Publications by authors named "Omer Dizdar"

122 Publications

Poorer baseline performance status is associated with increased thromboembolism risk in metastatic cancer patients treated with immunotherapy.

Support Care Cancer 2021 Sep 11;29(9):5417-5423. Epub 2021 Mar 11.

Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey.

Purpose: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in cancer patients. However, the association of VTE with immunotherapy remains poorly defined. We therefore evaluated the frequency of VTE in patients receiving immunotherapy and tried to determine predisposing factors.

Methods: A total of 133 adult metastatic cancer patients treated with immunotherapy for any cancer between were included. Baseline demographics, ECOG performance status, type of tumors, and baseline blood count parameters were recorded. Possible predisposing factors were evaluated with univariate and multivariate analyses.

Results: The median age was 60 (interquartile range (IQR) 48-66) years, and the median follow-up was 10.1 (IQR 5.8-18.5) months. Renal cell carcinoma (26.3%) and melanoma (24.1%) were most common diagnoses. Fifteen patients (11.3%) had an episode of VTE. Most of the VTEs were diagnosed as pulmonary emboli (10/15; 67%). Eighty percent (12/15) of these VTE cases were detected incidentally. Patients with a baseline ECOG performance status of 1 or more (29.3% of patients) had a significantly increased risk of venous thrombosis (ECOG ≥1 vs. 0, HR: 3.023, 95% CI: 1.011-9.039, p=0.048). Other factors, including patient age, tumor type, body mass index, baseline thrombocyte, neutrophil, and lactate dehydrogenase levels were not significantly associated with VTE risk.

Conclusions: In this study, we observed VTE development in more than 10% of immunotherapy-treated patients and increased VTE risk in patients with poorer ECOG status. With the asymptomatic nature of VTEs in most cases, a high index of suspicion level for VTE is required in patients treated with immunotherapy.
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http://dx.doi.org/10.1007/s00520-021-06139-3DOI Listing
September 2021

The Predictive Value of Red Blood Cell Distribution Width for Survival Outcomes of Metastatic Renal Cell Carcinoma Patients Treated with Targeted Therapy.

Nutr Cancer 2021 Jan 25:1-7. Epub 2021 Jan 25.

Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

Background: We aimed to investigate the prognostic value of red cell distribution width (RDW) in metastatic renal cell carcinoma (mRCC) patients treated with targeted therapy, including sunitinib and pazopanib.

Methods: A total of 104 mRCC patients were included. The Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS), and the long-rank test was used for comparison. Univariate and multivariate Cox proportional hazards models were used to determine the association between RDW and PFS and OS.

Results: The PFS and OS of all cohorts were 11.8 mo and 25.9 mo, respectively. Receiver operating characteristic analysis revealed that RDW level ≥15.4 was the optimal cutoff value for OS prediction with 73.53% sensitivity and 61.11% specificity (area under curve: 0.64,  = 0.012). RDW level ≥15.4 was found as an independent prognostic parameter for OS when adjusted for the number of covariates, including the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) scoring system (hazard ratio: 1.125, 95% confidence interval: 1.024-2.235,  = 0.014).

Conclusions: Our study revealed that high RDW level, a routinely and easily assessed marker, was significantly associated with worse survival outcomes in mRCC patients treated with targeted therapy.
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http://dx.doi.org/10.1080/01635581.2021.1871925DOI Listing
January 2021

Evaluation of early unplanned readmissions and predisposing factors in an oncology clinic.

Support Care Cancer 2021 Jul 6;29(7):4159-4164. Epub 2021 Jan 6.

Department of Medical Oncology, Hacettepe University Cancer Institute, 06100, Sıhhiye, Ankara, Turkey.

Background: Unplanned readmission in the first 30 days after discharge is an important medical problem, although the data on cancer patients is limited. So we planned to evaluate the rates and causes of early readmissions and the predisposing factors.

Methods: Patients hospitalized in Hacettepe University Oncology services between August 2018 and July 2019 were included. The demographic features, tumor stages, regular drugs, last laboratory parameters before discharge, and readmissions in the first 30 days after discharge were recorded. The predisposing features were evaluated with univariate and multivariate analyses.

Results: A total of 562 hospitalizations were included. The mean age of the patients was 58.5 ± 14.5 years. Almost 2/3 of the hospitalizations were due to symptom palliation and infections. Eighty-three percent of the patients had advanced disease, and over 60% had an ECOG score of 2 and above. In the first 30 days after discharge, 127 patients were readmitted (22.6%). Advanced stage disease, presence of polypharmacy (5 or more regular drugs), hospitalization setting (emergency department (ED) vs. outpatient clinic), and hypoalbuminemia (< 3 gr/dL) were associated with a statistically significant increase in the risk of readmission. Among these factors, advanced-stage disease (HR: 2.847, 95% CI: 1.375-5.895), hospitalization from ED (HR: 1.832, 95% CI: 1.208-2.777), and polypharmacy (HR: 1.782, 95% CI: 1.173-2.706) remained significant in multivariate analyses.

