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Yavuz A, Simsek K, Alpsoy A, Altunay B, Gedik EO, Unal B, Bassorgun CI, Tatli AM, Elpek GO. Prognostic significance of tumor budding, desmoplastic reaction, and lymphocytic infiltration in patients with gastric adenocarcinoma. World J Gastrointest Pathophysiol 2024; 15:91237. [DOI: 10.4291/wjgp.v15.i1.91237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/08/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Recent studies have shown that the tumor microenvironment significantly influences the behavior of solid tumors. In this context, Accumulated data suggests that pathological evaluation of tumor budding (TB), desmoplastic reaction (DR), and tumor-infiltrating lymphocytes (TILs) may be crucial in determining tumor behavior in the gastrointestinal tract. Regarding gastric adenocarcinoma (GAC), although some results suggest that TB and TILs may be effective in determining the course of the disease, the data do not agree. Moreover, very few studies have investigated the relationship between DR and survival. At present, the associations between tumor TB, DR and TILs in GAC patients have not been determined.
AIM To establish the relationships between TB, DR, and TILs in patients with GAC and to assess their influence on prognosis.
METHODS Our study group comprised 130 patients diagnosed with GAC. The definition of TB was established based on the International TB Consensus Conference. The DR was categorized into three groups according to the level of tumor stroma maturation. The assessment of TILs was conducted using a semiquantitative approach, employing a cutoff value of 5%. The statistical analysis of the whole group and 100 patients with an intestinal subtype of GAC was performed using SPSS version 27.
RESULTS A significant correlation between peritumoral budding (PTB) and intratumoral budding (ITB) was noted (r = 0.943). Tumors with high PTBs and ITBs had a greater incidence of immature DRs and low TILs (P < 0.01). PTB and ITB were associated with histological subtype, lymph node metastasis (LNM), and stage (P < 0.01). ITB, PTB, LNM, DR, and stage were significant risk factors associated with poor prognosis. The multivariate Cox regression analysis identified ITB, PTB, and LNM as independent prognostic variables (P < 0.05). In intestinal-type adenocarcinomas, a positive correlation between PTB and ITB was noted (r = 0.972). While univariate analysis revealed that LNM, stage, PTB, ITB, and DR were strong parameters for predicting survival (P < 0.05), only PTB and ITB were found to be independent prognostic factors (P < 0.001).
CONCLUSION TB may be a potential prognostic marker in GAC. However, further studies are needed to delineate its role in pathology reporting protocols and the predictive effects of DR and TILs.
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Affiliation(s)
- Aysen Yavuz
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Türkiye
| | - Kubra Simsek
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Türkiye
| | - Anil Alpsoy
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Türkiye
| | - Busra Altunay
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Türkiye
| | - Elif Ocak Gedik
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Türkiye
| | - Betul Unal
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Türkiye
| | | | - Ali Murat Tatli
- Department of Medical Oncology, Akdeniz University Medical School, Antalya 07070, Türkiye
| | - Gulsum Ozlem Elpek
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Türkiye
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Kahraman S, Karakaya S, Kaplan MA, Goksu SS, Ozturk A, Isleyen ZS, Hamdard J, Yildirim S, Dogan T, Isik S, Celebi A, Gulbagci BB, Paksoy N, Dogan M, Turk HM, Bilici A, Tatli AM, Akbas S, Turan N, Hacibekiroglu I, Dogu GG, Aydiner A, Sumbul AT, Akyurek S, Yalciner M, Demirkazik A, Gursoy P, Aykan MB, Sahin E, Karadag İ, Kostek O, Er MM, Artaç M, Duzkopru Y, Aydin D, Isik D, Karakas Y, Kilickap S, Erol C, Demir B, Civelek B, Ergun Y, Akinci MB, Dogan I, Karadurmus N, Yumuk PF, Sendur MAN. Treatment outcomes and prognostic factors in patients with driver mutant non-small cell lung cancer and de novo brain metastases. Sci Rep 2024; 14:5820. [PMID: 38461209 PMCID: PMC10925043 DOI: 10.1038/s41598-024-56046-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/01/2024] [Indexed: 03/11/2024] Open
Abstract
Central nervous system (CNS) metastases can be seen at a rate of 30% in advanced stages for patients with non-small cell lung cancer (NSCLC). Growing evidence indicates the predictive roles of driver gene mutations in the development of brain metastases (BM) in recent years, meaning that oncogene-driven NSCLC have a high incidence of BM at diagnosis. Today, 3rd generation targeted drugs with high intracranial efficacy, which can cross the blood-brain barrier, have made a positive contribution to survival for these patients with an increased propensity to BM. It is important to update the clinical and pathological factors reflected in the survival with real-life data. A multi-center, retrospective database of 306 patients diagnosed with driver mutant NSCLC and initially presented with BM between between November 2008 and September 2022 were analyzed. The median progression-free survival (mPFS) was 12.25 months (95% CI, 10-14.5). While 254 of the patients received tyrosine kinase inhibitor (TKI), 51 patients received chemotherapy as first line treatment. The median intracranial PFS (iPFS) was 18.5 months (95% CI, 14.8-22.2). The median overall survival (OS) was 29 months (95% CI, 25.2-33.0). It was found that having 3 or less BM and absence of extracranial metastases were significantly associated with better mOS and iPFS. The relationship between the size of BM and survival was found to be non-significant. Among patients with advanced NSCLC with de novo BM carrying a driver mutation, long-term progression-free and overall survival can be achieved with the advent of targeted agents with high CNS efficacy with more conservative and localized radiotherapy modalities.
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Affiliation(s)
- Seda Kahraman
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey.
| | - Serdar Karakaya
- Department of Medical Oncology, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Muhammed Ali Kaplan
- Department of Medical Oncology, Dicle University Medical Faculty Hospital, Diyarbakir, Turkey
| | - Sema Sezgin Goksu
- Department of Medical Oncology, Akdeniz University Hospital, Antalya, Turkey
| | - Akin Ozturk
- Department of Medical Oncology, Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zehra Sucuoglu Isleyen
- Department of Medical Oncology, Faculty of Medicine Hospital, Bezmialem Vakif University, Istanbul, Turkey
| | - Jamshid Hamdard
- Department of Medical Oncology, Medipol University Hospital, Istanbul, Turkey
| | - Sedat Yildirim
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Tolga Dogan
- Department of Medical Oncology, Pamukkale University Medical Faculty Hospital, Denizli, Turkey
| | - Selver Isik
- Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Abdussamet Celebi
- Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Burcu Belen Gulbagci
- Department of Medical Oncology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Nail Paksoy
- Department of Medical Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mutlu Dogan
- Department of Medical Oncology, Ankara Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Haci Mehmet Turk
- Department of Medical Oncology, Faculty of Medicine Hospital, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Bilici
- Department of Medical Oncology, Medipol University Hospital, Istanbul, Turkey
| | - Ali Murat Tatli
- Department of Medical Oncology, Akdeniz University Hospital, Antalya, Turkey
| | - Sinem Akbas
- Department of Medical Oncology, Koç University Medical Faculty Hospital, Istanbul, Turkey
| | - Nedim Turan
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Ilhan Hacibekiroglu
- Department of Medical Oncology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Gamze Gokoz Dogu
- Department of Medical Oncology, Pamukkale University Medical Faculty Hospital, Denizli, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Taner Sumbul
- Department of Medical Oncology, Baskent University Adana Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Serap Akyurek
- Department of Radiation Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merih Yalciner
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ahmet Demirkazik
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Pinar Gursoy
- Department of Medical Oncology, Ege University Medical Faculty Hospital, Izmir, Turkey
| | - Musa Baris Aykan
- Department of Medical Oncology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Elif Sahin
- Department of Medical Oncology, Kocaeli University Medical Faculty Hospital, Kocaeli, Turkey
| | - İbrahim Karadag
- Department of Medical Oncology, Hittite University Corum Training and Research Hospital, Corum, Turkey
| | - Osman Kostek
- Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Muhiddin Er
- Department Of Medical Oncology, Necmettin Erbakan University Meram Medical Faculty Hospital, Konya, Turkey
| | - Mehmet Artaç
- Department Of Medical Oncology, Necmettin Erbakan University Meram Medical Faculty Hospital, Konya, Turkey
| | - Yakup Duzkopru
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Dincer Aydin
- Department of Medical Oncology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Deniz Isik
- Department of Medical Oncology, Kocaeli Medical Park Hospital, Kocaeli, Turkey
| | - Yusuf Karakas
- Department of Medical Oncology, Acıbadem Bodrum Hospital, Mugla, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Liv Hospital, Istinye University, Ankara, Turkey
| | - Cihan Erol
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Bilgin Demir
- Department of Medical Oncology, Aydin Ataturk State Hospital, Aydin, Turkey
| | - Burak Civelek
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Yakup Ergun
- Department of Medical Oncology, Batman Training and Research Hospital, Batman, Turkey
| | - Muhammed Bulent Akinci
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Izzet Dogan
- Department of Medical Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Nuri Karadurmus
- Department of Medical Oncology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Perran Fulden Yumuk
- Department of Medical Oncology, Koç University Medical Faculty Hospital, Istanbul, Turkey
| | - Mehmet Ali Nahit Sendur
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
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Bardakci M, Demirtas Esmer D, Hafizoglu E, Yaslikaya S, Genc TB, Ozcelik M, Erdat EC, Hendem E, Buyukbayram ME, Alaca Topcu Z, Kalkan Z, Yildirim N, Celebi A, Ergun Y, Paydas S, Tatli AM, Karakas H, Koseci T, Sendur MAN. Comparison of the Efficacy and Safety of 3 Months of CAPOX Followed by 3 Months of Capecitabine and 6 Months of CAPOX/FOLFOX in the Adjuvant Treatment of Low-Risk Stage III Colon Cancer Treated Surgically. Oncology 2023; 101:723-729. [PMID: 37379817 DOI: 10.1159/000531722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION In the adjuvant treatment of low-risk stage III colon cancer treated surgically, 3 months of CAPOX followed by 3 months of capecitabine is not a common clinical practice. Since there are no data on this practice in the literature, we have no idea how often it is used. However, it should be noted that this application is used in some centers due to the cumulative neurotoxicity of oxaliplatin but there are insufficient data in the literature on its efficacy. METHODS The data of patients with colon cancer treated surgically who were followed up in 12 different oncology centers in Turkey between November 2004 and June 2022 were analyzed retrospectively. RESULTS The study included 194 patients. The treatment arms were as follows: 3 months of CAPOX followed by 3 months of capecitabine = arm A and CAPOX/FOLFOX (6 months) = arm B. There were 78 patients (40.2%) in arm A and 116 patients (59.8%) in arm B. The median age and sex distribution were similar between the treatment arms. The median follow-up period of all patients was 34.4 months (95% confidence interval, 29.1-39.7). When arm A was compared with arm B, 3-year disease-free survival (DFS) was 75.3% versus 88.4% and 5-year DFS was 75.3% versus 82.8%, respectively. There were similar DFS outcomes between the treatment arms (p = 0.09). Rates of any grade of neuropathy were numerically lower in arm A, but the difference between the treatment arms was not statistically significant (51.3% vs. 56.9%; p = 0.44). The frequency of neutropenia was similar between the treatment arms. CONCLUSION In this study, the efficacy and safety of the 3 months of CAPOX followed by 3 months of capecitabine chemotherapy regimen in the adjuvant treatment of low-risk stage III colon cancer treated surgically were proven. This result may also support the discontinuation of oxaliplatin at 3 months while continuing fluoropyrimidines, which is a common clinical practice but lacks sufficient data.
