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Öğe Economic burden of lung cancer in Turkey: a cost of illness study from payer perspective(Bmc, 2021) Cicin, Irfan; Oksuz, Ergun; Karadurmus, Nuri; Malhan, Simten; Gumus, Mahmut; Yilmaz, Ulku; Cansever, LeventBackground This study was designed to estimate economic burden of lung cancer in Turkey from payer perspective based on expert panel opinion on practice patterns in clinical practice. Methods In this cost of illness study, direct medical cost was calculated based on cost items related to outpatient visits, laboratory and radiological tests, hospitalizations/interventions, drug treatment, adverse events and metastasis. Indirect cost was calculated based on lost productivity due to early retirement, morbidity and premature death resulting from the illness, the value of lost productivity due to time spent by family caregivers and cost of formal caregivers. Results Cost analysis revealed the total per patient annual direct medical cost for small cell lung cancer to be euro8772), for non-small-cell lung cancer to be euro10,167. Total annual direct medical cost was euro497.9 million, total annual indirect medical cost was euro1.1 billion and total economic burden of lung cancer was euro1.6 billion. Hospitalization/interventions (41%) and indirect costs (68.6%) were the major cost drivers for total direct costs and the overall economic burden of lung cancer, respectively. Conclusions Our findings indicate per patient direct medical costs of small cell lung cancer and non-small-cell lung cancer to be substantial and comparable, indicating the substantial economic burden of lung cancer in terms of both direct and indirect costs. Our findings indicate that hospitalization/interventions cost item and indirect costs were the major cost drivers for total direct costs and the overall economic burden of lung cancer, respectively. Our findings emphasize the potential role of improved cancer prevention and early diagnosis strategies, by enabling cost savings related to drug treatment and metastasis management cost items, in sustainability of cancer treatments.Öğe Impact of adding pertuzumab to trastuzumab plus chemotherapy in neoadjuvant treatment of HER2 positive breast cancer patients: a multicenter real-life HER2PATH study(Taylor & Francis Ltd, 2023) Bilici, Ahmet; Olmez, Omer Fatih; Kaplan, Muhammed Ali; Oksuzoglu, Berna; Sezer, Ahmet; Karadurmus, Nuri; Cubukcu, ErdemAimTo investigate the pathological complete response (pCR) achieved after neoadjuvant therapy with versus without adding pertuzumab (P) to trastuzumab (H) plus neoadjuvant chemotherapy (NCT) in HER2+ breast cancer (BC) patients in a real-life setting.MethodsA total of 1528 female HER2+ BC patients who received NCT plus H with or without P were included in this retrospective real-life study. Primary endpoint was pCR rate (ypT0/Tis ypN0). Clinicopathological characteristics, event-free survival (EFS) time, and relapse rates were evaluated with respect to HER2 blockade (NCT-H vs. NCT-HP) and pCR.ResultsOverall, 62.2% of patients received NCT-H and 37.8% received NCT-HP. NCT-HP was associated with a significantly higher pCR rate (66.4 vs. 56.8%, p < 0.001) and lower relapse (4.5 vs. 12.2%, p < 0.001) in comparison to NCT-H. Patients with pCR had a significantly lower relapse (5.6 vs. 14.9%, p < 0.001) and longer EFS time (mean(SE) 111.2(1.9) vs. 93.9(2.7) months, p < 0.001) compared to patients with non-pCR. Patients in the NCT-HP group were more likely to receive docetaxel (75.0 vs. 40.6%, p < 0.001), while those with pCR were more likely to receive paclitaxel (50.2 vs. 40.7%, p < 0.001) and NCT-HP (41.5 vs. 32.1%, p < 0.001). Hormone receptor status and breast conservation rates were similar in NCT-HP vs. NCT-H groups and in patients with vs. without pCR. Invasive ductal carcinoma (OR, 2.669, 95% CI 1.596 to 4.464, p < 0.001), lower histological grade of the tumor (OR, 4.052, 95% CI 2.446 to 6.713, p < 0.001 for grade 2 and OR, 3.496, 95% CI 2.020 to 6.053, p < 0.001 for grade 3), lower T stage (OR, 1.959, 95% CI 1.411 to 2.720, p < 0.001) and paclitaxel (vs. docetaxel, OR, 1.571, 95% CI 1.127 to 2.190, p = 0.008) significantly predicted the pCR.ConclusionsThis real-life study indicates that adding P to NCT-H enables higher pCR than NCT-H in HER2+ BC, while pCR was associated with lower relapse and better EFS time.Öğe Nivolumab as second-line treatment and beyond for metastatic renal cell carcinoma: A real-life experience from Turkish Oncology Group Kidney Cancer Consortium (TKCC) Database.