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Background: Ribociclib, palbociclib and abemaciclib are currently approved CDK4/6 inhibitors along with aromatase inhibitors as the first-line standard-of-care for patients with hormone receptor-positive, HER2-negative metastatic breast cancer. Methods: The authors report retrospective real-life data for 600 patients with estrogen receptor- and/or progesterone receptor-positive and HER2-negative metastatic breast cancer who were treated with ribociclib and palbociclib in combination with letrozole. Results & conclusion: The results demonstrated that the combination of palbociclib or ribociclib with letrozole has similar progression-free survival and overall survival benefit in real life for the patient group with similar clinical features. Specifically, endocrine sensitivity may be a factor to be considered in the treatment preference.

Aim: Description of patient characteristics, effectiveness and safety in Turkish patients treated with pazopanib for metastatic soft tissue sarcoma (STS). Patients and methods: This multicenter study is based on retrospective review of hospital medical records of patients (≥ 18 years) treated with pazopanib for non-adipocytic metastatic STS at 37 Oncology clinics across Turkey. Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) were evaluated with further analysis of data on the three most common histological subtypes (leiomyosarcoma [LMS], undifferentiated pleomorphic sarcoma [UPS], synovial sarcoma [SS]) in the cohort. Results: Data of 552 adults (57.6% women, median age: 52 years) were analyzed. DCR and ORR were 43.1% and 30.8%, respectively. Median PFS was 6.7 months and OS was 13.8 months. For LMS, UPS and SS, median PFSs were 6.1, 5.9 and 7.53 months and median OSs were 15.03, 12.87 and 12.27 months, respectively. ECOG ≥ 2 was associated with poor PFS and OS. Liver metastasis was only a factor for progression. Second-line use of pazopanib (vs. front-line) was associated with better PFS, its use beyond third line predicted worse OS. Adverse events (AE) occurred in 82.7% of patients. Most common AEs were fatigue (58.3%) and anorexia (52.3%) which were graded as ≥ 3 in 8.2% and 7.4% of patients, respectively. Conclusion: Pazopanib is effective and well-tolerated in treatment of non-adipocytic metastatic STS. Its earlier use (at second-line), good performance status may result in better outcomes. Worldwide scientific collaborations are important to gain knowledge on rarer STS subtypes by conducting studies in larger patient populations.

AIM We aimed to compare weekly methotrexate (MTX) regimen and methotrexate-folinic acid (MTX-FA) 8-day regimen in the first line treatment of low-risk gestational trophoblastic neoplasia (GTN). METHODS The study included 73 patients with low-risk GTN according to FIGO risk score (FIGO risk score

BACKGROUND/AIMS: Gastric neuroendocrine tumors (G-NETs) are rare tumors, but their incidence is gradually increasing. Despite the existence of many classification systems, determining prognosis and planning treatment in patients with G-NETs remains a clinical challenge. In this study, the prognostic value of the World Health Organization (WHO) 2017 grading system and the effect of surgery on survival in low grade neuroendocrine tumors were investigated. MATERIALS AND METHODS: G-NETs who were diagnosed between January 2000 and May 2017 were included in the study. Patients’ demographic characteristics, treatment details, and survival data were obtained from medical charts. Pathological samples were re-classified according to the WHO 2017 grading system. RESULTS: Of the total 94 evaluated patients, 50 (53.2%) were classified with G1 NETs, 37(39.4%) with G2 NETs, 4(4.2%) with well-differentiated G3 NETs, and the remaining 3 patients with poorly differentiated G3 neuroendocrine carcinoma (NEC). The median follow-up time was 83.2 months. There was a statistically significant difference in 5-year progression free survival (PFS) between G1 tumors (100%) and G2 tumors (76%) (p

