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Yasar HA, Aktas BY, Ucar G, Goksu SS, Bilgetekin I, Cakar B, Sakin A, Ates O, Basoglu T, Arslan C, Demiray AG, Paydas S, Cicin I, Sendur MAN, Karadurmus N, Kosku H, Uner A, Yumuk PF, Utkan G, Kefeli U, Tanriverdi O, Cinkir H, Gumusay O, Turhal NS, Menekse S, Kut E, Beypinar I, Sakalar T, Demir H, Yekeduz E, Kilickap S, Erman M, Urun Y. Adrenocortical Cancer in the Real World: A Comprehensive Analysis of Clinical Features and Management from the Turkish Oncology Group (TOG). Clin Genitourin Cancer 2024; 22:102077. [PMID: 38626660 DOI: 10.1016/j.clgc.2024.102077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is a rare yet highly malignant tumor associated with significant morbidity and mortality. This study aims to delineate the clinical features, survival patterns, and treatment modalities of ACC, providing insights into the disease's prognosis. MATERIALS AND METHODS A retrospective analysis of 157 ACC patients was performed to assess treatment methodologies, demographic patterns, pathological and clinical attributes, and laboratory results. The data were extracted from the hospital's database. Survival analyses were conducted using the Kaplan-Meier method, with univariate and multivariate analyses being performed through the log-rank test and Cox regression analyses. RESULTS The median age was 45, and 89.4% had symptoms at the time of diagnosis. The median tumor size was 12 cm. A total of 117 (79.6%) patients underwent surgery. A positive surgical border was detected in 26 (24.1%) patients. Adjuvant therapy was administered to 44.4% of patients. The median overall survival for the entire cohort was 44.3 months. Median OS was found to be 87.3 months (95% confidence interval [CI] 74.4-100.2) in stage 2, 25.8 (95% CI 6.5-45.1) months in stage 3, and 13.3 (95% CI 7.0-19.6) months in stage 4 disease. Cox regression analysis identified age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as significant factors associated with survival in patients with nonmetastatic disease. In metastatic disease, only patients who underwent surgery exhibited significantly improved overall survival in univariate analyses. CONCLUSION ACC is an uncommon tumor with a generally poor prognosis. Understanding the defining prognostic factors in both localized and metastatic diseases is vital. This study underscores age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as key prognostic determinants for localized disease, offering critical insights into the complexities of ACC management and potential avenues for targeted therapeutic interventions.
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Affiliation(s)
| | | | - Gokhan Ucar
- Medical Oncology Department, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | | | - Irem Bilgetekin
- Medical Oncology Department, Gazi University, Ankara, Turkey
| | - Burcu Cakar
- Medical Oncology Department, Ege University, Izmir, Turkey
| | - Abdullah Sakin
- Medical Oncology Department, Van Yuzuncu Yıl University, Van, Turkey
| | - Ozturk Ates
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Tugba Basoglu
- Medical Oncology Department, Marmara University, Istanbul, Turkey
| | - Cagatay Arslan
- Medical Oncology Department, Bahcesehir University, MedicalPark Hospital, Izmir, Turkey
| | | | - Semra Paydas
- Medical Oncology Department, Adana Cukurova University, Adana, Turkey
| | - Irfan Cicin
- Medical Oncology Department, Trakya University, Edirne, Turkey
| | | | - Nuri Karadurmus
- Medical Oncology Department, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Hakan Kosku
- Medical Oncology Department, Ankara University, Ankara, Turkey
| | - Aytuğ Uner
- Medical Oncology Department, Gazi University, Ankara, Turkey
| | - Perran Fulden Yumuk
- Medical Oncology Department, Marmara University, Istanbul, Turkey; Medical Oncology Department, Koç University, Istanbul; Turkey
| | - Gungor Utkan
- Medical Oncology Department, Ankara University, Ankara, Turkey
| | - Umut Kefeli
- Medical Oncology Department, Kocaeli University, Kocaeli, Turkey
| | - Ozgur Tanriverdi
- Medical Oncology Department, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Havva Cinkir
- Medical Oncology Department, Gaziantep University, Gaziantep, Turkey
| | - Ozge Gumusay
- Medical Oncology Department, Gaziosmanpasa University, Tokat, Turkey
| | | | - Serkan Menekse
- Medical Oncology Department, Manisa City Hospital, Manisa, Turkey
| | - Engin Kut
- Medical Oncology Department, Manisa City Hospital, Manisa, Turkey
| | - Ismail Beypinar
- Medical Oncology Department, Afyon Health Sciences University, Afyon, Turkey
| | - Teoman Sakalar
- Medical Oncology Department, Aksaray University, Aksaray, Turkey
| | - Hacer Demir
- Medical Oncology Department, Afyon Health Sciences University, Afyon, Turkey
| | - Emre Yekeduz
- Medical Oncology Department, Ankara University, Ankara, Turkey
| | | | - Mustafa Erman
- Medical Oncology Department, Hacettepe University, Ankara, Turkey
| | - Yuksel Urun
- Medical Oncology Department, Ankara University, Ankara, Turkey.
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Guven DC, Aykan MB, Muglu H, Bayram E, Helvaci K, Dursun B, Celayir M, Chelebiyev E, Nayir E, Erman M, Sezer A, Urun Y, Demirci U, Er O, Disel U, Bilici A, Arslan C, Karadurmus N, Kilickap S. The efficacy of immunotherapy and chemoimmunotherapy in patients with advanced rare tumors: A Turkish oncology group (TOG) study. Cancer Med 2023; 13:e6869. [PMID: 38140782 PMCID: PMC10809296 DOI: 10.1002/cam4.6869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION The advances in immune checkpoint inhibitors (ICIs) were relatively slow in rare tumors. Therefore, we conducted a multi-center study evaluating the efficacy of ICI monotherapy and the combination of ICIs with chemotherapy (CT) in patients with advanced rare tumors. METHODS In this retrospective cohort study, we included 93 patients treated with ICIs for NCI-defined rare tumors from the 12 cancer centers in Turkey. The primary endpoints were the overall response (ORR) and disease control rate (DCR). RESULTS The cohort's median age was 56, and 53.8% of the patients were male. The most frequent diagnosis was sarcoma (29%), and 81.7% of the patients were previously treated with at least one line of systemic therapy in the advanced stage. The ORR and DCR were 36.8% and 63.2%, respectively. The germ cell tumors had the lowest ORR (0%), while the Merkel cell carcinoma had the highest ORR to ICIs (57.1%). Patients treated with ICI + ICI or ICI plus chemotherapy combinations had higher ORR (55.2% vs. 27.6%, p = 0.012) and DCR (82.8% vs. 53.4%, p = 0.008). The median OS was 13.47 (95% CI: 7.79-19.15) months, and the six and 12-month survival rates were 71% and 52%. The median duration of response was 16.59 months, and the 12-month progression-free survival rate was 66% in responders. The median time-to-treatment failure was 5.06 months (95% CI: 3.42-6.71). Three patients had high-grade irAEs with ICIs (grade 3 colitis, grade 3 gastritis, and grade 3 encephalitis in one patient each). CONCLUSION We observed over 30% ORR and a 13-month median OS in patients with rare cancers treated with ICI monotherapy or ICI plus CT combinations. The response rates to ICIs or ICIs plus CT significantly varied across different tumor types. Responding patients had over 2 years of survival, highlighting a need for further trials with ICIs for patients with rare tumors.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical OncologyHacettepe University Cancer InstituteAnkaraTurkey
| | - Musa Baris Aykan
- Department of Medical OncologyGulhane School of Medicine, University of Health SciencesAnkaraTurkey
| | - Harun Muglu
- Istanbul Medipol University Faculty of MedicineIstanbulTurkey
| | - Ertugrul Bayram
- Department of Medical OncologyCukurova UniversityAdanaTurkey
| | | | - Bengü Dursun
- Department of Medical OncologyAnkara UniversityAnkaraTurkey
| | - Melisa Celayir
- Department of Medical OncologyMAA Acıbadem UniversityİstanbulTurkey
| | - Elvin Chelebiyev
- Department of Medical OncologyHacettepe University Cancer InstituteAnkaraTurkey
| | - Erdinc Nayir
- Department of Medical OncologyMersin Medical Park HospitalMersinTurkey
| | - Mustafa Erman
- Department of Medical OncologyHacettepe University Cancer InstituteAnkaraTurkey
| | - Ahmet Sezer
- Baskent University Adana HospitalAdanaTurkey
| | - Yuksel Urun
- Department of Medical OncologyAnkara UniversityAnkaraTurkey
| | | | - Ozlem Er
- Department of Medical OncologyMAA Acıbadem UniversityİstanbulTurkey
| | - Umut Disel
- Department of Medical OncologyAcibadem Adana HospitalAdanaTurkey
| | - Ahmet Bilici
- Istanbul Medipol University Faculty of MedicineIstanbulTurkey
| | - Cagatay Arslan
- Department of Medical OncologySchool of Medicine, Medical Park Hospital, Izmir Economy UniversityIzmirTurkey
| | - Nuri Karadurmus
- Department of Medical OncologyGulhane School of Medicine, University of Health SciencesAnkaraTurkey
| | - Saadettin Kilickap
- Department of Medical OncologyIstinye University Faculty of MedicineIstanbulTurkey
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Yildirim HC, Kus F, Guven DC, Karaca E, Kaygusuz Y, Dizdar O, Aksoy S, Erman M, Yalcin S, Kilickap S. Mean Platelet Volume to Lymphocyte Ratio: A New Biomarker Predicting Response in Patients with Solid Tumors Treated with Nivolumab. J Immunother Precis Oncol 2023; 6:170-176. [PMID: 38143956 PMCID: PMC10734395 DOI: 10.36401/jipo-23-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/30/2023] [Accepted: 08/15/2023] [Indexed: 12/26/2023]
Abstract
Introduction Although immune checkpoint inhibitors (ICIs) are widely used in cancer treatment, identifying factors that predict treatment response remains a challenge in clinical practice. There is a need for biomarkers to identify patients who may not benefit from these treatments. It is crucial to identify a simple and cost-effective biomarker that can be easily incorporated into clinical practice. This study aims to investigate the mean platelet volume to lymphocyte ratio (MPVLR), as measured by a hemogram test, and median overall survival (mOS) in patients with cancer treated with nivolumab. Methods A total of 131 adult patients with metastatic cancer, including malignant melanoma (MM), renal cell carcinoma (RCC), non-small cell lung cancer (NSCLC), and head and neck cancer (HNC), were included in this study. Baseline demographics, ECOG (Eastern Cooperative Oncology Group) performance status, tumor type, and blood count parameters were recorded. Univariate and multivariate analyses were conducted to evaluate potential risk factors. Results The median age of the patients was 59.87 ± 11.97 years, and the median follow-up period was 20.20 months (IQR, 12.80-27.60). RCC (43.5%) and MM (25.9%) were the most common diagnoses. Patients with ECOG scores of 0-1 had a longer mOS than those with scores of 2-3 (mOS: 20.60 months [95% CI, 14.94-25.29] vs. 5.24 months [95% CI, 0-16.42], p < 0.001). Additionally, patients with lactate dehydrogenase (LDH) levels within the normal range had a longer mOS than those with high LDH levels (mOS: 24.54 months [95% CI, 14.13-34.96] vs. 13.10 months [95% CI, 4.49-21.72], p = 0.038). Patients with low MPVLR also had a longer mOS than those with high MPVLR (mOS: 33.70 months [95% CI, 25.99-41.42] vs. 11.07 months [95% CI, 6.89-15.24], p < 0.001). In the multivariate Cox regression analysis, high MPVLR, ECOG score of 2-3, and high LDH level were associated with shorter mOS (p < 0.001, p = 0.001, and p = 0.046, respectively). Conclusion This study demonstrates that MPVLR could serve as a novel biomarker for predicting response to nivolumab treatment. Incorporating MPVLR into clinical practice may aid in identifying patients who are less likely to benefit from the treatment.
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Affiliation(s)
- Hasan Cagri Yildirim
- Department of Medical Oncology, Hacettepe University Medical School, Ankara, Türkiye
| | - Fatih Kus
- Department of Medical Oncology, Hacettepe University Medical School, Ankara, Türkiye
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Medical School, Ankara, Türkiye
| | - Ece Karaca
- Department of Internal Medicine, Hacettepe University Medical School, Ankara, Türkiye
| | - Yunus Kaygusuz
- Department of Internal Medicine, Hacettepe University Medical School, Ankara, Türkiye
| | - Omer Dizdar
- Department of Medical Oncology, Hacettepe University Medical School, Ankara, Türkiye
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Medical School, Ankara, Türkiye
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Medical School, Ankara, Türkiye
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Medical School, Ankara, Türkiye
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Güner G, Aktaş BY, Başal FB, Demirkazık A, Gürsoy P, Demirci U, Erman M, Yumuk PF, Şenler FÇ, Çakar B, Çiçin İ, Öztürk A, Coşkun HŞ, Çubukçu E, Işıkdoğan A, Ölmez ÖF, Tatlı AM, Karaağaç M, Şakalar T, Eralp Y, Korkmaz T, Kılıçkap S. Is there any prognostic significance in pleural involvement and/or effusion in patients with ALK-positive NSCLC? J Cancer Res Clin Oncol 2023; 149:13271-13277. [PMID: 37480524 DOI: 10.1007/s00432-023-05190-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Anaplastic lymphoma kinase (ALK) mutations occurs in approximately 3-5% of patients with non-small cell lung cancer (NSCLC). Pleural involvement/effusion is common in ALK-positive patients with NSCLC at baseline. The aim of the study was to evaluate the characteristics of ALK-positive patients who have Ple-I/E. METHODS In this multicenter study, patients with ALK-positive NSCLC who have Ple-I/E were retrospectively analyzed. Clinical and demographic characteristics of the disease, response rates, median progression-free survival (PFS), and overall survival (OS) were evaluated in 362 ALK-positive patients with NSCLC. RESULTS Of the patients, 198 (54.7%) were male. The median age at the time of diagnosis was 54 (range 21-85) years. All patients' histology was adenocarcinoma (100%). At baseline, 57 (15.7%) patients had Ple-I/E. There was no association between Ple-I/E and gender, lung metastasis, or distant lymphadenopathy (LAP) metastasis. The frequencies of liver, brain, and bone metastases were significantly higher in ALK-positive patients without Ple-I/E compared to those with Ple-I/E (respectively 18.2% vs 4.8%, p = 0.008; 19.1% vs 4.8%, p = 0.001; 20.6% vs 8.9%, p = 0.002). The median PFS was longer in ALK-positive patients who had Ple-I/E (18.7 vs 10.6 months, p = 0.017). Similarly, the median OS was longer in ALK-positive patients who had Ple-I/E (44.6 vs 22.6 months, p = 0.051). CONCLUSION Brain, liver, and bone metastases were lower in ALK-positive patients with Ple-I/E. Patients presented with Ple-I/E were prone to have better PFS and OS.
