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    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 + ).
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    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.
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    The effect of concomitant proton pump inhibitor use on survival outcomes of Nivolumab-treated renal cell carcinoma patients: a multicenter study
    (Springer, 2023) Ugrakli, Muzaffer; Kocak, Mehmet Zahid; Dinc, Gulhan; Genc, Tugrul Burak; Caglayan, Melek; Ugrakli, Selin; Hendem, Engin
    AimWe aimed to evaluate the effect of concomitant proton pump inhibitors (PPI) use with nivolumab on survival outcomes in metastatic renal cell carcinoma (mRCC) in second-line setting.MethodsThe study was designed as a multicenter and retrospective involving patients with metastatic renal cell carcinoma receiving second-line nivolumab therapy. One hundred and nine patients with mRCC were divided into two groups based on whether they use PPI concomitantly with nivolumab: concomitant PPI users and non-users. Overall survival (OS) and progression-free survival (PFS) were compared between the groups with and without concurrent PPIs.ResultsOf 109 patients in our study, 59 were not using PPI concomitantly with nivolumab and 50 were using PPI concomitantly. The median PFS was 6.37 (5.2-7.5) months in the concomitant PPI group and 9.7 (4.5-15) months in the non-users (p = 0.03). The median OS was 14.6 (7.1-22.1) months in patients on PPI concurrently with nivolumab and 29.9 (17.1-42.7) months in the non-users (p = 0.01). Accordingly, PPI use for PFS (Non-use vs. Use = HR: 0.44, 95%Cl 0.28-0.96, p = 0.014) and PPI use for OS (Non-use vs. Use = HR: 0.68, 95%Cl 0.22-0.88, p = 0.01) were found to be as independent risk factors.ConclusionsConcomitant use of PPIs is associated with worse survival outcomes in patients with mRCC treated with nivolumab. Clinicians should carefully consider the concomitant use of PPIs in such patients.
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    Is pancreatic giant cell tumor resistant to standard chemotherapy?
    (Lippincott Williams & Wilkins, 2022) Caglayan, Dilek; Eryilmaz, Melek Karakurt; Korkmaz, Mustafa; Karaagac, Mustafa; Hendem, Engin; Artac, Mehmet
    Pancreatic giant cell tumors (PGCTs), undifferentiated pancreatic carcinoma are rare tumors of the pancreas. PGCTs consist of osteoclastic, pleomorphic and mixed variants. PGCT is usually diagnosed at an advanced stage. PGCT has a worse prognosis than pancreatic ductal adenocarcinoma. Although surgery can be curative, there is no standard treatment approach for advanced PGCT. We present a case of PGCT that is resistant to standard therapy and progresses in a short time.
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    Nephrotic syndrome induced by cetuximab in a patient with metastatic colorectal cancer
    (Sage Publications Ltd, 2022) Korkmaz, Mustafa; Hendem, Engin; Eryilmaz, Melek Karakurt; Demirkiran, Aykut; Karaagac, Mustafa; Artac, Mehmet
    Introduction Cetuximab, an anti-EGFR monoclonal antibody, often cause skin toxicity, most commonly acneiform rash. We present a rare case of glomerulonephritis associated with cetuximab therapy. Case Report A 58-year-old male patient recently completed cetuximab-based chemotherapy for metastatic colorectal adenocarcinoma. He presented with acute renal failure, anasarca edema and nephrotic proteinuria. The amount of protein in the 24-h urine test was over 15.6 grams. Management & Outcome The patient showed a dramatic improvement in renal function shortly after terminated of cetuximab therapy without immunosuppressive therapy. Discussion Therefore, drugs targeting epidermal growth factor receptor (EGFR) monoclonal antibody were thought to trigger nephrotic syndrome by causing glomerular damage. As a result, physicians using EGFR monoclonal inhibitors should be very careful about renal functions and proteinuria in patients.
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    Ribociclib-induced hepatotoxicity
    (Sage Publications Ltd, 2023) Muhiddin, Er Muhammed; Araz, Murat; Hendem, Engin; Eryilmaz, Melek Karakurt; Artac, Mehmet
    Introduction Cyclin-dependent kinase (CDK) 4/6 inhibitors have shown a different adverse effect. In this case, persistent grade 3 hepatoxicity was observed after ribociclib. Therefore, ribociclib therapy was stopped, and then palbociclib was introduced. Transaminase levels returned to normal by switching to palbociclib therapy. Case report 71-year-old postmenopausal female patient with luminal subtypes of metastatic breast cancer treated with ribociclib. Management & outcome Grade 3 hepatotoxicity secondary to ribociclib developed. She was successfully treated with palbociclib 125 mg. Discussion In our case, palbociclib was started with a full dose, to increase treatment success. Starting with a 125 mg dose was not cause any toxicity. Nevertheless, laboratory follow-up is required in terms of neutropenia and increased transaminases.