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- MakaleYalnız künye2026Scopus SJRQ1Efficacy and safety of doxorubicin-ifosfamide versus gemcitabine-docetaxel as first-line therapy in advanced nonuterine leiomyosarcoma: A multicenter real-world study
Tunbekici, Salih; Sahin, Gokhan; Yuksel, Haydar Cagatay; Acar, Caner; Akin, Imge; Aslanhan, Hasan; Isci, Mert; Kabaoglu, Ceren; Bal, Hamit; Sakin, Abdullah
Nonuterine leiomyosarcoma (NU-LMS) is a rare and biologically distinct subtype of soft tissue sarcoma (STS) with clinical behavior differing from that of uterine leiomyosarcoma. In advanced or metastatic STS, immunotherapy has demonstrated only modest activity, and chemotherapy remains the cornerstone of treatment. However, there is a persistent unmet need for more effective and better-tolerated options in this population. This multicenter, retrospective study included 150 patients with histologically confirmed metastatic NU-LMS who received first-line doxorubicin-ifosfamide (AI) or gemcitabine-docetaxel (GD) at 26 oncology centers in Turkey between 2010 and 2024. The primary endpoint was overall survival (OS). Survival was analyzed using Kaplan-Meier estimates and Cox proportional hazards models. Of 150 patients, 79 received AI and 71 received GD. Median OS for the entire cohort was 21.0 months. Median OS was 22.0 months with AI and 19.1 months with GD (p = .18), median progression-free survival was 7.3 versus 6.1 months (p = .66), and overall response rate was 25.3% versus 29.6% (p = .58), indicating no statistically significant differences in efficacy between the two regimens. Hematologic toxicities were less frequent with GD. AI and GD demonstrated comparable efficacy as first-line regimens for advanced or metastatic NU-LMS, with fewer hematologic toxicities observed for GD. Tumor location may have prognostic implications. These findings support individualized treatment selection and highlight the need for prospective studies in this rare and understudied sarcoma subtype, while the recent LMS-04 trial underscores the importance of future comparisons with doxorubicin-trabectedin to further refine first-line strategies in LMS.
- MakaleAçık Erişim2025Scopus SJRQ2Real-world comparison of doxorubicin-ifosfamide versus gemcitabine-docetaxel regimens in metastatic uterine leiomyosarcoma: a multicenter retrospective study
Tunbekici, Salih; Sahin, Gokhan; Yuksel, Haydar Cagatay; Acar, Caner; Akin, Imge; Aslanhan, Hasan; Isci, Mert; Kabaoglu, Ceren; Bal, Hamit; Sakin, Abdullah
BackgroundUterine leiomyosarcoma is a rare and aggressive malignancy with limited responsiveness to standard therapies. We conducted a real-world, multicenter study to compare the clinical efficacy and safety of two commonly used first-line chemotherapy regimens-doxorubicin-ifosfamide and gemcitabine-docetaxel-in patients with metastatic uterine leiomyosarcoma.MethodsThis retrospective cohort included 271 patients with advanced or metastatic uterine leiomyosarcoma treated between 2010 and 2023 across 30 centers in Turkey. Patients received either doxorubicin-ifosfamide (n = 142) or gemcitabine-docetaxel (n = 129) as first-line therapy. The primary endpoint was overall survival; secondary endpoints included progression-free survival, objective response rate, disease control rate, and safety. Adverse events were graded according to the Common Terminology Criteria for Adverse Events version 5.0, while survival outcomes were estimated using the Kaplan-Meier method and further analyzed with Cox proportional hazards models.ResultsMedian overall survival was 19.7 months with doxorubicin-ifosfamide and 20.2 months with gemcitabine-docetaxel (P = .26). Median progression-free survival was 5.5 months with doxorubicin-ifosfamide and 7.0 months with gemcitabine-docetaxel (P = .62). The objective response rate was numerically higher with gemcitabine-docetaxel (35% vs. 26%), although not statistically significant (P = .11). Grade 3-4 neutropenia (16% vs. 12%) and febrile neutropenia (7% vs. 6%) were more frequent with doxorubicin-ifosfamide.ConclusionsIn this largest-to-date real-world cohort of metastatic uterine leiomyosarcoma, doxorubicin-ifosfamide and gemcitabine-docetaxel demonstrated comparable survival outcomes. Gemcitabine-docetaxel, however, was associated with a more favorable hematologic safety profile. These findings support the clinical utility of both regimens while underscoring the need for prospective, biomarker-driven studies to refine treatment selection and improve personalization in this rare malignancy.
