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Objective: Percutaneous transhepatic cholangiography (PTC) is an invasive procedure used in patients with obstructive jaundice in the progress of some malignancies, and its most common complication is infection. We aimed to evaluate the patients who underwent PTC regarding their cultures, prophylaxis, and antibiotics used for treatment. Materials and Methods: In this cross-sectional study, patients who underwent PTC and were followed up in a medical oncology outpatient clinic between 2010-2017 were evaluated retrospectively. Patients’ data were obtained from the hospital record system (FONET), epicrisis forms, and patient progress files. Results: A total of 93 patients were included in the study. Prophylaxis was given in 50% of the cases. Complications developed in 68% of the cases after the intervention, and the infectious disease clinic consulted all. Blood cultures were obtained from 89% of the febrile patients; however, bile cultures were obtained only from 29%. The rate of resistant Gram-negative enteric bacteria in growing microorganisms was 52% (n=13). It was determined that 65% of the initiated empirical treatments were appropriate for the growth of microorganisms. Conclusion: The growth rate was significantly higher in blood cultures than in bile cultures. The lower growth rate in bile culture was attributed to the low number of bile cultures. There was no significant difference regarding the growth rate and drug resistance of the microorganisms. Therefore, we think giving antibiotics as treatment rather than prophylaxis is more appropriate. Taking cultures will ensure that patients receive appropriate antibiotic therapy for the causative agent. Keywords: Antibiotic prophylaxis, bacteremia, biliary tract infections, percutaneous transhepatic cholangiography

Aim: To evaluate the immunogenicity and safety of the CoronaVac vaccine in patients with cancer receiving active systemic therapy. Methods: This multicenter, prospective, observational study was conducted with 47 patients receiving active systemic therapy for cancer. CoronaVac was administered as two doses (3 μg/day) on days 0 and 28. Antibody level higher than 1 IU/ml was defined as ‘immunogenicity.’ Results: The immunogenicity rate was 63.8% (30/47) in the entire patient group, 59.5% (25/42) in those receiving at least one cytotoxic drug and 100% (five of five) in those receiving monoclonal antibody or immunotherapy alone. Age was an independent predictive factor for immunogenicity (odds ratio: 0.830; p = 0.043). Conclusion: More than half of cancer patients receiving active systemic therapy developed immunogenicity., Tweetable abstract Immunogenicity developed with CoronaVac in 25 (59.5%) of 42 patients who received at least one cytotoxic drug and in all patients (n = 5) who received monoclonal antibody or immunotherapy alone.

BACKGROUND: The relationship of the ABO blood group system with the immune response is known, but its relationship with immune checkpoint inhibitors (ICIs) has not been clearly investigated until now. OBJECTIVE: In this study, the relationship between different blood groups and nivolumab treatment response in patients with advanced malignant melanoma was investigated. METHODS: The data of patients who used nivolumab for advanced malignant melanoma between April 2018 and April 2021 were retrospectively reviewed. RESULTS: A total of 73 patients were included in the study. In the progression-free survival (PFS) analysis according to blood groups, it was 3.9 months, 16.1 months, 20.0 months and 3.0 months for A, B, AB and O, respectively (p= 0.1). Overall survival (OS) analysis according to blood groups was 5.1 months, 25.0 months, 20.0 months and 9.3 months for A, B, AB and O, respectively (p= 0.1). The B antigen group (B or AB) had significantly longer PFS and OS than the non-B antigen group (A or O) (16.1 vs. 3.5 months for PFS, respectively, p= 0.03; 20.0 vs. 7.4 months for OS, respectively, p= 0.02). CONCLUSIONS: The presence of B antigen provides a significant advantage in terms of survival in patients using ICIs for advanced melanoma.

Aim: It is known that approximately 10% of breast cancers are hereditary, and BRCA1/2 genes are responsible forapproximately 20% of these. Studies have shown that mutations of many genes other than BRCA1/2 in breast cancer alsocause this predisposition. In this study, it was aimed to investigate other causative cancer susceptibility genes in womenwith breast cancer.Material and Methods: In this retrospective study, 66 female patients who were evaluated in Ankara Dışkapı YıldırımBeyazıt Training and Research Hospital Genetics Department between 2016-2020 were included. Cancer susceptibilitygenes of the patients were examined using next-generation sequencing technique (NGS).Results: Mean age at diagnosis of the patients was 43 ± 8.0. By genetic analysis, causative genes were identified in 9(13.63%) of 66 patients. These genes are ATM (%11), BRIP1 (%11), CHEK2 (%34), FANCC (%11), MUTYH (%11) and PALB2(%22). Patients with a causal variant and others were grouped, and compared in terms of parameters such as age atdiagnosis, tumor localization, histopathological type of tumor, estrogen/progesterone receptor status, c-erbB2, stage,metastasis at diagnosis, and number of relatives with cancer. No statistical relationship was found between the groups.Conclusion: This study determined the rate of detection of causal variants of cancer susceptibility genes other thanBRCA1/2 in women with breast cancer who applied to the medical genetics department as 13.63%. Performing multiplegene tests with the NGS in cancer individuals will allow carrier individuals to receive correct diagnosis and appropriatetreatment and to be directed to necessary screenings., Amaç: Meme kanserlerinin yaklaşık %10'unun kalıtsal olduğu ve bunların yaklaşık %20'sinden BRCA1/2 genlerinin sorumlu olduğu bilinmektedir. Yapılan araştırmalar, meme kanserinde BRCA1/2 dışındaki birçok genin mutasyonlarının da yatkınlığa neden olduğunu göstermiştir. Bu çalışmada meme kanserli Türk kadınlarda diğer kanser yatkınlık genlerinin araştırılması amaçlanmıştır.Gereç ve Yöntemler: Bu retrospektif çalışmaya Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Genetik Bölümü'nde 2016-2021 yılları arasında değerlendirilen 66 kadın hasta dahil edildi. Hastaların kansere yatkınlık genleri, yeni nesil dizileme tekniği (NGS) kullanılarak incelendi.Bulgular: Hastaların ortalama tanı yaşı 43 ± 8.0 idi. Genetik analiz ile 66 hastanın 9'unda (%13,63) nedensel gen tespit edildi. Bu genler ATM (%13), CHEK2 (%36), FANCC (%13), MUTYH (%13) ve PALB2'dir (%25). Nedensel varyantı olan hastalar ve diğerleri gruplandırılarak tanı yaşı, tümör lokalizasyonu, tümörün histopatolojik tipi, östrojen/progesteron reseptör durumu, cerbb2, evre, tanı anındaki metastaz ve kanserli akraba sayısı gibi parametreler açısından karşılaştırıldı. Gruplar arasında istatistiksel bir ilişki bulunamadı.Sonuç: Bu çalışmada meme kanserli Türk kadınlarında BRCA1/2 dışındaki kansere yatkınlık genlerinin nedensel varyantlarının saptanma oranı %13,63 olarak belirlendi. Kanserli bireylerde NGS ile çoklu gen testlerinin yapılması, taşıyıcı bireylerin doğru tanı ve uygun tedavi almalarını ve gerekli taramalara yönlendirilmelerini sağlayacaktır.

