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Mutlu H, Bozcuk H, Artaç M, Eser İ. First-line immune-checkpoint inhibitor treatment in extensive-disease small-cell lung cancer: A classical and network meta-analysis. J Cancer Res Ther 2023; 19:S6-S11. [PMID: 37147977 DOI: 10.4103/jcrt.jcrt_721_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Background Small-cell lung cancer (SCLC) has a poor prognosis. For the last 30 years, first-line systemic treatment has remained unaltered. After the integration of ımmunotherapy, a new first-line gold standard, atezolizumab in combination with carboplatin plus etoposide, was approved in extensive-disease SCLC (ED-SCLC) in 2019. Materials and Methods First-line randomized controlled studies that investigated anti-programmed cell death protein 1 (PD-1)/PD-1 ligand-1 (PD-L1) and anti-T-lymphocyte-associated protein 4 (CTLA-4) agents in combination with platinum plus etoposide (EP) were scoured. A total of six studies (two - anti-CTLA-4 and four - anti-PD1/PD-L1) were included and classic and network meta-analyses (NMAs) were performed. Results Fixed model for overall survival (OAS) in the PD-1- or PD-L1-treated subgroup yielded a hazard ratio (HR) of 0.746 with a 95% confidence interval (CI) =0.662-0.840 and in the CTLA-4-treated subgroup a HR of 0.941 with a 95% CI = 0.816-1.084 for the immune therapy + chemotherapy versus chemotherapy comparison (CTLA-4-based versus PD-1- or PD-L1-based groups' comparison of OAS effect Q = 6.05, df = 1, P = 0.014). NMA showed that all chemotherapy + immunotherapy combinations were equally potent and more efficient than PE in terms of OAS and progression-free survival (PFS). Rank probability plots demonstrated nivolumab + EP as the most probable effective treatment modality in terms of OAS and PFS. Conclusion The usage of anti-PD1/PD-L1 immunotherapy agents results in significant OAS advantage, and anti-PD1/PD-L1 agents are superior to anti-CTLA-4 approach in combination with platinum plus etoposide regimen in ED-SCLC.
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Affiliation(s)
- Hasan Mutlu
- Department of Oncology, Istinye University School of Medicine, Istanbul, Turkey
| | - Hakan Bozcuk
- Department of Oncology, Lara Medicalpark Hospital, Antalya, Turkey
| | - Mehmet Artaç
- Department of Oncology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - İrfan Eser
- Department of Thoracic Surgery, Lara Medicalpark Hospital, Antalya, Turkey
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Bozcuk H, Coşkun HŞ, İlhan Y, Göksu SS, Yıldız M, Bayram S, Yerlikaya T, Koçer M, Artaç M, Uğraklı M, Ouisupov A, Aydeniz A, Şahin D, Yalçın G, Saatçi M, Mutlu H, Yıldırım M. Prospective external validation of an updated algorithm to quantify risk of febrile neutropenia in cancer patients after a cycle of chemotherapy. Support Care Cancer 2021; 30:2621-2629. [PMID: 34816328 DOI: 10.1007/s00520-021-06681-0] [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: 02/07/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Febrile neutropenia resulting from chemotherapy is a significant cause of morbidity and mortality in cancer patients. We had previously published the associates of the risk of febrile neutropenia, and this study now extends and modifies the previous model as well as tests its external validity. METHODS We have recruited documented febrile neutropenia cases with solid tumors, in addition to a selected control group of cancer patients from one institution treated between 2015 and 2019. We then united our sample with our previously published original derivation group, to modify and update our previous model by logistic regression analysis. Additionally, consecutive cancer patients from 5 institutions were recruited in 2020 to test external validity of the resultant algorithm. RESULTS A total of 4075 cycles of chemotherapy in 1282 cases were recruited in the updated, new model derivation group, and a total of 8 variables were selected for the updated algorithm. In the new external validation group, 653 cycles of chemotherapy in 624 patients were analyzed, to indicate that after cycles without prophylactic granulocyte colony-stimulating factor (GCSF) usage, the algorithm yielded a sensitivity value of 91%, specificity of 40%, and an area under curve (AUC) figure of 0.78, when a risk cutoff threshold value of ≥ 0.20 is chosen. This algorithm is now embedded in a web application for free clinical use. CONCLUSION Our algorithm identifies and quantifies the risk of febrile neutropenia in cancer patients. Further studies are required to improve this model with additional predictors.
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Affiliation(s)
- Hakan Bozcuk
- Department of Medical Oncology, Medical Park Hospital, Lara, Antalya, Turkey.
| | - Hasan Şenol Coşkun
- Department of Medical Oncology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Yusuf İlhan
- Department of Medical Oncology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Sema Sezgin Göksu
- Department of Medical Oncology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Mustafa Yıldız
- Department of Medical Oncology, SBU Antalya SUAM, Antalya, Turkey
| | - Selami Bayram
- Department of Medical Oncology, SBU Antalya SUAM, Antalya, Turkey
| | - Tahir Yerlikaya
- Department of Medical Oncology, SBU Antalya SUAM, Antalya, Turkey
| | - Murat Koçer
- Department of Medical Oncology, SBU Antalya SUAM, Antalya, Turkey
| | - Mehmet Artaç
- Department of Medical Oncology, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | - Muzaffer Uğraklı
- Department of Medical Oncology, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | - Ayberk Ouisupov
- Department of Medical Oncology, Medical Park Hospital, Lara, Antalya, Turkey
| | - Alev Aydeniz
- Department of Medical Oncology, Medical Park Hospital, Lara, Antalya, Turkey
| | - Dilhun Şahin
- Department of Medical Oncology, Medical Park Hospital, Lara, Antalya, Turkey
| | - Gözde Yalçın
- Department of Medical Oncology, Medical Park Hospital, Lara, Antalya, Turkey
| | - Meliha Saatçi
- Department of Medical Oncology, Medical Park Hospital, Lara, Antalya, Turkey
| | - Hasan Mutlu
- Department of Medical Oncology, Medical Park Hospital, Lara, Antalya, Turkey
| | - Mustafa Yıldırım
- Department of Medical Oncology, Sanko University, Gaziantep, Turkey
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Sarier M, Usta SS, Turgut H, Öztürk SA, Soylu A, Emek M, Kukul E, Bozcuk H, Sepin N. Prognostic value of HPV DNA in Urothelial Carcinoma of the Bladder: A Preliminary Report of 2-Year Follow-up Results. Urol J 2021; 19:45-49. [PMID: 33931844 DOI: 10.22037/uj.v18i.6429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The association between the human papillomavirus (HPV) and anogenital carcinomas is well established. However, despite its anatomic adjacency, the relationship between HPV and urothelial carcinoma of the bladder (UCB) is less clear. Recent meta-analysis and case-control studies demonstrated a significant relationship between the presence of HPV DNA and UCB. The aim of this clinical study was to compare the 2-year follow-up results of HPV-positive and HPV-negative UCB patients to evaluate the prognostic value of HPV DNA positivity in UCB. METHODS The study included patients with stage pTa and pT1 UCB who underwent polymerase chain reaction (PCR) analysis of HPV DNA between January 1 and November 30, 2018. Based on their PCR results, 19 HPV-positive and 38 HPV-negative UCB patients who had regular follow-up in our clinic were evaluated in terms of tumor recurrence and disease progression over a 2-year follow-up period. RESULTS There was no significant difference between the groups in terms of age, follow-up time, smoking, or tumor grade (P= .576, P= .368, P= .080, and P= .454). Tumor recurrence was observed at least once in 47.3% (n=9) of the 19 HPV-positive patients and 36.8% (n=14) of the 38 HPV-negative patients (P= .445). There was no difference in disease progression between the groups during follow-up. CONCLUSION In our sample of UCB patients, the presence of HPV DNA was associated with a trend toward higher recurrence rate during the 2-year follow-up, though the difference was not statistically significant. No difference in disease progression was observed based on HPV DNA positivity.
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Affiliation(s)
- Mehmet Sarier
- Department of Urology, Istinye University Istanbul Turkey .
| | - Sibel Süremen Usta
- Department of Obstetrics and Gynaecology, Medical Park Hospital Antalya Turkey .
| | - Hasan Turgut
- Department of Urology, Medical Park Hospital, Trabzon Turkey .
| | - Sefa Alperen Öztürk
- Department of Urology, Medical Faculty, Suleyman Demirel .University, Isparta.
| | - Ahmet Soylu
- Department of Urology, Gozde Academy Hospital, Malatya Turkey .
| | - Mestan Emek
- Department of Urology, Gozde Academy Hospital, Malatya Turkey .
| | - Erdal Kukul
- Department of Urology, Medical Park Hospital, Antalya Turkey .
| | - Hakan Bozcuk
- Department of Oncology, Medical Park Hospital, Antalya Turkey.
| | - Nevgun Sepin
- NevDepartment of Clinical Microbiology and Infectious Disease, Training and Research Hospital Antalya Turkey .
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Mutlu H, Bozcuk H. The optimal upfront therapy in metastatic hormone-sensitive prostate cancer: A network meta-analysis. J Cancer Res Ther 2021. [DOI: 10.4103/jcrt.jcrt_23_20] [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]
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Bozcuk H, Yıldırım M, Sever Ö, Mutlu H, Artaç M. Checkpoint inhibitors in advanced nonsmall-cell lung cancer; a Bayesian network meta-analysis. J Cancer Res Ther 2020; 16:828-837. [PMID: 32930126 DOI: 10.4103/jcrt.jcrt_450_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Checkpoint inhibitors (CPIs) have improved survival compared to chemotherapy alone in advanced nonsmall-cell lung cancer (NSCLC). This article aims to compare indirect evidence and rank the effect of different CPIs in this setting. Materials and Methods In this network meta-analysis, we searched for trials comparing CPIs in advanced NSCLC. Figures for survival endpoints were extracted. In addition, a network meta-regression analysis was carried out. Results A total of 9220 patients from 16 trials were included in the analysis. In the first-line setting, for the overall survival endpoint, the chemotherapy + Pembrolizumab combination had the highest effectivity rank probability as compared to chemotherapy (hazard ratio = 0.788, 95% credential interval = 0.728-0.855). For the second-line setting, and also for the efficacy in terms of progression-free survival, various CPIs and their combinations were ranked. Conclusion Some degree of differences in terms of efficacy exists between different types, dosages, settings, and combinations of CPI. We quantify these differences to guide clinical practice.
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Affiliation(s)
- Hakan Bozcuk
- Department of Medical Oncology, Medical Park Hospital, Antalya, Turkey
| | - Mustafa Yıldırım
- Department of Medical Oncology, Medical Park Hospital, Gaziantep, Turkey
| | - Özlem Sever
- Department of Internal Medicine, Sanko University School of Medicine, Gaziantep, Turkey
| | - Hasan Mutlu
- Department of Medical Oncology, Medical Park Hospital, Antalya, Turkey
| | - Mehmet Artaç
- Department of Medical Oncology, Necmettin Erbakan University, Konya, Turkey
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Bozcuk H, Artaç M, Mutlu H, Sever Ö, Yıldırım M. Programmed death-1 or programmed death ligand-1 inhibitors? A meta-analysis of differential efficacy as compared to chemotherapy in advanced non-small cell lung cancer. J Oncol Pharm Pract 2020; 27:405-413. [PMID: 33040676 DOI: 10.1177/1078155220964903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Programmed Death-1 (PD-1) and Programmed Death Ligand-1 (PDL-1) inhibitors have improved survival over chemotherapy in advanced Non- Small Cell Lung Cancer (NSCLC). However, it is unclear if there are class specific differences in the efficacy of Checkpoint Inhibitors (CPIs) in NSCLC, and this paper is designed to answer these clinical questions. METHODS For this Meta-analysis, we searched PubMed, Science of Web, "Clinicaltrials.gov" and online sources for trials comparing PD-1 and PDL-1 CPIs in advanced NSCLC. The data for Hazard Ratio (HR) and their Confidence Intervals (CI) for Overall Survival (OS) was extracted. RESULTS A sum of 9739 patients from 16 trials were included in the efficacy evaluation. For the OS endpoint, both PD-1 inhibitors (HR = 0.76, 95%CI = 0.69-0.83, P < 0.001) and PDL-1 inhibitors (HR = 0.84, 95%CI = 0.74-0.95, P < 0.001) were superior to chemotherapy in treatment naïve (upfront) patients, the results were similar in treatment refractory patients (PD-1 inhibitors (HR = 0.67, 95%CI = 0.60-0.75, P < 0.001) and PDL-1 inhibitors (HR = 0.78, 95%CI = 0.69-0.88, P < 0.001) were superior to chemotherapy). There was no difference in the effect of PD-1 and PDL-1 classes of CPIs over chemotherapy in treatment naïve and treatment refractory settings (Q = 1.88, df = 1, P = 0.017, and, Q = 3.27, df = 1, P = 0.070, respectively). CONCLUSION Efficacy of PD-1 and PDL-1 class of CPIs was not different, although differences among individual CPIs or their combinations cannot be excluded. We were also able to compute pooled efficacy data, as compared to chemotherapy alone, for trials where these groups of CPIs were utilized.
