Fadi Nasr

FOLFOX-6 combination as the first-line treatment of locally advanced and/or metastatic pancreatic cancer.

Objective:Advanced pancreatic carcinoma (APC) has a poor prognosis and chemotherapy remains the most common approach. Gemcitabine was the only drug recently approved for use as single agent therapy in APC. However, the combination of oxaliplatin and 5-fluorouracil (5-FU) has shown some promising results. This phase II trial was conducted to investigate the efficacy of oxaliplatin, 5-FU, and folinic acid (FOLFOX-6) in previously untreated APC patients. Methods:We studied response rate, time to progression, and toxicity profile. Treatment included oxaliplatin 100 mg/m2 and folinic acid 400 mg/m2 on day 1 followed by a 5-FU bolus 400 mg/m2 and a 46-hour infusion of 3000 mg/m2 every 2 weeks. Results:From January 2003 through December 2004, 30 eligible patients were included. Median age was 65 (range, 38–75). There were 22 patients who had metastatic disease and 29 had an adenocarcinoma. A total of 181 cycles were delivered with a mean of 6 cycles per patient. There were 23 patients evaluable for response. There were 8 patients with partial response (27.6% response rate) and 10 with stable disease status (34.5%), while tumor growth control was found in 62% of the patients. Recorded toxicities of grade 3/4 were: neutropenia (26.67%), thrombocytopenia and anemia (10% each), diarrhea (6.67%), and mucositis (3.33%). Neurosensory toxicity was mild. The median time to progression and the median survival were 4 and 7.5 months, respectively. Conclusion:In patients with APC, FOLFOX-6 regimen achieved an interesting response rate within a tolerable level of toxicity. This regimen seems to warrant further controlled investigation to confirm its efficacy.

Triple-Negative Breast Cancer in Lebanon: A Case Series

OBJECTIVES To determine the incidence, characteristics, and survival outcomes of triple-negative breast cancer patients in a medical oncology practice in Lebanon. METHODS The pathology reports of all breast cancer cases diagnosed or treated in 1997-2008 were reviewed. RESULTS One hundred seventy breast cancer cases (9.3%) of the 1,834 cases that were identified in this practice over a 10-year span had a triple-negative phenotype, with a median age at diagnosis of 52 years. The pathology distribution of those cases was as follows: invasive ductal carcinoma, 85%; medullary carcinoma, 5%; invasive lobular carcinoma, 5%; 95 cases (63%) were grade III. At diagnosis, 17% presented with stage I, 47% had stage II, 24% had stage III, and 12% had stage IV disease, whereas 11% had an inflammatory component. After a median follow-up of 17 months, 43 patients (25.3%) had relapsed and the most common sites of relapse were the brain (19%), lungs (19%), and bones (12%). The risk for recurrence peaked at 1.5 years and became almost nil after 3 years. Twenty patients received induction chemotherapy, among whom six (42.9%) had a complete response and six (42.9%) had a partial response to treatment. None of the patients progressed on neoadjuvant chemotherapy. The 5-year disease-free survival rate was 75% for stage I, 58% for stage II, and 40% for stage III patients, whereas the 5-year overall survival rate was 88% for stage I, 72% for stage II, and 63% for stage III patients. Adjuvant therapy was administered to 96% of patients, using a taxane-based regimen in 38% of cases. The median survival time for stage IV patients was 19 months, with a first line taxane-based regimen used in 50% of cases. CONCLUSIONS The incidence of triple-negative breast cancer in Lebanon is similar to that described in the literature. In order to determine targets for future therapeutic options, it is essential to understand the biology of this particular breast cancer subtype.