Objective To investigate the genetic causes of colorectal cancers (CRCs); and to determine the genotype-phenotype correlation. Study design Descriptive study. Place and duration of study Department of Medical Genetics, Diskapi Yildirim Beyazit Training and Research, Hospital, Ankara, Turkey, between January 2018 and January 2020. Methodology 59 cancer susceptibility genes of 41 patients, included in the study and diagnosed with CRC, were examined using next generation sequencing (NGS) technique. Statistical analysis of the possible relationships among the mutation carrier status of the patients and the parameters of gender, age at diagnosis, and family cancer history, were performed. Results The mean age at diagnosis of all CRC patients was 48.7 years (range 28-74). Mutations in MLH1, MSH6, CHEK2, PMS2 and MUTYH genes were detected in 10 patients (24.4%). The mean age at diagnosis of CRC was 46.2 years in those who carried the mutation, while it was 49.5 years in those without. Carriers and non-mutation carriers, when compared in terms of age at diagnosis, gender, family cancer history, no significant difference was observed. Conclusion Genes that may cause susceptibility to cancer may play a role in the etiopathogenesis of the CRC. NGS-based multigene panels allow these genes to be detected in the patient and to identify an inherited cancer syndrome. Key Words: Colorectal cancer, Lynch syndrome, Hereditary cancer, Gene, Next generation sequencing.

Purpose COVID-19 will continue to disrupt the diagnosis-treatment process of cancer patients. Dr. Abdurrahman Yurtaslan Ankara Oncology Hospital has been considered as a ‘non-pandemic’ center (‘clean’) in Ankara, the capital city of Turkey. The other state hospitals that also take care of cancer patients in Ankara were defined as ‘pandemic’ centers. This study aimed to evaluate hospital admission changes and the precautionary measures in clean and pandemic centers during the pandemic. The effect of these measures and changes on COVID-19 spreading among cancer patients was also evaluated. Methods The patients admitted to the medical oncology follow-up, new diagnosis, or chemotherapy (CT) outpatient clinics during the first quarter of pandemic period (March 15–June 1, 2020) of each center were determined and compared with the admissions of the same frame of previous year (March 15–June 1, 2019). COVID-19 PCR test results in clean and pandemic centers were compared with each other. Telemedicine was preffered in the clean hospital to keep on follow-up of the cancer patients as ‘noninfected’. Results In the clean hospital, COVID-19-infected patients that needed to be hospitalized were referred to pandemic hospitals. COVID-19 test positivity rate was eight-fold higher for outpatient clinic admissions in pandemic hospitals (p < 0.001). The number of patients admitted new diagnosis outpatient clinics in both clean and pandemic hospitals decreased significantly during the pandemic compared with the previous year. Conclusion We consider that local strategic modifications and defining ‘clean’ hospital model during infectious pandemic may contribute to protect and treat cancer patients during pandemic.

Background: Merkel cell carcinoma (MCC) is a rare but highly aggressive neuroendocrine carcinoma of the skin. In this study, we aimed to evaluate the clinicopathologic characteristics, treatment outcomes, and survival of MCC cases in Turkey. Materials and methods: The patients diagnosed with MCC between 1999 and 2018 at twenty different centers in Turkey were included in the study. Patient and tumor characteristics and adjuvant and metastatis treatment outcomes were analyzed retrospectively. Results: The median age of totally 89 patients was 70 (26-93). The most common primary location was lower limbs (n = 29, 32.5%). Immunohistochemically, CK20 positivity was present in 59 patients (66.3%). Only two patients had secondary malignancy. The majority of the patients (n = 76, 85.4%) were diagnosed at the localized stage. Surgery was performed for all patients in the early stage, and adjuvant radiotherapy or/and chemotherapy was applied to 52.6% (n = 40) of nonmetastatic patients. The median follow-up was 29 months. Recurrence developed in 21 (27.6%) of the 76 patients who presented with local or regional disease. Two-year disease-free survival (DFS) was 68.1% and 5-year DFS was 62.0% for localized stage. The 5-year DFS was similar for patients receiving adjuvant treatment (chemotherapy, radiotherapy, or sequential chemoradiotherapy) and without adjuvant therapy (P > 0.05). Two-year overall survival in patients who presented with localized disease was 71.3% and 18.5% in metastatic patients (P < 0.001). In the metastatic stage, platinum/etoposide combination was the most preferred combination regimen. Median progression-free survival (PFS) in first-line chemotherapy was 7 months (95% confidence interval: 3.5-10.5 months; standart error: 1.78). Conclusions: Although MCC is rare in Turkey, the incidence is increasing. Gender, CK20 status, tumor size, lymph node involvement, and adjuvant treatment were not associated with recurrence.

Introduction Neoadjuvant treatment is a widely accepted approach for locally advanced rectum cancer. Efforts to explore a surrogate endpoint for clinical trials revealed a new prognostic scoring system which is named as neoadjuvant rectal score (NAR) in patients who received neoadjuvant treatment for rectal cancer. Material and Methods 88 patients who met inclusion criteria were included in the study. The optimal cutoff value of the NAR score was 17.6 with 71% sensitivity and 63% specificity. Patients with NAR score > 17.6 (n: 48, 54%) were defined as the high-risk group and those with NAR score

Introduction Colonic wall thickening (CWT) is frequently observed incidentally via abdominal computerized tomography (aCT). Although the general approach to evaluating incidental CWT is a colonoscopic examination, there is a lack of definitive recommendation guidelines. Thus, we aimed to determine neoplasia rates and identify the factors predictive of neoplasia via colonoscopic examinations of patients with CWT incidentally diagnosed via aCT. Methods We retrospectively reviewed 5,300 colonoscopy reports. A total of 122 patients who had CWT incidentally observed via aCT were included in the study. CWT was graded as mild (3-5 mm), moderate (6-12 mm), or severe (≥12 mm). A logistic regression model was used to determine the predictive factors for neoplasia. Results The mean age of the patients was 60 years, and abnormal findings were noted in 52% of the colonoscopies. Neoplastic lesions were detected in 24 patients (19.6%), while colon adenocarcinoma was detected in 8 patients (6.5%). Multivariate analysis showed that moderate-severe, focal, and asymmetric CWT were independent factors for predicting neoplasia (p=0.049, p=0.033, and p=0.018, respectively). Conclusion Pathological findings can be noted via colonoscopic examination in cases of incidental CWT; therefore, patients with moderate-severe, focal, or asymmetric CWT require colonoscopic examination for the purpose of detecting neoplasia.

