Importance: Clinical trials are vital for advancing cancer treatments and improving patient outcomes. Understanding the factors that influence participants’ decision-making is critical for enhancing trial recruitment.Objective: To evaluate the attitudes of patients with cancer and their relatives toward clinical trial participation, identifying key barriers and motivators that affect their willingness to engage in such trials.Design, Setting, and Participants: This cross-sectional survey study was conducted between April 2020 and April 2021. Face-to-face questionnaires were administered by physicians across 6 tertiary hospital medical oncology departments in Turkey. Adults with cancer and their relatives were recruited. Data were analyzed from April to December 2021.Exposure: Participants’ knowledge, perceptions, and motivations regarding clinical trial participation were assessed through a structured questionnaire.Main Outcomes and Measures: Participants’ demographic information, their willingness to participate in clinical trials, their perceptions about the clinical trial participation, and the facilitators and barriers to participation.Results: A total of 978 participants were surveyed, with a median (range) age of 52 (18-82) years; 485 (49.6%) were male and 479 (49.0%) female. Of these, 578 (59.1%) were patients with cancer and 382 (39.1%) family members. Prior clinical trial experience was reported by 174 participants (17.8%), and 428 (43.8%) expressed a willingness to participate in clinical trials. Participants well-informed about clinical trials showed higher willingness (50 of 87 [57.5%] very willing) compared with those with no knowledge (27 of 303 [8.9%] very willing) (χ² = 275.095; P < .001). Greater willingness was observed in participants from less developed cities compared with the most developed cities (88 of 321 [27.4%] vs 94 of 615 [15.3%]; χ² = 21.093; P < .001), in individuals with a high school degree or greater compared with those with less than a high school degree (105 of 489 [21.5%] vs 76 of 452 [16.8%]; χ² = 33.311; P < .001), in those with monthly incomes above compared with below the poverty line (81 of 409 [19.8%] vs 100 of 512 [19.5%]; χ² = 16.145; P = .003), in those without prior cancer treatment compared with those with prior cancer treatment (125 of 591 [21.2%] vs 40 of 289 [13.8%]; χ² = 13.801; P = .008), and in participants with prior trial experience compared with those without (74 of 166 [44.6%] vs 111 of 786 [14.1%]; χ² = 87.771; P < .001). Participants were motivated by potential personal health benefits (604 [61.8%]) and access to new treatments (522 [53.4%]). The primary concerns included potential adverse effects (555 [56.7%]), feeling like a “test subject” (284 [29.0%]), and the risk of receiving a placebo (197 [20.1%]).Conclusions and Relevance: In this survey study of patients with cancer and their relatives, significant gaps in knowledge and persistent concerns about clinical trial safety were highlighted, impacting participation. Addressing these concerns through targeted education and transparent communication is essential for improving participation rates and ensuring more inclusive cancer research.

Background and Objectives: Bone metastases in patients can cause significant quality-of-life declines due to skeletal-related events (SREs). SRE is defined as the occurrence of radiotherapy for bone pain, pathologic fracture, bone surgery, spinal cord compression, or hypercalcemia. Bone-modifying agents (BMAs), such as denosumab and zoledronic acid, are crucial in reducing the frequency and severity of SREs. The inhibition of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors has emerged as the standard treatment for hormone receptor-positive metastatic breast cancer, demonstrating significant improvements in survival outcomes. This study aims to compare the effectiveness of denosumab and zoledronic acid in preventing SRE in patients receiving CDK4/6 inhibitors with endocrine therapy. Materials and Methods: This retrospective study included 328 patients diagnosed with bone metastatic breast cancer receiving first-line CDK4/6 inhibitor therapy (palbociclib or ribociclib). Patients were assigned to receive either subcutaneous denosumab or intravenous zoledronic acid every 4 weeks. Time to the first skeletal-related event post bone-modifying agent initiation, SRE incidence, and the safety data were evaluated. The data were analyzed using independent samples t-tests, chi-square tests, and Kaplan–Meier methods for time-to-event data. Results: In the denosumab group, the median time to the first skeletal-related event was significantly longer than in the zoledronic acid group (44.55 months and 29.16 months, respectively). Denosumab treatment was associated with a statistically significant reduction in the risk of developing the first SRE after bone-modifying agent initiation compared to zoledronic acid (HR: 0.56, p = 0.001). Additionally, ECOG PS and the number of metastatic bone sites were identified as independent prognostic factors for time to the first SRE. The safety profile was consistent with previous studies reported in the literature. Conclusions: Our study demonstrated that when used with CDK4/6 inhibitors, denosumab is associated with a delay in SREs and a lower SRE incidence than zoledronic acid in patients with bone metastases. These findings support the efficacy of denosumab in preventing SREs and suggest that CDK4/6 inhibitors may have distinct effects on the bone microenvironment, particularly when combined with denosumab.

