The 12th edition of the Emirates Oncology Conference (EOC), held from 15–17 November 2024 at Conrad Abu Dhabi Etihad Towers, brought together leading voices in oncology from across the globe. Organized by Abu Dhabi Health Services Company – SEHA, this flagship event continues to serve as a cornerstone for advancing cancer care through education, collaboration, and innovation.
This year’s conference convened over 2490 participants, including oncologists, surgeons, researchers, healthcare professionals, and industry stakeholders, representing 39 countries. The comprehensive scientific agenda featured 35 sessions and 18 hands-on workshops, led by 268 expert speakers, including 104 distinguished international faculty from North America, Europe, Asia, and the Middle East.
The EOC 2024 program spanned a broad spectrum of topics in oncology, such as breast and lung cancers, hematologic malignancies, radiation oncology, palliative care, pediatric oncology, gastrointestinal, genitourinary, and neuro-oncology. The rich exchange of clinical expertise and research insights reinforced the conference’s commitment to driving excellence in cancer prevention, diagnosis, and treatment.
A notable highlight of this year’s event was the presentation of 44 scientific abstracts, selected for their innovation and relevance. These abstracts, presented through oral and poster formats, reflect the continued pursuit of evidence-based advancements and multidisciplinary collaboration in oncology. The abstracts published herein represent some of the most impactful contributions submitted to EOC 2024.
On behalf of the meeting organizers, we extend our sincere appreciation to all contributors—scientific committees, speakers, delegates, and sponsors—whose dedication and support have once again established EOC as one of the premier oncology gatherings in the region.
Are Breast Cancer Patients at a Higher Risk of Developing Type II Endometrial Cancer: A Real-World Database Retrospective Study
Shahd Abdelghany1, Farah Abou Fakhr1, Safa Al-Dulaimi1, Saeed Rafii2
1Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE; 2Mediclinic City Hospital, Dubai, UAE
Introduction: Studies suggest that breast cancer (BC) patients may have a higher risk of type II endometrial cancer (EC). Although this has mainly been attributed to either tamoxifen use or genetics, such studies are inconclusive and are limited due to small sample sizes. Our research aims to determine whether BC patients have an increased risk of type II EC and identify the potential contributing factors.
Methods: We utilized TriNetX, a real-world global database, and identified 58,096,911 female patients aged 18 or older from 2000 to 2023. Our study group included BC patients who subsequently developed EC (n=9,277) and our control group included EC patients without BC (n=144,101). Analysis was conducted on TriNetX built-in statistical analysis software and SPSS (Version 28). Propensity score matching was applied to match for confounding factors. Relative risks (RR) were presented with 95% confidence interval (CI) and a p<0.05 was set for significance. Informed consent was not required for this study as all data on TriNetX is de-identified.
Results: The study group was at a higher risk of developing EC compared to the controls, (RR: 1.93, 95% CI: 1.85–2.04). There was a significantly greater RR for type II EC (RR: 3.46, 95% CI: 2.35–5.09) than type I EC (RR: 1.74, 95% CI: 1.41–2.41; p<0.001). No significant difference between the study and controls was observed for known risk factors of EC such as obesity and Type 2 Diabetes Mellitus (T2D). Tamoxifen use was associated with an increased EC risk, (RR: 2.37, 95% CI: 2.11–2.65), with no significant differences between type I (RR: 2.19, 95% CI: 1.30–3.67), and type II EC (RR: 2.10, 95% CI: 0.99–4.46; p=0.90). To establish if other factors are associated with type II EC, independent of tamoxifen use, we identified patients with a family history of cancer. After matching this group for known risk factors, BC patients in this group who were not treated with tamoxifen still had an increased risk of type II EC compared to the non-BC patients (RR: 2.20, 95% CI: 1.04–4.65).
Conclusion: Our study suggests that tamoxifen is not the sole factor increasing the risk of type II EC in BC patients; potential genetic factors may also contribute to this observed trend. Therefore, we recommend a wide genetic association study to accurately assess this relationship.
Exploring the Effect of Clinical Trial Capacity- Building Activities on Oncology Nurses’ Knowledge at a New Specialized Cancer Center in Oman
Aida Malik Al Kindy1, Huda Al Awaisi1
1Sultan Qaboos Comprehensive Cancer Care and Research Center (SQCCCRC), University Medical City (UMC), Muscat, Sultanate of Oman
Introduction: Clinical trials are essential in the advancement of global scientific knowledge. SQCCCRC, established in 2021, opened 15 clinical trials with more than 422 participants enrolled since its launch. The role of oncology nurses has become more significant because of their direct role in caring for clinical trial participants. This necessitated building their capacity through training to care for trial participants as per the International Council of Harmonization- Good Clinical Practice (ICH- GCP). The aim of this study is to investigate the effect of a capacity- building initiative including conducting Clinical Trial Workshops (CTW) and encouraging nurses to get certified in ICH-GCP that covers the ethical conduct of clinical trials on their knowledge about clinical trials.
Methods: This educational study was approved by the Institutional Review Board (IRB) of SQCCCRC-UMC. Data was collected from 2022 to 2024. Pretest and post-test scores were analyzed using paired t-test to compare averages. Nurses were asked to submit ICH-GCP certification to the clinical trials department (CTD) and this number was compared to the total number of nurses (n=326).
Results: (Figure 1) 19 CTW sessions were conducted in SQCCCRC with a total of 134 participants. Nurses represented 95.5% of the participants (n=128), which accounts for 39.3% of the total nursing staff (n=326).
Figure 1.
85% (n=109) of those nurses completed both the pretest and post-test. 78% of the test takers showed improved scores (n=85) with an average increase of 19.5% in the post-test compared to the pretest, while 19 showed no difference (17%) indicating statistical significance. (CI=0.95, t=0.05). 77 nurses have successfully completed the online ICH-GCP certification during the same period. (23.6% of all nurses, n=326).
