1
|
Kahraman S, Karakaya S, Kaplan MA, Goksu SS, Ozturk A, Isleyen ZS, Hamdard J, Yildirim S, Dogan T, Isik S, Celebi A, Gulbagci BB, Paksoy N, Dogan M, Turk HM, Bilici A, Tatli AM, Akbas S, Turan N, Hacibekiroglu I, Dogu GG, Aydiner A, Sumbul AT, Akyurek S, Yalciner M, Demirkazik A, Gursoy P, Aykan MB, Sahin E, Karadag İ, Kostek O, Er MM, Artaç M, Duzkopru Y, Aydin D, Isik D, Karakas Y, Kilickap S, Erol C, Demir B, Civelek B, Ergun Y, Akinci MB, Dogan I, Karadurmus N, Yumuk PF, Sendur MAN. Treatment outcomes and prognostic factors in patients with driver mutant non-small cell lung cancer and de novo brain metastases. Sci Rep 2024; 14:5820. [PMID: 38461209 PMCID: PMC10925043 DOI: 10.1038/s41598-024-56046-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/01/2024] [Indexed: 03/11/2024] Open
Abstract
Central nervous system (CNS) metastases can be seen at a rate of 30% in advanced stages for patients with non-small cell lung cancer (NSCLC). Growing evidence indicates the predictive roles of driver gene mutations in the development of brain metastases (BM) in recent years, meaning that oncogene-driven NSCLC have a high incidence of BM at diagnosis. Today, 3rd generation targeted drugs with high intracranial efficacy, which can cross the blood-brain barrier, have made a positive contribution to survival for these patients with an increased propensity to BM. It is important to update the clinical and pathological factors reflected in the survival with real-life data. A multi-center, retrospective database of 306 patients diagnosed with driver mutant NSCLC and initially presented with BM between between November 2008 and September 2022 were analyzed. The median progression-free survival (mPFS) was 12.25 months (95% CI, 10-14.5). While 254 of the patients received tyrosine kinase inhibitor (TKI), 51 patients received chemotherapy as first line treatment. The median intracranial PFS (iPFS) was 18.5 months (95% CI, 14.8-22.2). The median overall survival (OS) was 29 months (95% CI, 25.2-33.0). It was found that having 3 or less BM and absence of extracranial metastases were significantly associated with better mOS and iPFS. The relationship between the size of BM and survival was found to be non-significant. Among patients with advanced NSCLC with de novo BM carrying a driver mutation, long-term progression-free and overall survival can be achieved with the advent of targeted agents with high CNS efficacy with more conservative and localized radiotherapy modalities.
Collapse
Affiliation(s)
- Seda Kahraman
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey.
| | - Serdar Karakaya
- Department of Medical Oncology, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Muhammed Ali Kaplan
- Department of Medical Oncology, Dicle University Medical Faculty Hospital, Diyarbakir, Turkey
| | - Sema Sezgin Goksu
- Department of Medical Oncology, Akdeniz University Hospital, Antalya, Turkey
| | - Akin Ozturk
- Department of Medical Oncology, Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zehra Sucuoglu Isleyen
- Department of Medical Oncology, Faculty of Medicine Hospital, Bezmialem Vakif University, Istanbul, Turkey
| | - Jamshid Hamdard
- Department of Medical Oncology, Medipol University Hospital, Istanbul, Turkey
| | - Sedat Yildirim
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Tolga Dogan
- Department of Medical Oncology, Pamukkale University Medical Faculty Hospital, Denizli, Turkey
| | - Selver Isik
- Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Abdussamet Celebi
- Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Burcu Belen Gulbagci
- Department of Medical Oncology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Nail Paksoy
- Department of Medical Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mutlu Dogan
- Department of Medical Oncology, Ankara Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Haci Mehmet Turk
- Department of Medical Oncology, Faculty of Medicine Hospital, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Bilici
- Department of Medical Oncology, Medipol University Hospital, Istanbul, Turkey
| | - Ali Murat Tatli
- Department of Medical Oncology, Akdeniz University Hospital, Antalya, Turkey
| | - Sinem Akbas
- Department of Medical Oncology, Koç University Medical Faculty Hospital, Istanbul, Turkey
| | - Nedim Turan
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Ilhan Hacibekiroglu
- Department of Medical Oncology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Gamze Gokoz Dogu
- Department of Medical Oncology, Pamukkale University Medical Faculty Hospital, Denizli, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Taner Sumbul
- Department of Medical Oncology, Baskent University Adana Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Serap Akyurek
