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Sahin TK, Isik A, Guven DC, Ceylan F, Babaoglu B, Akyol A, Yalcin S, Dizdar O. The prognostic and predictive role of class III β-Tubulin and hENT1 expression in patients with advanced pancreatic ductal adenocarcinoma. Pancreatology 2024; 24:279-288. [PMID: 38272717 DOI: 10.1016/j.pan.2024.01.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND FOLFIRINOX and gemcitabine-nabpaclitaxel (GnP) are standard first-line treatment regimens for advanced pancreatic ductal adenocarcinoma (PDAC). However, currently, there is a lack of predictive biomarkers to aid in the treatment selection. We aimed to explore the prognostic and predictive value of class III β-Tubulin (TUBB3) and human equilibrative nucleoside transporter 1 (hENT1) expression, which have previously been shown to be associated with taxane and gemcitabine resistance in advanced PDAC. METHODS We conducted a retrospective analysis of 106 patients with advanced PDAC treated with GnP and/or FOLFIRINOX at our institution. TUBB3 and hENT1 immunohistochemical staining was performed on tumor specimens and subsequently evaluated based on the intensity and percentage of expression. RESULTS In patients who received the GnP regimen, a high combined score (TUBB3low/hENT1high) was associated with a higher DCR and longer PFS compared to those with intermediate (TUBB3high/hENT1high or TUBB3low/hENT1low) and low score (TUBB3high/hENT1low). In the multivariate analysis, a high combined score was an independent predictor of higher DCR (OR:11.96; 95 % CI:2.61-54.82; p = 0.001) and longer PFS (HR:0.33; 95%CI:0.18-0.60; p < 0.001). However, there was no difference in response rates or PFS based on TUBB3 and hENT1 expression among patients receiving the FOLFIRINOX regimen. CONCLUSION Our findings indicate that tumor TUBB3 and hENT1 expression may predict the efficacy of the GnP regimen, and low TUBB3 and high hENT1 expression (TUBB3low/hENT1high) are associated with a higher DCR and longer PFS in patients treated with GnP. Evaluating TUBB3 and hENT1 jointly can identify the patients most (as well as least) likely to benefit from GnP chemotherapy.
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Affiliation(s)
- T K Sahin
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - A Isik
- Hacettepe University Transgenic Animal Technologies Research and Application Center, Sıhhiye, Ankara, Turkey
| | - D C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - F Ceylan
- Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - B Babaoglu
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - A Akyol
- Hacettepe University Transgenic Animal Technologies Research and Application Center, Sıhhiye, Ankara, Turkey; Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - S Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - O Dizdar
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.
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Erul E, Guven DC, Ozbay Y, Altunbulak AY, Kahvecioglu A, Ercan F, Yesil MF, Ucdal MT, Cengiz M, Yazici G, Kuscu O, Suslu N, Gullu I, Onur MR, Aksoy S. Evaluation of sarcopenia as a prognostic biomarker in locally advanced head and neck squamous cell carcinoma. Biomark Med 2023; 17:87-99. [PMID: 37042459 DOI: 10.2217/bmm-2022-0748] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Background: We aimed to evaluate the effect of sarcopenia on survival in head and neck squamous cell carcinoma patients treated with chemoradiotherapy. Materials & methods: Disease-free survival and overall survival were compared according to cervical computed tomography for radiotherapy in 123 sarcopenic and non-sarcopenic patients with locally advanced head and neck squamous cell carcinoma treated with chemoradiotherapy with weekly cisplatin. Results: In multivariate analyses, pretreatment sarcopenia was associated with lower disease-free survival (hazard ratio: 2.60; 95% CI: 1.38-4.87; p = 0.003) and overall survival (hazard ratio: 2.86; 95% CI: 1.40-5.85; p = 0.004). Sarcopenic patients experienced more frequent radiotherapy-related toxicities and platinum-related side effects than non-sarcopenic patients. Conclusion: Sarcopenia could be a potential biomarker to predict prognosis and treatment toxicity in head and neck squamous cell carcinoma.
