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• Approximately two-thirds of donors in Lebanon have adequate knowledge of blood donation; nevertheless, they exhibit reluctance to donate owing to apathy. • Merely 22.2% of donors are voluntary non-remunerated donors (VNRDs), with the remaining 77.8% being replacement donors. • The fragmented blood transfusion system, compounded by the continuous financial and socioeconomic turmoil, political inertia, and geopolitical disruptions, collectively impede the achievement of the World Health Organization's goal of achieving 100% VNRDs. • The active engagement of public authorities combined with the implementation of strategies gleaned from successful experiences in culturally akin neighboring countries, such as Morocco, are crucial for enhancing blood donation rates in Lebanon. The World Health Organization advocates for the achievement of 100% voluntary non-remunerated blood donation (VNRD) globally by the year 2020. However, until today, little was known in Lebanon regarding its actual rate or influencing factors, particularly donor motivations and behaviors. Therefore, the aim of this study was to assess the knowledge, attitudes, and practices of blood donors in Lebanon. The ultimate goals were to retain first-time donors, encourage them to become regular ones, and facilitate the transition from replacement donation to VNRD. A multi-centric cross-sectional study was carried across the five governorates in Lebanon. A self-administered and structured questionnaire was used in this survey. Results were presented in terms of odds ratios, with statistical significance defined at a P value of 0.05 and a 95% confidence interval. Additionally, a benchmarking analysis of the situation of blood donation in Lebanon was also conducted, identifying several areas for improvement. A total of 620 blood donors participated in this study, with 21.3% being first-time donors and 78.7% repeat donors. While the latter were primarily motivated by self-esteem, solidarity or returning a favor (89%, 77.9% and 78.1%), the main obstacle for becoming regular donors was a lack of initiative (34.6%). Female donors (9.9% of the total) exhibited better knowledge (OR = 2.20, p = 0.011) and were more inclined to donate voluntarily (OR = 1.52, p = 0.048). Conversely, male donors were more likely to be repeat donors, often through replacement donation (OR = 2.95, p = 0.001). There is a significant disparity between the low rate of voluntary donation in Lebanon (22.2%) and the relatively high proportion of donors with adequate knowledge of the donation process (60.5%). Therefore, urgent action by public authorities, based on the evidence based strategies outlined in this article, is crucial to enhancing the voluntary donation rate in Lebanon. [ABSTRACT FROM AUTHOR]

• Desmoid tumors are rare mesenchymal tumors with distinct clinical and molecular features. • Active surveillance is the initial approach for the management of desmoid tumors. • Hormone therapy, chemotherapy and targeted therapy are potential therapeutic approaches. • Active therapy might be indicated in symptomatic and or progressive DT. • Gamma secretase inhibitors constitute a promising therapy with survival benefit in DT. Desmoid tumors (DT) are rare, slow-growing, locally invasive soft tissue tumors that often pose significant therapeutic challenges. Traditional management strategies including active surveillance, surgery, radiotherapy, and systemic therapy which are associated with varying recurrence rates and high morbidity. Given the challenging nature of DT and the modest outcomes associated with current treatment strategies, there has been a growing interest in the field of γ-secretase inhibitors as a result of its action on the Wnt/β-catenin signaling pathway. In this review article, we will shed the light on the pathogenesis and molecular biology of DT, discuss its symptoms and diagnosis, and provide a comprehensive review of the traditional therapeutic approaches. We will also delve into the mechanisms of action of γ-secretase inhibitors, its efficacy, and the existing preclinical and clinical data available to date on the use of these agents, as well as the potential challenges and future prospects in the treatment landscape of these tumors. [ABSTRACT FROM AUTHOR]

Myxoid liposarcoma (MLS) is a rare mesenchymal tumor that constitutes 10-20% of all liposarcomas. MLS is a translocation-related sarcoma (TRS) related to the chromosomal translocation t(12:16) (q13:p11), producing the FUS-CHOP oncoprotein that constitutes one of the main targets of trabectedin in MLS patients. It is known to be chemosensitive namely to trabectedin in contrast to other soft tissue sarcomas. The efficacy of this agent in MLS have been demonstrated in different settings including treatment-naïve and pre-treated patients with both locally advanced and metastatic disease. However, the benefits of trabectedin in MLS are shadowed by the limited activity of this drug in other subtypes of sarcomas that are enrolled within the same trials. This prompted us to screen the medical literature for clinical data that evaluates the efficacy and safety of trabectedin in MLS. In this review, we will summarize the available evidence for the applicability of trabectedin in MLS. [ABSTRACT FROM AUTHOR]