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Affiliation(s)
- Murat Bardakci
- Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | | | - Emre Hafizoglu
- Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Sendag Yaslikaya
- Department of Medical Oncology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Tugrul Burak Genc
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Melike Ozcelik
- Department of Medical Oncology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Efe Cem Erdat
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Engin Hendem
- Department of Medical Oncology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | | | - Zeynep Alaca Topcu
- Department of Medical Oncology, Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Ziya Kalkan
- Department of Medical Oncology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Nilgun Yildirim
- Department of Medical Oncology, Firat University Faculty of Medicine, Elazig, Turkey
| | - Abdussamet Celebi
- Department of Medical Oncology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Yakup Ergun
- Department of Medical Oncology, Batman World Hospital, Batman, Turkey
| | - Semra Paydas
- Department of Medical Oncology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ali Murat Tatli
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Hilal Karakas
- Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Tolga Koseci
- Department of Medical Oncology, Cukurova University Faculty of Medicine, Adana, Turkey
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4
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Akagündüz B, Guven DC, Ozer M, Okten IN, Atag E, Unek İT, Tatli AM, Karaoglu A. Tailoring adjuvant chemotherapy by circulating tumor DNA (ctDNA) in older patients with stage II-III colon cancer. J Geriatr Oncol 2023; 14:101367. [PMID: 36038467 DOI: 10.1016/j.jgo.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Baran Akagündüz
- Department of Medical Oncology, Erzincan Binali Yıldrıım University Medical School, Erzincan, Turkey.
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Medical School, Istanbul, Turkey
| | - Muhammet Ozer
- Department of Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA.
| | - Ilker Nihat Okten
- Department of Medical Oncology, Gaziantep Ersin Arslan State Hospital, Gaziantep, Turkey
| | - Elif Atag
- Department of Medical Oncology, Haydarpaşa Numune Research Hospital, Istanbul, Turkey
| | - İlkay Tugba Unek
- Department of Medical Oncology, Dokuzeylül University Medical School, 34000 Istanbul, Turkey
| | - Ali Murat Tatli
- Department of Medical Oncology, Akdeniz University Medical School, 07010 Antalya, Turkey
| | - Aziz Karaoglu
- Department of Medical Oncology, Dokuzeylül University Medical School, 34000 Istanbul, Turkey
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Gürbüz M, Kiliçkap S, Bilici A, Karadurmuş N, Sezer A, Şendur MAN, Paydaş S, Artaç M, Fulden Yumuk P, Gürsoy P, Uysal M, Şenol Coşkun H, Tatli AM, Selçukbiricik F, Dişel U, Köksoy EB, Güven DC, Uğrakli M, Akkuş E, Yücel Ş, Erol C, Karakaya S, Şakalar T, Khanmammadov N, Paksoy N, Demirkazik A. Crizotinib efficacy and safety in patients with advanced NSCLC harboring MET alterations: A real-life data of Turkish Oncology Group. Medicine (Baltimore) 2022; 101:e32368. [PMID: 36550824 PMCID: PMC9771320 DOI: 10.1097/md.0000000000032368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Crizotinib is a multikinase inhibitor, effective in non-small cell lung cancer (NSCLC) harboring mesenchymal-epidermal transition (MET) alterations. Although small prospective studies showed efficacy and safety of crizotinib in NSCLC with MET alterations, there is limited real-life data. Aim of this study is to investigate real-life efficacy and safety of crizotinib in patients with advanced NSCLC harboring MET alterations. This was a retrospective, multicenter (17 centers) study of Turkish Oncology Group. Patients' demographic, histological data, treatment, response rates, survival outcomes, and toxicity data were collected. Outcomes were presented for the study population and compared between MET alteration types. Total of 62 patients were included with a median age of 58.5 (range, 26-78). Major histological type was adenocarcinoma, and 3 patients (4.8%) had sarcomatoid component. The most common MET analyzing method was next generation sequencing (90.3%). MET amplification and mutation frequencies were 53.2% (n = 33) and 46.8% (n = 29), respectively. Overall response rate and disease control rate were 56.5% and 74.2% in whole study population, respectively. Median progression free survival (PFS) was 7.2 months (95% confidence interval [CI]: 3.8-10.5), and median overall survival (OS) was 18.7 months (95% CI: 13.7-23.7), regardless of treatment line. Median PFS was 6.1 months (95% CI: 5.6-6.4) for patients with MET amplification, whereas 14.3 months (95% CI: 6.7-21.7) for patients with MET mutation (P = .217). Median PFS was significantly longer in patients who have never smoked (P = .040), have good performance score (P < .001), and responded to the treatment (P < .001). OS was significantly longer in patients with MET mutation (25.6 months, 95% CI: 15.9-35.3) compared to the patients with MET amplification (11.0 months; 95% CI: 5.2-16.8) (P = .049). In never-smokers, median OS was longer than smoker patients (25.6 months [95% CI: 11.8-39.3] vs 16.5 months [95% CI: 9.3-23.6]; P = .049). The most common adverse effects were fatigue (50%), peripheral edema (21%), nausea (29%) and diarrhea (19.4%). Grade 3 or 4 adverse effects were observed in 6.5% of the patients. This real-life data confirms efficacy and safety of crizotinib in the treatment of advanced NSCLC harboring MET alteration.