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Affiliation(s)
- Hakan Bozcuk
- Department of Medical Oncology, Medical Park Hospital, Antalya, Turkey
| | - Mehmet Artaç
- Department of Medical Oncology, Necmettin Erbakan University, Konya, Turkey
| | - Hasan Mutlu
- Department of Medical Oncology, Medical Park Hospital, Antalya, Turkey
| | - Özlem Sever
- Department of Internal Medicine, Sanko University School of Medicine, Gaziantep, Turkey
| | - Mustafa Yıldırım
- Department of Medical Oncology, Medical Park Hospital, Gaziantep, Turkey
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Ergen SA, Dincbas FO, Yücel B, Altınok P, Akyurek S, Korkmaz Kıraklı E, Ulger S, Etiz D, Yilmaz U, Kılıc D, Bozcuk H. Risk factors of radiation pneumonitis in patients with NSCLC treated with concomitant chemoradiotherapy--Are we underestimating diabetes?--Turkish oncology group (TOG)/Lung cancer study group. Clin Respir J 2020; 14:871-879. [PMID: 32470205 DOI: 10.1111/crj.13220] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 12/03/2019] [Accepted: 05/12/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION To evaluate the clinical and dosimetric parameters that increase the risk of radiation pneumonitis (RP) in locally advanced non-small cell lung cancer (NSCLC) patients treated with concomitant chemoradiotherapy of nationwide multicentric data analysis. METHODS All data of 268 patients who underwent definitive chemoradiotherapy were retrospectively collected from eight institutes participating in this study. Patient, tumor and treatment-related factors and dosimetric parameters were analyzed for grade ≥2 RP. The toxicity scoring system of The Radiation Therapy Oncology Group used for grading the severity of pneumonitis. A relationship with the risk of RP with potential predictive factors were evaluated by univariate and multivariate analyses. A recursive partition analysis (RPA) was applied to stratify patients according to the risk of developing RP. RESULTS There were 90 (33.6%) patients who had grade ≥2 RP. The median time to pneumonitis after treatment was 4 months (range:1-6 months). In univariate analysis, diabetes mellitus (DM), use of cisplatin/etoposide, total and daily radiotherapy (RT) fraction dose, the planning target volume (PTV) size, mean lung dose, V5, V10 and RT technique were associated with the development of pneumonitis. In multivariate analysis, only DM (P = 0.008) was found to be independent risk factors for RP. According to RPA, the risk of developing RP was highest in patients with DM. CONCLUSIONS In our study, besides the known dosimetric factors, DM was found to be the most important risk factor causing RP development in multivariate analysis and RPA. The risk is tripled compared to patients without DM.
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Affiliation(s)
- Sefika A Ergen
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Fazilet O Dincbas
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Birsen Yücel
- Department of Radiation Oncology, Cumhuriyet University Medical Faculty, Sivas, Turkey
| | - Pelin Altınok
- Department of Radiation Oncology, Bezmialem Foundation University Medical Faculty Hospital, Istanbul, Turkey
| | - Serap Akyurek
- Department of Radiation Oncology, Ankara University Medical Faculty, Ankara, Turkey
| | - Esra Korkmaz Kıraklı
- Department of Radiation Oncology, Dr. Suat Seren Chest Disease and Surgery Training Hospital, Izmir, Turkey
| | - Sukran Ulger
- Department of Radiation Oncology (retired), Gazi University Medical Faculty, Ankara, Turkey
| | - Durmus Etiz
- Department of Radiation Oncology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Ufuk Yilmaz
- Department of Pulmonology, Dr. Suat Seren Chest Disease and Surgery Training Hospital, Izmir, Turkey
| | - Diclehan Kılıc
- Department of Radiation Oncology, Gazi University Medical Faculty, Ankara, Turkey
| | - Hakan Bozcuk
- Department of Medical Oncology, Medical Park Hospital, Antalya, Turkey
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Karaagac M, Artac M, Geredeli C, Eryilmaz M, Yildirim M, Akkuloglu T, Inal A, Isikdogan A, Bozcuk H, Demirkazik A. ERCC1 and XRCC1 single nucleotide polymorphisms can guide treatment decision in patients with metastatic non-small cell lung cancer. Med-Science 2020. [DOI: 10.5455/medscience.2019.08.9184] [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: 11/03/2022] Open
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Artac M, Bozcuk H, Ozdogan M, Demiral AN, Sarper A, Samur M, Savas B. Different Clinical Features of Primary and Secondary Tumors in Patients with Multiple Malignancies. Tumori 2019; 91:317-20. [PMID: 16277096 DOI: 10.1177/030089160509100406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinical features of the first and second primaries in patients with multiple malignancies have not been extensively studied. We compared patient and treatment characteristics of the primary malignancy in 48 consequent multiple primary cancer patients with those of the second primary in the same cohort. The second primaries comprised fewer breast cancers; 29.2% of primaries as opposed to 10.4% of second tumors were breast cancer (P = 0.049). In addition, primary tumors tended to be at a lower TNM stage than secondary tumors (P = 0.060). The median overall survival after the diagnosis of the first primary for the whole cohort was 22.3 years (95% CI, 2.0–42.5) and the median time to presentation of the second malignancy was 38 months after the diagnosis of the first primary (range, 0 to 384). Therefore, the prognosis of cancers in the multiple malignancy group appears to be good and they appear to have an indolent clinical behavior. Thus, we recommend a long screening time for secondary tumors after a curative treatment in patients with common cancers, taking into account the different occurrence patterns of second primaries with respect to first primaries.
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Affiliation(s)
- Mehmet Artac
- Akdeniz University Medical School, Department of Internal Medicine, Division of Medical Oncology, Antalya, Turkey
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Kaya V, Yildirim M, Yazici G, Gunduz S, Bozcuk H, Paydas S. Effectiveness of Platinum-Based Treatment for Triple Negative Metastatic Breast Cancer: a Meta-Analysis. Asian Pac J Cancer Prev 2018; 19:1169-1173. [PMID: 29801396 PMCID: PMC6031818 DOI: 10.22034/apjcp.2018.19.5.1169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Triple-negative breast cancer (TNBC) is a sub-group of breast cancers with a particularly poor prognosis. The results of studies investigating the role of platinum-based chemotherapy (PBC) in metastatic TNBC (mTNBC) have been conflicting. In this meta-analysis, our aim was to assess the effectiveness of PBCs for mTNBCs. Methods: The PubMed, Cochrane Controlled Trials Register Databases, and EBSCOhost databases were accessed. The English language was used as the search language and only human studies were included. The Newcastle–Ottawa Quality Assessment Scale and the Jadad scoring system were used to evaluate the quality of the included randomized controlled studies. Results: Seven studies and 1,571 patients were included in this meta-analysis. The pooled hazard ratio (HR) for overall survival (OS), evaluated on the basis of six studies, showed the use of PBC regimes to be related to OS in mTNBCs (HR 0.620; 95% CI 0.513-0.749; p:<0.001). Four studies containing HR and abstract statistics used for HR calculation were included in the meta-analysis for progression-free survival (PFS). The pooled HR again indicated a significant relation (HR, 0.628; 95% CI, 0.501-0.786; p:<0.001). Conclusions: In this meta-analysis, we confirmed that PBC regimes provide OS and PFS advantages compared to non-PBC regimes. The use of PBC regimes could be a good choice in mTNBC patients for better quality of life and survival.
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Affiliation(s)
- Vildan Kaya
- Medstar Antalya Hospital, Department of Radiation Oncology, Antalya Education and Research Hospital, Antalya,Turkey.
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Artac M, Turhal NS, Kocer M, Karabulut B, Bozcuk H, Yalcin S, Karaagac M, Gündüz S, Isik N, Uygun K. Do High-risk Features Support the Use of Adjuvant Chemotherapy in Stage II Colon Cancer? A Turkish Oncology Group Study. Tumori 2018; 100:143-8. [DOI: 10.1177/030089161410000205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background A high-risk group of patients with stage II colon cancer has been identified by the results of studies in Western populations. The aim of this study was to investigate the prognostic factors of adjuvant chemotherapy in Turkish patients with stage II colon cancer. Methods A total of 554 stage II colon cancer patients were retrospectively enrolled in the study. Three hundred fifty-three patients had received adjuvant chemotherapy (5-FU-LV, FOLFOX or FLOX) and 201 had received no adjuvant chemotherapy. T4 tumor stage, lymphovascular invasion, perineural invasion, bowel obstruction and/or perforation, <12 harvested lymph nodes, and poor differentiation were defined as high-risk factors. Results The median age of the patients was 62 years (range 26–88). The median disease-free survival (DFS) was 58.1 months (95% CI, 47.6 months to 68.5 months) in the non-treatment group and has not been reached in the treatment group (P <0.01). In univariate analysis, patient age >60 years and T4 tumor stage were statistically significant factors that affected DFS as poor prognostic factors. Adjuvant chemotherapy reduced the risk of recurrence with statistical significance (P <0.01). In multivariate analysis, patient age >60 years and T4 tumor stage were independent risk factors affecting DFS. In addition, adjuvant chemotherapy was an independent favorable prognostic factor for DFS (P <0.01). Conclusions Clinical and pathological risk factors in patients with stage II colon cancer may be different in the Turkish population compared to other populations. Further prospective studies in colon cancer are needed to understand the differences in biology and risk factors between races.
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Affiliation(s)
- Mehmet Artac
- Department of Medical Oncology, Medical Faculty, Necmettin Erbakan University, Meram-Konya
| | - Nazim Serdar Turhal
- Department of Medical Oncology, Medical Faculty, Marmara University, Istanbul
| | - Murat Kocer
- Department of Medical Oncology, Medical Faculty, Suleyman Demirel University, Isparta
| | - Bulent Karabulut
- Department of Medical Oncology, Medical Faculty, Ege University, Izmir
| | - Hakan Bozcuk
- Department of Medical Oncology, Medical Faculty, Akdeniz University, Antalya
| | - Suayip Yalcin
- Department of Medical Oncology, Medical Faculty, Hacettepe University, Ankara
| | - Mustafa Karaagac
- Department of Medical Oncology, Medical Faculty, Necmettin Erbakan University, Meram-Konya
| | - Seyda Gündüz
- Department of Medical Oncology, Medical Faculty, Akdeniz University, Antalya
| | - Nalan Isik
- Department of Medical Oncology, Medical Faculty, Hacettepe University, Ankara
| | - Kazim Uygun
- Department of Medical Oncology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
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Coban E, Samur M, Bozcuk H, Ozdogan M. The Value of CEA and CA 19-9 in Detecting Cancer in a Group of High-Risk Subjects with Gastrointestinal Symptoms. Int J Biol Markers 2018; 18:177-81. [PMID: 14535587 DOI: 10.1177/172460080301800304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this study was to evaluate the clinical value of CEA and CA 19-9 in a potential high-risk population of subjects with gastrointestinal complaints. The basic question was whether the determination of these markers, in addition to some other clinical features in this high risk population, could be helpful in diagnosing intraabdominal cancer. Two hundred and two patients with gastrointestinal complaints underwent standard diagnostic procedures and were followed for at least one year. For every patient, CEA and CA 19-9 levels were obtained at the first examination; the evaluating physician was blinded to the marker levels. The determinants of the likelihood of cancer were evaluated by multivariate analysis. Seventeen patients were diagnosed as having intraabdominal cancers. With the presence of melena (RR=101.63, p=0.007), nonspecific gastrointestinal symptoms (RR=12.54, p=0.026), increasing age (RR=1.09, p=0.028) and abnormal CEA (RR=240.79, p=0.000), the risk of having cancer increased significantly and independently. The presence of a primary gastric complaint was associated with a lower risk of cancer in this cohort (RR=0.01, p=0.04). Markers were not used in the diagnostic workup. In conclusion, in patients presenting with gastrointestinal complaints, the finding of elevated CEA levels may help in the diagnosis of cancer by prompting a more extensive search for intraabdominal cancer.
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Affiliation(s)
- E Coban
- Department of Internal Medicine, Akdeniz University Faculty of Medicine, Antalya, Turkey.
