Caglayan Geredeli

Aim: Efficacy of antiepidermal growth factor receptor (anti-EGFR) agents has been demonstrated in metastatic colorectal cancer (mCRC). Real-world evidence is especially important to detect patient findings outside of clinical trials. Therefore; we aimed to investigate the real-world data in patients with RAS wild-type mCRC. Methods: Medical records from 28 centers were collected for patients diagnosed with mCRC between January 2016 and April 2019. Patients were compared according to the first-line biological treatments as anti-EGFR group (Group A (panitumumab) and B (cetuximab)) and anti-VEGF group (Group C). Results: A total of 1064 patients with documented RAS wild-type mCRC were evaluated. Of these; 33%; 37% and 30% were treated with regimens including panitumumab; cetuximab; and anti-VEGF in the first-line; respectively. Overall response rate was 46.4%; 41.9% and 41.5% in A; B; and C groups; respectively (p = 0;170). The median OS was 26; 27; and 23 months in A; B and C group respectively (p = 0.044). The median PFS of the patients that treated with panitumumab; cetuximab and bevacizumab was 11;6; 11;0 and 9;6 months respectively (p = 0.012). ECOG performance status (PS) 0-1 and Braf wild-type status were found as independent prognostic factors in multivariate analysis for OS and only BRAF wild-type status for PFS (p

Background and Objectives: Clinically meaningful drug–drug interactions may be overlooked in oncology. Proton pump inhibitors (PPIs) may modulate outcomes with immune checkpoint inhibitors (ICIs) by altering the gut microbiome, altering the immune milieu, and affecting transporter interactions. We evaluated whether concomitant PPI use affects survival among patients with metastatic non-small cell lung cancer (NSCLC) treated with nivolumab. Materials and Methods: We retrospectively included patients with metastatic NSCLC who received second-line nivolumab across five oncology centers (January 2020–June 2023). Patients were grouped as concomitant PPI users vs. non-users. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan–Meier method and compared with the log-rank test; multivariable Cox models assessed independent associations. Results: A total of 194 patients were screened, of whom 30 were excluded according to predefined criteria. The final analysis included 164 patients—85 PPI users and 79 non-users. Median OS was 26.1 months (95% CI 15.5–36.7) in PPI users and 29.3 months (22.2–36.4) in non-users; this difference was not statistically significant (p = 0.54). Median PFS was 6.2 months (3.7–8.6) in PPI users vs. 10.2 months (7.1–13.2) in non-users (p = 0.04). In multivariable analysis, absence of concomitant PPI use (No vs. Yes) was independently associated with longer PFS (HR = 0.52, 95% CI 0.24–0.89, p = 0.03), whereas PPI use was not associated with OS (HR = 0.96, 95% CI 0.67–1.61, p = 0.83). Conclusions: Concomitant PPI use during nivolumab therapy was associated with significantly shorter PFS and a numerical reduction in OS in real-world metastatic NSCLC. Where clinically feasible, the need for PPIs should be re-evaluated before and during ICI therapy.

Ejmi Eurasian Journal of Medical Investigation

AIM: In early-stage breast cancer, the axillary lymph nodes play a crucial role in determining the prognosis of the disease. The rate of lymph node involvement might be a more valuable prognostic factor than the number of positive lymph nodes. Therefore, we aimed to evaluate whether the lymph node ratio (LNR) is a superior prognostic indicator compared to the pathologic lymph node count in early-stage disease. METHODS: We included 3053 non-metastatic, lymph node-positive breast cancer patients who were treated and followed at 6 medical oncology centers in Türkiye between 2004–2018. Based on LNR, patients were classified into three risk groups: high (>0.65), intermediate (0.21–0.65), and low (≤0.20). RESULTS: Classification of patients according to the TNM8 system based on the number of positive lymph nodes revealed that pathologic lymph node count (pN)1 accounted for 49.0% (n = 1495), pN2 for 30.0% (n = 917), and pN3 for 21.0% (n = 641). Based on the LNR risk group, the low-risk group accounted for 45.4% (n = 1385), intermediate for 36.2% (n = 1105), and high for 18.4% (n = 563) of the total patients. For the entire patient cohort, the 5- and 10-year disease-free survival (DFS) were 93% and 67%, respectively, while overall survival (OS) rates were 95% and 75%, respectively. The median DFS for patients with N1, N2, and N3 disease was 149 months (94.2–203.7), 120.1 months (108.2–132.0), and 81.8 months (68.4–131.1), respectively (p < 0.001). The median DFS for the three LNR risk groups (low, intermediate, and high risk) was 148.9 months (95.3–202.6), 118.7 months (99.9–137.7), and 81.8 months (68.2–95.3) respectively. Increasing LNR rate was an independent prognostic factor for DFS, according to multivariate analysis (p < 0.001). Furthermore, the median DFS was 133 months for pathologic N1 patients in the LNR intermediate-high risk group, while the median DFS was not reached in patients with LNR and the pN2 low risk group (p = 0.034). CONCLUSIONS: This study confirms the significance of LNR as a prognostic factor for DFS. The results show that in certain specific subgroups, LNR provides more information than pathologic lymph node counts.

