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Introduction:: Cancer is associated with a higher risk of venous thromboembolic events compared to the general population. About one-fifth of patients diagnosed with venous thromboembolic events have underlying cancer. The guidelines recommend both low molecular weight heparin and direct oral anticoagulants for the prevention and treatment of venous thromboembolic events. Further evidence is required to adequately characterize the exact role of direct oral anticoagulants Methods:: A systematic review of the literature was done by searching the databases of Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. The analysis included only randomized controlled trials enrolling adult patients with cancer and venous thromboembolic events comparing low molecular weight heparin versus direct oral anticoagulants. Duration of follow-up of at least 6 months was considered as a minimum. The studies had to assess the risk of thromboembolic recurrence rate, all-cause mortality, and risk of bleeding. Results:: The final search results led to the inclusion of five randomized controlled trials. The analysis showed a similar risk of recurrence of venous thrombotic events (RR 0.71, 95% CI 0.44-1.17; P = 0.18), mortality risk (RR 1.02, 95% CI 0.88-1.17; P = 0.8), and major bleeding (RR 1.05, 95% CI 0.69-1.62; P = 0.81) between the two treatment groups. Conclusion:: The use of direct oral anticoagulants is a feasible and practical option in ambulatory cancer patients with venous thromboembolic events. The efficacy and safety are similar to that of low molecular weight heparin.

Prostate cancer is the most common malignancy in male patients. The second-generation taxanes, cabazitaxel, is a therapeutic option with an overall survival advantage for patients with metastatic castration-resistant prostate cancer. This review explores specific aspects of cabazitaxel including the duration of treatment, the efficacy of lower dose and effect on the incidence of adverse effects, and optimal sequencing of cabazitaxel. A systematic search of data baselines "PubMed, Ovid Medline, Scopus, and Embase" was carried out using the keywords "cabazitaxel" and "metastatic prostate cancer." The search was limited to clinical studies performed after October 2010 addressing duration of treatment, the efficacy of lower dose, adverse effects, the sequence of cabazitaxel in relation to other lines of therapy and use in chemotherapy naïve patients. The current evidence supports the utility and safety of cabazitaxel as either a second- or third-line agent after docetaxel, or as an alternative to docetaxel in the chemotherapy-naive setting. Extended duration of cabazitaxel beyond 10 cycles is feasible and does not appear to lead to cumulative toxicity. In conclusion, cabazitaxel can improve survival in castrate-resistant prostate cancer with an acceptable risk of toxicity. Studies confirmed the efficacy of reduced dose and utility in patients without prior chemotherapy.

Aim Cabazitaxel prolongs survival in patients with metastatic castration-resistant prostate cancer in the postdocetaxel setting. We investigate the benefit of continuing cabazitaxel beyond 10 cycles in patients who are clinically responding without significant toxicity. Methods A comparison was made between patients who received cabazitaxel for >10 cycles and those who had ≤10 cycles. Overall survival (OS), prostate-specific antigen (PSA) response, alkaline phosphatase (ALP) changes and treatment-associated adverse events were evaluated. Results The median OS was 9 months (range 0.75–59), with OS significantly higher in patients who received extended duration of treatment: 14 months (range 3–90) vs 7 months (range 1.3–21) in patients treated with 4–10 cycles (HR 0.28, 95% CI 0.1 to 0.74, p=0.01). PSA decline did not show a significant correlation with OS (PSA decline ≥50%, p=0.54). Furthermore, there was no significant difference in OS between patients who had a normal versus high ALP at baseline. There was no clear evidence of cumulative toxicity in those having >10 cycles. Conclusion A substantial proportion of patients with metastatic castration-resistant prostate cancer were able to receive more than 10 cycles of cabazitaxel without clinically relevant cumulative toxicity.

Cancer is the leading cause of increased morbidity and mortality worldwide. This work aims to study the Arab-world females' cancers (AFCs), the similarities and disparities from epidemiological, economic and development-indices points of view.Descriptive - Analytical review of the 2018 Global Cancer Observatory concerning AFCs. Data on various cancers were compiled and compared among the countries in the regions and the world females' cancers (WFCs).A total estimate of 227,494 new AFCs; 2.64% of WFCs, with an average crude incidence rate of 111.7* and an age-standardized rate of 134.5*, compared to 228* and 182.6* of WFCs, respectively. Death cases estimated to be 122,903; 2.95% of WFCs, with an average crude mortality rate of 60.3* and age-standardizedrate of 75.4*, compared to 110.2* and 83.1* of WFCs, respectively. Five-year prevalent cases were 530,735; 2.33% of WFCs, with an average proportion of 260.5*, compared to 603.5* of WFCs. Mortality to Incidence Ratio was 0.54 (range 0.36 - 0.80), compared to 0.58, 0.52, 0.49 in the medium human development index, upper-middle-income countries and world countries, respectively. */100,000 population.Despite the demographic and cultural similarities among the Arab communities, there are apparent disparities in AFCs. A systematic approach is required to address these remarkable differences in cancer ranking and rates among Arab countries themselves and when compared to other world groups and nations.

