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Background/Aim: Fabry disease is an X-chromosome inherited disease, which constitutes a rare disease group. Fabry disease has a wide spectrum of symptoms and some of these symptoms that are seen in other diseases. Familial Mediterranean fever (FMF) is a common disease in countries along the Mediterranean coast, including our country. Although typical episodes of recurrent high fever and abdominal pain occur, patients can also present with nonspecific symptoms and signs. This study aimed to investigate the presence of Fabry disease in patients with FMF. Methods: Information about this cohort study was given to all patients who were followed up with a diagnosis of FMF. Those who agreed to sign the informed consent form were included in the study. Fabry disease screening was performed by galactosidase alfa (GLA) gene analysis in female patients and by examining lysosomal alpha galactosidase A (AGALA) enzyme activity in male patients. When enzyme activity was found to be low in male patients, a GLA gene analysis was also performed. Results: Fabry disease was screened in a total of 189 patients with familial Mediterranean fever, and it was not detected in any of our patients. Low AGALA enzyme activity was detected in approximately 20% of the male patients. In the GLA gene analysis performed on these patients, any genetic mutation that could be associated with Fabry disease was not detected. Conclusion: People with Fabry disease or FMF can present with common symptoms, such as arthritis, proteinuria, and abdominal pain. In our study, Fabry disease was not found in any of patients who had a diagnosis of FMF. However, only a few publications on this subject are available. In studies conducted in our country and around the world, it has been shown that GLA gene mutations that may cause Fabry disease can be detected in patients with FMF. However, such a mutation was not detected in our study.

Ibrutinib is a Bruton tyrosine kinase inhibitor used in the treatment of chronic lymphocytic leukemia (CLL). Panitumumab, an mAb for epidermal growth factor receptor, is used in the treatment of metastatic colorectal cancer (CRC). We wanted to present our case where we used ibrutinib and panitumumab in combination in a patient with metachronous CLL and CRC. A 58-year-old male patient with a diagnosis of CLL was receiving ibrutinib treatment and primary rectal cancer was detected. FOLFOX + panitumumab were started when metastasis was detected in the lung after neoadjuvant chemoradiotherapy for rectal cancer. The patients used ibrutinib and panitumumab in combination. There was no cumulative or unexpected toxicity due to the combination of both antineoplastic agents. The most important point to be considered in the use of combined drugs is the evaluation of drug-drug interactions. Toxic effects of the combination of ibrutinib and cetuximab have been reported in a patient with metastatic CRC. We used ibrutinib together with panitumumab in our case and we did not encounter any cumulative or unexpected side effects during the treatment.

ÖZET Timomalar ve timik karsinomlar genellikle ön mediasten yerleşimli timus kökenli nadir görülen tümörlerdir. İlk tanı anındaki evre ve timik tümörün cerrahi olarak tam çıkarılabilmesi en önemli prognostik faktörlerdir. Hastaların evresine göre neoadjuvan/adjuvan kemoterapi ve radyoterapiyi içeren tedavi stratejileri multidisipliner tümör konseylerinde planlanmalıdır. Ancak, lokal tedavilere rağmen hastaların az bir kısmında zaman içinde nüks gelişebilmekte veya daha ilk tanı anında metastaz saptanabilmektedir. Lokal tedavilere uygun olmayan hastalarda platin ve doksorubisin ile kombine kemoterapi rejimleri standart birinci basamak tedavidir. Ancak ikinci basamakta kesin kabul görmüş bir tedavi önerisi yoktur. Birinci basamak tedavi sonrası progresyon gelişen hastalarda vasküler endotelyal büyüme faktörünü hedefleyen tirozin kinaz inhibitörleri ve immünoterapiler ile yapılan çalışmaların sonuçları yakın zamanda açıklanmıştır. Bu derlemede, timoma ve timik karsinomlu hastaların genel olarak tedavi yönetimini, hedefli tedavilerin ve immünoterapi çalışmalarının sonuçlarını ve güncel pratiğe potansiyel yansımalarını analiz ettik. Anahtar Kelimeler: Hedefleyici tedaviler, immünoterapi, timik karsinom, timoma

Aim To evaluate the difference of progression free survival between the patients using concomitant proton pump inhibitors and non-users in the patients using CDK 4/6 inhibitors with HR + and HER2 negative mBC. Methods We included 86 patients with HR + and HER 2 negative mBC treated with CDK 4/6 inhibitors in this study. Patients were divided into two categories according to their status of PPI use. The primary end points was progression free survival(PFS). We compared PPI users and non-users. Results Forty-five (52.3%) patients used a PPI concomitantly with a CDK 4/6 inhibitor, and 41 (47.7%) did not. The median duration of follow-up was 10.68 (1.94–27.56) months. Of the patients; 50 (58.1%) palbociclib and 36 (41.9%) received ribociclib. The median progression free survival (mPFS) was 10.9 months (95% CI: 7.5-14.27) in the group with concomitant PPI use with a CDK 4/6 inhibitor, whereas the median progression free survival could not be reached in the group without concomitant PPI use (p = 0.04). In addition, concomitant PPI use with palbociclib was associated with a shorter PFS, there was no significant difference between the concomitant PPI users and non-users in terms of PFS in the patients using ribociclib. Conclusion Palbociclib and ribociclib are weak base drugs so their bioavailability is pH-dependent. PPIs can affect their solubility and their concentration in the plasma. Therefore we must avoid concomitant use of PPIs and CDK 4/6 inhibitors. If we need to use concomitant PPI and CDK 4/6 inhibitors, we should prefer ribociclib than palbociclib.

