M. Ali Kaplan

Is diabetes mellitus a negative prognostic factor for the treatment of advanced non-small-cell lung cancer?

BACKGROUND It has been demonstrated that there are a lot of different prognostic factors which are worthy of consideration whereas diabetes mellitus (DM) has not been clearly or consistently identified as a prognostic value in advanced non-small cell lung cancer (NSCLC). The aim of this study was to investigate the prognostic significance of the characteristics of patients in advanced NSCLC. Specifically, we investigated the impact of DM for progression-free survival (PFS) and overall survival (OS) in patients receiving first-line platinum-based doublets chemotherapy. METHODS We retrospectively reviewed 442 patients with advanced NSCLC. DM and other potential prognostic variables were chosen for analysis in this study. Univariate and multivariate analyses were conducted to identify prognostic factors associated with survival. RESULT The results of univariate analysis for OS were identified as having prognostic significance: performance status (p<0.001), stage (p<0.001), DM (p<0.001), liver metastasis (p=0.02) and brain metastasis (p<0.001). Stage, diabetes mellitus, and liver metastasis were identified as having prognostic significance for PFS. Multivariate analysis showed that poor performance status, presence of DM and advanced stage were considered independent negative prognostic factors for OS (p 0.001, p<0.001 and p<0.001 respectively). Furthermore, DM and stage were considered independent negative prognostic factors for PFS (p 0.005 and p 0.001 respectively). CONCLUSION In conclusion, DM at the time of diagnosis was associated with the negative prognostic importance for PFS and OS in the advanced stage patients who were receiving first-line platinum-based doublets chemotherapy. In addition poor performance status and advanced stage were identified as negative prognostic factors.

Prognostic Factors in First-Line Chemotherapy Treated Metastatic Gastric Cancer Patients: A Retrospective Study

BACKGROUND The majority of patients with gastric cancer in developing countries present with advanced disease. Systemic chemotherapy therefore has limited impact on overall survival. Patients eligible for chemotherapy should be selected carefully. The aim of this study was to analyze prognostic factors for survival in advanced gastric cancer patients undergoing first-line palliative chemotherapy. METHODS We retrospectively reviewed 107 locally advanced or metastatic gastric cancer patients who were treated with docetaxel and cisplatin plus fluorouracil (DCF) as first-line treatment between June 2007 and August 2011. Twenty-eight potential prognostic variables were chosen for univariate and multivariate analyses. RESULTS Among the 28 variables of univariate analysis, nine variables were identified to have prognostic significance: performance status, histology, location of primary tumor, lung metastasis, peritoneum metastasis, ascites, hemoglobin, albumin, weight loss and bone metastasis. Multivariate analysis by Cox proportional hazard model, including nine prognostic significance factors evident in univariate analysis, revealed weight loss, histology, peritoneum metastasis, ascites and serum hemoglobin level to be independent variables. CONCLUSION Performance status, weight loss, histology, peritoneum metastasis, ascites and serum hemoglobin level were identified as important prognostic factors in advanced gastric cancer patients. These findings may facilitate pretreatment prediction of survival and can be used for selecting patients for treatment.

Cytosine-arabinoside induced bradycardia in patient with non-Hodgkin lymphoma: A case report