Experience with palliative care in patients with advanced cancer at a tertiary care hospital in a developing country

The importance of palliative care in patients with advanced cancer is established. Reports on the experience with palliative care in the Middle East region are limited. A prospective study was performed to characterize the palliative care experience at a tertiary care center in Lebanon and to identify the profile of patients requiring palliative care. This communication highlights the results of the study. Authors conclude that the profile of needs for individuals requiring palliative care in Lebanon is similar to westernized countries. Revisiting the continuum of cancer care is called for to better identify the optimal timing of intervention and avoid end of life distress.

Efficacy of a Silicon Based Continuous Scalp Cooling System with Thermostat on Chemotherapy Induced Alopecia

Introduction: Alopecia although reversible, is one of the most distressing side effects of chemotherapy. Preventive measures mainly focus on scalp cooling with variable and unpredictable efficacy reported in the literature. The objective of this work is to test the tolerance and effectiveness of a new silicon based cooling technique in preventing chemotherapy induced alopecia (CIA) after each of six cycles of chemotherapy. Method: This is a one center prospective descriptive study. Included patients were females receiving Taxanes and/or Adriamycin based regimens at the oncology department of Hotel-Dieu de France University Hospital. Cooling was done using the Orbis-Paxman scalp cooling system. Hair loss severity was evaluated using the World Health Organization (WHO) grading system. Failure or success of cooling was defined on the basis of wig or head cover use. Independent factors like age, type of hair, type and dose of chemotherapy, total and post infusion cooling time hemoglobin and creatinine at each course. Results: 81 patients were included. Success ranged between 84.8% and 96% for the repeated cycles. No association was found with the independent factors, except for the dose of chemotherapy in the first course with higher doses of Adriamycin (99 mg v/s 77 mg, p value 0.037) as well as taxanes (140 mg v/s 122 mg, p value 0.035) in patients experiencing failure. Conclusion: Scalp cooling has proved to be a successful and well tolerated prevention method for CIA in breast cancer patients treated by Taxanes and Adriamycin.

Characteristics of Incident Testicular Cancer in Lebanon - 1990-2015 Single Institutional Experience

BACKGROUND Despite the fact that testicular cancer is a major health issue with its increasing incidence, very few studies have described its characteristics in the Middle East, particularly in Lebanon. MATERIALS AND METHODS We report in this paper a retrospective pilot study of the characteristics of testicular cancer in Lebanon. The demographic, epidemiologic and survival characteristics of 178 patients diagnosed between 1990 and 2015 at an oncology clinic affiliated to Hotel Dieu de France Hospital were analyzed. RESULTS The mean age at diagnosis was 32 ±10 years. The most prevalent testicular tumor was the germ cell type (GCT) (95.2%) of which non-seminomatous tumors (NST) were the commonest (64.7%). Most of our patients were diagnosed at an early stage. Lymph node spread affected most commonly the retroperitoneal region and distant visceral metastases occurred in 14.6%. All patients underwent orchiectomy with 67% receiving adjuvant treatment, mainly chemotherapy. After a median follow up of 2,248 days (75.9 months) 16 patients were reported dead. Two, five and ten-year overall survival rates were 96%, 94% and 89% respectively. The median overall survival rate was not reached. CONCLUSIONS Despite being part of the developing world, demographic, epidemiologic and survival analyses of testicular cancer reported in our study are in line with those reported from developed countries and would allow us to extrapolate management plans from these populations.

Successful Eltrombopag treatment of refractory idiopathic thrombocytopenic purpura associated with Crohn disease

http://dx.doi.org/10.1016/j.clinre.2014.10.011 2210-7401/© 2014 Elsevier Masson SAS. All rights reserved. ave been described with CD [1]. We herein report the case f a 25-year-old female who presented for a refractory CD ssociated with ITP. The patient presented to our department with a past edical history of an ileocecal CD refractory to treatment ith azathioprine, sulfasalazine, mesalmine and infliximab. he patient refused any surgical option and her CD inflamatory flairs were partially controlled with methotrexate. he presented to our emergency department for an inci-

Survival of Multiple Myeloma in the Lebanese Population between January 2005 and December 2017

