Person: YUMUK, PERRAN FULDEN
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YUMUK
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PERRAN FULDEN
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Publication Open Access Adoption of pleurectomy and decortication for malignant mesothelioma leads to similar survival as extrapleural pneumonectomy(MOSBY-ELSEVIER, 2016-02) YILDIZELİ, BEDRETTİN; Batirel, Hasan Fevzi; Metintas, Muzaffer; Caglar, Hale Basak; Ak, Guntulu; Yumuk, Perran Fulden; Yildizeli, Bedrettin; Yuksel, MustafaObjective: We changed our surgical approach to malignant pleural mesothelioma (MPM) in August 2011 and adopted pleurectomy and decortication (PD) instead of extrapleural pneumonectomy (EPP). In this study, we analyzed our perioperative and survival results during the 2 periods. Methods: All patients who underwent surgical intervention for MPM during 2003-2014 were included. Data were retrospectively analyzed from a prospective database. Before August 2011, patients underwent evaluation for EPP and adjuvant chemoradiation (group 1). After August 2011, patients were evaluated for PD and adjuvant chemotherapy and/or radiation (group 2). Demographic characteristics, surgical technique, histology, side, completeness of resection, and types of treatments were recorded. Statistics was performed using Student t test, chi(2) tests, uni- and multivariate regression, and Kaplan-Meier survival analysis. Results: The same surgical team operated on 130 patients. Median age was 55.7 years (range, 26-80 years) and 76 were men. EPP and extended PD was performed in 72 patients. Ninety-day mortality was 10%. Median survival was 17.8 months with a 5-year survival rate of 14%. Uni- and multivariate analyses showed that epithelioid histology, stage N0, and trimodality treatment were associated with better survival (P=.039, P=.012, and P<.001, respectively). Demographic variables and overall survival (15.6 vs 19.6 months, respectively) were similar between the groups, whereas nonepithelioid histology, use of preoperative chemotherapy, and incomplete resections were more frequent in group 2 (P<.001, P<.001, and P=.006, respectively). Follow-up was shorter in group 2 (22.5 +/- 20.6 vs 16.4 +/- 10.9 months; P<.001). Conclusions: Adoption of PD as the main surgical approach is not associated with survival disadvantage in the surgical treatment of MPM.Publication Open Access Concurrent chemoradiotherapy with low dose weekly gemcitabine in stage III non-small cell lung cancer(BMC, 2005-12) YUMUK, PERRAN FULDEN; Abacioglu, U; Yumuk, PF; Caglar, H; Sengoz, M; Turhal, NSBackground: Combined chemoradiotherapy (CRT) is the treatment of choice for stage III NSCLC. Gemcitabine (G) is a novel deoxycitidine analogue that has been proven to be a potent radiosensitizer. Twenty-two consecutive patients were treated with concurrent CRT to demonstrate the tolerability and efficacy of low dose G given weekly as radiosensitizer in stage III NSCLC. Methods: Patients with KPS >= 70, adequate bone marrow reserve, with no prior radiotherapy (RT) and surgery were included. Eighteen patients had received prior induction chemotherapy (CT). G (75 mg/m(2)/week) was infused over 1 hour for 6 weeks. Thoracic RT was given two hours later over 6 weeks at 1.8 Gy/day fractions (total dose of 61.2 Gy). Pulmonary toxicity was evaluated with computed tomography scans in 6 weeks. Results: Median age was 60 years (range, 48-75), median follow-up was 15 months (range, 2-40). Sixty-eight percent of patients were male and median KPS score was 90. Conformal 3D-RT planning was used in 64% of patients. G was given for a median of 5 weeks ( range 1-9). Twelve patients (54.6%) received all planned CT. G was stopped because of intolerance in 6 and death in 2 patients. Seven patients (31.8%) had radiation pneumonitis. Twenty patients were evaluated for overall response, 1 patient (4.5%) had clinical CR, 81.8% had PR while 9.5% had SD. Median overall survival (OS) was 14 +/- 5 months (95% CI 3-25). One- and 2-year OS rates were 55% and 38%. Sixteen patients died of disease-related events (6 with progression of primary tumor, 8 due to metastatic disease), 2 patients died of other causes. One- and 2-year progression- free survival and local control rates were 56%, 27% and 79%, 51%, respectively. Conclusion: G might be used as radiosensitizer for patients with stage III NSCLC who could not receive full doses CT with concurrent RT.Publication Open Access Role of clinical