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Gligorov J, Ataseven B, Verrill M, De Laurentiis M, Jung K, Azim H, Al-Sakaff N, Lauer S, Shing M, Pivot X, Koroveshi D, Bouzid K, Casalnuovo M, Cascallar D, Korbenfeld EP, Bastick P, Beith J, Colosimo M, Friedlander M, Ganju V, Green M, Patterson K, Redfern A, Richardson G, Ceric T, Gordana K, Beato CA, Ferrari M, Hegg R, Helena V, Ismael GF, Lessa AE, Mano M, Morelle A, Nogueira JA, Timcheva K, Tomova A, Tsakova M, Zlatareva-Petrova A, Asselah J, Assi H, Brezden-Masley C, Chia S, Freedman O, Harb M, Joy AA, Kulkarni S, Prady C, Gaete AAA, Matamala L, Torres R, Yanez E, Franco S, Urrego M, Gugić D, Vrbanec D, Melichar B, Prausová J, Vyzula R, Pilarte RG, León MI, Muñoz R, Ramos G, Azeem HA, Aziz AA, El Zawahry H, Osegueda FR, Alexandre J, Artignan X, Barletta H, Beguier E, Berdah JF, Marty CB, Bollet M, Bourgeois H, Bressac C, Burki F, Campone M, Coeffic D, Cojocarasu OZ, Dagada C, Dalenc F, Del Piano F, Desauw C, Desmoulins I, Dohollou N, Egreteau J, Ferrero JM, Foa C, Garidi R, Gasnault L, Gligorov J, Guardiola E, Hamizi S, Jarcau R, Jacquin JP, Jaubert D, Jolimoy G, Mineur HL, Largillier R, Leduc B, Martin P, Melis A, Monge J, Moullet I, Mousseau M, Nguyen S, Orfeuvre H, Petit T, Pivot X, Priou F, Bach IS, Simon H, Stefani L, Uwer L, Youssef A, Aktas B, von der Assen A, Augustin D, Balser C, Bauer LE, Bechtner C, Beyer G, Brucker C, Bückner U, Busch S, Christensen B, Deryal M, Farrokh A, Faust E, Friedrichs K, Graf H, Griesshammer M, Grischke EM, Hänle C, Heider A, Henschen S, Hesse T, Jackisch C, Kisro J, Köhler A, Kuemmel S, Lampe D, Lantzsch T, Latos K, Lex B, Liedtke C, Luedders D, Maintz C, Müller V, Overkamp F, Park-Simon TW, Paul M, Prechtl A, Ringsdorf U, Runnebaum I, Ruth S, Salat C, Scheffen I, Schilling J, Schmatloch S, Schmidt M, Schneeweiss A, Schrader I, Seipelt G, Simon E, Stefek A, Stickeler E, Thill M, Tio J, Tuczek A, Warm M, Weigel M, Wischnik A, Wojcinski S, Ziegler-Löhr K, Aravantinos G, Ardavanis A, Fountzilas G, Gogas H, Kakolyris S, Mavroudis D, Papadimitriou C, Papandreou C, Papazisis K, Castro H, Hernandez-Monroy CE, Ngan R, Yeo W, Bittner N, Boer K, Csejtei A, Horvath Z, Kocsis J, Mangel LC, Mezei K, Nagy Z, Szanto J, Atmakusuma D, Fadjari H, Kurnianda D, Prayogo N, Tanggo EH, Coate L, Hennessy B, Kelly C, Martin M, Nasim S, O'Connor M, Aieta M, Allegrini G, Amadori D, Bidoli P, Biti G, Bordonaro R, Bottini A, Carterni G, Cavanna L, Cazzaniga M, Cognetti F, Contu A, Cruciani G, Donadio M, Falcone A, Farci D, Forcignanò RC, Frassoldati A, Gaion F, Gamucci T, Giotta F, de Laurentiis M, Livi L, Lorusso V, Maiello E, Marchetti P, Mariani G, Mion M, Moscetti L, Musolino A, Pazzola A, Pedrazzoli P, Pigi A, de Placido S, Caremoli ER, Santoro A, Tienghi A, Ahn JS, Jung KH, Lee KS, Lee SH, Seo JH, Sohn JH, Cesas A, Juozaityte E, Cheah NLC, Chong FLT, Devi BC, Phua V, Teoh D, Ching LW, Yusof M, Corona J, Dominguez A, Mendoza RLG, Hernandez CA, Ramiro AJ, Santos JM, Espinosa PM, Villarreal Garza CM, Errihani H, Bakker S, van den Berkmortel F, Blaisse R, Huinink DTB, van den Bosch J, Braun J, Dercksen M, Droogendijk H, Erdkamp F, Haringhuizen A, de Jongh F, Kok T, Los M, Madretsma S, Terwogt JMM, van der Padt A, van Rossum-Schornagel QC, Smilde T, de Valk B, van der Velden A, van Warmerdam L, van de Wouw A, North R, Kersten C, Mjaaland I, Wist E, Aziz Z, Masood N, Rashid K, Shah M, Alcedo JC, Aleman D, Neciosup S, Reategui R, Valdiviezo N, Vera L, Fernando G, Roque F, Strebel HM, Krzemieniecki K, Litwiniuk M, Mruk A, Pienkowski T, Sawrycki P, Slomian G, Tomczak P, Afonso N, Cardoso F, Damasceno M, Nave M, Badulescu F, Ciule L, Curescu S, Eniu A, Filip D, Grecea D, Jinga DC, Lungulescu D, Oprean CM, Stanculeanu DL, Turdean M, Dvornichenko V, Emelyanov S, Lichinitser M, Manikhas A, Sakaeva D, Shirinkin V, Stroyakovskiy D, Abulkhair O, Zekri J, Filipovic S, Kovcin V, Nedovic J, Pesic J, Vasovic S, Ng R, Bystricky B, Leskova J, Mardiak J, Mišurová E, Wagnerova M, Takač I, Demetriou GS, Dreosti L, Govender P, Jordaan JP, Veersamy P, Romero JLA, Lopez NB, Arias CC, Chacon J, Aramburo AF, Morales LAF, Garcia M, Estevez LG, Garcia-Palomo Perez A, Garcia Saenz JA, Garcia Sanchis L, Cubells LG, Cortijo LG, Santiago SG, De Aranguiz BHF, Mañas JJI, Gallego PJ, Cussac AL, Ferrandiz CL, Garrido ML, Alvarez PL, Vega JML, Del Prado PM, Jañez NM, Murillo SM, Rosales AM, Jaso LM, Fernandez IP, Martorell AP, Carrion RP, Simon SP, Alcibar AP, Lorenzo JP, Garcia VQ, Asensio TRYC, Maicas MDT, Villanueva Silva MJ, Killander F, Svensson JH, Fehr M, Hauser N, Müller A, Pagani O, Passmann-Kegel H, Popescu R, Rabaglio M, Rauch D, Schlatter C, Zaman K, Chang TW, Huang CS, Wang HC, Yu JC, Bandidwattanawong C, Maneechavakajorn J, Seetalarom K, Dejthevaporn T(S, Somwangprasert A, Vongsaisuwon M, Akbulut H, Altundag K, Arican A, Bozcuk H, Eralp Y, Idris M, Isikdogan A, Senol CH, Sevinc A, Uygun K, Yucel E, Yucel I, Yumuk F, Shparyk Y, Voitko N, Jaloudi M, Adams J, Agrawal R, Ahmed S, Alhasso A, Allerton R, Anwar S, Archer C, Ashford R, Barraclough L, Bertelli G, Bishop J, Branson T, Butt M, Chakrabarti A, Chakraborti P, Churn M, Crowley C, Davis R, Dhadda A, Eldeeb H, Fraser J, Hall J, Hickish T, Hogg M, Howe T, Joffe J, Kelleher M, Kelly S, Kendall A, Kristeleit H, Lumsden G, Macmillan C, MacPherson I, Malik Z, Mithal N, Neal A, Panwar U, Proctor A, Proctor SJ, Raj S, Rehman S, Sandri I, Scatchard K, Sherwin E, Sims E, Singer J, Smith S, Tahir S, Taylor W, Tsalic M, Verrill M, Wardley A, Waters S, Wheatley D, Wright K, Yuille F, Alonso I, Artagaveytia N, Rodriguez R, Arbona E, Garcia Y, Lion L, Marcano D, Van Thuan T. Safety and tolerability of subcutaneous trastuzumab for the adjuvant treatment of human epidermal growth factor receptor 2-positive early breast cancer: SafeHer phase III study's primary analysis of 2573 patients. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Göksu SS, Bozcuk H, Koral L, Çakar B, Gündüz S, Tatlı AM, Arslan D, Uysal M, Koçer M, Artaç M, Karabulut B, Coşkun HS, Özdoğan M, Savaş B. Factors predicting lapatinib efficacy in HER-2+ metastatic breast carcinoma: Does it work better in different histologic subtypes? Indian J Cancer 2016; 52:517-9. [PMID: 26960462 DOI: 10.4103/0019-509x.178382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT Introduction of trastuzumab, a recombinant monoclonal antibody against the extracellular domain of HER-2, is a cornerstone in the treatment of HER-2+ breast carcinoma. However, many cancers that have an initial response to trastuzumab will progress some time later. After progression on trastuzumab-based first-line treatment, there are several options. Although TDM-1 (Trastuzumab emtansine) has prolonged progression-free survival (PFS) and overall survival in patients previously treated with trastuzumab and taxane, it is still not available in Turkey. Patients may be switched to lapatinib (an oral tyrosine kinase inhibitor targeting both HER-1 and HER-2), or they may re-challenge with trastuzumab. There is no clear definition of the patients who should be switched to lapatinib. AIM In this study, we investigated the factors predicting the efficacy of lapatinib. SUBJECTS AND METHODS Totally, 94 patients treated with lapatinib for metastatic breast carcinoma was included in our study. Retrospective data including pathology, treatments and treatment results, metastatic sites, and laboratory tests were collected. RESULTS Progression-free survival was 9.1 months. Histologic subtypes other than invasive ductal carcinoma and liver metastasis were inversely related with PFS. Overall survival was 22.1 months, and patients with histologic subtypes other than invasive ductal carcinoma and who progress with brain metastasis had a worse prognosis. CONCLUSION Clinicians should give attention to histologic subtype and metastatic sites when choosing patients for lapatinib treatment.
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Affiliation(s)
- S S Göksu
- Department of Medical Oncology, Kayseri State Hospital of Research and Education, Kayseri, Turkey
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Gunduz S, Bozcuk H, Yıldız M, Goksu SS, Uysal M, Arslan D, Tatlı AM, Mutlu H, Coşkun HS, Ozdogan M. Line of abiraterone acetate in castration-resistant metastatic prostate cancer--Does it matter? report of a multi-institutional experience. Indian J Cancer 2016; 52:658-60. [PMID: 26960509 DOI: 10.4103/0019-509x.178379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We present our data comparing retrospectively the efficacy of abiraterone and cabazitaxel in patients who progress after docetaxel treatment. PATIENTS AND METHODS The study included 56 patients diagnosed with hormone-refractory metastatic prostate cancer who were previously treated with abiraterone therapy at four oncology centers in Turkey. RESULTS With abiraterone, the patients had a median progression-free survival (PFS) of 5.9 months (95% confidence interval (CI) for hazard ratio (HR) (4.4-7.4)) and an overall survival of 13.4 months (95% CI for HR (5.5-21.3)). When we compared the disease-free survival (DFS) of reference patients treated with cabazitaxel as a second-line treatment with those receiving second-line abiraterone therapy, there was no significant difference. (PFS = 5.9 months with cabazitaxel vs. 6.7 months with abiraterone, P = 0.213). CONCLUSION This study has shown that in our experience abiraterone acetate is an effective agent in metastatic castration-resistant prostate cancer (mCRPC) regardless of the line of treatment.
