This study was conducted to investigate the efficacy of pre-phase therapy in preventing tumor lysis syndrome (TLS) in cases with hightumor burden. This study involved 42 lymphoma patients with moderate to high risk of developing TLS. All of the cases underwenta prephase treatment which consisted of 1 mg of vincristine first day and 100 mg/day of prednisolone for seven days. Afterwards,planned conventional chemotherapy regimens were given. The development of laboratory TLS was evaluated by the end of the conventional cytotoxic treatment. Among the patients, 85.6% had B cell neoplasia and 14,4% had T cell lymphoblastic lymphoma (TCLL).The risk of TLS was high in 57.2% of the cases and intermediate in 42.8%. A total of 42.8% cases developed laboratory TLS afterconventional treatment following prephase therapy. On the other hand, there were 7.1% patients who exceeded the normal laboratoryvalue limits. In addition, 2.3% of the cases had only clinical findings of TLS. Treatment response was complete in 57.1% and partial in40.5% with respect to the findings of PET-CT. Prephase therapy may decrease the severity of TLS in cases with a high tumor burden.Prephase therapy may be used in the initial phase in cases at moderate-to-high risk for TLS
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The new coronavirus disease-2019 (COVID-19) is rapidly spreading around the world and has been declared an outbreak by WHO.However, the effect of blood groups on COVID-19 infection and the severity of the disease is unclear. The aim of this study is todetermine the relationship between ABO blood group and susceptibility to COVID-19 infection and whether the blood group will be abiomarker for COVID-19 infection. Patients diagnosed with SARS-CoV-2 between March and May 2020 were included in this study.In order to compare the blood groups of the patients with the healthy group, patients who had previously performed ABO blood groupanalysis in the blood bank between February and May 2020 were included as the control group. Demographic data, clinical data,underlying comorbidities, laboratory findings and clinical results (hospitalization, need for intensive care, mortality) were obtained fromthe electronic medical records. A total of 179 patients with confirmed COVID-19 and 5200 healthy control patients were included inthe study. Patients with COVID-19 showed a distribution of 62.01% in group A,9.50% in group B, 8.94% in group AB and 19.55% ingroup O. In group A, length of stay in Intensive Care Unit was longer (10.42±11.61 days; p= 0.013). Compared to the blood groups ofthe healthy control group, COVID-19 patients had higher A blood group than the healthy group (62& vs.46.6%; p< 0.001) and lesserof the O blood group (19.6% vs. 34.7%; p< 0.001).Blood group A can be used as a predictive biomarker for COVID-19 disease.Inaddition, we concluded that the group A had a higher risk for COVID-19 disease and severity.
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RAS and BRAF mutation and primary tumour sideness are prognostic and predictive factors in metastatic colorectal cancer (mCRC). We aimed to investigate RAS-BRAF mutation rates and responses to biologic agents the effects of tumour sideness on survival. This was a retrospective study conducted at three Turkish institutes. 303 patients with mCRC who were examined for tumour RAS and 172 examined for tumour BRAF mutations between 2006-2018. A total of 303 (M/F= 186/117) patients were included to study. Median age was 63 (range: 23-86) years. Median follow-up was 22.8 (range: 19.1-26.4) months. In the RAS wild type population; ad-dition to anti-EGFR agents to standard chemotherapy (CT) had better outcomes than Bevacizumab+CT. Median PFS was improved with anti-EGFR agents (Respectively PFS; 14.5 months, 8.7 months) (log rank p= 0.007 HR= 0.59). Median OS was similar between CT+anti-EGFR and CT+Bevacizumab arms (Respectively OS; 29.3 months, 21.7 months) (log rank p= 0.418; HR= 0.75). RAS muta-tion rates were similar between right colon cancer (RCC) and left colon cancer (LCC), BRAF mutation rates were significantly increased in RCC (22.2 vs 2.7%, p< 0.0001). RCC (24.1%) had worse prognosis than LCC (75.9%). However, this difference was not significant (PFS: 10.4 vs 10.0 months (log rank p= 0.136) , OS: 21.5 vs 23.1 months (log rank p= 0.436). We concluded that in the patients with RAS wild type tumours, CT and anti-EGFR combination was reasonable approach for first line treatment. BRAF mutation, irrespective of CT regimen, was associated with poor survival and more common in RCC patients.
