Kamel Farag

Hormone Receptors and Age Distribution in Breast Cancer Patients at a University Hospital in Northern Egypt

Introduction Breast cancer is the most common cancer among Egyptian women. The disease is often advanced at diagnosis. Since molecular profiling is not feasible in routine practice, we sought to examine the association of age distribution with hormone receptor profile, disease stage and outcome among Egyptian women. Patients and Methods We conducted a retrospective review of breast cancer patients treated at Mansoura University Cancer Center in the Nile Delta from 2006 through 2011. Age groups were examined in relation to hormone receptors status and tumor clinicopathological criteria. Additionally, the effect of receptor status on disease relapse and disease-free survival was examined with logistic regression and Kaplan–Meier analysis. Results A total of 263 patients were included in the current analysis. About 66.9% (n = 176) of patients were hormone receptor positive, 14.1% (n = 37) were Her2/neu positive, and 19.0% (n = 50) were triple negative. Median age of the patients was 52 years and was equal across all receptor status types. Triple negative status correlated with increased risk of disease relapse (odds ratio = 1.8, P = 0.03) and with shortened disease-free survival (hazards ratio = 2.6, P < 0.01). Conclusion The age distribution and receptor status pattern in the Nile Delta region does not explain the aggressive behavior of the disease. The age of the patients at diagnosis is older than patients in earlier studies from Egypt emphasizing the importance of implementing mammographic screening programs.

Hyponatremia and SIADH Frequency in Clinically Euvolemic PatientsReceiving Chemotherapy: Prospective Study in Unselected PatientsCohort

Purpose: Biochemical hyponatremia is a common electrolyte abnormality in patients with cancer. In this prospective single center trial we aim to study the frequency of hyponatremia in patients receiving chemotherapy with special emphasis on syndrome of inappropriate secretion of anti-diuretic hormone (SIADH). Patients and Methods: This is a prospective study of consecutive patients receiving different types of outpatient chemotherapy between January 2013 and June 2014. Serum Sodium was measured as part of routine assessment for all patients receiving chemotherapy. Euvolemic patients with hyponatremia (Na 100 mOsmol/kg and urinary Sodium >30 mmol/L. Results: 1254 patients received different chemotherapy regimens were screened and 1150 fulfilled the inclusion criteria. Median age was 55 year (19-75). Biochemical hyponatremia developed in 105 (9.1%) of all patients and in 42/298 (14%), 25/357 (7%) and 38/495 (7.7%) of patients who received cisplatin, carboplatin/oxaliplatin and non-platinum chemotherapy regimens respectively. 68/105 (65%) fulfilled biochemical criteria of SIADH of which 26/42 (62%), 13/25 (52%) and 29/38 (76%) of hyponatremic patients received cisplatin, carboplatin/oxaliplatin and non-platinum regimens respectively. Cisplatin based regimens were significantly associated with SIADH compared to non-cisplatin regimens (OR: 1.521, 95% CI: 1.105-2.093; p=0.022). Conclusion: 9.1% of euvolemic patients receiving out-patient chemotherapy manifest a degree of biochemical hyponatremia with highest risk associated with cisplatin based regimens. Hyponatremia can be attributed to SIADH in two thirds of cases.

Obesity and outcome of post-menopausal women receiving adjuvant letrozole for breast cancer

Introduction Aromatase enzyme activity is predominant in adipose tissue. This has led to speculation that aromatase activity is elevated in obese women and subsequently decreased the clinical activity of adjuvant aromatase inhibitors (AIs) in women with estrogen receptor positive (ER+) breast cancer (BC). We investigated the effect of obesity on the outcome of this population. Patients and methods Records of 320 consecutive post-menopausal (PM) women with ER+ BC starting single agent adjuvant letrozole between years 2005 and 2014 were retrospectively reviewed. Tumour and patients characteristic including body mass index (BMI) on the day of starting letrozole were extracted. Endpoints of main interest were: (1) Frequency of obesity; (2) relapse-free survival (RFS) in nonobese (G1; BMI < 30) and obese (G2; BMI ≥ 30) patients. Results Obesity (BMI: 30–34.99) and morbid obesity (BMI ≥ 35) were present in 105/320 (32.8%) and 115/320 (35.9%) women, respectively. Median follow-up of patients was 49 months; RFS at 5 years (G1: 69% versus G2: 78%) and at 8 years (G1: 69% versus G2: 71%). Median RFS is not reached in both groups (Log rank; P = 0.097). There was no correlation between BMI and RFS (correlation coefficient r = 0.075; P = 0.174). Conclusion In this cohort, more than two-thirds of PM women starting adjuvant AIs are obese. Obesity did not adversely affect the outcome of women on adjuvant letrozole.

