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Öğe Bevacuzimab May Be Less Effective in Obese Metastatic Colorectal Cancer Patients(Springer, 2019) Artac, Mehmet; Korkmaz, Levent; Coskun, Hasan Senol; Dane, Faysal; Karabulut, Bulent; Karaagac, Mustafa; Cabuk, DevrimPurposeThe purpose of this study was to investigate whether obesity affects survival in metastatic colorectal cancer (mCRC) patients treated with bevacizumab combined with chemotherapy.MethodsA total of 563 patients with mCRC who had received first-line chemotherapy in combination with bevacizumab were studied. Patients were grouped as obese (BMI levels >30) or non-obese (BMI levels <30). Progression-free survival (PFS) and overall survival (OS) were analyzed. Primary tumor location was also investigated in terms of PFS and OS.ResultsThe median age of the patients was 59years. The non-obese group had longer PFS than the obese group (P=0.030). The 2-year survival rate of the non-obese group was also significantly higher (P=0.036). The median PFS of non-obese patients was significantly longer in Kras wild-type patients (10.1 vs. 8.1months, P=0.010). Among patients with left-sided primary tumor location, median PFS and OS were significantly higher in the non-obese group (PFS non-obese, 11.5months; obese, 8.8months; P=0.002) (OS non-obese, 29.4months; obese, 21.4months; P=0.026).ConclusionsEfficacy of bevacizumab may be lower in obese patients. Among patients with Kras wild-type left-sided tumors treated with bevacizumab-based regimens, the prognosis could be worse for obese patients than that for non-obese patients. There is a need for prospectively designed studies of obese patients to prove the efficacy and dosages of bevacizumab in treatment of mCRC.Öğe Chronic Myeloid Leukemia After Chemoradiotherapy in a Patient with Non-Small Cell Lung Cancer(2017) Demircioğlu, Sinan; Korkmaz, Levent; Yılmaz, Seda; Bektaş, Özlen; Çeneli, Özcan; Artaç, MehmetChronic myeloid leukemia(CML) is a myeloproliferative disease characterized by uncontrolled proliferation of mature and maturing granulocytes. Chronic myeloid leukemia accounts for approximately 15 to 20 percent of leukemias in adults. The incidence is 1-2/10000 per year.1-2 There is only one risk factor, which is ionized radiation.3 There are some publitions in the literature about CML development after chemotherapy and/or radiotherapy. Here we presented a case that CML occured after chemotherapy concurrent with radiotherapy in non-small cell lung cancer patient. Sixty year old man who has diagnosed inoperable lung adenocarcinoma in 2013. Carboplatin concurrent with radiotherapy was administered to him. After 2 years follow-up with no progression of disease, the level of leucocyte was started to increase. White blood cell level was 41700/ul, haemoglobin level was 14.3 g/dl and platelet level was 239000/ul. Peripheral blood smear suggested chronic myeloid leukemia. Bone marrow aspiration and biopsy was performed. The biopsy was supported chronic phase chronic myeloid leukemia. Cytogenetic analysis showed %95 translocation (9;22) in 20 metaphasis. BCR-ABL was detected as 60% IS. Sokal, Hasford and EUTOS risk score was calculated high. Imatinib therapy was started as 400 mg/day. Hematologic response was seen 2 weeks after imatinib treatment. After 3, 6, 12 months, BCR-ABL was detected as 27% IS, 1% IS, and 0.4 IS, respectively. The patient is still being followed as remission for both lung cancer and CML.Öğe Chronic Myeloid Leukemia After Chemoradiotherapy in a Patient with Non-Small Cell Lung Cancer(Akad Doktorlar Yayinevi, 2017) Demircioglu, Sinan; Korkmaz, Levent; Yilmaz, Seda; Bektas, Ozlen; Ceneli, Ozcan; Artac, Mehmet[Abstract Not Availabe]Öğe 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, MukreminPurposeWe 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.Öğe 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, MukreminPurpose: 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.Öğe Erlotinib Response in a Non-Small Cell Lung Cancer Patient with EGFR Exon 20 Mutation(Akad Doktorlar Yayinevi, 2016) Korkmaz, Levent; Artac, Mehmet; Karaagac, Mustafa; Er, Zehra; Boruban, Melih C.; Poyraz, Necdet; Kaya, Bugra[Abstract Not Availabe]Öğe Erlotinib Response in a Non-Small Cell Lung Cancer Patient with EGFR Exon 20 Mutation(2016) Korkmaz, Levent; Artaç, Mehmet; Karaagaç, Mustafa; Er, Zehra; Boruban, Melih C; Poyraz, Necdet; Kaya, Buğra; Tavlı, Lema; Ödev, KemalÖğe Prognostic Impact of Neutrophil/Lymphocyte Ratio, Platelet Count, CRP, and Albumin Levels in Metastatic Colorectal Cancer Patients Treated with FOLFIRI-Bevacizumab(Springer, 2017) Artac, Mehmet; Uysal, Mukremin; Karaagac, Mustafa; Korkmaz, Levent; Er, Zehra; Guler, Tunc; Boruban, Melih CemPurpose Metastatic colorectal cancer (mCRC) is a lethal disease and fluorouracil-leucovorin-irinotecan (FOLFIRI) plus bevacizumab (bev) is a standard approach. Hence, there