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Background: Prioritizing the continuum of care for cancer patients while maximizing patient safety is of paramount importance However, COVID-19 pandemic could create a collateral damage in all domains of cancer care Here, we evaluate the early changes in the inpatient and outpatient oncology clinics and discuss how we currently anticipate and mitigate risks for cancer patients at the Hacettepe University Cancer Institute by employing adaptive algorithms Methods: Patients applying the outpatient clinic and outpatient palliative care (OPC) clinic for the first time and patients admitted to wards in the first 30 days after the first case of COVID-19 in Turkey were evaluated This data was compared to data from the same time frame in the previous three years Results: A total of 868 inpatient and 809 outpatient admissions were evaluated in the study with a 114 OPC clinic admissions The mean number of daily new patient applications to the outpatient clinic (9 87±3 87 vs 6 43±4 03, p

In metastatic and recurrent head and neck cancer (M/R HN-SCC), the median survival is less than a year and locoregional recurrence is the main cause of death. Our aim was to evaluate the results of concurrent stereotactic body radiotherapy (SBRT) and immunotherapy (ICI) in these patients.Fifteen patients diagnosed with M/R HN-SCC were evaluated retrospectively. All patients received SBRT (3x8 Gy) to all recurrent and metastatic foci with concurrent ICI.Six months overall survival (OS) rates and progression-free survival (PFS) rates were 93% and 86%, respectively. Local control (LC) rate in the site of SBRT was 96%. Higher survival and LC rates were achieved with lower doses of radiotherapy with the synergistic effect of SBRT and ICI.Concurrent ICI and SBRT was feasible with excellent LC.

Background: In the new era the COVID-19 disease became a world-wide pandemic in a short time, medical practice is predicted to be affected due to the both physician and patient tendencies, and usage of limited diagnosis and treatment opportunities for the outbreak In this study we investigated the characteristics of the patients who received chemotherapy (CT) or supportive treatments at the Hacettepe University Oncology Hospital Daily Treatment Unit in the first 60 days after the first case was detected in Turkey Methods: Patients recieved any CT or any kind of supportive treatment between 11th March 2020-10th May 2020 and 11th March 2019-10th May 2019 were included to the study Demographic properties and diagnoses of the patients, number of protocols and sessions applied, and non-chemotherapy treatments were investigated retrospectively Results: Between 11 th March 2020 and 10th May 2020 the average daily chemotherapy (CT) sessions apllied decreased by 7% compared to the same period of the previous year Patients receiving treatment for the first time decreased by 50% in the COVID period comparing to the last year and decreased from 146 to 73 (p=0 03) (Table) Supportive hydration treatments applied to an average of 8 3 patients daily decreased by 55% to an average of 3 8 per day In the 2019 a total of 137 transfusions were performed while in the period of COVID-19, the number of transfusions decreased by 29% to 98 [Formula presented] Conclusions: A minimal change was observed in the total number of chemotherapy applied during the pandemic period It is imperative that treatment units continue to work because most of the treatments in oncology practice is not postponable Decrease in patients who received treatment for the first time is a parameter that should be followed closely Hesitation of the patients having symptoms to consult a doctor or prolong the diagnosis period may prevent the diagnosis of curable disease on time Similarly, delay in patients' access to supportive treatments, may lead to an increase morbidity and mortality Legal entity responsible for the study: The authors Funding: Has not received any funding Disclosure: All authors have declared no conflicts of interest

