Adil Debbagh

Is there any advantage to combined trastuzumab and chemotherapy in perioperative setting her 2neu positive localized gastric adenocarcinoma

We report here a 44-year-old Moroccan man with resectable gastric adenocarcinoma with overexpression of human epidermal growth factor receptor 2 (HER2) by immunohistochemistry who was treated with trastuzumab in combination with chemotherapy in perioperative setting. He received 3 cycles of neoadjuvant chemotherapy consisting of trastuzumab, oxaliplatin, and capecitabine. Afterwards, he received total gastrectomy with extended D2 lymphadenectomy without spleno-pancreatectomy. A pathologic complete response was obtained with a combination of trastuzumab and oxaliplatin and capecitabine. He received 3 more cycles of trastuzumab containing regimen postoperatively.We conclude that resectable gastric carcinoma with overexpression of the c-erbB-2 protein should ideally be managed with perioperative combination of trastuzumab with chemotherapy. Further research to evaluate trastuzumab in combination with chemotherapy regimens in the perioperative and adjuvant setting is urgently needed.

A Thumb Acrometastasis Revealing Lung Adenocarcinoma: A Case Reportand Review

Lung cancer is the commonest cause of acrometastatic disease to the fingers. Treatment of acrometastasis is palliative with radiation or amputation and the prognosis is poor. The authors report a case of phalangeal metastasis in a man aged 72 years old, diagnosed as a painful swelling of the thumb, revealing a bronchial adenocarcinoma. An amputation of the thumb was performed. Histology confirmed a metastasis from the lung adenocarcinoma. The patient died one month after discovery of the primary tumor.

Chemotherapy in the Treatment of Ovarian Psammocarcinoma: A CaseReport and Review of the Literature

Introduction: Psammocarcinoma is a rare form of epithelial serous ovarian carcinoma characterized by extensive formation of psammoma bodies, invasion of ovarian stroma, peritoneum or intraperitoneal viscera, and moderate cytological atypia. These tumors represent a real problem of the diagnostic, and the role of chemotherapy is not yet clearly demonstrated. Case presentation: We herein report a case of psammocarcinoma of ovary with peritoneal carcinosis in a forty year old Moroccan female. The patient underwent optimal surgical debulking and nine courses of chemotherapy with carboplatinum and paclitaxel with a complete response. The prognosis for this type of ovarian cancer is unclear, but it appears to be better than other forms of epithelial ovarian cancer. Conclusion: The psammocarcinome is a rare entity, majority of patients are diagnosed at an advanced stage. The role of chemotherapy is poorly defined; some authors have their patients treated by neoadjuvant or adjuvant chemotherapy. We currently lack evidence of increasing the benefits that can bring chemotherapy in the management of advanced ovarian psammocarcinomas. Only trials in wide yard can answer this question.

When tyrosine kinase inhibitor sunitinib can be discontinued in metastatic renal cell carcinoma to pancreas: a case report

BackgroundLong-term survival with durable response remains possible in the area of targeted therapies. Discontinuation of sunitinib could improve quality of life and reduce treatment costs in metastatic renal cell carcinoma with long-term disease stabilization. We discuss a case of successful interruption of antiangiogenic therapy in a patient with persisting evidence of metastases. The discontinuation of antiangiogenic therapy seems to be an option, even in indolent oligo-metastatic renal cell carcinoma with long disease stabilization before sunitinib. This observation contributes important data to the ongoing discussion on the discontinuation of treatment with kinase inhibitors in selected patients with metastatic renal cell carcinoma.Case presentationWe report a case of an 80-year-old Moroccan man treated for renal clear cell carcinoma with multiple pancreatic metastases. He was not on any other medications. He underwent active surveillance with deferred sunitinib at disease progression. He showed significant disease control on sunitinib therapy demonstrating partial response with stable disease after a total of 28 months of therapy. He experienced toxicities which were manageable with supportive care and dose adjustments. Our patient asked for a break of the sunitinib administration, and the treatment was stopped. The disease remained stable after 13 months’ discontinuation of sunitinib therapy. The patient was in excellent overall health.ConclusionsAll available agents for metastatic renal cell carcinoma have side effects, which may become serious in a minority of patients. Clinicians and patients must therefore carefully balance the goals of maximal efficacy with minimal toxicity. Sunitinib can be discontinued without negatively impacting outcomes in indolent disease. Further research is needed to characterize the molecular determinants of response and resistance to targeted therapy.

What about Treatment of Metastatic Bladder Cancer

Background: Bladder cancer is the most common malignancy of urinary tract with high rate of morbidity and mortality. Platinum-based chemotherapy remains the first line treatment of advanced disease. Despite several studies, the place of targeted therapies is not yet defined, whereas immunotherapy is currently the standard of care in second-line treatment.Materials and methods: A comprehensive search of MEDLINE/Pubmed and Embase was conducted to identify conference abstracts, basic science, original and review articles in English.Conclusion: This review of the literature will discuss the molecular mechanisms involved in tumor progression, the current management of metastatic bladder cancer and future potential treatment modalities.