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Updates in the Management of Neuroendocrine Tumors
2021-05-20 19:00 - 20:30 (Africa/Nairobi) | Virtual Event (Zoom), Kenya
Moderator: Dr. Njoki Njiraini, Resident Clinical and Radiation Oncologist at The Nairobi Hospital. Sponsor: Novartis Presenters:

Dr. Primus Ochieng, Programme Director of MMed Radiation Oncology training at the University of Nairobi. He is both a Lecturer and a Consultant Clinical Oncologist at Kenyatta National Hospital

Neuroendocrine tumors (NET) are a common malignant transformation of cells in the diffuse neuroendocrine system that regulates motility and secretion. The tumors are heterogeneous with a wide variety of clinical presentations and are difficult to diagnose. Neuroendocrine carcinomas are poorly differentiated with increased expression of Ki67. Most patients present with advanced disease and have a median survival of 33 months. NETs are distributed all over the body. Over 95% of NET is sporadic, with only a small percentage being genetic-related. Currently, there are no preventive strategies and no screening guidelines. Initially, the classification of NET was based on the tissue of origin. To date, WHO classification is based on grading and staging. Classification can also be based on functioning versus Non-functioning NET. Presentation is by tumor growth with pain, obstruction hepatomegaly, and early satiety. Diagnosis is by a systematic approach including history and physical examination, biochemical markers, and imaging, although conventional imaging has a limited role in diagnosis. Chromogranin A (CgA) is a valuable diagnostic and prognostic tool that can be used to monitor treatment response. It is more sensitive than radiology for measuring progression. The major challenge with this testing method is that other conditions can cause elevated CgA and also the CgA values vary considerably between different types of NETs. The test kits are also not universally standardized. Therapies for NETs apply three principles: surgical therapy, (best treatment option), symptomatic therapy, and anti-proliferative therapy. The current focus is shifting from symptom management to targeting tumors. Chemotherapy including temozolomide and capecitabine has been shown to improve overall survival benefits, better response, and progression-free survival. Considering immunotherapies, Pemblolizumab has benefits in NET tumors. Radiotherapies have palliative use. Although NETs are well managed with targeted therapy, the technology is not currently available in Kenya. Considering limited available data, there is a need to work in groups and generate local data on NETs.

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Chronic Myeloid Leukemia (CML) Treatment In Kenya
2021-05-13 19:00 - 20:30 | Virtual Event (Zoom), Kenya
Moderator: Prof. N. A. O. Abinya, Medical Oncologist, the Nairobi Hospital and GIPAP Physician
Sponsor: Novartis
Presenters:

Dr. Peter Oyiro, Medical Oncologist Kenyatta National Hospital Teaching and Referral Hospital

Chronic Myeloid leukemia is a cancer of bone marrow stem cells. The only known risk factors are radiation from nuclear reactors, with no evidence of heredity risk factors. It is characterized by a translocation between chromosomes 9 and 22, which results in an abnormal juxtaposition of two genes, bcr, and abl. It accounts for 15% of all leukemia cases and has an annual incidence of 1.5 cases per 100000 individuals. The median age at diagnosis is 55-65 years, with a median survival of 3-7 years. The clinical presentation is usually massive splenomegaly, where the disease has three phases: chronic, accelerated, and blast. Most patients are diagnosed in the chronic phase, often without symptoms. If untreated, all patients progress to the accelerated/blast phase within 3-5 years. Diagnosis is by physical examination of the spleen and liver size, complete blood cell count, bone marrow aspirate for cytological examination and cytogenetic, fluorescence in-situ hybridization, reverse transcriptase-polymerase chain reaction (RT-qPCR). Late referrals, inadequate infrastructure, and trained physicians are major challenges to diagnosis. The life expectancy of newly diagnosed patients with CML in the chronic phase is now very close to age-matched individuals in the general population of Western countries. In resource-constrained countries e.g. Kenya, the goal of treatment remains survival. The Glivec International Patient Assistance Program (GIPAP) is an international drug donation program established by Novartis Pharma AG and implemented in partnership with the Max Foundation. It has provided imatinib to eligible patients in Kenya since 2002, at the Nairobi and the Aga Khan Hospitals for free. Patients with CML diagnosis can be referred to the GIPAP. Before imatinib was approved (FDA 2001), most patients were being treated with supportive care, hydroxyurea, interferon, and allogeneic hematopoietic cell transplantation (“bone marrow transplant”). Today, CML management in Kenya is mainly based on imatinib. Those failing therapies are put on second and third-generation TKIs. It’s important to check on kinase mutations that confer resistance to kinase inhibitors. Patients resistant or intolerant to imatinib can be treated with nilotinib. The main goal of treatment is to reduce the leukemic burden and the risk of progression to AP or BC. However, if the warning signs are not recognized early, treatment can be either a success or a failure. Molecular responses such as MMR are associated with improved survival outcomes. The major challenge with treatment is the unavailability of some drugs and high prices. Due to the COVID-19 pandemic, there is a switch from physical to virtual review of files. The pandemic has greatly affected adherence and compliance to treatment.

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Optimizing Cancer Research in Kenya
2021-05-06 19:00 - 20:30
Moderator: Dr. Veronica Manduku, Radiologist at Kenya Medical Research Institute
Sponsor: Roche
Presenters:

Prof. Mansour Saleh, Chair, Department of hematology and oncology and consultant medical oncologist, Aga Khan University Hospital, Nairobi.
Prof. Fredrick Chite, CEO/Executive Director of International Cancer Institute (ICI)
Prof. N.A.O. Abinya, Medical Oncologist, the Nairobi Hospital and GIPAP Physician
Dr. Robai Gakunga, Independent Research Scientist, USIU-Africa

