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Güner G, Özçakar L, Baytar Y, Onur MR, Demir M, Aktaş BY, Aktepe OH, Güven DC, Taban H, Yıldırım HÇ, Akın S, Aksoy S, Kara M, Dizdar Ö. Sonographic Measurements of Rectus Femoris Muscle Thickness Strongly Predict Neutropenia in Cancer Patients Receiving Chemotherapy. Cancers (Basel) 2024; 16:1061. [PMID: 38473418 DOI: 10.3390/cancers16051061] [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: 02/12/2024] [Revised: 02/22/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
The objective of this study was to explore the possible association between low skeletal muscle mass (SMM)-assessed by computed tomography (CT) and ultrasound (US)-and hematologic toxicity in cancer patients. A prospective cohort study was conducted in cancer patients who received anthracycline-based chemotherapy between 2018 and 2020 and who had baseline abdominal CT including L3 level for measuring SMM. Regional muscle measurements were carried out using US. A total of 65 patients (14 males, 51 females) were included. ROC (receiver operating characteristic) analysis identified threshold values of 18.0 mm [AUC (area under the curve) = 0.765] for females and 20.0 mm (AUC = 0.813) for males, predicting severe neutropenia. Using these cut-offs, females with low rectus femoris (RF) thickness (<18.0 mm) had a significantly higher incidence of grade ≥3 neutropenia (50.0% vs. 10.8%, p = 0.005), and males with low RF values (<20.0 mm) had a higher incidence (80.0% vs. 22.2%, p = 0.063). A regression analysis, irrespective of age, gender, and body mass index, revealed that only low RF muscle thickness increased the risk of grade 3-4 neutropenia by 9.210 times (95% CI = 2.401-35.326, p = 0.001). Utilizing US to measure RF muscle thickness aids in identifying cancer patients at an elevated risk of developing neutropenia. Needless to say, US can serve as a convenient and easily accessible tool for assessing low SMM, providing repeat point-of-care evaluations in clinical practice.
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Affiliation(s)
- Gürkan Güner
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
- Department of Medical Oncology, Medical Point Hospital, Izmir Economy University Faculty of Medicine, Izmir 35575, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Yusuf Baytar
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Metin Demir
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Burak Yasin Aktaş
- 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
| | - Deniz Can Güven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Hakan Taban
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Hasan Çağrı Yıldırım
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Serkan Akın
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Ömer Dizdar
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
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Yıldırım HÇ, Kutlu Y, Mutlu E, Aykan MB, Korkmaz M, Yalçın S, Şakalar T, Celayir ÖM, Kayıkçıoğlu E, Aslan F, Hafızoğlu E, Altıntaş YE, Keskinkılıç M, Chalabiyev E, Çelebi A, Dursun B, Kapar C, Özen M, Acar Ö, Dülgar Ö, Kut E, Biter S, Kus F, Almuradova E, Erdoğan AP, Saray S, Güven DC, Şimşek ET, Üskent N, Kemal Y, Çakar B, Açıkgöz Ö, Kılıçkap S, Aksoy S. The efficacy of palbociclib and ribociclib in the first-line treatment of metastatic hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer in male patients: a Turkish oncology group (TOG) study. Int J Clin Oncol 2024; 29:258-265. [PMID: 38310597 DOI: 10.1007/s10147-023-02460-5] [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: 07/14/2023] [Accepted: 12/14/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Male breast cancer, comprising approximately 1% of all breast cancer cases, often leads to the exclusion of male patients as a criterion in clinical trials. While the efficacy of Cyclin-dependent kinases 4 and 6 (CDK 4/6) inhibitors has been established in metastatic hormone receptor-positive (HR +) and human epidermal growth factor receptor 2-negative (HER2 -) breast cancer in women, limited data exist on their effectiveness in male patients. We aimed to evaluate the efficacy and safety of palbociclib or ribociclib in male patients with breast cancer. METHODS This study is a multicenter, retrospective study. We included male patients with HR + and HER2-metastatic breast cancer who received palbociclib or ribociclib as first-line treatment. Our primary endpoints were progression-free survival (PFS), overall response rates (ORR), and drug-related adverse effects. RESULTS A total of 46 male patients from 27 institutions were enrolled. The median age at initiation of CDK 4/6 inhibitors was 63.64 ± 13.69 years, with a median follow-up of 21.33 (95% CI 14.92-27.74) months. The ORR were 84% for palbociclib and 76.2% for ribociclib. The mPFS for the entire cohort was 28.06 months (95% CI 18.70-37.42). No significant difference in PFS was observed between palbociclib and ribociclib (mPFS: 24.46 months (95% CI 11.51-37.42) vs 28.33 months (95% CI 14.77-41.88), respectively, p = 0.211). No new adverse events were reported. DISCUSSION This study demonstrates that palbociclib and ribociclib are effective and safe options for first-line treatment in male patients with HR + /HER2 - metastatic breast cancer. However, further prospective studies are warranted to establish their efficacy in this population.
