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Yasar HA, Aktas BY, Ucar G, Goksu SS, Bilgetekin I, Cakar B, Sakin A, Ates O, Basoglu T, Arslan C, Demiray AG, Paydas S, Cicin I, Sendur MAN, Karadurmus N, Kosku H, Uner A, Yumuk PF, Utkan G, Kefeli U, Tanriverdi O, Cinkir H, Gumusay O, Turhal NS, Menekse S, Kut E, Beypinar I, Sakalar T, Demir H, Yekeduz E, Kilickap S, Erman M, Urun Y. Adrenocortical Cancer in the Real World: A Comprehensive Analysis of Clinical Features and Management from the Turkish Oncology Group (TOG). Clin Genitourin Cancer 2024; 22:102077. [PMID: 38626660 DOI: 10.1016/j.clgc.2024.102077] [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: 08/27/2023] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is a rare yet highly malignant tumor associated with significant morbidity and mortality. This study aims to delineate the clinical features, survival patterns, and treatment modalities of ACC, providing insights into the disease's prognosis. MATERIALS AND METHODS A retrospective analysis of 157 ACC patients was performed to assess treatment methodologies, demographic patterns, pathological and clinical attributes, and laboratory results. The data were extracted from the hospital's database. Survival analyses were conducted using the Kaplan-Meier method, with univariate and multivariate analyses being performed through the log-rank test and Cox regression analyses. RESULTS The median age was 45, and 89.4% had symptoms at the time of diagnosis. The median tumor size was 12 cm. A total of 117 (79.6%) patients underwent surgery. A positive surgical border was detected in 26 (24.1%) patients. Adjuvant therapy was administered to 44.4% of patients. The median overall survival for the entire cohort was 44.3 months. Median OS was found to be 87.3 months (95% confidence interval [CI] 74.4-100.2) in stage 2, 25.8 (95% CI 6.5-45.1) months in stage 3, and 13.3 (95% CI 7.0-19.6) months in stage 4 disease. Cox regression analysis identified age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as significant factors associated with survival in patients with nonmetastatic disease. In metastatic disease, only patients who underwent surgery exhibited significantly improved overall survival in univariate analyses. CONCLUSION ACC is an uncommon tumor with a generally poor prognosis. Understanding the defining prognostic factors in both localized and metastatic diseases is vital. This study underscores age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as key prognostic determinants for localized disease, offering critical insights into the complexities of ACC management and potential avenues for targeted therapeutic interventions.
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Affiliation(s)
| | | | - Gokhan Ucar
- Medical Oncology Department, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | | | - Irem Bilgetekin
- Medical Oncology Department, Gazi University, Ankara, Turkey
| | - Burcu Cakar
- Medical Oncology Department, Ege University, Izmir, Turkey
| | - Abdullah Sakin
- Medical Oncology Department, Van Yuzuncu Yıl University, Van, Turkey
| | - Ozturk Ates
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Tugba Basoglu
- Medical Oncology Department, Marmara University, Istanbul, Turkey
| | - Cagatay Arslan
- Medical Oncology Department, Bahcesehir University, MedicalPark Hospital, Izmir, Turkey
| | | | - Semra Paydas
- Medical Oncology Department, Adana Cukurova University, Adana, Turkey
| | - Irfan Cicin
- Medical Oncology Department, Trakya University, Edirne, Turkey
| | | | - Nuri Karadurmus
- Medical Oncology Department, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Hakan Kosku
- Medical Oncology Department, Ankara University, Ankara, Turkey
| | - Aytuğ Uner
- Medical Oncology Department, Gazi University, Ankara, Turkey
| | - Perran Fulden Yumuk
- Medical Oncology Department, Marmara University, Istanbul, Turkey; Medical Oncology Department, Koç University, Istanbul; Turkey
| | - Gungor Utkan
- Medical Oncology Department, Ankara University, Ankara, Turkey
| | - Umut Kefeli
- Medical Oncology Department, Kocaeli University, Kocaeli, Turkey
| | - Ozgur Tanriverdi
- Medical Oncology Department, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Havva Cinkir
- Medical Oncology Department, Gaziantep University, Gaziantep, Turkey
| | - Ozge Gumusay
- Medical Oncology Department, Gaziosmanpasa University, Tokat, Turkey
| | | | - Serkan Menekse
- Medical Oncology Department, Manisa City Hospital, Manisa, Turkey
| | - Engin Kut
- Medical Oncology Department, Manisa City Hospital, Manisa, Turkey
| | - Ismail Beypinar
- Medical Oncology Department, Afyon Health Sciences University, Afyon, Turkey
| | - Teoman Sakalar
- Medical Oncology Department, Aksaray University, Aksaray, Turkey
| | - Hacer Demir
- Medical Oncology Department, Afyon Health Sciences University, Afyon, Turkey
| | - Emre Yekeduz
- Medical Oncology Department, Ankara University, Ankara, Turkey
| | | | - Mustafa Erman
- Medical Oncology Department, Hacettepe University, Ankara, Turkey
| | - Yuksel Urun
- Medical Oncology Department, Ankara University, Ankara, Turkey.
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Olmez OF, Bilici A, Gursoy P, Cubukcu E, Sakin A, Korkmaz T, Cil I, Cakar B, Menekse S, Demir T, Acikgoz O, Hamdard J. Impact of systemic inflammatory markers in patients with ALK-positive non-small cell lung cancer treated with crizotinib. Pulmonology 2023; 29:478-485. [PMID: 36564237 DOI: 10.1016/j.pulmoe.2022.11.006] [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: 06/19/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the prognostic utility of inflammation-based prognostic scores in patients with ALK-positive metastatic or non-resectable non-small-cell lung cancer (NSCLC) treated with crizotinib. PATIENTS AND METHODS A total of 82 patients with ALK-positive metastatic or non-resectable NSCLC who received ALK TKI crizotinib were included. Pre-treatment modified Glasgow prognostic score (mGPS), prognostic nutritional index (PNI), and systemic immune-inflammation index (SII) were calculated. Multivariable logistic regression and Cox proportional hazards models were used to assess the impact of pretreatment mGPS, PNI, and SII on overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). RESULTS The ORR was 77.2%, while 1-year OS and PFS rates were 95.0% and 93.5%, respectively. The univariate analysis revealed significantly higher 1-year PFS (89.4 vs. 64.4%, p=0.043) and OS (92.0 vs. 83.3%, p=0.01) rates in patients with low (<934.7) vs. high (≥934.7) SII scores. Multivariate analysis revealed that PNI ≥0.09 was a significant determinant of poorer 1-year OS rates (hazard ratio [HR]: 2.46, 95% confidence interval [CI] 0.88-4.85, p=0.035). No significant difference was observed in survival rates according to gender, age, smoking status, prior lines of therapy, or mGPS scores, while higher mGPS scores (odds ratio [OR]: 0.1, 95%CI 0.16-1.04; p=0.009) and higher PNI scores (OR: 0.16, 95% CI 0.02-0.55; p=0.035) were associated with poorer ORR. CONCLUSION Our findings indicate the prognostic significance of PNI and SII in terms of survival outcome and the impact of mGPS and PNI on treatment response in patients with ALK-positive NSCLC treated with crizotinib.
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Affiliation(s)
- O F Olmez
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - A Bilici
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - P Gursoy
- Ege University Faculty of Medicine, Izmir, Turkey
| | - E Cubukcu
- Uludag University Faculty of Medicine, Bursa, Turkey
| | - A Sakin
- University of Health Sciences Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - T Korkmaz
- Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - I Cil
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - B Cakar
- Ege University Faculty of Medicine, Izmir, Turkey
| | - S Menekse
- Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - T Demir
- Bezmialem University Faculty of Medicine, Istanbul; Turkey
| | - O Acikgoz
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - J Hamdard
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey.
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Bilici A, Olmez OF, Kaplan MA, Oksuzoglu B, Sezer A, Karadurmus N, Cubukcu E, Sendur MAN, Aksoy S, Erdem D, Basaran G, Cakar B, Shbair ATM, Arslan C, Sumbul AT, Sezgin Goksu S, Karadag I, Cicin I, Gumus M, Selcukbiricik F, Harputluoglu H, Demirci U. Impact of adding pertuzumab to trastuzumab plus chemotherapy in neoadjuvant treatment of HER2 positive breast cancer patients: a multicenter real-life HER2PATH study. Acta Oncol 2023; 62:381-390. [PMID: 37083566 DOI: 10.1080/0284186x.2023.2202330] [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: 04/22/2023]
Abstract
AIM To investigate the pathological complete response (pCR) achieved after neoadjuvant therapy with versus without adding pertuzumab (P) to trastuzumab (H) plus neoadjuvant chemotherapy (NCT) in HER2+ breast cancer (BC) patients in a real-life setting. METHODS A total of 1528 female HER2+ BC patients who received NCT plus H with or without P were included in this retrospective real-life study. Primary endpoint was pCR rate (ypT0/Tis ypN0). Clinicopathological characteristics, event-free survival (EFS) time, and relapse rates were evaluated with respect to HER2 blockade (NCT-H vs. NCT-HP) and pCR. RESULTS Overall, 62.2% of patients received NCT-H and 37.8% received NCT-HP. NCT-HP was associated with a significantly higher pCR rate (66.4 vs. 56.8%, p < 0.001) and lower relapse (4.5 vs. 12.2%, p < 0.001) in comparison to NCT-H. Patients with pCR had a significantly lower relapse (5.6 vs. 14.9%, p < 0.001) and longer EFS time (mean(SE) 111.2(1.9) vs. 93.9(2.7) months, p < 0.001) compared to patients with non-pCR. Patients in the NCT-HP group were more likely to receive docetaxel (75.0 vs. 40.6%, p < 0.001), while those with pCR were more likely to receive paclitaxel (50.2 vs. 40.7%, p < 0.001) and NCT-HP (41.5 vs. 32.1%, p < 0.001). Hormone receptor status and breast conservation rates were similar in NCT-HP vs. NCT-H groups and in patients with vs. without pCR. Invasive ductal carcinoma (OR, 2.669, 95% CI 1.596 to 4.464, p < 0.001), lower histological grade of the tumor (OR, 4.052, 95% CI 2.446 to 6.713, p < 0.001 for grade 2 and OR, 3.496, 95% CI 2.020 to 6.053, p < 0.001 for grade 3), lower T stage (OR, 1.959, 95% CI 1.411 to 2.720, p < 0.001) and paclitaxel (vs. docetaxel, OR, 1.571, 95% CI 1.127 to 2.190, p = 0.008) significantly predicted the pCR. CONCLUSIONS This real-life study indicates that adding P to NCT-H enables higher pCR than NCT-H in HER2+ BC, while pCR was associated with lower relapse and better EFS time.
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Affiliation(s)
- Ahmet Bilici
- Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Omer Fatih Olmez
- Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | | | - Berna Oksuzoglu
- University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ahmet Sezer
- Baskent University Adana Hospital, Adana, Turkey
| | - Nuri Karadurmus
- University of Health Sciences Gulhane Training and Research Hospital, Ankara, Turkey
| | - Erdem Cubukcu
- Uludag University Faculty of Medicine, Bursa, Turkey
| | | | - Sercan Aksoy
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Dilek Erdem
- Samsun Medical Park Hospital, Samsun, Turkey
| | - Gul Basaran
- School of Medicine, Acibadem University, Istanbul, Turkey
| | - Burcu Cakar
- Ege University Faculty of Medicine, Izmir, Turkey
| | | | | | | | | | | | - Irfan Cicin
- Trakya University Faculty of Medicine, Edirne, Turkey
| | - Mahmut Gumus
- Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
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Dogan I, Aksoy S, Cakar B, Basaran G, Ercelep O, Molinas Mandel N, Korkmaz T, Gokmen E, Sener C, Aydiner A, Saip P, Eralp Y. Demographic and Clinical Features of Patients with Metastatic Breast Cancer: A Retrospective Multicenter Registry Study of the Turkish Oncology Group. Cancers (Basel) 2023; 15:cancers15061667. [PMID: 36980554 PMCID: PMC10046761 DOI: 10.3390/cancers15061667] [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] [Received: 02/16/2023] [Revised: 03/04/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023] Open
Abstract
This multicenter registry study aims to analyze time-related changes in the treatment patterns and outcome of patients with metastatic breast cancer (MBC) over a ten-year period. Correlations between demographic, prognostic variables and survival outcomes were carried out in database aggregates consisting of cohorts based on disease presentation (recurrent vs. de novo) and the diagnosis date of MBC (Cohort I: patient diagnosed between January 2010 and December 2014; and Cohort II: between January 2015 and December 2019). Out of 1382 patients analyzed, 52.3% patients had recurrent disease, with an increased frequency over time (47.9% in Cohort I vs. 56.1% in Cohort II, p < 0.001). In recurrent patients, 38.4% (n = 277) relapsed within two years from initial diagnosis, among which triple-negative BC (TNBC) was the most frequent (51.7%). Median overall survival (OS) was 51.0 (48.0–55.0) months for all patients, which was similar across both cohorts. HER2+ subtype had the highest OS among subgroups (HER2+ vs. HR+ vs. TNBC; 57 vs. 52 vs. 27 months, p < 0.001), and the dnMBC group showed a better outcome than recMBC (53 vs. 47 months, p = 0.013). Despite the lack of CDK inhibitors, luminal A patients receiving endocrine therapy had a favorable outcome (70 months), constituting an appealing approach with limited resources. The only survival improvement during the timeframe was observed in HER2+ dnMBC patients (3-year OS Cohort I: 62% vs. Cohort II: 84.7%, p = 0.009). The incorporation of targeted agents within standard treatment has improved the outcome in HER2+ MBC patients over time. Nevertheless, despite advances in early diagnosis and treatment, the prognosis of patients with TNBC remains poor, highlighting the need for more effective treatment options.
