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    Cetuximab-induced rash is associated with overall survival in patients with recurrent/metastatic squamous cell carcinoma of head and neck
    (Springer, 2021) Goksu, Sema Sezgin; Tatli, Ali Murat; Geredeli, Caglayan; Atci, Mustafa; Besen, Ali Ayberk; Mertsoylu, Huseyin; Uysal, Mukremin
    Purpose In this study, we looked for whether treatment-induced rash predicts treatment efficacy in patients with recurrent/metastatic HNSCC treated with Cetuximab and chemotherapy. Methods Patients who were treated with platinum-based chemotherapy and cetuximab for the first line treatment of recurrent/metastatic HNSCC were recruited. Presence of rash, hypomagnesemia, hypopotassemia, anemia, neutropenia, thrombocytopenia during treatment and treatment response, date of progression, date of last visit and death were recorded. Results A total of 138 patients' data were available for analysis. Any grade of rash was detected in 57 (44.5%) of the patients. The incidence of rash was significantly higher in patients with objective response than in patients with disease progression (%56.8 vs %14.3, p < 0.001). Progression free survival was 7.06 months (4.98-9.15) in patients treated with cetuximab and chemotherapy as first line treatment. In the multivariate analysis; rash was significantly correlated with longer PFS (HR 2.136; 95% CI 1.067-4.278; p = 0.032). Progression free survival was 9.65 months in patients who experienced rash, and 6.02 months in patients without rash, (p = 0.019, log-rank test). Overall survival was 11.24 months (9.65-12.82). In multivariate analysis, the survival of patients with rash was significantly longer than patients without rash (HR 1.954; 95% CI 1.162-3.285; p = 0.012). Overall survival was 15.08 months in patients who experienced rash, and 8.61 months in patients without rash (p = 0.05, log-rank test). Conclusion Cetuximab-induced rash is associated with better ORR and longer PFS and OS in patients with recurrent/metastatic HNSCC treated with Cetuximab and platinum-based chemotherapy.
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    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.
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    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.
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    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.
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    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.
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    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 Cem
    Purpose 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.