Cancer in Lebanon: A Review of Incidence Rates from 2008 to 2015 and Projections Till 2025

Management of Metastatic Urothelial Carcinoma in Emerging Markets (EM): An Expert Opinion

Urothelial carcinoma (UC) is the 10th most common cancer globally with an almost 4 times higher prevalence in men. The main risk factors for development of urothelial carcinoma are advanced age, smoking, arsenic contamination, exposure to carcinogens. Metastatic urothelial carcinoma (mUC) has overall poor prognosis with a 5-year overall survival rate of only < 5%. The standard of care comprises of platinum-based chemotherapy, but the responses are often not sustained. A working group was established with an objective to discuss the most recent clinical data on the genitourinary tumors of interest and comprised of experts across Latin America, Emerging Asia (except China, Japan, and South Korea), Africa, and the Middle East (known as Emerging Markets or EM). There is an evident disparity in terms of uneven mortality and incidence rate distribution among various regions. There is a lack and/or insufficient data on epidemiology, treatment, and outcomes in the EM. The lack of registries impacts the healthcare decisions and the lower incidence from the region might not be reflective of the true disease burden. The treatment outcomes of mUC can be improved by understanding the current disease burden and treatment approach of mUC and identifying the gaps and challenges associated with management. Hence, a literature review was developed to summarize the current disease burden and treatment approach of mUC across EM. The review also highlights the unmet needs for mUC management in EM and suggests a way forward to improve the current situation in order to better serve the patients.

Cancer Incidence and Mortality Estimates in Arab Countries in 2018: A GLOBOCAN Data Analysis

BACKGROUND

Arab countries are projecting increase in cancer incidence and mortality; however, there are limited studies that compare the epidemiology of cancer in Arab countries compared with other parts of the world.

METHODS

We used the 2018 Global Cancer Observatory data to compare the age-standardized incidence and mortality estimates in Arab-speaking countries to the rest of the world.

RESULTS

Rates for incidence and mortality for all cancers in Arab countries were lower than the world's rates but the incidence rates of non-Hodgkin and Hodgkin lymphoma, bladder, breast, and liver cancers were higher. Arab countries generally had higher mortality-to-incidence ratio than the world's ratio. Incidence rates, even in age-specific groups, varied between subregions of Arab countries (the Levant, Arabian Gulf, and Arab African subregions), and Iraq and Egypt, suggesting some common and unique environmental factors and possible ethnic or genetic heritages.

CONCLUSIONS

There are essential scopes for improvements in Arab countries including better treatments to reduce the high mortality-to-incidence ratio, and supporting vaccination programs and antiviral treatments that would prevent the prevalent viral infection-related cancers. The high incidence of several cancers in younger Arabs suggests genetic factors and underlines the importance of genetic epidemiology studies.

IMPACT

This study is an essential reference to evaluate and monitor the progress of national cancer initiatives in Arab countries for surveillance and prevention programs and improving clinical management. The study also provides a comprehensive snapshot of cancers in a unique region that could shed light on the interplay of environmental, lifestyle, and genetic risk factors.

Cancer care in Lebanon and the climate-proofing of a burning phoenix

Beirut, the capital of Lebanon, has been burnt and rebuilt seven times, earning the title of an urban phoenix. Its strategic geolocation in the heart of the Mediterranean gave the country leverage for the economy, by becoming a hotspot for trade through its different ports. Its cultural and religious diversity provided a fertile ground for businesses to grow, most importantly the banking and healthcare sector. The strategic location also put the country in the eye of the storm of different major crises, leaving the small country a crippling state, swamped with political corruption, nepotism, fragile infrastructure, and an overall dysfunctional system. In October 2019, the collapse of the banking system led to a state of hyperinflation in the country, with the financial and economic crisis in Lebanon now ranked in the top 10 most severe crises episodes globally since the mid-nineteenth century. This crisis exposed the extent of corruption and dysfunctionality: a fragmented healthcare sector struggling to protect the vulnerable populations especially cancer patients, a workforce seeking exodus due to challenging work conditions amid a state of hyperinflation, and a fragile infrastructure unable to withstand climate changes in one of the hottest and driest areas on the planet, the Middle East. Despite being caught in this turmoil, Lebanon still managed to update its national climate pledge under the Paris Agreement. However, the financial recovery plan that is aiming to revive the economy and overcome short-term financial challenges, has a risk of affecting long-term climate-proofing efforts. In a multilevel crisis-torn country, it might be difficult to look on the impact of climate change in particular on cancer care, without accounting for the other ongoing troubles. In such circumstances, protecting public health becomes a major challenge yet a priority. The resilience of the system is currently being tested as the crisis evolves, and should be continuously monitored.