Conclusion: Attending CTW and completing ICH-GCP certification significantly improved nurses’ knowledge in building their capacity to care for patients in clinical trials, however, further research is needed to assess the comfort level of nurses in the actual encounters with clinical trial patients at SQCCCRC.
Soluble Immune Modulatory Cytokines and Immune Checkpoint Molecules as Predictors of Response to Anti-PD-1/PD-L1 Therapy in Non-Small Cell Lung Cancer
Sarra Mestiri1, Kirti Prabhu2, Afsheen Raza3, Varghese Philipose Inchakalody2, Reyad Mohsen4, Aladin Kanbour4, Abdul Rehman Zar Gul4, Anite Philip4, Suma Vijayakumar4, Shereena Hydrose5, Wafa Abualainin4, Shahab Uddin6,7, Fares H. Al Ejeh1, Ussama Al Homsi4, Said Dermime2,4,8,9
1Translational Oncology Research Center, Qatar Biomedical Research Institute, Doha, Qatar; 2Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; 3Department of Biomedical Sciences, College of Health Sciences, Abu Dhabi University, Abu Dhabi, UAE; 4Department of Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; 5Weill Cornell Medicine College, Doha, Qatar; 6Translational Research Institute and Dermatology Institute, Academic Health System, Hamad, Medical Corporation, Doha, Qatar; 7Laboratory Animal Research Center, Qatar University, Doha, Qatar; 8College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar; 9College of Health Sciences, Qatar University, Doha, Qatar
Introduction: The advent of immune checkpoint inhibitors (ICIs), anti-PD-1/anti-PD-L1 antibodies, has markedly improved treatment response and overall survival rates in non-small cell lung cancer (NSCLC). However, only 15-40% of patients benefit from ICIs therapy. Therefore, identification of biomarkers associated with responses are mandated in order to increase the efficacy of such therapy. The primary objective of the study aimed to identify pre- and post- treatment immune modulatory cytokines and immune checkpoint molecules levels as predictors of response to anti- PD-1/PD-L1 therapy in NSCLC patients.
Methods: The study was conducted at the National Center for Cancer Care and Research, Hamad Medical Corporation, Qatar from September 2021-June 2023. Sera from 31 locally advanced/metastatic NSCLC patients, eligible for anti-PD- 1/PD-L1 or combined chemoimmunotherapy, was collected pre- and post-treatment. A total of 65 Soluble immune modulatory cytokines and 72 immune checkpoint molecules were tested using Procarta Plex kits. The differential expression of the soluble markers was analyzed using Wilcoxon Signed Rank test and Mann-Whitney U test. Treatment response was assessed via PET-CT imaging and clinical assessment per RECIST criteria.
Results: In non-responders, T cell immune inhibitory checkpoints, PD-1, CD276 were significantly up-regulated after treatment. Furthermore, the elevated soluble CD134 and CD137 levels observed in non-responder may contribute to T cell function impairment. Additionally, natural killer cells inhibitory markers Arginase-1 and Nectin-2 were also found to be significantly upregulated in non-responders after treatment. Analysis of circulating immuno-oncology cytokines demonstrated that the upregulation of IL-15, IL-10, IL-2, IL-20, IL-21 and MCSF was associated with a favorable response while the upregulation of MIP1 alpha, MIP3 alpha, MIP1 beta, SDF1 alpha, TNF alpha, TNF receptor, TRAIL and TWEAK could imply an impaired response to ICIs +/- chemotherapy in NSCLC. These findings demonstrate the crucial role of these mediators in driving treatment response to ICIs. Analysis of soluble mediators with tissue PD-L1 (TPD- L1) status showed a significant upregulation of soluble immune inhibitory CD276 and CD134 in TPD-L1 positive non- responders while in TPD-L1 negative non-responders, significant downregulation of soluble CD134 and CD28 was observed post-treatment. Similarly, in non-responding patients with more than 50% TPD-L1 status, significant upregulation of soluble CD134 was observed after treatment. The results indicate that high TPD-L1 expression could be associated with an upregulation of the soluble immune inhibitory markers CD274 and CD134 leading to poor outcome.
Conclusion: These results can serve as baseline data for conducting larger studies in NSCLC to understand the role of identified soluble mediators as non-invasive prognostic and predictive biomarkers.
OAR Dose Variations in Image-Guided Interstitial Brachytherapy: The Impact of Subsequent Planning Scans Across Treatment Fractions
Fabiha Shakeel, Tooba Ali, Mariam Hina, Maham Khan, Laraib Khan, Bilal Ahmed, Ahmed Nadeem Abbasi, Bilal Mazhar Qureshi, Asim Hafiz, Maria Tariq, Nasir Ali
No affiliations provided
Background: This study aims evaluate how intra fractional motion affects time-dependent variations in organ at risk (OAR) doses during image-guided Interstitial brachytherapy.
Methods: Retrospective data of four patients (n=4) with carcinoma of cervix who underwent EBRT followed by interstitial brachytherapy was collected from March 2023 to March 2024. 2 patients with FIGO stage IIIB and 2 patients with FIGO stage IIB were included for analysis. These patients underwent a planning CT scan before every second fraction of brachytherapy, following the bladder and bowel preparation protocol. OARs and PTV were contoured on each set of planning scans. For each patient inter-fractional motion of OARs and corresponding EQD2 received by each of the OAR was recorded. The recorded data was analyzed using SPSS version 23 to determine the frequency distribution for each fraction.
