ABSTRACT
Cancer is a major health problem as it is the first or second leading cause of death worldwide. The global cancer burden is expected to rise 47% relative to 2020 cancer incidence. Recently, the fields of neuroscience, neuroimmunology and oncology have elaborated the neuroimmune crosstalk role in tumor initiation, invasion, progression, and metastases. The nervous system exerts a broad impact on the tumor microenvironment by interacting with a complex network of cells such as stromal, endothelial, malignant cells and immune cells. This communication modulates cancer proliferation, invasion, metastasis, induce resistance to apoptosis and promote immune evasion. This paper has two aims, the first aim is to explain neuroimmune crosstalk in cancer, tumor innervation origin and peripheral nervous system, exosomes, and miRNA roles. The second aim is to elaborate neuroimmune crosstalk impact on cancer therapy and research highlighting various potential novel strategies such as use of immune checkpoint inhibitors and anti-neurogenic drugs as single agents, drug repurposing, miRNA-based and si-RNA-based therapies, tumor denervation, cellular therapies, and oncolytic virus therapy.
ABSTRACT
The COVID-19 pandemic resulted in an overwhelming increase in research studies submitted to research ethics committees (RECs) presenting many ethical challenges. This article aims to report the challenges encountered during review of COVID-19 research and the experience of the Faculty of Medicine, Ain Shams University Research Ethics Committee (FMASU REC). From April 10, 2020, until October 13, 2020, the FMASU REC reviewed 98 COVID-19 research protocols. This article addressed the question of how to face an overwhelming amount of research submitted to the REC while applying the required ethical principles. Ethical challenges included a new accelerated mode of review, online meetings, balance of risks vs. benefits, measures to mitigate risks, co-enrolment in different studies, protection of a vulnerable COVID-19 population, accelerated decisions, online research, how to handle informed consent during the pandemic, and justification of placebo arm.
ABSTRACT
BACKGROUND: The aim of this study was to analyze the clinicopathological features of malignant pleural mesothelioma (MPM) and evaluate the therapeutic measures offered to patients with MPM and their impact on survival. METHODS: Data was retrospectively collected from the medical records of 304 patients who presented to the Department of Clinical Oncology and Nuclear Medicine, Ain Shams University between January 2003 and December 2008. RESULTS: The mean age of patients was 52.1 years (range 24-87 years). One hundred and ninety patients (62.5%) came from endemic areas and/or gave history of occupational asbestos exposure. One hundred and sixty-nine patients received chemotherapy. There was a significant difference between the median survival for patients who received chemotherapy (9 months, 95% CI 7.69-10.30) and those who were offered best supportive care (2 months, 95% CI 0.09-3.91). Other factors that affected the survival negatively were: non-epithelial pathology (P= 0.001); age >50 years (P= 0.012); bad performance status (P= 0.001); non-platinum based chemotherapy (P= 0.0001); and progressive disease (P= 0.000). Cox regression analysis revealed that the factors that predicted shorter survival were patients being offered best supportive care rather than chemotherapy and progressive disease. CONCLUSION: MPM is a growing health problem in Egypt that needs more attention. The current analysis of data reflects the importance of maintaining a high index of suspicion to allow for early diagnosis, especially for cases that live in areas with high asbestos exposure and for people who work in occupations that expose them to asbestos as well as their family members. Prospective randomized trials comparing multimodality approaches to other forms of treatment and including quality of life assessment are warranted.
ABSTRACT
BACKGROUND: Postoperative radiotherapy (RT) is the most commonly used adjuvant treatment in high risk endometrial carcinoma (HREC), it reduces the incidence of pelvic relapses but doesn't improve survival. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of concomitant weekly cisplatin and postoperative RT in HREC (stages IB grade 3, IC and IIA) followed by adjuvant cisplatin and weekly paclitaxel. PATIENTS AND METHODS: Eighteen patients with pathologically confirmed endometrial carcinoma were enrolled in this study. All patients underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy (TAHBSO) and surgical staging. Five patients (28%), 4 patients (22%) and 9 patients (50%) presented with stages IB grade 3, IC and IIA respectively. All patients received cisplatin once weekly during the 6 weeks of RT. After the chemoradiation course, 4 additional adjuvant courses of cisplatin and paclitaxel were administered. RESULTS: Between May 2000 and March 2002, a total of 18 patients with pathologically confirmed endometrial carcinoma, presented to Radiation Oncology & Nuclear Medicine Department, Ain Shams University Hospitals, were enrolled in this study. Their median age was 59 years. No severe toxicity was encountered during concomitant chemoradiation. Grade 3 hematological toxicities, leucopenia, neutropenia and anemia were recorded in one patient (5.6%) each during adjuvant chemotherapy. Two patients (11%) relapsed with distant metastases and one patient (5.6%) developed pelvic recurrence. Median time to progression was 67 months. Five year disease free survival and the 5 year overall survival were 89% (95%, CI: 74-100). CONCLUSION: Concomitant cisplatin and postoperative RT followed by adjuvant cisplatin and weekly paclitaxel is safe and acceptable treatment in patients with HREC. This study verifies the feasibility of this treatment to potentially reduce the incidence of local and distant relapses in order to improve survival. Randomized phase III studies with large number of patients are necessary to evaluate the benefits of this approach.
