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Öğe Anti-Ri-associated paraneoplastic neurological syndrome: Initial symptom of breast cancer with HER2 overexpression and treatment by dual HER2 blockade(SAGE Publications Ltd, 2019) Ölmez, Ömer Fatih; Kınıkoğlu, Oğuzcan; Helvacı Yılmaz, Nesrin; Bilici, Ahmet Erkan; Çubukçu, Erdem; Şeker, Mesut Metin; Çakır, Tansel; Yıldız, Özcan; Hamdard, JamshidParaneoplastic neurological syndrome is associated with anti-Ri antibodies, which are typically present with opsoclonus–myoclonus–ataxia. Human epidermal growth factor receptor 2 (HER2) overexpression is present in 15%–25% of breast cancer and is associated with poor prognosis. There are a few reports of paraneoplastic neurological syndrome associated with HER2-positive breast cancer in the literature, of which most are anti-Yo-associated paraneoplastic neurological syndrome. We present herein the case of a female patient with HER2-positive breast cancer who had atypical anti-Ri antibody associated with opsoclonus–myoclonus paraneoplastic neurological syndrome. Following the diagnosis of paraneoplastic syndrome, chemotherapy with dual HER2 blockade and immunomodulating treatment including intravenous immunoglobulin and oral prednisolone were administered. Although the patient was negative for serum anti-Ri antibodies, there was partial clinical improvement and her neurological deficit persisted. To our knowledge, this is the first case report of female patient with HER2-positive breast cancer who had atypical anti-Ri antibody associated with opsoclonus–myoclonus paraneoplastic neurological syndrome and treated with dual HER2 blockade.Öğe Are pretreatment inflammation-based prognostic scores useful in predicting the outcomes of patients with ALK-positive NSCLC?(Elsevier Science, 2019) Ölmez, Ömer Fatih; Bilici, Ahmet; Gürsoy, Pınar; Çubukçu, Erdem; Yıldız, Özcan; Sakın, Abdullah; Korkmaz, Taner; Çil, İbrahim; Çakar, Beyhan; Menekşe, Serkan; Demir, Tarık; Açıkgöz, Özgen; Hamdard, JamshidBackground: Approximately 5% of all diagnosed non-small cell lung cancer (NSCLC) patients harbor a genetic rearrangement between the ALK and EML4 genes, representing a specific molecular and clinical subgroup (ALK+ NSCLC). To date, upfront treatment with ALK-tyrosine-kinase inhibitors (ALK-TKIs) has replaced chemotherapy in the first line setting for this subset of patients with excellent results, but reliable prognostic markers are lacking. An increased systemic inflammatory response has been shown to be associated with a poor prognosis, and some of the parameters used to characterize this response can easily be measured in clinical practice in several tumor types, but have not been analyzed extensively in ALK+ lung cancer in the era of crizotinib. Method: We reviewed the medical records of all patients with previously treated advanced ALK-positive NSCLC who received crizotinib between January 2013 and March 2018 outside of a clinical trial. Pre-treatment modified Glasgow prognostic score (mGPS), Prognostic Nutritional Index (PNI) and Systemic immune-inflammation index (SII) were calculated. Multivariable logistic regression and Cox proportional hazards models were used to assess the impact of pretreatment mGPS, PNI and SII on overall survival (OS), progression-free survival (PFS), and overall response rate (ORR). Result: 82 patients were treated. Median age was 52.5 years (range; 20e77 years); 42.7% were female. Eighty-four point two percent of patients had an Eastern Cooperative Oncology Group Performance Status (ECOG PS) 1; 17.1% had received 2 prior systemic therapies. The objective response rate was 77.2% (CR+PR). The optimal cutoff levels were 0.09 for mGPS and PNI, 934.7 for SII by ROC curves analysis. Patients in the SII 934.7 grous was significantly correlated with worse PFS and OS by univariate analysis (Figure 1). In multivariate analyses, pretreatment prognostic nutritional index (PNI) 0.09 was independently associated with inferior OS (1 year OS rates, 90.2% vs. 73.7%; HR 2.46, 95% CI 0.88- 4.85; p ¼ 0.035). Additionally, we evaluated the effects of these markers on response prediction. The logistic regression analysis of the predictive factors for the response to crizotinib demonstrated that the mGPS and PNI were associated with inferior ORR (OR: 0.1, 95% CI 0.16-1.04; p ¼ 0.009 and OR: 0.16, 95% CI 0.02-0.55; p ¼ 0.035, respectively). Conclusion: In a cohort of patients with ALK positive NSCLC treated with crizotinib in routine practice, elevated pre-treatment SII was associated with shorter OS and PFS in univariate analysis and PNI was associated with shorter OS in multivariate analyses. Moreover the mGPS and PNI were associated with lower response rates.