Mehmet Artac

Leptin and breast cancer: an overview

Leptin is a well-known mediator of obesity. Leptin and its receptor are overexpressed in breast cancer, especially in high-grade tumors. It has an association with progression and poor survival of breast cancer. Leptin can regulate endothelial cell proliferation and promote angiogenesis. There are several other factors such as insulin and HER2 may be involved in the relationship between leptin and breast cancer. Leptin system has emerged as a new and promising therapeutic target for breast cancer. This review article summarizes the current knowledge about the relation of leptin and breast cancer.

Quality of Life in Patients With Advanced Non-small Cell Lung Cancer

Quality of life (QOL) has been shown to improve with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC), but the determinants of this improvement have not been thoroughly explored. Fifty consecutive NSCLC patients starting chemotherapy with measurable disease and with an Eastern Co-operative Oncology Group (ECOG) performance status of ≤2 were evaluated for change in QOL by European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). The status of global QOL before chemotherapy influenced the degree of change in physical functioning (F = 8.71, P =.001), global QOL (F = 23.82, P <.001), and fatigue (F = 7.92, P =.001), whereas age of the patient was again linked with the change in global QOL (F = 4.68, P =.014), and type of chemotherapy administration (1st vs. 2nd line) was associated with the change in fatigue (F = 7.82, P =.001). Our findings show that patient age and baseline QOL assessed by EORTC-QLQ-C30, but not ECOG performance status, may help predict the amount of improvement in certain aspects of QOL in patients with advanced NSCLC undergoing chemotherapy. Conversely, in this cohort, patients who are likely to have deteriorating QOL on chemotherapy may benefit from closer follow-up and nursing care to optimize supportive measures.

Chemotherapy-induced Hepatitis B virus reactivation in HbsAg positive cancer patients: a single center experience

Hepatitis B reactivation due to chemotherapy is a cause of serious morbidity and mortality in some of the patients with cancer. In this study, we retrospectively assessed the prevalence of hepatitis B reactivation among the patients undergoing cytotoxic chemotherapy. We investigated efficacy of lamivudine prophylaxis against hepatitis B reactivation as well.

Gene methylation of SFRP2, P16, DAPK1, HIC1, and MGMT and KRAS mutations in sporadic colorectal cancer

The aim of this study was to investigate the methylation of the SFRP2, P16, DAPK1, HIC1, and MGMT genes, as well as the mutation of amino acid codons 12 and 13 of the KRAS gene in normal and tumor tissue DNA of patients diagnosed with sporadic colorectal cancer (SCRC). The methylation of gene regions and the KRAS mutations of normal (N) and tumor tissue (T) DNA obtained from 17 patients diagnosed with SCRC and 20 healthy controls were investigated using the polymerase chain reaction and reverse-hybridization methods. There was an Asp mutation in four patients, an Asp and Ser mutations in one patient in codon 12 of the KRAS gene, and an Asp mutation in codon 13 in eight patients. Overall promoter methylation (OPM) in the SFRP2 gene was observed in one N and four T, whereas partial promoter methylation (PPM) was observed in two N and five T. OPM in the P16 gene was present in one T. In the DAPK1 gene, OPM existed in seven T and five N, while PPM was present in two N. In the HIC1 gene, OPM was demonstrated in three T, while PPM was noted in two N; however, no methylation existed in N. In the MGMT gene, OPM occurred in five T and two N, and PPM was present in one T. KRAS mutations in Turkish patients with SCRC are similar to those of other population groups. Methylations in the genes, which underwent methylation analysis, were higher in T in comparison with N, and it has been suggested that significant results would be obtained by making a study with a larger population.

The impact of waist-to-hip ratio on clinical outcomes in metastatic breast cancer patients treated with aromatase inhibitors☆

We aimed to identify whether abdominal fat distribution could affect the outcome in metastatic breast cancer (MBC) patients treated with aromatase inhibitors (AIs) or not. A total of 42 MBC patients treated with first line hormonal therapy were enrolled in this study. Factors associated with overall survival in the univariate analysis were age, c-erb-B2 expression intensity (+++ versus others by immunohistochemistry), and WHR, whereas only WHR retained significance in the multivariate analysis. Median overall survival figures were 472 days versus unreached for patients with a WHR of <0.92 and >or=0.92 (Log rank statistic=9.76, P=0.002). Similarly, the corresponding progression free survival figures for patients with a WHR of <0.92 and >or=0.92 were 423 versus 1004 days (Log rank statistic=6.37, P=0.012). This study suggests that WHR may serve as a potential predictive marker in MBC patients treated with AIs.

Do high-risk features support the use of adjuvant chemotherapy in stage II colon cancer? A Turkish Oncology Group study.

