[Protein tyrosine kinase inhibitors in cancer therapy]. / Bilan des inhibiteurs de protéine tyrosine kinase dans le traitement des cancers.

The tyrosine kinase inhibitors (TKI) are small molecules of low molecular weight that inhibit tyrosine kinases, enzymes responsible for the activation of signal transduction cascades. Currently, a number of TKI received approval in various cancers, while others are in clinical development process: TKI are specifically clinically active when they target a tyrosine kinase (TK) with constitutional activity subsequent to a mutation, being then a master-gene driving transformation and tumour progression. Already, this drug-family provides a major therapeutic weapon against cancer.

Aggressive ovarian psammocarcinoma: a case report.

Serous psammocarcinoma is a rare form of ovarian carcinoma characterized by massive psammoma body formation. We report a new case of aggressive ovarian psammocarcinoma with omental and peritoneal implants.

[Pleural extramedullary hematopoiesis]. / La plèvre myéloïde.

INTRODUCTION: Agnogenic myeloid metaplasia, associated with myelofibrosis, is a myeloproliferative disorder. Extramedullary hematopoiesis in the pleura is rare and its prognosis is often severe. EXEGESIS: Herein we report a 64-year-old woman, who presented with pleural extramedullary hematopoiesis, treated by hydroxyurea-based chemotherapy with disease control. CONCLUSION: Clinical, histological, therapeutic and evolutive aspects of this uncommon entity will be reviewed.

Novel agents in second-line therapy for EGFR wild-type Advanced Non-Small-Cell Lung Cancer.

Lung cancer is the leading cause of cancer-related mortality worldwide owing to its advanced-stage at the time of diagnosis. The majority of patients will require a second-line therapy after progression during first-line treatment. While treatment for NSCLC with EGFR mutation or EML4/ALK fusion, target therapy is the favored second-line therapy if not already used in first-line therapy, NSCLC with EGFR wild-type remains an unmet need and many oncologists favor cytotoxic therapy. Recently, a better understanding of lung cancer biology, with a better selection of patients based on histology, molecular biology and the identification of potential target antigens in the immune system have significantly improved patient outcome. This article will provide an update on different treatment options available for patients with EGFR wild-type advanced NSCLC who relapse after first-line therapy, which includes essentially ramucirumab, vandetanib, nivolumab, and pembrolizumab and considerations that may allow clinicians to a better choice of agent for second-line therapy.

Bevacizumab in clinical practice.

The development of targeted therapies and especially angiogenesis inhibitor drugs is undoubtedly a major advancement in the treatment of cancer in the 21st century. Bevacizumab is a recombinant humanized monoclonal antibody directed against vascular endothelial growth factor that was approved for the treatment of multiple solid tumors, we have reviewed the side effects cited in clinical trials of bevacizumab and the guidelines for their management and we can conclude that bevacizumab, is generally well tolerated but is associated with increase in some adverse side effects for which monitoring is required particularly vascular and renal side effects including hypertension, proteinuria, thromboembolic events and hemorrhage. The better understanding of bevacizumab toxicity profile and the guidelines for their optimal management as well as the education of patients may allow prolonged therapy and thus improved clinical outcomes.

Pain and Cancer: A systematic review.

Pain is the most common symptoms in patients with cancer, a significant number of cases it is undiagnosed and under treated. It is important to understand the nature of the pain experienced by patients, to distinguish between nociceptive and neuropathic pain. Successful management of cancer pain requires a good knowledge of the causes of pain and various treatment available and information to manage their side effects. Pain has a significant negative impact on the patient and his family, therefore it needs to be managed urgently and appropriately.

Celiac disease, enteropathy-associated T-cell lymphoma, and primary sclerosing cholangitis in one patient: a very rare association and review of the literature.

Enteropathy-associated T-cell lymphoma (EATL) is a very rare peripheral T-cell lymphoma which is mostly associated with celiac disease. However, the association of primary sclerosing cholangitis and enteropathy-associated T-cell lymphoma is uncommon. Herein we report and discuss the first case of patient who presented simultaneously with these two rare diseases. It is a 54-year-old man who stopped gluten-free diet after 15 years history of celiac disease. The diagnosis was based on the histological examination of duodenal biopsy and the diagnosis of primary sclerosing cholangitis was made on liver biopsy, as well as the magnetic resonance cholangiogram. The treatment of EATL is mainly based on chemotherapy in addition to the optimal management of complications and adverse events that impact on the response to treatment and clinical outcomes, although the prognosis remains remarkably very poor.