Cancer research in Kenya is mainly in the universities and is more of epidemiological studies with limited clinical research. Considering the increasing demand for cancer research in Kenya, there is a need to develop a curriculum, build capacity and create infrastructures to support quality research. Many drugs used in Africa are not tested in Africa, despite research showing variations in transcriptomics for example in triple-negative breast cancer for different races. Cancer research requires a multidisciplinary approach (MDT). Funding is a major challenge in cancer research. Additionally, managing clinical practice and research becomes difficult in Kenya where clinicians are expected to spend 100% of the time in practice, unlike in the USA, where there is the flexibility of working hours. In the USA, a clinician can spend 50% of the time in clinical practice and 50% in research. In Kenya, the workloads for doctors, clinicians, and lecturers are overwhelming, with no protected time for research from the institutions. In-Africa collaborations, as opposed to Africa-America, and networks between clinicians, consultants, academic institutions, and government agencies, would greatly help to generate local data. Data sharing and Trust is needed and the ability to work together to accomplish a goal. The University of Nairobi has an oncology training fellowship that is helping to build capacity in the region. Commitment in science for clinicians as well as developing and reviewing protocols collectively is necessary. Considering the high cost of cancer drugs, cancer clinical trials should seek collaborations with pharmaceutical companies. Community and patient engagement are important in clinical trials. There is a need for a data repository and registries. There is an epidemiological registry in breast cancer collected at Kenya National Hospital in collaboration with Roche. Collaborations will facilitate sharing of human resources, infrastructure, and samples. The literature review is equally important. The exchange program for fellows helps with gaining experience to see what other researchers are doing. Scientists are encouraged to apply for research grants, however small. There is a need for seed funds for young investigators. Government-government collaborations are also encouraged. Research governance is necessary. in lobbying government funding, in priority areas including the most prevalent cancers (breast cancer in women, prostate cancer in men).
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Testicular Cancer
2021-04-29 19:00 - 20:30
Moderator: Peter Oyiro, Medical Oncologist Kenyatta National Hospital Teaching and Referral Hospital
Sponsor: Glenmark
Presenters:

Dr. Amina H. Kidee, Medical Oncologist Aga Khan University Hospital
Dr. Carnjini Yogeswaran, Consultant Urological Surgeon, Aga Khan University Hospital

Testicular cancer (TC) accounts for less than 1% of adult neoplasms and 5% of urological tumors. It’s the most commonly diagnosed cancer in young men (20-34 years), and the incidence is increasing in industrialized countries., but there is a need for local data to determine incidence in Africa. It is predicted that the survival rate in Kenya is low since the disease is not diagnosed early. The risk factors for TC oncogenesis include cryptorchidism, history of subfertility, contralateral history of testicular cancer, history of germ cell neoplasm in situ, family history of TC, race, age, and HIV. Individuals at high risk should be informed about the importance of physical self-examination. WHO classification of TC is based on the tumor origin, and the presentation may be localized or disseminated. Diagnosis is by history, examination, imaging, and serum tumor markers used for prognosis and staging. Transcrotal ultrasound with Doppler is performed to confirm a testicular mass, to determine whether a mass is intra or extra testicular, and to explore the contralateral testis. Transscrotal biopsies of the testes should not be performed because of the risk of tumor cells seeding of the inguinal and pelvic lymphatic drainage. The biopsy is also of limited value because testicular germ cell tumors are heterogeneous. Management of the disease requires an integrated multidisciplinary team (MDT). Removal of the entire organ is necessary to properly identify the histologic type(s) present and to select the appropriate therapy. Radical inguinal Orchidectomy is the standard of care and involves the division of the spermatic cord at the internal inguinal ring. The scrotal approach should be avoided. Chemotherapy should be initiated prior to orchidectomy where applicable, to control the disease and stabilize the patient. Testis sparing surgery aims to preserve fertility and hormonal functions. Patients should be counseled and be informed of the risk of local recurrence which is 8%. The testicular prosthesis should be offered to all patients undergoing unilateral or bilateral orchidectomy. It can be inserted at orchidectomy or subsequently. Contralateral testicular biopsy should be offered to high-risk patients. Semen abnormalities occur in 24-50% of TC patients even prior to orchidectomy. Additionally, chemotherapy and radiotherapy can impair fertility. Semen preservation by sperm banking (cryopreservation) should be offered to all patients.

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Rectal Cancer – Multidisciplinary Approach
2021-03-18 19:00 - 20:30
Moderator: Dr. Njoki Njiraini
Sponsor: Roche
Presenters:

Dr. Anthony Ndiritu, Consultant Clinical Oncologist, Kenyatta National Hospital (KNH)
Dr. Alex Muturi, Consultant General Surgeon & Endoscopist, Kenyatta University Teaching Referral and Research Hospital (KUTRRH)

Management of colorectal cancer requires staging and risk assessment by a multidisciplinary team (MDT) to help in decision making and to audit and review the outcomes. Nutrition therapists are part of the MDT as the patients need to be nutritionally optimal before chemoradiotherapy and surgery for them to tolerate the effects of the treatment. Colorectal cancer is preventable and treatable if detected early. Early screening using immunochemical testing would help to pick the lesions when they are precancerous, thus reducing cancer-related death by between 40-60%. A low index of suspicion of colorectal cancer among the caregivers is a major hindrance to timely diagnosis. For example, patients with bloody stool may be treated for hemorrhage or other infections, due to low suspicion of colorectal cancer. An accurate diagnosis would require a colonoscopy. Traditional, extensive lymph node dissection with limited use of neoadjuvant radio is falling out of favor, due to high functional genitourinary impairments and the need for experienced individuals to perform adequate dissection for outcomes. There is evidence that the dissection has similar recurrent rates as with neoadjuvant. Surgical site infections are a major challenge to surgery and require management. The cost of screening in Kenya is Ksh. 1000-2500. Management of colorectal cancer is by chemoradiation followed by surgery. The decision to take short-course radiotherapy (within a week) as opposed to the long course (5 to 6 weeks) should be guided by MDT. Patients with complete clinical response to chemoradiotherapy but who refuse to take surgery are at higher risk of local failure.

