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Öğe Adrenal insufficiency caused by bilateral adrenal macrometastases: a rare case with metastatic colon cancer(Kare Publ, 2008) Cicin, Irfan; Uzunoglu, Sernaz; Karagol, Hakan; Usta, Ufuk; Temizoz, Osman; Ermantas, NilayA 42-year-old male with symptoms of weight loss, fatigue, hyponatremia, hypoglycemia, hypotension and fever was referred to our hospital. A computed tomographic scan of the abdomen and pelvis showed multiple solid masses in the liver, thickened wall of sigmoid colon and bilateral solid adrenal masses, 7x5x3 cm on the right side and 6x4.5x3.5 cm on the left side. A colonoscopic examination showed tumoral mass originating from the sigmoid colon. A biopsy was performed and adenocarcinoma was diagnosed. The patient was suspected of having primary adrenal insufficiency due to bilateral adrenal macrometastases. The diagnosis of adrenal insufficiency was confirmed by levels of ACTH serum, cortisol and ACTH stimulation test. Adrenal metastases are well-recognized, but compared with the prevalence of adrenal metastases, adrenocortical insufficiency in patients with cancer seems to be rare. We report the case of a patient with both bilateral surrenal macrometastases, which is rare in colorectal cancer, and subsequent adrenal insufficiency.Öğe Aflibercept Plus FOLFIRI for Second-line Treatment of Metastatic Colorectal Cancer: Observations from the Global Aflibercept Safety and Health-Related Quality-of-Life Program (ASQoP)(Cig Media Group, Lp, 2019) Riechelmann, Rachel P.; Srimuninnimit, Vichien; Bordonaro, Roberto; Kavan, Petr; Di Bartolomeo, Maria; Maiello, Evaristo; Cicin, IrfanThis study evaluated safety and quality of life in patients with metastatic colorectal cancer undergoing treatment with aflibercept and FOLFIRI (fluorouracil, leucovorin, irinotecan). Most patients treated with this combination experienced either improvement or stability in quality of life scores. Aflibercept plus FOLFIRI is tolerable in the treatment of patients with metastatic colorectal cancer with a safety profile similar to that seen in previous studies of these individual medications. Background: The objectives of this study were to evaluate the safety profile of aflibercept and health-related quality of life (HRQL) in patients with metastatic colorectal cancer (mCRC) provided with aflibercept access before marketing authorization. Patients and Methods: Patients received aflibercept followed by FOLFIRI (fluorouracil, leucovorin, irinotecan) on day 1 of a 2-week cycle until disease progression, unacceptable toxicity, death, or patient/investigator decision to discontinue. Treatment-emergent adverse events (TEAEs) were evaluated, and HRQL was assessed at baseline, cycle 3, and every other cycle using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC QLQ-CR29, and EuroQol 5-Dimensions 3-Levels questionnaires (NCT01571284). Results: Overall, 779 adult patients with mCRC, who received >= 1 prior oxaliplatin-based regimen and had disease progression during or following their last administration of oxaliplatin-based chemotherapy, were enrolled. At data cutoff, all patients had discontinued treatment, mainly owing to disease progression (51.7%). The most common TEAEs of any grade were diarrhea (61.6%), hypertension (48.4%), and nausea (43.3%). The most common grade 3/4 TEAEs were hypertension (24.1%), neutropenia (23.1%), and diarrhea (15.3%). Clinically meaningful changes in HRQL were reported for all measures. Most patients either had an improvement in their HRQL scores or remained stable during the treatment period based on patient-reported outcomes. Conclusion: The data from this study support the tolerability of the combination of aflibercept and FOLFIRI in a setting that more closely approximates real life in patients with mCRC who failed to respond to oxaliplatin-based chemotherapy, and also suggest an improvement in HRQL.