- Department of Radiation Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merih Yalciner
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ahmet Demirkazik
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Pinar Gursoy
- Department of Medical Oncology, Ege University Medical Faculty Hospital, Izmir, Turkey
| | - Musa Baris Aykan
- Department of Medical Oncology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Elif Sahin
- Department of Medical Oncology, Kocaeli University Medical Faculty Hospital, Kocaeli, Turkey
| | - İbrahim Karadag
- Department of Medical Oncology, Hittite University Corum Training and Research Hospital, Corum, Turkey
| | - Osman Kostek
- Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Muhiddin Er
- Department Of Medical Oncology, Necmettin Erbakan University Meram Medical Faculty Hospital, Konya, Turkey
| | - Mehmet Artaç
- Department Of Medical Oncology, Necmettin Erbakan University Meram Medical Faculty Hospital, Konya, Turkey
| | - Yakup Duzkopru
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Dincer Aydin
- Department of Medical Oncology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Deniz Isik
- Department of Medical Oncology, Kocaeli Medical Park Hospital, Kocaeli, Turkey
| | - Yusuf Karakas
- Department of Medical Oncology, Acıbadem Bodrum Hospital, Mugla, Turkey
| | - Saadettin Kilickap
- Department of Medical Oncology, Liv Hospital, Istinye University, Ankara, Turkey
| | - Cihan Erol
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Bilgin Demir
- Department of Medical Oncology, Aydin Ataturk State Hospital, Aydin, Turkey
| | - Burak Civelek
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Yakup Ergun
- Department of Medical Oncology, Batman Training and Research Hospital, Batman, Turkey
| | - Muhammed Bulent Akinci
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Izzet Dogan
- Department of Medical Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Nuri Karadurmus
- Department of Medical Oncology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Perran Fulden Yumuk
- Department of Medical Oncology, Koç University Medical Faculty Hospital, Istanbul, Turkey
| | - Mehmet Ali Nahit Sendur
- Department of Medical Oncology, Ankara Bilkent City Hospital, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| |
Collapse
|
2
|
Akyildiz A, Guven DC, Ozluk AA, Ismayilov R, Mutlu E, Unal OU, Yildiz I, Iriagac Y, Turhal S, Akbas S, Bayram E, Telli TA, Turkoz FP, Ozcelik M, Erciyestepe M, Selvi O, Gulbagci B, Erturk I, Isleyen ZS, Kahraman S, Akdag MO, Hamitoglu B, Unek IT, Unal C, Hacibekiroglu İ, Arslan C, Azizy A, Helvaci K, Demirci U, Dizdar O, Basaran M, Goker E, Sendur MA, Yalcin S. The safety and efficacy of first-line atezolizumab plus bevacizumab in patients with unresectable hepatocellular carcinoma: A multicenter real-world study from Turkey. Medicine (Baltimore) 2023; 102:e35950. [PMID: 37960746 PMCID: PMC10637501 DOI: 10.1097/md.0000000000035950] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023] Open
Abstract
The aim of the study was to evaluate the real-world clinical outcomes of atezolizumab and bevacizumab (Atez/Bev) as the initial therapy for advanced hepatocellular carcinoma (HCC). We retrospectively analyzed 65 patients treated with Atez/Bev for advanced HCC from 22 institutions in Turkey between September 2020 and March 2023. Responses were evaluated by RECIST v1.1 criteria. The median progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Cox regression model was employed to conduct multivariate analyses. The median age was 65 (range, 22-89) years, and 83.1% of the patients were male. A total of 1.5% achieved a complete response, 35.4% had a partial response, 36.9% had stable disease, and 26.2% had progressive disease. The disease control rate was 73.8% and associated with alpha-fetoprotein levels at diagnosis and concomitant antibiotic use. The incidence rates of any grade and grade ≥ 3 adverse events were 29.2% and 10.7%, respectively. At a median follow-up of 11.3 (3.4-33.3) months, the median PFS and OS were 5.1 (95% CI: 3-7.3) and 18.1 (95% CI: 6.2-29.9) months, respectively. In univariate analyses, ECOG-PS ≥ 1 (relative to 0), Child-Pugh class B (relative to A), neutrophil-to-lymphocyte ratio (NLR) > 2.9 (relative to ≤ 2.9), and concomitant antibiotic use significantly increased the overall risk of mortality. Multivariate analysis revealed that ECOG-PS ≥ 1 (HR: 2.69, P = .02), NLR > 2.9 (HR: 2.94, P = .017), and concomitant antibiotic use (HR: 4.18, P = .003) were independent predictors of OS. Atez/Bev is an effective and safe first-line therapy for advanced-stage HCC in a real-world setting. The survival benefit was especially promising in patients with a ECOG-PS score of 0, Child-Pugh class A, lower NLR, and patients who were not exposed to antibiotics during the treatment.
