ObjectiveThe prognostic value of body mass index (BMI) in metastatic breast cancer (MBC) has not been fully elucidated. In a prospective study to investigate the chemo-sensitizing effect of statins on clinical outcomes in MBC patients who were scheduled to receive palliative chemotherapy (Carboplatin and Vinorelbine), we sought to investigate the relationship between baseline BMI and clinical outcomes; response, overall survival (OS) and progression free survival (PFS), over a median follow-up of 40-months.ResultsEighty-Two MBC patients were enrolled and categorized using baseline BMI as underweight (BMI, < 18.5 kg/m2, n = 1), normal-weight (BMI, 18.5–24.9 kg/m2, n = 20), overweight (BMI, 25–29.9 kg/m2, n = 34), and obese (BMI, ≥ 30 kg/m2, n = 27). Median OS was 10 months in normal/underweight, 19 months in overweight, and 16 months in obese (P = 0.083). Univariate Cox model revealed that overweight patients were significantly less likely to die of MBC as normal BMI patients (hazard ratio [HR] = 0.54, 95% confidence interval [CI], (0.29–0.98), P = 0.044). Similarly, multivariate Cox model, after adjusting for age, number of metastatic sites, chemotherapy line’s grade, HER2 and hormone receptors status, confirmed longer survivorship of overweight in comparison with normal BMI patients (HR = 0.51, 95% CI (0.26–0.99), P = 0.047). Our data suggest that being overweight could improve OS in MBC patients.Electronic supplementary materialThe online version of this article (10.1186/s13104-017-2876-2) contains supplementary material, which is available to authorized users.

Preclinical studies support the anticancer activity of statins; however, the existing clinical evidence is inconsistent and not definitive. Our study aimed at evaluating a postulated cancer chemo-sensitizing effect of statin (simvastatin) in a cohort of metastatic breast cancer (MBC) patients. We designed a prospective, single-centered, randomized, double blinded, placebo-controlled trial that encompassed MBC patients with an ECOG Performance Status Scale ≤2 and scheduled to be treated with a chemotherapy regimen consisting of carboplatin and vinorelbine every 3 weeks at Al-Baironi Hospital, Damascus, Syria. Patients were enrolled between August 2011 and July 2012 and randomly allocated to receive a 15-day course of either simvastatin (40 mg) or placebo seven days prior to the first day of each chemotherapy cycle and then continued for eight days in each individual cycle. Primary endpoints were objective response rate (ORR) and toxicity, and the secondary endpoint was overall survival (OS). Eighty-two patients met the inclusion criteria and consented. ORR (35% vs. 32.5%) and predominant toxicity and grade ≥3 neutropenia (occurred in 30% vs. 40% of the patients) were not significantly different between simvastatin and placebo groups, respectively. Over a median follow-up of 44 months (range, 10–60), median OS was 15 months in the simvastatin group and 17 the in placebo group (hazard ratio (HR) = 1.16, 95% CI (0.70–1.91), P=0.57). Elevated baseline values of high-sensitivity C-reactive protein (hsCRP >10 mg/l), lactate dehydrogenase (LDH >480 U/L), and chemotherapy being ≥2nd line were significantly associated with shorter OS for the total cohort in both Univariate and multivariate analyses. Our data prove a safe profile of simvastatin at 40 mg per day combined with carboplatin and vinorelbine in MBC patients but without any beneficial increase of tumor sensitivity to chemotherapy. Moreover, we demonstrated a strong clinical advantage of baseline values of hsCRP and LDH as useful prognostic tools in MBC patients. This trial is registered with ISRCTN12964275.

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Introduction: Breast cancer is the most common cancer in women and the second most frequent cause of cancer death. Several factors affect response to chemotherapy including nodal status, hormonal status and human epidermal growth factor receptor (Her-2). Aim of Study: The study is aiming at evaluating Caspase-3, 7 levels in serum of patients with locally advanced and metastatic breast cancer and establishing the relation between Casepase level and response to chemotherapy. Patients and Methods: The study was performed at Al Bairouni University Hospital and the Faculty of Pharmacy (Damascus-Syria). We have included 60 patients with histologic confirmation of invasive ductal carcinoma of the breast treated with the combination (Docetaxel + Doxorubicin) with Caspase-3, 7 levels to be evaluated before treatment and 24 hours after the first and third cycle. Results: Caspase-3 level increases in serum 24 hours after the 1 st cycle correlated with different kinds of response in 39 patients (P value 0.0002) with better results in those with Estrogen Receptors (ER) positive patients (P 0.005). In a similar manner, Caspase-7 level increases 24 hours after the 1 st cycle correlated with response in 40 patients (P 0.005). However, ER status had no impact on response in Caspase-7 group (P 0.2). Conclusion: Caspase-3 and 7 levels in serum are useful as a predictive marker of response to chemotherapy in both locally advanced and metastatic breast cancer especially when tittered 24 hours after the first chemotherapy.