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Affiliation(s)
- Gürkan Güner
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey.
| | - Burak Yasin Aktaş
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | | | - Ahmet Demirkazık
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Pınar Gürsoy
- Department of Medical Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Umut Demirci
- Memorial Ankara Hospital, Medical Oncology Unit, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Perran Fulden Yumuk
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
- Division of Medical Oncology, Koç University, School of Medicine, Istanbul, Turkey
| | - Filiz Çay Şenler
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burcu Çakar
- Department of Medical Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - İrfan Çiçin
- Department of Medical Oncology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Akın Öztürk
- Department of Medical Oncology, Sureyyapasa Chest Disease Hospital, Istanbul, Turkey
| | - Hasan Şenol Coşkun
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Erdem Çubukçu
- Department of Medical Oncology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Abdurrahman Işıkdoğan
- Department of Medical Oncology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Ömer Fatih Ölmez
- Department of Medical Oncology, Medipol Mega Hospitals Complex (University Hospital), Istanbul, Turkey
| | - Ali Murat Tatlı
- Department of Medical Oncology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Mustafa Karaağaç
- Department of Medical Oncology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Teoman Şakalar
- Department of Medical Oncology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Yeşim Eralp
- Department of Medical Oncology, Acıbadem University, Maslak Acıbadem Hospital, Istanbul, Turkey
| | - Taner Korkmaz
- Department of Medical Oncology, Mehmet Ali Aydınlar Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - Saadettin Kılıçkap
- Department of Medical Oncology, Istinye University Faculty of Medicine, Istanbul, Turkey
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Guven DC, Yekeduz E, Erul E, Yazgan SC, Sahin TK, Karatas G, Aksoy S, Erman M, Yalcin S, Urun Y, Kilickap S. The benefit of treatment beyond progression with immune checkpoint inhibitors: a multi-center retrospective cohort study. J Cancer Res Clin Oncol 2023; 149:3599-3606. [PMID: 35960374 DOI: 10.1007/s00432-022-04268-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Treatment beyond progression (TBP) with immune checkpoint inhibitors (ICIs) is an evolving field due to the limitations of conventional imaging in response evaluation. However, real-life data on the benefit of TBP is scarce, especially from the limited resource settings and patients treated in the later lines. Therefore, we aimed to investigate the survival benefit of TBP with ICIs in patients with advanced tumors from a limited resource setting. METHODS For this multi-center retrospective cohort study, we included 282 patients treated with ICIs and had radiological progression according to RECIST 1.1 criteria. We evaluated post-progression survival according to the use of TBP (TBP and non-TBP groups) with univariate and multivariate analyses. RESULTS The cohort's median age was 61, and 84.4% were treated in the second or later lines. 82 (29.1%) of 282 patients continued on ICIs following the initial progression. In multivariate analyses, patients in the TBP group had improved post-progression survival compared to non-TBP (13.18 vs. 4.63 months, HR: 0.500, 95% CI: 0.349-0.717, p < 0.001). The benefit of the TBP was independent of the tumor type, treatment line, and age. Furthermore, TBP with ICIs remained associated with improved post-progression survival (HR: 0.600, 95% CI: 0.380-0.947, p = 0.028) after excluding the patients with no further treatment after progression in the non-TBP arm. CONCLUSIONS In this study, we observed that patients receiving ICIs beyond progression had considerably longer survival. Continuation of ICIs after progression should be considered a reasonable management option for patients with advanced cancer, specifically for patients with limited alternative options.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey.
| | - Emre Yekeduz
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Enes Erul
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sati Coskun Yazgan
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Taha Koray Sahin
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokturk Karatas
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Yuksel Urun
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Saadettin Kilickap
- Faculty of Medicine, Istinye University, Istanbul, Turkey
- Medical Oncology Unit, Liv Hospital Ankara, Ankara, Turkey
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Guven DC, Ozbek DA, Sahin TK, Kavgaci G, Aksun MS, Erul E, Yildirim HC, Chalabiyev E, Cebroyilov C, Yildirim T, Dizdar O, Aksoy S, Yalcin S, Kilickap S, Erman M, Arici M. The incidence and risk factors for acute kidney injury in patients treated with immune checkpoint inhibitors. Anticancer Drugs 2023; 34:783-790. [PMID: 36729111 DOI: 10.1097/cad.0000000000001463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Recent observational studies reported acute kidney injury (AKI) events in over 10% of the patients treated with immune checkpoint inhibitors (ICIs). However, these studies included patients treated in high-resource settings and earlier lines. Therefore, we aimed to assess the AKI rates and predisposing factors in ICI-treated patients from a limited resource setting. We evaluated 252 patients with advanced cancer for this retrospective cohort study. AKI events were defined by Kidney Disease Improving Global Outcomes criteria. The median age was 59 years. The melanoma (18.3%), non-small cell lung cancer (14.7%) and renal cell carcinoma (22.6%) patients comprised over half of the cohort. During the follow-up, 45 patients (17.9%) had at least one AKI episode. In multivariable analyses, patients with chronic kidney disease (CKD) [odds ratio (OR), 3.385; 95% confidence interval (CI), 1.510-7.588; P = 0.003], hypoalbuminemia (OR, 2.848; 95% CI, 1.225-6.621; P = 0.015) or renin-angiotensin-aldosterone system (RAAS) inhibitor use (OR, 2.236; 95% CI, 1.017-4.919; P = 0.045) had increased AKI risk. There was a trend towards increased AKI risk in patients with diabetes (OR, 2.042; 95% CI, 0.923-4.518; P = 0.78) and regular proton pump inhibitors use (OR, 2.024; 95% CI, 0.947-4.327; P = 0.069). In this study, we observed AKI development under ICIs in almost one in five patients with cancer. The increased AKI rates in CKD, hypoalbuminemia or RAAS inhibitor use pointed out a need for better onco-nephrology collaboration and efforts to improve the nutritional status of ICI-treated patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tolga Yildirim
- Nephrology, Hacettepe University Faculty of Medicine, Ankara
| | | | | | | | - Saadettin Kilickap
- Department of Medical Oncology, Istinye University Faculty of Medicine, Istanbul, Turkey
| | | | - Mustafa Arici
- Nephrology, Hacettepe University Faculty of Medicine, Ankara
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Samol J, Demedts I, Erman M, Kozlov V, Minatta J, Moiseenko F, Paats M, Rajappa S, Bailey T, Wallis H, Madondo M, Kahangire D, Zukin M. 26P Real-world use of tyrosine kinase inhibitors (TKI) in epidermal growth factor receptor mutated (EGFRm) advanced non-small cell lung cancer (NSCLC) in nine countries. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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Telli T, Tuncel M, Karabulut E, Aksoy S, Erman M, Akdogan B, Caglar M. Prognostic factors of overall and prostate-specific antigen-progression-free survival in metastatic castration-resistant prostate cancer patients treated with 177 Lu-PSMA-617. A single-center prospective observational study. Prostate 2023; 83:792-800. [PMID: 36919876 DOI: 10.1002/pros.24518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/22/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Metastatic castration-resistant prostate cancer (mCRPC) is characterized by heterogeneity among patients as well as therapy responses due to diverse genetic, epigenetic differences, and resistance mechanisms. At this stage of the disease, therapy modalities should be individualized in light of the patients' clinical state, symptoms, and genetic characteristics. In this prospective study, we aimed to evaluate the outcome of patients with mCRPC treated with 177 Lutetium labeled PSMA-617 therapy (PSMA-RLT), as well as baseline and therapy-related parameters associated with survival. METHODS This prospective study included 52 patients who received two to six cycles of PSMA-RLT. Primary endpoints were overall survival (OS) and prostate-specific antigen (PSA)-progression-free survival (PFS). 18 F-Fluorodeoxyglucose (FDG) and 68 Ga-PSMA (PSMA) Positron Emission Tomography/Computer Tomography (PET/CT) scans were performed for a comprehensive assessment of tumor burden and heterogeneity. Biochemical, imaging, clinical, and therapy-related parameters were analyzed with the Kaplan-Meier, log-rank, and Cox regression analyses to predict OS and PFS. RESULTS Median OS and PSA-PFS were 17.7 (95% confidence interval [CI]: 15.2-20.2) and 6.6 months (95% CI: 4.5-8.8), respectively. Primary resistance to PSMA-RLT (hazard ratio [HR]: 12.57, 95% CI: 2.4-65.2, p: 0.003), <30% PSA response rate after first cycle of PSMA-RLT (HR: 1.016, 95% CI: 1.006-1.03, p: 0.003), FDG > PSMA disease (HR: 4.9, 95% CI: 1.19-20.62, p: 0.03), PSA doubling time (PSA DT) of ≤2.4 months (HR: 15.7, 95% CI: 3.7-66.4, p: <0.0001), and low hemoglobin levels (HR: 0.59, 95% CI: 0.41-0.83, p: 0.003) were correlated with poor OS in the multivariate analysis. Bone scintigraphy > PSMA disease (HR: 5.6; 95% CI: 1.8-17, p: 0.002) and high C-reactive protein (HR: 1.4, 95% CI: 1.1-1.7, p: 0.001) were significant predictive biomarkers for PFS in the multivariate analysis. CONCLUSION PSA response rate and pattern to PSMA-RLT are the most important predictors of survival in patients receiving PSMA-RLT. Being a strong predictive biomarker, combined FDG and PSMA PET can be helpful for the decision of PSMA-RLT eligibility.
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Affiliation(s)
- Tugce Telli
- Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdem Karabulut
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bulent Akdogan
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Caglar
- Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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9
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Minatta J, Samol J, Moiseenko F, Demedts I, Kozlov V, Mark M, Rajappa S, Kahangire DA, Madondo M, Bailey T, Wallis H, Erman M, Zukin M. PP.02 Tyrosine Kinase Inhibitor (TKI) Real-World Use in Epidermal Growth Factor Receptor Mutated (EGFRm) Advanced Non-small Cell Lung Cancer (NSCLC) Patients. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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10
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Tural D, Arslan C, Selcukbiricik F, Olmez OF, Akar E, Erman M, Ürün Y, Erdem D, Kilickap S. Comparison of objective response rate and long-term overall survival in patients with treated immune checkpoint inhibitors in metastatic urothelial carcinoma. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
481 Background: In this study, we evaluated RECIST criteria-based objective response rate (ORR) as potential surrogate endpoints for overall survival (OS) in patients who were treated with immune checkpoint inhibitors therapy (ICT) and with long-term follow-up in metastatic urothelial carcinoma. Methods: The primary endpoint was overall ORR and OS, duration of treatment (DOR) with ICT. ORR was analyzed using Fisher’s exact test. Median follow-up and OS were estimated by using the Kaplan-Meier method. Results: The median follow-up time was 58 (1.15–71) months (mo). Progression developed in 94 (47%) patients during the first three months of treatment with ICT. The rate of complete response (CR) to ICT, partial response (PR) rate, and stable disease were 10% (n=20), 23% (n=46), and 20% (n=41), respectively. There was an imbalance in baseline characteristics between patients who had ORR and non-responder groups (Table). The 5–year OS rates for CR and PR were 73% and 23%, respectively. The median DOR for CR, PR, and SD were 51.8 mo% (44.5–59.1), 20.7mo (16.7–24.6), and 8.8 mo (5.5–12.1), respectively. Of the sixteen (80%) patients who had CR and 14 (30%) patients who had PR had an ongoing response at the time of the analysis. In univariate analysis, neutrophil-to-lymphocyte ratio (NLR) >3, liver metastases, ECOG PS ≥1, and hemoglobin levels below 10 mg/dl, PR, and CR were all significantly associated with OS. In multivariate analysis, liver metastases [HR=2.3; 95% CI 1.3-4.2; p < (0.004)] were independent related variable with short OS. Other hand, PR [HR=0.3; 95% CI 0.15-0.5; p < (0.001)] and CR [HR=0.06; 95% CI 0.014-0.27; p < (0.001)] were associated with improved OS. Conclusions: This five-year analysis of real-world data indicated a significant correlation between ORR, especially CR and OS in patients who received immune checkpoint inhibitors in metastatic urothelial cancer. Therefore, the identification of a potential surrogate marker for survival in patients treated with ICT would represent an important advance in the early identification of patients’ response or resistance to ICT.
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Affiliation(s)
- Deniz Tural
- University of Health Sciences, Bakirköy Dr. Sadi Konuk Training and Research Hospital, Department of Medical Oncology, İStanbul, Turkey
| | | | | | | | - Emre Akar
- Bakirköy Research and Education Hospital, Istanbul, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Yüksel Ürün
- Ankara University Faculty of Medicine, Cebeci, Turkey
| | | | - Saadettin Kilickap
- Istinye University Faculty of Medicine, Department of Medical Oncology, Istanbul, Turkey
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11
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de Castro G, Rizvi NA, Schmid P, Syrigos K, Martin C, Yamamoto N, Cheng Y, Moiseyenko V, Summers Y, Vynnychenko I, Lee SY, Bryl M, Zer A, Erman M, Timcheva C, Raja R, Naicker K, Scheuring U, Walker J, Mann H, Chand V, Mok T. NEPTUNE: Phase 3 Study of First-Line Durvalumab Plus Tremelimumab in Patients With Metastatic NSCLC. J Thorac Oncol 2023; 18:106-119. [PMID: 36240972 DOI: 10.1016/j.jtho.2022.09.223] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/29/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION NEPTUNE, a phase 3, open-label study, evaluated first-line durvalumab plus tremelimumab versus chemotherapy in metastatic NSCLC (mNSCLC). METHODS Eligible patients with EGFR and ALK wild-type mNSCLC were randomized (1:1) to first-line durvalumab (20 mg/kg every 4 weeks until progression) plus tremelimumab (1 mg/kg every 4 weeks for up to four doses) or standard chemotherapy. Randomization was stratified by tumor programmed death-ligand 1 expression (≥25% versus <25%), tumor histologic type, and smoking history. The amended primary end point was overall survival (OS) in patients with blood tumor mutational burden (bTMB) greater than or equal to 20 mutations per megabase (mut/Mb). Secondary end points included progression-free survival (PFS) in patients with bTMB greater than or equal to 20 mut/Mb and safety and tolerability in all treated patients. RESULTS As of June 24, 2019, 823 patients were randomized (intention-to-treat [ITT]); 512 (62%) were bTMB-evaluable, with 129 of 512 (25%) having bTMB greater than or equal to 20 mut/Mb (durvalumab plus tremelimumab [n = 69]; chemotherapy [n = 60]). Baseline characteristics were balanced in the intention-to-treat. Among patients with bTMB greater than or equal to 20 mut/Mb, OS improvement with durvalumab plus tremelimumab versus chemotherapy did not reach statistical significance (hazard ratio 0.71 [95% confidence interval: 0.49-1.05; p = 0.081]; median OS, 11.7 versus 9.1 months); the hazard ratio for PFS was 0.77 (95% confidence interval, 0.51-1.15; median PFS, 4.2 versus 5.1 months). In the overall safety population, incidence of grade 3 or 4 treatment-related adverse events was 20.7% (durvalumab plus tremelimumab) and 33.6% (chemotherapy). CONCLUSIONS NEPTUNE did not meet its primary end point of improved OS with durvalumab plus tremelimumab versus chemotherapy in patients with mNSCLC and bTMB greater than or equal to 20 mut/Mb. Despite the amended study design, with a resultant small primary analysis population, therapeutic activity was aligned with expectations based on mechanistic biology and previous studies.
