Breast cancer is a heterogenous disease, and genetic profiling helps to individualize adjuvant treatment. The Oncotype DX is a validated test to predict benefit of adjuvant systemic treatment. The ...aims of this study are to determine the costs of chemotherapy in government hospitals in Turkey and evaluate the cost-effectiveness of the Oncotype DX from the national insurance perspective.
A Markov model was developed to make long term projections of distant recurrence, survival, quality adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative or up to 3 node-positive early stage breast cancer. Turkish decision impact study patient data were captured for model reference. In that study, ten academic centers across Turkey participated in a prospective trial. Of 165 patients with pT1-3, pN0-N1mic, ER-positive, and HER-2 negative tumors, 57% had low recurrence score (RS), 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in chemotherapy treatment decisions following Oncotype DX was 33%.
The cost of adjuvant chemotherapy in public hospitals was estimated at $3.649, and Oncotype Dx test was $5.141. Based on the cost-effectiveness analysis, Oncotype DX testing was estimated to improve life expectancy (+0.86 years) and quality-adjusted life expectancy (+0.68 QALYs) versus standard care. The incremental cost-effectiveness ratio (ICERs) of Oncotype DX was estimated to be $7207.9 per QALY gained and $5720.6 per LY gained versus current clinical practice.
As Oncotype DX was found both cost-effective and life-saving from a national perspective, the test should be introduced to standard care in patients with ER+, HER-2 negative early-stage breast cancer in Turkey.
Objective
This study aims to investigate the role of F-18 fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) parameters in the prediction of treatment response and the prognosis in locally ...advanced rectal cancer.
Methods
We investigated the relationship of 18F-FDG PET/CT parameters rectal metabolic tumor volume (MTV), rectal total lesion glycolysis (TLG), rectal standard uptake value (SUV) max, rectal highest peak SUV, lymph node MTV, lymph node TLG, lymph node highest peak SUV with the pathological response and disease-free survival (DFS) in 60 patients who received neoadjuvant therapy for a diagnosis of locally advanced rectal cancer. Patients with a total score of 0 were assigned to the low-risk group, patients with a score of 1 were assigned to the intermediate-risk group and patients with a score of 2 were assigned to the high-risk group.
Results
The multivariate analysis revealed that, from baseline PET CT parameters, lymph node highest peak SUV strongly predicted the pathological response at a cutoff value of 2.23. DFS was predicted by the lymph node highest peak SUV at a cutoff value of 3.13 and by the MTV value at a cutoff value of 27 cm
3
. The risk scoring performed with regard to rectal MTV and lymph node highest peak SUV values determined a median DFS of 19 months in patients with a risk score of 2, whereas the median DFS was not reached in patients with risk scores of 0 and 1 (P < 0.001).
Conclusion
This study determined that rectal MTV and lymph node highest peak SUV predicted the response to neoadjuvant therapy and DFS.
Regorafenib is a multikinase inhibitor, the effectiveness of which was demonstrated in metastatic colorectal cancer. This study aimed to investigate the factors that could predict the effectiveness ...of regorafenib.
This study retrospectively reviewed the clinical characteristics, tumor characteristics, and previous therapies in 62 patients who presented to our center between 2016 and 2020 and used regorafenib for metastatic colorectal cancer. The effects of the investigated variables on the response obtained with regorafenib use were evaluated.
This study included a total of 62 patients diagnosed with metastatic colorectal cancer, of whom 30 (48.4%) were males and 32 (51.6%) were females. Patients' median age at diagnosis was 49 years (18- 68). Regorafenib therapy yielded a disease control rate of 64% complete response=0, partial response= 14 (28%), and stable disease=18 (36%). Objective response was obtained in 28% of patients complete response=0 and partial response=14 (28%). Progression-free survival was 4 months. The evaluation of the effects of patients' age, sex, performance status, previous treatments, metastatic sites, and RAS mutation status on the disease control rate and progression-free survival did not determine any positive or negative effects on progression-free survival. However, left-sided tumors had a positive effect on disease control rate (69.8% vs. 28.6%, P=.029). and previous use of cetuximab had a negative effect on disease control rate 76.5% vs. 37.5% (P=.007).
In our study, tumor localization and previous cetuximab use were found to be correlated with the disease control rate in patients on regorafenib. However, the need for novel biomarkers that will predict the effectiveness of regorafenib in metastatic colorectal cancer treatment persists.
Objective: Bone metastases, which show a milder course compared with visceral disease, are among the most common metastatic sites in prostate cancer. In the present study, we aimed to investigate the ...prognostic factors that influence the survival time in the castration-sensitive phase in patients diagnosed with prostate adenocarcinoma with isolated bone metastasis. Materials and Methods: The prognostic effects of the clinical (performance status, number of bone metastases) and laboratory parameters of a total of 217 patients, of whom the data could be accessed, on survival in the castration-sensitive phase were evaluated. Results: Of the 217 patients included in our study, 144 (66.4%) were metastatic at presentation. The mean age of the patients was 68.4 (42-88) years. The mean follow-up duration was 44 months. Of our 217 patients, 125 (57.6%) were included in the castration-sensitive group and 92 (42.4%) in the castration-resistant group. In multivariate analyses; lactate dehydrogenase, alkaline phosphatase (ALP) levels and the number of bone metastases were independent prognostic factors with a strong correlation with time to castration-resistant prostate cancer. The evaluation of these three parameters within the framework of a prognostic index and subsequent risk stratification revealed median progression-free survival times of 91, 36, 20 and 12 months for the very low-risk, low-risk, intermediate-risk and high-risk groups, respectively. Conclusion: Lactate dehydrogenase, ALP levels and the number of bone metastases were determined as strong and useful prognostic factors in predicting time to castration-resistant prostate cancer in metastatic prostate cancer.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Amaç: Luminal tip meme kanserinde birçok çalışma yapılmış olmasına rağmen günümüzde bu tip meme kanserinde patolojik tam yanıtı (pCR) predikte eden faktörler halen net olarak bilinmemektedir. Bu ...çalışmamızda neoadjuvan kemoterapi alan luminal tip meme kanserli hastalarda patolojik tam yanıtı predikte eden faktörleri incelemeyi amaçladık.
