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Öğe Biased view against biopsy among cancer patients and its reasons(Drunpp-Sarajevo, 2012) Kucukoner, Mehmet; Inal, Ali; Kaplan, Muhammed Ali; Urakci, Zuhat; Isikdogan, AbdurrahmanObjective: Because the belief that biopsy causes spread of the disease, is a widely accepted opinion among the people in our region. The aim of this study is to assess the view of patients diagnosed with cancer about biopsies and evaluate the factors influencing this. Material and Methods: Three hundred and twenty four patients who presented themselves to the Department of Medical Oncology between October 2009 and March 2010, were included in the study. Data were obtained from patient charts and evaluations of questionnaires. Results: Among those patients with low level of education, the number of people who are thinking that biopsy is harmful, was significantly high (p=0.001). The gender of patients thinking that biopsy was harmful was more female (p=0.065). However, significantly elderly patients (76.8%, n=99) aged over 40 years, considered biopsy as harmful compared to those aged less than 40 years (p=0.078). Significant differences were found in biopsy perception of patients based on their economic status (p=0.023). Conclusions: The education level of the patient should be taken into consideration in diagnosing cancer with biopsy and subsequent transition to treatment steps the consciousness level of the patient should be certainly increased as well.Öğe Can LMWH improve the outcome of patients with inoperable stage III non-small cell lung cancer?(Termedia Publishing House Ltd, 2012) Kucukoner, Mehmet; Isikdogan, Abdurrahman; Kaplan, Muhammed Ali; Inal, Ali; Zinciroglu, S.; Cit, Murtaza; Cil, TimucinAim of the study: Lung cancer is the most common malignancy, accounting for one-third of all deaths from cancer. Some studies have shown that low molecular weight heparin (LMWH) significantly prolongs the survival of patients with non-small cell lung cancer (NSCLC). The aim of this study was to determine the effects of treating inoperable stage III NSCLC with LMWH in addition to concurrent chemoradiotherapy. Material and methods: Eighty-two patients with inoperable stage III NSCLC were evaluated at Dicle University's Medical Oncology Department between 2005 and 2010. All patients were treated with concurrent chemoradiotherapy (CRT) with or without LMWH (enoxaparin 4000 IU/day) depending on the patient's risk of thrombosis. The primary objectives were to determine disease-free survival (DES) and overall survival (OS) for patients treated with LMWH. Results: A total of 38 patients in the LMWH negative group and 44 patients in the LMWH positive group were included in the study. The median OS was 11.2 months for the enoxaparin recipients and 12.7 months for the non-enoxaparin group (p = 0.4). The median DES was 9.3 months with CRT alone and 10.0 months with CRT plus enoxaparin (p = 0.9). The one-year OS rates were 47% and 34% for groups treated with CRT and enoxaparin plus CRT, respectively, while the two-year OS rates were 23% and 21%, respectively. No significant difference was noted between the two groups in terms of grade 3-4 hematologic toxicity and mucositis (p = 0.3). Conclusions: This study did not demonstrate improvements in survival for patients with NSCLC treated with enoxaparin. LMWH's positive contribution is still controversial.