Öğe Association between baseline and changes in early neutrophil-to-lymphocyte ratio on survival in patients with metastatic bladder carcinoma treated with immunotherapy(2024) Değerli, Ezgi; Arslan, Çağatay; Selçukbiricik, Fatih; Ölmez, Ömer Fatih; Erdem, Dilek; Hamdard, Jamshid; Tural, DenizBackground and Objectives: A high baseline neutrophil-to-lymphocyte ratio (NLR) is a poor prognostic factor in various cancers. However, its predictive role in metastatic bladder cancer (mBC) treated with immunotherapy is unclear. In this study, we aimed to investigate the relationship between the baseline and change in NLR and overall survival in mBC patients treated with immunotherapy, with the potential to significantly impact patient care. Materials and Methods: A retrospective analysis was conducted on 56 mBC patients who received second-line immunotherapy after progressing on platinum-based chemotherapy. Patients were classified into high and low NLR groups using a cutoff value of 3.3. A further division was made based on NLR changes after two cycles of immunotherapy: whether NLR increased (≥10%) or decreased (≥10%). The endpoint was to estimate the association between clinicopathological features and survival outcomes. Results: The study included 56 patients, with a median age of 66.6 years and a male-to-female ratio of 2.3:1. A low baseline NLR was associated with better OS than a high baseline NLR (p = 0.005). After two immunotherapy cycles, patients with a decreased NLR (≥10%) had significantly longer OS than those with an increased NLR (≥10%), regardless of the baseline NLR (p = 0.003). The overall median survival was 15 months, with 10 months for the NLR-increased group and not reached for the NLR-decreased group. Conclusions: Our study highlights the potential of baseline NLR and early changes in NLR as valuable prognostic markers for mBC patients receiving immunotherapy. Elevated neutrophils and lymphopenia negatively impact prognosis and treatment effectiveness, and NLR shows promise as a prognostic marker, inspiring further research and potential improvements in patient care.Öğe Efficacy and safety of folfiri plus aflibercept in second-line treatment of metastatic colorectal cancer: Real-life data from Turkish oncology group(NLM (Medline), 2022) Erol, Cihan; Şendur, Mehmet Ali Nahit; Bilgetekin, İrem; Bayır Garbioğlu, Duygu; Hamdard, Jamshid; Akbaş, Sinem; Hizal, Mutlu; Arslan, Çağatay; Sevinç, Alper; Küçükarda, Ahmet; Erdem, Dilek; Kahraman, Seda; Çakır, Emre; Demirkıran, Aykut; On, Sercan; Doğan, İzzet; Erdoğan, Atike Pınar; Koca, Sinan; Kubilay, Pınar; Eren, Orhan Önder; Çılbır, Ebru; Çelik, Emir; Araz, Murat; Tataroğlu Özyükseler, Deniz; Yıldırım, Mahmut Emre; Bahçeci, Aykut; Taşkaynatan, Halil; Oyman, Abdilkerim; Deniz, Gülhan İpek; Menekşe, Serkan; Kut, Engin; Gülmez, Ahmet; Sakin, Abdullah; Nayır, Erdinç; Acar, Ramazan; Şen, Erdem; İnal, Ali; Turhal, Serdar; Kaya, Ali Osman; Paydaş, Semra; Taştekin, Didem; Hacıbekiroğlu, İlhan; Çinçin, İrfan; Bilici, Ahmet; Mandel, Nil Molinas; Şener Dede, Didem; Akıncı, Muhammed Bülent; Öksüzoğlu, Berna; Uncu, Doğan; Yalçın, Bülent; Artaç, MehmetAims: The addition of aflibercept to the fluorouracil and irinotecan (FOLFIRI) regimen significantly improved clinical outcomes in patients with metastatic colorectal cancer (CRC) previously treated with oxaliplatin. We aimed to investigate the efficacy and safety of second-line FOLFIRI and aflibercept combination in patients with metastatic CRC in real-life experience. Materials and Methods: Four hundred and thirty-three patients who treated with FOLFIRI and aflibercept in the second-line were included in the study. The clinical and pathological features of the patients were recorded retrospectively. Survival (overall and progression-free survival [PFS]), response rates, and safety data were analyzed. Results: The median age was 61. Majority of patients (87.5%) received first-line bevacizumab and 10.1% of patients received anti-epidermal growth factor receptor agents. About 80% of patients had KRAS, 18.6% of patients had NRAS, and 6.4% of patients had BRAF mutations. The median OS was 11.6 months (95% confidence interval [CI], 10.6-12.6) and the median PFS was 6 months (95% CI, 5.5-6.5). About 4.6% of patients had complete response and 30.6% of patients had partial response as best tumor response. Grade 1-2 toxicities were seen in 33.4% of patients, while grade 3-4 toxicities were recorded in 27% of patients. Eight patients (2%) died due to treatment toxicity. Conclusions: Overall and PFS were similar in routine clinical practice compared to phase III pivotal VELOUR trial. However, response rates were found to be higher. It was observed that there were fewer adverse events compared to the VELOUR trial.