Serum atrial natriuretic peptide: a suspected biomarker of breast cancer

Aim of the study To assess serum levels of ANP in breast cancer female patients and its relationship to metastasis and some clinical parameters among those patients. Material and methods One hundred breast cancer patients with and without metastasis along with 20 healthy closely matched controls, were enrolled in the present cross sectional study. Background: To assess the serum levels of atrial natriuretic peptide in breast cancer Serum levels of ANP were assessed using ELISA. Results Mean serum levels of ANP breast cancer patients (13.9 ±10.1 ng/ml) were significantly elevated compared to healthy control group (2.2 ±1.3 ng/ml) (p < 0.001). The metastatic breast cancer patients showed significant elevated ANP levels (17.1 ±8.9 ng/ml) compared to non-metastatic group (6.4 ±8.8 ng/ml) p < 0.001. Within the metastatic group significant difference was detected between de novo metastatic, under follow-up, under hormonal control and locally advanced group (p = 0.007). Conclusions This study showed significant elevated levels of ANP in the serum of metastatic breast cancer patients compared to non-metastatic patients. Within the metastatic group the lowest levels were detected in metastatic breast Cancer under hormonal treatment either tamoxifen or aromatase inhibitor.

Assessment of bone health in breast cancer patients starting adjuvant aromatase inhibitors: A quality improvement clinical audit

Introduction Adjuvant Aromatase Inhibitors (AIs) predispose breast cancer patients to accelerated bone loss. Guidelines recommend initial screening and follow up of bone mineral density with dual energy X-ray absorptiometry (DEXA) scan. In this audit we assessed the rate of adherence to these guidelines and introduced awareness measures to improve it. Methods All post-menopausal women who started upfront adjuvant AIs (letrozole in all patients) between January 2007 and December 2013 were retrospectively identified. The standard to be audited was “These patients should have a baseline DEXA scan requested within the first 3 months of starting adjuvant AIs therapy”. A 90% or more compliance was accepted as satisfactory. Corrective measures in the form of educational and awareness sessions followed by re-auditing of the practice over the subsequent 12 months were planned in case of lower compliance rate. Results Three hundred and sixty seven eligible patients were identified. Baseline DEXA scan was performed in 188 (51.2%) patients. As planned, this result triggered the conduction of 4 consecutive educational sessions over a period of 2 weeks. Re-auditing the practice in the pre-defined subsequent subjects showed compliance in 47/52 (90.4%) patients. Conclusion This study of a sizable cohort confirms previous observations that adherence to skeletal health guidelines in this patient population is less than adequate. Adherence is improved dramatically by raising the awareness of relevant physicians.

Safety and efficacy of biweekly cetuximab based chemotherapy for patients with metastatic colorectal cancer

1College of Medicine, Alfaisal University, 11533 Riyadh, Saudi Arabia. 2Department of Oncology, King Faisal Special Hospital & Research Centre (Jeddah). 21499 Jeddah, Makkah, Saudi Arabia. 3Department of medical oncology, Mansoura University, 35516 Mansoura, Dakahlia Governorate, Egypt. 4Research Centre, King Faisal Special Hospital & Research Centre (Jeddah), 21499 Jeddah, Makkah, Saudi Arabia. 5Department of Radiology, King Faisal Special Hospital & Research Centre (Jeddah), 21499 Jeddah, Makkah, Saudi Arabia. 6Faculty of Medicine, Zagazig University, 44519 Ismailia, Egypt.