Purpose: Colorectal cancer is the third leading diagnosis accounting for nearly 10% of all new cancers worldwide. The distinct features among BRAF mutant colorectal cancers make these tumor groups hard to treat for oncologists. The median overall survival (OS) of these types of cancers is reported to be 9 to 14 months. Methods: The study was declared on the Turkish Oncology Study Group Conference and approved. The patients’ data was received from the centers who confirmed to participate. The BRAF-mutated patients were included in the study. The demographic features (age, gender, etc.), type of mutation, tumor localizations, histology, microsatellite instability (MSI) status, metastasis patterns chemotherapeutic agents and progression, and death times were recorded. Results: Thirty-nine patients were enrolled in the study. Sixteen patients had concurrent KRAS mutations, while 7 had NRAS mutations. Most of the patients received doublet chemotherapies in combination with anti-VEGF agents in the first and second line of the treatment. There was a significant difference in OS according to the stage which showed a decreased survival in stage IV patients at the time of diagnosis. Concurrent KRAS mutation resulted in increased OS. The median OS was 47 and 24 months favoring the KRAS mutant group. The patients whose primary tumor operated had better survival when compared with other patients. The median OS of the operated group was 47 months, while the non-operated group was 24 months. Liver metastasis was related to worse prognosis at the time of diagnosis in univariate analysis. Conclusion: In our study we found a high concurrent RAS mutation ratio in a BRAF mutant patient group which was different from prior studies. The concurrent mutations resulted in a favorable outcome in terms of OS which is also different from the current knowledge. More prospective studies are needed especially BRAF-mutated patient population and especially with concurrent RAS mutations. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

Introduction Oxaliplatin-based chemotherapy is the standard treatment in stage III colon cancer. Oxaliplatin may cause sinusoidal damage and sinusoidal obstruction syndrome (SOS) in the liver. Clinical reflections of SOS are splenomegaly and thrombocytopenia. This study aimed to investigate the frequency of splenomegaly development in patients receiving oxaliplatin-based chemotherapy and thrombocytopenia incidence rates related to this condition. Materials and methods Files of 50 patients having received fluorouracil and oxaliplatin (mFOLFOX6) regimen for stage 3 colon cancer between 2015 and 2017 were retrospectively reviewed. Spleen volumes (SV) of the patients were calculated using pre-and post-chemotherapy tomographic examinations. A 50% increase in the SV after chemotherapy (SV ≥1.5 change) was accepted as chemotherapy-associated splenomegaly. The patients were divided into two groups as having or not having splenomegaly after chemotherapy. Complete blood count was evaluated prior to each treatment cycle, and on the third month of treatment, termination was used for thrombocyte values. Results Splenomegaly was determined in 50% of the patients. Cumulative oxaliplatin dosage was found higher in those who developed splenomegaly (p = 0.003). Chemotherapy dose reduction was higher in patients who did not develop splenomegaly (p = 0.015). Thrombocytopenia was confirmed higher in patients who developed splenomegaly compared to those who did not (p = 0.047). Lower thrombocyte counts were found in the complete blood count of the patients having developed splenomegaly which was performed during and 3 months after chemotherapy when compared to those that did not develop splenomegaly (p-values, respectively, as 0.005, 0.038). Upon multivariate logistic regression analysis, cumulative oxaliplatin dose was the single independent factor related to splenomegaly (OR: 7.55 (1.90-31.61); p = 0.004). Conclusion Thrombocytopenia was confirmed to be higher in colon cancer patients receiving adjuvant mFOLFOX6 and developing splenomegaly during the post-treatment period. Moreover, splenomegaly was shown to be associated with the cumulative oxaliplatin doses received. Thrombocytopenia seen in patients receiving oxaliplatin for colon cancer should be a warning in terms of splenomegaly and SOS development.

Whether primary tumor resection (PTR) should be performed in patients with asymptomatic colorectal cancer (CRC) and unresectable synchronous metastasis is controversial. The purpose of this study was to investigate the prognostic impact of initial primary tumor resection in patients with synchronous unresectable metastatic CRC.The patients with unresectable synchronous metastatic CRC who had undergone primary tumor resection and then received chemotherapy were compared with the patients who received only palliative systemic chemotherapy.Survival analysis showed that median overall survival (OS) for all patients was 22.37 months. Primary tumor resection was associated with a significant survival benefit on unadjusted analysis (median survival 29.56 months vs. 14.25 months; p0.001). Two-year, 3-year and 5-year survival rates were 57%, 35%, 19% for the PTR group and 30%, 16%, 8% for the non-PTR group and all results were statistically significant and favored surgery.Our study suggests that primary tumor resection improves the survival of patients with metastatic CRC and unresectable synchronous metastasis.

The immune system plays a fundamental role in the response to neoadjuvant chemotherapy (NAC) of locally advanced breast cancer (LABC) patients. Patients with pathological complete response (pCR) after NAC have a higher survival rate. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are peripheral blood indicators of inflammatory response. This investigates the correlation between NLR, PLR, LMR, and other clinicopathological features of breast cancer patients before receiving NAC and pCR. Data of LABC patients who underwent NAC between 2009 and 2018 were retrospectively reviewed. Each patient's peripheral complete blood count was recorded before starting NAC. The cut-off values for neutrophils, lymphocytes, monocytes, and platelets in the peripheral blood and NLR, PLR, and LMR were determined by receiver operating characteristic curve analyses. The records of 131 patients were analyzed and divided into two groups, pCR (+ve) and pCR (-ve), and their clinicopathological features and laboratory findings were compared. pCR was achieved in 23.6% of patients. The cut-off values of neutrophils, lymphocytes, monocytes, and platelets at the time of diagnosis and NLR, PLR, and LMR were, respectively, 4150 mu L, 2000 mu L, 635 mu L, 271 x 10(3) mu L, 1.95, 119, and 3.35. The pCR rate was higher in patients with low neutrophil count, low NLR, and high lymphocyte count (P = .002

