We aimed to compare the efficacy and the safety of the FOLFOX and the FLOT regimens in metastatic gastric cancer (mGC) as first-line treatment. It was a retrospective multicenter observational study. The comparisons between groups were conducted in terms of progressionfree survival (PFS), overall survival (OS), objective response rate (ORR) and hematologic adverse events. Seventy-nine patients, diagnosed with mGC between March 2012 and December 2019, treated with FOLFOX (n = 43) or FLOT (n = 36) regimens as first-line treatment were included in the study. The mPFS was 10.9 months [95% confidence interval (CI), 5.8-16.1] in the FLOT arm and 7.1 months (95% CI, 5.1-9.1) in the FOLFOX arm (P < 0.001). The ORR was 63.9% in the FLOT arm and 30.2% in the FOLFOX arm (P = 0.003). The mOS was 13.3 months (95% CI, 11.3-15.4) in the FLOT arm and 10.9 months (95% CI, 8.2-13.5) in the FOLFOX arm (P = 0.103). The hematologic adverse events in all grades were 88.4% (n = 38) in the FOLFOX arm compared with 80.6% (n = 29) in the FLOT arm (P = 0.335). The FLOT regimen might be a preferred option in mGC with an improved PFS and ORR compared with the FOLFOX regimen. Anti-Cancer Drugs 33: e477-e485

Introduction To evaluate biosimilar understanding and preference trends of medical oncologists in Turkey. Methods A survey consisting of 24 multiple-choice questions with checkbox answers was conducted among medical oncologists. The questionnaire was divided into five parts to some intentions: demographic characteristics, general knowledge about biosimilars, knowledge about local approval and reimbursement issues, individual preference trends, and ranking the knowledge of their own. All answers were analyzed as whole cohort, specialists and fellows. Results Fellows (n = 47) consisted 42%, and academic clinicians (n = 37) consisted 35% of the participants. In the whole cohort, the overall rate of correct answers was 55.1% in the general knowledge about the biosimilars part, and 26.7% in the local approval and reimbursement issues part. At all, 57.7% of the participants declared that they object to switch from a reference product to a biosimilar product. The rate of those who defined themselves as extremely knowledgeable decreased from 8.1% to 2.7% in the whole cohort at the end of the survey. Conclusion The need for more accurate and clarified local regulations and education emerging in the biotechnology era must be met.

Objectives:The aim of this study was to evaluate the effect of the serum albumin/ globulin ratio (AGR) on the 30-day mortality of febrile neutropenia (FEN). The second aim of the study was to evaluate the effect of the combination of the AGR with the Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) risk indexes on 30-day mortality of FEN.Methods: A retrospective study evaluating the effect of serum AGR, MASCC and CISNE scores on 30-day FEN mortality.Results: A total of 137 FEN episodes in 120 patients were included in this study.Nineteen patients (14%) died within the first 30 days of FEN episodes. The 30day mortality rate was calculated as 4% in patients with high AGR and 23% in patients with low AGR (P = .002). According to the MASCC and CISNE risk scores, the mortality rates in low-risk patients were 8% and 6%, respectively, and in the high-risk group 22% and 29%, respectively (P = .024 vs P < .001). In the group of patients with MASCC <21 and CISNE ≥3, the 30-day mortality rate was 7%, when the AGR was >1.13, and in those with AGR ≤1.13 mortality rate increased to 50% (P = .012). Conclusion:A low AGR in a patient with FEN was found to be associated with an increased risk of 30-day mortality. Combining the AGR with MASCC and CISNE risk indexes might increase the predictive value of these scoring systems on 30-day mortality. What's known• MASCC and CISNE risk indices are used in the prognosis of febrile neutropenia.• However, the specificity and sensitivity of both indexes are limited.• More effective risk scoring is needed in the management of febrile neutropenia. What's new• Combining the AGR with MASCC and CISNE risk indexes might increase the predictive value of these scoring systems on 30-day mortality. How to cite this article: Sütcüoğlu O, Akdoğan O, Gürler F, et al. The role of serum albumin/globulin ratio in combination with prognostic risk indexes of febrile neutropenia. Int J Clin

Background/aim The aim of our study was to compare the efficacy and the safety of the FLOT and the modified DCF (mDCF) regimens in patients with metastatic gastric (GC) and gastroesophageal junction (GEJ) adenocarcinoma as first-line treatment. Materials and methods The medical records of 72 patients were retrospectively reviewed. Survivals and hematological adverse events of the patients were examined. Factors affecting survivals were analyzed in univariate analysis. A multivariate analysis was performed with the factors contributing to survivals in univariate analysis. Results The median PFS (mPFS) was 10.1 months (95% CI, 6.8–13.4) in the FLOT arm (n = 33) and 7.4 months (95% CI, 9.1–21.6) in the mDCF arm (n = 39) (p = 0.041). The median OS (mOS) was 12.9 months (95% CI, 9.7–16.1) in the FLOT arm and 15.4 months (95% CI, 9.1–21.6) in the mDCF arm (p = 0.622). It was found that all grade neutropenia was 51.3% vs. 72.7% (p = 0.063), febrile neutropenia was 8.3% vs. 6.3% (p = 0.743), and thrombocytopenia was 48.7% vs. 51.5% (p = 0.813) in the FLOT and mDCF arms, respectively. Anemia was 59% in the FLOT arm and 100% in the mDCF arm (p < 0.001). Grade 3–4 anemia was 7.7% in the FLOT arm and 24.2% in the mDCF arm (p = 0.052). Conclusion It was shown that the mPFS was significantly increased in the FLOT arm compared to the mDCF arm as the first-line treatment in patients with metastatic GC and GEJC. Hematological adverse events were more favorable in the FLOT arm than in the mDCF arm.

cohort, 87%, 80%, and 44% were referred to a cancer center, seen by an oncologist, and treated, respectively. Among referred patients, 73%, 24%, and 3% were from urban, rural, and unknown settings respectively. Median time from referral to consult was 11 days for both urban and rural populations (p¼0.05). Patients with fewer hospitalizations waited 9 days from referral to consult compared to 13 days for individuals with more hospitalizations (p<0.001). Rural patients were less likely to be referred (OR 0.442, 95% CI 0.269-0.725, p¼0.001) and treated (OR 0.643, 95% CI 0.426-0.971, p¼0.036) whereas hospitalized patients (OR 2.855, 95% CI 1.158-7.042, p¼0.023) and those with longer hospital stays (OR 2.728, 95% CI 1.603-4.644, p<0.001) were more likely to be referred. All patients experienced a poor prognosis, irrespective of urban vs. rural (HR 1.169, 95% CI 0.986-1.386, p¼0.072) and hospitalization (HR 0.993, 95% CI 0.824-1.198, p¼0.945) status.Conclusions: Rural patients with AGCs face potential access barriers due to geography. By the time that patients are hospitalized, referral and treatment still translated to poor survival. Prompt referral and entry into the cancer care system is essential, particularly for patients who live remotely.Legal entity responsible for the study: The authors.