Background: We aimed to evaluate the data of perioperative 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy regimen in locally advanced gastric cancer (LAGC) patients with real-life experience. Methods: In this retrospective study, LAGC patients who received perioperative FLOT chemotherapy regimen between 2017 and 2020 were included. The patients were grouped according to tumor regression grade (TRG): histopathological responders (complete/moderate response) and histopathological non-responders (minimal/poor response). The factors affecting TRG were evaluated and its relationship to clinical outcome was analyzed by disease-free survival (DFS) and overall survival (OS). Results: A total of 141 LAGC patients were included. Median age of patients was 62 (range: 35–75) years of whom 69.5% were men. According to TRG, 41 (29.1%) patients were histopathological responders (College of American Pathologists (CAP)-TRG 0/1). Grade, perineural and lymphovascular invasion, clinical stage, tumor markers (Carcinoembryonic antigen (CEA) and Carbohydrate antigen (CA)19-9), radiological response, and ypTNM stage were statistically significant in univariate analysis and lymphovascular invasion was detected as an independent factor in multivariate analysis for TRG. Grade 3-4 toxicities were observed in only 28 (19.9%) patients. Two years DFS and OS rates were higher in the histopathological responder group (100% and 100%) compared to the histopathological non-responder group (59% and 52.9%) (P = 0.01 and P = 0.02, respectively). Conclusion: In our study, it was found that the FLOT regimen had a favorable TRG and a safe toxicity profile in gastric cancer patients. In addition, while lymphovascular invasion could predict TRG, the survival and disease recurrence were positively affected by the favorable TRG response.

Aim: To evaluate the efficacy of trastuzumab and potential risk factors on survival in patients with HER2-positive metastatic gastric cancer. Methods: We retrospectively included 138 patients who w... Gastric cancer has a poor prognosis despite available treatments. Inclusive studies are still needed with real-life data. Our research retrospectively evaluated the efficacy of trastuzumab and pote...

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.

This study aimed to determine the differences in clinicopathological features of Turkish patients with high-risk breast cancer based on the mutation status of two breast cancer susceptibility genes (BRCA1/2) . This study enrolled patients with invasive breast cancer who have been evaluated for BRCA1/2 mutations due to the presence of high-risk factors admitted to two tertiary referral centers in Turkey. Clinical and histopathological features were analyzed in BRCA1 mutation carriers, BRCA2 mutation carriers, and non-carriers. A total of 302 patients with a mean age of 44.2±9.9 (22–82) years were included. BRCA1/2 mutation was found in 75 (24%) patients, of whom 41 (13.6%) were BRCA1 mutation carriers and 37 (12.3%) were BRCA2 mutation carriers. Moreover, 104 (34.4%) and 4 (1.3%) patients had family history of breast and ovarian carcinoma, respectively. The rates of triple negativity (56.1%), histologic grade 3 (65.9%), and lymphovascular invasion (78%) were significantly higher in BRCA1 mutation carriers than in non-carriers and BRCA2 mutation carriers. Furthermore, 87% of triple-negative BRCA1 mutation carriers had histologic grade 3 tumors compared with 38.9% in non-triple-negative BRCA1 mutation carriers, and the difference was significant. Findings of this study showed that BRCA1-related breast cancers represent a distinct group with unique pathological features, which are usually associated with a poor prognosis.

Herein, we report a case of appendix adenocarcinoma who presented with a recurrence 8 years after the initial diagnosis. A 54-year-old male underwent appendectomy in 2009. The pathology revealed a 1.7 cm diameter low grade mucinous carcinoid tumor. Any additional treatment was not recommended for patient other than appendectomy. The patient was admitted with the symptoms of ileus at 8 years after surgery and then underwent to right hemicolectomy in 2017. On histopathological examination of the specimen revealed a Goblet cell adenocarcinoid tumor, arising from iliocecal valv with pericolorectal tissue invasion of 5 cm in diameter. Lymph-node metastases were found in 16 dissected lymph nodes. The patient was initiated to treat with combined capecitabine and oxaliplatin chemotherapy. There is no clear evidence to support the superiority of any particular chemotherapy regimen for adjuvant treatment of appendix tumors. In this regard more studies are needed to use combined regimens.