Objective:Weaimed to compare the neutrophil lymphocyte ratio(NLR), which is a simplemethod, to determine whether the difference between the right colon and theleft colon tumors in our study is related to the inflammatory process betweenthe two regions.Materialand Method: We retrospectivelyreviewed the files of 142 patients who were diagnosed with stage 1-3 colorectalcancer between July 2011 and June 2015 at Medical Oncology Department, DışkapıYıldırım Beyazıt Education and Research Hospital. We examined whether tumorlocalization correlates with neutrophil lymphocyte ratio (NLR) and disease-freesurvival.Results:Thepatients were divided into right and left colon based on splenic flexure. Therewere 35 patients (24%) defined as right colon and 107 (76%) patients defined asleft colon. 85 (60%) of the patients were male and 57 (40%) were female. Theratio of neutrophil and lymphocytes at diagnosis was compared. The mean NLR valuesof the left and right colon were calculated as 4.43 and 5.05, respectively. Nostatistically significant difference was found between the right and left colon(p = 0.234). The disease-free survival rates were lower in the right colontumors than in the left colon, but not statistically significant (0,88 / 0,8440th and 60th at 20th month) 0.80 / 0.77 and0,80/0,77; p = 0.064)Conclusion:Inour study, we could not find any relation between the NLR and the localizationof the disease in patients with early stage colorectal cancer. Disease-freesurvival rates were calculated to be lower in right colon tumors, although theydid not reach statistical significance with respect to left colon., Amaç:Çalışmamızda sağ kolon ile sol kolon yerleşimli tümörler arasındaki farkın ikibölge arasındaki inflamatuvar süreçle ilişkili olup olmadığını basit bir yöntemolan nötrofil lenfosit oranına bakarak karşılaştırmayı amaçladık.Gereçve Yöntem: Dışkapı Yıldırım Beyazıt Eğitim veAraştırma Hastanesi Tıbbi Onkoloji bölümüne Temmuz 2011-Haziran 2015 tarihleriarasında başvuran evre 1-3 kolorektal kanser tanısı almış 142 hastanındosyalarını retrospektif olarak inceledik. Tümör lokalizasyonu ile nötrofil lenfosit oranı (NLO) ve hastalıksız sağkalım arasında ilişki olup olmadığını araştırdık.Bulgular:Hastalar splenik fleksura baz alınarak sağ ve sol kolon şeklinde ikiye ayrıldı.Sağ kolon olarak tanımladığımız 35 (%24), sol kolon olarak tanımladığımız 107(%76) hasta vardı. Hastaların 85’i (%60) erkek, 57’si (%40) kadındı. Tanıanındaki NLO karşılaştırıldı. Sağ ve sol kolonun NLO ortalama değerlerisırasıyla 4,43 ve 5,05 olarak hesaplandı. Sağ ve sol kolon arasında NLOaçısından istatiksel olarak anlamlı farklılık saptanmadı (p=0.234). Hastalıksız sağ kalım oranları sağ kolon tümörlerinde solkolona göre istatiksel anlamlılığa ulaşmasa da daha düşük olarak hesaplandı (20.ayda 0,88/0,84; 40. ve 60. ayda sırasıyla 0,80/0,77 ve 0,80/0,77; p =0,064).Sonuçlar:Yaptığımız çalışmada metastatik olmayan kolorektal kanserli hastalarda tanıanında bakılan NLO ile hastalığın lokalizasyonu arasında ilişki bulamadık. Hastalıksızsağ kalım oranlarını sağ kolon tümörlerinde sol kolona göre istatikselanlamlılığa ulaşmasa da daha düşük olarak hesapladık.

Amaç: Onkolojik hastalıkların erken tanı ve tedavisinde yeni gelişmeler hayatta kalma oranlarının artmasına neden olsa da, artmış sağ kalım oranlarına bağlı olarak gelişen uzun takipler sırasında ikinci primer maligniteler ortaya çıkabilmektedir. İkincil primer tümörlerin gelişimi için birçok faktör vardır. En önemlisi, yaşlı hastalar ın uzun vadede kanserojenlere maruz kalma olasılıkları daha yüksektir. Çoklu primer tümörler, genellikle iki malignite tanısı arasındaki zaman çizelgesine bağlı olarak metakron veya senkron olarak görülür. Senkron hastalıklar sıklıkla benzer karsinojenlere maruz kalma sonucu oluşsa da, metakron olanlar daha çok primer tümörün tedavisine bağlı advers etkilerle ilişkili olabilir. Bu tek merkezli çalışma, Ocak 2007 ile Aralık 2016 arasında multipl primer tümörlü hastaların klinikopatolojik özelliklerini araştırmayı amaçladı ve bunlardan 20'si senkron, 36'sı metakron olarak toplam 56 hasta dahil edildi. En yaygın kanser çiftlerinin erkeklerde kolon-akciğer ve prostat-mesane, kadınlarda meme-kolon ve meme-tiroid olduğu tespit edilmiştir. Yöntemler: Ocak 2007 ile Aralık 2017 tarihleri arasında merkezimizde takip edilen ÇPT’ lü hastaların dosyaları retrospektif olarak incelendi, 56 hastada multiple primer tümör olduğu tespit edildi. Hastaların cinsiyetler, yaşları tespit edildi. Tümörün hangi organlarda oluştuğu, ne zaman geliştiği, bulunabilen etyolojik veriler, sağ kalım oranları araştırıldı. Tüm istatistiksel analizler Package for Social Sciences (SPSS v 15.0, SPSS Inc., Chicago, IL, USA) ile yapıldı. Sonuç: Senkron hastalıklar genellikle benzer kanserojenlere maruz kalmanın bir sonucu olarak ortaya çıkarken, metakronöz hastalıkların primer tümörlerin tedavisinin yan etkileri ile ilişkili olması muhtemeldir

Tyrosine kinase inhibitors (TKIs) are frequently used drugs in oncology practice. Although oral administration is an advantage, long-term use increases potential drug-drug interaction risk. The purpose of this study was to assess the prevalence of potential TKI-drug interaction (PTDI) in patients who used TKIs and increase awareness of this subject.We retrospectively evaluated the data of 310 patients collected from four different oncology centers, where TKIs were administered for solid organ cancer, between January 2007 and December 2017. The potential interaction between TKI and any other prescribed drug was determined using ''Lexicomp® Drug Interactions, App Version 1.1'' software.Overall, 310 patients were included; among those, 301 (97.1%) were using another drug with TKI and 147 (47.4%) experienced PTDI at least once. The median number of additional drugs was 4 (range 1-12). We detected 250 PTDIs, of which 30.8% were major interactions. The most frequently interacting TKI was imatinib (29.6%), and the additional drug group was antibiotics (21.2%). We observed that PTDIs caused the following effects: TKI concentration was increased or decreased owing to 14.4% or 22.8% PTDIs, respectively, and electrocardiographic QT prolongation occurred in 22% of all PTDIs. Multivariate analysis demonstrated that use of higher number of additional drugs (odds ratio/OR=1.63), pre-existing lung cancer (OR=8.82), and use of pazopanib (OR=9.22) were potential risk factors.The rate of PTDI is quite high in patients using TKIs. Effort must be made to increase awareness of this subject. Increasing awareness aids in lowering toxicity rates and providing efficient antitumor therapy.