Results: For patient 1, the mean bladder and rectum distances from HRCTV were 0.5cm (SD + 0.14) cm and 0.65 cm(SD + 0.45)respectively, with corresponding EQD2 doses of 76.24 Gy (SD + 1.644) and 68.26 Gy (SD + 1.32). For patient 2, the mean distance to bladder was 0.35 cm (SD + 0.2) and 0.87 cm (SD + 0.20) rectum, with EQD2 doses of 73.96 Gy (SD + 5.08) and 64.96 Gy (SD + 4.01)respectively. Patient 3 had distances of 0.99 cm (SD + 0.61) for bladder and 0.3 cm (SD+0.07) rectum, with EQD2 doses of 64.98 Gy (SD + 0.77) and 63.96 Gy (SD + 1.50). In patient 4, the mean distances were 1.05 cm (SD + 0.11) bladder and 0.38 cm rectum (SD + 0.11), with EQD2 doses of 68.92 Gy (SD + 1.24) and 65.05 Gy (SD + 0.53).
Conclusion: In our group analysis, we observed variations in bladder and rectum positioning during each brachytherapy fraction, leading to differences in the corresponding EQD2 doses received by these OARs. This highlights the importance of interfraction CT-based planning in interstitial brachy-therapy.
Bridging the Gap: Cancer Prevalence and Undergraduate Career Guidance
Hanya Irfan1, Rana Mahmood2
1Oncology Society, Imperial College London, UK; 2Colchester Hospital, East Suffolk and North Essex Trust, United Kingdom
Introduction: Despite significant advances in oncology, medical education often offers fragmented and limited exposure to this vital field. Traditionally, oncology is taught across different anatomical systems, and there is a critical demand for better integration within medical school curricula. During my tenure as the University Oncology Society President, we sought to assess undergraduate students’ awareness of oncology and address the gaps in their perception of oncology as a career.
Methods: This project, over two Plan-Do-Study-Act (PDSA) cycles, prospectively evaluated and improved medical students’ awareness of oncology as a career pathway. We surveyed 50 clinical-year students to assess their understanding of the role of oncologists, training, and their interest in the field through open-text and Likert-scaled (1=low; 5=high) questions. After identifying knowledge gaps, we conducted targeted interventions including workshops, career panels, and mentorship sessions throughout the academic year. The questions were repeated at the end of the study period. Data was collected with informed consent.
Results: (Figure 2) A significant proportion (74%) of students felt that oncology careers were not adequately represented in their medical curriculum, and 68% believed they had limited clinical exposure to oncology specialties beyond a brief two-week rotation. Several themes to improve engagement were highlighted including teaching on “communication skills”. Following the programme, survey results showed substantial improvements. The percentage of students expressing confidence in their understanding of the role of radiotherapy increased from 20% to 60%. Perception of oncology as a career choice improved, with 68% of students rating the workshops and mentorship sessions as providing valuable insight into the field. 24 students correctly identified the training pathway and role of an oncologist, compared to six pre- intervention. The number of students with a keen interest in oncology rose from three to nine, and an additional six showed moderate interest up from the previous five.
Figure 2.
Conclusion: This project highlights the insufficiency of undergraduate oncology education. It also demonstrates that targeted, well organised interventions can significantly improve students’ awareness and interest in oncology as a career. The findings underscore the need to provide more cohesive oncology education, with a focus on providing career guidance and practical exposure to subspecialties. Future research should assess these interventions’ long-term impact on career decisions and propose scalable models for integrating oncology into medical education.
Genetic Characterization of BRCA1 and BRCA2 Mutations in Cancer and High-Risk Family Screening Cohorts in the UAE Population
Abeer Arif Abdalla Abutalib Al Ali1, Moza Mohamed Ali Alechleh Al Ali1, Dalia Mahmoud Abdel-Hamid El-Shourbagy2, Syed Hammad Hassan Tirmazy2, Imran Mirza3, Afsheen Raza4, Muhammad Farooq Latif2, Hemad Yasaei1,3
1Dubai Genetics Center, Pathology and Genetics Department, Latifa Hospital, Dubai Academic Health Corporation, Dubai, UAE; 2Department of Oncology, Dubai Hospital, Dubai Academic Health Corporation, Dubai, UAE; 3Department of Molecular Genomics, National Reference Laboratory, M42, Abu Dhabi, UAE; 4Department of Biomedical Sciences, College of Health Sciences, Abu Dhabi University, Abu Dhabi, UAE
Introduction: Germline BRCA1/2 (gBRCA1/2) mutations are strongly associated with hereditary cancers, and screening for these variants in high-risk populations is recommended for personalized management. This study aims to comprehensively characterize gBRCA1/2 variants in cancer and family screening cohorts from the Dubai Emirate, UAE.
Methods: A total of 443 patients were tested for gBRCA1/2 mutations from 2017 to 2022 using whole-gene sequencing, and data were analyzed using variant interpretation and in silico prediction tools. All BRCA1/2 variants were classified as pathogenic/likely pathogenic (P/LP) or variants of uncertain significance (VUS) according to ACMG guidelines.
Results: In the cancer cohort, 38 out of 306 patients (12.4%) harbored gBRCA1/2 mutations. Of these, 23 (61%) were classified as BRCA1/2 P/LP, while 15 (39%) were VUS. These variants were predominantly observed in estrogen receptor-positive/progesterone receptor-positive (ER+/PR+) and triple-negative breast cancer patients. Common BRCA1 P/LP variants included deletion frameshift mutations (c.4065_4068del, c.68_69delAG, c.3228_ 3229delAG), an insertion frameshift mutation (c.1140dup), and a nonsense stop-gained mutation (c.5251C>T). BRCA2 P/LP variants included a nonsense stop-gained mutation (c.5645C>A), a missense mutation (c.7007G>A), and a deletion frameshift mutation (c.2254_2257del). In the family screening cohort, 14 out of 137 samples (10%) were positive for BRCA1/2 P/LP and VUS mutations. Of these, 5 (36%) were classified as P/LP, while 9 (64%) were VUS. Pathogenic BRCA1 variants included deletions (c.4065_4068del, c.3756_3759del) and a nonsense variant (c.5095C>T), while BRCA2 pathogenic variants included a deletion frameshift (c.771_775del) and a novel missense variant (c.8377G>A). In both cohorts, novel distinct variants were observed.