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SARS-CoV-2 is a single-stranded RNA spherical virus spikes formed by glycoproteins. The leading cause of death was linked toacute respiratory distress syndrome, myocardial injury, or renal failure. After the first case reported on the 11th of March in TurkeyMinistry of Health and Interior declared some regulations on the public, such as travel restrictions, traffic restrictions, social distancinghomes, and centralized quarantine. Although chemotherapy adherence is a highly studied area for both oral and intravenous agentsin cancer patients, no available data exist in a pandemic world with many social restrictions. The records of patients who have activecancer treatment in the department of medical oncology retrospectively analyzed. The age, gender, diagnosis, chemotherapy type,rendezvous, and coming dates recorded. Four chemotherapy delays (3.7%) were observed out of 52 patients before the 11th ofMarch 2020, while 43 chemotherapy delays (39,8%9) occurred out of 107 patients after the first COVID-19 case and the restrictionsin Turkey. Twenty patients had treatment delay without reason and did not show up for treatment on the day of chemotherapy. Thetreatment delays without reasons are significantly different in the pre and post COVID-19 pandemic era. The hematologic toxicity rateswere similar when compared pre and post COVID-19 period. The non-specific regulations and declarations confuse the patients andprevent them from reaching the treatment which is needed. In the case of pandemic regulations, oncologic patients may have specialconsiderations for government decisions.
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Chemo-immunotherapy (CIT) with platin, etoposide and monoclonal antibodies targeting the PD-1/PDL-1 pathway has recently improvedsurvival in extensive-stage small-cell lung cancer (SCLC) after decades. We aimed to investigate the efficacy and safety ofCIT with atezolizumab in extensive-stage SCLC in chemotherapy naïve patients. Eleven patients who were treated and followed inour center were included in this retrospective observational study. All the patients received carboplatin, etoposide and atezolizumabin the induction phase and atezolizumab in the maintenance phase. The Kaplan–Meier test was used to determine progression-freesurvival (PFS) and overall survival (OS), and the effects of the sites of metastasis were analyzed using the log-rank test. The medianage was 69.9 years, and 81.8% were male. The median number of CIT and total atezolizumab cycles was 4 and 7, respectively.63.6% received maintenance therapy. Median PFS was 5.2 months (95% CI: 3.4-6.9), and median OS was 11.3 months (95% CI:1.0-21.5). The overall response rate was 63.6%. There was no significant difference between patients with and without liver metastasisin terms of PFS and OS. We observed toxicity higher than grade 2 in more than half of the patients, and hematological toxicitieswere prominent. CIT with carboplatin, etoposide and atezolizumab is efficient and safe in extensive-stage SCLC considering the PFS,OS, response rates, 12-month survival rate, and side effects. The progression of liver lesions was remarkable. Cranial and thoracicradiation are issues that should be discussed in the future with data from clinical studies.
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Fatih YILDIZ ,
Emre ERASLAN ,
Ayşegül İLHAN ,
Hacer DEMİR ,
Nazan DEMIR ,
Erkan ERDUR ,
Ozgen Ahmet YILDIRIM ,
Huseyin KANMAZ ,
Ferit ASLAN ,
Gülnihal TUFAN ,
Ayse DURNALI , Berna OKSUZOGLU,
UMUT DEMİRCİ
In patients with gastic cancer, five-year survival is poor in the locally advanced stage. Docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil(FLOT) combination regimen has been shown to provide a survival advantage in the locally advanced stage. In this study, weaimed to evaluate the efficacy and tolerability of FLOT with real-life data in patients with locally advanced gastric/esophagogastricjunction cancers. This retrospective study was conducted between June 2016 - March 2020 and included 106 patients’ data from sixcenters in Turkey. Median age was 60 (33-82). Primary tumor localization was stomach in 76 (71.7%) patients. Seventy-six (71.7%)patients were operated after median 4 (1-8 cycles) cycles of preoperative FLOT. Pathological complete regression (pCR)was obtainedin 10 (13.1%) of the operated patients. Median follow-up was 9.1 (1.4-45.7) months. One-year DFS was 63.2% and the two-yearOS was 65.1%. Three (2.8%) patients had chemotherapy-related deaths. Due to chemotherapy-related toxicity and intoleration, 19(17.9%) patients had dose reduction. The pCR obtained by FLOT appears higher than other regimens. This study is one of the raremulticentric real-life data showing the efficacy and tolerability of the FLOT regimen in the perioperative treatment in GC and EJC.