Introduction: Tamoxifen treatment has been shown to reduce the recurrence and mortality rates in hormone receptor-positive breast cancers independent from chemotherapy. This benefit increases with the prolongation of the use of tamoxifen but with increasing side effects. In this study, we aim to evaluate the presence of urogenital symptoms in breast cancer patients on tamoxifen and compare them with those who are not on any hormonotherapy. Materials and methods: This study was performed on patients diagnosed as early-stage breast cancer. The study group consisted of hormone receptor-positive patients given tamoxifen as adjuvant hormonal therapy. The control group consisted of breast cancer patients who had no hormonotherapy. Patients with a complaint of urinary incontinence with onset after tamoxifen usage were evaluated with Urogenital Distress Inventory Short Form (UDI-6), Incontinence Impact Questionnaire Short Form (IIQ-7) and Incontinence Quality of Life Questionnaire (I-QOL). Results: A total of 137 early-stage breast cancer patients were included in this study; 74 estrogen receptor-positive patients on tamoxifen therapy (study group) and 63 hormone receptor-negative patients with no hormonotherapy (control group). The median age was 44 (30-65) years for tamoxifen users and 49 (27-64) years for the control group. The stages of the patients were similar for both groups. 78.4% of the women in the tamoxifen group and 49.2% in the control group were in the premenopausal period. The groups were similar in regard to body mass index and parity. The complaint of urinary incontinence was more frequent in the study group compared to controls (39 (52.7%) vs. 5 (7.9%)). Women with the complaint of urinary incontinence were evaluated with self-reported UDI-6, IIQ-7 and I-QOL forms and the scores were similar for both study and control groups. A statistically significant relation was observed between cigarette smoking and the presence of urinary incontinence. The percentages of smokers were 50% of those with incontinence and 24.7% of those without incontinence. Conclusion: Urinary incontinence is positively correlated with tamoxifen usage in early-stage breast cancer patients.

Introduction: Due to variety of treatment alternatives for testicular tumours, parameters other than existing staging criteria are also needed. Most studies have revealed the correlation between cancer and inflammation. In this study, we aimed to investigate the value of preoperative inflammatory markers between early-stage testicular tumours and patients with advanced-stage, their relationship with tumour pathology and their importance in predicting stage. To calculate the differences between inflammatory markers, stage 1 tumours localized to the testis and advanced-stage tumours spread beyond the testis were classified into 2 groups according to tumour pathology. Materials and Methods: The data of 112 patients undergoing inguinal orchiectomy in between 2008 and 2018 were recorded retrospectively. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and systemic immune-inflammation index (SII) were calculated by using the numbers of blood cell counts based systemic markers of inflammation. The differences between markers of inflammation were calculated by dividing tumours into 2 groups including early-stage and advanced- stage testicle tumours. Results: According to the results of preoperative inflammatory markers in predicting the stage; in the seminoma group, the difference between the median NLR (2.37 vs. 4.39, p = 0.012), LMR (3.80 vs. 2.40, p = 0.018) and SII (612 vs. 1,127, p = 0.009) of stage 1 and advanced stage were statistically significant, while in the non-seminoma group, only the difference between median PLR (99 vs. 154, p = 0.002) of stage 1 and advanced stage was statistically significant. Sensitivity and specificity of predicting advanced stage according to cut-off values of markers were 69 and 75% in NLR (3.21), 83 and 75% in LMR, and 59 and 75% in SII in the seminoma group; on the other hand, in the non-seminoma group, the sensitivity, and specificity of predicting the advanced stage of PLR cut-off (104) were 71 and 88% respectively. Conclusions: The clinical use of inflammatory biomarkers in testicular tumours may represent an important step in understanding germ cell tumours biology and in supporting staging criteria and prognostic criteria.

Gemcitabine is among the standard first-line agents for the treatment of metastatic pancreatic cancer. However, as the median survival with gemcitabine monotherapy is 6 months, different combinations are being studied for better, prolonged survival. In this multicenter study, we aimed to compare the results of gemcitabine monotherapy with those of gemcitabine and cisplatin combination therapy as first-line treatments for metastatic pancreatic cancer.Data of 664 patients diagnosed with metastatic pancreatic cancer between January 2007 and December 2016 from seven oncology centers in Turkey were retrospectively evaluated, and 319 patients with gemcitabine alone (n=138) or gemcitabine and cisplatin combination (n=181) as first-line treatment were included.The median patient age was 62 years (range 42-79), being 60 years (42-75) in the gemcitabine/cisplatin arm and 67 years (52-79) in gemcitabine alone arm. no complete response was observed in either arm, whereas partial response rates were 30.1% in gemcitabine/cisplatin arm and 15.3% in gemcitabine alone arm (p=0.001). median overall survival was 8 months (95% CI:7.7-10.2) and was significantly longer in the gemcitabine/cisplatin arm than in the gemcitabine alone arm (10 vs. 6 months, p=0.004).The cemcitabine and cisplatin combination therapy as first-line treatment of metastatic pancreatic cancer yields significantly prolonged survival over gemcitabine monotherapy. In patients with favorable performance conditions, the combination therapy should be preferred.

Modified docetaxel, cisplatin, and 5-fluorouracil (mDCF) therapy has been shown to be a well tolerated and highly effective regimen for metastatic gastric carcinoma. Herein we investigated the effectiveness of the mDCF combination as the first-line treatment in patients with recurrent/metastatic squamous cell carcinoma of the head and neck (HNSCC).A total of 80 patients with recurrent/metastatic HNSCC who were treated with mDCF between 2009 and 2015 were enrolled into this study. All patients were treated in the first-line with 2-6 cycles of mDCF chemotherapy which consisted of docetaxel 60 mg/mThe most common grade 3-4 toxicities were neutropenia (22.5%), anemia (10%), thrombocytopenia (7.5%), nephrotoxicity (1.3%), hepatotoxicity (1.3%), and diarrhea (2.5%). Twelve patients (15%) experienced a febrile neutropenic episode. Dose modification was required in 22 (27.5%) of the patients due to drug toxicity. Complete response was achieved in 2.5% of all patients, while partial and stable responses were reported to be 43.8% and 25%, respectively, with a disease control rate of 71.3%. The median progression-free and overall survival was 7 (95% CI: 5.3-8.6) and 11.5 (95% CI: 9.4-13.7) months, respectively.The efficiency of the mDCF combination for induction chemotherapy has been well established previously. To our knowledge, this is one of the largest studies evaluating the survival and safety significance of mDCF chemotherapy as a first-line treatment in patients with recurrent/metastatic HNSCC.

Residual urethra is a common site of recurrence in patients undergoing radical cystectomy with urinary diversion for bladder cancer. Urethral recurrence (UR) clinically manifests as a penile mass or a bloody or purulent penile discharge at a median of 13 months after surgery. And on imaging studies, it characteristically appears as a focal intraluminal mass, urethral wall thickening, or an infiltrating mass arising from the urethra. We, herein, present an unusual case of UR manifesting as a large cyst in the penile root 4 years after radical cystectomy with urinary diversion for muscle-invasive bladder cancer. Further, a complex cystic mass developed in the same location 2 years after the excision of the cystic UR. This case shows that the imaging spectrum of UR after radical cystectomy may be wider and may include cystic and complex patterns.