Peripheral T Cell Lymphoma (PTCL) is a group of lymphoid malignancies which has never been treated with any confidence as opposed to its counterpart B Cell Lymphomas. Despite the studies, which were retrospective, the results in the majority of cases were disappointing, taking into consideration the aggressive clinical course of the disease, so survival did not exceed 2 years in median. To assess the response, progression-free survival and overall survival rates at 5 years using a new intensive combination chemotherapy. Enrolled patients were diagnosed with PTCL, confirmed by a referenced pathologist, treated with the new chemotherapy ACEP X 6 (Doxorubicine 75 mg/m² on day 1 + Cyclophosphamide 1,200 mg/m² on day 1 + Etoposide 300 mg/m² on day 1 and Prednisolone 60 mg/m² from day 1 through day 5) and Ifosfamide X 4 (Ifosfamide 4 grams/m² on day 1) which were given after the completion of the first 6 cycles of ACEP. The study was performed at Al-Bairouni University Hospital, and the study was approved by the Syrian Association of Clinical Oncology. Twenty-five patients underwent the treatment. Most of them showed a complete response after the completion of the first six cycles (17/25) forming 68 % of patients, while another 5 patients became complete responders after the completion of treatment. Consequently, 22 patients are still living after 5 years, with an overall survival rate of 88 %. (ACEP) and Ifosfamide appears to be a good choice in PTCLs, in light of the good response and overall survival rates, taking into account the acceptable toxicity profile. However, a larger sample is needed to make it an acceptable new combination chemotherapy for PTCLs patients.

Treatment of primary central nervous system lymphoma (PCNSL) associates with low response rates and poor survival using conventional radio and chemotherapy. Due to its favorable toxicity profile, temozolomide has emerged as a new option for treatment of PCNSL in young patients. In this study, we report a series of PCNSL patients treated with an innovative regimen combining high dose of both cytarabine and methotrexate with temozolomide without radiotherapy or intrathecal chemotherapy. To evaluate a new intensive chemotherapy with temozolomide, trying to assess response and progression-free survival rates and if the results are promising, we are aiming at evaluating the overall survival (OS) taking into consideration the toxicity profile. The study was performed at Al Mowassa Charity Hospital in Damascus (Syria). Forty patients with histologically confirmed PCNSL median age 52 years (range 20-65) years were included. Biopsies were cultured, and a karyotyping was made in 32 patients. An induction chemotherapy was started, and methotrexate 3 gr/m² over 12 h on day 1, cytarabine 3 gr/m² every 12 h on day 1 and temozolomide 150 mg/m² from day 2 through day 6 with a total of 6 cycles were given on a monthly basis. Among the 40 patients included in the study, a complete response was observed in 34 patients (85%) and a partial response in the remaining 6 patients (15%). Disease progressed in 8 out of 40 patients (20%) while 32 patients are still living at 5 years making the OS reaching 77%. Grade II nephrotoxicity was observed in 2 patients while grade III and IV hematotoxicity was observed in 5 patients. High dose of both Ara-C and MTX combined with temozolomide appears to be a good choice in the treatment of PCNSL, in the light of good response and OS rates, taking into consideration the acceptable toxicity profile. However, a larger trial is needed to make it an acceptable new combination as a first line for PCNSL patients.

Summary The outbreak of coronavirus disease 2019 (COVID-19) has put health systems worldwide under great pressure on numerous levels. COVID-19 is a heterogeneous situation where some people experience mild symptoms for which no serious intervention is needed, while others may experience serious situations ranging from acute respiratory distress syndrome (ARDS) or even respiratory failure and end organ damage. Serious COVID-19 cases may be complicated with a cytokine storm caused by hemophagocytic lymphohistocytosis, which is a life-threatening situation. Efforts should be directed to reveal accompanying diseases that may trigger the cytokine storm. Early diagnosis leads to a better understanding of how to deal with this emergency status; however, even with early intervention, outcomes are still very poor.

Background: Preclinical studies support anticancer activity of statins, however, the existing clinical evidence are inconsistent and not definitive. Our study aimed at evaluating a postulated cancer chemo sensitizing effect of statin (simvastatin) in a cohort of metastatic breast cancer (MBC) patients.Methods: We designed a prospective, single-centered, randomized, double blinded, and placebo controlled trial that encompassed MBC patients with an ECOG Performance Status scale ≤2 and undergoing a chemotherapy course consisting of carboplatin and vinorelbine at Al-Baironi Hospital, Damascus, Syria. Patients were enrolled between August 2011 and July 2012, and randomly allocated to receive a 15-day course of either simvastatin (40 mg) or placebo at the day -7 of each chemotherapy cycle. Primary endpoints were objective response rate (ORR) and toxicity, and secondary endpoint was overall survival (OS).Results: Eighty-Two patients met the inclusion criteria and consented. ORR (35% vs. 32.5%) and predominant toxicity; grade≥3 neutropenia (occurred in 30% vs. 40% of the patients) were not significantly different between simvastatin and placebo groups, respectively. Over a median follow-up of 44 months (range, 10-60), median OS was 15 months in simvastatin group and 17 in placebo group (Hazard ratio (HR)=1.16, 95% CI (0.70-1.91), P =0.57). Elevated baseline values of high-sensitivity C-reactive protein (hsCRP >10 mg/l), lactate dehydrogenase (LDH >480 U/L) and chemotherapy being ≥2 nd line significantly associated with shorter OS for the total cohort in both univariate and multivariate analyses. Conclusions: Our data prove a safe profile of simvastatin at 40 mg per day combined with carboplatin and vinorelbine in MBC patients, but without any beneficial increase of tumor sensitivity to chemotherapy. Moreover, we demonstrated a strong clinical advantage of baseline values of hsCRP and LDH as useful prognostic tools in MBC patients. Trial registration: Damascus University / 15073/. Registered on December 28, 2010.