Publications by authors named "Tarek Assi"

87 Publications

The outcome of patients with serous papillary peritoneal cancer, fallopian tube cancer, and epithelial ovarian cancer by treatment eras: 27 years data from the SEER registry.

Cancer Epidemiol 2021 Oct 9;75:102045. Epub 2021 Oct 9.

School of Community Health Sciences, University of Nevada, Reno, NV, USA.

Aim: To determine the differential effect of the treatment periods on the survival of patients with stage IV serous papillary peritoneal carcinoma (SPPC), fallopian tube cancers, and epithelial ovarian cancers (EOC).

Methods: This was an exploratory, population-based observational study of all patients with stage IV SPPC, fallopian tube cancers, and EOC collected from the SEER Research Data 1973-2017. The study period was divided into three time-periods: platinum combinations before the taxane era (1990-1995), platinum plus taxane chemotherapy era (1996-2013), and bevacizumab era (2014-2017).

Results: A total of 9828 patients were eligible for analyses: SPPC (3898 patients; 39.7%), fallopian tube cancers (1290 patients; 13.1%) and EOC (4640 patients, 47.2%). In the 1990-1995 era, the 3-year cause-specific survival was 40% for SPPC, 53% for fallopian tube cancers, and 40% for POC. In the following era 1993-2013, the 3-year cause-specific survival increased to 55% for SPPC, 74% for fallopian tube cancers, and 45% for POC. The last era 2014-2017 showed a 3-year cause-specific survival of 64%, 67%, and 45% for patients with SPPC, fallopian tube cancers, and POC, respectively. The differences in cause-specific survival were statistically significant for patients with SPPC (p=0.004). Multivariable analysis showed that the treatment eras and age at diagnosis were associated with cause-specific survival.

Conclusion: The results of this study are hypothesis-generating and cannot be considered conclusive given the inherent limitations of registry analysis. Subgroup analyses of the phase III randomized controlled trials, by tumor subset (EOC, fallopian tube cancer, and SPPC) would shed more light on the differential effects of novel therapies.
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http://dx.doi.org/10.1016/j.canep.2021.102045DOI Listing
October 2021

Chemotherapy in the management of periosteal osteosarcoma: A narrative review.

J Bone Oncol 2021 Oct 10;30:100389. Epub 2021 Sep 10.

Gustave Roussy, Sarcoma Group, Department of Ambulatory Cancer Care, Villejuif, France.

Periosteal osteosarcoma (PO), an intermediate-grade chondroblastic osteosarcoma (OST) arising from the surface of the bones, is a rare histological subtype among primary bone sarcomas, most commonly diagnosed in young patients. It is characterized by distinct specific radiological and pathological features. The current management strategy is based on several case reports and series, without any solid international recommendations. Most sarcoma experts agree on the crucial role of an optimal complete surgical approach. However, with the paucity of available reports, the role of systemic treatment and its timing remains debatable. With this paper, we will review the available data on the actual impact of chemotherapy in PO patients with emphasis on the radiological, pathological, and therapeutic characteristics of this rare entity.
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http://dx.doi.org/10.1016/j.jbo.2021.100389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8449265PMC
October 2021

Modulating tumor-associated macrophages to enhance the efficacy of immune checkpoint inhibitors: A TAM-pting approach.

Pharmacol Ther 2021 Sep 2:107986. Epub 2021 Sep 2.

INSERM UMR 1186, Integrative Tumor Immunology and Genetic Oncology, Gustave Roussy, F-94805, Villejuif, France.

Tumor-associated macrophages (TAM) plasticity and diversity are both essential hallmarks of the monocyte-macrophage lineage and the tumor-derived inflammation. TAM exemplify the perfect adaptable cell with dynamic phenotypic modifications that reflect changes in their functional polarization status. Under several tumor microenvironment (TME)-related cues, TAM shift their polarization, hence promoting or halting cancer progression. Immune checkpoint inhibitors (ICI) displayed unprecedented clinical responses in various refractory cancers; but only approximately a third of patients experienced durable responses. It is, therefore, crucial to enhance the response rate of immunotherapy. Several mechanisms of resistance to ICI have been elucidated including TAM role with its essential immunosuppressive functions that reduce both anti-tumor immunity and the subsequent ICI efficacy. In the past few years, thorough research has led to a better understanding of TAM biology and innovative approaches can now be adapted through targeting macrophages' recruitment axis as well as TAM activation and polarization status within the TME. Some of these therapeutic strategies are currently being evaluated in several clinical trials in association with ICI agents. This combination between TAM modulation and ICI allows targeting TAM intrinsic immunosuppressive functions and tumor-promoting factors as well as overcoming ICI resistance. Hence, such strategies, with a better understanding of the mechanisms driving TAM modulation, may have the potential to optimize ICI efficacy.
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http://dx.doi.org/10.1016/j.pharmthera.2021.107986DOI Listing
September 2021

Long-term extracranial metastatic relapse of an intraventricular solitary fibrous tumor: a case report.

