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Context: In Hodgkin's lymphoma [HL], PET-CT scan has established itself as the functional imaging modality of choice when it comes to evaluation and guiding treatment decisions. However, it remains an expensive imaging technique and therefore the number of PET-CTs is limited for each patient. Recent studies show that Interim PET-CT scan is gaining an important role as a predictor of survival and an influencer for treatment modifications
Objective: To identify the patients that are most likely to benefit from interim PET-CT scan and to acknowledge the utility of this imaging technique in the daily practice of Lebanese oncologists
Methods: We retrospectively reviewed the charts of 98 patients diagnosed with HL, treated and followed from 2009 to 2016 in our center. Patients were divided into three groups according to the stage of their disease: Group A[limited], Group B [intermediate] and Group C [advanced] according to ESMO guidelines. We studied the characteristics and the progression free survival [PFS] of patients in each group
Results: The progression free survival of the limited, intermediate and advanced stages were 75 months, 84 months and 61.51 months, with a p value of 0.482, 0.343 and 0.025 respectively. Patients who had a positive interim PET-CT scan had a PFS of 59.51 months, whereas patients who had a negative interim PET-CT scan had a PFS of 80.85 months, with a significant p value [p = 0.033]. In the advanced stage, patients with a positive interim PETCT scan were more likely to relapse with a PFS of 16.6 months vs 71.8 months for patients with negative interim PET-CT of the same category [p = 0.025]
Conclusion: In a country with limited resources, where functional imaging techniques remain restricted to a certain number of patients, interim PET-CT scan is most valuable in patients with advanced Hodgkin's lymphoma, where a positive Interim PET-CT is an indicator of a poor prognosis and therefore should influence an escalation in treatment strategies
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Background: Ovarian cancer is the 8th most common cancer among women in Lebanon. Despite new advances in the treatment of these tumors, their prognosis remains very poor. The histology of ovarian tumors and their stage at the time of diagnosis are the two most relevant prognostic factors. Epithelial tumors, including serous, mucinous, endometrioid, clear-cell, Brenner and seromucinous tumors, account for the vast majority of ovarian tumors. Germ cell tumors and tumors of the sexual cord are respectively the second and third subgroups of ovarian tumors. In Lebanon, there are no data concerning borderline and malignant ovarian tumors
Aim: We report the epidemiological and histological characteristics of borderline and malignant ovarian tumors in a Lebanese tertiary hospital
Material and Methods: This is a retrospective study evaluating the characteristics of borderline and malignant ovarian tumors diagnosed in 19 years [from 1999 to 2017] at the pathology laboratory of Hotel-Dieu de France, Saint Joseph University Hospital in Beirut, Lebanon. The data were extracted from the computerized registers of the laboratory. Statistical analysis was performed using SPSS 24.0
Results: Atotal of 996 ovarian lesions were found. Of these, 529 [53.1percent] were epithelial [342 [64.7percent] serous, 107 [20.2percent] mucinous, 23 [4.3percent] endometrioid, 18 [3.4percent] undifferentiated carcinoma, 15 [2.8percent] seromucinous, 12 [2.3percent] clear cell and 12 [2.5percent] Brenner]; 285 [28.6percent] were germinal [including 245 [86.0percent] mature teratomas, 12 [4.9percent] dysgerminomas and 7 [2.5percent] immature teratomas]; 83 [8.3percent] were stromal tumors of the sexual cord. Of the 529 epithelial tumors, 261 [49.3percent] were benign [60percent were serous cystadenomas], 46 [8.7percent] were borderline [26 serous, 18 mucinous and 2 serous] and 222 [42.0percent] were malignant [of which 139 [62.6percent] were high grade serous carcinomas, 19 [8.6percent] endometrioid, 18 undifferentiated, 12 low-grade serous and 12 clear cell]. Mean age for malignant epithelial tumors and borderline epithelial tumors were 54.3 years and 39.7 years respectively
Conclusion: Our data are compatible with those published in Western countries. Many studies will be launched on the basis of this database, including the evaluation of somatic and germinal ovarian panel mutations in high-grade ovarian serous carcinoma and in those with borderline tumor sequencing
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Context : The arise of the advanced and enhanced cancer remedies has extended the life expectancy of many patients who nevertheless survive now to fight the numerous concomitant long-term side effects. Trastuzumab had an accelerated FDA approval since it drastically improved the prognosis of HER-2 positive [HER-2+] breast cancer [BC] convalescents. Its cardiotoxic effect was noticed early during the trials and many guidelines were established to insure its early detection and treatment. Recent studies showed a controversial variation of compliance to the cardiac surveillance guidelines and a need for further testing to evaluate the vitality of increased monitoring
