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Cabozantinib plus Nivolumab and Ipilimumab in Renal-Cell Carcinoma
(Massachusetts Medical Soc, 2023) Beypinar, Ismail; Araz, Murat
[Abstract Not Availabe]
A case of pathologic complete response after neoadjuvant triplet chemotherapy for locally advanced colon cancer with mismatch repair enzyme proficiency
(Via Medica, 2023) Kocak, Mehmet Zahid; Cakir, Murat; Kerimoglu, Ulku; Araz, Murat; Eryilmaz, Melek Karakurt; Yumuk, Perran Fulden; Artac, Mehmet
Patients with potentially resectable colon cancer and expected to have negative margins should undergo resection rather than neoadjuvant chemotherapy. Recent studies have suggested that neoadjuvant immunotherapy may be an option for tumors with mismatch repair enzyme deficiency (dMMR), but standard treatment for locally advanced colon cancer with mismatch repair enzyme proficiency (pMMR) is still unclear. A 37-year-old male patient was diagnosed with clinical stage IIIC (T4b N1a M0) transverse colon cancer. Mismatch repair proteins were proficient. After 3 cycles of oxaliplatin (85 mg/m(2), day 1), irinotecan (150 mg/m2, IV, day 1), leucovorin (200 mg/m(2), IV, day 1), and 5-fluorouracil (3000 mg/m(2), 46 hours of continuous infusion initiating from day 1), there was a remarkable reduction in the tumoral mass on the abdominal computed tomography. A right hemicolectomy was performed. A pathologic complete response was obtained. Although there is no consensus on which patients are suitable for neoadjuvant therapy in pMMR locally advanced colon cancer, triplet chemotherapy may be a reasonable option in selected patients.
A case of severe vasculitis after FLOT chemotherapy in a patient with metastatic gastric cancer who received multiple line chemotherapy
(Sage Publications Ltd, 2022) Hendem, Engin; Korkmaz, Mustafa; Ukrakli, Muzaffer; Eryilmaz, Melek Karakurt; Karaagac, Mustafa; Araz, Murat; Artac, Mehmet
Introduction Leukocytoclastic vasculitis is a histopathological term describing vasculitis in which the inflammatory infiltrate in small vessels consists of neutrophils. Although FLOT is given perioperatively in locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma, it has recently become a popular treatment option for metastatic cancers. In this case report, we present a case of FLOT-induced LCV. Case Report We present a 52-year-old patient with metastatic gastric adenocarcinoma treated with FLOT. The patient developed necrotizing vasculitis in the lower extremity after 5 cycles of FLOT. Management & Outcome After discontinuation of the FLOT regimen, the necrotizing morbid LCV gradually regressed with steroid therapy. Discussion To the best of our knowledge, our case is the first case of LCV that developed after FLOT chemotherapy. The clinical appearance of the patient, occurrence after chemotherapy, erythematous rash developing on bilateral lower extremities, and palpable purpuric vasculitis made us suspect. We found a potential relationship between FLOT and vasculitis according to the Naranjo scale (score 4 + ).
Comparison of palonosetron and granisetron in triplet antiemetic therapy in nonmetastatic breast cancer patients receiving high emetogenic chemotherapy: a multicenter, prospective, and observational study
(Springer, 2019) Araz, Murat; Karaagac, Mustafa; Korkmaz, Levent; Koral, Lokman; Inci, Fatih; Beypinar, Ismail; Uysal, Mukremin
PurposeWe aimed to investigate the efficacy of 0.25mg dose of palonosetron and granisetron in triplet antiemetic prophylaxis in breast cancer patients receiving HEC.MethodsPatients with nonmetastatic breast cancer who received HEC [doxorubicin or epirubicin plus cyclophosphamide (AC/EC)] were enrolled in the study. The prophylactic triplet antiemetic regimens were used according to the doctor's preference during the first cycle of HEC as intravenous dexamethasone and palonosetron 0.25mg or granisetron 3mg on day 1 as well as oral aprepitant (125mg on day 1 and 80mg on days 2 and 3).The primary endpoint was complete response rate (CR) on acute and delayed chemotherapy-induced nausea and vomiting (CINV), separately.ResultsA total of 118 female patients were included in the study. Patients received AC (83%), EC (3%), and dose-dense AC (14%) as adjuvant (88%) or neoadjuvant (12%). The majority of patients received palonosetron (59%) containing antiemetic treatment. The CR rate on acute and delayed vomiting was very high and not statistically different in both of the arms (acute 87% vs. 96%, p=0.089; delayed 90% vs. 92%, p=0.489), respectively. Nevertheless, the CR rate on either acute or delayed nausea was lower than vomiting (acute 51% vs. 51%; delayed 38% vs. 29%, p=0.203; respectively).ConclusionsThis is the second study that compared a 0.25mg dose of palonosetron with first-generation setron in triplet antiemetic prophylaxis in cancer patients receiving HEC. We could not find meaningful statistical differences between two arms, regarding CR rate on acute and delayed CINV.
