Metastatic clear cell sarcoma of the pancreas:A sporadic cancer

Primary or secondary clear cell sarcoma of the pancreas is an exceedingly rare and aggressive disease.In addition to pathology,molecular analysis is pivotal in differential diagnosis,especially with malignant melanoma.A key aspect in identifying clear cell sarcoma is specific genetic alterations,notably the translocation of t(12;22)(q13;q13),a diagnostic hallmark of this sarcoma subtype,which is absent in malignant melanoma.Treatment of primary clear cell sarcoma of the pancreas is the same as that for adenocarcinoma.

Fasting and Cancer: Practice and Patients’ Quality of Life during Ramadan

Introduction: Ramadan is the ninth lunar month of the Muslim calendar, and fasting during Ramadan is one of the five pillars of Islam. Muslim cancer patients and health professionals are faced with a dilemma between the necessity of fasting and its possible adverse effects during Ramadan on the health status of cancer patients. We believe that addressing the issue of fasting in cancer patients is of global interest. Objectives: Prevalence of fasting in cancer patients during Ramadan;Predictive factors of Ramadan fasting in cancer patients;The effect of fasting during Ramadan on the quality of life of cancer patients. Materials and Methods: A structured questionnaire was used to interview adult cancer patients who received chemotherapy IV—or oral treatment at the medical oncology department at the Hassan II University Hospital in Fez during the month of Ramadan 1443 Hijri (April to May 2022). The quality of cancer patients’ lives during their fasting practice in Ramadan was evaluated via the QLQ-C30 questionnaires. Results: 48% of patients did not fast during Ramadan, 22% and 30% were partial and complete fasters respectively. Patients, with OMS 0 to 1, who receive outpatient treatment, non-metastatic patients and patients on oral treatment were more frequent in the completely fasted group. All these factors showed statistically significant values (p < 0.05). 44% of patients sought advice from the treating oncologist if they could fast, while only 15% of patients during Ramadan asked an imam if they could be excused from fasting. A comparison of the QLQ-C30 data showed a significant improvement in emotional functioning with fasting, however, patients had clinically more but not significantly fatigue after fasting. Conclusion: Female gender, good WHO, non-metastatic disease, and oral or outpatient treatment were more likely to be fasting. This study argues that fasting did not influence the quality of life, and appears to significantly improve emotional functioning in cancer patients during Ramadan.

Effect of exercise on colorectal cancer prevention and treatment

In recent years, because of improved cancer screening, detection and treatment modalities, a rapid increase in the population of colorectal and other cancer survivors has been observed. The increasing population has justified the requirement of preventive strategies such as lifestyle modifications with regard to obesity, physical activity, diet and smoking. Physical activity may prevent approximately 15% of the colon cancers. Furthermore, several observational studies have demonstrated the efficacy and dose-dependent and anti-cancer effects of exercise on decreasing the mortality and risk of recurrence before and after the colorectal cancer(CRC) diagnosis. However, the required exercise dose,type and intensity are yet unclear. The results of randomised prospective studies are expected to determine the optimal amount, type and intensity of exercise and formulate the most appropriate exercise plan and guidelines, according to the requirements and comorbidities of the patients. In addition, recent studies have focused on the molecular and genetic mechanisms underlying the effect of physical activity on disease outcomes and recurrence rates. This review aimed to investigate the effects of physical activity and the biological basis of these effects in preventing the risk and recurrence of CRC and decreasing the hazards of cancer and cancer treatment.

Dual HER2 inhibition strategies in the management of treatment-refractory metastatic colorectal cancer:History and status

Human epidermal growth factor receptor 2(HER2) signaling pathway activation has been identified as a contributor to de novo or acquired resistance to epidermal growth factor receptor(EGFR) inhibitors in a small subset of patients with metastatic colorectal cancer(mCRC). Dual anti-HER2-targeted treatment exhibits strong antitumor activity in preclinical models of HER2-positive mCRC, supporting its testing in clinical trials. The HERACLES trial at four Italian academic cancer centers has confirmed the effectiveness of dual blockage of HER2 with trastuzumab plus lapatinib in patients with heavily pretreated HER2-positive mCRC, refractory to the anti-EGFR antibodies cetuximab or panitumumab. Here, we reviewed the preclinical studies exploring the role of HER2 signaling in the development of anti-EGFR therapy resistance and discussed the status of clinical trials assessing the activity of HER2 inhibitors in this setting.