Conclusion: gBRCA1/2 variant prevalence in cancer and family screening cohorts can serve as beneficial personalized tool for management and treatment of cancer patients. Larger studies from other emirates of UAE will serve as a foundation for robust risk assessment and implementation of treatment and prevention strategies.
Enhancing Leadership Competencies in Healthcare: Impact of Leadership Skill Development Workshops for Radiation Oncology Professionals in Pakistan
Tooba Ali1, Ahmed Nadeem Abbasi1, Agha Muhammad Hammad Khan2, Maria Tariq1, Agha Muhammad Hassaan Khan3, Asim Hafiz1, Nasir Ali1, Bilal Mazhar Qureshi1
1Aga Khan University Hospital, Pakistan; 2McGill University, QC, Canada; 3Institute of Business Management
Introduction: Leadership in healthcare education is essential for improving clinical practice, medical research, and hospital administration. Effective leadership skills enable healthcare professionals to manage operations, enhance communication, and improve patient care. This study evaluates the impact of leadership skill development workshops on postgraduate residents and faculty in Radiation Oncology at Aga Khan University Hospital, Pakistan.
Methods: From January 2022 to January 2023, eight workshops were conducted, focusing on Emotional Intelligence, Problem-solving, Team Building, and Strategic Visioning. Pre- and post-workshop surveys were administered to 100 participants, analyzing their responses using SPSS version 20, with chi-square tests for significance.
Results: Most participants (63%) were aged 20-30, with the majority being postgraduate trainees (59%). Initial familiarity with workshop topics was low, with only 13% having extensive understanding. Pre-workshop, 74% anticipated gaining knowledge; post-workshop, this rose to 90%. Statistical analysis revealed a significant improvement in understanding (p = 0.000295).
Conclusion: The workshops effectively closed knowledge disparities and fostered professional development, advocating for structured leadership training frameworks in healthcare. This study supports the establishment of continuous education initiatives to cultivate future healthcare leaders, enhancing overall patient care and organizational effectiveness.
Predictive Factors and Treatment Outcomes in BRCA Mutated Ovarian Cancer Cohort in UAE
Saja Masalmeh1, Ariba Naushad2, Nabia Naushad3, Nadeen Quzah2, Noura Al Asaad2, Bara Masalmeh4, Khaled Al Qawasmeh5, Afsheen Raza2
1University of Manchester, UK; 2Abu Dhabi University, UAE; 3 Hamad Bin Khalifa University, Qatar; 4Delft University of Technology, The Netherlands; 5Tawam Hospital, UAE
Introduction: BRCA1 and BRCA2 mutations significantly increase morbidity and progression in ovarian cancer (OC). This study aims to identify clinical characteristics, risk groups, and factors to enhance diagnosis and treatment outcomes and progression-free survival (PFS) for BRCA1/2- mutated OC patients.
Methods: A retrospective study of 54 ovarian cancer patients from Tawam Hospital, UAE, included demographic, genetic, and clinical data. Statistical and machine learning models were applied. Ethical approval was obtained for this retrospective study, with data usage adhering strictly to institutional guidelines for patient confidentiality and privacy.
Results: Of the 54 ovarian cancer patients, 84% were diagnosed at Stage 3/4, with a median age of 56 years. Non-Arab patients were diagnosed at an earlier age, while diabetes was significantly associated with late-stage diagnosis (p=0.0009). Of BRCA1/BRCA2 Mutations: 26% (14/54) and 4% (2/54) were BRCA1/2 positive, respectively. Common BRCA1 pathogenic variants (c.4327C>T, c.5266dup) and novel mutations (c.4656C>A, c.5332 + 2T>A) were observed; BRCA2 pathogenic variants included c.4940_4941del and c.1573del. BRCA mutation presence correlated with improved PFS (p=0.0009) and reduced disease stage (OR=0.4749; p=0.0302). Furthermore, HRD positivity was strongly associated with BRCA mutations (p<0.0001), with 100% of BRCA-positive patients being HRD-positive. Logistic regression models demonstrated that increasing age was associated with a 9.1% higher likelihood of non-response to treatment per year (OR=1.134; p=0.0061), while HRD-positive status reduced the odds of non-response by 93.1% (OR=0.0694; p=0.0049). Additionally, logistic models showed excellent predictive performance with an AUC of 0.8855 (p<0.0001). Machine learning models, including decision trees, random forest, gradient boosting, and XGBoost, exhibited strong predictive power for treatment response and PFS, with AUC values up to 0.95 and accuracy up to 86%. These models highlighted HRD status, age, ethnicity, treatment type and family history as critical predictors, providing enhanced accuracy and deeper insights into patient outcomes.
Conclusion: These results highlight factors in BRCA-positive OC patients that serve as predictive and prognostic indicators, supporting personalized treatment strategies.
Evaluating Spinal Cord and Spinal Canal Dose Variability and Dose Heterogeneity by Simulating Isocenter Shifts in Craniospinal Radiation Planning
Mariam Hina, Muhammed Umer, Laraib Khan, Bilal Ahmed, Maria Tariq, Sehrish Abrar, Asim Hafiz, Nasir Ali, Ahmed Nadeem Abbasi, Bilal Mazhar Qureshi
Section of Radiation Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
Objective: To assess variation in spinal cord and spinal canal doses and dose heterogeneity by simulating isocenter shifts to absolute couch parameters in patients undergoing craniospinal radiation planning (CSI).
Methods: Five cases of standard risk medulloblastoma were selected from the hospital database. Three additional treatment plans were generated for each case, with 3 consecutive shifts of 1 mm, 2 mm and 3 mm. A total dose of 2340 cGy was planned in 13 fractions at 180 cGy/fraction to craniospinal axis. Radiation technique, length of junction in cm, total number of junctions, reference and experimental doses to spinal cord and spinal canal along with maximum and minimum dose values relative to junction were recorded.
