Annual Report 2014 INCTR
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Branch: INCTR (Belgium)
President: Dr Ian Magrath
Board Members: See main INCTR website for a list of present board members
Volunteers/Employees:
Collaborators: UK Office; Dr Mark Lodge
Partners: Global Health Dynamics
Tucca
World Health Organisation
Address: Rue Engeland 642
Brussels
Belgium
Country(s): Belgium
Year Established: 1998
Annual Report: 2014 was a busy year for INCTR and this report provides only an overview of the several important projects being undertaken.

What Can We Learn From Africa 4 - Report

The fourth meeting entitled "What can we learn from Africa" took place, as planned, at the Arusha Palace Hotel, Arusha, Tanzania from Feb13th to 15th 2014. Although we were expecting only some 50 people to attend, in the event, 74 people came to the meeting most from a various of African countries.

This is the fourth meeting in a series of annual workshops of the same name that have been held since 2011, after visits by INCTR pathologists and haematologist to a number of African pathology laboratories which led to their observation that many tumors were not being correctly diagnosed. The first meeting was held in Italy, the second in Paris, France, and the third in Mombasa, Kenya. The decision to hold such workshops was made following visits to pathology laboratories in several African countries to assess resources and skills (of both technologists and pathologists, the focus being on hematopathology). it became clear from examining cases with the patholgists responsible for making the diagnoses that due to their high (for Africa) cost, most diagnoses are made on the basis of histology alone, or, in the case of Burkitt lymphoma (BL) fine needle aspirate (FNA) alone - i.e., very few cases are diagnosed with the added certainty that immunohistochemistry gives to histochemistry. In the absence of immuno-histochemistry, the World Health Classification cannot be used since immunophenotyping is required in this widely used classification system. But for optimal treatment, or for epidemiological studies, including assessing the incidence and mortality rates of these tumors, the diagnosis must be correct, and it is important that as many centers in Africa as possible establish pathology laboratories capable of performing immunophenotyping. The first was held in Siena, Italy, the second i

The special lecture by Prof Falko Fend and the key note lecture given by Prof Harald Stein on the biology of B cells and the role of Epstein Barr Virus in Hodgkin lymphoma were of particular value in understanding the reasons that different neoplasms express different functional molecules on the cell surface. It is these functional molecules that enable the tumour cells to survive in unusual (for them) sites of the body, which is one of the characteristics of malignant cells. Sometimes, in order to do this, they must recreate their own microenvironment by secreting chemical messengers referred to as cytokines or chemokines. Innappropriately expressed cytokines and chemokines are capable of attracting specific cells to the vicinity of the neoplastic cells, and create a microenvironment in which they can flourish. This is particularly so in Hodgkin disease. In order to improve the inability of most African laboratories to perform immuno-histochemistry or other forms of immuno-phenotyping (flow cytometry can be used, for example, in the case of liquid tumors, i.e., leukemias), it was decided to try to establish immunohistochemistry by on-site training in at least 2 or 3 hospitals in equatorial Africa and to hold a meeting on the diagnosis of hematological malignancies in Africa on an annual basis in order to improve the knowledge and skills of African hematopathologists and clinicians regarding haematological malignancies which are which are commonly seen in African countries.

This workshop as the previous editions also addressed the role of infectious agents in the pathogenesis of lymphoma – the high incidence of chronic infections in tropical countries results in African countries having the highest overall rates of infection-related cancer. Knowing this, preventive measures, whether by means of vaccines, or treatment directed towards the infectious agent could be tested. This approach, of course, also reduces the incidence or severity of the infections against which they are directed, which, in terms of numbers of patients who benefit, far outweigh their importance in reducing the number of malignant tumours although the latter provide an added value of vaccines directed against infections associated with malignant disease.

Professor Peter Isaacson was awarded INCTR's Prize in Pathology. Prof. Isaacson was the discoverer, with Denis Wright of a new disease called MALT lymphoma, that was subsequently discovered to be caused by a bacterium - Helicobacter pylori.

The workshop was held under the auspices of INCTR's Pathology Program (which falls administratively under INCTR Brussels, and was coordinated by Lorenzo Leoncini, Martine Raphael, KK Naresh, N. Hurwitz, and Ian Magrath. Dr Edda Vuhahula, Dar-es-Salaam, was the local host. It was attended by participants from various African countries including Tanzania, Democratic Republic of Congo, Senegal, Nigeria, Rwanda, South Africa, Uganda and Kenya. The Faculty included pathologists from Italy, Germany, France and the USA.