The compliance with antiemetic guidelines of Turkish medical oncologists. A survey study of Turkish Oncology Group
(Mosby-Elsevier, 2019) Araz, Murat; Karaagac, Mustafa; Korkmaz, Levent; Beypinar, Ismail; Uysal, Mukremin
Purpose: We aimed to investigate the compliance of Turkish Medical Oncologists to antiemetic guidelines for treatment of acute and delayed chemotherapy-induced nausea and vomiting (CINV) in patients receiving high (HEC), moderate (MEC), and low (LEC) emetogenic chemotherapy. Method: A covering electronic mail letter with an online questionnaire link was sent to e-mail and mobile application groups including all 599 members of the Turkish Society of Medical Oncology in January 2018. The online survey has consisted of twelve questions. Results: Questionnaire form was responded by 146 of Turkish Medical Oncologists. The most of the participants were following up more than one antiemetic guideline (53%). While compliance with the antiemetic guidelines was higher in acute CINV prophylaxis for HEC and MEC, it was significantly lower in the delayed CINV treatment of HEC and LEC. The highest and lowest compliance rate was found in the prophylaxis of acute and delayed CINV of HEC (92% and 15%, respectively). The incidence of noncompliance for delayed CINV in HEC was statistically significantly higher in those who worked for <= five years in an oncology department, under 39 years of age, and non-academicians (p = 0.004, p = 0.042, p = 0.005, respectively). Conclusions: Noncompliance with the antiemetic guidelines is continue to be a big problem in Turkish Medical Oncologists. The use of standardized antiemetic protocols in chemotherapy order forms or a computerized decision-support system is now seen as a better tool to enhance compliance with the guidelines. (C) 2018 Elsevier Inc. All rights reserved.
Could the concomitant use of beta blockers with bevacizumab improve survival in metastatic colon cancer?
(Springer Heidelberg, 2023) Kocak, Mehmet Zahid; Er, Muhiddin; Ugrakli, Muzaffer; Hendem, Engin; Araz, Murat; Eryilmaz, Melek Karakurt; Artac, Mehmet
AimDrug-drug interactions are sometimes neglected in oncology practice. Due to drug pharmacokinetic and pharmacodynamic interactions, clinically increased or decreased drug effects and increased or decreased adverse effects may occur. Considering that the concomitant use of these two drugs that affect vascular endothelial growth factor receptor (VEGFR) may cause pharmacological potentiation or additive interaction, we aimed to evaluate the survival outcomes of concomitant use of bevacizumab and beta blockers in patients with metastatic colorectal cancer (mCRC).MethodsIn total, 181 patients with mCRC administered with bevacizumab plus cytotoxic chemotherapy regimen in a first-line setting were divided into two groups: concomitant beta-blocker user and nonuser.ResultsThe median overall survival (mOS) was 35.9 (95% CI: 27.9-43.9) months in the beta-blocker-using group and 29.6 (95% CI: 27.9-43.9) months in the beta-blocker-non-using group (p = 0.054). The median progression-free survival (mPFS) was 16.1 (95% CI: 12.4-19.9) months in the beta-blocker-using group and 12.8 (95% CI: 10.6-15.0) months in the beta-blocker-non-using group (p = 0.006). The multivariate analysis revealed that beta-blocker use was an independent predictor of mPFS (HR: 0.66, 95% CI: 0.46-0.93, p = 0.018) and mOS (HR: 0.57, 95% CI: 0.36-0.91, p = 0.02).ConclusionThis study demonstrated that concomitant usage of beta blockers improved both survival outcomes, irrespective of the kind of beta blocker.