Results: Majority of patients (n=4, 80%) were between 6- 20 years of age. Three patients (60%) were treated with Intensity Modulated Radiation Therapy (IMRT) and 2(40%) with Volumetric Modulated Arc Therapy (VMAT). Two (40%) patients had a junction at 10 cm, and the remaining patients (20%) at 3 cm, 4 cm, and 12 cm each. Three (60%) patients had 1 junction while 2(40%) had 2 junctions. Mean dose change in percentage for spinal cord was 0.98% (2.88), 1.46% (2.94) and 1.83% (2.99) for 1 mm, 2 mm and 3 mm shifts respectively. Mean dose change in percentage for spinal canal was 1.28% (2.3), 1.64% (2.7) and 1.82% (2.8) for 1mm, 2mm and 3mm shifts respectively. The maximum dose change relative to junction was 2.42% (3.6), 3.52% (6.1) and 3.96% (9) for 1mm, 2mm and 3mm shifts, respectively. The minimum dose change was 3.26% (6.3), 4.22% (8.2) and 7.08% (11.1) for 1mm, 2mm and 3mm shifts, respectively.
Conclusion: Our study explored the impact of various shifts in treatment planning for CSI, highlighting the importance of enhanced treatment delivery strategies to ensure optimal delivery of prescribed doses and reduce dose heterogeneity for patients undergoing CSI.
Ultra-Hypofractionated Breast Radiotherapy and Associated Acute Skin Toxicity
Maham Khan, Laraib Khan, Tooba Ali, Mariam Hina, Fabiha Shakeel, Bilal Ahmed, Sehrish Abrar, Nasir Ali
Section Radiation Oncology, Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
Introduction: Breast cancer management includes surgery, chemotherapy and radiotherapy as per indication. Adjuvant breast radiation is prescribed following breast conserving surgery to reduce the risk of local recurrence. Fast forward trial concluded that 26 Gy in 5 fractions over 1 week is non-inferior to the standard of 40 Gy in 15 fractions over 3 weeks for local tumor control, and is safe in terms of normal tissue effects up to 5 years for patients prescribed adjuvant local radiotherapy after primary surgery for early-stage breast cancer. We followed treatment schedule of 26 Gy in 5 fractions and evaluated the acute skin toxicity during and after the completion of treatment.
Methods: In this retrospective review, patient who were treated on the fast forward trial protocol were reviewed. Acute skin toxicity in terms of grades of dermatitis was noted during radiation therapy and 1 month after the completion of treatment.
Results: (Figure 3) Between January 2023 to November 2023, 55 patients on fast forward protocol with a mean age of 62.4 years (IQR = 44 - 91 years). Out of which 37 patients were right sided and rest were left sided breast cancers. Volumetric Modulated Arc Therapy (VMAT) planning was done in 29 patients and majority of those (n=18) were left sided tumors, however 26 patients were planned with Three-Dimensional Conformal Radiation Therapy (3DCRT). Dermatitis was graded according to the RTOG skin toxicity scale. Grade II skin side effects were observed in only 10 patients and grade 1 side effects were recorded in 45 patients at the completion of treatment. One month after completion of treatment, all side effects resolved in all patients. In only one patient moderate pain in irradiated breast was noted which was managed with oral anti- inflammatory medications and it resolved in further following 2 weeks’ time.
Figure 3.
Conclusion: Ultra-hypofractionated radiotherapy is well tolerated with breast cancer patients, and acute toxicity observed in our sample was acceptable. Also, this treatment is time efficient and cost effective aiding efficient management of resources with catering of logistics as well. Hence radiation therapy via Fast Forward trial can be adopted in our subset of population as well with minimal to no toxicity reported.
Real-World Clinical Outcomes of Sacituzumab Govitecan in Metastatic Triple-Negative and Hormone-Positive Breast Cancer: A Single Tertiary Centre Experience
Yara Alkanash, Jawaher Ansari, Emad Dawoud, Selveraj Girdharan, Diaeddin Trad, Nouri Bennini, Mawadah Hussein, Iman Tabash, Husam Marashi
Tawam Hospital, Al Ain, UAE
Introduction: Sacituzumab Govitecan (SG) has been approved by the Food and Drug Administration (FDA) for two indications in metastatic breast cancer: metastatic triple-negative breast cancer (mTNBC), as demonstrated in the ASCENT study, and metastatic hormone receptor- positive/HER2-negative breast cancer (HR+/HER2-), based on the TROPiCS study. This investigation presents real- world clinical outcomes and toxicity data from the Tawam Hospital, focusing on patients treated under these approved indications.
Methods: A retrospective analysis was conducted on 21 patients with mTNBC or HR+/HER2- metastatic breast cancer who received at least one dose of SG at Tawam Hospital between April 2020 and October 2024 were retrospectively analysed. All patients had previously undergone a minimum of two lines of chemotherapy in accordance with the approved indications. Ethical committee approval was obtained for this study.
Results: The median age of the 21 patients was 44 years (range, 31–57 years). The majority of patients (70%) exhibited an ECOG performance status of 0–1, each of these patients had visceral disease including cases with central nervous system (CNS) involvement, as well as liver, lung, and bone metastases. SG was administered as second-line treatment in 25% of cases, third-line in 4.7%, fourth-line in 14%, and fifth-line in 11%. In the mTNBC cohort (n = 10), the median number of prior treatment lines was two, and two patients experienced rapid disease progression within six months of adjuvant therapy. All the patients in this group had visceral metastases. The median progression-free survival (mPFS) was 5.2 months, and the median overall survival (mOS) was 7 months, respectively. For the HR+/HER2- group (n = 11), the median number of prior treatment lines was five (range: 2–10). All patients in this group were heavily pretreated and all exhibited visceral metastasis. The mPFS and mOS were 3 and 4 months, respectively. Notably, one patient, who had previously received trastuzumab deruxtecan achieved 13 months of disease control with SG. Overall, the most frequently observed adverse events (AEs) were fatigue (46.1%), neutropenia (7.9%), diarrhoea (7.7%), and nausea (23%). Dose reductions or treatment interruptions due to AEs were necessary in 36% of patients.