BACKGROUND A high-risk group of patients with stage II colon cancer has been identified by the results of studies in Western populations. The aim of this study was to investigate the prognostic factors of adjuvant chemotherapy in Turkish patients with stage II colon cancer. METHODS A total of 554 stage II colon cancer patients were retrospectively enrolled in the study. Three hundred fifty-three patients had received adjuvant chemotherapy (5-FU-LV, FOLFOX or FLOX) and 201 had received no adjuvant chemotherapy. T4 tumor stage, lymphovascular invasion, perineural invasion, bowel obstruction and/or perforation, <12 harvested lymph nodes, and poor differentiation were defined as high-risk factors. RESULTS The median age of the patients was 62 years (range 26-88). The median disease-free survival (DFS) was 58.1 months (95% CI, 47.6 months to 68.5 months) in the non-treatment group and has not been reached in the treatment group (P <0.01). In univariate analysis, patient age >60 years and T4 tumor stage were statistically significant factors that affected DFS as poor prognostic factors. Adjuvant chemotherapy reduced the risk of recurrence with statistical significance (P <0.01). In multivariate analysis, patient age >60 years and T4 tumor stage were independent risk factors affecting DFS. In addition, adjuvant chemotherapy was an independent favorable prognostic factor for DFS (P <0.01). CONCLUSIONS Clinical and pathological risk factors in patients with stage II colon cancer may be different in the Turkish population compared to other populations. Further prospective studies in colon cancer are needed to understand the differences in biology and risk factors between races.

Primary Tumor Resection and Survival in Patients with Stage IV Gastric Cancer

Purpose The aim of this study was to determine whether surgical resection of the primary tumor contributes to survival in patients with metastatic gastric cancer. Materials and Methods A total of 288 patients with metastatic gastric cancer from the Akdeniz University, Antalya Training and Research Hospital, and the Meram University of Konya database were retrospectively analyzed. The effect of primary tumor resection on survival of patients with metastatic gastric cancer was investigated using the log-rank test. Kaplan-Meier survival estimates were calculated. Multivariate analysis was performed using Cox proportional hazards regression modeling. Results The median overall survival was 12.0 months (95% confidence intewrval [CI], 10.4~13.6 months) and 7.8 months (95% CI, 5.5~10.0 months) for patients with and without primary tumor resection, respectively (P<0.001). The median progression-free survival was 8.3 months (95% CI, 7.1~9.5 months) and 6.2 months (95% CI, 5.8~6.7 months) for patients with and without primary tumor resection, respectively (P=0.002). Conclusions Non-curative gastrectomy in patients with metastatic gastric cancer might increase their survival rate regardless of the occurrence of life-threatening tumor-related complications.

An update on the multimodality of localized rectal cancer

New strategies have reduced the local recurrence (LR) rate and extended the duration of overall survival (OS) in patients with localized rectal cancer (RC) in recent decades. The mainstay of curative treatment remains radical surgery; however, downsizing the tumor by neo-adjuvant chemo-radiotherapy and adjuvant cytotoxic therapy for systemic disease has shown significant additional benefit. The standardization of total mesorectal excision (TME), radiation treatment (RT) dose and fractionation, and optimal timing and sequencing of treatment modalities with the use of prolonged administration of fluoropyrimidine concurrent with RT have significantly decreased the rates of LR in locally advanced rectal cancer (LARC) patients. This review focuses on the optimization of multi-modality therapies in patients with localized RC.

Metronomic oral chemotherapy with old agents in patients with heavily treated metastatic breast cancer.

BACKGROUND We aimed to assess the efficacy of a metronomic regimen with cyclophosphamide and etoposide in heavily treated patients with metastatic breast cancer (MBC). MATERIALS AND METHODS A total of 77 patients with MBC used continuous oral cyclophosphamide 50 mg/day and oral etoposide given as 2 × 50 mg/day for 2 days per week, were analyzed retrospectively from Akdeniz University and Selcuk University. The patients with MBC are predominantly refractory to antracyclines, taxanes, and antimetabolites. RESULTS The patients were treated and followed between May 2005 and June 2014. The median progression-free and overall survival (PFS and OS) were 7.03 (5.06-8.99) and 32.5 (22.5-42.4) months, respectively. No prognostic factor was found for OS. CONCLUSIONS Metronomic treatment regimen with cyclophosphamide and etoposide is a novel and effective strategy in heavily pretreated MBC patients. This regimen can be used in early or late steps as independently from prognostic factors. Moreover, it has very low toxicity and is cheap. Impressive survival data and low cost may make this regimen a highly preferable option.

Changes in lifestyle upon diagnosis of cancer or other chronic illnesses: A Turkish Oncology Group study

Cancer, like other chronic illnesses, changes the patients’ way of living significantly. Although some may think, for instance, that religiousness would increase with the diagnosis of cancer, no previous studies have been performed in the Turkish society to confirm this. We, as the Turkish Oncology Group, conducted a survey in seven different oncology centres, representing a large majority of Turkey, to investigate how patients’ lifestyles changed following a cancer diagnosis; we used dialysis patients as a chronic illness control group. The study findings showed how changes in spiritual practices are completely in line with what is observed in other chronic illnesses. These findings may help to address cancer patients’ needs and facilitate resource allocation accordingly.