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Cancer Statistics
Population in 2008: 4.2m
People newly diagnosed with cancer (excluding NMSC) / yr: 7,100
Age-standardised rate, incidence per 100,000 people/yr: 169.6
Risk of getting cancer before age 75:17.5%
People dying from cancer /yr: 4,900
Data from IARC GlobalCan (2008)
Lebanon Cancer Organisations and Resources
Latest Research Publications Related to Lebanon

Lebanon Cancer Organisations and Resources (6 links)

Latest Research Publications Related to Lebanon

Al-Haddad C, El Salloukh NA, El Moussawi Z
β-blockers in the treatment of periocular infantile hemangioma.
Curr Opin Ophthalmol. 2019; 30(5):319-325 [PubMed] Related Publications
PURPOSE OF REVIEW: To evaluate the medical literature on the use of β-blockers, through different routes, for the treatment of periorbital infantile hemangiomas and to summarize the recommendations available on dosage and monitoring.
RECENT FINDINGS: β-blockers for the treatment of infantile hemangioma are now considered to be first-line treatment. Growing literature on the role of oral propranolol confirmed its efficacy but also presented its multiple side-effects including hypotension, bradycardia, hypoglycemia, and bronchospasm. No universal guidelines exist concerning pretreatment evaluation, dosage, monitoring, and duration of treatment but different protocols have been created.In the aim of minimizing side-effects, other routes of administration and more selective β-blockers have emerged. Many studies showed promising results for topical timolol especially in the treatment of superficial hemangiomas. Few studies evaluated intralesional propranolol. Limited data exist on the use of more selective β-blockers promising similar results to propranolol with fewer side-effects.
SUMMARY: Oral β-blockers are now the mainstay of treatment for periorbital hemangiomas but still with no consensus on their administration and monitoring. The topical form or more selective β-blockers may be the solution to minimize side-effects.

Nassif S, El-Zaatari ZM, Attieh M, et al.
Lack of expression of ALK and CD30 in breast carcinoma by immunohistochemistry irrespective of tumor characteristics.
Medicine (Baltimore). 2019; 98(32):e16702 [PubMed] Related Publications
CD30 is a member of the tumor necrosis factor family of cell surface receptors normally expressed in lymphocytes, as well as some lymphomas, but has been described in other malignancies. Anaplastic lymphoma kinase (ALK) is a tyrosine kinase receptor that belongs to the insulin receptor superfamily, and is normally expressed in neural cells, but has been detected in several malignancies. There is conflicting data in the literature that describes the expression of these receptors in breast cancer, and the aim of this study is to test the expression of CD30 and ALK in a cohort of Middle Eastern patients with breast carcinoma.Cases of invasive breast cancer from the archives of AUBMC were reviewed over a period of 9 years, and the blocks that were used for immunohistochemical staining for ER, PR, Her-2/neu were selected. Immunohistochemical staining for CD30 (JCM182) and ALK (5A4 and D5F3) was performed.Two hundred eighty-four cases were identified (2 cases were male), with a mean age of 55 ± 12. CD30 and ALK expression was not seen in any of the cases.Our cohort showed complete negativity to both CD30 and ALK, adding to the conflicting data available in the literature, and more studies are needed to reliably identify a trend of expression of CD30 and ALK in breast carcinoma, especially in the Middle East.

Boileau M, Shirinian M, Gayden T, et al.
Mutant H3 histones drive human pre-leukemic hematopoietic stem cell expansion and promote leukemic aggressiveness.
Nat Commun. 2019; 10(1):2891 [PubMed] Free Access to Full Article Related Publications
Our ability to manage acute myeloid leukemia (AML) is limited by our incomplete understanding of the epigenetic disruption central to leukemogenesis, including improper histone methylation. Here we examine 16 histone H3 genes in 434 primary AML samples and identify Q69H, A26P, R2Q, R8H and K27M/I mutations (1.6%), with higher incidence in secondary AML (9%). These mutations occur in pre-leukemic hematopoietic stem cells (HSCs) and exist in the major leukemic clones in patients. They increase the frequency of functional HSCs, alter differentiation, and amplify leukemic aggressiveness. These effects are dependent on the specific mutation. H3K27 mutation increases the expression of genes involved in erythrocyte and myeloid differentiation with altered H3K27 tri-methylation and K27 acetylation. The functional impact of histone mutations is independent of RUNX1 mutation, although they at times co-occur. This study establishes that H3 mutations are drivers of human pre-cancerous stem cell expansion and important early events in leukemogenesis.

