Abstracts for The 6th National Scientific Forum of Young Oncologists

Ramada Plaza by Wyndham, Craiova, Romania, 14-16 May 2026

Liquid biopsy and circulating biomarkers in cutaneous head and neck cancers:
insights from a literature review

Iris-Iuliana Adam¹, Alina Ormenișan²

1. “Sf. Constantin” Hospital, Braşov; Dental Elite, Braşov, Romania

2. “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş; Mureş County Emergency Clinical Hospital, Târgu Mureş, Romania

Objective. Cutaneous head and neck cancers display heterogeneous tumor behavior, with variable aggressiveness and recurrence risk. This review aims to summarize current evidence on the role of liquid biopsy and circulating biomarkers in profiling these cancers and in assessing the prognostic potential. Materials and method. A systematic literature search was conducted in PubMed, Web of Science and Google Scholar, for studies published in the last five years. Clinical and preclinical studies investigating circulating tumor DNA (ctDNA), cell-free DNA (cfDNA) and micro­RNAs in cutaneous and head and neck cancers were included. Emphasis was placed on associations between biomarker levels, tumor aggressiveness, progression and recurrence. Results. Emerging evidence indicates that ctDNA mutations (e.g., BRAF, TP53) and tumor-specific microRNAs correlate with tumor burden, invasive potential and recurrence risk. Liquid biopsy enables dynamic monitoring of tumor biology, often detecting molecular changes prior to clinical or histopathological progression. Integrating biomarker data with clinical and pathological information may improve prognostic accuracy and patient stratification in oncology practice. Conclusions. Liquid biopsy represents a promising noninvasive approach for profiling cutaneous head and neck cancers. Circulating biomarkers provide valuable insights into tumor aggressiveness and recurrence risk, supporting personalized oncologic management. Further prospective studies are needed to validate these biomarkers and define standardized clinical protocols.

Keywords: liquid biopsy, ctDNA, circulating biomarkers, head and neck cancer, cutaneous cancer

The impact of HER-2 alterations in bladder cancers: current evidence and clinical pitfalls

A.C. Anater, A. Cosma, E.D. Nagy

Oncohelp Oncology Center, Timișoara, Romania

Objective. This literature review aims to summarize the currently available scientific evidence regarding the prognostic and predictive impact of HER-2 alterations in urothelial carcinomas (UC), while also highlighting the limitations inherent to pathological and molecular diagnosis. The objective of this review is to delineate the relevance of HER-2 testing and integration as a novel therapeutic target, and to document the current therapeutic advances associated with this approach. Materials and method. Following a comprehensive analysis of multiple publications from leading peer-reviewed journals (e.g., Science, Nature, The New England Journal of Medicine) addressing the aforementioned topic, we have synthesized a contemporary perspective on the clinical relevance of HER-2 alterations in the management of patients with metastatic urothelial carcinoma, presented in a clinically informative manner. Results. This review addresses the complexity of HER-2 alterations from both biological and clinical perspectives. Intra- and intertumoral heterogeneity represents a defining feature, accounting for variable expression between primary and metastatic lesions, among synchronous lesions within the same organ and across diverse molecular subtypes and histopathological variants of UC. These characteristics influence both prognosis and the clinical responses achieved with anti-HER-2 therapies. The significant and sustained activity of novel agents such as trastuzumab deruxtecan and disitamab vedotin, together with synergistic concepts between different agents, has reshaped the paradigm of integrating HER-2 alterations into the management sequence of urothelial carcinoma. Conclusions. The integration of HER-2 alterations into clinical practice remains hindered by their biological heterogeneity, the lack of standardization and diagnostic inconsistencies. However, the significant results recently achieved with antibody-drug conjugates (ADCs) have renewed clinical interest in HER-2 testing, and underscored its relevance as a biomarker within the therapeutic landscape of metastatic urothelial carcinoma.

Keywords: urothelial cancer, HER-2 alterations, biomar­ker, prediction, prognostication

Prognostic role of immune-related adverse events in patients with metastatic malignant melanoma – cohort study from a tertiary-level hospital

I.L. Antone-Iordache^1,2, Simona Coniac^1,3, Andreea-Iuliana Ionescu^1,2,4, Ana-Maria Barbu¹, V. T. Bardan¹, Ileana-Raluca Pătru^1,4

1. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

2. Department of Radiotherapy, Colţea Clinical Hospital, Bucharest, Romania

3. Department of Medical Oncology, Hospice Hope Bucharest, Romania

4. Department of Medical Oncology, Colțea Clinical Hospital, Bucharest, Romania

Objective. Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for malignant melanoma (MM), providing unprecedented progression-free survival (PFS) and overall survival (OS), but often causing unpredictable immune-related adverse events (irAEs). This study evaluates whether irAEs serve as valid prognostic markers for OS and PFS among metastatic MM patients in real-world clinical settings. Materials and method. We conducted a retrospective cohort study encompassing all metastatic MM patients treated with ICIs at the Colțea Clinical Hospital, Bucharest, Romania, between January 2017 and December 2025. The inclusion required completing at least one immunotherapy cycle. We used Kaplan-Meier curves, log-rank tests and Cox regression models calculating hazard ratios. Logistic regressions were also performed to predict the onset of irAEs. Results. Our cohort included 68 patients, with a median age of 66 years old and a median follow-up of 8.5 months. Overall, 35.6% of patients developed irAEs. This group demonstrated a statistically significant increase in median OS (27 versus 7.3 months; p=0.022) and PFS (26.9 versus 3.6 months). Hazard ratios were 0.45 (95% CI; 0.23-0.90) for OS and 0.42 (95% CI; 0.21-0.83) for PFS. A predictor for developing irAEs was the positive treatment response, while radiation at metastasis sites was associated with fewer irAEs. Conclusions. The development of irAEs strongly associates with significantly improved overall survival and progression-free survival in patients with metastatic malignant melanoma. Larger multicenter studies must verify these findings.

