14th World Cancer & Anti- Cancer Therapy Convention November 21-22, 2016 Dubai, UAE

Biography:

Abstract:

Biography:

Rasha Aboelhassan is an Oncology Consultant at the Nasser Institute Hospital for Research and Treatment. She’s an expert in Medical Oncology, 3Dimention Radiation Therapy (3DCRT) and Intensity Modulated Radiation Therapy (IMRT), Cancer Research and Supportive Care. She’s an optimistic oncologist with experience over 20 years; and she’s the Principle Investigator of many international clinical trials working on new treatment for lung cancer, soft tissue sarcoma and lymphoma. She also has many online publications in the field of supportive care, breast cancer and rare cancers. She honoured a certificate of appreciation from Egyptian Ministry of Health and Cairo Medical Syndicate for her dedication towards her work.

Abstract:

Granulocytic sarcoma is a rare condition with a wide list of differential diagnosis, and debatable guidelines of treatment in different cancer centers; most of literature recommended systemic chemotherapy with or without radiation therapy and minor role surgery. Diagnostic methods like CT, MRI and PET CT can facilitate follow up of response to treatment more than diagnosis, which depend mainly on pathological picture, IHC and bone marrow examination. This is a report for a rare case of myeloid sarcoma who was presented by hard palatine fistula who was successfully treated with chemotherapy, surgery and radiation therapy.

Biography:

Abstract:

Biography:

Jamal Abdulkarim finished his Radiology Training in University Hospitals of Leicester, UK and obtained the FRCR. Currently, he is a Consultant Radiologist at George Eliot Hospital. He has interest in research particularly in the field of intravenous iodinated contrast media and MRI.

Abstract:

Metastatic bone disease is a common manifestation of advanced cancers particularly breast, prostate and lung. Currently many hospitals rely on traditional imaging technique such as bone scan, CT scan and more recently PET CT scan. However, all the above involve ionizing radiation and do not necessarily provide accurate information about the disease activity. Whole-body DW imaging (WB-DWI) is emerging as a promising bone marrow assessment tool for detection and therapy monitoring of bone metastases. Advantages of WB-DWI include the fact that no ionizing radiation is administered and no injection of isotopes or any contrast medium is necessary. Importantly, whole-body skeletal examinations are possible in reasonably short data acquisition times. WBDWI is commonly performed at 1.5T because of the ability to uniformly suppress fat over large fields of view. Recent technological advances including improved shimming routines and multi-transmit equipped MRI systems do allow WB-DWI data acquisitions at 3T. We present our local experience in whole body MRI using new Siemens Magnetum Skyra (2016) with advanced shimmering software reducing the above mentioned artefacts. 

Biography:

David Huang, upon completion of his PhD in Particle Physics, was trained at Medical Physics Residency Program at UC San Francisco, San Francisco. Then he worked at Memorial Sloan-Kettering Cancer Center, New York as a Faculty Physicist before moving to Long Island Jewish Medical Center, New York as Senior Medical Physicist. In 1995, he went back to Taiwan to help in establishing the first cancer center there for 7 years as Chairman of Medical Physics Department at Sun Yat-Sen Cancer Center in Taipei. In 2002, he went back to Memorial Sloan-Kettering Cancer Center as Associate Attending and Chief Physicist/Radiation Safety Officer at Rockville Centre Site. In 2014 summer, he retired from Memorial Sloan-Kettering Cancer Center and accepted offer from Duke University as Professor and Director at Medical Physics Graduate Program at Duke Kunshan University, China. Besides the clinical experiences, he is also a Professor at Young-Ming University, Taiwan and Central Taiwan Technology University, Taiwan, a Visiting Professor at Beijing University, School of Oncology, China and at Tsing-Hwa University, China and Adjunct Professor at University of Missouri, USA.

Abstract:

It is well accepted that local tumor control and normal tissue complications have sigmoidally shaped dose-response curves. The success of radiotherapy highly depends on the radiosensitivity of the particular tumor being treated relative to that of the surrounding normal tissues. For tumor sites where the tumor control curve is less steep than the normal tissue complication curve, the high doses required for tumor cure may cause unacceptable normal tissue complications. The goal of radiotherapy is to sufficiently separate the dose-response curves of local tumor control and normal tissues complication, and also the total volume of normal tissue irradiated. During the past three decades, advances in radiological imaging and computer technology have significantly enhanced our ability to achieve this goal through the development of three-dimensional image-based conformal therapy (3DCRT). Intensity-modulated radiation therapy (IMRT) is an especially advanced method of 3DCRT that utilizes sophisticated computer controlled radiation beam delivery to improve the conformality of the dose distribution to the shape of the tumor. This is achieved by varying beam intensities within each beam portal, as opposed to uniform beam intensities as in conventional 3DCRT. Both 3DCRT and IMRT utilize sophisticated strategies for patient immobilization and positioning, image-guided treatment planning, computer enhanced treatment verification, and image-guided treatment delivery (IGRT). In the heart of these techniques is advanced computer technology and 3D patient imaging with CT, MR and/or PET. Besides the advances in external beam treatment, there are also new developments in stereotactic body radiotherapy fields. Also, the proton and heavy charged particle treatment open another door for radiotherapy with promising results. All these advances in radiotherapy improve the outcome for the cancer treatment; increase tumor control rate while minimizing the side effect. Furthermore, combination of chemotherapy and radiotherapy and new fractionation scheme make the cancer treatment to another new era. In my talks, I will share with you few clinical examples to illustrate the powerful IMRT, IGRT, Proton therapy, and SBRT techniques applied in nowadays cancer managements. 

Biography:

Rasha Aboelhassan is an Oncology Consultant at the Nasser Institute Hospital for Research and Treatment. She’s an expert in Medical Oncology, 3Dimention Radiation Therapy (3DCRT) and Intensity Modulated Radiation Therapy (IMRT), Cancer Research and Supportive Care. She’s an optimistic oncologist with experience over 20 years; and she’s the Principle Investigator of many international clinical trials working on new treatment for lung cancer, soft tissue sarcoma and lymphoma. She also has many online publications in the field of supportive care, breast cancer and rare cancers. She honoured a certificate of appreciation from Egyptian Ministry of Health and Cairo Medical Syndicate for her dedication towards her work

Abstract:

Introduction: Pericardial mesothelioma is a rare condition with a reported prevalence <0.002%, with different clinical picture and clinical manifestations that include constrictive pericarditis, cardiac tamponade, and heart failure or pericardial tuberculosis. Here we present a rare case of pericardial mesothelioma of 30 years old female patient who presented by dyspnea and cardiac tamponade. MRI of the heart was showing pericardial mass where biopsy leaded the diagnosis of sarcomatiod mesothelioma of the heart.