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To determine the relationship between 18F FDG PET/CT parameters of the primary tumor/nodal metastasis/distant metastasis andoverall survival (OS) of patients with newly diagnosed non-small cell lung cancer (NSCLC). Data from 159 patients with newly diagnosedNSCLC who underwent pretreatment 18F FDG PET/CT were analyzed. The SUVmax, SUVmean, the metabolic tumor volume(MTV), and total lesion glycolysis (TLG) of the primary tumor, lymph node metastasis, and distant metastasis were measured. The totalMTV and total TLG were calculated. The optimal cut-off values of the 18F FDG PET/CT parameters were determined using receiveroperating characteristics curve analysis. Kaplan-Meier curves were used to determine OS. There were a total of 101 deaths duringthe follow-up (range, 3.7-54.2 months). The median OS was 26.4 months for the entire group, 11.8 months for patients with metastasis,and 41 months for patients with no metastasis (p< 0.001). In all patients (n= 159), nodal SUVmax (SUVmaxN), total TLG, and thepresence of distant metastasis were independent predictors. The 2-year OS for patients with TLG ≥ 328 and TLG < 328 were 32%and 80%, respectively. Independent predictors for OS were found as SUVmaxN in the group of patients with distant metastasis, andSUVmax, MTV of the primary tumor (MTVT), and lymph node size (LNsize) in the group of patients without distant metastasis. 18F FDGPET/CT may distinguish patients with high risk for poor prognosis in patients with and without metastasis.
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Bone is the main metastatic site in breast cancer patients. A marker is needed for early identification of breast cancer patients whoare at risk of bone metastasis. Dickkopf-1 (DKK-1) plays an early role in the cascade of bone metastasis process in breast cancer.Therefore, detection of its expression is presumed to predict bone metastasis better than other biomarkers. This study was aimed todetermine the potential of DKK-1 expression as a predictor of bone metastasis in breast cancer and its association with clinicopathologicalfactors. The study design was a retrospective cohort study of medical records in the Surgical Oncology Division, Departmentof Surgery, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia from October 2018 to June 2019. Bivariate analysis wasperformed to analyse data using Chi square test or Fischer’s exact test. We included 76 subjects divided into two groups: bone metastasisgroup (n= 38) and non-bone metastasis group (n=38). The H-Score cut-off value for DKK-1 expression was 142.5. We founda statistically significant association between high expression of DKK-1 and the incidence of bone metastasis in breast cancer (oddratio [OR]= 12.083, 95% confidence interval [CI]= 4.101-35.600, p< 0.001). Associations between DKK-1 expression and clinicopathologicalfactors were not statistically significant. DKK-1 expression is potential to predict and an independent factor of the bonemetastasis occurrence in breast cancer.
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The role of consolidation chemotherapy is being investigated due to inconclusive outcomes, ascribed to high rates of recurrenceand mortality with standard concurrent chemoradiotherapy (CRT) in patients with unresectable locally advanced non-small-cell lungcancer (LA-NSCLC). We evaluated the impact of consolidation chemotherapy on the survival of patients with LA-NSCLC at our singlemedical centre. In total, 136 patients with unresected LA-NSCLC were evaluated to identify and compare the factors influencingsurvival rates. The median overall survival (OS) was 27 and 23.6 months and median progression-free survival (PFS) was 12.3 and12.8 months in the CRT and consolidation treatment groups (p= 0.840 and 0.808), respectively. Consolidation chemotherapy afterconcurrent CRT experiences has neither OS nor PFS survival benefit, compared with concurrent CRT alone. Thus, our study did notsupport favourable consolidation chemotherapy in patients with LA-NSCLC.
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