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Affiliation(s)
- Enes Erul
- Department of Internal Medicine, Hacettepe University, Ankara, 06230, Turkey
| | - Deniz C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, 06230, Turkey
| | - Yakup Ozbay
- Department of Radiology, Hacettepe University, Ankara, 06230, Turkey
| | | | - Alper Kahvecioglu
- Department of Radiation Oncology, Hacettepe University, Ankara, 06230, Turkey
| | - Fatih Ercan
- Department of Internal Medicine, Hacettepe University, Ankara, 06230, Turkey
| | - Muhammed F Yesil
- Department of Internal Medicine, Hacettepe University, Ankara, 06230, Turkey
| | - Mete T Ucdal
- Department of Internal Medicine, Hacettepe University, Ankara, 06230, Turkey
| | - Mustafa Cengiz
- Department of Radiation Oncology, Hacettepe University, Ankara, 06230, Turkey
| | - Gozde Yazici
- Department of Radiation Oncology, Hacettepe University, Ankara, 06230, Turkey
| | - Oguz Kuscu
- Department of Otorhinolaryngology & Head & Neck Surgery, Hacettepe University, Ankara, 06230, Turkey
| | - Nilda Suslu
- Department of Otorhinolaryngology & Head & Neck Surgery, Hacettepe University, Ankara, 06230, Turkey
| | - Ibrahim Gullu
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, 06230, Turkey
| | - Mehmet R Onur
- Department of Radiology, Hacettepe University, Ankara, 06230, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, 06230, Turkey
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Kus F, Guven DC, Yildirim HC, Chalabiyev E, Akyildiz A, Tatar OD, Sahin YB, Ileri S, Karaca E, Kertmen N, Arik Z. KELIM score predicts outcome in patients with platinum-resistant/refractory recurrent ovarian cancer. Biomark Med 2023; 17:379-389. [PMID: 37309756 DOI: 10.2217/bmm-2022-0923] [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] [Indexed: 06/14/2023] Open
Abstract
Aim: To assess the prognostic role of the CA-125 elimination rate constant K (KELIM) score in platinum-resistant/refractory ovarian cancer patients receiving second-line treatment. Methods: A retrospective study was carried out including 117 patients with advanced-stage platinum-resistant/refractory ovarian cancer treated with liposomal doxorubicin ± bevacizumab. The KELIM score, calculated using CA-125 measurements within the first 100 days of chemotherapy, was used. Survival analyses were performed for overall survival (OS) and progression-free survival (PFS). Results: Higher KELIM scores were associated with a superior PFS and OS. Multivariate analysis confirmed the independent prognostic value of the KELIM score for OS. Validation cohorts showed consistent results. Conclusion: KELIM score may serve as a valuable prognostic marker for predicting OS and PFS in platinum-resistant/refractory ovarian cancer patients receiving second-line treatment. Prospective studies are needed for validation.
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Affiliation(s)
- Fatih Kus
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Deniz C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Hasan C Yildirim
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Elvin Chalabiyev
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Arif Akyildiz
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Omer D Tatar
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Yigit B Sahin
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Serez Ileri
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Ece Karaca
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Neyran Kertmen
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Zafer Arik
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Acar R, Paydaş S, Yıldırım M, Kılıçarslan E, Sahın U, Dogan A, Guven DC, Ekıncı O, Tıglıoglu M, Erdogan I, Elıbol T, Kızıloz H, Aykan MB, Sayın S, Kaptan K, Soydan E, Gokmen A, Esen R, Barısta I, Albayrak M, Erturk I, Yıldız B, Keskın GY, Aylı M, Karadurmus N. Treatment options in primary mediastinal B cell lymphoma patients, retrospective multicentric analysis; a Turkısh oncology group study. J Cancer Res Ther 2023; 19:S138-S144. [PMID: 37147993 DOI: 10.4103/jcrt.jcrt_355_22] [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: 05/07/2023]
Abstract
Introduction and Aim Primary mediastinal B-cell lymphomas (PMBL) are aggressive B- cell lymphomas. Although the initial treatment models vary in PMBL, appropriate treatment methods are not known. We aim to show real-life data on health outcomes in adult patients with PMBL who received various type of chemoimmunotherapies in Turkey. Method We analyzed the data of 61 patients who received treatments for PMBL from 2010 to 2020. The overall response rate (ORR), overall survival (OS) and progression-free survival (PFS) of the patients were evaluated. Results 61 patients were observed in this study. The mean age of the study group was 38.4 ± 13.5 years. From among them, 49.2% of the patients were female (n = 30). For first-line therapy, 33 of them had received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen (54%). Twenty-five patients had received rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA-EPOCH-R) regimen. The ORR was 77%. The median OS and PFS were as follows: 25 months (95% CI: 20.4-29.4) and 13 months (95% CI: 8.6-17.3), respectively. The OS and PFS at 12 months were 91.3% and 50%, respectively. The OS and PFS at five years were 64.9% and 36.7%, respectively. Median follow-up time period was 20 months (IQR 8.5-38.5). Conclusion R-CHOP and DA-EPOCH-R showed good results in PMBL. These remain one of the best determined systemic treatment options for first-line therapy. Also, the treatment was associated with good efficacy and tolerability.