Objective: The effect of the COVID-19 pandemic on mental health in the long term is unclear. We evaluated severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)–related transmission fear and mental-health disorders in populations at high risk for COVID-19. Materials and Methods: Healthcare workers and patients with primary immunodeficiency disorders (PIDs), severe asthma, malignancy, cardiovascular disease, hypertension, and diabetes mellitus were included in the study. The hospital anxiety and depression scale (HADS) and Fear of Illness and Virus Evaluation (FIVE) scales were applied during face-to-face interviews. Results: There was a total of 560 participants, 80 per group; 306 (55%) were female. The FIVE and HADS-A scale scores of health care workers were significantly higher than the other groups (p = 0.001 and 0.006). The second-highest scores were in patients with PID. There was no significant difference between the groups in HADS-D scores (p = 0.07). There was a significant positive correlation between FIVE scale scores and anxiety (r = 0.828; p < 0.001) and depression (r = 0.660; p < 0.001). The FIVE scale had significant discriminatory power for anxiety (AUC = 0.870, 95% confidence interval [CI] = 0.836–0.904; p < 0.0001) and depression (area under the curve = 0.760, 95% CI = 0.717–0.803; p < 0.0001). Conclusion: During the COVID-19 pandemic, mental-health disorders may develop in patients with comorbidities, especially healthcare workers. They should be referred to mental-health centers. Keywords: Asthma, COVID-19, fear of virus transmission, mental health, primary immunodeficiency

Introduction Pazopanib is an agent that is being successfully used in soft tissue sarcomas. Some endocrine side effects may develop during pazopanib treatment. Here, we presented a case diagnosed with secondary adrenal insufficiency while being investigated for etiology of hypoglycemia which developed after pazopanib. Case report A 69-year-old male patient was operated in June 2019 due to a lung mass 26 × 18 × 10 cm in size. Pathological diagnosis revealed a solitary fibrous tumor with malignant behavior. The patient received three lines of chemotherapy. After pazopanib treatment, a hypoglycemic attack was reported. Management and outcome: Blood cortisol and ACTH (Adrenocorticotropic hormone) levels were not increased at the time of the hypoglycemic attack, and levels of other pituitary hormones were found to be normal. Electrolyte levels were in normal range. Since the counteracting hormone did not reach a sufficient level, it was considered secondary adrenal insufficiency. Hypoglycemic attacks did not occur during follow-up while taking steroid therapy and pazopanib. Discussion A single case of primary adrenal insufficiency has been reported in the literature. We here present a case who developed hypoglycemia after pazopanib and was diagnosed with drug-associated secondary adrenal insufficiency. When hypoglycemia develops during pazopanib treatment, we must be aware of adrenal insufficiency.

Introduction Regorafenib, a receptor tyrosine kinase inhibitor, is a routinely used targeted agent in the current treatment of patients with refractory metastatic colorectal carcinoma (mCRC). The aims of this study were to detect the presence of bowel wall edema during regorafenib treatment via computed tomography (CT) and to assess the relationship between survival and regorafenib-induced bowel wall edema in patients with mCRC receiving regorafenib. Patients and methods We retrospectively evaluated the presence of bowel wall edema on CT of 25 mCRC patients who received regorafenib and analyzed its relationship with progression free survival (PFS) and overall survival (OS). Results Among the 25 patients, 25 had small bowel wall edema (SBWE) and 14 had large bowel wall edema (LBWE) on at least one CT examination. The median SBWE value was 4.85 milimeters (mm). Of the 25 patients, 14 had SBWE ≤4.85 mm and 11 had SBWE >4.85 mm. Regorafenib intolerance was significantly higher at SBWE >4.85 mm patients (p = 0.03). The median PFS was 4.6 months (95% CI: 2.4–6.8) and median OS was 9.3 months (95% CI: 3.1–15.4). Median PFS and OS were shorter in patients with SBWE > 4.85 mm than in those with ≤4.85 mm, but not statistically significant (median PFS: 3.9 vs 4.6 months, p: 0.523; median OS: 5.6 vs 9.3 months, p: 0.977). Conclusions Regorafenib caused SBWE in patients with mCRC. Patients who developed more SBWE had a higher regorafenib intolerance and a shorter survival. Further studies are needed to confirm the predictor value of SBWE on the survival outcomes of patients with mCRC receiving regorafenib.

Introduction: Although several clinical factors which show the benefit of adjuvant chemotherapy (AC) in early-stage colon cancer use for evaluating the risk of relapse, there is no consensus on which risk factors are more reliable. In this study, we evaluated both the utility of MSI and the daily practice of the Turkish oncologists in stage II and III colon cancer. Material and method: We conducted an online questionnaire which was consisting of twenty questions including the treatment choices and duration about stage II-III colon cancer depending on sidedness and risk factors for relapse. Results: More than 65% of the oncologists declared the use of MSI testing in stage II colon cancer without considering any risk factors. In stage 3 colon cancer oncologists had an equal decision "to do or not to do" in MSI testing. More than 50% of the oncologists had preferred XELOX protocol in high-risk stage II (T4N0) colon cancer, while three out of four preferred observation in low-risk stage II (T3N0) patients without risk factors. Two-thirds of the oncologists had preferred 6 months of treatment in stage II colon cancer with at least one risk factor. Conclusion: Turkish oncologists participating to this trial had declared conflicting results about adjuvant treatment in early-stage colorectal cancer in their daily practice compared with the updated guidelines, especially, MSI evaluation utility in stage III colon cancers, adjuvant chemotherapy (AC) duration, and oxaliplatin adding to AC in elderly and stage II patients. WOS:000587097600001 33159235

Amaç: Bu çalışmanın amacı; hastanemizde istenen iç hastalıkları konsültasyonlarının retrospektif olarak incelenmesi ve konsültas-yon istemlerindeki eksikliklerin saptanmasıdır. Materyal ve Metot: 01.09.2017 – 31.10.2017 tarihleri arasında acil servis ve diğer yatan hasta kliniklerinden istenen iç hastalıkları konsültasyonları kayıtlar üzerinden retrospektif olarak incelendi. Hastaların demografik verileri ve konsültasyon istem metinleri kaydedildi. Dört soru ile konsültasyon metinleri yeterlilik açısından değerlendirildi ve puanlandı.Bulgular: 2 aylık sürede toplam 416 konsültasyon cevaplanmıştı. 172 acil servis, 244 diğer servislerdi. Yaş ortalaması acil servis için 62,7, diğer servisler için ise 61,8 idi. Nefroloji her iki grupta da en sık konsültasyon istenen iç hastalıkları yan dalı idi. Konsültasyonların %68 gibi büyük bir çoğunluğu ilk 1 saat içeris-inde sonuçlandırılmıştı. Hastaların %53,5’i için yatış kararı verild-iği görüldü. Her iki grupta da değerlendirme puanlarına bakıldığın-da konsültasyon istem metinlerinin yetersiz olduğu görüldü.Sonuç: Konsültasyon istem metinleri genel olarak yetersiz olup ilgili hekimleri yeterli olarak bilgilendirmemektedir. Danışılan hasta hakkında yeterli bilgi sahibi olmayan konsültan hekimin hasta hakkında doğru karar vermesi zorlaşmaktadır. Bu sebeple konsültasyon istem metinlerinin düzeltilmesi çok önemlidir., Objective: The aim of this study is; retrospectively examining the required internal medicine consultations in our hospital and deter-mining the deficiencies in the consultation requests.Materials and Meyhods: Between 01.09.2017 and 31.10.2017, the internal medicine consultations requested from emergency services and other inpatient clinics were retrospectively reviewed. Demographic data of the patients and the request for consultation were recorded. In four questions, the consultation texts were eva-luated and scored for proficiency.Results: A total of 416 consultations were answered within 2 months. 172 emergency services, 244 other services. The mean age was 62,7 for the emergency services and 61,8 for the other services. Nephrology was the most frequently consulted internal medicine in both groups. A large majority of 68% of the consulta-tions were concluded in the first 1 hour. 53.5% of the patients were admitted to hospital. When the evaluation scores were evalua-ted in both groups, it was seen that the request for consultation was insufficient.Conclusion: Consultation documents are generally inadequate and do not adequately inform physicians. It is difficult for the consul-tant who does not have enough information about the patient to make a correct decision about the patient. For this reason, it is very important to develop consultation request texts.