Keywords: malignant melanoma, immune checkpoint inhibitors, immune-related adverse events, real-world data

Caring for the emotional and mental health of cancer patients: a systematic review

Diana-Elena (Lazăr) Bălan^1,2, Roxana Postolica³, Teodora Alexa-Stratulat⁴, Asmaa Waheed Mohamed⁵, Bianca Hanganu⁶, Beatrice-Gabriela Ioan⁶

1. PhD School, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

2. Department of Oncology, “Sf. Ierarh Dr. Luca” Municipal Hospital, Oneşti, Bacău, Romania

3. Department of Psychology, Regional Institute of Oncology, Iaşi, Romania

4. Medicine III – Oncology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

5. Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

6. Medicine III – Legal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

Introduction. Caring for cancer patients requires treating not only the tumor, but also the mind coping with it. Objective. This review aims to describe the literature on mental adaptation to cancer and to examine how coping strategies influence psychological outcomes among cancer patients. Research questions. Which coping strategies related to mental adaptation to cancer are reported by patients with breast, lung, colorectal, prostate and bladder cancers? Design. Systematic review reported according to the PRISMA guidelines. Materials and method. A comprehensive literature search was conducted in the PubMed database. The study methodological quality was evaluated using the Joanna Briggs Institute critical appraisal tools, and the certainty of evidence was assessed according to the Oxford Centre for Evidence-Based Medicine. Results. The search identified 173,274 records, of which 42 studies met the eligibility criteria after screening. Most studies were cross-sectional and conducted in hospital oncology departments, outpatient clinics, rehabilitation programs or community follow-up services. The findings indicate that the diagnostic and early treatment phases are the most psychologically vulnerable periods for cancer patients. Maladaptive coping strategies, particularly helplessness-hopelessness and anxious preoccupation, were associated with greater psychological distress, including anxiety and depression. Sociodemographic factors, including age, gender, education, income and social support, also influenced the psychological outcomes. Conclusions. Early psychological assessment and psychosocial interventions during the first months after diagnosis may improve the mental health outcomes. Further research should explore digital health tools and remote support systems to enhance psychological care for cancer patients.

Keywords: mental adaptation to cancer, coping strategies, Mini-MAC, MAC, cancer patients, psychological distress, quality of life

From microbiome to molecule: can oral butyrate enhance the response to neoadjuvant chemoradiotherapy in rectal cancer?

Cristina-Georgiana Bratu^1,2, Florentina Ioniță-Radu¹

1. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

2. “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania

Objective. Growing evidence links gut microbiota dysbiosis to suboptimal outcomes in colorectal cancer; however, microbiome-directed interventions remain difficult to implement in routine oncology. Butyrate, a key microbial metabolite, exerts pleiotropic antitumor effects, including immune modulation (enhanced CD8⁺ T-cell activity, regulatory T-cell balance) and induction of tumor apoptosis. Emerging data also suggest synergy with immunotherapy and modulation of chemotherapy metabolism. We aim to evaluate whether oral sodium butyrate supplementation can improve pathological complete response (pCR) rates in locally advanced rectal cancer (LARC) patients undergoing neoadjuvant chemoradiotherapy (nCRT), independent of microbiome profiling. Materials and method. A systematic review of preclinical and clinical evidence was conducted (PubMed, Cochrane). Based on identified translational gaps, we propose a prospective, controlled interventional trial enrolling LARC patients treated with standard nCRT. Oral sodium butyrate will be administered throughout neoadjuvant treatment. The primary endpoint is pCR at surgery; secondary endpoints include toxicity, treatment compliance, quality of life and systemic inflammatory markers. No microbiome sequencing is required, enhancing feasibility and external validity. Discussion. While butyrate has been investigated in chemoprevention and correlated with immunotherapy outcomes, no prospective interventional trial has evaluated its role as a structured adjunct to nCRT in LARC with pCR as a primary endpoint. The existing data are limited by heterogeneity and lack of clinically meaningful endpoints. This study addresses a key translational gap by testing a biologically grounded yet pragmatic intervention. Conclusions. This ongoing study proposes a low-cost, scalable strategy to integrate microbiome-derived biology into daily oncology practice. If effective, oral butyrate could represent an accessible approach to improving treatment response in rectal cancer, without the need for complex microbiome profiling.