Öğe Clinical characteristics, treatment, and survival outcomes in malignant pleural mesothelioma: A institution experience in Turkey(Lippincott Williams & Wilkins, 2013) Kucukoner, Mehmet; Kaplan, Muhammed Ali; Inal, Ali; Urakci, Zuhat; Abakay, Ozlem; Tanrikulu, Abdullah; Abakay, Abdurrahman[Abstract Not Available]Öğe Efficacy of sorafenib in patients with gastrointestinal stromal tumors in the third- or fourth-line treatment: A retrospective multicenter experience(Spandidos Publ Ltd, 2013) Kefeli, Umut; Benekli, Mustafa; Sevinc, Alper; Yildiz, Ramazan; Kaplan, Muhammed Ali; Ciltas, Aydin; Balakan, OzanSorafenib is a multi-targeted tyrosine kinase receptor inhibitor used to treat patients with advanced gastrointestinal stromal tumors (GISTs). The present study evaluated the efficacy and tolerability of sorafenib therapy for patients with GISTs. Between January 2001 and November 2012, 25 patients, from multiple centers, who had received sorafenib as the third-or fourth-line treatment for GISTs were investigated retrospectively. In total, 17 patients were male and eight were female. The median age was 54.0 years (range, 16-82 years). From the patients, 21 received imatinib for longer than six months and four received it for less than six months. The clinical benefit rate of sorafenib was 40.0%. Treatment-related adverse events were reported in 72% of patients. These adverse events were generally mild to moderate in intensity. The median progression-free survival (PFS) and overall survival (OS) times of the patients who received sorafenib were 7.2 and 15.2 months, respectively. The duration of imatinib usage was an independent prognostic factor for PFS and OS. Sorafenib is an effective treatment in patients with GISTs showing a clinical benefit rate of 40.0% and an acceptable tolerability.Öğe Efficacy of Sunitinib in Turkish Patients with Gastrointestinal Stromal Tumors; Retrospective Multicenter Experience(H G E Update Medical Publishing S A, 2013) Kefeli, Umut; Buyukberber, Suleyman; Akyol, Murat; Yildiz, Ramazan; Kaplan, Muhammed Ali; Ciltas, Aydin; Sevinc, AlperBackground/Aims: Sunitinib is a multi-targeted thyrosine kinase receptor inhibitor used in patients with advanced gastrointestinal stromal tumours (GISTs). We evaluated the efficacy and tolerability of sunitinib therapy in Turkish patients with GISTs. Methodology: Between January 2001 and April 2012, 57 patients who had progressive disease or experienced unacceptable toxicity during imatinib treatment from multiple centers were investigated retrospectively. Results: Thirty-three patients were male and 24 were female. The median age was 55 years (range; 16-84 years). Thirty-eight of the patients received imatinib for longer than 12 months, 13 patients received for 6-12 months, and 6 patients received for less than 6 months. The clinical benefit of sunitinib was 73.7%. Treatment-related adverse events were reported in 78% of the patients. Adverse events were generally mild to moderate in intensity The median progression free survival (PFS) and overall survival (OS) of the patients that received sunitinib were 10.8 months and 23.9 months, respectively. The time of imatinib usage and response to sunitinib were independent prognostic factors for PFS and OS. Also, tumor size was an independent prognostic factor for PFS. Conclusions: Sunitinib is an effective treatment in Turkish patients with GISTs, with a clinical benefit of 73.7% and shows an acceptable tolerabilityÖğe Germ cell tumor in duodenum(Turkish Soc Gastroenterology, 2013) Kucukoner, Mehmet; Kaplan, Muhammed Ali; Inal, Ali; Ucmak, Feyzullah; Firat, Ugur; Isikdogan, Abdurrahman[Abstract Not Available]Öğe Impact of adding pertuzumab to trastuzumab plus chemotherapy in neoadjuvant treatment of HER2 positive breast cancer patients: a multicenter real-life HER2PATH study(Taylor & Francis Ltd, 2023) Bilici, Ahmet; Olmez, Omer Fatih; Kaplan, Muhammed Ali; Oksuzoglu, Berna; Sezer, Ahmet; Karadurmus, Nuri; Cubukcu, ErdemAimTo investigate the pathological complete response (pCR) achieved after neoadjuvant therapy with versus without adding pertuzumab (P) to trastuzumab (H) plus neoadjuvant chemotherapy (NCT) in HER2+ breast cancer (BC) patients in a real-life setting.MethodsA total of 1528 female HER2+ BC patients who received NCT plus H with or without P were included in this retrospective