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Affiliation(s)
- Hasan Çağrı Yıldırım
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Yasin Kutlu
- Department of Medical Oncology, Istanbul Medipol University Medical Faculty, Istanbul, Turkey
| | - Emel Mutlu
- Department of Medical Oncology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Musa Barış Aykan
- Department of Medical Oncology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Mustafa Korkmaz
- Department of Medical Oncology, Tokat State Hospital, Tokat, Turkey
| | - Selim Yalçın
- Department of Medical Oncology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | - Teoman Şakalar
- Department of Medical Oncology, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, Turkey
| | | | - Erkan Kayıkçıoğlu
- Department of Medical Oncology, Süleyman Demirel University, Isparta, Turkey
| | - Ferit Aslan
- Department of Medical Oncology, Medicalpark Ankara Batıkent Hospital, Ankara, Turkey
| | - Emre Hafızoğlu
- Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Yunus Emre Altıntaş
- Department of Medical Oncology, Koc University Medical Faculty, Istanbul, Turkey
| | - Merve Keskinkılıç
- Department of Medical Oncology, Eylül University Faculty of Medicine, İzmir, Turkey
| | - Elvin Chalabiyev
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Abdussamet Çelebi
- Department of Medical Oncology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Bengü Dursun
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Caner Kapar
- Department of Medical Oncology, Bakırkoy Dr. Sadi Konuk Educatıon and Research Hospital, Istanbul, Turkey
| | - Miraç Özen
- Department of Medical Oncology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Ömer Acar
- Department of Medical Oncology, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Özgecan Dülgar
- Department of Medical Oncology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Engin Kut
- Department of Medical Oncology, Manisa State Hospital, Manisa, Turkey
| | - Sedat Biter
- Department of Medical Oncology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Fatih Kus
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Elvina Almuradova
- Department of Medical Oncology, Tınaztepe Galen Hospital, Izmir, Turkey
| | - Atike Pınar Erdoğan
- Department of Medical Oncology, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Seray Saray
- Department of Medical Oncology, Balıkesir State Hospital, Balıkesir, Turkey
| | - Deniz Can Güven
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Necdet Üskent
- Department of Medical Oncology, Anadolu Medical Center, Kocaeli, Turkey
| | - Yasemin Kemal
- Department of Medical Oncology, Samsun Medical Park Hospital, Samsun, Turkey
| | - Burcu Çakar
- Department of Medical Oncology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Özgür Açıkgöz
- Department of Medical Oncology, Istanbul Medipol University Medical Faculty, Istanbul, Turkey
| | - Saadettin Kılıçkap
- Department of Medical Oncology, İstinye University Liv Hospital, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Avcı O, İriağaç Y, Çavdar E, Karaboyun K, Araz M, Şakalar T, Değerli E, Özdemir Ö, İnal A, Ocak B, Ürün M, Sakin A, Yıldız Tacar S, Koçak MZ, Demir H, Özer Ö, Tanrıkulu Şimşek E, Ersoy M, Karakaş Y, Arıkan R, Eşbah O, Ön S, Şenocak Taşçı E, Molinas Mandel N, Türker S, Kaçan T, Yıldırım HÇ, Alan Ö, Akbaş S, İpek Deniz G, Aydın İsak Ö, Taşkaynatan H, Şeber ES. PROPSEA, safety evaluation of palbociclib and ribociclib in older patients with breast cancer: A prospective real-world TOG study. J Geriatr Oncol 2023; 14:101604. [PMID: 37683369 DOI: 10.1016/j.jgo.2023.101604] [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: 12/19/2022] [Revised: 03/21/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION In this study, the toxicities and management of palbociclib and ribociclib in older patients (≥65 years) with metastatic breast cancer patients were investigated. MATERIALS AND METHODS Among older patients receiving palbociclib and ribociclib, Geriatric 8 (G8) and Groningen Frailty Index were used to evaluate frailty status. Dose modifications, drug withdrawal and other serious adverse events (SAEs) were recorded and analyzed according to baseline patient characteristics. RESULTS A total of 160 patients from 28 centers in Turkey were included (palbociclib = 76, ribociclib = 84). Forty-three patients were ≥ 75 years of age. The most common cause of first dose modification was neutropenia for both drugs (97% palbociclib, 69% ribociclib). Liver function tests elevation (10%) and renal function impairment (6%) were also causes for ribociclib dose modification. Drug withdrawal rate was 3.9% for palbociclib and 6% for ribociclib. SAEs were seen in 11.8% of those taking palbociclib and 15.5% of those on riboclib. An ECOG performance status of ≥2 and being older than 75 years were associated with dose reductions. Severe neutropenia was more common in patients with non-bone-only metastatic disease, those receiving treatment third-line therapy or higher, coexistance of non-neutropenic hematological side effects (for ribociclib). Neutropenia was less common among patients with obesity. DISCUSSION Our results show that it can be reasonable to start palbociclib and ribociclib at reduced dose in patients aged ≥75 years and/or with an ECOG performance status ≥2.
