Therapeutic Strategy for Functional Metastatic Malignant Paraganglioma: A Case Report and Review of the Literature.

Paraganglioma is a rare neuroendocrine tumor that arises outside of the adrenal gland, typically originating from the chromaffin tissue of the sympathetic or parasympathetic ganglia. It can manifest at any age, with a peak incidence occurring between 40 and 50 years old. When the tumor secretes catecholamines, it is referred to as "functional." Currently, there is no standardized therapeutic approach. However, the management of metastatic forms is based on a systemic treatment with tri-chemotherapy. Herein, we present the case of a young male patient with heavily metastatic functional malignant paraganglioma, which represents the first case managed in our department. After seven months of Somatuline treatment, our patient experienced disease progression. Subsequently, he received tri-chemotherapy comprising cyclophosphamide, vincristine, and dacarbazine, which proved to be suboptimal due to poor hematological tolerance and a progression-free survival of less than three months. In the third line of treatment, Sunitinib was administered, but the therapeutic response was poor, with clinical progression observed within two months, ultimately leading to the patient's demise at home. The overall survival was two years.

The Use of Granulocyte Colony-Stimulating Factor as Primary Prophylaxis in Patients Undergoing Chemotherapy: An Experience of Moroccan Oncologists.

Febrile neutropenia (FN) is a frequent and serious emergency for oncologic patients undergoing chemotherapy. Using granulocyte colony-stimulating factor (G-CSF) as primary prophylaxis of febrile neutropenia is an integral part of the management of cancer patients. Our study aims to identify the challenges that prevent Moroccan oncologists from prescribing G-CSF for primary prevention. Seventy doctors participated in our study, with a participation rate of 35.35%. Twenty-two participants had at least five years of experience in oncology. Most participants were medical oncologists (82.9%), and two-thirds of them practiced in teaching hospitals. Regarding the use of G-CSF in primary prevention, all participants complied with the recommendations for FN risk assessment and the prescription of G-CSF for prophylaxis in patients at high risk of FN (>20%). However, their use in intermediate-risk patients remains limited mainly by the cost of these drugs (45.7% of participants). FN remains a dreadful complication in oncology. Since the introduction of G-CSF into standard oncology practice, particularly in primary prevention, the management of certain patients has improved considerably. Nevertheless, the indications for G-CSF in our context, essentially in intermediate-risk patients, are uncertain.

Pazopanib-induced trismus in a young male with metastatic renal cell carcinoma: a case report and literature review.

The treatment landscape of advanced kidney cancer has radically changed over the years. Targeting tumor angiogenesis from historical cytokines to multi-tyrosine kinase inhibitors and recently the advent of immunotherapy resulted in a radical improvement in survival but presented substantial challenges in terms of toxicity management. In countries where the access to immune checkpoints inhibitors is still very limited, tyrosine-kinase inhibitors remain the optimal choice. The toxicity profile of these agents can influence both the clinician and the patient's preference for one molecule over another. This report describes the case of a young man treated with Pazopanib in a first-line setting for stage IV renal carcinoma who developed trismus under treatment. The occurrence of this off-target toxicity has made the patient ineligible for anti-angiogenic drugs. Although side effects of tyrosine kinase inhibitors seem manageable and reversible, some less known and unusual effects may evolve into severe and irreversible complications.

Chemotherapy-related adverse effects with anthracycline and taxane-containing regimens in patients with localized Breast cancer: a descriptive study : Mohammed VI University Hospital, Medical Oncology Department, Marrakech, Morocco.