real-life study. Primary endpoint was pCR rate (ypT0/Tis ypN0). Clinicopathological characteristics, event-free survival (EFS) time, and relapse rates were evaluated with respect to HER2 blockade (NCT-H vs. NCT-HP) and pCR.ResultsOverall, 62.2% of patients received NCT-H and 37.8% received NCT-HP. NCT-HP was associated with a significantly higher pCR rate (66.4 vs. 56.8%, p < 0.001) and lower relapse (4.5 vs. 12.2%, p < 0.001) in comparison to NCT-H. Patients with pCR had a significantly lower relapse (5.6 vs. 14.9%, p < 0.001) and longer EFS time (mean(SE) 111.2(1.9) vs. 93.9(2.7) months, p < 0.001) compared to patients with non-pCR. Patients in the NCT-HP group were more likely to receive docetaxel (75.0 vs. 40.6%, p < 0.001), while those with pCR were more likely to receive paclitaxel (50.2 vs. 40.7%, p < 0.001) and NCT-HP (41.5 vs. 32.1%, p < 0.001). Hormone receptor status and breast conservation rates were similar in NCT-HP vs. NCT-H groups and in patients with vs. without pCR. Invasive ductal carcinoma (OR, 2.669, 95% CI 1.596 to 4.464, p < 0.001), lower histological grade of the tumor (OR, 4.052, 95% CI 2.446 to 6.713, p < 0.001 for grade 2 and OR, 3.496, 95% CI 2.020 to 6.053, p < 0.001 for grade 3), lower T stage (OR, 1.959, 95% CI 1.411 to 2.720, p < 0.001) and paclitaxel (vs. docetaxel, OR, 1.571, 95% CI 1.127 to 2.190, p = 0.008) significantly predicted the pCR.ConclusionsThis real-life study indicates that adding P to NCT-H enables higher pCR than NCT-H in HER2+ BC, while pCR was associated with lower relapse and better EFS time.Öğe IPS-3 Validation in 1012 cases with classical hodgkin lymphoma(Pergamon-Elsevier Science LTD, 2021) Paydaş, Semra; Laçin, Şahin; Doğan, Mutlu; Barışta, İbrahim; Yıldız, Birol; Seydaoğlu, Gülşah; Civriz, Sinem; Kaplan, Muhammed Ali; Yağcı, Münci; Gürkan, Emel; Erçolak, VehbiThe aim of this study is to validate the IPS-3 scoring system as a prognostic indicator in 1012 patients with advanced stage classical Hodgkin Lymphoma (cHL) treated by doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD). According to the IPS-3 scoring system only 3.5 % had high risk and 50.8 % had low risk disease disease and 45.8 % of the cases had intermediate risk disease. Each factors of IPS-7 and IPS-3 scoring systems (age, sex, stage hemoglobin, albumin, lymphocyte count and white cell count) were found to be significant for overall survival (OS) and progression free survival (PFS) according to univariate analyses. Two different multivariate Cox analyses were performed for OS and PFS including the IPS-3/ IPS-7 scoring system parameters. Among 7 risk factors of IPS scoring system, gender and albumin were not found as independent risk factors for both OS and PFS according to cox regression model. But all parameters such as age, stage and hemoglobin those included in IPS-3, were found to be independent significant risk factors for both models obtained for OS and PFS. The results of the study shows that the IPS-3 scoring system can be used as a prognostic indicator in ABVD treated patients in every day practice which is more easily calculate according to the IPS-7.Öğe Is sunitinib-induced hypothyroidism a predictive clinical marker for better response in metastatic renal cell carcinoma patients?(Taylor & Francis Ltd, 2016) Bozkurt, Oktay; Karaca, Halit; Hacibekiroglu, Ilhan; Kaplan, Muhammed Ali; Duzkopru, Yakup; Uysal, Mukremin; Berk, VeliBackground: The main goal of this study was to examine whether the occurrence of hypothyroidism during sunitinib therapy in patients with metastatic renal cell carcinoma (mRCC) is associated with a better outcome. Methods: The study enrolled 81 patients with pathologically proven mRCC who were treated with sunitinib between March 2008 and June 2013. Thyroid function evaluation comprised (free-thyroxine) FT4 and thyroid-stimulating hormone (TSH) before treatment and