is a strong need for identifying new prognostic factors to show the efficacy of FOLFIRI-bev. Methods This is a retrospective study including patients (n = 90) with mCRC from two centers in Turkey. Neutrophil/lymphocyte (N/L) ratio, platelet count, albumin, and Creactive protein (CRP) were recorded before FOLFIRI-bev therapy. The efficacy of these factors on progression-free survival (PFS) was analyzed with Kaplan Meier and Cox regression analysis. And the cutoff value of N/L ratio was analyzed with ROC analysis. Results The median age was 56 years (range 21-80). Forty-seven percent of patients with N/L ratio >2.5 showed progressive disease versus 43 % in patients with N/L ratio <2.5 (p = 0.025). The median PFS was 8.1 months for the patients with N/L ratio >2.5 versus 13.5 months for the patients with N/L ratio <2.5 (p = 0.025). At univariate Cox regression analysis, high baseline neutrophil count, LDH, N/L ratio, and CRP were all significantly associated with poor prognosis. At multivariate Cox regression analysis, CRP was confirmed to be a better independent prognostic factor. CRP variable was divided into above the upper limit of normal (ULN) and normal value. The median PFSs of the patients with normal and above ULN were 11.3 versus 5.8 months, respectively (p = 0.022). Conclusions CRP and N/L ratio are potential predictors for advanced mCRC treated with FOLFIRI-bev.Öğe The Prognostic Value of Serum Semaphorin3A and VEGF Levels in Patients with Metastatic Colorectal Cancer(Springer, 2020) Karpuz, Tuba; Araz, Murat; Korkmaz, Levent; Kilinc, Ibrahim; Findik, Sidika; Karaagac, Mustafa; Eryilmaz, Melek KarakurtPurpose Despite new treatment options in metastatic colorectal cancer (mCRC), new prognostic markers are still needed to determine optimal chemoregimen especially for anti-angiogenesis drugs. In this study, we evaluated the serum semaphorin and VEGF-A levels as prognostic factors in patients with mCRC. Methods Patients with diagnosed mCRC who were treated with first-line bevacizumab plus chemotherapy were included in the study. Venous blood samples of 37 patients with metastatic colon cancer were taken, and serum semaphorin 3A and VEGF-A levels were studied in pre-treatment and the 1st and third months after the treatment was initiated. Results Totally, 37 patients were enrolled in the study. The patients' mean age was 62 years. Twenty-eight (49%) of the patients were male, and 19 (51%) were female. Serum semaphorin3A (sema3A) levels of the patients were 5.4 +/- 7.4 ng/ml before the treatment, 3.5 +/- 3.3 ng/ml at the first month, and 3.5 +/- 3.7 ng/ml at the third month. Serum VEGF-A levels were 27.7 +/- 32.9 ng/l before the treatment, 23.1 +/- 28.1 ng/l at the first month, and 28.9 +/- 30.2 ng/l at the third month. There was no significant correlation between the survival and pre-treatment VEGF-A level (p = 0.064). Overall survival (OS) was statistically significantly higher in patients with pre-treatment semaphorin 3A levels below 5.4 ng/ml than higher than 5.4 ng/ml (10.5 months vs 4.5 months, respectively, HR 0.23, 95% CI 19.635-11,391, p = 0.012). Conclusion Pre-treatment semaphorin 3A level can be a prognostic marker for the mCRC patients who were treated with bevacizumab in patients with metastatic colorectal cancer.Öğe The Relationship Between Plexin C1 Overexpression and Survival in Hepatocellular Carcinoma: a Turkish Oncology Group (TOG) Study(Springer, 2022) NazimTurhal, Serdar; Dogan, Mutlu; Esendagli, Guldal; Artac, Mehmet; Korkmaz, Levent; Coskun, Hasan Senol; Goker, ErdemPurpose Plexin C1 is a transmembrane receptor and plexin C1 overexpression might have role in carcinogenesis. Hepatocellular carcinoma (HCC) has poor prognosis because of its aggressive behavior and limited treatment options, especially in advanced stage. We recently documented that Plexin C1 was overexpressed in HCC. We aimed to evaluate the prognostic significance of Plexin C1 overexpression in HCC in the present study. Methods Plexin C1 overexpression was evaluated immunohistochemically on paraffin-embedded blocks of the HCC patients. Plexin C1 immunohistochemical staining was scored. Plexin C1 overexpression staining intensity and prevalence were used for plexin scale staining evaluation and plexin scores were estimated according this staining scale. Plexin C1 score and its association with survival and clinicopathological features was assessed. Results Sixty-seven HCC patients with adequate tissue for pathological evaluation were included. Median age was 63 years with male predominance (male to female ratio was 4.75 (n 57/12). Well-differentiated HCC (53.7%) patients had higher plexin C1 overexpression (p < 0.05). Median OS was 22.1 months. Patients with lower plexin C1 score (< 12) had shorter OS (17.5 vs 30.1 months, p = 0.036). Neutrophil count, GGT, and PNR (platelet/neutrophil ratio) had prognostic significance (p = 0.047, p = 0.018, and p = 0.045). Conclusion Plexin C1 overexpression is inversely correlated with grade in HCC. The patients with lower rate of Plexin C1 overexpression have worse survival outcome. It might be a prognostic factor in HCC.