Naji S, Issa K, Eid A, et al.
Cadmium Induces Migration of Colon Cancer Cells: Roles of Reactive Oxygen Species, P38 and Cyclooxygenase-2.
Cell Physiol Biochem. 2019; 52(6):1517-1534 [PubMed] Related Publications
BACKGROUND/AIMS: Cadmium (Cd) is a heavy metal contaminant whose toxicity is associated with colorectal cancer (CRC). However, the underlying molecular mechanisms of Cd-induced CRC malignancy remain obscure.
METHODS: A monolayer scratch assay was employed to assess the migration of HT-29 human adenocarcinoma cells. Luciferase reporter assay was used to determine cyclooxygenase-2 (COX-2) transcriptional activity, and Western blotting was used to detect p38 Mitogen Activated Protein Kinase (MAPK) and Akt phosphorylation as well as COX-2 expression. Prostaglandin E
RESULTS: Here, we show that Cd potentiates the migratory capacity of HT-29 CRC cells. Cd caused a time-dependent increase in COX-2 expression. Celecoxib, a COX-2 selective inhibitor, significantly reduced Cd-induced migration. Cd also increased levels of ROS and phosphorylated p38. Importantly, Cd-induced COX-2 expression and migration were significantly abolished by N-Acetyl-Cysteine (NAC), a ROS scavenger, or SB202190, a specific p38 inhibitor. Furthermore, Cd-induced p38 phosphorylation was inhibited by NAC. Cd (100 nM) also increased PGE
CONCLUSION: Taken together, our results suggest that exposure to low levels of Cd promotes a more migratory cancer phenotype in a ROS-p38-COX-2-PGE

El Rassy E, Assi T, Kattan J, Pavlidis N
Paraneoplastic syndromes in cancers of unknown primary: An unknown field for oncologists.
Bull Cancer. 2019; 106(6):590-603 [PubMed] Related Publications
Paraneoplastic syndromes are signs or symptoms that result from tissue damage at locations remote from tumour sites. Paraneoplastic syndromes associated with cancer of unknown primary (CUP) are not well recognized as they are rarely reported. These syndromes can impair various organ functions and include endocrine, neurologic, dermatologic, rheumatologic, hematologic and several other system alterations. To our knowledge, the association between the histological CUP type and the paraneoplastic syndrome has never been assessed. In some instances, paraneoplastic syndromes can become the major clinical problems determining survival. However, they can also herald earlier the occurrence of CUP in patients with asymptomatic tumors. In this article, we review the available literature of CUP patients presenting paraneoplastic syndromes by trying to collect all available published cases during the last three decades. One additional goal of this article is to make practicing oncologists aware of the coexistence of paraneoplastic syndromes in patients with CUP.

Sharma A, Jamil MA, Nuesgen N, et al.
Detailed methylation map of LINE-1 5'-promoter region reveals hypomethylated CpG hotspots associated with tumor tissue specificity.
Mol Genet Genomic Med. 2019; 7(5):e601 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: Long interspersed nuclear elements (LINE-1) sequences constitute a substantial portion of the human genome, and their methylation often correlating with global genomic methylation. Previous studies have highlighted the feasibility of using LINE-1 methylation to discriminate tumors from healthy tissues. However, most studies are based on only a few specific LINE-1 CpG sites.
METHODS: Herein, we have performed a systematic fine-scale analysis of methylation at 14 CpGs located in the 5'-region of consensus LINE-1, in bladder, colon, prostate, and gastric tumor tissues using a global degenerate approach.
RESULTS: Our results reveal variable methylation levels between different CpGs, as well as some tissue-specific differences. Trends toward hypomethylation were observed in all tumors types to certain degrees, showing statistically significance in bladder and prostate tumors. Our data points toward the presence of unique LINE-1 DNA methylation patterns for each tumor type and tissue, indicating that not the same CpGs will be informative for testing in all tumor types.
CONCLUSION: This study provides an accurate guide that will help to design further assays that could avoid artifacts and explain the variability of obtained LINE-1 methylation values between different studies.

Samkoe KS, Sardar HS, Bates BD, et al.
Preclinical imaging of epidermal growth factor receptor with ABY-029 in soft-tissue sarcoma for fluorescence-guided surgery and tumor detection.
J Surg Oncol. 2019; 119(8):1077-1086 [PubMed] Article available free on PMC after 01/06/2020 Related Publications
BACKGROUND AND OBJECTIVES: Fluorescence-guided surgery using epidermal growth factor receptor (EGFR) targeting has been performed successfully in clinical trials using a variety of fluorescent agents. We investigate ABY-029 (anti-EGFR Affibody
METHODS: Five xenograft soft-tissue sarcoma cell lines were implanted into immunosuppressed mice. ABY-029 and IRDye 700DX were each administered at 4.98 μM. Fluorescence from in vivo and ex vivo (fresh and formalin-fixed) fixed tissues were compared. The performance of three fluorescence imaging systems was assessed for ex vivo tissues.
RESULTS: ABY-029 is retained longer within tumor tissue and achieves higher tumor-to-background ratios both in vivo and ex vivo than IRDye 700DX. ABY-029 fluorescence is less susceptible to formalin fixation than IRDye 700DX, but both agents have disproportional signal loss in a variety of tissues. The Pearl Impulse provides the highest contrast-to-noise ratio, but all systems have individual advantages.
CONCLUSIONS: ABY-029 demonstrates promise to assist in wide local excision of soft-tissue sarcomas. Further clinical evaluation of in situ or freshly excised ex vivo tissues using fluorescence imaging systems is warranted.