DRESS (Drug Reaction with Eosinophilia and systemic symptoms) syndrome is thought to be a cause severe organ dysfunction syndrome. It is due to insufficient detoxification of drugs. When DRESS cases are screened, it is usually seen to be linked to antiepileptic drugs. Antibiotics can make DRESS syndrome even more rarely. We showed that with this case, DRESS may develop due to all drugs., DRESS (Drug Reaction With Eosinophilia And Systemic Symptoms) sendromunun ciddi organ işlev bozukluklarına yol açan bir sendrom olduğu düşünülmektedir. İlaçların yetersiz detoksifikasyonuna bağlıdır. DRESS vakaları tarandığında genellikle antiepileptik ilaçlara bağlı olduğu görülmektedir. Antibiyotikler ise daha nadir de olsa DRESS sendromu yapabilir. Biz bu vaka ile tüm ilaçlara bağlı DRESS gelişebileceğini göstermek istedik.

In this study, we aimed to evaluate the prognostic significance of adipose tissue distribution and metabolic activity in PET/CT to predict survival in patients with metastatic colorectal cancer (mCRC).The volume, density (HU), and FDG uptake (standardized uptake value (SUV)) of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and maximum FDG uptake of the tumor tissue were measured. Subcutaneous adipose tissue of volume-to-density ratio (SAT ratio) was calculated.The median OS for the patients with SAT ratio value -1.1 and ≥ -1.1 were 38.5 (95% CI 31.54-45.58) and 24.5 (95% CI 14.13-34.93) months, respectively (p = 0.05). During follow-up, 69 patients experienced disease progression. The median progression-free survival (PFS) was 11.03 months (95% CI: 9.11-12.95). Median PFS for patients with tumor SUV max value 11.5 and ≥ 11.5 were 9.2 (95% CI 7.25-11.27) and 12.6 (95% CI 10.02-15.27) months, respectively (p = 0.14). Forty-eight patients received bevacizumab therapy. VAT SUV mean (HR: 0.09; 95% CI 0.01-0.52, p = 0.008) was significantly associated with PFS in patients receiving bevacizumab. SAT ratio was the significant parameter for the OS (HR: 0.58; 95% CI 0.33-1.01, p = 0.05) and PFS (HR: 1.99; 95% CI 1.02-3.91, p = 0.043).SAT ratio was an independent prognostic factor for survival in patients with mCRC. Higher SAT volume is correlated with longer survival in mCRC patients.

Purpose: We compared the efficacy of first-generation granisetron and second-generation palonosetron in triplet anti-emetic prophylaxis in patients with non-small cell lung cancer (NSLC) receiving cisplatin-based high emetogenic chemotherapy (HEC).Methods: This prospective, multicenter, non-randomized, observational study was conducted between June 2018 and December 2021. Patients diagnosed with NSCLC who received triplet anti-emetic prophylactic treatment with aprepitant and dexamethasone plus granisetron or palonosetron before the first cycle of chemotherapy were included in the study.At the end of the first week after chemotherapy, the emesis scale was applied to the patients during the outpatientcontrol. The primary endpoint was complete response (CR) and total control (TC).Results: One hundred twenty-one patients were included in the study. Sixty-one patients were in the granisetron group and 60 patients were in the palonosetron group. CR was higher with granisetron in the acute phase (70.5% vs. 58.3%, p=0.16; respectively) and higher with palonosetron in the delayed phase (61.7% vs. 55.7%, p=0.5; respectively), although not statistically significant. The TC rates were also not significantly different between the groups (54.1% vs.57.6%, p=0.69). Conclusion: There was no significant difference between granisetron and palonosetron in both acute and delayed control of emesis in NSCLC patients receiving cisplatin-based HEC.

Introduction Leukocytoclastic vasculitis is a histopathological term describing vasculitis in which the inflammatory infiltrate in small vessels consists of neutrophils. Although FLOT is given perioperatively in locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma, it has recently become a popular treatment option for metastatic cancers. In this case report, we present a case of FLOT-induced LCV. Case Report We present a 52-year-old patient with metastatic gastric adenocarcinoma treated with FLOT. The patient developed necrotizing vasculitis in the lower extremity after 5 cycles of FLOT. Management & Outcome After discontinuation of the FLOT regimen, the necrotizing morbid LCV gradually regressed with steroid therapy. Discussion To the best of our knowledge, our case is the first case of LCV that developed after FLOT chemotherapy. The clinical appearance of the patient, occurrence after chemotherapy, erythematous rash developing on bilateral lower extremities, and palpable purpuric vasculitis made us suspect. We found a potential relationship between FLOT and vasculitis according to the Naranjo scale (score 4 + ).

Introduction Cyclin-dependent kinase (CDK) 4/6 inhibitors have shown a different adverse effect. In this case, persistent grade 3 hepatoxicity was observed after ribociclib. Therefore, ribociclib therapy was stopped, and then palbociclib was introduced. Transaminase levels returned to normal by switching to palbociclib therapy. Case report 71-year-old postmenopausal female patient with luminal subtypes of metastatic breast cancer treated with ribociclib. Management & outcome Grade 3 hepatotoxicity secondary to ribociclib developed. She was successfully treated with palbociclib 125 mg. Discussion In our case, palbociclib was started with a full dose, to increase treatment success. Starting with a 125 mg dose was not cause any toxicity. Nevertheless, laboratory follow-up is required in terms of neutropenia and increased transaminases.