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Affiliation(s)
- Okan Avcı
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Medical Oncology, Tekirdağ, Türkiye.
| | - Yakup İriağaç
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Medical Oncology, Tekirdağ, Türkiye
| | - Eyyüp Çavdar
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Medical Oncology, Tekirdağ, Türkiye
| | - Kubilay Karaboyun
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Medical Oncology, Tekirdağ, Türkiye
| | - Murat Araz
- Necmettin Erbakan University, Faculty of Medicine, Department of Medical Oncology, Konya, Turkiye
| | - Teoman Şakalar
- Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Türkiye
| | - Ezgi Değerli
- İstanbul University, Cerrahpaşa Faculty of Medicine, Department of Medical Oncology, İstanbul, Türkiye
| | - Özlem Özdemir
- İzmir Bozyaka Training and Research Hospital, Department of Medical Oncology, İzmir, Türkiye
| | - Ali İnal
- Mersin City Hospital, Mersin, Türkiye
| | - Birol Ocak
- Bursa Uludağ University, Faculty of Medicine, Department of Medical Oncology, Bursa, Türkiye
| | - Müslih Ürün
- Eskişehir City Hospital, Department of Medical Oncology, Eskişehir, Türkiye
| | - Abdullah Sakin
- Van Yüzüncü Yıl University, Faculty of Medicine, Deparment of Medical Oncology, Van, Türkiye
| | - Seher Yıldız Tacar
- Dr. Sadi Konuk Training and Research Hospital, Department of Medical Oncology, İstanbul, Türkiye
| | - Mehmet Zahid Koçak
- Necmettin Erbakan University, Faculty of Medicine, Department of Medical Oncology, Konya, Turkiye
| | - Hacer Demir
- Afyon Health Sciences University, Department of Medical Oncology, Afyon, Türkiye
| | - Özden Özer
- Dokuz Eylül University, Faculty of Medicine, Department of Medical Oncology, İzmir, Türkiye
| | - Eda Tanrıkulu Şimşek
- Haydarpaşa Numune Training and Research Hospital, Department of Medical Oncology, İstanbul, Türkiye
| | - Mustafa Ersoy
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Medical Oncology, Eskişehir, Türkiye
| | - Yusuf Karakaş
- Mehmet Ali Aydınlar Acıbadem University, Bodrum Hospital, Department of Medical Oncology, Muğla, Türkiye
| | - Rukiye Arıkan
- Marmara University, Faculty of Medicine, Department of Medical Oncology, İstanbul, Türkiye
| | - Onur Eşbah
- Düzce University, Faculty of Medicine, Department of Medical Oncology, Düzce, Türkiye
| | - Sercan Ön
- Ege University, Faculty of Medicine, Department of Medical Oncology, İzmir, Türkiye
| | - Elif Şenocak Taşçı
- Mehmet Ali Aydınlar Acıbadem University, Faculty of Medicine, Department of Medical Oncology, İstanbul, Türkiye
| | - Nil Molinas Mandel
- Koç University, American Hospital, Department of Medical Oncology, İstanbul, Türkiye
| | - Sema Türker
- Zonguldak Atatürk State Hospital, Department of Medical Oncology, Zonguldak, Türkiye
| | - Turgut Kaçan
- Bursa Yüksek İhtisas Training and Research Hospital, Department of Medical Oncology, Bursa, Türkiye
| | - Hasan Çağrı Yıldırım
- Hacettepe University, Faculty of Medicine, Department of Medical Oncology, Ankara, Türkiye
| | - Özkan Alan
- Tekirdağ Dr. Fehmi Cumalıoğlu City Hospital, Department of Medical Oncology, Tekirdağ, Türkiye
| | - Sinem Akbaş
- Koç University, Faculty of Medicine, Department of Medical Oncology, İstanbul, Türkiye
| | - Gülhan İpek Deniz
- Private Tansan Outpatient Clinic, Department of Medical Oncology, İstanbul, Türkiye
| | - Özlem Aydın İsak
- Dışkapı Yıldırım Beyazıd Training and Research Hospital, Department of Medical Oncology, Ankara, Türkiye
| | - Halil Taşkaynatan
- İzmir Private Ege City Hospital, Department of Medical Oncology, İzmir, Türkiye
| | - Erdoğan Selçuk Şeber
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Medical Oncology, Tekirdağ, Türkiye
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Yıldırım HÇ, Kavgaci G, Chalabiyev E, Dizdar O. Advances in the Early Detection of Hepatobiliary Cancers. Cancers (Basel) 2023; 15:3880. [PMID: 37568696 PMCID: PMC10416925 DOI: 10.3390/cancers15153880] [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: 05/29/2023] [Revised: 07/23/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Hepatocellular cancer (HCC) and biliary tract cancers (BTCs) have poor survival rates and a low likelihood of a cure, especially in advanced-stage disease. Early diagnosis is crucial and can significantly improve survival rates through curative treatment approaches. Current guidelines recommend abdominal ultrasonography (USG) and alpha-fetoprotein (AFP) monitoring for HCC screening in high-risk groups, and abdominal USG, magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP) monitoring for biliary tract cancer. However, despite this screening strategy, many high-risk individuals still develop advanced-stage HCC and BTC. Blood-based biomarkers are being developed for use in HCC or BTC high-risk groups. Studies on AFP, AFP-L3, des-gamma-carboxy prothrombin, glypican-3 (GPC3), osteopontin (OPN), midkine (MK), neopterin, squamous cell carcinoma antigen (SCCA), Mac-2-binding protein (M2BP), cyclic guanosine monophosphate (cGMP), and interleukin-6 biomarkers for HCC screening have shown promising results when evaluated individually or in combination. In the case of BTCs, the potential applications of circulating tumor DNA, circulating microRNA, and circulating tumor cells in diagnosis are also promising. These biomarkers have shown potential in detecting BTCs in early stages, which can significantly improve patient outcomes. Additionally, these biomarkers hold promise for monitoring disease progression and evaluating response to therapy in BTC patients. However, further research is necessary to fully understand the clinical utility of these biomarkers in the diagnosis and management of HCC and BTCs.