Case Report: Female patient, 30 years old, presented, in May 2016, with chest pain and dyspnea. She was missed diagnosed as a case of congestive heart failure causing bilateral pleural effusion which had a mild improvement of symptoms with treatment of heart failure. Upon her follow up, her physician noticed pericardial thickness during echocardiography where CT and MRI was requested showing pericardial mass invading right atrium. Biopsy and pathological examination was showing poorly differentiated bland spindle cells with a collagenous stroma. Immunohistochemistry was done showing the following: 1- Pan cytokeratin positive on neoplastic cells; 2- Calritinin positive 10% of neoplastic cells; and 3- Vimentin and actin positive on neoplastic cells. This revealed the diagnosis of pericardial sarcomatiod mesothelioma invading right atrium. The patient had good supportive care including management of heart failure that was caused by filling defect of right atrium and impaired cardiac motility due to peri-cardiac mass, and chest tube fixation to drain bilateral pleural effusion. After improvement of general condition, the patient performance status was improved and she began chemotherapy in the form of ifosfamide and doxorubicin. Now she ended two cycles with good tolerance and clinical response.

Discussion: Pericardial mesothelioma accounts for approximately 6% of all mesotheliomas; approximately 120 cases have been reported. It has been reported at any age with male predominance of 3:1. Diagnosis of primary pericardial mesothelioma is usually late due to misdiagnosis with other conditions of pericardial diseases. Radiologically: Most cases presented with pericardial mass with or without effusion but still any specific radiological features that can differentiate pericardial mesothelioma from other pericardial neoplasms, but in some literatures it was described that chest radiography in patients with pericardial mesothelioma typically demonstrates cardiac enlargement, evidence of pericardial effusion, an irregular cardiac contour, or diffuse mediastinal enlargement and MR imaging also readily demonstrates cardiac encasement by a soft-tissue pericardial mass, as well as an associated pericardial effusion; but sometimes the presentation occurs with multiple pericardial masses. Treatment guidelines specific for pericardial mesothelioma is not yet established but, like other sarcomatiod mesothelioma, surgery for this case was not an option, so we began treatment of this case with ifosfamide and doxorubicin. 

Biography:

Abstract:

Background & Aim: Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease with no effective treatment. PDAC cells are highly proliferative and metastatic. We have developed a new drug called Metavert that targets at the same time the glycogen synthase kinase 3 beta (GSK-3β) and histone deacetylase (HDAC), important mediators of cancer progression. The aim of this study was to test this agent for treatment of PDAC.

Methods: PDAC cell lines, patient-derived circulating tumor cells (CTCs), and normal cells were treated with different doses of Metavert and cell survival, apoptosis, epithelial to mesenchymal transition (EMT) markers, and invasion ability were measured. Treatments were performed alone and in combination with gemcitabine or exposure to irradiation. In vivo, Kras^LSL-G12D/+; Trp53^LSL-R172H/+; and Pdx^cre (KPC) mice were intra-peritoneally injected with Metavert (5mg/Kg) 3 times per week from age 2 months until death. Survival and number of metastasis were determined. Pancreatic lesions and tumor grades as well as fibrosis and inflammation were measured by immunohistochemistry. Cytokine production and expression of cytokine receptors were measured in tumor cells and in cells present in the tumor microenvironment.

Results: Metavert significantly (at nano-molar concentrations) decreased cancer cell survival and increased apoptosis in several PDAC cells lines. The anti-cancer effect was stronger than the effect of the combination of HDAC and GSK-3β inhibitors. The same doses of Metavert did not affect survival of normal hepatocytes and pancreatic ductal cells. Metavert decreased the survival of CTCs. Metavert increased histone acetylation, inhibited GSK-3β activity, decreased expression of markers of EMT/ metastasis and cancer stemness, and prevented migration of the cancer cell lines and CTCs. Furthermore, Metavert sensitized PDAC cells and CTCs to gemcitabine and radiotherapy as well. Treatment with Metavert significantly increased KPC mice survival by ~50%. Histologic examination showed that Metavert treatment inhibited formation of both early pancreatic intraepithelial neoplasia (PanIN) lesions and late lesions (carcinoma) in the pancreas of these animals. Distal metastasis was decreased from 29% in control KPC mice to 0% in Metavert treated KPC mice. Fibrosis and M2 macrophages levels were decreased in Metavert treated mice.

Conclusion: We have designed and synthesized a novel drug that shows a significant anti-cancer effect in vitro in PDAC cells and CTCs and in the most aggressive mouse model of experimental PDAC. Importantly, Metavert increased the survival of KPC mice and prevented metastasis in vivo with no significant toxicity to normal cells. Pre-clinical toxicity studies are ongoing and the drug is expected to be approved for clinical testing within one year.

Biography:

Gabriela El Haje Lobo has completed her Medical degree from UNIPLAC University in Brasilia, 2011. Currently, she is in her 3^rd of residency in Nuclear Medicine at a private service in Brasilia, Brazil

Abstract:

Introduction: Neuroendocrine tumors (NET) generally express somatostatin receptors (SR), allowing its treatment by radiolabeled somatostatin analogues (SA). Other tumors expressing these receptors are also amenable to such therapy.

Purpose: This paper aims to present the experience and the treatment results of 42 patients with ¹⁷⁷Lu-octreotate in the Federal Capital of Brazil.

Subjects & Methods: 42 patients with progressing neuroendocrine and no neuroendocrine tumors with SR expression started the Rotterdam protocol with ¹⁷⁷Lu-octreotate, from January 2008 to June 2016. These patients were selected after staging by anatomic imaging methods and SA affinity confirmed by scintigraphy, observing proper inclusion and exclusion criteria. Adverse effects during and after the doses administration were analyzed. 33 patients completed at least one cycle of treatment (4 doses of 200 mCi) and were assessed for clinical, laboratorial and anatomic response (complete, partial, stable or progression).

Conclusion: This ongoing experience of therapy with ¹⁷⁷Lu-octreotate reproduced the literature data for safety and also for low incidence of side effects. Not only patients with NET, but also those with other tumors expressing affinity for the somatostatin analogs were benefited from this therapy.