Conclusion: This study demonstrates that SG exhibits significant anti-tumour activity, particularly in heavily pretreated patients with mTNBC. The observed progression-free survival aligns with the results reported in the ASCENT trial. For HR+/HER2- patients, the earlier use of SG may enhance clinical outcomes, as suggested by the TROPiCS trial. Further investigations with larger patient cohorts are warranted to validate these findings, particularly in the HR+/HER2- subgroup.
Risk Factors Amongst Patients Developing Pneumonitis on Exposure to Immune Checkpoint Inhibitors - A Multi-Institutional Cohort Study
Ritika Abrol1, Rachel Powell2, Shobhit Baijal2, Ankit Jain1
1Department of Oncology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK; 2Department of Oncology, University Hospital, Birmingham, AL, USA
Introduction: Immune Checkpoint Inhibitors(ICIs) elicit anti- tumour effect by harnessing the immune system. However, adverse effects such as Checkpoint Inhibitor related Pneumonitis(CIP) limit their utility. Real world data collection shows that CIP is far more common than depicted by trials. Incidence as well as risk factors for CIP are poorly understood. The objective of this study was to identify risk factors amongst patients with ICI exposure who developed CIP.
Methods: We conducted a retrospective study of patients who developed CIP after receiving ICIs for various malignancies at two centers after seeking appropriate ethical clearance and consent. The patient’s baseline characteristics, type of malignancy, type of ICI used, clinical characteristics, laboratory tests, imaging and treatment information were analyzed by SPSS to determine overall risk factors for patients developing CIP.
Results: (Figure 4) 27 patients were recruited in the study. Positive male preponderance was noted amongst the test subjects with those over the age 65 being at increased risk (Odd’s Ratio [OR]- 2.500 95% Confidence Interval CI- 0.688- 9.084). Of the data set- prior radiotherapy exposure and pre-existing lung disease placed patients at an increased risk of developing CIP (OR- 1.467, 95% CI- 0.612-3.516; OR- 1.077, 95% CI- 0.464-2.502). There was a noticeable occupational distribution such as foundry workers, coal workers amongst patients developing CIP, however the same was not quantified in our study. The most common type of cancer for which ICI was given was Non-Small Cell Lung Cancer of the lung (77.7%), followed by Malignant Melanoma (11.1%) and Renal Cell Cancer comprising the rest. Among the study patients, 81.4% received Anti-PD-L1 monotherapy with 18.5% receiving combination therapy with CTLA-4 agents. All patients with CIP regardless of grade were treated with oral steroids and admission if necessary- however complete response was noted in only 25.9% of the patients, with 55.5% showing partial response and the rest coming under non-responders.
Figure 4.
Conclusion: Increased age, previous radiotherapy exposure and pre-existing lung disease increase risk of CIP in patients receiving ICI as per our study. This is in concordance with existing literature. However, a larger sample size and further research would be required to determine a predictive model for the same.
Dosimetric Comparison of Heart and Lung Doses Between Coached and Un-Coached Left Sided Breast Cancer Patients Undergoing Adjuvant Radiotherapy Using Deep Inspiration Breath Hold Technique
Laraib Khan, Tooba Ali, Maham Khan, Maria Tariq, Asim Hafiz, Bilal Mazhar Qureshi, Ahmed Nadeem Abbasi, Nasir Ali
Aga Khan University Hospital, Karachi, Pakistan
Introduction: Radiation exposure to heart in women with left sided breast cancer can lead to cardiac disease related mortality, and an excess of cardiac deaths in postmastectomy irradiated breast cancer patients was
shown in a meta-analysis. In a study it was reported that rates of coronary events increased with the mean dose to the heart linearly by 7.4% per gray. Therefore, it is important to improve cardiac avoidance in patients undergoing radiotherapy for left sided breast cancer. For improving cardiac outcomes, several techniques have been used such as deep inspiration breath hold (DIBH), respiratory gating, radiotherapy in prone position, accelerated partial breast irradiation (APBI), and use of modern 3-dimensional and intensity modulated radiation therapy (IMRT) planning. DIBH technique is based upon the observation that during inspiration, the flattening of the diaphragm and expansion of the lungs pulls the heart away from the chest wall hence reduces the cardiac and lung doses. Kim et al in his study reported further reduction in cardiac doses using DIBH when the patients were given coaching as compared with the non-coached patients. The aim of our study was to compare the maximum, mean and V5, V10, V30 Gy doses of heart and lung doses (V17 and V20) between coached and un-coached patients using DIBH technique in left sided breast cancer radiotherapy.
Methods: Patients with left-sided breast cancer who had received adjuvant radiotherapy, utilizing DIBH technique, were included in the study. This cohort was designated as uncoached patients. While these patients received verbal guidance regarding the breath hold technique, they did not undergo any formal coaching or structured training. In contrast, the second cohort involved the implementation of a comprehensive coaching protocol for the DIBH technique, which commenced in January and continued through June 2022. This protocol aimed to enhance the patients' understanding and execution of the breath hold technique to optimize cardiac protection during radiation therapy. The acceptance rate of the DIBH plan was noted based on several parameters, including the maximum and mean doses, as well as the V5, V10, and V30 Gy doses to the heart, and the V17 and V20 Gy doses to the lungs from both patient cohorts. These parameters were analyzed using Dose Volume Histograms (DVH), which are part of the routine evaluation and approval process for radiation treatment plans. Radiation therapy planning was conducted using the Aria-15 planning system on the Eclipse workstation by a clinical medical physicist.