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Affiliation(s)
| | | | | | - Omer Dizdar
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey; (H.Ç.Y.); (G.K.); (E.C.)
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Yekedüz E, Özbay MF, Çağlayan D, Yıldırım A, Erol C, Yıldırım HÇ, Tunç S, Özyurt N, Özdemir F, Şendur MAN, Işıkdoğan A, Kılıçkap S, Ürün Y, Yalçın Ş, Artaç M, Coşkun HŞ, Utkan G. Clinical outcomes of concomitant use of proton pump inhibitors and regorafenib in patients with metastatic colorectal cancer: a multicenter study. Eur J Clin Pharmacol 2022; 78:1973-1979. [PMID: 36266366 DOI: 10.1007/s00228-022-03403-1] [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: 08/04/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022]
Abstract
AIM To compare survival outcomes, response rates, and adverse events (AEs) in proton pump inhibitor (PPI) user and non-user patients with metastatic colorectal cancer (mCRC) treated with regorafenib. METHODS We included 272 patients with mCRC treated with regorafenib in this study. Patients were divided into two categories according to their status of PPI use. The primary endpoint was overall survival (OS). The secondary endpoints were time to treatment failure (TTF), response rates, and safety. To exclude immortal time bias in survival analyses, we compared PPI non-user patients and all patients. RESULTS There were 141 and 131 patients in the PPI non-user and user groups. Baseline characteristics were similar in each group. Pantoprazole was the most used PPI. At the median 35.2 (95% confidence interval (CI): 32.6-37.9) months follow-up, the median OS was similar in PPI non-user and all patients (6.9 months (95% CI: 5.3-8.5) and 7.7 months (95% CI:6.6-8.8), p = 0.913). TTF was also similar in PPI non-user and all patients (3.3 months (95% CI: 2.7-3.9) and 3.5 months (95% CI: 3.0-4.0), p = 0.661). In multivariable analysis, no statistically significant difference was observed between PPI user and non-user groups in OS and TTF (hazard ratio (HR), 0.99; 95% CI, 0.77-1.28; p = 0.963 for OS; HR, 0.93; 0.77-1.20, p = 0.598 for TTF). The objective response rates (ORR) were similar in the PPI non-user and user groups (19.8% and 16.8%, p = 0.455). The rates of any grade AEs were also similar in each group. CONCLUSION This study found no worse outcome in the combined use of PPI and regorafenib among patients with mCRC.
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Affiliation(s)
- Emre Yekedüz
- Department of Medical Oncology, Faculty of Medicine, Ankara University, 06590, Ankara, Turkey. .,Cancer Research Institute, Ankara University, Ankara, Turkey.
| | - Mehmet Fatih Özbay
- Department of Medical Oncology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Dilek Çağlayan
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Atila Yıldırım
- Department of Medical Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Cihan Erol
- Department of Medical Oncology, University Faculty of Medicine, Faculty of Medicine Ankara, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Hasan Çağrı Yıldırım
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sezai Tunç
- Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Neslihan Özyurt
- Medical Oncology Clinic, Prof. Dr. İlhan Özdemir State Hospital, Giresun, Turkey
| | - Feyyaz Özdemir
- Department of Medical Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Mehmet Ali Nahit Şendur
- Department of Medical Oncology, University Faculty of Medicine, Faculty of Medicine Ankara, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Abdurrahman Işıkdoğan
- Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Saadettin Kılıçkap
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.,Faculty of Medicine, Liv Hospital Medical Oncology Clinic, İstinye University, Ankara, Turkey
| | - Yüksel Ürün
- Department of Medical Oncology, Faculty of Medicine, Ankara University, 06590, Ankara, Turkey.,Cancer Research Institute, Ankara University, Ankara, Turkey
| | - Şuayib Yalçın
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Artaç
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hasan Şenol Coşkun
- Department of Medical Oncology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Güngör Utkan
- Department of Medical Oncology, Faculty of Medicine, Ankara University, 06590, Ankara, Turkey.,Cancer Research Institute, Ankara University, Ankara, Turkey
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Yıldırım HÇ, Mutlu E, Chalabiyev E, Özen M, Keskinkılıç M, Ön S, Çelebi A, Dursun B, Acar Ö, Kahraman S, Aykan MB, Kaman Ö, Doğan A, Erdoğan AP, Melisa Celayir Ö, Günenç D, Güven DC, Vedat Bayoğlu İ, Yavuzşen T, Hacıbekiroğlu İ, İnanç M, Kılıçkap S, Yalçın Ş, Aksoy S. Clinical outcomes of cyclin-dependent kinase 4-6 (CDK 4-6) inhibitors in patients with male breast cancer: A multicenter study. Breast 2022; 66:85-88. [PMID: 36208540 PMCID: PMC9547301 DOI: 10.1016/j.breast.2022.09.009] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Since breast cancer is less common in men than in women, data on the use of new therapeutic agents, including cyclin-dependent kinase 4-6 (CDK 4-6) inhibitors, are limited in patients with metastatic hormone receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) male breast cancer. Therefore; we aimed to investigate the treatment responses of metastatic HR+, HER2-male breast cancer patients treated with CDK 4-6 inhibitors in a multicenter real-life cohort. METHODS Male patients with a diagnosis of HR+ and HER2-metastatic breast cancer, treated with any CDK 4-6 inhibitor, were included in the study. Demographic and clinical characteristics of the patients were recorded. We aimed to determine progression-free survival (PFS) time, response rates and drug related side effects. RESULTS A total 25 patients from 14 institutions were recruited. The mean age at diagnosis was 57 years. Median follow-up was 19.53 (95% CI: 14.04-25.02) months. The overall response rate was 60%. While the median PFS was 20.6 months in the whole cohort, it wasn't reached in those using CDK 4-6 inhibitors in first line and 10 months in the subsequent lines (p:0.009). No new adverse events were encountered. CONCLUSION In our study, we found that CDK 4-6 inhibitors are effective and safe options in men with HR+ and HER2-metastatic breast cancer as in women. Our results support the use of CDK 4-6 inhibitor-based combinations in the first-line treatment of HR+ and HER2-metastatic male breast cancer.