Keywords: microbiome, butyrate, rectal cancer, neoadjuvant treatment

Incidental prostate cancer in radical cystectomy: a Romanian perspective

Anamaria Burnar¹, Camelia Coadă², Ramona Matei³, M. Buzoianu⁴, Iulia Andraș⁴, N. Crișan⁴, D. Dulf³

1. “Prof. Dr. Ion Chiricuță” Institute of Oncology, Cluj-Napoca, Romania

2. Department of Morphofunctional Sciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

3. Municipal Clinical Hospital Cluj-Napoca, Romania

4. Department of Urology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Objective. This study aimed to evaluate the incidence of prostate cancer in patients undergoing radical cystectomy for bladder cancer and to assess its pathological characteristics and prognostic significance in a Romanian cohort. Materials and method. A retrospective cohort study was conducted on 159 male patients who underwent radical cystectomy for bladder cancer between 2012 and 2024 at the Municipal Clinical Hospital in Cluj-Napoca, Romania. Clinical, surgical and histopathological data were analyzed. Incidental prostate cancer (iPCa) was defined as prostate cancer detected incidentally in cystoprostatectomy specimens and further classified as clinically significant or insignificant according to modified Epstein criteria. The survival outcomes were assessed using Kaplan-Meier and Cox regression analyses. Results. Incidental prostate cancer was identified in 32 patients (20.13%). Patients with iPCa were significantly older and had higher preoperative PSA levels. The majority of iPCa cases were organ-confined (pT2 in 93.75%), and had a Gleason score of 6 (68.75%). Overall, 84.4% were classified as clinically significant. However, no significant differences were observed in operative outcomes, progression-free survival or overall survival between patients with and without iPCa. Conclusions. Incidental prostate cancer is a frequent incidental finding in radical cystectomy specimens. Although most cases meet the histopathological criteria for clinical significance, iPCa does not appear to influence the oncological outcomes, suggesting that prognosis is primarily driven by bladder cancer characteristics.

Keywords: incidental prostate cancer, bladder cancer, radical cystectomy, incidence, prognosis, clinical significance

Modelling breast cancer metastasis: distinct dissemination patterns of three cell lines
in zebrafish xenografts

A.N. Ceobanu^1,2,3, A.F. Braniște^1,3, Paula-Alexandra Stache³, M.G. Dimofte^1,4

1. “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

2. Department of Oncology, Regional Institute of Oncology Iaşi, Romania

3. Transcend Research Center, Iaşi, Romania

4. Department of Surgery, Regional Institute of Oncology Iaşi, Romania

Introduction. Breast cancer (BC) metastasis is a primary cause of cancer-related mortality. The zebrafish (Danio rerio) embryo provides a rapid, in vivo platform for modeling tumor dissemination. This study evaluates the metastatic potential of three different BC cell lines, isolated from distinct clinical sites, using a zebrafish xenograft model. Materials and method. We utilized three human BC cell lines: MDA-MB-231 (triple-negative, derived from metastatic pleural effusion), SKBR3 (human epidermal growth factor receptor 2 [HER2]-positive, derived from metastatic pleural effusion) and HCC1954 (HER2-positive, derived from a primary ductal carcinoma). The cells were fluorescently labeled and microinjected into zebrafish embryos. Tumor cell behavior and dissemination patterns were monitored and evaluated using fluorescence microscopy. Results. The zebrafish xenografts successfully recapitulated the distinct metastatic behaviors of the three BC cell lines. MDA-MB-231 cells exhibited the highest susceptibility to metastasis, demonstrating aggressive dissemination and a strong capacity to extravasate, forming secondary tumors outside the vasculature. In contrast, the SKBR3 cell line showed a different migration pattern, tending to form predominantly intravascular metastases without significant extravasation. Meanwhile, the HCC1954 cells did not develop metastases, remaining localized at the initial injection site. Conclusions. The zebrafish xenograft model accurately reflects the diverse metastatic capabilities of BC cell lines with different phenotypes. This in vivo approach highlights distinct cellular dissemination patterns – from local retention to intravascular spread and active extravasation, proving to be a highly effective and robust platform for studying cancer metastasis.

Keywords: zebrafish xenograft, breast cancer, metastasis, in vivo model, cell dissemination

Predictive factors for the localization of multiple metastases in clear cell renal cell carcinoma (cc-RCC)

Andrei-Alexandru Cosma^1,2, Angelo Anater¹, Mihaela Paşca-Feneşan^1,2, Elena-Daniela Nagy¹, Anca-Maria Cîmpean², Şerban Negru¹

1. OncoHelp Oncology Center, Timişoara, Romania

2. Department of Microscopic Morphology/Histology, “Victor Babeş” University of Medicine and Pharmacy, Timișoara, Romania

Introduction and objective. Multiple metastases of clear cell renal cell carcinoma (cc-RCC) adversely affect therapy efficacy and survival rates. The examination of metastases at diagnosis has limited predictive prognostic signs, mostly associated with therapeutic response, recurrence and survival outcomes. We intended to stratify patients by age, by correlating leukocyte and platelet counts with the number and location of metastases at initial diagnosis. Materials and method. We examined the prevalence of metastases by anatomical region, age and clinicopathological variables. Results. In younger patients (ages 35-50 years old), cc-RCC metastases predominantly occur in the brain, bone and liver, with peripheral blood neutrophil counts directly influencing the first two sites. Women exhibit the highest prevalence of liver metastases. Lymph node metastases may exacerbate skin metastases; however, additional research is required. The age group of 51-65 years old exhibited no skin metastases and the lowest rate of metastasis. They had a partial positive correlation with neutrophil levels, and resul­ted in many lung and pleural metastases in males. Circulating neutrophils may inhibit brain metastases in this age group, due to their inverse correlation with them. In these two age groups, neutrophils and brain metastases exhibited distinct results, indicating that aging and potentially other factors influence neutrophil heterogeneity with varying functions. Our geriatric patients (66-85 years old) had the highest incidence of metastases and a pronounced neutrophil-platelet interaction, potentially ele­va­ting the risk of thrombosis. Conclusions. The metastatic potential of cc-RCC exhibits significant hete­ro­geneity across various age categories. We identified varying metastatic predispositions of cc-RCC based on age, sex, leukocyte, neutrophil and platelet counts, as well as heterogeneity in metastasis associations among different age groups.

