Publications by authors named "Nedim Turan"

23 Publications

  • Page 1 of 1

Factors affecting the mortality rate of patients with cancer hospitalized with COVID-19: a single center's experience.

J Chemother 2021 May 25:1-10. Epub 2021 May 25.

Department of Medical Oncology, Health Science University Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey.

The main objective is to define the mortality of patients with cancer admitted to our hospital, their clinical and demographic characteristics, investigate the risk of COVID-19 for patients with cancer, and determine factors that affect the mortality rates of patients with cancer dying of COVID-19. A total of 2401 patients were admitted to our hospital with the diagnosis of COVID-19 from March 11th, 2020, to May 31st, 2020. Ninety-two out of a total of 112 cancer patients were included in this study based on the planned inclusion/exclusion criteria. The clinical, demographic, and laboratory features and treatments provided were studied, and their effect on mortality rates was analyzed. In our study the median age of the patients was 67 years, and 55.4% were male. More than half (56.5%) of our patients had metastasis. The mortality rate was 6.2% in the overall population with COVID-19, whereas it was 23.9% in patients with cancer. The mortality rate in patients with metastasis was statistically significantly higher compared with those without metastasis (34.0% vs. 10.3%  0.008). The mortality rate in patients still smoking was statistically significantly higher than in non-smokers (37.5% vs. 12.5%  0.033). The mortality rates of patients with high average C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and D-dimer levels were statistically significantly higher than in those without, and the mortality rates of patients with lower average albumin and hemoglobin levels were statistically significantly higher than those without ( 0.001,  0.006,  0.041,  0.001,  0.001, and  0.028, respectively). Having metastases concurrent with COVID-19 was a statistically significant factor predictive of prognosis. Also, high CRP, ferritin, LDH, and D-dimer, and low albumin and hemoglobin were related to increased mortality rates. The predictive and prognostic role of possible factors related to prognosis is still unknown and further large, multicenter prospective studies are needed to confirm these results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/1120009X.2021.1923153DOI Listing
May 2021

Does systemic anti-tumor therapy increase COVID-19 risk in patients with cancer?

J Oncol Pharm Pract 2021 May 7:10781552211015762. Epub 2021 May 7.

Department of Medical Oncology, Kartal Dr. Lütfi Kirdar City Hospital, Health Science University, İstanbul, Turkey.

Purpose: We aimed to determine the COVID-19 infection rate and determine the factors that affect hospitalization and prognosis in patients receiving systemic chemotherapy (CT), immunotherapy (IT) and molecular-targeted therapies at our hospital within three months after the onset of COVID-19 pandemic.

Materials And Methods: The patients who received systemic treatment at chemotherapy unit with diagnosis of cancer between 11 March 2020 and 11 June 2020 were included. The clinical and demographic characteristics of patients, the systemic treatments that they received (CT, IT, targeted therapies), and the stage of disease were determined. For the parameters that affect the hospitalization of COVID-19 infected patients were also determined.

Results: Among 1149 patients with cancer, 84 of them were infected with COVID-19, and the median age of infected patients was 61.0 (IQR: 21-84) and 60.7% of them were male. As a subtype of cancers lung cancer was more frequent in the patients who infected with COVID compared with non-infected ones and the difference was statistically significant when the underlying malignities were compared (32.1% vs 19.0%,  = 0.031). The hospitalization rate and receiving COVID-19 treatment were more frequent in metastatic patients who were receiving palliative therapy, and the difference was statistically significant ( = 0.01,  = 0.03). In our study, infection rate was similar among patients treated with CT, IT and CT plus targeted therapy; however, fewer COVID-19 infections were seen at patients who received only targeted therapy.

Conclusion: COVID-19 infection is more frequent in cancer patients and tends to be more severe in metastatic cancer patients receiving anticancer treatment, and the continuation of palliative cancer treatments in these patients may cause increased cancer and infection-related morbidity and mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/10781552211015762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107490PMC
May 2021

Does the efficacy of regorafenib differ in chemotherapy refractory metastatic colorectal cancer patients who had mucinous pathology compared to those who had non-mucinous pathology?

Curr Probl Cancer 2021 Jun 22;45(3):100670. Epub 2020 Oct 22.

Department of Medical Oncology, Health Science University Kartal Dr. LütfiKırdar Training and Research Hospital, İstanbul, Turkey.

Purpose: To investigate the importance of mucinous histopathology on the assessment of tumor response in patients with metastatic colorectal cancer (mCRC) receiving regorafenib.

Materials And Method: All patients diagnosed with histologically confirmed mCRC in 2 oncology centers between 2013 and 2018 were retrospectively analyzed. Among 678 patients diagnosed with mCRC, 103 patients were treated with regorafenib. Ninety-four of these patients who had used at least 2 cycles of regorafenib and evaluable for treatment response were included in the analysis. Histopathologically, 18 patients with mucinous adenocarcinoma and 76 patients with nonmucinous adenocarcinoma were compared in terms of response rate and survival durations.

Results: Median follow-up duration of 6 months, median age of the patients was 61 (34-77) years. While 19.1% of the patients had mucinous histology, 80.9% had nonmucinous histology. The overall response rate was significantly lower in the mucinous subgroup than the nonmucinous subgroup (5.6% vs 43.4%, respectively, P = 0.003). Similarly, both progression-free survival (3.0 vs 4.0 months, respectively, P = 0.011) and overall survival duration were shorter in the mucinous subgroup (3.0 vs 7.0 months, P = 0.016, respectively) compared with the nonmucinous subgroup.