Biography:

Amani Mahbub  has completed MSc in Biomedical Basis of Disease in 2010 and PhD in Anti-Cancer Potential of Polyphenols in Treatment of Leukemia in 2015 at the Sheffield Hallam University of Biomedical Research Centre – Cancer Research, Sheffield, UK. She has been interested in investigating the biological effects of a number of nutraceutical compounds such as polyphenols alone and in combination with chemotherapies on the induction of apoptosis, reduced cell proliferation and signalling pathways that involved in the pathogenesis of leukaemias. She also has four published papers in the Journal of Pathology (2012), the Journal of Anti-cancer Agents in Medicinal Chemistry (2013) and recently two in Nature (2015), and two more papers under publications. In addition, she was awarded, the Alastair Currie prize for the best poster presentation at the Pathological Society of Great Britain & Ireland Conference in 2012, Sheffield, UK; and Best Poster Prize at 4^th International Conference on Blood Malignancies & Treatment, 2016 in Dubai, UAE. Currently, she is working at Umm Al-Qura University in Laboratory Medicine of Applied Medical Sciences College – Pathology Department, Makkah, KSA.

Abstract:

Background: The study aimed to assess the effects of polyphenol when used in combination with doxorubicin and etoposide, and determine whether polyphenols sensitized leukemia cells, causing cell-cycle arrest, inhibition of cell proliferation and induction of apoptosis. The rationale being that in some solid tumors, polyphenols have been shown to sensitize cells to apoptosis and/or cell-cycle arrest, potentially reducing doses, whilst maintaining efficacy.

Method: Quercetin, apigenin, emodin, rhein, cis-stilbene were investigated alone and in combination with etoposide and doxorubicin in two lymphoid (Jurkat and CCRF-CEM) and two myeloid (THP-1 and KG-1a) leukemia cells lines. Measurements were made of ATP levels (CellTiter-Glo®assay), cell-cycle progression (propidium iodide (PI) staining and flow cytometry) and apoptosis (NucView-caspase-3 assay and Hoechst 33342/PI staining). The effects of these combinations on the apoptotic pathway (caspases-3, -8 and -9 Glo®luminescent assays), glutathione levels (GSH-Glo™-glutathione assay and cell tracker™ green-5-chloromethylfluorescein-diacetate-glutathione staining) and DNA damage (Alexa Fluor® 647 Mouse anti-H2AX staining) were also determined.

Results: Doxorubicin and etoposide in combination with polyphenols synergistically reduced ATP levels, induced apoptosis and increased S- and/or G₂/M-phase cell-cycle arrest in lymphoid leukemia cell lines. In the myeloid cell lines, doxorubicin and etoposide displayed differential effects. Doxorubicin had a synergistic or additive effect when combined with quercetin, apigenin, emodin and cis-stilbene, but had an antagonistic effect when combined with rhein. Combination treatment caused a synergistic down regulation of glutathione (GSH) levels and increased DNA damage, driving apoptosis via caspase 8 and 9 activation. However, in myeloid cells were an antagonist effect this was associated with an up-regulation of GSH levels, a reduction in DNA damage and apoptosis.

Conclusion: Doxorubicin and etoposide activity can be enhanced by polyphenols, particularly in lymphoid leukemia cells, although effects were strongly dependent on type of cell line, with some interactions were antagonistic in myeloid cell lines.

Biography:

Khadijeh Jamialahmadi has completed her PhD from Tehran University of Medical Sciences, School of Pharmacy, Tehran, Iran. She is an Assistant Professor in the Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran. She has published more than 30 papers in reputed journals. Her current research interests are cancer targeted therapy, cancer epigenetics, identification of new biomarkers and therapeutic targets in cancer and multi drug resistance in cancer.

Abstract:

Breast cancer is the most frequent malignancy in women worldwide. Oestrogen receptor α (ERα) antagonists like tamoxifen are used in endocrine therapies for ERα-positive (ERα+) breast cancer patients. Unfortunately, the clinical benefit is limited due to intrinsic and acquired drug resistance. Gankyrin (P28GANK) is a newly defined oncoprotein which was reported to confer a multidrug resistant phenotype in some cancer cells. Gankyrin also functions as a dual-negative regulator of the two most important tumor suppressor pathways: (I) INK4-CDK-pRb, and (II) ARF-MDM2-p53. In the present study, the levels of protein expression and mRNA transcripts were determined using immunohistochemical analysis and Real-Time quantitative PCR in 72 matched formalin-fixed paraffin-embedded and fresh frozen breast cancer tissues (36 tamoxifen resistant and 36 tamoxifen sensitive). Overexpression of P28GANK was present in about 56% of the tamoxifen sensitive breast cancer patients and more frequently (91%) in tamoxifen-refractory tumors. P28GANK gene was also found to be overexpressed at the protein level in tamoxifen resistance patients compared to tamoxifen sensitive samples (p=0.045). These results for the first time suggest that Gankyrin plays a role in tamoxifen-resistant breast cancer, and the inhibition of this oncoprotein may be a potential target for re-sensitizing the resistant breast cancer patients to tamoxifen-treatment in endocrine-resistant breast cancer patients.

Biography:

Mahdiss Mohamadianamiri completed her graduation in Gynecology in the year 2009. She completed her Fellowship of Oncology in 2016 from Shahid Beheshti Medical University. Currently, she is serving as Assistant Professor in Iran Medical University.

Abstract:

Introduction: Among gynecologic cancers, epithelial ovarian cancer (EOC) is the major cause of mortalities in the United States, accounting for 3.6% of all types of gynecologic cancers. The major reason for this poor treatment is that most EOC patients are frequently involved in an advanced stage of the disease.

Case Presentation: Hereby, we report a 70-year-old female with ovarian cancer in which an isolated metastatic axillary lymph node was detected following cyto-reductive surgery and adjuvant chemotherapy.

Results: She had a sonography demonstrating hypoechoic solid mass in pelvis attached to fundus (adnexal mass). Serum CA-125 level was 102 μm/ml. The patient had history of laparotomy and TAH+BSO (please write in detail) with the pathology of poorly differentiated adenocarcinoma of pelvic mass and both ovaries. A 3*3 mass lesion was palpable in right axilla and abdominal CT scan was normal. The thorax CT revealed lobulated mass lesion in right axillary area due to lymphadenopathy.Histopathological and IHC examination of the axillary lymph node revealed Metastasic papillary serous axillary lymph node originated from ovary   and it was confirmed in second option. She has received Taxel+carboplatinum chemotherapy and the axillary lymph nodes revealed shrinkage in size

Conclusion: In current case, we represent the importance of differentiating accurately ovarian metastasis to the axillary area from primary breast cancer because prognosis and treatment differ significantly.