Keywords: metastases, age, clear cell renal cell carcinoma

Dynamic changes in neutrophil-to-lymphocyte ratio predict early disease progression
after radical cystectomy in bladder cancer

Maria-Delia Florea

Municipal Clinical Hospital Cluj-Napoca, Romania

Introduction. Systemic inflammatory response and the interplay between pro-tumoral and anti-tumoral immune mechanisms have emerged as key determinants of cancer outcomes. The neutrophil-to-lymphocyte ratio (NLR) is an accessible biomarker reflecting systemic inflammation and immune status. This study aimed to investigate the prognostic significance of perioperative NLR dynamics in patients with bladder cancer undergoing radical cystectomy, with a focus on progression-free survival (PFS). Materials and method. We retrospectively analyzed 100 patients diagnosed with bladder cancer who underwent radical cystectomy. Hematological parameters were collected at three predefined time points: preoperatively, postoperative day 1 and postoperative day 7. Cox proportional hazards regression models were employed for univariable and multivariable analyses to identify factors associated with PFS and overall survival (OS). Results. An increase in NLR from the preoperative assessment to postoperative day 1 was significantly associated with inferior PFS (HR 1.08; 95% CI; 1.01-1.15; p=0.02). Based on the magnitude of NLR variation, the patients were stratified into two groups, demonstrating significantly different outcomes, with median PFS of 46.7 months versus 15.2 months (log-rank p=0.02). In multivariable analysis, additional factors independently associated with PFS included the administration of chemotherapy (HR 0.49; 95% CI; 0.29-0.84; p=0.009), the presence of lymphovascular invasion (HR 2.46; 95% CI; 1.45-4.17; p=0.001) and advanced pathological stage (T stage: HR 7.32; 95% CI; 2.9-18.48; p<0.001; N stage: HR 1.10; 95% CI; 1.02-1.19; p=0.011). Conclusions. Perioperative NLR dynamics represent a simple, cost-effective and widely available biomarker that may improve risk stratification in bladder cancer patients undergoing radical cystectomy. The incorporation of NLR changes alongside established clinicopathological factors could facilitate the early identification of patients at a higher risk of disease progression. Prospective validation in larger cohorts is warranted to confirm its clinical utility.

Keywords: bladder cancer, neutrophil-to-lymphocyte ratio, radical cystectomy, progression-free survival, inflammatory biomarkers, prognostic factor

Real-world efficacy of BCG immunotherapy in high-risk non-muscle-invasive bladder cancer:
a retrospective analysis from a Romanian tertiary center

Diana-Elena Hosu-Durnea

Municipal Clinical Hospital Cluj-Napoca, Romania

Introduction. Intravesical Bacillus Calmette-Guérin (BCG) remains the cornerstone of management for high-risk non-muscle-invasive bladder cancer (NMIBC). This study aimed to characterize the clinical experience, treatment efficacy and oncological outcomes of patients receiving BCG therapy within a specialized tertiary uro-oncology institution in Romania. Materials and method. We re­tro­spectively analyzed data from 85 consecutive patients with NMIBC who underwent transurethral resection of the bladder (TURBT) and subsequent BCG immunotherapy at our center between January 1, 2021 and March 30, 2026. Clinical and pathological variables were evaluated alongside treatment response, defined according to the International Bladder Cancer Group (IBCG) criteria. Results. The therapy demonstrated high efficacy, with a success rate of 86.2%. BCG failure occurred in 13.8% of the cohort. No significant differences in baseline demographics, comorbidity burden or tumor characteristics (high-grade histology, pT1 stage and concomitant carcinoma in situ) were observed between responders and nonresponders. However, patients experiencing BCG failure had a markedly higher incidence of disease recurrence or progression at the last follow-up compared to the success group (75% versus 8%; p<0.05). Conclusions. These findings demonstrate that BCG immunotherapy in a Romanian tertiary setting achieves efficacy rates consistent with international benchmarks. While the majority of patients respond favorably, the severe progression risk observed in the failure subset underscores the importance of stringent surveillance and the role of specialized centers in managing treatment-resistant NMIBC.

