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Objectives: To compare the second-line treatments on survival after trastuzumab failure in HER2-positive metastatic gastric cancer. Methods: We retrospectively included 57 patients. Of whom, 32 (56%) received paclitaxel, whereas 25 (44%) received 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI). We analyzed the patient characteristics, and survival outcomes of the second-line treatment. Results: The median PFS was 3.5 months in the paclitaxel-group and 4.8 months in the FOLFIRI-group (p=0.569). The median overall survival (OS) was 6.0 months in paclitaxel-group and 11.0 months in FOLFIRI-group (p=0.410). FOLFIRI provided a significant OS advantage over paclitaxel in patients with grade 3 tumors or who did not have an objective first-line treatment response. Conclusion: FOLFIRI may be recommended as a preferred option over paclitaxel in patients with these identified risk factors. [ABSTRACT FROM AUTHOR]

Objectives: Small cell lung cancer (SCLC) is approximately 15% of all lung cancer. Topotecan is the preferred chemotherapy regimen in second-line treatment, but toxicity might be limiting to use in clinical routine. Physicians had more experience on weekly paclitaxel due to its easy access and good responses in many cancers. The present study aimed to examine the management of patients treated with topotecan and weekly paclitaxel as second-line treatment of SCLC. Methods: Patients were divided into two groups due to second-line treatment. The primary endpoint of this study was progression-free survival and overall survival. The secondary endpoint was overall response rate and disease control rate. Results: The median PFS was 4.5 months (Topotecan 3.7 vs. Paclitaxel 5.5, HR = 0.34, 95% CI: 0.30-0.64, p=0.000) and the median OS was 11 months (Topotecan 9.5 vs. Paclitaxel 12.7, HR = 0.25, 95% CI: 0.20-0.45, p=0.000). ORR was 10.2 % in topotecan group and 20.3%% in paclitaxel group (p: 0.047). DCR was 15.5% in patients treated with topotecan and 28.8% in paclitaxel group (p=0.033). Conclusion: The present study compared the currently preferred regimen topotecan with weekly paclitaxel and resulted in better survival and response rates with lower toxicity profile. [ABSTRACT FROM AUTHOR]

Aim: The aim was to investigate the RAS discordance 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 the RAS mutation 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‐type RAS tumours in 39 (47.6%) patients and mutant RAS tumours 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 mutant RAS tumours were 30 (36.6%) and 52 (63.4%), respectively. The comparison with the first biopsy specimens showed RAS status conversions in 17 (20.7%) patients. Univariate comparison between patients with and without RAS status conversion revealed that grade, pathological T stage, wild‐type RAS tumour and longer biological agent use time in the first‐line treatment were significant factors for RAS conversion. 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‐type RAS mCRC. [ABSTRACT FROM AUTHOR]