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Renal Cell Carcinoma
2021-03-11 19:00 - 20:30
Moderator: Dr. Caroline Tonio, Consultant Physician, and Medical Oncologist, Muranga County Hospital, Kenya. Sponsor: Roche Presenters:

Dr. David K. Kimani, Consultant Surgeon, and Urologist, Kenyatta National Hospital
Dr. Manel Haj Mansour, Consultant Physician, and Medical Oncologist, Aga Khan University Hospital

Kidney cancers account for 5% and 3% of all adult malignancies in men and women. It’s the 7th most common cancer in men and the 10th most common cancer in women. Renal cell carcinomas (RCC) account for 80% of kidney cancers with a median age of 64 years. The risk factors include lifestyle, comorbidities, environmental exposures, and genetic factors. Protective factors include the use of alcohol and coffee. Renal masses are primary or secondary, the majority of which are RCC while a few are transitional cell carcinomas. RCC is mainly asymptomatic, but the advanced disease has a range of symptoms. Mortality rates from RCC have remained stable or have decreased slightly in developed countries, mainly due to timely screening and early diagnosis. The current imaging modalities cannot reliably distinguish benign and malignant tumors or between indolent and aggressive tumor biology. Consequently, renal mass biopsy (RMB) should be considered when a mass is suspected to be hematologic, metastatic, inflammatory, or infectious, as they have a high sensitivity, specificity, and positive predictive value. The non-diagnostic rate of RMB can be reduced by a repeat biopsy. There is no specific molecular marker recommended for clinical prognostic use. Management of small renal masses is by active surveillance, nephron-sparing surgeries, ablative and radical therapies. Partial nephrectomy prioritizes the preservation of renal functions through optimum salvage of nephrons. Priority should be to maintain negative surgical margins and to avoid the possibility of positive surgical margins with a probability of local recurrence. For complex tumors where partial nephrectomy is challenging, radical nephrectomy is recommended. This involves the removal of the entire kidney with or without the adrenal gland and the lymph nodes. To remove the adrenal gland or not depends on findings of metastasis or direct invasion of the adrenal gland. The involvement of the adrenal gland is associated with a poor prognosis. In patients undergoing surgical excision of a renal mass, a minimally invasive approach should be considered when it would not compromise oncologic, functional, and perioperative outcomes. Since RCC is radioresistant, radiotherapy can only be used for palliative treatment. Systemic therapy should be prioritized over cytoreductive nephrectomy for patients with metastatic RCC. First-line treatment is different for the good or intermediate and the poor-risk groups. Currently, there is a paradigm shift to the use of immunotherapy treatment and immune checkpoint inhibitors. However, the high cost of drugs and the fact that the National Hospital Insurance Fund (NHIF) may not cover the entire costs, complicates effective treatment.

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Management of Advanced Prostate Cancer
2021-02-23 19:00 - 20:30
Moderator: Dr. Ahmed Komen
Sponsor: Beacon
Presenters:

Prof. Asim Jamal Shaikh, Associate professor of Medicine, Consultant Medical Oncologist, Aga Khan Hospital, Nairobi

Prostate cancer is the most common cancer in Kenyan men, where 80% of patients present with advanced disease, encompassing a broad spectrum of diseases. The disease can be metastatic or non-metastatic. Metastatic hormone-sensitive prostate cancer is diagnosed by serum total PSA, a biopsy, conventional imaging (not readily available in Kenya), and Next-Generation Imaging (NGI). NGI is useful in grouping the patients as high/low risk/volume, depending on the disease burden. The Kenya national cancer screening guidelines guide the screening process, which should be individualized with consultations between the physician and the patient. Management of Metastatic hormone-sensitive prostate cancer is by androgen deprivation therapy (ADT), achieved through surgical or medical castration. ADT should be started within 3 months of diagnosis. Advanced prostate cancer in patients who are hormone-sensitive or with high risk/volume requires a combination of ADT and chemotherapy treatment for a better outcome, where disease volume or aggressiveness may help tailor treatment selection. The addition of surgery and /or radiotherapy to systemic treatment may have a role in the treatment of newly diagnosed metastatic disease. Radiation therapy has a significant role in palliative treatment settings. Management of other histological subtypes of prostate cancer requires a histology review since the different subtypes are treated differently. Some patients transform from adenocarcinoma to neuroendocrine subtype hence may require ADT. However, the degree of differentiation should be put into consideration. Prognosis is relatively poor, hence it’s important to perform a pathology review in case the patient is not responding well to treatment. Prostate treatment affects a patient’s sexuality, but ADT and vacuum-assisted devices help to restore sexual function. Considering the high cost of treatment, chemotherapy and the use of generic forms of the drugs may be quite affordable.

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Molecular Testing For Breast Cancer and Implications For Treatment
2021-02-18 19:00 - 20:30
Moderator: Peter Oyiro, Medical Oncologist Kenyatta National Hospital Teaching and Referral Hospital
Sponsor: Beacon
Presenters:

Dr. Sitna Mwanzi, Consultant Physician and Medical Oncologist, Aga Khan Hospital, Nairobi

Breast cancer is the most common type of cancer with 6799 new cases and 3107 death in Kenya in 2020. The mean age is 45-51 years. Molecular signature by microarray and immunohistochemistry has classified four molecular subtypes of breast cancer as including luminal A, luminal B, HER2+, triple-negative breast cancer (TNBC), where luminal A and B are the most common molecular signatures The molecular profiles are important prognostic and predictive factors in breast cancer. Luminal A has a better prognosis followed by luminal B, hence patients with these subtypes are likely to be treated with surgery with or without adjuvant radiation therapy. HER2+ has a worse prognosis followed by TNBC, hence patients with these subtypes will require chemotherapy and neoadjuvant. Genetic testing can be recommended in a case where a family member has a known pathogenic variant, or in case of a personal history of breast cancer under the age of 45 years or within 45-60 years. Additionally, genetic testing is recommended in a new diagnosis of metastatic breast cancer, and for young patients TNBC. Management for patients with BRCA pathogenic variant involves continued screening using mammography with tomosynthesis (digital mammography) and discussion on the risk reduction mastectomy and salpingo-oophorectomy. Relatives of such patients should be counseled on screening for pathogenic variants and if possible, they should receive breast cancer screening at the age of 24-29 years, and the screening should be done annually. The major challenges of genetic testing in Kenya include a lack of technical expertise and a shortage of genetic counselors, to address the ethical concerns surrounding genetic counseling. The tests are unavailable in many health care facilities. Furthermore, the tests are not affordable, since the samples have to be shipped to the USA for analysis. Traditionally, the choice of adjuvant therapy was dependent on tumor size, nodal status, receptor status, tumor grade, age of the patient (younger patients were more likely to receive adjuvant chemotherapy). However, more recent understanding has revealed that not all node-negative hormone receptor-positive patients benefit from chemotherapy. Newer gene expression assays are helpful in tailoring treatment to avoid over and under-treatment.