BACKGROUND The potential prognostic value of survivin is variably reported depending on the gastric cancer. OBJECTIVE Evaluation of the prognostic and predictive significance of serum survivin and its relation with survival and treatment response rates in patients with locally advanced gastric cancer (LAGC). METHODS Serum samples were prospectively collected from 50 patients with newly diagnosed LAGC. Serum samples of 32 healthy subjects were also collected as control groups for survivin levels. Serum survivin levels were evaluated at baseline and after three cycles of neoadjuvant chemotherapy in LAGC patients. RESULTS Median survivin level was 147 IU/L (range = 4.4-4936) at baseline and was 27 IU/L (range = 4.2-4737) after neoadjuvant chemotherapy. The difference between survivin levels of the control group (26 IU/L, range = 3.8-1430) and pre-treatment patient group was statistically significant (p< 0.001). Clinical response to mDCF regimen was classified as progressive (progressive disease) and non-progressive groups (partial response + stable disease). Baseline survivin levels were similar between patients in progressive and non-progressive groups (p= 0.55). Survivin levels were significantly reduced after chemotherapy in non-progressive group (p< 0.001). In contrast, serum survivin levels increased in a stepwise fashion from baseline to post-chemotherapy in patients with progressive disease (p= 0.06). Patients were divided into low and high survivin groups according to baseline median survivin levels. Median DFS was 12.4 and 14.6 months for low and high groups, respectively (p= 0.18). Moreover, median OS was 14.4 and 24.9 months for low and high group, respectively (p= 0.14). CONCLUSION It can be suggested that serum survivin can be used as a predictor of response to chemotherapy- but not survival- in LAGC patients receiving neoadjuvant mDCF chemotherapy. However, large multicenter prospective studies are required to confirm these results.

Background/Aims: The association between platelet–lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR), and survival with response rates were evaluated in metastatic gastric cancer (MGC). Patients and Methods: MGC patients on firstline modified docetaxel/cisplatinum/5-fluorourasil [mDCF; docetaxel 60 mg/m2 (days 1–5), cisplatin 60 mg/m2 (day 1), 5FU 600 mg/m2 (days 1–5), q3w] were evaluated retrospectively. The cutoff values were 160 for PLR and 2.5 for NLR. Progression-free survival (PFS) and overall survival (OS) were estimated for group I (PLR >160), group II (PLR ≤ 160), group III (NLR ≥ 2.5), group IV (NLR < 2.5), group V (PLR > 160 and NLR ≥ 2.5), group VI (PLR ≤ 160 and NLR 160 and NLR < 2.5) and VIIb (PLR ≤160 and NLR ≥ 2.5)]. Results: One hundred and nine MGC patients were evaluated for basal hematological parameters and survival analysis, retrospectively. Most of the patients were male in their fifties with grade III adenocarcinoma (62.9%) and liver metastasis (46.7%). Patients with PLR > 160 and/or NLR ≥ 2.5 had significantly shorter PFS and OS (P = 0.04, 0.01, 0.019, and P = 0.003, 0.002, 0.000, respectively). Conclusion: High PLR (> 160) and/or NLR (≥ 2.5) seem to be poor prognostic factors in MGC.

Breast cancer is a second common form of malignancy and is one of the leading causes of mortality among cancer patients across the world. Locoregional recurrence occurs in 5–20% of patients despite upfront treatment. Local therapy (surgery plus minus re-irradiation) with or without systemic therapy is generally recommended for management. Local control rates vary; months to years, but a significant percentage lives 5 years. Therefore, treatment strategies to increase response rates are significant. Hyperthermia is one of the most potent radiosensitizers and data from meta-analysis and randomized trials support its use with radiotherapy. This study reviews the biologic rationale and clinical evidence about concomitant use of hyperthermia and radiotherapy in locally-recurrent breast cancer patients.

Introduction We investigated the impact of modern chemotherapy regimens and bevacizumab following pulmonary metastasectomy (PM) from metastatic colorectal cancer (CRC). Methods A total of 122 consecutive patients who were curatively resected for pulmonary metastases of CRC in twelve oncology centers were retrospectively analysed between January 2000 and April 2012. Results Of 122 patients, 14 did not receive any treatment following PM. The remaining 108 patients received fluoropyrimidine-based (n = 12), irinotecan-based (n = 56) and oxaliplatin-based (n = 40) chemotherapy combinations. Among these, 52 patients received bevacizumab (BEV) while 56 did not (NoBEV). Median recurrence-free survival (RFS) was 17 months and median overall survival (OS) has not been reached at a median follow-up of 25 months after PM. Three and five-year OS rates were 66% and 53%, respectively. RFS and OS were similar, irrespective of the chemotherapy regimen or BEV use. Positive pulmonary margin, KRAS mutation status, and previous liver metastasectomy were negative independent prognostic factors for RFS, while pathologically confirmed thoracic lymph node involvement was the only negative independent prognostic for OS in multivariate analysis. Conclusions No significant RFS or OS difference was observed in respect to chemotherapy regimens with or without BEV in patients with pulmonary metastases of CRC following curative resection.

41st Annual Congress of the European-Society-for-Medical-Oncology (ESMO) -- OCT 07-11, 2016 -- Copenhagen, DENMARK, WOS: 000393912500656, …, European Soc Med Oncol

Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO) / Clinical Science Symposium on Predicting and Improving Adverse Outcomes in Older Adults with Cancer -- MAY 29-JUN 02, 2015 -- Chicago, IL, WOS: 000358036902836, …, Amer Soc Clin Oncol

Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO) / Clinical Science Symposium on Predicting and Improving Adverse Outcomes in Older Adults with Cancer -- MAY 29-JUN 02, 2015 -- Chicago, IL, WOS: 000358036903002, …, Amer Soc Clin Oncol

Background: There is no standard treatment for patients with colorectal cancer (CRC) progressing after irinotecan and oxaliplatin treatment. Here we aimed to retrospectively evaluate the efficacy and tolerability of raltitrexed in combination with oral 5-fluoropyrimidine (uracil tegafur-UFT) or mitomycin C as salvage therapy in mCRC patients. Materials and Methods: A total of 62 patients who had received raltitrexed combined with UFT or mitomycin C were identified between December 2008 and June 2013. They were given raltitrexed 2.6 mg/m(2) (max 5 mg) i.v. on day 1 in combination with either oral UFT 500 mg/day on days 1-14 every 3 weeks (group A) or mitomycin C 6 mg/m(2) i.v. on day every 3 weeks (group B). Results: Forty-two patients (67.7%) were in group A and 20 (32.2%) in group B. In 15 patients (24%) grade 3/4 toxicity was observed, resulting in dose reduction, and in 13 patients (20.9%) dose delay was necessary. The median progression free survival (PFS) was 3 months (95% CI 2.65-3.34) and median overall survival (OS) was 6 months (95% CI 2.09-9.90) in the whole group. Median PFS was 3 months (95% CI 2.60-3.39) in group A vs 3 months (95% CI 1.64-4.35) in group B (p=0.90). Median OS was 6 months (95% CI 2.47-9.53) in group A vs 12 months (95% CI 2.83-21.1) in group B (p=0.46). Conclusions: The combination of raltitrexed with UFT or mitomycin C seem to be a salvage therapy option due to safety profile and moderate clinical activity in heavily-pretreated mCRC patients.