Öğe ALK TKI therapy in patients with ALK-positive non-small cell lung cancer and brain metastases: A review of the literature and local experiences(Elsevier Science Inc, 2022) Cicin, Irfan; Martin, Claudio; Haddad, Carolina Kawamura; Kim, Sang -We; Smolin, Alexey; Abdillah, Arif; Yang, XueThis article reviews the role of ALK tyrosine kinase inhibitors (TKIs) in the literature and provides expert commentary on local use in Argentina, Brazil, China, Russia, South Korea, and Turkey. We identified 56 articles involving patients with ALK-positive non-small cell lung cancer (NSCLC) and brain metastases (BM) treated with ALK TKIs published between January 2000 and June 2021. In first-line settings, central nervous system response rates in clinical trials with alectinib (86-94%), brigatinib (67-78%), and lorlatinib (42-82%) were generally higher than those reported with crizotinib (16-71%). Median progression-free survival in patients receiving crizotinib (5.6-7.4 months) was lower than alectinib (not reached), brigatinib (24.0 months), and ceritinib (10.7-25.2 months). Across these counties, next-generation TKIs are preferred for patients with progressing BM lesions. Although next-generation ALK TKIs demonstrate significant activity in these patients and following progression on crizotinib, access remains a challenge for personalized therapy.Öğe AMEERA-3, a phase 2 trial of SAR439859 vs endocrine monotherapy in pre- and post-menopausal, estrogen receptor-positive (ER plus )/human epidermal growth factor receptor 2-negative (her2-), locally advanced or metastatic breast cancer (BC) with prior exposure to hormonal therapies(Amer Assoc Cancer Research, 2021) Tolaney, Sara; Cicin, Irfan; Betancourt, Rafael; Chan, Arlene; Kaen, Diego; Kaufman, Peter; Delaloge, Suzette[Abstract Not Available]Öğe Assessment of CA-125 area under the curve as a prognostic factor in patients with ovarian cancer(Humana Press Inc, 2013) Uzunoglu, Sernaz; Aybatli, Aysun; Kaplan, Petek Balkanli; Cicin, Irfan; Sut, Necdet; Sayin, Cenk; Varol, FusunThe goal of this study was to evaluate the efficacy of CA-125 area under the curve (CA-125 AUC) as a prognostic factor following surgical treatment for ovarian cancer patients. A retrospective analysis was conducted on ninety-five patients with ovarian cancer who had primary treatment in a tertiary center between 2000 and 2010. After either optimal or cytoreductive surgery, all patients underwent adjuvant chemotherapy. CA-125 AUC was calculated for each patient that had a minimum of three CA-125 serum measurements during the treatment period. The mean age at diagnosis and mean survival were 53.9 years (range, 16-75 years) and 35.6 +/- 22.9 months (range, 3.1-95.4 months), respectively. The mean (and median) CA-125 AUC of patients of FIGO stages I, II, III, and IV was 53.0 (42.5), 58.06 (58.06), 97.8 (54.6), and 405.2 (149.3) IU/ml day, respectively (p = 0.004). The mean CA-125 AUC was 57.7, 410.1, and 636.3 IU/ml day for patients with a complete response, partial response, and no response/progressive disease to first-line chemotherapy, respectively (p < 0.001). The CA-125 AUC cut-off level for an overall survival of >= 5 years was 99.75 IU/ml day with a sensitivity of 90.9 % (95 % CI, 70.8-98.6) with 1.27 as positive likelihood ratio. Patients who suffer from ovarian cancer, with a lower CA125 AUC, have a better overall survival than those with a higher CA125 AUC. CA-125 AUC could be used as an independent factor for evaluating the treatment efficacy and chemotherapy response.Öğe Association of adverse events (AEs) with efficacy outcomes for cabozantinib (C) in patients (pts) with advanced hepatocellular carcinoma (aHCC) in the phase III CELESTIAL trial.(Amer Soc Clinical Oncology, 2019) Abou-Alfa, Ghassan K.; Meyer, Tim; Cheng, Ann-Lii; Cicin, Irfan; Bolondi, Luigi; Klumpen, Heinz Josef; Chan, Stephen Lam[Abstract Not Available]Öğe Association of obesity with breast cancer clinical and pathological factors: Analysis of Turkish National Breast Cancer Registry.