at day 1 of each 6-week cycle. Survival analysis was performed using the Kaplan-Meier method, and the differences among the groups were determined using the log-rank test. Results: Hypothyroidism occurred in 30 (37%) of 81 patients within a median 3 months (range 1-18) of treatment initiation. There was a statistically significant correlation between the occurrence of hypothyroidism during treatment and the rate of objective remission (ORR) (hypothyroid patients vs euthyroid patients: 46.7 vs 13.7%, respectively; P = 0.001). Median progression-free survival (PFS) was 10 (95% CI 6.13-13.8) months in the euthyroid patients, and 17 (95% CI 9.33-24.6) months in the hypothyroid patients (P = 0.001). The median overall survival (OS) was 39 (95% CI 25.4-52.5) months in the hypothyroid patients and 20 (95% CI 14.7-25.2) months in the euthyroid patients (P = 0.019). Conclusions: The occurrence of hypothyroidism during treatment in patients was significantly associated with longer PFS, OS and better ORR in the current study.Öğe Is there any significance of lung cancer histology to compare the diagnostic accuracies of 18F-FDG-PET/CT and 99mTc-MDP BS for the detection of bone metastases in advanced NSCLC?(Termedia Publishing House Ltd, 2014) Inal, Ali; Kaplan, Muhammed Ali; Kucukoner, Mehmet; Urakci, Zuhat; Dostbil, Zeki; Komek, Hail; Onder, HakanAim of the study: Bone scintigraphy (BS) and fluorine-18 deoxyglucose positron emission tomography computed tomography (18F-FDG-PET/CT) are widely used for the detection of bone involvement. The optimal imaging modality for the detection of bone metastases in histological subgroups of non-small cell lung cancer (NSCLC) remains ambiguous. The aim of this study was to compare the efficacy of 18F-FDG-PET/C and Tc-99m-methylene diphosphonate (Tc-99m-MDP) BS in the detection of bone metastases of patients in NSCLC. Specifically, we compared the diagnostic accuracies of these imaging techniques evaluating bone metastasis in histological subgroups of NSCLC. Material and methods: Fifty-three patients with advanced NSCLC, who had undergone both 18F-FDG-PET/CT and BS and were eventually diagnosed as having bone metastasis, were enrolled in this retrospective study. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG-PET/CT and BS were 90.4%, 99.4%, 98.1%, 96.6%, 97.0% and 84.6%, 93.1%, 82.5%, 93.2, 90.8%, respectively. The. statistics were calculated for 18F-FDG-PET/CT and BS. The kappa-value was 0.67 between 18F-FDG-PET/CT and BS in all patients. On the other hand, the kappa-value was 0.65 in adenocarcinoma, and 0.61 in squamous cell carcinoma between 18F-FDG-PET/CT and BS. The kappa-values suggested excellent agreement between all patients and histological subgroups of NSCLC. Conclusions: 18F-FDG-PET/CT was more favorable than BS in the screening of metastatic bone lesions, but the trend did not reach statistical significance in all patients and histological subgroups of NSCLC. Our results need to be validated in prospective and larger study clinical trials to further clarify this topic.Öğe Lack of Prognostic Value of Mean Corpuscular Volume with Capecitabine Therapy in Metastatic Breast Cancer(Asian Pacific Organization Cancer Prevention, 2014) Bozkurt, Oktay; Berk, Veli; Kaplan, Muhammed Ali; Cetin, Bulent; Ozaslan, Ersin; Karaca, Halit; Inanc, MevludeCapecitabine is an oral fluoropyrimidine derivative which is frequently used alone or in combination regimens for the treatment of metastatic breast cancer. Although overall and progression free survivals have increased in recent years with the use of new generation drugs, predictive factors that would further improve the outcomes are needed. Previous studies have demonstrated the relation between post-treatment increase in mean corpuscular volume (MCV) and predicting therapy response as well as survival. The present study investigated the clinical impact