e14533 Background: To determine impact of modern chemotherapy regimens after pulmonary metastasectomy from colorectal cancer (CRC). Methods: A total of 122 consecutive patients who curatively resected for pulmonary metastases of CRC in eleven oncology centers were retrospectively analysed between January 2000 and April 2012. Results: Of 122 patients, 108 who received chemotherapy with fluoropyrimidine-based (n = 12), irinotecan-based (n = 56) and oxaliplatin-based (n = 40) combinations were analyzed. Among these, 52 patients received bevacizumab (BEV) while 56 did not (NoBEV). With a median follow-up of 14 months after metastasectomy, median recurrence-free survival (RFS) was 17 months, overall survival (OS) was not reached. Three and 5-years OS rates were 66% and 53%, respectively. There was no significant difference among cytotoxic regimens in respect to RFS and OS. Similarly, no significant difference was seen between BEV and NoBEV arms in respect to OS and RFS. In univariate analysis prior liver metastasectomy (p = 0.045), positive pulmonary margin (p = 0.028), disease-free interval < 12 months (p = 0.013), and KRAS mutation (0.009) were negative significant prognostic for RFS. Thoracic pathological lymphatic involvement (p = 0.006) and higher prethoracotomy carcinoembryonic antigen (p = 0.038) were negative significant prognostic for OS. In multivariate analysis, positive pulmonary margin was the only negative independent prognostic for RFS, while thoracic lymphatic involvement was the only negative independent prognostic for OS. Conclusions: Chemotherapy type and addition of bevacizumab have no impact on both RFS and OS in the adjuvant setting following complete resection of colorectal pulmonary metastases.

Objective: There are some data regarding the role of cystatin C, a cysteine proteinase inhibitor, in determining the glomerular filtration rate (GFR) more accurately. We aimed to evaluate the correlation of serum cystatin C levels with the serum creatinine levels and GFR calculated by Cockcroft-Gault and modification of diet in renal disease (MDRD) formulations in the patients who received cisplatin-based chemotherapy. We also intended to demonstrate its potential use in the early prediction of the renal function changes in these patients. Materials and methods: In the study, 34 patients receiving cisplatin-based chemotherapy with various malignancies were included. The levels of cisplatin were determined prior to the chemotherapy and at the end of cisplatin infusion during the therapy. GFR was calculated by Cockcroft-Gault and MDRD formulations prior to the therapy and at the end of the third course. Results: A statistically significant linear correlation was found between the serum levels of cystatin C and creatinine prior to the chemotherapy (r - 0.42, p - 0.013). However, there was no correlation among the level of cystatin C subsequent to the cisplatin infusion and serum creatinine level following the third course and MDRD and creatinine clearance-Cockcroft-Gault formulations. Conclusion: Even though the serum cystatin C levels were correlated with the serum creatinine levels in our study, it was concluded that it was not an appropriate parameter to predict the potential impairments in the renal function during the chemotherapy.

Background: Surgery is the only curative treatment for operable non-small lung cancer (NSCLC) and the importance of adjuvant chemotherapy for stage IB patients is unclear. Herein, we evaluated prognostic factors for survival and factors related with adjuvant treatment decisions for stage I and IIA NSCLC patients without lymph node metastasis. Materials and Methods: We retrospectively analyzed 302 patients who had undergone curative surgery for prognostic factors regarding survival and clinicopathological factors related to adjuvant chemotherapy. Results: Nearly 90% of the patients underwent lobectomy or pneumonectomy with mediastinal lymph node resection. For the others, wedge resection were performed. The patients were diagnosed as stage IA in 35%, IB in 49% and IIA in 17%. Histopathological type (p=0.02), tumor diameter (p=0.01) and stage (p

e15548Background: Gastric cancer is usually diagnosed at locally advanced or metastatic stage. The superiority of combined systemic treatment to single agent and palliative treatment has been shown...

Aim: We examined impact of adjuvant treatment modalities in patients with curatively resected pancreatric adenocarcinoma (PAC). Methods: A total of 563 consecutive patients who were resected for PAC in 26 oncology centers were retrospectively analyzed between January 2003 and December 2013. Results: Of 563 patients, 472 received adjuvant treatment with chemotherapy alone (CT), chemoradiotherapy alone (CRT), and chemoradiotherapy with maintenance chemotherapy (CRT-CT) were analyzed. Of 472 patients, 231 were given CRT-CT, 26 were given CRT, and 215 were given CT. The median recurrence free survival (RFS) and overall survival (OS) were 12 and 19 months, respectively. Survival rates at 1st, 3rd, and 5th years were 70%, 23% and 16%, respectively. When CT and CRT-CT groups were compared, there was no difference with respect to both RFS and OS, and also there was no difference in RFS and OS among CRT-CT, CT and CRT alone groups. To further investigate the impact of addition of radiation to chemotherapy on subgroups, patients were stratified according to lymph node status and resection margins, and then analyzed separately. When patients with positive lymph node disease were considered, both RFS (p = 0.004) and OS (p = 0.003) were significantly longer in CRT-CT group than CT group. In contrast, there was no difference between groups when patients with no metastatic lymph node disease or patients with or without positive surgical margins were considered. Conclusions: Although adjuvant chemotherapy is the standart treatment in curatively resected PAC, radiation should be a part of treatment at least in patients with positive lymph node disease. Disclosure: All authors have declared no conflicts of interest.

e15045 Background: Platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) might affect survival in some malignancies. Our aim was to evaluate the basal PLR and NLR effect on survival...

662 Background: Oxaliplatin and irinotecan in combination with 5-fluorouracil and leucovorin for metastatic colorectal cancer (mCRC) accepted as the standard treatment. There is no standard treatment approach for patients after progression with these agents. In this study aimed to evaluate the efficacy and side effects of patients with previously treated metastatic colorectal cancer a salvage combination with oral 5-fluorouracil (tegafur-uracil UFT) or Mitomycin C and Raltitrexed. Methods: In the 7 centers, data of 62 patients who received Raltitrexed 2.6 mg/m2 (max. 5 mg) (day 1) and UFT 500 mg/day (1-14. days), or Mitomycin C 6mg/m2 (day 1) every 3 weeks, with a diagnosis of metastatic colorectal cancer, between December 2008 and June 2013 has been analyzed retrospectively. Overall survival (OS), progression-free survival (PFS), and toxicity profiles were evaluated. Results: The median age of patients was 51 (min-max: 18-76 years), and 35 (56%) were male and 27 (44%) were female. Thirty nine patients (63%) had ECOG performance status 0 and 1. Four patients (10%) received a combination of UFT and Raltitrexed at the second line and 38 patients (90%) had third, fourth, and fifth lines. Otherwise Mitomycin C plus Raltitrexed protocol used at the second and third lines. Twelve patients (19%) developed grade 3/4 toxicities as diarrhea and fatigue and 13 patients (21%) needed to dose reduction. In all patients the median PFS was 3 months (%95 CI, 2,65–3,34) and the median OS was 6 months (%95 CI, 2,09–9,90). Two groups were evaluated separately; the median PFS was 3 months (%95 CI, 2,60–3,39) and median OS was 6 months (%95 CI, 2,47–9,53) in UFT arm and, the median PFS was 3 months (%95 CI, 1,64–4,35) and median OS was 12 months (%95 CI, 2,83–21,1) in Mitomycin C arm. Statistical significance could not be determined (p>0.05). Conclusions: Thecombination of Raltitrexed with UFT and Mitomycin C showed an acceptable survival time and toxicity in the treatment of patients with previously treated mCRC. It could be considered as a salvage treatment option in mCRC.