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Affiliation(s)
- S Gunduz
- Department of Medical Oncology, Akdeniz University Hospital, Antalya, Turkey
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Ergen S, Dincbas F, Yucel B, Akyurek S, Ulger S, Etiz D, Korkmaz E, Yilmaz U, Senocak M, Bozcuk H, Kılıc D. Risk Factors of Radiation Pneumonitis in the Patients With Non-Small Cell Lung Cancer Treated by Concomitant Chemoradiation Therapy: TOG/TROD Lung Cancer Study Group. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Artaç M, Çoşkun HŞ, Korkmaz L, Koçer M, Turhal NS, Engin H, Dede İ, Paydaş S, Öksüzoğlu B, Bozcuk H, Demirkazık A. Using Interferon Alfa Before Tyrosine Kinase Inhibitors May Increase Survival in Patients With Metastatic Renal Cell Carcinoma: A Turkish Oncology Group (TOG) Study. Clin Genitourin Cancer 2016; 14:e347-53. [PMID: 27236771 DOI: 10.1016/j.clgc.2016.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 10/14/2015] [Revised: 04/20/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND We aimed to investigate the outcomes of interferon alfa and sequencing tyrosine kinase inhibitors (TKIs) in patients with metastatic renal cell carcinoma. PATIENTS AND METHODS This multicenter study assessing the efficacy of TKIs after interferon alfa therapy in the first-line setting in patients with metastatic renal cell carcinoma. Patients (n = 104) from 8 centers in Turkey, who had been treated with interferon alfa in the first-line setting, were included in the study. Prognostic factors were evaluated for progression-free survival (PFS). RESULTS The median age of the patients was 57 years. The median PFS of the patients treated with interferon alfa in the first-line was 3.6 months. A total of 61 patients received TKIs (sunitinib, n = 58; sorafenib, n = 3) after progression while on interferon alfa. The median PFS among the TKI-treated patients was 13.2 months. In the univariate analysis for interferon alfa treatment, neutrophil and hemoglobin level, platelet count, and Karnofsky performance status were the significant factors associated with PFS. In the univariate analysis for TKI treatment, neutrophil and hemoglobin levels were the significant factors for PFS. The median total PFS of the patients who had been treated with first-line interferon alfa and second-line TKIs was 24.9 months. CONCLUSION This study showed that first-line interferon alfa treatment before TKIs may improve the total PFS in patients with metastatic renal cell carcinoma.
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Affiliation(s)
- Mehmet Artaç
- Department of Medical Oncology, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey.
| | - Hasan Şenol Çoşkun
- Department of Medical Oncology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Levent Korkmaz
- Department of Medical Oncology, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | - Murat Koçer
- Department of Medical Oncology, Süleyman Demirel University Medical Faculty, Isparta, Turkey
| | - Nazım Serdar Turhal
- Department of Medical Oncology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Hüseyin Engin
- Department of Medical Oncology, Bülent Ecevit University Medical Faculty, Zonguldak, Turkey
| | - İsa Dede
- Department of Medical Oncology, Ankara University Medical Faculty, Ankara, Turkey
| | - Semra Paydaş
- Department of Medical Oncology, Cukurova University Medical Faculty, Adana, Turkey
| | - Berna Öksüzoğlu
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Hakan Bozcuk
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ahmet Demirkazık
- Department of Medical Oncology, Ankara University Medical Faculty, Ankara, Turkey
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Merdin A, Merdin FA, Gündüz Ş, Bozcuk H, Coşkun HŞ. Opioid endocrinopathy: A clinical problem in patients with cancer pain. Exp Ther Med 2016; 11:1819-1822. [PMID: 27168810 DOI: 10.3892/etm.2016.3156] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 11/25/2015] [Indexed: 11/05/2022] Open
Abstract
Opioids are commonly used in cancer pain management. The present study aimed to investigate the occurrence of endocrine dysfunction in patients with cancer pain treated with opioids. The study included 20 patients with cancer-associated pain. All data were obtained from malignant tumors diagnosed and followed up at the Oncology Clinic of Akdeniz University Hospital (Akdeniz, Turkey) between May 2009 and December 2013. Serum samples were collected to determine the levels of hypophyseal, gonadal and thyroid hormones. The inclusion criteria for the study were as follows: Chronic cancer pain, daily treatment with a morphine equivalent daily dose (MEDD) of ≥25 mg/dl for ≥1 month, and a visual analog score of <2. All independent predictors were evaluated using logistic regression analysis. The results did not demonstrate any significant association between MEDD and gender, or the levels of adrenocorticotropic hormone, cortisol, prolactin, thyroid-stimulating hormone, free thyroxine, follicle-stimulating hormone and luteinizing hormone. However, the levels of testosterone (P=0.040) and of free testosterone (P=0.041) were significantly affected by the MEDD. Conversely, prolactin levels were demonstrated to significantly increase with MEDD (P=0.083). The results also indicated that the required opioid analgesic dose and MEDD were significantly affected by age (P≤0.001). Opioid therapy in patients with cancer may inhibit gonadal function and cause hyperprolactinemia.
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Affiliation(s)
- Alparslan Merdin
- Department of Internal Medicine, Akdeniz University Hospital, Antalya 07058, Turkey
| | - Fatma Avci Merdin
- Department of Internal Medicine, Akdeniz University Hospital, Antalya 07058, Turkey
| | - Şeyda Gündüz
- Department of Medical Oncology, Antalya Education and Research Hospital, Antalya 07070, Turkey
| | - Hakan Bozcuk
- Department of Internal Medicine, Division of Oncology, Akdeniz University Hospital, Antalya 07058, Turkey
| | - Hasan Şenol Coşkun
- Department of Internal Medicine, Division of Oncology, Akdeniz University Hospital, Antalya 07058, Turkey
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Mutlu H, Arslan D, Gündüz Ş, Tural D, Büyükçelik A, Benderli Cihan Y, Aslan T, Bozcuk H, Şenol Coşkun H. The Optimal Treatment Modality in Patients with T4N2M0 Non-Small Cell Lung Cancer: The Best Choice May Be Definitive Chemoradiotherapy Followed by Consolidation Chemotherapy. Chemotherapy 2015; 60:107-111. [PMID: 25721008 DOI: 10.1159/000371414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/08/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stage IIIB non-small cell lung cancer (NSCLC) consists of T4N2M0 and TXN3M0 NSCLC. In the present study, we aimed to evaluate the efficacy of different treatment strategies on the survival of patients with radiologically confirmed T4N2M0 NSCLC. METHODS A total of 145 patients were evaluated in three groups according to the treatment protocol: induction chemotherapy followed by chemoradiotherapy (induction group); chemoradiotherapy (CRT group), and chemoradiotherapy followed by consolidation chemotherapy (consolidation group). The groups were compared regarding survival. RESULTS The median progression-free survival (PFS) was 10.9, 10.8 and 17.1 months for the induction, CRT and consolidation groups, respectively (p = 0.021). The median overall survival (OS) was 17.6, 13.8 and 25.2 months for the induction, CRT and consolidation groups, respectively (p = 0.001). CONCLUSIONS The patients with T4N2M0 NSCLC who were treated with chemoradiotherapy followed by consolidation chemotherapy had the best outcome in terms of PFS and OS.
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Abstract
BACKGROUND Gastric cancer is one of the frequently seen cancers in the world and it is the second most common reason for death due to cancer. The prognostic role of expression of p53 detected by immunohistochemistry in gastric cancer remains controversial. This meta-analysis aimed to explore any association between overexpression and survival outcomes. MATERIALS AND METHODS We systematically searched for studies investigating the relationships between expression of p53 detected by immunohistochemistry and prognosis of gastric cancer patients. Study quality was assessed using the Newcastle-Ottawa Scale. After careful review, survival data were extracted from eligible studies. A meta-analysis was performed to generate combined hazard ratios for overall survival and disease-free survival. RESULTS A total of 4.330 patients from 21 studies were included in the analysis. Our results showed tissue p53 overexpression in patients with gastric cancer to be associated with poor prognosis in terms of overall survival (HR, 1.610; 95% CI, 1.394 -5.235; p: <0.001). Pooled hazard ratio for disease free survival showed that p53 positivity or negativity were not statitistically significant (HR, 1.219; 95%CI, 0.782-1.899; p:0.382). CONCLUSIONS The present meta-analysis indicated overexpression of p53 detected by immunohistochemistry to be associated with a poor prognosis in patients with gastric cancer.
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Affiliation(s)
- Mustafa Yildirim
- Department of Medical Oncology, Ministry of Health Batman Regional Government Hospital, Batman, Turkey E-mail :
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Tural D, Kivrak Salim D, Mutlu H, Erkilic M, Gunduz S, Karakurt M, Musri F, Tuna S, Boz A, Aydin F, Karayalcin B, Bozcuk H, Senol Coskun H. Is there any relation between PET-CT SUVmax value and prognostic factors in locally advanced breast cancer? J BUON 2015; 20:1282-1286. [PMID: 26537076] [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: 06/05/2023]
Abstract
PURPOSE To investigate the relation between PET-CT SUVmax value and prognostic factors in locally advanced breast cancer. METHODS Data of 73 patients were retrospectively analyzed. Relations between SUVmax value, clinical stage, tumor grade and breast cancer molecular subtypes were analyzed by using one-way ANOVA and x(2) tests. Correlations between age, ki-67 scores and SUVmax were evaluated by using Pearson's correlation test. A p value <0.05 was considered statistically significant. RESULTS Median SUVmax values for clinical stages 1, 2 and 3 were 5 (range 2.1-4.1), 10.6 (range 2.9-19.6), and 12.2 (range 3.2-23.3), respectively. Statistically significant difference was noticed between stage 1 and 2 (p=0.014) and stage 1 and 3 (p=0.001). Median SUVmax values of triple negative, luminal A, luminal B and non-luminal HER2 positive groups were 14.4 (range 6.6-23.3), 8.2 (range 2.1-18.2), 10.1 (range 3.5-19.6), and 14 (range 4.1-22.9), respectively. Statistically significant differences were noticed in SUVmax values between triple-negative and luminal A groups (p=0.005) and between non-luminal HER2 positive and luminal A groups (p=0.02). Median SUVmax values of grade 1, 2 and 3 were 5.7 (range 2.1-18.2), 9.5 (range 2.2-21.3), and 11.6 (range 3.5-23), respectively. Statistically significant difference was noticed only between SUVmax values of grade 1 and 3 (p=0.035). There was negative correlation between age and SUVmax value (r=-0.23, p=0.047) and positive correlation between ki-67 and SUVmax value (r=0.43, p=0.016). CONCLUSION There were significant positive relations between PET-CT SUVmax value and clinical stage, tumor grade, and certain breast cancer molecular subtypes (triple-negative and non-luminal HER2 positive groups. Moreover, positive correlation was found between SUVmax value and ki-67 and negative correlation between SUVmax value and age.
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Affiliation(s)
- Deniz Tural
- Department of Medical Oncology, Akdeniz University, Medical School, Antalya, Bakirkoy Education and Research Hospital, Istanbul, Turkey
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Gündüz S, Göksu SS, Arslan D, Tatli AM, Uysal M, Gündüz UR, Sevinç MM, Coşkun HS, Bozcuk H, Mutlu H, Savas B. Factors affecting disease-free survival in patients with human epidermal growth factor receptor 2-positive breast cancer who receive adjuvant trastuzumab. Mol Clin Oncol 2015; 3:1109-1112. [PMID: 26623060 DOI: 10.3892/mco.2015.610] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/31/2015] [Indexed: 01/03/2023] Open
Abstract
Breast cancer is the most frequently diagnosed cancer in women worldwide and the second cause of cancer-related mortality. A total of 20-30% of patients with early-stage breast cancer develop recurrence within the first 5 years following diagnosis. Trastuzumab significantly improves overall survival and disease-free survival (DFS) in women with human epidermal growth factor receptor 2 (HER2)-positive early and locally advanced breast cancer. This study aimed to determine the factors that affect DFS following adjuvant transtuzumab therapy. A total of 62 patients treated with trastuzumab for early and locally advanced breast cancer were included in our study. Data, including pathology, treatment and treatment outcome, rate of recurrence and laboratory tests, were retrospectively collected. There was no significant association between DFS and age, menopausal status, disease stage and hormone receptor status. The median follow-up was 48.4 months. The median DFS of patients treated with adjuvant trastuzumab was 64.1 months. In addition, the median DFS was 44.3 vs. 66.8 months in patients with platelet-lymphocyte ratio (PLR) ≤200 vs. >200, respectively (log-rank test; P=0.001), and 70 vs. 45 months in patients with eosinophil count ≤70 vs. >70×103/mm3 (log-rank test; P=0.001). Our data revealed the prognostic relevance of a decrease in the peripheral blood eosinophil count and PLR value following trastuzumab therapy in breast cancer. PLR and eosinophil count measurements are cost-effective, readily available worldwide, non-invasive and safe. Combined with other markers, such as patient age, tumor stage and tumor histology, may be effectively used for patients with breast cancer.