Plasma Concentrations of Some Trace Element and Heavy Metals in Patients with Metastatic Colon Cancer

Purpose: It is well known that trace elements and heavy metals play a significant role in human health and disease. These elements play an important role in different metabolic pathways of cells and tissues. Trace element deficiency or excess is implicated in the development or progression of some cancers. We present a study which investigates serum/ plasma levels of trace-heavy elements in metastatic colon cancer patients and healthy subjects. Methods: Blood samples were collected from 29 healthy subjects and 40 patients with metastatic colon cancer in Oncology Department of Medical School of Yuzuncu Yil University. In both groups, the serum levels of copper (Cu), magnesium (Mg), lead (Pb), chromium (Cr), zinc (Zn) selenium (Se), manganese (Mn), and cadmium (Cd) were determined. Results: Higher levels of Cu, Mg, Pb, Cr, Zn, Mn and Cd were seen in patients with metastatic colon cancer compared to healthy subjects and these findings were statistically significant (p 0.05). Se levels were noted to be lower in patients with colon cancer in comparison to healthy subjects and this finding was also statistically significant (p 0.05). Conclusions: According to our findings there was significant diffence in trace elements and heavy metals levels between healthy subjects and metastatic colon cancer patients. Therefore heavy metal and trace elements may have prognostic significance in complex disorders including colon cancer. However, further comprehensive studies are needed in order to advance our understanding of the relationship between heavy metal and trace elements and their role in cancers.

Practical Use of Gemcitabine and Cisplatin Combination Therapy as First-Line Treatment for Japanese Patients with Advanced Biliary Tract Cancer

Gemcitabine and cisplatin combination therapy (GC) is accepted as a standard treatment for advanced biliary tract cancer (BTC). However, little information is available regarding such treatment in the clinical practice setting in Japan. We retrospectively examined the clinical data of patients with unresectable or recurrent BTC who received GC as first-line treatment. The regimen consisted of cisplatin (25 mg/m2) and gemcitabine (1000 mg/m2) administered intravenously on days 1 and 8 of repeated 3-week cycles. Twenty patients were analyzed. A total of 148 cycles of GC was administered, with a median of 8 and a range of 1 to 18 cycles. Treatment delay and dose reduction were noted in 35 (24%) and 41 (28%) of the 148 cycles, respectively. The major adverse events of grade 3 or 4 included neutropenia (50%), leukopenia (45%), anemia (30%), and thrombocytopenia (15%). Nonhematologic toxicities included nausea (10%), appetite loss (10%), and fatigue (10%). Median progression-free and overall survival times were 6.9 and 12.3 months, respectively. Gallbladder cancer showed a significantly higher response rate than did other types of BTC (chi-squaretest, P = 0.002). GC was thus effective and well tolerated as first-line chemotherapy for Japanese patients with advanced BTC in the clinical practice setting.

Impact of adjuvant treatment modalities on survival outcomes in curatively resected pancreatic and periampullary adenocarcinoma

Background： We examined the impact of adjuvant modalities on resected pancreatic and periampullary adenocarcinoma（PAC）.Methods： A total of 563 patients who were curatively resected for PAC were retrospectively analyzed between 2003 and 2013.Results： Of 563 patients, 472 received adjuvant chemotherapy（CT） alone, chemoradiotherapy（CRT） alone, and chemoradiotherapy plus chemotherapy（CRT-CT） were analyzed. Of the 472 patients, 231 were given CRT-CT, 26 were given CRT, and 215 were given CT. The median recurrence-free survival（RFS） and overall survival（OS） were 12 and 19 months, respectively. When CT and CRT-CT groups were compared, there was no significant difference with respect to both RFS and OS, and also there was no difference in RFS and OS among CRT-CT, CT and CRT groups. To further investigate the impact of radiation on subgroups, patients were stratified according to lymph node status and resection margins. In node-positive patients, both RFS and OS were significantly longer in CRT-CT than CT. In contrast, there was no significant differencebetween groups when patients with node-negative disease or patients with or without positive surgical margins were considered.Conclusions： Addition of radiation to CT has a survival benefit in patients with node-positive disease following pancreatic resection.

