Browsing by Author "Urun, Yuksel"

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Avelumab Maintenance in Patients With Metastatic Urothelial Carcinoma in a Real-Life Expanded-Access Program (Eap)
(Lippincott Williams & Wilkins, 2025) Tural, Deniz; Ozkan, Oguzcan; Yaslikaya, Sendag; Tatli, Ali Murat; Akdag, Goncaguel; Demir, Hacer; Urun, Yuksel
Citation - WoS: 2
Citation - Scopus: 1
Comparison of Two Alternative Sequences With Cabazitaxel and 177lu-P in Metastatic Castration-Resistant Prostate Cancer: a Retrospective Multicenter Study (Lucas)
(Elsevier Sci Ltd, 2025) Bolek, Hatice; Yazgan, Sati Coskun; Ceylan, Furkan; Esteban-Villarrubia, Jorge; Arslan, Cagatay; Kus, Tulay; Urun, Yuksel
Background: Cabazitaxel and 177Lu-PSMA-617 have been shown to improve survival in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with docetaxel and androgen receptor pathway inhibitors (ARPI). we aimed to evaluate the impact of sequencing cabazitaxel and 177Lu-PSMA-617 on survival outcomes in patients with mCRPC. Patients and methods: This is a retrospective, multicenter, cohort study which included patients with mCRPC who received sequential treatment with 177Lu-PSMA-617 and cabazitaxel between January 2015 and December 2023. Primary outcome was progression-free survival-2 (PFS-2) Results: A total of 68 patients with mCRPC who received sequential 177Lu-PSMA-617 and cabazitaxel were included in the study. The primary outcome, progression-free survival-2 (PFS-2), was similar in patients treated with 177Lu-PSMA-617 first (LU-CA) and those receiving cabazitaxel (CA-LU) first (10.8 and 11.7 months, respectively; p = 0.422). The median overall survival (OS) was also similar in the LU-CA and CA-LU groups (16.6 and 19.9 months, respectively; p = 0.917). The objective response rate (ORR) for 177Lu-PSMA-617 was 23.1 % when used first and 16.1 % after cabazitaxel. ORR for cabazitaxel was 25.6 % and 31.3 % when used as the first agent and when used after 177Lu-PSMA-617, respectively. Conclusions: In conclusion, treatment sequencing between cabazitaxel and 177Lu-PSMA-617 did not significantly affect survival outcomes in patients with mCRPC. These findings suggest that both drugs can be effectively integrated into the mCRPC treatment paradigm without concerns about the effect of sequencing. However, prospective data are needed to optimize sequencing strategies and explore their impact on specific patient subgroups for more personalized care.
Enhancing Outcomes in mCRPC: The Impact of Androgen Receptor Inhibitor Sequencing Before 177Lu-PSMA Therapy
(Oxford Univ Press, 2025) Yazgan, Sati Coskun; Kayas, Kamil; Arslan, Cagatay; Kapar, Caner; Oztekin, Sura; Ceylan, Furkan; Urun, Yuksel
Background Prostate-specific membrane antigen (PSMA) is a key target in metastatic castration resistance prostate cancer (mCRPC). Enzalutamide, an androgen receptor pathway inhibitor (ARPi), increases PSMA expression, potentially enhancing 177Lu-PSMA-617 radioligand therapy. This study evaluates the impact of prior ARPi (enzalutamide vs abiraterone acetate [AA]) on PSMA expression, PFS, and OS. Materials and Methods A retrospective analysis of 214 mCRPC patients treated with 177Lu-PSMA-617 across six Turkish centers (2015-2025) was conducted. Patients were grouped by prior ARPi therapy. PFS and OS were analyzed using Kaplan-Meier and Cox regression methods. Results Among 103 patients receiving ARPi before 177Lu-PSMA-617, 59 (57%) had enzalutamide and 44 (43%) AA. Median PFS was 7.6 months for enzalutamide versus 5.3 months for AA (P = .068). Median OS was significantly longer with enzalutamide (12.8 vs 6.9 months, P = .021). Patients with Eastern Cooperative Oncology Group Performance Scores (ECOG PS) 0-1 had significantly longer OS (27.6 vs 6.9 months for PS 2-3, P < .0001). Higher PSMA SUVmax (>20) correlated with longer OS (15.1 vs 7.8 months, P = .016). Among 86 patients with detectable PSMA SUVmax, 53 had SUVmax > 20; 66% had prior enzalutamide and 34% AA. Median OS was four months longer with enzalutamide (18.1 vs 13.9 months P = .120). Multivariate analysis identified ARPi type (HR: 2.24, P = .033) and ECOG PS (HR: 5.22, P < .0001) as independent OS predictors. Conclusion Enzalutamide prior to 177Lu-PSMA-617 significantly improves OS and enhances PSMA expression compared to AA. These findings highlight the importance of treatment sequencing in mCRPC and warrant further prospective studies.