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Affiliation(s)
- Mustafa Gürbüz
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
- * Correspondence: Mustafa Gürbüz, Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara 06100, Turkey (e-mail: ; )
| | - Saadettin Kiliçkap
- İstinye University Faculty of Medicine, Liv Ankara Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Ahmet Bilici
- İstanbul Medipol University Faculty of Medicine, Department of Medical Oncology, Istanbul, Turkey
| | - Nuri Karadurmuş
- University of Health Sciences, Department of Medical Oncology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Ahmet Sezer
- Başkent University Faculty of Medicine, Department of Medical Oncology, Adana, Turkey
| | - Mehmet Ali Nahit Şendur
- Yildirim Beyazit University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Semra Paydaş
- Çukurova University Faculty of Medicine, Department of Medical Oncology, Adana, Turkey
| | - Mehmet Artaç
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Medical Oncology, Konya, Turkey
| | | | - Pinar Gürsoy
- Ege University Faculty of Medicine, Department of Medical Oncology, İzmir, Turkey
| | - Mükremin Uysal
- Medstar Antalya Hospital, Department of Medical Oncology, Antalya, Turkey
| | - Hasan Şenol Coşkun
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Ali Murat Tatli
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | | | - Umut Dişel
- Acibadem Adana Hospital, Department of Medical Oncology, Adana, Turkey
| | - Elif Berna Köksoy
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Deniz Can Güven
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Muzaffer Uğrakli
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Medical Oncology, Konya, Turkey
| | - Erman Akkuş
- Ankara University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Şebnem Yücel
- Yildirim Beyazit University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Cihan Erol
- Yildirim Beyazit University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Serdar Karakaya
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Teoman Şakalar
- Necip Fazil City Hospital, Department of Medical Oncology, Kahramanmaraş, Turkey
| | - Nijat Khanmammadov
- İstanbul University Faculty of Medicine, Department of Medical Oncology, Istanbul, Turkey
| | - Nail Paksoy
- Tekirdağ Dr. İsmail Fehmi Cumalioğlu City Hospital, Department of Medical Oncology, Tekirdağ, Turkey
| | - Ahmet Demirkazik
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
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6
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Çağlayan D, Kocak MZ, Geredeli C, Tatli AM, Karakurt Eryılmaz M, Göksu SS, Araz M, Artac M. The effect of BMI on the outcomes of CDK 4/6 inhibitor therapy in HR-positive metastatic breast cancer patients. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13010 Background: The standard of care in patients with hormone receptor (HR) -positive metastatic breast cancer is a cyclin-dependent kinase (CDK) 4/6 inhibitor combined with endocrine therapy (ET). Preclinical studies show that metabolic processes and cell metabolism such as adipogenesis, lipid synthesis and glucose regulation is affected by cell cycle regulators such as CDK 4 and 6. There are limited data regarding the impact of body mass index (BMI) on the efficacy of cyclin-dependent kinase 4/6 inhibitors plus endocrine therapy (ET) in metastatic breast cancer. We aimed to investigate the effect of BMI on the progression-free survival (PFS) in HR-positive metastatic breast cancer who received CDK4/6 inhibitor. Methods: This study was conducted as a retrospective cohort study, and data were obtained from three institution medical records. Patients with metastatic HR-positive breast cancer receiving CDK 4/6 inhibitor (palbociclib or ribociclib) plus ET (letrozole, anastrozole, or fulvestrant) were enrolled in the study. 179 patients were enrolled in the study between the January 2018 and December 2021. The patients were divided into three groups according to BMI level as follows; group 1: 18.5-24.9 kg/m2, group 2: 25-29.9 kg/m2 and group 3: ≥ 30 kg/m2. Median follow-up was 10.94 months. Categorical variables were compared using the chi-square test or two-sided Fisher’s exact test. Comparison of PFS and BMI categories were performed through Kaplan-Meier curve and log-rank test. Results: 179 patients were included the study (42 [24%] in group 1, 65 [36%] in group 2, and 72 [40%] in group 3). The 12-month PFS was 52.9% in group 1, was 72.2% in group 2 and was 56.5% in group 3. There was no significant different between the groups (p = 0.054). However, group 2 patients tend to have a better outcome in term of PFS. When palbociclib plus ET and ribociclib plus ET were evaluated separately, the 12-month PFS rates between the BMI groups were higher in group 2 patients who received palbociclib plus ET, but there was no statistical significance (Ribociclib plus ET: 63.2% in group 1, 73.3% in group 2, 59.7% in group 3, p = 0.51. Palbociclib plus ET: 44.3% in group 1, 71.5% in group 2, 52.8% in group 3, p = 0.07). Hematological and non-hematological toxicity were similar between BMI groups (p > 0.05, for all). Adverse events of grade 3 or 4 occurred in 18 (42.9%) of 42 patients in group 1 and in 20 (30.8%) of 65 patients in group 2 and in 22 (30.6%) of 72 patients in group 3 (p = 0.34). Dose reduction for CDK4/6 inhibitors was also similar between groups (p = 0.42). Median PFS was not reached due to a limited number of events in each group. Conclusions: In this study, we demonstrated the tendency that overweight patients with metastatic breast cancer may benefit more from CDK4/6 inhibitors in term of PFS from interim analyses of our data. Similar toxicity rates and adverse events were observed in all BMI groups with CDK4/6 inhibitors plus ET.
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Affiliation(s)
- Dilek Çağlayan
- Necmettin Erbakan University Meram Faculty of Medicine Department of Medical Oncology, Konya, Turkey
| | - Mehmet Zahid Kocak
- Necmettin Erbakan University Meram Medical Faculty Medical Oncology Department, Konya, Turkey
| | - Caglayan Geredeli
- Okmeydani Training and Research Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Ali Murat Tatli
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Melek Karakurt Eryılmaz
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Medical Oncology, Konya, Turkey
| | - Sema Sezgin Göksu
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Murat Araz
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Medical Oncology, Konya, Turkey
| | - Mehmet Artac
- Necmettin Erbakan University Meram Faculty of Medicine Department of Medical Oncology, Konya, Turkey
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7
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Ilhan Y, Tatli AM, Teker F, Onder AH, Kose F, Geredeli C, Karaagac M, Kaplan MA, Inanc M, Goktas Aydin S, Kargi A, Arak H, Ozturk B, Besen AA, Selvi O, Korkmaz M, Oruc Z, Bozkurt O, Bilici A, Bayram S, Dae SA, Ozdogan M, Coskun HS, Sezgin Goksu S. Cisplatin plus paclitaxel and bevacizumab versus carboplatin plus paclitaxel and bevacizumab for the first-line treatment of metastatic or recurrent cervical cancer. Int J Gynecol Cancer 2022; 32:502-507. [PMID: 35086927 DOI: 10.1136/ijgc-2021-003165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Cisplatin-paclitaxel and bevacizumab is a frequently used treatment regimen for metastatic or recurrent cervical cancer, and carboplatin-paclitaxel and bevacizumab are also among the recommended regimens. In this study we aimed to evaluate the efficacy of these two regimens for the treatment of metastatic or recurrent cervical cancer. METHODS Patients with metastatic or recurrent cervical cancer treated with cisplatin-paclitaxel and bevacizumab or carboplatin-paclitaxel and bevacizumab were retrospectively evaluated in this study. The clinical and demographic characteristics of patients in each group were evaluated. Median overall survival, progression-free survival, and response rates between the two groups were compared. RESULTS A total of 250 patients were included. Overall, the numbers of patients with recurrent disease and metastatic disease were 159 and 91, respectively. The most common histologic subtype was squamous cell carcinoma (83.2%). The median duration of follow-up was 13.6 (range 0.5-86) months. The median progression-free survival was 10.5 (95% CI 9.0 to 11.8) months in the cisplatin-paclitaxel and bevacizumab group (group 1), and 10.8 (95% CI 8.6 to 13.0) months in the carboplatin-paclitaxel and bevacizumab group (group 2) (HR 1.20; 95% CI 0.88 to 1.63; p=0.25). The median overall survival was 19.1 (95% CI 13.0 to 25.1) months in group 1 and 18.3 (95% CI 15.3 to 21.3) months in group 2 (HR 1.28; 95% CI 0.91 to 1.80; p=0.15). CONCLUSIONS There is no survival difference between cisplatin or carboplatin combined with paclitaxel and bevacizumab in metastatic or recurrent cervical cancer.