Biography:

Abstract:

Biography:

Racha Sabbagh Dit Hawasli is a Clinical Pharmacy Graduate from the Lebanese American University. She has worked in community and hospital pharmacy settings before going into research. She is currently a PhD Researcher at Kingston University London, working on the diffusion of innovation in health, more specifically, the feasibility of ambulatory chemotherapy in Lebanon. She expanded her research topic to include occupational exposure to cytotoxic drugs in academic and healthcare settings. Her expertise lies in quantitative and qualitative methodologies and pharmacoeconomic modeling as she has conducted several assessments in this context over the past 4 years. She has also established strong connections with experts from the UK in occupational exposure, and is currently working on setting guidelines for the safe handling of cytotoxic drugs in academic research laboratories. She has several publications in international journals, and presented part of her work as posters at two annual meetings for the British Oncology Pharmacy Association (BOPA). She is a member of the International Society of Oncology Pharmacy Practitioners (ISOPP).

Abstract:

It has been often reported that cancer patients experience a sense of loss of control towards their fluctuating symptoms, disease management impacting their autonomy, and their life as a whole. Studies have shown that shared decision making can empower patients, improve adherence and overall quality of life. Therefore, governments have initiated policies supporting the involvement of patients in the management of their own care. One innovation in this context is ambulatory chemotherapy (AC), delivering chemotherapy to patients outside the hospital using a portable elastomeric infusion pump. AC is renowned for decreasing cost of care, enhancing quality of life, and empowering patients to regain control and normalcy. AC has become the standard of care for certain cancers in most developed countries. In Lebanon, a developing Mediterranean country with substantial demands for healthcare services and outstanding expenses, AC is not widely adopted yet. This research work entails the development of a framework to facilitate the uptake of AC in Lebanon. It involved a needs assessment of stakeholders and patients to understand the barriers and facilitators. This talk will present an overview of ambulatory chemotherapy, the types of ambulatory pumps used the patient journey, and finally a briefing of the work done in Lebanon to assess the feasibility of implementing this treatment modality. It is essential to assess the needs of the patients and the healthcare system for ambulatory chemotherapy to facilitate the commissioning this treatment modality and foster a strong infrastructure to support it.

Biography:

Abstract:

Biography:

Mu Ju Wei completed his MD at Cancer Hospital of CAMS and PUMC. He is the Deputy Director and Professor of Department of Thoracic Surgery. He majored in minimally invasive thoracic surgery including surgical treatment of malignant lung, esophageal and mediastinal lesions. He has completed and participated in several national natural funds, province natural funds, and published several papers in oncogene and BMJ open, et al. He is also serving as Editorial Board Member of several magazines (including JTD and WJG).

Abstract:

Data of consecutive 1553 patients who underwent video assisted thoracoscopic surgical (VATS) pulmonary resection for lung cancer in the Department of Thoracic Surgery of Cancer Hospital of CAMS and PUMC between November 2014 and January 2016 were prospectively collected and analyzed. There were 716 males and 837 females. The mean age was 58.90 years (25 to 82 years) and the conversion rate was 2.7% (42/1553) in this cohort. After propensity score matching, there were 207 patients in single-port and two-port group, and 680 patients in three-port group. Propensity-matched analysis demonstrated that there were no significant differences in duration of operation (129 versus 131 minutes, P=0.689), intra-operative blood loss (63 versus 70 mL, P=0.175), number of dissected lymph nodes (12 versus 13, P=0.074), total hospital expense ($9928 versus $9956, P=0.884) and cost of operation ($536 versus $535, P=0.879) between VATS single-port, two-port and conventional three-port pulmonary resection groups. There was no significant difference in the complication rate between two groups (5.3% versus 4.7%, P=0.220). However, compared with three-port group, patients who underwent single port and two-port experienced shorter postoperative length of stay (6.24 versus 5.61 d, P=0.033), shorter duration of chest tube (4,92 versus 4,25 d, P=0.008), and decreased volume of drainage (926 versus 791 d, P=0.003). We concluded that the short term outcomes between VATS single-port, two-port and conventional three-port groups for the surgical treatment of lung cancer were comparable. However, compared with three-port VATS pulmonary resection, single-port and two-port were associated with shorter postoperative length of stay, shorter duration of chest tube, and decreased volume of drainage.

Biography:

Abstract:

Background: The objective of the paper is to create awareness among people about alternative and complimentary methods to protect themselves from Chronic Airway diseases including throat and lung cancers. The following changes take place in airways as a result of diseases: 1) Inflammation: It is a physiological process and plays the role of immunological defense against infection, injury or allergy. 2) Hyper secretion of mucus: It is one of the important clinical and pathological features of airway inflammatory diseases including throat and lung cancers. It is the result of goblet cell hyperplasia in respiratory mucosa and is a prominent feature of inflammation. Chronic mucus hyper secretion is a potential risk factor for an accelerated loss of lung function. The thick viscous mucus in the lungs will be conducive to pathogens. Continued inflammation and mucus hyper secretion may significantly contribute to transformation of normal cells into cancer cells. 3) Broncospasm: is an additional factor in asthma patients. The three factors together cause breathlessness. Further, chronic inflammation and its prominent feature, hyper secretion of mucus are the fuses that ignite cancer. Without these factors, there cannot be inflammatory cell recruitment to the site of infection, injury or allergy. Continued presence of inflammatory cells or carcinogens may lead to cycles of tissue injury and repair resulting in carcinogenesis of airways. Therefore, treating these two factors is very important for airway integrity and to protect from airway diseases including throat and lung cancers. For resolution of the said factors, a rapid programmed clearance of excess mucus is necessary. As a result, the origin of it inflammation gets resolved. A little medicinal assistance may become necessary.

Methods: Exercises are important expectorant therapies. They are mucokineses and a recipe for healthy ageing. Exercises strengthen the remodeled airways and reset the biological ageing process. They are a) Upper airway passages cleansing Exercises: They help in cleansing mouth, nose and pharynx, the primary sites of colonization of pathogens and the sinuses, the way stations to the brain. These exercises should be practiced with hypertonic solution i.e., a solution having greater osmotic pressure than that of cells or body fluids and draws water out of cells thus inducing plasmolysis. b) Bronchial airways cleaning exercises: c) Physical, aerobic and yogic exercises help in strengthening the inspiratory and expiratory muscles.