Citation - WoS: 1
Citation - Scopus: 1
Evaluating the Prognostic Role of Glucose-to Ratio in Patients With Metastatic Renal Cell Carcinoma Treated with Tyrosine Kinase Inhibitors in First Line: A Study by the Turkish Oncology Group Kidney Cancer Consortium (TKCC)
(Springer Int Publ AG, 2025) Bolek, Hatice; Kuzu, Omer Faruk; Sertesen Camoz, Elif; Sim, Saadet; Sekmek, Serhat; Karakas, Hilal; Urun, Yuksel
Purpose Identifying prognostic indicators for risk stratification in metastatic renal cell carcinoma (mRCC) is crucial for optimizing treatment strategies and follow-up plans. This study aims to investigate the prognostic role of the glucose-to-lymphocyte ratio (GLR) in patients with mRCC receiving tyrosine kinase inhibitors (TKIs) as first-line therapy. Methods A retrospective cohort study was conducted using data from the Turkish Oncology Group Kidney Cancer Consortium Database. GLR was calculated by dividing the fasting glucose (mmol/L) by the lymphocyte count (x109/L). We categorized patients into two categories based on their median GLR level. Results The analysis included a total of 598 patients. We found that progression-free survival (PFS) was significantly longer in the GLR-low group, with a median PFS of 15.05 months (95% CI 12.7-17.4) compared to 7.79 months (95% CI 6.6-9.0) in the GLR-high group (p < 0.001). Multivariate analysis identified GLR as an independent risk factor for poor PFS (HR 1.39, 95% CI 1.12-1.72; p = 0.003). Overall survival (OS) was also significantly longer in the GLR-low group, with a median OS of 38.47 months (95% CI, 30.9-46.0) compared to 24.15 months (95% CI 18.0-30.2) in the GLR-high group (p = 0.001). GLR was an independent predictor for OS in multivariate analysis (HR 1.45, 95% CI 1.12-1.86; p = 0.004). Conclusion The GLR can be a valuable prognostic marker for glucose metabolism and systemic inflammatory status in this patient population. Our research highlights the potential prognostic value of GLR in patients with mRCC receiving TKIs, indicating its potential as a useful tool for clinical decision-making.