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Affiliation(s)
| | | | - Peter Schmid
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Konstantinos Syrigos
- 3rd Department of Medicine, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | | | | | - Ying Cheng
- Cancer Hospital of Jilin Province, Changchun, People's Republic of China
| | | | - Yvonne Summers
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ihor Vynnychenko
- Sumy State University, Sumy Regional Oncology Centre, Sumy, Ukraine
| | | | - Maciej Bryl
- E. J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznań, Poland
| | - Alona Zer
- Rabin Medical Center, Petah Tikva, Israel
| | - Mustafa Erman
- Hacettepe University Cancer Institute, Ankara, Turkey
| | | | | | | | | | | | | | | | - Tony Mok
- State Key Laboratory of South China, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong, People's Republic of China
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Yildirim H, Guven D, Kus F, Dizdar O, Aksoy S, Erman M, Yalçın Ş, Kilickap S. 22P Mean platelet volume to lymphocyte ratio: A new biomarker predictive of response in patients treated with immunotherapy. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Jabbour S, Houghton B, Robinson A, Quantin X, Wehler T, Kowalski D, Ahn M, Erman M, Giaccone G, Borghaei H, McLean J, Xu Y, Souza F, Pall G. KEYNOTE-867: Phase 3, Randomized, Placebo-Controlled Study of Stereotactic Body Radiotherapy (SBRT) with or without Pembrolizumab in Patients with Unresected Stage I or II Non–Small-Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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14
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Guven D, Sahin T, Erul E, Cakir I, Ucgul E, Yildirim H, Aktepe O, Erman M, Kilickap S, Aksoy S, Yalcin S. 421P The association between early changes in neutrophil-lymphocyte ratio and survival in patients treated with immunotherapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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15
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Guven DC, Incesu FGG, Yildirim HC, Erul E, Chalabiyev E, Aktas BY, Yuce D, Arik Z, Kilickap S, Aksoy S, Erman M, Hayran KM, Unal S, Alp A, Dizdar O. Immunogenicity of two doses of inactive COVID-19 vaccine and third booster dose mRNA vaccine in patients with cancer receiving active systemic therapy. Int J Cancer 2022; 152:679-685. [PMID: 36082448 PMCID: PMC9538436 DOI: 10.1002/ijc.34280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/28/2022] [Accepted: 08/31/2022] [Indexed: 02/01/2023]
Abstract
We aimed to evaluate the seroconversion rates after two doses of inactive COVID-19 vaccine (CoronaVac) and the benefit of a third dose mRNA vaccine booster in patients with cancer receiving active treatment. Patients with solid tumors receiving active treatment (n = 101) and patients with no-cancer (n = 48) as the control group were included in the study. All the patients and controls had received two doses of CoronaVac and a third booster dose of the mRNA vaccine (Bnt162b2). Anti-SARS-CoV-2 Spike Receptor Binding Domain IgG antibody levels after the second and third dose were measured with quantitative ELISA. The median age of the patients was 66 (IQR 60-71). 79% of the patients were receiving chemotherapy, and 21% were receiving immunotherapy at the time of vaccination. Antibody levels measured after two doses of CoronaVac were significantly lower in patients with cancer than in the control group (median 0 μg/ml [IQR 0-1.17 μg/ml] vs median 0.91 μg/ml [IQR 0-2.24 μg/ml], respectively, P = .002). Seropositivity rates were 46.5% in patients with cancer and 72.9% in the control group (P = .002). Antibody measurement was performed in 26 patients after the third dose. Seroconversion rate increased from 46.5% to 88.5% (P < .001), and the antibody titers significantly increased with the third-dose booster (median 0 μg/ml [IQR 0-1.17 μg/ml] after two doses vs 12.6 μg/ml [IQR 1.8-69.1 μg/ml] after third booster dose, P < .001). Immunogenicity of CoronaVac is low in patients with cancer receiving active treatment, and administering a third dose of an mRNA vaccine is effective in terms of improving seroconversion rates.
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Affiliation(s)
| | | | | | - Enes Erul
- Hacettepe University Cancer InstituteAnkaraTurkey
| | | | | | - Deniz Yuce
- Hacettepe University Cancer InstituteAnkaraTurkey
| | - Zafer Arik
- Hacettepe University Cancer InstituteAnkaraTurkey
| | | | - Sercan Aksoy
- Hacettepe University Cancer InstituteAnkaraTurkey
| | | | | | - Serhat Unal
- Faculty of Medicine, Department of Infectious DiseaseHacettepe UniversityAnkaraTurkey
| | - Alpaslan Alp
- Department of MicrobiologyHacettepe University Faculty of MedicineAnkaraTurkey
| | - Omer Dizdar
- Hacettepe University Cancer InstituteAnkaraTurkey
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16
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Guven D, Gulbahce Incesu F, Yildirim H, Erul E, Chalabiyev E, Aktas B, Yuce D, Arik Z, Kilickap S, Aksoy S, Erman M, Hayran K, Unal S, Alp A, Dizdar O. 1612P Immunogenicity of two doses of inactive COVID-19 vaccine and third booster dose mRNA vaccine in patients with cancer receiving active systemic therapy. Ann Oncol 2022. [PMCID: PMC9472463 DOI: 10.1016/j.annonc.2022.07.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Yildirim HC, Guven DC, Aktepe OH, Taban H, Yilmaz F, Yasar S, Aksoy S, Erman M, Kilickap S, Yalcin S. Blood Based Biomarkers as Predictive Factors for Hyperprogressive Disease. J Clin Med 2022; 11:jcm11175171. [PMID: 36079101 PMCID: PMC9457309 DOI: 10.3390/jcm11175171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/18/2022] [Accepted: 08/31/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose: With the widespread use of immunotherapy agents, we encounter treatment responses such as hyperprogression disease (HPD) that we have not seen with previous standard chemotherapy and targeted therapies. It is known that survival in patients with HPD is shorter than in patients without HPD. Therefore, it is important to know the factors that will predict HPD. We aimed to identify HPD-related factors in patients treated with immunotherapy. Methods: A total of 121 adult metastatic cancer patients treated with immunotherapy for any cancer were included. Baseline demographics, the ECOG performance status, type of tumors and baseline blood count parameters were recorded. Possible predisposing factors were evaluated with univariate and multivariate analyses. Results: The median age was 62.28 (interquartile range (IQR) 54.02−67.63) years, and the median follow-up was 12.26 (IQR 5.6−24.36) months. Renal cell carcinoma (33%) and melanoma (33.8%) were the most common diagnoses. Twenty patients (16.5%) had HPD. A high LDH level (p: 0.001), hypoalbuminemia (p: 0.016) and an NLR > 5 (p: 0.007) were found to be associated with hyperprogression. Sex (female vs. male, p: 0.114), age (>65 vs. <65, p: 0.772), ECOG (0 vs. 1−4, p: 0.480) and the line of treatment (1−5, p: 0.112) were not found to be associated with hyperprogression. Conclusions: In this study, we observed HPD in 16.5% of immunotherapy-treated patients and increased HPD risk in patients with a high LDH level (p: 0.001), hypoalbuminemia (p: 0.016) and an NLR > 5 (p: 0.007).
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Affiliation(s)
- Hasan Cagri Yildirim
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
- Correspondence: ; Tel.: +90-542-547-6138; Fax: +90-312-310-0195
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Oktay Halit Aktepe
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Hakan Taban
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Feride Yilmaz
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Serkan Yasar
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Istinye University, Istanbul 34010, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
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Yildirim H, Guven D, Aktepe O, Yilmaz F, Aktas B, Guner G, Dizdar O, Aksoy S, Erman M, Yalcin S, Kilickap S. 773P Differences between hyperprogressive disease and progressive disease in patients receiving immunotherapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Guven DC, Sahin TK, Erul E, Cakir IY, Ucgul E, Yildirim HC, Aktepe OH, Erman M, Kilickap S, Aksoy S, Yalcin S. The Association between Early Changes in Neutrophil-Lymphocyte Ratio and Survival in Patients Treated with Immunotherapy. J Clin Med 2022; 11:jcm11154523. [PMID: 35956139 PMCID: PMC9369683 DOI: 10.3390/jcm11154523] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/15/2022] [Accepted: 07/24/2022] [Indexed: 02/05/2023] Open
Abstract
Dynamic changes in the blood-based biomarkers could be used as a prognostic biomarker in patients treated with immune checkpoint inhibitors (ICIs), although the data are limited. We evaluated the association between the neutrophil−lymphocyte ratio (NLR) and early NLR changes with survival in ICI-treated patients. We retrospectively evaluated the data of 231 patients with advanced-stage cancer. We recorded baseline clinical characteristics, baseline NLR and fourth-week NLR changes, and survival data. A compound prognostic score, the NLR2-CEL score, was developed with the following parameters: baseline NLR (<5 vs. ≥5), ECOG status (0 vs. ≥1), Charlson Comorbidity Index (CCI, <9 vs. ≥9), LDH (N vs. ≥ULN), and fourth-week NLR change (10% or over NLR increase). In the multivariable analyses, higher NLR (HR: 1.743, p = 0.002), 10% or over NLR increase in the fourth week of treatment (HR: 1.807, p = 0.001), higher ECOG performance score (HR: 1.552, p = 0.006), higher LDH levels (HR: 1.454, p = 0.017), and higher CCI (HR: 1.400, p = 0.041) were associated with decreased OS. Compared to patients with the lowest scores, patients in the highest score group had significantly lower OS (HR: 7.967, 95% CI: 3.531−17.979, p < 0.001) and PFS. The composite score had moderate success for survival prediction, with an AUC of 0.702 (95% CI: 0.626−0.779, p < 0.001). We observed significantly lower survival in patients with higher baseline NLR values and increased NLR values under treatment.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
- Correspondence:
| | - Taha Koray Sahin
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey; (T.K.S.); (E.E.); (I.Y.C.); (E.U.)
| | - Enes Erul
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey; (T.K.S.); (E.E.); (I.Y.C.); (E.U.)
| | - Ibrahim Yahya Cakir
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey; (T.K.S.); (E.E.); (I.Y.C.); (E.U.)
| | - Enes Ucgul
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey; (T.K.S.); (E.E.); (I.Y.C.); (E.U.)
| | - Hasan Cagri Yildirim
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
| | - Oktay Halit Aktepe
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
| | - Mustafa Erman
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
| | - Saadettin Kilickap
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
- Department of Medical Oncology, Faculty of Medicine, Istinye University, 34396 Istanbul, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
| | - Suayib Yalcin
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
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Cho BC, Juergens RA, Cheng Y, de Castro G, Erman M, Bauman JR, Takahashi T, Schwarzenberger P, Li C, Pietanza MC, Yang JCH. Abstract CT561: KeyVibe-003: Randomized, double-blind, phase 3 study of first-line pembrolizumab with and without vibostolimab (anti-TIGIT) in patients with PD-L1-positive metastatic NSCLC. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Vibostolimab (MK-7684) is a humanized monoclonal antibody (mAb) that binds to the T-cell immunoreceptor with immunoglobulin and ITIM domains (TIGIT), blocking the interaction between TIGIT and its ligands, CD112 and CD155. Pembrolizumab, an anti-PD-1 mAb, significantly improves OS versus chemotherapy in patients with PD-L1-positive advanced non-small-cell lung cancer (NSCLC). In the first-in-human study (NCT02964013), the combination of vibostolimab plus pembrolizumab had a manageable safety profile and showed promising antitumor activity in patients with advanced NSCLC naive to anti-PD-(L)1 therapy; ORR was 31% and 25% in patients with PD-L1 tumor proportion score (TPS) ≥1% and less than 1%, respectively. The current phase 3 study (KeyVibe-003; ClinicalTrials.gov, NCT04738487) is comparing first-line treatment with MK-7684A, a co-formulation of vibostolimab plus pembrolizumab, versus pembrolizumab monotherapy in patients with PD-L1-positive metastatic NSCLC.
Methods: This randomized, multicenter, double-blind study is enrolling adults with pathologically confirmed, previously untreated, metastatic NSCLC with PD-L1 TPS ≥1% (centrally confirmed). Patients must have measurable disease per RECIST v1.1, an ECOG PS of 0-1, have no EGFR mutations or ALK or ROS1 gene rearrangements, and have no active or untreated CNS metastases. Patients are randomized 1:1 to receive intravenous treatment with vibostolimab 200 mg plus pembrolizumab 200 mg Q3W or pembrolizumab 200 mg Q3W for up to 35 cycles (approximately 2 years) or until PD, unacceptable AEs, intercurrent illness, or investigator decision. Patients who stop treatment after a CR or after completing 35 cycles and subsequently have PD can receive up to 17 additional cycles (approximately 1 year) of their randomized therapy. Randomization is stratified by ECOG PS (0 vs 1), PD-L1 TPS (1%-49% vs ≥50%), and region of enrollment (East Asia vs non-East Asia). The dual primary endpoints are PFS, per RECIST v1.1 by blinded independent central review (BICR), and OS. Secondary endpoints include ORR and DOR per RECIST v1.1 by BICR, patient-reported outcomes, and safety. Radiographic imaging occurs at baseline, Q9W from randomization through week 54, and then Q12W until PD, the start of new anticancer treatment, withdrawal of consent, or death. Health-related quality of life is assessed using validated patient-reported outcome instruments including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. AEs are graded according to National Cancer Institute Common Terminology Criteria for Adverse Events v5.0. Enrollment began in April of 2021, and is ongoing at 83 sites in 15 countries.