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Affiliation(s)
- Yusuf Ilhan
- Department of Medical Oncology, Akdeniz University, Antalya, Turkey
| | - Ali Murat Tatli
- Department of Medical Oncology, Akdeniz University, Antalya, Turkey
| | - Fatih Teker
- Department of Medical Oncology, Gaziantep University, Gaziantep, Turkey
| | - Arif Hakan Onder
- Department of Medical Oncology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Fatih Kose
- Department of Medical Oncology, Başkent Üniversitesi Adana Uygulama ve Araştırma Merkezi, Adana, Turkey
| | - Caglayan Geredeli
- Department of Medical Oncology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Karaagac
- Department of Clinical Oncology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | | | - Mevlude Inanc
- Department of Medical Oncology, Erciyes University, Kayseri, Turkey
| | - Sabin Goktas Aydin
- Department of Medical Oncology, Istanbul Medipol University, Istanbul, Turkey
| | - Aysegul Kargi
- Department of Medical Oncology, Medstar Antalya Hospital, Antalya, Turkey
| | - Hacı Arak
- Department of Medical Oncology, Gaziantep University, Gaziantep, Turkey
| | - Banu Ozturk
- Department of Medical Oncology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ali Ayberk Besen
- Department of Medical Oncology, Başkent Üniversitesi Adana Uygulama ve Araştırma Merkezi, Adana, Turkey
| | - Oguzhan Selvi
- Department of Medical Oncology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Korkmaz
- Department of Clinical Oncology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Zeynep Oruc
- Department of Medical Oncology, Dicle University, Diyarbakir, Turkey
| | - Oktay Bozkurt
- Department of Medical Oncology, Erciyes University, Kayseri, Turkey
| | - Ahmet Bilici
- Department of Medical Oncology, Istanbul Medipol University, Istanbul, Turkey
| | - Selami Bayram
- Department of Medical Oncology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Shute Ailia Dae
- Department of Medical Oncology, Başkent Üniversitesi Adana Uygulama ve Araştırma Merkezi, Adana, Turkey
| | - Mustafa Ozdogan
- Department of Medical Oncology, Medstar Antalya Hospital, Antalya, Turkey
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8
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Tatli AM, Urakci Z, Tastekin D, Koca D, Goksu SS, Uyeturk U, Kaplan MA, Coskun HS. A retrospective evaluation of geriatric patients with gastric cancer receiving systemic chemotherapy. J Cancer Res Ther 2021; 16:S138-S143. [PMID: 33380668 DOI: 10.4103/jcrt.jcrt_563_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The most common age at which gastric cancer is diagnosed is 70 years, and the majority of patients diagnosed are at the metastatic stage. However, although gastric cancer is a geriatric disease, there is no suggestion to discriminate treatment for the general geriatric patient population. Here, we evaluated patients receiving palliative chemotherapy for gastric cancer owing to advanced age. Patients and Methods Multicenter data of geriatric patients receiving palliative chemotherapy because of metastatic gastric cancer were retrospectively reviewed. Results In total, 262 geriatric patients with gastric cancer were included in the study. Of these, 167 patients, including 134 (51.8%) patients with metastasis at diagnosis and 33 patients with relapse after surgery, were evaluated for palliative therapy. Chemotherapy was started in 87 (52.1%) of 167 patients. The overall median survival of the patients receiving chemotherapy was 9.3 months. There was no difference in overall survival (OS) between patients aged >70 and <70 years. However, a significant difference was detected in OS of patients depending on their Eastern Cooperative Oncology Group (ECOG) performance status (PS) before treatment; survival was 15 months in the group with PS 0-1 and 7 months in the group with PS ≥2. Conclusion Advanced age chemotherapy receiving rates in patients with metastatic gastric cancer is decreasing. Survival is not associated with age, but pretreatment ECOG PS is important. Therefore, ECOG PS and comorbidities should be evaluated in detail, and combination therapies could contribute to patient survival.
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Affiliation(s)
- Ali Murat Tatli
- Department of Medical Oncology, Akdeniz University, Antalya, Turkey
| | - Zuhat Urakci
- Department of Medical Oncology, Dicle University, Diyarbakir, Turkey
| | - Didem Tastekin
- Department of Medical Oncology, Istanbul University, Istanbul, Turkey
| | - Dogan Koca
- Department of Medical Oncology, Bahcesehir University VM Medicalpark Hospital, Kocaeli, Turkey
| | | | - Ummugul Uyeturk
- Department of Medical Oncology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet Ali Kaplan
- Department of Medical Oncology, Dicle University, Diyarbakir, Turkey
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9
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Sari M, Ilhan Y, Sezgin Goksu S, Kostek O, Tatli AM, Coskun HS. The Relationship between Nutritional Parameters and Thrombosis Risk in Cancer Patients. Nutr Cancer 2021; 74:1370-1375. [PMID: 34309454 DOI: 10.1080/01635581.2021.1952631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Venous thromboembolism which consists of pulmonary embolism and deep venous thrombosis is one of the most important problems in cancer patients. The mechanisms of cancer-associated thrombosis are multi-factorial and still unclear. Nutrition is an important factor in the treatment and prognosis of cancer. Assessment of the nutritional status of cancer patients is multifactorial and it should be performed at each visit. We aimed to assess the relationship between nutritional status and thrombosis risk in various cancer types. It was a cross-sectional and single-center study and 582 cancer patients were included. Patients nutritional status was evaluated with their height, weight, BMI, triceps skinfold thickness, waist circumference, and upper arm circumference. It was found that there was a statistically significant relationship between the thrombosis risk and nutritional parameters such as weight, BMI, and waist circumference which are important anthropometric measurements. As a result, thrombosis is an important cause of morbidity and mortality in cancer patients. Obesity and cachexia are both important conditions in cancer patients and should be well evaluated. It has been shown that increased weight, BMI, and waist circumference indicating obesity are important risk factors for thrombosis risk in cancer patients.
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Affiliation(s)
- Merve Sari
- Department of Nutrition and Dietetics, Sultan 1. Murat State Hospital, Edirne, Turkey
| | - Yusuf Ilhan
- Department of Medical Oncology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Sema Sezgin Goksu
- Department of Medical Oncology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Osman Kostek
- Department of Medical Oncology, Sultan 1. Murat State Hospital, Edirne, Turkey
| | - Ali Murat Tatli
- Department of Medical Oncology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Hasan Senol Coskun
- Department of Medical Oncology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Bilgin B, Sendur MAN, Yucel S, Celik E, Ozyukseler DT, Ayhan M, Basoglu T, Ilhan A, Akdeniz N, Gulmez A, Dogan I, Aktas BY, Gurbuz M, Koca S, Paydas S, Tatli AM, Cinkir HY, Alan O, Erol C, Hizal M, Kut E, Menevse S, Sakalar T, Taskaynatan H, Deniz GI, Karaagac M, Avci O, Sen E, Karatas F, Akinci MB, Dede DS, Demir A, Demirkazık A, Oksuzoglu B, Kilickap S, Yumuk F, Yalcin B. Real-life comparison of the afatinib and first-generation tyrosine kinase inhibitors in nonsmall cell lung cancer harboring EGFR exon 19 deletion: a Turk Oncology Group (TOG) study. J Cancer Res Clin Oncol 2021; 147:2145-2152. [PMID: 33433657 DOI: 10.1007/s00432-020-03501-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The new second-generation tyrosine kinase inhibitors (TKIs) have superior survival outcome and worse toxicity profile when compared with first-generation TKIs according to the results of clinical trials. However, there are limited studies that investigate the efficacy and safety of the new generation TKIs in real-world patients. Thus, we aimed to compare the efficacy and safety of the afatinib, an irreversible inhibitor of ErbB family receptor, and first-generation TKIs in real-world patients. MATERIALS AND METHODS We included advanced nonsmall cell lung cancer (NSCLC) patients who had EGFR exon 19del mutation and treated with afatinib or first-generation TKIs as upfront treatment between 2016 and 2020. All patient's information was collected retrospectively. The study cohort was divided as afatinib arm and erlotinib/gefitinib arm. RESULTS A total of 283 patients at the 24 oncology centers were included. The 89 and 193 of whom were treated with afatinib and erlotinib/gefitinib, respectively. After 12.9 months (mo) of follow-up, the median PFS was statistically longer in the afatinib arm than erlotinib/gefitinib arm (19.3 mo vs. 11.9 mo, p: 0.046) and the survival advantage was more profound in younger patients (< 65 years). The 24-mo overall survival rate was 76.1% and 49.5% in the afatinib arm and erlotinib/gefitinib arm, respectively. Although all-grade adverse event (AE) rates were similar between the two arms, grade 3-4 AE rates were higher in the afatinib arm (30.7% vs. 15.2%; p: 0.004). DISCUSSION In our real-world study, afatinib has superior survival outcomes despite worse toxicity profile as inconsistent with clinical study results and it is the good upfront treatment option for younger patients and elderly patients who have good performance status.
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Affiliation(s)
- Burak Bilgin
- Medical Oncology, Ataturk Chest Disease and Chest Surgery Training and Reseasch Hospital, Ankara, Turkey.
| | | | - Sebnem Yucel
- Medical Oncology, Ataturk Chest Disease and Chest Surgery Training and Reseasch Hospital, Ankara, Turkey
| | - Emir Celik
- Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | - Murat Ayhan
- Kartal Dr. Lutfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | | | - Aysegul Ilhan
- Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | | | | | - Izzet Dogan
- Medical Oncology, Istanbul University, School of Medicine, Istanbul, Turkey
| | | | | | - Sinan Koca
- Istanbul Medeniyet University, Istanbul, Turkey
| | | | | | | | - Ozkan Alan
- Tekirdag State Hospital, Tekirdag, Turkey
| | - Cihan Erol
- Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Mutlu Hizal
- Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Engin Kut
- Manisa City Hospital, Manisa, Turkey
| | | | | | | | - Gulhan Ipek Deniz
- Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Okan Avci
- Namık Kemal University, Tekirdag, Turkey
| | - Erdem Sen
- Mehmet Akif Ersoy State Hospital, Canakkale, Turkey
| | | | | | | | | | | | - Berna Oksuzoglu
- Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
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Tatli AM, Arslan D, Uysal M, Goksu SS, Gunduz SG, Coskun HS, Ozdogan M, Savas B, Bozcuk HS. Retrospective analysis of third-line chemotherapy in advanced non-small cell lung cancer. J Cancer Res Ther 2016; 11:805-9. [PMID: 26881522 DOI: 10.4103/0973-1482.146092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND First- and second-line chemotherapies have been demonstrated to be effective in treatment of patients with inoperable, advanced non-small cell lung cancer (NSCLC), although the role of third-line chemotherapy remains unclear. The present investigation assessed treatment outcomes in patients with advanced NSCLC who received third-line and higher chemotherapy. PATIENTS AND METHODS This retrospective study included consecutive patients with advanced NSCLC who received at least three lines of systemic chemotherapy. RESULTS A total of 72 patients who had received third-line or higher chemotherapy were included in the analysis. The median age of patients was 49 years (range 41-76), and there were 13 (18.1%) women and 59 (81.9%) men. Estimated median survival was 26 months. Moreover, overall survival was significantly longer in patients for whom disease control was achieved after second-line chemotherapy compared to those with disease progression (34 vs. 17 months, respectively). Survival after third-line treatment was significantly longer in the group with Eastern Cooperative Oncology Group (ECOG) performance status 0-1 at the beginning of third-line therapy compared to patients with a status of 2-3. CONCLUSIONS In patients with advanced stage NSCLC, administration of third-line and higher systemic chemotherapy may be associated with increase in overall survival. Furthermore, greater increases in overall survival were also observed in patients for whom disease control was achieved after second-line therapy and in those with ECOG performance status of 0-1 before third-line treatment.
