Rasha Haggag

Pattern of cancer deaths in a saudi tertiary care hospital.

The medical records of deceased patients were reviewed to describe the pattern of cancer deaths in a newly established Saudi tertiary care hospital. During eleven months, 87 patients died of cancer. The majority (80 patients, 92%) died of incurable cancer; among which 53% did not receive any systemic anti-cancer therapy (SAT) and 43% received SAT with palliative intent. Younger age (< 65 years), relatively chemosensitive tumours and initial presentation in a potentially curable stage were associated with higher prevalence of palliative SAT administration (p = 0.009, 0.019 and 0.001, respectively). The last palliative SAT was administered during the last two months of life in 66% and during the last two weeks in 14%. During the last admission, 54% of patients were admitted through emergency room, 50% stayed >14 days and 14% died in intensive care unit or emergency room. The results demonstrate that palliative care is a realistic treatment for the majority of patients in our setting and that a significant proportion of these patients receive aggressive care at the end-of-life. There is a need to establish an integrative palliative care program to improve the quality-of-life of dying cancer patients in our region and to minimize the aggressiveness of end-of-life care.

Hepatitis C virus and non-Hodgkin’s lymphomas: A minireview

Graphical abstract Malignant lymphomas and HCV infection have a dual relationship.

Differentially Expressed Genes in Metastatic Advanced Egyptian Bladder Cancer

BACKGROUND Bladder cancer is one of the most common cancers worldwide. Gene expression profiling using microarray technologies improves the understanding of cancer biology. The aim of this study was to determine the gene expression profile in Egyptian bladder cancer patients. MATERIALS AND METHODS Samples from 29 human bladder cancers and adjacent non-neoplastic tissues were analyzed by cDNA microarray, with hierarchical clustering and multidimensional analysis. RESULTS Five hundred and sixteen genes were differentially expressed of which SOS1, HDAC2, PLXNC1, GTSE1, ULK2, IRS2, ABCA12, TOP3A, HES1, and SRP68 genes were involved in 33 different pathways. The most frequently detected genes were: SOS1 in 20 different pathways; HDAC2 in 5 different pathways; IRS2 in 3 different pathways. There were 388 down-regulated genes. PLCB2 was involved in 11 different pathways, MDM2 in 9 pathways, FZD4 in 5 pathways, p15 and FGF12 in 4 pathways, POLE2 in 3 pathways, and MCM4 and POLR2E in 2 pathways. Thirty genes showed significant differences between transitional cell cancer (TCC) and squamous cell cancer (SCC) samples. Unsupervised cluster analysis of DNA microarray data revealed a clear distinction between low and high grade tumors. In addition 26 genes showed significant differences between low and high tumor stages, including fragile histidine triad, Ras and sialyltransferase 8 (alpha) and 16 showed significant differences between low and high tumor grades, like methionine adenosyl transferase II, beta. CONCLUSIONS The present study identified some genes, that can be used as molecular biomarkers or target genes in Egyptian bladder cancer patients.

Low-dose versus standard-dose gemcitabine infusion and cisplatin for patients with advanced bladder cancer: A randomized phase II trial.

266 Background: Bladder carcinoma is the foremost oncologic problem in Egypt. Prolonged infusion of gemcitabine and cisplatin is an effective treatment for advanced bilharzial-related bladder cancer based on a previously published phase II trial. METHODS To compare efficacy and safety of both prolonged infusion and standard gemcitabine-cisplatin combination, this phase II randomized study of 60 untreated patients with stage III/IV bladder cancer was conducted. Patients were randomized to receive either gemcitabine (250 mg/m2) 6-hour infusion on days 1 and 8, and cisplatin (70 mg/m2) on day 2 every 21-day cycle (Arm1) or gemcitabine (1,250 mg/m2) 30-min infusion on days 1 and 8, and cisplatin (70 mg/m2) on day 2 every 21-day cycle (Arm 2). RESULTS The 47 males and 13 females had a median age of 60 years (range 40-73 years). A total of 44 patients had transitional cell, 12 had squamous cell, and 4 had undifferentiated cell carcinoma. Among the 53 evaluable patients (26 patients in arm1 and 27 patients in arm 2), complete response rate was achieved in 19.3% (5/26 patients of arm 1) and 7.4% (2/27 patients of arm 2). Eight patients in arm 1 (30.7%) and 7 patients (25.9%) in arm 2 had partial response on therapy. Thus the overall response rate of patients in arm1 and arm 2 was 50% (13/26 patients) and 33.3% (9/27patients), respectively (p = 0.21). No significant difference in median time to disease progression (6.7 months versus 7.9 months, p = 0.42), median survival (9.7 months versus 8.8 months, p = 0.3), and 1-year survival (27% versus 6%, p = 0.3) was detected between arms 1 and 2, respectively. No treatment- related deaths occurred. Main hematologic and nonhematologic toxicities were similar in both arms with no statistically significant differences. CONCLUSIONS In the treatment of advanced bilharzial bladder cancer, gemcitabine in low dose and prolonged infusion in combination with cisplatin is not inferior to high-dose short infusion gemcitabine and cisplatin in terms of overall survival, time to disease progression, and response rates with favorable toxicity profile and less financial costs. No significant financial relationships to disclose.