Conclusion: The histological subgroup may predict tumor response in mCRC patients receiving regorafenib. Its efficacy on nonmucinous histology had significantly more favorable than mucinous subtype.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.currproblcancer.2020.100670DOI Listing
June 2021

Is eribulin treatment prognostic factor in patients with metastatic breast cancer treated with this drug? Retrospective analysis of a multicentre study.

J BUON 2020 Mar-Apr;25(2):641-647

Mersin City Hospital, Department of Medical Oncology, Mersin, Turkey.

Purpose: This study aimed to analyze prognostic factors for survival and the reliability and the effectiveness of eribulin therapy in metastatic breast cancer (MBC) patients.

Methods: A total of 80 patients treated with eribulin in 12 medical oncology centers in Turkey between 2013-2017 were retrospectively evaluated. Sixteen potential prognostic variables were assessed for analysis.

Results: The patients had received a median of 5 prior chemotherapy regimens and a median of 3 eribulin cycles for MBC. Median progression-free survival (PFS) was 5.5 months (95% Cl: 4.1-7.8) and median overall survival (OS) was 11 months (95 % Cl: 6-15). Multivariate analysis showed that eribulin treatment line was shown to have independent prognostic significance for PFS. PFS difference was demostrated in patients who received 3 chemotherapy lines for advanced disease compared to those who had more than 3 chemotherapy lines [median PFS; 3 lines: 8.6 months (6.2-11) and ˃3 lines: 4.6 months (3.7-4.6) p=0.00]. The clinical benefit rate (CBR) was 52.5 and 35% in patients treated with three lines and with ˃3 previous chemotherapeutic regimens. Most common toxicities were neutropenia (62.5%), fatigue (52.5%), alopecia (50%) and nausea (37.5%).

Conclusions: Eribulin treatment line was identified as indepedent prognostic factor for PFS in MBC patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2021

Prognostic factors of ado-trastuzumab emtansine treatment in patients with metastatic HER-2 positive breast cancer.

J Oncol Pharm Pract 2021 Apr 19;27(3):547-554. Epub 2020 May 19.

Department of Medical Oncology, Istanbul Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey.

Background: Ado-trastuzumab emtansine is an antibody-drug conjugate that combines the cytotoxic activity of emtansine with human epidermal growth factor receptor 2-targeted antitumor features of trastuzumab.

Objective: We conducted a study of metastatic breast cancer patients treated with trastuzumab emtansine. By evaluating progression-free survival, overall survival, and response rates, we aimed to find prognostic factors of trastuzumab emtansine treatment.

Methods: Our study is a single-center, retrospective, observational study. We have clinical data from 78 patients treated with trastuzumab emtansine for metastatic breast cancer, from May 2016 through May 2019, at Kartal Dr Lutfi Kirdar Education and Research Hospital, Medical Oncology Department. Our objective is to assess the survival and response rates in trastuzumab emtansine-treated individuals and the factors associated with survival. The factors we analyzed were cancer antigen 15-3 sensitivity, Eastern Cooperative Oncology Group-Performance Status, presence or absence of visceral metastases, presence or absence of cranial metastases, and treatment-associated thrombocytopenia.

Results: Among 78 patients, median progression-free survival was 7.8 months, and overall survival was 21.1 months. Twenty of the patients had an objective tumor response. The results showed that trastuzumab emtansine was tolerable with a manageable safety profile and consistent with the results of the previous literature. Mostly seen adverse events were anemia, thrombocytopenia, fatigue, and increased levels of alkaline phosphatase. Patients with Eastern Cooperative Oncology Group-Performance Status = 2 had worse progression-free survival and overall survival compared to ones with Eastern Cooperative Oncology Group-Performance Status < 2; progression-free survival and overall survival are worse in cancer antigen 15-3-sensitive breast cancer patients. According to our findings, treatment-associated thrombocytopenia was a significant prognostic factor for survival. Patients with thrombocytopenia had 12 months progression-free survival, whereas patients without thrombocytopenia had only 4.1 months progression-free survival. In like manner, overall survival was much better in the thrombocytopenia-experienced patients as 29.5 versus 11.8 months.

Conclusions: Trastuzumab emtansine prolongs progression-free survival and overall survival with a manageable safety profile. Thrombocytopenia, Eastern Cooperative Oncology Group-Performance Status, and cancer antigen 15-3 are correlated with progression-free survival and/or overall survival.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1078155220924088DOI Listing
April 2021

Is eribulin treatment prognostic factor in patients with metastatic breast cancer treated with this drug? Retrospective analysis of a multicentre study.

J BUON 2019 Sep-Oct;24(5):1876-1883

Mersin City Hospital, Department of Medical Oncology, Mersin, Turkey.

Purpose: This study aimed to analyze prognostic factors for survival and the reliability and the effectiveness of eribulin therapy in metastatic breast cancer (MBC) patients.

Methods: A total of 80 patients treated with eribulin in 12 medical oncology centers in Turkey between 2013-2017 were retrospectively evaluated. Sixteen potential prognostic variables were assessed for analysis.

Results: The patients had received a median of 5 prior chemotherapy regimens and a median of 3 eribulin cycles for MBC. Median progression-free survival (PFS) was 5.5 months (95% Cl: 4.1-7.8) and median overall survival (OS) was 11 months (95 % Cl: 6-15). Multivariate analysis showed that eribulin treatment line was shown to have independent prognostic significance for PFS. PFS difference was demostrated in patients who received 3 chemotherapy lines for advanced disease compared to those who had more than 3 chemotherapy lines [median PFS; 3 lines: 8.6 months (6.2-11) and ˃3 lines: 4.6 months (3.7-4.6) p=0.00]. The clinical benefit rate (CBR) was 52.5 and 35% in patients treated with three lines and with ˃3 previous chemotherapeutic regimens. Most common toxicities were neutropenia (62.5%), fatigue (52.5%), alopecia (50%) and nausea (37.5%).