Background/Aim: Many epidemiological studies describe a relationship between pancreatic cancer (PC) and Diabetes mellitus (DM). However, there are not enough studies investigating the effect of DM on survival of patients with metastatic PC. The purpose of this retrospective study was to investigate the effect of DM and its treatment on survival of patients with metastatic PC who received chemotherapy (CT) as first line treatment. Methods: Patients with metastatic PC who were followed up at the department of medical oncology between 2006 and 2018 were enrolled in this retrospective cohort study. Patients aged 18 years and over, who had metastatic disease at diagnosis and were treated with CT were analyzed. Patients with DM were stratified into two groups based on the history of medical treatments used for DM as follows: Oral antidiabetic (OAD) and OAD + insulin combination. Results: Following results were obtained after analyzing the medical records of 372 patients with metastatic PC, among which 125 (33.6%) had type II DM at the time diagnosis: The median age of the patients was 61 (range: 28-83) years. There were 136 (36.6%) female patients, and the median overall survival (OS) was 9.0 months in patients without DM, and 7.0 months (P=0.023) in those with DM. OS was 8.0 months in diabetic patients using OAD+insulin combination compared to 7.0 months in those receiving OAD (P=0.614) only. Multivariate analysis revealed that the presence of DM [Hazard ratio (HR), 1.43)], Eastern Cooperative Oncology Group Performance Status 3 (HR, 1.62), treatment with gemcitabine+Nab-paclitaxel (HR, 0.29) or folfirinox (HR, 0.46), and CA 19-9 level (HR, 1.01) were factors related to OS. Conclusion: In our study, we observed that the presence of DM adversely affected survival in metastatic PC patients who received CT as first line treatment; however, whether these patients used OAD or OAD+insulin combination did not affect survival. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aims to investigate the factors affecting survival in operated pancreatic ductal adenocarcinoma (PDAC) and the possible prognostic effect of primary tumor localization on treatment outcomes. METHODS: In this study, 98 patients with curatively-operated PDAC, who were followed up and treated for the years 2008 through 2018, were enrolled. Metastatic and locally advanced stages and patients under 18 years of age were excluded from this study. Patients were divided into two groups based on the primary tumor localization as *head or *body/tail. RESULTS: Sixty-seven (68.3%) patients were male and 31 (31.7%) were female, with a median age of 62 years (range, 35-82 years). The numbers of patients with a primary tumor located in *head vs.*body/tail were 74 (75.4%) vs. 24 (24.6%), respectively. Patients with a primary tumor located in *head vs.*body/tail; median disease-free survival was 16.0 months vs. 13 months (p=0.972), respectively, with corresponding median overall survival was 25 months vs. 33 months (p=0.698). The level of carcinoembryonic antigen(CEA) at diagnosis (Hazard ratio[HR], 1.09 95%CI, 1.01-1.18), stage III disease (HR, 2.09 95%CI, 1.16-4.35), and receiving adjuvant treatment (HR, 0.20 95%CI, 0.09-4.34) were the independent predictors of survival. CONCLUSION: Our study revealed that high levels of CEA at diagnosis and stage III disease adversely affected the survival in non-metastatic PDAC patients, while receiving adjuvant therapy had a positive effect on survival. The findings suggest that primary tumor localization did not affect survival in operated PC patients. The results on this issue are still inconsistent and under debate in the literature. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Squamous cell esophageal cancer (ESCC) is a highly fatal malignancy. This study aims to investigate the factors affecting survival in patients with metastatic and non-metastatic ESCC. METHODS: Between 2008 and 2016, 107 patients with ESCC who were followed up in an oncology clinic were included in the analysis. Patients were grouped based on the stage of disease as clinical-stage II to IV. RESULTS: Of the 107 patients, 55 (55.1%) of them were male and 52 (48.6%) of them were female. The mean age was 60.8 years. Based on the clinical-stage, 28 (26.2%) patients had stage II disease, 33 (30.8%) had stage III disease, and 46 (43.0%) had stage IV disease. Twenty-nine (27.1%) patients with the non-metastatic disease underwent surgery following neoadjuvant chemoradiotherapy (CRT), while 29 (27.1%) patients received definitive CRT. Twenty-six (56.5%) patients with metastatic disease received chemotherapy (CT). While median overall survival (mOS) could not be reached in patients who underwent surgery following neoadjuvant CRT, mOS for patients receiving definitive CRT versus patients treated with surgery alone-was 22.0 months and 24.0 months, respectively (p=0.008). In the metastatic stage, mOS was 8.0 months for the patients treated with a first-line CT and 3.0 months for patients receiving best supportive care (p<0.001). In multivariate analysis, factors predicting survival in patients with the non-metastatic disease were ECOG PS 3-4 (Hazard ratio [HR], 6.13), undergoing surgery (HR, 0.22), clinical-stage III disease (HR, 3.19), and presence of recurrence (HR, 24.12). For patients with metastatic disease, ECOG PS 3-4 (HR, 3.31), grade-III histology (HR, 3.39), liver metastasis (HR, 2.53), and receiving CT (HR, 0.15) were the factors associated with survival in multivariate analysis. CONCLUSION: In our study, surgery and early clinical-stage increased survival, whereas experiencing recurrence adversely affected survival in non-metastatic ESCC. In the metastatic stage, ECOG PS 3-4, grade-3 histology and liver metastasis adversely affected survival, while receiving CT significantly improved survival. [ABSTRACT FROM AUTHOR]

