FromPink October ToBlue November N o v e m b e r 2 0 2 2 I s s u e 7 Let's Talk Let's Talk Breast & Prostate Breast & Prostate Cancers Cancers
Disclaimer: All references used in the newsletter are found on the last page.
Word by Dr. Nasser Al Sharif DeanofLAU's SchoolofPharmacy
I am happy to be asked to write my second message in the Newsletter. After 9 months tenure at the SOP, I continue to be amazed by the leadership, commitment, resilience, high motivation and service orientation of our students I am also thrilled to see many examples of their advocacy for our profession.
As a profession, we offer society a unique service which impacts their health and wellbeing. The Newsletter is one example of providing evidence based health information.
In this edition, our students are highlighting the topics of Breast and Prostate Cancer as well as many of the co-curricular activities they are involved in to increase awareness and knowledge. This important activity and others are also critical to shape the professional identity of our students and for them to truly exhibit the responsibility, a hallmark of a professional, to impact their fellow students, members of the healthcare, and the larger public. I am very appreciative of our students and the faculty for this diligent work on the Newsletter.
Word by Dr. Aline Bou Maroun Co-Curriculum Coordinator
It is with utmost pride and excitement that I share with you this academic year ’ s first issue of the Sixth Floor News, prepared and published by a passionate and dedicated team of our SOP students.
With us being back to full in person attendance on campus, students were thrilled and worked wholeheartedly to prepare a special issue of our newsletter, putting their skills, creativity, enthusiasm, and passion into perspective, despite the demotivating challenges we are still facing on a daily basis.
The current issue focuses mainly on breast and prostate cancers, which are the most common cancers in Lebanon in female and male patients, respectively. Cancer treatment remains a challenge for Lebanese patients who struggle to secure their chemotherapy medications as it is almost impossible to be found on the market, partly due to the subsidization, but also due to smuggling Patients are reaching out to family members, friends, or even acquaintances from outside Lebanon to secure their chemo regimens. This comes with its own risks, namely counterfeit medications, or inappropriate storage conditions, adding another distress to an already exhausted patient
Raising awareness, patient education, and close coordination between all stakeholders in patient care is needed to get through these hardships.
Enjoy reading a professionally-written edition of the Sixth Floor news Please do not hesitate to share any feedback you may have!
C O N T E N T S C O N T E N T S T A B L E O F T A B L E O F 6 Breast cancer 11 Prostate cancer 15 Understanding Cholera 20 CCA: What's New? 27 Did You Know? 28 Thank You Board 30 Games Time! 31 Meet Our Committee 33 Special Thanks 34 References
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BREAST BREAST CANCER CANCER Let's get it off our chests!
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Breast Cancer Breast Cancer
What
Breast cancer is a disease in which cells in the breast grow out of control. The kind of breast cancer depends on which cells in the breast turn into cancer. It most often spreads to the bones, liver, lungs, and brain.
Factors
Risk
is it? Signs and Symptoms
Increasing Age Genetics BRCA1-BRCA2 Menarche <12 yo Menopause >55 yo Nulliparity or First childhood >35 yo Chest Irradiation Prolonged HRT Diet, Alcohol, Smoking Obesity Lumps in breast or underarm Thickening or swelling of the skin Dimpling Redness or flaky skin Pulling in of the nipple or pain in the nipple area Finding upon breast examination:
Breast Cancer Breast Cancer
Self Examination
The best time to perform self-examinations is the week after menstruation ends.
Squeeze your hips, and observe any pitting in the breasts.
Raise your hands and check for any abnormal changes.
Rub your breast in a circular motion to feel for any lumps.
Press along the axilliary region to feel any lumps in the lymph nodes.
Mammograms
Women aged 45 to 54 should get mammograms every year.
Women aged 55 and older should switch to mammograms every 2 years, or can continue yearly screening.
Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.
Chemotherapy Surgery RECURRENT/ METASTATIC HER2 NEGATIVE Doxorubicin Paclitaxel Gemcitabine or Capecitabine Hormone Therapy Paclitaxel + Trastuzumab TCH: Docetaxel/Carboplatin/ Trastuzumab Radical Therapy (Removal of the entire breast) OR Breast Conserving Therapy PRE-OP HER 2 NEGATIVE Dose-dense AC: Doxorubicin/Cyclophosph amide followed by Paclitaxel PRE-OP HER 2 POSITIVE RECURRENT/MET ASTATIC HER2 POSITIVE Pertuzumab + Trastuzumab + docetaxel or paclitaxel Surgery is only possible for Breast Cancer stages I-III. Some patients are candidates for chemotherapy prior to surgery. Ovarian ablation in pre-menopausal women Selective Estrogen Receptor Modulator (SERM): Tamoxifen Aromatase Inhibitors in post menopausal women: Anastrozole, Letrozole Breast Cancer Breast Cancer Treatments
Breast Cancer Breast Cancer
Combination: Double blockade of HER2 and incresed response
HER2 targeted therapy Oral TKI Direct inhibition of downstream tyrosine kinase domain
Target HER2-presenting cells
Trastuzumab Emastine
Targeted delivery of highly cytotoxic agent
Trastuzumab
Pertuzumab
Binds on extracellular domain of HER2, slows tumor growth by reversing/blocking signaling agents
Inhibition of receptor dimerixation
Novelties in the Treatment
A new discovery in medicinal chemistry highlights 1,2,3 triazoles derived from naturally available Coumarin. The Coumarin moiety, thanks to its excellent safety profile and potential to interact with a variety of enzymes and receptors such as kinase, telomerase, and aromatase, was found to be an excellent pharmacophore for the development of novel anticancer agents.
