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Resume Introduction Les therapies orales se developpent de plus en plus en oncologie. Leur prescription est devenue une pratique courante en oncologie. Cependant, il existe une variabilite et une diversite dans la pratique de leur prescription, son ampleur a ete tres peu etudiee dans la litterature. A notre connaissance, il s’agit de la premiere etude au Maroc et en Afrique du Nord a evaluer la pratique de la prescription de la chimiotherapie orale. Materiels et methodes Entre Janvier et juin 2019, nous avons mene une enquete nationale, transversale et exhaustive, pour evaluer la pratique de la prescription d’une chimiotherapie orale de type « capecitabine » par les oncologues medicaux marocains et identifier les strategies, permettant de promouvoir ladhesion a un traitement antineoplasique oral. Resultats Au total, 91 oncologues medicaux ont participe, parmi 118, dont 29,7 % travaillent dans des centres d’oncologie publics, 58,2 % dans des hopitaux universitaires et 12,1 % dans le secteur prive. Trente-quatre oncologues ont repondu par courrier electronique, 33 par conversation telephonique et 24 en remplissant des questionnaires papier. Trente-deux pour cent des prescriptions etaient manuscrites et 51,6 % etaient electroniques. Quarante-six pour cent des oncologues medicaux consacraient plus de temps a la prescription de la capecitabine par rapport a son equivalent intraveineux 5FU. Cependant, 33 % des oncologues medicaux consacraient moins de temps pour cette prescription, et 20,9 % d’entre eux prenaient le meme temps pour la forme orale et intraveineuse. L’observance de la chimiotherapie orale type capecitabine etait evaluee par un simple interrogatoire des patients dans la plupart des cas (94 %) et 4 % des oncologues medicaux ont declare ne pas avoir evalue l’adherence a la capecitabine. Parmi les medecins oncologues marocains, 87,9 % ont declare ne pas avoir recu de formation specifique a l’education therapeutique du patient recevant une chimiotherapie orale. Conclusion Au Maroc, il existe une grande variabilite dans les pratiques de prescription et de suivi des patients sous chimiotherapie orale. Il existe un manque de standardisation de la prescription et du suivi des antineoplasiques oraux, mettant ainsi en peril la qualite et la securite de leur prescription.

Oral anticancer therapy is becoming increasingly developed; their prescription has become a common practice in oncology. However, there is a variability and diversity in prescription practice. Its magnitude has been very little studied in scientific literature. To our knowledge, this is the first study in Morocco and North Africa to evaluate the practice of prescribing oral chemotherapy.The authors conducted a national exhaustive cross-sectional survey, to evaluate the practice of the oral chemotherapy "Capecitabine" type prescription by Moroccan oncologists and to identify strategies to promote an adherence to oral anti-neoplasic therapy.Ninety-one medical oncologists answered out of 118, from public oncology centres (29.7%), Hospital University (58.2%), and private sector (12.1%). Thirty-four of the oncologists replied by email, 33 through phone conversation and 24 by filling paper questionnaires. In total, 32% of the cases were handwritten prescriptions, and 51.6% electronically generated. Forty-six percent of medical oncologists dedicated more time to the oral chemotherapy type Capecitabine prescription versus its intravenous equivalent 5FU. However, 33% medical oncologists take less time to this prescription, and 20.9% of them take the same time. Adherence to oral chemotherapy was evaluated by simply questioning of patients in most of the cases (94%) and 4% of medical oncologist declared that they did not evaluate this adherence. In total, 87.9% of Moroccan medical oncologists revealed that they have not received any specific training in the therapeutic education of the patient with oral anti-cancer treatment.In Morocco, there is a great variability in prescription and follow-up practice for patients receiving oral chemotherapy. There is a lack of a national standardization with regards to the procedures of prescribing and monitoring patients to ensure the quality and safety of the oral chemotherapy prescription.

This letter to the editor reflects on the recently published article about management of cancer patients during the COVID-19 pandemic by Al-Shamsi et al., specifically as regards the management of febrile neutropenia in the context of the pandemic.

Langerhans cell histiocytosis is a rare disease involving clonal proliferation of langerhans cells seen in children and young adults. Clinical presentation is variable, ranging from a single location in the bone to severe multivisceral involvement. Moreover, spinal involvement causing myelopathy is even rare and unusual. We report a rare case of adult Langerhans cell histiocytosis in the dorsal spine causing a spinal cord compression associated with a pulmonary process treated by surgery, radiotherapy and systemic therapy with good evolution.

Ovarian granulosa cell tumors (TGO) are rare neoplasms. They arise from sex cord stromal cells of the ovaries. They are characterized by their slow natural history, and their tendency to relapse long time after the initial diagnosis. Complete staging surgery of the disease is the cornerstone of treatment. Chemotherapy is indicated for localized tumors with a high risk of recurrence, and for recurrent or advanced tumors. Prolonged follow-up is recommended.

Bevacizumab is a recombinant humanized monoclonal antibody targeting the vascular endothelial growth factor; it is actually approved for the treatment of unresectable, locally advanced and metastatic non-small cell lung cancer in association with chemotherapy and as maintenance therapy. Infection risk due to use of bevacizumab is a very rare event. Several cases of aspergillosis in patients treated with monoclonal antibodies have been reported, mostly following treatment with tumor necrosis factor alpha blockers. We present a case of a 60 year-old patient treated for stage IV non-small cell lung cancer, who has been diagnosed with invasive aspergillosis following bevacizumab treatment, and, we postulate that bevacizumab may contribute to this infection.