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Shifting Paradigms In Triple-Negative Breast Cancer (TNBC) With Cancer Immunotherapy
2020-12-09 19:00 - 21:00
Moderator: Dr.Njoki Njiraini Sponsor: Roche Presenters:

Prof. Asim Jamal Shaikh, Associate professor of Medicine, Consultant Medical Oncologist, Aga Khan Hospital, Nairobi.
Prof. Peter Schmid, Lead, Centre for Experimental Cancer Medicine, Barts Cancer Institute, St Bartholomew’s Hospital the Queen Mary University of London.
Prof. Nadia Harbeck, MD LMU Breast Center.

Triple-negative breast cancer (TNBC) is a heterogeneous disease with differential gene expression profiles. The morphological subtypes of TNBC include ER, PR, and Her 2 Neu Negative cancers. Hormone receptor-negative patients are usually young (mean age 48.8-34%) and are diagnosed with grade III tumors. The biomarkers are different for African, African American, and caucasian women The differences have clinical and biological implications which could be targeted for the development of personalized therapeutics. Testing for immunohistochemistry and participation in clinical trials may improve disease management, which is a global challenge as well as in Kenya. Poor handling of collected samples, challenges with sample analysis, quality control, and data registry affect data collection in Kenya. There are challenges with the correct pathologic diagnosis, as a result of differences in diagnostic methods. Testing for immunohistochemistry and participation in clinical trials may improve disease management. Data generated by molecular and genomic profiling is promising to open new therapeutic options. Today, neoadjuvant therapy is the standard for early TNBC management. Immunotherapies targeting single-agent anti-PD-L1/PD-1 in combination with chemotherapy are effectively treating TNBC, with good tolerability. Sacituzumab is a new antibody-conjugate in the treatment of TNBC. Other treatment options involve offering multiple lines of treatment, where standard chemotherapy contains anthracyclines and taxanes. However, the cost of treatment and diagnostics is still a big challenge in Kenya.

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The 6th Kenya International Cancer Conference
2020-11-21 08:00 - 17:00 | Virtual Event (Zoom), Kenya
Theme: Making Strides Towards Quality Cancer Care

EXECUTIVE SUMMARYThere is need for patient-centered, high-quality, and value-based care in the management of cancers in general. This includes the whole continuum from prevention, timely access to screening, diagnosis, treatment and palliative care services; and improving rehabilitation and support activities.
Practicing Oncologists are invariably asking questions around value-based care in oncology. For the first time, KESHO held a virtual forum looking critically at the value of cancer care in Kenya and Africa. The 2020 Kenya International Cancer Conference looked at Value as a measure of a patients’ expectations of care and how this can be translated into cost effectiveness, and how these two factors can be combined in a low-resource setting.
The conference had an impressive line-up of presenters from across the globe sharing their experiences on how HCPs can continue to deliver quality care as well as the considerations for providing the quality of care in the Covid environment. The virtual event incorporated several breakout sessions including site-specific discussions around delivering care as well as the related challenges, actual management of cancer patients, policy and advocacy, palliative care, nursing care in oncology, haematological conditions Click here to view agenda
The event also highlighted some of the challenges around delivering care and how to restructure and build systems that deliver effective care. Also, part of the Agenda was a collaborative session with AORTIC where presenters shared anecdotal experiences around research, education, training and building regional networks.
There is an increasing consciousness around how we as a continental community can generate our own evidence and look at what our best practice is, and a critical component to this is setting up our own clinical trials in Africa. Some of these issues were discussed by the conference keynote speakers who gave their experiences on clinical trials in Africa and offered practical tips that HCPs can use to build up our continental collaborations and gather robust clinical data for improved patient outcomes.
The conference also included a session looking at media and the oncologist which touched on effective communication with patients, effective communication with media and how to effectively package key messages for maximum impact.
The 2020 Kenya International Cancer (Virtual) Conference attracted over 400 attendees from various countries around the world including Kenya, Nigeria, Ghana, Rwanda, Ethiopia, Egypt, UK, USA, China, SA, Netherlands, Sudan, India, Tanzania, Libya, Zimbabwe, Germany, Argentina, Switzerland and many others. The 2020 KICC programme featured talks from leading specialists as well as primary care professionals from across Africa and the world.

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The 6th Kenya International Cancer Conference attracted 13 exhibitors including sponsors.

The 2020 Kenya International Cancer (Virtual) Conference attracted over 400 attendees. These included haematologists, oncologists, pathologists, nurses, radiotherapists, surgeons, patient advocates and medical students. The Conference brought together top multi-disciplinary professionals from across Africa and the globe. They shared how they were making strides towards quality cancer care especially under the shadow of the pandemic.

Find below the programme for the 6th Kenya International Cancer Conference.

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Management Of Sickle Cell Disease: A Multidisciplinary Approach
2020-10-29 19:00 - 20:30
Moderator: Dr. Gladwell Gatheca Sponsor: Novartis Presenters:

Dr. Fredrick Okinyi, Lecturer, hematologist, University of Nairobi, Kenya
Dr. Esther Nafula, Palliative Care Specialist and Head of Department, KNH Palliative Care Unit