Objectives This study aims to investigate the prevalence of systemic rheumatic diseases (SRDs) among patients with breast cancer (BC) and to identify the clinicopathological characteristics of these patients. Patients and methods A total of 3,744 female patients with BC (mean age 49±11.7 years; range, 18 to 92 years) followed in Hacettepe University Faculty of Medicine, Medical Oncology Department between January 2006 and December 2015 were retrospectively assessed. Patients with or without SRD were compared in terms of clinicopathological features including age, menopausal state, smoking status, Body Mass Index (BMI), age of menarche, age at first labor, and number of children. The groups were also evaluated regarding tumor grade, stage, estrogen receptor and progesterone receptor expression, human epidermal growth factor receptor 2 overexpression, and survival. Results Of the patients analyzed, 68 (1.81%) had concomitant SRD. Among these patients, 33 (48.6%) had rheumatoid arthritis, eight (11.8%) had familial Mediterranean fever, eight (11.8%) had Behcet's disease, four (5.8%) had Sjogren's syndrome, four (5.8%) had systemic lupus erythematosus, six (8.8%) had ankylosing spondylitis, three (4.4%) had systemic sclerosis, one (1.4%) had polymyositis, and one (1.4%) had temporal arteritis. The groups with or without SRDs were similar in terms of age, smoking status, BMI, menopausal state, breast feeding duration, age at menarche and first birth. Stage 1 and 2 BC was more prevalent in SRD patients (74.6% vs. 64.5%, p=0.018). The rate to receive chemotherapy was significantly lower in patients with SRD. However, there was no significant difference in five-year overall survival rates between patients with or without SRD. Conclusion Among patients with BC, 1.81% had concomitant SRD. These patients were diagnosed at early stages and given chemotherapy less frequently. However, they had similar survival rates compared to those without SRDs.

Introduction: This study aims to evaluate whether serum ferritin levels differ between recently diagnosed patients with type 2 diabetes mellitus (DM) and healthy controls, and to assess the relationship between serum ferritin level, insulin resistance and metabolic control in patients with type 2 DM.Material and methods: This study included 40 patients with recently diagnosed type 2 DM and 40 healthy controls. The Homeostasis Model Assessment of insulin resistance (HOMA-IR) score was used for evaluation of insulin resistance. HOMA-IR scores ≥2.7 were accepted as insulin resistance. The patient and control groups were compared in terms of age, gender, BMI, serum ferritin, insulin, HbA1c, and HOMA-IR scores. If ferritin levels correlated with other parameters was assessed in the patient group. Furthermore, patients with good (HbA1c, Giriş: Bu çalışmanın amacı yeni tanı tip 2 DM hastaları ile sağlıklı bireyler arasında serum ferritin düzeyi açısından fark olup olmadığını değerlendirmek, ayrıca tip 2 DM hastalarında serum ferritin düzeyinin insülin direnci ve metabolik kontrol ile ilişkisini araştırmaktır.Materyal ve metod: Çalışmaya 40 yeni tanı tip 2 DM hastası ile 40 sağlıklı kişiden oluşan kontrol grubu dahil edildi. İnsülin direncini değerlendirmek için Homeostasis Model Assessment of insülin resistance (HOMA-IR) skoru kullanıldı. HOMA-IR skorunun ≥2,7 olması insulin direnci olarak kabul edildi. Hasta ve kontrol grubunu oluşturan bireyler yaş, cinsiyet dağılımı, VKİ, serum ferritin düzeyi, insülin düzeyi ve HOMA-IR skoru açısından karşılaştırıldı. Hasta grubundaki bireylerin ferritin düzeyi ile diğer parametreler arasındaki ilişki incelendi. Ayrica iyi metabolik kontrollü (HbA1c

Aim This study aims to determine the frequency of germline BRCA 1/2 mutations in Turkish women with epithelial ovarian cancer (EOC) and evaluate its relationship with clinicopathological characteristics. Methods In this cross-sectional study, all women with recently diagnosed EOC presenting to Zekai Tahir Burak Women's Health Training and Research Hospital Medical Oncology Clinic between 2016 and 2019 were referred for BRCA testing. Peripheral blood samples were obtained from 76 patients applying to Medical Genetics and BRCA1/2 genes were sequenced using next-generation sequencing. The American College of Medical Genetics and Genomics 2015 criteria were followed for classification of genetic variants. Results Twenty-four women (31.6%) had pathogenic germline BRCA1/2 mutations. Of these, 17 patients (22.4%) harbored germline BRCA1 mutations and 7 (9.2%) had BRCA2 mutations. When we compared the patients with and without BRCA mutations, there was significant difference in terms of family history (41.7% vs 9.6%, respectively, P = .001). Among all patients, 15 (19.7%) had history of breast or ovarian cancer in first- or second-degree relatives. Germline BRCA1/2 mutations were detected in 66.7% of patients with family history, while these mutations were found in 22.9% of patients without family history (P = .001). Conclusion In this sample 31.6% of Turkish women with EOC harbored germline BRCA1/2 mutations, which seems higher compared to other ethnic groups except for the Ashkenazi Jews population. All women with EOC should be referred for BRCA testing regardless of family history, age at diagnosis, and histological subtype.