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Affiliation(s)
- Ramazan Acar
- Department of Medical Oncology, Mersin City, Research and Training Hospital, University of Health Science, Mersin, Turkey
| | - Semra Paydaş
- Department of Medical Oncology, School of Medicine, University of Cukurova, Adana, Turkey
| | - Murat Yıldırım
- Department of Hematology, Gulhane School of Medicine, University of Health Science, Ankara, Turkey
| | - Emrah Kılıçarslan
- Department of Medical Hematology, Sultan Abdulhamid Han Research and Training Hospital, University of Health Science, Istanbul, Turkey
| | - Ugur Sahın
- Department of Hematology, Medicana International Hospital, Ankara, Turkey
| | - Ali Dogan
- Department of Hematology, Van Yuzuncu Yil School of Medicine, University of Van Yuzuncu Yil, Van, Turkey
| | - Deniz C Guven
- Department of Medical Oncology, Hacettepe School of Medicine, University of Hacettepe, Ankara, Turkey
| | - Omer Ekıncı
- Department of Hematology, Fırat School of Medicine, University of Fırat, Elazıg, Turkey
| | - Mesut Tıglıoglu
- Department of Hematology, Dıskapı Research and Training Hospital, University of Health Science, Ankara, Turkey
| | - Isıl Erdogan
- Department of Hematology, Goztepe Research and Training Hospital, University of Istanbul Medeniyet, Ankara, Turkey
| | - Tayfun Elıbol
- Department of Hematology, Goztepe Research and Training Hospital, University of Istanbul Medeniyet, Ankara, Turkey
| | - Halil Kızıloz
- Department of Urology, Nevsehir Government Hospital, Nevsehir, Turkey
| | - Musa B Aykan
- Department of Medical Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Turkey
| | - Selim Sayın
- Department of Medical Oncology, School of Medicine, University of Cukurova, Adana, Turkey
| | - Kursat Kaptan
- Department of Medical Hematology, Sultan Abdulhamid Han Research and Training Hospital, University of Health Science, Istanbul, Turkey
| | - Ender Soydan
- Department of Hematology, Medicana International Hospital, Ankara, Turkey
| | - Ayla Gokmen
- Department of Hematology, Medicana International Hospital, Ankara, Turkey
| | - Ramazan Esen
- Department of Hematology, Van Yuzuncu Yil School of Medicine, University of Van Yuzuncu Yil, Van, Turkey
| | - Ibrahim Barısta
- Department of Medical Oncology, Hacettepe School of Medicine, University of Hacettepe, Ankara, Turkey
| | - Murat Albayrak
- Department of Hematology, Dıskapı Research and Training Hospital, University of Health Science, Ankara, Turkey
| | - Ismail Erturk
- Department of Medical Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Turkey
| | - Birol Yıldız
- Department of Medical Oncology, Medical Park Hospital, Ankara, Turkey
| | - Gulsema Y Keskın
- Department of Medical Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Turkey
| | - Meltem Aylı
- Department of Hematology, Gulhane School of Medicine, University of Health Science, Ankara, Turkey
| | - Nuri Karadurmus
- Department of Medical Oncology, Gulhane School of Medicine, University of Health Science, Ankara, Turkey
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Guven DC, Sahin TK, Akın S, Uckun FM. SARS-CoV-2 Vaccine Efficacy in Patients with Hematologic Malignancies: Practical Points for Further Research. Oncologist 2022; 27:e917-e918. [PMID: 36005823 PMCID: PMC9632303 DOI: 10.1093/oncolo/oyac173] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/18/2022] [Indexed: 01/05/2023] Open
Abstract
This letter to the editor responds to comments on a recently published article on seroconversion rates after COVID-19 vaccination.