Conclusions: Any mucus related respiratory health problem commences from upper airway passages and spreads to tracheo bronchial tree as they constitute only one path way. The mucociliary clearance mechanism becomes defunct when excess and sticky mucus forms. Once the upper airway passages are cleaned of it, the defunct cilia become active and ciliate mucus towards nasal passages and it can be blown out easily. The respiratory and other diseases originating from its pathway come under control. The exercises are based on the concept “Once the offending factor, excess mucus is removed, the origin of it, inflammation gets resolved”. There will be no scope for formation of lesions leading to carcinomas in the lungs and if already lesions are formed, treating them will become easy. 

Biography:

Sanjay R Jain has obtained his Medical degree from the University of Rajasthan in India and then pursued his MS and PhD in Immunology at Kent State University in Kent, OH. He has then completed his Residency training in Internal Medicine at Brown University in Providence, RI, and his Fellowship training in Hematology and Oncology at Harvard Medical School in Boston, MA. He has been in academic medicine since 1999 and particularly interested in novel drug discovery and development, especially immune therapies and the toxicities associated with the use of these agents.

Abstract:

The role of immune system in protection of the host against spontaneously arising tumors has been recognized for several centuries. The Natural Killer Cells perform an important function of immune surveillance against such tumors. However, our understanding of the mechanisms involved and more importantly of the mechanisms by which tumors escape and evade an immune response is limited. We are now beginning to better understand some of the pathways responsible for tumor destruction by immune cells. Therapeutic advances in the treatment of malignant melanoma and renal cancer and now lung cancer have allowed us an opportunity to harness the immune system against tumors and limit the use of cytotoxic chemotherapy with its attendant side effects. We still do not fully understand the epitopes on tumor cells towards which NK cells and other components of the immune system are directed; doing so will enable us to develop more effective immune therapies which have a sustained and effective response against tumors. Enrichment of Tumor Infiltrating Lymphocytes, the use of chimeric antigen receptors, anti CTLA-4, PD-1 and PD-L1 directed therapies are a beginning in that effort and the combination of cellular and humoral approaches against tumors would likely allow for effective and relatively non-toxic and safer mechanisms of achieving durable and possibly life-long tumor control. Such approaches could also be utilized in primary prevention of sporadic and familial tumors. The history and current landscape of immune therapies is discussed. Also discussed are the toxicities and adverse effects associated with the use of immune therapies and possible future approaches of combinations of different components of the innate and adaptive immune systems, as well other classes of agents (chemotherapy, biological agents and radiation therapy). Possible experimental and clinical trial models are proposed.

Biography:

Nuri Ünal has completed his PhD from Ankara University and Postdoctoral studies from Free University Department of Physics Berlin Germany. He is the Head of Physics Department in Science Faculty at Akdeniz University, Antalya, Turkey. He has published more than 40 papers in reputed journals and has been serving as an Editorial Board Member of repute. 

Abstract:

Since the discovery of X-rays in 1895, radiation therapy has been prompted by continuous technological advances. Radiotherapy aims to achieve the optimal dose on the tumour volume while sparing normal tissues. The benefits can be entitled by patient cure, organ preservation and cost-efficiency. The efficacy of radiotherapy was demonstrated by many studies. The major importance for the treatment quality has been fostered during the past decade by linear accelerators produced X-rays, protons etc., with computer-assisted technology. More recently, these developments were augmented by proton and particle beam radiotherapy, usually combined with surgery and medical treatment in a multidisciplinary and personalized strategy against cancer. Current limiting factors of treatment with protons are the size, heavy weight and cost regarding conventional machines. New technological innovations are ongoing, such as those consisting of designing machines can be installed at a reasonable price in hospital‑based centres. Heavy particles as C-12 have the same treatment advantage as protons. The Bragg peak characteristics of them have made them attractive especially for radioresistant cancers. The main goal was to improve the ratio between an optimal dose in the tumour and the lowest dose possible in the organs at risk. This talk reviews the timeline of radiotherapy with a focus on breakthroughs in the physics of radiotherapy and technology during the past two decades. In conclusions, innovations in radiation therapy technology need continuous effort of research that would not be possible without the scientists, engineers, radiation oncologists and all the persons involved in the field of science and medical practice.

Biography:

Larysa M Skivka has completed her PhD from R E Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology, NAS of Ukraine and Post-doctoral studies from Taras Shevchenko National University of Kyiv. She is currently the Head of the Department of Microbiology and General Immunology of SCE Institute of Biology - Taras Shevchenko National University of Kyiv. Her areas of scientific activities are: Immunomodulation as a component of adjuvant cancer therapy and functional polarization of phagocytes in the pathogenesis of inflammatory diseases. She has published more than 13 papers in reputed journals and more than 40 abstracts in scientific congresses.

Abstract:

NSC 631570 (the mixture of alkaloids from C. majus) has shown anticancer activities against different types of solid tumor. Previous studies showed an anticancer effect of NSC 631570 in prostate cancer patients. The cytotoxic effect of the drug was evident in preclinical studies in prostate cancer cell line (PC-3). The aim of the work was to perform comparative investigation of optic characteristics of urine samples from prostate cancer patients (PCs) and healthy volunteers (HVs) to confirm different uptake of alkaloids mixture in both normal and cancer patients. Five PCs and five HVs were recruited to participate in this study. Urine samples were obtained before and 2, 4 and 6 hours after the sublingual administration of the drug. The UV light absorption spectrum characteristic for NSC 631570 was registered 2 h after the drug administration in HVs. PC1 showed an absorption spectrum similar to NSC 631570 4 hours after the drug intake. But absorption spectra of PC 2-5 was completely different during the entire observation period when compared with those observed in HVs (p<0.05). Patterns of urine fluorescence in PCs had substantial differences from those in HVs. Urine fluorescence was increasing in all PCs after the drug administration, till the end of the observation period followed by a moderate decrease of the fluorescence intensity 6 hours after the drug intake. Thus urine optic characteristics after the drug intake make the differences between PCs and HCs. It suggests that this method could be potentially used to test whether non-clinically pathologic subject might be affected by cancer.

Biography:

Wassil Nowicky has received his degree of a Dr. Sci. Tech from the University of Vienna. He is the Director of Nowicky Pharma and the Inventor of the Anticancer Preparation NSC631570. He is a Member of New York Academy of Sciences, European Union for Applied Immunology and American Association for Scientific Progress. He has more than 49 papers published in reputed journals. 

