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With cancer being the third leading cause of mortality in the United Arab Emirates (UAE), there has been significant investment from the government and private health care providers to enhance the quality of cancer care in the UAE. The UAE is a developing country with solid economic resources that can be utilized to improve cancer care across the country. There is limited data regarding the incidence, survival, and potential risk factors for cancer in the UAE. The UAE Oncology Task Force was established in 2019 by cancer care providers from across the UAE under the auspices of Emirates Oncology Society. In this paper we summarize the history of cancer care in the UAE, report the national cancer incidence, and outline current challenges and opportunities to enhance and standardize cancer care. We provide recommendations for policymakers and the UAE Oncology community for the delivery of high-quality cancer care. These recommendations are aligned with the UAE government's vision to reduce cancer mortality and provide high quality healthcare for its citizens.

e24105 Background: Cancer care has been severely affected by covid 19 pandemic leading to medical, ethical and organizational issues. Oncology healthcare professionals face challenges due to reorganization of cancer services and increasing health care requirements resulting in uncertainty and psychological stress. Aim of this study is to evaluate the impact of covid 19 pandemic on psychological well being of oncology clinicians in the MENA region. Methods: We randomly invited 1500 oncology clinicians including medical oncologists, clinical oncologists, radiation oncologists and surgical oncologists from 17 countries in the MENA region to complete a web based survey to determine the level of psychological stress during covid 19 pandemic from October 2020 to January 2021. The questionnaire was based on Perceived Stress Scale (PSS), Generalized Anxiety Disorders Scale (GAD-7) and WHO Well-being Index (WHO-5). The data was analyzed using SPSS version 21 and difference between groups was measured by T-test and ANOVA. Results: Overall 520 (35%) oncology clinicians including 368 (71%) males and 152 (29%) females participated in the survey. Most of the participants were medical oncologists (38%) from teaching institutions (76%) and the public sector (84%). 46% (n = 242) participants were 35-45 years of age. Majority of clinicians reported moderate (45.6%) to severe (42.3%) anxiety on GAD-7 scale. Females had statistically higher levels of anxiety (average score;15.46 ±4.87, p = 0.04). On PSS, the majority of participants reported higher stress with average scores (29.64 ±3.83) for males and (30.23 ±4.62) for females. Average score for WHO wellbeing index was 62.95 (±20.52) for males and 74.3 (±20.87) for females denoting a preservation of general well being, even in a higher stress and anxiety situation. Female gender was significantly associated with anxiety level on GAD-7 scale (p = 0.04), but this difference in stress level and well being was not observed on PSS (p = 0.134) and WHO well being index (p = 0.709). Clinicians of ages 25-35 years had significantly higher anxiety levels on GAD-7 scale (p = 0.004) and higher stress on PSS (p = 0.000). Age over 55 years was associated with lower levels of anxiety and stress on GAD-7 and PSS. Oncology clinicians working in public sector experienced significantly lower stress as compared to private sector on PSS scale (p = 0.041) Conclusions: Covid 19 pandemic has significantly increased the anxiety and stress levels among oncology clinicians in the MENA region. Anxiety and stress were higher in females and young clinicians. Clinicians over 55 years of age and oncologists working in the public sector reported less stress and anxiety. General well being of clinicians was well preserved even in a highly stressful and anxious situation.