Anticancer Drugs 2021 Aug 16. Epub 2021 Aug 16.

Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon Department of Cancer Medicine, Gustave Roussy, Villejuif Department of Neurosurgery Department of pathology, Hotel-Dieu de France, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon, France.

Solitary fibrous tumors (SFTs), an uncommon subtype of soft tissue sarcomas mesenchymal, are frequently diagnosed in the intra-thoracic region. Distant metastasis is detected in 10-40% of SFT patients with a predilection site to the lungs; nevertheless, these can occur rarely in the liver, brain, and bones. This entity was also reported in the abdomen, trunk, head, and neck, extremities but also, in the central nervous system (CNS). In the latter form of SFTs, the meninges were mostly affected while only a few cases were reported in the intraventricular and intraparenchymal region with distinct clinical and behavioral characteristics. In this article, we report the rare case of a relapsing intraventricular SFT with secondary extra-cranial metastases to the bones and soft tissues after 11 years of initial diagnosis, with focus on the available data in the literature on CNS SFTs.
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http://dx.doi.org/10.1097/CAD.0000000000001182DOI Listing
August 2021

Machine-Learning-Based Radiomics MRI Model for Survival Prediction of Recurrent Glioblastomas Treated with Bevacizumab.

Diagnostics (Basel) 2021 Jul 14;11(7). Epub 2021 Jul 14.

Department of Medical Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France.

Anti-angiogenic therapy with bevacizumab is a widely used therapeutic option for recurrent glioblastoma (GBM). Nevertheless, the therapeutic response remains highly heterogeneous among GBM patients with discordant outcomes. Recent data have shown that radiomics, an advanced recent imaging analysis method, can help to predict both prognosis and therapy in a multitude of solid tumours. The objective of this study was to identify novel biomarkers, extracted from MRI and clinical data, which could predict overall survival (OS) and progression-free survival (PFS) in GBM patients treated with bevacizumab using machine-learning algorithms. In a cohort of 194 recurrent GBM patients (age range 18-80), radiomics data from pre-treatment T2 FLAIR and gadolinium-injected MRI images along with clinical features were analysed. Binary classification models for OS at 9, 12, and 15 months were evaluated. Our classification models successfully stratified the OS. The AUCs were equal to 0.78, 0.85, and 0.76 on the test sets (0.79, 0.82, and 0.87 on the training sets) for the 9-, 12-, and 15-month endpoints, respectively. Regressions yielded a C-index of 0.64 (0.74) for OS and 0.57 (0.69) for PFS. These results suggest that radiomics could assist in the elaboration of a predictive model for treatment selection in recurrent GBM patients.
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http://dx.doi.org/10.3390/diagnostics11071263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305059PMC
July 2021

COVID-19 pandemic shakes the trust between oncologists and their patients.

Int J Clin Pract 2021 Oct 5;75(10):e14556. Epub 2021 Jul 5.

Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.

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http://dx.doi.org/10.1111/ijcp.14556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420392PMC
October 2021

Immune checkpoints inhibitors in metastatic squamous cell carcinoma of the vulva.

Future Oncol 2021 08 2;17(24):3133-3135. Epub 2021 Jul 2.

Department of Hematology & Oncology, Hammoud Hospital University Medical Centre, Saida 652, Lebanon.

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http://dx.doi.org/10.2217/fon-2021-0610DOI Listing
August 2021

Is there a role for immune checkpoint inhibitors in chordoma?

Authors:
Tarek Assi

Immunotherapy 2021 08 3;13(12):967-970. Epub 2021 Jun 3.

Department of Hematology-Oncology, Faculty of medicine, Saint-Joseph University, Beirut, Lebanon.

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http://dx.doi.org/10.2217/imt-2021-0066DOI Listing
August 2021

Targeting the VEGF Pathway in Osteosarcoma.