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Affiliation(s)
- Izzet Dogan
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul 34093, Turkey; (I.D.)
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06100, Turkey
| | - Burcu Cakar
- Department of Medical Oncology, Faculty of Medicine, Ege University, Izmir 35100, Turkey
| | - Gul Basaran
- Department of Medical Oncology, Acibadem University, Altunizade Acibadem Hospital, Istanbul 34662, Turkey
| | - Ozlem Ercelep
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul 34722, Turkey
| | - Nil Molinas Mandel
- Department of Medical Oncology, Koç University Amerikan Hospital, Istanbul 34010, Turkey
| | - Taner Korkmaz
- Department of Medical Oncology, Acibadem University, Maslak Acibadem Hospital, Istanbul 34457, Turkey
| | - Erhan Gokmen
- Department of Medical Oncology, Faculty of Medicine, Ege University, Izmir 35100, Turkey
| | - Cem Sener
- Incidence Medical Research and Biostatistics Consultancy Services, Istanbul 34440, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul 34093, Turkey; (I.D.)
| | - Pinar Saip
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul 34093, Turkey; (I.D.)
| | - Yesim Eralp
- Research Institute of Senology, Acıbadem University, Maslak Acıbadem Hospital, Istanbul 34457, Turkey
- Correspondence:
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Ozbay B, Simsek E, Kemal H, Cakar B, Yavuzgil O. Anthracycline Chemotherapy-Induced Electro-Mechanical Changes: Strain Echocardiography Combined with Repolarization Parameters on Electrocardiography to Predict Early Cardiotoxicity. Turk Kardiyol Dern Ars 2022; 50:478-484. [DOI: 10.5543/tkda.2022.22359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Özdemir Ö, Zengel B, Yildiz Y, Uluç BO, Cabuk D, Ozden E, Salim DK, Paydas S, Demir A, Diker O, Pilanci KN, Sönmez ÖU, Vatansever S, Dogan I, Gulmez A, Cakar B, Gursoy P, Yildirim ME, Ayhan M, Karadurmus N, Aykan MB, Cevik GT, Sakalar T, Hacibekiroglu I, Gülbagci BB, Dincer M, Garbioglu DB, Kemal Y, Nayir E, Taskaynatan H, Yilmaz M, Avci O, Sari M, Coban E, Atci MM, Esen SA, Telli TA, Karatas F, Inal A, Demir H, Kalkan NO, Yilmaz C, Tasli F, Alacacioglu A. The effectiveness and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early-stage human epidermal growth factor receptor 2-positive breast cancer: Turkish Oncology Group study. Anticancer Drugs 2022; 33:663-670. [PMID: 35703239 DOI: 10.1097/cad.0000000000001310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In our study, we aimed to evaluate the pathological response rates and side effect profile of adding pertuzumab to the treatment of HER2+ locally advanced, inflammatory, or early-stage breast cancer. This study was conducted by the Turkish Oncology Group (TOG) with data collected from 32 centers. Our study was multicentric, and a total of 364 patients were included. The median age of the patients was 49 years (18-85 years). Two hundred fifteen (60%) of the cases were hormone receptor/HER2+ positive(ER+ or PR+, or both), and 149 (40%) of them were HER2-rich (ER and PR negative). The number of complete responses was 124 (54%) in the docetaxel+trastuzumab+pertuzumab arm and 102 (45%) in the paclitaxel+trastuzumab+pertuzumab arm, and there was no difference between the groups in terms of complete response. In 226 (62%) patients with complete response, a significant correlation was found with DCIS, tumor focality, removed lymph node, and ER status P < 0.05. Anemia, nausea, vomiting, myalgia, alopecia, and mucosal inflammation were significantly higher in the docetaxel arm, P < 0.05. In our study, no statistical difference was found between the before-after echocardiography values. DCIS positivity in biopsy before neoadjuvant chemotherapy, tumor focality; the number of lymph nodes removed and ER status were found to be associated with pCR. In conclusion, we think that studies evaluating pCR-related clinicopathological variables and radiological imaging features will play a critical role in the development of nonsurgical treatment approaches.
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Affiliation(s)
| | - Baha Zengel
- General Surgery, Bozyaka Training and Research Hospital
| | - Yaşar Yildiz
- Department Medical of Oncology, Katip Çelebi University, Atatürk Training and Research Hospital, Izmir
| | | | - Devrim Cabuk
- Department of Medical Oncology, Kocaeli University Faculty of Medicine Hospital, Kocaeli
| | - Ercan Ozden
- Department of Medical Oncology, Kocaeli University Faculty of Medicine Hospital, Kocaeli
| | - Derya Kivrak Salim
- Department of Medical Oncology, Health Sciences University Antalya Training and Research Hospital, Antalya
| | - Semra Paydas
- Department of Medical Oncology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Atakan Demir
- Department of Medical Oncology, Acibadem Hospital, Istanbul
| | - Omer Diker
- Department of Medical Oncology, Near East University Hospital, Lefkosa, Cyprus
| | | | | | - Sezai Vatansever
- Department of Medical Oncology, Istanbul University Faculty of Medicine, Istanbul
| | - Izzet Dogan
- Department of Medical Oncology, Istanbul University Faculty of Medicine, Istanbul
| | - Ahmet Gulmez
- Department of Medical Oncology, Inonu University Faculty of Medicine, Malatya
| | - Burcu Cakar
- Department of Medical Oncology, Ege University Faculty of Medicine, Izmir
| | - Pinar Gursoy
- Department of Medical Oncology, Ege University Faculty of Medicine, Izmir
| | | | - Murat Ayhan
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul
| | - Nuri Karadurmus
- Department of Medical Oncology, Health Sciences University Gulhane Training and Research Hospital, Ankara
| | - Musa Baris Aykan
- Department of Medical Oncology, Health Sciences University Gulhane Training and Research Hospital, Ankara
| | - Gökcen Tugba Cevik
- Department of Medical Oncology, Usak University Training and Research Hospital, Usak
| | - Teoman Sakalar
- Department of Medical Oncology, Kahramanmaras Necip Fazil City Hospital, Kahramanmaras
| | - Ilhan Hacibekiroglu
- Department of Medical Oncology, Sakarya University Training and Research Hospital, Sakarya
| | - Burcu Belen Gülbagci
- Department of Medical Oncology, Sakarya University Training and Research Hospital, Sakarya
| | - Murat Dincer
- Department of Medical Oncology, Osmangazi University Faculty of Medicine Hospital, Eskisehir
| | - Duygu Bayir Garbioglu
- Department of Medical Oncology, Osmangazi University Faculty of Medicine Hospital, Eskisehir
| | - Yasemin Kemal
- Department of Medical Oncology, Medical Park Hospital, Samsun
| | - Erdinc Nayir
- Department of Medical Oncology, Medical Park Hospital, Mersin
| | | | - Mesut Yilmaz
- Department of Medical Oncology, Bakirköy Dr. Sadi Konuk Training and Research Hospital, Istanbul
| | - Okan Avci
- Department of Medical Oncology, Namik Kemal University Hospital, Tekirdag
| | - Murat Sari
- Department of Medical Oncology, Haydarpaşa Numune Training and Research Hospital
| | - Ezgi Coban
- Department of Medical Oncology, Haydarpaşa Numune Training and Research Hospital
| | | | | | - Tugba Akin Telli
- Department of Medical Oncology, Marmara University Faculty of Medicine, Istanbul
| | - Fatih Karatas
- Department of Medical Oncology, Karabuk University Faculty of Medicine, Karabuk
| | - Ali Inal
- Department of Medical Oncology, Mersin City Training and Research Hospital, Mersin
| | - Hacer Demir
- Department of Medical Oncology, Afyonkarahisar Health Sciences University, Afyonkarahisar
| | - Nurhan Onal Kalkan
- Department of Medical Oncology, Van Yuzuncu Yil Faculty of Medicine, Van
| | | | - Funda Tasli
- Department of Pathology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ahmet Alacacioglu
- Department Medical of Oncology, Katip Çelebi University, Atatürk Training and Research Hospital, Izmir
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Bilici A, Olmez OF, Sezer A, Oksuzoglu B, Kaplan MA, Karadurmus N, Cubukcu E, Sendur MA, Aksoy S, Erdem D, Basaran G, Cakar B, Seker M, Arslan C, Sezgin Goksu S, Cicin I, Gumus M, Selcukbiricik F, Harputluoglu H, Helvaci K. Real-life analysis of pathologic complete response with neoadjuvant trastuzumab plus taxane with or without pertuzumab therapy in HER2 positive locally-advanced breast cancer (HER2PATH Study). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e12610] [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
e12610 Background: Studies in HER2+ locally-advanced breast cancer (LABC) patients with neoadjuvant dual HER2 blockage therapy demonstrated high rates of pathologic complete response (pCR). This study evaluates neoadjuvant chemotherapy (NCT) plus trastuzumab (H) with or without pertuzumab (P) therapy with a nation-wide real world setting. Methods: In this study, 1528 female HER2+ LABC patients’ data received NCT plus H with or without P were collected retrospectively from 21 centers. Ethics committee approved the study (NCT04765124). Primary end point was pCR rate (ypT0/Tis ypN0 in the current AJCC staging system). Results: Of the 1528, 951 (62.2%) were received NCT-H, 577 (37.8%) were received NCT-HP, follow-up durations were 30 months and 15 months, median ages were similar between 2 groups (47 years, range: 20-81 and 47 years, range 22-88, respectively). According to the menopausal and hormone receptor status 60% and 53.7% of patients were classified as premenopausal, 56% and 57.8% as estrogen receptor positive and 46.2% and 47.2% as progesterone receptor positive respectively at NCT-HP and NCT-H groups. Despite the patients at NCT-HP group mostly received docetaxel (75%), NCT-H group received weekly paclitaxel (59.4%) as taxane (p<0.001). pCR rate for patients treated with NCT-HP was significantly better than that for patients received NCT-H (66.4% vs. 56.8%, respectively, p<0.001) and there were not any statistical difference according to hormone receptor status. Two-years event-free survival (EFS) rates were 93.5% and 93.2% for NCT-HP and NCT-H groups, respectively (p=0.655), however, two years EFS rate was statistically significant in patients who achieved pCR compared to those who did not achieve pCR (95.1% vs. %90.6, p<0.001). There was not any toxicity leading to death. Conclusions: Our analysis of this real world data shows higher rates of pCR than in clinical trials, also adding pertuzumab to NCT-H demonstrates higher pCR rates and EFS rates compared with NCT-H in patients with HER2+ LABC.