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Affiliation(s)
- Ali Murat Tatli
- Department of Medical Oncology, Van Training and Research Hospital, Van, Turkey
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12
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Tatli AM, Urakci Z, Kalender ME, Arslan H, Tastekin D, Kaplan MA. Alpha-fetoprotein (AFP) elevation gastric adenocarcinoma and importance of AFP change in tumor response evaluation. Asian Pac J Cancer Prev 2015; 16:2003-7. [PMID: 25773802 DOI: 10.7314/apjcp.2015.16.5.2003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elevated serum alpha-fetoprotein (AFP) levels in adults are considered abnormal. This parameter is used mostly in the diagnosis and follow-up of hepatocellular carcinomas and yolk sac tumors. Among the other rare tumors accompanied with elevated serum AFP levels, gastric cancer is the most common. In this study, we evaluated the follow-up and comparison of the treatment and marker response of patients with metastatic gastric cancer who had elevated serum AFP levels. MATERIALS AND METHODS We performed a retrospective study, including all consecutive patients with advanced gastric cancer, who received systemic chemotherapy with elevated AFP level. RESULTS Seventeen metastatic gastric cancer patients with elevated AFP levels at the time of diagnosis were evaluated. Fourteen (82.4%) were males and three (17.6%) were females. The primary tumor localization was the gastric body in 8 (76.4%), cardia in 7 (41.2%), and antrum in 2 (11.8%). Hepatic metastasis was observed in 13 (76.4%) at the time of diagnosis. When the relationship of AFP levels and carcinoembryonic antigen (CEA) response of the patients with their radiologic responses was evaluated, it was found that the radiologic response was compatible with AFP response in 16 (94.1%) patients and with CEA response in 12 (70.6%); however, in 5 (29.4%) patients no accordance was observed between radiological and CEA responses. CONCLUSIONS Follow-up of AFP levels in metastatic gastric cancer patients with elevated AFP levels may allow prediction of early treatment response and could be more useful than the CEA marker for follow-up in response evaluation.
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Affiliation(s)
- Ali Murat Tatli
- Department Oncology Medical, Van Training and Research Hospital, Van, Turkey E-mail :
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13
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Gündüz S, Göksu SS, Arslan D, Tatli AM, Uysal M, Gündüz UR, Sevinç MM, Coşkun HS, Bozcuk H, Mutlu H, Savas B. Factors affecting disease-free survival in patients with human epidermal growth factor receptor 2-positive breast cancer who receive adjuvant trastuzumab. Mol Clin Oncol 2015; 3:1109-1112. [PMID: 26623060 DOI: 10.3892/mco.2015.610] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/31/2015] [Indexed: 01/03/2023] Open
Abstract
Breast cancer is the most frequently diagnosed cancer in women worldwide and the second cause of cancer-related mortality. A total of 20-30% of patients with early-stage breast cancer develop recurrence within the first 5 years following diagnosis. Trastuzumab significantly improves overall survival and disease-free survival (DFS) in women with human epidermal growth factor receptor 2 (HER2)-positive early and locally advanced breast cancer. This study aimed to determine the factors that affect DFS following adjuvant transtuzumab therapy. A total of 62 patients treated with trastuzumab for early and locally advanced breast cancer were included in our study. Data, including pathology, treatment and treatment outcome, rate of recurrence and laboratory tests, were retrospectively collected. There was no significant association between DFS and age, menopausal status, disease stage and hormone receptor status. The median follow-up was 48.4 months. The median DFS of patients treated with adjuvant trastuzumab was 64.1 months. In addition, the median DFS was 44.3 vs. 66.8 months in patients with platelet-lymphocyte ratio (PLR) ≤200 vs. >200, respectively (log-rank test; P=0.001), and 70 vs. 45 months in patients with eosinophil count ≤70 vs. >70×103/mm3 (log-rank test; P=0.001). Our data revealed the prognostic relevance of a decrease in the peripheral blood eosinophil count and PLR value following trastuzumab therapy in breast cancer. PLR and eosinophil count measurements are cost-effective, readily available worldwide, non-invasive and safe. Combined with other markers, such as patient age, tumor stage and tumor histology, may be effectively used for patients with breast cancer.
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Affiliation(s)
- Seyda Gündüz
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Sema Sezgin Göksu
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Deniz Arslan
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Ali Murat Tatli
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Mükremin Uysal
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Umut Riza Gündüz
- Department of Surgery, Antalya Research and Training Hospital, Antalya 07070, Turkey
| | - Mert Mahsuni Sevinç
- Department of Surgery, Istanbul Research and Training Hospital, Istanbul 34000, Turkey
| | - Hasan Senol Coşkun
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Hakan Bozcuk
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Hasan Mutlu
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Burhan Savas
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
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Goksu SS, Tastekin D, Arslan D, Gunduz S, Tatli AM, Unal D, Salim D, Guler T, Coskun HS. Clinicopathologic features and molecular subtypes of breast cancer in young women (age ≤35). Asian Pac J Cancer Prev 2015; 15:6665-8. [PMID: 25169505 DOI: 10.7314/apjcp.2014.15.16.6665] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Breast cancer in young women is a relatively rare disease; however it tends to be more aggressive and is the leading cause of cancer death in this population. The aim of this study is to investigate the clinical and biological features of breast cancer arising in young Turkish breast cancer patients. MATERIALS AND METHODS Patients with breast cancer aged 35 or less (≤35 years) were selected for the study. In total 211 cases were included. Pathologic features; histologic subtypes, grade, lymphovascular invasion, axillary involvement, and stage were recorded for each. RESULTS The most common subtype was luminal B (36.5%), followed by luminal A (30.8%), triple negative (23.2%) and HER2+(9.5%) subtypes. Twelve percent of the patients had stage 4, 32.7% had stage 3, 46.4% had stage 2, and 6.2% had stage 1 disease at the time of diagnosis. Mean tumour diameter was 3.87 cm (range 0.3-13 cm). The axillary lymph nodes were positive in 74.4% of the patients, while lympho-vascular invasion was seen in 56.4%. Some 9.5% of patients had grade 1, 51.2% had grade 2, and 31.8% had grade 3 tumors. CONCLUSIONS Young women with breast cancer in Turkey are more likely to present with luminal B subtype. Tumors in young women are more likely to present with advanced disease, to be high grade and and to have more lymphovascular invasion. Further research should focus on whether we need new treatment strategies for young patients with breast carcinoma.
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Affiliation(s)
- Sema Sezgin Goksu
- Department of Medical Oncology, Kayseri State Hospital of Research and Education, Kayseri, Turkey E-mail :
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15
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Goksu SS, Gunduz S, Unal D, Uysal M, Arslan D, Tatli AM, Bozcuk H, Ozdogan M, Coskun HS. Use of blood transfusion at the end of life: does it have any effects on survival of cancer patients? Asian Pac J Cancer Prev 2015; 15:4251-4. [PMID: 24935379 DOI: 10.7314/apjcp.2014.15.10.4251] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of anemia is an important issue in the palliative care setting. Blood transfusion is generally used for this purpose in supportive care. However the place of blood transfusion in terminally ill cancer cases is less far established. OBJECTIVE We aimed to outline the use of transfusions and to find the impact of blood transfusion on survival in patients with advanced cancer and very near to death. DESIGN Patients dying in 2010-2011 with advanced cancer were included in the study. We retrospectively collected the data including age, type of cancer, the duration of last hospitalisation, ECOG performance status, Hb levels, transfusion history of erythrocytes and platelets, cause and the amount of transfusion. The anaemic patients who had transfusion at admission were compared with the group who were not transfused. Survival was defined as the time between the admission of last hospitalisation period and death. RESULTS Three hundred and ninety eight people with solid tumours died in 2010-2011 in our clinic. Ninety percent of the patients had anemia at the time of last hospitalisation. One hundred fifty three patients had erythrocyte transfusion at admission during the last hospitalisation period (38.4%). In the anaemic population the duration of last hospitalisation was longer in patients who had erythrocyte transfusion (15 days vs 8 days, p<0.001). CONCLUSIONS Patients who had blood transfusion at the end of life lived significantly longer than the anaemic patients who were not transfused. This study remarks that blood transfusions should not be withheld from terminal cancer patients in palliative care.