Collapse
Affiliation(s)
- Arif Akyildiz
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Ahmet Anil Ozluk
- Department of Medical Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Rashad Ismayilov
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Emel Mutlu
- Department of Medical Oncology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Olcun Umit Unal
- Department of Medical Oncology, Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Ibrahim Yildiz
- Department of Medical Oncology, Acibadem University Hospital, Istanbul, Turkey
| | - Yakup Iriagac
- Department of Medical Oncology, Namik Kemal University, Tekirdag, Turkey
| | - Serdar Turhal
- Department of Medical Oncology, Anadolu Medical Center, Kocaeli, Turkey
| | - Sinem Akbas
- Department of Medical Oncology, Koc University Hospital, Istanbul, Turkey
| | - Ertugrul Bayram
- Department of Medical Oncology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Tugba Akin Telli
- Department of Medical Oncology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fatma Paksoy Turkoz
- Department of Medical Oncology, Istinye University, Medical Park Goztepe Hospital, Istanbul, Turkey
| | - Melike Ozcelik
- Department of Oncology, Kartal Lutfi Kirdar Teaching and Research Hospital, Istanbul, Turkey
| | - Mert Erciyestepe
- Department of Medical Oncology, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Oguzhan Selvi
- Department of Medical Oncology, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Burcu Gulbagci
- Department of Medical Oncology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Ismail Erturk
- Department of Medical Oncology, Gulhane School of Medicine, Ankara, Turkey
| | - Zehra Sucuoglu Isleyen
- Department of Medical Oncology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Seda Kahraman
- Department of Medical Oncology, Ankara City Hospital, Yildirim Beyazit University, Ankara, Turkey
| | | | - Buket Hamitoglu
- Department of Medical Oncology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Ilkay Tugba Unek
- Department of Medical Oncology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Caglar Unal
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - İlhan Hacibekiroglu
- Department of Medical Oncology, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Cagatay Arslan
- Department of Medical Oncology, Izmir University of Economics Faculty of Medicine, Izmir, Turkey
| | - Abdulmunir Azizy
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Kaan Helvaci
- Department of Medical Oncology, Memorial Ankara Hospital, University of Uskudar, Ankara, Turkey
| | - Umut Demirci
- Department of Medical Oncology, Memorial Ankara Hospital, University of Uskudar, Ankara, Turkey
| | - Omer Dizdar
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mert Basaran
- Department of Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Erdem Goker
- Department of Medical Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mehmet Ali Sendur
- Department of Medical Oncology, Ankara City Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| |
Collapse
|
3
|
Ulas M, Akbas E, Akbas S, Aktemur G, Durcanoglu N, Aksak K, Atalar AA, Yıldırım S, Akalin I. Physiological aspect of apoptosis-regulating microRNAs expressions during fasting. Eur Rev Med Pharmacol Sci 2023; 27:2210-2215. [PMID: 37013738 DOI: 10.26355/eurrev_202303_31754] [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: 04/05/2023]
Abstract
OBJECTIVE Fasting is an activity that requires a certain calorie restriction without consuming food or drinks for a certain period of daytime. However, fasting triggers many complex events, including activating cellular stress response pathways, autophagy promotion, apoptosis pathways, and a change in hormonal balance. Among the many events affecting the regulation of apoptosis, the expression of microRNAs (miRNAs) plays an important role. Therefore, we aimed to investigate the levels and importance of miRNA expression in fasting. PATIENTS AND METHODS The expressions of 19 miRNAs regulating different pathways from saliva samples, isolated by matching healthy university students (n = 34) as group 1 (fasting for 17 consecutive hours) and group 2 (testing 70 minutes after meal consumption), were examined using the real-time PCR method. RESULTS In fasting, modulation of apoptotic pathways by miRNAs triggers anti-pathogenic effects, and the adaptation of abnormal cells in the body decreases. For this reason, vital diseases, such as cancer, can be treated by preventing the proliferation and growth of cancerous cells by increasing programmed cell death due to the downregulation expression mechanism of miRNAs. CONCLUSIONS Our study aims to improve the knowledge about the mechanisms and functions of miRNAs in various apoptosis pathways during fasting and may be a model for further future physiological and pathological studies.
