Dr. Deogratias Ruhangaza

Background: Of the cancers diagnosed in Rwanda, stomach cancer is one of the most encountered. In fact, Rwanda belongs to the region where it is most incident in Africa. Most of the patients present with advanced disease. Studies showed that some gastric cancers overexpress Human Epidermal Growth Factor Receptor 2 (HER2/neu) protein and can be treated with Herceptin/Tras-tuzumab. This targeted therapy improves survival in patients with advanced disease. We conducted a study on Immunohistochemical profile of HER2/neu in gastric adenocarcinomas at two main Rwandan tertiary centers. Methodology: We tested for HER2/NEU in gastric adenocarcinomas diagnosed at University Teaching Hospital of Kigali (CHUK) and University Teaching Hospital of Butare (CHUB). Demographic and pathologic parameters were collected. Immunohistochemistry (IHC) for HER2/neu using c-erb/HER-2/neu (clone SP3) Rabbit Monoclonal antibody was done. Using the guidelines established by Hoffman et al., the agreed score between 2 Rwandan pathologists and 1 USA pathologist was considered each time. Data were entered and statistically analyzed using SPSS 22. Descriptive statistical analysis method was used. P-value calculated with Chi-square analysis for positive vs negative and equivocal negative to correlate HER2/neu overexpression with other variables across both hospitals. Results: A total of 286 cases were tested. HER2/neu overexpression (score 3+ or positive) was found in 29 cases (10.1%). 8 cases (2.8%) were equivocal negative (score 2+) while 249 cases (87.1%) were negative (score 0 and 1+). Conclusion: HER2/neu is overexpressed in a subset of gastric cancers in Rwanda, a phenomenon that has been reported in other areas of the world. Testing for HER2/neu could identify patients who would get a targeted treatment with Herceptin. Keywords: Gastric, Cancer, Rwanda, HER2, Immunohistochemistry

PURPOSE At the 12th meeting of AORTIC (African Organization for Research and Training in Cancer) in Maputo, Mozambique, held between November 5 and November 8, 2019, a special workshop was organized to focus on the need for collaboration and coordination between governments and health systems in Africa with academic, industry, association, and other nongovernmental organizations to effect sustainable positive change for the care of patients with cancer. METHODS Representatives from seven different projects in Africa presented implementation science and demonstration projects of their to date efforts in cancer system improvement including patient access, South-South partnerships, in-country specialized training, palliative care consortium, treatment outcomes, and focused pathology and diagnostic capacity building. Key partners of the various projects served as moderators and commentators during the session. RESULTS From across all the presentations, lessons learned and exemplary evidence of the value of partnerships were gathered and summarized. CONCLUSION The concluding synthesis of the presentations determined that with the broad needs across cancer requiring in-depth expertise at each point on a patient’s journey, no single organization can effect change alone. Multipartner collaborations not only should be the norm but should also be coordinated so that efforts are not duplicated and maximum patient access to cancer diagnosis and care is achieved.

PURPOSE Nephroblastoma is a highly curable pediatric cancer that requires multidisciplinary care. Few reports have assessed long-term treatment outcomes in low-resource settings using a task-shifting model of care. We report outcomes of a large cohort and factors associated with survival. METHODS We performed a retrospective chart review of all patients with nephroblastoma presenting to the Butaro Cancer Center of Excellence in Rwanda between July 2012 and June 2018. RESULTS In total, 136 patients were identified and treated according to International Society of Pediatric Oncology guidelines for low-income settings. Median age at diagnosis was 39.7 months (interquartile range, 25.3-61.8 months); 56.6% were female. Sixty-one (44.9%) patients presented with stage I-III disease, 35 (25.7%) with stage IV disease, and 6 (4.4%) with stage V disease; the remainder were unstaged (n = 34; 25.0%). Most patients completed surgery (n = 97; 71.3%) and postoperative chemotherapy (n = 82; 60.2%); 17 patients received radiotherapy. With a median follow-up time of 18.1 months, 44.9% of patients were alive, 41.9% had died, 8.8% were lost to follow-up, and 4.4% were referred for palliative care or declined further care at the end of the study. Three-year overall survival was 57.5% (95% CI, 48.1 to 65.8) for the entire cohort, and 80.1% (95% CI, 66.8 to 88.5) and 44.0% (95% CI, 26.8 to 60.0) for stages I-III and IV-V, respectively. CONCLUSION We demonstrate that patients with nephroblastoma can be successfully treated in a low-resource setting. Survival remains lower than in high-income countries, in part due to early deaths, contributing to approximately 30% of patients not being medically able to receive surgical intervention. Next steps include the development of strategies that focus on earlier diagnosis, supportive care during the early phases of therapy, and efficient and timely transitions between specialties for multimodal care.