BACKGROUND: Although the side effects of chemotherapy are frequently described in research studies, there is little evidence on how common they are in everyday clinical care. This study's goal was to assess the most prevalent short-term side effects experienced by patients with localized breast cancer, undergoing chemotherapy based on anthracyclines and taxane-containing treatments, at the medical oncology department of the Mohammed VI University Hospital of Marrakech, Morocco. METHODS: This was a descriptive study. We conducted a listening session at the outpatient department of the hospital with the help of a structured questionnaire. The session engaged 122 women who had undergone cycles of chemotherapy. A chi-square test was used to compare the incidence and relative risk of short side effects with both anthracycline and taxane-containing regimens. RESULTS: The average age of participants was 49.1 years. In both regimens, the findings highlighted the frequency and relative risk of the following adverse effects: systemic symptoms (fever, asthenia and sleep disorder), gastrointestinal toxicity (Vomiting, nausea, diarrhoea, constipation, mucositis and loss of appetite), dermatological toxicity (Skin reactions on hands/feet, nail toxicity, allergies, alopecia and peripheral edema), neurological toxicity (neuropathy), arthromyalgia and ocular toxicity. CONCLUSIONS: In conclusion, it is crucial for healthcare professionals to be conscious of the significance of these adverse effects. They must also know how to manage them. Likewise, the listening approach highlights its importance in the daily follow-up and monitoring of patients.

Single agent vs combination immunotherapy in advanced melanoma: a review of the evidence.

PURPOSE OF REVIEW: The aim of this review is to outline the current landscape of advanced melanoma treatment options, provide insights on selecting combination therapies within different clinical scenarios, capture clinical relevance of anti-programmed cell death protein 1 (PD-1) monotherapy, and explore the unmet needs with immune check-point inhibitors (ICI) in advanced melanoma. RECENT FINDINGS: ICI based treatment consisted of single agent ICI or dual combination ICI-ICI is the standard of care of front-line treatment of metastatic or unresectable melanoma. PD-1 inhibitors (Pembrolizumab and Nivolumab) improved progression free survival (PFS) and overall survival (OS) compared to chemotherapy and cytotoxic T-lymphocyte associated protein 4 (CTLA-4) inhibitors (Ipilimumab and Tremelimumab). The dual ICI combination (Nivolumab and Ipilimumab) provided profound and durable responses better than monotherapy, and the longest overall survival ever achieved in advanced disease, including in patients with murine sarcoma viral oncogene homolog B (BRAF)-mutated disease, but at the cost of a high risk of severe toxicity. The new dual blockage of LAG-3 and PD-1 (Nivolumab-Relatlimab) emerges as a valid option with promising efficacy outcomes and a favourable toxicity profile. Mature survival data is still needed to capture the real benefit. SUMMARY: These new plethora of options pose new challenges not only for optimal treatment sequencing strategies but especially for management of adverse effects, endorsing the need to integrate a holistic and personalized approach for patient care.

Development of a well-defined tool to predict the overall survival in lung cancer patients: an African based cohort.

BACKGROUND: Nomogram is a graphic representation containing the expressed factor of the mathematical formula used to define a particular phenomenon. We aim to build and internally validate a nomogram to predict overall survival (OS) in patients diagnosed with lung cancer (LC). METHODS: We included 1200 LC patients from a single institution registry diagnosed from 2013 to 2021. The independent prognostic factors of LC patients were identified via cox proportional hazard regression analysis. Based on the results of multivariate cox analysis, we constructed the nomogram to predict the OS of LC patients. RESULTS: We finally included a total of 1104 LC patients. Age, medical urgency at diagnosis, performance status, radiotherapy, and surgery were identified as prognostic factors, and integrated to build the nomogram. The model performance in predicting prognosis was measured by receiver operating characteristic curve. Calibration plots of 6-, 12-, and 24- months OS showed optimal agreement between observations and model predictions. CONCLUSION: We have developed and validated a unique predictive tool that can offer patients with LC an individual OS prognosis. This useful prognostic model could aid doctors in making decisions and planning therapeutic trials.

A Case Report of SMARCA4-Deficient Thoracic Sarcoma: A Rare and Aggressive Disease With a Grim Prognosis.