of MCV elevation in metastatic breast cancer patients treated with capecitabine. Materials and Methods: The data of a total of 82 patients from three centers followed between June 2005 and June 2013 were retrospectively analyzed. The demographic data and hormone receptor status of the patients, as well as initial examination before and after treatment and data concerning progression were recorded. MCV >= 100 fl was considered as macrocytosis. Capecitabine was given at a dose of 2500 mg/m(2) daily for 14 days every three weeks. Pre-treatment and post-treatment MCV and other parameters of complete blood count were recorded. Post-treatment initial evaluation was performed after 2 cycles of therapy. Results: The median age of the patients was 46.5 years (range 26-72 years) and 54% were premenopausal. Performance status was ECOG 0 and 1 in 81 (99%) patients. The median number of cycles for capecitabine therapy was 5 (min-max: 2-18). The median Delta MCV level (post-treatment values at sixth week - baseline) was 6.4. Whilst Delta MCV was >= 6.4 in 42 patients, it was <6.4 in 40 patients. Clinical benefit (complete response+partial response+stable disease) was observed in 37 (88%) of 42 patients with a median Delta MCV >= 6.4 and in 30 (75%) of 40 patients with Delta MCV <6.4 with no statistically significant difference (p=0.158). No significant difference was determined between the group with Delta MCV >= 6.4 and the group with Delta MCV <6.4 in terms of progression-free survival (11 vs 12 months) (p=0.55) and overall survival (20 months vs. 24 months) (p=0.11). Conclusions: The identification of new predictive markers in metastatic breast cancer is very important. In some recent studies, increase in MCV has been suggested as a marker in tumor response. In the present study, however, no significant difference was determined between tumor response and increase in MCV. Further studies including higher numbers of patients are needed to determine whether increase in MCV is a predictive marker or not.Öğe Metoclopramide-induced parkinsonism due to bilateral basal ganglia and brain stem involvement in a patient with laryngeal carcinoma(2012) Işıkdoğan, Abdurrahman; Küçüköner, Mehmet; Ekici, Faysal; Urakçı, Zuhat; Kaplan, Muhammed Ali; İnal, Ali; Uzar, ErtuğrulMetoklopramid gibi antiemetik ilaçlara bağlı parkinsonizmve bazal ganglion tutulumu nadirdir. Ancak, bilateral bazalganglion ve beyin sapı tutulumu ilaca bağlı parkinsonizm hastalarında henüz bildirilmemiştir. Larinks kanseri olan 52 yaşındaki erkek hasta dosetaksel, sisplatin ve 5-fluorourasil (DCF) kemoterapisi ile tedavi edildi. Kemoterapinin ilk küründen 15 gün sonra şiddetli bulantı ve kusma şikayeti nedeniyle metoklopramid verildi. Metoklopramid tedavisinin 6. gününde parkinsonizm belirtileri gözlendi. Çekilen serebral MRG’de bilateral bazal ganglionlarda ve beyin sapında tutulum saptandı. Metoklopramid tedavisi derhal kesilerek ve ağızdan biperiden başlandı. Parkinsonizm bulguları bir ay sonra gerçekleştirilen kontrol muayenesinde neredeyse tamamen düzeldi. Hastaya daha sonraki kemoterapi tedavilerinde metoklopramid verilmedi. Üç ay sonra çekilen serebral MRG’de lezyonlar tamamen düzeldi. Kemoterapi ile tedavi edilen larinks kanserli hastada beyin sapı ve bazal ganglion tutulumu ile birlikte metoklopramidin indüklediği parkinsonizm çok nadir görülen bir durumdur. Klinik ve radyolojik iyileşme neden olan ilacın kesilmesi ve biperiden tedavisi ile gözlenmiştir.