AtıfOpenAlex2
İncele - MakaleAçık Erişim2025Scopus SJRQ3Efficacy of Second-Line Treatments After Atezolizumab and Bevacizumab in Advanced Hepatocellular Carcinoma and Related Prognostic Factors: A Multicenter Study by the Turkish Oncology Group (TOG)
Majidova, Nargiz; Yaslikaya, Sendag; Mildanoglu, Maral Martin; Coskun, Alper; Uzundal, Duygu Ercan; Sahin, Taha Koray; Akyildiz, Arif; Akbas, Sinem; Camanli, Ufuk; Sahin, Elif
Background/Aims: The treatment of hepatocellular carcinoma (HCC), which accounts for 90% of all liver cancers, is highly varied. The use of second-line treatments following progression on first-line atezolizumab and bevacizumab (Atez/Bev) for advanced HCC remains controversial. The aim of this study was to analyze the real-world clinical results of second-line treatments in progression after Atez/Bev and to determine the factors affecting prognosis. Materials and Methods: Fifty-eight patients treated with second-line sorafenib, regorafenib, and cabozantinib for progression after first-line Atez/Bev for advanced/metastatic HCC from 20 centers in T & uuml;rkiye between October 2020 and June 2024 were retrospectively analyzed. Responses were evaluated by Response criteria, specifically Response Evaluation Criteria in Solid Tumors (RECIST v1.1) criteria. Median overall survival (OS) and progression-free survival (PFS) were computed with the Kaplan-Meier method. The Cox regression model was utilized to analyze multivariate analyses. Results: About 82.8% of the patients were male and the median age of the whole group was 62 (range, 18-78) years. All patients progressed after first-line Atez/Bev and were given second-line treatment. The most commonly used second-line treatment option was sorafenib (70.7%), followed by regorafenib (12.1%) and cabozantinib (10.3%). Both median PFS (4.1 months) and median OS (7.8 months) were longer in patients treated with sorafenib compared to other treatments. In univariate analyses, Child-Pugh score B, high alpha-fetoprotein (AFP) levels (>200 ng/mL), extrahepatic spread, and Prognostic Nutritional Index (PNI) < 47.6 substantially raised the risk of overall mortality. Multivariate analysis showed that extrahepatic spread (HR (Hazard ratio): 0.41, P = .012), PNI level (HR: 0.24, P = .005), and AFP level (HR:1.97, P = .049) were independent predictors of OS. Conclusion: Although second-line therapies after Atez/Bev show different degrees of efficacy, survival rates are consistent with the literature. Extrahepatic spread, AFP level, and PNI level are the main prognostic factors. In light of this information, personalized treatment strategies may improve outcomes for this challenging patient group.