Tripe palm is a rare cutaneous paraneoplastic syndrome that can be overlooked and frequently appears with acanthosis nigricans. If tripe palm and acanthosis nigricans occur in a patient together, gastric cancer should come to mind. A 50-year-old female patient had signs of abdominal pain and velvety thickening in the palms and soles. Tripe palm and acanthosis nigricans were considered as paraneoplastic syndrome after other benign causes were excluded. It was determined that the underlying malignancy was gastric cancer. After neoadjuvant FLOT chemotherapy regimen, gastrectomy was performed, and the patient received adjuvant chemotherapy. With the recognition of tripe palm, a rare cutaneous paraneoplastic syndrome, patients can be diagnosed and treated early.

Backgrounds: We aimed to investigate whether the HALP score is a predictive marker in patients with recurrent GBM who were given bevacizumab plus irinotecan.Methods: We compared the survival of patients followed up in our clinic with the diagnosis of recurrent GBM and treated with bevacizumab plus irinotecan, according to HALP score.Results: Median PFS and OS were 4.5 (0.9-14.9) and 8 (0.9-21.3) months, respectively. The median PFS of the low HALP score group was 1.85 (1.3-3.37) months, and of the high HALP score group was 4.96 (0.9-14.9) months (p=0.03). The OS of the high HALP score group (9.63 [7.28-11.9]) was statistically higher compared with low HALP score group (2.26 [0.88-3.65]) (pp<0.001). Conclusion: We showed that the HALP score at the start of treatment is an independent prognostic factor for PFS and OS in patients with recurrent GBM treated with bevacizumab plus irinotecan. The HALP score, which can be easily calculated by routine tests before chemotherapy, can be used as a predictive marker for bevacizumab treatment decision.

Introduction Trastuzumab emtansine (TDM-1) is an antibody–drug conjugate effective in human epidermal growth factor receptor-2 - expressing advanced breast cancer. Pulmonary complications of TDM-1 are rarely reported. TDM-1-associated interstitial lung disease is referred to as pneumonitis. Case report A 47-year-old female patient who underwent modified radical mastectomy and axillary lymph node dissection operations due to a palpable mass in the right breast and axillary region. The patient who had received multiple chemotherapy was last receiving TDM-1 treatment. Fatigue, dyspnea, and tachypnea were detected for the first time on 20 days after the 6th treatment. Menagement and outcome In our case, we first considered metastasis, pneumonia and fungal infection based on radiological findings, but the lack of response to the treatments and the results of the investigations suggested drug-induced pneumonia and steroid treatment was started. Our case had a complete radiological recovery and complete response to sterod therapy. In such cases, it is important to first exclude infections and metastasis. In cases of drug-induced pneumonia, the first treatment option is systemic corticosteroids and generally responded well. Discussion Unlike other cases of interstitial pneumonia, lung imaging of our case was resembling a metastasis, pneumonia and fungal infection. With increasing use of TDM-1, we will have more experience in both efficacy and complications of TDM-1. Although TDM-1 is a well-tolerated drug, clinicians should be aware of rare pulmonary complications and prepared to respond appropriately.

Purpose: In this study, we aimed to evaluate prognostic significance of adipose tissue distribution and metabolic activity in PET/CT to predict survival in patients with metastatic colorectal cancer (mCRC).Methods: The volume, density (HU) and FDG uptake (standardized uptake value-[SUV]) of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and maximum FDG uptake of the tumor tissue were measured. Subcutaneous adipose tissue of volume-to-density ratio (SAT ratio) was calculated.Results: The median OS for the patients with SAT ratio value Conclusions: SAT ratio was an independent prognostic factor for survival in patients with mCRC. Higher SAT volume is correlated with longer survival in mCRC patients

Aim: The metastatic pattern of non-small cell lung cancer (NSCLC) has been described in several studies. Frequent metastatic sites are lung, liver, bone, surrenal, and brain. Hypotheses were speculated to explain the tendency of specific sites. Over-expression of EGFR alters the biology and tumoral behavior. The mutations of EGFR mainly occur in exon 19, and 21and could lead the way through the tumor growth and metastasis. We try to elucidate the relationship between EGFR mutation and metastatic pattern. Material and Method: In this retrospective nested case-control study, one hundred and five patients diagnosed with lung adenocarcinoma included who had EGFR mutation status and imaging studies at the time of diagnosis. Results: The metastatic pattern was not different between EGFR mutant and wild type patients. There was no statistical difference in terms of survival between EGFR mutant and wild type patients (p = 0.25). The OS according to the organ metastasis between EGFR mutant and wild type group was not significant except liver. The EGFR mutant patients with liver metastasis had better survival compared with wild type patients (p = 0.04). Also, the multiplicity and solidarity of the metastatic tumors were compared in metastatic organs. There was no significant difference between groups. The subsequent EGFR mutation type was not related to the metastatic pattern. Conclusion: The incidence of the metastatic sites was not different between EGFR mutant and wild type patients in our study. In contrast to the literature, liver metastasis found to be related to improved OS. Keywords: Non-small cell lung cancer, Adenocarcinoma, EGFR mutation, Metastasis pattern