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Affiliation(s)
- Seyda Gündüz
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Sema Sezgin Göksu
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Deniz Arslan
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Ali Murat Tatli
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Mükremin Uysal
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Umut Riza Gündüz
- Department of Surgery, Antalya Research and Training Hospital, Antalya 07070, Turkey
| | - Mert Mahsuni Sevinç
- Department of Surgery, Istanbul Research and Training Hospital, Istanbul 34000, Turkey
| | - Hasan Senol Coşkun
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Hakan Bozcuk
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Hasan Mutlu
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
| | - Burhan Savas
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya 67070, Turkey
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Goksu SS, Gunduz S, Unal D, Uysal M, Arslan D, Tatli AM, Bozcuk H, Ozdogan M, Coskun HS. Use of blood transfusion at the end of life: does it have any effects on survival of cancer patients? Asian Pac J Cancer Prev 2015; 15:4251-4. [PMID: 24935379 DOI: 10.7314/apjcp.2014.15.10.4251] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of anemia is an important issue in the palliative care setting. Blood transfusion is generally used for this purpose in supportive care. However the place of blood transfusion in terminally ill cancer cases is less far established. OBJECTIVE We aimed to outline the use of transfusions and to find the impact of blood transfusion on survival in patients with advanced cancer and very near to death. DESIGN Patients dying in 2010-2011 with advanced cancer were included in the study. We retrospectively collected the data including age, type of cancer, the duration of last hospitalisation, ECOG performance status, Hb levels, transfusion history of erythrocytes and platelets, cause and the amount of transfusion. The anaemic patients who had transfusion at admission were compared with the group who were not transfused. Survival was defined as the time between the admission of last hospitalisation period and death. RESULTS Three hundred and ninety eight people with solid tumours died in 2010-2011 in our clinic. Ninety percent of the patients had anemia at the time of last hospitalisation. One hundred fifty three patients had erythrocyte transfusion at admission during the last hospitalisation period (38.4%). In the anaemic population the duration of last hospitalisation was longer in patients who had erythrocyte transfusion (15 days vs 8 days, p<0.001). CONCLUSIONS Patients who had blood transfusion at the end of life lived significantly longer than the anaemic patients who were not transfused. This study remarks that blood transfusions should not be withheld from terminal cancer patients in palliative care.
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Affiliation(s)
- Sema Sezgin Goksu
- Department of Medical Oncology, Kayseri State Hospital of Research and Education, Kayseri, Turkey E-mail :
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Doval D, Cinieri S, Bozcuk H, Pierga JY, Altundag K, Wang X, Gupta S, Lopez Vivanco G, Gupta V, Chmielowska E, Bines J, Montcuquet P, Namour A, Alba E, Mustacchi G, Cortes P, de Ducla S, Freudensprung U, Fallowfield L, Gligorov J. Abstract P2-12-16: Exploratory post hoc analyses of patient-reported outcomes (PROs) in the IMELDA randomized phase III trial: Maintenance bevacizumab (BEV) ± capecitabine (CAP) after initial first-line BEV plus docetaxel (DOC) for HER2-negative metastatic breast can. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p2-12-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND The addition of CAP to maintenance BEV demonstrated statistically significant and clinically relevant improvements in progression-free survival (PFS [primary endpoint]; HR 0.38 [95% CI 0.27–0.55]; log-rank p<0.001) and overall survival (OS [secondary endpoint]; HR 0.43 [95% CI 0.26–0.69]; log-rank p<0.001) in patients (pts) without disease progression (PD) on initial first-line BEV–DOC for HER2-negative mBC in the IMELDA trial. This benefit was achieved despite the smaller than planned sample size due to premature recruitment discontinuation because of regulatory withdrawal of BEV–DOC.
METHODS Pts with HER2-negative measurable mBC, ECOG PS <2, and no prior chemotherapy for mBC were eligible. After 3–6 cycles of BEV–DOC, pts without PD were randomized to either BEV alone or BEV–CAP (BEV 15 mg/kg q3w; CAP 1000 mg/m2 bid d1–14 q3w) until PD. PROs (secondary endpoint) were assessed using the EORTC QLQ-C30 completed at screening (before BEV–DOC), at randomization to CAP vs no CAP, then every 3 cycles until PD, and at (but not beyond) PD. Analyses of mean change from randomization were prespecified. A 28-day window around the scheduled timepoints from randomization was applied to maximize the number of questionnaires available for analysis. Exploratory post hoc analyses included mixed-model repeated measures (MMRM; modeling weighted treatment effect from randomization across all available timepoints) and responder analyses using the global health status/QoL subscale. Pts were categorized as having improved (≥10-point increase), stable (change of <10 points), or worsened (≥10-point decrease) scores from randomization [Osoba, 2005].
RESULTS Adherence with questionnaire completion was 65–85% for all assessment timepoints during the first year of maintenance therapy. MMRM analysis of the global health status/QoL subscale showed no difference between the treatment arms in change from randomization (least squares mean estimate 0.40 [95% CI –6.07 to 6.87]). Similar results were observed for other subscales, including the diarrhea symptom subscale.
No. of pts (%)BEV (N=94)BEV–CAP (N=91)Week 9aN=51N=59Improved15 (29.4)17 (28.8)Stable26 (51.0)34 (57.6)Week 18aN=29N=57Improved11 (37.9)12 (21.1)Stable12 (41.4)30 (52.6)Week 27aN=23N=43Improved7 (30.4)16 (37.2)Stable12 (52.2)20 (46.5)Week 36aN=15N=35Improved4 (26.7)14 (40.0)Stable9 (60.0)17 (48.6)aNo. of patients with completed questionnaires at both randomization and the respective week. Only weeks with ≥10 pts in both arms shown.
CONCLUSIONS The IMELDA sample size was smaller than planned but protocol adherence with PRO completion was relatively high. Prespecified change from randomization and exploratory post hoc MMRM analyses of PROs suggest that the clinically meaningful PFS and OS benefit from adding CAP to BEV is achieved while maintaining QoL, with no difference between BEV and BEV–CAP treatments. Responder analyses over time showed improved or stable global health status/QoL scores in the majority of pts at each timepoint in both treatment arms.
Citation Format: Dinesh Doval, Saverio Cinieri, Hakan Bozcuk, Jean-Yves Pierga, Kadri Altundag, Xiaojia Wang, Sudeep Gupta, Guillermo Lopez Vivanco, Vineet Gupta, Ewa Chmielowska, Jose Bines, Philippe Montcuquet, Alfred Namour, Emilio Alba, Giorgio Mustacchi, Paulo Cortes, Sabine de Ducla, Ulrich Freudensprung, Lesley Fallowfield, Joseph Gligorov. Exploratory post hoc analyses of patient-reported outcomes (PROs) in the IMELDA randomized phase III trial: Maintenance bevacizumab (BEV) ± capecitabine (CAP) after initial first-line BEV plus docetaxel (DOC) for HER2-negative metastatic breast can [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-12-16.
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Affiliation(s)
- Dinesh Doval
- 1Rajiv Gandhi Cancer Institute & Research Center
| | | | | | | | | | | | | | | | | | | | | | | | | | - Emilio Alba
- 14Hospital University Clinic Virgen de la Victoria
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Gligorov J, Bines J, Alba E, Mustacchi G, Cinieri S, Gupta V, Pierga JY, Bozcuk H, Gaafar R, Gupta S, Lopez Vivanco G, Wang X, Costa R, Altundag K, Chmielowska E, de Ducla S, Freudensprung U, Cortes P, Doval D. Abstract P2-17-01: Overall survival (OS) in the IMELDA randomized phase III trial of maintenance bevacizumab (BEV) with or without capecitabine (CAP) for HER2-negative metastatic breast cancer (mBC). Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p2-17-01] [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: 11/16/2022]
Abstract
Abstract
BACKGROUND The open-label randomized phase III IMELDA trial demonstrated that adding CAP to maintenance BEV until disease progression (PD) after initial BEV–docetaxel (DOC) provides statistically significant and clinically meaningful improvements in both progression-free survival (PFS [primary endpoint]; hazard ratio [HR] 0.38 [95% CI 0.27–0.55]; log-rank p<0.001) and OS. We present OS in subgroups representing stratification factors and clinically important populations.
METHODS Patients (pts) with HER2-negative measurable mBC, ECOG PS <2, and no prior chemotherapy for mBC were eligible. After 3–6 cycles of BEV–DOC, pts without PD were randomized to BEV alone or BEV–CAP (BEV 15 mg/kg q3w; CAP 1000 mg/m2 bid d1–14 q3w) until PD. Stratification factors were estrogen receptor (ER) status, visceral metastases, response status, and lactate dehydrogenase (LDH) concentration. OS from randomization was a secondary endpoint. The planned sample size of 360 enrolled pts (290 randomized) was calculated assuming a PFS HR of 0.70 (median PFS 5.8→8.3 months) with 80% power at 2-sided α=0.05 after 244 PFS events. Recruitment was stopped prematurely after regulatory withdrawal of the BEV–DOC combination but pts who had already been enrolled and randomized were followed as originally planned.
RESULTS Between Jun 2009 and Mar 2011, 284 pts were enrolled and treated. Of these, 99 were not eligible for randomization (most commonly due to PD [41%] or AEs/toxicity [31%]) and 185 (65%) were randomized. At the time of the primary PFS analysis, representing study closure, median follow-up (from randomization) was 31.6 months. Median OS from randomization was 23.7 months in the BEV arm and 39.0 months in the BEV–CAP arm (events in 36% of pts). The HR for OS in the two randomized arms showed consistency between subgroups, favoring the BEV–CAP arm in all subgroups analyzed.
SubgroupNo. of events/No. of pts (%)Unstratified HR (95% CI)1-y OS rate (%) BEVBEV–CAP BEVBEV–CAPAll53/94 (56)33/91 (36)0.43 (0.26-0.69)a7290<65 y46/81 (57)27/77 (35)0.51 (0.32-0.82)7293≥65 y7/13 (54)6/14 (43)0.50 (0.16-1.60)6879Triple negative16/21 (76)10/25 (40)0.44 (0.19-0.99)6290Hormone receptor positive37/73 (51)23/66 (35)0.53 (0.31-0.89)7591ER positiveb36/69 (52)23/64 (364)0.53 (0.32-0.90)7590ER negativeb17/25 (68)10/27 (37)0.44 (0.20-0.99)6491<3 metastatic organ sites17/40 (43)17/48 (35)0.75 (0.38-1.49)8193≥3 metastatic organ sites36/54 (67)16/43 (37)0.39 (0.22-0.71)6588Visceral metastasesb38/65 (58)23/62 (37)0.43 (0.26-0.73)7092No visceral metastasesb15/29 (52)10/29 (34)0.76 (0.34-1.70)7688Complete or partial responseb36/68 (53)24/68 (35)0.61 (0.37-1.03)7389Stable diseaseb14/22 (64)6/20 (30)0.22 (0.08-0.63)68100Non-measurableb3/4 (75)3/3 (100)0.30 (0.03-2.98)6767LDH ≤1.5×ULNb50/89 (56)30/85 (35)0.49 (0.31-0.76)7294LDH >1.5×ULNb3/5 (60)3/6 (50)1.01 (0.20-5.00)6044aStratified analysis. bStratification factor.
CONCLUSIONS. Combining maintenance BEV with CAP until PD after initial BEV–DOC for mBC provides a statistically significant and clinically meaningful improvement in OS (secondary endpoint), seen consistently irrespective of baseline characteristics.
Citation Format: Joseph Gligorov, Jose Bines, Emilio Alba, Giorgio Mustacchi, Saverio Cinieri, Vineet Gupta, Jean-Yves Pierga, Hakan Bozcuk, Rabab Gaafar, Sudeep Gupta, Guillermo Lopez Vivanco, Xiaojia Wang, Romulo Costa, Kadri Altundag, Ewa Chmielowska, Sabine de Ducla, Ulrich Freudensprung, Paulo Cortes, Dinesh Doval. Overall survival (OS) in the IMELDA randomized phase III trial of maintenance bevacizumab (BEV) with or without capecitabine (CAP) for HER2-negative metastatic breast cancer (mBC) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-17-01.
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Affiliation(s)
| | | | - Emilio Alba
- 3Hospital University Clinic Virgen de la Victoria
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- 18Rajiv Gandhi Cancer Institute & Research Center
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Gunduz S, Mutlu H, Tural D, Yıldız Ö, Uysal M, Coskun HS, Bozcuk H. Platelet to lymphocyte ratio as a new prognostic for patients with metastatic renal cell cancer. Asia Pac J Clin Oncol 2015; 11:288-92. [PMID: 25871569 DOI: 10.1111/ajco.12358] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2015] [Indexed: 11/29/2022]
Abstract
AIM The objective of this study was to evaluate the blood platelet-lymphocyte ratio (PLR) for its prognostic value in patients with metastatic renal cell cancer (RCC). METHODS We retrospectively reviewed 100 patients diagnosed with metastatic RCC previously treated with tyrosine kinase inhibitors from three centers. We assessed the prognostic value of pretreatment PLR and other clinical and laboratory parameters based on univariate and multivariate analyses. RESULTS Median progression-free survival (PFS) was 7.3 months and median overall survival (OS) was 15.3 months. Multivariate analysis revealed that PFS is significantly affected by ECOG PS (P = 0.047), PLR (P = 0.029) and calcium level (P = 0.023). Median PFS was 13.9 versus 5.3 months in patients with PLR ≤ 210 versus PLR > 210 (log rank; P = 0.001). Median OS was 25.9 versus 10.9 months with PLR ≤ 210 versus PLR > 210 (log rank; P = 0.013). CONCLUSIONS This study shows that increased pretreatment PLR is an independent prognostic indicator in patients with metastatic RCC who use tyrosine kinase inhibitors.
