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Öğe Checkpoint inhibitors in advanced nonsmall-cell lung cancer; a Bayesian network meta-analysis(Wolters Kluwer Medknow Publications, 2020) Bozcuk, Hakan; Yildirim, Mustafa; Sever, Ozlem; Mutlu, Hasan; Artac, MehmetBackground: Checkpoint inhibitors (CPIs) have improved survival compared to chemotherapy alone in advanced nonsmall-cell lung cancer (NSCLC). This article aims to compare indirect evidence and rank the effect of different CPIs in this setting. Materials and Methods: In this network meta-analysis, we searched for trials comparing CPIs in advanced NSCLC. Figures for survival endpoints were extracted. In addition, a network meta-regression analysis was carried out. Results: A total of 9220 patients from 16 trials were included in the analysis. In the first-line setting, for the overall survival endpoint, the chemotherapy + Pembrolizumab combination had the highest effectivity rank probability as compared to chemotherapy (hazard ratio = 0.788, 95% credential interval = 0.728-0.855). For the second-line setting, and also for the efficacy in terms of progression-free survival, various CPIs and their combinations were ranked. Conclusion: Some degree of differences in terms of efficacy exists between different types, dosages, settings, and combinations of CPI. We quantify these differences to guide clinical practice.Öğe DOES PRIMARY TUMOR RESECTION AFFECT SURVIVAL IN ELDERLY PATIENTS WITH METASTATIC GASTRIC CANCER?(Gunes Kitabevi Ltd Sti, 2016) Yalcin Musri, Fatma; Mutlu, Hasan; Karaagac, Mustafa; Gunduz, Seyda; Karakurt Eryilmaz, Melek; Kivrak Salim, Derya; Tazegul, GokhanIntroduction: In this study, the effect of primary tumor resection (PTR) on the survival of patients with metastatic gastric carcinoma (mCG) aged over 65 years was aimed to be searched. Materials and Method: In total, 98 patients with mCG from the Akdeniz University, Necmettin Erbakan University, and Antalya Training and Research Hospital databases who were aged over 65 years were retrospectively evaluated. The patients were divided into two groups based on PTR: PTR (+) and PTR (-). Results: The median progression-free survival in the PTR (+) group was 10.2 months (95% confidence interval [CI] 6.6-13.7) and in the PTR (-) group was 5.9 months (95% CI 2.6-9.3) (p=0.054). When we evaluated the overall survival (OS) of the groups, the median OS was significantly higher in the PTR (+) group (11.5 months, 95% CI 8.4-14.6) than in the PTR (-) group (7.2 months, 95% CI 4.3-10.0) (p=0.001). In the final multivariate analysis, none of the parameters studied were independent prognostic factors. Conclusion: PTR may be beneficial for the survival of patients with mGC aged over 65 years.Öğe Primary Tumor Resection and Survival in Patients with Stage IV Gastric Cancer(Korean Gastric Cancer Assoc, 2016) Musri, Fatma Yalcin; Mutlu, Hasan; Karaagac, Mustafa; Eryilmaz, Melek Karakurt; Gunduz, Seyda; Artac, MehmetPurpose: The aim of this study was to determine whether surgical resection of the primary tumor contributes to survival in patients with metastatic gastric cancer. Materials and Methods: A total of 288 patients with metastatic gastric cancer from the Akdeniz University, Antalya Training and Research Hospital, and the Meram University of Konya database were retrospectively analyzed. The effect of primary tumor resection on survival of patients with metastatic gastric cancer was investigated using the log-rank test. Kaplan-Meier survival estimates were calculated. Multivariate analysis was performed using Cox proportional hazards regression modeling. Results: The median overall survival was 12.0 months (95% confidence intewrval [CI], 10.4 similar to 13.6 months) and 7.8 months (95% CI, 5.5 similar to 10.0 months) for patients with and without primary tumor resection, respectively (P<0.001). The median progression-free survival was 8.3 months (95% CI, 7.1 similar to 9.5 months) and 6.2 months (95% CI, 5.8 similar to 6.7 months) for patients with and without primary tumor resection, respectively (P=0.002). Conclusions: Non-curative gastrectomy in patients with metastatic gastric cancer might increase their survival rate regardless of the occurrence of life-threatening tumor-related complications.Öğe Programmed death-1 or programmed death ligand-1 inhibitors? A meta-analysis of differential efficacy as compared to chemotherapy in advanced non-small cell lung cancer(Sage Publications Ltd, 2021) Bozcuk, Hakan; Artac, Mehmet; Mutlu, Hasan; Sever, Ozlem; Yildirim, MustafaBackground Programmed Death-1 (PD-1) and Programmed Death Ligand-1 (PDL-1) inhibitors have improved survival over chemotherapy in advanced Non- Small Cell Lung Cancer (NSCLC). However, it is unclear if there are class specific differences in the efficacy of Checkpoint Inhibitors (CPIs) in NSCLC, and this paper is designed to answer these clinical questions. Methods For this Meta-analysis, we searched PubMed, Science of Web, Clinicaltrials.gov and online sources for trials comparing PD-1 and PDL-1 CPIs in advanced NSCLC. The data for Hazard Ratio (HR) and their Confidence Intervals (CI) for Overall Survival (OS) was extracted. Results A sum of 9739 patients from 16 trials were included in the efficacy evaluation. For the OS endpoint, both PD-1 inhibitors (HR = 0.76, 95%CI = 0.69-0.83, P < 0.001) and PDL-1 inhibitors (HR = 0.84, 95%CI = 0.74-0.95, P < 0.001) were superior to chemotherapy in treatment naive (upfront) patients, the results were similar in treatment refractory patients (PD-1 inhibitors (HR = 0.67, 95%CI = 0.60-0.75, P < 0.001) and PDL-1 inhibitors (HR = 0.78, 95%CI = 0.69-0.88, P < 0.001) were superior to chemotherapy). There was no difference in the effect of PD-1 and PDL-1 classes of CPIs over chemotherapy in treatment naive and treatment refractory settings (Q = 1.88, df = 1, P = 0.017, and, Q = 3.27, df = 1, P = 0.070, respectively). Conclusion Efficacy of PD-1 and PDL-1 class of CPIs was not different, although differences among individual CPIs or their combinations cannot be excluded. We were also able to compute pooled efficacy data, as compared to chemotherapy alone, for trials where these groups of CPIs were utilized.
