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Background Ifosfamide-induced encephalopathy (IIE) is a rare and serious adverse reaction. Thus far, no standard medication has been documentedto be efficient in the reversal of IIE, and while ifosfamide infusion interruption and hydration are recommended, methylene blue (MB) administration remains controversial. Methods We retrospectively reviewed medical records to assess cases with IIE after ifosfamide infusion. We included all patients having received an ifosfamide infusion during their hospitalization in the medical oncology unit of the National Institute of Oncology in Rabat, Morocco, between September 2016 and September 2017. We subsequently conducted a literature review to determine the role of MB in IIE by searching PubMed using the terms “Methylene Blue” and “Ifosfamide”. Results A total of 88 patients received ifosfamide, and four patients had IIE. Ifosfamide infusion was stopped immediately after the IIE occurrence, and patients underwent renal function correction with hydration. All patients received MB infusion, and three patients had an improvement of their neurological status. As regards the literature review, 34 articles were reviewed and 16 items were included in the review. Overall, 38 (65.5%) patients received MB infusion and 28 (75.6%) patients responded favorably to the treatment. Conclusions Methylene blue can be used as a treatment for IIE owing to the severity of the IIE as well as absence of standard medication. Nonetheless, side effects such as serotonergic syndrome should be investigated. More broadly, prospective studies and controlled trials are needed to explore the contribution of MB in IIE management and encourage its use.

Background: Mutations in the epidermal growth factor receptor ( EGFR) gene are commonly observed in non-small cell lung cancer (NSCLC), particularly in adenocarcinoma histology. The frequency of EGFR mutations is ethnicity-dependent, with a higher proportion reported in Asian populations than Caucasian populations. There is a lack of data on these mutations in north Africa. Methods: Tumor specimens from Moroccan patients with NSCLC were collected from five pathology laboratories between November 2010 and December 2017 to determine frequency and types of EGFR mutations. Tumors were tested in a reference center for EGFR by polymerase chain reaction and sequencing of exons 18, 19, 20, and 21. Results: A total of 334 patients were enrolled: 242 (72.5%) males and 92 females (27.5%). A total of 56.9% had a history of smoking. EGFR testing of the 334 lung adenocarcinoma samples demonstrated a wild-type EGFR in 261 (78.1%) and mutated EGFR in 73 (21.9%). Mutations were mainly detected in the exon 19 deletion (65.8%), followed by exon 21 L858 (17.8%) and other exon 21 codon mutations (5.5%) and exon 18 (6.8%), whereas primary mutations of exon 20 were less frequent (4.1%). In patients with advanced NSCLC, the detection of EGFR mutation was independently associated with sex (41.3% female vs 14.5% male; p < 0.001) and smoking status (34.8% nonsmokers vs 12.9% active smokers; p < 0.001). The mean age was significantly different between the two groups ( p = 0.041). Conclusion: Our findings confirm the genetic heterogeneity of NSCLC worldwide, reporting frequency of EGFR mutations in Moroccan patients with NSCLC between those of Asian and Caucasian populations.

Management of cancer patients during the COVID-19 pandemic is a worldwide challenge – in particular in developing countries where the risk of saturation of health facilities and intensive care beds must be minimized. The first case of COVID-19 was declared in Morocco on 2 March 2020, after which a panel of Moroccan experts, consisting of medical oncologists from universities and regional and private oncology centers, was promptly assembled to conduct a group reflection on cancer patient's management. The main objective is to protect the immunocompromised population from the risk of COVID-19, while maintaining an adequate management of cancer, which can quickly compromise their prognosis. Recommendations are provided according to each clinical situation: patients undergoing treatment, new cases, hospitalized patients, palliative care and surveillance.