Objective By 2020, 70% of all cancers will occur in patients aged 65 years and older, causing an increase in related morbidity, mortality, and cost. This study projects cancer trends in the elderly population in Lebanon, a country experiencing accelerating aging trends. Findings will guide future policy decisions regarding geriatric oncology in Lebanon and the surrounding Arab world. Materials and Methods Cancer incidence rates were derived for men and women 65 years and above, divided into three age groups: 65–69 years, 70–74 years, and 75 years and above. Raw data were obtained from the National Cancer Registry reports 2003–2010. The eight consecutive year data were used to project the incidence until 2025 using a logarithmic model. The Average Annual Percent Change in incidence rates was calculated to determine whether it would significantly increase, decrease, or remain stable over time. Results Incidence rates are projected to increase significantly in all age groups of both genders until 2025. In men, the fastest rise is expected in prostate cancer, followed by bladder, lung, colorectal, and NHL. In women, the rise will be fastest in breast, followed by colorectal, lung, NHL, and ovary. Projected rates increase faster in the “younger” age group 65–69 compared to the “oldest” ≥ 75, both in men and women. Only kidney and liver cancers continue to rise significantly after 75. Conclusions Cancer incidence is projected to increase in individuals between 65 and 74 years of age. Lebanese and Middle Eastern physicians must implement adapted therapeutic strategies in the management of the increasing caseload among frail, elderly patients. [ABSTRACT FROM AUTHOR]

Objectives: Comprehensive geriatric assessment (CGA) is a complex and interdisciplinary approach to evaluate the health status of elderly patients. The Karnofsky Performance Scale (KPS) and Physical Performance Test (PPT) are less time-consuming tools that measure functional status. This study was designed to assess and compare abridged geriatric assessment (GA), KPS and PPT as predictive tools of mortality in elderly patients with cancer. Materials and Methods: This prospective interventional study included all individuals aged >70 years who were diagnosed with cancer during the study period. Subjects were interviewed directly using a procedure that included a clinical test and a questionnaire composed of the KPS, PPT and abridged GCA. Overall survival (OS) was the primary endpoint. The log rank test was used to compare survival curves, and Cox's regression model (forward procedure) was used for multivariate survival analysis. Results: One hundred patients were included in this study. Abridged GA was the only tool found to predict mortality [median OS for unfit patients (at least two impairments) 467 days vs 1030 days for fit patients; p = 0.04]. Patients defined as fit by mean PPT score (>20) had worse median OS (560 vs 721 days); however, this difference was not significant (p = 0.488 on log rank). Although median OS did not differ significantly between patients with low (≤80) and high (>80) KPS scores (467 and 795 days, respectively; p = 0.09), survival curves diverged after nearly 120 days of follow-up. Visual and hearing impairments were the only components of abridged GA of prognostic value. Conclusion: Neither KPS nor PPT were shown to predict mortality in elderly patients with cancer whereas abridged GA was predictive. This study suggests a possible role for visual and hearing assessment as screening for patients requiring CGA. [ABSTRACT FROM AUTHOR]

Tumor-associated macrophages (TAM) plasticity and diversity are both essential hallmarks of the monocyte-macrophage lineage and the tumor-derived inflammation. TAM exemplify the perfect adaptable cell with dynamic phenotypic modifications that reflect changes in their functional polarization status. Under several tumor microenvironment (TME)-related cues, TAM shift their polarization, hence promoting or halting cancer progression. Immune checkpoint inhibitors (ICI) displayed unprecedented clinical responses in various refractory cancers; but only approximately a third of patients experienced durable responses. It is, therefore, crucial to enhance the response rate of immunotherapy. Several mechanisms of resistance to ICI have been elucidated including TAM role with its essential immunosuppressive functions that reduce both anti-tumor immunity and the subsequent ICI efficacy. In the past few years, thorough research has led to a better understanding of TAM biology and innovative approaches can now be adapted through targeting macrophages' recruitment axis as well as TAM activation and polarization status within the TME. Some of these therapeutic strategies are currently being evaluated in several clinical trials in association with ICI agents. This combination between TAM modulation and ICI allows targeting TAM intrinsic immunosuppressive functions and tumor-promoting factors as well as overcoming ICI resistance. Hence, such strategies, with a better understanding of the mechanisms driving TAM modulation, may have the potential to optimize ICI efficacy. [ABSTRACT FROM AUTHOR]