Introduction: Immune checkpoint inhibitors (ICI) represent a major component of systemic therapy in advanced malignancy. Studies have reported unique spectrum of toxicity profile of ICI as compared to systemic chemotherapy. Aim of this study is to evaluate toxicities of ICI in our population and to compare this with published data. Material and Methods: We retrospectively reviewed medical records of patients treated with ICI at Dubai hospital and American hospital Dubai from November 2015 to April 2019. After patient identification from hospitals cancer registry, data regarding patients’ demographics, cancer type, type of ICI, adverse events, and duration of treatment were collected. Results: Forty-Five patients were identified with median age of 60 (27-80) years. 27 (60%) patients were male and 18 (40%) were female. Underlying diagnosis was lung cancer (n=25), renal cell cancer (n=6), melanoma (n=5), bladder cancer (n=3), Hodgkins lymphoma (n=3) and other malignancies (n=3). Majority of patients received Nivolumab (n=20, 44%) followed by Pembrolizumab (n=19, 42%), Atezolizumab (n=4, 9%) and Durvalumab (n=2, 5%) respectively. Thyroid dysfunction was the most common side effect observed in 17 (38%) patients including hypothyroidism (n=12, 27%) and hyperthyroidism (n=5, 11%). 53 % patients treated with Nivolumab developed thyroid dysfunction as compared to Pembrolizumab (22%). 7 patients (16%) had elevated liver enzymes. Grade II and III hepatotoxicity was noted in 1 patient (2.2 %) each. One patient (2.2 %) developed grade II skin toxicity. One patient (2.2 %) developed grade III colitis. Grade II, III and IV pneumonitis was observed in 2 (4.4 %), 1 (2.2%) and 1 (2.2%) patient respectively. Immune mediated adverse events were managed according to standard guidelines and 2 patients (4.4 %) had treatment discontinuation due to grade IV Pneumonitis and grade III Colitis. Conclusion: Our study reports relatively higher incidence of thyroid adverse events in patients treated with ICI. The incidence of grade III-IV immune related toxicity remains low. Overall treatment with ICI was tolerated reasonably well and toxicity was manageable.

Purpose Breast cancer is the most common cancer among females worldwide in general and in the Middle East and the North African region (MENA region) in particular. Management of breast cancer in the MENA region faces a lot of challenges, which include younger age at presentation, aggressive behaviour, lack of national breast screening programmes and lack of reliable data registries as well as socioeconomic factors. These factors make applying the international guidelines for breast cancer management very challenging. The aim of this project is to explore the need for a regional breast cancer guideline as well as to screen the clinical practice of breast cancer management in the MENA region. Methodology Three web-based designed surveys were sent to more than 600 oncologists in the MENA region from the period of August 2013 to October 2014. Full descriptive data and information regarding the application of international breast cancer guidelines were collected. The software was using the IP address to prevent duplication of collected data. Descriptive analysis and results were shown as numbers and percentages. Results During the period of the survey, 104 oncologists responded, representing around an 11% response rate. The majority of replies came from Egypt (59 responses (59%)), followed by Saudi Arabia (ten responses (9.6%)). Fifty-one per cent of responders had more than ten years of experience, and further 31.7% had 5-10 years of experience. Seventy-four per cent were working in governmental hospitals, which is our target sector. There was a major defect in having a genetic counsel unit (78.8% declared an absence of this service), presence of a national breast screening programme (55.8% declared an absence of this service), performing sentinel lymph node biopsy (43.3% declared an absence of this service). The need for regional guidelines for the management of breast cancer was agreed upon by 90.6% of responders. Conclusion There is a clear need to improve the management of breast cancer in the MENA region. Creating a national breast screening programme and a reliable database is essential. A regional guideline is required to establish the best possible management of breast cancer according to the patients and disease specification as well as the regional socioeconomic factors and facilities available. There is also a need to improve clinical research that meets the region's needs.

Small round cell mesenchymal component in breast metaplastic carcinoma is very rare and could be confused with other small round cell neoplasms of the breast. Synovial sarcoma exceptionally involves the breast and rarely may show a poorly differentiated small round cell component. These unusual small round cell components in biphasic metaplastic carcinoma and synovial sarcoma as well as collision tumor of ductal carcinoma and Ewing sarcoma might have overlapping clinical, histologic and immunohistochemical features which make distinction between these neoplasms difficult for the pathologists. Separation between these neoplasms is important for the treating oncologists because each tumor type has different prognostic implications and treatment modalities. Certain immunohistochemical markers might help, but cytogenetics study is the final confirmatory test. We report a unique example of a biphasic breast neoplasm in a 43-year-old woman that showed a combination of a minor central component of adenocarcinoma distinct from the bulky surrounding component of small round cell tumor. The histologic and immunohistochemical features were overlapping between metaplastic carcinoma, poorly differentiated synovial sarcoma and a composite collision tumor of invasive ductal carcinoma and Ewing sarcoma.