Objective: Study the compliance to the cardiac surveillance guidelines at our institution for HER-2+ non-metastatic breast cancer [NMBC] patients treated with Trastuzumab
Methods :The data of 99 patients diagnosed with HER-2+ NMBC treated with Trastuzumab was collected and analyzed retrospectively for echocardiographic results and dates. The dates were evaluated looking for the presence or absence of a comparable timeline with the guidelines within a range of 21 days. The presence of cardiotoxic events was indicated to analyze its incidence and timing to be able to deduce a need for closer monitoring. Patients were then analyzed according to the type of associated systemic therapy and treating physicians
Results: This study analyzed the data of 99 NMBC female HER-2+ patients diagnosed between January 2002 and February 2018. All patients received Trastuzumab. An anthracycline-based regimen was prescribed to 51.5 percent of the cases and the remaining 48.5 percent received a non-anthracycline therapy. At baseline, they had a mean age of 52y.o., and body mass index [BMI] 26.8. The percentages of patients who had respectively HTA, DM, DLP, CAD and cardiomyopathy at baseline were 21.21 percent, 90.9 percent, 20.20 percent, 3.03 percent and 1.01 percent. The stages were divided as follows: stage 0 [2 percent], IA [23.2 percent], IB [1 percent], IIA [22.2 percent], IIB [30.3 percent], IIIA [13.1 percent], IIIB [6.1 percent], IIIC [2 percent]. The anthracycline and non-anthracycline groups who had an almost equal number of patients had no significant differences with age and comorbidities at baseline except when comparing BMIs [Anthracycline group 27.99 +/- [ 5.53], non-anthracycline group 25.70 +/-[ 3.72], T-test p = 0.02]. Surveillance within baseline, 90, 180, 270, 360, 540 days intervals respectively had 36.36 percent, 21.21 percent, 21.21 percent, 27.27 percent, 20.20 percent, and 11.11 percent of available data. The anthracycline group had in general a better compliance to treatment during the follow-up period with 43.14 percent of available results at baseline compared to 29.17 percent in the non-anthracycline group. The overall incidence of cardiotoxic events was between 7 percent and 16 percent [16 percent at baseline, 3 percent discontinuation of Trastuzumab, 6 percent symptomatic treated drop]. Age, comorbiditie and the treatment groups were independent variables. Only the BMI had a significant difference between the anthracycline and non-anthracycline group, therefore, it was the only confounding factor that had a significant effect on this study when comparing between the two treatment clusters. However, further statistical analysis showed that it wasn't a risk factor for further LVEF drop since the variation of BMI didn't change statistically the LVEF variations even at baseline where we had the highest percentage of LVEF drop [16 percent] [Mann Whitney p = 0.717]. We were unable to evaluate the strain rate because of the lack of data. A descriptive analysis of the LVEF variations and the cardiac follow-up was set based on Patient-X included in BCIRG006 trial, treated with anthracyclines and Trastuzumab, and it showed a perfect compliance to surveillance, and death of heart failure [HF] after 11 years of the first dose of Trastuzumab
Conclusion: Overall, there was an insufficient obedience to the guidelines with a significant incidence of cardiotoxic events. This is an indication for increasing the awareness on this topic at our institution. The missing data could be due to deficient prescription, compliance or collection of data. The variation of the concordance tested per doctor emphasizes the physician's role in maintaining good conforming patients and data collection. On the other hand, the importance of the predictive value of the global longitudinal strain [GLS] measures should be discussed. The descriptive analysis of our BCIRG 006 inclusion was analogous to the released statement about Trastuzumab positive influence on survival, and how its combination with anthracyclines has prejudicial repercussions on the cardiac state
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Background: Pancreatic adenocarcinoma [PAC] forms 85 percent of pancreatic cancers. In Lebanon the annual mortality rate is 4.3 per 100 000 persons. Data are lacking in the Lebanese population on the treatment evolution of pancreatic adenocarcinoma. We conducted a study to compare two groups of pancreatic adenocarcinoma patients through time