oncology pharmacist in determination of pharmaceutical care needs in patients with colorectal cancer(BMJ PUBLISHING GROUP, 2018-03) SANCAR, MESUT; Tezcan, Songul; Izzettin, Fikret Vehbi; Sancar, Mesut; Turhal, Nazim Serdar; Yumuk, Perran FuldenObjective To determine and evaluate the pharmaceutical care needs and quality of life of patients with colorectal cancer. Methods 36 Patients with colorectal cancer eligible for chemotherapy after surgery were included in the study. The patients were followed up during 3 courses of chemotherapy and individual pharmaceutical care plans were developed. The quality of life of patients was evaluated before and after the third course of chemotherapy. Results The incidence of drug-related problems (DRPs) in chemotherapy-treated patients was reduced in the 3rd course as compared with 1st course (63.9% vs 75%, respectively; n = 36; p > 0.05). The clinical oncology pharmacist gave 147 recommendations to patients, which were followed in 98% (n = 144) of cases. 91.7% (n = 132) of the recommendations of clinical oncology pharmacists solved the drug-related problems; however, the remaining 8.3% (n = 12) did not solve the problems and the patients were referred to a doctor for further investigations. The symptom-related quality of life of patients related to anaemia, diarrhoea and neurotoxicity was reduced after the third course of chemotherapy (p < 0.05). Conclusions The pharmaceutical care provided by the clinical oncology pharmacist has an important role in the identification and resolution of DRPs. Evaluation of symptom-related quality of life is important for the monitoring of patients receiving chemotherapy.Publication Open Access Prognostic factors of perioperative FLOT regimen in operable gastric and gastroesophageal junction tumors: real-life data (Turkish Oncology Group)(2022-01-01) YUMUK, PERRAN FULDEN; Erol C., Sakin A., Başoglu T., Özden E., ÇABUK D., Doğan M., Öksüzoğlu B., YILDIRIM H. Ç. , Öner İ., Karakurt Eryilmaz M., et al.© TÜBİTAK.Background/aim: Perioperative FLOT regimen is a standard of care in locally advanced operable gastric and GEJ adenocarcinoma. We aimed to determine the efficacy, prognostic factors of perioperative FLOT chemotherapy in real-life gastric and GEJ tumors. Materials and methods: The data of patients who were treated with perioperative FLOT chemotherapy were retrospectively analyzed from 34 different oncology centers in Turkey. Baseline clinical and demographic characteristics, pretreatment laboratory values, histological and molecular characteristics were recorded. Results: A total of 441 patients were included in the study. The median of age our study population was 60 years. The majority of patients with radiological staging were cT3-4N(+) (89.9%, n = 338). After median 13.5 months (IQR: 8.5–20.5) follow-up, the median overall survival was NR (95% CI, NR to NR), and median disease free survival was 22.9 (95% CI, 18.6 to 27.3) months. The estimated overall survival at 24 months was 62%. Complete pathological response (pCR) and near pCR was achieved in 23.8% of all patients. Patients with lower NLR or PLR have significantly longer median OS (p = 0.007 and p = 0.033, respectively), and patients with lower NLR have significantly longer median DFS (p = 0.039), but PLR level did not affect DFS (p = 0.062). The OS and DFS of patients with better ECOG performance scores and those who could receive FLOT as adjuvant chemotherapy instead of other regimens were found to be better. NLR was found to be independent prognostic factor for OS in the multivariant analysis. At least one adverse event reported in 57.6% of the patients and grade 3–4 toxicity was seen in 23.6% patients. Conclusion: Real-life perioperative FLOT regimen in operable gastric and GEJ tumors showed similar oncologic outcomes compared to clinical trials. Better performance status, receiving adjuvant chemotherapy as same regimen, low grade and low NLR and PLR improved outcomes in real-life. However, in multivariate analysis, only NLR affected OS.Publication Open Access Assessment of Palliative Care in Lung Cancer in Turkey(KARGER, 2017) YUMUK, PERRAN FULDEN; Bulbul, Y.; Ozlu, T.; Arinc, S.; Ozyurek, B. A.; Gunbatar, H.; Senturk, A.; Bahadir, A.; Ozcelik, M.; Yilmaz, U.; Akbay, M. O.; Saglam, L.; Kilic, T.; Kirkil, G.; Ozcelik, N.; Tatar, D.; Baris, S. A.; Yavsan, D. M.; Sen, H. S.; Berk, S.; Acat, M.; Cakmak, G.; Yumuk, P. F.; Intepe, Y. S.; Toru, U.; Ayik, S. O.; Basyigit, I.; Ozkurt, S.; Mutlu, L. C.; Yasar, Z. A.; Esme, H.; Erol, M. M.; Oruc, O.; Erdogan, Y.; Asker, S.; Ulas, A.; Erol, S.; Kerget, B.; Erbaycu, A. E.; Teke, T.; Besiroglu, M.; Can, H.; Dalli, A.; Talay, F.Objective: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. Subjects and Methods: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the. 2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. Results: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. Conclusion: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey. (C) 2016 S. Karger AG, BaselPublication Open Access Is insulin resistance a predictor for complete response in breast cancer patients who underwent neoadjuvant treatment?