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WOS: 000335651700087, PubMed ID: 24761926, Background: Hepatocellular cancer (HCC) is one of the important health problems in Turkey, being very common and highly lethal. The aim of this study was to determine clinical, demographic features and risk factors. Materials and Methods: Nine hundred and sixth-three patients with HCC from 13 cities in Turkey were included in this study. Results: Only 205 (21%) of the 963 patients were women, with a male: female predominance of 4.8:1 and a median age of 61 years. The etiologic risk factors for HCC were hepatitis B in 555 patients (57.6%), 453 (81%) in men, and 102 (19%) in women, again with male predominance, hepatitis C in 159 (16.5%), (14.9% and 22.4%, with a higher incidence in women), and chronic alcohol abuse (more than ten years) in 137 (14.2%) (16.8% and 4.9%, higher in males). The Child-Pugh score paralleled with advanced disease stage amd also a high level of AFP. Conclusions: According to our findings the viral etiology (hepatitis B and hepatitis C infections) in the Turkish population was the most important factor in HCC development, with alcohol abuse as the third risk factor. The Child-Pugh classification and AFP levels were determined to be important prognostic factors in HCC patients.

e14533 Background: To determine impact of modern chemotherapy regimens after pulmonary metastasectomy from colorectal cancer (CRC). Methods: A total of 122 consecutive patients who curatively resected for pulmonary metastases of CRC in eleven oncology centers were retrospectively analysed between January 2000 and April 2012. Results: Of 122 patients, 108 who received chemotherapy with fluoropyrimidine-based (n = 12), irinotecan-based (n = 56) and oxaliplatin-based (n = 40) combinations were analyzed. Among these, 52 patients received bevacizumab (BEV) while 56 did not (NoBEV). With a median follow-up of 14 months after metastasectomy, median recurrence-free survival (RFS) was 17 months, overall survival (OS) was not reached. Three and 5-years OS rates were 66% and 53%, respectively. There was no significant difference among cytotoxic regimens in respect to RFS and OS. Similarly, no significant difference was seen between BEV and NoBEV arms in respect to OS and RFS. In univariate analysis prior liver metastasectomy (p = 0.045), positive pulmonary margin (p = 0.028), disease-free interval < 12 months (p = 0.013), and KRAS mutation (0.009) were negative significant prognostic for RFS. Thoracic pathological lymphatic involvement (p = 0.006) and higher prethoracotomy carcinoembryonic antigen (p = 0.038) were negative significant prognostic for OS. In multivariate analysis, positive pulmonary margin was the only negative independent prognostic for RFS, while thoracic lymphatic involvement was the only negative independent prognostic for OS. Conclusions: Chemotherapy type and addition of bevacizumab have no impact on both RFS and OS in the adjuvant setting following complete resection of colorectal pulmonary metastases.

Lapatinib is a dual tyrosine kinase inhibitor (TKI) that has a considerable efficacy in ErbB2-positive metastatic breast cancer (MBC). Previous studies revealed that TKIs caused cardiotoxicity in approximately 10 % of the patients. This study assessed the cardiac safety of lapatinib in women with ErbB2-positive MBC. In this observational single center study, all patients with ErbB2-positive MBC who were previously treated with anthracycline, taxanes, and trastuzumab in the adjuvant and/or metastatic setting were assigned to receive lapatinib at a dose of 1,250 mg per day continuously plus capecitabine at a dose of 2,000 mg/m(2) in two divided doses on days 1 through 14 of a 21-day cycle. Cardiac toxicity was assessed with symptoms, transthoracic echocardiography, electrocardiography and biochemical markers (brain natriuretic peptide (BNP), creatine kinase (CK) and creatine kinase-MB) at baseline and every 9 weeks until disease progression. Twenty-six patients were treated with lapatinib and capecitabine therapy for a median of 18 (range 3-60) weeks. The median age was 48 (range 28-83) years. All patients had ErbB2-positive MBC. Among 25 eligible patients, 5 (19.2 %) patients experienced new cardiac events compared with baseline findings. Of these 5 patients, 1 (3.8 %) had T wave negativity, 1 (3.8 %) had sinus tachycardia, 1 (3.8 %) had grade 1 (453 ms) QT prolongation, and 2 (7.7 %) had decreased LVEF below the critical level. Among eligible 21 patients, 2 (7.7 %) had increased BNP, 1 (3.8 %) had increased CK, and 1 (3.8 %) had increased CK-MB level compared with baseline. No serious cardiac events that required monitorization or medication occurred. There was no statistically significant relationship between the duration of lapatinib administration and LVEF changes, QT prolongation, BNP, CK, and CK-MB level. According to our findings, lapatinib was safe and well tolerated and has a low incidence of cardiac side effects. Therefore, it seemed that cardiotoxicity was not a class effect of TKIs. However, despite the absence of clinically significant adverse cardiac effects under lapatinib therapy, the incidence of cardiotoxicity reported in our study was higher than previous lapatinib studies.