Cells 2021 05 18;10(5). Epub 2021 May 18.

Sarcoma Group, Gustave Roussy, 94800 Villejuif, France.

Osteosarcoma is the most common primary tumor of the bones affecting mainly young adults. Despite the advances in the field of systemic anticancer therapy, the prognosis of relapsed of metastatic osteosarcoma patients remain dismal with very short survival. However, the better understanding of the pathophysiology of this subtype of sarcoma has led to the identification of new targeted agents with significant activity. In fact, increased angiogenesis plays a major role in the tumor growth and survival of osteosarcoma patients. Several targeted agents have demonstrated a significant anti-tumor activity including multi-kinase inhibitors. In this review, we will discuss the pathophysiology, rationale, and role of targeting angiogenesis via the VEGF pathway in patients with osteosarcoma with emphasis on the published clinical trials and future directions.
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http://dx.doi.org/10.3390/cells10051240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157846PMC
May 2021

Narrative review on serous primary peritoneal carcinoma of unknown primary site: four questions to be answered.

Ann Transl Med 2020 Dec;8(24):1709

University of Ioannina, Stavros Niarchou Avenue, Ioannina, Greece.

Serous peritoneal papillary carcinoma (SPPC) represents a particular cancer of unknown primary (CUP) entity that arises in the peritoneal surface lining the abdomen and pelvis without a discriminative primary tumor site. In this review, we discuss the validity of SPPC as a distinct entity. Clinically, patients with SPPC are older, have higher parity and later menarche, are more often obese and probably have poorer survival compared to those with primary ovarian cancer. Pathologically, SPPC is more anaplastic and multifocal, unlike primary ovarian cancer which is commonly unifocal. Biologically, it presents a higher expression of proliferative signals and similar cell cycle and DNA repair protein expression. These differences hint towards SPPC and primary ovarian cancer being as a spectrum of disease. Patients with SPPC are traditionally managed similarly to stage III-IV ovarian cancer. The recommended approach integrates aggressive cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, and systemic chemotherapy to remove the macroscopic tumor, eradicate the microscopic residual disease, and control the microscopic metastasis. However, the available evidence lacks proper randomized or prospective studies on SPPC and is limited to retrospective series. The diligent identification of SPPC is warranted to design specific clinical trials that eventually evaluate the impact of the new therapeutics on this distinct entity.
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http://dx.doi.org/10.21037/atm-20-941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812188PMC
December 2020

Current Status of Cancer-Related Pain and Opioid use in South Lebanon: A Pilot Study.

Gulf J Oncolog 2020 Sep;1(34):52-57

Department of Hematology-Oncology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon.

Objective: This study aimed to evaluate the patients and health providers' (doctors and nurses) knowledge and understanding of the disease-related pain, and the perception of pain drugs (opioids) in South Lebanon.

Patients And Methods: This was a pilot study conducted at different hospitals in South Lebanon among patients with confirmed cancer diagnosis and providers. Data was collected using patients' and providers' questionnaires.

Results: 43 patients and 42 providers were included. 22 (52%) patients were male. Nine (21%) patients were aware of their diagnosis and only 60% talked about their pain to their oncologist. Pain was not optimally controlled with 25 (58%) patients having uncontrolled pain and 18 (42%) patients having continuous pain. Morphine was negatively perceived with 55.8% of patients believing that morphine causes addiction and 59% taking pain medications only when the pain is maximal. This led to a 58% short duration control of intermittent pain. 60% of the providers were certain that cancer pain cannot be relieved by morphine while only 33% believed that morphine can cause complete relief. Addiction seemed to be the main obstacle for morphine use with 37 (89%) thinking that narcotics causes addiction and 51% considering morphine withdrawal if side effects appear. Finally, 30% suggested to discontinue morphine in the terminal stages of cancer.

Discussion And Conclusion: Major misconceptions in cancer patients are observed in the approach to antalgic treatment in our population. With good education, better knowledge and optimal palliative care units, misconceptions about opioids can be corrected with best management of cancer pain.
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September 2020

Is there a role for immune checkpoint inhibitors in selected rare subtypes of soft tissue sarcoma?

Immunotherapy 2021 02 9;13(2):91-93. Epub 2020 Dec 9.

Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France.

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http://dx.doi.org/10.2217/imt-2020-0301DOI Listing
February 2021

Should we screen patients with hematologic malignancies for COVID-19?