Conclusions: In this study, 22% of cancer patients had early readmissions. The readmission risk increased in patients with advanced disease, hospitalization from ED, and polypharmacy. The optimal post-discharge plan may reduce readmissions in all oncology patients, with priority for these patient groups.
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http://dx.doi.org/10.1007/s00520-020-05927-7DOI Listing
July 2021

Clinical features and outcomes of COVID-19 in patients with solid tumors: Turkish National Registry Data.

Int J Cancer 2020 Dec 7. Epub 2020 Dec 7.

Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

We present demographic, clinical, laboratory characteristics and outcomes of the patients with solid malignancies and novel coronavirus disease (COVID-19) collected from the National COVID-19 Registry of Turkey. A total of 1523 patients with a current or past diagnosis of solid tumors and diagnosed with COVID-19 (confirmed with PCR) between 11 March and 20 May 2020 were included. The primary outcome was 30-day mortality. Median age was 61 (range: 18-94), and 752 (49%) were male. The most common types of cancers were breast (19.8%), prostate (10.9%) and colorectal cancer (10.8%). 65% of the patients had at least one comorbidity. At least one COVID-19-directed therapy was given in 73% of the patients.. Hospitalization rate of the patients was 56.6% and intensive care unit admission rate was 11.4%. Seventy-seven (5.1%) patients died within 30 days of diagnosis. The first multivariate model which included only the demographic and clinical characteristics showed older age, male gender and presence of diabetes and receipt of cytotoxic therapy to be associated with increased 30-day mortality, while breast and prostate cancer diagnoses were associated with lower 30-day mortality. In the second set, we further included laboratory parameters. The presence of leukocytosis (OR 6.7, 95% CI 3.3-13.7, P < .001), lymphocytopenia (OR 3,1, 95% CI 1,6-6,1, P = .001) and thrombocytopenia (OR 3,4 95% CI 1,5-8,1, P = .005) were found to be associated with increased 30-day mortality. Relatively lower mortality compared to Western countries and China mainly results from differences in baseline risk factors but may also implicate the importance of intensive supportive care.
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http://dx.doi.org/10.1002/ijc.33426DOI Listing
December 2020

Comments on "Survival impact of adjuvant chemotherapy in patients with stage IIA colon cancer: Analysis of the National Cancer Database".

Authors:
Omer Dizdar

Int J Cancer 2021 02 7;148(4):1027. Epub 2020 Sep 7.

Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

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http://dx.doi.org/10.1002/ijc.33258DOI Listing
February 2021

Chemoimmunotherapy for the salvage treatment of Ewing sarcoma: A case report.

J Oncol Pharm Pract 2021 Jul 18;27(5):1281-1283. Epub 2020 Oct 18.

Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

Introduction: Although, immune check-point inhibitors changed the course of many cancers, the outcomes in sarcomas were rather disappointing with less than 10% response rates. Ewing sarcoma is a poorly differentiated and aggressive tumor mostly seen in the children and adolescents. It's a distinct type of sarcoma with prominent chemosensitivity in the early stages. However, the relapsing disease has a poor prognosis with limited treatment options.

Case Report: Herein, we represent a case of relapsed Ewing sarcoma treated with multiple lines of chemotherapy. The patient had a very good response to salvage treatment with a combination of paclitaxel and nivolumab which lasted for twelve months after the cessation of treatment.

Discussion: We think that chemotherapy plus immunotherapy can be an option for Ewing sarcoma patients treated with multiple lines of chemotherapy.
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http://dx.doi.org/10.1177/1078155220965677DOI Listing
July 2021

Predictive biomarkers for immunotherapy efficacy in non-small-cell lung cancer: current status and future perspectives.

Biomark Med 2020 10 16;14(14):1383-1392. Epub 2020 Oct 16.

Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

In recent years, immune checkpoint inhibitors have rapidly changed treatment paradigms and have been pivotal for the treatment of advanced NSCLC patients. However, many patients don't respond to immunotherapy, and toxicities are a concern. Mounting evidence suggests that PD-L1 expression and tumor mutational burden are useful biomarkers in NSCLC and widely used in clinical practice. Given various limitations of PD-L1 and tumor mutational burden, many candidate biomarkers have emerged. From these biomarkers, peripheral blood-based biomarkers are promising options for the prediction of immunotherapy efficacy with ease of access, repeatability and low cost. This review provides an overview of recent developments on the biomarkers in immunotherapy efficacy together with comments on future perspectives.
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http://dx.doi.org/10.2217/bmm-2020-0310DOI Listing
October 2020

All Positives May Not Be the Same in Pancreatic Cancer: Lessons Learned From the Past.

Am J Clin Oncol 2020 09;43(9):676

Department of Medical Oncology Hacettepe University Cancer Institute Ankara, Turkey.

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http://dx.doi.org/10.1097/COC.0000000000000723DOI Listing
September 2020

Evaluation of emergency departments visits in patients treated with immune checkpoint inhibitors.

Support Care Cancer 2021 Apr 26;29(4):2029-2035. Epub 2020 Aug 26.

Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

Background: The emergency department (ED) is a crucial encounter point in cancer care. Yet, data on the causes of ED visits are limited in patients treated with immune checkpoint inhibitors (ICI). Therefore, we evaluated ED visits in patients treated with ICIs in attempt to determine the predisposing factors.

Methods: We performed a retrospective chart review on adult cancer patients treated with ICIs for any type of cancer in the Hacettepe University Cancer Center. The data on ED visits after the first dose of ICIs to 6 months after the last cycle of ICIs were collected.

Results: A total of 221 patients were included in the study. The mean age was 58.46 ± 13.87 years, and 65.6% of patients were males. Melanoma was the most common diagnosis (27.6%), followed by kidney and lung cancers. Eighty-three of these patients (37.6%) had at least one emergency department (ED) visit. Most of the ED visits were related to symptoms attributable to the disease burden itself, while immune-related adverse events comprised less than 10% of these visits. While baseline Eastern Cooperative Oncology Group performance status, age, polypharmacy, concomitant chemotherapy, eosinophilia, and lactate dehydrogenase levels did not significantly increase the risk, patients with regular opioid use and baseline neutrophilia (> 8000/mm) had a statistically significant increased risk of visiting the ED (p = 0.001 and 0.19, respectively). These two factors remained significant in the multivariate analyses.

Conclusion: In this study, almost 40% of ICI-treated patients had ED visits. Collaboration with other specialties like emergency medicine is vital for improving the care of patients receiving immunotherapy.
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http://dx.doi.org/10.1007/s00520-020-05702-8DOI Listing
April 2021

COVID-19 pandemic: changes in cancer admissions.

BMJ Support Palliat Care 2020 Jul 14. Epub 2020 Jul 14.

Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey.

Background: COVID-19 pandemic could create a collateral damage to cancer care denoting disruptions in care due to a significant burden on healthcare and resource allocations. Herein, we evaluate the early changes in the inpatient and outpatient oncology clinics to take a snapshot of this collateral damage at Hacettepe University Cancer Institute.

Methods: Patients applying the outpatient clinic and outpatient palliative care (OPC) clinic for the first time and patients admitted to inpatient wards in the first 30 days after the first case of COVID-19 in Turkey were evaluated. These data were compared with data from the same time frame in the previous 3 years.

Results: The mean number of daily new patient applications to the outpatient clinic (9.87±3.87 vs 6.43±4.03, p<0.001) and OPC clinic (3.87±1.49 vs 1.13±1.46, p<0.001) was significantly reduced compared with the previous years. While the number of inpatient admissions was similar for a month frame, the median duration of hospitalisation was significantly reduced. The frequency of hospitalisations for chemotherapy was higher than in previous years (p<0.001). By comparison, the rate of hospitalisations for palliative care (p=0.028) or elective interventional procedures (p=0.001) was significantly reduced.

Conclusion: In our experience, almost all domains of care were affected during the pandemic other than patients' systemic treatments. There were significant drops in the numbers of newly diagnosed patients, patients having interventional procedures and palliative care services, and these problems should be the focus points for the risk mitigation efforts for prevention of care disruptions.
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http://dx.doi.org/10.1136/bmjspcare-2020-002468DOI Listing
July 2020

Targeting lysyl oxidase (LOX) overcomes chemotherapy resistance in triple negative breast cancer.

Nat Commun 2020 05 15;11(1):2416. Epub 2020 May 15.

Department of Drug Discovery and Biomedical Sciences, University of South Carolina, Columbia, SC, 29208, USA.