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Affiliation(s)
- Sema Sezgin Goksu
- Department of Medical Oncology, Kayseri State Hospital of Research and Education, Kayseri, Turkey E-mail :
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Kose F, Sedef AM, Özdemir N, Gunaldi M, Urun Y, Besen AA, Sumbul AT, Goksu SS, Dogan O, Mertsoylu H, Tatli AM, Erdem D, Demirci S, Gunduz S, Yildirim M, Ozyilkan O, Abali H. Can primary tumor localization predict the which patient will have benefit from addition of taxanes to platin-5-FU based regimens in metastatic gastric cancer. Multi center retrospective analysis from Turkey, Society of Turkish Oncology Group study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fatih Kose
- Department of Medical Oncology, Baskent University Faculty of Medicine, Adana, Turkey
| | | | - Nuriye Özdemir
- Yildirim Beyazit University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Meral Gunaldi
- Bakirkoy Dr. Sadi Konuk Research and Training Hospital Department of Medical Oncology, Istanbul, Turkey
| | - Yuksel Urun
- Department of Medical Oncology, Gaziantep State Hospital, Gaziantep, Turkey
| | | | | | - Sema Sezgin Goksu
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | | | - Huseyin Mertsoylu
- Department of Medical Oncology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Ali Murat Tatli
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Dilek Erdem
- Samsun Education and Research Hospital, Samsun, Turkey
| | - Serkan Demirci
- Ankara Numune Education and Research Hospital, Ankara, Turkey
| | | | | | - Ozgur Ozyilkan
- Department of Medical Oncology, Baskent University Faculty of Medicine, Adana, Turkey
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Gunduz S, Coskun HS, Arslan D, Goksu SS, Tatli AM, Uysal M, Ozdogan M, Savas B. Can positron emission tomography-computed tomography predict response in locally advanced rectal cancer patients treated with induction folinic acid and 5-florouracil? Indian J Cancer 2015; 51:138-41. [PMID: 25104195 DOI: 10.4103/0019-509x.138234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this study was to determine the pathological complete response rates in a group of locally advanced rectal cancer patients who underwent chemoradiotherapy (CRT) after treatment with induction folinic acid and 5-florouracil (FOLFOX) chemotherapy and the relationship between the complete response and positron emission tomography-computed tomography (PET-CT). MATERIALS AND METHODS The files of 239 patients who were diagnosed with rectal cancer between January 2008 and January 2012 were evaluated retrospectively. Of these, there were 24 locally advanced rectal cancer patients who met the following criteria: They were administered CRT after receiving four courses induction oxaliplatin, FOLFOX and they underwent PET-CT for staging and for the evaluation of their response to FOLFOX treatment. Of these 24 patients, 20 operable patients were included in the study. RESULTS The pathological complete response was obtained in seven patients (35%) who were operated on and then given induction four courses FOLFOX chemotherapy and CRT. We determined that age, gender, clinical stage at diagnosis and PET-CT before and after induction chemotherapy were not predictive of the pathological complete response to tumor fluorodeoxyglucose uptake activity. CONCLUSION The rates of pathological complete response were increased in locally advanced rectal cancer patients who underwent short-term induction chemotherapy. Although the PET-CT has retained its importance in predicting pathological complete response, there is still a need for studies with a larger number of patients and long-term follow-ups.
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Affiliation(s)
- S Gunduz
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey
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18
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Arslan D, Tural D, Koca T, Tastekin D, Kaymak Cerkesli A, Basaran H, Gunduz S, Murat Tatli A, Sezgin Goksu S, Uysal M, Kargi A, Kargi B, Koral L, Ibrahim Bassorgun C, Unal D, Mutlu H, Senol Coskun H, Ozdogan M, Bozcuk H. Prognostic factors in clinical stage T4N2 locally advanced non-small cell lung cancer. J BUON 2015; 20:573-579. [PMID: 26011352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Relatively few studies have focused on T4N2 (stage IIIB) locally advanced non-small cell lung cancer (NSCLC). In this study, we tried to identify prognostic factors for patients with clinical stage T4N2 NSCLC. METHODS We retrospectively identified 223 patients, of which 168 met the inclusion criteria. Patients treated with curative intent using concurrent chemoradiotherapy (CRT) with or without adjuvant chemotherapy, or concurrent CRT after induction chemotherapy, were included in this study. Relevant patient, treatment, and disease factors were evaluated for their prognostic significance in both univariate and multivariate analyses using the Cox proportional hazards model. RESULTS The median progression-free survival (PFS) was 13 months (95% confidence interval [CI], 10.6-15.4). The median overall survival (OS) was 20 months (95% CI, 16.8-23.1), and 71, 40.3 and 28.2% of the patients survived for 1, 2 and 3 years after diagnosis, respectively. Multivariate analysis showed Eastern Cooperative Oncology Group (ECOG) performance status (PS) was independent predictor of PFS (hazard ratio [HR], 0.24; 95% CI, 0.13-0.43; p=0.001), and OS [HR, 0.48; 95% CI, 0.26-0.87; p=0.015). Absence of multifocal T4 tumors was also associated with a significantly longer OS (HR, 046; 95% CI, 0.31-0.7; p=0.001). There was no statistically significant difference in OS and PFS between treatment modalities. CONCLUSION PFS and OS were significantly shorter in patients with poor ECOG PS. OS was also significantly shorter in patients with multifocal T4 tumors. There were no differences between the two therapeutic approaches with respect to outcome.
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Affiliation(s)
- Deniz Arslan
- Erzurum Research and Education Hospital, Medical Oncology Department, Erzurum, Turkey
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19
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Can A, Dogan E, Bayoglu IV, Tatli AM, Besiroglu M, Kocer M, Dulger AC, Uyeturk U, Kivrak D, Orakci Z, Bal O, Kacan T, Olmez S, Turan N, Ozbay MF, Alacacioglu A. Multicenter epidemiologic study on hepatocellular carcinoma in Turkey. Asian Pac J Cancer Prev 2015; 15:2923-7. [PMID: 24761926 DOI: 10.7314/apjcp.2014.15.6.2923] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatocellular cancer (HCC) is one of the important health problems in Turkey, being very common and highly lethal. The aim of this study was to determine clinical, demographic features and risk factors. MATERIALS AND METHODS Nine hundred and sixth-three patients with HCC from 13 cities in Turkey were included in this study. RESULTS Only 205 (21%) of the 963 patients were women, with a male:female predominance of 4.8:1 and a median age of 61 years. The etiologic risk factors for HCC were hepatitis B in 555 patients (57.6%), 453 (81%) in men, and 102 (19%) in women, again with male predominance, hepatitis C in 159 (16.5%), (14.9% and 22.4%, with a higher incidence in women), and chronic alcohol abuse (more than ten years) in 137 (14.2%) (16.8% and 4.9%, higher in males). The Child-Pugh score paralleled with advanced disease stage amd also a high level of AFP. CONCLUSIONS According to our findings the viral etiology (hepatitis B and hepatitis C infections) in the Turkish population was the most important factor in HCC development, with alcohol abuse as the third risk factor. The Child-Pugh classification and AFP levels were determined to be important prognostic factors in HCC patients.
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Affiliation(s)
- Alper Can
- Department of Medical Oncology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey E-mail :
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20
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Tastekin D, Kargin S, Karabulut M, Yaldız N, Tambas M, Gurdal N, Tatli AM, Arslan D, Gok AFK, Aykan F. Synuclein-gamma predicts poor clinical outcome in esophageal cancer patients. Tumour Biol 2014; 35:11871-7. [PMID: 25142230 DOI: 10.1007/s13277-014-2429-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 07/31/2014] [Indexed: 02/05/2023] Open
Abstract
The synuclein gamma (SNCG) protein, a member of neuronal protein family synuclein, has been considered as a promising potential biomarker as an indicator of cancer stage and survival in patients with cancer. The present study was conducted to evaluate the prognostic value of SNCG in patients with esophageal carcinoma (EC). SNCG levels were assessed immunohistochemically in cancer tissues from 73 EC patients. Median age was 57 (range, 29-78) years old. Forty-seven percent of the patients were male. Thirty-seven percent of the patients had upper or middle localized tumor whereas 59 % had epidermoid carcinoma. More than half of the patients (61 %) had undergone operation where 57 % received adjuvant treatment including chemotherapy or chemotherapy plus radiotherapy. Median overall survival was 11.3 ± 1.8 months (95% confidence interval (CI): 7.7-14.9 months). SNCG positivity was significantly associated with the histological type of EC and inoperability (for SNCG positive vs. negative group; epidermoid 80 vs. 53 %; p = 0.05 and inoperable 59 vs.32 %; p = 0.04, respectively). Lymph node metastasis, inoperability and receiving no adjuvant treatment had significantly adverse effect on survival in the univariate analysis (p = 0.01, p < 0.001, and p = 0.001, respectively). SNCG positivity had significantly adverse effect on survival in both univariate and multivariate analysis (p = 0.02 and p = 0.01, respectively). Our results are the first to suggest that SNCG is a new independent predictor for poor prognosis in EC patients in the literature.