Development of second primary multiple myeloma five years after treatment for limited-stage small cell lung cancer: a rare case report
(Via Medica, 2021) Eryilmaz, Melek Karakurt; Aykut, Talat; Korkmaz, Mustafa; Karaagac, Mustafa; Araz, Murat; Artac, Mehmet
Introduction. The development of a second primary malignancy (SPM) following small cell lung cancer (SCLC) has been previously reported in the literature. Especially smoking-related malignancy coupling is well known. The development of multiple myeloma (MM) in long-term survivors after treatment for SCLC is unknown. Here, we report the first case in the literature who developed MM 5 years after treatment for limited-stage SCLC. Case report. A 67-year-old male patient was diagnosed with limited-stage SCLC. After he received chemotherapy and radiotherapy, he was followed up without medication. He was admitted to the hospital with back pain and dyspnea 5 years after the diagnosis of small cell lung cancer. MRI revealed osteolytic lesions in the vertebrae. Laboratory testing revealed a markedly elevated serum IgA and an elevated serum beta-2 microglobulin level. Serum immunofixation revealed IgA lambda-type M-protein. Lambda excretion in urine immunofixation electrophoresis was observed. Bone marrow aspiration revealed the frequency of plasma cells to be 80% of all nucleated cells. Hence, the final diagnosis revealed IgA lambda free light chain MM. Treatment was given for multiple myeloma. In the follow-up, the patient experienced increased dyspnea and developed bilateral pleural effusion. The cytology sent from thoracentesis sampling was reported as plasmocyte-rich material. The patient fell into a coma and died in an intensive care unit. Conclusion. We presented the development of MM 5 years after treatment in a patient with SCLC who were treated for one year and then followed up with stable findings. It should be kept in mind that a patient with SCLC who is a long-term survivor and presents with back pain may have developed a primary malignancy originating from bone marrow rather than a bone metastasis. Patients should be advised smoking cessation after the treatment and diagnosis of SCLC. Also, the patients with SCLC who are long-term survivors should be closely monitored for the development of SPM.
Does Vitamin D Replacement Alter the Chemotherapy Outcome in Lung Cancer
(Kare Publ, 2019) Araz, Murat; Beypinar, Ismail; Beypinar, Dilek; Demir, Hacer; Uysal, Mukremin
Objectives: Lung cancer accounts for 20% of cancer-related deaths worldwide. Several studies have shown that Vitamin D levels at the time of diagnosis are prognostic in lung cancer. In this study, we evaluated the relationship between pre-diagnosis Vitamin D replacement levels and platinum-based chemotherapy results. Methods: In this cross-sectional study, we retrospectively analyzed archive records of all 247 patients diagnosed with lung cancer from an oncology center in Turkey, between 2012-2018.The chemotherapy outcomes, Vitamin D levels and replacement doses of these patients up to 6 months ago were recorded. Results: Vita min D levels of 153 patients were below 15 ng/mL, 65 patients had a level of 15-30 ng/mL, and 29 patients had a vitamin D level higher than 30 ng/mL. In the study population, 215 had a replacement below 300.000 IU whereas 32 had a replacement above 300.000 IU. When the patients were evaluated based on their chemotherapy responses, no difference was observed between the patients with below and above 300.000 IU. In our study, Vitamin D and replacement level at the time of diagnosis did not change the chemotherapy response. Conclusion: Vita min D replacement levels were not significantly associated with chemotherapy outcomes in our study.