Chemoresistance is a major obstacle in triple negative breast cancer (TNBC), the most aggressive breast cancer subtype. Here we identify hypoxia-induced ECM re-modeler, lysyl oxidase (LOX) as a key inducer of chemoresistance by developing chemoresistant TNBC tumors in vivo and characterizing their transcriptomes by RNA-sequencing. Inhibiting LOX reduces collagen cross-linking and fibronectin assembly, increases drug penetration, and downregulates ITGA5/FN1 expression, resulting in inhibition of FAK/Src signaling, induction of apoptosis and re-sensitization to chemotherapy. Similarly, inhibiting FAK/Src results in chemosensitization. These effects are observed in 3D-cultured cell lines, tumor organoids, chemoresistant xenografts, syngeneic tumors and PDX models. Re-expressing the hypoxia-repressed miR-142-3p, which targets HIF1A, LOX and ITGA5, causes further suppression of the HIF-1α/LOX/ITGA5/FN1 axis. Notably, higher LOX, ITGA5, or FN1, or lower miR-142-3p levels are associated with shorter survival in chemotherapy-treated TNBC patients. These results provide strong pre-clinical rationale for developing and testing LOX inhibitors to overcome chemoresistance in TNBC patients.
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http://dx.doi.org/10.1038/s41467-020-16199-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229173PMC
May 2020

Cancer incidence in Behçet's disease.

Ir J Med Sci 2020 Nov 8;189(4):1209-1214. Epub 2020 May 8.

Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey.

Background: Previous studies demonstrated an increased cancer risk in autoimmune diseases. Behçet's disease (BD) was also reported to be associated with an increased risk of cancer, although the data is limited.

Aims: In this study, we aimed to assess cancer incidence in a large cohort of BD patients and to compare with the data of the same age and gender groups.

Methods: The study cohort consisted of BD patients of > 18 years of age who were prospectively recorded in the Hacettepe University Vasculitis Center. Data on any cancer was collected from the patient files. Cancer incidence was compared with age- and gender-specific cancer incidence rates of the normal population retrieved from the 2014 Turkish National Cancer Registry (TNCR) data using standardized incidence rates (SIR).

Results: Totally, 451 adult cases with BD were included. The median age of the cohort was 43 (20-75), and 52.5% of the patients were males. Eleven cancer cases were observed during a median of 124 months follow-up. Behçet's disease was associated with an increase in cancer risk compared with expected counts in the corresponding age and sex group (SIR 2.84, 95% CI 1.50-4.94, p < 0.001). Patients with papulopustular lesions had a trend toward a decreased risk of cancer (p = 0.060), and patients using azathioprine had a significantly decreased cancer risk (p = 0.031).

Conclusion: This study revealed BD patients had approximately three times increased cancer risk compared with corresponding age and sex groups. Besides the routine care, increased attention for cancer surveillance is required in the follow-up of BD patients.
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http://dx.doi.org/10.1007/s11845-020-02244-0DOI Listing
November 2020

Development of de novo psoriasis during nivolumab therapy in a patient with small cell lung cancer.

J Oncol Pharm Pract 2020 Jan 29;26(1):256-258. Epub 2019 Sep 29.

Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

Introduction: The immune checkpoint inhibitors recently entered to small cell lung cancer (SCLC) stage, firstly in the third and recently in the first lines of therapy. This efficacy comes at the expense of many toxicities including skin toxicity. This toxicity is usually in the form of rash and pruritis; however, rare reactions like psoriasis can also be seen.

Case Report: Herein, we report an SCLC case who developed de novo psoriasis while treated with nivolumab as the third-line treatment for SCLC.

Management And Outcome: The psoriatic plaques were regressed with the topical highly potent steroid therapy, and immunotherapy was continued without further complications.

Discussion: We think that rare adverse events like de novo psoriasis are important considering the expanding role of these agents; their timely recognition and treatment are important in the management of cancer patients.
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http://dx.doi.org/10.1177/1078155219877234DOI Listing
January 2020

Cancer chemotherapy: incidence and predictors of 30-day mortality.

BMJ Support Palliat Care 2019 Jul 4. Epub 2019 Jul 4.

Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

Objectives: Thirty-day mortality (30 DM) is a measure of quality of cancer treatment and the predictors for 30 DM are important to identify vulnerable patients who are least likely to benefit from chemotherapy. We assessed the incidence and potential predictors of 30 DM in patients receiving chemotherapy.

Methods: All patients who received chemotherapy within an 8-month period in our hospital were assessed. Baseline prechemotherapy clinical features, vital signs, Modified Early Warning Scores (MEWS) and laboratory tests were recorded. Potential predictors of 30 DM were evaluated using multivariate logistic regression analysis.