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Affiliation(s)
- Didem Tastekin
- Department of Medical Oncology, Oncology Institute, Istanbul University, 34390, Istanbul, Turkey,
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21
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Gunduz S, Mutlu H, Goksu SS, Arslan D, Tatli AM, Uysal M, Coskun HS, Bozcuk H, Ozdogan M, Savas B. Oral cyclophosphamide and etoposide in treatment of malignant pleural mesothelioma. Asian Pac J Cancer Prev 2014; 15:8843-6. [PMID: 25374217 DOI: 10.7314/apjcp.2014.15.20.8843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malignant mesothelioma (MM) is almost always fatal and few treatment options are available. The aim of this study was to evaluate the efficacy of oral cyclophosphamide and etoposide for patients who underwent standard treatment for advanced MM. MATERIALS AND METHODS This study included 22 malignant pleural mesothelioma patients who were treated with oral cyclophosphamide and etoposide (EE). RESULTS The average follow-up period of the patients was 39.1 months. Under the treatment of oral EE, median progression- free survival was 7.7 months [95%CI HR (4.3-11.1)] and median overall survival was 28.1 months [95%CI HR (5.8-50.3)]. The treatment response rates were as follows: 4 patients (27.3%) had a partial response (PR), 12 (54.5%) had stable disease (SD), and progressive disease (PD) was observed in 6 (35.9%). CONCLUSIONS Oral EE can be administered effectively to patients with inoperable malignant mesothelioma who had previously received standard treatments.
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Affiliation(s)
- Seyda Gunduz
- Department of Medical Oncology, Antalya Education and Research Hospital, Antalya, Turkey E-mail :
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22
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Uysal M, Ozdogan M, Kargi A, Gunduz S, Sezgin Goksu S, Murat Tatli A, Arslan D, Mutlu H, Senol Coskun H, Bozcuk H. Prolonged progression-free survival with maintenance metronomic oral cyclophosphamide and etoposide treatment in macroscopic residual disease or recurrent/advanced stage ovarian cancer. J BUON 2014; 19:980-984. [PMID: 25536605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE In ovarian cancer permanent remission may be provided with optimal cytoreductive surgery and adjuvant chemotherapy. However survival is short in patients with residual macroscopic disease after surgery or recurrent ovarian cancer. Applicable maintenance therapies with low toxicity are required to prolong progression-free survival (PFS) for patients with no curative treatment options. In this study, we investigated the effect of maintenance metronomic oral cyclophosphamide and etoposide (CE) in ovarian cancer patients with post operative residual or recurrent disease. METHODS Forty five patients that received metronomic oral CE (cyclophosphamide 50 mg/daily and etoposide 50 mg for 1-5 days, every 21 days) as maintenance therapy for residual disease due to incomplete surgical resection or recurrent advanced-stage ovarian cancer were evaluated. The time between the beginning of oral CE and disease progression was also evaluated. RESULTS The mean patient age was 58 years, the vast majority had serous adenocarcinoma (78%) and received a mean of 2 (range 1-4) lines of various intravenous regimens for postoperative residual or recurrent disease. Mean duration of oral CE was 11.3 months (range 2.9-29). Median PFS was 10.3 months (range 7.9-12.8). Only 5 patients discontinued treatment due to intolerance and grade 3-4 toxicity was recorded in 3 patients (7%). CONCLUSION Maintenance metronomic oral CE treatment was found effective, minimally toxic and sustainable in patients with macroscopic residual or recurrent advanced-stage ovarian cancer. However, randomized and placebo-controlled well designed studies are required.
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Affiliation(s)
- Mukremin Uysal
- Afyon Kocatepe University Faculty of Medicine, Department of Medical Oncology, Afyon, Turkey
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23
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Arslan D, Gündüz S, Avci F, Merdin A, Tatli AM, Uysal M, Tural D, Başsorgun Cİ, Savaş B. Pilomatrix carcinoma of the scalp with pulmonary metastasis: A case report of a complete response to oral endoxan and etoposide. Oncol Lett 2014; 7:1959-1961. [PMID: 24932268 PMCID: PMC4049690 DOI: 10.3892/ol.2014.2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 02/26/2014] [Indexed: 11/27/2022] Open
Abstract
Pilomatrix carcinoma is an extremely rare skin tumor derived from basaloid cells in the hair follicles; it often exhibits locally aggressive behavior with a tendency toward local recurrence. The average age of occurrence is 45 years, and there appears to be a male to female incidence ratio of 4:1. Although pilomatrix carcinomas are predominantly identified in the neck and scalp, there are studies in the literature reporting other tumor development sites, including the upper extremities, torso and popliteal fossa. If diagnosed at an early stage, this malignant tumor is generally treated with wide surgical resection. However, for the advanced-stage tumors, there are no standard treatment procedures known to produce good results. The current study presents the case of a 76-year-old male with pilomatrix carcinoma originating from the scalp with metastases to the lung. The patient had a rapid and complete clinical response following an oral combination chemotherapy regimen of cyclophosphamide and etoposide.
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Affiliation(s)
- Deniz Arslan
- Department of Medical Oncology, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
| | - Seyda Gündüz
- Department of Medical Oncology, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
| | - Fatma Avci
- Department of Internal Medicine, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
| | - Alparslan Merdin
- Department of Internal Medicine, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
| | - Ali Murat Tatli
- Department of Medical Oncology, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
| | - Mükremin Uysal
- Department of Medical Oncology, Afyon Kocatepe University, Ahmet Necdet Sezer Research and Practice Hospital, Afyon, Turkey
| | - Deniz Tural
- Department of Medical Oncology, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
| | | | - Burhan Savaş
- Department of Medical Oncology, Akdeniz University Hospital, Konyaalti, Antalya, Turkey
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Uysal M, Bozcuk H, Sezgin Göksu S, Murat Tatli A, Arslan D, Gündüz S, Senol Coskun H, Ozdogan M, Savas B. Basal proteinuria as a prognostic factor in patients with metastatic colorectal cancer treated with bevacizumab. Biomed Pharmacother 2014; 68:409-12. [PMID: 24721326 DOI: 10.1016/j.biopha.2014.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The beneficial effects of bevacizumab, a widely used agent in metastatic colorectal cancer (mCRC), on clinical survival have been proven. This study investigated the correlation of the clinical benefits and prognosis with proteinuria and other parameters. METHODS The study included mCRC patients receiving bevacizumab. Hypertension, 24-hour urine proteinuria, and other routine parameters were recorded at baseline and at certain intervals during treatment. RESULTS The study included 36 consecutive patients. The median progression-free survival (PFS) duration was 10.9±2.6months, and the median overall survival (OS) was 23±3.1months. The median PFS was 7.2months among patients with basal proteinuria above 114mg/day, whereas the median PFS was 12months among patients with an equal or lower level (P=0.010). Similarly, PFS was shorter in patients with high lactate dehydrogenase (LDH) or carcinoembryonic antigen (CEA) levels (LDH, P=0.022; CEA, P=0.014). Bevacizumab response's performance status was good (P=0.05) and was even better in patients with a single liver metastasis (P=0.034) or hypertension (P=0.034). CONCLUSIONS We demonstrated that high basal proteinuria, LDH, or CEA levels may be negative prognostic factors in mCRC patients receiving bevacizumab.
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Affiliation(s)
- Mukremin Uysal
- Afyon Kocatepe University Faculty of Medicine, Department of Medical Oncology, Izmir Karayolu 8.km, 03200 Afyon, Turkey.