Methods: We randomly assigned 70 patients from NDS-UH who were diagnosed having PAC from the beginning of the year 2000 until the end of 2017. All patients were above 18 years old at time of diagnosis, with an ECOG PS of 0 or 1. All of them had not received any prior chemotherapy or radiotherapy, and they all had a locally advanced i.e. inoperable or metastatic PAC. The 70 patients were divided into 2 groups. The first group is formed by all patients diagnosed before 2010 and the second group by all patients diagnosed after 2010. The primary endpoint is the OS rate in each group. The secondary endpoints are the PFS1, PFS2, RR and the mean OS variability in each gender with time
Results: The groups of people studied in this analysis were 64.3 percent male 35.7 percent female with a mean age of 64.37 years. 58.6 percent had an ECOG-PS of 0 while the remaining 41.4 percent had an ECOG-PS of 1. 60 percent of the cancers were located in the head of the pancreas, 14.3 percent in its tail and 22.9 percent in the body. The mean size of the tumor regarding the location was 36.24 mm [body: 36.88 mm, tail: 57.4 mm, head: 30.95 mm]. The stages were divided as follow: 17.15 percent stage IIB, 24.28 percent stage III and 58.57 percent stage IV. 40 percent of the patients had metastases in the lymph nodes at diagnosis while 44.3 percent, 5.7 percent, 4.3 percent and 5.7 percent had hepatic, pulmonary, hepatic and pulmonary metastases and peritoneal carcinoses at diagnosis respectively. The mean Ca 19-9 was 16 080.8197 U/ml. Our two groups were statistically similar in terms of sex, age, ECOG PS, stages and location of the cancer in the pancreatic gland at diagnosis with identical mean WBC, LDH, Ca19-9, total and direct bilirubin and HbA1C levels at time of diagnosis. The mean glycemia level was different in the 2 groups with 132 mg/ml in the group diagnosed before 2010 versus 181.32 mg/ml in the group diagnosed after 2010 with a p value of 0.019. The mean OS was 11.5 months [95 percent CI, 7.4 to 15.5] in patients diagnosed before 2010 vs. 14.39 months [95 percent CI, 11.4 to 17.3] in patients diagnosed after 2010. The median OS was 7.3 months [95 percent CI, 4.28-10.45] in the first group vs. 12.4 months [95 percent CI, 8.15-16.64] in the second group with a p value of 0.23; p > 0.005 percent. The mean PFS1 was 10.34 months [95 percent CI, 8.05 to 12.63] after 2010 vs. 7.94 months [95 percent CI, 4.7 to 11.14] in the first group. We saw an increase of 4 months in the median PFS1 between the 2 groups with 4.27 months [95 percent CI, 3.2 to 5.2] in the first group vs. 8.23 months [95 percent CI, 5.4 to 10.9] in the second with a p value of 0.18; p > 0.005 percent. Mean PFS2 in the first group is 6.08 months [95 percent CI, 3.4 to 8.7] vs. 6.96 months [95 percent CI, 1.088 to 4.8] in the second group. Median PFS2 is 3.8 months [95 percent CI, 1.84 to 5.76] for the former group vs. 6.1 months [95 percent CI, 2.68 to 9.5] for the latter group, with a p value of 0.43; p > 0.005 percent. The response rate was higher in the group of patients diagnosed after 2010 with 37.5 percent com- pared to 20 percent in the group of patients diagnosed before 2010. When comparing the OS between genders we saw a stable OS in female patients within the 2 groups while the male groups had an increase in their OS. In the group of patients diagnosed before 2010, males had a mean OS of 10 months [95 percent CI, 5.2 to 14.8] and females had a mean OS of 14.4 months [95 percent CI, 7.1 to 21.6]. In the group of patients diagnosed after 2010, males had a mean OS of 14.1 months [95 percent CI, 9.9 to 18.2] and females a mean OS of 14.8 months [95 percent CI, 11 to 18.6]. In other terms, the MR in female remained stable with time, while it decreased in the males that were diagnosed after 2010
Conclusion: Overall, there was an absolute increase of 5.1, 3.96 and 2.3 months in the median OS, PFS1 and PFS2 respectively, between the groups of patients diagnosed before and after 2010 without any statistical significance. This lack of significance can be due to the fact that our study was based on comparing two periods of time and not different chemotherapeutic regimens as seen in all the literature
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Aim: The administration of total parenteral nutrition [TPN] in terminally ill cancer patients is aggressive with a relatively high risk of complications. In this paper, we investigated the use of TPN in Lebanese cancer patients at end of life. To our knowledge, this is the first study describing TPN administration to Middle Eastern patients with advanced cancer
Methods: We conducted this observational study at Hotel-Dieu de France University Hospital, Lebanon. Eligible cases included all cancer patients that died at our institution between the 1st of January and the 31st of December 2014. The patients and tumors characteristics as well as the management plan were retrieved from the hospital records