Jacobs MF, Dust H, Koeppe E, et al.
Outcomes of Endoscopic Surveillance in Individuals With Genetic Predisposition to Hereditary Diffuse Gastric Cancer.
Gastroenterology. 2019; 157(1):87-96 [PubMed] Related Publications
BACKGROUND & AIMS: Pathogenic germline variants in CDH1 are associated with risk for diffuse gastric cancer (DGC) and lobular breast cancer. The reported high incidence of DGC and limited sensitivity of endoscopy in detection have prompted recommendation for total prophylactic gastrectomy for carriers of pathogenic or likely pathogenic (PLP) germline variants of CDH1. Multigene panel tests have identified increasing numbers of carriers of PLP variants in CDH1 who lack a family history of DGC. We evaluated outcomes of endoscopic surveillance for carriers of PLP variants of CDH1 with and without family history of DGC.
METHODS: Individuals from 13 families with germline PLP variants of CDH1 were evaluated at the Michigan Medicine Cancer Genetics Clinic from January 1998 through May 2018. Outcomes of esophagogastroduodenoscopy examinations, histopathology analyses, and surgery were compared between individuals with and without a family history of DGC.
RESULTS: We identified 20 carriers of germline CDH1 PLP variants; they underwent endoscopic examinations and/or gastrectomy. None had abnormal findings visible during endoscopy. Signet ring cell carcinoma (SRCC) was detected in 12 of 20 subjects. All but 1 of the carcinomas were tiny and confined to the lamina propria, and 1 was transmural. Seven of 12 subjects who had SRCC reported no diagnoses of DGC in first-degree relatives and did not meet established criteria for CDH1 analysis based on a 3-generation family pedigree.
CONCLUSIONS: More than half of individuals with germlines variants of CDH1 that are PLP had histopathologic evidence for DGC on endoscopy and/or gastrectomy. Family history of DGC and endoscopic findings therefore do not appear to be reliable determinants of risk of SRCC in individuals with genetic predisposition to DGC.

Mukherji D, Massih SA, Tfayli A, et al.
Three different polymorphisms of the DPYD gene associated with severe toxicity following administration of 5-FU: a case report.
J Med Case Rep. 2019; 13(1):76 [PubMed] Article available free on PMC after 01/06/2020 Related Publications
BACKGROUND: Dihydropyrimidine dehydrogenase deficiency secondary to polymorphisms in the DPYD gene can lead to significant toxicity associated with the administration of fluoropyrimidine chemotherapy.
CASE PRESENTATION: We report a case of a 59-year-old Lebanese woman with metastatic pancreatic cancer who received FOLFIRINOX therapy and developed severe 5-fluorouracil toxicity after a single cycle. The entire DPYD gene was sequenced, and the patient was found to be heterozygous for three different polymorphisms that have reportedly been associated with dihydropyrimidine dehydrogenase deficiency.
CONCLUSION: Because data regarding the prevalence and clinical significance of several heterozygous polymorphisms in a single DPYD gene are very limited, we suggest that full gene sequencing should be carried out, at least in populations in which the allele frequencies are unknown.

Wang L, Pei J, Cong Z, et al.
Development of anisamide-targeted PEGylated gold nanorods to deliver epirubicin for chemo-photothermal therapy in tumor-bearing mice.
Int J Nanomedicine. 2019; 14:1817-1833 [PubMed] Article available free on PMC after 01/06/2020 Related Publications
Background: Gold nanorods (AuNRs), due to the optical and electronic properties namely the surface plasma resonance, have been developed to achieve the light-mediated photothermal therapy (PTT) for cancer. However, PTT alone may suffer from inefficient tumor killing. Recently, the combination of PTT and chemotherapy has been utilized to achieve synergistic anticancer effects.
Methods: In this study, AuNRs capped with hexadecyltrimethylammonium bromide (CTAB), poly(acrylic acid) (PAA), and PEGylated anisamide (a ligand known to target the sigma receptor) have been developed to produce a range of negatively charged anisamide-targeted PEGylated AuNRs (namely Au-CTAB-PAA-PEG-AA) for the combination of PTT and chemotherapy (termed as chemo-photothermal therapy [CPTT]). Epirubicin (EPI, an anthracycline drug) was efficiently loaded onto the surface of Au
Results: The resultant complex demonstrated pH-dependent drug release, facilitated nucleus trafficking of EPI, and induced antiproliferative effects in human prostate cancer PC-3 cells. When Au
Conclusion: These results demonstrate a promising strategy for clinical application of CPTT in cancer.