Abstract:

One of the most significant problems of cancer therapy is the damaging activity of anticancer drugs against normal body cells. All attempts to develop a therapeutic agent with a selective cytotoxic effect on tumor cells had no much success because of the high degree of biological identity between healthy and malignant cells. The celandine is being used in the medicine over more than 3500 years. The first data concerning the therapeutic effect of the juice of celandine in the patient with malignant melanoma were published in Germany in 1536. From that time drugs based on biologically active substances of celandine are widely used to treat cancer and non-cancer disease. It is well known that tumor cell is more negatively charged as compared to normal cell. We have used this feature of the tumor cell to give NSC631570 a property to selectively interact with it, without endangering healthy cells and tissues. The drug is strongly positively charged. Due to this it has an ability to be selectively accumulated in tumor tissue and to induce tumor cell apoptosis only in tumor cells without harmful effect on normal cells. Potent selective antitumor effect of NSC631570 has been repeatedly proven by the results of clinical trials. There is an assumption that the same high selective cytotoxicity of drug on tumor cells of different origin is the result of its interaction with a ubiquitous tumor-specific (or overexpressed in tumor cells) compound involved in the induction of cell death. It remains to find this compound.

Biography:

Bogusław Maciejewski has completed his PhD and Scientific Title of a Full Professor in Radiotherapy. He has done many research projects in the UCLA Los Angeles, Gray Lab London, MGH Harvard University Boston, MDACC Houston and other Cancer Centers in Europe. He was the Director of Cancer Center-Institute Gliwice, Poland till 2015. He is the author of over 200 papers which are published in reputed journals (IF=1650 and citation index=3500). He was awarded the G F Fletcher Gold Medal and Gold Medal of Life Achievements in Oncology by all European Oncologic Societies. He is an honorary member of American College of Radiology, Radiotherapy Expert of the IAEA in Vienna and for 10 years he was a Member of European Board of Radiotherapy. His major interest focuses on the importance of treatment time and tumor repopulation; and altered dose fractionation in Clinical Radiotherapy for human tumors.

Abstract:

Results of our studies on dose fractionation and time factor for more than 1000 head and neck cancer cases are presented. For a constant total dose (TCD₅₀) extension of overall treatment time (OTT) significantly decreases tumor cure probability by 1-1.50% per each one day extension of the OTT for laryngeal cancer. Further studies focused on oral cavity and oropharyngeal cancer and showed that due to accelerated repopulation of tumor clonogens starting about week 3 of irradiation of conventional fractionation 5 days/week, about 0.6 Gy/day (D_rep) of 2.0 Gy fractions is balanced by repopulation. In early 80-ties it became a basic rationale for altered fractionation (accelerated, hyperfractionation and hybrid fractionation). There were over 50 clinical trials carried out through the next 20 years but meta-analysis of these results has shown only 6-7% overall therapeutic gain, much lower than expected. Because of various fractionation schedules, it is not possible to separate biological effect of dose escalation from that of changes in dose per fraction. When hypofractionated radiosurgery became the object of interest, there is promising perspectives to improve tumor local control at least for some tumor types and sites. The results of these studies will be presented and discussed.

Biography:

Nina Tunçel has completed her PhD from Istanbul University Oncology Institutes in Medical Radiation Physics. She was the Chief Medical Physicist from 1999 to 2013 at Akdeniz University Medical School, Radiation Oncology Department. She has her career as teaching staff for training in Medical Physics at Physics Department of Science Faculty of Akdeniz University. She has published more than 30 papers in reputed journals and has been serving as an Editorial Board Member of repute. 

Abstract:

Adaptive radiation therapy (ART) is a radiation therapy process where treatment is adapted to account for internal anatomical changes. Some organs in the body that require radiation therapy can change in size and shape over the days and weeks that a course of treatment can take. The aim of ART is to account for these changes and deliver the radiation dose to the tumor as accurately as possible. With the emergence of the onboard-volumetric-imaging device, the implication of ART has dramatically changed. For the first time, it leads to construction of the patient’s on-treatment geometric model. Thus, one can adaptively modify not only the PTV margin, but also the spatial dose distribution to best accommodate any change in patient anatomy as well as the dosimetric deviation from the prescription incurred in previous fractions. A treatment plan provides an overall estimate of the treatment. In the last few years, much research has been devoted and also notably, various vendors are making significant efforts. With technical advancements, particularly in computer, network technology and optimization algorithms, online practices is becoming increasingly feasible and may likely become a “Standard Practice” in the near future. In this approach, the role of simulation geometry and treatment plan is different from that in current practice. In conclusion, the workflow and technology features are essential factors for introducing and providing robust adaptation of the treatment plan throughout the course of treatment. Indeed the useful measure to identify patients in need for an adaptive treatment is the goal of strategy.

Biography:

Simona Doniņa, MD, PhD, Assoc. Prof., Latvian Oncology Centre, is Oncologist and Immunologist at the Institute of Microbiology and Virology of Riga Stradiņš University, with over 20 years of experience in Clinical Oncology. She is author of 11 scientific publications indexed in PubMed.

Abstract:

Statement of Problem: Melanoma is one of the fastest growing cancers and has the highest mortality-rate of skin cancers. The oncolytic property of viruses has been observed for over a century and is presently intensively studied. Rigvir® is the first registered oncolytic virus and the only one approved that has not been genetically modified. It is an ECHO-7 virus registered for melanoma therapy. The present retrospective study was made to determine the effectiveness of Rigvir® in sub-stage IB, IIA, IIB and IIC melanoma patients on overall survival.

Methodology & Theoretical Orientation: Caucasian patients (N=79) who had surgical excision of the primary melanoma tumor and histologically verified diagnosis were included in the study. Circulating levels of clinical chemistry parameters were recorded. Survival was analyzed by multivariate Cox regression. Current guidelines for melanoma advise no treatment for patients who are classified into sub‑stages IB and IIA. Patients in sub-stages IIB and IIC were given three options: Participation in a clinical trial, observation, and interferon. Thus, 52 study participants received Rigvir® and 27 were observed according to guidelines. Due to the low number, the patients treated with interferon are excluded. The study was approved by the respective ethics committee.

Findings: Rigvir® significantly prolonged survival in sub-stage IB-IIC melanoma patients following surgery compared to patients who were under observation. The hazard ratio (HR) for patients under observation vs. treated with Rigvir® is statistically significantly different: HR 6.27 for all, 4.39 for sub-stage IIA-IIB-IIC and 6.57 for sub-stage IIB-IIC patients. Safety assessment of adverse events according to NCI-CTCAE did not show any value above grade 2 in Rigvir® treated patients.

Conclusions & Significance: These results show that the patients treated with Rigvir® had 4.39-6.57 times lower mortality than those under observation. In this study, there was no untoward side effect or discontinuation of Rigvir® treatment.