Results: Among 4560 patients included, 77 patients (1.7%) died within 30 days of chemotherapy. Patients who died were older (62 vs 58, p=0.002), mostly males (61% vs 43%, p=0.006), had worse Eastern Cooperative Oncology Group performance scores (ECOG PS), and higher MEWS scores compared with those who survived. Multivariate analysis identified age ≥60 years (OR 2.2, 95% CI 1.2 to 4.1, p=0.01), male gender (OR 2.1, 95% CI 1.1 to 3.9, p=0.02), ECOG PS≥3 (OR 3.2, 95% CI 1.1 to 8.8, p=0.03), pulse rate ≥90 bpm (OR 3.8, 95% CI 2.0 to 7.0, p<0.01), systolic blood pressure <110 mm Hg (OR 2.1, 95% CI 1.1 to 4.1, p=0.02), body mass index <25 kg/m (OR 2.1, 95% CI 1.1 to 3.8, p=0.02) and haemoglobin< 90 g/L (OR 14.2, 95% CI 4.3 to 46.6, p<0.01) to be associated with increased risk of 30 DM.

Conclusions: Along with well-known prognostic factors such as ECOG PS and disease stage, other simple and readily available parameters may predict early mortality after chemotherapy and produce a signal for the physicians to carefully reevaluate vulnerable patients before chemotherapy administration.
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http://dx.doi.org/10.1136/bmjspcare-2019-001807DOI Listing
July 2019

Complete responses to two different anti-PD1 agents in a metastatic melanoma patient.

J Oncol Pharm Pract 2020 Mar 29;26(2):496-499. Epub 2019 Jun 29.

Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

In the last decade, immune checkpoint inhibitors changed the landscape of metastatic melanoma. However, the optimal duration of treatment and treatment cessation in responders is largely unknown. Herein, we represent a heavily pretreated metastatic melanoma case who had a complete response to pembrolizumab and also a complete response with nivolumab after progression during drug-free follow-up. We think that reinduction with a different anti-PD1 antibody may be used in patients with metastatic melanoma responders. Clinical trials with prespecified sequential treatment protocols and large real-life data can further delineate this subject.
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http://dx.doi.org/10.1177/1078155219858657DOI Listing
March 2020

Evaluation of cancer risk in patients with periodontal diseases

Turk J Med Sci 2019 06 18;49(3):826-831. Epub 2019 Jun 18.

Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey

Background/aim: In this study, we aimed to assess the cancer risk among patients with periodontal disease.

Materials And Methods: Patients diagnosed with periodontal diseases at Hacettepe University between 2007 and 2012 were included and data on the diagnosis of any cancer after periodontal disease were collected from patient files. The age- and sex-standardized incidence rates (SIRs) were calculated using Turkish National Cancer Registry 2013 data.

Results: A total of 5199 patients were included. Median follow-up was 7.2 years. Patients with periodontal diseases had 17% increased risk of cancer compared with the expected counts for the corresponding age and sex groups (SIR: 1.17; 95% CI: 1.04–1.3, P = 0.006). The increased cancer risk was statistically significant in women (SIR: 1.24; 95% CI: 1.05–1.45, P = 0.008) but not in men. Among women with periodontal disease, the risks of breast cancer (SIR: 2.19) and head and neck cancer (SIR: 4.71) were significantly increased. Among men, the risks of prostate cancer (SIR: 1.84), head and neck cancer (SIR: 3.55), and hematological cancers (SIR: 1.76) were significantly increased.

Conclusion: This study showed that periodontal diseases were associated with increased risk of several cancers. Besides other well-known benefits for health, the provision of oral/dental health should be considered and employed as a cancer prevention measure.
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http://dx.doi.org/10.3906/sag-1812-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018248PMC
June 2019

Exploiting DNA repair defects in breast cancer: from chemotherapy to immunotherapy.

Expert Rev Anticancer Ther 2019 07 17;19(7):589-601. Epub 2019 Jun 17.

a Department of Medical Oncology , Hacettepe University Cancer Institute , Ankara , Turkey.