Uterine sarcoma accounts for 3-9% of uterine malignant tumors and has poor prognosis. Pazopanib is an oral multi-kinase inhibitor and the only tyrosine kinase inhibitor which has been approved for metastatic soft tissue sarcoma. In the present study we aimed to evaluate the efficacy of pazopanib in metastatic uterine sarcoma.The data of 28 metastatic uterine sarcoma patients receiving pazopanib therapy, who were followed in four oncology centers in Ankara, Turkey between May 2013 and June 2018, were retrospectively analyzed. Patients over 18 years, ECOG performance status ≤ 2, receiving at least one line of chemotherapy for metastatic disease, measurable disease at diagnosis, and histologically proven uterine high grade sarcoma were the inclusion criteria. Progression-free survival (PFS), overall survival (OS), and response rates to pazopanib were retrospectively evaluated.The median age was 53 years (range, 26-76). The majority of the patients had uterine leiomyosarcoma (LMS) (n=25, 89.3%), 2 (7.1%) had undifferentiated uterine sarcoma (UUS), and 1(3.6%) had high grade endometrial stromal sarcoma (ESS). The most common site of metastasis was lung (n: 21, 75%). The median time for pazopanib therapy was 5 months (0.6-28.3). In 22 patients (78.5%), pazopanib was discontinued due to disease progression, while 2 patients (7.1%) quitted therapy owing to toxicity. Partial response was achieved in 4 patients (14.3%), while 17 (60.7%) had stable disease. Median PFS was 5.2 months (95% CI 2.8-7.5) and median OS was 11.4 months (95% CI 3.4-19.5).In the present study aiming to assess the real-life outcome of pazopanib-treated patients, we found that pazopanib is efficient in metastatic uterine sarcoma, and our results correspond to the literature.

Background: Endocan, known as endothelial cell specific molecule (ESM), is a novel endothelial dysfunction marker. The aim of this study is to examine the plasma endocan level and its prognostic significance in newly diagnosed breast cancer patients. Methods: A total of 84 patients were enrolled the study. Plasma endocan level was measured by specific enzyme-linked immunosorbent assay (ELİSA) kit. Ethical approval and informed consent were attained. Results: At the time of diagnosis, 33 patients had stage 4 disease. The median plasma endocan level was 619.9 (min 259.9–2813.2) ng/L and its level was significantly higher in metastatic breast cancer group compared to non–metastatic breast cancer group. According to molecular sub-type of breast cancer, there is not statistical difference in plasma endocan level, but its level was higher in patients with Her-2 amplified and triple negative breast cancer (TNBC). Median follow-up time is 11 (1-30) months. Event free survival (EFS) was 15 months in patients with plasma endocan level lower than 620, while it was 4 months in patients with serum endocan level greater than 620 (p = 0.016). There was no difference between groups in terms of hypertension, age, Lymphovascular invasion (LVI), extra capsular extension (ECE), body mass index (BMI) and White blood cells (WBC), platelet count and plasma endocan level. Conclusion: Plasma endocan levels higher than non metastatic breast cancer. Patients with high plasma endocan levels are short EFS. Further studies would be useful to assess endocan level as a prognostic factor in breast cancer. Keywords: Endothelial cell specific molecule, Breast cancer, Prognosis