Some of the discovered compounds displayed potent CDK9 target inhibition, which is emerging as a promising target of anticancer therapy with functions in apoptosis and differentiation/proliferation switch and in T cell and lymphoid B cell differentiation. This way, hybrid molecules are introduced for anti breast cancer drug design, and further research could eventually concretize into new agents to combat the difficult disease.
Lapatinib Afatinib Neratinib
HER-2 Targeted Therapy
Discovery of New CDK9 Inhibitors with Potent Anti-breast Cancer Activity
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PROSTATE PROSTATE CANCER CANCER Let’s fight it together!
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What Is it? Prostate Cancer Prostate cancer is the carcinoma of the prostate gland. It may spread to other parts of the body, particularly lymph nodes and bones. The 5-year survival rate of prostate cancer in the United States is 98% What Are the Risk Factors? Average age at diagnosis is 66 1. Poor health literacy 2. Ethnicity (African American) 3. Diet (high in animal fat and low in vegetables) 4. Smoking 5. Obesity and physical inactivity 6. Infections and chronic inflammation 8. Genetic factors (BRCA carriers) 7. What Are the Signs & Symptoms? Polyuria Hematuria Nocturia Incontinence Hematospermia Bone Pain Fatigue Weight Loss Weakness Erectile Dysfunction
What Is PSA? Prostate Cancer
PSA, or prostate-specific antigen, is a protein made by the prostate gland and released in the blood. Its production usually increases with age.
PSA is specific to the prostate gland and not to cancer, but its level correlates with the risk of prostate cancer:
PSA < 4 ng/mL: 15% chance of having prostate cancer
PSA between 4 and 10 ng/mL: 30 to 35% chance of having prostate cancer
PSA >10 ng/mL: 67% chance of having prostate cancer
What Are the Treatment Modalities? Radiation therapy Radical prostatectomy Removal of the prostate and surrounding tissues Androgen deprivation therapy (ADT) Combined with GnRH agonists or orchiectomy Used to prevent testosterone surge Flutamide, Nilutamide, Bicalutamide Orchiectomy (surgical castration) GnRH analog (medical castration) Suppress LH and FSH production Initial testosterone surge Drugs: Goserelin, Leuprolide, Triptorelin, Histrelin Chemotherapy in advanced cases
Long Non-coding RNAs (IncRNAs) Prostate Cancer
High throughput sequencing technologies have been developed to advance knowledge on transcription. A new discovery highlights the role of long noncoding RNAs (lncRNAs) in human cellular function and disease.
Transcripts longer than 200 nucleotides with no coding potential. Epigenetic factors; do not encode for any protein. Regulate gene expression at transcriptional, posttranscriptional, and epigenetic levels. Their expression can undergo dysregulation, and there is evidence of the involvement of lncRNAs in tumor development and disease progression.
Therefore, due to the role of lncRNAs in regulating malignant transformation and disease progression in breast cancer, and the existence of lncRNAs with a tumor-promoting role in prostate cancer, they are a promising target of new pharmacotherapies for both the diagnosis or treatment.
The ENACT Clinical Trial
Xtandi (Enzalutamide), is a nonsteroidal antiandrogen (NSAA) drug used in the treatment of prostate cancer. The ENACT trial was a phase 2, open-label, randomized clinical trial conducted from June 2016 to August 2020 in US and Canadian sites. The trial found that in the 227 patients tested, and compared with active surveillance alone, enzalutamide significantly reduced the risk of prostate cancer progression by 46% and was well tolerated, suggesting that enzalutamide monotherapy may be an alternative treatment to active surveillance for low-risk and intermediate-risk localized prostate cancer.
VS Active Surveillance in Low-risk or Intermediate-risk Localized Prostate Cancer
Enzalutamide
NEWS
LEBANON NEWS CHOLERA
IMPENDING OUTBREAK
BREAKING BREAKING
NEWS
ANDTHE
Cholera
D e f i n i t i o n
R i s k F a c t o r s Drinking water or eating food contaminated with cholera Inadequate water treatment Poor sanitation Inadequate hygiene Eating raw or undercooked
Letuscombatfearwithknowledgeandmythswithfacts! Butfirst, WhatisCholera? An acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. Patients often have mild symptoms or no symptoms, but cholera can be severe.