CRKL and CK2 <i>β</i>over Expression Are Independent Predictors of Patients Survival in Endometrioid Endometrial Carcinoma

Context: The prognostic significance of expression of V-Crk avian sarcoma virus CT10 oncogene homolog-like (CRKL) and Protein kinase CK2 β in endometroid carcinoma is not fully clarified. Aim: To assess the prognostic values and clinicopathological roles of CRKL and CK2 β expression in endometroid carcinoma by correlation their expression levels with clinicopathological parameters, response to therapy, and recurrence of the tumor and patients survival. Settings: Faculty of Medicine, Zagazig University, and Mansoura University. Methods: CRKL and CK2 β expressions were evaluated in 50 paraffin blocks EC patients that were followed up for 5 years. The relationship between their level of expressions, clinicopathological criteria and prognosis of patients was analyzed. Statistical analysis used: SPSS 22.0 for windows (SPSS Inc., Chicago, IL, USA) and MedCalc windows (Software bvba 13, Ostend, Belgium). Results: High expression of CRKL and CK was positively correlated with higher grade of the tumor (p = 0.004 and 0.006 respectively), presence of L.N metastases (p = 0.009 and 0.003 respectively), presence of distant metastases (p = 0.029 and 0.003 respectively) and advanced FIGO stage (p 0.001), poor response to therapy (p = 0.046 and 0.005 respectively), higher incidence of recurrence of the tumor after therapy (p = 0.004 and 0.048 respectively), higher incidence of cancer progression p = 0.018 and 0.044 respectively), poor PFS (p = 0.008 and 0.013 respectively), and OS rates

Shattering the castle walls: Anti-stromal therapy for pancreatic cancer

Despite the availability of potent chemotherapy regimens, such as 5-fluorouracil, folinic acid, irinotecan, and oxaliplatin(FOLFIRINOX) and nab-paclitaxel plus gemcitabine, treatment outcomes in metastatic pancreatic cancer(PC) remain unsatisfactory. The presence of an abundant fibrous stroma in PC is considered a crucial factor for its unfavorable condition. Apparently, stroma acts as a physical barrier to restrict intratumoral cytotoxic drug penetration and creates a hypoxic environment that reduces the efficacy of radiotherapy. In addition, stroma plays a vital supportive role in the development and progression of PC, which has prompted researchers to assess the potential benefits of agents targeting several cellular(e.g., stellate cells) and acellular(e.g., hyaluronan) elements of the stroma. This study aims to briefly review the primary structural properties of PC stroma and its interaction with cancer cells and summarize the current status of antistromal therapies in the management of metastatic PC.

Existing anti-angiogenic therapeutic strategies for patients with metastatic colorectal cancer progressing following first-line bevacizumab-based therapy

Continuous inhibition of angiogenesis beyond progression is an emerging treatment concept in the management of metastatic colorectal cancer patients with prior bevacizumab exposure. Treatment options include the continuation or reintroduction of bevacizumab during the second-line chemotherapy or switching to a different antiangiogenic monoclonal antibody such as aflibercept or ramucirumab. In the selection of treatment, patient-based factors such as performance status, age, tumor burden, and tolerance and sensitivity to the firstline bevacizumab-based therapy, as well as treatment-related factors such as toxicity, efficacy, and cost, should be taken into consideration.

Coincidence of three solid tumors in a patient with multiple myeloma

Multiple primary cancers （MPC） are specific .malignant tumors type, manifesting as more than one primary tumor diagnosed in the same patient, either simultaneously or sequentially. The diagnostic criteria include： the cancer must be clearly malignant as determined by histological evaluation; each cancer must be geographically separate and distinct;