Conclusions: Eribulin treatment line was identified as indepedent prognostic factor for PFS in MBC patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2020

Retrospective evaluation of patients diagnosed solid pseudopapillary neoplasms of the pancreas.

Curr Probl Cancer 2019 02 19;43(1):27-32. Epub 2018 Jul 19.

Department of Medical Oncology, Faculty of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey.

Purpose: Solid pseudopapillary neoplasm (SPN) is a rare, low-grade neoplasm with excellent prognosis. In this study, we evaluated clinicopathological characteristics of patients diagnosed with SPN retrospectively.

Methods: This is a retrospective study intended to characterize patients with the diagnosis of SPN between 2005 and 2015. Clinicopathological features, recurrence rate, and overall survival of 28 patients were recorded. Malignant SPN criteria were defined as the presence of distant metastasis (developed at diagnosis or during follow up) or lymph node involvement.

Results: The mean age at diagnosis was 42 (range: 17-41). Among patients, 82% (n = 23) were female and 17.9% (n = 5) were male. The mean size of tumor was 5.81 cm (range: 2-15). The mean follow up period was 55.6 months, 1-year survival was 96.5% and 5-year survival rate was 88%. A total of 25 patients were alive at the end of follow-up period and 3 of the patients became exitus due to disease. Two patients had a metastatic presentation in livers at the diagnosis and metastasis developed in 3 patients during follow-up (liver of 1 patient, peritoneum in 1 patient and liver and peritoneum in 1 patient). The reason of admission was headache in 68% patients. The type of operation was frequently subtotal pancreatectomy (n = 11, 39.3%) and distal pancreatectomy (n = 10, 35.7%). Tumors were located frequently in body and tail regions (n = 18, 64.3%) and the number of patients with malignant criteria was 6 (21.4%). Although the mean age of malignant patients was significantly higher than benign patients (P = 0.046), there was no significant difference between 2 groups in terms of gender, tumor size, capsule invasion, perineural invasion, vascular invasion, and margin status.

Conclusion: SPN is a rarely seen tumor with low malignity potential. Surgical resection provides long-term survival rate even in local invasion or metastasis conditions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.currproblcancer.2018.06.014DOI Listing
February 2019

Prognostic Factors in Stage III Non-Small-Cell Lung Cancer Patients

Asian Pac J Cancer Prev 2016 10 1;17(10):4693-4697. Epub 2016 Oct 1.

Acıbadem Hospitals Group, Birsen Yücel, Kayseri, Turkey. Email:

Aim: The objective of this study is to investigate prognostic factors affecting survival of patients undergoing concurrent or sequential chemoradiotherapy (CRT) for stage III non-small-cell lung cancer (NSCL). Methods and materials: We retrospectively reviewed the clinical records of 148 patients with advanced, inoperable stage III NSCLC, who were treated between 2007 and 2015. Results: The median survival was found to be 19 months and 3-year overall survival was 27%. Age (<65 vs ≥65 years, p=0.026), stage (IIIA vs IIIB, p=0.033), dose of radiotherapy (RT) (<60 vs ≥60 Gy, p=0.024) and treatment method (sequential chemotherapy+RT vs concurrent CRT , p=0.023) were found to be factors affecting survival in univariate analyses. Gender, histological subtype, weight loss during CRT, performance status, induction/consolidation chemotherapy and presence of comorbidities did not affect survival (p>0.050). Conclusion: Young age, stage IIIA, radiotherapy dose and concurrent chemoradiotherapy may positively affect survival in stage III NSCL cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454619PMC
http://dx.doi.org/10.22034/apjcp.2016.17.10.4693DOI Listing
October 2016

Outcomes of surveillance versus adjuvant chemotherapy for patients with stage IA and IB nonseminomatous testicular germ cell tumors.

World J Urol 2017 Jul 3;35(7):1103-1110. Epub 2016 Nov 3.

Department of Medical Oncology, Medical Faculty, Gaziantep University, Gaziantep, Turkey.

Background: Currently, it is accepted that risk assessment of clinical stage I (CS I) nonseminomatous germ cell tumors (NSGCT) patient is mainly dependent on the presence of lymphovascular invasion (LVI). Initial active surveillance, adjuvant chemotherapy and retroperitoneal lymph node dissection (RPLND) are acceptable treatment options for these patients, but there is no uniform consensus. The purpose of this study was to compare outcomes of active surveillance with adjuvant chemotherapy.

Methods: A total of 201 patients with CS I NSGCT after orchiectomy were included. Outcomes of active surveillance and adjuvant chemotherapy were retrospectively analyzed. The prognostic significance of risk factors for survival and relapse was evaluated.