AtıfWoS1
İncele - MakaleAçık Erişim2025Scopus SJRQ1Regorafenib Treatment for Recurrent Glioblastoma Beyond Bevacizumab-Based Therapy: A Large, Multicenter, Real-Life Study
Tünbekici, Salih; Yuksel, Haydar cagatay; Acar, Caner; Sahin, Goekhan; Orman, Seval; Majidova, Nargiz; Coskun, Alper; Seyyar, Mustafa; Dilek, Mehmet siddik; Kara, Mahmut
Background/Objectives: In the REGOMA trial, regorafenib demonstrated an overall survival advantage over lomustine, and it has become a recommended treatment for recurrent glioblastoma in guidelines. This study aimed to evaluate the effectiveness and safety of regorafenib as a third-line treatment for patients with recurrent glioblastoma who progressed while taking bevacizumab-based therapy. Methods: This retrospective, multicenter study in Turkey included 65 patients treated between 2021 and 2023 across 19 oncology centers. The main inclusion criteria were histologically confirmed isocitrate dehydrogenase (IDH)-wildtype glioblastoma, progression after second-line bevacizumab-based treatment, and an Eastern Cooperative Oncology Group (ECOG) performance status score of <= 2. Patients received regorafenib 160 mg once daily for the first 3 weeks of each 4-week cycle. Results: The median age of the patients was 53 years (18-67 years), with a median progression-free survival of 2.5 months (95% Confidence Interval: 2.23-2.75) and a median overall survival of 4.1 months (95% CI: 3.52-4.68). The median overall survival was improved in patients who received subsequent therapy after regorafenib treatment compared with those who did not (p = 0.022). Progression-free survival was longer in patients with ECOG 0-1 than in those with ECOG 2 (p = 0.042). The safety profile was consistent with that of the REGOMA trial, with no drug-related deaths observed. Conclusions: Regorafenib shows good efficacy and safety as a third-line treatment for recurrent glioblastoma after bevacizumab-based therapy. This study supports the use of regorafenib and emphasizes the need for further randomized studies to validate its role and optimize treatment strategies.
AtıfWoS6OpenAlex11İncele - MakaleAçık Erişim2019Scopus SJRQ3Prostate volume effect on Gleason score upgrading in active surveillance appropriate patients
Çamur, Emre; Coskun, Alper; Kavukoglu, Ovunc; Can, Utku; Kara, Onder; Çamur, Arzu Develi; Sarica, Kemal; Narter, Kamil Fehmi
Introduction: Gleason Score (GS) upgrading rates in the literature are reported to be around 33-45%. The relationship between prostate volume and GS upgrading should be defined, aiming to reduce upgrading rates in patients with low risk groups who are eligible for active surveillance (AS) or minimally invasive treatment, by varying biopsy cores, or lengths of cores according to prostate volumes. In this regard, the aim of our study was to establish the relationship between prostate volume and GS upgrading. Materials and methods: We retrospectively analyzed the medical records of 78 patients, who were appropriate for AS between 2011-2016 at our hospital. Inclusion criteria were patient age under 65 years, PSA level under 10 ng/ml, GS (3 + 3) or (3 + 4), and 3 or less positive cores, clinical stages <= T2. GS increase in radical prostatectomy specimen was considered as 'upgrading' and in addition, score reported by biopsy as 3 + 4 but in surgical specimen as 4 + 3 were also considered as 'upgrading'. The effect of prostate volume on Gleason grade upgrading was examined by calculating upgrading rates separately for patients with prostate volume 30 ml or less, those with 30 to 60 ml, and those over 60 ml. Results: As a result of the analysis of the data, upgrading was seen in 35 (44.8%) of 78 patients included in the study. In the cohort mean prostate volume was 49.8 (+/- 26.3) ml. Twenty-two patients (28.2%) had prostate volume 30 ml or less, 34 (43.6%) 30 to 60 ml, and 22 (28.2%) 60 ml or more. The patients were divided into two groups as those with and without GS upgrading. Between the groups prostate volume and prostate volume range (0-30/31-60/> 60) were not significantly different (p value > 0.05). Conclusions: Gleason grade upgrading causes patients to be classified in a lower risk group than they actually are, and may lead to inappropriate treatment. This condition has a direct effect on the decision of active surveillance. Therefore, it is important to define the factors that can predict GS upgrading in active surveillance appropriate patients. In this study, we found that prostate volume has no significant effect on upgrading in active surveillance appropriate patients.
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