Background Clinical pharmacists are contributing to safe medication use by providing comprehensive management to patients and medical staff. The aim of this study is to document and evaluate the role of clinical pharmacy services in oncology department. Patients and methods A prospective, descriptive, observational study was carried out from July 2018 through June 2019 at the Department of Medical Oncology at the National Institute of Oncology, Morocco. Medication reviews concerning hospitalized adult cancer patients were performed every day by the clinical pharmacist assigned to the department. Results A total of 3542 prescriptions of 526 adult cancer patients were analyzed. The pharmacist identified 450 drug-related problems (12.7% of the prescriptions) primarily related to the analgesics (31.5%). Medication problems included mostly untreated indications (31.3%), overdosing (17.1%), drug–drug interactions (12.4%), underdosing (11.1%), administration omissions (6.7%), drug not indicated (6.0%), and contraindication (5.3%). Interventions ( n = 450) led to drug additions (30.7%), drug dosing adjustments (27.1%), treatment discontinuations (20.0%), recall of the treatment (6.2%), replacement of a drug with another one (5.1%), administration optimization (4.0%), therapeutic drug monitoring (3.1%), alternate routes of administration (2.5%), and extension of treatment duration (1.3%). Most (98%) of the interventions were accepted and implemented by the medical staff—172 (38.2%) having a significant clinical impact on the patient, 88 (19.6%) as having a very significant clinical impact, and 71(15.8%) as having a potential vital impact. Conclusion This work highlights the positive clinical relevance of pharmacists’ interventions in oncology and the importance of medicopharmaceutical collaboration to prevent medication error.

Statins are commonly prescribed to reduce plasma cholesterol levels and risk of cardiovascular events and mortality. Statin exposure may have cancer-preventive properties in some solid tumors, including Renal Cell Carcinoma (RCC). Emerging evidences show that statins can inhibit RCC cell growth by inducing cell cycle arrest and apoptosis in a dose- and time-dependent manner. In addition, statins inhibit the phosphorylation of AKT, mammalian target of rapamycin (mTOR), and ERK leading to reduced motility of RCC cells. Interestingly, the potential impact of concomitant statin intake has been recently evaluated in RCC patients treated by targeted therapy or immunotherapy. In this review, we illustrate the most recent data on the preclinical activity of statins in Renal Cell Carcinoma models and discuss the impact of their use on the prevention and survival of patients affected by this tumor.

Mutations in the epidermal growth factor receptor (Tumor specimens from Moroccan patients with NSCLC were collected from five pathology laboratories between November 2010 and December 2017 to determine frequency and types ofA total of 334 patients were enrolled: 242 (72.5%) males and 92 females (27.5%). A total of 56.9% had a history of smoking.Our findings confirm the genetic heterogeneity of NSCLC worldwide, reporting frequency of

Angiosarcoma of breast or chest wall is a rare recognized side effect in breast cancer survivors secondary to Adjuvant radiation. The treatment of angiosarcoma of the breast is carried out in number of ways. We would like to report the case of a 50-year old woman. She developed an angiosarcoma of the breast following adjuvant radiation to her conserved breast and was successfully treated with classical Cyclophosphamide, Methotrexate, and 5- fluorouracil (CMF) chemotherapy leading to a successful local surgical salvage.

Background A multicentre cohort study was held in Morocco, designed to evaluate the quality of life of cancer patients. The aim of this paper is to report the assessment of the quality of life of early colorectal cancer patients, before and after cancer treatment, to identify other factors which are related to this quality of life. Methods We used the third version of the QLQ-C30 questionnaire of the European organization for Research and treatment of Cancer (EORTC) after a transcultural validation. The Data collection was done at inclusion and then every twelve weeks to achieve one year of follow up. Results Overall 294 patients presented with early colorectal cancer, the median age was 56 years (range: 21–88). The male–female sex ratio was 1.17. At inclusion, the global health status was the most affected functional dimension. For symptoms: financial difficulties and fatigue scores were the highest ones. Emotional and social functions were significantly worse in rectal cancer. Most symptoms were more present in rectal cancer. At inclusion, global health status score was significantly worse in stage III. Anorexia was significantly more important among colorectal female patients. For Patients over 70 years-old, the difference was statistically significant for the physical function item which was lower. Overall, Functional dimensions scores were improved after chemotherapy. The symptoms scores did not differ significantly for patients treated by radiotherapy, between inclusion and at one year. Conclusion Our EORTC QLQ C30 scores are overall comparable to the reference values. Neither chemotherapy, nor radiotherapy worsened the quality of life at one year.