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Affiliation(s)
- Ahmet Bilici
- Istanbul Medipol University, Medical Faculty, Istanbul, Turkey
| | | | - Ahmet Sezer
- Department of Medical Oncology, Başkent University, Adana, Turkey
| | - Berna Oksuzoglu
- University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Medical Oncology Department, Ankara, Turkey
| | | | - Nuri Karadurmus
- University of Health Sciences Gülhane Education and Research Hospital, Medical Oncology, Ankara, Turkey
| | | | | | - Sercan Aksoy
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Dilek Erdem
- Samsun Medicalpark Hospital Atakum, Samsun, Turkey
| | - Gul Basaran
- Acibadem Altunizade Hospital, Istanbul, Turkey
| | - Burcu Cakar
- Ege University Medical Faculty Hospital, İZmir, Turkey
| | - Mesut Seker
- Bezmialem Vakif University Hospital, Istanbul, Turkey
| | | | - Sema Sezgin Goksu
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Irfan Cicin
- Trakya University Medical Center, Edirne, Turkey
| | - Mahmut Gumus
- Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
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8
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Tural D, Olmez OF, Sümbül AT, Artac M, Ozhan N, Akar E, Cakar B, Kostek O, Ekenel M, Coskun HS, Selcukbiricik F, Keskin Ö, Paksoy Turkoz F, oruc K, Bayram S, Yilmaz U, Bilgetekin I, Yildiz B, Sendur MAN, Erman M. Association of response to first-line chemotherapy with the efficacy of atezolizumab in patients with metastatic urothelial carcinoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.409] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
409 Background: In the current study, we evaluated whether the response first-line chemotherapy could impact atezolizumab benefit in terms of response rate and overall survival in patients with metastatic urothelial carcinoma. Methods: In this study, we present the retrospective analysis of 105 patients with urothelial cancer treated with ATZ after progression on first-line chemotherapy. The association between response to first-line chemotherapy and ATZ was assessed using Fisher’s exact test. Overall survival (OS) was estimated by using the Kaplan-Meier method. Univariate analysis was used to identify clinical and laboratory factors that significantly impact OS. Variables were retained for multivariate analysis if they had a statistical relationship with OS (p˂0.1) and then included the final model if p˂0.05. Results: Best response to first-line chemotherapy was complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) in 5(4.8%), 38(36.2%), 16(15.2%), 46(43.8%) patients, respectively. Best response to atezolizumab was CR, PR, SD, PD in 9(8.6%), 22(21%), 23(21,9%), 51(48,5%). Forty (74.1%) of patients who benefited from first-line chemotherapy also benefited from atezolizumab, while only 14 (25.9%) of patients with initial PD after first-line chemotherapy subsequently experienced clinical benefit with atezolizumab (Fisher’s exact test, p=0.001). Patients with clinical benefit from first-line chemotherapy had a higher OS. The median OS of atezolizumab were 14.8 and 3.4 months for patients with clinical benefit and progressive disease in response to first-line chemotherapy, respectively (log-rank p=0.001). In univariate analysis, Patients with clinical benefit from first-line chemotherapy, liver metastases, baseline creatinine clearance less (GFR)than 60 ml/min, Eastern Cooperative Oncology Group (ECOG) performance status (1 ≥), and hemoglobin levels below 10 mg/dl were all significantly associated with OS. Three of the adverse prognostic factors according to the Bellmunt criteria were independent factor of short survival: liver metastases (Hazard Ratio [HR]= 0.6; 95% CI 0.174-0.60; p=0.04), ECOG PS≥1 (HR= 0.36; 95% CI 0.2-0.66; p=0.001), and Hemoglobin level below 10 mg/dl (HR= 0.36; 95% CI 0.2-0.66; p <0.001). In addition, Patients with clinical benefit from first-line chemotherapy (HR= 0.39; 95% CI 0.24-0.65; p <0.001) maintained a significant association with OS in multivariate analysis. Conclusions: Our study demonstrated that clinical benefit from first-line chemotherapy was independent prognostic factor on OS in patients' use of atezolizumab as second-line treatment in metastatic bladder cancer. Furthermore, these findings are important for stratification factors for future immunotherapy study design in patients with bladder cancer who have progressed after first-line chemotherapy.
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Affiliation(s)
- Deniz Tural
- Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | | | - Mehmet Artac
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Medical Oncology, Konya, Turkey
| | - Nail Ozhan
- Pamukkale University, School of Medicine, Denizli, Turkey
| | - Emre Akar
- Bakirköy Research and Education Hospital, Istanbul, Turkey
| | - Burcu Cakar
- Yunus Emre State Hospital Medical Oncology Unit, Eskisehir, Turkey
| | - Osman Kostek
- Trakya University, School of Medicine, Edirne, Turkey
| | - Meltem Ekenel
- Istanbul University, Institute of Oncology, Medical Oncology, Istanbul, Turkey
| | | | | | - Özge Keskin
- Selcuk University Faculty of Medicine, Konya, Turkey
| | | | - kerem oruc
- Cerrahpasa Medical School, İstanbul, Turkey
| | | | | | - Irem Bilgetekin
- Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Birol Yildiz
- Ankara Gulhand Egitim ve Arastirma Hastanesi, Ankara, Turkey
| | | | - Mustafa Erman
- Hacettepe University Cancer Institute, Department of Preventive Oncology, Ankara, Turkey
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9
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Ozbay B, Kemal H, Simsek E, Cakar B, Yavuzgil O. Electromechanical changes of the myocardium after anthracycline chemotherapy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.116] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and objectives
The most common side effects of chemotherapeutics in breast cancer is on the cardiovascular system. Global longitudinal strain (GLS) is the only parameter recommended for follow-up in current guidelines with limited evidence. Other strain imaging parameters and electrical changes after chemotherapy is not well studied. It is not known whether electrical or mechanical changes occur initially. The aim of this study is to evaluate repolarization parameters on ECG and mechanical changes together after chemotherapy in breast cancer patients.
Subjects and method
Consecutive patients who received chemotherapy due to breast cancer were included. Strain echocardiography and ECGs were performed pre-treatment (T0) and 3rd month after chemotherapy (T2). Additionally, just in three hours of first dose of chemotherapy (T1) another ECG was performed. QT and QT correction for heart rate (QTc), QT dispersion (QT disp) and QTc dispersion (QTc disp), T wave peak to end time (Tpe) and Tpe corrected for QT-QTc measurements were performed (figüre 1 and 2). GLS, longitudinal strain for myocardial layers, circumferential strain (CS), radial strain (RS) and torsion measurements were performed. All mechanical and electrical parameters from different time intervals were compared.
Results
Thirty-five consecutive patients (35 females, mean age 48.9 ± 11.8 years) who received chemotherapy (mean doxorubicin cumulative dose 415 ± 32 mg/m2) due to breast cancer were included. There was no significant change in mean GLS values before and after treatment (T0 -%18.8 ± 6.82, T1 18.6 ± 3.5 p = 0,863 respectively). However, there was a significant decrease in CS, RS and torsion (T0 -%17,2 ± 3,5, T1-%13 ± 2,84 p <0,001, T0 %45,1 ± 8,3, T1 %35,6 ±10 p <0,001 and T0 %12,1 ± 3.5, T1 %7.7 ± 2.1 p <0,001, respectively). QT, QTc, QTc disp and Tpe, Tpe/QTc parameters were prolonged just after chemotherapy and were still prolonged 3 months after ((QTc: T1 440.01 ± 27.63, T2 468.00 ± 38.98, T3 467.86 ± 35.09), (QTc disp T1 55.48 ± 20.22, T2 78.59 ± 16.15, T3 66.16 ± 14.62), (Tpe (QTc) T1 104 ± 18.52, T2 148.62 ± 19.16, T3 139.77 ± 21.63), (Tpe/QTc T1 0.213 ± 0.05, T2 0.281 ± 0.08, T3 0.258 ± 0.06).
Conclusion
Electrical and mechanical functions of the heart could be impaired together acutely even three months after doxorubicin chemotherapy. Cardio toxicity should be evaluated in terms of both electrically and mechanically.
Abstract Figure. ECG repolarization parameters
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Affiliation(s)
- B Ozbay
- Ege University, cardiology , Izmir, Turkey
| | - H Kemal
- Near East University Hospital , Cardiology, Nicosia, Cyprus
| | - E Simsek
- Ege University, cardiology , Izmir, Turkey
| | - B Cakar
- Ege University, oncology, Izmir, Turkey
| | - O Yavuzgil
- Ege University, cardiology , Izmir, Turkey
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10
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Zheng ZY, Anurag M, Lei JT, Cao J, Singh P, Peng J, Kennedy H, Nguyen NC, Chen Y, Lavere P, Li J, Du XH, Cakar B, Song W, Kim BJ, Shi J, Seker S, Chan DW, Zhao GQ, Chen X, Banks KC, Lanman RB, Shafaee MN, Zhang XHF, Vasaikar S, Zhang B, Hilsenbeck SG, Li W, Foulds CE, Ellis MJ, Chang EC. Neurofibromin Is an Estrogen Receptor-α Transcriptional Co-repressor in Breast Cancer. Cancer Cell 2020; 37:387-402.e7. [PMID: 32142667 PMCID: PMC7286719 DOI: 10.1016/j.ccell.2020.02.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/15/2019] [Accepted: 02/06/2020] [Indexed: 12/18/2022]
Abstract
We report that neurofibromin, a tumor suppressor and Ras-GAP (GTPase-activating protein), is also an estrogen receptor-α (ER) transcriptional co-repressor through leucine/isoleucine-rich motifs that are functionally independent of GAP activity. GAP activity, in turn, does not affect ER binding. Consequently, neurofibromin depletion causes estradiol hypersensitivity and tamoxifen agonism, explaining the poor prognosis associated with neurofibromin loss in endocrine therapy-treated ER+ breast cancer. Neurofibromin-deficient ER+ breast cancer cells initially retain sensitivity to selective ER degraders (SERDs). However, Ras activation does play a role in acquired SERD resistance, which can be reversed upon MEK inhibitor addition, and SERD/MEK inhibitor combinations induce tumor regression. Thus, neurofibromin is a dual repressor for both Ras and ER signaling, and co-targeting may treat neurofibromin-deficient ER+ breast tumors.
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Affiliation(s)
- Ze-Yi Zheng
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Meenakshi Anurag
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan T Lei
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA; Interdepartmental Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jin Cao
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Purba Singh
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Jianheng Peng
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Physical Examination, the First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Hilda Kennedy
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Nhu-Chau Nguyen
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Yue Chen
- Adrienne Helis Malvin Medical Research Foundation, New Orleans, LA, USA
| | - Philip Lavere
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Jing Li
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Xin-Hui Du
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Bone and Soft Tissue, Zhengzhou University Affiliated Henan Cancer Hospital and College of Basic Medical Sciences, Zhengzhou University, Zhengzhou, P. R. China
| | - Burcu Cakar
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Wei Song
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Beom-Jun Kim
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Jiejun Shi
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Sinem Seker
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Doug W Chan
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Guo-Qiang Zhao
- Department of Bone and Soft Tissue, Zhengzhou University Affiliated Henan Cancer Hospital and College of Basic Medical Sciences, Zhengzhou University, Zhengzhou, P. R. China
| | - Xi Chen
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Maryam Nemati Shafaee
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Xiang H-F Zhang
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Suhas Vasaikar
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Bing Zhang
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Susan G Hilsenbeck
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Wei Li
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Charles E Foulds
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA; Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | - Matthew J Ellis
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Eric C Chang
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.
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11
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Tural D, Olmez OF, Sumbul AT, Artac M, Ozhan N, Akar E, Cakar B, Kostek O, Paksoy N, Erman M, Coskun HS, Selcukbiricik F, Keskin Ö, Paksoy Turkoz F, Oruc K, Bayram S, Yilmaz U, Bilgetekin I, Yildiz B, Kilickap S. Atezolizumab in patients with metastatic urothelial carcinoma who have progressed after first-line chemotherapy: Results of real-life experience. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.451] [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
451 Background: Anti-tumor activity and manageable safety profile of atezolizumab (ATZ) has been demonstrated in the previous clinical trials in patients with locally advanced or metastatic platinum-resistant urothelial carcinoma. In this study, we reported the results of real-life data of urothelial carcinoma patients in Turkey who were treated with ATZ. Methods: Data of the patients with metastatic urothelial carcinoma registered to ATZ Expanded-Access Program and treated with at least one course of ATZ from 36 oncology centers in Turkey were collected. The primary endpoint was the overall response rate (ORR); secondary endpoints were overall survival (OS), progression-free survival (PFS), duration of the ATZ treatment and safety. Results: Data of 115 eligible patients were analyzed. Of the patients, 100 (87%) were male and 13% were female. The median age was 65.3 years (37-86). Most of the patients (92.3%) had received only one chemotherapy regimen prior to ATZ. The median follow-up time was 23.5 months. The complete response rate to ATZ, partial response rate, and ORR were 8.7% (n=10), 20.0% (n=23), and 28.7% (n=33), respectively. The median duration of response was 20.4 months (95% CI 6.47–28.8). Of the thirty-three patients who responded to treatment, 20 (60%) had an ongoing response at the time of the analysis. PFS and OS with ATZ were 3.8 months (95% 2.25–5.49) and 9.8 months (95% 6.7–12.9), respectively. The 12-month PFS rate was 22.3% and the 24-month PFS rate was 16.9%. The 12-month OS rate was 42.2% and the 24-month OS rate was 23.5%, respectively. Sixty-four percent of patients experienced a treatment-related adverse event of any grade, and 24 (20%) of patients had a grade 3–4 treatment-related adverse event. Because of treatment-related side effects, dose reduction was performed in 9 (7.8%) patients and ATZ was discontinued in 8 patients (7.0%). Adverse event that required systemic steroid use was reported in only 7 (6.1%) patients. Four patients (3.5%) died due to treatment-related causes. Conclusions: ATZ is an effective and tolerable treatment for patients with metastatic platinum-resistant urothelial carcinoma.