Impact of First-Line Tyrosine Kinase Inhibitor Selection on Survival Outcomes With Second-Line Nivolumab in Metastatic Renal Cell Carcinoma
(BMC, 2025) Kuzu, Omer Faruk; Bolek, Hatice; Camoz, Elif Sertesen; Karakas, Hilal; Sekmek, Serhat; Sim, Saadet; Urun, Yuksel
IntroductionAccess to first-line immune checkpoint inhibitor (ICI) combinations in metastatic renal cell carcinoma (mRCC) remains limited in many low- and middle-income countries. Consequently, tyrosine kinase inhibitors (TKIs) are still widely used. This study investigates the impact of first-line sunitinib versus pazopanib on survival outcomes with second-line nivolumab.MethodsWe conducted a retrospective analysis of 245 patients with mRCC from the Turkish Oncology Group Kidney Cancer Consortium Database. Patients received first-line sunitinib or pazopanib, followed by second-line nivolumab. Primary endpoints were time to treatment failure (TTF) and overall survival (OS). Subgroup analyses were performed based on IMDC risk classification and presence of sarcomatoid features.ResultsA total of 245 patients who were treated with sunitinib or pazopanib monotherapy as first-line treatment followed by nivolumab as second-line treatment were included in this study. Median TTF following nivolumab initiation was similar between prior sunitinib and pazopanib groups (7.79 vs 7.72 months; p = 0.892). Median OS-2 was 27.21 months with prior sunitinib and 18.92 months with prior pazopanib (p = 0.496). In patients with sarcomatoid features (n = 20), those pretreated with pazopanib demonstrated numerically longer OS-2 compared to sunitinib (p = 0.023), although the small sample size limits definitive conclusions.ConclusionNo significant differences in survival outcomes were observed between first-line sunitinib and pazopanib before nivolumab in mRCC. In the small subgroup with sarcomatoid features, pazopanib pre-treatment was associated with a numerically longer survival. These findings warrant cautious interpretation and further prospective validation, especially in resource-constrained settings.
The Impact of Smoking on Nivolumab Outcomes in Renal Cell Carcinoma: Real-World Data From the Turkish Oncology Group Kidney Cancer Consortium
(Oxford Univ Press, 2025) Camoz, Elif Sertesen; Bolek, Hatice; Kuzu, Omer Faruk; Sim, Saadet; Karakas, Hilal; Sekmek, Serhat; Urun, Yuksel
Background: The study aims to evaluate the effect of smoking status on treatment results in patients with metastatic renal cell carcinoma (RCC) treated with nivolumab in the second and following lines of therapy. Materials and Methods: The Turkish Oncology Group Kidney Cancer Consortium (TKCC) database was used to extract retrospective data from patients with metastatic RCC treated with nivolumab in the second line and beyond. Patients were evaluated according to their smoking status. Results: A total of 247 patients were evaluated. The majority of the current smokers were male (93.8%, P = .002). Nivolumab is mainly used in the second-line therapy (84.2%). Median time to treatment failure (TTF) and median overall survival were shorter in patients with currently smoking (10.81 vs. 4.11 months, P < .001 and 32.33 vs. 16.76 months, P < .049, respectively). Multivariate analysis showed that current smoking status was an independent adverse factor on median TTF (HR 2.06 95% confidence interval (CI) = 1.20-3.54, P = .009) and median OS (, HR 2.06, 95% CI = 1.25-3.38, P = .004) in metastatic RCC patients treated with nivolumab in the second line and beyond. Conclusions: Current smoking status is an independent adverse prognostic factor for both TTF and OS in patients with metastatic RCC treated with nivolumab in the second line and beyond.
Long-Term Outcome and Safety in Patients Treated With Immune Checkpoint Blockade Therapies for Urothelial Carcinoma: Experience From Real-World Clinical Practice.