HER2-amplified breast cancer (BC) has a poor prognosis. The combination of trastuzumab with chemotherapy in the adjuvant setting decreases recurrence and improves overall survival in HER2-positive BC. However, the role of adjuvant treatment in patients with HER2-amplified small BC without lymph node involvement is still under debate. The purpose of this study was to investigate the safety of adjuvant paclitaxel and trastuzumab (APT) in this group of patients.A total of 87 operated early BC patients without lymph node involvement (N0) were treated with APT for 12 weeks followed by trastuzumab alone for a total of 9 months. Clinicopathological features and adverse events were analyzed.The median patient age was 50 years (range 28- 82), and 51% of them were postmenopausal. The median tumor diameter was 2.4 cm (range 0.5-6), with 51% of the patients having tumor size between 2 and 3 cm. Eighty-one percent of patients had invasive ductal carcinoma (IDC), and 64% had grade 3 tumors. Adjuvant hormone therapy and adjuvant radiotherapy were administered to 65 and 54% of patients, respectively. At a median follow up of 13 months (range 6-38), one patient (1.1%, 95% CI 0-3.4) experienced an asymptomatic decrease in left ventricular ejection fraction (LVEF) and 3 patients (3.4%, 95% CI 0-6.9) experienced grade 3 neuropathy.APT appears to be a safe combination in early-stage, HER2-amplified and node-negative BC.

BACKGROUND: Synovial sarcoma (SS) is a malignant mesenchymal tumor, which comprises 5%–10% of all the sarcomas. There is insufficient information on prognostic factors and salvage treatments of advanced SS. In this study, we aimed to further clarify the clinicopathological features, prognostic factors, and treatment modalities in advanced SS. MATERIALS AND METHODS: A total of 45 SS patients followed up between 2001 and 2015 at our cancer institute, Department of Medical Oncology, were retrospectively evaluated. Eleven patients were initially metastatic, and remaining patients developed metastasis or became inoperable due to locally advanced disease. Overall survival was evaluated by Kaplan–Meier analysis. RESULTS: The median age of patients was 37 (17–70) years and 60% (n = 26) of them were female. SS was most commonly localized in the lower extremity and abdomen-pelvis (29% and 29%, respectively). Median follow-up time was 33 (6–175) months. Patients were treated with a median of two (1–5) line chemotherapies at metastatic stage. Ifosfamide plus adriamycin (IMA) (49%, n = 22) and cisplatin-etoposide (13%, n = 6) were the most often used chemotherapy regimen as first line in metastatic stage. Partial response was obtained in 32% of the patients treated with IMA chemotherapy. Furthermore, median progression-free survival was 6 (1–123) months. Median survival of metastatic stage at diagnosis or in follow-up was 21 months (14–27) and 21 (12–29) months (P = 0.53), respectively. Most metastatic locations were lung (75%) and bone. Factors influencing survival at metastatic stage were evaluated; statistically significant longer survival was observed in patients with lung metastasis, primary tumor size smaller than 10 cm, patients who underwent surgery for the metastasis, and development-to-metastasis period longer than 12 months. CONCLUSION: Median survival of patients in metastatic stage SS was 21 months. Lung was the most common metastatic site.

Educational status may be an important parameter in assessing breast cancer risk and prognosis. The purpose of this study was to investigate the correlation between the level of education and clinicopathological characteristics of breast cancer, including tumor grade, HER-2 and estrogen receptor (ER) status, tumor size, axillary lymph node involvement and metastasis.The study included 1800 women who were diagnosed with invasive breast cancer during 2005-2013 at Hacettepe University Cancer Institute. Patients were divided into three groups according to their educational status at the time of diagnosis as follows: low (illiterate and elementary school, 5 years or less of education), medium (secondary school and upper secondary school, 6-12 years of education) and high (university level, more than 12 years of education). The associations between educational status and clinicopathologic features of breast cancer at the time of diagnosis were evaluated.In all patient, a significant relationship was found between educational status and T stages (p0.0001). Patients with higher educational levels were reported to have smaller tumor size regardless to their age and were less likely to have axillary lymph node involvement (p=0.001) or metastasis (p=0.001). A significant correlation was found between educational status and ER positivity in patients over 50 years of age (p=0.03). When the patients of all ages were evaluated, no statistically significant correlation was shown (p=0.27) between educational status and ER positivity. A significant relationship was found between educational status and HER-2 status (p=0.003), regardless of the patients' age. HER-2 positivity increased in patients with low educational status, however this significance was lost in patients over the age of 50 (p=0.1).The relationship between educational status and biological factors in breast cancer are not conclusive as yet, but this particular study revealed that educational status played a major influence in each of the five breast cancer prognostic factors: ER status, HER-2 status, tumor size, lymph node status and metastasis.