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    Advanced Hepatocellular Cancer Treated with Sorafenib and Novel Inflammatory Markers
    (Springer, 2023) Gulmez, Ahmet; Harputluoglu, Hakan
    Objective Hepatocellular cancer (HCC) is an aggressive tumor with an increasing incidence in recent years. Life expectancy is limited, especially due to limited effective treatments and tumor biology. In this study, we aimed to examine the effect of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), prognostic nutritional index (PNI) parameters of treatment efficacy of patients using sorafenib in primary systemic therapy, progression-free survival (PFS), and overall survival (OS). Materials and Methods In this study, we retrospectively analyzed 78 patients who used sorafenib as a first-line systemic treatment. NLR, PLR, and PNI values were calculated with the existing formulas. Cut-off values for these markers were determined by performing ROC curve analysis. These values were determined respectively as 2.88, 111.05, and 38.25. Patients were divided into two groups according to this threshold value. OS and PFS values were calculated using a Cox proportional risk model. The effects of markers on OS and PFS were examined based on the cut-off value. Results The mean PFS was 7.1 (range 1-46) months, and the mean OS was 14.1 (range 1.5-94) months. The pre-treatment decreased NLR (< 2.88) value was prognostic for higher PFS and OS rates. These values were determined respectively as 9.23 +/- 1.79 and 3.45 +/- 0.32 months for PFS and 21.17 +/- 4.53 and 5.32 +/- 0.53 months for OS. Pre-treatment decreased PLR (< 111.05) was found to be a positively significant prognostic value for both survival. These values were determined respectively as 7.37 +/- 1.43 months and 3.16 +/- 0.47 months for PFS and 21.12 +/- 5.52 months and 6.16 +/- 0.87 months for OS. And also, low PNI (< 38.25) value was prognostic for lower PFS and rates. These values were determined respectively as 7.47 +/- 0.59 months and 3.25 +/- 0.21 months for PFS and 16.36 +/- 4.37 months and 5.15 +/- 0.42 for OS. All three parameters were found to be statistically significant (p < 0.05) for both OS and PFS as independent prognostic markers. Conclusion Today, as the standard first-line treatment of HCC has shifted to combinations with immunotherapy (IO), IO transportation is not possible in most countries of the world. However, there are also patients who achieve great survival with only sorafenib. The important point is to identify the biomarkers that predict which patient will benefit better from which treatment. With the markers in our study and a scoring system that can be obtained with these markers, it can be evaluated which patient will be given IO combination and which patient will be given only TKI treatment. We think that such a scoring system can be used to identify suitable patients, especially in countries where, for financial reasons, not every patient can access Immunotherapy. The advantage of these tests is that they are inexpensive, easily calculable and standardized.
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    Breast cancer after multiple myeloma treatment
    (Mosby-Elsevier, 2019) Gulmez, Ahmet
    Breast cancer is the most common cancer in women. In addition, it is the second leading cause of death after lung cancer.(1,2) The prevalence of epidemiological studies in previous studies is 22%-26%. The risk of mortality due to breast cancer is around 18%.(3,4) Multiple myeloma (MM) is a malignant disease of differentiated plasma cells. It is also the most common hematological neoplasm after lymphoma. Thirty five percent of MM patients are under the age of 65, 28% are between 65 and 74 of age and 37% are over the age of 75.(5) Pathophysiological mechanisms of MM include abnormal plasma cells (myeloma cells) occupying bone marrow, producing monoclonal immunoglobulin (M protein, M-component, and paraprotein) and increased bone destruction.(6) Breast cancer cases diagnosed concurrently with myeloma have been reported in previous case reports. There is also a patient diagnosed with myeloma following breast cancer chemotherapy. In our case, the patient was first diagnosed with MM. And then autologous bone marrow transplantation was performed following 3 cycles of chemotherapy. This presentation is unique, because in literature there is no breast cancer case after myeloma in literature review. (C) 2019 Elsevier Inc. All rights reserved.
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    Early thrombocytopenia predicts longer time-to-treatment discontinuation in trastuzumab emtansine treatment
    (Spandidos Publ Ltd, 2023) Sahin, Ahmet Bilgehan; Caner, Burcu; Ocak, Birol; Gulmez, Ahmet; Hamitoglu, Buket; Cubukcu, Erdem; Deligonul, Adem
    Thrombocytopenia is a characteristic adverse event of trastuzumab emtansine (T-DM1), one of the essential treatment options for human epithelial growth factor receptor 2 (HER2)-positive breast cancer. The present study investigated the predictive value of thrombocytopenia for time-to-treatment discontinuation (TTD) in patients receiving T-DM1 for advanced-stage HER2-positive breast cancer. The present observational study enrolled 138 patients who received T-DM1 at six oncology centers from January 2016 to December 2021. Univariate and multivariate Cox regression analyses were performed to determine the factors affecting TTD. The median age of patients was 50 years (range, 26-83). The median number of T-DM1 cycles was 9 (range, 2-58), the overall response rate was 50.0% and the disease control rate was 69.6%. At a median follow-up time of 19.3 months, the median TTD was 9.5 months [95% confidence interval (CI), 7.3-11.7], and the median overall survival was 28.2 months (95% CI, 19.2-37.2). Thrombocytopenia during treatment was observed in 39% of all patients, and 66.7% of these patients experienced early thrombocytopenia (in the first four treatment cycles). Multivariate analysis revealed that the independent factors for TTD were hormone receptor status [hazard ratio (HR), 1.837; 95% CI, 1.249-2.701; P=0.002], Eastern Cooperative Oncology Group performance status score (HR, 3.269; 95% CI, 1.788-5.976; P<0.001) and thrombocytopenia during treatment (HR, 0.297; 95% CI, 0.198-0.446; P<0.001). Patients with early thrombocytopenia had a significantly longer TTD of 17.3 months (95% CI, 11.8-22.8) compared with 7.6 months (95% CI, 5.8-9.4) for patients without early thrombocytopenia (P<0.001). The results of the present study indicated that patients with early thrombocytopenia had improved survival outcomes compared with those without. Thus, maximum benefit from T-DM1 treatment may be achieved by confirming the predictive role of thrombocytopenia in T-DM1 treatment in prospective studies and large-scale cohorts.