Results: Of the 201 patients, 110 (54.7%) received adjuvant chemotherapy, while the remaining 91 patients (45.3%) underwent surveillance. Relapses were significantly higher for patients underwent surveillance compared to adjuvant chemotherapy group (18.3 vs. 1.2%, p < 0.001). The 5-year relapse-free survival (RFS) rate for patients who were treated with adjuvant chemotherapy was significantly better than those of patients underwent surveillance (97.6 vs. 80.8%, respectively; p < 0.001). Univariate analysis showed that the presence of LVI (p = 0.01) and treatment option (p < 0.001) were prognostic factors for RFS and pT stage (p = 0.004) and invasion of rete testis (p = 0.004) and the presence of relapse (p < 0.001) were significant prognostic factors for OS. Multivariate analysis revealed that the treatment strategy was an independent prognostic factor for RFS (p < 0.001, HR 0.54). A logistic regression analysis demonstrated that treatment options (p = 0.031), embryonal carcinoma (EC) >50% (p = 0.013) and tumor diameter (p = 0.016) were found to be independent factors for predicting relapse.

Conclusions: Our results indicate that adjuvant chemotherapy is associated with improved RFS compared with surveillance for CS I NSGCT patients. Moreover, the treatment strategy is an important prognostic indicator for RFS and a predictive factor for relapse. Although adjuvant chemotherapy seems to be a suitable treatment for patients with risk factors for relapse, surveillance is still preferred management option.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00345-016-1964-6DOI Listing
July 2017

Impact of adjuvant treatment modalities on survival outcomes in curatively resected pancreatic and periampullary adenocarcinoma.

Chin J Cancer Res 2015 Aug;27(4):408-16

1 Department of Medical Oncology, Faculty of Medicine, Cumhuriyet University, Sivas 58140, Turkey ; 2 Department of Medical Oncology, Faculty of Medicine, Gazi University, Ankara 06560, Turkey ; 3 Department of Medical Oncology, Faculty of Medicine, Dokuz EylulUniversity, Izmir 35340, Turkey ; 4 Department of Medical Oncology, Faculty of Medicine, Necmettin Erbakan University, Konya 42080, Turkey ; 5 Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul 34000, Turkey ; 6 Department of Radiation Oncology, Faculty of Medicine, Gazi University, Ankara 06560, Turkey ; 7 Department of Medical Oncology, Numune Education and Research Hospital, Ankara 06100 Turkey ; 8 Department of Medical Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon 61000, Turkey ; 9 Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne 22020, Turkey ; 10 Department of Medical Oncology, Rize Education and Research Hospital, Rize 53200, Turkey ; 11 Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakir 21280, Turkey ; 12 Department of Medical Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul 34668, Turkey ; 13 Department of Medical Oncology, Sakarya Education and Research Hospital, Sakarya 54050, Turkey ; 14 Department of MedicalOncology, Faculty of Medicine, Pamukkale University, Denizli 20070, Turkey ; 15 Department of Medical Oncology, Faculty of Medicine, Inonu University, Malatya 44315, Turkey ; 16 Department of Medical Oncology, Faculty of Medicine, Firat University, Elazig 23200, Turkey ; 17 Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Education and Research Hospital, Ankara 06200, Turkey ; 18 Department of Medical Oncology, Faculty of Medicine, Yuzuncu Yil University, Van 65080, Turkey ; 19 Department of Medical Oncology, Faculty of Medicine, Erciyes University, Kayseri 38000, Turkey ; 20 Department of Medical Oncology, Faculty of Medicine, SutcuImam Univer

Background: We examined the impact of adjuvant modalities on resected pancreatic and periampullary adenocarcinoma (PAC).

Methods: A total of 563 patients who were curatively resected for PAC were retrospectively analyzed between 2003 and 2013.

Results: Of 563 patients, 472 received adjuvant chemotherapy (CT) alone, chemoradiotherapy (CRT) alone, and chemoradiotherapy plus chemotherapy (CRT-CT) were analyzed. Of the 472 patients, 231 were given CRT-CT, 26 were given CRT, and 215 were given CT. The median recurrence-free survival (RFS) and overall survival (OS) were 12 and 19 months, respectively. When CT and CRT-CT groups were compared, there was no significant difference with respect to both RFS and OS, and also there was no difference in RFS and OS among CRT-CT, CT and CRT groups. To further investigate the impact of radiation on subgroups, patients were stratified according to lymph node status and resection margins. In node-positive patients, both RFS and OS were significantly longer in CRT-CT than CT. In contrast, there was no significant difference between groups when patients with node-negative disease or patients with or without positive surgical margins were considered.

Conclusions: Addition of radiation to CT has a survival benefit in patients with node-positive disease following pancreatic resection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3978/j.issn.1000-9604.2015.08.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560744PMC
August 2015

The impact of immunohistochemical staining with ezrin-carbonic anhydrase IX and neuropilin-2 on prognosis in patients with metastatic renal cell cancer receiving tyrosine kinase inhibitors.

Tumour Biol 2015 Nov 31;36(11):8471-8. Epub 2015 May 31.

Department of Internal Medicine, Division of Medical Oncology, Gazi University Faculty of Medicine, Ankara, Turkey.