Does Vitamin D Replacement Alter the Chemotherapy Outcome in Lung Cancer
(Kare Publ, 2019) Araz, Murat; Beypinar, Ismail; Beypinar, Dilek; Demir, Hacer; Uysal, Mukremin
Objectives: Lung cancer accounts for 20% of cancer-related deaths worldwide. Several studies have shown that Vitamin D levels at the time of diagnosis are prognostic in lung cancer. In this study, we evaluated the relationship between pre-diagnosis Vitamin D replacement levels and platinum-based chemotherapy results. Methods: In this cross-sectional study, we retrospectively analyzed archive records of all 247 patients diagnosed with lung cancer from an oncology center in Turkey, between 2012-2018.The chemotherapy outcomes, Vitamin D levels and replacement doses of these patients up to 6 months ago were recorded. Results: Vita min D levels of 153 patients were below 15 ng/mL, 65 patients had a level of 15-30 ng/mL, and 29 patients had a vitamin D level higher than 30 ng/mL. In the study population, 215 had a replacement below 300.000 IU whereas 32 had a replacement above 300.000 IU. When the patients were evaluated based on their chemotherapy responses, no difference was observed between the patients with below and above 300.000 IU. In our study, Vitamin D and replacement level at the time of diagnosis did not change the chemotherapy response. Conclusion: Vita min D replacement levels were not significantly associated with chemotherapy outcomes in our study.
Early-stage gastric cancer presenting with tripe palm and acanthosis nigricans
(Via Medica, 2021) Kocak, Mehmet Zahid; Araz, Murat; Korkmaz, Mustafa; Demirkiran, Aykut
Tripe palm is a rare cutaneous paraneoplastic syndrome that can be overlooked and frequently appears with acanthosis nigricans. If tripe palm and acanthosis nigricans occur in a patient together, gastric cancer should come to mind. A 50-year-old female patient had signs of abdominal pain and velvety thickening in the palms and soles. Tripe palm and acanthosis nigricans were considered as paraneoplastic syndrome after other benign causes were excluded. It was determined that the underlying malignancy was gastric cancer. After neoadjuvant FLOT chemotherapy regimen, gastrectomy was performed, and the patient received adjuvant chemotherapy. With the recognition of tripe palm, a rare cutaneous paraneoplastic syndrome, patients can be diagnosed and treated early.
The effect of BMI on the outcomes of CDK 4/6 inhibitor therapy in HR-positive metastatic breast cancer patients.
(Lippincott Williams & Wilkins, 2022) Caglayan, Dilek; Kocak, Mehmet Zahid; Geredeli, Caglayan; Tatli, Ali Murat; Eryolmaz, Melek Karakurt; Goksu, Sema Sezgin; Araz, Murat
[Abstract Not Availabe]
The effect of concomitant use of proton pump inhibitors with CDK 4/6 inhibitors on survival in metastatic breast cancer
(Springer Heidelberg, 2023) Caglayan, Dilek; Kocak, Mehmet Zahid; Geredeli, Caglayan; Tatli, Ali Murat; Goksu, Sema Sezgin; Eryilmaz, Melek Karakurt; Araz, Murat
Aim To evaluate the difference of progression free survival between the patients using concomitant proton pump inhibitors and non-users in the patients using CDK 4/6 inhibitors with HR + and HER2 negative mBC. Methods We included 86 patients with HR + and HER 2 negative mBC treated with CDK 4/6 inhibitors in this study. Patients were divided into two categories according to their status of PPI use. The primary end points was progression free survival (PFS). We compared PPI users and non-users. Results Forty-five (52.3%) patients used a PPI concomitantly with a CDK 4/6 inhibitor, and 41 (47.7%) did not. The median duration of follow-up was 10.68 (1.94-27.56) months. Of the patients, 50 (58.1%) palbociclib and 36 (41.9%) received ribociclib. The median progression free survival (mPFS) was 10.9 months (95% CI: 7.5-14.27) in the group with concomitant PPI use with a CDK 4/6 inhibitor, whereas the median progression free survival could not be reached in the group without concomitant PPI use (p = 0.04). In addition, concomitant PPI use with palbociclib was associated with a shorter PFS; there was no significant difference between the concomitant PPI users and non-users in terms of PFS in the patients using ribociclib. Conclusion Palbociclib and ribociclib are weak base drugs so their bioavailability is pH-dependent. PPIs can affect their solubility and their concentration in the plasma. Therefore, we must avoid concomitant use of PPIs and CDK 4/6 inhibitors. If we need to use concomitant PPI and CDK 4/6 inhibitors, we should prefer ribociclib than palbociclib.