Results: N/A
Conclusions: N/A
Citation Format: Byoung Chul Cho, Rosalyn A. Juergens, Ying Cheng, Gilberto de Castro Jr., Mustafa Erman, Jessica R. Bauman, Toshiaki Takahashi, Paul Schwarzenberger, Chengxiang Li, M. Catherine Pietanza, James Chih-Hsin Yang. KeyVibe-003: Randomized, double-blind, phase 3 study of first-line pembrolizumab with and without vibostolimab (anti-TIGIT) in patients with PD-L1-positive metastatic NSCLC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT561.
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Affiliation(s)
- Byoung Chul Cho
- 1Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Ying Cheng
- 3Jilin Cancer Hospital, Changchun, China
| | | | - Mustafa Erman
- 5Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | | | | | | | | | | | - James Chih-Hsin Yang
- 9National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
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Jabbour SK, Houghton B, Robinson AG, Quantin X, Wehler T, Kowalski D, Ahn MJ, Erman M, Giaccone G, Borghaei H, McLean J, Xu Y, Souza F, Pall G. Phase 3, randomized, placebo-controlled study of stereotactic body radiotherapy (SBRT) with or without pembrolizumab in patients with unresected stage I or II non–small cell lung cancer (NSCLC): KEYNOTE-867. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps8597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS8597 Background: Anti–PD-(L)1-directed therapy following radiotherapy or following concurrent chemoradiation is associated with significantly longer PFS and OS in patients with advanced or metastatic NSCLC, including those with locally advanced inoperable tumors. KEYNOTE-867 (NCT03924869) evaluates the efficacy and safety of SBRT with or without pembrolizumab in patients with unresected stage I or II NSCLC. Methods: In this phase 3, randomized, placebo-controlled study, approximately 530 adult patients with previously untreated, unresected, histologically/cytologically confirmed stage I or II (T1 to limited T3, N0, M0) NSCLC are randomized 1:1 to receive thoracic SBRT to primary tumors for ≤2 wk (Table) and either pembrolizumab 200 mg or placebo every 3 wk for 17 cycles (approximately 1 year) or until disease recurrence, development of unacceptable AEs, SBRT not started for any reason, or study withdrawal. Randomization is stratified by disease stage (I vs II), ECOG PS (0 or 1 vs 2), geographic region (East Asia vs non-East Asia), and reason for not receiving surgery (medically inoperable vs refused surgery). Imaging assessment by blinded independent central review (BICR) occurs at 12 wk (≥10 wk after SBRT completion), followed by every 16 wk for 3 y, and then every 6 mo. Primary endpoints are event-free survival (EFS) by BICR and OS. Secondary endpoints include time to death or distant metastases and safety; exploratory endpoints are time to subsequent treatment, disease-specific survival, and time to recurrence/progression on subsequent line of therapy. AEs are monitored throughout the trial until 30 d after last dose (90 for serious AEs) and graded according to NCI CTCAE version 4.0. EFS and OS are analyzed by the nonparametric Kaplan-Meier method, treatment differences by stratified log-rank test, and hazard ratios by stratified Cox proportional hazard model with Efron's method of tie handling. Enrollment started on June 17, 2019, and is ongoing at 168 sites around the world. Clinical trial information: NCT03924869. [Table: see text]
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Affiliation(s)
- Salma K. Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Baerin Houghton
- Mid North Coast Cancer Institute, Port Macquarie Base Hospital, Port Macquarie, NSW, Australia
| | - Andrew George Robinson
- Department of Oncology, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, ON, Canada
| | - Xavier Quantin
- Department of Medical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - Thomas Wehler
- Department of Hematology, Oncology and Pulmonology, Evangelisches Krankenhaus Hamm gGmbH, Hamm, Germany
| | - Dariusz Kowalski
- The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Myung-Ju Ahn
- Department of Hematology & Oncology, Samsung Medical Center, Seoul, South Korea
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Giuseppe Giaccone
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY
| | - Hossein Borghaei
- Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Jessica McLean
- Oncology Clinical Research, Merck & Co., Inc., Kenilworth, NJ
| | - Yan Xu
- Biostatistics, Merck & Co., Inc., Kenilworth, NJ
| | - Fabricio Souza
- Oncology Clinical Research, Merck & Co., Inc., Kenilworth, NJ
| | - Georg Pall
- Department of Internal Medicine V, Hematology/Oncology, University Hospital Innsbruck, Innsbruck, Austria
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Guven DC, Sayegh N, Tripathi N, Erman M, Agarwal N, Swami U. Effect of docetaxel (D) use on survival outcomes in patients with metastatic castration-sensitive prostate cancer (mCSPC) treated with novel hormonal therapies (NHTs): A meta-analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5079 Background: ARASENS and PEACE-1 trials have shown that the addition of NHTs to D + androgen deprivation therapy (ADT) improves overall survival (OS) outcomes in mCSPC. However, whether a true synergism is present with using NHT+ADT+D is unknown due to the lack of a trial testing the efficacy of adding D to the NHT+ADT backbone. Our objective was to evaluate the survival outcomes with NHTs according to D use in mCSPC. Methods: The literature search was done from PubMed and Embase databases to identify published studies until February 12th, 2022 for meta-analysis. The MeSH search terms were “castration-sensitive prostate cancer” OR “hormone-sensitive prostate cancer” OR “hormone-naïve prostate cancer” AND “abiraterone” OR “apalutamide” OR “enzalutamide” OR “darolutamide”. The target outcome measures were progression-free survival (PFS) and OS. Generic inverse-variance method with a fixed-effects model was used, with hazard ratios with 95% two-sided confidence intervals (CI) as the principal summary measure (Review Manager software, version 5.3, The Nordic Cochrane Center, The Cochrane Collaboration, Copenhagen, Denmark). P values below 0.05 were considered statistically significant. Results: The literature search retrieved a total of 2565 records. Six phase III studies encompassing 6701 patients evaluating survival outcomes with NHTs in mCSPC (TITAN, ARCHES, ENZAMET, LATITUDE, STAMPEDE Abi- M1, and PEACE-1) were included after filtering of the available records. Results summarized in below table. In the combined analysis, the addition of NHTs to standard of care (SOC) improved PFS and OS. PFS benefit with NHTs was similar in studies (or study subgroups) with or without D use. However the relative OS benefit with a NHT was higher in studies (or study subgroups) without D than studies permitting D (concurrent or sequential). Conclusions: In this meta-analysis, the PFS and OS benefit with NHT in mCSPC was observed independent of D use. A randomized phase III study comparing D+NHT+ADT with NHT+ADT is needed to evaluate the contribution of D to survival outcomes in patients with mCSPC receiving treatment with NHT+ADT. [Table: see text]
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Affiliation(s)
- Deniz Can Guven
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Nicolas Sayegh
- Huntsman Cancer Institute-University of Utah Health Care, Salt Lake City, UT
| | | | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Bailey T, Moiseenko F, Paats M, Demedts I, Erman M, Kahangire D, Kozlov V, Mark M, Minatta J, Rajappa S, Zukin M, Madondo M, Taylor A, Samol J. 100P Physician perceptions of testing practices in patients with early and advanced stage EGFR mutation-positive (EGFRm) NSCLC: A global survey. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ismayilov R, Aktepe OH, Sardarova K, Leblebici CB, Erman M. Everolimus and/or Nivolumab-Associated Cytomegalovirus Colitis in a Patient with Metastatic Renal Cell Carcinoma. Eurasian J Med 2022; 54:77-79. [PMID: 35307634 DOI: 10.5152/eurasianjmed.2022.20300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Everolimus-associated cytomegalovirus colitis is very rare in cancer patients. We present a case of cytomegalovirus colitis that occurred on using everolimus in a 64-year-old male with metastatic renal cell carcinoma who received pazopanib, nivolumab, and everolimus treatments, respectively. Although an increasing number of nivolumab-related cytomegalovirus colitis cases are reported recently, its mechanism of development is still unknown. Our study highlights that clinicians should remember cytomegalovirus reactivation in the presence of diarrhea or colitis in patients receiving everolimus and/or nivolumab. Further studies are needed to elucidate the relationship between immune checkpoint inhibitors and cytomegalovirus reactivation, and these will also be a guide to prevent other possible viral infections.
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Affiliation(s)
- Rashad Ismayilov
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oktay Halit Aktepe
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Konul Sardarova
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Can Berk Leblebici
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Erman
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Tural D, Arslan C, Selcukbiricik F, Olmez OF, Erman M, Ürün Y, Karadurmus N, Akar E, Kilickap S. Long-term outcome and safety in patients treated with immune checkpoint blockade therapies for urothelial carcinoma: Experience from real-world clinical practice. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
474 Background: Anti-tumor activity and manageable safety profile of immune checkpoint blockade therapies (ICT) have been demonstrated in previous clinical trials in patients with metastatic urothelial carcinoma. To the best of our knowledge, very limited real-life data is available with the long follow-up time that confirms the durable antitumor activity and safety of ICT. In this study, we reported the real-life results of 56 months follow-up data of urothelial carcinoma patients who were treated with ICT. Methods: Metastatic urothelial carcinoma patients treated with at least one course of ICT included in the study. The primary endpoint was the overall response rate (ORR); secondary endpoints were overall survival (OS), progression-free survival (PFS), duration of the ICT treatment, and safety. Median follow-up, PFS, and OS were estimated by using the Kaplan-Meier method. Results: Data of 185 eligible patients were analyzed, 11.9% of these patients received the ICT as the first line, 76.8 % as the second line, and 11.3 % as the third or more line of treatment. The median age of the patients was 66 years, and 156 (84.3%) were male (37-86). The majority of patients (93.5%) had ECOG PS scores of 0–1 and primary tumor in the bladder was predominant (86.7%). The median follow-up time was 47(1.15-56) months. The complete response rate to ICT, partial response rate, and ORR were 10.3% (n = 19), 19.5% (n = 36), and 29.8% (n = 55), respectively. The median duration of response was 33.1 months (95% CI, 16.5–49.7). Of the fifty-five patients who responded to treatment, 28 (51%) had an ongoing response at the time of the analysis. Median PFS and OS was 3.8 (2.6–5.1) months and 8.9 (6.8–11.1) months, respectively. 56-month PFS and OS rate was 9.2% and 11.4%, respectively. 56-month PFS and OS rate for CR and PR was 56.2% and 20%, respectively. Fifty-nine percent of patients experienced a treatment-related adverse event of any grade, and 32 (17.3%) of patients had a grade 3–4 treatment-related adverse event. Because of treatment-related side effects, treatment was discontinued in 8 (4.3%) patients and adverse event that required systemic steroid use was reported in only 13 (7%) patients. Four patients (2.2%) died due to treatment-related causes. Conclusions: This 56-month analysis of real-world data confirms the durable response and long-term survival with ICT in metastatic urothelial carcinoma patients. The safety profile was consistent with prior reports, and no new safety signals emerged.
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Affiliation(s)
- Deniz Tural
- Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Cagatay Arslan
- Izmir Ekonomi University, Medicalpark Hospital, Izmir, Turkey
| | | | | | - Mustafa Erman
- Hacettepe University Cancer Institute, Department of Preventive Oncology, Ankara, Turkey
| | - Yüksel Ürün
- Ankara University Faculty of Medicine, Medical Oncology Department, Ankara, Turkey
| | - Nuri Karadurmus
- University of Health Sciences Gülhane Education and Research Hospital, Medical Oncology, Ankara, Turkey
| | - Emre Akar
- Bakirköy Research and Education Hospital, Istanbul, Turkey
| | - Saadettin Kilickap
- Hacettepe University Faculty of Medicine, Medical Oncology Department, Ankara, Turkey
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Guven DC, Aktepe OH, Aksun MS, Sahin TK, Kavgaci G, Ucgul E, Cakir IY, Yildirim HC, Guner G, Akin S, Kertmen N, Dizdar O, Aksoy S, Erman M, Yalcin S, Kilickap S. The association between albumin-globulin ratio (AGR) and survival in patients treated with immune checkpoint inhibitors. Cancer Biomark 2021; 34:189-199. [PMID: 34958005 DOI: 10.3233/cbm-210349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The albumin-globulin ratio (AGR) could be a prognostic biomarker in patients with cancer, although the data is limited in patients treated with immune-checkpoint inhibitors (ICIs). OBJECTIVES We aimed to evaluate the association between AGR and survival in ICI-treated patients. METHODS The data of 212 advanced-stage patients were retrospectively evaluated in this cohort study. The association between AGR with overall (OS) and progression-free survival (PFS) were evaluated with multivariate analyses. Additionally, receptor operating curve (ROC) analysis was conducted to assess the AGR's predictive power in the very early progression (progression within two months) and long-term benefit (more than twelve months survival). RESULTS The median AGR was calculated as 1.21, and patients were classified into AGR-low and high subgroups according to the median. In the multivariate analyses, patients with lower AGR (< 1.21) had decreased OS (HR: 1.530, 95% CI: 1.100-2.127, p= 0.011) and PFS (HR: 1.390, 95% CI: 1.020-1.895, p= 0.037). The area under curve of AGR to detect early progression and long-term benefit were 0.654 (95% CI: 0.562-0.747, p= 0.001) and 0.671 (95% CI: 0.598-0.744, p< 0.001), respectively. CONCLUSIONS In our experience, survival with ICIs was impaired in patients with lower AGR. Additionally, the AGR values could detect the very early progression and long-term benefit ICIs.