The identification of prognostic factors in patients with renal cell carcinoma (RCC) represents an area of increasing interest. In this retrospective study, we evaluated the prognostic role of carbonic anhydrase-IX, ezrin, and neuropilin in metastatic RCC patients. The expression of several biomarkers were measured by immunohistochemistry (IHC) in 45 patients with advanced stage RCC treated with second-line tyrosine kinase inhibitors (TKIs) targeting vascular endothelial growth factor (VEGF) after failure of interferon-alpha between January 2007 and June 2012. Kaplan-Meier curves and log-rank tests were used for analysis of progression-free survival (PFS) and overall survival (OS), and a multivariate Cox proportional hazard model was employed to identify factors with an independent effect on the survival. Age, ezrin and neuropilin-2 overexpression were found to be statistically significant factors (P < 0.05) for PFS in the univariate analysis. Ezrin and neuropilin-2 overexpression, hemoglobin and albumin level were statistically significant factors (P < 0.05) for OS in the univariate analysis. Multivariate analysis revealed that low expression of ezrin and neuropilin-2 was an independent prognostic factor for PFS and OS. The median PFS was 4 months for patients overexpressing neuropilin-2 versus 11 months for those with lower expression of neuropilin-2 (p = 0.033). The median OS was longer in patients with low levels of neuropilin-2 expression (26 months) compared to patients overexpressing neuropilin-2 (13 months) (p = 0.023). Increased expression of ezrin was associated with poor prognosis in patients treated with TKIs targeting VEGF (PFS, 3 vs 7 months; p = 0.012). High ezrin expression was associated with shorter OS (p = 0.009). This is the first study in the literature showing that neuropilin-2 and ezrin are related with prognosis in patients with advanced RCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13277-015-3589-6DOI Listing
November 2015

KRAS discordance between primary and metastatic tumor in patients with metastatic colorectal carcinoma.

J BUON 2015 Jan-Feb;20(1):128-35

1Dr.Abdurahman Yurtarslan Oncology Hospital, Department of Medical Oncology, Ankara, Turkey.

Purpose: Adding targeted therapies to chemotherapy in metastatic colorectal cancer (CRC) improves response rates and survival. KRAS is a predictive indicator for anti-epidermal growth factor receptor (EGFR) treatments. The most important reasons for KRAS discordance are intratumoral heterogeneity and incorrect mutation analysis. Evaluating the status of KRAS in primary and metastatic lesions becomes even more crucial to ensure efficient usage of anti-EGFR treatments.

Methods: Patients with metastatic CRC, whose primary disease and liver and/or lung metastases were operated, were retrospectively evaluated, and KRAS assessment was performed on 31 patients who were suitable for DNA analysis. Pyrosequencing with polymerase chain reaction (PCR) was used for KRAS analysis.

Results: The median age of 31 patients diagnosed with rectal cancer (N=13) and colon cancer (N=18) was 63 years (range 33-73). Metastasectomy locations included the liver (N=27), lung (N=3), and both lung and liver (N=1). KRAS discordance was detected in 22% (7/31) of the patients. While 3 patients with detected discordance had mutated KRAS in the primary material, wild type KRAS was detected in their liver or lung lesions. On the other hand, while 4 patients had wild type KRAS in the primary material, mutated KRAS was determined in their liver or lung lesions. The McNemar test revealed no significant discordance between primary and metastatic disease (p=1.00). No progression free survival (PFS) difference was detected between patients with determined discordance and patients with undetermined discordance (10.6 vs 14.7 months, p=0.719).

Conclusion: This is the first study to evaluate KRAS discordance between primary and metastasis in CRC patients, who underwent metastasectomy, together with survival data. In the literature and recent studies with large patient numbers in which modern KRAS tests were used, the KRAS discordance rate varies between 3-12%. In our study, a higher KRAS discordance (22%) was detected, and no survival difference was determined between patients with or without discordance. In recent years, the rising interest in borderline resectable disease may bring forward discussions related to which material the KRAS status should be analyzed.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2015

Prognostic factors and adjuvant treatments for surgically treated cancers of the biliary tract: a multicentre study of the Anatolian Society of Medical Oncology (ASMO).

Asian Pac J Cancer Prev 2014 ;15(22):9687-92

Department of Medical Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey E-mail :

Background: Biliary tract cancers are rare, and surgical resection is the standard treatment at early stages. However, reports on the benefits of adjuvant treatment following surgical resection are conflicting. This study aimed to evaluate the factors affecting survival and adjuvant treatments in patients with surgically treated biliary tract cancers.

Materials And Methods: Patient clinical features, adjuvant treatments, and efficacy and prognostic factor data were evaluated. Survival analyses were performed using SPSS 15.0.

Results: The median overall survival was 30.7 months (95% confidence interval [CI], 18.4-42.9 months). Median survival was 19 months (95% CI, 6-33) for patients treated with fluorouracil based chemotherapy and 53 months (95% CI, 33.2-78.8) with gemcitabine based chemotherapy (p=0.033). On univariate analysis, poor prognostic factors for survival were galbladder localization, perineural invasion, hepatic invasion, a lack of adjuvant chemoradiotherapy treatment, and a lack of lymph node dissection. On multivariate analysis, perineural invasion was a poor prognostic factor (p=0.008).

Conclusions: Biliary tract cancers generally have poor prognoses. The main factors affecting survival are tumour localization, perineural invasion, hepatic invasion, adjuvant chemoradiotherapy, and lymph node dissection. Gemcitabine-based adjuvant chemotherapy is more effective than 5-fluorouracil-based chemotherapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7314/apjcp.2014.15.22.9687DOI Listing
August 2015

Adjuvant systemic chemotherapy with or without bevacizumab in patients with resected pulmonary metastases from colorectal cancer.

Thorac Cancer 2014 Sep 25;5(5):398-404. Epub 2014 Aug 25.

Department of Medical Oncology, Gazi University Faculty of Medicine Ankara, Turkey.

Introduction: We investigated the impact of modern chemotherapy regimens and bevacizumab following pulmonary metastasectomy (PM) from metastatic colorectal cancer (CRC).

Methods: A total of 122 consecutive patients who were curatively resected for pulmonary metastases of CRC in twelve oncology centers were retrospectively analysed between January 2000 and April 2012.