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Affiliation(s)
- Deniz C Guven
- Corresponding Author: Deniz Can Guven, Hacettepe Universitesi Tip Fakultesi, Turkey.
| | - Taha K Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serkan Akın
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey,Bone Marrow Transplantation Unit, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Fatih M Uckun
- Immuno-Oncology Program and COVID-19 Task Force, Ares Pharmaceuticals, St. Paul, MN, USA
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6
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Guven DC, Sahin TK, Akın S, Uckun FM. Impact of Therapy in Patients with Hematologic Malignancies on Seroconversion Rates After SARS-CoV-2 Vaccination. Oncologist 2022; 27:e357-e361. [PMID: 35274729 PMCID: PMC8982368 DOI: 10.1093/oncolo/oyac032] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 08/26/2021] [Accepted: 01/16/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The leading professional organizations in the field of hematology have recommended severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) vaccination for all patients with hematologic malignancies notwithstanding efficacy concerns. Here we report a systematic literature review regarding the antibody response to SARS-CoV-2 vaccination in patients with hematologic malignancies and its key determinants. METHODS We conducted a systematic search of original articles evaluating the seroconversion rates with SARS-CoV-2 vaccines in hematological malignancies from the PubMed database published between April 1, 2021 and December 4, 2021. Calculated risk differences (RD) and 95% confidence intervals (CI) to compare seroconversion rates between patients with hematologic malignancies versus healthy control subjects used the Review Manager software, version 5.3. RESULTS In our meta-analysis, we included 26 studies with control arms. After the first dose of vaccination, patients with hematologic malignancies had significantly lower seroconversion rates than controls (33.3% vs 74.9%; RD: -0.48%, 95% CI: -0.60%, -0.36%, P < .001). The seroconversion rates increased after the second dose, although a significant difference remained between these 2 groups (65.3% vs 97.8%; RD: -0.35%, 95% CI: -0.42%, -0.28%, P < .001). This difference in seroconversion rates was particularly pronounced for Chronic Lymphocytic Leukemia (CLL) patients (RD: -0.46%, 95% CI: -0.56, -0.37, P < .001), and for patients with B-lineage leukemia/lymphoma treated with anti-CD20 antibodies (RD: -0.70%, 95% CI: -0.88%, -0.51%, P < .001) or Bruton Tyrosine Kinase Inhibitors (BTKi; RD: -0.63%, 95% CI: -0.85%, -0.41%, P < .001). The RD was lower for patients under remission (RD: -0.10%, 95% CI: -0.18%, -0.02%, P = .01). CONCLUSION The seroconversion rates following SARS-CoV-2 vaccination in patients with hematologic malignancies, especially in CLL patients and patients treated with anti-CD20 antibodies or BTKi, were significantly lower than the seroconversion rates in healthy control subjects. Effective strategies capable of improving vaccine efficacy in these vulnerable patient populations are urgently needed.
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Affiliation(s)
- Deniz C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey,Corresponding author: Deniz Can Guven, Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey. Tel: +90 312 305 43 30;
| | - Taha K Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serkan Akın
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey,Bone Marrow Transplantation Unit, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Fatih M Uckun
- Immuno-Oncology Program and COVID-19 Task Force, Ares Pharmaceuticals, St. Paul, MN 55110, USA
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Guven DC, Sahin TK, Kilickap S, Uckun FM. Antibody Responses to COVID-19 Vaccination in Cancer: A Systematic Review. Front Oncol 2021; 11:759108. [PMID: 34804957 PMCID: PMC8599356 DOI: 10.3389/fonc.2021.759108] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 08/15/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION After the results of phase III vaccine studies became available, the leading oncology societies recommended two doses of COVID-19 vaccination to all patients with cancer with no specific recommendation for tumor type and active treatments. However, the data on the COVID-19 vaccine efficacy in cancer patients is limited due to exclusion of cancer patients from most vaccine clinical trials. Therefore, we systemically reviewed the available evidence evaluating the antibody responses in cancer patients. METHODS We conducted a systematic search from the Pubmed database and calculated risk differences (RD) and 95% confidence intervals (CI) to compare seroconversion rates between cancer patients and controls using the Review Manager software, version 5.3. RESULTS Our systematic search retrieved a total 27 studies and we included 17 studies with control arms in the analyses. Cancer patients had significantly lower seroconversion rates (37.3%) than controls (74.1%) (RD: -0.44, 95% CI: -0.52, -0.35, p<0.001) with first vaccine dose. After two doses, the seroconversion rates were 99.6% in control arm and 78.3% in cancer patients (RD: -0.19, 95% CI: -0.28, -0.10, p<0.001). The difference in seroconversion rates was more pronounced patients with hematologic malignancies (72.6%) (RD: -0.25, 95% CI: -0.27, -0.22, p<0.001) than patients with solid tumors (91.6%) (RD: -0.09, 95% CI: -0.13, -0.04, p<0.003) and patients in remission (RD: -0.10, 95% CI: -0.14, -0.06, p<0.001). CONCLUSION In conclusion, COVID-19 vaccine seroconversion rates were significantly lower in patients with hematological malignancies and patients under active treatment. Further research focusing on the approaches to improve vaccine efficacy and exploration of novel treatment options is urgently needed for these patients.