Background/Objectives: Dose reductions in CDK4/6 inhibitors, such as ribociclib and palbociclib, are often necessary due to treatment-related toxicities in patients with advanced breast cancer. This study aims to evaluate the impact of the timing of dose reductions on progression-free survival (PFS) and overall survival (OS) in a real-world cohort. Methods: This single-center, retrospective study included patients treated with ribociclib or palbociclib between 2019 and 2023 at a cancer center in Turkey. Dose reductions due to drug-related toxicities were recorded, and survival outcomes were analyzed. Patients were categorized based on the timing of dose reductions: within the first 3 months (early) and after 3 months (late). Results: Among 392 patients (mean age 57.13 years), 16.8% had dose reductions within 3 months, 21.7% had late dose reductions, and 61.5% had no dose reductions. The mPFS was 14.26 months for early dose reductions, 33.12 months for late dose reductions, and 20.6 months for no dose reductions (p < 0.001). The mOS was 37.12 months for early dose reductions, not reached for late dose reductions, and 57.76 months for no dose reductions (p < 0.001). Hematological toxicity, primarily neutropenia, was the most common cause of dose reductions. The ECOG performance status, line of therapy, and CDK4/6 inhibitor type were also significant predictors of PFS and OS. Conclusions: Early dose reductions in CDK4/6 inhibitors negatively affect PFS and OS, highlighting the importance of maintaining treatment intensity in the first 3 months. However, late dose reductions do not negatively affect progression-free survival (PFS) or overall survival (OS), with late dose reductions associated with better outcomes. Prospective studies in larger patient populations will further clarify our knowledge on this subject.

This study compares survival predictions made by an artificial intelligence (AI) based chatbot with real-world data in hepatocellular carcinoma (HCC) patients. It aims to evaluate the reliability and accuracy of AI technologies in HCC prognosis. A retrospective analysis was conducted on patients diagnosed with HCC. The estimated survival times for each patient were calculated using an artificial intelligence chatbot. The follow-up periods and mortality data for the patients were used to obtain real-life survival data. The predicted and actual survival times were statistically compared. ChatGPT-4o consistently overestimated the overall survival (OS) times compared to real-world outcomes.A statistically significant discrepancy was observed between the predicted and actual survival times (p < 0.05). Nevertheless, while the survival predictions of AI were more accurate in patients with advanced-stage HCC, the predictions differed significantly in patients with early-stage HCC. AI has the potential to play an important role in the prognosis of complex diseases such as HCC. However, this study’s findings indicate that AI’s predictions are not entirely consistent with real-world data, particularly in the context of early-stage diseases. Further large-scale studies may enhance the dependability of incorporating AI into clinical decision-support systems. The use of AI-assisted predictions may prove to be a valuable tool for the prediction of survival in patients with HCC. Nevertheless, further studies are required to substantiate the accuracy and reliability of these systems before they can be implemented in clinical practice.