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Affiliation(s)
| | | | - Melek Seren Aksun
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Taha Koray Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gozde Kavgaci
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Enes Ucgul
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ibrahim Yahya Cakir
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Gurkan Guner
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Serkan Akin
- Hacettepe University Cancer Institute, Ankara, Turkey
| | | | - Omer Dizdar
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Sercan Aksoy
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mustafa Erman
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Suayib Yalcin
- Hacettepe University Cancer Institute, Ankara, Turkey
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Guven D, Aktepe O, Aksun M, Sahin T, Kavgaci G, Ucgul E, Cakir I, Yildirim H, Guner G, Akin S, Kertmen N, Dizdar O, Aksoy S, Erman M, Yalcin S, Kilickap S. 38P The association between albumin-globulin ratio (AGR) and survival in patients treated with immune checkpoint inhibitors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Erman M, Biswas B, Danchaivijitr P, Chen L, Wong YF, Hashem T, Lim CS, Karabulut B, Chung HJ, Chikatapu C, Ingles S, Slimane K, Kanesvaran R. Correction to: Prospective observational study on Pazopanib in patients treated for advanced or metastatic renal cell carcinoma in countries in Asia Pacific, North Africa, and Middle East regions: PARACHUTE study. BMC Cancer 2021; 21:1191. [PMID: 34753434 PMCID: PMC8576870 DOI: 10.1186/s12885-021-08848-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mustafa Erman
- Medical Oncology, Hacettepe University, Ankara, Turkey
| | - Bivas Biswas
- Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | | | - Lingwu Chen
- Medical Oncology, The First Affiliated Hospital of Sun Yat-sen, Guangzhou, Guangzhou, Guangdong Province, China
| | - Yoke Fui Wong
- Radiotherapy and Oncology, National Cancer Institute, Putrajaya, Malaysia
| | - Tarek Hashem
- Medical Oncology, Dr. Tarek Hashem's Clinic, Cairo, Egypt
| | - Chun Sen Lim
- Clinical Oncology, Sultan Ismail Hospital, Johor Bahru, Malaysia
| | | | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital and Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Sara Ingles
- Oncology, Novartis Pharma AG, Basel, Switzerland
| | | | - Ravindran Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
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Hellmann M, Cho B, Juergens R, Cheng Y, De Castro G, Erman M, Bauman J, Takahashi T, Schwarzenberger P, Zhang P, Pietanza M, Yang J. P14.01 Phase 3 Study of First-Line Pembrolizumab ± Vibostolimab (anti-TIGIT) in Patients With PD-L1‒Positive Metastatic NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Arık Z, Erman M. Should Protocols Specific to Histologic Subtypes Be Applied in the Follow-Up of NSCLC? J Thorac Oncol 2021; 16:e77. [PMID: 34561037 DOI: 10.1016/j.jtho.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Zafer Arık
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Erman M, Biswas B, Danchaivijitr P, Chen L, Wong YF, Hashem T, Lim CS, Karabulut B, Chung HJ, Chikatapu C, Ingles S, Slimane K, Kanesvaran R. Prospective observational study on Pazopanib in patients treated for advanced or metastatic renal cell carcinoma in countries in Asia Pacific, North Africa, and Middle East regions: PARACHUTE study. BMC Cancer 2021; 21:1021. [PMID: 34521387 PMCID: PMC8442269 DOI: 10.1186/s12885-021-08738-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background Clinical effectiveness and safety data of pazopanib in patients with advanced or mRCC in real-world setting from Asia Pacific, North Africa, and Middle East countries are lacking. Methods PARACHUTE is a phase IV, prospective, non-interventional, observational study. Primary endpoint was the proportion of patients remaining progression free at 12 months. Secondary endpoints were ORR, PFS, safety and tolerability, and relative dose intensity (RDI). Results Overall, 190 patients with a median age of 61 years (range: 22.0–96.0) were included. Most patients were Asian (70%), clear-cell type RCC was the most common (81%), with a favourable (9%), intermediate (47%), poor (10%), and unknown (34%) MSKCC risk score. At the end of the observational period, 78 patients completed the observational period and 112 discontinued the study; 60% of patients had the starting dose at 800 mg. Median RDI was 82%, with 52% of patients receiving < 85%. Of the 145 evaluable patients, 56 (39%) remained progression free at 12 months, and the median PFS was 10 months (95% CI: 8.48–11.83). 19% of patients (21/109) were long-term responders (on pazopanib for ≥18 months). The best response per RECIST 1.1 was CR/PR in 24%, stable disease in 44%, and PD in 31%. Most frequent (> 10%) TEAEs related to pazopanib included diarrhoea (30%), palmar-plantar erythrodysesthesia syndrome (15%), and hypertension (14%). Conclusions Results of the PARACHUTE study support the use of pazopanib in patients with advanced or mRCC who are naive to VEGF-TKI therapy. The safety profile is consistent with that previously reported by pivotal and real-world evidence studies.
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Affiliation(s)
- Mustafa Erman
- Medical Oncology, Hacettepe University, Ankara, Turkey
| | - Bivas Biswas
- Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | | | - Lingwu Chen
- Medical Oncology, The First Affiliated Hospital of Sun Yat-sen, Guangzhou, Guangdong Province, China
| | - Yoke Fui Wong
- Radiotherapy and Oncology, National Cancer Institute, Putrajaya, Malaysia
| | - Tarek Hashem
- Medical Oncology, Dr Tarek Hashem's Clinic, Cairo, Egypt
| | - Chun Sen Lim
- Clinical Oncology, Sultan Ismail Hospital, Johor Bahru, Malaysia
| | | | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital and Department of Urology, College of Medicine and Shu-Tien Urological Research Cente, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Sara Ingles
- Oncology, Novartis Pharma AG, Basel, Switzerland
| | | | - Ravindran Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
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Blackhall F, Jao K, Greillier L, Cho BC, Penkov K, Reguart N, Majem M, Nackaerts K, Syrigos K, Hansen K, Schuette W, Cetnar J, Cappuzzo F, Okamoto I, Erman M, Langer SW, Kato T, Groen H, Sun Z, Luo Y, Tanwani P, Caffrey L, Komarnitsky P, Reinmuth N. Efficacy and Safety of Rovalpituzumab Tesirine Compared With Topotecan as Second-Line Therapy in DLL3-High SCLC: Results From the Phase 3 TAHOE Study. J Thorac Oncol 2021; 16:1547-1558. [PMID: 33607312 DOI: 10.1016/j.jtho.2021.02.009] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION DLL3, an atypical Notch ligand, is expressed in SCLC tumors but is not detectable in normal adult tissues. Rovalpituzumab tesirine (Rova-T) is an antibody-drug conjugate containing a DLL3-targeting antibody tethered to a cytotoxic agent pyrrolobenzodiazepine by means of a protease-cleavable linker. The efficacy and safety of Rova-T compared with topotecan as second-line therapy in patients with SCLC expressing high levels of DLL3 (DLL3-high) was evaluated. METHODS The TAHOE study was an open-label, two-to-one randomized, phase 3 study comparing Rova-T with topotecan as second-line therapy in DLL3-high advanced or metastatic SCLC. Rova-T (0.3 mg/kg) was administered intravenously on day 1 of a 42-day cycle for two cycles, with two additional cycles available to patients who met protocol-defined criteria for continued dosing. Topotecan (1.5 mg/m2) was administered intravenously on days 1 to 5 of a 21-day cycle. The primary end point was overall survival (OS). RESULTS Patients randomized to Rova-T (n = 296) and topotecan (n = 148) were included in the efficacy analyses. The median age was 64 years, and 77% had the extensive disease at initial diagnosis. The median OS (95% confidence interval) was 6.3 months (5.6-7.3) in the Rova-T arm and 8.6 months (7.7-10.1) in the topotecan arm (hazard ratio, 1.46 [95% confidence interval: 1.17-1.82]). An independent data monitoring committee recommended that enrollment be discontinued because of the shorter OS observed with Rova-T compared with topotecan. Safety profiles for both drugs were consistent with previous reports. CONCLUSIONS Compared with topotecan, which is the current standard second-line chemotherapy, Rova-T exhibited an inferior OS and higher rates of serosal effusions, photosensitivity reaction, and peripheral edema in patients with SCLC. A considerable unmet therapeutic need remains in this population.
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Affiliation(s)
- Fiona Blackhall
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Department of Medical Oncology, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom.
| | - Kevin Jao
- Department of Hematology and Oncology, Hopital du Sacre Coeur Montreal, Montreal, Canada
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, Centre de Recherche en Cancérologie de Marseille (CRCM), Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique-Hopitaux de Marseille (APHM), Aix-Marseille University, Marseille, France
| | - Byoung Chul Cho
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Noemi Reguart
- Department of Medical Oncology, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Margarita Majem
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Kristiaan Nackaerts
- Department of Pulmonology and Respiratory Oncology, University Hospital Leuven, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Konstantinos Syrigos
- Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Karin Hansen
- Department of Oncology, Odense Universitets Hospital, Odense, Denmark
| | - Wolfgang Schuette
- 2nd Medical Department, Krankenhaus Martha-Maria Halle-Doelau, Halle, Germany
| | - Jeremy Cetnar
- Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Federico Cappuzzo
- Department of Medical Oncology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Isamu Okamoto
- Department of Medical Oncology, Kyushu University Hospital, Fukuoka, Japan
| | - Mustafa Erman
- Department of Medical Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Seppo W Langer
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Terufumi Kato
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Harry Groen
- Department of Pulmonary Disease, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Yan Luo
- AbbVie, Inc., North Chicago, Illinois
| | | | | | | | - Niels Reinmuth
- Thoracic Oncology Department, Asklepios Fachkliniken München-Gauting, Gauting, Germany
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Halit Aktepe O, Sinem Ardic F, Yuce D, Can Guven D, Guner G, Cagri Yildirim H, Kilickap S, Turker A, Kertmen N, Akin S, Aksoy S, Dizdar O, Yalcin S, Erman M. Efficacy analyses of axitinib and nivolumab in metastatic renal cell carcinoma after failure of targeted therapy: which is better? J BUON 2021; 26:2067-2073. [PMID: 34761618 DOI: pmid/34761618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The objective of the present study was to compare the efficacy of axitinib and nivolumab in metastatic renal cell carcinoma (mRCC) previously treated with targeted therapy. METHODS A total of 79 patients were enrolled (39 patients in axitinib group, 40 patients in nivolumab group). Survival outcomes of patients, progression-free survival (PFS), and overall survival (OS) were estimated using the Kaplan-Meier method and compared with the log-rank test. The associations between potential prognostic variables and OS were evaluated in univariate and multivariate Cox regression analyses. RESULTS The median PFS and OS of all cohort were 8.1 and 36.6 months, respectively. Higher PFS and OS were evaluated in axitinib group than nivolumab group (PFS: 9.4 months vs 6.3 months, p=0.386; OS: 38.2 months vs 36.6 months, p=0.671, respectively). Patients treated with axitinib had numerically higher objective response rate (ORR) and disease control rate (DCR) than those treated with nivolumab (ORR: 43.6% vs 27.6%, p=0.157, DCR: 74.4% vs 62.5%, p=0.157, respectively). Multivariate analysis revealed that the independent predictors of OS were higher tumor grade (hazard ratio [HR]: 6.178, p=0.004), worse response to axitinib and nivolumab (HR:4.902, p=0.011), the presence of lung metastasis (HR:15.637, p=0.002) and the presence of liver metastasis (HR:12.010, p=0.001). CONCLUSION Comparable survival outcomes were detected in the axitinib and nivolumab groups. However, head to head comparisons are needed to highlight the relative efficacy of these therapies in mRCC.
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Affiliation(s)
- Oktay Halit Aktepe
- Department of Medical Oncology, Bolu Abant Izzet Baysal University, 14030, Bolu, Turkey
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Guven DC, Aktepe OH, Taban H, Aktas BY, Guner G, Yildirim HC, Sahin TK, Aksun MS, Dizdar O, Aksoy S, Erman M, Yalcin S, Kilickap S. Lower prognostic nutritional index is associated with poorer survival in patients receiving immune checkpoint inhibitors. Biomark Med 2021; 15:1123-1130. [PMID: 34397271 DOI: 10.2217/bmm-2020-0674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: Blood-based biomarkers like prognostic nutritional index (PNI) are readily available biomarkers for immunotherapy efficacy, although the data are limited. So, we aimed to evaluate the association between PNI and overall survival (OS) in immunotherapy-treated patients. Materials & methods: For this retrospective cohort study, data of 150 immunotherapy-treated advanced cancer patients were evaluated. The association between clinical factors and OS was evaluated with multivariate Cox-regression analyses. Results: After a median follow-up of 8.5 months, 94 patients died. The median OS was 11.07 months. The low PNI (hazard ratio [HR]: 2.065; p = 0.001), high lactate dehydrogenase (HR: 2.515; p = 0.001) and poor Eastern Cooperative Oncology Group (ECOG) status (HR: 2.164; p = 0.009) was associated with poorer OS in multivariate analyses. Conclusion: In our experience, survival with immunotherapy was impaired in patients with lower PNI and higher lactate dehydrogenase levels and poorer ECOG status.
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Affiliation(s)
- Deniz C Guven
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Oktay H Aktepe
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Hakan Taban
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Burak Y Aktas
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Gurkan Guner
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Hasan C Yildirim
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Taha K Sahin
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Melek S Aksun
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Omer Dizdar
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey.,Department of Medical Oncology, Istinye University, Istanbul, Turkey
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Yuce Sari S, Aktas BY, Kertmen N, Elmali A, Kilickap S, Karli Oguz K, Mut M, Erman M, Soylemezoglu F, Zorlu F, Yazici G. Does Combined Fractionated Stereotactic Radiotherapy and Immunotherapy Change the Outcome of Recurrent High-Grade Gliomas? Cureus 2021; 13:e15852. [PMID: 34327080 PMCID: PMC8301269 DOI: 10.7759/cureus.15852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/05/2022] Open
Abstract
Background Radiotherapy (RT) with immune checkpoint inhibitors (ICI) has yielded good responses in many cancers. We aimed to report the results of combined fractionated stereotactic radiotherapy (FSRT) and ICI in patients with recurrent high-grade glioma. Methodology Patients were treated with FSRT and nivolumab which were continued until progression or toxicity. The Response Assessment in Neuro-oncology and Immunotherapy Response Assessment in Neuro-oncology criteria were used to assess treatment response on magnetic resonance imaging. Treatment-related toxicity was noted in all patients. Results A total of eight patients were included. Recurrence was detected after a median of 5.8 months following the first RT, all in the treatment field. FSRT (3 × 8 Gy) was applied with neoadjuvant, concurrent, and adjuvant nivolumab. After a median follow-up of 21.3 months from diagnosis and 12.6 months from recurrence, one patient was alive and seven succumbed to the disease. The median overall survival was 20.9 months after diagnosis and 12.9 months after recurrence. The median progression-free interval was 2.3 months after FSRT. The local control (LC) rate was 62.5% with a median local recurrence-free survival of nine months. Progression in other regions of the brain was observed in four patients with a median progression-free survival of 2.1 months. Acute toxicity was not observed. ICI-related grade 3 late pneumonitis was observed in two patients, and grade 1 late thyroid toxicity in two patients. One patient with pneumonitis also developed osteoporosis and radiation necrosis. Conclusions A high LC rate was achieved with concurrent FSRT and ICI with a severe late toxicity rate of 25%. This combination can be an option in recurrent high-grade gliomas.