Yöntemler: Çalışmaya Ocak 2010 ile Aralık 2018 arasında onkoloji merkezimizde neoadjuvan kemoterapi alan, luminal tip lokal ve lokal ileri evre meme kanserli, 18 yaşından büyük, 122 kadın hasta dahil edildi. Çalışmamızda neoadjuvan kemoterapi alan luminal tip meme kanseri tanılı hastalarda patolojik tam yanıtı predikte etme potansiyeli olan faktörleri retrospektif olarak inceledik.
Bulgular: Hastaların menopozal durumu (p=0.638), tümör lokalizasyonu (sağ-sol) (p=0.791) ve tümör boyutu (p=0.861) ile pCR arasında istatistiksel olarak anlamlı ilişki izlenmedi. Patolojik tam yanıt ile invaziv duktal karsinom histolojisine sahip olma (p=0.001), östrojen reseptör (ER) negatifliği (p=0.034), insan epidermal büyüme faktörü reseptör-2 pozitifliği (HER2) (p=0.030) ve nod negatifliği (p=0.023) arasında istatistiksel olarak anlamlı ilişki saptandı. Patolojik tam yanıt ile hastalığın evresi (II-III) (p=0.051) ve Ki-67 düzeyi (
Vascular endothelial growth factor (VEGF) is one of the parameters that has been studied in differential diagnosis of malignant fluids. This study is aimed at evaluate applicability of serum, fluid ...VEGF level and fluid to serum VEGF ratio in the diagnosis of malignant pleural mesothelioma (MPM).
The patients with pleural effusion over age of 18, between 2011 and 2015 were included in the study. They were divided into three groups: group 1 - mesothelioma patients; group 2 - other malignancies; and group 3 - benign aetiologies. Group 1 and 2 were termed as the malignant group. Fluid, serum VEGF levels, and the ratio of fluid/serum VEGF level were studied to evaluate the fluid/serum VEGF ratio in all groups.
Twenty cases with mesothelioma, 44 cases with other malignancies, and 20 cases with benign aetiologies were included in this study. No statistically significant difference was found according to serum VEGF levels for all groups, (group 1: 437 ±324 pg/ml, group 2: 354 ±223 pg/ml, group 3: 373 ±217 pg/ml,
= 0.836), while fluid VEGF levels showed a statistically significant difference (group 1: 3359 ±700 pg/ml, group 2: 2175 ±435 pg/ml, group 3: 1092 ±435 pg/ml,
= 0.041). The ratio of fluid to serum VEGF levels showed a difference, at the significance limit, between the malignant (group 1 and group 2) and benign (group 3) groups (8.83 ±1.29 vs. 4.57 ±1.07,
= 0.059) but showed a statistically significant difference between the mesothelioma and benign groups (12.11 ±1.68 vs. 4.57 ±1.07,
= 0.044).
The VEGF fluid/serum ratio may be an applicable parameter in the differential diagnosis of malignant fluids, especially MPM.
Combination of gemcitabine and nab-paclitaxel has superior clinical efficacy than gemcitabine alone. Nevertheless, health-related quality of life. (QoL) associated with this combination therapy when ...administered at first-line in advanced pancreatic adenocarcinoma is unknown.
A total of 125 patients were randomized to combination therapy (1000 mg/m2 gemcitabine + 125 mg/m2 nab-paclitaxel) and single-agent gemcitabine (1000 mg/m2) arms to take treatment weekly for 7 of 8 weeks, and following 3 of 4 weeks, until progression or severe toxicity. Primary endpoints were three-months of definitive deterioration free percent of patients, and QoL.
Overall QoL analyses showed that 34 and 58.3% of cases in gemcitabine and gemcitabine+nab-P arms had no deterioration in 3rd month QoL scores (p = 0.018). These proportions were 27.3 and 36.6% in 6
month assessments, respectively (p = 0.357). Median overall survivals in combination and single-agent arms were 9.92 months and 5.95 months, respectively (HR: 0.64, 95% CI: 0.42-0.86, p = 0.038). Median progression free survivals in these treatment arms were 6.28 and 3.22 months, respectively (HR: 0.58, 95% CI: 0.39-0.87, p = 0.008). Median time-to-deterioration were 5.36 vs 3.68 months, and objective response rates were 37.1% vs 23.7% (p = 0.009), respectively in combination and single-agent arms.
Combination therapy with gemcitabine + nab-paclitaxel had better overall and progression-free survival than gemcitabine alone. Also, combination therapy showed increased response rate without toxicity or deteriorated QoL. Combination treatment with gemcitabine and nab-paclitaxel may provide significant benefit for advanced pancreatic cancer.
This study has been registered in ClinicalTrials.gov as NCT03807999 on January 8, 2019 (retrospectively registered).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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