Hematol Oncol 2020 Dec 8;38(5):648-653. Epub 2020 Aug 8.

Hematology and Oncology Department, Saint Joseph University, Lebanon.

The coronavirus disease (COVID-19) pandemic has posed several challenges to the hematology community to re-organize the medical care of patients with hematologic malignancies. Whereas the oncology societies favored a more or less conservative approach which considered the possibility of delaying treatment administration on a case-by-case basis, the hematology community guidelines were less stringent and recommended adequate individualized regimens. As countries are de-escalating the lockdown and the medical community is unable to foresee the end of the current outbreak will and whether the pandemic would eventually come back as a seasonal infection, there is interest in screening of patients with hematology malignancies with COVID-19 instead of limiting access to curative treatments. The rapidly accumulating knowledge about COVID-19 allows a better understanding of the diagnostic tools that may be potentially used in screening. Herein, we briefly review the pathophysiology of COVID-19, the rationale of screening of patients with hematologic malignancies, tools for screening, and available guidelines.
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http://dx.doi.org/10.1002/hon.2780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405152PMC
December 2020

Screening Strategies for COVID-19 in Patients With Hematologic Malignancies.

Front Oncol 2020 3;10:1267. Epub 2020 Jul 3.

Radiology Department, Gustave Roussy Cancer Campus, Villejuif, France.

COVID-19 has been declared a pandemic by the world health organization. Patients with cancer, and particularly hematologic malignancies may be at higher risk for severe complications due to their malignancy, immune dysregulation, therapy, and associated comorbidities. The oncology community has been proactive in issuing practice guidelines to help optimize management, and limit infection risk and complications from SARS-COV-2. Although hematologic malignancies account for only 10% of all cancers, their management is particularly complex, especially in the time of COVID-19. Screening or early detection of COVID-19 are central for preventative/mitigation strategy, which is the best current strategy in our battle against COVID-19. Herein, we provide an overview of COVID-19 screening strategies and highlight the unique aspects of treating patients with hematologic malignancies.
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http://dx.doi.org/10.3389/fonc.2020.01267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348065PMC
July 2020

Targeting CDK4 (cyclin-dependent kinase) amplification in liposarcoma: A comprehensive review.

Crit Rev Oncol Hematol 2020 Sep 18;153:103029. Epub 2020 Jun 18.

French Sarcoma Group, Gustave Roussy Cancer Campus, Villejuif, France.

Well-differentiated/dedifferentiated (WD/DD) liposarcomas, the most common form of liposarcomas, constitute up to 20 % of all soft tissue sarcomas. Several oncogenes are thought to be involved in liposarcoma pathogenesis, mainly MDM2, CDK4 and HMGA2. While MDM2 inhibitors are now tested in clinical trials, a second actionable and promising target appears to be cyclin-dependent kinase 4 (CDK4), which is amplified in up to 90 % of well differentiated or dedifferentiated (WD/DD) liposarcoma. With the paucity of available therapeutic options, the inhibition of CDK4 represent a potential therapeutic option. In this paper, we review the role of CDK4/6 inhibitors in targeting the commonly identified CDK4 amplification in WD/DD liposarcoma, with an emphasis on the published and currently ongoing trials.
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http://dx.doi.org/10.1016/j.critrevonc.2020.103029DOI Listing
September 2020

Epithelioid sarcoma as the prototype for personalized therapy in soft tissue sarcoma.

Per Med 2020 07 26;17(4):241-244. Epub 2020 Jun 26.

Saint-Joseph University, Faculty of medicine, Beirut, Lebanon.

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http://dx.doi.org/10.2217/pme-2020-0006DOI Listing
July 2020

The management of patients with metastatic prostate cancer during the COVID-19 pandemic.

Future Oncol 2020 Jul 15;16(20):1455-1461. Epub 2020 May 15.

Department of Hematology-Oncology, Faculty of Medicine, Saint-Joseph University, Beirut, BP 17-5208, Lebanon.

During the ongoing global pandemic of coronavirus disease 2019 (COVID-19), the benefit of treating patients with cancer must be weighed against the COVID-19 infection risks to patients, staff and society. Prostate cancer is one of the most common cancers among men and raises particular interest during the pandemic as recent reports show that the TMPRSS2 (and other serine proteases), which facilitate the entry, replication and budding of the virion from a cell, can be inhibited using androgen deprivation therapy. Nevertheless, patients with metastatic prostate cancer commonly receive chemotherapy which may compromise their immune system. This paper aims to address the current status of the COVID-19 in patients with cancer overall and suggests an optimal approach to patients with metastatic prostate cancer.
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http://dx.doi.org/10.2217/fon-2020-0361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426764PMC
July 2020

Docetaxel Rechallenge in Patients with Metastatic Prostate Cancer: A Comprehensive Review.

