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Öğe Atezolizumab combined with chemotherapy in the first-line treatment of extensive-stage small cell lung cancer: A real-life data of the Turkish Oncology Group(Springer, 2022) Gürbüz, Mustafa; Kutlu, Yasin; Akkuş, Erman; Köksoy, Elif Berna; Köse, Naziyet; Öven, Bala Başak; Uluç, Başak Oyan; Demiray, Atike Gökçen; Erdem, Dilek; Demir, Bilgin; Turhal, Nazım Serdar; Uskent, Necdet; Akbaş, Sinem; Selçukbiricik, Fatih; İnal, Ali; Bilici, Ahmet; Kılıçkap, SaadettinPurpose Atezolizumab has been shown to be efective and safe in randomized trial in the frst-line treatment of extensivestage small cell lung cancer (SCLC). However, there are limited real-life data on atezolizumab. In this study, we aimed to determine the real-life efcacy and safety of atezolizumab combined with chemotherapy in the frst-line treatment of extensive-stage SCLC. Methods This trial is a retrospective multicenter study of the Turkish Oncology Group, which included extensive-stage SCLC patients who received atezolizumab combined with chemotherapy in a frst-line treatment. The characteristics of the patients, treatment and response rates, and PFS and OS are presented. Factors associated with PFS and OS were analyzed by univariate and multivariate analysis. Results A total of 213 patients at the 30 oncology centers were included. The median number of chemotherapy cycle was 5 (1–8) and atezolizumab cycle was 7 (1–32). After median 11.9 months of follow-up, median PFS and OS was 6.8 months (95%CI 5.7–7.8), and 11.9 months (95%CI 11–12.7), respectively. The ORR was 61.9%. ECOG-PS (p=0.002) and number of metastatic sites (p=0.001) were associated with PFS and pack-year of smoking (p=0.05), while ECOG-PS (p=0.03) and number of metastatic sites (p=0.001) were associated with OS. Hematological side efects were common and toxicities were manageable. Conclusion This real-life data confrm the efcacy and safety of atezolizumab in combination with chemotherapy in frstline treatment of extensive-stage SCLC.Öğe Crizotinib efficacy and safety in patients with advanced NSCLC harboring MET alterations: a real-life data of Turkish oncology group(Lippincott Williams and Wilkins, 2022) Gürbüz, Mustafa; Bilici, Ahmet; Karadurmuş, Nuri; Sezer, Ahmet; Şendur, Mehmet Ali Nahit; Paydaş, Semra; Artaç, Mehmet; Fulden Yumuk, Perran; Gürsoy, Pınar; Uysal, Mükremin; Şenol Coşkun, Hasan; Kılıçkap, SaadettinCrizotinib is a multikinase inhibitor, effective in non-small cell lung cancer (NSCLC) harboring mesenchymal-epidermal transition (MET) alterations. Although small prospective studies showed efficacy and safety of crizotinib in NSCLC with MET alterations, there is limited real-life data. Aim of this study is to investigate real-life efficacy and safety of crizotinib in patients with advanced NSCLC harboring MET alterations. This was a retrospective, multicenter (17 centers) study of Turkish Oncology Group. Patients’ demographic, histological data, treatment, response rates, survival outcomes, and toxicity data were collected. Outcomes were presented for the study population and compared between MET alteration types. Total of 62 patients were included with a median age of 58.5 (range, 26–78). Major histological type was adenocarcinoma, and 3 patients (4.8%) had sarcomatoid component. The most common MET analyzing method was next generation sequencing (90.3%). MET amplification and mutation frequencies were 53.2% (n = 33) and 46.8% (n = 29), respectively. Overall response rate and disease control rate were 56.5% and 74.2% in whole study population, respectively. Median progression free survival (PFS) was 7.2 months (95% confidence interval [CI]: 3.8–10.5), and median overall survival (OS) was 18.7 months (95% CI: 13.7–23.7), regardless of treatment line. Median PFS was 6.1 months (95% CI: 5.6–6.4) for patients with MET amplification, whereas 14.3 months (95% CI: 6.7–21.7) for patients with MET mutation (P = .217). Median PFS was significantly longer in patients who have never smoked (P = .040), have good performance score (P < .001), and responded to the treatment (P < .001). OS was significantly longer in patients with MET mutation (25.6 months, 95% CI: 15.9–35.3) compared to the patients with MET amplification (11.0 months; 95% CI: 5.2–16.8) (P = .049). In never-smokers, median OS was longer than smoker patients (25.6 months [95% CI: 11.8–39.3] vs 16.5 months [95% CI: 9.3–23.6]; P = .049). The most common adverse effects were fatigue (50%), peripheral edema (21%), nausea (29%) and diarrhea (19.4%). Grade 3 or 4 adverse effects were observed in 6.5% of the patients. This real-life data confirms efficacy and safety of crizotinib in the treatment of advanced NSCLC harboring MET alteration.