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Affiliation(s)
- Deniz Tural
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | | | - Mehmet Artac
- Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Nail Ozhan
- Pamukkale University, School of Medicine, Denizli, Turkey
| | - Emre Akar
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Burcu Cakar
- Ege University, School of Medicine, Izmir, Turkey
| | - Osman Kostek
- Trakya University, School of Medicine, Edirne, Turkey
| | - Nail Paksoy
- Istanbul University, Institute of Oncology, Istanbul, Turkey
| | - Mustafa Erman
- Hacettepe University School of Medicine, Ankara, Turkey
| | | | | | - Özge Keskin
- Selcuk University Faculty of Medicine, Konya, Turkey
| | | | - Kerem Oruc
- Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Selami Bayram
- Antalya Training and Research Hospital, Antalya, Turkey
| | | | - Irem Bilgetekin
- Ankara Dr. A.Y. Oncology Training and Research Hospital, Ankara, Turkey
| | - Birol Yildiz
- Ankara Gulhane Training and Research Hospital, Ankara, Turkey
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Demirci U, Gokmen E, Eralp Y, Gunduz S, Goksu SS, Korkmaz T, Kostek O, Turhal S, Paydas S, Topcu S, Cakar B, Karabulut B, Tanrıverdi O, Karaca B, Deniz GI, Alan O, Turkoz FP, Basaran G. Abstract P5-11-19: Ribociclib for the treatment of hormone receptor-positive refractory advanced breast cancer: Managed access programme in Turkey. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-11-19] [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: 11/16/2022]
Abstract
Abstract
Background: Ribociclib combined with endocrine therapy (ET) have demonstrated efficacy in patients with hormone receptor (HR) positive advanced breast cancer (ABC) who experienced progression during prior ET. However, there are scarce data chemo-endocrine refractory patients with ribociclib. We analyzed the efficiency and safety of ribociclib from the real world evidence in this heavily treated group of patients in Managed Access Programme (MAP).
Methods: MAP launched in Turkey, between October 2017 and March 2018. We retrospectively analyzed survival outcomes and toxicities of 52 patients from this programme.
Results: The median age of the total population was 54.5 years (28-76 years) and 71.2% (n=37) of the patients were postmenapousal. Median estrogen receptor and progesterone receptor positivity were 90% (15-100) and 25% (0-100), respectively. Median Ki67 was 25% (3-90%). 46.2% and 73.1% of the patients had adjuvant chemotherapy and ET, respectively. Denovo metastatic disease was detected 28.8% of the patients. Visceral disease (lung, liver, and others) was present in 21 patients (40.3%), and 16 (30.8%) had bone-only disease.
Median treatment line of ABC before ribociclib was 4 (1-9). ET was performed 36.5% and 38.4% for the first and second line treatment of ABC, respectively. Most of the patients (71.5%) treated anthracycline and taxanes before ribociclib. Ribociclib combined with ET in the majority of the patients; aromatase inhibitors (51.9%), fulvestrant (26.9%) and tamoxifen (3.8%). However, 4 patients were receiving ribociclib monotherapy. As of May 21, 2019, 26.9% (n=14) of patients were still receiving treatment.
Objective response rate was 38.4% (n=20) and additional 18 (34.6%) stable diseases were detected. Median progression free survival and overall survival were 5 months (3.9-6.1 months) and 15.2 months (13.7-16.8 months), respectively. While 48.1% of the patients treated with chemotherapy after ribociclib failure, only two patients treated with ET after ribociclib failure.
Ribociclib was generally well tolerated all the study population, grade 2 emesis was developed only two patients. Grade 3/4 neutropenia was developed in 36.5% of the patients. There was no febrile neutropenia. Urosepsis (n=1) and grade 4 thrombocytopenia (n=1) were developed in seperate patients. A prolongation of QTcF from baseline occurred in two patients. Dose reductions occurred in 21.2% (n=11) of the patients. There was 3 deaths during treatment.
Conclusions: Ribociclib is an effective agent with tolerable safety profile even in the heavily pretreated patients with HR positive ABC especially combined with ET.
Citation Format: Umut Demirci, Erhan Gokmen, Yesim Eralp, Seyda Gunduz, Sema Sezgin Goksu, Taner Korkmaz, Osman Kostek, Serdar Turhal, Semra Paydas, Sevgi Topcu, Burcu Cakar, Bulent Karabulut, Ozgur Tanrıverdi, Burcak Karaca, Gulhan Ipek Deniz, Ozkan Alan, Fatma Paksoy Turkoz, Gul Basaran. Ribociclib for the treatment of hormone receptor-positive refractory advanced breast cancer: Managed access programme in Turkey [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-11-19.
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Affiliation(s)
- Umut Demirci
- 1Dr. A. Y. Ankara Oncology Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Erhan Gokmen
- 2Ege University, Department of Medical Oncology, Izmir, Turkey
| | - Yesim Eralp
- 3Florence Nightingale Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Seyda Gunduz
- 4Memorial Antalya Hospital, Department of Medical Oncology, Antalya, Turkey
| | - Sema Sezgin Goksu
- 5Akdeniz University, Department of Medical Oncology, Antalya, Turkey
| | - Taner Korkmaz
- 6Acıbadem Mehmet Ali Aydinlar University, Department of Medical Oncology, Istanbul, Turkey
| | - Osman Kostek
- 7Trakya University, Department of Medical Oncology, Edirne, Turkey
| | - Serdar Turhal
- 8Anadolu Medical Center, Department of Medical Oncology, Kocaeli, Turkey
| | - Semra Paydas
- 9Cukurova University, Department of Medical Oncology, Adana, Turkey
| | - Sevgi Topcu
- 10Ege University, Department of Medical Oncology, İzmir, Turkey
| | - Burcu Cakar
- 2Ege University, Department of Medical Oncology, Izmir, Turkey
| | | | - Ozgur Tanrıverdi
- 11Mugla Sitki Kocman University, Department of Medical Oncology, Mugla, Turkey
| | - Burcak Karaca
- 2Ege University, Department of Medical Oncology, Izmir, Turkey
| | - Gulhan Ipek Deniz
- 12Istanbul University Cerrahpasa Medical Faculty, Department of Medical Oncology, Istanbul, Turkey
| | - Ozkan Alan
- 13Tekirdag State Hospital, Department of Medical Oncology, Edirne, Turkey
| | - Fatma Paksoy Turkoz
- 14Medical Park Goztepe Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Gul Basaran
- 15Acıbadem Mehmet Ali Aydınlar University, Department of Medical Oncology, Istanbul, Turkey
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Kilickap S, Buğdaycı Başal F, Demirkazik A, Gursoy P, Demirci U, Erman M, Yumuk F, Cay Senler F, Cakar B, Cicin I, Ozturk A, Coskun H, Çubukçu E, Işıkdoğan A, Olmez O, Tatlı A, Karaagac M, Şakalar T, Eralp Y, Korkmaz T. Is there any prognostic significance in pleural involvement and/or effusion (Ple-I/E) in patients with ALK-positive NSCLC? Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bilici A, Olmez O, Gursoy P, Çubukçu E, Yildiz O, Sakin A, Korkmaz T, Cil I, Cakar B, Menekse S, Demir T, Acikgoz O, Hamdard J. P2.01-64 Systemic Inflammatory Markers as a Predictors of Response to Crizotinib in Patients with ALK-Positive Non-Small-Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Olmez O, Bilici A, Gursoy P, Çubukçu E, Yildiz O, Sakin A, Korkmaz T, Cil I, Cakar B, Menekse S, Demir T, Acikgoz O, Hamdard J. P1.14-01 Are Pretreatment Inflammation-Based Prognostic Scores Useful in Predicting the Outcomes of Patients with ALK-Positive NSCLC? J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Peng J, Zheng ZY, Cakar B, Li J, Singh P, Szafrain AT, Stossi F, Dubrulle J, Mancini MA, Mao R, Miles G, Ellis MJ, Chang EC. Abstract P5-04-30: Developing an immunohistochemistry protocol to detect neurofibromin as an effective, simple, and rapid method to identify NF1-negative breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-04-30] [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: 11/16/2022]
Abstract
Abstract
Background:Neurofibromin is a key tumor suppressor, well-known as a GTPase-Activating-Protein (GAP) to attenuate Ras signaling. It is encoded by the NF1gene, so named because its inactivation was first discovered to cause Neurofibromatosis type 1, an autosomal dominant genetic disorder. We have recently reported thatnonsense (NS) and frameshift (FS) mutations, but not missense mutations, in NF1are associated with a markedly higher risk of relapse and death in early stage ER+breast cancer after adjuvant tamoxifen monotherapy (Griffith et al. in press). Surprisingly, despite being best known as a GAP, no missense mutations inactivating NF1's GAP activity were found in our cohort. We have evidence that these NF1NS/FS mutations cause the resulting mRNAs to be degraded, leading to depletion of the entire NF1 protein. In a separate study that was presented here last year, we showed that NF1 is also an ER co-repressor, which partially explains why the loss of the single tumor suppressor NF1 is so detrimental — because this turns on two potent oncogenic pathways. Thus far there is no effective means to assess loss of NF1 protein in cancer. The objective of this project is to identify these aggressive NF1-negative breast cancers by establishing an immunohistochemistry (IHC) protocol with a valid NF1 antibody in order to properly find and treat them in the future.
Methods:A monoclonal antibody was raised against the C-terminus of NF1. Immunostaining as well as IHC was performed using a set of breast cancer cell lines with varying degrees of NF1 protein levels, including several NF1 null-like cell lines as negative controls. To assess whether the IHC protocol can be used on patients, NF1+and NF1–PDXs as well as patient biopsies were examined.
Results: We have purified a monoclonal antibody against NF1 (m376). By immunostaining, a strong NF1 signal can be seen in T47D cells, which have four copies of the NF1gene. In contrast, there was barely any signal in MDA-MB-175VII cells, which lack detectable NF1 due to NF1FS mutations. While NF1 appears mostly cytoplasmic, 10-15% can be seen in the nucleus. Nuclear NF1 levels can be further increased by the nuclear export blocker leptomycin-B, suggesting that NF1 is shuttled in and out of the nucleus. IHC staining confirmed these features of NF1. In addition, a weak nuclear signal can be seen in cancer cells carrying NF1FS mutations. Experiments are on-going to assess how to analyze tumor samples for NF1 loss and whether NF1FS mutations cause expression of truncated proteins that are nuclear.
Conclusion: Our results suggest that the m376 antibody has the potential to be used for IHC, provided that samples known to be NF1+or NF1–are included as controls. The success of this project will have particular clinical impact in telling us who should notbe treated by tamoxifen. Furthermore, we have an approved clinical trial protocol to assess the concept that these NF1–patients should instead be treated by combining a Ras pathway inhibitor and a SERD.
Citation Format: Peng J, Zheng Z-y, Cakar B, Li J, Singh P, Szafrain AT, Stossi F, Dubrulle J, Mancini MA, Mao R, Miles G, Ellis MJ, Chang EC. Developing an immunohistochemistry protocol to detect neurofibromin as an effective, simple, and rapid method to identify NF1-negative breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-04-30.
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Affiliation(s)
- J Peng
- Baylor College of Medicine, Houston, TX
| | - Z-y Zheng
- Baylor College of Medicine, Houston, TX
| | - B Cakar
- Baylor College of Medicine, Houston, TX
| | - J Li
- Baylor College of Medicine, Houston, TX
| | - P Singh
- Baylor College of Medicine, Houston, TX
| | | | - F Stossi
- Baylor College of Medicine, Houston, TX
| | | | | | - R Mao
- Baylor College of Medicine, Houston, TX
| | - G Miles
- Baylor College of Medicine, Houston, TX
| | - MJ Ellis
- Baylor College of Medicine, Houston, TX
| | - EC Chang
- Baylor College of Medicine, Houston, TX
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Chang EC, Zheng Z, Anurag M, Gao J, Cakar B, Du X, Li J, Lavere P, Lei JT, Singh P, Seker S, Song W, Peng J, Nguyen T, Chan D, Chen X, Banks KC, Lanman RB, Shafaee M, Hilsenbeck S, Foulds C, Ellis MJ. Abstract 1814: NF1 as an estrogen receptor-α co-repressor in breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-1814] [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: 11/16/2022]
Abstract
Abstract
NF1 has been best known as a GAP (GTPase Activating Protein) that inactivates Ras. However, we are now finding evidence that it also functions as an ER co-repressor, whose loss leads to endocrine therapy resistance. Sequencing tumor DNA from >600 ER+ breast cancers treated by tamoxifen adjuvant monotherapy, we found that frameshift (FS) and nonsense (NS) NF1 mutations, which can create an NF1-null state, strongly correlate with relapse risk (HR=2.6, submitted). Surprisingly, no recurrent missense NF1 mutations inactivating GAP activity were found in our cohort, and such mutations are rare in primary cancers in general. We thus posulated that complete loss of NF1 protein (e.g., caused by NS/FS mutations), but not GAP inactivation alone, is required to drive endocrine therapy resistance.