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Affiliation(s)
- Hasan Çağrı Yıldırım
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey.
| | - Emel Mutlu
- Erciyes University Faculty of Medicine, Department of Medical Oncology, Kayseri, Turkey
| | - Elvin Chalabiyev
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Miraç Özen
- Sakarya University Faculty of Medicine, Department of Medical Oncology, Sakarya, Turkey
| | - Merve Keskinkılıç
- 9 Eylül University Faculty of Medicine, Department of Medical Oncology, İzmir, Turkey
| | - Sercan Ön
- Ege University Faculty of Medicine, Department of Medical Oncology, İzmir, Turkey
| | - Abdussamet Çelebi
- Marmara University Faculty of Medicine, Department of Medical Oncology, İstanbul, Turkey
| | - Bengü Dursun
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Ömer Acar
- Manisa Celal Bayar University Faculty of Medicine, Department of Medical Oncology, Manisa, Turkey
| | - Seda Kahraman
- Ankara Yıldırım Beyazıt University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Musa Barış Aykan
- Gulhane Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Ömür Kaman
- Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Akif Doğan
- Kartal Dr. Lütfi Kirdar City Hospital, Department of Medical Oncology, İstanbul, Turkey
| | - Atike Pınar Erdoğan
- Manisa Celal Bayar University Faculty of Medicine, Department of Medical Oncology, Manisa, Turkey
| | | | - Damla Günenç
- Ege University Faculty of Medicine, Department of Medical Oncology, İzmir, Turkey
| | - Deniz Can Güven
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - İbrahim Vedat Bayoğlu
- Marmara University Faculty of Medicine, Department of Medical Oncology, İstanbul, Turkey
| | - Tuğba Yavuzşen
- 9 Eylül University Faculty of Medicine, Department of Medical Oncology, İzmir, Turkey
| | - İlhan Hacıbekiroğlu
- Sakarya University Faculty of Medicine, Department of Medical Oncology, Sakarya, Turkey
| | - Mevlüde İnanç
- Erciyes University Faculty of Medicine, Department of Medical Oncology, Kayseri, Turkey
| | - Saadettin Kılıçkap
- İstinye University Liv Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Şuayib Yalçın
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Sercan Aksoy
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
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7
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Erol C, Sakin A, Başoğlu T, Özden E, Çabuk D, Doğan M, Öksüzoğlu B, Yıldırım HÇ, Öner İ, Eryılmaz MK, Dülgar Ö, Aydın D, Doğan N, Özen M, Hacıbekiroğlu İ, Özdemir N, Gürler F, Paksoy N, Karabulut S, Aksoy A, Hızal M, Kahraman S, Şen E, Paydaş S, Çılbır E, Fırat F, Akdeniz N, Özçelik M, Oyman A, Baytemür NK, Acar R, Almuradova E, Karabulut B, Şakalar T, Arak H, Değerli E, Türker S, Alan Ö, Er Ö, Taşçı EŞ, Demir N, Çavdar E, Turhal S, Dede DŞ, Akıncı MB, Yalçın B, Yumuk F, Yalçın Ş, Şendur MAN. Prognostic factors of perioperative FLOT regimen in operable gastric and gastroesophageal junction tumors: real-life data (Turkish Oncology Group). Turk J Med Sci 2022; 52:1022-1032. [PMID: 36326360 PMCID: PMC10387859 DOI: 10.55730/1300-0144.5404] [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: 02/07/2022] [Accepted: 05/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Perioperative FLOT regimen is a standard of care in locally advanced operable gastric and GEJ adenocarcinoma. We aimed to determine the efficacy, prognostic factors of perioperative FLOT chemotherapy in real-life gastric and GEJ tumors. METHODS The data of patients who were treated with perioperative FLOT chemotherapy were retrospectively analyzed from 34 different oncology centers in Turkey. Baseline clinical and demographic characteristics, pretreatment laboratory values, histological and molecular characteristics were recorded. RESULTS A total of 441 patients were included in the study. The median of age our study population was 60 years. The majority of patients with radiological staging were cT3-4N(+) (89.9%, n = 338). After median 13.5 months (IQR: 8.5-20.5) follow-up, the median overall survival was NR (95% CI, NR to NR), and median disease free survival was 22.9 (95% CI, 18.6 to 27.3) months. The estimated overall survival at 24 months was 62%. Complete pathological response (pCR) and near pCR was achieved in 23.8% of all patients. Patients with lower NLR or PLR have significantly longer median OS (p = 0.007 and p = 0.033, respectively), and patients with lower NLR have significantly longer median DFS (p = 0.039), but PLR level did not affect DFS (p = 0.062). The OS and DFS of patients with better ECOG performance scores and those who could receive FLOT as adjuvant chemotherapy instead of other regimens were found to be better. NLR was found to be independent prognostic factor for OS in the multivariant analysis. At least one adverse event reported in 57.6% of the patients and grade 3-4 toxicity was seen in 23.6% patients. DISCUSSION Real-life perioperative FLOT regimen in operable gastric and GEJ tumors showed similar oncologic outcomes compared to clinical trials. Better performance status, receiving adjuvant chemotherapy as same regimen, low grade and low NLR and PLR improved outcomes in real-life. However, in multivariate analysis, only NLR affected OS.
