Although systolic and diastolic left ventricular functions after cancer chemotherapy are well studied, there are a few investigations about the right ventricular functions. We aimed to investigate the early effects of chemotherapy on right heart, if any, in addition to the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) and right heart echocardiographic indices. Thirty-seven consecutive patients with newly diagnosed breast cancer who were planned to receive either AC protocol [cyclophosphamide (600 mg/m(2)) + adriamycin (60 mg/m(2))] or CAF protocol [cyclophosphamide (600 mg/m(2)) + adriamycin (60 mg/m(2)) + 5-fluorouracil (600 mg/m(2))] for six cures were enrolled between February 2009 and June 2010. Echocardiography was performed before the onset of the chemotheurapeutic regimen (T1), on the day after the completion of the first cure (T2), and after the completion of two cures of the regimen (T3). Serum NT-proBNP levels were also measured at T1, T2, and T3. The mean right ventricular fractional area change (RVFAC) was 63.7 ± 3.63, 63.3 ± 3.67, and 61.2 ± 4.41% at T1, T2, and T3, respectively (pT1-T3 and pT2-T3 <0.05). Tricuspid annular plane systolic excursion (TAPSE) has decreased in time (1.82 ± 0.2, 1.78 ± 0.19, and 1.62 ± 0.24 cm; pT1-T2, pT1-T3, and pT2-T3 were 0.002, <0.001, and <0.001, respectively). Tricuspid annular mean E'/A' ratios were 1.42 ± 0.16, 1.36 ± 0.18, and 1.11 ± 0.32 (pT1-T2 = 0.013, pT1-T3 < 0.001, and pT2-T3 < 0.001). Mean tricuspid annular systolic velocities were 11.35 ± 1.85, 11.0 ± 1.82, and 10.45 ± 1.75 cm/s for T1, T2, and T3; and the differences between T1 and T2, T1 and T3, and T2 and T3 were all significant (P = 0.005, <0.001, and 0.001). Median serum NT-proBNP levels were 82 (60-247), 116 (60-426), and 170 (60-600) pg/mL at T1, T2, and T3. The amount of change in RVFAC and TAPSE between T1 and T3 were found to be correlated with the amount of change in NT-proBNP measurements between T1 and T3 (R: -0.7, P < 0.001; R: -0.62, P < 0.001). There is a subclinical decrease in right ventricular systolic and diastolic echocardiographic indices, although mostly, in the normal range, in a relatively short time interval after onset of chemotherapy.

Efficiency and Side Effects of Sorafenib Therapy for Advanced Hepatocellular Carcinoma: A Retrospective Study by the Anatolian Society of Medical Oncology Hepatocellular carcinoma;sorafenib;Turkey; Background: Inoperable and metastatic hepatocellular carcinoma (HCC) is associated with a poor prognosis and low chemotherapeutic efficiency. Sorafenib is an oral multi-kinase inhibitor exerting its effects via the RAF/MEK/ERK pathway, vascular endothelial growth factor receptor (VEGFR) and platelet derived growth factor receptor beta (PDGFR-${\beta}$) tyrosine kinases. Randomized studies have shown a significant contribution of sorafenib to life expectancy and quality of life of cancer patients. The aim of the present study is to evaluate the efficacy and side effects of sorafenib therapy in Turkey. Materials and Methods: Data for 103 patients (82 males, 21 females) receiving sorafenib therapy in 13 centers from February 2008 to December 2012 were evaluated. Median age was 61 years and median ECOG performance status was 1 (range: 0-2). 60 patients (58%) had hepatitis B, 15 patients (15%) had hepatitis C infection and 12 patients (12%) had a history of alcohol consumption. All of the patients had Child scores meeting the utilization permit of the drug in our country (Child A). Results: A total of 571 cycles of sorafenib therapy were administered with a median of four per patient. Among the evaluable cases, there was partial response in 15 (15%), stable disease in 52 (50%), and progressive disease in 36 (35%). Median progression-free survival was 18 weeks and median overall survival was 48 weeks. The dose was reduced only in 6 patients and discontinued in 2 patients due to grade 3-4 toxicity, 18 patients (17%) suffering hand-foot syndrome, 7 (7%) diarrhea, and 2 (2%) vomiting. Conclusions: This retrospective study demonstrated better efficacy of sorafenib therapy in patients with advanced HCC compared to the literature while progression-free survival and overall survival findings were comparable. The side effect rates indicate that the drug was tolerated well. In conclusion, among the available treatment options, sorafenib is an efficient and tolerable agent in patients with inoperable or metastatic HCC.

Determination of human epidermal growth factor receptor-2 status in advanced gastric cancer is important in clinical decision making. In the trastuzumab for GC trial, trastuzumab-based therapy demonstrated a significant overall survival benefit in patients with human epidermal growth factor receptor-2-positive advanced gastric cancer. Human epidermal growth factor receptor-2 discordance in gastric cancer primary and its metastases has been long debated. The aim of the study was to evaluate the rate of human epidermal growth factor receptor-2 discordance and its effect on treatment decisions in advanced gastric cancer. A total of 74 patients with advanced gastric cancer were included in the study. Both immunohistochemical staining and dual-color silver in situ hybridization were performed in all patients to evaluate the human epidermal growth factor receptor-2 status of the primary lesion and paired metastasis. The assessment of human epidermal growth factor receptor-2 status with the immunohistochemical staining method and dual-color silver in situ hybridization revealed a discordance rate of 9.5 and 16.2%, respectively. However, this discordance was clinically meaningful in only one patient leading to a change in treatment decision. While this patient had a human epidermal growth factor receptor-2-negative status in primary tumor (immunohistochemical = 0, dual-color silver in situ hybridization = negative), the human epidermal growth factor receptor-2 status was positive for liver metastasis (immunohistochemical = 2+, dual-color silver in situ hybridization = positive). Trastuzumab was added to the chemotherapy regimen. In this study, we found a higher rate of human epidermal growth factor receptor-2 discordance between primary gastric tumor and metastatic lesions compared with the rates reported in previous studies. Detection of a human epidermal growth factor receptor-2-positive metastasis with a human epidermal growth factor receptor-2-negative primary tumor suggests that investigation of human epidermal growth factor receptor-2 is also required for the metastatic lesion and that trastuzumab could be administered in the case of a positive result.