Key points Immunoproliferative small intestinal disease (IPSID), also known as alpha chain disease, is a rare disease. In the recent WHO classification of hematopoietic and lymphoid tissue, IPSID is considered as a variant of extranodal mucosa-associated lymphoid tissue (MALT) lymphoma. Campylobacter jejuni is a specific pathogen, found to be related to IPSID. Diagnosis is based on histology and immunochemistry (±fluorescent in situ hybridization), with presence of many variable levels of abnormal immunoglobulin in the serum, identified to be truncated alpha-heavy chains. Early-stage disease is treated by antibiotics (tetracyclines). Chemotherapy is recommended up front for patients with advanced disease at presentation or refractory to antibiotics. The chemotherapy schedule used is the CHOP (cyclophosphamide, vincristine, doxorubicin, and prednisone) regimen.

e13064Background: Inflammatory breast cancer (IBC) is the most aggressive breast carcinoma, with the clinical and biological characteristics of a rapidly proliferating disease. A number of molecula...

Les métastases thyroïdiennes sont très peu fréquentes. Elles peuvent de façon exceptionnelle révéler le cancer primitif. Nous rapportons le cas d'une patiente qui a présenté une dysphonie secondaire à un gros nodule thyroïdien lobaire droit. L'examen anatomopathologique de la pièce de l'hémi thyroïdectomie a révélé la présence d'un adénocarcinome d'origine pulmonaire. Le bilan d'extension a confirmé la présence d'une masse au niveau du Fowler droit ainsi qu'une métastase du trochanter fémoral droit et une récidive au niveau de la loge thyroïdienne. Une chimiothérapie à base de Paclitaxel, Carboplatine et Bevacizumab a été débuté. L'évaluation après 4 cures est en faveur d'une stabilité radiologique avec amélioration des symptômes.Key words: Métastase intra-thyroïdienne, cancer bronchique, dysphonie

Introduction La décision médicale partagée ‘Shared decision making’ est un concept qui se développe depuis les années 1990. Il donne aux patients le soutien nécessaire pour exprimer leurs préférences et partager la décision médicale. Cette étude cherche à estimer le degré de participation du patient Marocain atteint de cancer au choix thérapeutique. Méthodes Cette enquête a été réalisée auprès de 272 malades sous chimiothérapie pour une pathologie cancéreuse sous forme d'un entretien verbal basé sur un questionnaire. Les patients ont été sélectionnés selon un mode d’échantillonnage aléatoire, le nombre de patients a été choisi pour une marge d'erreur de 5% et un seuil de probabilité qui approxime les 90%. Résultats Seulement 5.5% des patients dans l'enquête ont participé activement dans le choix thérapeutique. Pour 94% des patients de l’échantillon la stratégie thérapeutique adoptée par le médecin est la bonne et représente l'option optimale. Les principales causes retrouvées qui expliquent la non participation à la décision thérapeutique sont le bas niveau d'instruction, la non réceptivité à l'information ainsi que des défauts majeures dans la transmission et la perception de l'information. Conclusion Ces résultats prouvent que la relation médecin malade dans notre contexte baigne toujours dans le modèle paternaliste. La responsabilité de la décision thérapeutique est le plus souvent laissée au médecin. Il est nécessaire d'informer et d'impliquer le patient de façon active dans le choix thérapeutique afin de mieux sauvegarder la relation médecin-malade qui doit être fondée sur la confiance ainsi que sur une approche participative.

Background: The study aims to determine the impact of cancer on Moroccan patients of Moslem faith. Method: Patients included a convenience sample with histological confirmed cancer. Cases with cerebral metastasis or lacking capacity were excluded. Participants were assessed prospectively using a questionnaire covering epidemiological and socio-economic characteristics, religious affiliation, repercussions of disease on religious beliefs and practices. Results and conclusions: One thousand and six hundred patients (median age 49 years) were approached; 41% females and 74% from rural areas. There was a high rate of illiteracy (38%) and only 7% had higher education. Seventeen per cent were divorced, among whom 41% were divorced after diagnosis of cancer. Eighty-seven per cent had no medical insurance. All were Muslims; 49% practising believers and 51% non-practising. In the first group cancer represented a divine test that permitted acceptance of the disease. In the second group of ‘non-practising believers’, patients reported a feeling of culpability and 95% of them started taking up religious practices, often with extremism and sometimes in contradiction of medical advice. In both groups new behaviours were noticed; 450 women now wore the ‘Hijab’ (scarf), 19% used popular medicine and plants in their diet recommended by the Koran. While these results require replication they indicate changes in behaviour by those within the Moslem faith following a cancer diagnosis. Copyright © 2007 John Wiley & Sons, Ltd.

Ovarian granulosa cell tumors (TGO) are rare neoplasms. They arise from sex cord stromal cells of the ovaries. They are characterized by their slow natural history, and their tendency to relapse long time after the initial diagnosis. Complete staging surgery of the disease is the cornerstone of treatment. Chemotherapy is indicated for localized tumors with a high risk of recurrence, and for recurrent or advanced tumors. Prolonged follow-up is recommended.

Immunoproliferative small intestinal disease (IPSID), also known as alpha chain disease, is a rare disease. In the recent WHO classification of hematopoietic and lymphoid tissue, IPSID is considered as a variant of extranodal mucosa-associated lymphoid tissue (MALT) lymphoma. Campylobacter jejuni is a specific pathogen, found to be related to IPSID. Diagnosis is based on histology and immunochemistry (± fluorescent in situ hybridization), with presence of many variable levels of abnormal immunoglobulin in the serum, identified to be truncated alpha-heavy chains. Early-stage disease is treated by antibiotics (tetracyclines). Chemotherapy is recommended up front for patients with advanced disease at presentation or refractory to antibiotics. The chemotherapy schedule used is the CHOP (cyclophosphamide, vincristine, doxorubicin, and prednisone) regimen.