: Impaired DNA damage response (DDR) and subsequent genomic instability are associated with the carcinogenic process itself, but it also results in sensitivity of tumor cells to certain drugs and can be exploited to treat cancer by inducing deadly mutations or mitotic catastrophe. Exploiting DDR defects in breast cancer cells has been one of the main strategies in both conventional chemotherapy, targeted therapies, or immunotherapies. : In this review, the authors first discuss DDR mechanisms in healthy cells and DDR defects in breast cancer, then focus on current therapies and developments in the treatment of DDR-deficient breast cancer. : Among conventional chemotherapeutics, platinum-based regimens, in particular, seem to be effective in DDR-deficient patients. PARP inhibitors represent one of the successful models of translational research in this area and clinical data showed high efficacy and reasonable toxicity with these agents in patients with breast cancer and BRCA mutation. Recent studies have underlined that some subtypes of breast cancer are highly immunogenic. Promising activity has been shown with immunotherapeutic agents, particularly in DDR-deficient breast cancers. Chemotherapeutics, DNA-repair pathway inhibitors, and immunotherapies might result in further improved outcomes in certain subsets of patients with breast cancer and DDR.
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http://dx.doi.org/10.1080/14737140.2019.1631162DOI Listing
July 2019

Analysis of and in saliva of colorectal cancer patients.

Biomark Med 2019 06 3;13(9):725-735. Epub 2019 Jun 3.

Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey.

The aim of the study was to examine the prevalence and amount of (), () and () in the saliva of colorectal cancer (CRC) patients and controls. PCR analyses performed in 71 CRC patients and 77 controls. Saliva samples of patients had higher amounts of (p = 0.001) and (p < 0.001) compared with controls. Amount of and were lower in the microsatellite instability (+) group. Evaluation of salivary amount by receiver operating characteristics analysis found to have diagnostic value for CRC (AUC: 0.84, 95% CI: 0.72-0.96). We found higher amounts of and in the saliva of CRC patients. Salivary could helpful in distinction of CRC.
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http://dx.doi.org/10.2217/bmm-2019-0020DOI Listing
June 2019

Classifying sarcopenia: using median value or cut-off values?

Breast Cancer Res Treat 2019 07 25;176(2):479. Epub 2019 Apr 25.

Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey.

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http://dx.doi.org/10.1007/s10549-019-05247-3DOI Listing
July 2019

Cancer incidence in familial Mediterranean fever patients: a retrospective analysis from central Anatolia.

Rheumatol Int 2019 Jun 25;39(6):1045-1051. Epub 2019 Apr 25.

Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey.

Although chronic inflammation has been associated with increased cancer risk in various disease including hepatitis or inflammatory bowel disease, a lower incidence of cancer has been reported recently in familial Mediterranean fever (FMF) which is an auto-inflammatory disease with persistent inflammation. We have assessed cancer incidence among FMF patients with or without amyloidosis to investigate this hypothesis. We performed a retrospective review of FMF patients, diagnosed and treated in Hacettepe University hospitals between 2001 and 2018. We identified patients from the hospital medical records using the ICD-10 code for FMF. We collected data on demographic and clinical features, drug history, the presence of amyloidosis and subsequent diagnosis of cancer. The expected cancer incidence was estimated using age- and gender-specific standardized incidence rates (SIRs) in comparison with the general Turkish population according to Turkish National Cancer Registry data at 2014. Total of 3899 FMF patients (120 patients had also amyloidosis) were included. Median age was 22 and 56% were females. Thirty-eight patients were diagnosed with cancer during 100,283 person-years of follow-up. The most common cancer was breast cancer in females (7/28 patients) and leukemia (2/10 patients) in males. The overall cancer incidence among patients with FMF was significantly lower in both males {SIR 0.42 [95% confidence interval; (CI) 0.21-0.75], p = 0.019} and females [SIR 065 (95% CI 0.44-0.93), p = 0.002]. The overall cancer incidence among patients with FMF and amyloidosis was [SIR 1.21 (95% CI 0.49-2.52), p = 0.73] without gender difference. Cancer incidence was significantly lower in FMF patients compared with the general Turkish population. We found no increased cancer incidence in FMF patients having amyloidosis. Possible underlying mechanisms need to be explained.
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http://dx.doi.org/10.1007/s00296-019-04311-xDOI Listing
June 2019

Short-time use of crizotinib as neoadjuvant in ALK-positive non-small cell lung carcinoma can be a chance for resectability.

Cancer Chemother Pharmacol 2019 06 12;83(6):1195-1196. Epub 2019 Mar 12.

Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Because of the rapid response to crizotinib, patients with ALK-positive locally advanced disease may become resectable with the use of neoadjuvant crizotinib. A 41-year-old never-smoking man who presented with asthma attack was found to have a suspicious lesion on chest X-ray after. Pathological examination was consistent with ALK(+), the signet-ring cell adenocarcinoma. Surgery was not performed because of mediastinal invasion of the mass. After 4 weeks of crizotinib treatment, a major response was achieved and the tumor became completely cavitary. Short-term neoadjuvant therapy with crizotinib for 4 weeks might be a promising therapy in locally advanced ALK-positive NSCLC and might provide a chance for resectability.
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http://dx.doi.org/10.1007/s00280-019-03810-9DOI Listing
June 2019

The frequency and predictors of persistent amenorrhea in premenopausal women with colorectal cancer who received adjuvant chemotherapy.