Gastrointestinal stromal tumors (GIST) are the most common sarcomas of the gastrointestinal tract. They affect all segments of the digestive tract. They develop from the interstitial cells of Cajal. Mutations in the Kit gene is present in 86% of cases and in PDGFR gene in 15% of cases. The marker CD 117 is present in 95% of cases. Surgery is the standard treatment in localized forms. The tyrosine kinase inhibitor, imatinib is standard in first-line metastatic gastrointestinal stromal tumors, as well as adjuvant treatment after surgery. Sunitinib is the standard in second line.

Bladder cancer is the fourth most common cancer for men and the eighth most common cancer for women. Transitional cell carcinoma is the most predominant histological type. Bladder cancer is highly chemosensitive. In metastatic setting the treatment is based on cisplatin chemotherapy regimens type MVAC, MVAC-HD or gemcitabine plus cisplatin. The standard treatment of muscle invasive operable bladder cancer (T2–T4) used widely was radical cystectomy with pelvic lymph nodes dissection; the anatomical extent of pelvic lymphadenectomy has not accurately been defined so far. However, in the last decade, the treatment of tumors was improved by the introduction of chemotherapy as part of the management of the disease. Neoadjuvant chemotherapy should be considered at first, as standard treatment of choice, before local treatment for patients with good performance status (0–1) and good renal function–glomerular filtration rate (GFR) >60 mL/min. For patients treated with primary surgery, adjuvant chemotherapy is a valuable option in the case of lymph nodes involvement. This brief review would provide the evidence of the role of neoadjuvant chemotherapy in the management of operable muscle invasive (T2–T4) bladder cancer.

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.

Points essentiels Le cancer de la vesicule biliaire est une tumeur agressive. Son incidence est variable en fonction de la geographie. La chirurgie est le traitement de reference au stade localise. En situation metastatique ou localement avancee, il n’y a pas de standard. Les etudes sont le plus souvent des essais de phase II aux faibles effectifs avec des biais de selection et d’inclusion. Elles concernent a la fois les tumeurs vesiculaires, et les autres tumeurs du tractus biliopancreatique, alors qu’il s’agit de deux entites differentes. Un seul essai randomise ABC-02, bien conduit a pu montrer un benefice en survie en faveur de l’association gemcitabine (GEM) + cisplatine (CDDP), laquelle peut etre consideree comme le standard en situation metastatique. Le traitement adjuvant, apres resection chirurgicale, n’est pas valide. Par ailleurs, la comprehension des mecanismes moleculaires de la carcinogenese des tumeurs vesiculaires a ouvert la voie a l’utilisation des therapies ciblees. Cette nouvelle therapeutique ameliorerait la survie et la qualite de vie de nos patients.

Background Breast cancer is uncommon in young women and induces more aggressive biologic characteristics. Survival in young women has been widely studied in developed countries. Less favorable prognosis and low survival were found. In Morocco, this study is the first investigation of clinical features, treatment and prognosis associated with breast cancer in young women. Findings Four hundred and nine women aged 35 years or less were included in this study. All these women were diagnosed as having breast cancer at the National Institute of Oncology in Rabat, Morocco between 2003 and 2007. The relation between clinical and therapeutic characteristics and event-free survival (EFS) and overall survival (OS) were assessed by Cox regression analysis. The median age of the patients was 32 years. Fifty three patients (13%) have metastatic disease at diagnosis and 356 patients (87%) had localised disease. In 57.9% of the cases, the estrogen receptors status was positive. The median follow-up was 32.2 months. After 3 years the survival rate was 80.6%. In the case of localised disease, OS and EFS at 3 years were 83.2% and 62.5%, respectively. OS and EFS at 3 years was higher in patients with stage I than patients with stage II and stage III (p = 0.001). Positive estrogen receptors was significantly associated to OS and EFS at 3 years compared to negative estrogen receptors (p = 0.001). Adjuvant chemotherapy, adjuvant radiotherapy and adjuvant hormone therapy were associated with net benefit in OS and EFS at 3 years. Cox regression analysis showed that negative ER was significantly associated with poorer OS (HR = 2.42, 95% CI = 1.25 - 4.66, p < 0.009) and poorer EFS (HR = 1.73, 95%CI = 1.05 - 2.86, p = 0.03). Stage III disease were associated to poorer EFS (HR = 5.35, 95%CI = 1.60 -17.84, p = 0.006). Conclusions In Morocco, young women with breast cancer had less favorable prognosis. Multivariate analysis showed that negative hormone receptor status was associated with lower EFS and OS. Clinical trials should be launched to improve the survival of these young women with breast cancer.