Oncol Res Treat 2020 7;43(6):299-306. Epub 2020 May 7.

Department of Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.

Background: Recent years have witnessed a huge shift in the management and prognosis of metastatic prostate cancer with the advent of new-generation anti-hormonal treatments. Docetaxel, which was initially approved in the castrate-resistant prostate cancer setting, has been approved in the earlier course of the disease as it is still castrate sensitive.

Summary: Apart from cabazitaxel and in the absence of other effective chemotherapies, docetaxel rechallenge (DR) in patients with proved sensitivity to docetaxel in the earlier stage of the disease remains a possible option. Unfortunately, the pivotal trials rarely reported on the outcomes of docetaxel retreatment which seems a plausible option in patients initially responding to docetaxel and maintaining a minimum progression-free interval of 3-6 months. In this review, a summary of the clinical evidence and potential concerns for the use of DR in patients with metastatic prostate cancer will be presented. Key Messages: Pivotal trials of docetaxel in metastatic castrate-sensitive prostate cancer as well as metastatic castrate-resistant prostate cancer have not reported on the outcomes of DR except in the GETUG-AFU 15 trial where the outcomes were disappointing. Based on the published retrospective data, DR may be effective in patients who initially responded to docetaxel and maintained a progression-free interval exceeding 6 months.
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http://dx.doi.org/10.1159/000506693DOI Listing
September 2020

What the oncologist needs to know about COVID-19 infection in cancer patients.

Future Oncol 2020 Jun 23;16(17):1153-1156. Epub 2020 Apr 23.

Department of Medical Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon.

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http://dx.doi.org/10.2217/fon-2020-0312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192200PMC
June 2020

Diagnostic Value of TLE1 in Synovial Sarcoma: A Systematic Review and Meta-Analysis.

Sarcoma 2020 29;2020:7192347. Epub 2020 Jan 29.

Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Background: Synovial sarcoma can present morphologically in multiple forms, including biphasic and monophasic subtypes. As a result, the histological diagnosis can sometimes be challenging. Transducin-Like Enhancer 1 (TLE1) is a transcriptional corepressor that normally is involved in embryogenesis and hematopoiesis but is also expressed in certain tumors. This systematic review examines the potential role of TLE1 as a diagnostic biomarker for the synovial sarcoma. . A literature review and meta-analysis were conducted using the electronic databases Pubmed, the Cochrane Library, and Google Scholar. Thirteen studies met our eligibility criteria and were selected for in-depth analysis.

Results: The mean sensitivity and specificity of TLE1 in detecting synovial sarcoma were 94% (95% CI 91%-97%) and 81% (95% CI 72%-91%), respectively, when all studies were aggregated together. The mean positive predictive value (PPV) of TLE1 was 75% (95% CI 62%-87%), whereas the negative predictive value (NPV) was 96% (95% CI 93%-98%).

Conclusion: TLE1 is a sensitive and specific marker for synovial sarcoma that can aid in its diagnosis. Due to its involvement in several relevant signaling pathways, TLE1 might have direct relevance to the pathophysiology of the disease.
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http://dx.doi.org/10.1155/2020/7192347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166261PMC
January 2020

Do checkpoint inhibitors compromise the cancer patients' immunity and increase the vulnerability to COVID-19 infection?

Immunotherapy 2020 04 14;12(6):351-354. Epub 2020 Apr 14.

Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.

The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) has been declared a pandemic by the WHO that claimed the lives of thousands of people within a few months. Cancer patients represent a vulnerable population due to the acquired immunodeficiency associated with anti-cancer therapy. Immune checkpoint inhibitors have largely impacted the prognosis of a multitude of malignancies with significant improvement in survival outcomes and a different, tolerable toxicity profile. In this paper, we assess the safety of ICI administration in cancer patients during the coronavirus pandemic in order to guide the usage of these highly efficacious agents.
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http://dx.doi.org/10.2217/imt-2020-0077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161588PMC
April 2020

Detection of PIK3R1 (L449S) Mutation in a Patient with Ovarian Cancer: A Case Report.