Biography:

Madhulika Singh has completed PhD in the year 2003 from University of Lucknow (India) and Postdoctoral studies from CSIR-Indian Institute of Toxicology Research, Lucknow (India). Presently, she is working as Faculty in Department of Zoology at Maharishi University of Information Technology, Lucknow, India. She has published more than 36 research papers, review articles and book chapters in reputed journals and also been serving as an Editorial Board Member and Reviewer in many journals. Her research is based on understanding the self-renewal and differentiation capacities of cancer stem-like cells. Along with this, she is also engaged in discovering the scientific basis for anticancer activities of phytochemicals.

Abstract:

Background: Mucin 1 (Muc1) is a secreted, oncogenic mucin that is aberrantly overexpressed in breast cancer cells but its potential role in breast cancers stem cells (BCSCs) have not been explored. MicroRNAs (miRNA), small noncoding RNAs that play critical roles in normal stem cell functions during development, have emerged as important regulators of BCSCs as well.

Methods: Muc positive (+)/(-) cells were isolated from patient-derived cancer (n=25), and normal BC tissues (n=15) and propagated in non-adhesive suspension cell culture to assess their phenotypic characteristics. Further miRNAs expression profiling was done by using microRNA TaqMan® Low Density Array Cards v2.0 (TLDA cards A, Invitrogen), based on qReal-Time PCR array.

Results: Significantly altered expression of miRNAs were found (17 upregulated and 29 down regulated) in Muc (+) BCSCs as compared to Muc(-) (p<0.05). All these miRNAs were having significant role in BCSCs self-renewal, proliferation potential and were also involved in cancer metastasis. Further, selected miRNAs expression levels were individually tested and validated in mammospheres generated from tissue samples. Muc(+) BCSCs were showing higher level of miRNAs -9, 16, 34a, 195-5p and 454 as compared to Muc(-) BCSCs. Significantly downregulated expression of miR-106a, 125b and 218 was also noted in Muc (+) BCSCs as compared to adhered and Muc(-) cell population.

Conclusions: These miRNAs can potentially be used to develop a panel for classification and prognosis in order to better predict the progression of the disease and facilitate the choice of treatment strategy.

Biography:

Abstract:

Biography:

Ambreen Muzaffar alongside being an experienced Medical Physicist from the last six years is keeping her dream alive and currently progressing with her research work towards completion of MPhil. She is aiming towards excelling in the field of Medical Physics. Currently, she is an active participant in the overall initiative of her organization for achieving JCI accreditation. She is in possession of multidimensional technical and professional skills such as Precise Treatment Planning System 2.15 (3DCRT/IMRT), Eclipse Treatment Planning System 13.5 (3DCRT/IMRT), Multidata Treatment Planning System (Multi Slices) (2D), using ARIA 13.5 for VARIAN LINAC, Using MOSAIQ for Elekta LINAC. Her work was 3-D treatment planning of chest wall/breast using monoisocentric technique with junction verification, and Intensity modulated radiation therapy in organ confined/locally advanced prostate cancer. She has presented at conference in March 2013 held by PSCO. Her current ongoing researches include radiation of setup errors in SIB-IMRT of head and neck cancers as a part of her course work towards MPhil in Physics in “small field dosimetry-comparison of Monte Carlo simulations with experimental measurements”.

Abstract:

Purpose: Breast boards are used in breast radiation which increases normal lung and heart doses, when supraclavicular field is included. Therefore, in this study through dose volume histogram (DVHs), lung and heart doses comparison was done between two different setups i.e. with and without breast board, for the treatment of left chest wall and supraclavicular fossain postmastectomy left breast cancer.

Materials & Methods: In this study, CT-simulation scans of ten breast cancer patients were done with and without breast board, at Shifa International Hospitals Islamabad, to investigate the differences between the two different setups of the irradiation of left chest wall in terms of lung and heart doses. For immobilization, support under the neck, shoulders and arms was used. Precise PLAN 2.15 treatment planning system (TPS) was used for 3D-CRT planning. The total prescribed dose for both the plans was 5000 cGy/25 fractions. The chest wall was treated with a pair of tangential photon fields and the upper supraclavicular nodal regions were treated with an anterior photon field. A mono-isocentric technique was used to match the tangential fields with the anterior field at the isocentre. The dose volume histogram was used to compare the doses of heart and ipsilateral lung.

Results: Both the plans of each patient were generated and compared. DVH results showed that for the same PTV dose coverage, plans without breast board resulted in a reduction of lung and heart doses compared with the plans with breast board. There was significant reductions in V20, V<25 and mean doses for lung and V<9 and mean doses for heart.

Conclusion: In comparison of both the plans, setup without breast board significantly reduced the dose-volume of the ipsilateral lung and heart in left chest wall patients.

Biography:

Manijeh Beigi is a PhD student in Medical Physics from Tehran University, Iran and has worked for 6 years as a Radiotherapy Physicist in Jorjani Radiotherapy Center (Imam Hosein Hospital) in Tehran. 

Abstract:

Background: GBM is the most common primary malignant brain tumors. Intra-tumoral heterogeneity causes to variable behavior, different clinical symptoms and survival time. Diffusion tensor imaging (DTI) can be used to characterize different regions of tumor, distinguishing solid regions from necrotic and edema regions.

Methods: 11 patients with GBM underwent diffusion tensor imaging and conventional MRI before chemo-radiation therapy. Patients were followed till death date. K-means clustering algorithm applied on (p,q) space to segment different regions of GBM with different isotropic and anisotropic characteristics. The percentage of each region to whole tumor volume was calculated. Correlation between tumor volume, percentage of each region (solid, necrotic and edema) with survival and age were acquired.

Results: Segments with greater isotropic diffusivity represent edema regions, segment with low isotropic and low anisotropic diffusivity represent the solid tumor and segment with high isotropic and low anisotropic diffusivity represent necrotic regions. The correlation’s results were as follows: Negative correlation between percentage of solid and edema regions with overall survival (r: 0.527, 0.469 respectively at significant level of 0.05), negative correlation between tumor volumes with ages (r: 0.687, p value: 0.021).

Discussion: Our initial result suggested that applying the k-means algorithm on (p, q) space may potentially provide contrast between edema, anisotropic solid tumor and necrotic region so can be used for prediction of overall survival. The results will be validated in a larger patient population to determine which extracted regions along with another imaging and clinical factor can be adopted as relevant biomarkers for survival time.

Biography:

Shrikant Solav holds a Postgraduate degree in Medicine and Nuclear Medicine. Currently, he owns Spect Lab in Pune, India.