Here we demonstrate that NF1 loss (by gene silencing) in ER+ breast cancer cells greatly enhances ligand-dependent ER transcriptional activity in vitro and in vivo, causing estradiol (E2) hypersensitivity and tamoxifen agonism. Mechanistically we show that NF1 can bind directly to ER, an interaction enhanced by tamoxifen but not by E2. Binding is mediated by leucine/isoleucine-rich motifs in NF1, analogous to other ER co-repressors. Mutations in these motifs (some of which are targeted by somatic mutation in cancer) inhibit ER binding and transcriptional activity without impacting GAP activity; conversely, inactivating GAP activity does not impact ER binding and repression. To validate NF1 as an ER co-repressor, we examined proteomic data from >100 breast cancer patients in the CPTAC data base and found that proteins whose levels are positively correlated with NF1 are highly enriched with factors known to bind nuclear receptors; by contrast, levels of another GAP, p120, which lacks ER binding sites, are negatively correlated with these molecules. Importantly, preclinical treatment studies indicate that while NF1-deficient ER+ breast cancer should not be treated by tamoxifen or aromatase inhibitors, fulvestrant, which degrades ER, remains effective. However, fulvestrant monotherapy can activate the Ras-MAP pathway, which may promote cell survival and acquired fulvestrant resistance unless combined with dabrafinib and trametinib to inhibit Raf and MEK —a clinical trial for this combination is in development.
Our data suggest that NF1 is a dual negative regulator at the intersection of two potent oncogenic signaling pathways, Ras and ER. Combination therapy targeting both the ER and the Ras-Raf pathways should be investigated for NF1-deficient cancers driven by ER.
Citation Format: Eric C. Chang, zeyi Zheng, Meenakshi Anurag, Jin Gao, Burcu Cakar, Xinhui Du, Jing Li, Philip Lavere, Jonathan T. Lei, Purba Singh, Sinem Seker, Wei Song, Jianheng Peng, Tiffany Nguyen, Doug Chan, Xi Chen, Kimberly C. Banks, Richarad B. Lanman, Maryam Shafaee, Susan Hilsenbeck, Charles Foulds, Matthew J. Ellis. NF1 as an estrogen receptor-α co-repressor in breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1814.
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Affiliation(s)
| | - zeyi Zheng
- 1Baylor College of Medicine, Houston, TX
| | | | - Jin Gao
- 1Baylor College of Medicine, Houston, TX
| | | | - Xinhui Du
- 1Baylor College of Medicine, Houston, TX
| | - Jing Li
- 1Baylor College of Medicine, Houston, TX
| | | | | | | | | | - Wei Song
- 1Baylor College of Medicine, Houston, TX
| | | | | | - Doug Chan
- 1Baylor College of Medicine, Houston, TX
| | - Xi Chen
- 1Baylor College of Medicine, Houston, TX
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Niravath P, Cakar B, Ellis M. Current Challenges Associated With Next-Generation Sequencing of Breast Cancer—Reply. JAMA Oncol 2017; 3:1284. [DOI: 10.1001/jamaoncol.2017.0665] [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: 11/14/2022]
Affiliation(s)
| | - Burcu Cakar
- Lester & Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas
| | - Matthew Ellis
- Lester & Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas
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Cakar B, Chan D, Yan P, Zheng Z, Singh P, Lei JT, Haricharan S, Ellis M, Chang E. Abstract P1-08-07: Assessing the impact of loss of NF1 protein on endocrine therapy resistance. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-08-07] [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: 11/16/2022]
Abstract
Abstract
Background: The vast majority of breast cancers belong to the luminal subtype, which expresses the estrogen receptor-α (ER). Although great strides have been made in targeting the ER pathway for treating the ER+ tumors, relapse and death is common and ongoing. In order to identify the cause for treatment resistance, we have conducted a retrospective analyses on the tumor genomes of >600 patients treated by tamoxifen monotherapy in the adjuvant setting with a median follow-up of 10.4 years. Our data have revealed that NF1 (Neurofibromatosis type 1) gene loss of function mutations were greatly associated with poor prognosis. NF1 is a tumor suppressor acting mostly as a GAP (GTP ase activating protein) to switch off activated Ras. We aim to define the impact of loss of NF1 protein on patient outcome in ER+ breast cancer patients by establishing an immunohistochemistry (IHC) protocol to detect NF1.
Method and results: We have first surveyed commercially available antibodies by Western blot and found one that could efficiently detect endogenous NF1. We then use this to validate inducible shRNA clones against NF1, as well as a breast cancer cell line that is NF1-null. This antibody has high background. We have thus partially purified a commercially available NF1 antibody by preclearing using NF1-null cell lysate. We then performed immunostaining using NF1-silenced and null cells as control and found that NF1 is mostly cytoplasmic and nuclear. To get antibody of high quality, we have decided to make our own antibody by expressing a C-terminal fragment of NF1 as a GST-tagged protein (GST-NF1c). Production of polyclonal and monoclonal antibody is in progress.
Conclusion: Our clinical profiling data suggest that loss of NF1 protein, a very common event in a wide range of other cancers, promotes endocrine therapy resistance. An efficient IHC protocol will enable us to firmly validate whether loss of the NF1 protein indeed correlates with poor patient outcome. This method will ultimately enable us to identify high risk NF1 deficient patients and to properly treat them.
Citation Format: Cakar B, Chan D, Yan P, Zheng Z, Singh P, Lei JT, Haricharan S, Ellis M, Chang E. Assessing the impact of loss of NF1 protein on endocrine therapy resistance [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-08-07.
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Affiliation(s)
- B Cakar
- Baylor College of Medicine, Houston, TX
| | - D Chan
- Baylor College of Medicine, Houston, TX
| | - P Yan
- Baylor College of Medicine, Houston, TX
| | - Z Zheng
- Baylor College of Medicine, Houston, TX
| | - P Singh
- Baylor College of Medicine, Houston, TX
| | - JT Lei
- Baylor College of Medicine, Houston, TX
| | | | - M Ellis
- Baylor College of Medicine, Houston, TX
| | - E Chang
- Baylor College of Medicine, Houston, TX
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Zheng ZY, Cakar B, Lavere P, Cao J, Yao J, Singh P, Lei JT, Toonen JA, Haricharan S, Anurag M, Shah K, Kavuri M, Chan DW, Chen X, Gutmann DH, Foulds CE, Ellis MJ, Chang EC. Abstract P1-08-01: Regulation of estrogen receptor-α by NF1. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-08-01] [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: 11/16/2022]
Abstract
Abstract
Background. Although great strides have been made in targeting the ER pathway for treating ER+ breast cancer, relapse and death is common and is closely linked to resistance to ER-targeting agents. As a result, the majority of deaths from breast cancer still come from ER+ tumors. To discover drivers for endocrine resistance, we have sequenced tumor DNAs from a cohort of >600 patients treated with 5-year tamoxifen (Tam) monotherapy with a median 10.4 years follow up. Our preliminary data show that the worst outcome mutations (Hazard Ratio of ∼3 for relapse) were mostly those of the Neurofibromatosis type 1 (NF1) gene (encoding Neurofibromin), with nonsense/frame shift mutations creating early stop codons.
Germline NF1mutations cause neurofibromatosis type 1, a common inherited disorder that predisposes individuals to both benign and malignant tumors of the nervous system, as well as an increased risk for breast cancer. Analysis of DNA sequencing data has also shown that the NF1 gene is mutated in a wide range of common cancers (e.g., melanoma, lymphoma, and cancers of the lung, breast, and colon). Thus, NF1-deficiency underlies the formation and/or progression of a large number of cancers, so that the development of therapies targeted to NF1-deficient malignancies would have broad impact.
These observations support the hypothesis that NF1 gene inactivation is associated with aggressive tumor behaviors, such as endocrine therapy resistance in breast cancer. The key focus of this study is to define how the NF1 protein neurofibromin, regulates endocrine therapy resistance. Although neurofibromin is best known as a negative regulator for Ras, our data show that it may have other functions.
Method. Our data suggest that many of the identified nonsense/frame shift create a NF1 null state; thus, we have used gene-silencing to recapitulate the effects of such NF1 mutations on the activities of ER+ breast cancer cells. NF1+ and NF1– ER+ breast cancer cells were grown in defined media to measure how estradiol (E2) and Tam impact their growth, transforming activities, and gene expression. The binding between neurofibromin and components of the ER transcriptional pathway was measured biochemically and using the mammalian two-hybrid system.
Results. Our data showed that NF1-silenced cells use Tam as an agonist and can grow with very little E2, and these activities are driven by enhanced recruitment of ER to the ERE, leading to efficient expression of many classic ER-responsive genes. Expressing the NF1-GAP domain does not restore normal responses to Tam and E2 in NF1-silenced cells, suggesting that neurofibromincan regulate ER activity in a Ras-independent manner. To investigate the possibility that neurofibromin can directly regulate ER, we found that it can bind ER; furthermore, neurofibromin was more strongly recruited to the ERE by Tam than by E2.
Conclusion. Our data support a model whereby neurofibromin acts like a co-repressor for ER. As such,NF1 loss may result in more aggressive tumor behaviors by activating, not only the Ras pathways, but also the ER transcriptional pathways. Simultaneous activation of two powerful oncogenic pathways by the loss of a single tumor suppressor may explain why neurofibromin is such a potent tumor suppressor lost in a wide range of cancers.
Citation Format: Zheng Z-Y, Cakar B, Lavere P, Cao J, Yao J, Singh P, Lei JT, Toonen JA, Haricharan S, Anurag M, Shah K, Kavuri M, Chan DW, Chen X, Gutmann DH, Foulds CE, Ellis MJ, Chang EC. Regulation of estrogen receptor-α by NF1 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-08-01.
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Affiliation(s)
- Z-Y Zheng
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - B Cakar
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - P Lavere
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - J Cao
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - J Yao
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - P Singh
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - JT Lei
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - JA Toonen
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - S Haricharan
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - M Anurag
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - K Shah
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - M Kavuri
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - DW Chan
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - X Chen
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - DH Gutmann
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - CE Foulds
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - MJ Ellis
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
| | - EC Chang
- Baylor College of Medicine, Houston, TX; Washington University in St. Louis, St. Louis, MO
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Abstract
Importance The application of next-generation sequencing (NGS) genomic testing for somatic mutations in breast oncology has been slower than anticipated due to issues with clinical applicability and natural heterogeneity of breast cancer. This review summarizes the state of the field and considers approaches for more effective implementation. Observations While there is an emerging role for germline genetic testing potentially predicting sensitivity to platinum salts and PARP inhibitors, the data regarding somatic mutation for prediction of drug sensitivity remains controversial. Currently, there are no guidelines or regulatory approvals for genomic somatic tumor mutation testing to direct therapy. However, some small populations show promise, such as those with ERBB2/HER2 mutation who may represent the first population to have a positive drug somatic mutation match. Similarly, those with ESR1 mutation may be the first to emerge for a negative association with the efficacy of aromatase-inhibitor treatment. One of the barriers to progress is the necessary focus on metastatic disease, which is often challenging, expensive, and risky to biopsy. In addition, because of the clonal heterogeneity of advanced disease, a single sample may not contain all the genomic information necessary for treatment. Thus, circulating tumor DNA analysis is perhaps one of the most practical and promising approaches. Conclusions and Relevance Circulating tumor DNA analysis, once sensitive and broad enough, will accelerate progress in the quest to make NGS technologies relevant to breast cancer treatment. A broad and coordinated coalition to systematically connect somatic mutations to clinical and pharmacologic data will be critical for progress. We recommend instituting an open source encyclopedia, which would serve as a reference for NGS sequencing report interpretation and would be available to all clinicians to help direct therapy.
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Affiliation(s)
- Polly Niravath
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas
| | - Burcu Cakar
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas
| | - Matthew Ellis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas
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Cakar B, Muslu U, Erdogan AP, Ozisik M, Ozisik H, Tunakan Dalgic C, Durusoy R, Karaca B, Sezgin C, Karabulut B, Uslu R. The Role of Body Mass Index in Triple Negative Breast Cancer. Oncol Res Treat 2015; 38:518-22. [PMID: 26452262 DOI: 10.1159/000439551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 08/03/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) has none of the targeted treatment choices due to its distinct biological property, making this subtype a unique disease. In this study, we evaluated the impact of obesity on clinical outcomes of TNBC. METHODS The data of breast cancer patients admitted to our department were collected. TNBC was defined as lack of estrogen receptor (ER), progesterone receptor (PR) and HER-2. The body mass index (BMI) of 112 TNBC patients was calculated with weight at the time of diagnosis and height. The patients were classified into groups with a BMI of < 25 (normal/underweight), 25-29.9 (overweight) or ≥ 30 (obese). After a mean follow-up of 23.2 ± 15.5 months, there were 12 recurrences (10.71%) and 6 deaths (5.35%). Disease-free survival (DFS) and overall survival (OS) were assessed. RESULTS The survival analyses of all the patients did not demonstrate any differences in OS or DFS in obese as compared to non-obese patients. However, we showed that obesity was associated with a poorer OS for postmenopausal TNBC patients (p < 0.05). CONCLUSION Obesity is related to a poorer OS in postmenopausal TNBC patients. Due to the heterogeneous disease profile of TNBC, larger randomized studies will be needed to clarify the exact role of obesity in TNBC.
