Sorafenib-Induced Erythema Multiforme Major and Severe Hepatic Failure in Metastatic Hepatocellular Carcinoma: A Case Report

Sorafenib, a kinase inhibitor, is known to cause skin toxicity, which sometimes leads to treatment interruption or drug dose reduction. Erythema multiforme (EM) is one of these dermatologic toxicities induced by sorafenib. We report the case of a 28-year-old male with hepatocellular carcinoma (HCC). Two months after surgery, the patient presented with multiple metastases to the retroperitoneal lymph nodes and lungs. Therefore, systemic therapy with sorafenib was indicated. While receiving the medication, the patient presented signs compatible with EM. The signs occurred on the torso and then spread to the rest of the body. Sorafenib treatment was interrupted the same day when skin lesions appeared and moisturizers with topical steroids and oral antihistamines were prescribed. The skin lesions decreased in size but without significant cutaneous improvement. The patient showed biologically severe liver failure and radiological progression. Because of the severe hepatic failure, initiation of intravenous steroids and establishment of another line of chemotherapy following tumor progression were contraindicated. The decision of the multidisciplinary staff with patient consent was to proceed with the best supportive care. The patient died in ambulatory care 12 days after discharge and local treatment. This report highlights the possibility of developing severe EM while receiving sorafenib. Patients with HCC who have liver resection without liver dysfunction should not be administered sorafenib, or it must be used with caution at very low doses and accompanied by close and regular follow-ups to avoid disease progression and deaths.

Comparison of different Pancreatic cancer treatments: a three-year retrospective study in the oncology center of Tangier university hospital, Morocco

BACKGROUND

Pancreatic cancer is among the most lethal malignancies, with a 5-year overall survival (OS) of less than 10% for all stages. The present study aims to evaluate the epidemiological and clinical characteristics, as well as the results of different treatments of patients diagnosed and treated between 2019 and 2021 in the Oncology Center of Tangier, University Hospital, Morocco.

METHODS

To compare the evolution of the pancreatic cancer between the different chemotherapy regimens, a retrospective study was performed using data collected over a period of 3 years. For each patient, the data were described and statistically analyzed in the dedicated operating sheet.

RESULTS

55 pancreatic cancer patients were included in this study, and the median follow up was 3 months. The mean age of patients was 59.5 ± 10.3 years (extremes 34-79) and the sex ratio male/female was 0.9. Most patients were diagnosed with adenocarcinoma (92.3%), but metastatic stage was the most frequent (56.4%). The surgery was applied to 16.36% of patients. 10.9% of patients have received adjuvant chemotherapy and 76.4% received palliative chemotherapy. Chemotherapy regimens included mainly Gemcitabine and Folfirinox. The median OS was significantly longer for patients treated with Folfirinox versus Gemcitabine (6 months versus 3 months, p-value < 0.016). The median OS for patients that received Folfirinox and Gemcitabine successively (19.7 months) was significantly longer compared to patients that received a monotherapy with either Folfirinox or Gemcitabine alone (p-value < 0.016).

CONCLUSION

These findings reinforce the use of advanced methods for earlier detection of pancreatic cancer and the development of effective immunotherapies or more targeted therapies.

Cancer in Moroccan elderly: the first multicenter transverse study exploring the sociodemographic characteristics, clinical profile and quality of life of elderly Moroccan cancer patients

Background

Moroccan incidence of cancer is increasing with the lengthening of life expectancy. Data regarding elderly Moroccan cancer patients are lacking. In the context of our project aiming to develop an adapted version of the Comprehensive Geriatric Assessment CGA to the Moroccan population, we launched the first Moroccan multicenter transverse study to explore the characteristics of elderly Moroccan cancer patients.

Methods

The study was conducted in nine Moroccan medical oncology departments. Patients were enrolled over 4 months. Inclusion criteria were patients aged 65 years or over with verified solid cancer. The questionnaire included four sections: socio-demographic and economic data, clinical data, vulnerability and EORTC-QLQ C30. We explored the entire included population. Then, we compared the results according to age (65–70 years old and ≥ 71 years old) and sex. We also explored the correlation between G8 scores and the ability to practice religion as an indicator of fitness level.

Results

In total, 164 patients were enrolled. The mean age was 73.18 ± 6.01 years. The majority of patients were married, lived with their children and received their financial income from them. Fifteen percent of families asked to hide the diagnosis from the patient. Breast (23%), colorectal (15.9%) and lung (14%) cancers were the most frequent, and 83.5% had an abnormal G8. The majority of the patients were independent for basic daily activities. Female patients had poorer social and economic conditions. Abnormal G8 was correlated with religious practice and quality of life scores.

Conclusion

This is the first multicenter prospective study designed to collect data on the lifestyle and clinical profiles of elderly Moroccan cancer patients as an Arab and Muslim population. Our study shows that it is a well-cared-for population with strong social ties. However, there is deep economic vulnerability, especially among women, requiring urgent care. Religious practice is an important daily activity for our elderly patients and should be included in the Moroccan CGA.