• Chemotherapy should be suggested to patients with high-risk characteristics. • Chemotherapy should be discussed for tumor downsizing before excisional surgery. • Further studies are needed to identify potential predictive biomarkers in PO patients. Periosteal osteosarcoma (PO), an intermediate-grade chondroblastic osteosarcoma (OST) arising from the surface of the bones, is a rare histological subtype among primary bone sarcomas, most commonly diagnosed in young patients. It is characterized by distinct specific radiological and pathological features. The current management strategy is based on several case reports and series, without any solid international recommendations. Most sarcoma experts agree on the crucial role of an optimal complete surgical approach. However, with the paucity of available reports, the role of systemic treatment and its timing remains debatable. With this paper, we will review the available data on the actual impact of chemotherapy in PO patients with emphasis on the radiological, pathological, and therapeutic characteristics of this rare entity. [ABSTRACT FROM AUTHOR]

Immune checkpoint blockers (ICBs) in combination with antiangiogenic drugs showed synergistic efficacy in several tumour types. New patterns of progression have recently been defined upon treatment with ICB alone including atypical responses such as pseudoprogression (PsPD), dissociated response and hyperprogressive disease (HPD). This study aimed to describe the patterns of response observed in patients treated with combination ICB with antiangiogenic drugs. We conducted a monocentric retrospective analysis of patients (pts) enrolled in phase I trials at Gustave Roussy assessing the combination of ICB and antiangiogenic drugs. Radiological CT scans were centrally reviewed by a senior radiologist according to iRECIST criteria including progressive disease (PD), partial response (PR) and stable disease (SD). HPD was defined as a progression at the first evaluation with a delta tumour growth rate exceeding 50%. PsPD was defined as initial progression followed by stabilisation or decrease of tumour size, DisR as a concomitant size decrease in some tumour lesions and size increase in others. Both PsPD and DisR are defined as atypical responses. Overall response rate included PR and complete response (CR) and disease control rate included PR, CR and SD. Between December 2016 and June 2020, 111 pts were included. The median follow up was 12.8 months (11.3–15.1). The most common tumour types were lung and pleura (20%), kidney (18%) and bladder (17%). The overall response rate and disease control rate were 21.6% (n = 24) and 59% (n = 65), respectively. Twenty-one patients (19%) experienced PD as the best response. PsPD, DisR and HPD were observed in 4 (3.6%), 11 (9.9%) and 7 (6.3%) pts, respectively. DisR and PsPD were associated with longer iProgression Free Survival (median: 6.9 and 18.9 months, respectively) and iOverall Survival (median: 28.4 and 31.1 months, respectively) than a median of SD in immune progression-free survival (median: 4.2 months) and immune overall survival (median: 12.7 months). Patients treated with ICBs and antiangiogenic agents display atypical responses. Survival might be longer in patients with DisR responses and PsPD disease than patients with HPD, PD and SD. [Display omitted] • Patients treated with immune checkpoint blockers and antiangiogenic agents display atypical responses. • Atypical responses were pseudoprogression, dissociated response and hyperprogressive disease and were observed in 6%, 10% and 6% pts. • Survival might be longer in patients with dissociated response and pseudoprogression than patients with stable disease. [ABSTRACT FROM AUTHOR]

To determine the existence of guidelines regarding the appropriate clinical use of blood and blood components, transfusion requests, and blood issuing/reception documents and procedures. The different bedside transfusion organizations/processes and hemovigilance are also analyzed. The ultimate objective is to identify safe potential options in order to improve blood safety at the lowest cost. Data emanating from eight Arabic eastern/southern Mediterranean countries who responded to five surveys were collected and tabulated. National recommendations for the clinical use of blood components especially for hemoglobinopathies are lacking in some countries. In matter of good practices in the prescription, issuing and reception of BCs, efforts were made either on national or local basis. Procedures regarding patient information and ethical issues are still lacking. Almost all Mediterranean countries apply two blood testing procedures on each patient sample. Only Morocco, Tunisia and Algeria perform bed side blood group testing; Egypt and Lebanon perform antibody screen and antiglobulin cross matching universally. Automation for blood testing is insufficiently implemented in almost all countries and electronic release is almost absent. National hemovigilance policy is implemented in Tunisia, Morocco, and Lebanon but the reporting system remains inoperative. Insufficient resources severely hinders the implementation of expensive procedures and programs; however, the present work identifies safe procedures that might save resources to improve other parts in the transfusion process (e.g. electronic release to improve safety in issuing). Moreover, setting up regulations regarding ethics in transfusing recipients along with local transfusion committees are crucially needed to implement hemovigilance in transfusion practice. [ABSTRACT FROM AUTHOR]