Doumit MAA, Rahi AC, Saab R, Majdalani M
Spirituality among parents of children with cancer in a Middle Eastern country.
Eur J Oncol Nurs. 2019; 39:21-27 [PubMed] Related Publications
PURPOSE: Family caregivers of children with cancer face emotional, psychological, and spiritual challenges coping with their child's illness. For ensuring comprehensive multidisciplinary pediatric care, there is a need to understand and define what spirituality means for them in relation to their child's illness. The purpose of this study is to understand the meaning of spirituality for parents of cancer patients in Lebanon.
METHODS: This qualitative study followed the Heideggerian interpretive phenomenological method. Through purposeful sampling, 11 parents (mother or father) of children with cancer receiving treatment at a tertiary care center in Beirut, Lebanon were interviewed. Data were analyzed following the hermeneutical process as described by Diekelmann and Ironside (1998).
RESULTS: A constitutive pattern and overarching theme, "spirituality is a two-level relationship. It is a relation with God and with people. It is the act of receiving and giving back" and five major themes emerged from the data. These were "Being there for me; " "Connectedness with other parents is a blessing and a torment; " "The power of knowing; " "Communication with Unknown" and "Spirituality is not religiosity".
CONCLUSION: Lebanese parents of children with cancer defined the elements of their own spirituality. Relational aspects dominated and communication was an important factor.
IMPLICATIONS FOR PRACTICE: This is the first study in the Middle East to address the meaning of spirituality in this population, and would pave the way for a customized palliative care program and integrative approach to patient care.

Temraz S, Haibe Y, Charafeddine M, et al.
The unveiling of a new risk factor associated with bladder cancer in Lebanon.
BMC Urol. 2019; 19(1):16 [PubMed] Article available free on PMC after 01/06/2020 Related Publications
BACKGROUND: No accurate evaluation of smoking and water pollution on bladder cancer has been conducted in the Lebanese population. Our aim is to examine the significance of smoking and one of the main water pollutants Trihalomethanes (THM) on bladder cancer risk.
METHODS: Population Attributable Fraction (PAF) was used to quantify the contribution of the risk factors smoking and THMs on bladder cancer in Lebanon. To calculate PAF for each risk factor, we used the proportion of the population exposed and the relative risk for each risk factor. Relative risks for each risk factor were obtained from published meta-analyses. The population at risk values were obtained from a report on chronic disease risk factor surveillance in Lebanon which was conducted by the World Health Organization between 2008 and 2009 and a national study by Semerjian et al. that conducted a multipathway exposure assessment of selected public drinking waters of Lebanon for the risk factors smoking and THMs, respectively.
RESULTS: Bladder cancer cases that were the result of smoking in Lebanon among males and females are 33.4 and 18.6%, respectively. Cases attributed to mid-term exposure to THM contamination of drinking water is estimated at 8.6%.
CONCLUSION: This paper further highlights the negative impact of smoking on bladder cancer risk and adds an overlooked and often underestimated risk that THMs have on this type of cancer. Thus, it is imperative that a national based study which assesses THM exposure by gender and smoking status be implemented to determine the real risk behind this byproduct.

Sarkis M, Ghanem E, Rahme K
Jumping on the Bandwagon: A Review on the Versatile Applications of Gold Nanostructures in Prostate Cancer.
Int J Mol Sci. 2019; 20(4) [PubMed] Article available free on PMC after 01/06/2020 Related Publications
Prostate cancer (PCa) has remarkably emerged as a prominent disease in the face of the male population. Conventional treatments like prostatectomy or radiation can be curative only if PCa is diagnosed at an early stage. In the field of targeted therapy, a bevy of novel therapeutic approaches have left a landmark in PCa treatment and have proven to extend survival via distinct modes of actions. Nanotherapy has started to take root and has become the hype of the century by virtue of its abundant advantages. Scientists have invested a great deal of interest in the development of nanostructures such as gold nanoparticles (AuNPs), which hold particularly great hope for PCa theranostics. In this article, we present an overview of the studies published after 1998 that involve the use of different functionalized AuNPs to treat and diagnose PCa. Special reference is given to various in vitro and in vivo methods employed to shuttle AuNPs to PCa cells. Major studies show an enhancement of either detection or treatment of PCa when compared to their non-targeted counterparts, especially when AuNPs are tagged with specific ligands, such as antibodies, tea natural extracts, folate, anisamide, receptor inhibitors, and chitosan. Future approaches of treatment are dependent on those worthy multifunctional molecules, and are dictated by their ability to achieve a more versatile cancer therapeutic approach.

Phillips JD, Hasson RM
Surgical management of colorectal lung metastases.
J Surg Oncol. 2019; 119(5):629-635 [PubMed] Related Publications
Pulmonary metastasectomy for colorectal cancer is an established means of treatment for select patients. This article will highlight the recent evidence published in the literature related to current practices for the surgical management of colorectal lung metastases and propose a diagnostic algorithm for use in clinical practice. It will also discuss controversies related to pulmonary metastasectomy, including the optimal timing of surgery, the extent of lymph node sampling/dissection, and the extent of surgical resection.