(BMC, 2020-12) DANE, FAYSAL; Alan, Ozkan; Akin Telli, Tugba; Aktas, Bilge; Koca, Sinan; Okten, Ilker Nihat; Hasanov, Rahib; Basoglu, Tugba; Arikan, Rukiye; Demircan, Nazim Can; Ercelep, Ozlem; Kaya, Serap; Ugurlu, Mustafa Umit; Kaya, Handan; Akgul Babacan, Nalan; Dane, Faysal; Yumuk, Perran FuldenPurpose Neoadjuvant chemotherapy is the standard front-line treatment modality in locally advanced breast cancer. Achieving pathological complete response (pCR) is a significant prognostic factor for prolonged disease-free and overall survival. Insulin resistance is defined as a pathological condition in which insulin effect is impaired in peripheral target tissues such as the skeletal muscle, liver, and adipose tissue. The relationship between breast cancer and insulin resistance is controversial. In this study, our aim is to evaluate the role of insulin resistance, body mass index (BMI), metabolic syndrome, and inflammation markers to predict complete response in breast cancer patients who underwent neoadjuvant treatment. Methods Data from 55 locally advanced non-diabetic breast cancer patients, treated with neoadjuvant chemotherapy between 2015 and 2017, were retrospectively evaluated. Homeostatic model assessment, IR = insulin resistance (HOMA-IR) was calculated by using the obtained insulin and fasting blood glucose values before neoadjuvant chemotherapy (fasting insulin x fasting glucose/405). We considered a cut-off of 2.5 for insulin resistance. The systemic inflammatory index (SII), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were calculated. Results Twenty-five patients had no insulin resistance. The most common pathologic subtype (56%) was hormone receptor (HR) positive and human epidermal growth factor receptor-2 (Her-2)-negative invasive ductal carcinoma. Sixteen (29%) patients had a pathological complete response (pCR). We found that the probability of pCR in patients with insulin resistance was 4.7 times lower than that in patients without insulin resistance [OR: 4.7 (95%CI 1.7-17.2),p= 0.01]. Conclusion Our results revealed that insulin resistance may have a negative effect on pathological complete response (pCR) following neoadjuvant therapy particularly with hormone-positive and Her-2-negative cases of non-diabetic breast cancer.Publication Open Access Smokers having Activating EGFR Mutant Non-Small Cell Lung Cancer Might Benefit from EGFR-TKI Treatment - Single-Center Experience(KARE PUBL, 2020) DANE, FAYSAL; Ercelep, Ozlem; Telli, Tugba Akin; Alan, Ozkan; Hasanov, Rahib; Simsek, Eda Tanrikulu; Babacan, Nalan Akgul; Kaya, Serap; Kaya, Handan; Dane, Faysal; Yumuk, Perran FuldenOBJECTIVE This study aims to evaluate the predictive impacts of cigarette smoking on treatment outcomes of EGFR tyrosine kinase inhibitors (TKIs) in Non-Small Cell Lung Cancer (NSCLC) patients with activating EGFR mutations. METHODS We retrospectively evaluated the data of 46 patients with metastatic NSCLC (adenocarcinoma) and EGFR mutation (exon 19 deletion, exon 21 mutation, and exon 18 activating mutation) treated with EGFR-TKI between 2012 and 2017. RESULTS Median age was 61 (range 30-80), and 56.5% (26/46) was female. Median follow-up was 39 months. The rate of smoking was 41.3% (19/46). The EGFR mutations were present in the patients, exon 19 deletion in 29 patients (64%), exon 21 mutation in 13 patients (28%) and exon 18 activating mutations in four patients (8%). Progression-free survival (PFS) was 21 months in smokers, whereas it was 25 months in non-smokers (p=0.330). Median PFS was 21 months for patients using EGFR-TKI in the first-line (35 patients), and 13 months in the second-line setting (11 patients). CONCLUSION There were no statistically significant PFS differences between the smoker and non-smoker groups. Smokers should be tested for EGFR mutations, as some