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Affiliation(s)
- Deniz C. Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Taha K. Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
- Department of Medical Oncology, Istinye University, Istanbul, Turkey
| | - Fatih M. Uckun
- Department of Immunology and Inflammatory Disorders, Reven Pharmaceuticals, Westminster, CO, United States
- Immuno-Oncology Program and COVID-19 Task Force, Ares Pharmaceuticals, St. Paul, MN, United States
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Affiliation(s)
- D C Guven
- 64005Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - H Taban
- 64005Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - O Dizdar
- 64005Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
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Guven DC, Eroglu I, Ismayilov R, Ulusoydan E, Aktepe OH, Telli Dizman G, Arik Z, Dizdar O, Unal S, Metan G, Kertmen N. Lesson learned from the pandemic: Isolation and hygiene measures for COVID-19 could reduce the nosocomial infection rates in oncology wards. J Oncol Pharm Pract 2021; 28:1807-1811. [PMID: 34590515 PMCID: PMC9626366 DOI: 10.1177/10781552211043836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 02/05/2023]
Abstract
Introduction It was previously demonstrated that seasonal influenza incidence was
significantly decreased during the COVID-19 pandemic, possibly due to
respiratory and hygiene precautions. From this point, we hypothesized that
the COVID-19 precautions could lead to a decrease in nosocomial infection
rates in oncology inpatient wards. Methods We evaluated the nosocomial infection rates in an inpatient palliative
oncology ward in the first 3 months of the COVID-19 pandemic in our country
and compared this rate with the same time frame of the previous year in our
institution. Results The percentage of nosocomial infections complicating the hospitalization
episodes were significantly reduced in the first 3 months of the pandemic
compared to the previous year (43 vs. 55 nosocomial infection episodes;
18.6% vs. 32.2%, p = 0.002). The decrease in the nosocomial
infections was consistent in the different types of infections, namely
pneumonia (4.8% vs. 7.6%), urinary tract infection (5.2% vs. 7.6%),
bacteremia (5.2% vs. 7%) and intraabdominal infections (2.6% vs. 3.5%). The
median monthly disinfectant use was significantly increased to 98 liters
(interquartile range: 82 – 114) in 2020 compared to 72 L (interquartile
range: 36 – 72) in 2019 (p = 0.046). Conclusion The continuation of the simple and feasible hygiene and distancing measures
for healthcare workers and patient relatives and adaptations for earlier
discharge could be beneficial for preventing nosocomial infections in
oncology wards. These measures could be implemented routinely even after the
COVID-19 pandemic for patient safety, especially in settings with higher
nosocomial infection rates like inpatients palliative care units.