Anticancer Drugs 2019 03;30(3):289-294

Medical Oncology, Hacettepe University Cancer Institute.

The purpose of this study was to identify the frequency of chemotherapy-induced amenorrhea and associated factors thereof in premenopausal female patients diagnosed with colon cancer. Premenopausal female patients under the age of 50 years who were diagnosed with stages I, II, and III colon cancer were included. A questionnaire surveying personal history including menarche, comorbidities, drugs, other clinical features, and menstrual history during and after completion of chemotherapy was filled by the patients during outpatient visits. Patients who received pelvic radiotherapy were excluded from the study. A total of 60 patients were included in the study. Eleven patients had been treated with surgery alone, and 49 patients had received adjuvant chemotherapy with either fluorouracil (5-FU) alone (n=22) or 5-FU+oxaliplatin (n=27). The frequency of persistent amenorrhea 1 year after receiving chemotherapy was 20% in the whole group, 18% in patients who had received adjuvant chemotherapy with 5-FU alone, and 22% in patients who had received chemotherapy with 5-FU+oxaliplatin. Frequency of persistent amenorrhea was 3.5% in patients under the age of 44 years and 42.8% in patients aged 44 years and older. Multivariate analysis showed that age of 44 years and older (hazard ratio: 29.3; 95% confidence interval: 2.8-309.2, P=0.005) and menarche age of 14 years and older (hazard ratio: 7.6; 95% confidence interval: 1.2-49, P=0.076) were significantly associated with increased risk of persistent amenorrhea. In this study, we found that the frequency of persistent amenorrhea was 20% in patients who received 5-FU monotherapy or oxaliplatin-based adjuvant chemotherapy protocols in colon cancer treatment. Older age and later menarche were the factors that increased the risk of persistent amenorrhea 1 year after chemotherapy.
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http://dx.doi.org/10.1097/CAD.0000000000000728DOI Listing
March 2019

Real world survival data of a rare malignancy: Anal cancer results in HIV negative patients from Turkey.

Turk J Gastroenterol 2018 07;29(4):411-418

Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

Background/aims: An organ preservation approach using chemoradiotherapy has been established for anal cancer. This retrospective cohort study aimed to define the clinico-demographic characteristics and outcomes of cases of human immunodeficiency virus (HIV)-negative anal carcinoma during a period of 20 years in a single comprehensive cancer institute.

Materials And Methods: This was a single-center retrospective cohort study of patients who were treated between January 1995 and January 2015. The primary outcome measures that were investigated included overall survival (OS), progression-free survival (PFS), colostomy rates, and colostomy-free survival (CFS).

Results: A total of 28 patients who were principally treated with standard 5-fluorouracil + mitomycin combination chemoradiotherapy were eligible for analysis. The 3- and 5-year PFS rates were 92.4% and 63%, respectively. The lower T stage was found to be associated with a prolonged PFS (p=0.001). The 3- and 5-year CFS rates were 84.3% and 74.9%, respectively. A longer CFS was observed with lower T stages (p=0.05). At the last follow-up, 75% of the patients with anal cancer were alive, and 71.4% of the patients were disease free. The median OS was not reached with a median follow-up of 54 months (range, 6-115 months). The 3- and 5-year OS rates were 82% and 71.1%, respectively. No late toxicity was observed during the follow-up period.

Discussion: The short- and long-term prognoses of HIV-negative patients with anal squamous cell carcinoma were good, and low-grade toxicity was rare, thereby demonstrating that these patients can be successfully treated in a real-life setting with favorable outcomes.
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http://dx.doi.org/10.5152/tjg.2018.17660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284643PMC
July 2018

When side effect becomes the effect: Efficacy of capecitabine in refractory psoriasis.

Dermatol Ther 2018 11 19;31(6):e12629. Epub 2018 Sep 19.

Medical Oncology Department, Hacettepe University Oncology Institute, Ankara, Turkey.

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http://dx.doi.org/10.1111/dth.12629DOI Listing
November 2018

Glucocorticoids in breast cancer treatment: real benefit or selection bias?

Breast Cancer Res Treat 2018 Nov 26;172(1):243. Epub 2018 Jul 26.

Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.

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http://dx.doi.org/10.1007/s10549-018-4871-2DOI Listing
November 2018

Ifosfamide and doxorubicin in the treatment of advanced leiomyosarcoma.