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Affiliation(s)
- Sezin Yuce Sari
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | | | - Neyran Kertmen
- Medical Oncology, Hacettepe University Medical School, Ankara, TUR
| | - Aysenur Elmali
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | | | | | - Melike Mut
- Neurosurgery, Hacettepe University Medical School, Ankara, TUR
| | - Mustafa Erman
- Medical Oncology, Hacettepe University Medical School, Ankara, TUR
| | | | - Faruk Zorlu
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | - Gozde Yazici
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
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Guven DC, Acar R, Yekeduz E, Bilgetekin I, Baytemur NK, Erol C, Ceylan F, Sendur MA, Demirci U, Urun Y, Karadurmus N, Erman M, Kilickap S. The association between antibiotic use and survival in renal cell carcinoma patients treated with immunotherapy: a multi-center study. Curr Probl Cancer 2021; 45:100760. [PMID: 34130864 DOI: 10.1016/j.currproblcancer.2021.100760] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/02/2021] [Accepted: 05/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Immunotherapy improves overall survival (OS) in the second and later lines of renal cell carcinoma (RCC) treatment. Recent studies have suggested that antibiotic (ATB) use either shortly before or after the start of immunotherapy could lead to decreased OS. Herein, we evaluate the impact of ATB use on OS in RCC patients treated with nivolumab in a multi-center cohort from Turkey. METHODS The data of 93 metastatic RCC patients treated with nivolumab in the second line or later were retrospectively collected from 6 oncology centers. Previous treatments, sites of metastases, International Metastatic RCC Database Consortium risk classification, and ATB use in the three months before (-3) or three months after (+3) the start of immunotherapy were recorded together with survival data. The association of clinical factors with OS and progression-free survival (PFS) was analyzed with univariate and multivariable analyses. RESULTS The median age was 61 (interquartile range 54-67), and 76.3% of the patients were male. The median OS of the cohort was 23.75 ± 4.41, and the PFS was 8.44 ± 1.61 months. Thirty-one (33.3%) patients used ATBs in the 3 months before (-3) or 3 months after (+3) nivolumab initiation. In the multivariable analyses, ATB exposure (HR: 2.306, 95% confidence interval [CI]: 1.155-4.601, P = 0.018) and the presence of brain metastases at the baseline (HR: 2.608, 95% CI: 1.200-5.666, P = 0.015) had a statistically significant association with OS, while ATB exposure was the only statistically significant parameter associated with PFS (HR: 2.238, 95% CI: 1.284-3.900, P = 0.004). CONCLUSION In our study, patients with ATB exposure in the 3 months before or 3 months after the start of immunotherapy had shorter OS. Our findings further support meticulous risk-benefit assessments of prescribing ATBs for patients who are either receiving or are expected to receive immunotherapy.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey.
| | - Ramazan Acar
- Department of Medical Oncology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Emre Yekeduz
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Irem Bilgetekin
- Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Cihan Erol
- Department of Medical Oncology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Furkan Ceylan
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Mehmet Ali Sendur
- Department of Medical Oncology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Umut Demirci
- Department of Medical Oncology, Memorial Ankara Hospital, Ankara, Turkey
| | - Yuksel Urun
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nuri Karadurmus
- Department of Medical Oncology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Ankara, Turkey; Department of Medical Oncology, Istinye University Faculty of Medicine, Istanbul, Turkey
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Güven DC, Ozbek DA, Sahin TK, Aksun MS, Kavgaci G, Cebrayilov C, Yildirim T, Dizdar O, Aksoy S, Kilickap S, Yalcin S, Erman M, ARICI MUSTAFA. MO368THE INCIDENCE AND RISK FACTORS FOR ACUTE KIDNEY INJURY IN PATIENTS TREATED WITH IMMUNE CHECKPOINT INHIBITORS: A REAL-LIFE STUDY. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab082.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
The immune checkpoint inhibitors (ICIs) became a vital part of cancer treatment. The ICIs seem to be safer than chemotherapy for kidneys in clinical trials. However, recent observational studies from high-resource settings pointed out the possible underreporting of renal adverse events like acute kidney injury (AKI) in the clinical trials due to focusing only to the renal immune-related adverse events. Additionally, clinical trials generally enroll a fitter population with lesser comorbidities and include mostly treatment-naive patients making studies in real-life cohorts imperative for evaluating the AKI rates during ICI treatment. From these points, we aimed to evaluate the AKI rates and predisposing factors in ICI-treated patients.
Method
This retrospective study has evaluated the data of adult metastatic cancer patients treated with ICIs in Hacettepe University Cancer Center from 01.2014 to 12.2019. All patients other than the ones treated within the context of clinical trials or followed in other institutions after the first dose of ICIs were included. Baseline demographics, cancer types, patient weight and heights, ICI type and the number of cycles, serum creatinine and the estimated GFR values under treatment, regular medications, and comorbidities were recorded. AKI was defined by Kidney Disease Improving Global Outcomes criteria. The predisposing factors to AKI development were evaluated with the univariate and multivariate analyses.
Results
A total of 147 patients were included in the analyses. Median age was 61 [interquartile range (IQR) 51-67], and 69.4% of the patients were male. Patients were given a median of 8 (IQR 5-17) ICI cycles. Patients with melanoma (24.5%), non-small cell lung cancer (15%), and renal cell carcinoma (25.9%) comprised almost 2/3 of the cohort and 72.8% of the patients were treated with nivolumab. Hypertension was the most common comorbidity (38.1%), followed by chronic kidney disease (21.2%) and type 2 diabetes (19.7%). Median Charlson Comorbidity Index (CCI) was 8 (7-9).
Median follow-up was 10.3 (IQR 6.3-19.4) months, and patients had median 9 (IQR 5-18) serum creatinine measurements. During the follow-up, 28 patients (19%) had at least one AKI episode with multiple AKI episodes in 3 patients (10.7%). The median time to AKI development was 2.53 (IQR 1.39-6.19) months. Almost all AKI events were mild (grade 1 or 2 in 27/28) and reversible (25/28). In univariate analyses, coronary artery disease (CAD) (p=<0.001), chronic kidney disease (CKD) (p=0.002), previous nephrectomy (p=0.015), iodinated contrast exposure in the week before immunotherapy (p=0.035), the use of renin-angiotensin-aldosterone system inhibitors (p=0.046) or proton pump inhibitors (PPI) (p=0.041) was associated with an increased AKI risk. The association between diabetes (p=0.067), higher CCI (9 vs. ≥9, p=0.107), baseline lactate dehydrogenase levels (p=0.177), and performance status (ECOG 0 vs. ≥1, p=0.235) and AKI risk did not reach statistical significance. In multivariate analyses, patients with CKD (OR: 3.719, 95% CI: 1.375- 10.057, p=0.010) or CAD (OR: 4.774, 95% CI: 1.803- 12.641, p=0.002) had increased AKI risk. Additionally, regular PPI use (OR: 2.734, 95% CI: .991- 7.542, p=0.052) had borderline statistical significance for AKI development. The development of AKI was not associated with decreased survival (HR: 0.726, 95% CI: 0.409-1.291, p=0.276).
Conclusion
In this study, we observed AKI development under ICIs in almost one in five cancer patients. The increased AKI rates in patients with CAD, CKD, or regular PPI use pointed out the need for better onco-nephrology collaboration in all ICI-treated patients, with a particular emphasis in these high-risk patients.
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Affiliation(s)
- Deniz Can Güven
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Deniz Aral Ozbek
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Taha Koray Sahin
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Melek Seren Aksun
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Gozde Kavgaci
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | | | - Tolga Yildirim
- Hacettepe University Faculty of Medicine, Department of Nephrology
| | - Omer Dizdar
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Sercan Aksoy
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Saadettin Kilickap
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Suayib Yalcin
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Mustafa Erman
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - MUSTAFA ARICI
- Hacettepe University Faculty of Medicine, Department of Nephrology
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Özdemir N, Dizdar Ö, Yazıcı O, Aksoy S, Dede DS, Budakoğlu B, Metan G, Alp A, Budakoğlu II, Öksüzoğlu ÖBÇ, Özet A, Kılıçkap S, Turhal NS, Çelik İ, Erman M, Ata N, Çelik O, Hayran M. Clinical features and outcomes of COVID-19 in patients with solid tumors: Turkish National Registry Data. Int J Cancer 2021; 148:2407-2415. [PMID: 33284987 DOI: 10.1002/ijc.33426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022]
Abstract
We present demographic, clinical, laboratory characteristics and outcomes of the patients with solid malignancies and novel coronavirus disease (COVID-19) collected from the National COVID-19 Registry of Turkey. A total of 1523 patients with a current or past diagnosis of solid tumors and diagnosed with COVID-19 (confirmed with PCR) between 11 March and 20 May 2020 were included. The primary outcome was 30-day mortality. Median age was 61 (range: 18-94), and 752 (49%) were male. The most common types of cancers were breast (19.8%), prostate (10.9%) and colorectal cancer (10.8%). 65% of the patients had at least one comorbidity. At least one COVID-19-directed therapy was given in 73% of the patients.. Hospitalization rate of the patients was 56.6% and intensive care unit admission rate was 11.4%. Seventy-seven (5.1%) patients died within 30 days of diagnosis. The first multivariate model which included only the demographic and clinical characteristics showed older age, male gender and presence of diabetes and receipt of cytotoxic therapy to be associated with increased 30-day mortality, while breast and prostate cancer diagnoses were associated with lower 30-day mortality. In the second set, we further included laboratory parameters. The presence of leukocytosis (OR 6.7, 95% CI 3.3-13.7, P < .001), lymphocytopenia (OR 3,1, 95% CI 1,6-6,1, P = .001) and thrombocytopenia (OR 3,4 95% CI 1,5-8,1, P = .005) were found to be associated with increased 30-day mortality. Relatively lower mortality compared to Western countries and China mainly results from differences in baseline risk factors but may also implicate the importance of intensive supportive care.
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Affiliation(s)
- Nuriye Özdemir
- Department of Medical Oncology, Gazi University School of Medicine, Ankara, Turkey
| | - Ömer Dizdar
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Ozan Yazıcı
- Department of Medical Oncology, Gazi University School of Medicine, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Didem Sener Dede
- Department of Medical Oncology, Anakar Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Burçin Budakoğlu
- Department of Medical Oncology, Medikalpark Medical Center, Ankara, Turkey
| | - Gökhan Metan
- Department of Infectious diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Alpaslan Alp
- Department of Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Isıl Irem Budakoğlu
- Department of Medical Education and Informatics, Gazi University School of Medicine, Ankara, Turkey
| | - Ömür Berna Çakmak Öksüzoğlu
- Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ahmet Özet
- Department of Medical Oncology, Gazi University School of Medicine, Ankara, Turkey
| | - Saadettin Kılıçkap
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Nazim Serdar Turhal
- Department of Medical Oncology, İstanbul Anadolu Medical Center and President of Turkish Medical Oncology Association, Istanbul, Turkey
| | - İsmail Çelik
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Naim Ata
- Strategy Development Department of the Ministry of Health, Ankara, Turkey
| | - Osman Çelik
- Strategy Development Department of the Ministry of Health, Ankara, Turkey
| | - Mutlu Hayran
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Aktepe OH, Güner G, Güven DC, Şahin TK, Ardıç FS, Yüce D, Yalçın Ş, Erman M. The platelet to lymphocyte ratio predicts overall survival better than the neutrophil to lymphocyte ratio in metastatic renal cell carcinoma. Turk J Med Sci 2021; 51:757-765. [PMID: 33350295 PMCID: PMC8203127 DOI: 10.3906/sag-2009-75] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/19/2020] [Indexed: 02/05/2023] Open
Abstract
Background/aim The prognostic values of systemic inflammatory markers, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) on overall survival (OS) of metastatic renal cell carcinoma patients (mRCC) treated with tyrosine kinase inhibitors (TKI) remain unclear. Thus, the present study aimed to investigate the prognostic impact of these markers on OS of mRCC patients. Materials and methods A total of 150 patients receiving TKIs were retrospectively analyzed. Progression-free survival and OS times were analyzed with the Kaplan–Meier method, and the log‐rank test was used for comparison. Univariable and multivariable Cox regression models evaluated the impact of NLR and PLR on OS of the patients. The receiver operating characteristic curve analysis determined that the optimal cut-off values of NL, and PLR in predicting OS were 2 and 204, respectively. Results Patient with PLR > 204 had significantly lower median OS time than those with PLR ≤ 204 (14.6 months vs. 31.6 months, P < 0.001). While the univariate analyses showed that both NLR and PLR associated with OS (NLR: P = 0.002; PLR: P < 0.001), PLR, not NLR, was an independent determinant for OS in the multivariate analyses (Hazard Ratio: 2.535, 95% CI: 1.564-4.108, P < 0.001). Additionally, the presence of brain metastases and International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic scoring system were identified as independent prognostic factors for OS (brain metastases: P = 0.040; IMDC: P < 0.001). Conclusion The PLR is a readily and inexpensively obtained marker, which may predict OS in patients with mRCC treated with TKIs.
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Affiliation(s)
- Oktay Halit Aktepe
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gürkan Güner
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Can Güven
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Taha Koray Şahin
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fadime Sinem Ardıç
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Yüce
- Department of Preventive Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Şuayib Yalçın
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Erman
- Department of Preventive Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Guven DC, Kavgaci G, Aktepe OH, Yildirim HC, Sahin TK, Aksoy S, Erman M, Kilickap S, Yalcin S. The burden of polypharmacy and drug-drug interactions in older cancer patients treated with immunotherapy. J Oncol Pharm Pract 2021; 28:785-793. [PMID: 33878976 DOI: 10.1177/10781552211012038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Polypharmacy is a common problem in older cancer patients, although the data about polypharmacy and potentially inappropriate prescription practices is limited in patients treated with immune checkpoint inhibitors (ICIs). Therefore, we aimed to evaluate the polypharmacy frequency and drug-drug interactions in older cancer patients (≥65 years) treated with ICIs. METHODS A total of 70 geriatric patients with advanced cancer were included. The polypharmacy was defined as regular use of 5 or more drugs. The START/STOPP Criteria Version 2 was used for the potentially inappropriate medications (PIM) and potential prescription omissions (PPO). The Medscape Drug Interaction Checker was used for potential drug-drug interactions. RESULTS The patients had a median of 6 regular drugs, and polypharmacy was present in 77.1%. The polypharmacy risk was significantly increased in patients over 75 years of age (p = 0.028) and with opioid use (p = 0.048). The 50% of patients had category D or X interactions. Patients with higher Charlson Comorbidity Index had significantly increased risk for drug interactions (CCI ≤10 vs. >10, p = 0.017). The PIMs were present in 44.3% and the PPOs in 68.6% of the patients. While the overall survival and immune related adverse events were similar according to polypharmacy, in patients using seven or more drugs, the acute kidney injury risk was increased (HR: 4.667, p = 0.038). CONCLUSION In this study, we observed a high rate of polypharmacy and inappropriate prescription practices in ICI-treated patients. These issues pointed out the need for improved general medical care and attention for better comedication management in ICI-treated patients.