(Lippincott Williams & Wilkins, 2021) Yekeduz, Emre; Erturk, Ismail; Tural, Deniz; Karadurmus, Nuri; Karakaya, Serdar; Hizal, Mutlu; Arslan, Cagatay[Abstract Not Available]Öğe Nivolumab in metastatic renal cell carcinoma: results from the Turkish Oncology Group Kidney Cancer Consortium database(Future Medicine Ltd, 2021) Yekeduz, Emre; Erturk, Ismail; Tural, Deniz; Karadurmus, Nuri; Karakaya, Serdar; Hizal, Mutlu; Arikan, RukiyeLay abstract Nivolumab is an immune checkpoint inhibitor (ICI) that blocks the communication between T cells and cancer cells and instead activates T cells to fight against cancer. Metastatic renal cell carcinoma (mRCC) is one of the most susceptible tumors to ICIs. The Checkmate 025 trial showed the efficacy of nivolumab in patients with previously treated mRCC. In this real-world study, 173 patients with mRCC were treated with nivolumab in the second line and beyond. Nivolumab was effective in the real-world setting without additional safety concerns. Aim: The authors present real-world data on the efficacy and safety of nivolumab in patients with metastatic renal cell carcinoma (mRCC). Methods: The Turkish Oncology Group Kidney Cancer Consortium (TKCC) database includes patients with mRCC from 13 cancer centers in Turkey. Patients with mRCC treated with nivolumab in the second line and beyond were extracted from the TKCC database. Results: A total of 173 patients were included. The rates of patients treated with nivolumab in the second, third, fourth and fifth lines were 47.4%, 32.4%, 14.5% and 5.7%, respectively. The median overall survival and progression-free survival were 24.2 months and 9.6 months, respectively. Nivolumab was discontinued owing to adverse events in 11 (6.4%) patients. Conclusion: Nivolumab was effective in patients with mRCC and no new safety signal was observed.Öğe Real-world treatment outcomes from nationwide ONCO-colon Turkey registry in RAS wild-type patients treated with biologics first-line metastatic colorectal cancer.(Lippincott Williams & Wilkins, 2021) Kefeli, Umut; Arslan, Cagatay; Yildirim, Mahmut Emre; Isikdogan, Abdurrahman; Karadurmus, Nuri; Karabulut, Bulent; Cubukcu, Erdem[Abstract Not Available]Öğe Real-world treatment outcomes from nationwide Onco-colon Turkey registry in RAS wild-type patients treated with biologics second-line mCRC(Sage Publications Ltd, 2024) Yildirim, Mahmut Emre; Karadurmus, Nuri; Okten, Ilker Nihat; Turk, Haci Mehmet; Urakci, Zuhat; Arslan, Cagatay; Celik, SinemisBackgrounds and Objectives Colorectal cancer is one of the leading causes of mortality both globally and in our country. In Turkey, we conducted a multicenter investigation into the effectiveness of second-line treatments and real-life data for patients with RAS wild-type metastatic colorectal cancer (NCT04757311).Materials and Methods In this retrospective analysis, records from 28 centers were collected, and histopathological, molecular, and clinical characteristics were documented. Patients were categorized into groups based on their second-line biological treatments: anti-EGFR (Group A and Group B, panitumumab and cetuximab) and anti-VEGF (Group C, bevacizumab and aflibercept). They were then compared within these groups.Results A total of 588 patients with documented RAS wild-type status were evaluated. The median OS was 15.7, 14.3 and 14.7 months in Group A, Group B and Group C, respectively (p = 0.764). The median PFS of the patients in second-line setting that received panitumumab, cetuximab and bevacizumab/aflibercept were 7.8, 6.6 and 7.4 months, respectively (p = 0.848).Conclusion According to the results of our real-life data study, there is no significant difference in efficiency between the combination of biological agent and chemotherapy used in the second-line treatments.Öğe Secondary pneumothorax during immunotherapy in two patients with metastatic solid tumors; a new entity(Future Medicine Ltd, 2021) Kucukarda, Ahmet; Sayin, Sezin; Gokyer, Ali; Aykan, Musa Baris; Karadurmus, Nuri; Cicin, IrfanLay abstract Immune checkpoint inhibitors are used with increasing frequency in cancer therapy. New side effects associated with these drugs have been identified. Air accumulation between the pleural membranes, which envelop the lungs and protect them in the ventilation function, without trauma may occur after using these drugs. We present here two cases that were treated with these drugs and developed this side effect. Patients with newly developed shortness of breath during this treatment should be careful about side effects such as this. Background: We present two cases of secondary pneumothorax after immunotherapy in two different clinics. Case summary: A 25-year old female patient with metastatic osteosarcoma, treated with atezolizumab. Grade 2 pneumonitis developed twice in the first year. Treatment was continued after recovery and areas of pneumonitis and pneumothorax were observed on computed tomography. No other reason could be found to cause pneumothorax. Pneumothorax resorbed spontaneously during follow-up. A 36-year old female patient treated with nivolumab for metastatic renal cell carcinoma (RCC), areas of pneumonitis and pneumothorax were only found as the cause of dyspnea. After treatment, remission was achieved on computed tomography findings. Pneumothorax was detected for the second time during continued therapy, and immunotherapy stopped permanently. Conclusion: These cases, indicate that immunotherapy can cause secondary immune-related pneumothorax based on immune pneumonitis.