Sponsors: INCTR would like to thank the generous sponsorships provided by: the European Association for Haematopathology; Office of HIV and AIDS Malignancies, NCI, USA; Center for Global Health, NCI, USA; Aga Khan Foundation; Institut National du Cancer, France; Leica Microsystems; Dako; Bactlabs, East Africa, Ltd.

Meeting Evaluation: The meeting of professionals, both pathologists and clinicians, from Africa, Europe and USA is likely to stimulate further research, particularly into aetiology and pathogenesis, as well as enhancing knowledge about diagnostic methods and therapy. This meeting also provided an opportunity for African haematopathologists and haematologists to discuss cases with their colleagues from Europe and the USA, and to share experiences on maximal use of limited resources. On this topic there was an excellent talk by Prof Ethel Ceserman on developing a PCR machine powered by solar energy to improve the early diagnosis of Kaposi Sarcoma on the field. The session “Challenges in Lymphoma Diagnosis in Africa," included an excellent presentation from the participants from Nairobi, Eldoret, Mwanza and Dakar, illustrating the improvements that have taken place in diagnosis since the introduction of basic immunohistochemestry in the last few years, mainly due, according to the African presenters, to the increased knowledge that has been obtained from attending this series of workshops. In this regard, the tutorial session gave the participants an opportunity to learn about the value of highly specific monoclonal antibodies used in essentially all cases diagnosed in more highly developed countries, that can make the difference between a right and wrong diagnosis.

Throughout the course of the meeting, a microscope was set up and made available for individual African pathologists to discuss their own cases with members of INCTR’s Pathology Program, including Professor Lorenzo Leoncini, Dr Kikkeri Naresh, Dr Martine Raphael and Dr Nina Hurwitz.

Immediately after the pathology meeting on haematological neoplasms, a smaller implementation meeting took place relating to the BL project entitled "Developing a total model of care for Burkitt lymphoma" referred to in the January 2014 Newsflash. In the course of this meeting, chaired by Melissa Adde, all aspects of the project were discussed and plans made for the next 3-4 month period. During this time it will be necessary to audit data collection ongoing at the Bugando Medical Center and St Mary's Hospital, Lacor, to determine whether the the participating centers have reached a sufficient level to actively participate in the next treatment protocol. In addition, educational tools will be developed to ensure that the public and the physicians and medical assistants they are likely to consult are familiar with the signs of this disease and have developed a referral plan with the tertiary centers in each country mentioned above how to promptly refer patients to these hospitals which are capable of treating at least selected cancers (such as Burkitt lymphoma (very few physicians in Africa have had oncology training, and in many African countries only 3-4 hospitals in the entire country can administer therapy. The situation is made worse by the need for patient's families to pay out of pocket for all services rendered by the hospital. Even the cost of transferring the patient can be prohibitive. Burkitt lymphoma has a median age of 7 years. It occurs, however, at all ages, although jaw tumors - a highly characteristic feature of Burkitt lymphoma, and orbital tumors, which can easily be confused with retinoblastoma - occur at highest frequency (when combined with orbital tumors, which often occur in association with jaw tumors, almost 100% in children aged 2-4 years have tumor at these sites). Fortunately, because of the deearth of radiation therapy units in equatorial Africa, this tumor can be cured with chemotherapy alone, and at present, after treating more than 700 patients with Burkitt Lymphoma according to a protocol developed by INCTR's African Clinical Studies Group, over 60% are alive 5 years after treatment.

INCTR is grateful to OFID and to other INCTR branches and members of the public who are supporting this project.