Background Impaired DNA damage response (DDR) mechanisms and subsequent genomic instability is associated with carcinogenic process itself, but it also results in sensitivity of tumor cells to certain drugs and can be exploited to treat cancer by inducing deadly mutations or mitotic catastrophe. As a result, BRCA1/2 testing is recommended for a group individuals with breast/ovarian cancer. Methods In this study, we retrospectively invesitigated clinicopathologic features of 303 breast cancer patients tested for BRCA 1/2 mutation in an oncology institute. NCCN recommendations are used to select patients to be tested for BRCA mutations. Results A total of 303 patients were analysed for BRCA 1/2 mutations. Median age of the patients at diagnoses were 40 (21-65). Family history for BRCA related cancers were detected in 120 patients (39.6%). BRCA 1/2 mutations have been shown in 98 of 303 patients (32.3%). Of 98 BRCA mutated patients, 43 had pathogenic BRCA1 mutation, 39 had pathogenic BRCA2 mutation, 11 had variant of uncertain significance (VUS) BRCA2 mutation, 3 had VUS BRCA1 mutation and 2 had pathogenic BRCA1 and 2 mutations. Molecular subtypes of tumors have been shown in Table. Table . 316P Molecular subtypes of tumors BRCA Status HR(+)/ HER2(-), N(%) HR(+)/ HER2(+), N(%) HR(-)/ HER2(+), N (%) Triple(-), N (%) N/A,N(%) BRCA1 18 (41.8%) 2 (4.6%) 0 22 (51.1%) 1 (2.3%) BRCA2 25 (64.1%) 3 (7.7%) 0 6 (15.3%) 5 (12.8%) BRCA1 VUS 2 (66.7%) 0 0 1 (33.3%) 0 BRCA2 VUS 11 (100%) 0 0 0 0 BRCA1 + 2 0 1 (50%) 0 1 (50%) 0 BRCA mut (-) 126 (61.4%) 25 (12.1%) 12 (5.8%) 32 (15.6%) 10 (4.8%) TOTAL 182 (60%) 31 (10.2%) 12 (3.9%) 62 (20.4%) 16 (5.2%) Twelve of 98 BRCA mutated patients (12.2%) were de novo metastatic while 15 patients (15.3%) faced with metastatic disease during follow-up. In the BRCA mutated group there was significantly high rate of metastatic disease has been detected comparing BRCA non-mutated group (27.5% vs %16.5% respectively, p = 0.026). Metastatic BRCA mutant patients showed worse OS numerically but data is not statistically significant (P = 0.894). Nine patients were diagnosed with contralateral breast cancer, and 3 patients was diagnosed with BRCA-related cancers during follow-up. Prophylactic surgery (contralateral mastectomy and/or oophorectomy) was performed in 32 of 98 patients. Conclusions According to this retrospective study, BRCA mutant patients tend to have worse clinical and pathological features comparing age-matched controls. Legal entity responsible for the study Sercan Aksoy. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Purpose Excision repair cross-complementation group 1 enzyme (ERCC1) plays a key role in the removal of platinum induced DNA adducts and cisplatin resistance. Prognostic role of ERCC1 expression in the neoadjuvant setting in bladder cancer has not been reported before. We evaluated the prognostic role of ERCC1 expression in bladder cancer receiving platinum-based neoadjuvant chemotherapy. Materials and methods Thirty-eight patients with muscle invasive bladder cancer who received neoadjuvant platinum-based chemotherapy were included. Clinical and histopathologic parameters along with immunohistochemical ERCC1 staining were examined and correlated with response rates and survival. Results Pathologic complete response rates were similar between patients with low and high ERCC1 expression. Median disease-free survival (DFS) was 9.3 vs. 20.5 months ( P = 0.186) and median overall survival (OS) was 9.3 vs. 26.7 months ( P = 0.058) in patients with high ERCC1 expression compared with those with low expression, respectively. In multivariate Cox regression analysis: pathological complete response (pCR) after chemotherapy (hazard ratio (HR) 0.1, 95% CI 0.012–0.842, P = 0.034) and high ERCC1 expression (HR 3.7, 95% CI 1.2–11.2, P = 0.019) were significantly associated with DFS. Patient age (>60 vs. ≤60 years) (HR 3.4, 95% CI 1.2–9.4, P = 0.018), the presence of pCR (HR 0.11, 95% CI 0.014–0.981, P = 0.048) and high ERCC expression (HR 6.1, 95 CI 1.9–19.9, P = 0.002) were significantly associated with OS. Conclusions Our results showed that high ERCC1 expression was independently associated with shorter disease-free and overall survival in patients with bladder cancer who received neoadjuvant platinum-based chemotherapy. ERCC1 may represent a potential predictive marker for platinum-based treatment in bladder cancer.

Central nervous system (CNS) metastases are detected in up to one third of patients with advanced breast cancer, but their incidence and outcomes by breast cancer subtypes are not precisely documented. Herein, we retrospectively analyzed clinicopathologic data of 259 breast cancer patients with CNS metastases to evaluate the association between breast cancer subtypes and CNS metastasis. The patient groups were classified according to their hormone receptor status and HER-2 expression. Median follow-up time among the patients was 42 months and median survival after CNS metastasis detection was 7.8 months. In HER-2 overexpressing group, median time period between the diagnosis of breast cancer and the detection of CNS metastasis (15.9 months) was significantly shorter compared to the other groups (p = 0.01). The triple negative group had the shortest median survival time after CNS metastasis (6.6 months), although statistically not significant (p = 0.3). In multivariate Cox regression analyses, having solitary CNS metastasis (HR 0.4, 95% CI; 0.2-0.7, p = 0.004), and receiving chemotherapy after CNS metastasis (HR 0.4, 95% CI; 0.287-0.772, p = 0.003) were independent prognostic factors for increasing survival after CNS metastasis. In conclusion, new and effective treatment strategies are required for breast carcinoma patients with brain metastasis considering the positive effect of the treatment on survival.