Weaimed to compare the clinical and histopathologic features at the time ofdiagnosis of patients with metastatic colorectal cancer according to the RASmutation status. In thiscross-sectional study, archive records of patients with diagnosing colorectalcancer who were followed-up and treated at oncology center of an universityhospital in Turkey between 01.04.2012 and 24.08.2017 was analyzed retrospectively. A totally 530patients' archive records were evaluated. The relationship between the RASmutant/wild groups and primary tumor localization, location of metastases atdiagnosis, tumor markers, tumor differentiation grade and overall survivalrates were compared with the literature data. Wefound no statistically significant difference between RAS mutant and wildgroups. When overall survival rates were compared with the RAS mutation status,the overall survival of 2 years in patients with RAS wild type was 59% whilethe 2 year overall survival of RAS mutant patients was 27.8% and thisdifference was statistically significant (p = 0.004). However, there was nostatistically significant difference between the median survival of patientsreceiving bevacizumab or cetuksimab/panitumumab in th efirst line treatment ofRAS wild patients (57.1% versus 70.7%; p=0.221, respectively). Inthis study, we determined that RAS mutation status of our patients withmetastatic colorectal cancer is more similar to Western countries and theclinical and pathological characteristics of patients at the time of diagnosisare independent of RAS mutation status. However, there is still need broaderparticipation and prospective trials in this subject., Bu çalışmada metastatik kolorektalkanserli hastalarda tanı anındaki histopatolojik ve klinik özelliklerin RASmutasyon durumuna göre karşılaştırılması amaçlandı. Bu kesitsel çalışma için, 01.04.2012-24.08.2017 tarihleri arasındabir üniversite hastanesinin onkoloji merkezinde takip ve tedavisi yapılmıştoplam 530 kolorektal kanser tanısı almış hastanın dosyası retrospektif olarakincelendi. Çalışmaya 18 yaşından büyük, tanı anında metastatik hastalığa sahipveya takipleri boyunca metastaz gelişen ve RAS mutasyonu bakılmış 75 hastadahil edildi. Rasmutant olan ve olmayan hastaların tümör lokalizasyonu, tanıanındaki metastaz yerleri, tümör belirteçleri, tümör diferansiyasyon derecesive genel sağkalım süreleri arasındaki farklılıklar analiz edildi. RAS mutasyonusıklığı %50.7 olarak saptandı. Klinik ve patolojik özellikler açısındanbakıldığında RAS mutant ve wild gruplar arasında istatistiksel anlamı farklılıksaptamadık. RAS mutasyon durumuna göre genel sağkalım süreleri incelendiğinde,RAS wild tip olan hastaların 2 yıllık genel sağkalımı% 59 iken, RAS mutanthastalarımızın 2 yıllık genel sağkalımı %27.8 idi ve bu fark istatiksel olarakanlamlıydı (p=0.004). Ancak, RAS wild hastaların ilk hat tedavisindebevacizumab veya cetuksimab/panitumumab alan hastaların ortalama sağkalımlarıarasında (sırasıyla %57.1'e karşı %70.7; p=0.221) istatistiksel farksaptanmadı. Bu çalışmada, metastatikkolorektal kanserli hastalarımızın RAS mutasyon durumunun daha ziyade Batılıülkelere benzer olduğunu ve hastaların tanı anındaki klinik ve patolojiközelliklerinin RAS mutasyon durumundan bağımsız olduğunu saptadık. Ancak bukonuda yapılacak prospektif ve daha geniş katılımlı çalışmalara hala ihtiyaçduyulmaktadır.

Despite new treatment options in metastatic colorectal cancer (mCRC), new prognostic markers are still needed to determine optimal chemoregimen especially for anti-angiogenesis drugs. In this study, we evaluated the serum semaphorin and VEGF-A levels as prognostic factors in patients with mCRC. Patients with diagnosed mCRC who were treated with first-line bevacizumab plus chemotherapy were included in the study. Venous blood samples of 37 patients with metastatic colon cancer were taken, and serum semaphorin 3A and VEGF-A levels were studied in pre-treatment and the 1st and third months after the treatment was initiated. Totally, 37 patients were enrolled in the study. The patients’ mean age was 62 years. Twenty-eight (49%) of the patients were male, and 19 (51%) were female. Serum semaphorin3A (sema3A) levels of the patients were 5.4 ± 7.4 ng/ml before the treatment, 3.5 ± 3.3 ng/ml at the first month, and 3.5 ± 3.7 ng/ml at the third month. Serum VEGF-A levels were 27.7 ± 32.9 ng/l before the treatment, 23.1 ± 28.1 ng/l at the first month, and 28.9 ± 30.2 ng/l at the third month. There was no significant correlation between the survival and pre-treatment VEGF-A level (p = 0.064). Overall survival (OS) was statistically significantly higher in patients with pre-treatment semaphorin 3A levels below 5.4 ng/ml than higher than 5.4 ng/ml (10.5 months vs 4.5 months, respectively, HR 0.23, 95% CI 19.635–11,391, p = 0.012). Pre-treatment semaphorin 3A level can be a prognostic marker for the mCRC patients who were treated with bevacizumab in patients with metastatic colorectal cancer.

Prophylactic antiviral treatment is controversial due to a lack of studies in both HBsAg negative/HBcIgG positive patients who treated conventional chemotherapy with solid malignancy, unlike HBsAg positive. In this cross-sectional and retrospective study, we analyzed that the reactivation risk of Hepatitis B Virus (HBVr) of totally 457 HBcIgG positive patients with solid cancer in archives records between 2011 and 2018 years of two different centers. Totally 217 HBcIgG positive patients with solid cancer were included in the study. Anti-HBs positive and negative patients were 119 (54.8%) and 98 (45.2%), respectively. Frequent diagnosis of the patients was lung (28.1%), colorectal (19.4%), breast (17.5%) and hepatobiliary tract cancers (8.3%), respectively. Most of the study population had stage 4 disease (48.8%) and received palliative chemotherapy. When the patients were stratified due to American Gastroenterological Association Institute (AGA) guideline, HBVr risk of chemo regimen was moderate in 21 patients (17.5%), low in 8 patients (3.7%). The majority of the patients were undefined risk group (78.8%). We did not determine any HBVr in the patients who have received different conventional chemotherapy regimens and have different primer tumor site despite all the patients did not receive the prophylactic antiviral drug. [Med-Science 2019; 8(2.000): 418-21]

Purpose Breast cancer classifies to 4 major subgroups according to immunohistochemistry staining features as Luminal A, Luminal B, human epidermal growth factor receptor 2 overexpression, and Triple Negative. Cancer Antigen15-3 (CA15-3) is used as a tumor marker in breast cancer while its value in early stage and in breast cancer subgroups is still controversial. In this study, we aimed to investigate that whether it is or not differences of the serum preoperative CA15-3 levels in early breast cancer subgroups. Methods We retrospectively investigated medical records of 751 breast cancer patients who admitted to Afyon Kocatepe University Department of Medical Oncology between January 2010 and December 2016. Total 361 patients were included in this study. The cut off value of Ki-67 was used as 20 to distinguish between Luminal A from Luminal B subgroups. Cutoff values of CA15-3 were evaluated as 25U/mL. Results CA15-3 levels were not significantly different according to clinical features. Molecular subgroups were similar in CA15-3 levels (P = 0.666). Elevated levels of CA15-3 ≥ 25 U/mL were found 34 patients (20.5%) in Luminal A, 15 patients (28.3%) in Luminal B1, 15 patients (20.3%) in Luminal B2, 7 patients (25%) in human epidermal growth factor receptor 2 overexpressed and 9 patients (22.5%) in triple negative groups. Conclusion There was no relationship preoperative CA15-3 levels and breast cancer subgroups.