Results: Of 122 patients, 14 did not receive any treatment following PM. The remaining 108 patients received fluoropyrimidine-based (n = 12), irinotecan-based (n = 56) and oxaliplatin-based (n = 40) chemotherapy combinations. Among these, 52 patients received bevacizumab (BEV) while 56 did not (NoBEV). Median recurrence-free survival (RFS) was 17 months and median overall survival (OS) has not been reached at a median follow-up of 25 months after PM. Three and five-year OS rates were 66% and 53%, respectively. RFS and OS were similar, irrespective of the chemotherapy regimen or BEV use. Positive pulmonary margin, KRAS mutation status, and previous liver metastasectomy were negative independent prognostic factors for RFS, while pathologically confirmed thoracic lymph node involvement was the only negative independent prognostic for OS in multivariate analysis.

Conclusions: No significant RFS or OS difference was observed in respect to chemotherapy regimens with or without BEV in patients with pulmonary metastases of CRC following curative resection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/1759-7714.12107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4704370PMC
September 2014

Multicenter epidemiologic study on hepatocellular carcinoma in Turkey.

Asian Pac J Cancer Prev 2014 ;15(6):2923-7

Department of Medical Oncology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey E-mail :

Background: Hepatocellular cancer (HCC) is one of the important health problems in Turkey, being very common and highly lethal. The aim of this study was to determine clinical, demographic features and risk factors.

Materials And Methods: Nine hundred and sixth-three patients with HCC from 13 cities in Turkey were included in this study.

Results: Only 205 (21%) of the 963 patients were women, with a male:female predominance of 4.8:1 and a median age of 61 years. The etiologic risk factors for HCC were hepatitis B in 555 patients (57.6%), 453 (81%) in men, and 102 (19%) in women, again with male predominance, hepatitis C in 159 (16.5%), (14.9% and 22.4%, with a higher incidence in women), and chronic alcohol abuse (more than ten years) in 137 (14.2%) (16.8% and 4.9%, higher in males). The Child-Pugh score paralleled with advanced disease stage amd also a high level of AFP.

Conclusions: According to our findings the viral etiology (hepatitis B and hepatitis C infections) in the Turkish population was the most important factor in HCC development, with alcohol abuse as the third risk factor. The Child-Pugh classification and AFP levels were determined to be important prognostic factors in HCC patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7314/apjcp.2014.15.6.2923DOI Listing
January 2015

Prognostic factors for lymph node negative stage I and IIA non-small cell lung cancer: multicenter experiences.

Asian Pac J Cancer Prev 2013 ;14(11):6287-92

Department of Medical Oncology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey E-mail :

Background: Surgery is the only curative treatment for operable non-small lung cancer (NSCLC) and the importance of adjuvant chemotherapy for stage IB patients is unclear. Herein, we evaluated prognostic factors for survival and factors related with adjuvant treatment decisions for stage I and IIA NSCLC patients without lymph node metastasis.

Materials And Methods: We retrospectively analyzed 302 patients who had undergone curative surgery for prognostic factors regarding survival and clinicopathological factors related to adjuvant chemotherapy.

Results: Nearly 90% of the patients underwent lobectomy or pneumonectomy with mediastinal lymph node resection. For the others, wedge resection were performed. The patients were diagnosed as stage IA in 35%, IB in 49% and IIA in 17%. Histopathological type (p=0.02), tumor diameter (p=0.01) and stage (p<0.001) were found to be related to adjuvant chemotherapy decisions, while operation type, lypmhovascular invasion (LVI), grade and the presence of recurrence were important factors in predicting overall survival (OS), and operation type, tumor size greater than 4 cm, T stage, LVI, and visceral pleural invasion were related with disease free survival (DFS). Multivariate analysis showed operation type (p<0.001, hazard ratio (HR):1.91) and the presence of recurrence (p<0.001, HR:0.007) were independent prognostic factors for OS, as well visceral pleural invasion (p=0.01, HR:0.57) and LVI (p=0.004, HR:0.57) for DFS.

Conclusions: Although adjuvant chemotherapy is standard for early stage lymph node positive NSCLC, it has less clear importance in stage I and IIA patients without lymph node metastasis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7314/apjcp.2013.14.11.6287DOI Listing
January 2015

Large cell neuroendocrine carcinoma: retrospective analysis of 24 cases from four oncology centers in Turkey.

Thorac Cancer 2013 05;4(2):161-166

Department of Medical Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey Department of Medical Oncology, Ankara Oncology Hospital, Ankara, Turkey Department of Medical Oncology, Atatürk Education and Research Hospital, Ankara, Turkey Department of Medical Oncology, Gazi University Medical Faculty, Ankara, Turkey.

Background: Large cell neuroendocrine carcinoma (LCNEC) of the lung is classified as a variant of large cell lung carcinoma by the World Health Organization, however, the clinical and biological behavior of LCNEC resembles small cell lung carcinoma (SCLC) with a high mitotic index and a positivity of tumor cells with neuroendocrine markers. As there have only been a small number of patients with LCNEC recorded in literature, there is no consensus about the management of this subset. In the present study, we evaluated the incidence and prognosis of LCNEC in four oncology centers in Turkey.

Method: We analyzed 24 patients with diagnoses of LCNEC from 3138 non-small cell lung cancer patients who were diagnosed and treated between 2008 and 2010 in four different medical oncology centers in Turkey.