Iterative and prolonged remission in metastatic breast cancer using pegylated irinotecan: a case report

Introduction

Pegylated irinotecan NKTR-102 is a topoisomerase I inhibitor-polymer conjugate. This new formulation of irinotecan has been evaluated in a phase II clinical trial and is showing remarkable activity. To the best of our knowledge, this is the first case report of an impressive iterative response to pegylated irinotecan NKTR-102 in metastatic breast cancer.

Case presentation

We report the case of a 49-year-old Caucasian woman diagnosed with metastatic luminal A breast cancer with initial bone followed by liver and bone marrow metastases, treated with three lines of hormonal therapy, targeted therapy and six lines of chemotherapy. She showed no major response to conventional treatment, whereas, the tumor shrinkage under pegylated irinotecan NKTR-102 was impressive, durable and iterative.

Conclusions

Reintroduction of an active drug is a valid approach as illustrated by our case. The results of the current phase III trials of pegylated irinotecan NKTR-102 are eagerly awaited.

Case Report: Mammary and rectal metastases from an ovarian cancer: report of two cases and review of literature

In this paper we report two interesting cases of metastatic ovarian cancer. The first case is a patient who developed rectal and breast metastases mimicking an inflammatory breast cancer. In the second case, subclinical breast and axillary lymph node metastases were revealed by PET/CT. Metastases in the breast originating from solid tumors are extremely rare. The ovarian primitive is the fourth most common origin. The occurrence of breast metastasis is associated with an advanced disease and a poor prognosis. Their incidence is increasing since they are found more often due to better imaging techniques and to better treatment that, accordingly, improve patients' survival. Thus, unusual sites of metastases are more and more reported. Indeed, some authors reported the occurrence of colorectal metastases from ovarian cancer. However, they remain much less frequent.

Psychosocial impact of parental cancer on Moroccan children: Result of an exploratory study

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Background: Cancer diagnosis and treatment of a parent has considerable impact on the lives of their children. The aim is to identify whether the diagnosis of parental cancer is associated with an increased risk of psychosocial difficulties amongst children and adolescents in Moroccan population. Methods: At the National Institute of Oncology in Rabat, from September to December 2009, 194 Children and adolescents whose parents were diagnosed with a cancer were interviewed. We used a questionnaire covering socio-epidemiological characteristics exploring the disease repercussions to their psychic. Results: There were 52% son and 48% daughters, aged between 10-15 years old (yo) in 26%, 15 - 20 yo in 44% and 20-22 yo in 30% of cases respectively. 67% were studying. Communication difficulties between parents with cancer and their children were observed in 100%. 20% of children were not aware of their parents' cancer. Only the children who were informed about their parents’ cancer were interviewed. All of them had traumatism, initial denial and anguish of loss of the parent. Guilt feelings were present in 90% of cases. 87% of them felt abandoned. The fear of having a stepfather or stepmother was observed in 41.2% of daughters and 12.8% of son, especially when the parent who had the cancer was the mother. Fear of inheriting cancer was seen in 80% of daughters whose mothers were suffering from breast cancer. The process of parentification was benign in 54% and destructive in 23% of cases. Enuresis was present in 30% of cases (20.6% in daughters 9.4% in son). Introversion was seen in 70% of cases. 30% of children noted a regression in their school abilities. Toxic habits appeared in 15% of cases. Conclusions: The result of this transversal study suggests that Moroccan children who have parents suffering from cancer, experiment an important distress. Unfortunately, the Moroccan parents do not use the services of psychological assistance. Thus, we should be vigilant to detect any potential psycho-pathologic disorders and to enable the family to live as normal as possible.

Socio-demographic and psychological features in Moroccan patients with cancer: A prospective multicentric large cohort study

e20516

Background: To explore socio-demographic features and functional dimensions in patients included in a large Moroccan cohort study. Methods: This is the first Moroccan study which was designed to evaluate the quality of life in cancer patients. It is a prospective multicentric cohort study (the 10 existing centers). Patients with breast, cervical, lung or colorectal cancer were included during 2009. EORTC QLQ C30, BR23, CX24 and LC13 questionnaires were used after a transcultural validation. Results: Over 12 months, 2903 patients were included. Breast cancer was the most common (50.4%). Socio-demographic features: The average age at diagnosis was 52.7 years old. Most of them were women (75%). All of patients were Muslims. 75.1% were married. 60% were illiterate. 20% of patients were professionally active and 59.3% were housewives. 27.2% came from rural towns. The socioeconomic status was 65.8% low and 32.4% intermediate. 71.4% of patients had no social welfare. To get to the oncology centers, 77.8% of patients used public transportation while only 0.6% of total cases came in ambulances. The average distance was 150 kilometers. Psychosocial dimensions: For all types of cancer, functional dimensions were noticeably deteriorated with the stage. The lowest scores were observed in lung cancer, whereas the highest ones were for breast cancer. (Emotional function 62.54 vs. 53.05 professional function and leisure 74.14 vs. 42.22 cognitive activity 83.25 vs 26.93 social activity 86,17 vs. 77.69 p<0.001). The financial problems score was higher in lung cancer (68.34). The future perspective was the most affected dimension in QLQ BR23 questionnaire (score40.51), while in QLQ CX24, the sexual enjoyment was the most impacted dimension (score 52.1). Conclusions: In the Moroccan culture, the social relationships the social relationships offset the negative impact of cancer on other functional dimensions. Social activity scores were the less affected. Financial issues are the major concern, resulting in a negative impact on the quality of life of our patients. Finally, over a period of one year, the scores of reported dimensions were significantly improved by the cancer treatment.