Small cell lung cancer (SCLC) is differentiated from non-small cell lung cancers with its histological and morphological features, rapid response to chemotherapy, and recurrence in a short time after treatment is discontinued. Platinum plus etoposide chemotherapy combination has been used as a standard treatment, and no new drug has been found for more than 30 years in this disease. In research, the targeted pathways that may affect survival have not been identified yet. During the second half of the second decade of the 2000s, with immunotherapies that inhibit immune checkpoints, improvements in survival were achieved for the first time in treating SCLC after many years. Then a rapid increase was observed in chemotherapy plus immunotherapy combination studies in this field. Updated analyses of these studies were represented at international oncology meetings in 2020. Here, we reviewed immunotherapy studies conducted in patients with SCLC and the reflections on the daily practice.

Various cutaneous metastasis patterns are described in breast cancer. Zosteriform metastases are rare cutaneous metastases, which appear in a dermatomal distribution. A 66-year woman presented with a 1-month history of nodular lesions on the left posterior hemithorax area. Biopsy was reported as human epidermal growth factor receptor (Her) 2 positive, hormone receptor-negative breast carcinoma metastasis. Dual blockade therapy targeting Her-2 overexpression was initiated for the patient. Treatment response was obtained after 3 cycles. There was a significant improvement in skin lesions. Zosteriform cutaneous metastases can be the early sign of systemic spread and can show an initial response to therapy. Therefore, physicians should perform an exhaustive physical examination including that of skin.

e13010 Background: The standard of care in patients with hormone receptor (HR) -positive metastatic breast cancer is a cyclin-dependent kinase (CDK) 4/6 inhibitor combined with endocrine therapy (ET). Preclinical studies show that metabolic processes and cell metabolism such as adipogenesis, lipid synthesis and glucose regulation is affected by cell cycle regulators such as CDK 4 and 6. There are limited data regarding the impact of body mass index (BMI) on the efficacy of cyclin-dependent kinase 4/6 inhibitors plus endocrine therapy (ET) in metastatic breast cancer. We aimed to investigate the effect of BMI on the progression-free survival (PFS) in HR-positive metastatic breast cancer who received CDK4/6 inhibitor. Methods: This study was conducted as a retrospective cohort study, and data were obtained from three institution medical records. Patients with metastatic HR-positive breast cancer receiving CDK 4/6 inhibitor (palbociclib or ribociclib) plus ET (letrozole, anastrozole, or fulvestrant) were enrolled in the study. 179 patients were enrolled in the study between the January 2018 and December 2021. The patients were divided into three groups according to BMI level as follows; group 1: 18.5-24.9 kg/m2, group 2: 25-29.9 kg/m2 and group 3: ≥ 30 kg/m2. Median follow-up was 10.94 months. Categorical variables were compared using the chi-square test or two-sided Fisher’s exact test. Comparison of PFS and BMI categories were performed through Kaplan-Meier curve and log-rank test. Results: 179 patients were included the study (42 [24%] in group 1, 65 [36%] in group 2, and 72 [40%] in group 3). The 12-month PFS was 52.9% in group 1, was 72.2% in group 2 and was 56.5% in group 3. There was no significant different between the groups (p = 0.054). However, group 2 patients tend to have a better outcome in term of PFS. When palbociclib plus ET and ribociclib plus ET were evaluated separately, the 12-month PFS rates between the BMI groups were higher in group 2 patients who received palbociclib plus ET, but there was no statistical significance (Ribociclib plus ET: 63.2% in group 1, 73.3% in group 2, 59.7% in group 3, p = 0.51. Palbociclib plus ET: 44.3% in group 1, 71.5% in group 2, 52.8% in group 3, p = 0.07). Hematological and non-hematological toxicity were similar between BMI groups (p > 0.05, for all). Adverse events of grade 3 or 4 occurred in 18 (42.9%) of 42 patients in group 1 and in 20 (30.8%) of 65 patients in group 2 and in 22 (30.6%) of 72 patients in group 3 (p = 0.34). Dose reduction for CDK4/6 inhibitors was also similar between groups (p = 0.42). Median PFS was not reached due to a limited number of events in each group. Conclusions: In this study, we demonstrated the tendency that overweight patients with metastatic breast cancer may benefit more from CDK4/6 inhibitors in term of PFS from interim analyses of our data. Similar toxicity rates and adverse events were observed in all BMI groups with CDK4/6 inhibitors plus ET.

Aim: This study aimed to determine the effects of adjuvant therapy on body mass index (BMI) and body fat (BF) measurements in women with early-stage breast cancer (ESBC).Material and Methods: We prospectively evaluated BMI and BF measurements including trunk fat mass kilograms (kg), trunk fat mass (%) and total body fat (%) on a bioelectric impedance analyzer in 29 women with stages I-III breast cancer. All of the patients received anthracycline-based adjuvant chemotherapy (ACT). Six patients were hormone receptor (HR)-negative. Twenty-three patients were HR-positive and received adjuvant endocrine therapy (AET) following ACT. Eleven HR-positive postmenopausal patients were treated with an aromatase inhibitor (AI), and the remaining twelve HR-positive premenopausal patients were treated with tamoxifen (TMX). A total of 3 measurements were performed in the beginning of chemotherapy, at 6th, and 12th months.Results: Although the BMI was significantly increased, there was no significant change in the BF during chemotherapy in patients receiving only ACT. Both BMI and BF measurements were significantly increased in premenopausal patients receiving TMX after ACT. However, no significant change was observed in BMI and BF measurements in postmenopausal patients receiving AI after ACT.Conclusions: ACT increased both BMI and BF measurements in patients with HR-positive premenopausal ESBC. Treatment with TMX or AI after ACT did not enhance the changes due to chemotherapy on body composition. Therefore, especially patients with HR-positive premenopausal ESBC should be careful not to gain weight during ACT.Keywords: Early breast cancer; adjuvant therapy; body mass index; body fat measurements.