SMARCA4-deficient thoracic sarcoma (DTS) is a rare malignancy defined by inactivating SMARCA4 mutations leading to protein loss. It was recently described as an aggressive disease with a dismal prognosis, mostly affecting young men with a history of heavy smoking. Histologically, SMARCA4-DTS is a poorly differentiated tumor with rhabdoid or epithelioid features that can be distinguished from other soft tissue, and thoracic sarcomas by a higher tumor mutation burden (TMB) and the presence of smoking signatures, including KRAS, STK11, and KEAP1 mutations. Currently, there is no approved treatment for SMARCA4-DTS, which is known to be chemo-resistant, but more recent studies have shown some effectiveness with immune checkpoint inhibitors. We report the case of a 42-year-old man with a family history of cancer who was admitted to the hospital with acute respiratory distress and superior vena cava syndrome. He had been experiencing thoracic pain, dry cough, dyspnea, fatigue, and unintentional weight loss for a month. Imaging revealed multiple masses and lymph nodes in the chest, as well as pleural effusion. PET scan showed widespread metastases. A cervical lymph node biopsy confirmed the diagnosis of SMARCA4-deficient thoracic sarcoma. Unfortunately, his general condition did not allow an aggressive treatment. He was started on Pazopanib 800mg per day, but deteriorated rapidly and passed away. This report highlights the aggressive nature and unfavorable prognosis associated with SMARCA4-deficient thoracic sarcoma. Accurate diagnosis of this entity can be challenging due to its unique marker expression and unfamiliar histological features. Currently, there are no established treatment strategies for this condition; however, recent studies have shown promising results with immune checkpoint inhibitors and targeted therapies. Further research is necessary to identify the most effective treatment approaches for SMARCA4-DTS.

Eighteen Years of Medical Oncology in Morocco: A Bibliometric Evaluation.

Medical publications constitute an essential tool for sharing scientific advances in the medical field. They are also an educational tool of great significance in initial medical training, and also in further medical education. These publications are necessary to ensure an interface between the researchers and members of the medical scientific community, who are always looking for the correct and optimal treatment for their patients. Several golden rules have been laid out in terms of assessing the improvement in scientific productivity, namely the quality of the subject, the type of publication, the publication review and its impact factor, and the establishment of international collaborations. Bibliometrics is a quantitative and qualitative analysis of scientific publications, which aids in assessing the scientific productivity of a community or a scientific institution. To the best of our knowledge, this is the first bibliometric study to evaluate the scientific productivity in the field of medical oncology in Morocco.

Metastatic Small Cell Carcinoma of a Male Breast: A Case Report and Review of the Literature.

Neuroendocrine breast cancers are rare tumors that were recognized as a distinct entity by WHO classification in 2003. It is much rarer in male breast cancer. Diagnosis is based on immunochemical analysis in which the expression of at least one neuroendocrine marker is required, associated with the exclusion of another primary site of the tumor. These tumors have a worse long-term outcome compared to other breast cancers. Small cell carcinoma of the breast is a high-grade subtype, presents with more advanced disease, and has a poorer prognosis compared with other neuroendocrine breast subtypes. A proper therapeutic strategy is still not well established. In the herein reported case, a 62-year-old male patient was diagnosed with small cell neuroendocrine carcinoma of the breast, metastatic to the liver, lung, bone and lymph node, and was treated with a first-line Platinum-Etoposide chemotherapy combination with a good clinical and radiological response. Only four previous cases of male small cell breast carcinoma were reported. Keywords: Neuroendocrine Breast Carcinoma, Small Cell Carcinoma, Diagnosis, Prognosis, Treatment.

Lung cancer in middle and southern Morocco.