Publication of Cancer Control 2014

The second edition of our annual publication, "Cancer Control," was published by health care publisher, Global Health Dynamics in August. Copies will be sent free of charge to INCTR members as well as others who register on the Global Health Dynamics website. A free online edition is also available at ([http://www.cancercontrol.info) or via the INCTR website. Topics covered include:

An assessment of current initiatives in cancer control planning including cancer care beyond the Millennium Development Goals; the increasing challenges of tobacco control; the case for continued investment in cervical and breast cancer in low- and middle-income countries;
building capacity and infrastructure, such as radiotherapy resources, in under-resourced health systems; treating children and adolescents suffering with retinoblastoma in Africa, integrating palliative care into a children’s health services in India and establishing a meaningful twinning programme between children’s hospitals. From a regional perspective we look at cancer priorities in Zimbabwe, screening programmes in China, the use of cancer registries in Bulgaria and a multisectoral approach by the Ministry of Transport in India to improve access to care for cancer patients. This volume also includes an article on accessing the value of international cancer control congresses

Our contributors include: Cary Adams, Union for International Cancer Control; Professor Pierre Bey, AMCC; Dr Mary Borok, University of Zimbabwe; Dr Freddie Bray, IARC, France. Professor Robert Burton, Monash University, Australia; Professor Vivien Davis Tsu, PATH, Oregon; Dr Nadya Dimitrova, National Cancer Registry, Bulgaria; Dr Michael P Eriksen, Editor, The Tobacco Atlas; Felicia Knaul, Harvard Medical School and Professor Mary Gospodarowicz, President of the Union for International Cancer Control. The secretary-general of the World Health Organisation, Dr Margaret Chan wrote the Introduction.

The website [http://www.cancercontrol.info] contains details of how to register for a free printed copy of the 2015 edition if you are not an INCTR member, as well as how to buy copies of the 2013 and 2014 editions.

INCTR Branches are encouraged to put a link to Cancer Control on their websites or to forward the URL to colleagues who might be interested. Our objective is to share knowledge and experiences as widely as possible.

Cancer Control 2014 is supported by a small number of sponsors, which feature in the book and on the web. The Editor-in-Chief of Cancer Control 2013 is Dr Ian Magrath, INCTR President, and the Commissioning Editor, Mark Lodge, Director of the UK INCTR.

New INCTR Branch (India)

A new INCTR Branch was established in Jaipur, Rajasthan in the northern part of India in June of this year. The fledgling branch is directed by a board of Trustees: Dr Shivraj Singh (Chairman), Dr S.S AgarwalAgarwal (also President of the large "Indian Medical Association," Mr Apurv Kumar, Mr Rajiv Sahai and Dr Ian Magrath. The branch is presently in the process of establishing an advisory board and developing a more detailed strategic plan (a decision has already been made that the branch will have a strong focus on cancer prevention, early diagnosis and palliative care. As time goes by, and depending upon the Branches success in fund-raising, the slate of activities will be broadend. The branch will have a policy of working closely with other Indian Institutions and organizations and will complement the increasing number of resources for cancer control in India. The Cancer Grid, for example, established by the Tata Memorial Hospital, will link all cancer centers in India and attempt to ensure a uniform standard of treatment across the country.

World Oncology Forum

INCTR was invited to attend the World Oncology Forum which, like the first, was held in Lugano, Switzerland on 24th and 25th October. The meeting addressed several critical issues that will affect the future of cancer treatment across the world, at a time when cancer is becoming increasingly important as a cause of premature mortality. The topics discussed included the translation of basic cancer research into new, effective treatments for cancer (and the related issues of the cost of developing such agents and their cost-effectiveness); the new role of immunotherapy in cancer treatment; the provision of cancer drugs to Eastern Europe and the Global Taskforce on radiotherapy for cancer control. There was considerable discussion about the very high cost of developing new anti-cancer agents and the fact that this often has little relationship to the effectiveness of the agent, although it was recognized that some agents that are of limited efficacy in late stage patients with metastatic cancer may prove to be more effective in earlier stage patients or in combination with other agents.

Cancer in developing countries was discussed, and the enormous differences in resources between the low income countries and the high income countries was emphasized. WOF does not intend to simply discuss these issues, but to explore measures that can be taken that will ensue that patients with cancer will have access to the treatment they need, and that research is made more patient-centric rather than profit-driven. For more information see [http://www.eso.net/pagine-interne/wof2014.html]

End-of-Year Fund Raising Campaign

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INCTR entered Global Giving's Year End campaign in an attempt to reach its target of $50,000 - the funding is used to support its project relating to the treatment of Burkitt lymphoma in Africa. As with last year, we reached and passed the GG target with respect to both funds raised ($3,000) and the number of individual donors (30). In fact, in December we received almost $10,000, leaving less than $5,000 required to reach the project target of $50,000 and qualifying INCTR to receive an extra $1000 from Global Giving. All who give over 50$ are eligible to become associate members of INCTR. For more information,or to make a donation, go to [http://goto.gg/9630]

Obituaries

Sadly, this year INCTR lost two of its most distinguished members.