| | - Hakan Bozcuk
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Sema Sezgin Göksu
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Ali Murat Tatli
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Deniz Arslan
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Seyda Gündüz
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Hasan Senol Coskun
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Mustafa Ozdogan
- Medstar Antalya Hospital, Department of Medical Oncology, Antalya, Turkey
| | - Burhan Savas
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
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Uyeturk U, Tatli AM, Gucuk S, Oksuzoglu B, Ulas A, Avci N, Ozbay MF, Gunduz S, Akinci MB, Salim DK, Sonmez OU, Akdag F, Ergenc H. Risk Factors for Stage IV Breast Cancer at the Time of Presentation in Turkey. Asian Pac J Cancer Prev 2013; 14:7445-9. [DOI: 10.7314/apjcp.2013.14.12.7445] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Tatli AM, Coskun HS, Uysal M, Goksu SS, Arslan D, Gunduz S, Ozdogan M, Bozcuk HS, Savas B. Capecitabine plus bevacizumab (Cape-Bev) as a maintenance treatment after induction treatment with FOLFIRI plus bevacizumab (FOLFIRI-Bev) in metastatic colorectal cancer (mCRC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14683 Background: Bevacizumab is human monoclonal antibody that inhibits vascular endothelial growth factor and has been shown improvement progression-free survival and overall survival when combined with chemotherapy for treatment of mCRC in the first and second-line settings. The purpose of this study is to show the effectiveness of maintenance therapy with Cape-Bev in patients with mCRC who benefit of first-line (induction) chemotherapy with FOLFIRI-Bev. Methods: The study included patients with mCRC who received FOLFIRI-Bev as first-line chemotherapy. Maintenance therapy with Cape-Bev (Cape 1000 mg/m2 bid d1-14, Bev 7,5 mg/kg d1 q3w) was given until disease progression to patients who had achieved an objective response after 6-months FOLFIRI-Bev regimen. The time to disease progression, survival and toxic effects were analyzed from the beginning of bevacizumab-based chemotherapy. Results: We enrolled 30 patients, 16 men and 14 women. The mean age of the patients was 62 years. The patients who administered maintenance treatment received a median number of 11 cycles. The median progression-free and overall survivals were 22±4 months and 39±4 months, respectively. Significantly higher PFS and OS were seen among patients who complete or near-complete response to induction therapy with FOLFIRI-Bev (Table). Acceptable hand-foot syndrome was observed 14 patients (%51) treated with the Cape-Bev. No patient experienced severe toxicity. Conclusions: Cape-Bev regimen may be an effective maintenance treatment after response to first-line (induction) FOLFIRI plus bevacizumab treatment in selected mCRC with favorable safety profile. Further studies will be needed to demonstrate conclusively that. [Table: see text]
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Affiliation(s)
- Ali Murat Tatli
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Hasan Senol Coskun
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Mukremin Uysal
- Afyon Kocatepe University Faculty of Medicine, Department of Medical Oncology, Afyon, Turkey
| | - Sema Sezgin Goksu
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Deniz Arslan
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Seyda Gunduz
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | | | - Hakan Sat Bozcuk
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Burhan Savas
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
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Arslan D, Bozcuk HS, Tatli AM, Gunduz S, Uysal M, Goksu SS, Koral L, Coskun HS, Savas B. Survival results and prognostic factors in T4 N0-3 non-small cell lung cancer patients according to the AJCC 7th edition staging system. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e18517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18517 Background: In our study, we evaluated the survival results and prognostic factors among T4 local advanced non-small cell lung cancer (LA-NSCLC) patients in a large heterogeneous group, in accordance with the new staging system. Methods: We retrospectively evaluated the files of LA-NSCLC patients who have been treated at two centers between November 2003 and June 2012. One hundred twenty two T4 N0-3 M0 LA-NSCLC patients, identified according to the new staging system, were included in the study. Results: Median OS was 18.3 months, 1 year overall survival (OS) rate was 72%, 5 year OS rate was 28%. The median follow-up period was 17.4 months. Statistically significant predictors of survival were (p<0.20) ECOG-PS, age, subgroups of T4 factor, stage and primary treatment in OS univariate analysis. It was found that the statistically significant variables in multivariate analysis of OS rate were ECOG-PS (p=0.001), diagnostic stage (p=0.021), and primary treatment (p=0.004). In the group given non-curative treatment, the median OS was 11.0 months, 19.0 months in the definitive RT group as for 26.6 months in the curative treatment group. While there was a significant difference between the non-curative group and the groups which had definitive RT and curative operations (respectively p<0.001 and P=0.001) in terms of OS, no statistically significant difference (p=0.22) was found between the groups which had definitive RT and curative operations. Median EFS rate was 9.9 months, 46% in 1 year EFS rate, 19% in 3 years and 15% in 5 years. In univariate analysis of EFS rate with ECOG-PS, weight loss and staging, statistical significances were found only in PET-CT use, stage and primary treatment (p<0.20). In multivariate analysis with EFS, only the primary treatment was statistically significant (p=0.001). In the group that was approached with non-curative treatment, the median EFS was 10.5 months and in the curative operation group it was 14.7 months. Conclusions: Independent prognostic factors among this heterogeneous group of T4 N0-3 M0 122 LA-NSCLC patients were diagnosis age, ECOG-PS, stage and primary treatment. Primary treatment was a significant prognostic indicator of EFS rate.
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Affiliation(s)
- Deniz Arslan
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Hakan Sat Bozcuk
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ali Murat Tatli
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Seyda Gunduz
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Mukremin Uysal
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Sema Sezgin Goksu
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Lokman Koral
- Deparment of Medical Oncology, Faculty of Medicine, Selcuk University Cancer Center, Konya, Turkey
| | - Hasan Senol Coskun
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Burhan Savas
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
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Gunduz S, Coskun HS, Goksu SS, Arslan D, Tatli AM, Uysal M, Savas B, Ozdogan M. Can PET CT predict response in locally advanced rectal cancer patients treated with induction FOLFOX? J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e14696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14696 Background: The aim of this study was to determine the pathological complete response rates in a group of locally advanced rectal cancer patients who underwent chemoradiotherapy after treatment with induction FOLFOX chemotherapy and the relationship between the complete response and Positron emission tomography - computed tomography (PET-CT). Methods: The files of 239 patients who were diagnosed with rectal cancer between January 2008 and January 2012 were evaluated retrospectively. Of these, there were 24 locally advanced rectal cancer patients who met the following criteria: they were administered chemoradiotherapy after receiving four courses induction oxaliplatin, folinic acid and 5-Florouracil (FOLFOX) and they underwent PET-CT for staging and for the evaluation of their response to FOLFOX treatment. Of these 24 patients, 20 operable patients were included in the study. Results: The pathological complete response was obtained in 7 patients (35%) who were operated on, and then given induction four courses FOLFOX chemotherapy and chemoradiotherapy. We determined that age, gender, clinical stage at diagnosis, and PET-CT before and after induction chemotherapy were not predictive of the pathological complete response to tumor fluorodeoxyglucose (FDG) uptake activity. Conclusions: The rates of pathological complete response were increased in locally advanced rectal cancer patients who underwent short-term induction chemotherapy. Although the PET-CT has retained its importance in predicting pathological complete response, there is still a need for studies with a larger number of patients and long-term follow-ups.
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Affiliation(s)
- Seyda Gunduz
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Hasan Senol Coskun
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Sema Sezgin Goksu
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Deniz Arslan
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Ali Murat Tatli
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Mukremin Uysal
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Burhan Savas
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Mustafa Ozdogan
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
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Uysal M, Bozcuk H, Karakilinc H, Goksu S, Tatli AM, Gunduz S, Arslan D, Coskun HS, Savas B. Pesticides and Cancer: The First Incidence Study Conducted in Turkey. J Environ Pathol Toxicol Oncol 2013; 32:245-9. [DOI: 10.1615/jenvironpatholtoxicoloncol.2013008232] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Uysal M, Bozcuk HS, Goksu SS, Tatli AM, Arslan D, Gunduz S, Coskun HS, Ozdogan M, Savas B. Proteinuria as a predictive factor in metastatic colorectal cancer patients treated with bevacizumab. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14070 Background: Efficacy of bevacizumab -which is widely used at metastatic colorectal cancer (mCRC)- on clinical survival has been proved. But parameters predicting this clinical efficacy are unknown at present. With this study, we aimed to investigate the predictors of treatment benefit with bevacizumab based chemotherapy in patients with mCRC. Methods: Thirty-six successive patients with mCRC receiving bevacizumab based chemotherapy were enrolled into the study. Hypertension, 24-hour proteinuria and other routine parameters were recorded before and during the treatment with certain intervals. After a 1-year follow up, relationship of progression free survival (PFS) and response with various parameters and especially proteinuria, was evaluated. Results: Of 36 patients included, 20 (55.6%) were male and 16 (44.4%) were female, where mean age was 57. Overall median PFS was calculated as 275 days (9.8 months). Patients with basal proteinuria higher than 114 gr/day had a lower median PFS as 184 days (6.5 months) (p=0.046), where median PFS of patients with basal proteinuria equal to or lower than 114 gr/day was not reached. Therefore, higher level of renal proteinuria is a negative prognostic factor in these patients. Similarly, PFS was observed to be lower at patients with high LDH levels (p=0.0024, Exp(B)=23). Bevacizumab response was observed to be better at patients with favorable performance status (p=0.05), who have a single liver metastasis (p=0.034) and who tend to be hypertensive during the treatment (p=0.034). Conclusions: In conclusion, we demonstrated that basal proteinuria and LDH levels may be prognostic at patients with mCRC receiving bevacizumab-based treatment. In the literature, there has been no study up to now that questions basal proteinuria as a prognostic factor for patients receiving bevacizumab-based treatment. This observation is an important step for more focused use of bevacizumab. We believe that it is important to investigate whether basal proteinuria really has a predictive role in this group of patient with further studies, and this has practical and clinical implications.
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Affiliation(s)
- Mukremin Uysal
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Hakan Sat Bozcuk
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Sema Sezgin Goksu
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Ali Murat Tatli
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Deniz Arslan
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Seyda Gunduz
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Hasan Senol Coskun
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Mustafa Ozdogan
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Burhan Savas
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
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