MONARCH-2,3, MONARCH plus, PALOMA-1,2,3). In the meta-analysis of these studies, CDK 4/6 inhibitors plus ET arms were associated with increased all grades infections (

Introduction Immune checkpoint inhibitors and angiogenesis inhibitors are novel treatment options for renal cell carcinoma and widely used in clinical practice. They are related with adverse events that occur as a consequence of immune system activation and inhibition of angiogenesis. Herein, we report a rare case of inflammatory arthritis seen in a patient treated with an anti Programmed cell death-1 pembrolizumab and an anti-vascular endothelial growth factor pazopanib. Case report A 60-year-old Caucasian male presented to our clinic with inflammatory arthritis with pitting edema. He had been started on pembrolizumab therapy for metastatic renal cell carcinoma after enrolling in the KEYNOTE-679 study. After six cycles of treatment with pembrolizumab, metastasis had been determined in the lung. Then, the patient’s therapy was changed to pazopanib. While the patient was on pazopanib treatment, he noticed a gradual swelling of both hands. Rheumatoid factor, anti-nuclear antibody and anti-cyclic citrullinated peptide were negative. Joint ultrasonography revealed acute tenosynovitis and soft tissue swelling with pitting edema, and a diagnosis of remitting seronegative symmetrical synovitis with pitting edema was made. Management and outcome: He was started on 10 mg prednisolone daily. His symptoms dramatically responded to corticosteroid. He continued to take pazopanib. Then, the patient was discharged with 10 mg prednisolone daily. Discussion Pembrolizumab- and/or pazopanib-induced remitting seronegative symmetrical synovitis with pitting edema can be among the rare rheumatic immune-related adverse events that clinicians may encounter as the immune check point inhibitors and anti-VEGF use increases. Corticosteroid therapy can relieve symptoms and cessation of therapy may not be necessary.