Öğe Impact of SPARC expression on treatment response of pembrolizumab and brain metastasis in patients with metastatic non-small cell lung cancer(Elsevier B.V., 2023) Göktaş Aydın, Sabin; Bilici, Ahmet; Çalış, Elif; Kutlu, Yasin; Hamdard, Jamshid; Muğlu, Harun; Ölmez, Ömer Fatih; Karcı, Ebru; Açıkgöz, ÖzgürBackground: Non-small cell lung cancer (NSCLC) often exhibits elevated Secreted Protein Acidic and Cysteine-Rich (SPARC) expression. In this study, we investigated the impact of SPARC expression on clinicopathologic features, pembrolizumab response, and prognosis in metastatic NSCLC patients. Methods: Thirty-six patients diagnosed with metastatic NSCLC without actionable driver mutation and who received pembrolizumab with or without chemotherapy were included in this study. PD-L1 and SPARC expression were evaluated, with PD-L1 expression categorized based on tumor proportion score and SPARC staining intensity graded as 1+, 2+, and 3 +. Patients’ characteristics were compared across groups, and possible predictive markers were determined by binary logistic regression analysis. Results: No significant associations were found between SPARC expression and smoking status, histopathological tumor type, T and N status, and liver and bone metastasis. Higher SPARC expression was significantly linked to lower brain metastasis rates but higher CNS progression rates (p = 0.022 and p = 0.011, respectively. The objective response rate (ORR) showed a trend of being higher in the SPARC 1 + group (85.7% vs. 43.8% and 50.0% in 2 + and 3 + groups, respectively, p = 0.052. Univariate analysis did not find SPARC expression to be a significant prognostic factor for progression-free survival (PFS) (p = 0.7) and overall survival (OS) (p = 0.07).SPARC 1 + expression negatively affected the pembrolizumab response(p = 0.04,OR:0.11, 95%CI 0.01–0.92). Conclusions: Our study sheds light on a novel aspect of SPARC expression as a potential predictor of pembrolizumab response and a marker for CNS progression in metastatic NSCLC patients treated in the first-line setting.Öğe Major and minor salivary gland cancers: A multicenter retrospective study(John Wiley and Sons Inc, 2023) Hacıoğlu, Muhammet Bekir; Erdoğan, Bülent; Bardakçı, Murat; Algın, Efnan; Gülbağcı, Burcu; Hacıbekiroğlu, İlhan; Hamdard, Jamshid; Ölmez, Ömer Fatih; Akkuş, Hadi; Çiçin, İrfanBackgroundMost of the studies on salivary gland cancers are limited for various reasons such as being single-center, small number of patients, including only major or minor SGCs, or only including epidemiological data. MethodsA total of 37 medical oncology clinics from different regions of Turkey participated in this retrospective-multicenter study. The analyzed data included clinical and demographical features, primary treatment, metastasis localizations, and treatments and includes certain pathologic features. ResultsThe study included data from a total of 443 SGCs. 56.7% was in major salivary glands and 43.3% was in minor salivary glands. Distant metastasis in the major SGCs was statistically significantly more common than in the minor SGCs, locoregional recurrence was statistically significantly more common in the minor SGCs than in the major SGCs (p = 0.003). ConclusionsEpidemiological information, metastasis and recurrence patterns, treatment modalities, and survival analysis of the patients over 20 years of follow-up are presented.Öğe Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as prognostic markers in patients with extensive-stage small cell lung cancer treated with atezolizumab in combination with chemotherapy(NLM (Medline), 2023) Kutlu, Yasin; Göktaş Aydın, Sabin; Bilici, Ahmet; Öven, Bala Başak; Ölmez, Ömer Fatih; Açıkgöz, Özgür; Hamdard, JamshidAtezolizumab is now the standard treatment for extensive-stage small cell lung cancer (ES-SCLC). Herein, we investigated the prognostic role of inflammatory markers in patients treated with atezolizumab plus chemotherapy and evaluated the efficacy and safety of adding atezolizumab to chemotherapy for patients with ES-SCLC and prognostic and predictive factors as a real-life experience. This retrospective study included 55 patients who received front-line atezolizumab with etoposide plus platin regimen for ES-SCLC. We analyzed the survival outcomes and factors that may predict response and survival. The objective response rate (ORR) was 81.8%. At a median follow-up of 23.5 months, the median progression-free survival (PFS) time was 10.8 months, and the median overall survival (OS) time was 15.2 months. In univariate analysis for PFS, limited-stage disease at the time of diagnosis, the presence of prophylactic cranial irradiation (PCI), the presence of liver metastasis, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were found to be prognostic factors (P = .041, P = .034, P = .031, P = .004, and P = <.001, respectively). In other words, while the median PFS time was 14.1 months in patients with PLR ? 