Collapse
Affiliation(s)
- M Ulas
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Erol C, Sendur Mehmet AN, Bilgetekin I, Garbioglu DB, Hamdard J, Akbas S, Hizal M, Arslan C, Sevinc A, Kucukarda A, Erdem D, Kahraman S, Cakir E, Demirkiran A, On S, Dogan I, Erdogan AP, Koca S, Kubilay P, Eren OO, Cilbir E, Celik E, Araz M, Ozyukseler DT, Yildirim ME, Bahceci A, Taskaynatan H, Oyman A, Deniz GI, Menekse S, Kut E, Gulmez A, Sakin A, Nayir E, Acar R, Sen E, Inal A, Turhal S, Kaya AO, Paydas S, Tastekin D, Hacibekiroglu I, Cincin I, Bilici A, Mandel NM, Dede DS, Akinci MB, Oksuzoglu B, Uncu D, Yalcin B, Artac M. Efficacy and safety of folfiri plus aflibercept in second-line treatment of metastatic colorectal cancer: Real-life data from Turkish oncology group. J Cancer Res Ther 2022; 18:S347-S353. [PMID: 36510987 DOI: 10.4103/jcrt.jcrt_1104_21] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aims The addition of aflibercept to the fluorouracil and irinotecan (FOLFIRI) regimen significantly improved clinical outcomes in patients with metastatic colorectal cancer (CRC) previously treated with oxaliplatin. We aimed to investigate the efficacy and safety of second-line FOLFIRI and aflibercept combination in patients with metastatic CRC in real-life experience. Materials and Methods Four hundred and thirty-three patients who treated with FOLFIRI and aflibercept in the second-line were included in the study. The clinical and pathological features of the patients were recorded retrospectively. Survival (overall and progression-free survival [PFS]), response rates, and safety data were analyzed. Results The median age was 61. Majority of patients (87.5%) received first-line bevacizumab and 10.1% of patients received anti-epidermal growth factor receptor agents. About 80% of patients had KRAS, 18.6% of patients had NRAS, and 6.4% of patients had BRAF mutations. The median OS was 11.6 months (95% confidence interval [CI], 10.6-12.6) and the median PFS was 6 months (95% CI, 5.5-6.5). About 4.6% of patients had complete response and 30.6% of patients had partial response as best tumor response. Grade 1-2 toxicities were seen in 33.4% of patients, while grade 3-4 toxicities were recorded in 27% of patients. Eight patients (2%) died due to treatment toxicity. Conclusions Overall and PFS were similar in routine clinical practice compared to phase III pivotal VELOUR trial. However, response rates were found to be higher. It was observed that there were fewer adverse events compared to the VELOUR trial.
Collapse
Affiliation(s)
- Cihan Erol
- Department of Medical Oncology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Ali Nahit Sendur Mehmet
- Department of Medical Oncology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Irem Bilgetekin
- Department of Medical Oncology, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Duygu Bayir Garbioglu
- Department of Medical Oncology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Jamshid Hamdard
- Department of Medical Oncology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Sinem Akbas
- Department of Medical Oncology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mutlu Hizal
- Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Cagatay Arslan
- Department of Medical Oncology, Izmir Medical Park Hospital, Izmir, Turkey
| | - Alper Sevinc
- Department of Medical Oncology, Gaziantep Medical Park Hospital, Edirne, Turkey
| | - Ahmet Kucukarda
- Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Dilek Erdem
- Department of Medical Oncology, Samsun Medical Park Hospital, Samsun, Turkey
| | - Seda Kahraman
- Department of Medical Oncology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Emre Cakir
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Aykut Demirkiran
- Department of Medical Oncology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sercan On
- Department of Medical Oncology, Istanbul University, Institute of Oncology, Istanbul, Turkey
| | - Izzet Dogan
- Department of Medical Oncology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Atike Pinar Erdogan
- Department of Medical Oncology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sinan Koca
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Pinar Kubilay
- Department of Medical Oncology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Orhan Onder Eren
- Department of Medical Oncology, Diskapi Training and Research Hospital, Ankara, Turkey
| | - Ebru Cilbir
- Department of Medical Oncology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Emir Celik
- Department of Medical Oncology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Araz
- Department of Medical Oncology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Deniz Tataroglu Ozyukseler