Sickle cell disease (SCD) is a neglected genetic disease in sub-Saharan Africa that is responsible for 5-16% of mortality in children under 5 years. Approximately 75% of children die before 5 years of age. SCD has a mortality rate of 58/1000 cases per year. The goals of clinical assessment in to give an impression and confirm the diagnosis in new patients, to determine the symptomatology, acute or chronic complications, stable or unstable in known cases, to classify the type of crisis and precipitating factors in acutely sick patients, to decide on the level of care as outpatient/inpatient or referral. Diagnosis for new patients is based on clinical presentation, family history, clinical features (signs and symptoms), and laboratory testing which can be considered as neonatal screening. Preliminary laboratory tests include full blood counts, reticulocyte counts, blood film morphology. Sickling tests can be easily performed in the laboratory of lower-level facilities. Since the test is positive for individuals with sickle cell disease as well as in sickle cell trait, a Hb separation technique is necessary for a positive test. Confirmatory tests include hemoglobin electrophoresis (HE), High-performance Liquid Chromatography (HPLC), and Isoelectric Focusing (IEF). The point of care rapid tests has high specificity and sensitivity when compared with the HPLC. They are useful in lower-level facilities. Although rapid tests can identify the hemoglobins Hb A, Hb S, and Hb C, they cannot quantify the different hemoglobins or accurately identify some of the other forms of SCD such as Hb S beta-thalassemia. SCD patients should attend clinics as an outpatient management practice. Acute complications should be managed. Fluid management is an important aspect since SCD patients are at risk of dehydration due to impaired renal concentrating power and poor fluid intake. Simple transfusion may use packed red blood cells, where the donor hematocrit should be about 0.6. Exchange transfusion may be undertaken to rapidly reduce the percentage of sickle cells in circulation, especially in severe sickle chest syndrome. The complications of the sickle cell disease range from mild to severe and vary among individuals. Counseling is very important in pre-marital, early childhood, Adolescence/ adulthood, and end of life. Pain management involves the use of strong opioids for severe pain, weak opioids for moderate pain, and regular paracetamols. SCD is incurable often leading to premature death. The patients should be helped to achieve a good death, mainly through control of pain and other physical symptoms, accepting death is inevitable, forgiving others, reconciling with self, family, and God, and being in control of the dying process.

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Breast Cancer Management: A Comprehensive Approach Part 3
2020-10-27 19:00 - 20:30
Moderator: Sponsor: AstraZeneca Presenters:

Dr. Daniel Ojuka, Consultant General & Breast Surgeon & Lecturer, University of Nairobi
Dr. Andrew Odhiambo, Consultant Medical Oncologist & Lecturer, University of Nairobi

Breast cancer is the most common cancer in women globally. Although the surgery was previously the most successful form of treatment; it was associated with mortality (approximately 15%) and increased morbidity, hence was abandoned in the 1960s. Consequently, advances in general anesthesia and antiseptic techniques facilitated more extensive procedures. In Kenya, the current changes in breast cancer management are driven by early detection and diagnosis and timely referrals, resulting in better outcomes. Unfortunately, late diagnosis is still frequent. The current breast cancer management approach is multidisciplinary, consisting of a multidisciplinary team (MDT), of highly qualified specialists and a coordinator. The MDTs are economical and result in service improvement and better outcomes. To date, breast surgery involves MRM-Auchoncloss, skin, and nipple-sparing mastectomy techniques, which are selected depending on patient morphology, breast ptosis, and type of reconstruction planned. Since the female breast is a symbol of beauty, fertility, and femininity, and surgery causes disfigurement, mastectomy for younger women requires proper communication and engagement with the patient, especially on the use of an aesthetic approach to breast conservation and rehabilitation therapy. Alternative approaches to surgery include hormonal therapy, targeted therapy, and chemotherapy, where the choice depends on the stage, setting, disease biology, patient characteristics, and the genomic patterns of the patients. A combination of approaches such as the use of neoadjuvant chemotherapy before surgery has proven to be beneficial especially in ulcerated patients. Considering the anatomical and molecular staging, the stage-based treatment survival rate is dependent on the subtypes of breast cancer. The national cancer treatment protocols and training programs for capacity building have been availed to all the counties by the Ministry of Health, Kenya, to support the treatment of cancer patients, especially in the counties.

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Breast Cancer Early Diagnosis and Screening Part 2
2020-10-21 19:00 - 20:30
Moderator: Dr. Vera Manduku Presenters:

Dr. Mary Nyangasi, Head of Division, National Cancer Control Program, Ministry of Health, Kenya
Dr. Miriam Mutebi, Consultant, Breast Surgical Oncologist, Aga Khan University Hospital

The ministry of health is commemorating the annual national breast cancer awareness month 2020 by giving hope and saving the lives of breast cancer patients. Globally, cancer is a major cause of death, accounting for 1 out of 6 deaths annually. Over 70% of deaths occur in low and middle-income countries, where breast cancer accounts for 6.6% of all cancer deaths. In Kenya, cancer is the second leading cause of death from non-communicable diseases, accounting for 7% of overall mortality. Breast cancer is the third leading cause of death after esophageal and cervical cancers. Good prognosis is associated with timely screening and early detection, followed by timely treatment. Unfortunately, awareness and uptake of screening services remain low in Kenya. Consequently, 70% of breast cancer cases are diagnosed in advanced stages. Since survival of breast cancer patients is highly dependent on the stage of diagnosis, a low survival rate is observed in stage IV patients. To support the management of breast cancer, the ministry of health, Kenya has put infrastructure for screening mammography in all the 47 County Referral Hospitals. In addition, the ministry has provided national cancer screening guidelines (2018) to guide an organized and unified approach for screening priority cancers including cervix, breast, colorectal, prostate, and retinoblastoma. Mammography is the recommended method of screening for women in the average-risk population, and the only screening modality shown to reduce breast cancer mortality. Previous studies have shown that screening mammography helps with the early detection of cancer and greatly reduces breast cancer deaths for women aged 40-74 years as well as those above 74 years. However, mammography is very costly and is only recommended for countries with good health infrastructure that can afford long-term programs. Other early detection techniques include a clinical breast examination, ultrasound, monthly breast self-examination, and breast self-awareness. Breast cancer management in low and middle-income countries is complicated by poor health systems, poverty, and retrogressive cultural practices. In these countries, awareness of early signs and symptoms and screening by clinical breast examinations are recommended for the early detection of breast cancer. In Kenya, screening is mainly opportunistic, mainly due to challenges associated with lack of equipment, radiologists, and radiology personnel. The risk of breast cancer is stratified into two: the average-risk population, accounting for 80%, while the high-risk population (20%). While there is a need for risk reduction strategies, the risks involved in mammography are non-lethal; hence screening benefits outweigh the risks involved. Some of the risks include recall for additional imaging, needle biopsy, false positives, anxiety, and over-diagnosis. Lifestyle and environmental factors can have an impact on breast cancer risk. Some of the risk reduction measures include maintaining a healthy weight, exercising regularly, and limiting the amount of alcohol.