Factors Affecting Survival in Egyptian Patients Suffering from Urinary Bladder Cancer: A Multicenter Retrospective Study

Background: Bladder cancer is the second most common malignancy among Egyptian males. Patients and methods: To investigate the factors affecting survival in Egyptian patients suffering from urinary bladder cancer, we analyzed the geographical patterns of 564 bladder cancers patients from Oncology Departments of Ain Shams University, Mansoura University, Zagazig University and Damietta oncology centerover a period of 7 years between January 2006 and September 2013. Results: Among the included 564 patients, Males represented 72.5% of the patients. While, 27.5% were female with a male to female ratio of 2.6, 227 patients presented with non-metastatic and 337 patients with metastatic urinary bladder cancer. Grade III was found in 36% of our patients and 60% of them had stage IV. Mean DFS was (9.15 ± 0.5) and (4.4 ± 0.1) while, mean OS was (13.5 ± 0.7) and (7.5 ± 0.15) months for non-metastatic, and metastatic patients, respectively. In univariate analysis, patients with no bilharzial infection, Non-SCC, responding patients had significant better DFS and OS vs. patients with bilharzial infection, SCC, non-responding patients (respectively, p=0.001 for all). In multivariate analysis, response (OS and PFS), SCC (OS and PFS) and bilharzias is (OS and PFS) where found to be highly statistically significant (Cox regression, P<0.001 for all) in the metastatic and non-metastatic group of patients. Conclusion: Non-responding, SCC type and bilharzial infected patients had significant independent poor prognostic factors for OS and PFS in the metastatic and non-metastatic group of patients.

The Value of HER2 neu and EphA2 expressions in Gastric Adenocarcinoma Prognosis

Background: Gastric adenocarcinoma (GAC) is a serious disease with poor outcome. Discovering novel molecular targeted therapies is a recent point of research to improve prognosis. One of the newly discovered targets is the receptor tyrosine kinases (RTKs); it is a member of trans-membrane receptors which had important roles in proliferation and apoptosis. RTKs were found to have different expression patterns in several malignancies. HER2 neu which is a member of HER family is a proto-oncogene that is formed of four receptor tyrosine kinases. Erythropoietinproducing hepatocellular (Eph) molecules are major RTKs members and one of those molecules is EphA2 which has many different functions in cancer as tumor initiation, progression, angiogenesis and spread. We aimed to explore the expression patterns of both HER2 neu and EphA2 in GAC patients using immunohistochemistry, and to correlate their expressions with clinico-pathological factors and prognosis of our patients Methods: HER2 neu and EphA2 expressions were assessed in sections from forty blocks of paraffin which were diagnosed as GAC. Then we analyzed the correlations between their expressions and disease outcome of GAC patients. Results: HER2 neu and EphA2 positive expressions in GAC were positively correlated with tumor grade and stage (p<0.001 and p=0.002 respectively), inadequate response to therapy (p<0.001 and p=0.002 respectively), increase recurrence rate of GAC (p=0.002), and with poor survival (p<0.001). Conclusion: GAC patients with high expressions of both HER2 neu and EphA2 had unfavorable prognosis.