Background: Hepatocellular carcinoma (HCC), the main malignant tumor of the liver, is very common and highly lethal. The aim of this study was to determine its clinicopathologic characteristics and risk factors in Turkey. Materials and methods: In this study, patients who were diagnosed as suffering from HCC in the period between August 2004 and December 2011 were evaluated retrospectively. Results: A total of 98 patients were included, with a median age 61 (range: 16 to 82). Seventy nine (80.6%) were male 59 (60.2%) were infected with hepatitis B virus (HBV) and 15 (15.3%) with HCV, another 15 (15.3%) being alcohol abusers. Seventy two (73.5%) were at advanced stage and 54 (55.1%) had elevated serum alpha-fetoprotein (AFP). Surgery, chemoembolization, systemic chemotherapy and application of the tyrosine kinase inhibitor sorafenib were the major treatment options. Conclusions: According to our findings HCC is mostly diagnosed in advanced stage and age, being five times more common in males than females. Main risk factors of HCC are HBV infection, HCV infection and alcohol abuse. Elevation in AFP may facilitate early diagnosis of HCC in high risk groups.

We investigate retrospectively the demographic and clinico-pathological characteristics of patients with triple-negative breast cancer (TNBC) compared to those with non-TNBC. Patients with breast cancer diagnosed from 1981 to 2008 in our clinic were retrospectively analyzed. Patient demographics including survival data and tumor characteristics were obtained from charts. A total of 795 patients were assessed in the study, including 140 patients (17.6%) with TNBC and 655 patients (82.4%) with non-TNBC. Patients with non-TNBC were further classified into 3 groups according to hormone receptor (HR) and HER-2 status. Median age was 49 (range 38–60 years) and similar between patients with TNBC and non-TNBC. Patients with TNBC had an increased likelihood of a higher histological grade III compared with HR(+) HER-2(−) subgroup (P > 0.001) and lower stage compared with HR(+)/HER2(+) and HR(−)/HER2(+) subgroups (P < 0.001 and P = 0.002, respectively). In patients with TNBC, the disease-free survival (DFS) rate was 66% at 5 years. In subgroup analysis of non-TNBCs, 5-year-DFS rates of the patients in HR(+)/HER2(−), HR(+)/HER2(+) and HR(−)/HER2(+) subgroups were 59, 66, and 57%, respectively. There was no significant difference between the TNBC and non-TNBC subgroups (P = 0.238). In multivariate analysis, nodal involvement (RR = 2.8, 95% CI: 0.99–8.3, P = 0.052) and the presence of lymphovascular invasion (RR = 3.2, 95% CI: 1.1–9.2, P = 0.029) were significantly associated with increased recurrence risk in patients with TNBC. Although there are differences in patient and tumor features, patients with TNBC had similar clinical course with those with non-TNBC.