Keywords: BCG immunotherapy, NMIBC, tertiary center, uro-oncology, real-world evidence

T-DXd-OH – a single-center study on real-world data safety and efficacy of trastuzumab deruxtecan in HER2-positive breast cancer treatment

V. Lupu^1,2,3, Cristina Oprean^1,2,3, Sorela Barbu¹

1. OncoHelp Oncology Center, Timişoara, Romania

2. ANAPATMOL Research Center, Timişoara, Romania

3. “Victor Babeș” University of Medicine and Pharmacy, Timişoara, Romania

Introduction. Trastuzumab deruxtecan is an antibody-drug conjugate that transformed the treatment landscape in advanced HER2-positive breast cancer. In this real-world retrospective and prospective study, we aim to present a real-world cohort study of trastuzumab deruxtecan (T-DXd), as observed in our high-volume center in Timişoara, Romania, with an update as of March 2026. Materials and method. The cases were selected by performing a search in the institution’s database for patients receiving at least one cycle of treatment with trastuzumab deruxtecan in the HER2-positive advanced breast cancer setting. The selection included patients enrolled in early access programs. The primary objective was progression free survival (PFS), and the secondary objectives were overall survival (OS), response rate (RR) and safety, while extensive data were collected. The statistical analysis was performed by the authors. Results. In total, we identified 49 patients who have received at least one cycle of T-DXd, either in the second line or in later lines of treatment. The disease burden was significant, with extensive liver (53%), lung (57%), brain (43%) and bone (61%) involvement. Also, 52% of the patients were treated in the third line or later. Median PFS for all patients was 31 months, while median PFS for the third line and above was 17.2 months. ORR was 59.2%, with 8% complete responses and a 90% disease control rate. While any grade toxicity tends to be more frequent compared to the registration trials, grade 3-5 events occur less frequently. There were no serious (grade 3+) interstitial lung disease events. Conclusions. The reported findings suggest that T-DXd is highly effective in Romanian patients, with results mirroring the published real-world data from other publications with regard to later lines of treatment, while surpassing survival data in the second line. The safety profile did not reveal any new signals, confirming T-DXd as a safe and effective option for HER2-positive patients.

Keywords: breast cancer, HER2-positive, real-world data, trastuzumab deruxtecan

Quality of life assessment in head and neck cancer patients undergoing radiotherapy using EORTC QLQ-C30 and QLQ-HN43

I. Mologani^1,2, L.I. Antone-Iordache^1,2, L. Bucurescu², G. Bocancea², G. Gagiu^1,2, H.D. Lișcu^2,3

1. Radiotherapy Department, Colţea Clinical Hospital, Bucharest, Romania

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

3. Emergency University Hospital Bucharest, Romania

Introduction. Radiotherapy (RT), with or without concurrent chemotherapy, remains a cornerstone of treatment for head and neck cancers (HNC), yet its impact on the quality of life (QoL) is substantial. This prospectively study evaluated the QoL changes during radiotherapy in 33 HNC patients treated in the Radiotherapy Clinic of the Colţea Clinical Hospital, Bucharest, Romania, over four months, focusing on functional outcomes, symptom burden and the influence of clinical variables on post-treatment QoL. Materials and method. Thirty-three patients with histologically confirmed HNC (97% squamous cell, 84.8% locally advanced, stages III-IVB) were evaluated using EORTC QLQ-C30 and QLQ-HN43 questionnaires at the initiation and completion of RT. Concurrent chemotherapy was administered in 78.8% of patients. Paired and independent samples T-Tests, Wilcoxon and Mann-Whitney U tests, along with Pearson/Spearman correlations were applied. Results. Social functioning showed the most significant decline during treatment (91.7 versus 74.7; p=0.019). Physical function deteriorated clinically but not significantly (82.1 versus 70.1; p=0.120), and a decrease in social contact was noted (p=0.045), while global QoL remained largely unchanged. Significant symptom worsening was observed for skin toxicity (p=0.031), wound-related issues (p=0.008) and coughing (p=0.018). Patients over 65 years old experienced significantly worse post-treatment physical function (p=0.032) and sensory issues (p=0.004) compared to younger patients. Older age at diagnosis was associated with markedly lower physical functioning and with reduced ability to perform daily activities after treatment completion. Conclusions. While radiotherapy remains an essential and often curative treatment for head and neck cancers, it carries a significant symptom burden that meaningfully impacts the patients’ daily lives. Proactive symptom management, efficient patient-physician communication, closer clinical monitoring and dedicated supportive care, particularly for elderly patients, should be integral components of the oncological treatment plan, in order to preserve the quality of life throughout the course of therapy.

Keywords: head and neck cancer, squamous cell carcinoma, quality of life, EORTC, radiotherapy, chemotherapy

Real-world effectiveness of palbociclib in Romanian patients with HR+/HER2− metastatic breast cancer

Alexandra-Irene Neculau¹, T.M. Vancea², O. Bochiș¹

1. “Prof. Dr. Ion Chiricuţă” Institute of Oncology, Cluj-Napoca, Romania

2. Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Introduction. Palbociclib, a cyclin-dependent kinase 4/6 inhibitor, has demonstrated its efficacy in patients with hormone receptor-positive (HR+), HER2-negative metastatic breast cancer. This study aimed to explore clinical outcomes and real-world effectiveness of palbociclib. Study design. This was a retrospective cohort study conducted at the Oncology Institute in Cluj-Napoca, Romania, using data from 2018 to 2026. We included patients with HR+/HER2− metastatic breast cancer treated with palbociclib, grouped by age at diagnosis, age at metastasis, prior adjuvant therapies, lines of treatment, dose reductions, treatment status (ongoing, progression, lost) and patterns of metastasis (bone, visceral, mixed). Materials and method. We included 269 patients, 266 women and three men. We assessed global progression-free survival (PFS), and we examined whether the outcomes differed by metastatic origin (de novo versus recurrent), dose adjustments and their association with the endocrine therapy partner. The study explored correlations between histologic subtype, nodal involvement, Ki-67 le­vels, hormone receptor status and PFS. Results. The global median PFS was 21 months, with 30.1% of patients still on treatment. Palbociclib was mainly used in the first line (68%) and second line (24.9%). Ninety-four patients required dose reductions because of hematologic toxicity. De novo cases showed a PFS of 23 months versus 19 months for recurrent disease, although the difference was not significant. Tumor grade and initial stage were significant predictors of progression-free survival. No significant correlation was found between PFS and metastatic site, histologic subtype and Ki-67 levels. Study limitations. This study is limited by its retrospective, single-center design and the potential selection bias with incomplete clinical data and loss to follow-up in some patients. Conclusions. This retrospective study suggests that palbociclib efficacy in real-world practice aligns with data from clinical trials.