Metastatic ameloblastoma responding to combination chemotherapy: case report and review of the literature

BACKGROUND

Ameloblastoma is a rare benign odontogenic tumor with locally aggressive behavior and a high recurrence rate. When metastases occur, which are uncommon, lungs constitute the most frequent site involved. Malignant ameloblastomas are different from ameloblastic carcinomas. Malignant ameloblastomas are tumors considered metastatic despite the appearance of well-differentiated or benign histology, while ameloblastic carcinomas are histologically malignant in both primary and metastatic sites.

CASE PRESENTATION

A 24-year-old Moroccan man presented a malignant ameloblastoma of the mandible. The tumor was entirely resected. Five years later, a local recurrence occurred. Our patient was treated by exclusive radiotherapy with persistence of a residual disease. After two years he developed multiple lung metastases. Our patient received a combination chemotherapy using doxorubicin and cisplatin.

CONCLUSION

Less than 50 cases of ameloblastoma with metastases have been reported. There is still no standard treatment for metastatic ameloblastoma. Only through continuous reporting of such cases will clinicians be able to draw an optimal strategy for management of this pathology.

Chemotherapy in advanced bladder cancer: current status and future

Bladder cancer occurs in the majority of cases in males. It represents the seventh most common cancer and the ninth most common cause of cancer deaths for men. Transitional cell carcinoma is the most predominant histological type. Bladder cancer is highly chemosensitive. In metastatic setting, chemotherapy based on cisplatin should be considered as standard treatment of choice for patients with good performance status (0-1) and good renal function-glomerular filtration rate (GFR) > 60 mL/min. The standard treatment is based on cisplatin chemotherapy regimens type MVAC, HD-MVAC, gemcitabine plus cisplatin (GC) or dose dense GC. In unfit patients, carboplatin based regimes; gemcitabine plus carboplatin or methotrexate plus carboplatin plus vinblastine (MCAVI) are reasonable options. The role of targeted therapies when used alone, or in combination with chemotherapy, or in maintenance, was evaluated; targeting angiogenesis seem to be very promising. The purpose of this literature review is to highlight the role of chemotherapy in the management of advanced transitional cell carcinoma of the bladder.

Successful management of primary non Hodgkins lymphoma of the cranial vault

Primary bone lymphoma (PBL) is a relatively uncommon entity. However, involvement of the cranial vault is an unusual manifestation of aggressive non-Hodgkin's lymphoma. We report the case of a 42-year old immunocompetent woman who presented with an enlarging mass involving the right parietal bone. Magnetic resonance imaging (MRI) of the brain revealed an expansive tumor that affects the right parietal bone. Computed tomographic (CT) scans of the abdomen, chest and pelvis were negative for lymphadenopathy or organomegaly. Biopsy of the mass showed diffuse large B-cell non-Hodgkin's lymphoma confirmed by immunohistochemical study. The patient had a complete response after 4 cycles of chemotherapy followed by external beam radiotherapy. After a follow-up of more than 9 months the patient is still in good local control without distant metastasis. The aim of our work is to report a case of Primary bone lymphoma of the cranial vault with good response to treatment combining sequential chemotherapy and radiotherapy.

Symptomatic hypopituitarism revealing primary suprasellar lymphoma

BACKGROUND

The most common cause of hypopituitarism is pituitary adenoma. However, in the case of suprasellar masses different etiologies are possible. We report an unusual case of primary suprasellar lymphoma presented with hypopituitarism.

CASE PRESENTATION

A 26 year old woman presented with amenorrhea, galactorrhea and neurological disorders. Also, the laboratory work-up revealed partial hypopituitarism. The magnetic resonance imaging of the head showed a suprasellar mass. A presumptive diagnosis of granulomatous processes was made and the patient was given steroid therapy. Repeated brain MRI detected new lesions in the brain with regression of the suprasellar mass. Stereotactic biopsy of the paraventricular lesion revealed the diagnosis of B-cell lymphoma.

CONCLUSION

This case presentation reports a rare cause of hypopituitarism. Primary suprasellar lymphoma is extremely rare and represented a real diagnostic challenge. Besides, suprasellar masses are varied in aetiology and can present diagnostic problems for a radiologist. Also, because of the increased incidence of PCNSL, lymphoma must be kept in mind in the differential diagnosis of lesions in the suprasellar region.