BACKGROUND The adverse effects of COVID-19 pandemic on the mental health of high-risk group patients for morbidity and mortality and its impact on public health in the long term have not been clearly determined. OBJECTIVE To determine the level of COVID-19 related transmission fear and anxiety in healthcare workers and patients with primary immunodeficiency disorder (PID), severe asthma, and the ones with other comorbidities. METHODS The healthcare workers and patients with PID, severe asthma (all patients receiving biological agent treatment), malignancy, cardiovascular disease, hypertension (90% of patients receiving ACEI or ARB therapy), diabetes mellitus (42 % of patients receiving DPP-4 inhibitor therapy) were included in the study. A total of 560 participants, 80 individuals in each group, were provided. The hospital anxiety and depression scale ( HADS ) and Fear of illness and virus evaluation (FIVE ) scales were applied to the groups with face to face interview methods. RESULTS The mean age was 49.30 years and 306 (55 %) were female. The FIVE Scale and HADS-A scale scores of health care workers were significantly higher than other groups' scores (p = 0.001 and 0.006). The second-highest scores belonged to patients with PID. There was no significant difference between the groups for the HADS-D score (p=0.07). The lowest score in all scales was observed in patients with hypertension. CONCLUSIONS This study demonstrated that in the pandemic process, patients with primary immunodeficiency, asthma patients, and other comorbid patients, especially healthcare workers, should be referred to the centers for the detection and treatment of mental health conditions.

The essential treatment for patients with renal cell carcinoma is nephrectomy. As no lymph node dissection (LND) could be performed in the majority of these patients, healthy staging could not be carried out. In this study, we investigated the impact of LND during nephrectomy on patient survival.A total of 181 patients-58 (32%) were female and 123 (68%) were male-were included in the study. Median follow-up period was 48 months. The patients were separated into 4 groups according to their stage during diagnosis; group 1 (T1-3N0M0), group 2 (T1-3NXM0), group 3 (T1-3N1M0), and group 4 (T1-4N0/XM1). The disease-free survival of nonmetastatic patients and the overall survival of all groups were calculated.Mean age was 58.4 ± 12.0 years. Median survival for Group 1 could not be reached. Median survival was 89 months in Group 2, 50 months in Group 3, and 39 months in Group 4 (P0.001). There was no statistically significant difference between the N1 and M1 groups (P = 0.297). For the NX patient group without LND, median survival was 89 months, which is worse than the N0 group and better than the N1 group (P = 0.002).Our study presumes that the patients without LND are not staged sufficiently, NX patients have worse survival rates when compared with N0 patients, node-positive patients have poor survival rates as do the metastatic patients, and it should be defined as TNM stage4.

BackgroundThe adverse effects of COVID-19 pandemic on the mental health of high-risk group patients for morbidity and mortality and its impact on public health in the long term have not been clearly determined.ObjectiveTo determine the level of COVID-19 related transmission fear and anxiety in healthcare workers and patients with primary immunodeficiency disorder (PID), severe asthma, and the ones with other comorbidities.MethodsThe healthcare workers and patients with PID, severe asthma (all patients receiving biological agent treatment), malignancy, cardiovascular disease, hypertension (90% of patients receiving ACEI or ARB therapy), diabetes mellitus (42 % of patients receiving DPP-4 inhibitor therapy) were included in the study. A total of 560 participants, 80 individuals in each group, were provided. The hospital anxiety and depression scale (HADS) and Fear of illness and virus evaluation (FIVE) scales were applied to the groups with face to face interview methods.ResultsThe mean age was 49.30 ± 13.74 years and 306 (55 %) were female. The FIVE Scale and HADS-A scale scores of health care workers were significantly higher than other groups scores (p = 0.001 and 0.006). The second-highest scores belonged to patients with PID. There was no significant difference between the groups for the HADS-D score (p=0.07). The lowest score in all scales was observed in patients with hypertension.ConclusionsThis study demonstrated that in the pandemic process, patients with primary immunodeficiency, asthma patients, and other comorbid patients, especially healthcare workers, should be referred to the centers for the detection and treatment of mental health conditions.

Introduction Soft tissue sarcomas are a heterogeneous and rare group of cancers with a short median overall survival despite the chemotherapy. Pazopanib has approval for the treatment of advanced soft tissue sarcoma. We aimed to investigate the clinical outcomes of Turkish patients with advanced soft tissue sarcoma who received pazopanib. Patients and methods This was a retrospective study. The inclusion criteria were: ≥18 years of age, having histologically proven advanced soft tissue sarcoma and receiving pazopanib at least one day. Results A total of 79 patients were assessed in this study. The median age was 49.6 years. The average dose intensity of pazopanib was 767 mg (400–800). The median duration of pazopanib treatment was 6.11 months. Fourteen patients (17.7%) used pazopanib at first line for advanced soft tissue sarcomas. The most common cause of discontinuation of pazopanib was the progression of the disease (89.6%). Pazopanib was well tolerated. The most common grade ≥3 side effect was anemia. The most common grade ≤2 side effects were anemia and hyperbilirubinemia. The median progression-free survival, overall survival, and follow-up were 3.97 months, 11.40 months, and 32.72 months, respectively. Female gender, good performance status, and the presence of pazopanib-induced hypothyroidism were associated with longer progression-free survival. Also, good performance status and being a responder to first-line treatment were associated with longer overall survival. Conclusions We showed that pazopanib was well tolerated and had clinical benefit in patients with advanced soft tissue sarcoma in a Turkish cohort. This is the first study that suggests pazopanib-induced hypothyroidism may act as a predictive marker for better outcomes in patients with advanced soft tissue sarcoma.

Objective: Patients with solid cancers frequently suffer from thrombosis, which is associated with considerable cost, morbidity, and mortality. The infusional chemotherapy regimen, especially in gastrointestinal cancers, has a long-term need for central venous catheterization. Implantable ports (IP) are increasingly used for the administration of chemotherapy and supportive treatment to cancer patients. Material and Methods: In this study, we evaluated the factors affecting the port thrombosis in gastrointestinal cancers. The patients with gastric, colorectal and pancreatic cancer were included in the study. Results: There were 113 patients with IP locations on subclavian and 7 on femoral veins. IP thromboses were detected in 10 patients. One of the patients had two thrombosis sites on both femoral and subclavian veins. The median time duration from the placement of the port to thrombosis was 4 months. There were 9 patients who underwent treatment with low molecular weight heparin, while one patient received warfarin treatment. There were ten non-port events related to thrombosis events. There was a significant difference between port thrombosis due to location (p

Aims: 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. © 2022 Authors. All rights reserved.