135.7, it was 7.5 months in patients with > 135.7. Similarly, median PFS was 14.9 months in patients with NLR ? 3.43, while it was 9.6 months in patients with > 3.43. Univariate analysis for OS revealed that limited stage at the time of diagnosis, NLR and PLR were significant prognostic indicators (P = .01, P = .006, and P = .007, respectively). Median OS time for patients with both NLR ? 3.43 and PLR ? 135.7 was significantly better than that of patients with NLR > 3.43 and PLR > 135.7 (16.9 vs 11.3 and 16.9 vs 11.5 months, respectively). Logistic regression analysis demonstrated that PLR was an independent significant predictive factor for the response to atezolizumab plus chemotherapy (OR: 0.07, P = .028). The patients with PLR ? 135.7 were significantly good responders to atezolizumab plus chemotherapy treatment. Real-life data demonstrated a significant correlation between survival and NLR and, PLR in ES-SCLC patients treated with atezolizumab. In addition, PLR was a significant predictive indicator of response to atezolizumab plus chemotherapy.Öğe Platelet to lymphocyte ratio is associated with tumor localization and outcomes in metastatic colorectal cancer(Lippincott Williams & Wilkins, 2021) Açıkgöz, Özgür; Çakan, Burçin; Demir, Tarık; Bilici, Ahmet; Öven, Bala Başak; Hamdard, Jamshid; Olmuşçelik, Oktay; Ölmez, Ömer Fatih; Şeker, Mesut; Yıldız, ÖzcanThe aim of this study was to investigate the predictive and prognostic value of PLR, and the relationship between PLR and tumor localization. A total of 229 patients with de-novo metastatic CRC were retrospectively analyzed. The cutoff value for PLR was defined by the receiver operating characteristic (ROC) curve analysis and threshold value of 196.5 as best cut-off value was found. The higher rate of BRAF mutation was significantly detected for patients with PLRhigh (> 196.5) compared to those with PLRlow (<= 196.5) (P = .001). PLR was significantly higher in tumors located on the right colon (P = .012). PLR, tumor localization, the presence of surgery for primary tumor, the presence of curative surgery, the presence of metastasectomy for progression-free survival (PFS) and PLR, gender, BRAF mutation, tumor localization, the presence of surgery for primary tumor, the presence of metastasectomy for overall survival (OS) were found to be prognostic factors by univariate analysis. Multivariate analysis showed that PLR, the presence of curative surgery and the presence of metastasectomy for both PFS and OS were found to be independent prognostic factors. Moreover, a logistic regression analysis indicated that PLR and tumor localization were found to be an independent factors for predicting response to systemic treatment (P P = .023 respectively). Our results showed that pretreatment PLR was readily feasible and simple biomarker predicting response to treatment and survival, in addition it was significantly associated with tumor localization.Öğe Platelet to lymphocyte ratio is associated with tumour localization and outcomes in patients with metastatic colorectal cancer(Oxford University Press, 2019) Bilici, Ahmet; Çakan, Banu; Demir, Tarık; Öven, Bala Başak; Açıkgöz, Özgür; Hamdard, Jamshid; Ölmez, Ömer Fatih; Ölmüşçelik, Olcay; Şeker, Mesut; Yıldız, ÖzcanBackground The prognostic importance of platelet-to-lymphocyte ratio(PLR)has been also investigated in some cancer types including colorectal cancer (CRC).Several studies have found that PLR is associated with poor prognosis in patients with CRC,but,the results are controversial.The aim of this study was to investigate the predictive and prognostic value of PLR,and the relationship between PLR and tumor localization. Methods A total of 201 patients with metastatic CRC and candidate to systemic treatments were retrospectively analyzed.Pretreatment complete blood cell count was evaluated to calculate PLR.The cutoff value for PLR was defined by the receiver operating characteristic(ROC)curve analysis and threshold value of 205.5 as best cut-off value was found.The prognostic and predictive significance of PLR was evaluated by univariate and logistic regression analysis. Results Significant relationship was detected between PLR and BRAF mutation,tumor localization.The higher rate of BRAF mutation was significantly detected for patients with PLRhigh(> 205.5)compared to those with PLRlow(<205.5)(p?