Immunotherapy in metastatic malignant melanoma and non-small cell lung cancer; a brief review and position statement from the immuno-oncology clinical forum [IOCF], Iran

Given the unmet needs in cancer treatment, extensive research and development has evolved to offer therapies for cancers to extend survival and minimize side effects. Immunotherapy, an approach to harness normal immune cells against cancers not only today's breakthrough but in fact the future of oncology therapeutics. Taking into consideration the recent approvals for new lines of therapy including anti-programmed-death-1 or programmed-death-1 ligand [PD-1/PD-L1] monoclonal antibodies for the treatment of Malignant Melanoma [MM] and Non-Small Cell Lung Cancer [NSCLC], local strategies need to be established following the field experts' concurrence. Expert input forums are among the key approaches to define locally-adapted clinical-pathways with regard to the novel treatments. To this end, a panel of Iranian medical oncology experts reviewed the available evidence, taking into consideration recent practice guidelines with regard to the treatment of MM and NSCLC in order to draw an agreed-upon approach highlighting the position of immunotherapy in their current practice. Having addressed the key questions and considering the possible limitations and challenges, the panel could reach an agreed position. This report highlights the discussions with regards to the role of immunotherapy in MM and NSCLC during the immune-oncology clinical forum [IOCF] comprising an Iranian panel of experts

Clinico-pathologic manifestations of Iranian patients with breast cancer

Breast cancer is the most common malignancy in women and is the second cause of cancer death in female population. The objective was to find out different clinical manifestations and epidemiology of breast cancer among various ethnics groups to help improve health system in the country. In this retrospective cross sectional study, we evaluated clinical and pathologic features of one thousand Iranian women with breast cancer. The data including age, type of surgery, pathology report, tumor size, lymph node involvement, tumor stage and receptor status were extracted from medical records and were analyzed. The highest prevalence of breast cancer was in patients in 40-49 years age group [37.4%]. The most common performed surgery was modified radical mastectomy and the most common pathology report was intra-ductal carcinoma. Tumor size was 2-5 cm in most of patients. Sixty percent of patients had lymph node involvement. Finally, 49.1% of patients were diagnosed when they were in stage II and 36.7% were in stage III. In 72.9% of patients, estrogen receptor, progesterone receptor or both receptors were positive and of 116 patients who were checked for Her-2, 27 patients [23.2%] were 3+ positive. Our findings suggest that Iranian breast cancer patients are relatively younger than patients in western countries and mostly present at higher pathologic stages. We highly recommend screening test to be performed at lower ages [at least 40 years old]

Postpartum hypercalcemia secondary to a neuroendocrine tumor of pancreas; a case report and review of literature

Parathyroid hormone-related protein producing pancreatic neuroendocrine tumors have been infrequently reported. Here-in, we report a case of an Iranian woman who had such a tumor during pregnancy, and gave birth to a female neonate with esophago-tracheal fistula and imperforated anus. Hypercalcemia was diagnosed at postpartum because of elevated serum calcium levels in the neonate and neurologic deterioration of the mother. Extensive literature review revealed 42 cases with pancreatic neuroendocrine tumors and hypercalcaemia. The clinical and laboratory findings of such patients are reviewed in this manuscript

Consolidation chemotherapy with docetaxel after platinum-based chemotherapy in patients with non- small cell lung cancer: a preliminary report

The efficacy of second line chemotherapy for relapsed non small cell lung cancer has been established. In this study, we evaluated the efficacy and toxicity of maintenance therapy with docetaxel in patients with non-small cell lung cancer who were stabilized with first line chemotherapy and had good performance status before relapse. The primary objective was to determine one-year survival and the other objectives were evaluation of adverse effects and time to progression. Eighteen patients with lung cancer were included in this study. All patients were at stage III and IV, without distant metastasis or neuropathy. All patients had been treated with platinum based regimen initially and were responsive or stable with no progression. The patients were treated with docetaxel 75 mg/m[2] for a total of 4 cycles repeated every 3 weeks. All patients accomplished 4 chemotherapy cycles and a total of 72 cycles were administered. The mean time of progression free survival [PFS] was 9-10 months and one- year survival [OS] was 94.4% without any significant adverse effect necessitating medical intervention. The mean survival time of patients was 18 [12-20] months. Using docetaxel as consolidation chemotherapy in patients with non small cell lung cancer can prolong time to progression of disease and probably patients' survival without significant adverse effects or negative impact on the quality of life

[Is serum testosterone level higher in patients with breast cancer with unfavorable histopathologic factors?]

Breast cancer is more common in women with high serum testosterone level. Few studies showed that high level of serum testosterone is associated with poor prognosis. The association of testosterone level with histopathological findings has not been studied yet. In this study we investigated this association. Patients referred to a medical oncology clinic with no history of previous chemotherapy, hormone therapy, oophorectomy, or other cancers enrolled in the study. Morning serum testosterone was checked. Histopathologic findings were extracted from pathologic reports. Relationship between testosterone level and histopathologic types was analysed. 106 patients were studied whose mean age was 47 +/- 10 years. 63.2% of our patients were premenopausal. Histopathologic factors were unfavourable in 50%. The rate of vascular invasion was 56.4% and 73% were receptor positive. Mean level of serum testosterone was 0.56 +/- 0.52 ng/ml in patients with favourable histopathology and 0.70 +/- 0.77 ng/ml with unfavourable histopathology [p<0.4]. No testosterone level was above normal range. There was no relation between serum testosterone level and histopathologic findings; viz. serum testosterone level was not higher in breast cancers with unfavourable histopathologic factors. So we need to conduct more studies to figure out the reasons for the poor prognosis observed in patients with higher levels of serum testosterone

Specific chromosomal abnormalities in patients with acute nonlymphocytic leukemia from the Islamic Republic of Iran.

Cytogenetic analysis performed at diagnosis is considered to be the most valuable prognostic factor in acute non-lymphocytic leukemia (ANLL), a very heterogeneous disease. Little data exist in Iran regarding the cytogenetic characteristics of ANLL . Therefore, cytogenetic investigations were performed for 58 patients with various subtypes of ANLL with unstimulated short term culture and high resolution cell synchronization techniques. Among the 58 evaluated patients, 45 (77.5%) showed clonal karyotypic abnormalities and the percentages of the abnormal cells were recorded within the range of 30%-100%. Some 14 were classified as M1, 20 as M2, 19 as M3 , 3 as M4, 1 as M5 and 1 as M6. The most common chromosome rearrangements were t(15;17), t( 8;21) and t(9;22). Trisomy of chromosome 8 (+8) was the most frequent numerical alteration in 3 patients with M1, M2 and M6. The incidence of other chromosomal defects, including -10, DMCs , -19 , 5q- , dicentric(dic), chromatid breaks, and marker chromosomes was relatively high. Similarities and dissimilarities of our study with others may be due to the role of genetic sensitivities as well as uneven geographic distribution in the pathogenesis of ANLL. Further prospective studies are warranted to precisely elucidate ethnic differences in the pathogenesis of this disease in different populations.