(Amer Soc Clinical Oncology, 2015) Coskun, Ugur; Altundag, Kadri; Aliustaoglu, Mehmet; Uncu, Dogan; Ozkan, Metin; Cicin, Irfan; Ciltas, Aydin[Abstract Not Available]Öğe Bintrafusp Alfa Versus Pembrolizumab in Patients With Treatment-Naive, Programmed Death-Ligand 1-High Advanced NSCLC: A Randomized, Open-Label, Phase 3 Trial(Elsevier Science Inc, 2023) Cho, Byoung Chul; Lee, Jong Seok; Wu, Yi-Long; Cicin, Irfan; Dols, Manuel Cobo; Ahn, Myung-Ju; Cuppens, KristofIntroduction: Bintrafusp alfa, a first-in-class bifunctional fusion protein composed of the extracellular domain of TGF-bRII (a TGF-b trap) fused to a human immuno-globulin G1 monoclonal antibody blocking programmed death-ligand 1 (PD-L1), has exhibited clinical activity in a phase 1 expansion cohort of patients with PD-L1-high advanced NSCLC. Methods: This adaptive phase 3 trial (NCT03631706) compared the efficacy and safety of bintrafusp alfa versus pembrolizumab as first-line treatment in patients with PD-L1-high advanced NSCLC. Primary end points were progression-free survival according to Response Evaluation Criteria in Solid Tumors version 1.1 per independent review committee and overall survival. Results: Patients (N = 304) were randomized one-to-one to receive either bintrafusp alfa or pembrolizumab (n = 152 each). The median follow-up was 14.3 months (95% confidence interval [CI]: 13.1-16.0 mo) for bintrafusp alfa and 14.5 months (95% CI: 13.1-15.9 mo) for pem-brolizumab. Progression-free survival by independent re-view committee was not significantly different between bintrafusp alfa and pembrolizumab arms (median = 7.0 mo [95% CI: 4.2 mo-not reached (NR)] versus 11.1 mo [95% CI: 8.1 mo-NR]; hazard ratio = 1.232 [95% CI: 0.885- 1.714]). The median overall survival was 21.1 months (95% CI: 21.1 mo-NR) for bintrafusp alfa and 22.1 months (95% CI: 20.4 mo-NR) for pembrolizumab (hazard ratio = 1.201 [95% CI: 0.796-1.811]). Treatment-related adverse events were higher with bintrafusp alfa versus pembrolizumab; grade 3-4 treatment-related adverse events occurred in 42.4% versus 13.2% of patients, respectively. The study was discontinued at an interim analysis as it was unlikely to meet the primary end point. Conclusions: First-line treatment with bintrafusp alfa did not exhibit superior efficacy compared with pembrolizumab in patients with PD-L1-high, advanced NSCLC.(c) 2023 International Association for the Study of Lung Cancer. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).Öğe Breast Cancer Subtypes and Prognosis: Answers to Subgroup Classification Questions, Identifying the Worst Subgroup in Our Single-Center Series(Dove Medical Press Ltd, 2022) Cosar, Rusen; Sut, Necdet; Ozen, Alaattin; Tastekin, Ebru; Topaloglu, Sernaz; Cicin, Irfan; Nurlu, DilekPurpose: Many studies report the triple negative breast cancer (TNBC) as the worst subgroup, as such patients do not benefit from anti-hormonal therapy and human epidermal growth factor receptor 2 (HER2) antagonists. While HER2 overexpression was a poor prognostic factor in breast cancer before trastuzumab (Herceptin) was available, TNBC is often reported as the worst BC subgroup since targeted therapy is currently not possible. Since the patience-specific experiences and the current literature did not always align, we aimed to determine the BC subgroup with the shortest survival in our center.Methods: The records of patients with BC who were admitted to Trakya University Faculty of Medicine Department of Medical and Radiation Oncology between July 1999 and December 2019 were reviewed. Patients were divided into four main groups (Luminal A, Luminal B, TNBC, and HER2-enriched) according to the St Gallen International Consensus Panel and four subgroups in accordance with estrogen receptor, progestin receptor and HER2 positivity. Patient characteristics, treatment characteristics and clinical outcomes of the four main subgroups were evaluated. Survival curves were generated using the Kaplan-Meier method, and the significance of survival differences among the selected variables was compared by using the Log rank test. Factors affecting disease-free survival (DFS) and overall survival (OS) were analyzed by Cox regression analysis.Results: Statistical analysis was performed on 2017 patients, after excluding