The Medical Bulletin of Sisli Etfal Hospital

Background: Triple antiemetic therapy, such as a 5-HT3 receptor antagonist (5H3-RA), aprepitant and dexamethasone, is recommended for the prophylaxis of highly emetogenic chemotherapy induced nausea and vomiting in patients with breast cancer. In the present study, we aimed to verify whether adding metoclopramide to the triplet antiemetic therapy is superior to the triplet antiemetic therapy in preventing CINV in patients with breast cancer.

Background/Objectives: Epithelial ovarian cancer (EOC) is a leading cause of death among forms of gynecologic cancer. Significant causes of mortality include high recurrence rates and the development of resistance to platinum-based chemotherapy. This highlights the need for reliable prognostic biomarkers to improve patient stratification and inform treatment decisions. Claudin-4, a tight junction protein frequently overexpressed in epithelial tumors, has been associated with tumor progression and resistance to chemotherapy. Methods: We retrospectively analyzed 83 patients with EOC who underwent debulking surgery. Claudin-4 expression was assessed by immunohistochemistry and categorized as high or low based on a semi-quantitative scoring system. Survival outcomes were evaluated using Kaplan–Meier analysis and Cox regression. Predictors of platinum resistance were examined using logistic regression. Results: High Claudin-4 expression was observed in 55.4% of cases and was associated with significantly shorter disease-free survival (DFS) (23 vs. 66 months, p = 0.00024) and overall survival (OS) (85 months vs. NR, p = 0.0031). In multivariable analysis, platinum resistance (DFS; HR 4.99, OS; HR 4.27) and high Claudin-4 expression (DFS; HR 2.46, OS; HR 3.59) were independent predictors of poor outcomes. Logistic regression further demonstrated that high Claudin-4 expression and interval debulking surgery were independent predictors of platinum resistance. Conclusions: High Claudin-4 expression was associated with inferior survival and an increased risk of platinum resistance in EOC. Our findings suggest that Claudin-4 may serve as a negative prognostic biomarker and a potential therapeutic target. Future prospective studies are warranted to further elucidate the underlying mechanisms and validate Claudin-4’s clinical utility.

Purpose: Insomnia places significant physical and psychological burdens on female cancer patients undergoing chemotherapy, affecting their quality of life. This study aimed to investigate the prevalence of insomnia and its associated factors in female outpatients receiving chemotherapy. Patients and Methods: A cross-sectional study was conducted with female cancer patients receiving chemotherapy. The questionnaire included items assessing sociodemographic and clinical characteristics. Insomnia was measured using the Insomnia Severity Index. Results: A total of 206 female patients undergoing chemotherapy were included, with a mean age of 56.1 years (SD ± 11.7). The most common cancer types were breast (57.3%), gastrointestinal (22.8%), and gynecological malignancies (19.9%). Based on the Insomnia Severity Index (ISI), 34.0% of participants had subclinical insomnia and 17.0% had clinical insomnia. Increasing age was significantly associated with lower insomnia severity (aOR: 0.971; 95% CI: 0.945– 0.998; p = 0.038). Among gynecological cancer patients, insomnia was more prevalent in those receiving treatment for metastatic disease (76.2% vs 35.0%). Psychiatric conditions (depression and/or anxiety) requiring medication and the presence of pain were both significantly associated with higher rates of insomnia (p < 0.001 for both). Conclusion: Insomnia was highly prevalent among female cancer patients undergoing chemotherapy. Younger age, presence of pain, psychiatric comorbidities (particularly depression and/or anxiety), and metastatic disease status emerged as significant correlates. Considering the relationship between insomnia and physical and psychological distress, it is anticipated that regular screening and treatment approaches for insomnia will contribute to the holistic cancer care process by improving patient quality of life.

Background/Objectives: Claudin-18.2 (CLDN18.2) has recently emerged as a therapeutic target in gastric cancer; however, its prognostic relevance in the neoadjuvant setting remains insufficiently defined. We evaluated the clinical significance of CLDN18.2 and fibroblast growth factor receptor 2b (FGFR2b) expression in patients with locally advanced gastric cancer treated with neoadjuvant therapy. Methods: This retrospective single-center study included 64 patients with locally advanced gastric cancer who received neoadjuvant chemotherapy followed by curative surgery. Pretreatment endoscopic biopsy specimens were analyzed using immunohistochemistry to assess CLDN18.2 and FGFR2b expression. Survival outcomes were evaluated using Kaplan–Meier analysis and Cox proportional hazards regression models. Results: CLDN18.2 positivity was detected in 29.7% of patients and was not associated with baseline clinicopathological characteristics or pathological treatment response. However, CLDN18.2-positive tumors demonstrated significantly shorter relapse-free survival (median 19.0 vs. 36.6 months, p = 0.038) and overall survival (median 28.9 vs. 53.4 months, p = 0.005). In multivariable analysis, CLDN18.2 positivity remained an independent predictor of relapse-free survival. FGFR2b positivity was observed in 14.1% of patients and was evaluated descriptively due to limited case numbers. Conclusions: CLDN18.2 expression may represent a clinically relevant prognostic biomarker reflecting aggressive tumor biology in locally advanced gastric cancer treated with neoadjuvant therapy.