Prognostic Impact of 25-Hydroxyvitamin D Levels in Egyptian Patientswith Breast Cancer

Background: According to the literature, vitamin D (Vit D) deficiency is a risk factor for breast cancer developing with lack of information on its direct prognostic effects in breast cancer. Patients and methods: A total of 168 women with proven breast cancer diagnosed in Zagazig university hospitals- Egypt were enrolled in this study. Serum level of 25 (OH) Vit D was measured in stored blood just after diagnosis. Vit D levels were classified into three groups: deficient: 30 ng/ml. Clinical-pathological data and disease outcome were accessed to examine prognostic effect of vitamin D in breast cancer. Results: Median age was 51.5 (26-77) years, Metastasis was present in 13.1% of the cases. The median serum level of 25(OH) Vit D was 20 (5-98) ng/ml; it was deficient in 36.9% of patients, insufficient in 32.1% of patients, and sufficient in 31% of patients. Serum level of 25 (OH) VitD levels decreased significantly with increasing body mass index (BMI) (P=0.00), also the relations of 25 (OH) Vit D level with the number of positive lymph nodes, tumor size, tumor stage and KI 67 level were statistically significant (p= 0.01, p=0.011, p=0.002, p= 0.001 respectively). The level of 25 (OH) vitamin D was significantly low in metastatic patients (p=0.01). For those non -metastatic BC patients; there was no statistically significant difference in mean Disease-Free Survival (DFS) times across the 3 categories of serum Vitamin D (p=0.13), also for metastatic patients, serum vit D level didn’t affect the median PFS (p=0.98). The mean OS of the 3 different categories of serum vit D (sufficient, insufficient and deficient) were 45.8 months, 39.7 months and 39 months respectively (p=0.047). Univariate analysis, showed that OS was significantly affected by age, BMI, grade, stage, molecular type and vit D levels (p=0.014, p=0.002, p=0.002, p<0.0001, and p=0.047 respectively), but in Multivariate analysis: age, BMI, stage, and vit D levels were the only independent factors significantly affect the OS (p=0.01, 0.001, p<0.0001 and p=0.022, respectively). Conclusion: There may be an association between serum 25 (OH) Vit D level and breast cancer prognosis.

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.

Abiraterone Acetate in Patients with Advanced Castrate Resistant Prostate Cancer: Initial Real Life Experience in 2 Cancer Units

Introduction : Abiraterone Acetate (AA) improves outcome of patients with castrate resistant prostate cancer (CRPC) and is currently recommended for chemo-naA¯ve patients and after progression on chemotherapy. We reviewed our initial experience with the use of AA in these patients. Patients and Methods : Forty six consecutive CRPC patients were treated with AA 1000 mg/day and prednisolone 5 mg twice daily in 2 cancer centres in England and Saudi Arabia. Treatment was continued until disease progression or unacceptable toxicity. Patients achieving prostate specific antigen decline (PSA) ≥ 50% were considered as marker responders. Results : Median age was 76 (52-91) years. 28 and 18 patients received AA in pre-chemotherapy and post-chemotherapy setting respectively. PSA marker response was achieved in 56.1% (23/41) assessable patients. Objective radiological response rate was seen in 31.6% (6/19) and stable disease in 15.8% (3/19) assessable patients. After a median follow up of 20 months, median time to PSA progression was 12 months (95% CI: 9.5-14.5) and median overall survival was not reached (mean = 21 months, 95% CI: 18-24.5). Toxicity was assessed in 18 patients. All grades adverse events of special interest were hypokalaemia (22%) and hypertension (11%). Conclusion : In daily clinical practice, AA is an effective treatment for patients with CRPC. It produces meaningful marker and objective responses, marker progression free survival and OS that are comparable to those reported in clinical trials. Monitoring of blood pressure and serum potassium is recommended.

Predictive and prognostic value of SALL4 and Tau protein in serous ovarian cancer patients treated with chemotherapy.

Ola A. Harb 1 , Rasha Haggag 2 , Amira Amin Salem 1 , Walid Abdalla Abdesalam 3 and Reham Amin Salim 4 . 1. Department of pathology, Faculty of Medicine, Zagazig University, Sharkia, Egypt. 2. Department of Medical Oncology, Faculty of Medicine, Zagazig University, Sharkia, Egypt. 3. Department of Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Sharkia, Egypt. 4. Department of Clinical Oncology and Nuclear medicine, Faculty of Medicine, Zagazig University, Sharkia, Egypt.