patients with phyllodes tumor, carcinoma-in-situ and missing information from a total of 2474 patients with BC. There were 952 (47.1%) patients in the Luminal A group, 236 (34.1%) in the Luminal B group, 236 (11.7%) in the TNBC group and 142 (7.1%) patients in the HER2 enriched group. HER2-enriched patients had the shortest survival (p < 0.001), with 113.70 +/- 7.17 months of DFS and 125.45 +/- 3.03 months of OS. For patients who received Herceptin, DFS was 101.50 +/- 6.4 months and OS was 118.14 +/- 6.16. Patients who did not receive Herceptin had 92.79 +/- 18 months of DFS and 94.44 +/- 15.23 months of OS.Conclusion: The HER2-enriched subgroup had the worst prognosis despite receiving targeted therapy. While the duration of DFS and OS had no significant difference between TNBC and Luminal A-B subgroups, HER2 enriched subgroup had significantly shorter survival when compared to any other subgroup. HER2-enriched subgroup had a 10-fold greater risk of death compared to the Luminal A subgroup.Öğe Breast Conserving Surgery and Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer: Single Center Experience(Galenos Publ House, 2011) Sezer, Atakan; Alas, Rusen Cosar; Cicin, Irfan; Hoscoskun, Zeki; Tuncbilek, NerminObjective: Patients with locally advanced breast cancer may undergo breast conserving surgery after neoadjuvant chemotherapy. The aim of the study is to evaluate the results of locally advanced breast cancer patients who underwent breast conserving surgery, axillary dissection and sentinel lymph node biopsy in a single center. Material and Methods: 12 patients with locally advanced breast cancer stage IIIA/IIIB were included in the study between 2002-2009. The patients were given anthracycline-based regimen before surgery. Patients underwent breast conserving surgery, axillary dissection, and sentinel lymph node biopsy followed by radiotherapy. Results: There were five patients in stage IIIA, six in stage IIIB, and one in stage IIIC. Patients had received 3-6 regimen of FAC/FEC. Eight had partial and four had complete response. Five positive axilla were detected. The median value of the lymph nodes was 12 (n:8-19). Five patients underwent sentinel lymph node biopsy. The biopsy has failed in one patient and the median value of dissected sentinel node was 3.5 (n:3-4). Locoregional recurrence was not observed in any patients. The mean follow-up of the patients was 29.8 months and median time was 16 (n:2-80) months. Of the 12 patients 10 are alive and 2 were deceased. Conclusion: In selected locally advanced patients, breast conserving surgery and sentinel lymph node biopsy may be applied by a multidisciplinary approach, and excellent success may be achieved in those patients as in early breast cancer patients.Öğe A brief look at the evaluation of the development and effectiveness of cytotoxic chemotherapy in advanced non-small-cell lung cancer(Kare Publ, 2010) Uzunoglu, Sernaz; Karagol, Hakan; Tanriverdi, Ozgur; Cicin, Irfan; Caloglu, Murat; Kocak, ZaferSystemic chemotherapy for patients with advanced-stage non-small-cell lung cancer prolongs survival and palliates symptoms, when compared with the best supportive care alone. However, the results of standard cytotoxic regimens are not yet satisfactory. As the effectiveness in the treatment of refractory disease is low, it still remains critical to better understand and develop new treatment options for refractory disease. Within the second-line therapeutic approaches, there are new chemotherapeutic schemes as well as molecular-targeted treatment options that block the epidermal growth factor receptor or angiogenesis. Future research efforts should focus on identifying prognostic and predictive markers of benefit not only for the standard cytotoxic agents, but also for the new target-driven agents currently.Öğe Cabozantinib (C) versus placebo (P) in patients (pts) with advanced hepatocellular carcinoma (HCC) who have received prior sorafenib: Results from the randomized phase 3 CELESTIAL trial.