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mahmut Emre Yildirim
- Department of Medical Oncology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Aykut Bahceci
- Department of Medical Oncology, Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | - Halil Taskaynatan
- Department of Medical Oncology, Necip Fazil City Hospital, Kahramanmaras, Turkey
| | - Abdilkerim Oyman
- Department of Medical Oncology, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Gulhan Ipek Deniz
- Department of Medical Oncology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Serkan Menekse
- Department of Medical Oncology Manisa City Hospital, Manisa, Turkey
| | - Engin Kut
- Department of Medical Oncology Manisa City Hospital, Manisa, Turkey
| | - Ahmet Gulmez
- Department of Medical Oncology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Abdullah Sakin
- Department of Medical Oncology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Erdinc Nayir
- Department of Medical Oncology, Mersin Medical Park Hospital, Mersin, Turkey
| | - Ramazan Acar
- Department of Medical Oncology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Erdem Sen
- Department of Medical Oncology, Mehmet Akif Ersoy Hospital, Canakkale, Turkey
| | - Ali Inal
- Department of Medical Oncology, Mersin City Hospital, Mersin, Turkey
| | - Serdar Turhal
- Department of Medical Oncology, Anadolu Medical Center, Kocaeli, Turkey
| | - Ali Osman Kaya
- Department of Medical Oncology, Faculty of Medicine, Biruni University, Istanbul, Turkey
| | - Semra Paydas
- Department of Medical Oncology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Didem Tastekin
- Department of Medical Oncology, Istanbul University, Institute of Oncology, Istanbul, Turkey
| | - Ilhan Hacibekiroglu
- Department of Medical Oncology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Irfan Cincin
- Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Ahmet Bilici
- Department of Medical Oncology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Nil Molinas Mandel
- Department of Medical Oncology, Istanbul American Hospital, Istanbul, Turkey
| | - Didem Sener Dede
- Department of Medical Oncology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Muhammed Bulent Akinci
- Department of Medical Oncology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Berna Oksuzoglu
- Department of Medical Oncology, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, 5Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Dogan Uncu
- Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Bulent Yalcin
- Department of Medical Oncology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Mehmet Artac
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| |
Collapse
|
5
|
Okut G, Turgut E, Kaplan K, Bag YM, Akbas S, Sumer F, Kayaalp C. Does laparoscopic-guided transversus abdominis plane block have an effect on postoperative pain and recovery after sleeve gastrectomy? Eur Rev Med Pharmacol Sci 2022; 26:5406-5412. [PMID: 35993635 DOI: 10.26355/eurrev_202208_29408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Postoperative pain management is thought to have an effect on patient comfort, morbidity, and mortality after bariatric surgery. Local anesthetic agents are frequently used for this purpose. Local anesthetics can be used in many different ways. In this study, we aimed to investigate the effect of transversus abdominis plane (TAP) block on postoperative pain by laparoscopic method. PATIENTS AND METHODS A prospective randomized clinical trial was performed. While TAP block was applied to one group with bupivacaine, no action was taken for the other group. Postoperative analgesia was given to both patient groups with the "patient-controlled analgesia (PCA)" device. Demographic, operational, and postoperative clinical and pain data of the patients were recorded. RESULTS TAP block and non-TAP block groups consisted of 30 patients each. Visual analog scale (VAS) scores of the patients at 6, 12, and 24 hours were lower in the TAP group compared to the non-TAP group (p=0.015, 0.018, 0.04, respectively). According to the PCA device data, the analgesic requirement was lower in the TAP group at 6, 12, and 24 hours (p <0.001). Rescue analgesia was required more in the non-TAP group (p=0.04). There was no statistically significant difference between the two groups in terms of gas discharge time (p=0.102), stool discharge occurred earlier in the TAP group (p=0.02). Oral intake times (p=0.554) and length of stay hospital (p=0.551) were similar. CONCLUSIONS Laparoscopic TAP block using bupivacaine can be safely administered in morbidly obese patients and reduces postoperative analgesic requirements. Thus, side effects that may develop secondary to the use of analgesics are avoided.