Keywords: palbociclib, HR+/HER2−, PFS, dose reduction

Complete and durable responses to atezolizumab-bevacizumab in advanced hepatocellular carcinoma: a case series

Denisa Oprean, Dalina-Maria Duinea, R.A. Vidra

Medical Oncology, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania

Introduction. To describe the clinical characteristics, treatment response and outcomes of patients with advanced or unresectable hepatocellular carcinoma (HCC) who achieved complete response to first-line therapy with atezolizumab plus bevacizumab. Materials and method. We conducted a retrospective case series, including eight patients with HCC who achieved radiological complete response, selected from a cohort of 75 patients treated at our institution between 2022 and 2025. The eligible patients were ≥18 years old, had confirmed HCC, BCLC stage B or C disease not amenable to curative treatment, preserved liver function (Child-Pugh A) and ECOG performance status 0-1. All patients received ate­zo­li­zumab (1200 mg) plus bevacizumab (15 mg/kg) every three weeks. The complete response was defined according to RECIST 1.1 or modified RECIST criteria. Results. Eight patients (10.6%) achieved complete response. The median age was 70 years old, and most patients were male (87.5%) with underlying cirrhosis. The majority had BCLC stage C disease (75%) with portal invasion, without extrahepatic spread. The median follow-up was 24 months, and the median number of treatment cycles was 24. The complete response was achieved within the first seven months in all patients. The response was durable, with a median duration of 20 months; five patients remained on treatment at data cut-off. Treatment discontinuation occurred in three cases due to liver function deterioration, disease progression or patient preference. No grade ≥3 adverse events or treatment discontinuations due to toxicity were reported, and all patients were alive at the time of analysis. Conclusions. Complete response to atezolizumab plus bevacizumab, although uncommon, can occur in real-world clinical practice, and it is associated with durable disease control and favorable outcomes. The median duration of response observed in our cohort appears comparable to or slightly higher than that reported in clinical trials and real-world studies, further supporting the presence of exceptional responders.

Keywords: hepatocellular carcinoma, complete response, immunotherapy, atezolizumab-bevacizumab

Baseline neutrophil-to-lymphocyte ratio as a prognostic factor for progression-free survival
in patients with hepatocellular carcinoma receiving systemic therapy

Mădălina-Raluca Ostafe, Diana-Ioana Panaite, C. Volovăț

Department of Medical Oncology, Euroclinic Oncology Center, Victoria Hospital, Iaşi, Romania

Department of Medical Oncology and Radiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

Introduction. Systemic inflammation plays a key role in hepatocellular carcinoma (HCC) progression. Neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential prognostic biomarker, but its role in patients receiving contemporary systemic therapies remains incompletely defined. This study evaluates the prognostic value of baseline NLR using real-world data from patients with HCC treated in Romania. Materials and method. We conducted a retrospective analysis of 207 patients with HCC diagnosed between 2019 and 2025. Of these, 118 received systemic therapy, and were included in the final analysis. Baseline clinical, demographic and laboratory parameters at treatment initiation were evaluated. Patients were treated with atezolizumab plus bevacizumab or sorafenib. Progression-free survival (PFS) was assessed using Kaplan-Meier and Cox regression. The multivariable models included NLR, treatment type and Child-Pugh score, with subgroup analyses performed for each treatment group. Results. In the overall cohort, baseline NLR was independently associated with shorter PFS in multivariable analysis (HR 1.26; 95% CI; 1.05-1.51; p=0.012). Kaplan-Meier analysis showed a trend toward worse outcomes in patients with high NLR (p=0.069). In subgroup analyses, NLR was not independently associated with PFS in either the atezolizumab-bevacizumab or sorafenib groups, although a consistent trend toward poorer outcomes with higher NLR was observed. Conclusions. Baseline NLR represents a significant independent prognostic factor for progression-free survival in patients with hepatocellular carcinoma receiving systemic therapy. These findings support the use of neutrophil-to-lymphocyte ratio as an accessible biomarker for risk stratification in clinical practice. Larger prospective studies are needed to confirm these findings.