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Affiliation(s)
- Deniz C Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Gozde Kavgaci
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oktay H Aktepe
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Hasan C Yildirim
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Taha K Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Guven DC, Aksun MS, Sahin TK, Aktepe OH, Yildirim HC, Taban H, Ceylan F, Kertmen N, Arik Z, Dizdar O, Kilickap S, Aksoy S, Yalcin S, Erman M. Poorer baseline performance status is associated with increased thromboembolism risk in metastatic cancer patients treated with immunotherapy. Support Care Cancer 2021; 29:5417-5423. [PMID: 33709186 DOI: 10.1007/s00520-021-06139-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/04/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in cancer patients. However, the association of VTE with immunotherapy remains poorly defined. We therefore evaluated the frequency of VTE in patients receiving immunotherapy and tried to determine predisposing factors. METHODS A total of 133 adult metastatic cancer patients treated with immunotherapy for any cancer between were included. Baseline demographics, ECOG performance status, type of tumors, and baseline blood count parameters were recorded. Possible predisposing factors were evaluated with univariate and multivariate analyses. RESULTS The median age was 60 (interquartile range (IQR) 48-66) years, and the median follow-up was 10.1 (IQR 5.8-18.5) months. Renal cell carcinoma (26.3%) and melanoma (24.1%) were most common diagnoses. Fifteen patients (11.3%) had an episode of VTE. Most of the VTEs were diagnosed as pulmonary emboli (10/15; 67%). Eighty percent (12/15) of these VTE cases were detected incidentally. Patients with a baseline ECOG performance status of 1 or more (29.3% of patients) had a significantly increased risk of venous thrombosis (ECOG ≥1 vs. 0, HR: 3.023, 95% CI: 1.011-9.039, p=0.048). Other factors, including patient age, tumor type, body mass index, baseline thrombocyte, neutrophil, and lactate dehydrogenase levels were not significantly associated with VTE risk. CONCLUSIONS In this study, we observed VTE development in more than 10% of immunotherapy-treated patients and increased VTE risk in patients with poorer ECOG status. With the asymptomatic nature of VTEs in most cases, a high index of suspicion level for VTE is required in patients treated with immunotherapy.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey.
| | - Melek Seren Aksun
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Taha Koray Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oktay Halit Aktepe
- Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey
| | - Hasan Cagri Yildirim
- Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey
| | - Hakan Taban
- Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey
| | - Furkan Ceylan
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Neyran Kertmen
- Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey
| | - Zafer Arik
- Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey
| | - Omer Dizdar
- Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey
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Aktepe OH, Güner G, Güven DC, Taban H, Yıldırım HÇ, Şahin TK, Ardıç FS, Yeter HH, Yüce D, Erman M. Impact of albumin to globulin ratio on survival outcomes of patients with metastatic renal cell carcinoma. Turk J Urol 2021; 47:113-119. [PMID: 33819441 DOI: 10.5152/tud.2021.20377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/14/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The albumin to globulin ratio (AGR) has been demonstrated to be associated with survival outcomes in various tumor types. However, the prognostic value of AGR in patients with metastatic renal carcinoma (mRCC) remains unclear. Therefore, this study aimed to investigate the impact of AGR values in predicting overall survival (OS) of patients with mRCC treated with targeted therapy. MATERIAL AND METHODS A total of 163 patients with mRCC treated with targeted therapy between 2008 and 2019 were enrolled. The AGR value was measured as AGR: albumin/(total protein-albumin). The Kaplan-Meier method with long-rank testing and Cox proportional hazard models were used to estimate the correlation of AGR with OS. RESULTS The receiver operating characteristic curve analysis showed that the optimal cut-off value of AGR in predicting OS was 1.11 with a sensitivity of 37.25% and specificity of 85.25% (area under curve, 0.62; 95% confidence interval [CI], 0.54-0.69; p=0.005). OS was significantly higher in patients with AGR>1.11 than in those with AGR≤1.11 (36.2 vs. 12.4 months; p<0.001). After adjustment for the number of covariates, multivariate Cox regression analysis identified a high AGR as an independent indicator of better OS (hazard ratio, 0.476; 95% CI, 0.304-0.745; p=0.001). CONCLUSION Our results suggested that AGR value, which is an easily obtainable and cost-effective marker in routine biochemistry testing, could function as an independent predictor of OS in patients with mRCC treated with targeted therapy.
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Affiliation(s)
| | - Gürkan Güner
- Hacettepe University Cancer Institute, Ankara, Turkey
| | | | - Hakan Taban
- Hacettepe University Cancer Institute, Ankara, Turkey
| | | | - Taha Koray Şahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fadime Sinem Ardıç
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hacı Hasan Yeter
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Deniz Yüce
- Department of Preventive Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Erman
- Department of Preventive Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Tural D, Olmez OF, Sümbül AT, Artac M, Ozhan N, Akar E, Cakar B, Kostek O, Ekenel M, Coskun HS, Selcukbiricik F, Keskin Ö, Paksoy Turkoz F, oruc K, Bayram S, Yilmaz U, Bilgetekin I, Yildiz B, Sendur MAN, Erman M. Association of response to first-line chemotherapy with the efficacy of atezolizumab in patients with metastatic urothelial carcinoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
409 Background: In the current study, we evaluated whether the response first-line chemotherapy could impact atezolizumab benefit in terms of response rate and overall survival in patients with metastatic urothelial carcinoma. Methods: In this study, we present the retrospective analysis of 105 patients with urothelial cancer treated with ATZ after progression on first-line chemotherapy. The association between response to first-line chemotherapy and ATZ was assessed using Fisher’s exact test. Overall survival (OS) was estimated by using the Kaplan-Meier method. Univariate analysis was used to identify clinical and laboratory factors that significantly impact OS. Variables were retained for multivariate analysis if they had a statistical relationship with OS (p˂0.1) and then included the final model if p˂0.05. Results: Best response to first-line chemotherapy was complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) in 5(4.8%), 38(36.2%), 16(15.2%), 46(43.8%) patients, respectively. Best response to atezolizumab was CR, PR, SD, PD in 9(8.6%), 22(21%), 23(21,9%), 51(48,5%). Forty (74.1%) of patients who benefited from first-line chemotherapy also benefited from atezolizumab, while only 14 (25.9%) of patients with initial PD after first-line chemotherapy subsequently experienced clinical benefit with atezolizumab (Fisher’s exact test, p=0.001). Patients with clinical benefit from first-line chemotherapy had a higher OS. The median OS of atezolizumab were 14.8 and 3.4 months for patients with clinical benefit and progressive disease in response to first-line chemotherapy, respectively (log-rank p=0.001). In univariate analysis, Patients with clinical benefit from first-line chemotherapy, liver metastases, baseline creatinine clearance less (GFR)than 60 ml/min, Eastern Cooperative Oncology Group (ECOG) performance status (1 ≥), and hemoglobin levels below 10 mg/dl were all significantly associated with OS. Three of the adverse prognostic factors according to the Bellmunt criteria were independent factor of short survival: liver metastases (Hazard Ratio [HR]= 0.6; 95% CI 0.174-0.60; p=0.04), ECOG PS≥1 (HR= 0.36; 95% CI 0.2-0.66; p=0.001), and Hemoglobin level below 10 mg/dl (HR= 0.36; 95% CI 0.2-0.66; p <0.001). In addition, Patients with clinical benefit from first-line chemotherapy (HR= 0.39; 95% CI 0.24-0.65; p <0.001) maintained a significant association with OS in multivariate analysis. Conclusions: Our study demonstrated that clinical benefit from first-line chemotherapy was independent prognostic factor on OS in patients' use of atezolizumab as second-line treatment in metastatic bladder cancer. Furthermore, these findings are important for stratification factors for future immunotherapy study design in patients with bladder cancer who have progressed after first-line chemotherapy.
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Affiliation(s)
- Deniz Tural
- Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | | | - Mehmet Artac
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Medical Oncology, Konya, Turkey
| | - Nail Ozhan
- Pamukkale University, School of Medicine, Denizli, Turkey
| | - Emre Akar
- Bakirköy Research and Education Hospital, Istanbul, Turkey
| | - Burcu Cakar
- Yunus Emre State Hospital Medical Oncology Unit, Eskisehir, Turkey
| | - Osman Kostek
- Trakya University, School of Medicine, Edirne, Turkey
| | - Meltem Ekenel
- Istanbul University, Institute of Oncology, Medical Oncology, Istanbul, Turkey
| | | | | | - Özge Keskin
- Selcuk University Faculty of Medicine, Konya, Turkey
| | | | - kerem oruc
- Cerrahpasa Medical School, İstanbul, Turkey
| | | | | | - Irem Bilgetekin
- Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Birol Yildiz
- Ankara Gulhand Egitim ve Arastirma Hastanesi, Ankara, Turkey
| | | | - Mustafa Erman
- Hacettepe University Cancer Institute, Department of Preventive Oncology, Ankara, Turkey
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Guven DC, Yildirim HC, Bilgin E, Aktepe OH, Taban H, Sahin TK, Cakir IY, Akin S, Dizdar O, Aksoy S, Yalcin S, Erman M, Kilickap S. PILE: a candidate prognostic score in cancer patients treated with immunotherapy. Clin Transl Oncol 2021; 23:1630-1636. [PMID: 33586122 DOI: 10.1007/s12094-021-02560-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/26/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although the immune checkpoint inhibitors (ICIs) became a vital part of cancer care, many patients do not respond to treatment, indicating need for biomarkers. The Pan-Immune-Inflammation Value (PIV) is a recently developed peripheral blood count-based biomarker. Herein, we evaluated a PIV-based candidate scoring system as a prognostic biomarker in ICI-treated patients. METHODS A total of 120 advanced cancer patients treated with anti-PD-1 or anti-PD-L1 inhibitors for any cancer type were included in this study. The PILE scoring system incorporating the PIV (< median vs. ≥ median), lactate dehydrogenase levels (normal vs. > normal) and Eastern Cooperative Oncology Group performance status (0 vs. ≥ 1) was constructed from the multivariate analyses and used for stratification. The association between overall survival (OS), progression-free survival and PILE risk category was evaluated with multivariate analysis. RESULTS The median follow-up was 9.62 months and the median OS of all cohort were 12.42 ± 2.75 months. Patients with higher PIV had significantly decreased OS (7.75 ± 1.64 vs. 18.63 ± 4.26 months, p = 0.037). The patients in the PILE high-risk group (PILE score 2-3) had decreased OS (18.63 ± 4.02 vs. 5.09 ± 1.23 months, HR: 2.317, 95% CI: 1.450-3.700, p < 0.001) and PFS (7.69 ± 1.30 vs. 2.69 ± 0.65 months, HR: 1.931, 95% CI: 1.263-2.954, p = 0.002) compared to PILE low-risk group (PILE score 0-1). The Harrell C-Index values were 0.65 and 0.61 for OS and PFS prediction, respectively. CONCLUSION In this study, we demonstrated a decreased overall survival in ICI-treated patients with a higher PILE score. If prospective studies validate our results, PILE score could be a biomarker for immunotherapy.
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Affiliation(s)
- D C Guven
- Hacettepe University Cancer Institute, Ankara, Turkey. .,Department of Medical Oncology, Hacettepe University Cancer Institute, 06100, Sihhiye, Ankara, Turkey.
| | - H C Yildirim
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - E Bilgin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - O H Aktepe
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - H Taban
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - T K Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - I Y Cakir
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - S Akin
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - O Dizdar
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - S Aksoy
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - S Yalcin
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - M Erman
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - S Kilickap
- Hacettepe University Cancer Institute, Ankara, Turkey
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Aktepe OH, Guven DC, Sahin TK, Yildirim HC, Celikten B, Yeter HH, Yuce D, Dizdar O, Erman M. The Predictive Value of Red Blood Cell Distribution Width for Survival Outcomes of Metastatic Renal Cell Carcinoma Patients Treated with Targeted Therapy. Nutr Cancer 2021; 73:1957-1963. [PMID: 33491495 DOI: 10.1080/01635581.2021.1871925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND We aimed to investigate the prognostic value of red cell distribution width (RDW) in metastatic renal cell carcinoma (mRCC) patients treated with targeted therapy, including sunitinib and pazopanib. METHODS A total of 104 mRCC patients were included. The Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS), and the long-rank test was used for comparison. Univariate and multivariate Cox proportional hazards models were used to determine the association between RDW and PFS and OS. RESULTS The PFS and OS of all cohorts were 11.8 mo and 25.9 mo, respectively. Receiver operating characteristic analysis revealed that RDW level ≥15.4 was the optimal cutoff value for OS prediction with 73.53% sensitivity and 61.11% specificity (area under curve: 0.64, P = 0.012). RDW level ≥15.4 was found as an independent prognostic parameter for OS when adjusted for the number of covariates, including the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) scoring system (hazard ratio: 1.125, 95% confidence interval: 1.024-2.235, P = 0.014). CONCLUSIONS Our study revealed that high RDW level, a routinely and easily assessed marker, was significantly associated with worse survival outcomes in mRCC patients treated with targeted therapy.