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Affiliation(s)
- Cihan Erol
- Department of Medical Oncology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Abdullah Sakin
- Department of Medical Oncology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Tuğba Başoğlu
- Department of Medical Oncology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Ercan Özden
- Department of Medical Oncology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Devrim Çabuk
- Department of Medical Oncology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Mutlu Doğan
- Department of Medical Oncology, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Berna Öksüzoğlu
- Department of Medical Oncology, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Hasan Çağrı Yıldırım
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İrem Öner
- Department of Medical Oncology, Konya Meram State Hospital, Konya, Turkey
| | - Melek Karakurt Eryılmaz
- Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Özgecan Dülgar
- Department of Medical Oncology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbul, Turkey
| | - Dinçer Aydın
- Department of Medical Oncology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Neslihan Doğan
- Department of Medical Oncology, Prof. Dr. A. İlhan Özdemir Education and Research Hospital, Giresun University, Giresun, Turkey
| | - Miraç Özen
- Department of Medical Oncology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - İlhan Hacıbekiroğlu
- Department of Medical Oncology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Nuriye Özdemir
- Department of Medical Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Fatih Gürler
- Department of Medical Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Nail Paksoy
- Department of Medical Oncology, Institute of Oncology, İstanbul University, İstanbul, Turkey
| | - Senem Karabulut
- Department of Medical Oncology, Institute of Oncology, İstanbul University, İstanbul, Turkey
| | - Asude Aksoy
- Department of Medical Oncology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Mutlu Hızal
- Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Seda Kahraman
- Department of Medical Oncology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Erdem Şen
- Department of Medical Oncology, Çanakkale Mehmet Akif Ersoy State Hospital, Çanakkale, Turkey
| | - Semra Paydaş
- Department of Medical Oncology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ebru Çılbır
- Department of Medical Oncology, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Feyza Fırat
- Department of Medical Oncology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Nadiye Akdeniz
- Department of Medical Oncology, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Melike Özçelik
- Department of Medical Oncology, Ümraniye Education and Research Hospital, İstanbul, Turkey
| | - Abdilkerim Oyman
- Department of Medical Oncology, Ümraniye Education and Research Hospital, İstanbul, Turkey
| | | | - Ramazan Acar
- Department of Medical Oncology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Elvina Almuradova
- Department of Medical Oncology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Bülent Karabulut
- Department of Medical Oncology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Teoman Şakalar
- Department of Medical Oncology, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Hacı Arak
- Department of Medical Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ezgi Değerli
- Department of Medical Oncology, Cerrahpaşa School of Medicine, İstanbul University, İstanbul, Turkey
| | - Sema Türker
- Department of Medical Oncology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey
| | - Özkan Alan
- Department of Medical Oncology, Tekirdağ State Hospital, Tekirdağ, Turkey
| | - Özlem Er
- Department of Medical Oncology, Acıbadem Maslak Hospital, İstanbul, Turkey
| | - Elif Şenocak Taşçı
- Department of Medical Oncology, Acıbadem Maslak Hospital, İstanbul, Turkey
| | - Nazan Demir
- Department of Medical Oncology, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Eyyüp Çavdar
- Department of Medical Oncology, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Serdar Turhal
- Department of Medical Oncology, Anadolu Medical Center, Kocaeli, Turkey
| | - Didem Şener Dede
- Department of Medical Oncology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turke
| | - Muhammed Bülent Akıncı
- Department of Medical Oncology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turke
| | - Bülent Yalçın
- Department of Medical Oncology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turke
| | - Fulden Yumuk
- Department of Medical Oncology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Şuayib Yalçın
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Ali Nahit Şendur
- Department of Medical Oncology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turke
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8
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Başoğlu T, Sakin A, Erol C, Özden E, Çabuk D, Çılbır E, Tataroğlu Özyükseler D, Ayhan M, Şendur MA, Dogan M, Öksüzoğlu B, Eryılmaz MK, Er Ö, Taşçı EŞ, Özyurt N, Dülgar Ö, Özen M, Hacıbekiroğlu İ, Öner İ, Bekmez ET, Çağrı Yıldırım H, Yalçın Ş, Paydaş S, Yekedüz E, Aksoy A, Özçelik M, Oyman A, Almuradova E, Karabulut B, Demir N, Dinçer M, Özdemir N, Erdem D, Ak N, İnal A, Salim DK, Deniz Gİ, Şakalar T, Gülmez A, Kaçan T, Özdemir Ö, Alan Ö, Ünal Ç, Karakaş Y, Turhal S, Yumuk PF. Real life experience of patients with locally advanced gastric and gastroesophageal junction adenocarcinoma treated with neoadjuvant chemotherapy: a Turkish oncology group study. J Chemother 2022; 35:142-149. [PMID: 35579894 DOI: 10.1080/1120009x.2022.2073159] [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] [Indexed: 10/18/2022]