Luan X, Rahme K, Cong Z, et al.
Anisamide-targeted PEGylated gold nanoparticles designed to target prostate cancer mediate: Enhanced systemic exposure of siRNA, tumour growth suppression and a synergistic therapeutic response in combination with paclitaxel in mice.
Eur J Pharm Biopharm. 2019; 137:56-67 [PubMed] Related Publications
Small interfering RNA (siRNA) has recently illustrated therapeutic potential for malignant disorders. However, the clinical application of siRNA-based therapeutics is significantly retarded by the paucity of successful delivery systems. Recently, multifunctional gold nanoparticles (AuNPs) as non-viral delivery carriers have shown promise for transporting chemotherapeutics, proteins/peptides, and genes. In this study, AuNPs capped with polyethylenimine (PEI) and PEGylated anisamide (a ligand known to target the sigma receptor) have been developed to produce a range of positively charged anisamide-targeted PEGylated AuNPs (namely Au-PEI-PEG-AA). The anisamide-targeted AuNPs effectively complexed siRNA via electrostatic interaction, and the resultant complex (Au

Serhal R, Saliba N, Hilal G, et al.
Effect of adipose-derived mesenchymal stem cells on hepatocellular carcinoma:
World J Gastroenterol. 2019; 25(5):567-583 [PubMed] Article available free on PMC after 01/06/2020 Related Publications
AIM: To investigate the effect of adipose-derived mesenchymal stem cells (ADMSCs) and their conditioned media (CM) on hepatocellular carcinoma (HCC) cell tumorigenesis.
METHODS: The proliferation rate of HepG2 and PLC-PRF-5 HCC cancer cells was measured using the trypan blue exclusion method and confirmed using the cell-counting kit 8 (commonly known as CCK-8) assay. Apoptosis was detected by flow cytometry using annexin V-FITC. Protein and mRNA expression was quantified by ELISA and real time PCR, respectively. Migration and invasion rates were performed by Transwell migration and invasion assays. Wound healing was examined to confirm the data obtained from the migration assays.
RESULTS: Our data demonstrated that when co-culturing HCC cell lines with ADMSCs or treating them with ADMSC CM, the HCC cell proliferation rate was significantly inhibited and the apoptosis rate increased. The decreased proliferation rate was accompanied by an upregulation of P53 and Retinoblastoma mRNA and a downregulation of c-Myc and hTERT mRNA levels. More notably, ADMSCs and their CM suppressed the expression of the two important markers of HCC carcinogenicity, alpha-fetoprotein and Des-gamma-carboxyprothrombin. In addition, the migration and invasion levels of HepG2 and PLC-PRF-5 cells significantly decreased, potentially through increased expression of the tissue inhibitor metalloproteinases TIMP-1, TIMP-2 and TIMP-3.
CONCLUSION: These findings shed new light on a protective and therapeutic role for ADMSCs and their CM in controlling HCC invasiveness and carcinogenesis.

Dallel M, Sghaier I, Finan RR, et al.
Circulating leptin concentration, LEP gene variants and haplotypes, and polycystic ovary syndrome in Bahraini and Tunisian Arab women.
Gene. 2019; 694:19-25 [PubMed] Related Publications
BACKGROUND AND AIM: Epidemiological studies suggested that ethnic/racial background influences the associations of altered leptin secretion and leptin gene (LEP) polymorphisms with polycystic ovary syndrome (PCOS). We investigated the association between LEP variants and plasma leptin levels with PCOS in Tunisian and Bahraini Arab women.
SUBJECTS AND METHODS: Retrospective case-control study, involving 255 PCOS cases and 253 control subjects from Bahrain, and 320 women PCOS cases and 447 controls from Tunisia. LEP genotyping was done by allele exclusion on real-time PCR.
RESULTS: Minor allele frequencies of rs10487506, rs7799039, rs2167270, rs12706832, and rs10954173 LEP variants were not significantly different between PCOS cases and control women among Bahraini and Tunisians, even before applying the Bonferroni correction. Similarly, the genotype distribution of the tested LEP variants was comparable between women with PCOS and control women among Bahraini and Tunisian subjects. None of the tested LEP variants was linked with altered leptin serum concentrations. However, five-locus haplotype analysis identified GGGGG and GAGGG haplotypes to be positively, and haplotype AAGGG to be negatively associated with PCOS in Bahraini women, after adjusting for HOMA-IR. No LEP haplotype associated with PCOS was identified in Tunisians.
CONCLUSION: This is the first study to document differential contribution of LEP gene variants with PCOS according to ethnic/racial background of study subjects, highlighting the need for controlling for ethnicity in genetic association studies.