Results: The median age was 56 (range; 36-64) and most patients were male, with three women included in the study. Ten out of 24 patients (41.6%) had locally advanced or metastatic disease, therefore, surgery could not be performed. Five patients (20.8%) were staged with stage I, six (25%) with stage II, five (20.8%) with stage III, and eight (33.3%) with stage IV. All patients had a history of smoking. Nine patients received chemotherapy postoperatively. At the 14.4-month follow-up period (range; 3-59) the median overall survival (OS) and progression-free survival (PFS) rates were 32.7 and 9.5 months respectively. Tumor, node, metastasis (TNM) stage, performance status (PS) and the performance of surgery were significantly related to rates of both OS and PFS (P < 0.05).

Conclusion: LCNEC was generally diagnosed postoperatively. Prognosis of LCNEC is poor and surgery has not proven an effective solution for long-term survival, therefore, adjuvant chemotherapy has been suggested.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1759-7714.2012.00129.xDOI Listing
May 2013

The role of positron emission tomography with 18F-fluorodeoxyglucose in nodal staging of clinical and radiological N₀ head and neck cancers.

Eur Arch Otorhinolaryngol 2013 Aug 3;270(8):2307-13. Epub 2013 Jan 3.

Division of Medical Oncology, Department of Internal Medicine, Gazi University Faculty of Medicine, Besevler, Ankara 06500, Turkey.

The objective of the study was to evaluate the impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) imaging on nodal staging for head and neck cancers. This was a retrospectively analyzed single institution study. The study population consisted of 36 patients with head and neck cancers who were evaluated with PET/CT and went on to neck dissection. All of them had clinically and radiographically negative neck (N₀) and each patient underwent PET/CT imaging before undergoing selective neck dissection for N₀ disease. Tissues were submitted for histopathologic examination and were oriented for the pathologist to permit correlation between the histopathologic findings and the imaging results. The sizes of the lymph nodes and the maximum standardized uptake values (SUVmax) measured from PET/CT images were compared with the histopathologic findings. All primary tumors were visualized with PET/CT. On histopathological examination, 19 patients had positive and 17 patients had negative lymph nodes. Receiver operating characteristic analyses were used to predict the optimal corrected SUVmax cutoffs; the optimal value was 2.95 for respective outcomes of lymph node involvement. This cutoff value yielded 84.2% sensitivity and 76.5% specificity for nodal-level staging. PET/CT proved to be accurate in 27 (75%) patients and inaccurate in 9 (25%) patients. PET/CT was a valuable tool to assess nodal stage of head and neck cancers, and should be considered before surgical treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00405-012-2337-4DOI Listing
August 2013

Adjuvant systemic chemotherapy with or without bevacizumab in patients with resected liver metastases from colorectal cancer.

Oncology 2013 16;84(1):14-21. Epub 2012 Oct 16.

Department of Medical Oncology, Gazi University Faculty of Medicine, Ankara, Turkey.

Background: We aimed to investigate the impact of adjuvant systemic therapy with modern chemotherapy combinations on survival outcomes in patients with resected liver-confined metastases from colorectal carcinomas, and whether addition of bevacizumab (BEV) provides further benefit.

Methods: A total of 229 consecutive patients who underwent resection for liver-confined colorectal liver metastases were retrospectively analyzed.

Results: Of 229 patients, 204 who received chemotherapy with fluoropyrimidine-based (n = 27), irinotecan-based (n = 84) and oxaliplatin-based (n = 93) combinations were analyzed. Among these, 87 patients received BEV while 117 did not (NoBEV). With a median follow-up of 27 months after metastasectomy, the median recurrence-free survival (RFS) and overall survival (OS) were 17 and 53 months, respectively. OS rates at 3 and 5 years were 71% and 40%, respectively. No significant differences were found in the median RFS (p = 0.744) and OS (p = 0.440) among different chemotherapy regimens. The median RFS (p = 0.375) and OS (p = 0.251) were similar in BEV and NoBEV arms. In multivariate analysis, having 4 liver metastases was the only negative independent factor on both RFS and OS, while positive surgical margin was another negative independent factor for RFS.

Conclusion: Chemotherapy type and addition of BEV have no impact on both RFS and OS in the adjuvant setting following complete resection of colorectal liver metastases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000342429DOI Listing
January 2013

Sunitinib- and sorafenib-induced nephrotic syndrome in a patient with gastrointestinal stromal tumor.

Ann Pharmacother 2012 Oct 2;46(10):e27. Epub 2012 Oct 2.

Gazi University Faculty of Medicine, Besevler, Ankara, Turkey.

Objective: To report a case of nephrotic syndrome (NS) induced by both sunitinib and sorafenib therapy.

Case Summary: A 61-year-old woman with metastatic gastrointestinal stromal tumor (GIST) presented with NS and hypertension following therapy with sunitinib 400 mg/day. Because of grade 3 toxicity, the drug was discontinued. After sunitinib discontinuation, NS and hypertension resolved. However, NS recurred on rechallenge. A similar picture developed following therapy with sorafenib 800 mg/day. A renal biopsy revealed a focal segmental glomerulosclerosis (FSGS). A few months after sorafenib cessation, resolution of NS and hypertension was again achieved.

Discussion: Several cases of NS have been reported among patients receiving sunitinib and sorafenib. However, renal histopathologic data were obtained in only a few patients. Although biopsy-proven cases of FSGS associated with sunitinib have been reported, this is, to our knowledge, the first reported case of biopsy-proven FSGS associated with sorafenib. The Naranjo probability scale indicated probable causality for NS developing with sorafenib, and definite causality with sunitinib. The clinical and histopathologic findings have led us to agree with the class effect proposal that all antiangiogenic drugs share a similar toxicity profile. Evidence supporting this hypothesis includes worsening of hypertension and proteinuria by both drugs, with full recovery occurring within a few months after cessation of the drugs, which favors the role of vascular endothelial growth factor receptor inhibition in FSGS development.