=?0.006).In addition,PLR was significantly higher in tumors located on the right colon than those with tumor on the left colon(p?=?0.026).PLR, the presence of the primary tumor surgery, tumor localization, the presence of metastasectomy for progression-free survival(PFS)andPLR,age, BRAF mutation and the type of targeted therapy for overall survival(OS)were found to be prognostic factors by univariate analysis.Moreover,a logistic regression analysis indicated that PLR and the presence of metastasectomy were found to be an independent factors for predicting response to systemic treatment(p?Öğe Predictive significance of inflammatory markers and mGPS in metastatic castration-resistant prostate cancer treated with abiraterone or enzalutamide(Springer, 2024) Göktaş Aydın, Sabin; Kutlu, Yasin; Muğlu, Harun; Aydın, Ahmet; Açıkgöz, Özgür; Hamdard, Jamshid; Karcı, Ebru; Bilici, Ahmet; Ölmez, Ömer Fatih; Yıldız, ÖzcanBackground: Prostate cancer is a prevalent cancer in men worldwide, and castration-resistant prostate cancer (CRPC) is characterized by disease progression despite androgen deprivation therapy. While clinical and prognostic biomarkers have been identified in CRPC, the significance of serum inflammatory markers remains unclear. Materials and methods: This retrospective study included 79 CRPC patients treated with abiraterone or enzalutamide. Inflammatory markers, including the modified Glasgow prognostic score (mGPS), systemic immune-inflammation index (SII), and neutrophil-to-lymphocyte ratio (NLR), were assessed as predictive tools for treatment response. Patient data were obtained from medical charts, and statistical analyses were performed. Results: The median age of the patients was 67 years, with most having a Gleason score of 8–10. The median values for NLR, PLR, and SII were 2.9, 168.5, and 713.5, respectively. The objective response rate (ORR) to abiraterone or enzalutamide therapy was 55.1%. mGPS showed a significant association with ORR, with the mGPS 0 group having the highest response rate (59.5%). Median progression-free survival (PFS) was 12.8 months, and median overall survival (OS) was 35.4 months. Palliative radiotherapy during therapy and PSA doubling time were independent prognostic factors for PFS. Conclusions: mGPS and PSA doubling time significantly impacted survival, and mGPS significantly predicted the treatment response in mCRPC, which may lead to further prospective studies.Öğe Prognostic implications of response to neoadjuvant chemotherapy in breast cancer subtypes(Taylor and Francis Ltd., 2024) Yıldız, Anıl; Bilici, Ahmet; Açıkgöz, Özgür; Hamdard, Jamshid; Basım, Pelin; Çakır, Tansel; Çakır, Aslı; Ölmez, Ömer Fatih; Gezen, Cem; Yıldız, ÖzcanThe current study was designed to assess the response to treatment, as well as clinical and survival outcomes, across different breast cancer subtypes in patients who underwent neoadjuvant chemotherapy (NAC). From 2014 to 2019, a total of 139 patients who were histologically confirmed to have breast cancer, underwent NAC, and subsequently received breast and axillary surgery, were retrospectively included in this study. The rates of pathological complete response (pCR) to NAC were significantly higher for HER2-positive and triple-negative subtypes than for luminal A and HER2-negative subtypes (p = 0.013). Multivariate analysis for disease-free survival (DFS) revealed that tumour grade and the presence of pCR were independent prognostic factors. The presence or absence of a pCR with NAC was an independent prognostic indicator in the multivariate analysis for overall survival (OS). Lastly, achieving a pCR was independently predicted by 18F-FDG PET/CT findings, the HER2-positive subtype, and the triple-negative subtype. Despite the inherent methodological limitations, our findings underscore the significance of identifying predictive markers to tailor NAC plans, with the aim of improving survival outcomes.Öğe Prognostic significance of metastatic lymph node ratio in patients with pN3 gastric cancer who underwent curative gastrectom(Karger, 2019) Bilici, Ahmet; Biricik, Fatih Selçuk; Şeker, Mesut; Öven, Başak Bala; Ölmez, Ömer Fatih; Yıldız, Özcan; Ölmüşçelik, Oktay; Hamdard, Jamshid; Açıkgöz, Özgür; Çakır, Aslı; Kapran, Yersu; Balık, Emre; Öncel, MustafaBackground: Lymph node involvement is an important prognostic factor in patients with gastric cancer. The aim of this study was to determine the prognostic significance of metastatic lymph node ratio (MLNR) and compare it to the number of lymph node metastasis in pN3 gastric cancer. Methods: We retrospectively analyzed 207 patients with pN3 gastric cancer who had undergone radical