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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.

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.

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.

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.

Background Triple-negative breast cancer (TNBC) is defined by the lack of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) expression. This is an aggressive malignancy with a poor prognosis despite the high rates of response to chemotherapy. The aim of this study is to determine the clinicopathological, therapeutic features and outcomes associated with this type of breast cancer. Methods This is a retrospective study of confirmed triple negative breast cancer females collected at the National institute of oncology of Rabat in Morocco, between January 2007 and December 2008. Epidemiological, clinical, histological, therapeutic and evolutive data were analyzed. OS and DFS rates were estimated by Kaplan-Meier analysis. Results A total of one 152 patients with breast cancer, were identified as having triple-negative breast cancer (16,5%). The median age at diagnosis was 46 years. 130 patients (86%) had infiltrating ductal carcinoma and thirteen had medullar carcinoma (9%). 84 cases (55%) were grade III Scarff-Bloom-Richardson (SBR). 48 % had positive lymph nodes, and 5 % had distant metastases at diagnosis. According TNM staging, 12 patients (8%) had stage I, 90 patients (60%) had stage II and the 43(28%) had stage III. 145 patients received surgery. 41 (28%) had conservative surgery and 104 (72%) received radical mastectomy with axillary lymph nodes dissection. 14 patients with advanced tumors or inflammatory breast cancer have received neoadjuvant chemotherapy and four patients (28%) had complete pathologic response. From 131 patients how received adjuvant chemotherapy, 99 patients (75,5%) had Anthracycline based chemotherapy) and 27 patients (20,6%) had sequential Anthracycline and docetaxel,. Seven patients with metastatic disease received anthracycline-based regimen in the first line metastatic chemotherapy. The median follow-up time was 46 months (range 6,1 -60 months). Overall survival at 5 years for all patients was 76,5%. Conclusion These results suggest that most TNBC characteristics in Moroccan patients are in accordance with literature data, especially concerning young age at diagnosis high grade tumors, advanced stage at diagnosis, and short time to relapse. Although the high response rate to chemotherapy, the overall prognosis of this subset of tumors remains poor.

Les tumeurs malignes de l’intestin grêle (TMPIG) sont des tumeurs rares. Elles représentent 1 à 5% de toutes les tumeurs du tube digestif. Elles sont caractérisées par une hétérogénéité anatomopathologique et une symptomatologie pauvre et non spécifique entrainant ainsi un retard diagnostic, des difficultés Thérapeutiques et donc un mauvais pronostic. Nous rapportant les caractéristiques épidémiologiques, diagnostiques et thérapeutiques ainsi que la survie des patients atteints des TMIG au sein de l’institut national d’oncologie de Rabat. Il s’agit d’une analyse rétrospective des dossiers cliniques des 27 patients ayant le diagnostic de tumeurs malignes de l’intestin grêle admis dans notre institut entre 1998 et 2002. L’âge médian était de 46 ans (15-70 ans). Le délai médian de diagnostic était de 6 mois (0-96 mois). La douleur abdominale était le symptôme le plus fréquent (77.8%). L’étude anatomopathologique a montré 63% de lymphome non Hodgkinien, 14.8% d’adénocarcinome, 7.4% de tumeur stromale, 7.4% de carcinome neuroendocrine et 7.4% de sarcome intestinal. Vingt patients (76. 9%) ont eu une résection chirurgicale et 14 patients (53. 8%) ont eu une chimiothérapie en fonction du stade de la maladie et du type histologique. Après un recul médian de 11.6 mois, la survie globale après 12 mois était de 44.4% et la médiane de survie était de 11.6 mois. Les tumeurs malignes de l’intestin grêle sont rares. Leur diagnostic est tardif limitant ainsi la prise en charge thérapeutique curative. Les cliniciens doivent être avertis des symptômes gastro-intestinaux non spécifiques.