Case Rep Oncol 2020 Jan-Apr;13(1):188-192. Epub 2020 Feb 20.

Department of Hematology-Oncology, Saint Joseph Faculty of Medicine, Beirut, Lebanon.

Ovarian cancer (OC) is one of the most dangerous gynecological diseases and greatly increases the death risk worldwide. The heterogeneity of the ovarian tumors among patients and the lack of sufficient therapies for these tumors make the selection of the appropriate treatment a hard challenge. Understanding the mechanisms leading to OC becomes an urgent need in order to find out better therapeutic strategies. In this study, we have identified a point mutation (L449S) in the regulatory subunit of PI3K in an OC Lebanese patient. This genomic alteration had not been previously reported in OC and could plausibly enhance the PIK3CA amplification effect in strengthening AKT/mTOR pathway activity and leading to tumorigenesis.
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http://dx.doi.org/10.1159/000505723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098360PMC
February 2020

TRK inhibition in soft tissue sarcomas: A comprehensive review.

Semin Oncol 2020 02 9;47(1):73-84. Epub 2020 Mar 9.

Hematology-Oncology Department, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.

Soft-tissue sarcomas (STS) are a group of rare mesenchymal tumors that constitutes ∼1% of all solid tumors. It remains a rare tumor which lacks effective treatment options. Precision oncology may be of interest in this regard by identifying potential targets for emerging novel therapies. Neurotrophic receptor tyrosine kinase (NTRK) fusions are rare oncogenic driver mutations found in a broad range of common and rare tumor subtypes including STS. The recent approvals of NTRK inhibitors (larotrectinib and entrectinib) represent new therapeutic options in the drug armamentarium especially valuable in advanced STS given the paucity of treatment options and the generally poor prognosis of these tumors. We review the methods used to detect NTRK fusions in STS with focus on incidence, diagnosis and management of these rare and intriguing oncogenic targets.
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http://dx.doi.org/10.1053/j.seminoncol.2020.02.009DOI Listing
February 2020

Comprehensive review into the challenges of gastrointestinal tumors in the Gulf and Levant countries.

World J Clin Cases 2020 Feb;8(3):487-503

Oncology Department, Basra College of Medicine, Basra, Iraq.

Although gastrointestinal stromal tumors (GISTs) are rare, with an incidence of 1/100000 per year, they are the most common sarcomas in the peritoneal cavity. Despite considerable progress in the diagnosis and treatment of GIST, about half of all patients are estimated to experience recurrence. With only two drugs, sunitinib and regorafenib, approved by the Food and Drug Administration, selecting treatment options after imatinib failure and coordinating multidisciplinary care remain challenging. In addition, physicians across the Middle East face some additional and unique challenges such as lack of published local data from clinical trials, national disease registries and regional scientific research, limited access to treatment, lack of standardization of care, and limited access to mutational analysis. Although global guidelines set a framework for the management of GIST, there are no standard local guidelines to guide clinical practice in a resource-limited environment. Therefore, a group of 11 experienced medical oncologists from across the Gulf and Levant region, part of the Rare Tumors Gastrointestinal Group, met over a period of one year to conduct a narrative review of the management of GIST and to describe regional challenges and gaps in patient management as an essential step to proposing local clinical practice recommendations.
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http://dx.doi.org/10.12998/wjcc.v8.i3.487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031830PMC
February 2020

Exploring the biological hallmarks of cancer of unknown primary: where do we stand today?

Br J Cancer 2020 04 11;122(8):1124-1132. Epub 2020 Feb 11.

University of Ioannina, Ioannina, Greece.

Cancer of unknown primary (CUP) affects a small percentage of the general population. Nonetheless, a substantial number of these patients have a poor prognosis and consequently succumb to their illness within a year of diagnosis. The natural history of CUP is characterised by early metastasis from the unknown primary site, aggressive course and resistance to conventional chemotherapy. Unfortunately, the processes by which this orphan disease originates and progresses have not been fully elucidated and its biology remain unclear. Despite the conceptual progress in genetic and molecular profiling made over the past decade, recognition of the genetic and molecular abnormalities involved in CUP, as well as the identification of the tissue of origin remain unresolved issues. This review will outline the biology of CUP by exploring the hallmarks of cancer in order to rationalise the complexities of this enigmatic syndrome. This approach will help the reader to understand where research efforts currently stand and the pitfalls of this quest.
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http://dx.doi.org/10.1038/s41416-019-0723-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156745PMC
April 2020

A comprehensive review on the diagnosis and management of intimal sarcoma of the pulmonary artery.