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Childhood Cancers and Early Detection
2020-10-13 19:00 - 20:30
Moderator: Dr. Sitna Mwanzi
Presenters:

Dr. Valerian Mwenda, Medical epidemiologist, Lead Cancer registration, Monitoring, Evaluation and Research, Division of National Cancer Control Program, Ministry of Health.
Dr. Doreen Karimi Mutua, Paediatric, hematologist/ oncologist, Gertrude’s Children’s Hospital, Childhood Cancer Initiative

Childhood cancer is becoming a public health crisis in the developing world. In high-income countries, the childhood cancer prevalence is only 20%, with up to 80% cure rates. Low and middle-income countries account for 80% of all new cancer cases and less than 20% survival rates. In 2018, 3000 new cases of childhood cancers were reported in Kenya, where the survival rate is less than 19-30%. The low survival rate is attributed to the late presentation of patients, lack of knowledge and awareness of symptoms and signs among health care workers, weak referral systems, few cancer diagnostic and treatment centers, cultural beliefs and myths, and financial constraints. To overcome these challenges, there is a need to raise awareness among caregivers and health care workers on early warning signs, encourage health-seeking behavior among Kenyans, strengthen referral systems to avoid time wastage, equip and train staff to diagnose and treat, adopt evidence-based protocols for the treatment of cancer patients, maintain data on the outcomes, and use it for treatment and resource planning. The global initiative for childhood cancer target for 2030 is to realize a double cure rate, ensuring at least 60% survival for children with cancer globally, and reducing suffering for all. To achieve this, efforts are being put in place to increase the capacity of countries to provide quality services for children with cancer, and to increase the prioritization of childhood cancer at the global, regional, and national levels. According to Kenya National Cancer Registry, the most common childhood cancers are Leukemia, Retinoblastoma, Renal, Lymphoma, and Central Nervous System. The risk factors are majorly unknown, though exposure to ionizing radiation and infectious agents has been associated with some cancers. The goal of the Kenya Cancer Policy is to provide a multi-sectoral framework to comprehensively address the cancer burden in the country. The national cancer control strategy (2017-2022) aims to optimize treatment and palliative care for childhood cancers. The national cancer screening guidelines guide early diagnosis while the national cancer treatment protocols guide treatment. Barriers to effective childhood cancer control include a low level of awareness, low index of suspicion among the caregivers, poor referral systems, and inadequate access to palliative care. Other system challenges include poor access to health care, lack of finances, and inadequate surveillance and tracking systems. To counter these challenges the ministry of health Kenya is increasing advocacy, training among the health care providers, and universal health coverage. Early detection of childhood cancer is key to improved survivorship and health outcomes, timely access to treatment and care, lower intensity of treatment, cost-saving for families and health systems, and a lower burden of short and long-term toxicity.

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The Role of Immunotherapy in Cancer Management
2020-10-08 19:15 - 20:30
Moderator: Dr. Miriam Mutebi
Sponsor: Beacon
Presenters:

Prof. Asim Jamal Shaikh, Associate professor of Medicine, Consultant Medical Oncologist, Aga Khan Hospital, Nairobi.

Immunotherapy is a type of cancer treatment that boosts the body’s natural defenses to fight cancer cells. It uses substances made by the body or in a laboratory to improve how your immune system works to find and destroy cancer cells. Traditional therapies such as surgery, radiation, and cytotoxic/targeted therapy target tumor cells, while immunotherapy harnesses the body’s immune system to fight diseases. Anti-tumor immunotherapy includes cancer vaccines that educate T cells to better recognize and kill the pre-existing tumor. Adoptive immunotherapy activates and increases T cell numbers to better kill tumor cells. Immunomodulation uses drugs or antibodies to either increase stimulation or to overcome immune inhibition. Many tumors escape the immune response by creating an immunosuppressive microenvironment that prevents an effective anti-tumor response, mainly through the involvement of the immune checkpoints located in the central or peripheral regions. The immune checkpoints PD-L1 binds to PD-1 and inhibits T cell killing of tumor cell, therefore, blocking PD-L1 or PD-1 allows T cell killing of tumor cells, while CTLA4 regulate the early phase of activation of naïve and memory T cells in response to T cell receptor (TCR) stimulation by peptides presented by MHC ligands expressed by antigen-presenting and processing cells. Its upregulation prevents normal T cell activation. Several checkpoint inhibitors with FDA approval are in clinical use and have proven to be highly effective in the treatment of relapsed, progressive solid cancers, with relatively mild but distinct safety profiles. Some immune checkpoint inhibitors available in Kenya, are quite costly, and hence National Hospital Insurance Fund (NHIF) is too little to cover for this treatment. Aga Khan is building capacity for PD-L1 analysis, an immunohistochemistry test, in addition to next-generation sequencing. More data is required on the safety of immunotherapy and its use on immunocompromised individuals e.g. HIV, and those with autoimmune diseases, Since several clinical trials, are in progress; more new indications are likely to emerge.

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Management of Hormone Receptor Positive Breast Cancer
2020-09-29 19:00 - 20:30 | Virtual Event (Zoom), Kenya
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Management of Neuroendocrine Tumors
2020-09-15 19:15 - 20:30
Moderator: Dr. Sitna Mwanzi
Sponsor: Novartis
Presenters:

Njoki Njiraini, a consultant clinical oncologist based at the Cancer Centre in Kenyatta University Teaching Research and Referral Hospital.