To the Editor, A 43-year-old woman had been operated for infiltrative ductal carcinoma of the left breast with modified radical mastectomy in 2006. She was staged as T2N1M0 disease with positive ER/PR and her2/neu. She was given 3 cycles of adjuvant chemotherapy with CEF (cyclophosphamide, epirubicin, 5-fluorouracil), followed by weekly paclitaxel for 12 weeks. She received radiotherapy to the chest wall and surrounding lymphatic regions for 5 weeks. Then, she received adjuvant tamoxifen for two years. Her breast cancer has been in clinical remission after an uneventful follow-up of three years. However, she has experienced gingival bleeding and thrombocytopenia in September 2009. Peripheral smear and bone marrow aspiration and biopsy revealed acute promyelocytic leukemia (APL) with chromosal abnormality of t (15; 17) on cytogenetic examination. Her medical history was noncontributory except for breast fibroadenoma for 20 years and hypothyroidism. The patient was diagnosed as APL secondary to adjuvant therapy for breast cancer, and treatment with alltrans retinoic acid and idarubicin was initiated. We present a rare case of therapy-related APL (classified as AML-M3 in the French-American-British (FAB) classification) that may have been caused by adjuvant chemotherapy and/or regional radiation for breast cancer. Chemotherapy and radiotherapy are important in breast cancer therapy for improving survival of women with high-risk breast cancer [1]. The most common adjuvant chemotherapy agents used for breast cancer are alkylating agents (cyclophosphamide) and anthracyclines (epirubicin, doxorubicin). Although these agents have beneficial effects for the breast cancer, secondary malignancy including acute myeloblastic leukemia (AML) or myelodysplastic syndrome (MDS) may develop with alkylating agents (within 2–3 years) and anthracyclines (within 3–8 years) after the initial cancer treatment [2–4]. The combinations of these leukemogenic antineoplastic agents including epirubicin and cyclophosphamide may increase the risk of treatmentrelated AML and/or MDS. Additionally, the use of regional irradiation for patients with node-positive breast cancer may contribute to this increased risk [5]. Different chromosal abnormalities, especially those involving loss of all or part of chromosome 5 and/or 7, are noted with therapy-related AML/MDS [6]. On the other hand, it has been shown that patients with breast cancer have a higher susceptibility to develop a second malignancy even among patients undergoing only surgical approaches [3, 7]. Although the overall risk for a second malignancy in female patients with breast cancer appeared to be small (20–30% excess risk), it has been established that young age at diagnosis predicts for an increased risk for second malignancy [8]. Age-specific incidences showed peak among women in 40s, and 2.02% of the patients developed secondary malignancy [8]. The series of secondary APL are mostly clustered in patients with breast cancer in the literature. Interestingly, there is a correlation between the BRCA2 mutation and the risk of hematologic malignancy, and that the break point on chromosome 17 in the t (15;17) translocation is at or near the location of BRCA2 [9]. It is also noteworthy that there is an increased incidence of hypothyroidism (as in our case) in acute leukemia patients at diagnosis [10]. Thyroid hormone and retinoic acid receptor genes belong to the same family of nuclear receptor gene superfamily, and thyroid hormones are important regulators of hematopoiesis using receptors similar to differentiating factors such as retinoids [10]. O. Kara E. Ozdemir C. Arslan E. Dogan K. Altundag (&) Department of Medical Oncology, Hacettepe University Institute of Oncology, Sihhiye, Ankara 06100, Turkey e-mail: altundag66@yahoo.com

To The Editor, Patients with breast cancer survive longer after advances in treatment options [1]. During their follow-up, they may develop secondary malignancies or became patients with breast cancer secondary to previously diagnosed malignancies. The aim of our study was to evaluate the other malignancies among patients with breast cancer. Between years 2004 and 2009, 987 consecutive patients with breast cancer presenting at Hacettepe University Institute of Oncology were evaluated retrospectively. Median follow-up of all patients was 3.6 years (range 0.3–28). Of all the study population, 19 (1.9%) had other malignancies. Among all patients with breast cancer, 14 and 5 patients developed secondary malignancies before and after the diagnosis of breast cancer, respectively. The most frequently observed ones were ovarian cancer. The frequency of other malignancies was shown in Table 1. Median age of breast cancer diagnosis was 49, while median age of previous malignancies was 45 years old. Patients with breast cancer can survive longer after the advances in treatments. This can cause enough time to develop secondary malignancies. Secondary malignancies may develop sporadically, or due to environmental factors, genetic susceptibility and treatment complications [2]. Ewertz et al. reported the risk of second primary cancer in approximately 55,000 patients with breast cancer. They found that risk of a developing second malignancy was 13% [3]. In our study, frequency of other malignancies was 1.9%. This is most probably due to the short follow-up period. In our series, nearly 50% malignancies diagnosed were gynecological tumors. Therefore, close follow-up of patients who had gynecological tumors is very important due to risk of developing secondary cancer, especially breast cancer.

e21166 Background: We aimed to investigate whether a relation exists between primary tumor localization at breast and metastasis sites in breast cancer patients. Methods: Data of metastatic breast ...

e11041 Background: The majority of breast carcinomas are the luminal type, which has the higher levels of estrogen receptor, tend to be low grade with a favorable prognosis. Altered glycosylation, ...