Professor Guy Blaudin de The, a pioneer in the field of virus-related cancers and President of the Alliance Mondiale Contre le Cancer (AMCC - INCTR's Franch Branch) since its inception in 2002 died on 7th August 2014. Prior to this, Professor Guy de Thé had supported the creation of INCTR in 1998. Despite his many responsibilities, Prof de Thé played an active role in the work undertaken by AMCC and was a strong supporter of its promotion of the fight against cancer, particularly in women and children in sub-Saharan Africa. At that time, he had already become well known for his work in East Africa, conducted while working at the International Agency for Research in Cancer and directed towards determining whether the Epstein-Barr virus, discovered in 1964 in a cell line derived from a tumor in an African child, was a causal agent of Burkitt's lymphoma, the disease from which the child was suffering.

Professor Angelo Angelo Rosolen, Co-Director of INCTR's Ethics Committee since its inception in 2001 on 12th February 2014 died late last year (December 9th 2013) from a rare disease - Gall-bladder cancer. Not surprisingly, he fought his brutal illness with the same kind of humility, dignity, and determination that marked his entire life. With his passing, the pediatric oncology community in Italy and all over the world has lost a wonderfully caring, committed, and talented physician- scientist. Angelo was born in Treviso province of the Veneto region of Italy in 1959. Although his work took him all over the United States and Europe, he always thought of this beautiful area as his home. He pursued his medical and pediatric training at the University of Padova, an institution, which he served in a host of ways throughout his life. At the time of his death, he was Director of Pediatrics at Santa Maria della Misercordia clinic in Udine.
Future Plans: In 2015, INCTR will vigorously pursue its project on the treatment of Burkitt lymphoma in Tanzania and Uganda. It will publish a third edition of its annual, Cancer Control and will move to increase its membership base. For individual Branch plans, see their respective websites.
Publications: 144. Ian Magrath, Eva Steliarova-Foucher, Sidnei Epelman et al. Improving cancer care for children and young people 2. Paediatric cancer in low-income and middle-income countries. Lancet Oncol. 2013 Mar;14(3):e104-16.

145. Richard Sullivan, Jerzy R Kowalczyk, Bharat Agarwal, Ruth Ladenstein et al. Improving cancer care for children and young people 4; New policies to address the global burden of childhood cancers, Lancet Oncol. 2013 Mar;14(3):e125-35.

146. Magrath I and Epelman S. Cancer in Adolescents and Young Adults in Countries with Limited Resources. Curr Oncol Rep. 201315(4):332-46.

147. Epelman S, Magrath I. Planning cancer control--the view of an NGO. Lancet Oncol. 2013 Apr;14(5):388-90. doi: 10.1016/S1470-2045(13)70090-1

148. Magrath I, Epelman S. Cancer in adolescents and young adults in countries with limited resources. Curr Oncol Rep. 2013 Aug;15(4):332-46. doi:
10.1007/s11912-013-0327-3. PMID: 23832788

149. Magrath, Ian T; Bellan, Christiana; Leoncini, Lorenzo; Venkatesh, Hemachandra (June 2014) Non-Hodgkin Lymphomas. In: eLS 2014, John Wiley & Sons Ltd: Chichester http://www.els.net/ [DOI: 10.1002/9780470015902.a0002171.pub3]

150. Magrath I, Epelman S. Cancer in adolescents and young adults in countries with limited resources. Curr Oncol Rep. 2013 Aug;15(4):332-46. doi: 10.1007/s11912-013-0327-3. PMID: 23832788

151. Coleman CN, Formenti SC, Williams TR, Petereit DG, Soo KC, Wong J, Chao N, Shulman LN, Grover S, Magrath I, Hahn S, Liu FF, DeWeese T, Khleif SN, Steinberg M, Roth L, Pistenmaa DA, Love RR, Mohiuddin M, Vikram B. The international cancer expert corps: a unique approach for sustainable cancer care in low and lower-middle income countries. Front Oncol. 2014 Nov 19;4:333. doi: 10.3389/fonc.2014.00333.
Month: 12
Year: 2014
Date of Last Report: 12/2013
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