The Effect of RAS/BRAF Mutation Status on Prognosis and Relapse Pattern in Early Stage Colon Cancers
(Springer, 2023) Kunt, Nazli; Araz, Murat; Yildirim, Mahmut Selman; Findik, Siddika; Kocak, Mehmet Zahid; Eryilmaz, Melek Karakurt; Artac, Mehmet
PurposeIt is known that the RAS and BRAF mutations are predictive for targeted therapies in treating metastatic colon cancer and negatively affect the prognosis of the disease. However, there are limited studies in early-stage colon cancer about the relationship of this mutational condition with the prognosis and relapse pattern of the disease. In this study, we evaluated the effects of mutational status on the clinical pattern of recurrence and survival in early-stage colon cancer in addition to classical risk factors.MethodsPatients with early-stage colon cancer at the first time of diagnosis and developing recurrence or metastasis on following up were included in this study. Patients were divided into two groups according to the at the time of relapse RAS/BRAF mutation status: mutant or non-mutant/wild types. Then, mutation analysis was performed again from the early-stage tissue of the patients if available. The relationship between early-stage mutation status and progression-free survival (PFS), overall survival (OS), and relapse pattern was analyzed.ResultsThe number of patients with mutant and non-mutations in the early stage was 39 and 40, respectively. Mutant and non-mutant patients with stage 3 disease were similar (69% and 70%, respectively). OS (47.27 months vs. 67.53 months; p = 0.02) and PFS (25.12 vs. 38.13 months; p = 0.049) were statistically significantly lower in mutant patients, respectively. Most patients had distant metastases on both sides at recurrence (61.5% vs. 62.5%, respectively). There was no significant difference between mutant and non-mutant patients regarding distant metastasis and local recurrence rates (p = 0.657). A discordance of 11.4% between early-stage and late-stage tissue mutation status.ConclusionThe presence of mutation in early-stage colon cancer is associated with shorter OS and PFS. The mutational status did not have a significant effect on the recurrence pattern. Because of the discordance of early-stage and late-stage mutational status, it is recommended to perform mutation analysis from tissue at relapse.
Effects of adjuvant therapy on body composition measurements in women with early breast cancer
(2019) Eryılmaz, Melek Karakurt; Karaağaç, Mustafa; Araz, Murat; Atabek, Mehmet Emre; Artaç, Mehmet
Aim: This study aimed to determine the effects of adjuvant therapy on body mass index (BMI) and body fat (BF) measurements inwomen with early-stage breast cancer (ESBC).Material and Methods: We prospectively evaluated BMI and BF measurements including trunk fat mass kilograms (kg), trunk fatmass (%) and total body fat (%) on a bioelectric impedance analyzer in 29 women with stages I-III breast cancer. All of the patientsreceived anthracycline-based adjuvant chemotherapy (ACT). Six patients were hormone receptor (HR)-negative. Twenty-threepatients were HR-positive and received adjuvant endocrine therapy (AET) following ACT. Eleven HR-positive postmenopausalpatients were treated with an aromatase inhibitor (AI), and the remaining twelve HR-positive premenopausal patients were treatedwith tamoxifen (TMX). A total of 3 measurements were performed in the beginning of chemotherapy, at 6th, and 12th months.Results: Although the BMI was significantly increased, there was no significant change in the BF during chemotherapy in patientsreceiving only ACT. Both BMI and BF measurements were significantly increased in premenopausal patients receiving TMX afterACT. However, no significant change was observed in BMI and BF measurements in postmenopausal patients receiving AI after ACT.Conclusions: ACT increased both BMI and BF measurements in patients with HR-positive premenopausal ESBC. Treatment withTMX or AI after ACT did not enhance the changes due to chemotherapy on body composition. Therefore, especially patients withHR-positive premenopausal ESBC should be careful not to gain weight during ACT.