Mucinous colorectal adenocarcinoma (MCAC) is a distinct subtype of colorectal carcinoma (CRC). The prognostic and predictive significance of mucinous histology remains controversial. It was aimed to investigate the prognostic and/or predictive role of mucinous histology in left-sided metastatic CRC (mCRC) with wild-type RAS. This is a retrospective multicenter study of mCRC treated with first line anti-EGFR combined 5-fluorouracil based chemotherapy (CT). Patients were stratified according to presence (>50% extracellular mucin) or absence of mucinous histology. Survival analyses were performed firstly regardless of treatment options and then performed as separating according to CT regimens. Additional analyses were performed for MCAC patients considering backbone CT regimens. A total of 125 patients were included, consisting of 40 (32.0%) patients with MCAC and 85 (68.0%) patients with non-MCAC. Median follow-up time was 19.7 months. Median progression-free survival (PFS) was 10.7 months in all patients, and PFS was lower in MCAC than non-MCAC (9.9 vs. 12.0 months, respectively, P=0.005). Median overall survival (OS) was 25.7 months in all patients. OS was lower in MCAC than non-MCAC (22.8 vs. 29.7 months, respectively, P=0.005). When considering backbone CT regimens, in multivariate analyses, mucinous histology was an independent prognostic factor for OS in both for mFOLFOX6 (HR: 1.92, P=0.04) and FOLFIRI (HR: 2.04, P=0.04) groups and was associated with poor PFS in only mFOLFOX6 (HR: 3.86, P<0.001) group. When outcomes were analyzed for the MCAC group, median OS of MCAC patients receiving mFOLFOX6 and FOLFIRI was 22.47 and 14.22 months, respectively (P=0.41). Median PFS of MCAC patients receiving mFOLFOX6 and FOLFIRI was 10.15 and 8.11 months, respectively (P=0.73). The study revealed poor prognosis of mucinous histology, both in whole study population and in backbone CT groups. Moreover, lower PFS of MCAC patients was revealed in only mFOLFOX6 group and this finding may be a valuable issue for the future research. However, considering all analyses, the present results did not indicate a special benefit of any backbone CT regimen for MCAC patients. [ABSTRACT FROM AUTHOR]

Retroperitoneal sarcomas (RPS) account for approximately 15% of all soft tissue sarcomas (STS) and encompass a heterogeneous group of tumors with limited multimodality treatment options. Surgical resection with negative margins remains the standard primary treatment for patients with localized RPS. In this multicenter study, we aimed to demonstrate the real-world data on factors affecting survival in RPS treated with upfront surgery. We included a total of 197 patients who underwent curative-intent resection of a primary non-metastatic RPS between 2000-2020 at ten experienced medical oncology departments in Turkey. The median follow-up was 33 months. The median age of patients was 53 years, 57.4% of patients were female. Univariate analysis revealed that; tumor size, grade, necrosis, resection margin status, were factors affecting recurrence-free survival (RFS) (p= 0.002, p= 0.044, p= 0,024, p= 0.003 respectively). Age, tumor size, stage, resection margin status were factors affecting overall survival (OS) (p= 0.038, p= 0.001, p= 0.032, p< 0.001, respectively). In multivariate analysis, tumor size and resection margin status were independent factors affecting RFS and OS (all p-values < 0.05). Our study demonstrated that tumor size, and resection margin status were the main factors affecting survival in resected RFS. In comparison, adjuvant chemotherapy (CT), radiotherapy (RT), or multimodality treatment did not show OS and RFS advantages. We believe that advances in the molecular characterization of these tumors might help clinicians to detect the best candidates for adjuvant therapies in RPS. [ABSTRACT FROM AUTHOR]