7069 Background: In recent years, a rapid increase in lung cancer mortality has been observed among women. The aim of this study was to describe the epidemiological profiling and to analysis the su...

e14533 Background: Postoperative chemoradiation as per the Intergroup 116 trial demonstrated a superior survival for completely resected high-risk gastric cancer. To investigate the tolerability and survival of this regimen in clinical practice setting, we analyzed retrospective data in a single Institution of Oncology in Morocco. Methods: Patients with resected gastric adenocarcinoma were treated with postoperative concomitant chemoradiotherapy. Inclusion criteria were T3, T4 disease or positive regional lymph nodes. Adjuvant treatment consisted of 425 mg/m2 of fluorouracil plus 20 mg/m2 of leucovorin for 5 days, followed by 45 Gy of radiotherapy for 5 weeks, with fluorouracil and leucovorin on the first 4 and the last 3 days of radiotherapy. Two 5-day cycles of fluorouracil and leucovorin were given 4 weeks after the completion of radiotherapy. Toxicity was recorded according to RTOG criteria. Overall and disease free survival rates were calculated using the Kaplan-Meier method. Results: Between 2006 an...

Introduction Malgre leur relative rarete les lymphomes non hodgkiniens (LNH) a grandes cellules primitifs de l’estomac localises suscitent un interet constant dans la litterature et leur prise en charge optimale reste controversee. En particulier, la place de la gastrectomie doit etre clarifiee. L’objectif de ce travail est de comparer une exerese chirurgicale suivi d’une polychimiotherapie a une polychimiotherapie seule. Patients et Methodes Nous avons revu facon retrospective tous les dossiers cliniques des patients presentant un LNH primitif gastrique et pris en charge a l’institut national d’oncologie de Rabat au Maroc entre janvier 1999 et decembre 2006. Les patients eligibles devaient avoir (a) un lymphome a grandes cellules primitif gastrique, (b) des informations cliniques completes et une preuve anatomopathologique, (c) un stade localise I et II selon AnnArbor modifie par Musshoff [1], (d) ayant recu soit une resection chirurgicale suivi d’une polychimiotherapie adjuvante a base d’anthracycline dans le groupe I soit une polychimiotherapie seule a base d’anthracycline dans le groupe II. Resultats Nous avons colliges respectivement 30 patients dans le groupe I et 52 patients dans le groupe II. Les caracteristiques cliniques et pathologiques etaient similaires dans les deux groupes en dehors de l’atteinte ganglionnaire locoregionale qui etaient plus importantes dans le groupe II (P Conclusion Les resultats de cette etude retrospective suggerent que l’exerese chirurgicale suivi d’une polychimiotherapie n’ameliore pas les resultats therapeutiques du LNH gastrique a grandes cellules localise par rapport a une polychimiotherapie seule et que celle-ci peut constituer une alternative therapeutique raisonnable a proposer aux malades qui gardent une qualite de vie meilleure mais ceci doit etre verifier dans une etude randomisee prospective a large effectif qui devrait evaluer aussi l’apport du Rituximab dans cette localisation lymphomateuse.