Keywords: hepatocellular carcinoma, neutrophil-to-lymphocyte ratio, prognosis, immunotherapy, sorafenib

Synergistic activity of KRAS inhibitors and statins in PDAC: preliminary pharmacological characterization and patient-derived organoid development

A.I. Pîntea^1,2, Daniela Lixandru^2,3, Alina-Veronica Ghionescu³, A. Șorop³, Simona-Olimpia Dima^2,3,4

1. Oncology Department, Fundeni Clinical Institute, Bucharest, Romania

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

3. Center of Excellence in Translational Medicine (CEMT), Fundeni Clinical Institute, Bucharest, Romania

4. General Surgery Department, Fundeni Clinical Institute, Bucharest, Romania

Introduction. Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, and it is driven by KRAS alterations in most cases. Statins may enhance KRAS-targeted therapy through mevalonate-pathway inhibition. We explored the activity of BI-2865 and atorvastatin in PDAC models, and we assessed the feasibility of patient-derived organoid (PDO) generation. Materials and method. Tumor tissue was prospectively collected from resected pancreatic tumors, and PDOs were established from histologically confirmed PDAC specimens. Cell viability was evaluated in PANC-1 and MIA PaCa-2 cells using absorbance-based assays. BI-2865 was tested as a single agent, while BI-2865 plus atorvastatin was assessed in a 5×9 checkerboard matrix. Drug interaction was quantified by the Chou-Talalay combination index (CI). Results. Twenty patients were enrolled: ten with confirmed PDAC, five awaiting histological confirmation, and five with alternative diagnoses. PDOs were successfully generated in 4/10 confirmed PDAC cases (40%). BI-2865 showed high-micromolar IC50 values of 149±8.5 µM in PANC-1 and 105.9±8 µM in MIA PaCa-2. Atorvastatin IC50 values were 185.6 µM and 59.4 µM, respectively. The combination demonstrated an overall synergistic effect in PANC-1 (median CI=0.83) and a strong synergy in MIA PaCa-2 (median CI=0.49), with the most pronounced effects observed in MIA PaCa-2. Conclusions. PDO development from resected PDAC is feasible. BI-2865 and atorvastatin showed synergistic antiproliferative activity, supporting further validation of KRAS inhibition plus statin-based combinations in PDO models and future translational studies.

Keywords: pancreatic ductal adenocarcinoma, KRAS inhibition, atorvastatin, patient-derived organoid

Serous ovarian carcinoma: correlations between histological subtype and the expression
of P53, Ki-67, ER and PR markers

Valeria Pînzaru^2,3,4, Tatiana Mărițoi^2,3, C. Pînzaru^1,3,5, V. David^2,3, Corina Iliadi-Tulbure⁶, Ecaterina Foca^1,2, L. Șaptefrați^2,3

1. IMSP Institute of Oncology, Chişinău, Republic of Moldova

2. Department of Histology, Cytology and Embryology, “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova

3. Morphology Laboratory, “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova

4. Department of Oncology, “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova

5. Department of Pathology, “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova

6. Department of Obstetrics and Gynecology, “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova

Introduction. Ovarian serous carcinoma is the most common and aggressive epithelial ovarian tumor, frequently diagnosed at advanced stages and associated with an unfavorable prognosis. Biologically, it comprises two distinct subtypes: high-grade and low-grade serous carcinoma, which differ in pathogenetic mechanisms and immunohistochemical profiles. Objective. To evaluate the clinicopathological and immunohistochemical characteristics of ovarian serous carcinoma and to analyze the correlation between histological subtype (high-grade versus low-grade) and the expression of p53, Ki-67, ER and PR markers. Materials and method. A retrospective study of 15 consecutive cases of ovarian serous carcinoma selected from the archive of the Institute of Oncology, Chişinău, Republic of Moldova, was performed. Formalin-fixed paraffin-embedded tissue blocks from surgical specimens were analyzed. Immunohistochemical staining was performed for p53, Ki-67, estrogen receptor (ER) and progesterone receptor (PR). Clinicopathological data (age, menopausal status, laterality, stage and tumor subtype) were assessed. Statistical analysis included contingency tables and Fisher’s exact test, with a significance threshold of p<0.05. Results. Most cases were classified as high-grade serous carcinoma (60%), predominantly diagnosed at stage III (73.3%) and frequently associated with bilateral involvement (66.7%). The majority of patients were postmenopausal (66.7%). Aberrant p53 expression was identified in all high-grade cases, being absent in low-grade tumors, demonstrating a statistically significant correlation (p<0.001). Ki-67 proliferative index was significantly higher in high-grade tumors (p<0.05). ER expression was frequently positive, whereas PR was absent in most cases, without a significant association with tumor subtype. Conclusions. High-grade serous ovarian carcinoma exhibits a distinct immunophenotypic profile characterized by aberrant p53 expression and increased proliferative activity. p53 represents a major discriminative marker between high-grade and low-grade subtypes, with diagnostic and potential prognostic value.

Keywords: ovarian serous carcinoma, histological subtype (high-grade versus low-grade), p53, Ki-67, hormonal receptors (ER/PR)

Expectations, perceptions and treatment adherence among patients with bone metastases receiving denosumab: a mixed-methods observational study

Anca Stolojanu¹, Elena Iovanescu^1,2, R. Matei^1,2, Adelina Gheorghe^1,2, Sânziana Prundianu¹, Ioana Geală¹, Ioana Dochinoi¹, Dana-Lucia Stănculeanu^1,2