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Affiliation(s)
- Seyda Gunduz
- Department of Medical Oncology, Akdeniz University Hospital, Antalya, Turkey
| | - Hasan Mutlu
- Department of Medical Oncology, Akdeniz University Hospital, Antalya, Turkey
| | - Deniz Tural
- Department of Medical Oncology, Akdeniz University Hospital, Antalya, Turkey
| | - Özcan Yıldız
- Istanbul Medipol University Hospital, Istanbul, Turkey
| | - Mukremin Uysal
- Afyon Kocatepe University Ahmet Necdet Sezer Research and Practice Hospital, Afyon, Turkey
| | - Hasan Senol Coskun
- Department of Medical Oncology, Akdeniz University Hospital, Antalya, Turkey
| | - Hakan Bozcuk
- Department of Medical Oncology, Akdeniz University Hospital, Antalya, Turkey
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Arslan D, Tural D, Koca T, Tastekin D, Kaymak Cerkesli A, Basaran H, Gunduz S, Murat Tatli A, Sezgin Goksu S, Uysal M, Kargi A, Kargi B, Koral L, Ibrahim Bassorgun C, Unal D, Mutlu H, Senol Coskun H, Ozdogan M, Bozcuk H. Prognostic factors in clinical stage T4N2 locally advanced non-small cell lung cancer. J BUON 2015; 20:573-579. [PMID: 26011352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Relatively few studies have focused on T4N2 (stage IIIB) locally advanced non-small cell lung cancer (NSCLC). In this study, we tried to identify prognostic factors for patients with clinical stage T4N2 NSCLC. METHODS We retrospectively identified 223 patients, of which 168 met the inclusion criteria. Patients treated with curative intent using concurrent chemoradiotherapy (CRT) with or without adjuvant chemotherapy, or concurrent CRT after induction chemotherapy, were included in this study. Relevant patient, treatment, and disease factors were evaluated for their prognostic significance in both univariate and multivariate analyses using the Cox proportional hazards model. RESULTS The median progression-free survival (PFS) was 13 months (95% confidence interval [CI], 10.6-15.4). The median overall survival (OS) was 20 months (95% CI, 16.8-23.1), and 71, 40.3 and 28.2% of the patients survived for 1, 2 and 3 years after diagnosis, respectively. Multivariate analysis showed Eastern Cooperative Oncology Group (ECOG) performance status (PS) was independent predictor of PFS (hazard ratio [HR], 0.24; 95% CI, 0.13-0.43; p=0.001), and OS [HR, 0.48; 95% CI, 0.26-0.87; p=0.015). Absence of multifocal T4 tumors was also associated with a significantly longer OS (HR, 046; 95% CI, 0.31-0.7; p=0.001). There was no statistically significant difference in OS and PFS between treatment modalities. CONCLUSION PFS and OS were significantly shorter in patients with poor ECOG PS. OS was also significantly shorter in patients with multifocal T4 tumors. There were no differences between the two therapeutic approaches with respect to outcome.
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Affiliation(s)
- Deniz Arslan
- Erzurum Research and Education Hospital, Medical Oncology Department, Erzurum, Turkey
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Geredeli C, Artac M, Yildirim S, Inal A, Dede I, Guler T, Boruban MC, Koral L, Karaagac M, Zamani AG, Altinok T, Aribas O, Bozcuk H, Demirkazik A. Prognostic value of ERCC1, ERCC2, XRCC1, and TP53 single nucleotide polymorphisms in patients with early-stage non-small cell lung cancer. Tumour Biol 2015; 36:4279-85. [PMID: 25596702 DOI: 10.1007/s13277-015-3066-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/05/2015] [Indexed: 11/28/2022] Open
Abstract
Identification of biomarkers used for the prognostic evaluation of non-small cell lung cancer (NSCLC) patients is important. The aim of this study was to evaluate the potential prognostic value of XRCC1, ERCC1, ERCC2, and TP53 single nucleotide polymorphisms (SNPs) in completely resected NSCLC patients. In total, 130 patients, surgically treated for NSCLC between 2000 and 2012, were included. An analysis of SNPs from peripheral blood cells was performed by polymerase chain reaction. XRCC1 Arg399Gln, ERCC1 Asn118Asn, ERCC2 Lys751Gln, and TP53 Arg72Pro polymorphisms were evaluated in conjunction with clinical and pathological parameters and survival. Kaplan-Meier method and Cox regression analysis were used. Median age rate was 59.3, ranging between 36 and 78 years. Median relapse-free survival duration (RFS) was found as 46.2 months. In those with ERCC2 CC allele, median RFS was detected as 28.3 months (95 % confidence interval (CI), 20.8-35.8), 46.9 months in those with CT heterozygous (95 % CI, 18.6-75.2), and 80.1 months for those with TT mutant allel (95 % CI, 33.0-127.2). Median RFS was seen to be longer in mutant group and also statistically significant (P = 0.018). Additionally, upon evaluating CC normal group with CT + TT alleles including mutant alleles, median RFS was found as 56.5 months (95 % CI, 24.6-88.4) in CT + TT group, and this was statistically significant (P = 0.005) Also, median RFS was 15.1 months in those including ERCC2 CC allele and 56.5 months in CT + TT allele in the group with no adjuvant treatment (P = 0.001). In conclusion, our study showed that ERCC2/XPD polymorphism is an independent prognostic factor in operated NSCLC patients, and these findings should be supported with prospective studies.
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Affiliation(s)
- Caglayan Geredeli
- Department of Medical Oncology, Meram Medical Faculty, Necmettin Erbakan University, Meram, 42100, Konya, Turkey,
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Gunduz S, Mutlu H, Uysal M, Coskun HS, Bozcuk H. Prognostic value of hematologic parameters in patients with metastatic renal cell carcinoma using tyrosine kinase inhibitors. Asian Pac J Cancer Prev 2015; 15:3801-4. [PMID: 24870797 DOI: 10.7314/apjcp.2014.15.8.3801] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prognostic significance of the neutrophil-to-lymphocyte ratio for progression free survival in patients with metastatic renal cell carcinoma is unclear. MATERIALS AND METHODS We retrospectively reviewed 45 patients diagnosed with metastatic RCC previously treated with tyrosine kinase inhibitors from two centers, Akdeniz University Hospital and Afyon Kocatepe University. The prognostic value of the pretreatment neutrophil- tolymphocyte ratio, and other clinical and laboratory parameters were assessed by univariate and multivariate analysis. RESULTS Median progression free survival (PFS) was 13.9 months [95% CI for HR (6.88-20.91)] and overall survival figure of 16.6 months [95% CI for HR (7.23-26.03)] Univariate analysis revealed that PFS was significantly affected by hemoglobin level [p=0.013 (95% CI for HR (0.71-0.96))], eosinophil count [p=0.031 (95% CI for HR (0.20-0.92))], ratio of neutrophil lymphocytes (NLR) [p=0.007 (95% CI for HR (1.47-11.74))] and calcium level [p=0.006 (95% CI for HR (0.15-0.73))]. However, only NLR [p=0.031 (95% CI for HR (1.15- 18.1))] and calcium levels [p=0.018 (95% CI for HR (0.20-18.1))] retained significance with multivariate analysis. Median PFS was 23.9 vs 8.6 months in patients with NLR ≤ 2 vs NLR >2 (Log rank; p= 0.040). CONCLUSIONS This study showed that increased pretreatment NLR is an independent prognostic factor for patients with metastatic RCC using tyrosine kinase inhibitors.
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Affiliation(s)
- Seyda Gunduz
- Department of Medical Oncology, Faculty of Medicine, Akdeniz University, Antalya, Turkey E-mail :
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Mutlu H, Musri F, Artaç M, Kargi A, Özdogan M, Bozcuk H. Metronomic oral chemotherapy with old agents in patients with heavily treated metastatic breast cancer. J Cancer Res Ther 2015; 11:287-90. [DOI: 10.4103/0973-1482.154008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Goksu SS, Bozcuk H, Uysal M, Ulukal E, Ay S, Karasu G, Soydas T, Coskun HS, Ozdogan M, Savas B. Determinants of opioid efficiency in cancer pain: a comprehensive multivariate analysis from a tertiary cancer centre. Asian Pac J Cancer Prev 2014; 15:9301-5. [PMID: 25422216 DOI: 10.7314/apjcp.2014.15.21.9301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain is one of the most terrifying symptoms for cancer patients. Although most patients with cancer pain need opioids, complete relief of pain is hard to achieve. This study investigated the factors influencing persistent pain-free survival (PPFS) and opioid efficiency. MATERIALS AND METHODS A prospective study was conducted on 100 patients with cancer pain, hospitalized at the medical oncology clinic of Akdeniz University. Patient records were collected including patient demographics, the disease, treatment characteristics, and details of opioid usage. Pain intensity was measured using a patient self-reported visual analogue scale (VAS). The area under the curve (AUC) reflecting the pain load was calculated from daily VAS tables. PPFS, the primary measure of opioid efficacy, was described as the duration for which a patient reported a greater than or equal to two-point decline in their VAS for pain. Predictors of opioid efficacy were analysed using a multivariate analysis. RESULTS In the multivariate analysis, PPFS was associated with the AUC for pain (Exp (B)=0.39 (0.23-0.67), P=0.001), the cumulative opioid dosage used during hospitalisation (Exp (B)=1.00(0.99-1.00), P=0.003) and changes in the opioid dosage (Exp (B)=1.01 (1.00-1.01), P=0.016). The change in VAS score over the standard dosage of opioids was strongly associated with current cancer treatment (chemotherapy vs. others) (β=-0.31, T=-2.81, P=0.007) and the VAS for pain at the time of hospitalisation (β=-0.34, T=-3.07, P= 0.003). CONCLUSIONS The pain load, opioid dosage, concurrent usage of chemotherapy and initial pain intensity correlate with the benefit received from opioids in cancer patients.
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Affiliation(s)
- Sema Sezgin Goksu
- Kayseri State Hospital of Research and Education, Department of Medical Oncology, Kayseri, Turkey E-mail :
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Sezgin Goksu S, Gunduz S, Unal D, Uysal M, Arslan D, Tatlı AM, Bozcuk H, Ozdogan M, Coskun HS. Use of chemotherapy at the end of life in Turkey. BMC Palliat Care 2014; 13:51. [PMID: 25435808 PMCID: PMC4247666 DOI: 10.1186/1472-684x-13-51] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 11/10/2014] [Indexed: 12/18/2022] Open
Abstract
Background An increasing number of patients receive palliative chemotherapy near the end of life. The aim of this study is to evaluate the aggressiveness of chemotherapy in Turkish individuals near the end of life. Methods Patients diagnosed with solid tumors and died from 2010 to 2011 in the medical oncology department of Akdeniz University were included in the study. Data about the diagnosis, treatment details and imaging procedures were collected. Results Three hundred and seventy-three people with stage IV solid tumors died from 2010 to 2011 in our clinic. Eighty-nine patients (23.9%) patients underwent chemotherapy in the last month of life while 39 patients (10.5%) received chemotherapy in the last 14 days. The probability of undergoing chemotherapy in the last month of life was influenced by: age, ‘newly diagnosed’ patients, and performance status. There was no significant association of chemotherapy in the last month of life with gender and tumor type. Having a PET-CT scan did not alter the chemotherapy decision. Conclusion In conclusion, chemotherapy used in the last month of life in a tertiary care center of Turkey is high. Increasing quality of life should be a priority near the end of life and physicians should consider ceasing chemotherapy and direct the patient to early palliative care.