Neuroendocrine Neoplasms arise from diffuse neuroendocrine cells in the body and are broadly divided into well-differentiated neuroendocrine tumors (NETs), including the sporadic small intestine, pancreatic, thorax, and thymus NETs, and poorly differentiated neuroendocrine carcinomas (NECs), classified based on differentiation, Ki67 levels, and mitotic figures. NETs arise from neuroendocrine cells throughout the body. There has been increasing incidence over the last 15 years, with a male preponderance and a more adverse outcome. Diagnosis is mainly through histology and immunohistochemistry. Staging for NECs is mainly by adenocarcinoma staging system, which mainly involves imaging through CT scan, MRI, Contrast-Enhanced USS, endoscopic USS, and functional imaging. Treatment is dependent on TNM staging and grading of the disease and includes surgery, somatostatin analogs, hepatic-directed therapies, and chemotherapeutics. For a patient with carcinoid syndrome, the short-acting octreotide can be considered first, while waiting for long-acting octreotide to act. Locally, therapies are available in 20 mg from Novartis retailing at 68000 Kenya shillings, but 30mg are also available in the market through other distributors. The toxicity profiles should be put into consideration e.g. diarrhea, although sometimes it’s difficult to differentiate drugs’ side effects from the initial tumor signs. Neuroendocrine carcinomas are classified as small or large cells and mostly the patients have poor outcomes. There is a need to improve imaging and multidisciplinary teams to share local experiences of neuroendocrine patients.

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Management of Iron Overload
2020-09-08 19:15 - 20:30
Moderator: Dr. Paresh Dave
Sponsor: Novartis
Presenters:

Peter Oyiro, Medical Oncologist Kenyatta National Hospital Teaching and Referral Hospital

Iron overload is a poly etiologic condition characterized by a moderate to severe increase in the body iron that has or will have negative effects secondary to iron deposition in tissues or body organs. It may be hereditary or acquired. It is important to detect the disease before organ damage occurs. Iron overload affects overall survival partly due to the underlying biology of the disease but also because of the sequelae of iron overload, including cardiomyopathy, cardiac events, liver disease, and the development of diabetes. For patients with higher serum ferritin levels, the 100-day post-transplant mortality is worse with inferior overall survival (OS) and a higher rate of graft vs host disease. Therefore, iron chelation therapy can improve OS and is effective at reducing serum ferritin levels, cardiac events, and diabetes in patients with blood-transfusion-related iron overload. Compliance is highly encouraged to realize successful treatment. The safety profile of each chelator should be evaluated before the initiation of treatment. Patients receiving chemotherapy and who have a drop in blood count parameters require evaluation to find out the causes. Iron studies are required to generate more data. Iron supplementary can be toxic. Patients with severe organ dysfunction can have a combination of iron chelation therapy. Ferritin levels should be done every 3 months. Iron chelation OS is not contraindicated in HIV patients with evidence of iron overload.

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Cancer and Thrombosis Current Perspective
2020-08-27 07:00 - 20:30 | Virtual Event (Zoom), Kenya

Emerging Therapies in Hodgkin's Lymphoma Management - Treatment Beyond The Basics
2020-08-11 19:15 - 20:15
Moderator: Dr. Miriam Mutebi
Sponsor: Takeda, a pharmaceutical company with a patient assistance program for Hodgkin’s lymphoma in Kenya.
Presenters:

Dr. Anna Sureda, Head of the Clinical Hematology Department and the Stem Cell Transplantation program of Institut Catala d’Oncologia – Hospitalet, Barcelona

Hodgkin’s lymphoma (HL) is one of the most curable hematological malignancies with first-line treatment, which is a combination of radiotherapy and chemotherapy. Autologous hematopoietic stem cell transplantation (auto-HCT) is the standard therapy for HL patients relapsing after first-line chemotherapy. The use of allogeneic stem cell transplantation (ASCT) has improved the overall survival (OS) of patients over time. To improve the landscape of chemotherapy treatment for refractory disease, a new drug, Brentuximab vedotin, has been introduced. This drug is an antibody-drug conjugate (ADC) consisting of 3 components; it binds to CD30 forming a complex that is internalized and traffics to the lysosome. The drug was granted accelerated approval by the US FDA in 2011. The European Medicines Agency (EMA) approved this drug in 2012 for the treatment of adult patients with relapsed or refractory CD30+ HL, anaplastic large cell lymphoma, and those at increased risk of relapse or progression following ASCT. The efficacy reported as median observation time from the first dose at study closure was 35.1 months (1.8-72.9). Studies revealed that Brentuximab vedotin and ESHAP are highly effective as second-line therapy for Hodgkin’s patients. Brentuximab vedotin was the first targeted therapy that was tested in patients with relapsed/refractory HL. It was very effective as a single drug in patients that relapse or progress after auto-HCT. Brentuximab vedotin is able to potentially increase the number of patients that are candidates to auto-HCT. It improves progression-free survival (PFS) in those patients with a high risk of relapse after auto-HCT when used as a consolidation strategy. It has demonstrated an adequate and safe toxicity profile, even in HIV-positive patients with HL. Brentuximab vedotin is being used in other settings with very interesting results (RR setting in combination with chemotherapy, first line). However, the cost of the treatment in Kenya is quite high; a single vial costs Kshs. 330,000. A patient assistance program in partnership with Takeda is helping patients in Kenya who cannot afford to pay, to complete their treatment. Although this program is run in private hospitals, physicians seeing patients at public facilities can refer the patients to the private facilities for assistance, but continue to follow up on the patients.

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Ovarian Cancer, The Good, The Bad, And The Ugly
2020-07-30 19:15 - 20:30 | Virtual Event (Zoom), Kenya
Moderator: Dr. Andrew Odhiambo, Consultant Medical Oncologist & Lecturer, University of Nairobi
Sponsor: Merck
Presenters:

Dr. Benjamin Odongo Elly, Gynecologic Oncologist at Moi Teaching and Referral University.