Purpose: Determining risk factors associated with a fatal disease such as lung cancer (LC) remains an important key to understanding the factors related to its development and therefore using the correct emergent or accessible treatments. For that, we sought to highlight by describing, and analysing, the risk factors related to LC survival, reflecting the actual situation in Morocco. Patients and methods: We included 987 LC patients diagnosed from 2015 to 2021 at the Medical Oncology Department at the Mohammed VI University Hospital of Marrakech. An overview of the LC situation was described, and analysed, to determine the risk factors related to survival. The independent prognostic factors were determined using Cox Proportional Hazards Regression Analysis. To create a distinction between different risks group in the survival curve, stratification was done, respectively, within sex, age, histology type, treatments and radiation therapy. Results: We finally included 862 patients with 15 parameters among the 27 extracted, all meeting the inclusion criteria. 89.1% of the patients were male (n = 768) and 10.9% were female (n = 94), of whom 83.5% had a history of tobacco smoking (n = 720). The median survival of both sexes was 716 (5-2,167) days. The average age at diagnosis was 60 years. Five hundred and thirty-four patients presented with advanced stage. Patients above 66 years were the more diagnosed category with adenocarcinoma at T4N2M1c pathological category, and endocrinal comorbidity, in addition to pleurisy syndrome. Moreover, family history was found to be a bad prognostic factor. Interestingly, smoking status was not a bad contributor to survival. Age at diagnosis, histology subtype, performance status, haemoglobin, numbers of cures of the first-line chemotherapy, radiotherapy, anaemia and treatments were identified as risk factors related to survival. Conclusion: We established a descriptive and analytical overview of the current LC epidemiology situation in the oncology division of Mohammed VI University Hospital in a non-industrialised state taking into account smoking status.

Management of cancer disease in Burundi, a health challenge.

Cancer is a major public health problem that affects every country in the world. Some countries, most often developed, have made significant diagnostic and therapeutic advances over the years, transforming cancer into a long-term chronic disease and sometimes permitting a cure, even at the metastatic stage. Other countries are lagging behind and the challenge posed by cancer remains as relevant as ever. Burundi is one of these countries as well as several others in the African region. For many years, the care of cancer patients in Burundi has been exported to foreign countries (Rwanda, Kenya, South Africa, Morocco, France, India…) in search of quality care. This is particularly possible for the more affluent, with a total cost much higher than a local dispensation. For this reason, the strengthening of the local health system, the establishment of dedicated infrastructure, the promotion of training and research in cancer as well as the strengthening of the information and education policy could help meet the challenge posed by cancer in Burundi.

Severe and fatal interstitial lung disease induced by gemcitabine in advanced pancreatic adenocarcinoma: a case report.

Gemcitabine is a cytotoxic drug commonly used in the treatment of several types of cancer. While gemcitabine is generally considered safe and effective, it can cause some side effects, including pulmonary toxicity. Interstitial lung disease is a rare but potentially serious event. We report a case of a 63-year-old patient with advanced pancreatic adenocarcinoma. She received Gemcitabine 1000 mg/m2 on day 1, and day 8, and presented on day 15 of the first cycle with respiratory distress rapidly aggravating. Clinical and radiological findings were concordant with interstitial lung disease. Management consisted of high doses of corticosteroids and oxygen therapy. There was no clinical improvement and the patient passed away after a few days. Despite its low incidence, gemcitabine-induced interstitial lung disease may be responsible for a fatal clinical picture. Clinicians must be aware of this possibility and address respiratory symptoms as soon as possible.

Localised breast cancer: neoadjuvant chemotherapy impact evaluation on the pathological complete response (PCR) in a lower middle-income country.

Introduction: Neoadjuvant chemotherapy followed by surgery remains the current recommended therapeutic strategy for the management of locally advanced breast cancer. The standard chemotherapy protocol is sequential with anthracycline followed by taxanes. However public hospitals in Morocco are confronted with a shortage in healthcare products. We, therefore, evaluated the efficacy of the different protocols proposed to patients, by evaluating the clinical response after chemotherapy especially through the pathological complete response (PCR) after surgery. Methods: We focused on the database of the medical oncology department of the only public hospital covering middle and southern Morocco. We included patients diagnosed between 2018 and 2020. Two groups of patients distinguished in group A (GA) received the standard therapy, and group B (GB) received a non-standard protocol. The therapeutic response was assessed clinically before surgery and then by pathological examination of the surgical specimens. The Sataloff classification defined the histological response for both tumour and lymph nodes. We included both groups in one variable to determine their impact on outcomes. A logistic regression-based analysis was adopted to define variables related to the PCR. Results: Over the study period, 120 patients met our inclusion criteria. They were distinguished at 72% in GA and 28% in GB. 60.8% over 120 got a partial response, whereas, only 33.3% achieved a complete response. The general PCR rate was 28% with 14.3% in GB and 85.7% in GA. The tumour PCR was obtained in 40 (33.3%) over 120 patients and 51.7% of lymph node PCR. The multivariate logistic regression analysis results show no relative factors associated with general PCR achievement. Conclusion: These first interesting results from an institutional database inform us about our clinical practice and require additional research using prospective randomised controlled studies.