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Affiliation(s)
- Sema Sezgin Goksu
- Department of Medical Oncology, Kayseri State Hospital of Research and Education, Kayseri, Turkey
| | - Seyda Gunduz
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Dilek Unal
- Department of Radiation Oncology, Kayseri State Hospital of Research and Education, Kayseri, Turkey
| | - Mukremin Uysal
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Deniz Arslan
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Ali M Tatlı
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Hakan Bozcuk
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Mustafa Ozdogan
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Hasan S Coskun
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
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Gunduz S, Mutlu H, Goksu SS, Arslan D, Tatli AM, Uysal M, Coskun HS, Bozcuk H, Ozdogan M, Savas B. Oral cyclophosphamide and etoposide in treatment of malignant pleural mesothelioma. Asian Pac J Cancer Prev 2014; 15:8843-6. [PMID: 25374217 DOI: 10.7314/apjcp.2014.15.20.8843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malignant mesothelioma (MM) is almost always fatal and few treatment options are available. The aim of this study was to evaluate the efficacy of oral cyclophosphamide and etoposide for patients who underwent standard treatment for advanced MM. MATERIALS AND METHODS This study included 22 malignant pleural mesothelioma patients who were treated with oral cyclophosphamide and etoposide (EE). RESULTS The average follow-up period of the patients was 39.1 months. Under the treatment of oral EE, median progression- free survival was 7.7 months [95%CI HR (4.3-11.1)] and median overall survival was 28.1 months [95%CI HR (5.8-50.3)]. The treatment response rates were as follows: 4 patients (27.3%) had a partial response (PR), 12 (54.5%) had stable disease (SD), and progressive disease (PD) was observed in 6 (35.9%). CONCLUSIONS Oral EE can be administered effectively to patients with inoperable malignant mesothelioma who had previously received standard treatments.
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Affiliation(s)
- Seyda Gunduz
- Department of Medical Oncology, Antalya Education and Research Hospital, Antalya, Turkey E-mail :
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Arslan D, Koca T, Tastekin D, Basaran H, Bozcuk H. Impact of poster presentations on academic knowledge transfer from the oncologist perspective in Turkey. Asian Pac J Cancer Prev 2014; 15:7707-11. [PMID: 25292050 DOI: 10.7314/apjcp.2014.15.18.7707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently poster presentations offer a common visual medium for knowledge transfer by a wide range of health professionals. Our study aimed to determine the scientific importance of poster presentations for Medical and Radiation Oncologists. METHODS A survey form including 40 questions was distributed to a total of 131 oncologists experienced in poster presentations. One hundred completed survey forms were included in the study. Descriptive statistics and modified thematic analyses were performed on the responses. RESULTS Overall 64% of the participants agreed that posters were a good medium for knowledge transfer. Some 88% agreed that concise and clear styled presentations would increase appealing interests for poster contents. Visual appearance was cited more influential than content of the subject; 70% of participants agreed that appearances of posters could help to draw more viewer attention. Of respondents, 63% believed that posters accompanied by their author were more attractive for congress attendees, and 33% of them declared that the halo effect of the poster presenter was also important. CONCLUSION The present study indicated that intelligibility, appearance and visuality of posters are most important factors from the aspect of oncologist participants. Presenters must take into account these important points when preparing their academic posters.
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Affiliation(s)
- Deniz Arslan
- Department of Medical Oncology, Regional Teaching and Research Hospital, Erzurum, TurkeyE-mail :
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Uysal M, Ozdogan M, Kargi A, Gunduz S, Sezgin Goksu S, Murat Tatli A, Arslan D, Mutlu H, Senol Coskun H, Bozcuk H. Prolonged progression-free survival with maintenance metronomic oral cyclophosphamide and etoposide treatment in macroscopic residual disease or recurrent/advanced stage ovarian cancer. J BUON 2014; 19:980-984. [PMID: 25536605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE In ovarian cancer permanent remission may be provided with optimal cytoreductive surgery and adjuvant chemotherapy. However survival is short in patients with residual macroscopic disease after surgery or recurrent ovarian cancer. Applicable maintenance therapies with low toxicity are required to prolong progression-free survival (PFS) for patients with no curative treatment options. In this study, we investigated the effect of maintenance metronomic oral cyclophosphamide and etoposide (CE) in ovarian cancer patients with post operative residual or recurrent disease. METHODS Forty five patients that received metronomic oral CE (cyclophosphamide 50 mg/daily and etoposide 50 mg for 1-5 days, every 21 days) as maintenance therapy for residual disease due to incomplete surgical resection or recurrent advanced-stage ovarian cancer were evaluated. The time between the beginning of oral CE and disease progression was also evaluated. RESULTS The mean patient age was 58 years, the vast majority had serous adenocarcinoma (78%) and received a mean of 2 (range 1-4) lines of various intravenous regimens for postoperative residual or recurrent disease. Mean duration of oral CE was 11.3 months (range 2.9-29). Median PFS was 10.3 months (range 7.9-12.8). Only 5 patients discontinued treatment due to intolerance and grade 3-4 toxicity was recorded in 3 patients (7%). CONCLUSION Maintenance metronomic oral CE treatment was found effective, minimally toxic and sustainable in patients with macroscopic residual or recurrent advanced-stage ovarian cancer. However, randomized and placebo-controlled well designed studies are required.
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Affiliation(s)
- Mukremin Uysal
- Afyon Kocatepe University Faculty of Medicine, Department of Medical Oncology, Afyon, Turkey
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Gunduz S, Mutlu H, Uysal M, Coskun HS, Bozcuk H. Elucidating the correlation between treatment with tyrosine kinase inhibitors and mean platelet volume in patients with metastatic renal cell cancer. Oncol Lett 2014; 8:2249-2252. [PMID: 25289104 PMCID: PMC4186555 DOI: 10.3892/ol.2014.2495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 08/07/2014] [Indexed: 12/21/2022] Open
Abstract
Patients with cancer are at increased risk of thrombosis. Additionally, an increased mean platelet volume (MPV) has been demonstrated to be associated with thromboembolism. Tyrosine kinase inhibitors (TKIs) may modulate the activation of systemic coagulation in cancer patients, rendering them more susceptible to thromboembolism. The aim of the current study was to investigate the association between antiangiogenic TKIs and MPV. A total of 45 patients with metastatic renal cell carcinoma (RCC), who were treated with TKIs and were patients at the Akdeniz University Hospital and Afyon Kocatepe University Ahmet Necdet Sezer Research and Practice Hospital, were retrospectively reviewed. The results prior to treatment and after three months for the MPV values and platelet levels were evaluated. The MPV values increased following the treatment with TKIs; however, no statistically significant difference was observed between the baseline and three month values (P=0.286). Conversely, a significant decrease was observed in the platelet levels following treatment (P=0.005). Treatment with TKIs in patients with metastatic RCC caused a modest increase in MPV, which is an indicator of thrombocytic reactivity; however, further studies are required to validate these results.
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Affiliation(s)
- Seyda Gunduz
- Department of Medical Oncology, Akdeniz University Hospital, Antalya 07070, Turkey
| | - Hasan Mutlu
- Department of Medical Oncology, Akdeniz University Hospital, Antalya 07070, Turkey
| | - Mukremin Uysal
- Department of Medical Oncology, Afyon Kocatepe University Ahmet Necdet Sezer Research and Practice Hospital, Afyon 3000, Turkey
| | - Hasan Senol Coskun
- Department of Medical Oncology, Akdeniz University Hospital, Antalya 07070, Turkey
| | - Hakan Bozcuk
- Department of Medical Oncology, Akdeniz University Hospital, Antalya 07070, Turkey
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Bozcuk H, Yildiz M, Uçar S, Mutlu H, Coşkun H. The Correlates of Dose Reduction in Chemotherapy for Patients with Common Cancers. a Prospective Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu326.74] [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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Gunduz S, Ozgur O, Bozcuk H, Coşkun HS, Ozdogan M, Erkilic M, Sindel T, Yldlzs A, Ylmaz S, Boz A, Aydin F, Karayalçin B, Savas B. Yttrium-90 radioembolization in patients with unresectable liver metastases: determining the factors that lead to treatment efficacy. Hepatogastroenterology 2014; 61:1529-1534. [PMID: 25436337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Locoregional treatments, such as radioembolization, can be used to treat patients with unresectable liver metastases. We aimed to determine the progression-free survival and factors that predict survival of patients with liver metastases whose response to selective internal radiation therapy (SIRT) with Y-90 was assessed by positron emission tomography-computed tomography (PET-CT). PATIENTS Our study included 78 liver cancer patients who were treated with Y-90 radioembolization. RESULTS The post-treatment response rates were as follows: 7 patients (9%) had stable disease (SD), 26 patients (33.3%) had a partial response (PR), 4 patients (5.1%) had a complete response (CR). The median hepatic progression-free survival (HPFS) was 4.4 months while median overall survival was 10.1 months. Univariate analysis revealed that HPFS is significantly affected by international normalized ratio (INR) levels and age (Hazard Ratio(HR)=0.54 (95%CI:0.30-096), P=0.034, HR=1.03(95%CI:1.00-1.05), P=0.051). However, only INR levels retained significance with multivariate analysis (HR=0.53 (95%CI:0.30-0.93), P=0.028), while age had limited significance (HR =1.02 (95% CI:1.00-1.05), P=0.051). CONCLUSIONS We determined that Y-90 radioembolization is effective as a salvage therapy in patients with predominant liver metastases. For the first time, we showed that age and INR values reflecting the functional hepatic reserve can be used as positive predictive factors for HPFS.
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Avcı, F, Merdin A, Gunduz S, Bozcuk H, Coşkun H. Opioid Endocrinopathy: a Clinical Problem in Patients with Cancer Pain. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu356.46] [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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Artac M, Turhal NS, Kocer M, Karabulut B, Bozcuk H, Yalcin S, Karaagac M, Gündüz S, Isik N, Uygun K. Do high-risk features support the use of adjuvant chemotherapy in stage II colon cancer? A Turkish Oncology Group study. Tumori 2014. [PMID: 24852857 DOI: 10.1700/1491.16397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A high-risk group of patients with stage II colon cancer has been identified by the results of studies in Western populations. The aim of this study was to investigate the prognostic factors of adjuvant chemotherapy in Turkish patients with stage II colon cancer. METHODS A total of 554 stage II colon cancer patients were retrospectively enrolled in the study. Three hundred fifty-three patients had received adjuvant chemotherapy (5-FU-LV, FOLFOX or FLOX) and 201 had received no adjuvant chemotherapy. T4 tumor stage, lymphovascular invasion, perineural invasion, bowel obstruction and/or perforation, <12 harvested lymph nodes, and poor differentiation were defined as high-risk factors. RESULTS The median age of the patients was 62 years (range 26-88). The median disease-free survival (DFS) was 58.1 months (95% CI, 47.6 months to 68.5 months) in the non-treatment group and has not been reached in the treatment group (P <0.01). In univariate analysis, patient age >60 years and T4 tumor stage were statistically significant factors that affected DFS as poor prognostic factors. Adjuvant chemotherapy reduced the risk of recurrence with statistical significance (P <0.01). In multivariate analysis, patient age >60 years and T4 tumor stage were independent risk factors affecting DFS. In addition, adjuvant chemotherapy was an independent favorable prognostic factor for DFS (P <0.01). CONCLUSIONS Clinical and pathological risk factors in patients with stage II colon cancer may be different in the Turkish population compared to other populations. Further prospective studies in colon cancer are needed to understand the differences in biology and risk factors between races.
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Mutlu H, Gündüz S, Büyükçelik A, Yıldız O, Uysal M, Tural D, Bozcuk H, Coşkun HŞ. The necessity of cytoreductive nephrectomy in patients with metastatic renal cell carcinoma using antiangiogenic targeted therapy after interferon alfa-2b. Clin Genitourin Cancer 2014; 12:447-50. [PMID: 25022784 DOI: 10.1016/j.clgc.2014.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/03/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Targeted therapy has improved the survival of patients with metastatic RCC. In the present study, we evaluated whether there was an effect of cytoreductive surgery on prognosis of patients with metastatic RCC using antiangiogenic tyrosine kinase inhibitor (TKI) agents. PATIENTS AND METHODS A total of 52 patients with metastatic RCC from Akdeniz University, Afyon Kocatepe University, and Medipol University participated in the study. All the patients had received targeted antiangiogenic therapy after interferon alfa-2b. According to previous CRN, the patients were divided into 2 groups as CRN (+) and CRN (-). RESULTS The CRN (+) group was younger than the CRN (-) group (P < .001) and the hemoglobin levels were significantly higher in the CRN (+) group (P = .023). The median progression-free survival time from the date of starting TKIs were 8.5 and 3.0 months for the CRN (+) and CRN (-) groups, respectively (P = .104). The median overall survival was 15.1 and 5.4 months for the CRN (+) and CRN (-) groups, respectively (P = .034). CONCLUSION We speculate that CRN is still an important part of treatment modalities in patients with metastatic RCC in modern era targeted therapy, which is currently the best systemic therapy. However, the indications of CRN might be limited to good-risk patients with metastatic RCC. Further randomized studies are warranted to clarify the necessity of CRN in patients with metastatic RCC.