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Affiliation(s)
- Deniz C Guven
- Department of Medical Oncology, 37515Hacettepe University Cancer Institute, Turkey
| | - Imdat Eroglu
- Department of Internal Medicine, 37515Hacettepe University, Turkey
| | - Rashad Ismayilov
- Department of Internal Medicine, 37515Hacettepe University, Turkey
| | - Ege Ulusoydan
- Department of Internal Medicine, 37515Hacettepe University, Turkey
| | - Oktay H Aktepe
- Department of Medical Oncology, 37515Hacettepe University Cancer Institute, Turkey
| | - Gulcin Telli Dizman
- Department of Clinical Microbiology and Infectious Disease, 37515Hacettepe University, Turkey
| | - Zafer Arik
- Department of Medical Oncology, 37515Hacettepe University Cancer Institute, Turkey
| | - Omer Dizdar
- Department of Medical Oncology, 37515Hacettepe University Cancer Institute, Turkey
| | - Serhat Unal
- Department of Clinical Microbiology and Infectious Disease, 37515Hacettepe University, Turkey
| | - Gokhan Metan
- Department of Clinical Microbiology and Infectious Disease, 37515Hacettepe University, Turkey
| | - Neyran Kertmen
- Department of Medical Oncology, 37515Hacettepe University Cancer Institute, Turkey
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Guven DC, Aktepe OH, Taban H, Aktas BY, Guner G, Yildirim HC, Sahin TK, Aksun MS, Dizdar O, Aksoy S, Erman M, Yalcin S, Kilickap S. Lower prognostic nutritional index is associated with poorer survival in patients receiving immune checkpoint inhibitors. Biomark Med 2021; 15:1123-1130. [PMID: 34397271 DOI: 10.2217/bmm-2020-0674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/08/2023] Open
Abstract
Aim: Blood-based biomarkers like prognostic nutritional index (PNI) are readily available biomarkers for immunotherapy efficacy, although the data are limited. So, we aimed to evaluate the association between PNI and overall survival (OS) in immunotherapy-treated patients. Materials & methods: For this retrospective cohort study, data of 150 immunotherapy-treated advanced cancer patients were evaluated. The association between clinical factors and OS was evaluated with multivariate Cox-regression analyses. Results: After a median follow-up of 8.5 months, 94 patients died. The median OS was 11.07 months. The low PNI (hazard ratio [HR]: 2.065; p = 0.001), high lactate dehydrogenase (HR: 2.515; p = 0.001) and poor Eastern Cooperative Oncology Group (ECOG) status (HR: 2.164; p = 0.009) was associated with poorer OS in multivariate analyses. Conclusion: In our experience, survival with immunotherapy was impaired in patients with lower PNI and higher lactate dehydrogenase levels and poorer ECOG status.
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Affiliation(s)
- Deniz C Guven
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Oktay H Aktepe
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Hakan Taban
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Burak Y Aktas
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Gurkan Guner
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Hasan C Yildirim
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Taha K Sahin
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Melek S Aksun
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Omer Dizdar
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey.,Department of Medical Oncology, Istinye University, Istanbul, Turkey
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Guven DC, Kavgaci G, Aktepe OH, Yildirim HC, Sahin TK, Aksoy S, Erman M, Kilickap S, Yalcin S. The burden of polypharmacy and drug-drug interactions in older cancer patients treated with immunotherapy. J Oncol Pharm Pract 2021; 28:785-793. [PMID: 33878976 DOI: 10.1177/10781552211012038] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Polypharmacy is a common problem in older cancer patients, although the data about polypharmacy and potentially inappropriate prescription practices is limited in patients treated with immune checkpoint inhibitors (ICIs). Therefore, we aimed to evaluate the polypharmacy frequency and drug-drug interactions in older cancer patients (≥65 years) treated with ICIs. METHODS A total of 70 geriatric patients with advanced cancer were included. The polypharmacy was defined as regular use of 5 or more drugs. The START/STOPP Criteria Version 2 was used for the potentially inappropriate medications (PIM) and potential prescription omissions (PPO). The Medscape Drug Interaction Checker was used for potential drug-drug interactions. RESULTS The patients had a median of 6 regular drugs, and polypharmacy was present in 77.1%. The polypharmacy risk was significantly increased in patients over 75 years of age (p = 0.028) and with opioid use (p = 0.048). The 50% of patients had category D or X interactions. Patients with higher Charlson Comorbidity Index had significantly increased risk for drug interactions (CCI ≤10 vs. >10, p = 0.017). The PIMs were present in 44.3% and the PPOs in 68.6% of the patients. While the overall survival and immune related adverse events were similar according to polypharmacy, in patients using seven or more drugs, the acute kidney injury risk was increased (HR: 4.667, p = 0.038). CONCLUSION In this study, we observed a high rate of polypharmacy and inappropriate prescription practices in ICI-treated patients. These issues pointed out the need for improved general medical care and attention for better comedication management in ICI-treated patients.