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Affiliation(s)
- Burcu Cakar
- Division of Medical Oncology, Yunus Emre State Hospital, Eskisehir, Turkey
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Surmeli Z, Cakar B, Gursoy P, Karabulut B, Sanli U, Uslu R. 1917 Prognostic role of surrogate intrinsic subtypes in non-metastatic inflammatory breast cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30866-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Surmeli ZG, Varol U, Cakar B, Degirmenci M, Arslan C, Piskin GD, Zengel B, Karaca B, Sanli UA, Uslu R. Capecitabine maintenance therapy following docetaxel/capecitabine combination treatment in patients with metastatic breast cancer. Oncol Lett 2015; 10:2598-2602. [PMID: 26622896 DOI: 10.3892/ol.2015.3546] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 11/06/2014] [Accepted: 06/16/2015] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to analyze the efficacy of maintenance therapy with single agent capecitabine for human epidermal growth factor receptor (HER2) negative metastatic breast cancer (MBC) patients following disease control with 6 cycles of docetaxel plus capecitabine chemotherapy as the first-line treatment. As an initial treatment, 6 cycles of docetaxel plus capecitabine followed by maintenance therapy with capecitabine were administered. A total of 55 patients received combination therapy and 48 patients proceeded to maintenance therapy: Of these, 32 patients (66.7%) were postmenopausal and 37 (77.1%) had estrogen and progesterone receptor positive disease. The median progression-free survival rate with maintenance therapy was 5.5 months (95% CI, 0-11.4 months) and the median overall survival (OS) was 26.6 months (95% CI, 21.8-30.1 months). The use of maintenance therapy improved previous responses in 4 patients (8.3%; 2 partial and 2 complete responses) and 32 patients (66.7%) had stable disease. The median number of maintenance therapy cycles applied was 6.5 (range 1-28, total 441). The observation of side effects, including grade 3/4 neutropenia, febrile neutropenia and fatigue was more common during combination therapy. The results of the present study indicate that maintenance with single agent capecitabine therapy is an effective and tolerable treatment option for HER2 negative MBC patients in which disease control with 6 cycles of docetaxel plus capecitabine chemotherapy is achieved in the first-line setting.
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Affiliation(s)
- Zeki Gokhan Surmeli
- Department of Internal Medicine, Division of Medical Oncology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - Umut Varol
- Medical Oncology Clinic, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Burcu Cakar
- Department of Internal Medicine, Division of Medical Oncology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - Mustafa Degirmenci
- Medical Oncology Clinic, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Cagatay Arslan
- Medical Oncology Clinic, Izmir University, Medical Park Hospital, Izmir, Turkey
| | - Gonul Demir Piskin
- Medical Oncology Clinic, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Baha Zengel
- Medical Oncology Clinic, Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Burcak Karaca
- Department of Internal Medicine, Division of Medical Oncology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - Ulus Ali Sanli
- Department of Internal Medicine, Division of Medical Oncology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - Ruchan Uslu
- Department of Internal Medicine, Division of Medical Oncology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
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Bicakli DH, Varol U, Degirmenci M, Tunali D, Cakar B, Durusoy R, Karaca B, Sanli UA, Uslu R. Reply To the Editor, Re: Bicakli et al. Adjuvant chemotherapy may contribute to an increased risk for metabolic syndrome in patients with breast cancer. J Oncol Pharm Pract, published online September 2014. DOI: 10.1177/1078155214551315. J Oncol Pharm Pract 2015; 21:318-9. [PMID: 25979298 DOI: 10.1177/1078155215585051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Derya Hopanci Bicakli
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Turkey
| | - Umut Varol
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Turkey
| | - Mustafa Degirmenci
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Turkey
| | - Didem Tunali
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Turkey
| | - Burcu Cakar
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Turkey
| | - Raika Durusoy
- Department of Public Health, School of Medicine, Ege University, Turkey
| | - Burcak Karaca
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Turkey
| | - Ulus Ali Sanli
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Turkey
| | - Ruchan Uslu
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Turkey
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Bicakli DH, Varol U, Degirmenci M, Tunali D, Cakar B, Durusoy R, Karaca B, Ali Sanli U, Uslu R. Adjuvant chemotherapy may contribute to an increased risk for metabolic syndrome in patients with breast cancer. J Oncol Pharm Pract 2014; 22:46-53. [PMID: 25233884 DOI: 10.1177/1078155214551315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 01/28/2023]
Abstract
PURPOSE Cytotoxic treatment may cause weight gain and important alterations in the metabolic status of breast cancer (BC) patients. The aim of this study was to investigate the changes in metabolic and anthropometric parameters of patients with BC who received adjuvant chemotherapy. METHODS All consecutive women treated with adjuvant TAC (docetaxel 75 mg/m(2), doxorubicine 50 mg/m(2), cyclophosphamide 500 mg/m(2)) chemotherapy for node-positive breast carcinoma at our Institution between 2008 and 2010 were included. RESULTS Among 104 patients, 84 of them were stage II and 20 of them were stage III. When we compared the measurements between 1(st) and 6(th) adjuvant chemotherapy, we observed statistically significant increases in weight and serum triglyceride levels, and decreases in high density lipoprotein, apolipoprotein A-1, transferrin, albumin and prealbumin levels. An elevation of follicle stimulating hormone, luteinizing hormone together with the decrease of estradiol was detected. Waist-to-hip ratio has also increased significantly. In subgroup analyses, we observed dramatic changes in body mass index in pre-menopausal women whereas no significant change was seen in the post-menopausal group. CONCLUSIONS Adjuvant chemotherapy may contribute to an increased risk for metabolic syndrome in patients with BC and these changes are more profound in pre-menopausal patients.
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Affiliation(s)
- Derya Hopanci Bicakli
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Umut Varol
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Mustafa Degirmenci
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Didem Tunali
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Burcu Cakar
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Raika Durusoy
- Department of Public Health, School of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Burcak Karaca
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Ulus Ali Sanli
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
| | - Ruchan Uslu
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey
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Varol U, Cakar B, Yildiz I, Tunakan Dalgic C, Ozisik H, Ozisik M, Karaca B, Karabulut B, Uslu R. Survival Analysis of Triple Negative and Her2 Positive Breast Cancer Patients: Single Center Report. J Breasth Health 2014. [DOI: 10.5152/tjbh.2014.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cakar B, Karaca B, Uslu R. Sexual dysfunction in cancer patients: a review. J BUON 2013; 18:818-823. [PMID: 24344003] [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: 06/03/2023]
Abstract
Cancer is a life-threatening disease despite the advanced therapeutic strategies now available. A common problem is that physicians and patients tend to concentrate on intensive medical treatment options and underestimate the treatment-related adverse effects. In this review, we summarize one of these adverse effects in cancer patients; sexual dysfunction (SD). In addition, current therapeutic choices with optimal doses and patient selection strategies are defined. All patients should be informed about problems associated with therapy-related SD and must be guided toward the most appropriate therapeutic options before starting treatment.
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Affiliation(s)
- B Cakar
- Ege University Schhol of Medicine, Tulay Aktas Oncology Hospital, Bornova, Izmir, Turkey
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Mohamed A, Krajewski K, Cakar B, Ma CX. Targeted therapy for breast cancer. Am J Pathol 2013; 183:1096-1112. [PMID: 23988612 DOI: 10.1016/j.ajpath.2013.07.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 02/06/2023]
Abstract
Breast cancer is a heterogeneous group of diseases that are clinically subdivided as hormone receptor-positive, human epidermal growth factor receptor 2-positive (HER2(+)), and triple-negative breast cancer, to guide therapeutic interventions. Agents that target estrogen receptor (ER) and HER2 are among the most successful cancer therapeutics. However, de novo or acquired resistance is common, despite the development of newer agents against these pathways. As our understanding of tumor biology improves, novel targets are being identified. Notably, inhibitors against several pathways [including, among others, the phosphoinositide 3-kinase/mammalian target of rapamycin (PI3K/mTOR), cell-cycle regulation, heat shock protein, and epigenetic pathways] have demonstrated promising activity in clinical trials, and the mTOR-inhibitor everolimus has been approved for advanced or metastatic aromatase inhibitor-resistant ER(+) breast cancer. At present, there are no established targeted agents for triple-negative breast cancer (negative ER, progesterone receptor, and HER2). Although poly(ADP-ribose) polymerase inhibitors have shown promising activity in BRCA-related cancers, its value in the treatment of triple-negative breast cancers remains to be demonstrated. In this Review, we present a basic understanding of the major targeted agents in current practice and under development for the treatment of breast cancer in the context of the three clinical subgroups.
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Affiliation(s)
- Ali Mohamed
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kenneth Krajewski
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Burcu Cakar
- Ege University School of Medicine, Tulay Aktas Oncology Hospital, Izmir, Turkey
| | - Cynthia X Ma
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.
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Varol U, Cirak Y, Cakar B, Karaca B, Sezgin C, Uslu R, Karabulut B. Survival analysis of metastatic colorectal cancer patients who were treated with the five major therapeutic agents over the course of disease. J BUON 2013; 18:647-652. [PMID: 24065478] [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: 06/02/2023]
Abstract
PURPOSE Exposure to all active agents may be more important than specific sequence of drug administration in the treatment of patients with metastatic colorectal cancer (mCRC). The purpose of this study was to evaluate the overall survival (OS) of mCRC patients who were treated with all 5 major therapeutic agents used in this malignancy. METHODS We retrospectively reviewed the medical records of 395 mCRC patients referred to our clinic. The study included patients who received 5-fluorouracil (5-FU)-, irinotecan- or oxaliplatin-based chemotherapy and at least 3 cycles of bevacizumab and 4 weeks of cetuximab sequentially in various combinations. RESULTS Forty mCRC patients received the 5 major therapeutic agents effectively and sequentially, and their mean OS was 26.43±2.04 months. The 3- and 4- year OS survival rates were 26.7% and 16.7%, respectively. When survival analysis was limited to the metastatic patients with at least 6 cycles of bevacizumab therapy in addition to standard duration of other chemotherapeutic agents (N=33), the mean OS was 26.7±2.38 months. With a further survival analysis limited to metastatic patients who were treated with at least both 6 cycles of bevacizumab and 8 weeks of cetuximab in addition to other therapies (N=17), the mean OS was 44.8±11.03 months. CONCLUSION This study demonstrated that in mCRC patients there may be a significant survival advantage if an adequate tumor response was achieved with all major therapeutic agents. Therefore, we believe that we should treat our patients with the 5 major therapeutic drugs as effectively as possible.
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Affiliation(s)
- U Varol
- Department of Medical Oncology, Mugla University Research and Training Hospital, Mugla, Turkey
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Karaca B, Bulut G, Surmeli Z, Cakar B, Sanli U, Sezgin C, Karabulut B, Uslu R. Comparison of Survival of Colorectal Cancer Patients Undergone for Metastasectomy Before or After Chemotherapy with Liver Only Metastases. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt203.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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Gursoy P, Surmeli ZG, Cakar B, Arslan C, Zengel B, Karaca B, Sezgin C, Karabulut B, Sanli UA, Uslu R. Capecitabine maintenance therapy after docetaxel/capecitabine combination chemotherapy in patients with metastatic breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e12018] [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
e12018 Background: Addition of capecitabine to docetaxel improves survival outcomes compared with single agent docetaxel in metastatic breast cancer (MBC). In this study we analyzed efficacy of maintenance therapy with single agent capecitabine after six cycles of docetaxel/capecitabine chemotherapy in MBC patients. Methods: Patients with metastatic HER2 negative breast cancer were included. Six cycles of docetaxel (75mg/m2 q3wk) / capecitabine (1650mg/m2/day on days 1 to 14) followed by capecitabine (2000 mg/m2/day on days 1 to 14) were administered. Demographic features, progression free (PFS) and overall survival (OS) and response to treatment were recorded. Results: Fifty-four patients were included. Thirty-five patients (65%) were postmenopausal, and 40 (74%) were ER/PR positive. Median age was 53 (range 28 – 70). Number of metastatic sites was one in 23 patients, two in 21, three or more in 10 patients. Most common metastatic sites were bone (67%), lymph nodes (33%), lungs (30%), liver (13%); 13 patients (24%) had bone only disease. Forty-four (81.5%) patients received treatment in first-line, 10 (18.5%) received in second line setting. Median number of cycles applied (including docetaxel/capecitabine combination) was 9 (range 2 – 31, total 576). Median PFS was 9 months (10.4 for hormone receptor positive, 7.3 for negative patients) and median OS was 28 months. Objective response was assessable in 38 patients. Overall response rate (partial + complete response) was 42.6% (95% CI 29.6 – 55.6) with 1 complete response. Toxicities were evaluated in 41 patients; grade 3/4 neutropenia was observed in 10% and grade 3/4 hand-foot syndrome was observed in 24% of patients. Dose reduction was performed in capecitabine in 37%, and in docetaxel in 20% of patients. Conclusions: Maintenance with single agent capecitabine therapy after six cycles of docetaxel/capecitabine chemotherapy is an effective and tolerable treatment option for HER2 negative MBC patients.