(Lippincott Williams & Wilkins, 2022) Tural, Deniz; Arslan, Cagatay; Selcukbiricik, Fatih; Olmez, Omer Fatih; Erman, Mustafa; Urun, Yuksel; Karadurmus, Nuri
[Abstract Not Available]
Navigating Second-Line Therapy in Metastatic Renal Cell Carcinoma: a Comparative Analysis of Immune Checkpoint Inhibitors and Tyrosine Kinase Inhibitors: a Study of Turkish Oncology Group Kidney Cancer Consortium
(Sage Publications Ltd, 2025) Aykan, Musa Baris; Bolek, Hatice; Yekeduz, Emre; Sertesen, Elif; Tural, Deniz; Karacin, Cengiz; Urun, Yuksel
Background: Despite progress in treatment, many metastatic renal cell carcinoma (mRCC) patients still experience progression after first-line tyrosine kinase inhibitor (TKI), necessitating effective second-line options. While guidelines endorse combination therapies, accessibility limitations often restrict therapy to TKI monotherapy.Objectives: Existing decision-making relies on limited evidence, lacking direct comparisons between the leading second-line options (cabozantinib and nivolumab) which surpass everolimus in advanced mRCC. To address this gap, this study compares the efficacy of TKI versus nivolumab in second line while investigating factors influencing outcomes.Design: This was a retrospective cohort study.Methods: Turkish Oncology Group Kidney Cancer Consortium includes more than 1000 mRCC patients from 13 centers in T & uuml;rkiye. It has the largest national data. We extracted 214 patients treated with a TKI in the first line and nivolumab or TKI in the second line.Results: The median overall survival (OS) and time to treatment failure (TTF) were similar in the TKI-TKI and TKI-immune checkpoint inhibitor (ICI; 41.1 and 44.8 months, p = 0.446 for OS; 27.4 and 29.8 months, p = 0.857 for TTF). The presence of previous nephrectomy for TTF made a significant difference in univariable and multivariable analysis. Bone metastases negatively affected TTF in both univariable and multivariable analyses. In the neutrophil-to-lymphocyte ratio (NLR)-high group, OS and TTF were longer in patients treated with TKI-ICI than in the TKI-TKI. In multivariable analysis, NLR was an independent prognostic factor for OS and TTF to select ICI in the second-line.Conclusion: Our analysis revealed no significant difference in OS between patients receiving ICIs or TKIs as second-line therapy. In the subgroup of patients with elevated NLR, ICI therapy was found to cause no improvement in OS. This finding suggests the potential utility of NLR as a biomarker to guide targeted selection of ICI therapy among patients progressing after first-line TKIs. Furthermore, our study identified other noteworthy prognostic factors influencing outcomes, including the presence of bone or liver metastases, Eastern Cooperative Oncology Group performance status, and International Metastatic Renal Cell Carcinoma Database Consortium risk score.
Prognostic Role of Smoking in Metastatic Renal Cell Carcinoma in Real-World Data From the Turkish Oncology Group Kidney Cancer Consortium (TKCC)
(Nature Portfolio, 2026) Bolek, Hatice; Sertesen Camoz, Elif; Kuzu, Omer Faruk; Karakas, Hilal; Sim, Saadet; Sekmek, Serhat; Urun, Yuksel
Smoking has been implicated as a potential factor influencing cancer progression and outcomes in various malignancies, including metastatic renal cell carcinoma (mRCC). This study aimed to evaluate the effect of smoking status on treatment outcomes in mRCC patients, with a focus on metastatic sites. This retrospective cohort study utilized data from the Turkish Oncology Group Kidney Cancer Consortium (TKCC). The primary endpoint of the study was overall survival (OS) across metastatic sites. A total of 779 patients were included, of whom 464 (58.1%) were former/current smokers. Smoking status did not significantly affect OS in the overall cohort. However, in the bone metastatic subgroup, former/current smokers exhibited worse OS compared to never smokers (33.9 vs. 22.1 months; p = 0.005). Multivariate Cox regression analysis showed that former/current smoking was an independent predictor for OS in patients with bone metastasis (former/current smoker vs never smoker HR 1.44, 95% CI 1.05-1.99; p = 0.026) and bone-only metastasis (former/current smoker vs never smoker HR 4.44; 95% CI 1.27-15.55; p = 0.020) after adjusting for confounding factors. Smoking is an independent predictor of poor survival in mRCC patients with bone metastases, highlighting the organ-specific effects of smoking on cancer progression. Further research is needed to explore underlying mechanisms and evaluate outcomes in the context of modern therapies.