Abstract
Neoadjuvant chemotherapy (NACT) in gastroesophageal junction (GEJ) and gastric cancer (GC) was shown to improve survival in recent studies. We aimed to share our real-life experience of patients who received NACT to compare the efficacy and toxicity profile of different chemotherapy regimens in our country. This retrospective multicentre study included locally advanced GC and GEJ cancer patients who received NACT between 2007 and 2021. Relation between CT regimens and pathological evaluation were analysed. A total of 794 patients from 45 oncology centers in Turkey were included. Median age at the time of diagnosis was 60 (range: 18-86). Most frequent NACT regimens used were FLOT (65.4%), DCF (17.4%) and ECF (8.1%), respectively. In the total study group, pathological complete remission (pCR) rate was 7.2%, R0 resection rate 86.4%, and D2 dissection rate was 66.8%. Rate of pCR and near-CR (24%), and R0 resection (84%) were numerically higher in FLOT arm (p > 0.05). Patients who received FLOT had also higher chemotherapy-related toxicity rate compared to patients who received other regimens (p > 0.05). Median follow-up time was 16 months (range: 1-154 months). Estimated median overall survival (OS) was 58.4months (95% CI: 35.2-85.7) and disease-free survival (DFS) was 50.7 months (95% CI: 25.4-75.9). The highest 3-year estimated OS rate was also shown in FLOT arm (68%). We still do not know which NACT regimen is the best choice for daily practice. Clinicians should tailor treatment regimens according to patients' multifactorial status and comorbidities for to obtain best outcomes. Longer follow-up period needs to validate our results.
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Affiliation(s)
- Tuğba Başoğlu
- Medical Oncology, Marmara University School of Medicine, İstanbul, Turkey
| | - Abdullah Sakin
- Medical Oncology, Van Yuzuncu Yil University Faculty of Medicine, Van, Turkey
| | - Cihan Erol
- Medical Oncology, Ankara Yildirim Beyazit Universtiy, Ankara, Turkey
| | - Ercan Özden
- Medical Oncology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Devrim Çabuk
- Medical Oncology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Ebru Çılbır
- Medical Oncology, Dışkapı Training and Research Hospital, Ankara, Turkey
| | | | - Murat Ayhan
- Medical Oncology, Kartal Dr.LütfiKırdar Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Ali Şendur
- Medical Oncology, Ankara Yildirim Beyazit Universtiy, Ankara, Turkey
| | - Mutlu Dogan
- Medical Oncology, Ankara Dr.Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Berna Öksüzoğlu
- Medical Oncology, Ankara Dr.Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Özlem Er
- Medical Oncology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Elif Şenocak Taşçı
- Medical Oncology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Neslihan Özyurt
- Medical Oncology, Giresun Education and Research Hospital, Giresun, Turkey
| | - Özgecan Dülgar
- Medical Oncology, İstanbul Medeniyet University Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Miraç Özen
- Medical Oncology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | | | - İrem Öner
- Medical Oncology, Konya City Hospital, Konya, Turkey
| | | | | | - Şuayib Yalçın
- Medical Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Semra Paydaş
- Medical Oncology, Cukurova University School of Medicine, Adana, Turkey
| | - Emre Yekedüz
- Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Asude Aksoy
- Medical Oncology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Melike Özçelik
- Medical Oncology, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Abdilkerim Oyman
- Medical Oncology, Umraniye Training and Research Hospital, İstanbul, Turkey
| | | | - Bülent Karabulut
- Medical Oncology, Ege University School of Medicine, İzmir, Turkey
| | - Nazan Demir
- Medical Oncology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Murat Dinçer
- Medical Oncology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Nuriye Özdemir
- Medical Oncology, Gazi University School of Medicine, Ankara, Turkey
| | - Dilek Erdem
- Medical Oncology, VM Medical Park Samsun Hospital, Samsun, Turkey
| | - Naziye Ak
- Medical Oncology, İstanbul University, İstanbul, Turkey
| | - Ali İnal
- Medical Oncology, Mersin City Hospital, Mersin, Turkey
| | - Derya Kıvrak Salim
- Medical Oncology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Gülhan İpek Deniz
- Medical Oncology, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Teoman Şakalar
- Medical Oncology, Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Ahmet Gülmez
- Medical Oncology, İnönü University, Elazığ, Turkey
| | - Turgut Kaçan
- Medical Oncology, Bursa High Specialized Education and Research Hospital, Bursa, Turkey
| | - Özlem Özdemir
- Medical Oncology, İzmir Bozyaka Research and Training Hospital, İzmir, Turkey
| | - Özkan Alan
- Medical Oncology, Tekirdağ State Hospital, Tekirdağ, Turkey
| | - Çağlar Ünal
- Medical Oncology, Florance Nightingale Hospital, İstanbul, Turkey
| | - Yusuf Karakaş
- Medical Oncology, Bodrum Acıbadem Hospital, Muğla, Turkey
| | - Serdar Turhal
- Medical Oncology, Anadolu SağlıkMerkezi Anadolu Health Center, İstanbul, Turkey
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9
