Acute nonvariceal upper gastrointestinal bleeding related to oxidative damage, ischemia, and trace element status

Background and objective: Oxidative stress (OxS) is known to play a role in the etiopathogenesis of many diseases. Many studies have shown increased oxidative damage in various gastrointestinal (GI) diseases, but the mechanism of this in GI bleeding has not been fully explained. The aim of this study was to assess the levels of trace elements, ischemia-modified albumin (IMA), malondialdehyde (MDA), and vitamin C in the etiopathogenesis of GI hemorrhage. Materials and methods: Our study group consisted of 40 acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) patients and 44 non-ulcer dyspepsia (NUD) subjects who underwent upper endoscopy. The whole blood count and biochemical parameters were measured by an automated analyzer. Trace elements were measured by inductively coupled plasma optical emission spectrometry (ICP-OES). Serum ischemia-modified albumin (IMA) was measured by albumin-cobalt binding (CAB) test. MDA levels were measured using a thiobarbituric acid reactive substances assay. The concentration of vitamin C in the serum was estimated by the phenylhydrazine spectrophotometry method. Results: The white blood cell (WBC) count (p < 0.005), prothrombin time (PT) (p < 0.001), and hemoglobin (Hb) (p < 0.001), alanine aminotransferase (ALT) (p < 0.008), albumin (Alb) (p < 0.001), vitamin C (p < 0.001), zinc (Zn) (p < 0.001), selenium (Se) (p < 0.001), and iron (Fe) (p < 0.004) levels were found lower in the ANVUGIB group than in the NUD group. However, the erythrocyte sedimentation rate (ESR) (p < 0011), international normalized ratio (INR) (p < 0.001), and creatinine (Cr) (p < 0.002), urea (p < 0.001), MDA (p < 0.001), IMA (p < 0.001), and copper (p < 0.018) levels were higher in the -ANVUGIB group than in the NUD group. Conclusion: Our results showed that together with trace elements, oxidative damage and ischemia were involved in the etiopathogenesis of ANVUGIB. Further studies are required to clarify the details of the mechanisms underlying the disease

Efficacy and safety of trastuzumab emtansine in older patients with HER2-positive advanced breast cancer: a real-world study

Introduction: Ado-trastuzumab emtansine (T-DM1) is an antibody-drug conjugate and its survival advantage has been shown in advanced human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, clinical trials underrepresent patients > 65 years of age, leading to a lack of information in this population. We analyzed the real-world outcomes of older women who were treated with T-DM1 therapy. Methods: We performed a multicenter, observational, retrospective analysis of patients aged > 65 years treated with T-DM1. A total of 93 patients from 10 cancer centers were involved in the study. Our goal was to determine the survival, response rates, and toxicity profile in T-DM1-treated patients, as well as the factors that influence survival. Results: Median follow-up was 12.2 months. Objective response rate was 29%. Median progression-free survival (PFS) and overall survival (OS) were 8.47 and 15.0 months, respectively. In multivariate analysis, Eastern Cooperative Oncology Group Performance Score 2 was found to be an independent prognostic factor for worse PFS (hazard ratio [HR] 1.81, p = 0.032) and OS (HR 2.33, p = 0.006). Any adverse event (AE) was seen in 92.5% of patients; grade 3 or 4 AEs were seen in 30.1%. Dose reduction or treatment discontinuation rates were 11.8% and 6.5%, respectively. Conclusion: The efficacy of T-DM1 was acceptable and it was generally well-tolerated among older patients with advanced HER2-positive breast cancer

Clinical outcomes of cyclin-dependent kinase 4-6 (CDK 4-6) inhibitors in patients with male breast cancer: A multicenter study

Background: Since breast cancer is less common in men than in women, data on the use of new therapeutic agents, including cyclin-dependent kinase 4-6 (CDK 4-6) inhibitors, are limited in patients with metastatic hormone receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) male breast cancer. Therefore; we aimed to investigate the treatment responses of metastatic HR+, HER2-male breast cancer patients treated with CDK 4-6 inhibitors in a multicenter real-life cohort. Methods: Male patients with a diagnosis of HR+ and HER2-metastatic breast cancer, treated with any CDK 4-6 inhibitor, were included in the study. Demographic and clinical characteristics of the patients were recorded. We aimed to determine progression-free survival (PFS) time, response rates and drug related side effects. Results: A total 25 patients from 14 institutions were recruited. The mean age at diagnosis was 57 years. Median follow-up was 19.53 (95% CI: 14.04-25.02) months. The overall response rate was 60%. While the median PFS was 20.6 months in the whole cohort, it wasn't reached in those using CDK 4-6 inhibitors in first line and 10 months in the subsequent lines (p:0.009). No new adverse events were encountered. Conclusion: In our study, we found that CDK 4-6 inhibitors are effective and safe options in men with HR+ and HER2-metastatic breast cancer as in women. Our results support the use of CDK 4-6 inhibitor-based combinations in the first-line treatment of HR+ and HER2-metastatic male breast cancer

Real life experience of patients with locally advanced gastric and gastroesophageal junction adenocarcinoma treated with neoadjuvant chemotherapy: a Turkish oncology group study

Neoadjuvant chemotherapy (NACT) in gastroesophageal junction (GEJ) and gastric cancer (GC) was shown to improve survival in recent studies. We aimed to share our real-life experience of patients who received NACT to compare the efficacy and toxicity profile of different chemotherapy regimens in our country. This retrospective multicentre study included locally advanced GC and GEJ cancer patients who received NACT between 2007 and 2021. Relation between CT regimens and pathological evaluation were analysed. A total of 794 patients from 45 oncology centers in Turkey were included. Median age at the time of diagnosis was 60 (range: 18-86). Most frequent NACT regimens used were FLOT (65.4%), DCF (17.4%) and ECF (8.1%), respectively. In the total study group, pathological complete remission (pCR) rate was 7.2%, R0 resection rate 86.4%, and D2 dissection rate was 66.8%. Rate of pCR and near-CR (24%), and R0 resection (84%) were numerically higher in FLOT arm (p > 0.05). Patients who received FLOT had also higher chemotherapy-related toxicity rate compared to patients who received other regimens (p > 0.05). Median follow-up time was 16 months (range: 1-154 months). Estimated median overall survival (OS) was 58.4months (95% CI: 35.2-85.7) and disease-free survival (DFS) was 50.7 months (95% CI: 25.4-75.9). The highest 3-year estimated OS rate was also shown in FLOT arm (68%). We still do not know which NACT regimen is the best choice for daily practice. Clinicians should tailor treatment regimens according to patients' multifactorial status and comorbidities for to obtain best outcomes. Longer follow-up period needs to validate our results