Ibrutinib and panitumumab used in combination safely in a patient with metachronous colorectal cancer and chronic lymphocytic leukemia
(Lippincott Williams & Wilkins, 2022) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Karaagac, Mustafa; Araz, Murat; Ceneli, Ozcan; Artac, Mehmet
Ibrutinib is a Bruton tyrosine kinase inhibitor used in the treatment of chronic lymphocytic leukemia (CLL). Panitumumab, an mAb for epidermal growth factor receptor, is used in the treatment of metastatic colorectal cancer (CRC). We wanted to present our case where we used ibrutinib and panitumumab in combination in a patient with metachronous CLL and CRC. A 58-year-old male patient with a diagnosis of CLL was receiving ibrutinib treatment and primary rectal cancer was detected. FOLFOX + panitumumab were started when metastasis was detected in the lung after neoadjuvant chemoradiotherapy for rectal cancer. The patients used ibrutinib and panitumumab in combination. There was no cumulative or unexpected toxicity due to the combination of both antineoplastic agents. The most important point to be considered in the use of combined drugs is the evaluation of drug-drug interactions. Toxic effects of the combination of ibrutinib and cetuximab have been reported in a patient with metastatic CRC. We used ibrutinib together with panitumumab in our case and we did not encounter any cumulative or unexpected side effects during the treatment.
Immunotherapy era in the treatment of small cell lung cancer
(Humana Press Inc, 2021) Araz, Murat; Karakurt Eryilmaz, Melek
Small cell lung cancer (SCLC) is differentiated from non-small cell lung cancers with its histological and morphological features, rapid response to chemotherapy, and recurrence in a short time after treatment is discontinued. Platinum plus etoposide chemotherapy combination has been used as a standard treatment, and no new drug has been found for more than 30 years in this disease. In research, the targeted pathways that may affect survival have not been identified yet. During the second half of the second decade of the 2000s, with immunotherapies that inhibit immune checkpoints, improvements in survival were achieved for the first time in treating SCLC after many years. Then a rapid increase was observed in chemotherapy plus immunotherapy combination studies in this field. Updated analyses of these studies were represented at international oncology meetings in 2020. Here, we reviewed immunotherapy studies conducted in patients with SCLC and the reflections on the daily practice.
Irinotecan-induced NASH and liver failure
(Elsevier Masson, Corp Off, 2021) Araz, Murat; Kilinc, Fahriye; Kerimoglu, Ulku; Keskin, Muharrem; Kucukkartallar, Tevfik
[Abstract Not Availabe]
Is lymph node dissection necessary for staging while undergoing nephrectomy in patients with renal cell carcinoma?
(Mosby-Elsevier, 2021) Demir, Tarik; Aliyev, Altay; Besiroglu, Mehmet; Araz, Murat; Kostek, Osman; Sakin, Abdullah; Shbair, Abdallah T. M.
Objective: The essential treatment for patients with renal cell carcinoma is nephrectomy. As no lymph node dissection (LND) could be performed in the majority of these patients, healthy staging could not be carried out. In this study, we investigated the impact of LND during nephrectomy on patient survival. Methods: A total of 181 patients-58 (32%) were female and 123 (68%) were male-were included in the study. Median follow-up period was 48 months. The patients were separated into 4 groups according to their stage during diagnosis; group 1 (T1-3N0M0), group 2 (T1-3NXM0), group 3 (T1-3N1M0), and group 4 (T14N0/XM1). The disease-free survival of nonmetastatic patients and the overall survival of all groups were calculated. Results: Mean age was 58.4 +/- 12.0 years. Median survival for Group 1 could not be reached. Median survival was 89 months in Group 2, 50 months in Group 3, and 39 months in Group 4 (P <0.001). There was no statistically significant difference between the N1 and M1 groups (P = 0.297). For the NX patient group without LND, median survival was 89 months, which is worse than the N0 group and better than the N1 group (P = 0.002). Conclusions: Our study presumes that the patients without LND are not staged sufficiently, NX patients have worse survival rates when compared with N0 patients, node-positive patients have poor survival rates as do the metastatic patients, and it should be defined as TNM stage4. (c) 2020 Elsevier Inc. All rights reserved.