Background: The level of serum cardiac troponin-T (cTnT) increases with myocardial damage. We sought to assess whether cTnT level could be a useful marker for the early detection of anthracycline cardiotoxicity. Patients and methods: Forty-one patients who had been scheduled to receive anthracycline-containing combination chemotherapy were included in the study. Serum cTnT levels were measured before (baseline) and after the first cycle of chemotherapy, and again, after the last cycle of chemotherapy. In all patients, the left ventricular ejection fraction (LVEF), fractional shortening (FS), early peak flow/atrial flow velocity (E/A) ratio, and the isovolemic relaxation time (IRT) were measured echocardiographically, both before and after the completion of chemotherapy. Results: LVEF and FS did not change in any patients. In 21 patients (49%), the E/A ratio decreased after therapy as compared to the pre-treatment values. The decrease in E/A ratio was more prominent in patients who were older than the mean age of our study group, which was 44 years. The post-treatment IRT was prolonged compared with the pretreatment IRT (94.0 ± 2.0 versus 85.6 ± 10.5 ms, respectively). cTnT levels after completion of therapy were elevated in 14 (34%) patients, and exceeded the upper limit of the normal range (>0.1 ng/ml) in only one patient. cTnT levels measured after completion of therapy were significantly higher, compared with those measured at baseline and after the first cycle of therapy. In the younger age group (< 44 years old), there was a two-fold decrease in the E/A ratio in those patients whose cTnT levels increased during the therapy, when compared with those whose cTnT levels did not change (21% versus 43%, respectively). Conclusion: Increased serum cTnT level can be detected in the early stages of anthracycline therapy and it is associated with diastolic dysfunction of the left ventricle. Therefore, serum cTnT level could be a useful measure for early detection of anthracycline-induced cardiotoxicity.

The increasing number of allogeneic stem cell transplantations has made the management of graft-versus-host disease (GVHD) a continuing problem for transplantation professionals. GVHD is a complicated disease the treatment of which requires an equally multifaceted approach. Despite therapeutic efforts to decrease its distressing and potentially lethal clinical manifestations, treatment is still not optimal. Fludarabine phosphate is a purine analogue, which is known to cause immunosuppression and long-lasting T-cell lymphopenia it is commonly employed in the therapy of hematological malignancies and non-myeloablative stem cell transplantation conditioning regimens. Myelosuppression, especially leuko- and lymphopenia is the major dose-limiting toxicity of fludarabine. However, a prolonged reduction in CD4+ T-cell count may be a desired effect for the treatment of GVHD. Clinical observations, preclinical data on the management of GVHD and well-known immunosuppressive properties suggest that fludarabine should be tested in clinical grounds for GVHD prophylaxis and treatment.

Bisphosphonates, effectively used for metastatic bone disease and hypercalcemia, may evidentially have antiangiogenic properties. However, mechanism(s) of antiangiogenic effects of bisphosphonates are not fully understood. Their most pronounced effect is on metabolism of calcium, which is a main point of intersection for many distinct molecular signaling pathways that promote and modulate angiogenesis. An elevation of Ca 2+ plays a role in the mitogenic and secretory effects of growth factors. Some preclinical clues imply that antiangiogenic effects of bisphosphonates are related to its well-known hypocalcemic activity. Consequently, it may not be right to routinely recommend vitamin D and calcium supplementation to correct hypocalcemia unless it is symptomatic.

In this report, clinical, echocardiographic, and pathologic findings of a patient with multiple masses caused by tuberculosis both in the left and right side of the heart are presented. After antituberculosis treatment some of the masses disappeared and some became smaller. Although an intracardiac mass caused by tuberculosis is very rare, it should be considered in the list of masses detected by echocardiography.