Results: (Figure 5) Our interim analysis indicates that there is a statistically significant reduction in the maximum radiation dose delivered to the heart in patients who received coaching compared to those who did not (p=0.02). Conversely, the analysis revealed no statistically significant differences in the other dosimetric parameters assessed between the two cohorts.
Figure 5.
Conclusion: These findings suggest that coaching may play a crucial role in optimizing treatment delivery while minimizing potential cardiac toxicity and can be mandated for all compliant left sided breast cancer patients.
Transitioning From Weekly to Daily Peer Review Meetings in Radiation Oncology
Laraib Khan, Maham Khan, Mariam Hina, Maria Tariq, Asim Hafiz, Nasir Ali, Ahmed Nadeem Abbasi, Bilal Mazhar Qureshi
Aga Khan University Hospital, Karachi, Pakistan
Introduction: Peer review is considered as a means of feedback and is a valuable tool central to quality assurance (QA) programs. Inter-observer variability in target volumes of radiation therapy has been demonstrated in multiple studies1. Due to the need of peer review in radiation therapy planning, peer review meetings (PRMs) were held weekly at the Aga Khan University Hospital (AKUH). To evaluate the efficacy of more frequent PRM in our setting, the Department of Radiation Oncology at AKUH now employs daily PRM, where all patients who are being planned to receive radiation therapy are routinely discussed. This study aimed to observe the impact of daily PRM in radiation oncology, and to determine the frequency of changes suggested during these meetings.
Methods: Radiation treatment plans of 249 patients from April 2022 to September 2022 were discussed in departmental PRMs daily after being approved by primary radiation oncologist. During PRM each plan was reviewed by a team of radiation oncologists and their suggestions were documented as no change, minor change, major change, or missing contour (Table 1). Changes were further stratified as changes in target volumes, treatment field, RT doses and treatment decisions.
Results: (Figure 6) Out of 249, 139 (55.8%) were male and 110 (44.2%) were female. The setting of treatment was definitive in 101 (40.6%) patients, adjuvant in 144 (57.8%) and neoadjuvant in 4 (1.6%) patients. Most of our patients were treated with radical intent, i.e., 212 (85.1%). A larger volume of discussed plans comprised of head & neck cancers n= 79 (31.7%), thorax 55 (22.1%) followed by brain and pelvis each 39 (15.7%). Most of the plans i.e., 190 (76.3%) were based on IMRT/VMAT. The results gathered from our institution showed that changes in 132 (53.1%) of the plans were not suggested changes during PRM. However, in 114 (45.7%) cases, PRM changes were suggested where 78 (31.3%) were minor and 36 (14.5%) were major changes. In most cases the changes were suggested in CTV i.e., 62 (24.9%) while PTV was suggested modifications in 21 (8.4%) of the cases during PRM discussion. Among all, head and neck was the region with most frequent PRM changes suggestions 53 (57.6%) followed by pelvis 18 (19.5%). We switched from weekly to daily peer review meetings to enhance the quality of discussions, resulting in even more frequent suggestions for changes during the meetings, being 45.7% compared to 22.4% in the previous study2. This can be attributed to a reduced number of cases discussed daily, allowing for more extensive discussion on each case.
Figure 6.
Conclusion: Peer review is an important tool for quality assurance and can be used to overcome deficiencies in radiation treatment plans. It can also serve as an effective learning tool with a goal of improved and individualized patient care.
Efficacy and Safety of Pembrolizumab in Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma: Real-World Experience from a Tertiary Centre in the United Arab Emirates
Iman Tabash, Mawada Hussein, Yara Al Kanash, Emad Dawoud, Jawaher Ansari, Selveraj Giridharan, Diaeddine Trad, Khaled Qawasmeh, Husam Marashi
Tawam Hospital, Al Ain, UAE
Introduction: Head and neck squamous cell carcinoma (HNSCC) is the fifth most common cancer worldwide reporting more than half a million new cases every year, with the heavy burden of disease associated with head and neck malignancies in the world and the significant toxicities associated with platinum chemotherapy, there is a need for new and improved treatment modalities. Recent landmark clinical trials KEYNOTE-048 established the programmed death-1 inhibitor pembrolizumab with and without chemotherapy as a new standard first-line treatment for patients with platinum-sensitive Recurrent/Metastatic HNSCC. This study evaluates the efficacy, safety, and outcomes of Recurrent/Metastatic Head and Neck Cancer receiving Pembrolizumab based therapy in our tertiary Cancer Centre.
Methods: In this retrospective single-centre study, we examined 21 patients treated with Pembrolizumab based therapy from 2019-2023. PFS, Radiological response and further line of therapy were examined. Adverse events were recorded using the Common Toxicity Criteria for Adverse Events (CTCAE). Data analysis utilized SPSS software, under approval from the hospital Research Ethics Board.
Results: Total of 21 patients were included. The median age was 55 years. Patients with ECOG performance status (PS) 0,1 and 2 were included. PDL1 CPS ≥1in 12 patients (57%), our cohort included patients in metastatic squamous cell carcinoma of oral cavity cancers 47%, larynx 9%, hypopharynx 23% and paranasal sinus cancer 19%, 33% of patients had locoregional disease where the rest had distant metastases. Pembrolizumab treatment was administered as 1st line treatment for all patients with a median PFS of 10 months, radiological response was assessed using RECIST criteria CR was seen in 10%, PD 14%, PR 33%, SD 24% and around 19% didn’t have disease assessment due to lost follow up, Overall toxicity analysis showed the most common adverse events (AEs) with 38% incidence of hypothyroidism.
Conclusion: This study confirming that using pembrolizumab in first line recurrent/metastatic head and neck squamous cell carcinoma showed substantial anti- tumour activity in this small cohort, the data were compatible in regard to PFS to that reported in Keynote 048 trial, larger sample is needed for further assessment.