Is the Prognostic Nutritional Index a Prognostic Marker for the Survival of Patients with Lymph-Node Positive Stage II-III Gastric Cancer Who Receive Adjuvant Chemotherapy?
(Springer, 2023) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Er, Muhammed Muhiddin; Kocak, Mehmet Zahid; Demirkiran, Aykut; Karaagac, Mustafa; Araz, Murat
Purpose The prognostic nutritional index (PNI), like other systemic inflammatory markers, has been shown to be a prognostic factor in various cancer patients. In this study, we aimed to show whether PNI calculated before adjuvant chemotherapy is a prognostic factor for overall survival (OS) and disease-free survival (DFS) in patients with lymph node-positive stage II-III gastric cancer.Methods The PNI was calculated using the albumin and lymphocyte count. The PNI cut-off value was found to be 39.5. They were divided into two groups as being = 39.5 (PNI low group) and > 39.5 (PNI high group).Results Our study included 168 patients with lymph node-positive stage II-III gastric cancer who received adjuvant chemotherapy. Of the patients, 116 (69.0%) were 65 years or younger, and 52 (31.0%) were over 65 years old. Of the patients, 117 (69.6%) were pT3, 51 (30.4%) were pT4. Seventy-three (43.4%) patients had pN1-2 disease and 95 (56.6%) patients had pN3 disease. The number of stage II patients was 73 (43.5%) and the number of stage III patients was 95 (56.5%). There were 73 patients with PNI = 39.5 and 95 patients with PNI > 39.5. The mOS of the patients with low PNI group was 39.5 months, while the OS of the patients with high PNI group was 96.8 months (p = 0.002). In the group of patients with PNI low group, mDFS 24.4 months was significantly higher than those with PNI high group was 50.7 months (p = 0.021). The PNI score was statistically significant in univariate and multivariate analyzes for both DFS and OS.Conclusion PNI can be used as an independent prognostic factor for both OS and DFS in patients lymph node-positive, stage II-III gastric cancer who will receive adjuvant chemotherapy.
Low-dose (7.5 mg/kg) bevacizumab may be a viable option in recurrent ovarian cancer: A retrospective study
(Wolters Kluwer Medknow Publications, 2023) Demirkiran, Aykut; Eryilmaz, Melek Karakurt; Karaagac, Mustafa; Araz, Murat; Korkmaz, Mustafa; Kocak, Mehmet Zahid; Artac, Mehmet
Objective: Bevacizumab (BEV) is a humanized monoclonal antibody of vascular endothelial growth factor receptors and, as a result of clinical trials, was approved for the treatment of recurrent ovarian cancer (ROC). The aim of this study was to assess the clinical utility of BEV in patients with ROC in real-world practice beyond clinical trials. Materials and Methods: In this single-center retrospective cohort study, we evaluated the medical data of all patients with ROC who were treated with BEV between October 2013 and March 2020. Results: A total of 76 females were evaluated. Forty-nine (64.5%) patients were platinum sensitive and 27 (35.5%) patients were platinum resistant. BEV was used in combination with chemotherapy agents in all patients, and the most preferred combinations were gemcitabine/carboplatin (GC) (78.9%) and carboplatin/paclitaxel (14.5%). In all patients, the BEV dose was 7.5 mg/kg every 3 weeks. The median progression-free survival (PFS) was 11.1 months (95% confidence interval [CI]: 9.6-12.6), and the median overall survival (OS) was 22.3 months (95% CI: 17.5-27.2). In multivariate analysis, serous histological type (P = 0.01), maintenance BEV administration (P = 0.001), and combination of GC-BEV (P < 0.001) were associated with better PFS, while serous histological type (P = 0.016) and good performance status (P = 0.006) were associated with prolonged OS. Conclusions: Low-dose (7.5 mg/kg) BEV was found to be effective in the second-line treatment of patients with ROC in our real-life study. In addition, the combination of BEV with GC was shown to be a viable option, especially in the treatment selection of platinum-resistant patients.

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