Oxaliplatin is a third-generation platinum anti-neoplastic agent, which is used in the treatment of colorectal, gastric, and biliary tract cancers with combination other chemotherapy drugs. In rare cases, thrombocytopenia may occur suddenly in approximately 24 hours due to immune-mediated reactions. This reaction is usually seen after long term usage of oxaliplatin-based chemotherapy. Here, we present our case of immune-mediated thrombocytopenia associated with oxaliplatin. A 56 years old man who had stage IV rectum cancer with liver metastasis, had palliative surgery due to bowel obstruction after initial diagnostic approach. After failure of first line treatment, mFOLFOX6 plus Cetuximab (Cetuximab: 500mg/m2 on day 1, Oxaliplatin: 85 mg/m2 day 1, Leucovorin (LV): 400 mg/m2 day 1, 5-FU 400 mg/m2 IV bolus on day 1 followed by 2400 mg/m2 on day 1 infused over 46 hours every two weeks) regimen was started. Before the 21st cycle of oxaliplatin plus cetuximab regimen, the patient had normal thrombocyte, haemoglobin and neutrophile count. Approximately 8 hours after the chemotherapy patient had been taken to the emergency service with petechia, vigorous gastrointestinal and nasal bleeding. The thrombocyte levels were 3000 at μl. The patient was given methylprednisolone for three days. The thrombocyte levels recover quickly in 24 hours. After this reaction, oxaliplatin stopped and the chemotherapy was changed to capesitabine plus cetuximab regimen. In conclusion, oxaliplatin induced immune-mediated thrombocytopenia is a rare side effect but a life threatening complication. A physician who uses oxaliplatin as a treatment option should keep in mind the possibility immune-mediated thrombocytopenia which may cause life-threatening bleeding. Especially the long term use of oxaliplatin (median >10 cycles) may alert the physician for immune-mediated adverse effects.

Objective:This study was conducted for the purpose of adapting the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale (FACIT–Sp) for the Turkish context and determining its validity and reliability.Method:In 2016, a convenience sample of 137 cancer patients from Malatya State Hospital completed a structured questionnaire, which provided demographic characteristics, and the FACIT–Sp–12 for patients with cancer. The obtained data were assessed using Cronbach's alpha reliability coefficient (α), Pearson's product-moment correlation coefficient (r), factor analysis, Bartlett's test of sphericity, and the Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy.Results:The result of the KMO test was determined to be 0.827 and that of Bartlett's test 988.692, and both were observed to be significant at a level of p Significance of results:Our study determined that the Turkish version of the FACIT–Sp has validity and reliability and can be used in Turkish society. We believe that the scale can be used safely in determining convenient care and in planning individual educational programs to enhance patients' spiritual well-being.

Objectives: Pazopanib is an orally administered drug and has approval for the treatment of advanced Soft Tissue Sarcomas (aSTS). The absorption of pazopanib is pH-dependent. Acid-Reducing drugs such as proton pump inhibitors (PPI) may reduce the bioavailability of pazopanib. The primary purpose of this study was to assess whether the use of concomitant PPI and pazopanib had negative effects on survival outcomes. Methods: In this retrospective cross-sectional study, age ≥18 years, having histologically proven STS, receiving pazopanib at least one day, and availability of information about the use of PPI during pazopanib treatment were the inclusion criteria. Patients with adipocytic sarcoma were excluded. Results: A total of 46 eligible patients were assessed in this study. Thirty-one patients used concomitant PPI and pazopanib, 17 of them frequently used PPI, and the others occasionally. Fifteen patients never used concomitant PPI and pazopanib. The median progression-free survival (PFS) was 2.76 months, and the median overall survival (OS) was 7.39 months for patients who never used concomitant PPI and pazopanib. Also, the median PFS was 5.22 months, and the median OS was 14.52 months for patients who used concomitant PPI and pazopanib. In univariate analysis; using concomitant PPI (p=0.049) and primarily uterine located tumors (p=0.038) were significant parameters for PFS. In multivariate logistic regression analysis; both of using concomitant PPI (Wald=6.02; p=0.014) and primarily uterine located tumors (Wald=5.69; p=0.017) retained their association with longer PFS. No parameter was significant for OS. Conclusions: We showed that the use of concomitant PPI and pazopanib was associated with improved PFS. These results may help guide clinicians and researchers for allowing patients co-administrating PPI and pazopanib, especially when treating or investigating patients with dyspeptic symptoms

Colorectal cancer is one of the most common malignancies in the World. RAS-BRAF mutational status and primary tumor location are also important factors for the selection of optimal combinations therapies. In this study, we aimed to evaluate the Turkish oncologists' treatment decisions depending on tumor location and mutational status in metastatic colorectal cancer.An online survey link was sent to the medical oncologists who are registered to Turkish Society of Medical Oncology via e-mail and mobile applications.Ninety-four oncologists (85.5%) reported that tumor localization affects their treatment modality. In RAS-BRAF wild type left colon tumors, Turkish oncologists mostly use chemotherapy and anti-EGFR therapy (90.1%) for the first-line treatment, while on the right side, oncologists favored anti-VEGF therapy in combination with chemotherapy (65.5%). BRAF-mutant tumors in left colon had nearly the same rates of treatment tendency with both anti-VEGF and anti-EGFR antibodies in combination with chemotherapy, while in right-sided tumors the main treatment selection of the participants was anti-VEGF-based treatment (83.6%). In RAS-mutant patients, a great number of oncologists selected anti-VEGF-based treatment. On the right and left colon tumors, anti-VEGF treatment options ratios were 91.7 and 92.7%, respectively. Maintenance treatment is usually preferred by oncologists in both anti-VEGF and anti-EGFR-based treatment.Turkish oncologists are considering tumor sidedness as an indicator for treatment individualization of patients. The selection of monoclonal antibodies is being affected by tumor localization and mutation status.