e18546 Background: Small cell lung cancers (SCLC) constitute a mean of 15% of lung cancers and present with advanced disease at time of diagnosis in 60% of cases. Cisplatin plus etoposide schedule is the standard treatment in these patients , whereas the role of maintenance therapy is debated. We assessed the efficacy and safety of oral etoposide maintenance therapy following cisplatin plus etoposide in advanced SCLC. Methods: Demographic features, treatment response, survival rate, and toxicity rate were assessed in our patients who were followed up for advanced SCLC between 2006 and 2012, had a ECOG performance status of 0-1, and were given oral etoposide maintenance therapy (50mg/day, given 14 days of a 21-day cycle, a total of 6 cycles) following 6 courses of cisplatin (75 mg/m2, 1 day) and etoposide (100mg/m2, 3 days). Results: A total of 51 patients were studied, 46 (90.2%) of whom were male; the mean age was 59 (28-78) years at diagnosis. Forty-four (86.2%) patients had partial remission while 7 (13.7%) had complete remission. Nine (17.6%) developed neutropenic fever while grade 3-4 toxicities, neutropenia, anemia, thrombocytopenia, neuropathy, diarrhea, nausea and vomiting were present in 39.2%, 9.8%, 5.9%, 1.9%, 3.9%, 3.9%, and 1.9% respectively. Chemotherapy was postponed in fourteen (27.4%) patients due to toxicity. Six (11.7%) patients taking oral etoposide developed febrile neutropenia and 3 (5.9%) developed grade 3-4 thrombocytopenia. Chemotherapy was postponed in 5 (9.8%) patients due to toxicity while no toxic death was observed. After a median follow-up of 19 months, 32 (62.7%) patients experienced progression of disease and 29 (56.8%) died. Median progression free survival was found 11.6 months (%95 CI; 10.2-12.9 months) and median overall survival was found 15.6 (%95CI; 11.5-19.7 months) months. Conclusions: Our results were similar with the previous literature. Oral etoposide maintenance therapy following cisplatin plus etoposide therapy in advanced SCLC is effective and tolerable. Further randomized studies are needed in this topic.

e15175 Background: Docetaxel, cisplatin, and 5FU (DCF) has been shown to be an effective regimen for metastatic gastric carcinomas. However, treatment-related adverse events is quite high with original dose DCF. We evaluated the outcomes of the metastatic gastric carcinomas who treated with modified dose DCF (mDCF) in our institution. Methods: A single institution retrospective review of patients with metastatic gastric cancer treated with three weekly mDCF from 1/2006 to 1/2013 was evaluated. Over this time period a standard order-set was in place in which cisplatin 60 mg/m2, 5FU 600 mg/m2 and docetaxel 60 mg/m2 was given three weekly. Tumor response was calculated retrospectively using RECIST criteria. Results: One hundred and ninety-one patients were included the study. The median age was 55 years (23 to 76), 74% were male, and 82% were chemo-naive. Eighty percent of the patients were metastatic at the time of diagnosis. The median number of cycles administered was 6 (2-10). Hematological toxicity was mild with grade 3/4 granulocytopenia in 25% of the patients, grade 3/4 thrombocytopenia in 4% of the patients, and grade 3/4 anemia in 9% of the patients. Neutropenic infection occurred in 9 (%5) patients. Grade 3/4 nausea/vomiting was reported by 10% of the patients, and diarrhea by 7%. A total of 19 (10%) patients had dose delays or dose reductions related to toxicity. Six (3%) patients had complete response and 43 (23%) patients had partial response. Stable disease were occurred in 83 (45%) patients and 56 (23%) progressive disease. Ninety percent of the patients have died with median follow-up of 8 months. Progression-free survival was 7 months (95% CI 6 to 7.8 m) and overall survival was 10 months (95% CI 8.7 to 11.2 m). Conclusions: mDCF has mild hematological toxicity and overall excellent tolerance in first line metastatic gastric cancer patients. Response rate and the survival of these patients with a minimal toxicity are comparable with the original dose DCF.

e15110 Background: Risk factors for the pancreatic cancer are cigarette smoking, obesity, family history, chronic pancreatitis and type 2 diabetes mellitus. Diabetes mellitus is associated with 2-3 fold increase in the risk of pancreas cancer development. Down-regulation of mTOR pathway which begins with the insulin signaling is the possible protective effect of metformin in the oncogenesis of pancreatic cancer. In this study, we aimed to evaluate whether the use of metformin in diabetic pancreas cancer patients has an advantage or not. Methods: The data of 467 patients with the diagnosis of pancreas cancer in from 2003 to 2012 were analyzed, retrospectively. Results: Four hundred and sixty seven patients with the median age of 62 (20-85) were reviewed Median tumour size was 42 mm (14-145 mm). According to 2010 TNM staging, 23 patients had stage 1 (4.9%), 97 patients stage 2 (20.8%), 70 patients stage 3 (15%) and 277 patients had stage 4 disease (59.3%). Diabetes mellitus was detected in 173 (37%) patients. In this group 23 patients had stage 1 (4.9%), 97 patients stage 2 (20.8%), 70 patients stage 3 (15%) and 98 patients had stage 4 disease (56.6%). Thirty seven percent (64 patients) of the patients with diabetes were using metformin. Median time for metformin usage was 14±2,3 months. Median follow-up time was 7 months (1-88 months). Median overall survival (OS) of all pancreas cancer patients was 8 months. Surprisingly, median OS of diabetic pancreas cancer patients and non-diabetics was 9 and 8 months, respectively (statistically not significant). Median OS of diabetic patient subgroup who use metformin or not was 7 versus 10 months, respectively (statistically not significant). In the subgroup of stage 3 pancreatic cancer patients with diabetes mellitus, the median OS were 16 months and 10 months according to metformin usage or not, respectively (p=02). Conclusions: In this study, the median OS of diabetic pancreas cancer patients was superior from the non-diabetics. Multi-center prospective trials including large number of patients are needed to understand well enough the benefit of metformin in diabetic pancreas carcinoma patients.