S244 Group’s definition of complete response and to reduce the influence of inherent errors in IHC at lower levels caused by its difficulty in assessing very small percentages of cells. Results: MMPC% measurements by MFC positively correlated to IHC; r1⁄40.58, p<0.001. The calculated linear regression coefficient of 0.252 (95% CI: 0.1640.340) with intercept -1.11 (95%CI: -1.57-0.64) suggests both constant and proportional under-estimation biases by MFC. The false MRD negative rate by MFC was 10.3% and negative predictive value was 95.2%. Conclusions: MMPC% measured by MFC correlates to IHC but is consistently underestimated and carries a significant false negative rate at the 10 sensitivity level. Further studies comparing MFC to an agreed goldstandard should be undertaken if MFC is to be used more widely for prognosis.

Toxicities Associated with Docetaxel-Based Regimens in the Adjuvant Treatment of Early-Stage Breast Cancer: A Multicenter Prospective Real-Life Experience

Background: The present study reports on the efficacy and safety of adjuvant docetaxel in real-life patients with early-stage breast cancer. Methods: This is a prospective, multicenter, post-marketing study that evaluates the efficacy and safety of docetaxel-based regimens in patients with early breast cancer treated between 2007 and 2012. Results: A total of 698 female breast cancer patients receiving adjuvant docetaxel-based regimens were included in this study. Docetaxel monotherapy was administered in 4.2%, whilst most patients received polychemotherapy. Non-hematological adverse events included skin reactions in 32.7% of the subjects. Multiple adverse events were reported and most commonly included asthenia (66.5%), alopecia (43.4%), and diarrhea (24.2%). It is noteworthy that no fatal toxicities occurred. Several hematological adverse events were reported during treatment, with anemia being the most common. Conclusion: The results of this real-life experience, characterized by a relatively large sample size and long follow-up, confirm that docetaxel is effective and well tolerated in early-stage breast cancer patients.

Late Recurrence of Low-Risk Stage II Colorectal Cancer Shortly After Etanercept.

Tumor necrosis factor alpha (TNF alpha), as its name would indicate, is an immunomodulatory cytokine shown to have anti-tumor activity [1]. The use of TNF alpha inhibitors in rheumatologic diseases has grown substantially, but debate has emerged regarding the administration of these agents to patients known to have a history of solid malignancies in remission [2, 3].We present here a case of systemic recurrence of low-risk colorectal cancer after the use of etanercept, a TNF alpha-sequestering agent.

Adherence to Monitoring Tests in Patients With Chronic Myeloid Leukemia in Lebanon

The present study was performed to determine whether the adherence to regular follow-up assessments using standardized real-time quantitative polymerase chain reaction (qPCR) and/or cytogenetic tests in Lebanese patients with chronic myeloid leukemia (CML) meet the European LeukemiaNet recommendations. The present study was a retrospective analysis of 34 patients diagnosed with chronic phase CML who had been treated with tyrosine kinase inhibitors and monitored with regular cytogenetic tests and/or measurement of the BCR-ABL transcript level at 3, 6, and 12 months from 2006 until 2015 in 3 university hospitals in Lebanon. All patients were included and monitored in an adherence program (SAWA program). The male/female ratio was 3:1. The median age was 50 years, and the mean age was 50 years. As frontline treatment, 29 patients started imatinib and 5 patients received second-generation tyrosine kinase inhibitors. We defined compliance to the monitoring tests as regulary realizing the qPCR at 3, 6, and 12 months. Of the 36 patients, 15 underwent the recommended tests at 3, 6, and 12 months, representing a compliance rate of 41.6%; 28 of the 34 patients underwent the recommended tests only twice in the first follow-up year. Only 14 patients underwent qPCR at 3 months. We believe that despite the inclusion of our patients in an adherence program, the compliance rate is still low. We also believe that greater effort is required to improve the adherence to regular follow-up examinations.