Unusual penile localization of melanoma.

Penile's melanoma is a rare situation, often associated with late diagnosis and high morbidity and mortality. We report the case of a 70-year-old man. He represented progressive skin lesions of the penile gland. A surgical biopsy with histopathological and immunohistochemical studies established the diagnosis of malignant melanoma of the penis in the metastatic stage. This case was managed by palliative immunotherapy and is currently under treatment by Pembrolizumab. Malignant melanoma of the penis represents an exceptional situation, in which only rapid diagnosis at an early stage allows treatment with optimal therapeutic results.

What does it take to conduct clinical trials in African countries? Insights from Morocco.

The progress on cancer diagnosis and treatment has attained, in the last decade, enormous achievements by any estimate. Immunotherapy, new generations of targeted therapies, Chimeric antigen T-cells, cancer vaccines and the fascinating breakthroughs in translational research and cancer biology have changed the direction of cancer care. However, the fact that all patients worldwide cannot have access to these advances is dramatic. Alongside this, taking part in clinical research is one way to improve and invest in cancer care. Patients from African-and most low-resources countries-are rarely offered the chance of being included in clinical trials. This well-known fact paints a disheartening picture of what having cancer is like in the poorest settings. This situation will further decline with population aging, major changes in risk profile imported from developed countries and life expectancy increasing in most African countries. If no radical changes are made, this North-South contrast will become more critical and continue to grow. Yet, there is room for hope because only when we acknowledge the problem can we begin to address it. We need a better understanding of the reasons behind this gap and to advocate for more representation from African patients in clinical trials, with respect to the socio-economic, epidemiological and unique demands of each country across the continent.

Incidence Trends of Cancer in Morocco: The Tale of the Oncological Center of Marrakech (Morocco) over 8 Years.

Background: Determining cancer incidence and mortality is a key factor in the implementation of health policies and cancer prevention strategies. This report aims to describe the trends of cancer incidence in a single referral oncology department from the Marrakech region (Morocco). Material and Methods. All new cancer cases of age ≥ 15 years registered at the Medical Oncology department of Mohammed VI University Hospital of Marrakesh between January 1, 2012, and December 31, 2019, were included. Central nervous system (CNS) cancers, tumors of hematopoietic and lymphoid tissues, and thyroid cancers for which chemotherapy was not indicated or was managed in other cancer-specialized departments were excluded from the analysis. Manual data collection from printed archived medical records of the study population was performed. Descriptive statistics were analyzed using R software and Joinpoint Regression Program. Results: A total of 15648 new cancer cases were analyzed. Missing data (n = 1822) accounted for 11.64%, and 4.1% (n = 652) were excluded. The final statistical analysis and registration included 13174 cases. The median age at diagnosis is 54 years for females and 61 years for males. Female patients outnumbered males with a ratio of 1.58 among all age groups except those aged ≥75 y. The age-standardized incidence rate (ASIR) for all sites was 68,0 per 100.000 person-years, which has increased with an annual percent change (APC) of 10.61%. The five most common malignancies among males are lung, stomach, prostate, colic, and rectal cancers. Among females, the five most frequent cancers are breast, cervix, ovary, colon, and stomach. Conclusion: The higher incidence observed in our results translates into a growing burden on the center and is expected to impact our ability to deliver cancer care. Epidemiological studies to identify risk factors and effective efforts are needed to further invest in cancer control and prevention plans.

An Open-Label, Multinational, Multicenter, Phase IIIb Study with Subcutaneous Administration of Trastuzumab in Patients with HER2-Positive Early Breast Cancer to Evaluate Patient Satisfaction.