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Affiliation(s)
- Deniz C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Gozde Kavgaci
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oktay H Aktepe
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Hasan C Yildirim
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Taha K Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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12
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Guven DC, Yildirim HC, Bilgin E, Aktepe OH, Taban H, Sahin TK, Cakir IY, Akin S, Dizdar O, Aksoy S, Yalcin S, Erman M, Kilickap S. PILE: a candidate prognostic score in cancer patients treated with immunotherapy. Clin Transl Oncol 2021; 23:1630-1636. [PMID: 33586122 DOI: 10.1007/s12094-021-02560-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/22/2020] [Accepted: 01/26/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although the immune checkpoint inhibitors (ICIs) became a vital part of cancer care, many patients do not respond to treatment, indicating need for biomarkers. The Pan-Immune-Inflammation Value (PIV) is a recently developed peripheral blood count-based biomarker. Herein, we evaluated a PIV-based candidate scoring system as a prognostic biomarker in ICI-treated patients. METHODS A total of 120 advanced cancer patients treated with anti-PD-1 or anti-PD-L1 inhibitors for any cancer type were included in this study. The PILE scoring system incorporating the PIV (< median vs. ≥ median), lactate dehydrogenase levels (normal vs. > normal) and Eastern Cooperative Oncology Group performance status (0 vs. ≥ 1) was constructed from the multivariate analyses and used for stratification. The association between overall survival (OS), progression-free survival and PILE risk category was evaluated with multivariate analysis. RESULTS The median follow-up was 9.62 months and the median OS of all cohort were 12.42 ± 2.75 months. Patients with higher PIV had significantly decreased OS (7.75 ± 1.64 vs. 18.63 ± 4.26 months, p = 0.037). The patients in the PILE high-risk group (PILE score 2-3) had decreased OS (18.63 ± 4.02 vs. 5.09 ± 1.23 months, HR: 2.317, 95% CI: 1.450-3.700, p < 0.001) and PFS (7.69 ± 1.30 vs. 2.69 ± 0.65 months, HR: 1.931, 95% CI: 1.263-2.954, p = 0.002) compared to PILE low-risk group (PILE score 0-1). The Harrell C-Index values were 0.65 and 0.61 for OS and PFS prediction, respectively. CONCLUSION In this study, we demonstrated a decreased overall survival in ICI-treated patients with a higher PILE score. If prospective studies validate our results, PILE score could be a biomarker for immunotherapy.
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Affiliation(s)
- D C Guven
- Hacettepe University Cancer Institute, Ankara, Turkey. .,Department of Medical Oncology, Hacettepe University Cancer Institute, 06100, Sihhiye, Ankara, Turkey.
| | - H C Yildirim
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - E Bilgin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - O H Aktepe
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - H Taban
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - T K Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - I Y Cakir
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - S Akin
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - O Dizdar
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - S Aksoy
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - S Yalcin
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - M Erman
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - S Kilickap
- Hacettepe University Cancer Institute, Ankara, Turkey
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Guven DC. We know the problem, now it is time to find a solution: supporting residents during the COVID-19 pandemic. Intern Med J 2021; 51:155. [PMID: 33572008 PMCID: PMC8013578 DOI: 10.1111/imj.15130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/21/2020] [Indexed: 02/05/2023]
Affiliation(s)
- D C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Abstract
INTRODUCTION Kaposi sarcoma (KS) is an angioproliferative malignancy associated with HHV-8. It is mostly observed in patients affected by HIV and/or chronic immunosuppression, while classic KS without underlying immunosuppression are relatively rare. Systemic chemotherapy is used for advanced diseases, although there is no consensus in treatment algorithms. With the demonstration of PD-1 expression in KS, immune-checkpoint-inhibitors (ICI) emerged as possible treatment options. Notwithstanding, the data of ICIs is limited to case reports/series. Herein, we present a case of advanced classic KS, which has been treated successfully with nivolumab. CASE REPORT 82-year-old male patient was investigated for erythematous lesions on thigh. Punch biopsy lead to KS diagnosis. Abdominal CT showed lymphadenopathies in the inguinal region. After radiotherapy follow-up, patient had shown vertebral & gastric metastases. Because of the PSA elevation patient was diagnosed with prostatic adenocarcinoma. Metastases were investigated for origin. The lesions showed no uptake in Ga-68 PET-CT, therefore accepted as KS metastases. Patient rejected chemotherapy options and consented to immunotherapy trial.Management and outcome: Nivolumab was initiated 3 mg/kg bi-weekly with 12-dose protocol. After nivolumab patient wellbeing is improved and control endoscopy shown no metastases. With these findings patient has been assessed as complete response. DISCUSSION ICI on KS is still a blurred option to be included in standard regimens; but progressive understanding of PD-1 expression and its role in disease progression may be a milestone for further treatment algorithms on KS. Besides good efficacy, tolerability of ICIs could be helpful patients with comorbidities precluding the use of chemotherapy.