Some retrospective studies in different populations have evaluated the prognostic value of microsatellite instability status (MSI) in patients with gastric cancer (GC). A small number of studies have focused on the effect of MSI status on the outcome of GC patients who have received adjuvant chemotherapy (CT). Medical records of 318 patients with stage II or III GC who had been treated with adjuvant CT after D2 gastrectomy between 2016 and 2019 were scanned. Eligible patients were divided into two groups: MSI-H and microsatellite stable (MSS). The determinant factors were examined using Cox regression analysis. A statistical significance level of alpha was accepted as p < 0.05. The study included 207 GC patients and 21 (10.1%) MSI-high patients. A median disease-free survival was not reached (95% CI NR) in MSI-H patients, whereas a median disease-free survival was 30 months in MSS patients (95% CI 24.3-35.6) (p= 0.046). A median overall survival (OS) was not reached in MSI-H patients, whereas a median overall survival of 46 months (95% CI: 28.8 - 60.1) was reached in MSS patients (p= 0.032). In the multivariate Cox regression analysis for OS, female gender and MSI-H status were positive predictors of OS, whereas stage III disease negatively affected OS (p= 0.009, p= 0.030, and p= 0.009, respectively). Microsatellite instability status may be a prognostic factor in stage II and III Turkish GC patients who have received adjuvant oxalip..based CT. [ABSTRACT FROM AUTHOR]

Fluoropyrimidine+cisplatin/oxaliplatin+trastuzumab therapy is recommended for the first-line treatment of HER2-positive metastatic gastric adenocarcinoma. However, there is no comprehensive study on which platinum-based treatment should be preferred. This study aimed to compare the treatment response and survival characteristics of patients with HER2-positive metastatic gastric or gastroesophageal junction (GEJ) cancer who received fluorouracil, oxaliplatin, and leucovorin (mFOLFOX)+trastuzumab or cisplatin and fluorouracil (CF)+trastuzumab as first-line therapy. It was a multicenter, retrospective study of the Turkish Oncology Group, which included 243 patients from 21 oncology centers. There were 113 patients in the mFOLFOX+trastuzumab arm and 130 patients in the CF+trastuzumab arm. The median age was 62 years in the mFOLFOX+trastuzumab arm and 61 years in the CF+trastuzumab arm (P = 0.495). 81.4% of patients in the mFOLFOX+trastuzumab arm and 83.1% in the CF+trastuzumab arm had gastric tumor localization (P = 0.735). The median progression-free survival (PFS) was significantly higher in the mFOLFOX+trastuzumab arm (9.4 months vs. 7.3 months, P = 0.024). The median overall survival (OS) was similar in both groups (18.4 months vs. 15.1 months, P = 0.640). Maintenance trastuzumab was continued after chemotherapy in 101 patients. In this subgroup, the median OS was 23.3 months and the median PFS was 13.3 months. In conclusion, mFOLFOX+trastuzumab is similar to CF+trastuzumab in terms of the median OS, but it is more effective in terms of the median PFS in the first-line treatment of HER2-positive metastatic gastric and GEJ cancer. The choice of treatment should be made by considering the prominent toxicity findings of the chemotherapy regimens.

Purpose: This study aimed to assess the effect of pretreatment albumin-bilirubin (ALBI) score on treatment outcomes in pancreatic cancer (PC) patients with liver metastasis at the time of diagnosis treated with chemotherapy (CT) in the first-line setting., Methods: This was a retrospective study of 273 PC patients ≥18 years of age who had liver metastasis at the time of diagnosis and received CT in the first-line. ALBI score was calculated through the following formula; [(log10 bilirubin (μmol/L)×0.66)+[albumin(g/l)×-0.0852]. Patients were stratified into 3 categories based on the ALBI score as follows; grade I:ALBI ≤-2.60, grade II:-2.60-1.39., Results: A total of 273 patients, [180 (65.9%) men and 93 (34.1%) women], were evaluated. The median age was 60 years. ALBI grade was I in 45 (16.4%) patients, II in 156 (57.1%) patients, and III in 72 (26.5%) patients. Based on the ALBI grade, median progression-free survival (mPFS) was 9 months in grade I patients, 6 months in grade II patients, and 4 months in grade III patients (p=0.002), with median overall survival (mOS) durations of 12 months vs. 8 months vs. 5 months, respectively (p<0.001). Multivariate analysis showed that ALBI grade II (HR,1.543) or III (HR,2.260) negatively affected survival., Conclusion: A higher pretreatment ALBI grade is related to worse OS and PFS in PC patients with liver metastasis treated with a first-line CT, and therefore it can help predict the treatment outcomes in these patients.