Collapse
Affiliation(s)
- G Okut
- Gastroenterology Surgery Department, Bozyaka Research and Training Hospital, Izmir, Turkey.
| | | | | | | | | | | | | |
Collapse
|
6
|
Akbas S, Ozkan AS, Durak MA, Yologlu S. Efficacy of Intravenous Paracetamol and Ibuprofen on Postoperative Pain and Morphine Consumption in Lumbar Disc Surgery: Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Neurochirurgie 2021; 67:533-539. [PMID: 33989641 DOI: 10.1016/j.neuchi.2021.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Effective postoperative pain management after lumbar disc surgery reduces complications and improves postoperative care. The purpose of this prospective, randomized, double-blind, placebo-controlled clinical study is to evaluate the effects of IV paracetamol and ibuprofen on postoperative pain, morphine consumption and side effects of morphine in patients who underwent lumbar disc surgery. MATERIALS AND METHODS Seventy-five patients aged 18-85 years scheduled for lumbar disk surgery with a single level laminectomy included in this study. All patients received morphine with an IV patient-controlled analgesia device during the first postoperative 24hour. The patients were divided randomly and double-blinded into three groups (control, paracetamol and ibuprofen). The demographic characteristics and procedure data, VAS score, cumulative morphine consumption, opioid-related side effects were recorded. RESULTS There was no significant difference regarding to demographic characteristics, comorbidities, and durations of anesthesia and surgery. There was a significant difference between all groups regarding to total morphine consumption (P<0.001). IV ibuprofen significantly reduced the total morphine consumption in comparison with control and paracetamol (P<0.001). Repeated measures ANOVA showed in all periods of the study that VAS score was significantly lower in ibuprofen (P<0.001), but not in paracetamol (P=0.394) in comparison with control. There was no difference between groups regarding postoperative heart rate, mean arterial pressure, nausea-vomiting, pruritus and urinary retention. CONCLUSIONS This study showed that pain scores and morphine consumption, but not the side effects of patient-controlled analgesia during 24hours after the lumbar disk surgery, were significantly reduced by IV ibuprofen as a supplemental analgesic when compared with controls and paracetamols.
Collapse
Affiliation(s)
- S Akbas
- Department of Anesthesiology and Reanimation, Inonu University Medical Faculty, Malatya, Turkey
| | - A S Ozkan
- Department of Anesthesiology and Reanimation, Inonu University Medical Faculty, Malatya, Turkey.
| | - M A Durak
- Department of Neurosurgery, Inonu University Medical Faculty, Malatya, Turkey
| | - S Yologlu
- Department of Biostatistics, Inonu University Medical Faculty, Malatya, Turkey
| |
Collapse
|
7
|
Akbas S, Sahin A, Calis S, Oncel H, Capan Y. Characterization of bevacizumab by dynamic light scattering while maintaining its native structure. Pharmazie 2018; 73:369-374. [PMID: 30001769 DOI: 10.1691/ph.2018.8024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Bevacizumab, is a humanized monoclonal antibody and patents on Avastin® (Bevacizumab, Roche) will expire in the US in 2019 and in Europe in 2022. Therefore, bevacizumab is a popular target for biosimilar developers. One of the most common problems in the formulation of antibody drugs is protein aggregation. Dynamic light scattering (DLS) is a well-established method for the determination of hydrodynamic dimensions, aggregates, and aggregation points of proteins. In contradistinction to other techniques that require diluted samples or specific conditions, proteins and aggregates can maintain their native structure during DLS measurements. In recent studies, bevacizumab was characterized by DLS using diluted samples. In this study, we aimed at investigating the hydrodynamic dimensions, aggregates, and aggregation onset of bevacizumab (Altuzan®, Turkey, Roche) by DLS, while maintaining its native structure. The intensity, volume, and number-based particle size distribution profiles of the test samples were evaluated and the aggregation onset of the formulation was successfully determined against increasing temperature. It is shown that the preservation of the native structure of commercial formulations in DLS measurements provides an opportunity to the characterization of commercial products and development of biosimilars.
