Tania Moussa

An unexpected response to second line EGFR inhibitor in relapsing leptomeningeal carcinomatosis from lung adenocarcinoma raises questions on differential mechanisms of action of these agents

The prognosis of patients with non-small cell lung cancer (NSCLC) has drastically improved with the major breakthroughs in the treatment arsenal. However, a small subset of patients (5–10%) develops leptomeningeal metastasis (LM), which dictates a deteriorated prognosis limited to 2–3 months [1]. Effectively, overall survival (OS) is limited with the various treatment modalities including radiotherapy and systemic/intrathecal chemotherapy [2]. Several reports showed that the drugs targeting the epidermal growth factor receptor (EGFR) pathway might be efficacious but the results are still far from satisfactory with a short median OS [3]. Clear recommendations concerning the management of NSCLC with LM are inexistent despite the promising results reported with the newer generations of anti-EGFRs. Therefore, we report the rare case of a NSCLC patient with LM that was successfully stabilized with two different generations of anti-EGFRs. A previously healthy 48-year-old man was referred to our oncology department following the diagnosis of LM upon the results of a brain MRI and two lumbar punctures for meningitis.

Isolated Celiac and Splenic Artery Dissection: A Case Report and Review of the Literature

An isolated dissection of the celiac artery is an extremely rare condition that requires a high level of suspicion to evoke the diagnosis. Once established, the natural course is unpredictable in view of the discrepancies in its management requiring a case-by-case analysis. In this paper, we report an unusual case of spontaneous abdominal pain that was diagnosed with celiac and splenic artery rupture secondary to physical stress. This paper underlines the necessity to maintain a high level of suspicion for arterial dissections and we also review the management plan in such cases.

Efficacy and safety of everolimus in hormone receptor positive breast cancer in a developing country: Real-life single institutional experience

Introduction: Breast cancer is the second leading cause of cancer-related mortality despite the staggering improvement in cancer therapeutics. So far, published data illustrate endocrine therapy as the cornerstone treatment for patients with hormone receptor-positive metastatic breast cancer. Unfortunately, most patients eventually develop resistance to this treatment. Methods: The purpose of this study is to evaluate the efficacy of mammalian target of rapamycin inhibition in reversing hormone resistance in the Lebanese breast cancer patients. Efficacy of the intervention according to the independent factors and notable side effects encountered were the primary points of the evaluation. Results: In total, fifty patients received the combination of everolimus and exemestane. The mean age of the study population was 61 ± 11 years. Sensitivity to hormonal therapy before the start of the combination treatment was estimated at 64%. Response rate was 14%, and all patients were partial responders. After regular interval evaluation, the median progression-free survival was 5.2 months since the initiation of therapy. The main toxicities associated with the combination were stomatitis (22%), myalgia (22%), skin toxicity (8%), and hyperglycemia (4%), all Grades 1 and 2. Conclusion: Everolimus has been shown to be effective in overcoming hormonal resistance in Lebanese breast cancer patients with results inferior to those reported in the BOLERO-2 population. The particular differences in molecular and pathological aspects of breast cancer in our region should stimulate the extensive research for a better understanding of the particular pattern of the disease.

A Two-Front War : Targeting Synchronous Metastatic Pancreatic and Renal Cell Carcinomas with the Combination of Gemcitabine and Sunitinib

The occurrence of multiple synchronous primary tumors is extremely rare. The management plan of synchronous cancers has long been debatable and difficult mainly in tumors with different molecular characteristics. In this report, we present the second case in literature of a concomitant diagnosis of a metastatic pancreatic adenocarcinoma and a locally advanced renal cell carcinoma. We also elaborate on our management combining chemo-therapy and targeted therapy through an extensive review of literature.

The Forgotten Complication of Recurrent Nephrolithiasis: “Squamous Cell Carcinoma of the Renal Pelvis”—A Case and Review of the Literature

Squamous cell carcinoma (SCC) of the renal pelvis is an aggressive tumor with insidious onset of unspecific symptoms and advanced stages at diagnosis. It is a rare entity, accounting for 0.5–8% of renal tumors. In this paper, we describe the case of a patient with a history of recurrent nephrolithiasis that presented with an aggressive form of SCC of the renal pelvis with rapid relapse after resection.

Venous Thrombosis Associated with Peripherally Inserted Central Catheters in Oncology Patients: A Single Institutional Experience

Purpose: The use of peripherally inserted central catheters (PICCs) had gradually increased in recent years,especially incancer patients, as it facilitates blood sampling and treatment administration. Unfortunately, they were associated with a high incidence of complications that limited their widespread use. The purpose of this study is to evaluate the characteristics of oncology patients presenting for complications of their PICC lines and to establish possible associated factors such as age, sex, type of cancer, site of insertion of PICC in our institution. Materials and methods: This retrospective study includes all cancer patients who underwent placement of PICC, from January 2012 till December 2013, under radiology guidance at Hotel-Dieu de France university hospital. All patients were evaluated at enrollment for age, sex, site of PICC insertion, type of neoplasia (solid vs. hematologic malignancy), and followed up for complications for a minimum of two months. Results: During the recruitment period, forty-four patients were enrolled in our study with 54.4% women and 45.6% men. Mean and median age at PICC insertions were 57 and 59 years respectively (standard deviation 16).Nineteen patients (43.2%) had hematologic malignancies and twenty-five had solid tumors (56.8%). Complications including dislodgement, infection, and thrombosis were encountered in eight patients. Thrombosis was the most frequent complication and was reported in six out of eight patients. Time of thrombosis occurrence varied from 1 to 132 days with an average of 37 days. No statistically significant association was found between thrombosis of the PICC and any of the evaluated factors listed above but we found a trend toward a higher rate of thrombosis in hematological cancer patients compared to solid tumor patients (26% v/s 4%). Conclusions: Venous thrombosis complicating PICCs was reported in 13.7% of our oncology patients which represents a similar rate compared to the literature. However, the small number of recruited patients limits any conclusion and warrants more patients to be enrolled with a longer follow-up period.