Background: Guidelines regarding treatment post progression on Trastuzumab have recently varied with lots of options available. Decision whether to continue on Trastuzumab or to switch to other anti-Her2 treatment varies due to many factors, including the guidelines recommendations, definition of resistance to Trastuzumab, availability of drugs, and socioeconomic factors. The objective of our survey is to evaluate and asses these factors. Material and methods: The survey was emailed to more than 600 oncologists worldwide through BGICS database. Three main questions were covered by the survey; Definition of progression on Trastuzumab, how to deal with progression, and the factors affecting decision making. Results: The survey was send to 612 oncologists worldwide, 167 replied. Participants were mainly from Egypt, Romania, and France. 28.7% consider resistance to Trastuzumab if progression happened while on Trastuzumab, 28.7 % consider resistance if any progression happened after receiving Trastuzumab whatever the duration or the site of progression, 18% consider resistance if progression took place after less than 6 months of receiving Trastuzumab. In case of CNS progression 35.3% had chosen start on Lapatinib, while 25.1% had chosen to change the chemotherapy and continue on Trastuzumab. 18.6% had chosen to give combination of Lapatinib with Trastuzumab. Conclusion: This is the second publication of Medicalsurveys-17 Research Group. Our data revealed that more effort is required to define resistance to Trastuzumab and how to manage patients based on type of resistance and site of progression. Mini Abstract Through this survey, we tried to define the oncologist perspective about resistance to Trastuzumab, the approach to deal with this progression and the factors that affect decision making.

Background and study aims The transforming growth factor (TGF)-β signalling pathway plays a dual role in hepatocarcinogenesis. It has been recognised for its role as a tumour suppressor as well as a tumour promoter depending on the cellular context. The aim of this study was to investigate the clinical significance of serum TGF-β1 level and TGF-β1 messenger RNA (mRNA) in the peripheral blood of liver cirrhosis and hepatocellular carcinoma (HCC) patients as noninvasive biomarkers in diagnosing HCC. Patients and methods Twenty patients were allocated to each of the liver cirrhosis and HCC groups, in addition to 20 healthy volunteers. TGF-β1 gene expression in peripheral blood was quantitated using real-time polymerase chain reaction (PCR), while serum TGF-β1 was analysed using enzyme-linked immunosorbent assay (ELISA). Results TGF-β1 gene expression was significantly lower in HCC patients (median 0.401 (0.241–0.699) fold change) than in liver cirrhosis patients (median 0.595 (0.464–0.816)) ( p = 0.042) and normal controls (median 1.00 (0.706–1.426) fold change) ( p = 0.001). TGF-β1 gene expression showed significant positive correlation with serum TGF-β1 ( r = 0.272, p = 0.036) and significant negative correlation with alpha-fetoprotein (AFP) ( r = −0.528, p = 0.001). Receiver operating characteristic (ROC) analysis was conducted for TGF-β1 gene expression in comparison with AFP. The area under the curve for TGF-β1 gene expression was 0.688 (95% CI = 0.517–0.858) ( p = 0.042) and AFP was 0.869 (95% CI = 0.761–0.976) ( p = 0.001). The sensitivity and specificity of TGF-β1 gene expression were 65% and 75%, respectively, at a cutoff value of 0.462 fold change. Conclusion TGF-β1 gene expression in the peripheral blood may be used as a molecular marker for the diagnosis of HCC. Additional studies on a large-scale population are necessary to gain greater insight into the impact of TGF-β1 gene expression in the pathogenesis of HCC.

Aero-servoelasticity (ASE) is a multi-disciplinary study of interactions among structural dynamics, unsteady aerodynamics,and control systems. In this paper, the Aircraft Test Model (ATM) developed...