Curr Probl Cancer 2018 May - Jun;42(3):344-349. Epub 2018 Jan 31.

Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

Leiomyosarcomas (LMS) are rare tumors with poor prognosis owing to the high rate of recurrent and metastatic disease. The combination of doxorubicin (Adriamycin) plus ifosfamide and mesna (AIM) results in moderate response rates of 10%-30%. The aim of this study was to assess the efficacy of the AIM regimen along with multimodality treatment including surgery and radiotherapy in patients with LMS. The clinicopathologic characteristics and outcomes of 51 patients with recurrent or metastatic LMS diagnosed between 2000 and 2014 who received the AIM regimen were analyzed retrospectively. Treatment consisted of ifosfamide 2500mg/m² on days 1-3 (with mesna 2500mg/m² days 1-3, 4-hour i.v. infusion), and doxorubicin 60mg/m² on day 1 (2-hour i.v. infusion), which was repeated every 21 days. The mean age of the patients at diagnosis was 48.9 ± 11.2 years. A total of 42 patients were females (82.4%). The primary tumor site was the uterus in 30 (58.8%) patients. The most common metastatic sites were lung and liver. The median follow-up was 27.9 months (min: 4.3 max: 164.8). The median progression-free survival was 6.7 months (95% CI: 4.1-9.2). The median overall survival (OS) was 24.6 months (95% CI: 16.2-33.0). The overall response rate was 12% (6/51 pts). Response rates were higher in patients with uterine LMS (17%) compared with those with nonuterine LMS (5%); however, the OS times were similar. Surgical intervention for local or distant recurrence was associated with improved median OS (41 vs 16.6 months, P < 0.001). Myelosuppression was the major toxicity of this combination. In our study, the AIM regimen was effective in patients with LMS. Resection of local or distant recurrence was found to improve survival in our study.
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http://dx.doi.org/10.1016/j.currproblcancer.2018.01.011DOI Listing
April 2019

Familial Mediterranean Fever: New Insights Into Cancer Immunoprevention? Comment on the Article by Brenner et al.

Arthritis Rheumatol 2018 07 14;70(7):1167. Epub 2018 May 14.

Hacettepe University School of Medicine, Ankara, Turkey.

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http://dx.doi.org/10.1002/art.40497DOI Listing
July 2018

The Effect of Total Size of Lesions in Multifocal/Multicentric Breast Cancer on Survival.

Clin Breast Cancer 2018 08 9;18(4):320-327. Epub 2017 Nov 9.

Mustafa Kadri Altundag (MKA) Breast Cancer Clinic, Ankara, Turkey. Electronic address:

Background: In this study, we aimed to assess the prognostic performance of determining the T stage according to the total size of lesions compared with the size of the largest lesion in the breast in patients with multifocal/multicentric (MF/MC) breast cancer.

Patients And Methods: The charts of the patients with MF/MC breast cancer who were diagnosed between 2003 and 2014 were reviewed. The T stage of MF/MC tumors was determined according to the largest lesion size (T) as well as the sum of the longest diameters of the lesions (T) in the breast.

Results: Multifocal/multicentric tumors were identified in 323 of 3890 patients (8.3%) with breast cancer. Ten-year rates of overall survival (OS; 75% and 74%; P = .965) and disease-free survival (DFS; 66% and 61%; P = .817) were similar in patients with unifocal and MF/MC tumors, respectively. When the T stage was determined by summing the sizes of the lesions, the T stage of 67 (20.7%) and 63 (19.5%) patients advanced from T1 to T2 and from T2 to T3, respectively. Thus, the T stage increased in 130 patients (40.2%) according to American Joint Committee on Cancer. Discriminatory ability of T was better than T in terms of OS and DFS, as shown with higher Royston D and Harrel C statistics and Schemper V values.

Conclusion: The new T classification proposed in this report stands out as a better predictive classification particularly in patients with low disease burden.
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http://dx.doi.org/10.1016/j.clbc.2017.11.002DOI Listing
August 2018

Anti-VEGF Therapy in the Treatment of Unresectable Appendiceal Epithelial Neoplasms.

Ann Surg Oncol 2017 12 22;24(Suppl 3):620. Epub 2017 Nov 22.

Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.

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http://dx.doi.org/10.1245/s10434-017-6147-1DOI Listing
December 2017

Fusobacterium and colorectal carcinogenesis.

Carcinogenesis 2018 01;39(1):84

Hacettepe Universitesi, Hacettepe University Cancer Institute, Department of Preventive Oncology, Turkey.

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http://dx.doi.org/10.1093/carcin/bgx092DOI Listing
January 2018
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