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Affiliation(s)
- Hasan Mutlu
- Department of Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey.
| | - Seyda Gündüz
- Department of Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Abdullah Büyükçelik
- Department of Internal Medicine, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Ozcan Yıldız
- Department of Medical Oncology, Medipol University, Istanbul, Turkey
| | - Mükremin Uysal
- Department of Medical Oncology, Kocatepe University School of Medicine, Afyon, Turkey
| | - Deniz Tural
- Department of Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Hakan Bozcuk
- Department of Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Hasan Şenol Coşkun
- Department of Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey
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Geredeli C, Artac M, Yildirim S, Dede I, Inal A, Guler T, Boruban M, Zamani A, Bozcuk H, Demirkazik A. P0146 The prognostic role of XRCC1, ERCC1, ERCC2, and TP53 single nucleotide polymorphisms in resected non-small-cell lung cancer. Eur J Cancer 2014. [DOI: 10.1016/j.ejca.2014.03.190] [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: 11/25/2022]
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Arslan D, Bozcuk H, Gunduz S, Tural D, Tattli AM, Uysal M, Goksu SS, Bassorgun CI, Koral L, Coskun HS, Ozdogan M, Savas B. Survival Results and Prognostic Factors in T4 N0-3 Non-small Cell Lung Cancer Patients According to the AJCC 7thEdition Staging System. Asian Pac J Cancer Prev 2014; 15:2465-72. [DOI: 10.7314/apjcp.2014.15.6.2465] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Uysal M, Bozcuk H, Sezgin Göksu S, Murat Tatli A, Arslan D, Gündüz S, Senol Coskun H, Ozdogan M, Savas B. Basal proteinuria as a prognostic factor in patients with metastatic colorectal cancer treated with bevacizumab. Biomed Pharmacother 2014; 68:409-12. [PMID: 24721326 DOI: 10.1016/j.biopha.2014.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The beneficial effects of bevacizumab, a widely used agent in metastatic colorectal cancer (mCRC), on clinical survival have been proven. This study investigated the correlation of the clinical benefits and prognosis with proteinuria and other parameters. METHODS The study included mCRC patients receiving bevacizumab. Hypertension, 24-hour urine proteinuria, and other routine parameters were recorded at baseline and at certain intervals during treatment. RESULTS The study included 36 consecutive patients. The median progression-free survival (PFS) duration was 10.9±2.6months, and the median overall survival (OS) was 23±3.1months. The median PFS was 7.2months among patients with basal proteinuria above 114mg/day, whereas the median PFS was 12months among patients with an equal or lower level (P=0.010). Similarly, PFS was shorter in patients with high lactate dehydrogenase (LDH) or carcinoembryonic antigen (CEA) levels (LDH, P=0.022; CEA, P=0.014). Bevacizumab response's performance status was good (P=0.05) and was even better in patients with a single liver metastasis (P=0.034) or hypertension (P=0.034). CONCLUSIONS We demonstrated that high basal proteinuria, LDH, or CEA levels may be negative prognostic factors in mCRC patients receiving bevacizumab.
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Affiliation(s)
- Mukremin Uysal
- Afyon Kocatepe University Faculty of Medicine, Department of Medical Oncology, Izmir Karayolu 8.km, 03200 Afyon, Turkey.
| | - Hakan Bozcuk
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Sema Sezgin Göksu
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Ali Murat Tatli
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Deniz Arslan
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Seyda Gündüz
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Hasan Senol Coskun
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Mustafa Ozdogan
- Medstar Antalya Hospital, Department of Medical Oncology, Antalya, Turkey
| | - Burhan Savas
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
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Kargi A, Uysal M, Bozcuk H, Coskun HS, Savas B, Ozdogan M. The importance of COX-2 expression as prognostic factor in early breast cancer. J BUON 2013; 18:579-584. [PMID: 24065467] [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 A number of studies have been carried out, showing that the risk for breast carcinoma is decreased in those using non-steroidal anti-inflammatory drugs (NSAIDs). Increased cyclooxygenase-2 (COX-2) level is considered as a factor indicating poor prognosis and responsible for angiogenesis, increased cellular proliferation, apoptotic defect and aromatase enzyme induction. For this reason the level of COX-2 might have a prognostic and predictive value in breast cancer as well. This question has become the basis of the present study. METHODS Eighty-eight female patients with early stage breast cancer being under adjuvant anthracycline based chemotherapy were prospectively recruited. The patient age, body weight, menopausal status, tumor size and grade as well as axillary lymph node involvement were recorded. Routine pathological examination was performed, and COX-2, CerbB2 (HER2), estrogen (ER) and progesterone receptors (PR) levels in breast cancer tissue were determined immunohistochemically. RESULTS Multivariate analysis confirmed the independent predictive value of both menopausal status and ER expression for overall survival (OS) (p=0.009, HR=1.92, and p=0.014, HR=0.20, respectively). A negative correlation was observed between COX-2 levels and the levels of ER and PR (p=0.006, R= -0.303, and p=0.004, R=-0.312, respectively) whereas no significant correlation was observed concerning CerbB2. No statistically significant correlation was determined between COX-2 levels and the disease-free (DFS) and OS rates. CONCLUSION Further studies investigating the role of COX- 2 levels in breast cancer progression are needed.
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Affiliation(s)
- A Kargi
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
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Geredeli C, Artac M, Yildirim S, Dede I, Inal A, Guler T, Boruban MC, Zamani AG, Bozcuk H, Demirkazik A. The prognostic role of XRCC1, ERCC1, ERCC2, and TP53 single nucleotide polymorphisms (SNPs) in resected non-small cell lung cancer (NSCLC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e18521] [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
e18521 Background: Identification of biomarkers that can be used for the prognostic evaluation of NSCLC patients is important. The aim of this study was to evaluate the potential prognostic value of XRCC1, ERCC1, ERCC2 and, TP53 SNPs in completely resected NSCLC patients. Methods: In total 130 patients, who had been surgically treated for NSCLC between 2000 and 2012, were included in this study. Analysis of SNPs from peripheral blood cells was performed by polymerase chain reaction. XRCC1 Arg399Gln, ERCC1 Asn118Asn, ERCC2 Lys751Gln and, TP53 Arg72Pro polymorphisms were evaluated in conjunction with clinical and pathological parameters and survival. Kaplan-Meier method and Cox regression analysis were used. Results: In the univariate analysis for disease free survival (DFS) post operative stage (HR,0.50; 95%CI, 0.26-0.96; P=0.03), ERCC2 genotype (HR, 2.47; 95%CI, 1.28-4.78; P=0.007) and PET-CT staging (HR, 0.27;95%CI, 0.14-0.52; P<0.001) were significant parameters. Adjuvant chemotherapy, age and the other SNPs were not significant. In the multivariate analysis post operative stage (HR, 0.40;95%CI, 0.20-0.81; P=0.01), ERCC2 genotype (HR, 2.66;95%CI, 1.35-5.27; P=0.005), PET-CT staging (HR, 0.24;95%CI, 0.12-0.47; P<0.001) retained their significance. The median DFS was 56.5 months (95%CI, 24.6-88.4 months) for the ERCC2 mutant (TT) and heterozygote (GT) genotypes, and 28.3 months (95%CI, 20.8-35.8 months) for the ERCC2 normal (GG) genotype (P=0.005). Conclusions: In addition to stage and PET-CT staging, ERCC2 genotype independently predicted DFS in resected NSCLC patients. Future prospective studies are needed for the further evaluation of potential prognostic SNPs in resected NSCLC.
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Affiliation(s)
- Caglayan Geredeli
- Necmettin Erbakan University Meram Medical Faculty, Department of Medical Oncology, Konya, Turkey
| | - Mehmet Artac
- Necmettin Erbakan University Meram Medical Faculty, Department of Medical Oncology, Konya, Turkey
| | - Selman Yildirim
- Necmettin Erbakan University Meram Medical Faculty, Department of Genetics, Konya, Turkey
| | - Isa Dede
- Ankara University Medical Faculty Department of Medical Oncology, Ankara, Turkey
| | - Ali Inal
- Dicle University, Diyarbakir, Turkey
| | - Tunc Guler
- Necmettin Erbakan University Meram Medical Faculty, Department of Medical Oncology, Konya, Turkey
| | - Melih Cem Boruban
- Necmettin Erbakan University Meram Medical Faculty, Department of Medical Oncology, Konya, Turkey
| | - Ayse Gul Zamani
- Necmettin Erbakan University Meram Medical Faculty, Department of Genetics, Konya, Turkey
| | - Hakan Bozcuk
- Akdeniz University Medical Faculty Department of Medical Oncology, Antalya, Turkey
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Uysal M, Bozcuk H, Karakilinc H, Goksu S, Tatli AM, Gunduz S, Arslan D, Coskun HS, Savas B. Pesticides and Cancer: The First Incidence Study Conducted in Turkey. J Environ Pathol Toxicol Oncol 2013; 32:245-9. [DOI: 10.1615/jenvironpatholtoxicoloncol.2013008232] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
AIM The study was planned to determine the hope levels of people with cancer and the variables affecting hope. BACKGROUND Hope is essential for patient well-being and positively correlated with improved coping skill. DESIGN A descriptive and exploratory design. METHODS The study sample included 240 consecutive patients treated with chemotherapy and attending the Day Chemotherapy Unit of a University Hospital in Turkey. The study was conducted between December 2009-January 2010. Personal Information Form and Herth Hope Scale were used for data collection. The determinants and subscales of hope were evaluated with univariate and multivariate regression analyses. RESULTS These mean scores showed high levels of hope among the patients included in the study. It was found that net family income, knowledge level about the disease, feeling of improvement, perception of satisfactory family support by the patient, mouth ulcers, feeling anxious or worried and presence of fear were independently related with the total hope score. CONCLUSIONS The study results showed high levels of hope among the participating patients. It is concluded that physical, financial and psychological well-being and information and support needs are directly and independently related with hope in people with cancer. These findings support the need for clinicians to continue to practise and implement hope fostering/hindering interventions among their patients.
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Bozcuk H, Abali H, Coskun S. The correlates of benefit from neoadjuvant chemotherapy before surgery in non-small-cell lung cancer: a metaregression analysis. World J Surg Oncol 2012; 10:161. [PMID: 22877422 PMCID: PMC3463432 DOI: 10.1186/1477-7819-10-161] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 07/16/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although neoadjuvant chemotherapy (NCT) is widely used, it is not clear which subgroup of locally advanced non-small-cell lung cancer (NSCLC) patients should be treated with this approach, and if a particular benefit associated with NCT exists. In this study, we aimed to investigate the potential correlates of benefit from NCT in patients with NSCLC. METHODS All randomized clinical trials (RCTs) utilizing a NCT arm (without radiotherapy) versus a control arm before surgery were included for metaregression analysis. All regression analyses were weighed for trial size. Separate analyses were conducted for trials recruiting patients with different stages of disease. Previously published measures of treatment efficacy were used for the purpose of this study, regardless of being published in full text or abstract form. RESULTS A total of 14 RCTs, consisting of 3,615 patients, were selected. Histology, stage, various characteristics of the NCT protocol, and different trial features including trial quality score were not associated with the benefit of NCT. However, in trials of stage 3 disease only, there was a greater benefit in terms of reduction in mortality from NCT, if protocols with three chemotherapeutics were used (B = -0.18, t = -5.25, P = 0.006). CONCLUSIONS We think that patients with stage 3 NSCLC are served better with NCT before surgery if protocols with three chemotherapy agents or equally effective combinations are used. In addition, the effect of neoadjuvant chemotherapy is consistent with regard to disease and patient characteristics. This finding should be tested in future RCTs or individual patient data meta-analyses.
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Affiliation(s)
- Hakan Bozcuk
- Akdeniz University Hospital, Dept. of Medical Oncology, Antalya, Turkey
| | - Huseyin Abali
- Adana Başkent Hospital, Dept. of Medical Oncology, Adana, Turkey
| | - Senol Coskun
- Akdeniz University Hospital, Dept. of Medical Oncology, Antalya, Turkey
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Uysal M, Goksu SS, Coskun HS, Savas B, Ozdogan M, Bozcuk H. Intraarticular hemorrhage due to bevacizumab in a patient with metastatic colorectal cancer: a case report. J Med Case Rep 2012; 6:188. [PMID: 22776219 PMCID: PMC3464779 DOI: 10.1186/1752-1947-6-188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 05/11/2012] [Indexed: 01/22/2023] Open
Abstract
Introduction Bevacizumab is a monoclonal antibody against vascular endothelial growth factor. It is widely used in the treatment of metastatic colorectal cancer. It has some specific side effects including severe bleeding, wound healing problems, gastrointestinal perforation, proteinuria and hypertension. Case presentation We present the case of a 65-year old Asian man with synovial metastasis of the knee who experienced intraarticular hemorrhage after bevacizumab treatment. He presented with monoarthritis of the left knee. Conclusion Bevacizumab-related hemorrhage can cause serious morbidity and unusual sites of hemorrhage may be seen.
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Affiliation(s)
- Mukremin Uysal
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
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