Background Concurrent chemoradiotherapy (CCRT) after breast surgery was investigated by few authors and remains controversial, because of concerns of toxicity with taxanes/anthracyclines and radiation. This treatment is not standard and is more commonly used for locally advanced breast cancer. The aim of our study was to evaluate the efficacy and safety of the concomitant use of anthracycline with radiotherapy (RT). Findings Four hundred women having operable breast cancer, treated by adjuvant chemotherapy (CT) and RT in concomitant way between January 2001 and December 2003, were included in this retrospective cohort study. The study compares 2 adjuvant treatments using CCRT, the first with anthracycline (group A) and the second with CMF (group B). The CT treatment was repeated every 21 days for 6 courses and the total delivered dose of RT was 50 Gy, divided as 2 Gy daily fractions. Locoregional recurrence free (LRFS), event free (EFS), and overall survivals (OS) were estimated by the Kaplan-Meier method. The log-rank test was used to compare survival events. Multivariate Cox-regression was used to evaluate the relationship between patient characteristics, treatment and survival. In the 2 groups (A+B) (n = 400; 249 in group A and 151 in group B), the median follow-up period was 74.5 months. At 5 years, the isolated LRFS was significantly higher in group A compared to group B (98.7% vs 95.3%; hazard ratio [HR] = 0.258; 95% CI, 0.067 to 0.997; log-rank P = .034). In addition, the use of anthracycline regimens was associated with a higher rate of 5 years EFS (80.4% vs 75.1%; HR = 0.665; 95% CI, 0.455 to 1.016; log-rank P = .057). The 5 years OS was 83.2% and 79.2% in the anthracycline and CMF groups, respectively (HR = 0.708; 95% CI, 0.455 to 1.128; log-rank P = .143). Multivariate analysis confirmed the positive effect of anthracycline regimens on LRFS (HR = 0.347; 95% CI, 0.114 to 1.053; log-rank P = .062), EFS (HR = 0.539; 95% CI, 0.344 to 0.846; P = 0.012), and OS (HR = 0.63; 95% CI, 0.401 to 0.991; P = .046). LRFS, EFS and OS were significantly higher in the anthracycline group where the patients (n = 288) received more than 1 cycle of concurrent CT (P = .038, P = .026 and P = .038, respectively). LRFS and EFS were significantly higher in the anthracycline group within the BCT subgroup (P = .049 and P = .04, respectively). There were more hematologic, and more grade 2/3/4 skin toxicity in the anthracycline group. Conclusions After mastectomy or BCT, the adjuvant treatment based on anthracycline and concurrent RT reduced breast cancer relapse rate, and significantly improved LRFS, EFS and OS in the patients receiving more than 1 cycle of concurrent CT. There were more hematologic and non hematologic toxicities in the anthracycline group.

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.

Introduction Metastases to the breast from extramammary malignancies are infrequent, the most common primary sites are malignant melanoma, leukemia, lymphoma, and cancer of the lung, stomach, prostate and ovary. The cervical origin is exceptional. Splenic metastasis from squamous cell carcinoma of the cervix is also rare. To the best of our knowledge, only three cases of isolated splenic metastasis have been reported in the literature. Case presentation We describe the case of a 55-year-old North African woman who presented with a nodule in her left breast eight months after treatment for stage IIB squamous cell uterine cervical carcinoma. The excisional biopsy with histological study demonstrated a poorly differentiated squamous cell carcinoma. A computed tomography scan revealed a splenic secondary location. Conclusions We report here a case of two unusual metastatic sites of uterine cervical carcinoma, the breast and spleen. It is the first case of this association without widespread disease.

Background Adult granulosa cell tumor associated with antecedent use of tamoxifen as adjuvant hormonotherapy for breast cancer is rare. The pathogenesis of this occurrence remains difficult to explain. The estrogenic effect of tamoxifen can be one such explanation. Case presentation A 47 year-old women was treated with surgery, chemotherapy, radiotherapy and tamoxifen for stage III estrogen receptor positive breast carcinoma. Ten months after stopping tamoxifen, we diagnosed a stage Ic granulosa cell tumor of the ovary. Conclusions Use of tamoxifen has been found to be associated with gynecological tumors like endometrial carcinoma. Its association with granulosa cell tumor of the ovary is uncommon. Only two previous cases have been reported in literature.