1117 Background: Obesity is related with luminal type breast cancer. The aim of this study is to evaluate the association between body mass index (BMI) and breast cancer subtypes. Methods: 1,255 br...

e11001 Background: Lapatinib (L) is a tyrosine kinase inhibitor (TKI) that has efficacy in breast cancer. This study assessed the cardiac safety of lapatinib in women with cerbB-2 amplified metasta...

e13664 Background: Fin-HER study showed that addition of nine-weeks of trastuzumab to adjuvant chemotherapy improved disease-free survival and distant disease free survival in operable HER2-positiv...

1147 Background: We aimed to investigate the mean corpuscular volume (MCV) changes of red blood cells (RBC), and the possible association of clinical response in metastatic breast cancer patients (MBCP) under capecitabine treatment retrospectively. Methods: The data of 75 MBCP receiving capecitabine treatment between years of 2001 and 2005 were evaluated retrospectively. Capecitabine was used 2,500 mg2 daily for 14 days every 3 weeks. The complete blood count (CBC) including MCV (fl) was controlled at the beginning of capecitabine treatment, and periodically thereafter. ΔMCV was calculated by subtraction of MCV at the beginning from control date. Results: Forty-six of MBCP were premenopausal (61.3%). Mean age was 51.5 ± 10.8 years. Sixty-seven patients had invasive ductal carcinoma (89.4%). Estrogen and progesterone receptors were positive at 56% and 49% of the patients, respectively. Forty-eight patients (64%) had visceral, 11 had (14.7%) bone, 16 had soft tissue (21.3%) metastases. Capecitabine was admi...

e11106 Background: TAC (docetaxel/doxorubicin/cyclophosphamide) chemotherapy is commonly used as adjuvant chemotherapy for node-positive breast cancer. However, data are lacking for HER2-negative s...

Background: Metabolic syndrome is a cluster of multiple risk factors including obesity, insulin resistance, hypertriglyceridemia, low HDL (high density lipoprotein), and hypertension. Metabolic syndrome is associated with an increased risk of breast cancer. We evaluated the frequency and determinants of metabolic syndrome in patients with operable stage I-III breast cancer.Methods: In this cross-sectional study we analyzed the frequency and determinants of metabolic syndrome in patients with stage I-III breast cancer. Metabolic syndrome was defined according to NCEP (National Cholesterol Education Program) definitions. Data on metabolic syndrome criteria were collected along with demographic data, tumor size, grade, lymph node, estrogen, progesterone, HER2 status, grade and history of chemotherapy/endocrine therapy.Results: A total of 331 patients were analyzed. Median age was 50.0 years (range 20-84 years). Eighty-five patients were using tamoxifen, 98 patients were using aromatase inhibitors and the remaining 148 patients were not receiving hormonal therapy (newly diagnosed and/or triple-negative patients). According to the NCEP criteria 48.0% of the patients had metabolic syndrome. More patients receiving aromatase inhibitors had metabolic syndrome than those receiving tamoxifen (60.2% vs. 37.6%, p = 0.008). The frequency of MS among those not taking any hormonal therapy was 45.9%. Additionally, post-menopausal patients had higher rate of MS compared to pre-menopausal ones (53.4% vs. 25.0% p= Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5121.

e11537 Background: In a few number of studies a possible relationship between inflammatory markers and the prognosis, chemotherapy response and survival in breast cancer has been reported. The aim of this study is to point out the place of serum markers as a prognostic factor in early stage breast cancer. Methods: This study was conducted in Hacettepe University Cancer Institute. Patients operated and stage IA to III C for breast cancer between December 2009 and June 2012 were included the study. Before the any adjuvant therapy inflammation markers were studied. Results: A total of 704 patients were included in the study. The median age of the patients was 50 (25-92). 42,8% of the patients were premenopausal and 48,2% postmenopausal. The median follow up period for the whole study group was 22 months (3-287). We studied the CRP, erythrocyte sedimentation rate, B2 microglobulin, LDH, albumin, and ferritin studied and values for each marker were grouped as high and normal. There was no statistically significant difference in disease free survival and overall survival for each marker who had high and normal levels. Conclusions: We did not found any inflammatory markers as a prognostic value. However our follow up time is short and we should be wait for more mature data.