Background and Objectives: Perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) is the standard of care for resectable gastric and gastroesophageal junction adenocarcinoma; however, up to 50% of patients develop metastatic recurrence. These patients have prior exposure to platinum and taxane agents, and optimal first-line treatment in the metastatic setting remains undefined. This study aimed to characterize real-world treatment patterns and outcomes in patients progressing after perioperative FLOT, focusing on relapse timing and HER2 status. Materials and Methods: This retrospective, multicenter cohort study included 296 patients from 31 centers across Türkiye, stratified into early relapse (≤6 months, n = 114) and late relapse (>6 months, n = 182) groups. Survival analyses were performed using the Kaplan-Meier method and Cox proportional hazards regression. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Results: Median PFS and OS for the entire cohort were 6 and 9 months, respectively. Early relapsers had significantly shorter median PFS (4 vs. 6 months, p = 0.029) and OS (8 vs. 12 months, p = 0.047); however, early relapse timing did not retain independent prognostic significance on multivariable analysis. No significant difference in PFS or OS was observed between cytotoxic chemotherapy regimens in either relapse group. HER2 positivity was the only independent predictor of improved PFS on multivariable Cox analysis (HR 0.48, 95% CI 0.29–0.81; p = 0.006). In the late relapse group, trastuzumab-based chemotherapy achieved a median PFS of 14 months and OS of 18 months, significantly superior to all cytotoxic regimens (PFS p = 0.007; OS p = 0.029). Conclusions: In patients progressing after perioperative FLOT, cytotoxic chemotherapy regimen selection did not demonstrate a statistically significant survival difference in this retrospective cohort, regardless of relapse timing. HER2 positivity is the dominant predictive biomarker, and trastuzumab-based therapy suggests a potential survival benefit that warrants prospective validation. Comprehensive biomarker profiling at metastatic diagnosis and prospective trials designed for this post-FLOT population are needed to establish evidence-based treatment standards.

Objective: Invasive fungal infections (IFI) and Cytomegalovirus (CMV) infections are seen in gradually increasing frequencies in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. This study aimed to evaluate the risk factors for the development of IFI and CMV infections in allo-HSCT recipients. Materials and Methods: The risk factors for IFI and CMV infection development before and after transplantation were analyzed in 379 allo-HSCT patients, 370 of whom underwent transplantation between June 1, 2005, and May 17, 2012, at the Stem Cell Transplantation Unit of the Hematology Department, Ankara University Faculty of Medicine. The characteristics of allo-HSCT recipients and donors and the data about the allo-HSCT process were retrospectively evaluated. Results: According to the EORTC/MSG criteria, probable and/or proven IFI was identified in 63 allo-HSCT patients (16.6%). In the univariate analysis, IFI development was significantly associated with conditioning regimen type (myeloablative vs. reduced intensity), graft-versus-host disease (GvHD) prophylaxis, CMV infection occurrence, frequency and timing, thrombocyte engraftment, and mortality. In the multivariate logistic regression analysis, CMV infection and the absence of thrombocyte engraftment were found to increase the risk of IFI development by 3.66-fold (95% confidence interval [CI]: 1.696–7.937, p=0.001) and 2.45-fold (95% CI: 1.043–5.785, p=0.040), respectively. CMV infection occurred in 243 allo-HSCT patients (64.1%). In the univariate analysis, CMV infection development was significantly associated with recipient and donor age, acute and chronic GvHD, IFI occurrence, neutrophil and thrombocyte engraftment, and transplantation-related mortality. However, none of these associations remained statistically significant in the multivariate logistic regression analysis. Conclusion: The identification of CMV infection and the absence of thrombocyte engraftment as significant risk factors for IFI development in allo-HSCT recipients underscores the need for tailored preventive strategies. A more personalized approach to post-transplant care, incorporating early detection and targeted interventions, could enhance patient outcomes and reduce IFI-related complications.