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Affiliation(s)
- Pinar Gursoy
- Department of Medical Oncology, Ege University, Izmir, Turkey
| | - Zeki Gokhan Surmeli
- Ege University, Tulay Aktas Oncology Hospital, School of Medicine, Izmir, Turkey
| | - Burcu Cakar
- Ege University, Tulay Aktas Oncology Hospital, School of Medicine, Izmir, Turkey
| | - Cagatay Arslan
- Department of Medical Oncology, Izmir Tepecik Research and Training Hospital, Izmir, Turkey
| | - Baha Zengel
- Department of General Surgery, Bozyaka Research and Training Hospital, Izmir, Turkey
| | - Burcak Karaca
- Ege University, Tulay Aktas Oncology Hospital, School of Medicine, Izmir, Turkey
| | - Canfeza Sezgin
- Department of Medical Oncology, Ege University, Izmir, Turkey
| | | | - Ulus Ali Sanli
- Department of Medical Oncology, Ege University, Izmir, Turkey
| | - Ruchan Uslu
- Department of Medical Oncology, Ege University, Izmir, Turkey
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Atmaca H, Bozkurt E, Cakar B, Surmeli ZG, Uzunoglu S, Uslu R, Karaca B. Trabectedin to induce mitochondrial membrane potential dissipation and reactive oxygen species generation in breast cancer cells. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e13580] [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
e13580 Background: Trabectedin (Yondelis; ET-743) is a tetrahydroisoquinoline alkaloid that was originally derived from the marine tunicate Ecteinascidia turbinata and is currently prepared synthetically. It ıs currently used for the treatment of soft tissue sarcomas. It has been shown that Trabectedin provides the production of superoxides near the DNA strand, resulting in DNA backbone cleavage and cell apoptosis, however the apoptotic mechanisms of Trabectedin is still very limited. The objective of this study is to investigate the underlying mechanisms of apoptosis Trabectedin in two human breast cancer cell lines (MDA-MB-231 and MDA-MB-453) and one human immortalized non-transformed breast epithelial cell line (MCF-10A), to see if similar oxidation processes take place in breast cancer. Methods: Cytotoxicity was assessed by XTT cell viability assay. Apoptosis was shown by measuring DNA fragmentation, caspase 3/7 activation. Mitochondrial membrane potential (MMP) was evaluated by TMRE dye. Measurement of reactive oxygen species (ROS) was done by using Glutathione S-Transferase (GST) Assay Kit and CM-H2DCFDA dye. Results: Trabectedin induced the cytotoxicity in breast cancer cells in a time and dose dependent manner. Moreover, it increased DNA fragmentation and the MMP dissipation in tested breast cancer cells. The levels of ROS production in parallel with GST enzyme activity were sharply increased by Trabectedin treatment. Conclusions: This is the first study to investigate the role of Trabectedin activity and mechanisms of apoptosis in human breast cancer cells. These preliminary results might show us a way to use Trabectedin alone, or in combination for breast cancer treatment in near future.
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Affiliation(s)
- Harika Atmaca
- Molecular Biology Department, Faculty of Science and Letters, Celal Bayar University, Manisa, Turkey
| | - Emir Bozkurt
- Molecular Biology Department, Faculty of Science and Letters, Celal Bayar University, Manisa, Turkey
| | - Burcu Cakar
- Ege University, Tulay Aktas Oncology Hospital, School of Medicine, Izmir, Turkey
| | - Zeki Gokhan Surmeli
- Ege University, Tulay Aktas Oncology Hospital, School of Medicine, Izmir, Turkey
| | - Selim Uzunoglu
- Molecular Biology Department, Faculty of Science and Letters, Celal Bayar University, Manisa, Turkey
| | - Ruchan Uslu
- Ege University, Tulay Aktas Oncology Hospital, School of Medicine, Izmir, Turkey
| | - Burcak Karaca
- Ege University, Tulay Aktas Oncology Hospital, School of Medicine, Izmir, Turkey
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Cakar B, Gursoy P, Atmaca H, Kisim A, Bozkurt E, Uzunoglu S, Sezgin C, Sanli UA, Karabulut B, Uslu R, Karaca B. Paclitaxel in combination with AT-101 induces apoptosis via supressing Bcl-2, bcl-XL, mcl-1 proteins in human breast cancer cells. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e13578] [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: 11/20/2022] Open
Abstract
e13578 Background: Paclitaxel, a microtubule stabilizing agent, has been a standard of care for breast cancer. AT-101, is an -/- enantiomer of gossypol, inhibits the Bcl-2 family proteins which contain BH3 domain. We reported previously that Paclitaxel in combination with AT-101 showed strong synergistic cytotoxic and apoptotic effects in human breast cancer cells. In this study, to elucidate the molecular mechanisms involved in the apoptotic effect of AT-101/Paclitaxel combination treatment in breast cancer cells, we investigated the possible roles of anti-apoptotic Bcl-2, Bcl-XL and Mcl-1 proteins which contain BH3 domain. Involvement of caspase 3 and 7 activation was also investigated. Methods: Human breast cancer cells were treated with increasing concentrations of drugs alone or with the synergistic combination doses of AT-101 and Paclitaxel. Cell Death Detection Elisa Plus Kit (Roche) was used to detect apoptosis. Caspase 3/7 activity was evaluated by Caspase-Glo 3/7 (Promega, Madison, WI) kit. Changes in the mRNA levels of Bcl-2, Bcl-XL and Mcl-1 genes were evaluated by qRT-PCR. Expression levels of these proteins were also investigated by Western blot analysis. Results: Combined treatment was shown to have strong synergistic apoptotic effects in MCF-7 and MDA- MB-231 human breast cancer cells. mRNA levels of Bcl-2, Bcl-XL and Mcl-1 molecules were reduced by the combination treatment in both cell lines. In parallel with mRNA levels, Bcl-2, Bcl-XL and Mcl-1 protein levels were significantly reduced after this novel drug combination. Combined treatment also induced caspase 3/7 activation in breast cancer cells. Conclusions: These preliminary data suggest that anti-apoptotic proteins such as Bcl-2, Bcl-XL and Mcl-1 may play important role in the underlying mechanistic rationale of apoptotic effect of AT-101/paclitaxel combination, while pro-apoptotic Bcl-2 related genes (Caspase-3 and Caspase-7) also seem to regulate this synergistic interaction.
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Affiliation(s)
- Burcu Cakar
- Ege University, Tulay Aktas Oncology Hospital, School of Medicine, Izmir, Turkey
| | - Pinar Gursoy
- Ege University, Tulay Aktas Oncology Hospital, School of Medicine, Izmir, Turkey
| | - Harika Atmaca
- Molecular Biology Department, Faculty of Science and Letters, Celal Bayar University, Manisa, Turkey
| | - Asli Kisim
- Molecular Biology Department, Faculty of Science and Letters, Celal Bayar University, Manisa, Turkey
| | - Emir Bozkurt
- Molecular Biology Department, Faculty of Science and Letters, Celal Bayar University, Manisa, Turkey
| | - Selim Uzunoglu
- Molecular Biology Department, Faculty of Science and Letters, Celal Bayar University, Manisa, Turkey
| | - Canfeza Sezgin
- Department of Medical Oncology, Ege University, Izmir, Turkey
| | - Ulus Ali Sanli
- Department of Medical Oncology, Ege University, Izmir, Turkey
| | | | - Ruchan Uslu
- Ege University, Tulay Aktas Oncology Hospital, School of Medicine, Izmir, Turkey
| | - Burcak Karaca
- Ege University, Tulay Aktas Oncology Hospital, School of Medicine, Izmir, Turkey
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Cakar B, Bulut G, Kisim A, Bozkurt E, Atmaca H, Uzunoglu S, Uslu R, Karaca B. AT-101 (-/- Gossypol) in Combination with Trastuzumab Triggers Apoptosis Through Inhibiting BCL-2, BCL-XL AND MCL-1 Protein Levels in Human HER2-Positive Breast Cancer Cells. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt086.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cakar B, Varol U, Junushova B, Muslu U, Gursoy Oner P, Gokhan Surmeli Z, Cirak Y, Karaca B, Sezgin C, Karabulut B, Uslu R. Evaluation of the efficacy of adjuvant chemotherapy in patients with high-risk stage II colon cancer. J BUON 2013; 18:372-376. [PMID: 23818348] [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: 06/02/2023]
Abstract
PURPOSE This study aimed at comparing the disease-free survival (DFS) in high-risk TNM stage II colon cancer patients who had been subjected to adjuvant chemotherapy and TNM low-risk stage II patients who did not receive chemotherapy. METHODS We retrospectively reviewed the medical records of stage II colon cancer patients between January 2006 and December 2011. High-risk patients were defined those with any colonic obstruction/perforation, mucinous histology, inadequate lymph node sampling, T4 disease, lymphatic/ vascular or perineural invasion, preoperatively elevated carcinoembryonic antigen (CEA) and high-grade tumor. All patients with high-risk features received adjuvant chemotherapy. RESULTS There were 42 patients in the high-risk treatment group and 21 patients in the non-treatment (observation) group. There were no significant differences in terms of gender, tumor size, tumor localization, or the number of excised lymph nodes between the groups. The median follow- up time was 33.9 months in the treatment group and 29.3 months in the non-treatment group. Recurrence developed in 4 patients (6.3%), 3 of which were in the treatment group. DFS in both groups was statistically similar. CONCLUSION Adjuvant chemotherapy in the high-risk patients resulted in similar DFS as that in the low-risk patients. Although the role of adjuvant chemotherapy for stage II colon cancer is unclear, it is rational to offer adjuvant chemotherapy to patients with high-risk stage II colon cancer.
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Affiliation(s)
- B Cakar
- Tulay Aktas Oncology Hospital, Ege University School of Medicine, Izmir, Turkey
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Cirak Y, Sarsik B, Cakar B, Sen S, Simsir A, Uslu R. Predictive and prognostic values of Tau and BubR1 protein in prostate cancer and their relationship to the Gleason score. Med Oncol 2013; 30:526. [PMID: 23475578 DOI: 10.1007/s12032-013-0526-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 02/22/2013] [Indexed: 11/30/2022]
Abstract
The aim of this study is to detect the expression levels of spindle assembly checkpoint protein-BubR1 and microtubule-associated protein-Tau in human prostate cancer tissues of different Gleason score, and to test whether there is a relationship between their expression levels and clinicopathologic parameters including response to docetaxel treatment, Gleason score, and overall survival (OS). Moreover, to test whether Tau protein expressed in the cancerous prostate tissue is phosphorylated. Thirty patients who received at least three cycles docetaxel for metastatic castrate-resistant prostate cancer were included into the trial. The patients' formalin-fixed and paraffin-embedded prostate tissue specimens were retrospectively obtained from the pathology department archives of Ege University School of Medicine. The expression status of BubR1 protein was defined by immunohistochemical (IHC) using the anti-BubR1 antibody. The expression status of Tau protein was defined by IHC using the two types of Tau antibodies: anti-Tau-1 antibody (that recognizes Tau only in its dephosphorylated form) and anti-PHF-Tau antibody (that recognizes all isoforms of human Tau proteins independent of its phosphorylation status). The BubR1 and Tau were overexpressed in about 63 and 23 % of the study group, respectively. Tau overexpression was significantly associated with lower Gleason score. There was no significant association between the expression levels of BubR1 and Tau proteins, and docetaxel response. Reduced BubR1 expression was strongly associated with longer survival (P = 0.008), whereas Tau expression status did not effect survival. Moreover, the Tau expression of cancerous prostate tissue was highly dephosphorylated. In this clinicopathological study, our findings did not confirm the preclinical observations that low BubR1 and Tau expression confer selective sensitivity to microtubulisin drugs. Our data imply that reduced BubR1 expression was a predictor for longer OS, and the possibility that high Tau expression may be involved in better prognosis due to its relationship to the Gleason score. Furthermore, our data suggest that both Tau and BubR1 may be a promising prognostic marker rather than predictive marker in patients with prostate cancer.