patients may benefit from EGFR TKI treatment for longer than reported in the literature.Publication Open Access Association of Pre-treatment Sarcopenia with Side Effects and Prognosis in Non-small Cell Lung Cancer Patients Receiving Erlotinib(2022-08-01) DEMİRCAN, NAZIM CAN; ENGÜR, CEREN ÖZGE; AKIN TELLİ, TUĞBA; BAŞOĞLU TÜYLÜ, TUĞBA; ARIKAN, RUKİYE; ÖZGÜVEN, SALİH; DANE, FAYSAL; KAYA, HANDAN; ÖNEŞ, TUNÇ; YUMUK, PERRAN FULDEN; DEMİRCAN N. C. , ENGÜR C. Ö. , AKIN TELLİ T., BAŞOĞLU TÜYLÜ T., Arikan R., Yasar A., Celebi A., Alan O., Isik S., ÖZGÜVEN S., et al.OBJECTIVE We investigated the relationship of baseline sarcopenia with toxicities, treatment response, and survival in patients who had non-small cell lung cancer (NSCLC) harboring an epidermal growth factor receptor (EGFR) mutation and received erlotinib.METHODS Computed tomography images from PET/CT scans before erlotinib treatment were retrospectively assessed. Skeletal muscle index, calculated as skeletal muscle area at third lumbar vertebra level/square of height, was used to define sarcopenia with < 52.4 cm2/m2 for males and < 38.5 cm2/m2 for females. Cox hazard models were conducted to determine predictors of survival.RESULTS The study included 30 patients, and 11 (36.7%) were sarcopenic. All-grade and Grade 3 toxicities were more frequent in sarcopenic group, although it was statistically insignificant (81.8% vs. 63.2%, p=0.282 for all-grade, and 18.2% vs. 10.5%, p=0.552 for grade 3). Response rates were 63.6% in sarcopenic and 68.4% in non-sarcopenic patients (p=0.789). Median progression-free survival was 7.9 and 9.2 months in sarcopenic and non-sarcopenic cases, respectively (p=0.561). However, median overall survival (OS) of sarcopenic patients was significantly shorter than non-sarcopenic ones (11.8 vs. 30.2 months, p=0.023), and sarcopenia predicted OS independently in multivariate analysis (Hazard ratio=2.63, p=0.029).CONCLUSION Early recognition, treatment, and prevention of sarcopenia may improve long-term survival in EGFRmutant NSCLC patients treated with first-line erlotinib.Publication Open Access Results of paclitaxel (day 1 and 8) and carboplatin given on every three weeks in advanced (stage III-IV) non-small cell lung cancer(BMC, 2005-12) YUMUK, PERRAN FULDEN; Yumuk, PF; Turhal, NS; Gumus, M; Hatabay, NF; Turken, O; Ozkan, A; Salepci, T; Aliustaoglu, M; Ahiskali, RBackground: Both paclitaxel ( P) and carboplatin ( C) have significant activity in non-small cell lung cancer (NSCLC). The weekly administration of P is active, dose intense, and has a favorable toxicity profile. We retrospectively reviewed the data of 51 consecutive patients receiving C and day 1 and 8 P chemotherapy (CT) regimen in advanced stage NSCLC to evaluate the efficacy and toxicity. Methods: Patients treated in our institutions having pathologically proven NSCLC, no CNS metastases, adequate organ function and performance status (PS) ECOG 0-2 were given P 112.5 mg/m(2) intravenously (IV) over 1 hour on day 1 and 8, followed by C AUC 5 IV over 1 hour, repeated in every three weeks. PC was given for maximum of 6 cycles. Results: Median age was 58 ( age range 39-77) and 41 patients (80%) were male. PS was 0/1/2 in 29/17/5 patients and stage was IIIA/IIIB/IV in 3/14/34 patients respectively. The median number of cycles administered was 3 ( 1 6). Seven patients (14%) did not complete the first 3 cycles either due to death, progression, grade 3 hypersensitivity reactions to P or lost to follow up. Best evaluable response was partial response (PR) in 45% and stable disease (SD) in 18%. Twelve patients (24%) received local RT. Thirteen patients (25%) received 2nd line CT at progression. At a median follow-up of 7 months (range, 1-20), 25 (49%) patients died and 35 patients (69%) progressed. Median overall survival ( OS) was 11 +/- 2 months (95% CI; 6 to 16), 1-year OS ratio was 44%. Median time to progression (TTP) was 6 +/- 1 months (95% CI; 4 to 8), 1-year progression free survival (PFS) ratio was 20%. We observed following grade 3 toxicities: asthenia (10%), neuropathy (4%), anorexia (4%), anemia (4%), hypersensitivity to P (2%), nausea/vomiting (2%), diarrhea ( 2%) and neutropenia (2%). Two patients (4%) died of febrile neutropenia. Doses of CT were reduced or delayed in 12 patients (24%). Conclusions: P on day 1 and 8 and C every three weeks is practical and fairly well tolerated outpatient regimen. This regimen seems to be comparably active to regimens given once in every three weeks.