Collapse
|
8
|
Sahin A, Spiroux F, Guedon I, Arslan FB, Sarcan ET, Ozkan T, Colak N, Yuksel S, Ozdemir S, Ozdemir B, Akbas S, Ultav G, Aktas Y, Capan Y. Using PVA and TPGS as combined emulsifier in nanoprecipitation method improves characteristics and anticancer activity of ibuprofen loaded PLGA nanoparticles. Pharmazie 2018; 72:525-528. [PMID: 29441979 DOI: 10.1691/ph.2017.7015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
In the preparation of nanoparticles (NPs) by the nanoprecipitation method, emulsifiers play a key role for NPs' characteristics. The present study aimed to investigate the combined emulsifier effect on ibuprofen loaded poly(lactic-co-glycolic acid) (PLGA) NPs' characteristics and anticancer activity. Ibuprofen loaded PLGA NPs were prepared by nanoprecipitation using different concentrations of PVA (poly(vinyl alcohol)) or PVA-TPGS (d-α-tocopherol polyethylene glycol 1000 succinate) combination as emulsifier. It was found that encapsulation efficiencies of NPs varied between 17.9 and 41.9 % and the highest encapsulation efficiency was obtained with 0.5% PVA + 0.1% TPGS (coded as PLGA PVA/TPGS NPs). PLGA PVA/TPGS NPs were characterized and compared with PLGA PVA NPs, which was obtained by 0.5% PVA alone. Polydispersity index of PLGA PVA/TPGS and PLGA PVA NPs were found to be 0.08 and 0.15, respectively. Incorporation of TPGS with PVA slightly decreased the initial ibuprofen release. Transmission electron microscopy analyses demonstrated a nearly uniform particle size distribution and spherical particle shape of the PLGA PVA/TPGS NPs. Additionally, PLGA PVA/TPGS NPs were significantly more cytotoxic than PLGA PVA NPs on the MCF-7 (human breast adenocarcinoma cells) and Caco-2 (human epithelial colorectal adenocarcinoma) cells (p<0.05). Also PLGA PVA/TPGS NPs were not cytotoxic on normal cells (L929, mouse healthy fibroblast cells) (p>0.05). In conclusion, these results indicated that using a combination of TPGS and PVA as an emulsifier in nanoprecipitation could be a promising approach for preparing ibuprofen loaded PLGA NPs because of their improved characteristics and anticancer activity.
Collapse
|
9
|
Abstract
Background The aim of our study was to compare the hemodynamic responses and adverse events associated with nasotracheal intubation (NTI) using a fiberoptic bronchoscope (FOB) and a direct laryngoscope (DLS) in children undergoing general anesthesia for outpatient dental surgery. Methods Eighty children (aged 5-15 years) were scheduled to undergo outpatient dental surgery under general anesthesia and of these children those who required NTI were included. Results NTI was significantly longer in the FOB group (P = 0.03). In both groups, systolic blood pressure (SBP) and heart rate (HR) significantly decreased after the induction of anesthesia when compared with the baseline values. SBP was significantly higher in both groups at intubation and 1 and 3 min after intubation when compared with postinduction. SBP significantly increased in the DLS group compared with the FOB group at intubation and 1 min after intubation. HR was significantly increased at intubation and 1 min after intubation in the DLS group compared with the FOB group. Nose bleeding after intubation was significantly more frequent in the DLS group (30%) than in the FOB group (7.5%) (P = 0.034). The incidence of sore throat 24 h after surgery was 20% (8/40) in the DLS group and 2.5% (1/40) in the FOB group (P = 0.014). Conclusions There are fewer hemodynamic responses and adverse events in the FOB group than in the DLS group; therefore, FOB can be safely used for NTI in children undergoing outpatient dental surgery, and FOB may be more successful than DLS for NTI.
Collapse
Affiliation(s)
- A S Ozkan
- Faculty of Medicine, Inonu University, Malatya, Turkey
| | - S Akbas
- Faculty of Medicine, Inonu University, Malatya, Turkey
| |
Collapse
|
10
|
Ure E, Cingoz M, Kandemirli SG, Akbas S, Tutar O, Ogut AG. CT and MR imaging features of diffuse lipomatosis of the abdomen. Diagn Interv Imaging 2016; 97:1189-1191. [PMID: 27138071 DOI: 10.1016/j.diii.2016.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/21/2016] [Accepted: 03/25/2016] [Indexed: 11/16/2022]
Affiliation(s)
- E Ure
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Kocamustafapasa, Istanbul, Turkey.
| | - M Cingoz
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Kocamustafapasa, Istanbul, Turkey.
| | - S G Kandemirli
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Kocamustafapasa, Istanbul, Turkey.
| | - S Akbas
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Kocamustafapasa, Istanbul, Turkey.
| | - O Tutar
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Kocamustafapasa, Istanbul, Turkey.
| | - A G Ogut
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Kocamustafapasa, Istanbul, Turkey.
| |
Collapse
|