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    Impact of pharmacist-led educational intervention on pneumococcal vaccination rates in cancer patients: a randomized controlled study
    (Springer, 2023) Ozdemir, Nesligul; Aktas, Burak Y. Y.; Gulmez, Ahmet; Inkaya, Ahmet C. C.; Bayraktar-Ekincioglu, Aygin; Kilickap, Saadettin; Unal, Serhat
    Purpose This study aimed to evaluate clinical pharmacist's contribution to the pneumococcal vaccination rate by providing education to cancer patients in hospital settings. Methods This study was conducted in 2 tertiary-care hospitals' medical oncology outpatient clinics. Patients over 18 years of age and diagnosed with cancer for less than 2 years, in remission stage, and have not previously received the pneumococcal vaccine were included. Patients were randomized to intervention and control groups. The intervention group was provided vaccination education and recommended to receive the PCV13 vaccine. The control group received routine care. Patients' knowledge about pneumonia/pneumococcal vaccine, Vaccine Attitude Examination Scale (VAX) score, and vaccination rates were evaluated at baseline and 3 months after the education. Results A total of 235 patients (intervention: 117, control: 118) were included. The mean age +/- SD was 57.86 +/- 11.88 years in the control and 60.68 +/- 11.18 years in the intervention groups. The numbers of correct answers about pneumonia/pneumococcal vaccine (p = 0.482) and VAX scores (p = 0.244) of the groups were similar at baseline. After the intervention, the median (IQR) number of correct answers in intervention group [10(3)] was higher than control group [8(4)] (p < 0.001). After the education, the total VAX score (mean +/- SD) was less in intervention group (33.09 +/- 7.018) than the control group (36.07 +/- 6.548) (p = 0.007). Three months after the education, 20.2% of the patients in the intervention and 6.1% in the control groups were vaccinated with pneumococcal vaccine (p = 0.003). Conclusions The pneumococcal vaccination rate in cancer patients has increased significantly by the education provided by a clinical pharmacist in hospital settings.
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    A rare case Of gastric cancer: Isolated vaginal metastasis
    (Mosby-Elsevier, 2020) Gulmez, Ahmet; Dikilitas, Mustafa
    Gastric cancer is one of the most common cancers worldwide. The vast majority of gastric cancer is adeno-carcinoma histologically. The majority of gastric cancer patients show distant metastasis at the time of diagnosis. Because they are diagnosed with metastatic disease, most often they are inoperable ovarian metastasis is a well-known metastasis of gastric cancer. Vaginal metastasis happens by the local spreading of ovarian or uterine metastasis. This study reports a gastric cancer case that presented with isolated vaginal metastasis in the absence of ovarian or uterine metastasis (C) 2020 Elsevier Inc. All rights reserved.
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    The unexpected effect of the combination of lapatinib and capecitabin in cranial metastasis
    (Wolters Kluwer Medknow Publications, 2023) Gulmez, Ahmet
    Cranial metastasis (CM) is a serious problem in breast cancer patients. In patients with CM, quality of life is adversely affected and the survival of patients is reduced. It is also very difficult to manage breast cancer patients with cranial metastases whose life expectancy is generally 1 year or less. There is no case report in the literature of CM with more than 5 years of progression-free survival (PFS) with oncological treatment. I presented a rare case about the widespread CM developed with tamoxifen treatment in an advanced breast cancer patient who completed chemotherapy and radiotherapy after primary surgery. Systemic treatment was started as a combination of capecitabine and lapatinib after whole-brain radiotherapy was applied to the patient with extensive CM. At the end of about 3 years, there is complete response of cranial metastases, and PFS is over 5 years. The treatment was well tolerated, and she is still being followed up in the 74th month of this treatment without recurrence. There are no case reports of HER-2-positive breast cancer patients with such widespread cranial metastases in complete remission at 34 months of systemic therapy and 74 months of PFS. Our article is unique in this respect. It should be kept in mind that it is not appropriate to change the treatment plan of patients with only one case report. Although the options have increased with the use of new generation antihuman epidermal growth factor receptor 2 treatments, lapatinib can be a very effective treatment tool in selected patients.