OBJECTIVE: This study was designed to investigate treatment satisfaction in patients and Health Care Professionals (HCP) and to evaluate the safety and tolerability of subcutaneous (SC) trastuzumab in patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (eBC). MATERIALS AND METHODS: Two-hundred and twenty-three patients with eBC were screened, of whom 173 patients met the eligibility criteria and received at least one dose of SC trastuzumab. The primary efficacy endpoint was to assess patient satisfaction via a questionnaire. RESULTS: The majority of patients (n = 166, 97.6%) reported satisfaction with the SC route. Patients and HCPs stated that SC trastuzumab was easy to use (93.5% and 62.5%, respectively) compared to the intravenous (IV) route and all HCPs (n = 16) expressed satisfaction with the SC route. Progression, disease recurrence or death was reported in 24 patients (13.8%) by two years of follow up. Four-year disease-free survival (DFS) and overall survival (OS) rates were 84.2% (±3.1) and 90.5% (±4.7), respectively. A total of 1299 adverse events (AEs) were recorded over 4-years follow-up, nearly 97% of which were judged non-serious. The most common AEs were arthralgia (n = 54, 4.2%), flu-like symptoms (n = 41, 3.2%) and nausea (n = 39, 3.0%). Fifty-four cardiac events, including left ventricular dysfunction, left ventricular failure and cardiotoxicity, were reported. Ejection fraction (EF) decrease [median decrease 3.5% (0.12-19.0)] was reported in 5.4% of cases. SC trastuzumab treatment was interrupted due to decreased EF in two cases. CONCLUSION: SC trastuzumab was widely acceptable to both patients and HCPs. The safety and tolerability of SC trastuzumab was consistent with the known safety profile of SC and IV administration.

Factors influencing Quality of life in Moroccan patients with cancer: A monocentric Prospective study.

BACKGROUND: Cancer as a chronic and serious disease affects the quality of life (QoL) of patients, which has increasingly become a major challenge at the heart of cancer management. The purpose of our study was to define the most involved factors in the degradation of QoL in cancer patients. MATERIALS AND METHODS: We conducted a prospective, mono-centric, qualitative and descriptive study carried out within the medical oncology department of the Ibn Sina Military Hospital spread over six months between January and June 2019. RESULTS: Of the 100 patients included, 58% were male with a median age of 54.42 years. 90% were married, 39% were illiterate and 43% were retired while 99% of patients had social coverage. Breast cancer was the most common in 29%. More than 54% of the patients included had localized cancer while 38% were metastatic. The Pain was estimated to be greater than or equal to six on the Visual Analog Scale (VAS) in 23%. In 78% of the cases, chemotherapy was indicated in these patients and treatment with psychotropic drugs was initiated only in 2% of the patients. The analytical study showed that most of the patients had a slightly degraded QoL 63% with a large participation of the psychic dimension, followed by the physical and spiritual dimension while the socioeconomic dimension came last. It was established a clear correlation between the QoL and certain socio-demographic factors (sex, marital status, level of education), and significant correlation with some factors related to the disease (a type of cancer, stage, and treatment received). CONCLUSION: We tried to assess the impact of cancer and to identify factors affecting the QoL of patients to guide the establishment of the support structure and accompanying devices.

Managing cancer care during the COVID-19 pandemic: brief report from a North African single center.

The potential threat of COVID-19 pandemic on the continuity of care for cancer patients is thought to be significant. Oncologists are weighing up the balance of risks and benefits carefully when planning daily cancer care and making treatment decisions in the face of rapid change during this public health crisis. This report describes management strategies and care models that have been adopted by a single Medical Oncology department in a North Africa, Morocco.

Repurposing anticancer drugs for the management of COVID-19.

Since its outbreak in the last December, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has rapidly spread worldwide at a pandemic proportion and thus is regarded as a global public health emergency. The existing therapeutic options for COVID-19 beyond the intensive supportive care are limited, with an undefined or modest efficacy reported so far. Drug repurposing represents an enthusiastic mechanism to use approved drugs outside the scope of their original indication and accelerate the discovery of new therapeutic options. With the emergence of COVID-19, drug repurposing has been largely applied for early clinical testing. In this review, we discuss some repurposed anticancer drugs for the treatment of COVID-19, which are under investigation in clinical trials or proposed for the clinical testing.