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Yekeduz E, Ozbay MF, Çağlayan D, Yıldırım A, Erol C, Yıldırım HÇ, Tunç S, Özyurt N, Ozdemir F, Sendur MAN, Isikdogan A, Kilickap S, Ürün Y, Yalcin S, Artac M, Coskun HS, Utkan G. Clinical outcomes of concomitant use of proton pump inhibitors and regorafenib in patients with metastatic colorectal cancer: A multicenter study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.130] [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
130 Background: Tyrosine kinase inhibitors (TKI) are the most common oral drugs in cancer patients. Similarly, proton pump inhibitors (PPI) are commonly used to relieve dyspeptic symptoms in patients with cancer. However, gastric pH levels may affect the absorption of TKI through the gastrointestinal system. However, all TKIs do not have the same chemical structure, and the absorption rate of each TKI depends on their solubility in different gastric pH levels. Limited data is available about the clinical outcomes of concomitant use of PPI and regorafenib in patients with metastatic colorectal cancer (mCRC). We present here the results of the multicenter study following the initial results of our single-center experience. Methods: Patients with mCRC treated with regorafenib were included in this multicenter and retrospective study. Patients prescribed PPI after initiation of regorafenib were assigned to the PPI user group, and the remaining patients were assigned to the PPI non-user group. To exclude immortal time bias, the log-rank test was performed between PPI non-user and all patients. The primary outcome was overall survival (OS), and secondary outcomes were time to treatment failure (TTF) and adverse events (AEs) profile. Results: Two hundred and seventy-two patients from eight cancer centers were included in this study. Most patients were male (59.9%), had liver metastasis (62.1%), and received regorafenib in the third line (52.2%). The median age at the initiation of regorafenib was 60 years (interquartile range (IQR): 51-66)). Eastern Cooperative Oncology Group performance score was 0 or 1 in approximately three out of four patients. The rate of patients with K-RAS mutation was 46.7%. There were 131 (48.2%) and 141 (51.8%) in the PPI user and non-user groups, respectively. The most prescribed PPI was pantoprazole (40.4%). At a median 34.2 months follow-up, the median OS was 6.9 months (95% Confidence Interval (CI): 5.3-8.5) and 7.7 months (95% CI:6.6-8.8) in the PPI non-user and all patients, respectively. No statistical significance was observed between the groups (p = 0.913). The median TTF was 3.3 months (95% CI: 2.6-3.9) and 3.4 months (95% CI:2.9-4.0) in the PPI non-user and all patients, respectively. No statistical significance was observed between the groups (p = 0.651). In the time-dependent covariate Cox regression model, there was no difference between PPI user and non-user groups in OS and TTF (adjusted Hazard Ratio (aHR):0.96, 95% CI:0.74-1.24, p = 0.735 for OS; aHR:0.88, 0.68-1.14, p = 0.354 for TTF). The rates of all AEs were also similar in the PPI user and non-user groups (p = 0.628). Conclusions: To our knowledge, this was the first study evaluating the effect of concomitant use of PPI and regorafenib in patients with mCRC, and no adverse survival and safety outcome was observed with the concomitant use of PPI and regorafenib in those patients.
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Affiliation(s)
- Emre Yekeduz
- Ankara University Faculty of Medicine, Medical Oncology Department, Ankara, Turkey
| | - Mehmet Fatih Ozbay
- Akdeniz University Faculty of Medicine Department of Medical Oncology, Antalya, Turkey
| | - Dilek Çağlayan
- Necmettin Erbakan University Meram Faculty of Medicine Department of Medical Oncology, Konya, Turkey
| | - Atila Yıldırım
- Karadeniz Technical University Faculty of Medicine Department of Medical Oncology, Trabzon, Turkey
| | - Cihan Erol
- Ankara Yıldırım Beyazıt University Faculty of Medicine Department of Medical Oncology, Ankara, Turkey
| | - Hasan Çağrı Yıldırım
- Hacettepe University Faculty of Medicine Department of Medical Oncology, Ankara, Turkey
| | - Sezai Tunç
- Dicle University Faculty of Medicine Department of Medical Oncology, Diyarbakır, Turkey
| | - Neslihan Özyurt
- Prof. Dr. A İlhan Özdemir State Hospital Medical Oncology Clinic, Giresun, Turkey
| | - Feyyaz Ozdemir
- Karadeniz Technical University Faculty of Medicine Department of Medical Oncology, Trabzon, Turkey
| | - Mehmet Ali Nahit Sendur
- Ankara Yıldırım Beyazıt University Faculty of Medicine Department of Medical Oncology, Ankara, Turkey
| | - Abdurrahman Isikdogan
- Dicle University Faculty of Medicine Department of Medical Oncology, Diyarbakır, Turkey
| | - Saadettin Kilickap
- İstinye University Faculty of Medicine Ankara Liv Hospital Medical Oncology Clinic, Ankara, Turkey
| | - Yüksel Ürün
- Ankara University Faculty of Medicine, Medical Oncology Department, Ankara, Turkey
| | - Suayib Yalcin
- Hacettepe University Faculty of Medicine Department of Medical Oncology, Ankara, Turkey
| | - Mehmet Artac
- Necmettin Erbakan University Meram Faculty of Medicine Department of Medical Oncology, Konya, Turkey
| | - Hasan Senol Coskun
- Akdeniz University Faculty of Medicine Department of Medical Oncology, Antalya, Turkey
| | - Gungor Utkan
- Ankara University Faculty of Medicine, Medical Oncology Department, 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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