Objective: Squamous cell esophageal cancer (ESCC) is a highly fatal malignancy. This study aims to investigate the factors affecting survival in patients with metastatic and non-metastatic ESCC., Methods: Between 2008 and 2016, 107 patients with ESCC who were followed up in an oncology clinic were included in the analysis. Patients were grouped based on the stage of disease as clinical-stage II to IV., Results: Of the 107 patients, 55 (55.1%) of them were male and 52 (48.6%) of them were female. The mean age was 60.8 years. Based on the clinical-stage, 28 (26.2%) patients had stage II disease, 33 (30.8%) had stage III disease, and 46 (43.0%) had stage IV disease. Twenty-nine (27.1%) patients with the non-metastatic disease underwent surgery following neoadjuvant chemoradiotherapy (CRT), while 29 (27.1%) patients received definitive CRT. Twenty-six (56.5%) patients with metastatic disease received chemotherapy (CT). While median overall survival (mOS) could not be reached in patients who underwent surgery following neoadjuvant CRT, mOS for patients receiving definitive CRT versus patients treated with surgery alone-was 22.0 months and 24.0 months, respectively (p=0.008). In the metastatic stage, mOS was 8.0 months for the patients treated with a first-line CT and 3.0 months for patients receiving best supportive care (p<0.001). In multivariate analysis, factors predicting survival in patients with the non-metastatic disease were ECOG PS 3-4 (Hazard ratio [HR], 6.13), undergoing surgery (HR, 0.22), clinical-stage III disease (HR, 3.19), and presence of recurrence (HR, 24.12). For patients with metastatic disease, ECOG PS 3-4 (HR, 3.31), grade-III histology (HR, 3.39), liver metastasis (HR, 2.53), and receiving CT (HR, 0.15) were the factors associated with survival in multivariate analysis., Conclusion: In our study, surgery and early clinical-stage increased survival, whereas experiencing recurrence adversely affected survival in non-metastatic ESCC. In the metastatic stage, ECOG PS 3-4, grade-3 histology and liver metastasis adversely affected survival, while receiving CT significantly improved survival., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (Copyright: © 2020 by Istanbul Northern Anatolian Association of Public Hospitals.)

Purpose: Local treatments for isolated synchronous or metachronous liver metastases in colorectal cancer (CRC) have been shown to improve overall survival (OS). The aim of this study was to investigate the factors affecting OS in CRC patients with isolated liver metastasis in whom the primary tumor and corresponding liver metastasis were treated with curative intent using local ablative or surgical methods., Methods: A total 47 surgical operated CRC patients presenting with an initial or subsequent isolated liver metastasis, who were treated with local surgical or ablative treatment for liver metastasis with curative intent, were enrolled in this study between 2007 and 2017. The possible factors affecting OS were analyzed., Results: Of the 47 patients, 35 (74.5%) were male. The median age was 61 (25 - 80) years. Thirty-four (72.3%) patients underwent liver metastasectomy, while 13 (27.7%) patients were treated with non-surgical local ablative therapies (NSLAT) for liver metastasis. Median OS (mOS) could not be reached in patients who underwent metastasectomy at the time of diagnosis compared to 55 months in those undergoing metastasectomy following a chemotherapy period (p = 0.03). Patients treated with NSLAT had a mOS of 60 months compared to ''not reached'' in those who underwent liver metastasectomy (p = 0.45). mOS was higher in patients with pT4 stage vs. with