Sinno SAJ, Chakhachiro ZI, Nassif SR
Review of Hematopathology Consult Cases: A Two-Year Experience in a Tertiary Referral Center in Lebanon.
Biomed Res Int. 2018; 2018:3028625 [PubMed] Article available free on PMC after 01/06/2020 Related Publications
Hematopathology remains a difficult diagnostic field. With the significant ongoing changes in the classification system that happened over the past several decades, the general pathologist faces many challenges when dealing with patients suspected to have lymphoma or leukemia. The authors assessed referred hematopathology cases that were reviewed by specialized hematopathologists. Of 309 cases, major discrepancy was found in 23% of them. The discrepancy ranged from lymphoma reclassification to other major revisions that had significant impact on patient treatment and management. This paper highlights some of the challenges that may face the general practicing pathologist when dealing with suspected hematopoietic neoplasms.

Rizk M, Guilloteau A, Mouillot T, et al.
Dietary components modulate the risk of hepatocellular carcinoma in cirrhotic patients.
Nutr Res. 2019; 61:82-94 [PubMed] Related Publications
Eighty percent of hepatocellular carcinoma (HCC) cases occur after cirrhosis from various etiologies. The association between diet and cancer is well accepted, but the links with cirrhosis progression and HCC risk have been poorly investigated. However, we hypothesized that diet could be a modifiable preventive factor for HCC. Thus, the aim of our study was to explore the relationships between dietary factors and the risk of HCC in a population of cirrhotic patients. A total of 582 cirrhotic patients were studied: 401 without HCC (controls) and 181 with HCC (cases). These patients were recruited between 2008 and 2012 for the "CiRCE" case-control study conducted in six French university hospitals. Information about the consumption of 208 food items and 23 nutrients were collected through a diet history questionnaire. Unconditional multivariate logistic regressions were performed for each residual food group and nutrients in tertiles. HCC patients were more often men, diabetic and older than controls. After adjustment, a significant positive association was found between HCC risk and carbonated beverages (OR

El Rassy E, Assi T, Bakouny Z, et al.
Comparison of second-line treatments of recurrent and/or metastatic squamous cell carcinoma of the head and neck.
Future Oncol. 2019; 15(8):909-923 [PubMed] Related Publications
AIM: The literature lacks direct evidence comparing the different regimens evaluated in the second-line treatment of recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN).
METHODS: We conducted a network meta-analysis (NMA) of the randomized controlled Phase III trials reporting on the second-line drug treatment options in R/M SCCHN.
RESULTS: The eligible trials included 11 regimens among which six targeted therapies, two immune checkpoint inhibitors and three chemotherapy regimens. Only nivolumab has shown statistically significant superiority over methotrexate in terms of overall survival (HR: 0.64; 95% CI: 0.43-0.96) and objective response rate (OR: 2.51; 95% CI: 1.07-5.86).
CONCLUSION: Based on the efficacy and safety outcomes of this network meta-analysis, nivolumab seems the most favorable regimen inthe management of R/M SCCHN.

Tran TAN, Linos K, Carlson JA, Bridge JA
A primary cutaneous vascular neoplasm with histologic features of anastomosing hemangioma.
J Cutan Pathol. 2019; 46(5):353-357 [PubMed] Related Publications
Anastomosing hemangioma (AH) is a relatively novel variant of benign vascular tumors originally described in the genitourinary tract. Although AH was subsequently documented in various anatomic locations, a primary AH of the skin has not been reported in the literature. The current case report documents a vascular lesion with histologic features reminiscent of an AH. A 41-year-old female patient underwent an excision of a painful nodule on the leg. Histologic examination showed a well-circumscribed vascular lesion composed of anastomosing sinusoidal capillary-sized vessels, several intravascular fibrin thrombi, rare intraluminal nucleated red blood cells, and focal intracytoplasmic hyaline globules. As AH was hitherto only documented in extracutaneous sites, most dermatopathologists are probably not familiar with this variant of hemangioma. The current case report details the morphologic features of a potential example of a primary cutaneous AH to increase the awareness of this distinctive hemangioma variant among dermatopathologists. Larger studies of vascular lesions with similar histologic features and immunohistochemical profiles are warranted to investigate the potential existence of primary AH in the skin.

Nasr L, Naffaa L, El Alayli A, et al.
Isolated delayed metastasis to the talus from Ewing's sarcoma.
J Radiol Case Rep. 2018; 12(8):17-24 [PubMed] Article available free on PMC after 01/06/2020 Related Publications
Bone metastasis to the hands and feet, known as acrometastasis, is a very rare finding and tends to be associated with extensive metastasis. We herein report the case of a 14-year-old girl known to have a history of successfully treated Ewing's sarcoma arising from the ribs, who presented with a pathologically proven isolated metastatic lesion to the talus 7 years after achieving clinical and radiologic remission. We describe the imaging findings on MRI, CT scan and PET-CT. To our knowledge, talar metastasis from Ewing's sarcoma has been previously reported only twice in the English literature. Noteworthy is the fact that one of the previously reported lesions was considered a skip metastasis, and the other was under-described in terms of primary and secondary tumor location and time to metastasis. In addition, the overall imaging findings were rather suggestive of a benign lesion, particularly on CT scan.