Cytarabine (Ara-C) is an arabinose nucleoside in the group of antimetabolite anticancer drugs. It is one of the critical agents for the treatment of acute myelogenous leukemia (AML). Moreover, Ara-C is used in the treatment of other hematological malignancies, such as non-Hodgkin’s lymphoma, chronic myelogenous leukemia, and acute lymphoblastic leukemia. The toxicity profile of Ara-C is highly dependent on the dose and schedule of administration. Well-known toxicities of Ara-C are myelosuppression, gastrointestinal and neurological toxicity. Other side effects associated with Ara-C include conjunctivitis, painful hand-foot syndrome, and anaphylactic reaction [1]. Cardiopulmonary complications of Ara-C including pericardial and myocardial complications are extremely rare [2 – 10]. Pericardial complications including pericarditis, effusion, and tamponade of Ara-C are more common than myocardial complications such as arrhytmias and congestive heart failure. Herein, we reported a patient who developed sinus bradycardia while receiving cytarabine as a second line therapy for non-Hodgkin’s lymphoma. The available information regarding a possible association of cytarabine with sinusal bradycardia is presented. A 53-year-old male patient admitted to our clinic with multiple cervical and abdominal lymphadenopathy. Histopathological examination of the excised cervical lymph node showed that dense lymphocytic infiltrates were composed predominantly of large dysplastic lymphocytes, which were marked as B cells (CD20(þ)). Six cycles of CHOP chemotherapy protocol (cyclophosphamide 750 mg/m Day 1, doxorubicine 50 mg/m Day 1, vincristine 1,4 mg/m Day 1, prednisone 100 mg Days 1 – 5) was administered as first line treatment and complete remission was achieved at the end of therapy. The disease progressed after 6 months, and DHAP chemotherapy protocol (dexamethasone 40 mg/day, 1 – 4 days; cisplatin 100 mg/m/day, 1 day; cytarabine 4 g/m/ day, 1 – 2 days) was started as second line treatment. Before administration of first DHAP chemotherapy protocol, the patient’s physical examination showed the following: body temperature 37.48C, blood pressure 120/80 mmHg, and radial arterial pulse 88 min. Sinusal rhythm was detected by electrocardiography (ECG), and normal echocardiographical examination revealed 60% ejection fraction. The patient complained of dizziness, five minutes after the administration of cytarabine. No other drugs (e.g. the dexamethasone) had been administered prior to the Ara-C. At this time, on physical examination of patient, pulse rate of 46 min and blood pressure of 100/65 mmHg were detected. His ECG showed sinusal bradycardia with 46 beats/min (Figure 1). Correct QT interval was 0.38 during bradycardia period. Bradycardia persisted 24 min after cessation of Ara-C. The patient’s pulse rate was 84 min prior to commencement of the Ara-C. No anti-emetic medications were administered at the time of Ara-C infusion, but granisetron was administered before cisplatin infusion on the first day of DHAP protocol. His condition improved with administration of 1 mg atropine, pulse increased to 96 min, and blood pressure increased to 110/ 65 mmHg. Patient was asymptomatic for 2 h after

Prognostic factors for second-line treatment of advanced non-small-cell lung cancer: retrospective analysis at a single institution.

BACKGROUND Platinum-based chemotherapy for advanced non-small cell lung cancer (NSCLC) is still considered the first choice, presenting a modest survival advantage. However, the patients eventually experience disease progression and require second-line therapy. While there are reliable predictors to identify patients receiving first-line chemotherapy, very little knowledge is available about the prognostic factors in patients who receive second-line treatments. The present study was therefore performed. METHODS We retrospectively reviewed 107 patients receiving second-line treatments from August 2002 to March 2012 in the Dicle University, School of Medicine, Department of Medical Oncology. Fourteen potential prognostic variables were chosen for analysis in this study. Univariate and multivariate analyses were conducted to identify prognostic factors associated with survival. RESULT The results of univariate analysis for overall survival (OS) were identified to have prognostic significance: performance status (PS), stage, response to first-line chemotherapy, response to second- line chemotherapy and number of metastasis. PS, diabetes mellitus (DM), response to first-line chemotherapy and response to second-line chemotherapy were identified to have prognostic significance for progression-free survival (PFS). Multivariate analysis showed that PS, response to first-line chemotherapy and response to second- line chemotherapy were considered independent prognostic factors for OS. Furthermore, PS and response to second-line chemotherapy were considered independent prognostic factors for PFS. CONCLUSION In conclusion, PS, response to first and second-line chemotherapy were identified as important prognostic factors for OS in advanced NSCLC patients who were undergoing second-line palliative treatment. Furthermore, PS and response to second-line chemotherapy were considered independent prognostic factors for PFS. It may be concluded that these findings may facilitate pretreatment prediction of survival and can be used for selecting patients for the correct choice of treatment.

Cisplatin-based therapy for the treatment of elderly patients with non-small-cell lung cancer: a retrospective analysis of a single institution.