Öğe Molecular subtypes are prognostic for N3 breast cancer patients in the modern therapeutic era(Spandidos Publ Ltd, 2019) Yersal, Ozlem; Kaplan, Muhammed Ali; Isikdogan, Abdurrahman; Ozdemir, Nuriye; Aliustaoglu, Mehmet; Barutca, Sabri; Erdogdu, Halil IbrahimNodal (N) status and molecular subtypes are well-known prognostic factors for breast cancer patients. The aim of the present study was to evaluate whether there was a prognostic role of molecular subtypes for pN3a breast cancer patients in the inodern therapeutic era. The present study retrospectively evaluated a total of 521 breast cancer patients who had 10 or more metastatic lymph nodes and received adjuvant systemic therapy at the Oncology Department of four different centers in Turkey between 2000-2015. Patients were divided into four molecular subtypes by immunohistochemical staining. There were no significant differences in relapse rates according to the molecular subtypes (P=0.07). The five year disease free survival rate was 62% for the whole study population, 67% for Luminal A tumors, 53% for Luminal B tumors, 64% for human epidermal growth factor receptor 2-positive tumors and 56% for triple negative tumors. Luminal A patients had a better progression free survival when compared with Luminal B (P=0.026) and triple negative (P=0.07) patients. pT stage (P<0.001), and breast cancer subtype (P<0.001), remained significant independent factors for disease free survival. Therefore, breast cancer subtypes are still prognostic for patients with pN3 breast cancer.Öğe Prognostic importance of tumor location and anti-EGFR therapy in patients with K-RAS wild type metastatic colorectal cancer(Imprimatur Publications, 2019) Kucukoner, Mehmet; Oztekin, Esen; Akdeniz, Nadiye; Morkuzu, Suat; Yerlikaya, Halts; Urakci, Zuhat; Kaplan, Muhammed AliPurpose: To compare anti-EGFR and anti-VEGF agents in patients with K-RAS wild-type metastatic colorectal cancer (mCRC) with regards to tumor location. Methods: 450 patients diagnosed with mCRC, who applied to our center were included in this retrospective study. Of 450 patients, 303 underwent K-RAS mutation tests, assessed as having right-sided or left-sided mCRC and grouped according to localization of right and left colon. Sixty-five patients with K-RAS wild-type mCRC, who were treated with first-line anti-EGFR or anti-VEGF containing combination therapies of fluorouracil with leucovorin and either irinotecan or oxaliplatin were compared. Results: 393 (87%) out of 450 mCRC patients had left-sided colon cancers, and 57(13%) had right-side colon cancers. K-RAS analysis was performed in 303 of 450 patients with mCRC, 186 (61.4%) patients had K-RAS wild-type and 117 (38.6%) had K-RAS mutant. Median survival for right-sided cancers was 23.3 months and 29.4 months for left-sided cancers (p=0.309). Median progression-free survival (PFS) was 10.4 months (95% CI 7.3-13.4) in the anti-EGFR containing regimens group and 9.7 months (8.2-11.1) in the anti-VEGF containing regimens group (p=0.037); however, median overall survival (OS) was 18.4 months (95% CI 11.7-25.1) in the anti-EGFR containing regimens group and 19.3 months (95% CI 15.7-22.9) in the anti-VEGF containing regimens group (p=0.635). Conclusion: Addition of anti-EGFR in left sided K-RAS wild-type mCRC regarding PFS was beneficial, however there was no difference in terms of OS.Öğe Real-world outcomes of pazopanib in metastatic soft tissue sarcoma: a retrospective Turkish oncology group (TOG) study(Springer Science and Business Media, 2023) Bilici, Ahmet; Koca, Sinan; Karaaǧaç, Mustafa; Aydın, Sabin Göktaş; Eraslan, Emrah; Kaplan, Muhammed AliAim: Description of patient characteristics, effectiveness and safety in Turkish patients treated with pazopanib for metastatic soft tissue sarcoma (STS). Patients and methods: This multicenter study is based on retrospective review of hospital medical records of patients (≥ 18 years) treated with pazopanib for non-adipocytic metastatic STS at 37 Oncology clinics across Turkey. Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) were evaluated with further analysis of data on the three most common histological subtypes (leiomyosarcoma [LMS], undifferentiated pleomorphic sarcoma [UPS], synovial sarcoma [SS]) in the cohort. Results: Data of 552 adults (57.6% women, median age: 52 years) were analyzed. DCR and ORR were 43.1% and 30.8%, respectively. Median PFS was 6.7 months and OS was 13.8 months. For LMS, UPS and SS, median PFSs were 6.1, 5.9 and 7.53 months and median OSs were 15.03, 12.87 and 12.27 months, respectively. ECOG ≥ 2 was associated with poor PFS and OS. Liver metastasis was only a factor for progression. Second-line use of pazopanib (vs. front-line) was associated with better PFS, its use beyond third line predicted worse OS. Adverse events (AE) occurred in 82.7% of patients. Most common AEs were fatigue (58.3%) and anorexia (52.3%) which were graded as ≥ 3 in 8.2% and 7.4% of patients, respectively. Conclusion: Pazopanib is effective and well-tolerated in treatment of non-adipocytic metastatic STS. Its earlier use (at second-line), good performance status may result in better outcomes. Worldwide scientific collaborations are important to gain knowledge on rarer STS subtypes by conducting studies in larger patient populations.Öğe Sequential Use of Sorafenib and Regorafenib in Hepatocellular Cancer Recurrence After Liver Transplantation: Treatment Strategies and Outcomes(Mdpi, 2024) Ozbay, Mehmet Fatih; Harputluoglu, Hakan; Karaca, Mustafa; Tekin, Omer; Sendur, Mehmet Ali Nahit; Kaplan, Muhammed Ali; Sahin, BerksoyBackground and Aims: During liver transplantation, hepatocellular carcinoma (HCC) recurrence remains a critical challenge for patient survival. Targeted therapies, such as sorafenib and regorafenib, have been utilized to manage relapsed HCC in this unique setting. This study aimed to assess the efficacy of Sorafenib and Regorafenib in patients with HCC who experienced recurrence after liver transplantation. We focused on survival outcomes, treatment responses, and the management of side effects in this patient group. Methods: We conducted a retrospective analysis of 73 patients who experienced HCC recurrence post-liver transplantation between 2012 and 2022 across 11 oncology centers in Turkey. Patients were categorized according to Child-Pugh classification and treated with sorafenib as first-line therapy and Regorafenib in case of progression. Survival rates were analyzed using the Kaplan-Meier method, and risk factors were evaluated using Cox regression analysis. Results: Of the 73 patients included in the study, 62 were male (84.9%), and 11 were female (15.1%), with a mean age of 61.5 +/- 10.9 years. All patients received sorafenib as first-line treatment. Among patients who experienced progression with sorafenib or discontinued treatment due to toxicity, 45.2% (n = 33) continued treatment with regorafenib. The median progression-free survival (PFS1) time with sorafenib was 5.6 months, and the one-year survival rate was 24.3%. The median progression-free survival (PFS2) time with regorafenib, which was administered as second-line treatment, was also calculated as 5.9 months. Overall survival (OS) duration was determined as 35.9 months. The most common side effects associated with both drugs included fatigue, hand and foot syndrome, and hypertension. Significantly better survival outcomes were shown in the Child-Pugh A group compared to other patients. Conclusions: These results suggest that Sorafenib and Regorafenib treatments offer a survival advantage in patients with relapsed HCC post-transplantation. However, individualized treatment strategies and close follow-up are crucial for optimizing outcomes. Further studies are needed to refine therapeutic protocols and enhance the care of this specific patient group.Öğe Treatment outcomes and prognostic factors in patients with driver mutant non-small cell lung cancer and de novo brain metastases(Nature Portfolio, 2024) Kahraman, Seda; Karakaya, Serdar; Kaplan, Muhammed Ali; Göksu, Sema Sezgin; Öztürk, Akın; İşleyen, Zehra Sucuoğlu; Hamdard, JamshidCentral 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.