Segars KA, Baltazar D, Baribault K, Miller RA
Cutaneous ganglioneuroma: A case report and discussion of the literature.
J Cutan Pathol. 2019; 46(4):293-296 [PubMed] Related Publications
Ganglioneuromas (GNs) are benign tumors composed of ganglion cells in a Schwannian stroma. They are derived from neural crest cells that give rise to the sympathetic nervous system. Hence, GNs can be found anywhere a sympathetic ganglion is present. Most commonly, GNs are found in the posterior mediastinum and abdominal cavity. Within the abdominal cavity, they are most likely to be found in the retroperitoneal space or adrenal glands. Cutaneous involvement is uncommon and rarely reported in literature. We report an interesting case of a cutaneous ganglioneuroma on the abdomen of an 83-year-old male.

Semaan A, Haddad FG, Eid R, et al.
Immunotherapy: last bullet in platinum refractory germ cell testicular cancer.
Future Oncol. 2019; 15(5):533-541 [PubMed] Related Publications
Testicular germ cell tumors are chemosensitive with very high cure-rates even in the metastatic setting. However, patients with platinum-refractory and relapsing tumors after autologous stem cell transplant have very poor outcomes despite salvage treatments, and with no effective alternative therapies. Immunotherapy, notably with PD-1 inhibitors, has proven to be very effective in treating various solid tumors. This review summarizes the experience with anti-PD-1 agents (pembrolizumab, nivolumab) in the treatment of testicular germ cell tumor relapsing after multiple lines of treatment, and exposes future trials evaluating newer checkpoint inhibitors in this setting.

Finianos A, Matar CF, Taher A
Hepatocellular Carcinoma in β-Thalassemia Patients: Review of the Literature with Molecular Insight into Liver Carcinogenesis.
Int J Mol Sci. 2018; 19(12) [PubMed] Article available free on PMC after 01/06/2020 Related Publications
With the continuing progress in managing patients with thalassemia, especially in the setting of iron overload and iron chelation, the life span of these patients is increasing, while concomitantly increasing incidences of many diseases that were less likely to show when survival was rather limited. Hepatocellular carcinoma (HCC) is a major life-threatening cancer that is becoming more frequently identified in this population of patients. The two established risk factors for the development of HCC in thalassemia include iron overload and viral hepatitis with or without cirrhosis. Increased iron burden is becoming a major HCC risk factor in this patient population, especially in those in the older age group. As such, screening thalassemia patients using liver iron concentration (LIC) measurement by means of magnetic resonance imaging (MRI) and liver ultrasound is strongly recommended for the early detection of iron overload and for implementation of early iron chelation in an attempt to prevent organ-damaging iron overload and possibly HCC. There remain lacking data on HCC treatment outcomes in patients who have thalassemia. However, a personalized approach tailored to each patient's comorbidities is essential to treatment success. Multicenter studies investigating the long-term outcomes of currently available therapeutic options in the thalassemia realm, in addition to novel HCC therapeutic targets, are needed to further improve the prognosis of these patients.

Radwan H, Hasan H, Ballout RA, Rizk R
The epidemiology of cancer in the United Arab Emirates: A systematic review.
Medicine (Baltimore). 2018; 97(50):e13618 [PubMed] Article available free on PMC after 01/06/2020 Related Publications
OBJECTIVE: We conducted a systematic review to explore the United Arab Emirates (UAE)'s cancer-specific epidemiological profiles.
METHODS: We followed the standardized methods for conducting and reporting systematic reviews. We employed a highly sensitive and extensive strategy to identify all studies on the prevalence and incidence of cancer in the UAE, searching electronic databases and the grey literature. We assessed the methodological quality of the studies, summarized them, and qualitatively analyzed their results.
RESULTS: We included 4 retrospective studies published between 2003 and 2011, reporting data gathered between 1982 and 2004. The majority of the data were collected from national cancer registries and addressed adult Emiratis and certain cancer types. All included studies employed validated procedures for diagnostic confirmation. The overall age-standardized cancer rates were 70.1 and 74.2 per 100,000 in males and females, respectively. Lung, gastric, and prostate cancer ranked as the top 3 types in Emirati males; while breast, cervical, and thyroid cancer were the top 3 types in Emirati females. Men exhibited higher rates of lung and stomach cancers compared with women. The majority of the studies were of acceptable methodological quality.
CONCLUSIONS: Our findings highlight the need for high-quality future research and systematic cancer data collection and registration to provide reliable data on the current incidence of cancer. We hope that our findings guide the tailoring of interventions aimed at curbing cancer rates in the UAE.