gastrectomy. Prognostic factors and MLNR were evaluated by univariate and multivariate analysis. Results: An MLNR of 0.75 was found to be the best cut-off value to determine the prognosis of patients with pN3 gastric cancer (p = 0.001). The MLNR was significantly higher in patients with large-sized and undifferentiated tumors, vascular, lymphatic and perineural invasion, and total gastrectomy. In multivariate analysis, MLNR (p = 0.041), tumor differentiation (p = 0.046), and vascular invasion (p = 0.012) were found to be independent prognos-tic factors for disease-free survival, while both MLNR (p <0.001) and pN stage (p = 0.002) were independent prognostic indicators, as was tumor size, for overall survival. There was significant difference with respect to the recurrence patterns between MLNR groups. Lymph node and peritoneal recurrences were significantly higher in patients with MLNR> 0.75 compared to the MLNR <0.75 group (p <0.05). However, recurrence patterns were similar between pN3a and pN3b. Conclusion: Our results showed that MLNR was a useful indicator to determine the prognosis and recurrence patterns of patients with radically resected gastric cancer. Moreover, MLNR is a beneficial and reliable technique for evaluating lymph node metastasis.Öğe Prognostic significance of primary tumor localization in patients with metastatic colorectal cancer: Is it beneficial to select targeted treatment? Real-life experience from Turkey(Zerbinis Publications, 2021) Çakan, Burçin; Açıkgöz, Özgür; Bilici, Ahmet; Demir, Tarık; Öven, Bala Başak; Hamdard, Jamshid; Olmuşçelik, Oktay; Ölmez, Ömer Fatih; Şeker, Mesut; Yıldız, ÖzcanPurpose: The purpose of this study was to investigate the prognostic value,and the effect of primary tumor location on targeted therapy selection in patients with metastatic colorectal cancer (mCRC). Methods: A total of 201 patients with de novo mCRC who received first line treatment were retrospectively analyzed. Clinicopathological features, treatment outcomes, the primary tumor surgery, metastasectomies/local therapies and survivals were evaluated in terms of both RAS mutation status and primary tumor sidedness. Results: Tumor localization showed 140 (69.7%) patients with left-sided and 61 (30.3%) with right-sided tumors. Median progression-free survival (PFS) and overall survival (OS) were significantly shorter in patients with right-sided tumor than those with left-sided tumors (10.1 vs 12.9 months, p=0.005; 25 vs 44.4 months, p=0.008, respectively). In addition,the median OS interval of patients receiving anti-VEGF containing regimen was better than those treated with anti-EGFR containing regimen (50.7 vs. 26.9 months, p=0.001). Multivariate analysis indicated that age (HR:0.41,p=0.045), primary tumor resection (HR:0.41,p=0.037) and primary tumor localization (HR:0.38,p=0.021) for PFS and age (HR:0.39, p=0.09), the presence of BRAF mutation (HR:0.59,p=0.019) and the type of targeted therapy (HR:3.16,p=0.025) for OS were independent prognostic factors. Conclusions: Our results showed that primary tumor location is a prognostic factor in mCRC patients regardless of RAS status. Primary tumor location before treatment decision may be a simple indicator predicting survival and in choosing targeted agent.Öğe Real-life analysis of immunotherapy as the second or later lines treatment in patients with metastatic non-small cell lung cancer(Ankara Society of Hematology and Oncology, 2021) Göktaş Aydın, Sabin; Açıkgöz, Özgür; Kutlu, Yasin; Bilici, Ahmet; Hamdard, Jamshid; Ölmez, Ömer Fatih; Yıldız, ÖzcanBackground: Immunotherapy agents such as atezolizumab and nivolumab are appropriate option for non-small cell lung cancer (NSCLC) accounts in the absence of driver mutation, regardless of PDL-1 expression in second and later line setting. Herein we aimed to evaluate the efficacy and safety of immunotherapy for the second and later line settings in metastatic NSCLC patients as a single center experience. Methods: Totally, 37 patients with metastatic NSCLC who received atezolizumab or nivolumab in the second or later lines were included. Clinicopathological features of patients and survival outcomes were analyzed. The safety profile and the factors that may predict survival were also evaluated. Results: Twenty-nine (78.4%) of patients were men and 8 of patients (21.6%) were woman with median age of 61 years (range:42-80). Atezolizumab was preferred in 22 (59.5%) of these patients and nivolumab in 15 (40.5%) of them. Objective response rate was 35.1%. At a median follow up of 22.5 months, median progression-free survival (PFS) was 4.7 months, median overall survival (OS) was 24.1 months. Univariate analysis for PFS revealed that gender (p=0.03), age (p=0.005), the presence of brain metastasis (p=0.02), PDL-1 status >1% (p=0.035), ECOG PS (p=0.04) and the good response to frontline treatment (p=0.015) were found to be significant prognostic indicators. It also showed that the presence of brain metastasis (p=0.03), PDL-1 status >1% (p=0.027), good response to frontline treatment (p=0.022) and atezolizumab preference (p=0.018) were prognostic factors for OS. Conclusion: Our real-life analysis indicated that atezolizumab and nivolumab improved survivals with good safety profile in second and later lines treatment of metastatic NSCLC patients.