Citation - WoS: 1
Citation - Scopus: 1
Sunitinib in Metastatic Renal Cell Carcinoma: Clinical Outcomes Across Risk Groups in a Turkish Oncology Group Kidney Cancer Consortium
(Wiley, 2025) Bolek, Hatice; Kuzu, Omer Faruk; Sertesen Camoz, Elif; Sim, Saadet; Sekmek, Serhat; Karakas, Hilal; Urun, Yuksel
Treatment Patterns and Attrition in Metastatic Renal Cell Carcinoma: Real-Life Experience From the Turkish Oncology Group Kidney Cancer Consortium (tkcc) Database
(Cig Media Group, Lp, 2024) Bolek, Hatice; Sertesen, Elif; Kuzu, Omer Faruk; Tural, Deniz; Sim, Saadet; Sendur, Mehmet Ali Nahit; Urun, Yuksel; Arslan, Cagatay
The inclusion of patients with more favorable prognoses in clinical trials imits generalizability to broader and more diverse patient group. This study examines treatment patterns and attrition rates in Turkish oncology clinics for metastatic renal cell carcinoma. The percentages of patients receiving treatment in the second, third, and fourth lines of therapy were 62.8%, 27.4%, and 8.9%, respectively. Disease progression was the primary cause of attrition, followed by toxicity. Introduction: Despite the rapid evolution in management of metastatic renal cell carcinoma (mRCC) over the past decade, challenges remain in accessing new therapies in some parts of the world. Despite therapeutic advancements, attrition rates remain persistently high. This study aims to assess the treatment patterns and attrition rates of patients with mRCC in oncology clinics across Turkey. Patients and Methods: Patients diagnosed with mRCC between January 1, 2008, and December 31, 2022, with first-line systemic treatment data, were retrospectively evaluated using the Turkish Oncology Group Kidney Cancer Consortium (TKCC) Database. Results: The final analysis included a total of 1126 patients. The percentages of patients treated in the 2nd, 3rd, 4th, and 5th lines of therapy were 62.8%, 27.4%, 8.9%, and 2.1%, respectively. The drugs that were most commonly used in the groups were tyrosine kinase inhibitors (TKIs) (52.2%) and interferon (IFN)-alpha (43.3%) for the first line, TKIs (66.3%) and immunotherapy (IO) monotherapy (25.9%) for the second line, TKI (41.4%) and mTOR inhibitors (28.8%) for the third line, TKI (44.4%) and mTOR inhibitors (29%) for the fourth line, and IO monotherapy (37.5%) and TKI (25%) for the fifth line. For the first-line treatment, the primary cause of attrition was disease progression (66.4%), followed by toxicity (16.5%), death (11.2%), and patient preference (5.9%). The primary reason for attrition across all treatment lines was disease progression. Over time, the use of TKIs in first-line treatment increased, while IFN-alpha usage declined. IOs began to be utilized in earlier lines, predominantly in second-line treatment, though use of IO-based combination therapies remains limited. Conclusion: This study underscores that despite significant progress in therapeutic options, the adoption of novel agents remains slow, and attrition rates are still high. These findings indicate a disparity in systemic therapy compared to developed countries.
Uric Acid Level in Metastatic Renal Cell Carcinoma Treated With Nivolumab: a Turkish Oncology Group Kidney Cancer Consortium (TKCC) Study
(Taylor & Francis Ltd, 2025) Sekmek, Serhat; Bolek, Hatice; Kuzu, Omer Faruk; Camoz, Elif Sertesen; Sim, Saadet; Karakas, Hilal; Urun, Yuksel
AimsTo investigate the effect of uric acid level on prognosis in patients with metastatic renal cell carcinoma (mRCC) treated with nivolumab.Materials and methodsThis retrospective study utilized data from the Turkish Oncology Group Kidney Cancer Consortium (TKCC), which is a multicenter registry encompassing 13 cancer centers across T & uuml;rkiye.Results and conclusionsA total of 189 patients were included in the study. The median age was 61 years in all cohort. Univariable analyses revealed longer TTF (17.87 vs. 6.57 months, p = 0.014) and OS (52.01 vs. 25.36, p = 0.032) in the uric acid-high (UAH) group than in the uric acid-low (UAL) group. In multivariable analyses, low uric acid level emerged as an independent risk factor for OS (hazard ratio (HR): 1.82, 95% confidence interval (CI): 1.09-3.05; p = 0.022), whereas no significant association was observed with TTF (HR: 1.24, 95% CI: 0.72-2.13; p = 0.431). While uric acid levels were a significant independent prognostic factor for OS, no association was found with TTF. Our findings underscore the prognostic importance of uric acid in mRCC, suggesting its potential role as a biomarker for risk stratification