Crit Rev Oncol Hematol 2020 Mar 30;147:102889. Epub 2020 Jan 30.

French Sarcoma Group, Gustave Roussy Cancer Campus, Villejuif, France.

Only a few hundred cases of intimal sarcomas of pulmonary artery (ISPA) were reported on the literature. Diagnosis of this rare entity is a challenging dilemma with the need for a high expertise in the radiological and pathological identification of ISPA. Treatment strategies rely initially on an early aggressive surgery aiming for complete surgical resection with clear margins while no clear recommendations guiding the choice for additional drug therapy or radiotherapy exist. In this article, we perform an extensive review of the literature on ISPA with details on the clinical presentation, diagnosis and management strategies. An additional goal of this paper is to make practicing oncologists aware of this rare entity with clear idea on the initial management.
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http://dx.doi.org/10.1016/j.critrevonc.2020.102889DOI Listing
March 2020

Is there a role for maintenance therapy after platinum chemotherapy in bladder cancer in the era of immune therapy?

Future Oncol 2019 Dec 15;15(34):3877-3879. Epub 2019 Nov 15.

Department of Oncology, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon.

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http://dx.doi.org/10.2217/fon-2019-0542DOI Listing
December 2019

Palbociclib safety and efficacy beyond Ribociclib-induced liver toxicity in metastatic hormone-receptors positive breast cancer patient.

Anticancer Drugs 2020 01;31(1):85-89

Oncology Medicine Department, Jules Bordet Institute, Université Libre de Bruxelles, Bruxelles, Belgium.

CDK4/6 inhibitors in association with aromatase inhibitors have led to a paradigm shift in the management of metastatic positive hormone-receptors breast cancer. Liver toxicity is common with these agents, but no data are reported on the sequential use of these CDK4/6 inhibitors in case of confirmed efficacy and intolerable toxicity. In this article, we report the successful use of Palbociclib in a metastatic positive hormone-receptors breast cancer patient after initial response to Ribociclib, which was interrupted for grade 4 liver toxicity.
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http://dx.doi.org/10.1097/CAD.0000000000000845DOI Listing
January 2020

Total Parenteral Nutrition in Middle Eastern Cancer Patients at End of Life: Is it Justified?

Gulf J Oncolog 2019 Sep;1(31):21-25

Department of Hematology-Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.

Purpose: The use of total parenteral nutrition (TPN) in terminally ill cancer patients is considered an aggressive approach with very limited benefits. We examined the practice of TPN in our end of life cancer patients and we investigated the patient and tumor characteristics that justify this practice. To our knowledge, this is the first study describing TPN administration of Middle Eastern patients with advanced cancer.

Methods: We conducted this retrospective observational study at Hotel-Dieu de France University Hospital, Lebanon. Eligible cases included all cancer patients that died at our institution between the 1st of January and the 31st of December 2014. The patients and tumors characteristics were analyzed for their potential role as determinant of TPN administration. The patients' hospitalization and causes of death were evaluated for the analysis of TPN benefits.

Results: Among the 129 patients enrolled, 39% had received TPN among which TPN administration correlated negatively to hyperlipidemia (OR= 0.33; 95% CI [0.12-0.87]) and to the presence of at least three cardiovascular risk factors (OR= 0.28; 95% CI [0.10 - 0.80]). However, it correlated positively to gastrointestinal tumors (OR= 3.9; 95% CI [1.3- 11.7]) and to imaging studies during the last month of life (OR= 3.4; 95% CI [1.3 - 9.0]). The TPN administration did not correlate to hospitalization during the last two weeks of life.

Conclusion: The adoption of an optimal palliative care approach in Middle Eastern cancer patients at the end of life remains challenging. Oncologists seem to consider cardiovascular risk factors as a probable surrogate to predict complications of TPN.
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September 2019

[A breast cancer case in the only Lebanese family with Fabry disease].

Bull Cancer 2019 Nov 2;106(11):1065-1066. Epub 2019 Oct 2.

Hôpital universitaire de Hammoud, département d'hématologie-oncologie, Sidon, Liban; Université Saint-Joseph, faculté de médicine, département d'hématologie-oncologie, Beyrouth, Liban. Electronic address:

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http://dx.doi.org/10.1016/j.bulcan.2019.06.007DOI Listing
November 2019
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