(Amer Soc Clinical Oncology, 2018) Abou-Alfa, Ghassan K.; Meyer, Tim; Cheng, Ann-Lii; El-Khoueiry, Anthony; Rimassa, Lorenza; Ryoo, Baek-Yeol; Cicin, Irfan[Abstract Not Available]Öğe Cabozantinib (C) versus placebo (P) in patients (pts) with advanced hepatocellular carcinoma (HCC) who have received prior sorafenib: Results from the randomized phase III CELESTIAL trial.(Lippincott Williams & Wilkins, 2018) Abou-Alfa, Ghassan K.; Meyer, Tim; Cheng, Ann-Lii; El-Khoueiry, Anthony B.; Rimassa, Lorenza; Ryoo, Baek-Yeol; Cicin, Irfan[Abstract Not Available]Öğe Cancer-related hypercalcemia and potential treatments(Frontiers Media Sa, 2023) Almuradova, Elvina; Cicin, IrfanCancer-related hypercalcemia is a common finding typically seen in patients with advanced cancer and occurs in about 20 to 30 percent of cases. The most common cause of hypercalcemia in hospitalized patients is hypercalcemia due to malignancy.This clinical problem is seen in patients with both solid tumors and patients with hematologic malignancies. Hypercalcemia is associated with a poor prognosis in oncology patients. This pathologic condition can occur due to many different mechanisms but is usually caused by abnormal calcium use resulting from bone resorption, intestinal absorption, or renal excretion. Hypercalcemia may present with a wide range of symptoms ranging from gastrointestinal system symptoms to neurologic symptoms. Timely diagnosis and initiation of treatment by the physician significantly reduce the risk of complications. Treatment aims to decrease serum calcium by increasing calciuresis, decreasing bone resorption, and decreasing intestinal calcium absorption. The mainstays of treatment are IV hydration, bisphosphonates and calcitonin, denosumab, and in some patients, prednisone, and cinacalcet. Patients with underlying advanced kidney disease and refractory severe hypercalcemia should be evaluated for hemodialysis. Every physician dealing with oncology patients should know the fastest and most effective management of hypercalcemia. We aimed to contribute in this sense.Öğe Carnitine or dimethyl sulfoxide, or both, for the treatment of anthracycline extravasation in rats(Informa Healthcare, 2013) Uzunoglu, Sernaz; Cosar, Rusen; Cicin, Irfan; Ibis, Kamuran; Demiralay, Ebru; Benlier, Erol; Erdogan, BulentThis study aimed to compare the efficacy of topical dimethyl sulfoxide (DMSO), intralesional and systemic carnitine as monotherapy and in combination against ulceration in rats induced by intradermal doxorubicin extravasation. Sixty-nine 3-month-old male Wistar albino rats, weighing between 200-225 g, were used in this study. Rats were applied monotherapy or a combination of topical DMSO, intraperitoneal or intralesional carnitine. Control groups received saline or no drug. The necrotic area was measured and extravasated neutrophil leukocytes were counted in healthy tissue adjacent to necrotic areas. Monotherapy with topical and systemic carnitine did not significantly reduce the size of necrotic areas. However, topical DMSO had reduced necrotic areas and inflammatory cells significantly and the addition of systemic carnitine to topical DMSO had increased the efficacy. DMSO is an effective, safe, and easy-to-apply treatment for doxorubicin-induced extravasation. Further clinical studies are needed to evaluate the use of carnitine in combination with DMSO.Öğe A case of gastric adenocarcinoma with rectal metastasis in the form of linitis plastica presenting as primary rectum carcinoma(Aves Yayincilik, Ibrahim Kara, 2008) Uzunoglu, Sernaz; Cicin, Irfan; Karagol, Hakan; Tanriverdi, Oezguer; Genchellac, Hakan; Usta, UfukIt is often reported that metastases in the form of linitis plastica developed in the gastrointestinal system are rare cases and frequently the primary tumor is located in the stomach. We presented a case of gastric adenocarcinoma developing a metastasis in the rectum in the form of linitis plastica, which appeared as a primary local advanced rectum cancer. We discussed the clinical, radiological, and pathological characteristics of the intestinal metastases of gastric adenocarcinomas.