1. “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest, Romania

2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Objective. To explore the relationship between patients’ expectations and perceptions regarding denosumab treatment and therapeutic adherence in individuals with bone metastases, within the broader context of pain burden and quality-of-life impairment. Materials and method. We designed a mixed-methods observational study, integrating quantitative and qualitative components. The quantitative component includes adult patients with bone metastases receiving denosumab and employs the EORTC QLQ-BM22, the Brief Pain Inventory-Short Form and a structured questionnaire assessing treatment-related knowledge, perceived benefits, perceived risks and patient expectations. Therapeutic adherence is evaluated according to continuity of treatment administration and compliance with the recommended dosing schedule. The qualitative component consists of semi-structured interviews conducted in a purposively selected subsample of participants, aimed at exploring subjective experiences, perceived barriers and facilitators influencing treatment continuation. Data integration combines descriptive and exploratory quantitative analyses with thematic analysis of qualitative material. Results. This design enables a multidimensional assessment of symptom burden, treatment-related representations and adherence behavior. It is suited to identify clinically meaningful patterns linking pain intensity, functional impairment associated with bone metastases, level of information, perceived efficacy, concerns about adverse effects, and continuity of denosumab administration. The qualitative component adds interpretive depth by capturing the motivational, emotional and cognitive dimensions that may shape treatment persistence. Conclusions. An integrated evaluation of the experience of patients with bone metastases treated with denosumab may inform more individualized communication strategies and supportive interventions. Such an approach may be relevant for improving treatment adherence and for optimizing patient-centered oncologic and palliative care.

Keywords: bone metastases, denosumab, treatment adherence, pain, risk perception, palliative care

Hormonal and PSA response in patients with prostate cancer undergoing ADT: a single-center comparative study of GnRH agonists and antagonists

Bristena-Octavia Tertan

Municipal Clinical Hospital Cluj-Napoca, Romania

Introduction. Androgen deprivation therapy (ADT) remains the cornerstone of treatment for advanced prostate cancer. Gonadotropin-releasing hormone (GnRH) agonists have historically been the standard of care; however, they are associated with an initial testosterone surge, potentially leading to clinical flare. Although both approaches achieve castration levels of testosterone, differences in hormonal suppression and prostate-specific antigen (PSA) response may have clinical implications. This study represents the first real-world analysis from Romania comparing PSA and testosterone dynamics in patients treated with GnRH agonists versus antagonists. Materials and method. We conducted a retrospective comparative study, including 60 patients with prostate cancer treated with ADT, of whom 30 received GnRH agonists, and 30 received GnRH antagonists. Baseline clinical and biochemical parameters were recorded. Testosterone and PSA levels were assessed at baseline and at first follow-up. Primary endpoints included the proportion of patients achieving castration levels of testosterone and PSA decline. Secondary analyses evaluated associations between baseline characteristics and treatment response. Results. Baseline characteristics were comparable between groups. At the first follow-up, most patients achieved castration levels of testosterone in both groups, without significant differences. PSA levels decreased significantly following ADT initiation. A numerically greater PSA and testosterone reduction was observed in the antagonist group; however, this difference did not reach statistical significance. Higher baseline PSA was associated with a less pronounced relative PSA decline. Conclusions. GnRH agonists and antagonists demonstrated comparable short-term biochemical efficacy, highlighting the efficacy of both therapeutic approaches in routine clinical practice. Although antagonists showed a tendency toward greater PSA reduction, the differences were not statistically significant.

Keywords: prostate cancer, ADT, GnRH antagonist, GnRH agonist

Effectiveness of avelumab first-line maintenance in metastatic urothelial carcinoma: real-world evidence from a single-center cohort

Miruna-Laura Văscan

“Prof. Dr. Ion Chiricuță” Institute of Oncology, Cluj-Napoca, Romania

Introduction. Avelumab first-line maintenance after platinum-based chemotherapy is a standard of care in advanced urothelial carcinoma, based on the survival benefit demonstrated in JAVELIN Bladder 100. However, real-world data in unselected populations remain limited. We evaluated the effectiveness and safety of avelumab maintenance in routine clinical practice. Materials and method. We conducted a retrospective, single-center analysis of consecutive patients with metastatic urothelial carcinoma treated between 1 January 2020 and 1 April 2026, who received avelumab first-line maintenance after non-progressive disease on platinum-based chemotherapy. The primary endpoint was time to treatment failure (TTF). Secondary endpoints included overall survival (OS), progression-free survival (PFS) in exploratory subgroup analyses, disease control rate (DCR) and safety. Survival outcomes were estimated using the Kaplan-Meier method. Safety was assessed according to CTCAE v5.0. Exploratory subgroup analyses were performed based on the presence of visceral metastases. Results. The cohort included 19 patients, with a median age of 74 years old; 79% were male, and 79% had visceral metastases. Median time to treatment failure (TTF) was 16.6 months. At data cut-off, six patients remained progression-free on treatment; median OS was 32.2 months, with a 12-month OS rate of 69%. The DCR was 76.5%, including partial responses in 47% and stable disease in 29.5%, while 23.5% experienced disease progression. The treatment was well tolerated, with no new safety signals observed. Exploratory analyses suggested heterogeneity in outcomes according to metastatic pattern, with a trend toward longer PFS in patients without visceral meta­stases and poorer outcomes in those with hepatic involvement. Conclusions. In this single-center real-world cohort, avelumab maintenance was associated with durable treatment benefit and encouraging survival, supporting its effectiveness outside clinical trials. Outcomes appeared less favorable in patients with visceral – particularly hepatic – metastases.

Keywords: urothelial carcinoma, avelumab, immune checkpoint inhibitors, maintenance immunotherapy, time to treatment failure, real-world evidence