Öğe Genetic testing and counseling challenges in personalized breast cancer care: review article with insights from Türkiye(Future Medicine Ltd, 2024) Cicin, Irfan; Karadurmus, Nuri; Bilici, Ahmet; Bahsi, Taha; Sendur, Mehmet Ali; Demirci, Umut; Goksu, Sema SezginAccording to current evidence, testing for germline BRCA pathogenic variants in newly diagnosed breast cancer (BC) patients has the potential to reduce the burden of the disease through targeted therapies and secondary prevention. A personalized approach to testing can lead to improved individual outcomes for patients. Despite the proven clinical utility and therapeutic impact of BRCA1/2 tests in shaping therapy for metastatic BC, awareness and access to these tests are limited in many developing countries, including Turkiye. This limitation impacts the healthcare economy as delayed or missed interventions can lead to increased long-term costs. The limited access is mainly due to fear of stigmatization among patients, country-specific legislation and costs, a lack of awareness, vagueness surrounding the tests and access restrictions. This review offers a perspective for policymakers and healthcare providers in Turkiye to establish pathways that integrate the patient experience into comprehensive care pathways and national cancer control plans.Öğe Real-life comparison of afatinib and erlotinib in non-small cell lung cancer with rare EGFR exon 18 and exon 20 mutations: a Turkish Oncology Group (TOG) study(Springer, 2022) Tatlı , Ali Murat; Erdem, Dilek; Göker, Erdem; Çelik, Emir; Demirci, Nebi Serkan; Sakin, Abdullah; Atçı , Muhammed Mustafa; Bayram, Ertuğrul; Akın Telli, Tuğba; Bilgin, Burak; Bilici, Ahmet; Akangündüz , Baran; Ballı, Sevinç; Demirkazık, Ahmet; Selçukbiricik, Fatih; Menekşe, Serkan; Çavdar, Eyyüp; Öztürk, Akın; Türkmen Bekmez, Esma; Turhal, Serdal; Kılıçkap, Sadettin; Yıldırım, Hasan Çağrı; Oyan, Başak; Aksoy, Asude; Paksoy Türköz, Fatma; Kut, Engin; Katgı, Nuran; Sakalar, Teoman; Akyol, Murat; Ellez, Halil İbrahim; Topçu, Atakan; Erdoğan, Atike Pınar; Pılancı, Kezban Nur; Hedem, Engin; Arak, Hacı; Akdeniz, Nadiye; Alan, Özkan; Yapar, Burcu; Nart, Deniz; Yumuk, Perran FuldenObjectives To compare the survival of frst- and second-generation tyrosine kinase inhibitors (TKIs) in patients with rare EGFR exon 18 and exon 20 mutation-positive non-small cell lung cancer (NSCLC). Materials and methods We retrospectively evaluated survival characteristics of 125 patients with EGFR exon 18 and exon 20 mutated NSCLC who received erlotinib or afatinib as frst line treatment between 2012 and 2021 from 34 oncology centres. Since exon 20 insertion is associated with TKI resistance, these 18 patients were excluded from the study. Results EGFR exon 18 mutations were seen in 60%, exon 20 mutations in 16%, and complex mutations in 24% of the patients with NSCLC who were evaluated for the study. There were 75 patients in erlotinib treated arm and 50 patients in afatinib arm. Patients treated with erlotinib had progression-free survival time (PFS) of 8.0 months and PFS was 7.0 months in the afatinib arm (p=0.869), while overall survival time (OS) was 20.0 vs 24.8 months, respectively (p=0.190). PFS of exon 18 mutated arm was 7.0 months, exon 20 mutated arm was 4.3 months, and complex mutation positive group was 17.3 months, and this was statistically signifcant (p=0.036). The longest OS was 32.5 months, seen in the complex mutations group, which was not statistically diferent than exon 18 and in exon 20 mutated groups (21.0 and 21.2 months, respectively) (p=0.323). Conclusion In this patient group, especially patients with complex mutations are as sensitive to EGFR TKI treatment similar to classical mutations, and in patients with rare exon 18 and exon 20 EGFR mutation both frst- and second-generation EGFR-TKIs should be considered, especially as frst- and second-line options.