Amin Asnafi A, Bagheri M, Zibara K, et al.
Expression and Activity of Matrix Metalloproteinases in Leukemia.
J Pediatr Hematol Oncol. 2019; 41(2):87-95 [PubMed] Related Publications
Matrix metalloproteinases (MMPs) are responsible for the degradation of extracellular matrix components and hence play a crucial role in physiological and pathologic processes. The imbalance between the expression of MMPs and their inhibitors can be effective in leukemic cell processes such as migration, angiogenesis, survival, and apoptosis, playing a key role in the progression and prognosis of leukemia. In this review, we discuss the potential involvement of MMPs and their inhibitors in the pathogenesis and progression of leukemia by examining their role in the prognosis of leukemia. Inducing leukemic cell growth, migration, invasiveness, and angiogenesis are the main roles of MMPs in leukemia progression mediated by their degradative activity. Given the important role of MMPs in leukemia progression, further clinical trials are needed to confirm the link between MMPs' expressions and leukemia prognosis. It is hoped to use MMPs as therapeutic targets to improve patients' health by recognizing the prognostic value of MMPs in leukemia and their effect on the progression of these malignancies and their response to treatment.

Albisinni S, Aoun F, Diamand R, et al.
Cytoreductive prostatectomy: what is the evidence? A systematic review.
Minerva Urol Nefrol. 2019; 71(1):1-8 [PubMed] Related Publications
INTRODUCTION: Cytreductive prostatectomy is an experimental surgical approach to metastatic prostate cancer (mPCa), with the scope of improving local symptoms and potentially ameliorate oncologic outcomes. Aim of the current systematic review is to analyze available evidence to support this approach and explore published data a future trial on cytoreductive prostatectomy.
EVIDENCE ACQUISITION: A systematic review was conducted searching all relevant studies published in PubMed, EMBASE, Cochrane Library, CINAHL, Google Scholar and Ovid database until August 1, 2018. A search was performed including the combination of following words: "cytoreductive" AND "prostatectomy" AND "prostate" AND "cancer"). Of the 49 initial papers identified, 28 were excluded after screening by the authors, leaving 21 articles eligible for the review.
EVIDENCE SYNTHESIS: In vitro and in vivo models support the concept of removing the primary tumor, considered a "sanctuary site," in order to reduce the metastatic potential of prostate cancer. Large retrospective population studies have reported improved oncologic outcomes for men undergoing cytoreductive prostatectomy, though such results are limited by the retrospective design and major selection biases. Little evidence from well designed prospective trials is available, yet a net improvement of overall survival has not been reported. Nonetheless, most studies reported a reduction of local complications after cytoreductive prostatectomy (<10%) compared to best systemic therapy (25-30%). Prospective randomized trials are underway: their results will help elucidate the true impact of cytoreductive prostatectomy on oncologic outcomes of mPCa.
CONCLUSIONS: Although supported from a biological point of view and albeit encouraging results of population-based studies, cytoreductive remains to date experimental. A true benefit on overall survival of mPCa is not supported by current evidence. The results of prospective trials are eagerly awaited.

Salame H, Issa M, Nicolas G, et al.
A Rare Case of a Ruptured Metastatic Hepatic Lesion from a Jejunal Gastrointestinal Stromal Tumor (GIST) Treated by Arterial Embolization.
Am J Case Rep. 2018; 19:1480-1487 [PubMed] Article available free on PMC after 01/06/2020 Related Publications
BACKGROUND Gastrointestinal stromal tumors (GISTs) are rare gastrointestinal neoplasms. The spontaneous rupture of a jejunal GIST is very rare and spontaneous rupture of liver metastasis from an intestinal GIST is even rarer with only a few cases reported in the literature. CASE REPORT In this article, we reported a case of spontaneous rupture of a liver metastasis from a malignant jejunal GIST that presented with active tumoral bleeding, hypovolemic shock, and hemoperitoneum. The patient was successfully treated with arterial embolization of the tumor. CONCLUSIONS In appropriately selected patients, arterial embolization appears to be an effective safe treatment for a GIST metastasis rupture.

Habre M, Salloum A, Habre SB, et al.
Skin adverse events in recently approved targeted therapies in solid malignancies.
Future Oncol. 2019; 15(3):331-343 [PubMed] Related Publications
Targeted anticancer therapies are an important weapon in the fight against cancer. Targeted therapies interfere with specific molecules necessary for tumor growth and cancer progression. They are divided mainly to either monoclonal antibodies or small molecules inhibitors. Their primary objective is to target directly and precisely the cancer cells leading to a minimal side-effects profile. The dermatologic adverse reactions of these targeted therapies is different from those seen with classical cytotoxic chemotherapy. Rashes, xerosis, hand-foot-skin reaction and mucositis are the most frequent side effects. In this paper, we aim to present a comprehensive review of the dermatologic side effects of targeted therapies including, specific side effects related to recently, approved targeted therapies.

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