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Affiliation(s)
- Yalcin Cirak
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege Universtiy, Bornova, 35100 Izmir, Turkey.
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Karaca B, Muslu U, Surmeli Z, Cakar B, Atmaca H, Asli K, Sezgin C, Uzunoglu S, Karabulut B, Uslu R. 98P Octreotide in Combination with Docetaxel Triggers Apoptosis by Inducing Sstr2 and Sstr5 Levels in Human Breast Cancer Cells, Mcf-7 and Mda-Mb-231. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(19)65742-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Karaca B, Atmaca H, Asli K, Bozkurt E, Cakar B, Surmeli Z, Gursoy P, Karabulut B, Uzunoglu S, Sezgin C. 94P Comparison of A Novel, Label-Free, and Real-Time cell Based System (Xcelligence) With a Conventional Viability Assay (Xtt) to Determine the Anti-Proliferative Effect of At-101 in Human Breast Cancer Cells. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(19)65737-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Surmeli Z, Gursoy P, Cakar B, Asli K, Atmaca H, Sezgin C, Karabulut B, Uslu R, Karaca B. 99P Zoledronic Acid in Combination with Serine/Threonine Phosphatase Inhibitors Induces Cytotoxicity and Apoptosis in Human Breast Cancer Cells via Decreasing the Activities of Pp1 and Pp2A. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(19)65743-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Cakar B, Karaoglanoglu M, Sayici Y, Gonullu Demirag G, Yucel I. The prognostic value of thrombocytosis in newly diagnosed lung cancer patients: a retrospective analysis. J BUON 2011; 16:677-681. [PMID: 22331721] [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: 05/31/2023]
Abstract
PURPOSE The importance of thrombocyte count as a prognostic factor has not been adequately investigated in patients with lung cancer. We retrospectively examined the value of thrombocytosis as a prognostic factor and investigated its relationship with other clinicopathologic factors and survival. METHODS The medical records of 260 patients with lung cancer were reviewed. Pretreatment thrombocyte count, histopathological diagnosis, disease stage, gender, age, performance status (PS), thrombotic episodes, weight loss and paraneoplastic syndromes were recorded. Overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS) were evaluated in all patient subgroups. Thrombocytosis was defined as platelet count >400,000/μl. We assessed statistically the possible correlation between thrombocytosis, other clinicopathologic factors and survival parameters. A two-sided p value < 0.05 was considered significant. RESULTS There were no statistically significant differences between histological subgroups (small cell/SCLC and non-small cell/NSCLC) according to age, disease stage and gender. Sixty-six (25.38%) patients had thrombocytosis before starting treatment. We found no relationship between thrombocytosis and disease stage, gender, age, PS and thrombotic episodes. Thrombocytosis was significantly correlated only with weight loss (p=0.011) and paraneoplastic syndromes (p=0.027). OS was shorter in the thrombocytosis group, but without statistical significance. PFS and DFS did not differ between thrombocytemic and non-thrombocytemic patients. CONCLUSION Pretreatment thrombocytosis is not an independent prognostic factor of survival in lung cancer patients and is related with paraneoplastic syndromes.
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Affiliation(s)
- B Cakar
- Ege University Medical Faculty, Tulay Aktas Oncology Hospital, Department of Medical Oncology, Izmir, Turkey.
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Cakar B, Muslu U, Karaca B, Junushova B, Uslu R, Goker E. Alveolar rhabdomyosarcoma originating from the uterine cervix. EUR J GYNAECOL ONCOL 2011; 32:196-198. [PMID: 21614913] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Cervical alveolar rhabdomyosarcoma is a rare condition associated with poor prognosis. An 18-year-old patient presented with vaginal bleeding and a protruding mass from the vagina. Biopsy of the mass revealed alveoler rhabdomyosarcoma (ARMS), and radiological evaluation demonstrated that it originated from the uterine cervix. First, Wertheim's operation was carried out followed by four cycles of vincristine, actinomycine-D, ifosfamide (VAI) chemotherapy. However, the disease relapsed within three months, and the patient died of disease progression. Despite combination treatment, we could not achieve a desirable survival advantage in ARMS. Future studies may unveil the genomic profile of this rare condition, leading to invention of targeted therapies, which is the emerging trend in the treatment of sarcomas.
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Affiliation(s)
- B Cakar
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Izmir, Turkey.
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Karabulut B, Karaca B, Varol U, Muslu U, Cakar B, Atmaca H, Kisim A, Uzunoglu S, Uslu R. Enhancing cytotoxic and apoptotic effect in OVCAR-3 and MDAH-2774 cells with all-trans retinoic acid and zoledronic acid: a paradigm of synergistic molecular targeting treatment for ovarian cancer. J Exp Clin Cancer Res 2010; 29:102. [PMID: 20673323 PMCID: PMC2924277 DOI: 10.1186/1756-9966-29-102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 07/30/2010] [Indexed: 01/24/2023]
Abstract
Background Ovarian cancer is the most fatal gynecologic malignancies in the world. Although, platinum based treatments are widely used, the disease becomes treatment refractory within two years, and novel treatment options should be searched. All- trans retinoic acid (ATRA) induces growth arrest, differentiation and cell death in some types of cancer cells and its combination with various anticancer agents results in enhanced cytotoxicity. Zoledronic acid is a common bisphosphonate known for its anticancer effects beyond its current use in the treatment of cancer-induced bone disease. We aimed to investigate the possible additive/synergistic effect of both agents in OVCAR-3 and MDAH-2774 ovarian cancer cell lines, since both agents show superiority to conventional cytotoxics in terms of adverse events. Methods XTT cell proliferation assay was used for showing cytotoxicity. For verifying apoptosis, both DNA Fragmentation by ELISA assay and caspase 3/7 activity measurement were used. OligoGeArray® which consists of 112 apoptosis related genes was used to elucidate the genetic changes within cancer cells. To validate our oligoarray results, quantitative real-time PCR was performed on four selected genes that were maximally effected by the combination treatment: lymphotoxin beta receptor (LTBR), myeloid cell leukemia-1 (MCL-1), tumor necrosis factor receptor superfamily, member 1A (TNFRSF1A), TNFRSF1A-associated death domain protein (TRADD). Results We demonstrated that a novel combination of ATRA and zoledronic acid is a strong inducer of apoptotic related cell death in both ovarian cancer cells. While the combination therapy significantly induced proapoptotic genes such as tumor necrosis factor receptor superfamily (TNFRSF), TRADD and caspase 4, some of the antiapoptotic genes such as members of MCL-1, LTBR, BAG3 and Bcl-2 family members were inhibited. Conclusions These are the preliminary molecular results of a novel combination treatment of ATRA and zoledronic acid, with fewer side effects as compared to conventional cytotoxic agents. With additional experimental analysis, it may serve as a good option for the treatment of refractory and elderly ovarian cancer patients, for whom there exists very limited choice of treatment.
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Affiliation(s)
- Bulent Karabulut
- Division of Medical Oncology, Tulay Aktas Oncology Hospital, School of Medicine, Ege University, Bornova, Izmir, Turkey
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Karaca SB, Muslu U, Cakar B, Kisim A, Atmaca H, Unuvar Purcu D, Uzunoglu S, Uslu R. Synergistic cytotoxic/apoptotic effects of AT-101, a phytochemical with BH3-mimetic property, in combination with paclitaxel in human breast cancer cells. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e21082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bektaş A, Cakar B, Ustaoğlu M, Turgut M, Bakir T. Fatal hepatitis B reactivation in an immune patient after anti-leukemic chemotherapy. Turk J Gastroenterol 2010; 21:73-74. [PMID: 20533122 DOI: 10.4318/tjg.2010.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Yigit E, Gönüllü G, Yücel I, Turgut M, Erdem D, Cakar B. Relation between hemostatic parameters and prognostic/predictive factors in breast cancer. Eur J Intern Med 2008; 19:602-7. [PMID: 19046726 DOI: 10.1016/j.ejim.2007.06.036] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Revised: 05/25/2007] [Accepted: 06/06/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND In our study, we searched for a relation between various prognostic and predictive factors and hemostatic parameters. METHODS One hundred women with newly diagnosed breast cancer after surgery were included. Patients did not receive systemic therapy or radiotherapy. The control group included 100 healthy, age-matched women. In the patient group, age, menopausal status, tumor size, grade, axillary lymph node status, steroid receptor status, p53, and HER2/neu were evaluated. Plasma levels of factor VIII, factor IX, D-dimer, fibrinogen, protein C, protein S, vWF, and antithrombin III were measured in both groups. RESULTS Plasma levels of factor VIII, factor IX, vWF, and CRP in patients with breast cancer were higher than those in controls. Protein S levels in patients were lower than in controls. There was no significant difference in other hemostatic parameters between the groups. In patients with axillary lymph node metastasis, factor VIII levels were significantly higher than in node-negative patients. There was a strong correlation between axillary lymph node status, number of metastatic nodes, and factor VIII levels. There was no correlation between factor VIII levels and CRP. Factor VIII levels were higher in the group having high HER2/neu (3+) than in the group with negativity for HER2/neu. CONCLUSION There was a strong correlation between axillary lymph node involvement, number of metastatic nodules, overexpression of HER2/neu, hemostatic parameters, and factor VIII levels. Our study showed that factor VIII level measurement can provide additional data for evaluation of breast cancer patients' prognosis.
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Affiliation(s)
- Engin Yigit
- Department of Internal Medicine, Ondokuz Mayis University Medical School, Kurupelit/Samsun, Turkey
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Abstract
Self-measurement of blood pressure (BP) at home is more common than 10 years ago and encouraged by current guidelines to increase patient adherence to treatment and reach the goal of target BP. The aims of this study are to evaluate the accuracy of home sphygmomanometers and to investigate behavior/knowledge of the sphygmomanometer owners. A campaign was planned to determine the accuracy of home sphygmomanometers in 2006. Seven hundred and twenty-three home sphygmomanometers were brought by individuals to the University Hospital Hypertension Clinic within 1 year and 693 (96%) of the devices were in adequate working condition and suitable for analysis. Four hundred and thirty-nine (63%) of the sphygmomanometers were automatic. Four hundred and eleven (59.3%) of the 693 sphygmomanometer were inaccurate. About 80% (256/320) of the wrist devices were inaccurate. Most studies evaluating the accuracy of sphygmomanometers are conducted in hospital or primary care settings; studies investigating home sphygmomanometers are rare. High frequency of inaccurate home devices is a major public health problem. In conclusion, inaccurate devices have been used in home BP measurements frequently and frequency of device-related errors can be decreased by awareness and training of the patients. Physicians and healthcare providers should advise the patients to check the accuracy of their home sphygmomanometers regularly.
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Affiliation(s)
- Melda Dilek
- Department of Nephrology, Ondokuz Mayis University School of Medicine, Samsun, Turkey.
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Men S, Cakar B, Conkbayir I, Hekimoglu B. Detection of prostatic carcinoma: the role of TRUS, TRUS guided biopsy, digital rectal examination, PSA and PSA density. J Exp Clin Cancer Res 2001; 20:473-80. [PMID: 11876539] [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: 02/24/2023]
Abstract
The purpose of this study was to evaluate the efficacy of various diagnostic tests including transrectal ultrasound (TRUS), TRUS guided biopsy, digital rectal examination (DRE), prostate specific antigen (PSA), and prostate specific antigen density (PSAD) in detecting prostatic carcinomas. One hundred and thirty-four men underwent TRUS guided random, or directed and random sonographic biopsies of the prostate. The mean age was 64.67 (range, 31- 88) years. Indications for biopsy were abnormal findings suggesting prostatic carcinoma on DRE or increased levels of PSA, defined as 4.0 ng/ml or greater in a monoclonal antibody assay. PSAD was calculated by dividing the serum PSA in ng/ml to the volume of the entire prostate in cm3. The biopsy results were grouped as benign, malign and, prostatitis. The patients were also divided into three groups according to their PSA values. Of the 134 patients evaluated, 31 (23.1%) had prostate adenocarcinoma, 89 (66.4%) had benign prostatic tissue, hyperplasia or prostatic intraepithelial neoplasia, and 14 (10.4%) had prostatitis. The mean PSA and PSAD of the carcinoma group were significantly higher than those of the noncancer group. In the group of patients with PSA levels between 4 and 10 ng/ml, abnormal TRUS or DRE increased cancer detection rate, where neither PSA nor PSAD was capable of discriminating the patients with and without cancer. PSAD did not prove to be superior to the other diagnostic tests in this study. We recommend biopsy when either TRUS or DRE is abnormal in patients with PSA levels between 4 and 10 ng/ml. In the patients with PSA levels greater than 10 ng/ml, biopsy is indicated whatever the findings on TRUS or DRE are, since cancer detection rate is high.
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Affiliation(s)
- S Men
- SSK Ankara Egitim Hastanesi (Social Security Ankara Hospital), Dept. of Radiology, Turkey
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