Results: Our study enrolled 129 cancer patients at end of life among which 39 percent had received TPN: 28 percent during the last 6 weeks and 34 percent during the last 3 months. The mean duration of TPN administration was 33 days [range: 1 to 211]. The mean duration between the end of TPN administration and death was 37 days [range: 0 to 315]. TPN administration correlated negatively to hyperlipidemia [OR = 0.33; 95 percent CI [0.12 - 0.87]] and to the presence of three cardiovascular risk factors [OR = 0.28; 95 percent CI [0.10 - 0.80]]. On the other hand, it correlated positively to gastrointestinal tumors [OR = 3.9; 95 percent CI [1.3 - 11.7]] and to imaging studies during the last month of life [OR = 3.4; 95 percent CI [1.3 - 9.0]]. In the multivariate analysis, only hyperlipidemia was found to be a significant determinant of the TPN administration [p = 0.010; ORa= 0.29 [0.11 - 0.74]
Conclusion: The prevalent use of TPN at end of life underlines a difficulty in adopting a palliative care approach in our population. This is truly applicable in Middle Eastern populations that seem to refuse a patient-centered supportive care approach
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Introduction: Localized form of gastric cancer is currently treated, independently of genetic profiles, by surgical resection with perioperative chemotherapy, radiotherapy and/or targeted therapy. Next-generation sequencing (NGS) recently provided new information regarding gene mutations related to gastric cancer pathogenesis. This information can determine new therapeutic pathways to successfully treat gastric cancer depending on its molecular profiling. Ramucirumab is a humanized monoclonal antibody directed against vascular endothelial growth factor receptor 2. Ramucirumab is approved in second-line therapy for advanced or metastatic gastric cancer as a single agent or combined with chemotherapy in molecularly unselected patients. Some studies determined prognostic value of plasma biomarkers and cytokines in patients treated with Ramucirumab (RAINBOW trial). Other studies have shown no relationship between Ramucirumab therapy and VEGFR-2 mutation (REGARD trial). However, no studies have shown significant survival benefit for certain genetic profiles in patients treated with Ramucirumab therapy. The aim of this study is to assess the value of certain molecular profiles in predicting response to Ramucirumab therapy in advanced or metastatic gastric cancer
Methods: This is a retrospective study to determine molecular profiles for gastric cancer that predict outcomes of treatment with Ramucirumab. Patients' molecular profiling will be studied using NGS. Included patients are those with advanced or metastatic gastric cancer treated with second-line Ramucirumab therapy combined with Paclitaxel. Patient characteristics are collected retrospectively from medical records including tumor localization, size, stage, type of surgery, definitive histological subtype, number of lymph nodes resected. Type and response to first line chemotherapy as well as overall survival (OS) and disease free survival (DFS) are acquired for all patients
Results o Kaplan-Meier curves for DFS and OS will be compared between subjects with different somatic mutations using log-rank test. Multivariate Cox regression models for DFS and OS with mutated somatic genes as independent variables were computed. Any predictive factor for response to Ramucirumab, especially molecular, will be reported
Conclusion o Molecular characteristics of advanced gastric cancer patients will be analyzed to define any predictive value for response to Ramucirumab in second-line based therapy
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Objective: To estimate the frequency of patients in Lebanon who report an impact of chemotherapy-induced nausea and vomiting [CINV] on their daily life and to evaluate the determinants of such impact, considering not only the prognostic factors related to the patient, disease and treatment, but also the intrinsic characteristics of the CINV, namely, the distinction between acute and delayed phase, and the intensity of nausea and vomiting
Methods: This prospective cross-sectional study, performed between January 2016 and December 2016, included 328 patients. The Functional Living Index - Emesis [FLIE] score was used to evaluate the impact of CINV on patients' daily lives and day-to-day functioning
Results: The results of the backward logistic regression taking the two-category FLIE score as dependent variable showed that current alcohol drinking would increase the odds of having a high FLIE score . 108 by more than 8 times [p = 0.047; ORa = 8.114], while having an anticipatory feeling of nausea/vomiting, number of acute vomiting episodes and the intensity of late nausea would significantly increase the odds of having a FLIE score < 108 by 98.6 percent, 48.4 percent and 29.6 percent respectively [p < 0.0001, ORa = 0.014; p < 0.0001, ORa = 0.516 and p = 0.006, ORa = 0.704]
Conclusion: Chemotherapy-induced nausea and vomiting are still affecting the quality of life[QOL] of oncology patients despite all treatment novelties. Astrong association between the number of vomiting episodes, the intensity of late nausea and the anticipatory feeling of nausea/vomiting and a decrease in the patient's QOL and comfort was found. This research was able to shed the light on the importance of well-controlling CINV to preserve the patient's QOL