Can plasma vitamin C predict survival in stage IV colorectal cancer patients? Results of a prospective cohort study

Background and Aims

In light of the inconclusive evidence on the association between vitamin C status and colorectal cancer (CRC) outcome, this study assessed the prognostic value of vitamin C in participants with metastatic CRC (mCRC).

Methods

Adults with mCRC and cancer-free controls were recruited in this prospective cohort study to allow for comparison of vitamin C levels with healthy individuals from the same population. Sociodemographic, lifestyle, medical variables, BRAF and KRAS mutations, as well as Vitamin C plasma level and food intake were evaluated. Predictors of diminished vitamin C level were assessed via multivariate logistic regression. Mortality and progression free survival (PFS) among mCRC participants were analyzed based on plasma vitamin C level.

Results

The cancer group (n = 46) was older (mean age: 60 ± 14 vs. 42 ± 9.6, p = 0.047) and included more males (29% vs. 19%, p &lt; 0.001) than the cancer-free group (n = 45). There was a non-significant difference in the vitamin C intake between the two groups; however, the mean plasma vitamin C level was lower in the cancer group (3.5 ± 3.7 vs. 9.2 ± 5.6 mg/l, p &lt; 0.001). After adjusting for age and gender, the cancer group was more likely to be deficient compared to the cancer-free group [Adjusted Odds Ratio (95%CI): 5.4 (2.1–14)]. There was a non-significant trend for higher mortality in the vitamin C deficient cancer group (31% vs. 12%, p = 0.139). PFS did not differ based on vitamin C deficiency and patients with BRAF and KRAS mutations did not have significant differences in vitamin C levels.

Conclusion

mCRC patients have lower plasma vitamin C levels than healthy controls. The trend toward higher mortality in the vitamin C deficient cancer group was not statistically significant. Whether this phenomenon affects survival and response to treatment warrants further exploration in phase III clinical trials.

The Lebanese Red Algae Jania rubens: Promising Biomolecules against Colon Cancer Cells

Colorectal cancer (CRC) is ranked the second most lethal type of tumor globally. Thus, developing novel anti-cancer therapeutics that are less aggressive and more potent is needed. Recently, natural bioactive molecules are gaining interest as complementary and supportive antineoplastic treatments due to their safety, effectiveness, and low cost. Jania rubens (J. rubens) is a red coral seaweed abundant in the Mediterranean and bears a significant pharmacological essence. Despite its therapeutic potential, the natural biomolecules extracted from this alga are poorly identified. In this study, the proximal analysis revealed high levels of total ash content (66%), 11.3% proteins, 14.5% carbohydrates, and only 4.5% lipids. The elemental identification showed magnesium and calcium were high among its macro minerals, (24 ± 0.5 mg/g) and (33 ± 0.5 mg/g), respectively. The Chlorophyll of J. rubens was dominated by other pigments with (0.82 ± 0.02 mg/g). A 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay identified effective antioxidant activity in various J. rubens extracts. More importantly, a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) tetrazolium reduction and wound healing assays indicate that organic extracts from J. rubens significantly counteract the proliferation of colon cancer cell lines (HCT-116 and HT-29) and inhibit their migratory and metastatic properties in a dose and time-dependent manner. Overall, this study provides insight into the physicochemical properties of red seaweed, J. rubens, and identifies its significant antioxidant, cytotoxic, and anti-migratory potential on two colorectal cell lines, HCT-116 and HT-29.