Aim: Trastuzumab induced cardiotoxicity (TIC) was defined as the most serious side effect of trastuzumab. In this study, we aimed to define risk factors of adjuvant 9-weeks and 52-weeks trastuzumab therapies of HER2-positive breast cancer. Methods: Patients who completed 9 or 52-weeks adjuvant trastuzumab in HER2 positive breast cancer were included to the study. A total of 164 patients were included to this study; 108 and 56 patients were treated with 9-weeks and 52-weeks trastuzumab, respectively. The demographic characteristics and echocardiographic measurements of all patients enrolled in the study were recorded. Echocardiographic measurements were made at baseline and every 3 cycles during trastuzumab. Results: The median follow-up of our study was 32 (10-95) months. Symptomatic heart failure was not observed during trastuzumab treatment in both 9-weeks and 52-weeks trastuzumab groups. Asymptomatic LVEF decline was observed in 19 (11.5%) during trastuzumab treatment. In 7 patients of 52-weeks trastuzumab treatment group, mean LVEF values were decreased below 50% and all of them were treated with heart failure medications. In 52-weeks treatment group 5 patients failed to complete 52-weeks trastuzumab. The mean trastuzumab dose was 49.7 week in 52-weeks arms. According to the risk factor analyses, no association was found between TIC and hypertension (P = 0.54), hyperlipidemia (P = 0.69), diabetes (P = 0.59), obesity (P = 0.79), total anthracycline dose (P = 0.68) and family history of coronary artery disease (P = 0.68). Despite the risk of TIC was increased with advanced age (>50 year) (P = 0.08) and with combination taxane and anthracycline regimens (P = 0.07), this risk was not significant. But the risk of TIC was increase with the longer duration (1.9% and 30.3% in 9-weeks and 52-weeks trastuzumab treatment groups, respectively; P Conclusions: In our study, no risk factor association was found between hypertension, hyperlipidemia, diabetes, obesity and total anthracycline dose and the risk TIC. But the risk of TIC was increased non-significantly with advanced age (≥ 50 year) and with combination taxane and anthracycline regimens. The main risk factor of TIC was longer duration usage of trastuzumab in our study like trials of longer duration usage of trastuzumab in HERA and PHARE trials. Disclosure: All authors have declared no conflicts of interest.

Aim: In literature many trials reported that estrogen receptor (ER)-negative; progesterone receptor (PR)-positive breast carcinomas are biologically different from ER + PR+ tumors and have a poor clinical outcome. However, biological significance of only PR positive tumors is unclear. Although the only PR positive breast cancer patients treated as hormone receptor positive patients, clinically they behave more aggressive than hormone receptor positive tumors. Therefore, we aimed to retrospectively compare the clinical parameters and survival rates of the only PR positive breast cancer patients with triple negative patients. Methods: We retrospectively evaluated the data of triple negative and the only PR positive breast cancer patients who admitted to department of medical oncology in Hacettepe University and Ankara Numune Education and Research Hospital between years 2002 and 2013. We exclude the data of ER and/or HER-2 receptor positive breast cancer patients. The clinical characteristics and survival ratios of the only PR positive patients compared with triple negative patients. Results: The total 449 patients were included in study [Triple negative n = 349, the only PR positive n = 100]. The median follow up time was 46 (min:3- max:312) months. The mean age at diagnosis in triple negative and PR positive group was 48.1 ± 12 and 47.6 ± 10, respectively, difference was not significant. Menopausal status, histological subtypes, lymphovascular and perineural invasion rates, histological grade, comorbid diseases, were similar between two groups (p > 0.05). At the time of diagnosis the rate of metastatic disease in triple negative and PR positive group were 6.6% and 4%, respectively (p = 0.59). The 90% of PR positive group had hormonal therapy. In PR positive and triple negative groups the rates of patients who had radiotherapy and chemotherapy as follows; 74% and 71%, 87 and 84%, respectively (p > 0,05). The estimated disease free survival time for PR positive and triple negative group was, 157 (95% CI, 92-221) months and 166 (95% CI, 144-187) months (p = 0.75). In triple negative and PR positive group the 5 th year overall survival rates were similar (82% versus 83%, p = 0.92). Conclusions: In this study we showed that the only PR positivite breast cancer patients had similar clinical features and survival rates with triple negative counterparts. Disclosure: All authors have declared no conflicts of interest.