Öğe A case of Guillain-Barre syndrome in a patient with small cell lung cancer treated with chemotherapy(Kare Publ, 2014) Turkmen, Esma; Erdogan, Bulent; Hacibekiroglu, Ilhan; Kodaz, Hilmi; Uzunoglu, Sernaz; Celik, Yahya; Cicin, IrfanGuillain-Barre syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy characterized by bilateral progressive symmetrical paralysis. GBS is rarely seen neuropathy in cancer patients. In the literature some cases of GBS associated with anticancer chemotherapy. In this case; the guillain-barre syndrome developed after the treatment of a 59-year-old male patient with metastatic small cell lung carcinoma who admitted to hospital with neutropenic fever after cisplatin/etoposide chemoteraphy regime is presented. The patients complained of bilteral progressive symmetrical paralysis in upper and lower limbs with depressed deep tendon reflexes and hypoesthesia. There was no pathological findings on electromyography. There was no a sign at radiological imaging that explained cranial and spinal mestastasis. The cerebrospinal fluid had albuminocytologic dissociation. Decline in tumoral lesions were detected on chest radiography. Accompanied by clinical and laboratory findings, a diagnosis of Guillain-Barre syndrome was considered. Semptoms completely disapperared after intravenous immunoglobulin for five days. Recurrence did not during follow-up. The patients was administered a total of 4 cycles of cisplatin/etoposide chemotherapy. The patient died due to disease progression six months later. We think that, in this case GBS was not a paraneoplatic syndrome because there was more than 50% tumor shrinkage. We propose GBS was induced by infection and chemotherapy rather than malignancy.Öğe A Case of Malignant Melanoma With Cardiac and Gallbladder Metastases Detected by FDG PET-CT(Lippincott Williams & Wilkins, 2009) Ozulker, Tamer; Ozulker, Filiz; Cicin, Irfan; Ozpacaci, TevfikAn F-18-fluoro-2-deoxyglucose (F-18 FDG) whole-body positron emission tomography/computed tomography (PET/CT) study was requested with the purpose of staging for a 31-year-old man with a history of cutaneous malignant melanoma surgically removed from the skin of the left supraclavicular area 15 days ago. Mass lesions with increased FDG uptake in the right atrium, gallbladder, right adrenal gland, and subcutaneous tissue in the left side of the abdomen were detected on F-18 FDG PET/CT scan. The patient underwent cholecystectomy and the lesion in the right atrium was removed surgically. The histopathology of the both lesions revealed metastases from malignant melanoma.Öğe A case of non-Hodgkin's lymphoma presenting as a large chest wall mass(Kare Publ, 2008) Uzunoglu, Sernaz; Tanriverdi, Ozgur; Karagol, Hakan; Cicin, Irfan; Caloglu, Vuslat; Tokatli, FusunMalignant lymphoma as a solitary chest wall mass is rare. Although surgical resection is the main treatment modality for malignant chest wall tumors, the treatment of primary chest wall lymphomas is controversial. A 65-year-old male patient with an enlarging mass on the left side of his chest wall, which had first appeared four months before, applied to our hospital. The patient was directed to our polyclinic with a diagnosis of large B-cell lymphoma after the biopsy. Following the clinical investigation, stage IIEB extranodal am-Hodgkin's lymphoma was determined, and after a palliative radiotherapy, eight cycles of chemotherapy were planned. However, shortly after the completion of the sixth cycle of chemotherapy, poor performance status developed secondary to chemotherapy and the patient was diagnosed with pulmonary embolus. Following the stop of chemotherapy after six cycles, a complete clinical remission and a nearly complete radiologic remission were achieved. The patient is still under follow-up and was free of disease at four months.Öğe Characteristics of Turkish colorectal cancer patients and bevacizumab preference.(Amer Soc Clinical Oncology, 2017) Cicin, Irfan; Gumus, Mahmut; Uncu, Dogan; Ozkan, Metin; Kilickap, Saadettin; Elkiran, Tamer E.; Isikdogan, Abdurrahman[Abstract Not Available]