Öğe Survivin Expression May Affect The Neoadjuvantchemotherapy Response İn Breast Cancer Patients(2017) Er, Zehra; Peştereli, Hatice Elif; Tavlı, Lema; Bozcuk, Hakan; Erdoğan, Gülgün; Esen, Hacı Hasan; Artaç, Mehmet; Korkmaz, Levent; Gündüz, Şeyda; Karaağaç, Mustafa; Demircioğlu, SinanTo investigate whether there is a predictive effect of NF-kappaB, survivin, and Ki-67 expressions on pathological response and disease relapse in breast cancer (BC) patients. Ki-67, survivin and NF-kappaB expressions were analyzed in the pathology specimens of breast biopsy before and after neoadjuvant chemotherapy (NeoCT) in BC patients (n52). Event -free survival (EFS) (defined as recurrence or metastasis free) analyze was performed. The median overall survival was 43.5 months and the median EFS was 51 months (95% CI: 33.3-68.9) in all patients. The expression percentages of NF-kappaB, survivin, and Ki-67 significantly decreased after NeoCT (p>0.001). Survivin expression level before NeoCT was significantly higher in patients who did not respond to NeoCT than both partial-responders and complete-responders (p0.038, p0.010, respectively). Type of NeoCT was the only independent factor on pathological response status (p0.007). Addition of taxanes to NeoCT improved pathological complete response rates about six times. However, no predictor was found to be a prognostic factor for EFS in multivariate analyze. Higher survivin expression level before NeoCT may be associated with poor pathological response to NeoCT. These findings must be tested with prospective clinical trials.Öğe An update on the multimodality of localized rectal cancer(Elsevier Science Inc, 2016) Artac, Mehmet; Korkmaz, Levent; El-Rayes, Bassel; Philip, Philip A.New strategies have reduced the local recurrence (LR) rate and extended the duration of overall survival (OS) in patients with localized rectal cancer (RC) in recent decades. The mainstay of curative treatment remains radical surgery; however, downsizing the tumor by neo-adjuvant chemo-radiotherapy and adjuvant cytotoxic therapy for systemic disease has shown significant additional benefit. The standardization of total mesorectal excision (TME), radiation treatment (RT) dose and fractionation, and optimal timing and sequencing of treatment modalities with the use of prolonged administration of fluoropyrimidine concurrent with RT have significantly decreased the rates of LR in locally advanced rectal cancer (LARC) patients. This review focuses on the optimization of multi-modality therapies in patients with localized RC. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Öğe Using Interferon Alfa Before Tyrosine Kinase Inhibitors May Increase Survival in Patients With Metastatic Renal Cell Carcinoma: A Turkish Oncology Group (TOG) Study(Cig Media Group, Lp, 2016) Artac, Mehmet; Coskun, Hasan Senol; Korkmaz, Levent; Kocer, Murat; Turhal, Nazim Serdar; Engin, Huseyin; Dede, IsaSurvival outcomes of interferon-alfa and tyrosine kinase inhibitors for 104 cases of metastatic renal cell carcinoma were included in this study. First-line interferon-alfa treatment before tyrosine kinase inhibitors had an additive survival affect. Background: We aimed to investigate the outcomes of interferon alfa and sequencing tyrosine kinase inhibitors (TKIs) in patients with metastatic renal cell carcinoma. Patients and Methods: This multicenter study assessing the efficacy of TKIs after interferon alfa therapy in the first-line setting in patients with metastatic renal cell carcinoma. Patients (n = 104) from 8 centers in Turkey, who had been treated with interferon alfa in the first-line setting, were included in the study. Prognostic factors were evaluated for progression-free survival (PFS). Results: The median age of the patients was 57 years. The median PFS of the patients treated with interferon alfa in the first-line was 3.6 months. A total of 61 patients received TKIs (sunitinib, n = 58; sorafenib, n = 3) after progression while on interferon alfa. The median PFS among the TKI-treated patients was 13.2 months. In the univariate analysis for interferon alfa treatment, neutrophil and hemoglobin level, platelet count, and Karnofsky performance status were the significant factors associated with PFS. In the univariate analysis for TKI treatment, neutrophil and hemoglobin levels were the significant factors for PFS. The median total PFS of the patients who had been treated with first-line interferon alfa and second-line TKIs was 24.9 months. Conclusion: This study showed that first-line interferon alfa treatment before TKIs may improve the total PFS in patients with metastatic renal cell carcinoma. (C) 2016 Elsevier Inc. All rights reserved.