BACKGROUND In spite of the fact that platinum-based doublets are considered the standard therapy for patients with advanced non-small-cell lung cancer (NSCLC), no elderly-specific platinum based prospective phase III regimen has been explored. The aim of this retrospective singlecenter study was to evaluate the efficacy and side effects of cisplatin-based therapy specifically for the elderly. METHODS Patients receiving platinum-based treatment were divided into three groups. In the first group (GC), Gemcitabine was administrated at 1000 mg/m2 on days 1, 8 and cisplatin was added at 75 mg/m2 on day 1. In the second group (DC), 75 mg/m2 docetaxel and cisplatin were administered on day 1. The third group (PC) received 175 mg of paclitaxel and 75 mg of cisplatin on day 1. These treatments were repeated every three weeks. RESULT GC arm had 36, the DC arm 42 and the PC arm 29 patients. Grade III-IV thrombocytopenia was higher in the GC arm (21.2% received GC, 2.8% received DC, and 3.8% received PC), while sensory neuropathy was lower in patients with GC arm (3.0%, 22.2%, and 23.1% received GC, DC and PC, respectively). There were no statistically significant difference in the response rates among the three groups (p>0.05). The median Progression-free survival (PFS) was 5.0 months and the median Overall survival (OS) in each group was 7.1, 7.4 and 7.1 months, respectively (p>0.05). CONCLUSION The response rate, median PFS and OS were similar among the three treatment arms. Grade III-IV thrombocytopenia was higher in the GC arm, while the GC regimen was more favorable than the other cisplatin-based treatments with regard to sensory neuropathy.

Efficacy and safety of raltitrexed combinations with uracil- tegafur or mitomycin C as salvage treatment in advanced colorectal cancer patients: a multicenter study of Anatolian Society of Medical Oncology (ASMO).

BACKGROUND There is no standard treatment for patients with colorectal cancer (CRC) progressing after irinotecan and oxaliplatin treatment. Here we aimed to retrospectively evaluate the efficacy and tolerability of raltitrexed in combination with oral 5-fluoropyrimidine (uracil tegafur-UFT) or mitomycin C as salvage therapy in mCRC patients. MATERIALS AND METHODS A total of 62 patients who had received raltitrexed combined with UFT or mitomycin C were identified between December 2008 and June 2013. They were given raltitrexed 2.6 mg/m2 (max 5 mg) i.v. on day 1 in combination with either oral UFT 500 mg/day on days 1-14 every 3 weeks (group A) or mitomycin C 6 mg/m2 i.v. on day every 3 weeks (group B). RESULTS Forty-two patients (67.7%) were in group A and 20 (32.2%) in group B. In 15 patients (24%) grade 3/4 toxicity was observed, resulting in dose reduction, and in 13 patients (20.9%) dose delay was necessary. The median progression free survival (PFS) was 3 months (95%CI 2.65-3.34) and median overall survival (OS) was 6 months (95%CI 2.09-9.90) in the whole group. Median PFS was 3 months (95%CI 2.60-3.39) in group A vs 3 months (95%CI 1.64-4.35) in group B (p=0.90). Median OS was 6 months (95%CI 2.47-9.53) in group A vs 12 months (95%CI 2.83-21.1) in group B (p=0.46). CONCLUSIONS The combination of raltitrexed with UFT or mitomycin C seem to be a salvage therapy option due to safety profile and moderate clinical activity in heavily-pretreated mCRC patients.

Is Diabetes Mellitus a Prognostic Factor for Survival in Patients with Small Cell Lung Cancer

BACKGROUND Previous studies have pointed to many different prognostic factors for small cell lung cancer (SCLC) but diabetes mellitus (DM) has not been clearly or consistently identified as of prognostic value. The aim of this study was to investigate the prognostic significance of the characteristics of patients and clinical laboratory tests in SCLC. Specifically, we investigated that the impact of DM for survival in the patients receiving first-line etoposide plus cisplatin (EP) chemotherapy. METHODS We retrospectively reviewed 161 patients with SCLC with a focus on DM and other potential prognostic variables were chosen for univariate and multivariate analyses with respect to survival. RESULT Among the sixteen variables of univariate analysis, five were identified to have prognostic significance: performance status (PS) (p <0.001), stage (p=0.001), DM (p=0.005), serum albumin (p <0.001) and hemoglobin levels (p=0.03). Multivariate analysis showed PS, stage and serum albumin level to be independent prognostic factors for survival (p=0.02, p=0.02 and p=0.009 respectively), but DM was not an independnet factor. CONCLUSION In conclusion, PS, stage and serum albumin level were identified as important prognostic factors, while DM at the time of diagnosis of SCLC did not have prognostic importance for survival.