Clinical prognostic factors in locally advanced nasopharyngeal carcinoma in Moroccan population.

BACKGROUND: Nasopharyngeal carcinoma is a distinct cancer of head and neck by its pathology, etiology, epidemiology and clinical behavior. Morocco is considered an endemic region with intermediate incidence. The aim of our report is to underline some clinical determinants of survival in locally advanced disease. PATIENTS AND METHODS: We conducted a retrospective study from January 2003 to December 2005. All patients with undifferentiated nasopharyngeal carcinoma treated in the National Institute of Oncology of Rabat, Morocco were recorded. Classified stage II to IVB disease according to TNM classification adopted by the AJCC (American Joint Committee of Cancer) 6th edition. RESULTS: The study included 339 patients, 122 women and 217 men (sex-ratio: 1.7). Mean age was 43 years old (range: 6-91years). Median duration to diagnosis was 6 months (range: 1-72) presenting symptoms at diagnosis were predominantly cervical lymph node in 79%. Forty- two patients have T1 tumors, 159 = T2 tumors, 64 = T3 tumors and 69 = T4 tumors. Sixty-five patients do not have lymph-node involvement, 49 have N1, 128 have N2 and 95 have N3. Three patients were at stage IIA, 57 patients were at stage IIB, 40 patients were at stage III, and 57 patients were at stage IVA and the remaining 96 patients were at stage IVB. Eighty-seven percent of patients underwent sequential chemoradiation and 17% underwent concurrent chemo-radiation (CTR). Response to induction chemotherapy was assessed in 235 patients. There were 31 patients with complete response and 59 patients have partial response. Complete response to radiotherapy was reached in 235 patients. Mean overall survival (OS) was 66.2%. Gender was a prognostic factor of OS (p=0.045) and DFS favoring women. Age wasn't a prognostic factors determining the outcome with no difference between patients aged more than 40 years old and patients younger. Tumor size was not a determinant of survival with a non-significant p in OS and DFS (0.27 and 0.46 respectively) but T4 stage patients appear to have a worse prognosis. Lymph node involvement was significantly determining the outcome either in OS and DFS (p=0.001 and 0.009 respectively). TNM stage was also a significant prognostic factor in OS but not in DFS favoring those with early stage (p= 0, 004 and p= 0, 13 respectively). The treatment strategy was not a significant prognostic factor with no difference between patients who underwent sequential or concurrent chemoradiation (OS p= 0, 48 and DFS p= 0, 9). In multivariate analysis, lymph-node involvement is the most significant factor. CONCLUSION: Our findings were mostly concordant with the literature data in endemic areas for TNM staging; however we are limited by the bias of retrospective studies. Prospective studies would be more accurate to define those prognostic factors in our population. KEYWORDS: UCNT, prognostic factors, endemic areas, lymph node involvement.

Metastatic desmoplastic small round cell tumor controlled by an anthracycline-based regimen: review of the role of chemotherapy.

Desmoplastic small round cell tumors (DSRCT) are rare and aggressive malignant neoplasms that usually occur in young males. They usually present intraabdominally with widespread peritoneal involvement at diagnosis and are sometimes associated with lymphadenopathies and liver metastases. Intraabdominal DSRCT is usually disseminated; no curative outcome has yet been achieved. We report a case of metastatic intraabdominal DSRCT controlled by an anthracycline-based regimen. A literature review of the treatment options, mainly chemotherapy, available for this unusual neoplasm, will be discussed. In patients with unresectable or metastatic disease, symptom control is most important because treatment modalities minimally impact survival. Palliative chemotherapy (mainly monotherapy) is preferable.

Pancreatic adenocarcinoma in young adults in a moroccan population.