Aim: Gastric cancer is often diagnosed in advanced stage. Palliative chemotherapy or best supportive care is recommended for patients with metastatic gastric patients. In several clinical trials palliative chemotherapy improved overall survival (OS) and disease free survival (DFS), but the survival benefit of second line chemotherapy was demostrated in small cohort studies. The main aim of our study is to compare the efficacy of second line fluorouracil-folinic acid-irinotecan (FOLFIRI) and epirubicin-oxaliplatin-capacitabine (EOX) regimens. Methods: Metastatic gastric cancer patients who progressed after completed modified docetaxel-cisplatin-fluorouracil (DCF) regimens were included. A total 105 patients were included to this study; 55 and 50 patients were treated with EOX and FOLFIRI regimens. The clinicopathological and demographic characteristics of all patients were collected from the medical charts. Kaplan–Meier survival analysis was carried out for DFS and OS. Results: The median follow-up of our study was 15 (4-85) months. In both groups, all of the patient were treated with prior modified DCF. In our study, prior median DCF cycle was 4 (2-6) and 5 (3-8) in EOX and FOLFIRI groups, respectively. Median cycle of chemotherapy was 3 (1-8) and 3.5 (1-6) in EOX and FOLFIRI groups, respectively (P = 0.44). Median DFS was 5.3 months and 6.3 months (P = 0.91) whereas median OS was 6 and 7 months (P = 0.67) in EOX and FOLFIRI groups, respectively. Six months and 1-year DFS rate was 43.4% and 13.7% in EOX regimen; 54.7% and 11.3% in FOLFIRI regimen arms (P = 0.91). Six months and 1-year OS rate was 48.1% and 24.1% in EOX regimen; 53.8% and 29.3% in FOLFIRI regimen arms (P = 0.67). Conclusions: Published trials and meta-analyses showed the efficacy of second-line chemotherapy in the treatment of metastatic gastric cancer, but the optimal treatment regimen was not still known. In our trial both platin based and irinotecan based second line chemotherapies showed similar efficacy in metastatic gastric cancer. Like iriotekan based regimens, oxaliplatin based regimens can be effective in the second line treatment of metastatic gastric cancer patients. Disclosure: All authors have declared no conflicts of interest.

Aim: Trastuzumab is the first anti-HER2 humanized monoclonal antibody. The benefit of adjuvant trastuzumab has been shown in randomized phase 3 trials. Despite trastuzumab being recommended for 52 weeks in the adjuvant treatment of HER-2 positive breast cancer according to the current breast cancer guidelines, there is still no consensus on the optimal duration of adjuvant trastuzumab. The aim of our study is to investigate the efficacy and safety of adjuvant 9-weeks and 52-weeks trastuzumab in axillary lymph node-positive HER-2 positive breast cancer patients, retrospectively. Methods: A total of 271 HER-2 and axillary node-positive breast cancer patients who received trastuzumab as adjuvant treatment between 2005 and 2013 years were retrospectively analyzed. Patients with axillary node-positive HER-2-positive breast cancer who were non-metastatic were enrolled to the study. Patients were considered as 9-week trastuzumab group (n = 155) and 52-week trastuzumab group (n = 116). Kaplan–Meier survival analysis was carried out for disease-free survival (DFS) and overall survival (OS). Two-sided P values of Results: The median follow-up time for this analysis was 34 (4-95) months. Patients' clinical and pathological characteristics are well-balanced between the two treatment arms. In the 9-week trastuzumab treatment group, DFS rate was 96.7%, 84.8% and 74.9% whereas in 52-week trastuzumab treatment group, DFS rate was 94.3%, 80.0% and 80.0% in the first, third and fifth years, respectively (P = 0.76). In the 9-week trastuzumab treatment group, OS rate was 99.3%, 92.2% and 88.3% whereas in the 52-week trastuzumab treatment group, OS rate was 99.0%, 94.7% and 78.6% in the first, third and fifth years, respectively (P = 0.99). In both groups, symptomatic heart failure was not reported but asymptomatic left ventricular ejection fraction (LVEF) decline was observed in 3 (1.9%) and 18 (15.5%) patients in the 9-week and 52-week trastuzumab treatment groups, respectively (P Conclusions: In our study, the efficacy of 52-weeks and 9-weeks trastuzumab was similar in node-positive HER-2 positive breast cancer. Cardiotoxicity was significantly increased in 52-weeks trastuzumab arm compared with the 9-week trastuzumab arm. Disclosure: All authors have declared no conflicts of interest.

Breast cancer rarely occurs in young women. Our knowledge about disease presentation, prognosis and treatment effects is largely dependent upon older series. Breast cancer in women