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Affiliation(s)
- E Cesmeci
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - D C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - B Y Aktas
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - S Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Abstract
INTRODUCTION Testicular germ cell tumors (GCT) are the most common tumor in young men. Their distinctive feature is the exceptional response to platin based combination chemotherapy.Since the prognosis is poor in relapsed and refractory patients, the immune checkpoint inhibitors are candidate agents in these patients although clinical trials are mostly lacking. Herein, we describe a patient with a refractory nonseminomatous GCT using nivolumab as a last resort therapy and provided long term response without any significant toxicity. CASE REPORT A 41-year-old male presented with the complaint of flank pain eleven years ago. The patient underwent a retroperitoneal lymph node excision and pathology reported as the mixed germ cell tumor. There were no mass in the testicles and the patient was diagnosed with a primary retroperitoneal GCT. Since the disease has progressed under multiple lines of chemotherapy and autologous stem cell transplantation, treatment was started with nivolumab. MANAGEMENT AND OUTCOME The patient started to treatment with nivolumab 3 mg/kg two weekly as a last resort treatment. The nivolumab was continued and the patient's response to this treatment is ongoing and has been stable for 13 months. DISCUSSION There are limited treatment options in platinum-refractory germ cell tumors. Recently, immune checkpoint inhibitors tried in this setting with some success in especially non-seminomatous GCTs. We see a good response and prolonged benefit with the use of nivolumab in our patient. Further research including prospective studies on the use of immune checkpoint inhibitors in platinum-resistant testicular cancer can further delineate the role of immunotherapy.
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Affiliation(s)
- M S Aksun
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - E Ucgul
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - T K Sahin
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - D C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - S Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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C Guven D, Kilickap S, Guner G, Taban H, Dizdar O. Development of de novo psoriasis during nivolumab therapy in a patient with small cell lung cancer. J Oncol Pharm Pract 2019; 26:256-258. [PMID: 31566114 DOI: 10.1177/1078155219877234] [Citation(s) in RCA: 10] [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] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The immune checkpoint inhibitors recently entered to small cell lung cancer (SCLC) stage, firstly in the third and recently in the first lines of therapy. This efficacy comes at the expense of many toxicities including skin toxicity. This toxicity is usually in the form of rash and pruritis; however, rare reactions like psoriasis can also be seen. CASE REPORT Herein, we report an SCLC case who developed de novo psoriasis while treated with nivolumab as the third-line treatment for SCLC. MANAGEMENT AND OUTCOME The psoriatic plaques were regressed with the topical highly potent steroid therapy, and immunotherapy was continued without further complications. DISCUSSION We think that rare adverse events like de novo psoriasis are important considering the expanding role of these agents; their timely recognition and treatment are important in the management of cancer patients.
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Affiliation(s)
- Deniz C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Gurkan Guner
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Hakan Taban
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Omer Dizdar
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Kilickap S, Guven DC, Aktepe OH, Aktas BY, Dizdar O. Complete responses to two different anti-PD1 agents in a metastatic melanoma patient. J Oncol Pharm Pract 2019; 26:496-499. [PMID: 31256744 DOI: 10.1177/1078155219858657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/05/2023]
Abstract
In the last decade, immune checkpoint inhibitors changed the landscape of metastatic melanoma. However, the optimal duration of treatment and treatment cessation in responders is largely unknown. Herein, we represent a heavily pretreated metastatic melanoma case who had a complete response to pembrolizumab and also a complete response with nivolumab after progression during drug-free follow-up. We think that reinduction with a different anti-PD1 antibody may be used in patients with metastatic melanoma responders. Clinical trials with prespecified sequential treatment protocols and large real-life data can further delineate this subject.
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Affiliation(s)
- Saadettin Kilickap
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Deniz C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Oktay H Aktepe
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Burak Y Aktas
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Omer Dizdar
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Aktas BY, Guven DC, Dizdar O. Noninferiority for Short-HER or short-chemotherapy? Ann Oncol 2019; 30:147. [PMID: 30395162 DOI: 10.1093/annonc/mdy491] [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: 02/05/2023] Open
Affiliation(s)
- B Y Aktas
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.
| | - D C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - O Dizdar
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Guven DC, Babacan T, Sarici F, Akin S, Altundag K, Turker A. Acute erythroid leukemia in a patient with chronic lymphocytic leukemia. J BUON 2014; 19:1127. [PMID: 25536628 DOI: pmid/25536628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Deniz C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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