INTRODUCTION: Pancreatic adenocarcinoma (PAC) is diagnosed generally in patients older than 60 years old of age. It is rarely diagnosed in young adults. There is a dearth of data in younger population of patients with pancreatic ductal adenocarcinoma regarding epidemiology, prognosis, and outcome. The aim of our study of young PAC patients was to characterize the clinical features of this distinct young population who were treated in the National Institute of Oncology of Rabat. We selected the age of 45 years and under as the cutoff point in defining our patient population of interest. MATERIALS AND METHODS: A retrospective analysis of patients referred to the national institute of oncology of Rabat with PAC, who were ≤45 years at the date of histological diagnosis, between January 2005 and February 2010, was performed. Epidemiological, clinical, and pathological staging and therapeutic and follow-up data were extracted. RESULTS: The study included 32 cases of PAC. Male:female ratio was 2:1. It represents 17% of the entire population (N = 176) of PAC referred to the National Institute of Oncology over the time of study period. Mean age was 44-years-old (range: 28-45). Age range distribution was 1, 5, and 26 patients in age subgroups 20-29, 30-39, 40-45 years, respectively. Four patients (12.5%) had a smoking history and two patients (6%) had diabetes. None of the patients had a positive familial history of PAC or chronic pancreatitis. Tumor was located in head of pancreas in 75%, body in 12.5 %, and tail in 12,5%. Six patients (18.7%) had localized resectable disease and underwent resection with curative intent. Seven (21.8%) presented with locally advanced, inoperable disease. Two of them received only concurrent chemoradiation. Nineteen patients (59.3%) presented as AJCC Stage IV. Four (12.5%) of the six patients with resected tumors underwent adjuvant chemoradiation. Median overall survival was 50% at median follow-up of 6.8 months. CONCLUSION: This is the first reported study in our patient population of young patients with PAC. The data suggested that patients with younger age seem to have the same poor prognosis as the typical (older) patient population with PAC. No risk factors have been identified. However, this study is retrospective and more larger studies are needed in this young population.

Growing teratoma syndrome and peritoneal gliomatosis.

The growing teratoma syndrome (GTS) is defined as a detection of an enlarged mass during or after chemotherapy treatment for germ cell tumor. We report a case of an 18-year-old girl treated for growing teratoma syndrome after chemotherapy for malignant germ cell tumor of the ovary associated with peritoneal gliomatosis. Chemotherapy induced normalisation of alpha-fetoprotein rate whereas there was an enlargement of the mass. Subsequent complete resection was performed, and the patient remained in good control for 60 months. This clinical picture suggested the diagnosis of "GTS". This syndrome can lead to confusion with progression or relapse of a germ cell tumour because of increase in tumour volume during chemotherapy, so it is important to recognize it.

Treatment for metastatic nasopharyngeal carcinoma.

Nasopharyngeal carcinoma (NPC) is a specific entity different from head and neck carcinoma. Incidence is higher in South-East Asia and North Africa. Prognosis, especially for locally advanced stages (IIB - IVB) and metastasis, remains poor: more than third of cases will present local and/or metastatic recurrence. Overall 5-year survival for all NPC stages ranges from 50% to 70%. The role of chemotherapy in metastasis is well established, and remains an important palliative treatment, although no randomized trial has been reported comparing the different chemotherapy regimens. As 1(st)-line treatment, platin-based regimens seems optimal; in 2(nd) line and after progression under platins, there is no consensus: monotherapy with drugs such as gemcitabine, capecitabine or taxanes has been the most widely tested, with acceptable results. Future trials should integrate targeted therapy, in the light of overexpression of EGFR1 and C-kit in NPC. The present study presents a review of the literature concerning the various studies of metastatic NPC.

[Psycho-social and religious impact of cancer diagnosis on Moroccan patients: experience from the National Oncology Center of Rabat]. / Impact psychosocial et religieux du diagnostic de cancer chez les patients marocains: expérience de l'Institut national d'oncologie de Rabat.

The impact cancer occurrence is variable according to the sociocultural issue, specific to each context and each area. In order to determine the psychosocial profile of Moroccan patients that have developed cancers, four studies were performed at the National institute of oncology (INO) in Rabat. These studies were prospective, included between 125 and 1,600 patients and were based on questionnaires developed by a medical oncologist, a psychologist and a sociologist. These studies were focused on the psychosocial characteristics of the Moroccan cancer occurrence on patients, the impact of cancer on the religious practice as well as the impact of cancer and its treatments on patients' sexuality. In this article, we will develop the particular characteristics of moroccan patients that were specific to their sociocultural context.