First-Line CDK4/6 Inhibitor Therapy in HR+/HER2- Metastatic Breast Cancer: Real- World Evidence from a Tertiary Centre
Yara Alkanash, Hussam Marashi, Jawaher Ansari, Emad Dawoud, Khalid Gawasmeh, Lina Wahbeh, Mawada Hussein, Iman Tabesh
Tawam Hospital, Al Ain, UAE
Introduction: Cyclin-dependent kinase (CDK) 4/6 inhibitors have notably enhanced the prognosis of patients with metastatic hormone receptor (HR)-positive human epidermal growth factor receptor 2 (HER2)-negative breast cancer. When combined with endocrine therapy (ET), these agents double progression-free survival (PFS) compared to ET alone. Currently, the FDA has approved three CDK4/6 inhibitors, palbociclib, ribociclib and abemaciclib for first and subsequent lines of treatment of HR+/HER2- metastatic breast cancer. This study examined real-world outcomes based on retrospective data from Tawam Hospital.
Methods: A retrospective analysis was conducted on 212 patients with metastatic HR+/HER2- breast cancer who received a minimum of three months of treatment with a CDK4/6 inhibitor between 1st Jan 2016 and 1st Aug 2024 at Tawam Hospital as first line treatment. All data were collected and analysed retrospectively after obtaining approval from the institutional ethics committee.
Results: The median age of the patients was 51 years (27– 89 years).Patient’s distribution by ECOG performance status was PS 0,1 was 73%, PS 2 and above was 27% including 13% PS 3&4.The most frequent metastasis site was bone 77%,the least frequent was brain10%.50% had de novo MBC. Palbociclib was used in 55%, Ribociclib in 42%, and Abemaciclib in 4%.In whom CDK 4/6 inhibitors was used as first line, the overall mPFS is 26.3 months, mOS is 60 months. Abemaciclib mPFS not reached, Palbociclib mPFS 23.6 months, Ribociclib mPFS 28 months. The best response post the 1st-line treatment was SD. Clinical benefit rate was 90% per RECIST criteria. The most frequent side effect was neutropenia found in 24%.Effects of different variables was studied, the mPFS decreases as we move up to PS 3 and 4; 47 months at 0,1 PS,23 months at PS 2, and 14 months at 3-4 PS. Also mOS decreases as we move up to the 3 and 4 PS; it's 77months at 0-1 PS, 45 months at PS 2 and 28 months at 3-4 PS. The mPFS is lower among those with metastasis at liver than those without;26 months, as compared to 47 months respectively. The mOS is also lower 52 months as compared to 75 months respectively. The mPFS is lower among those with metastasis at brain than those without;18 months as compared to 42 months respectively. Also mOS is lower; 43 months as compared to 68 months respectively. The mPFS is higher among those with metastasis at bone than those with visceral metastasis; 49 months as compared to 35 months respectively. Also mOS is higher; 78 months as compared to 60 months respectively. The mPFS increases as the PR% increases; Less than 10% of ki67 expression showed lower mPFS in comparison to higher levels of expression. Second line therapy in this cohort was either chemotherapy based or endocrine based therapy, mPFS was 6.0, 5.8 months respectively.
Conclusion: This study reinforces the substantial anti- tumor efficacy of CDK 4/6 inhibitors as a first-line treatment for metastatic HR+/HER2- breast cancer as it shows improvements in mOS and mPFS. Patients with a poorer PS of 3/4 had shorter mPFS than those with better PS. However, introducing CDK 4/6 inhibitors may still offer clinical benefits by extending PFS and enhancing PS. Data analysis aims to shed light on second-line treatment, providing insights into the efficacy of evolving treatment options. Our data aligns with published clinical trials in terms of efficacy, safety, and overall outcomes.
Breast Cancer Awareness, Knowledge of Risk Factors, and Cultural Competency Among Medical Students in the United Arab Emirates: A Cross-Sectional Study
Ayham Khan Ansari, Zainaldeen Muslim Al-Mathno, Ibrahim Hassan Ibrar, Ans Ahmed Mahmood
Gulf Medical University College of Medicine, Ajman, UAE
Introduction: Breast cancer remains a leading health concern globally, especially in the UAE where it is the primary cause of cancer-related deaths among women. Early detection through increased awareness of breast cancer risk factors and symptoms is crucial for better patient outcomes. Given the UAE's diverse society, medical education must include cultural competency to ensure effective patient care. Studies completed in Saudi Arabia and Syria have revealed varying levels of breast cancer awareness among medical students, indicating gaps in their understanding of risk factors and cultural sensitivity. This study seeks to identify such gaps among UAE medical students and propose changes to the medical curriculum to overcome these weaknesses.
Methods: This cross-sectional study targeted clinical-year medical students from Gulf Medical University, Ajman, and other UAE universities. Students participated voluntarily and anonymously, with students completing a structured questionnaire designed to assess their breast cancer knowledge, awareness of risk factors, cultural competency, and interest in breast cancer awareness activities. Survey content included the following five sections: student demographics, general knowledge of breast cancer, knowledge of breast cancer risk factors, cultural competency in breast cancer, and interest in breast cancer awareness activities. All participants were assured of confidentiality, and data were securely stored. The study adhered to ethical guidelines for research involving human subjects.
Results: (Figure 7) Out of 62 respondents, 36 were female (58%) and 26 were male (42%). There was a high awareness of common symptoms, such as lumps in the breast or armpit: all respondents (100%) correctly identified lumps in the breast as a symptom, while 97% recognized breast pain as a potential indicator. A majority, 54 students (88%), expressed that their current curriculum does not adequately address breast cancer awareness.
Figure 7.
Conclusion: The study highlighted a solid foundation of breast cancer knowledge among UAE medical students but also revealed gaps in understanding risk factors and cultural competence. Enhancements to the curriculum are needed to better cover these aspects of breast cancer awareness.