Conclusions: The clinical adverse spectrum of antiangiogenic drugs may be broader than initially observed because of a lack of renal biopsy data and routine screening for proteinuria. It can be speculated that proteinuria, as well as hypertension, is a class effect of all antiangiogenic drugs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1345/aph.1R160DOI Listing
October 2012

XELOX vs. FOLFOX4 as second line chemotherapy in advanced pancreatic cancer.

Hepatogastroenterology 2012 Nov-Dec;59(120):2635-9

Dept. of Medical Oncology, Erciyes University Medical Faculty, M. Kemal Dedeman Oncology Hospital, Kayseri, Turkey.

Background/aims: The efficacy and tolerability of oxaliplatin in combination with either folinic acid, fluoro-uracil (5-FU) (FOLFOX4 regimen) or capecitabine (XE-LOX regimen) was evaluated in advanced pancreatic cancer.

Methodology: In this study, eighty-five patients with advanced pancreatic cancer were enrolled after failing to gemcitabine-based chemotherapy between November 2005 and August 2011. FOLFOX4 was repeated every two weeks and XELOX regimen was repeated every three weeks until either disease progression or unacceptable toxicity occurred.

Results: Eighty-five patients were evaluated for tumor response.Seven patients (18%) achieved a partial response with XELOX and stable disease was observed in 16 patients (41%). Eight patients (17%) achieved a partial response with FOLFOX4 and stable disease was observed in 12 patients (26%). Disease control rates were 59%in the XELOX arm and 43% in the FOLFOX4 arm. The median time to progression was 16 weeks in both arms.The median overall survival was 21 weeks with XELOX and 25 weeks with FOLFOX4.

Conclusions: Oxaliplatin-based combination therapy showed moderate clinical activity with acceptable toxicity in patients who had progressive disease after receiving gemcitabine-based chemotherapy for advanced and/or metastatic pancreatic cancer. We conclude that XELOX is similar in terms of efficacy and toxicity profile to FOLFOX4 in the sec-ond-line treatment of metastatic pancreatic cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5754/hge12181DOI Listing
March 2013

The use of plasmapheresis for rapid hormonal control in severe hyperthyroidism caused by a partial molar pregnancy.

Arch Gynecol Obstet 2009 Apr 23;279(4):569-71. Epub 2008 Aug 23.

Department of Obstetrics and Gynaecology, Yuzuncu Yil University, Van, Turkey.

Introduction: The hormone human chorionic gonadotropin (hCG), secreted by molar tissue, is structurally similar to thyroid-stimulating hormone (TSH). Hyperthyroidism in trophoblastic disease is thought to be the result of TSH receptor activation by extremely elevated levels of hCG. Significant elevations in hCG levels are less common in cases of partial moles.

Materials And Methods: We describe a patient with partial molar pregnancy in which the levels of hCG and thyroid hormones were significantly high. It was not possible to decrease the elevated thyroid hormone concentrations to safer levels using medical treatment strategies only. Since the patient's vaginal bleeding increased gradually, plasmapheresis was used to rapidly control the thyroid hormones during the preoperative preparation of the patient for anesthesia and surgery. After the evacuation of the molar tissue, the levels of the thyroid hormones detected after the plasmapheresis started to decrease even further.

Conclusion: Plasmapheresis may be used as an alternative to antithyroid medication for the rapid control of thyroid hormones in cases of severe hyperthyroidism caused by molar pregnancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00404-008-0762-9DOI Listing
April 2009

Usefulness of pulsed-wave tissue Doppler echocardiography for the assessment of the left and right ventricular function in patients with clinical hypothyroidism.

Echocardiography 2006 Jul;23(6):471-7

Department of Cardiology, Inonu University, Faculty of Medicine, Turgut Ozal Medical Center, Malatya, Turkey.

Clinical hypothyroidism (HT) is often associated with cardiovascular disorders, such as endothelial and myocardial dysfunction. Previous studies have explored left ventricular (LV) function using pulsed-wave tissue Doppler echocardiography (TDE) in HT. However, no study has utilized this technique in the assessment of right ventricular (RV) function in HT. Accordingly, we investigated the effects of clinical HT on LV and RV function by TDE. The study subjects included 35 newly diagnosed HT patients and 32 healthy normal controls. For each subject, serum FT3, FT4, TT3, TT4, and thyroid stimulating hormone (TSH) levels were measured, and standard echocardiography and TDE were performed. No statistically significant difference was found between patients and controls with regard to age, gender, body mass index, heart rate, and blood pressure. Compared to controls, TSH levels were significantly higher, and TT4 and FT4 levels were significantly lower. TDE showed that patients had significantly lower early diastolic tricuspid annular velocity (Ea) and early/late (Ea/Aa) diastolic tricuspid annular velocity ratio (P < 0.001 and P < 0.001, respectively), and significantly longer isovolumetric relaxation time (P < 0.001) than those of the controls. Aa, Sa, isovolumetric contraction time, and ejection time did not significantly differ. In addition, a significant relationship between some TDE indexes, and thyroid hormones (TT4 and FT4) and TSH was observed. We showed that patients with clinical HT are associated with impaired RV diastolic function, in addition to impaired LV diastolic function using TDE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1540-8175.2006.00243.xDOI Listing
July 2006