Moi Teaching and Referral Hospital (MTRH) cancer center offers a holistic approach to cancer treatment. Germ cell tumors account for 10-115% of all ovarian tumors and affect young females of reproductive age. They are very chemosensitive hence are curable, using fertility-sparing surgery. Stromal tumors account for 3-5% of all ovarian tumors and affect women of all ages. These tumors are diagnosed early and are histologically low-grade, with a good prognosis, when treated with surgery, followed by adjuvant treatment. However, some tumors are aggressive and lethal. Epithelial tumors represent 80-85% of all ovarian tumors. They have a poor prognosis and are always detected late. Warning signs include abdominal bloating, abdominal/pelvic pain, bowel/bladder symptoms, and irregular vaginal bleeding. Prevention of ovarian cancer is by avoidance of risk factors and prophylactic surgery in high-risk women. There is currently no good screening test for the general population. Diagnosis is by appropriate physical examination, pelvic/transvaginal ultrasound, tumor markers, and CT scan. The majority of patients are diagnosed with advanced-stage disease (stage III or IV) leading to poor overall 5-year survival. However, patients are living longer with the disease due to advances in surgery and chemotherapy treatment. As a country, there is a need to improve the early diagnosis of ovarian cancer through advocacy, patient education, human resource, training capacity building, and availing resources to the health care facilities. Dear Guest, this content is restricted to only KESHO Members.
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TOPIC: Management of Brain Tumors
2019-11-21 20:00 - 22:00 | Crowne Plaza Hotel
Finally, KESHO partnered with the Neurological Society of Kenya to discuss the management of brain tumors with a stimulating surgical perspective from Dr Edwin Mogere Neurosurgeon and an in-depth discussion of management of medical symptoms from brain tumors by Dr Judy Kwasa Neurologist.

TOPIC: BCR-ABL and OSTEOGENIC SARCOMA
2019-08-29 20:00 - 22:00 | Sarova Panafric Hotel, Nairobi, Kenya., Kenya
We took a well-deserved break in July 2019 and came back in August for a mixed presentation on CML and osteogenic sarcoma from Prof Nicholas Abinya Medical Oncologist and Dr Mohammed Ezzi Medical Oncologist. The outcome for patients with CML has significantly improved with TKI therapies, yet challenges persist in adequate monitoring which is expensive. The lack of co-ordinated multidisciplinary care needed for osteogenic sarcoma led to many lost to follow up and incomplete treatments with poor outcomes. MDTs prior to treatment is a potential strategy for reversing this trend.

SSA Breast Cancer
2019-08-29 17:00 - 20:00 | Sarova Panafric Hotel, Nairobi, Kenya., Kenya
Another busy month for us with three meetings in October. First off, Prof Asim Jamal Medical Oncologist gave an excellent overview of presentation, diagnosis and management of neuroendocrine tumors which are not as rare as originally felt. KESHO then partnered with Pathologists Lancet Kenya to discuss molecular diagnostics in hemato-oncology. Speakers from France and our very own experts deliberated on the changing landscape of hemato-oncology and what is practical in our setting. Finally, a multidisciplinary webinar session on breast cancer concluded our sessions for the month in recognition of the Breast Cancer Awareness month, with presentations from Dr. Gladwell Kiarie Medical Oncologist, Dr. Fred Okuku Medical Oncologist, Dr. Aba Anoa Scott Radiation/Clinical Oncologist and Prof. Ronald Wasike Breast Surgeon.

TOPIC: Paediatric Malignancies; Optimising Care In Acute Leukaemia
2019-06-27 11:00 - 20:00 | Sarova Panafric Hotel, Nairobi, Kenya., Kenya
We directed our focus on hematology and this time we concentrated on pediatric malignancies. Dr. Jamila Rajab Consultant Haematologist, Dr. Grace Mbatia Paediatric Oncologist and Dr Festus Njuguna Paediatric Oncologist. We got a glimpse on the myriad challenges our colleagues in hematology face in the management of pediatric hematological malignancies including complicated regimens, high rate of drop outs and poor supportive care. The outcome was to continue in the process of development of national treatment protocols that can be used which can also help in comparing treatment outcomes in the different settings.

TOPIC: Colon Cancer; A Multidisciplinary Approach
2019-05-23 20:00 - 22:00 | Radisson Blu, Upperhill Nairobi, Nairobi, Nairobi, 00100, Kenya
This was a busy month for our members with three educational events! Dr. Joe Ruturi Cardiothoracic Surgeon and Dr. Solomon Mutua Clinical Oncologist started off the month with discussions on upper GI cancers, in particular esophageal cancer. KESHO collaborated with ROCHE in their sub-Saharan MPANGO two-day meeting in which many of our members were speakers. The conference focused on triple negative and HER2 breast cancer, colon and lung cancer. The month ended with an excellent multidisciplinary meeting on colon cancer spearheaded by our very own past Chair, Dr. Gladwell Kiarie Medical Oncologist and Dr. Rajendra Chauhan Surgical Oncologist. There was a lot of input from our surgical and radiation colleagues.

TOPIC: HIV Malignancies Symposium
2019-04-27 20:00 - 22:00 | Movenpick Hotel, Nairobi
KESHO held a half-day joint symposium with the HIV Clinicians Society discussing the various aspects of HIV related malignancies and how we can better co-manage these patients for improved outcomes. More local research is needed to understand the true prevalence of a co-diagnosis of HIV and cancer and in particular non-AIDS defining malignancies.

Topic: Acute Leukaemia
2019-03-28 00:00 - 23:59 | Sarova Panafric Hotel, Nairobi, Kenya., Kenya
Prof. Nicholas Abinya Medical Oncologist and Dr. Anne Mwirigi Haematologist gave stimulating perspectives on their care of patients with AML in a public versus a private setting. This led to discussions on collaborations on improving standards of care in our country and in particular with regards to supportive care and financing. KESHO is now engaging with NHIF and the NCCP to outline a treatment package for these patients that factor other costs apart from direct chemotherapy drugs.

Topic: Updates on Recently Launched Cancer Screening Guidelines
2019-02-28 00:00 - 23:59
In line with the launch of the Kenya Cancer Screening guidelines, Dr Andrew Odhiambo Medical Oncologist and Dr Primus Ochieng Clinical Oncologist presented on their perspectives on the new guidelines and their experience in other settings outside of Kenya. The Screening Guidelines is as shown below:

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Topic: Updates in Breast Cancer Management
2019-01-31 00:00 - 23:59 | Sarova Panafric Hotel, Nairobi, Kenya., Kenya
We started off the year discussing the most common cancer in women in Kenya and worldwide with two presentations. Dr Miriam Mutebi Surgical Oncologist gave an update on the surgical techniques of breast cancer management and Dr Njoki Njiriani Clinical Oncologist talking on new therapies for advanced hormone positive breast cancer