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Affiliation(s)
- Oktay Halit Aktepe
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Taha Koray Sahin
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hasan Cagri Yildirim
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Burcu Celikten
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Haci Hasan Yeter
- Department of Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Deniz Yuce
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Omer Dizdar
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mustafa Erman
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Guven D, Aktepe O, Taban H, Aktas B, Guner G, Yildirim H, Sahin T, Aksun M, Dizdar O, Aksoy S, Erman M, Yalcin S, Kilickap S. 98P Low prognostic nutritional index is independently associated with poorer survival in patients receiving immune checkpoint inhibitors. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Guven D, Acar R, Yekeduz E, Bilgetekin I, Baytemur NK, Erol C, Ceylan F, Sendur M, Demirci U, Urun Y, Karadurmus N, Erman M, Kilickap S. 99P The association between antibiotic use and survival in renal cell carcinoma patients treated with nivolumab: A multi-center study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Jabbour SK, Houghton B, Robinson AG, Quantin X, Wehler T, Kowalski D, Ahn MJ, Erman M, Giaccone G, Borghaei H, McLean J, Zhang J, Souza F, Decker R. Abstract CT288: Phase 3, randomized, placebo-controlled study of stereotactic body radiotherapy (SBRT) with or without pembrolizumab in patients with inoperable stage I/IIA non-small-cell lung cancer (NSCLC): KEYNOTE-867. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Anti-PD-(L)1-directed therapy following radiotherapy or following concurrent chemoradiation is associated with significantly longer PFS and OS in patients with advanced or metastatic NSCLC, including those with locally advanced inoperable tumors. KEYNOTE-867 (NCT03924869) evaluates the efficacy and safety of SBRT with or without pembrolizumab in patients with inoperable stage I/IIA NSCLC. Trial Design: In this phase 3, randomized, placebo-controlled study, approximately 530 adult patients with previously untreated, medically inoperable, histologically/cytologically confirmed stage I/IIA NSCLC are randomized 1:1 to receive thoracic SBRT to primary tumors for ≤2 wk (Table) and either pembrolizumab 200 mg or placebo every 3 wk for 17 cycles (approximately 1 year) or until disease recurrence, development of unacceptable AEs, SBRT not started for any reason, or study withdrawal. Randomization is stratified by disease stage (I/IIA), ECOG PS (0-1/2), and geographic region (East Asia/other). Imaging assessment by blinded independent central review (BICR) occurs at 12 wk (≥10 wk after SBRT completion), followed by every 16 wk for 3 y, and then every 6 mo. Primary endpoints are event-free survival (EFS) by BICR and OS. Secondary endpoints include time to death or distant metastases and safety; exploratory endpoints are time to subsequent treatment, disease-specific survival, and time to recurrence/progression on subsequent line of therapy. AEs are monitored throughout the trial until 30 d after last dose (90 for serious AEs) and graded according to NCI CTCAE version 4.0. EFS and OS are analyzed by the nonparametric Kaplan-Meier method, treatment differences by stratified log-rank test, and hazard ratios by stratified Cox proportional hazard model with Efron's method of tie handling. Enrollment started on June 17, 2019, at 131 sites.
Table.Stereotactic Body Radiotherapy RegimenUnit Dose Strength(s)Peripheral tumors3×15 Gy or 3×18 Gy fractions (preferred regimens); 4×12 Gy or 5×10 Gy fractions (acceptable regimens)Tumors abutting the chest wall4×12 Gy fractions or 5×10 Gy fractionsCentral tumors5×10 Gy fractions
Citation Format: Salma K. Jabbour, Baerin Houghton, Andrew G. Robinson, Xavier Quantin, Thomas Wehler, Dariusz Kowalski, Myung-Ju Ahn, Mustafa Erman, Giuseppe Giaccone, Hossein Borghaei, Jessica McLean, Jin Zhang, Fabricio Souza, Roy Decker. Phase 3, randomized, placebo-controlled study of stereotactic body radiotherapy (SBRT) with or without pembrolizumab in patients with inoperable stage I/IIA non-small-cell lung cancer (NSCLC): KEYNOTE-867 [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT288.
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Affiliation(s)
- Salma K. Jabbour
- 1Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Baerin Houghton
- 2Mid North Coast Cancer Institute, Port Macquarie Base Hospital, Port Macquarie, NSW, Australia
| | - Andrew G. Robinson
- 3Department of Oncology, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada
| | - Xavier Quantin
- 4Department of Medical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - Thomas Wehler
- 5Department of Hematology, Oncology and Pulmonology, Evangelisches Krankenhaus Hamm gGmbH, Hamm, Germany
| | - Dariusz Kowalski
- 6Department of Lung Cancer and Thoracic Oncology, Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland
| | - Myung-Ju Ahn
- 7Department of Hematology & Oncology, Samsung Medical Center, Seoul, Republic of Korea
| | - Mustafa Erman
- 8Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | | | - Hossein Borghaei
- 10Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Jessica McLean
- 11Oncology Clinical Research, Merck & Co., Inc., Kenilworth, NJ
| | - Jin Zhang
- 12Biostatistics, Merck & Co., Inc., Kenilworth, NJ
| | - Fabricio Souza
- 11Oncology Clinical Research, Merck & Co., Inc., Kenilworth, NJ
| | - Roy Decker
- 13Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
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Peled N, Gillis R, Kilickap S, Froesch P, Orlov S, Filippova E, Demirci U, Christopoulos P, Cicin I, Basal FB, Yilmaz C, Fedor M, Korkmaz T, Paydas S, Gautschi O, Zirtiloglu A, Eralp Y, Cinkir HY, Sezer A, Erman M, Tural D, Turna H, Mazieres J, Dudnik E, Reguart N, Camidge DR, Ng TL, Şenler FÇ, Beypınar İ, Yazılıtaş D, Demirkazık A, Karaoğlu A, Okutur K, Coşkun HŞ, Şendur MAN, Isikdogan A, Cabuk D, Yumuk PF, Yıldız I, Kaplan MA, Özyılkan Ö, Öztop İ, Olmez OF, Aydin K, Aydıner A, Meydan N, Grinberg RD, Roisman LC. GLASS: Global Lorlatinib for ALK(+) and ROS1(+) retrospective Study: real world data of 123 NSCLC patients. Lung Cancer 2020; 148:48-54. [PMID: 32799090 DOI: 10.1016/j.lungcan.2020.07.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022]
Abstract
Lorlatinib is a third-generation tyrosine-kinases inhibitor (TKI) targeting ALK/ROS1 fusions. The FDA has approved lorlatinib for TKI-pretreated ALK(+) NSCLC, while its approval for ROS1(+) is still pending. Here we present the largest real-world data of NSCLC patients harboring ALK/ROS1 rearrangements treated with lorlatinib. METHODS 123 patients were enrolled retrospectively (data cut-off 1/1/2019). Lorlatinib was administered through an early access program for patients with no other available therapy. Outcome and response were defined by each investigator upon RECIST 1.1 criteria. RESULTS 106 ALK(+) and 17 ROS1(+) patients recruited from 8 different countries. The ALK(+) cohort included 50 % males, 73 % never-smokers and 68 % with brain metastases. Extracranial (EC) and intracranial (IC) response rates (RR) were 60 % and 62 %, with disease control rates (DCR) of 91 % and 88 % respectively. Mean duration of therapy (DoT) was 23.9 ± 1.6 months and median overall survival (mOS) was 89.1 ± 19.6 months. ROS1 cohort enrolled 53 % males, 65 % never-smokers and 65 % had brain metastases. EC and IC RR were 62 % and 67 % with DCR of 92 % and 78 % respectively. Median DoT was 18.1 ± 2.5 months and mOS of 90.3 ± 24.4 months. OS and DoT in both cohorts were not significantly correlated with line of therapy nor other parameters. The most common adverse events of any grade were peripheral edema (48 %), hyperlipidemia (47 %), weight gain (25 %) and fatigue (30 %). CNS adverse events such as cognitive effect of grade 1-2 were reported in 18 % of patients. CONCLUSION Lorlatinib shows outstanding EC/IC efficacy in ALK/ROS1(+) NSCLC. The observed mOS of 89 ± 19 months in ALK(+) NSCLC supports previous reports, while mOS from of 90 ± 24 months is unprecedented for ROS1(+) NSCLC.
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Affiliation(s)
- Nir Peled
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.
| | - Roni Gillis
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Saadettin Kilickap
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Patrizia Froesch
- Oncology Institute of the Southern Switzerland, Bellinzona, Switzerland
| | - Sergei Orlov
- Pavlov First Saint Petersburg State Medical University, St Petersburg, Russia
| | - Elena Filippova
- Pavlov First Saint Petersburg State Medical University, St Petersburg, Russia
| | - Umut Demirci
- Uskudar University, Faculty of Medicine, Department of Medical Oncology, Turkey
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, and Translational Lung Research Heidelberg, Member of the German Center for Lung Research (DZL), Germany
| | - Irfan Cicin
- Trakya University, Faculty of Medicine, Department of Medical Oncology, Turkey
| | - Fatma Bugdayci Basal
- University of Health Sciences, Dr. A.Y. Ankara Oncology Hospital, Department of Medical Oncology, Turkey
| | - Cengiz Yilmaz
- Ege University, Faculty of Medicine, Department of Medical Oncology, İzmir, Turkey
| | - Moiseenko Fedor
- N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, 197798, Russian Federation; St. PetersburgClinical Research and Practical Center for Specialized Types of Medical Care (Oncologic), St. Petersburg, 197758, Russian Federation
| | - Taner Korkmaz
- Acibadem MAA University Hospital, School of Medicine, Department of Medical Oncology, Maslak Hospital, İstanbul, Turkey
| | - Semra Paydas
- Department of Oncology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Oliver Gautschi
- University of Berne and Cantonal Hospital of Lucerne, Switzerland
| | - Alisan Zirtiloglu
- Department of Medical Oncology, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yesim Eralp
- Acibadem MAA University Hospital, School of Medicine, Department of Medical Oncology, Maslak Hospital, İstanbul, Turkey
| | - Havva Yesil Cinkir
- Gaziantep University, Faculty of Medicine, Department of Medical Oncology, Gaziantep, Turkey
| | - Ahmet Sezer
- Adana Baskent University, Faculty of Medicine, Department of Medical Oncology, Adana, Turkey
| | - Mustafa Erman
- Department of Preventive Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Deniz Tural
- Department of Medical Oncology, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hande Turna
- Cerrahpasa University, Faculty of Medicine Department of Medical Oncology, Istanbul, Turkey
| | - Julien Mazieres
- Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Elizabeth Dudnik
- Thoracic Cancer Service, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, 49100, Israel
| | - Noemi Reguart
- Division of Medical Oncology, Hospital Clínic, Barcelona,Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - David Ross Camidge
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, 1665 North Aurora Court, Aurora, CO, 80045, USA
| | - Terry L Ng
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Filiz Çay Şenler
- Department of Medical Oncology, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - İsmail Beypınar
- Yildirim Beyazit University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Doğan Yazılıtaş
- Dokuz Eylul University Faculty of Medicine, Department of Medical Oncology, Izmir, Turkey
| | - Ahmet Demirkazık
- Department of Medical Oncology, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - Aziz Karaoğlu
- Medicalpark Bahçelievler Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Kerem Okutur
- Akdeniz University Faculty of Medicine, Department of Medical Oncology, Antalya, Turkey
| | - Hasan Şenol Coşkun
- Dicle University Faculty of Medicine, Department of Medical Oncology, Diyarbakir, Turkey
| | | | - Abdurrahman Isikdogan
- Dicle University Faculty of Medicine, Department of Medical Oncology, Diyarbakir, Turkey
| | - Devrim Cabuk
- Kocaeli University, Division of Medical Oncology, Kocaeli, Turkey
| | - Perran Fulden Yumuk
- Marmara University Faculty of Medicine, Department of Medical Oncology, Istanbul, Turkey
| | - Ibrahim Yıldız
- Acibadem MAA University Hospital, School of Medicine, Department of Medical Oncology, Maslak Hospital, İstanbul, Turkey
| | - M Ali Kaplan
- Dicle University Faculty of Medicine, Department of Medical Oncology, Diyarbakir, Turkey
| | - Özgür Özyılkan
- Adana Baskent University, Faculty of Medicine, Department of Medical Oncology, Adana, Turkey
| | - İlhan Öztop
- Medicalpark Bahçelievler Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Omer Fatih Olmez
- Medipol University Faculty of Medicine, Department of Medical Oncology, Istanbul, Turkey
| | | | - Adnan Aydıner
- Istanbul University Institute of Cancer, Department of Medical Oncology, Istanbul, Turkey
| | - Nezih Meydan
- Adnan Menderes Univesity Faculty of Medicine, Turkey
| | - Roxana Denisa Grinberg
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Laila C Roisman
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
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Guven DC, Sahin TK, Aksun S, Taban H, Aktepe OH, metin Aksu N, Akkas M, Erman M, Kilickap S, Dizdar O, Aksoy S. Evaluation of emergency department visits in patients treated with immune checkpoint inhibitors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24160 Background: Immune checkpoint inhibitors (ICIs) are the main drugs for immunotherapy. Their efficacy comes at the expense of adverse events including immune-related adverse events (IRAEs). The emergency department (ED) is an important encounter point in the cancer care. However, the data on the causes of ED visits is scarce. Therefore, we evaluated the ED visits of patients treated with ICIs and tried to determine the predisposing factors. Methods: We performed a retrospective review of adult cancer patients treated with ICIs for any cancer type between 09/2014 and 06/2019 in Hacettepe University Cancer Center. The data about ED visits after the first dose of ICIs to six months after the last dose of ICIs was collected from the hospital registries. Baseline characteristics, stages and types of patients’ tumors, types of ICI, causes for emergency visits and hospital admissions were recorded. Results: A total of 221 patients were included. The median age was 60.7 years (18-86) and 65.6% of patients were males. Median follow-up was 9 months (0.2-55). Nivolumab was the most common immunotherapy (67.9%). Melanoma was the most common diagnosis (27.6%) followed by kidney and lung cancer. 90% of patients had advanced disease and more than half of patients were treated with two or more lines of therapy. The 83 patients (37.6%) had at least one emergency department (ED) visit. Half of these visits resulted in hospital admissions. Thirty-eight patients had more than one ED visits with 14 patients having three or more ED visits. Immune-related adverse events comprised less than 10% of the ED visits with most of the ED visits were related to symptoms attributable to disease burden itself. The median time to ED visit after the first dose of ICI was 126 days. While baseline ECOG status, age, polypharmacy (defined as the regular use of five or more drugs), concomitant chemotherapy, eosinophilia and lactate dehydrogenase levels didn’t significantly increase the risk, patients with regular opioid use and baseline neutrophilia ( > 8000) had a statistically significant risk of ED visits (p values 0.001 and 0.19 respectively). These two factors remained significant in the multivariate analyses. Conclusions: In this study, almost 40% of ICI treated patients had ED visits. Recognition and addressing of this patient group’s problems in the ED is very important as evidenced by ability to discharging half of patients from the ED. Collaboration between the other specialists like emergency medicine specialists is vital for improving the care of patients treated with immunotherapy.
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Affiliation(s)
- Deniz Can Guven
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Taha Koray Sahin
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Seren Aksun
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Hakan Taban
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Oktay Halit Aktepe
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Nalan metin Aksu
- Hacettepe University Faculty of Medicine, Department of Emergency Medicine, Ankara, Turkey
| | - Meltem Akkas
- Hacettepe University Faculty of Medicine, Department of Emergency Medicine, Ankara, Turkey
| | - Mustafa Erman
- Hacettepe University Cancer Institute, Department of Preventive Oncology, Ankara, Turkey
| | - Saadettin Kilickap
- Hacettepe University Cancer Institute, Department of Preventive Oncology, Ankara, Turkey
| | - Omer Dizdar
- Hacettepe University Cancer Institute, Department of Preventive Oncology, Ankara, Turkey
| | - Sercan Aksoy
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
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