Öğe Real-life analysis of immunotherapy as the second or later lines treatment in patients with metastatic non-small cell lung cancer(Elsevier Science Inc., 2021) Aydın, S. G.; Kutlu, Yasin; Açıkgöz, Özgür; Bilici, A.; Hamdard, Jamshid; Ölmez, Ömer Fatih; Yıldız, ÖzcanIntroduction: Non-small cell lung cancer (NSCLC) accounts for the majority of lung cancer and in the absence of driver mutation preferred treatment is incorporation of immunotherapy.But for patients treated with chemotherapy alone,in second line setting atezolizumab or nivolumab are appropriate option regardless of PD -L1 expression.Herein we aimed to evaluate the efficacy and safety of immunotherapy for the second and later line settings in metastatic NSCLC.Öğe Systemic inflammatory markers as a predictors of response to crizotinib in patients with ALK-positive non-small-cell lung cancer(Elsevier Science Inc, 2019) Bilici, Ahmet; Ölmez, Ömer Fatih; Gürsoy, Pınar; Çubukçu, Erdem; Yıldız, Özcan; Sakın, Abdullah; Korkmaz, Taner; Çil, İbrahim; Çakar, Beyhan; Menekşe, Serkan; Demir, Tarık; Açıkgöz, Özgen; Hamdard, JamshidThe significance of the presence of a systemic inflammatory response (SIR) in predicting survival has been demonstrated in patients with cancer. Moreover, neutrophil-to-lymphocyte ratio (NLR), lymphocyteratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) have been also investigated in patients with both early and advanced non-small-cell lung cancer (NSCLC). However, determination of SIR predicting outcomes of patients who are likely to response to crizotinib in ALK-positive NSCLC patients has not been clearly demonstrated.Öğe The conversion ofRASstatus in metastatic colorectal cancer patients after first-line biological agent treatment(Wiley, 2021) Arıcı, Serdar; Hamdard, Jamshid; Sakin, Abdullah; Şengiz Erhan, Selma; Atçı, Muhammed Mustafa; Cekin, Ruhper; Saka, Burcu; Köse, Emin; Saydam, Tuba; Geredeli, Çağlayan; Cihan, Şener; Bilici, AhmetAim The aim was to investigate theRASdiscordance between initial and recurrent metastasectomy specimens in metastatic colorectal cancer (mCRC) patients treated with chemotherapy (CT) plus biological agents in a first-line setting. Methods Patients who had been treated with CT plus bevacizumab or cetuximab or panitumumab followed by R0 resection for potentially resectable colorectal cancer liver metastases were scanned. Among these, patients who developed resectable new metastases after a disease-free interval longer than 6 months were included in the study. We compared theRASmutation status between the first biopsy and the second metastasectomy specimen. Results A total of 82 mCRC patients treated with CT plus biological agents in a first-line setting were included in the study. The first biopsy assessment showed wild-typeRAStumours in 39 (47.6%) patients and mutantRAStumours in 43 (52.4%) patients. The mean time for new operable liver metastasis after R0 resection was 15.5 months. In the second metastasectomy specimens, the numbers of wild-type and mutantRAStumours were 30 (36.6%) and 52 (63.4%), respectively. The comparison with the first biopsy specimens showedRASstatus conversions in 17 (20.7%) patients. Univariate comparison between patients with and withoutRASstatus conversion revealed that grade, pathological T stage, wild-typeRAStumour and longer biological agent use time in the first-line treatment were significant factors forRASconversion. Conclusion Our results suggest that re-biopsy is needed for an optimal second-line treatment decision in mCRC patients regardless of backbone biological agent, especially in patients with wild-typeRASmCRC.