An elderly lady presented with a 2-year history of intermittent vaginal bleeding and later the development of a vulvovaginal mass. A core biopsy histology specimen from the mass and the left inguinal lymph node was suggestive of metastatic adenocarcinoma of breast origin. No breast lesion was detected on mammography, and axillary nodes were negative. The histopathologic features and the expression of GATA3, cytokeratin (CK)7, mammaglobin staining and estrogen and progesterone receptors led to a diagnosis of breast cancer originating from the ectopic mammary tissue in the vulva. Given the rarity of these lesions, and the lack of standard treatment guidelines, the management of the patient was extrapolated from the established breast cancer treatment guidelines. Radiotherapy and chemotherapy followed by hormone therapy with aromatase inhibitor were administered to this patient in the metastatic setting with good palliation.

Pulmonary hypertension is a rare vascular disease that can affect patients with or surviving malignancy resulting in significant morbidity and high mortality. Malignant diseases can lead to elevated pulmonary artery pressure through different mechanisms, either directly by structural obstruction of pulmonary vessels or indirectly through hyperco­agulable state or treatment toxicity culminating in high pulmonary vascular resistance. The most common causes of cancer-related pulmonary hypertension are thromboembolic diseases, tumour emboli and treatment toxicity and less commonly intravascular tumours and malignant extrinsic compression.

Background Neoadjuvant systemic therapy (NAST) can be used to treat breast cancer. Pathologic complete response (pCR) is a surrogate marker for improved survival. This study examined response in the breast and axilla to NAST and identified features associated with pCR. Methods Patients undergoing NAST and surgery between January 2012 and June 2016 by surgeons at Westmead Breast Cancer Institute were identified. Patients with inflammatory or metastatic disease were excluded. Data were analysed to identify factors predictive of pCR. Results Ninety-one patients were identified. Mean age was 49 years. Forty-one patients had axillary metastases identified prior to NAST. Eighty-three patients received chemotherapy alone, six endocrine therapy alone and two had both. Thirty-seven patients had mastectomy and 54 had breast-conserving surgery. The overall breast pCR rate was 29% higher in patients with triple-negative (50%) or HER2-positive (39%) disease and lower in luminal disease (11.6%, P = 0.001). Forty percent of node-positive patients became node negative. The only variable associated with pCR was tumour biology. Patients with HER2-positive breast cancer were more likely to have axillary pCR than those with luminal cancer (odds ratio: 28, P = 0.00005). Conclusion pCR in either the breast or axilla was most likely to be achieved in patients with HER2-positive or triple-negative breast cancers. In patients with luminal cancers, the goal of NAST is best considered to facilitate surgical options rather than obtaining a pCR.

Neoadjuvant systemic therapy (NAST) can be used to treat breast cancer. Pathologic complete response (pCR) is a surrogate marker for improved survival. This study examined response in the breast and axilla to NAST and identified features associated with pCR.Patients undergoing NAST and surgery between January 2012 and June 2016 by surgeons at Westmead Breast Cancer Institute were identified. Patients with inflammatory or metastatic disease were excluded. Data were analysed to identify factors predictive of pCR.Ninety-one patients were identified. Mean age was 49 years. Forty-one patients had axillary metastases identified prior to NAST. Eighty-three patients received chemotherapy alone, six endocrine therapy alone and two had both. Thirty-seven patients had mastectomy and 54 had breast-conserving surgery. The overall breast pCR rate was 29% higher in patients with triple-negative (50%) or HER2-positive (39%) disease and lower in luminal disease (11.6%, P = 0.001). Forty percent of node-positive patients became node negative. The only variable associated with pCR was tumour biology. Patients with HER2-positive breast cancer were more likely to have axillary pCR than those with luminal cancer (odds ratio: 28, P = 0.00005).pCR in either the breast or axilla was most likely to be achieved in patients with HER2-positive or triple-negative breast cancers. In patients with luminal cancers, the goal of NAST is best considered to facilitate surgical options rather than obtaining a pCR.