Abstract:

Fever/pyrexia of unknown origin (PUO) is defined as temperature greater than 38.5 degree Celsius lasting for more than three weeks, of which at least 2 weeks have been spent in thorough investigations. The causes of PUO can be divided into infectious, malignancy, autoimmune and others. Tuberculosis, abdominal, pelvic, dental abscesses, infective endocarditis, prostatitis are some of the common infectious causes of PUO. Lymphoma, chronic leukemia, renal cell carcinoma, hepatoma, colon carcinomas are some of the malignant conditions for PUO. Rheumatic fever, rheumatoid arthritis, systemic lupus erythematosus, temporal arteritis are some of the causes of autoimmune disorders accounting for PUO. Certain drugs, sarcoidosis, deep vein thrombosis are some other causes of PUO. After thorough clinical examination, blood culture, serology, the imaging tests include chest radiograph, ultrasonography, CT and MRI of relevant regions, trans-oesophageal echocardiography for evidence of infective endocarditis. The nuclear medicine procedures include Technetium 99m-Methylene diphosphonate skeletal scintigraphy, Gallium-67 citrate for occult infection, sarcoidosis and malignancy, Tc-99m-WBC scan for abdominal/pelvic infections. Positron emission tomography using Fluorine-18-Fluorodeoxyglucose may be performed to look for occult infection or neoplasm. Presented here is a list of cases of PUO that were finally diagnosed using FDG PET/CT scan.

Biography:

Sarah Koushyar has completed an undergraduate degree in Biomedical Science. She has also completed a Master’s and is now undertaking a PhD at Cardiff University. The PhD project is focused on mechanisms involved in androgen independence in Prostate Cancer. She has published two abstracts and two reviews during her PhD studies. 

Abstract:

Prostate cancer (PC) is a worldwide health dilemma. Initially, PC cell growth is dependent upon androgen stimulation carried out by the androgen receptor (AR). Therapies which inhibit this androgen stimulation are initially successful until the tumor becomes non-reliant upon androgen supply through aberrant AR signaling, thus relapse occurs. Once the cancer transitions to an androgen-independent state, treatment options are scarce and prognosis becomes increasingly poor. The mechanisms for androgen independence and anti-androgen therapy resistance are inadequately understood, but may involve AR cofactors and co-repressors. Interestingly, a known co-repressor of the AR, namely prohibitin (PHB) has been previously identified to be down-regulated in metastatic PC when compared to healthy controls both in vivo and in vitro. PHB has also been shown to be down-regulated in bicalutamide resistant prostate cancer cells. PHB normally suppresses the cell cycle via unknown mechanisms; however this is disrupted upon AR activation. The aims of this project are to identify how PHB affects the cell cycle in a doxycycline inducible LNCaP cell line. Moreover, to identify key genes involved in both DNA replication and cell cycle regulation that PHB directly influences. Further, to understand how PHB’s interaction with these key genes is altered in the presence of androgen stimulation. RNA-Seq was used to assess genes that were modulated in response to PHB over-expression. These genes were then validated by SYBR green real time Q-PCR. A luciferase assay was used to assess PHB’s repressive function of genes involved in DNA replication; MCMs. FACs analysis was used to assess PHB’s effect on the cell cycle phases. An immunoprecipitation (IP) assay was carried out to identify the direct interaction of PHB and E2F1 (a known cell cycle activator) and how this interaction is altered in the presence of androgen. Increased expression of PHB showed a decreased expression in family members of the MCM, E2Fs, cyclins and an increase in cell cycle inhibitors (n=2). These results were further confirmed with real time SYBR green Q-PCR. FACs analysis demonstrates that PHB over-expression caused an increase in the G1 sub-population of cells and a decrease in the G2 sub-population. Activity of both MCM5 and MCM6 were significantly reduced in the presence of increasing concentrations of PHB, highlighted by a luciferase assay. Finally, an IP demonstrated the direct interaction of PHB with E2F1 in the WT LNCaP cell line that was lessened in the presence of androgen. Data presented here confirm that PHB plays a key role in halting the cell cycle by down-regulation of genes associated with the cell cycle. Such genes include members of the E2F family, that are crucial in progressing the cell cycle and members of the MCM family that enable DNA replication. As AR signaling initiates the repression of PHB expression, PHB over-expression could unveil mechanisms underlying the transition of PC from androgen dependence to androgen independence, that is essential to improve the limited options available at the moment for patient therapy. 

Biography:

M A Nezami is a Board Certified Physician graduated from USC and UCSF residencies and fellowship and trained in Integrative Cancer Therapy. He serves as Researcher and national and international Speaker, in Oncology and Epigenetic field. He has been involved in many research projects and publications/presentations. He is an Inventor and Innovator and has designed a new method of treating advanced cancer, called Multi Molecular Targeted Epigenetic Therapy (MTET). With this method, over the last 7 years, he has successfully treated many patients, mostly with advanced cancer who had failed conventional methods.

Abstract:

There are several barriers that influence the effective treatment of solid tumors by conventional therapies. These barriers include tumor heterogeneity and the genetic instability of cancer. It has been hypothesized that these problems may be managed by targeting angiogenesis, as angiogenic signals modify the micro-environmental cross-talk by the tumor. Oncogenic driver events may also influence the viability and clinical behavior of a given tumor. Some driver mutations are found to be targets for therapy, whereas others play crucial roles in resistance to therapy. The challenge is that tumor cells have a very sophisticated mechanism of survival, by switching their driving pathways and signaling transduction pathways in a dynamic fashion. This understanding has prompted efforts aimed at treating tumor cells with multiple drugs to inhibit as many targets as possible. The majority of these combination therapies have failed to be clinically advantageous. Research of epigenetic regulations of these targets, including angiogenesis, is relevant and exciting. We present a summary of cases of advanced Stage IV patients with heterogeneous cancer who were treated using a novel epigenetic therapy, in a protocol called multi targeted epigenetic therapy (MTET), resulting in independent “antiangiogenic response”, as well as decreased heterogeneity of tumors, and overall reduction of tumor burden. These reductions were measured by serum/plasma VEGF measurements as a biomarker for vasculogenesis, circulatory tumor DNA and by circulatory tumor cells analysis. These markers translated to improved progression free or overall survival, and proved to be prognostic in many cases. We conclude that this small sample presents considerable effect size, and may impact the current practice of oncology by providing better prognostic and therapeutic tools targeting epigenetic aberrancies in refractory heterogeneous disease, by regulating the epigenome.