Öğe The prognostic role of mismatch repair status and CDX-2 expression with inflammatory markers and pathological risk factors in stage ıı and ııı colon cancer: Multicenter real-life data(2024) Aydın, Sabin Göktaş; Ölmez, Ömer Fatih; Selvi, Oğuzhan; Geredeli, Çağlayan; Özden, Ferhat; Bilici, Ahmet; Açıkgöz, Özgür; Karcı, Ebru; Kutlu, Yasin; Hamdard, Jamshid; Aydın, AhmetObjective: Colorectal cancer is common worldwide, and adjuvant treatment’s benefit is still controversial. We designed this study to determine the role of MSI and CDX-2 status determined by immunohistochemistry (IHC) combined with the inflammatory markers and pathological parameters in predicting disease recurrence in stage II and III colon cancer. Methods: A total of 226 stage II/III colon cancer patients with a median age of 59 years who underwent initial surgery were included in this retrospective study. The pathologic assessment of MSI and CDX-2 was performed twice by immunohistochemistry (IHC) and two different pathologists. No staining/weak staining below 10% of the tumor was accepted as CDX-2 negative, and any MSI clones with weak staining below 10% were accepted as MSI-H. The laboratory parameters were noted at the initial diagnosis. Results: One hundred twenty-one and 105 patients were diagnosed with stage III and II colon cancer. 58.0% of patients were male, 46 (20.4%) of tumor tissue were MSS, and 17 (7.5%) were CDX-2 negative. One hundred twenty-nine tumors were localized in the right colon. Disease recurrence was significantly correlated with tumor localization, CDX-2 status, stage at diagnosis, and preoperatively median CRP and CEA levels. DFS rates for MSS patients with CDX-2 negative and positive were 36.7% and 98.1%, respectively [p < 0.001]. There was no significant correlation between MSI status and CDX-2 status. MSI status, the presence of adjuvant treatment, and systemic inflammatory markers were not significant prognostic factors for DFS. CDX-2 status [HR:0.08, CI 95% 0.03–0.17, p < 0.001 HR: 1.7, CI 95% 1.1–3.0, p = 0.03], disease stage [HR:2.6, CI 95% 1.43–4.74], and preoperatively CEA levels [HR:4.1 CI 95% 2.18–785, p < 0.001 were independent significant prognostic factors for DFS. Conclusion: CDX-2 loss was an independent prognostic factor for DFS and disease recurrence in early-stage colon cancer. MSS patients with CDX-2 loss had significantly worse survival outcomes, and this might be the reason for deciding on adjuvant chemotherapy.Öğe The role of 18F-FDG PET/CT in predicting the neoadjuvant treatment response in patients with locally advanced breast cancer(Karger, 2022) Göktaş Aydın, Sabin; Bilici, Ahmet; Ölmez, Ömer Fatih; Öven, Bala Başak; Açıkgöz, Özgür; Çakır, Tansel; Basım, Pelin; Çakır, Aslı; Kutlu, Yasin; Hamdard, JamshidPurpose: Patients with locally advanced breast cancer (LABC) should be treated with neoadjuvant chemotherapy (NAC). Pathological complete response (pCR) is related to better disease-free survival (DFS). The best strategy for assessing the efficacy of NAC has not been established yet, but several studies have shown that 18F-FDG PET/CT is a potential imaging tool for assessing pCR. The aim of this study is to investigate the merits of 18F-FDG PET/CT imaging in predicting pCR in both axillary and breast tissue and to establish a threshold maximum standard uptake value (SUVmax) for predicting the response after completion of NAC. Methods: A total of 186 LABC patients, treated with an NAC regimen according to tumor subtype, were retrospectively analyzed in this study. All patients underwent 18F-FDG PET/CT imaging before and after completion of NAC. PET parameters were measured in the most FDG avid breast tissue and axillary lymph nodes. We analyzed the correlation between the tumor SUVmax of the PET/CT response and the pCR after surgery. DFS was also evaluated with respect to pCR. Results: Higher pCR rates were significantly associated with a higher tumor grade, an initial Ki-67 >= 20% (p = 0.03 and p = 0.003, respectively), a triple-negative subtype (32.9%), and a human epidermal growth factor receptor 2 (HER-2)-positive subtype (24.7%) (p < 0.001). There was a significant correlation between the pCR and a complete response in 18F-FDG PET/CT (p < 0.001). The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT to determine the pCR after NAC were 100%, 72.2%, 85%, 75.2%, and 100%, respectively. We demonstrated a 1.1 cutoff SUVmax for breast tumors after NAC (OR: 3.94, 95% CI: 1.14-5.05, p = 0.004), the 18F-FDG PET/CT response to NAC (OR: 0.50, 95% CI: 0.25-0.99, p = 0.003), and the molecular subtype of breast tumors (OR: 0.58, 95% CI: 0.38-0.88, p = 0.011). Conclusion: Our results confirm that 18F-FDG PET/CT is a useful method for predicting the NAC response in LABC.Öğe Treatment outcomes and prognostic factors in patients with driver mutant non-small cell lung cancer and de novo brain metastases(Nature Research, 2024) Kahraman, Seda; Karakaya, Serdar; Kaplan, Muhammed Ali; Sezgin Göksu, Sema; Öztürk, Akın; Sucuoğlu İşleyen, Zehra; Hamdard, Jamshid; Yıldırım, Sedat; Şendur, Mehmet Ali NahitCentral 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.