1 in 10 people will develop severe symptoms such as watery diarrhea, vomiting, and leg cramps. In these patients, rapid loss of body fluids leads to dehydration and shock, so treatment is necessary to avoid death.
shellfish
TREATMENT Lethargic or unconscious Absent or weak pulse Respiratory distress Sunken eyes Not a drinks Skin p very s One or more danger signs: OR at least two of the following: Irritable or restless Sunken eyes Rapid pulse Thirsty (drinks eagerly) Skin pinch goes back slowly No danger signs AND at least two of the following: Awake and alert Normal pulse Normal thirst Eyes not sunken Skin pinch normal AccordingtotheCentersforDiseaseControl&Prevention Or prompt restoration of fluids and salts, is the primary treatment for cholera patients. Rehydration Therapy Antibiotic Therapy Is indicated for severe cases of cholera and reduces fluid requirements and duration of illness. Severe Dehydration Some Dehydration No Dehydration REHYDRATION THERAPY Whatarethesignsandsymptomsofdehydration? Cholera
Oral Intravenous REHYDRATION THERAPY How to Use ORS? Give ORS immediately to dehydrated patients who can sit up and drink. Commercial electrolyte solutions such as Pedialyte and Infalyte are available and help prevent electrolyte disturbances. Commercial ORT preparations typically contain ~50 mEq/L of sodium 25 g/L of dextrose, which helps prevent hypoglycemia without causing osmotic diuresis, and 30 mEq/L of bicarbonate, which leads to less vomiting and more efficient correction of acidosis. If ORS is not available, provide water, broth, and/or other fluids. If the patient vomits, give small, frequent sips or give ORS by nasogastric tube. During the initial stages of therapy, while still dehydrated, adults can consume as much as 1,000 ml of ORS per hour, if necessary, and children as much as 20 ml/kg body weight per hour. VS Do not provide drinks with a high sugar content, such as juice, soft drinks, or sports drinks, because they could worsen diarrhea.
thetypesof Rehydration Therapy? Cholera
Whatare
Antibiotic Therapy Children < 12 years old Doxycycline 2–4 mg/kg by mouth (per os, p.o.) single dose Azithromycin 20 mg/kg (max 1 g) p.o. single dose Ciprofloxacin 20 mg/kg (max 1 g) p.o. single dose Children≥12years oldandadults, includingpregnant women Doxycycline 300 mg p.o. single dose Azithromycin 1 g p.o. single dose Ciprofloxacin 1 g p.o. single dose Drink only bottled, boiled, or chemically treated water and bottled or canned beverages. When using bottled drinks, make sure the seal has not been broken. Avoid tap water, fountain drinks, and ice cubes. Wash your hands often with soap and clean water, especially before you eat or prepare food and after using the bathroom. Use bottled, boiled, or chemically treated water to wash dishes, brush teeth, wash and prepare food, and make ice. Eat foods that are packaged or that are freshly cooked and served hot. Do not eat raw or undercooked meats and seafood, or raw or undercooked fruits and vegetables unless they are peeled. Dispose of feces in a sanitary manner to prevent contamination of water and food sources. Cholera Age Group First line Drug Choice Alternative Drug PREVENTION? PREVENTION? BetterbeSafethanSorry! Followtheseeasysteps!
CCA What'sNew? What'sNew?
Open Pharmacy Day
Curious high schoolers visited LAU to get to know the pharmacy major. There were several stops where pharmacy students of all levels had the chance to talk about the academic challenges and the exciting student life of pharmacy school. High schoolers asked questions, played games, and enjoyed their time touring the Byblos campus!
Wear Pink for Breast Cancer Day
October 28
Because the month of October is that of standing in solidarity with breast cancer survivors and raising awareness about the disease, pharmacy students got the chance to participate in several events, on and off-campus, to help in educating the public. Here, they are seen wearing pink on the occasion.
October 15
P1 P2 P3
White Coat Ceremony
October 28
As tradition goes, this year ’ s P1 students received their white coats at the yearly White Coat Ceremony held by the SOP. The students were very excited to enter into their professional years of pharmacy school. We send them all our best wishes as they embark on this amazing journey!
What the Health
November 2
NAPHASS collaborated with the Pre Medical Society for an on campus awareness campaign for colorectal and prostate cancer. The club pioneered the initiative, collaborating as well with Said NGO, which brought a life sized model of a colon to explore and explain the pathology of colorectal cancer at the tissue level. Students also designed posters around both prostate and colorectal cancer and readily answered the questions of anyone passing by.
Karaoke Party
November 11
Pharmacy students had a little - welldeserved fun time at the student lounge, singing and dancing. The karaoke night, organized by P2 students, was a blast to say the least. The best part was that both students and staff got to sing their favorite song!
Antimicrobial Resistance Event
November 25
Antimicrobial resistance is every pharmacist’s nightmare! For this reason, the Pharmacy Education Committee, with the aim of highlighting the importance of this issue, organized a booth to educate students of all majors on antimicrobials, including when and how to use them. Students were excited to answer the questions and charades prepared by the committee, which definitely boosted their knowledge on antibiotics!
Meet the
Whole CCA Committee Organizing Committee
Scheduling Committee
Lea Ghajar, P4 Chairperson of the CCA Committee Mahmoud Nasrallah, P2 Secretary of the CCA Committee Sarah El Ali, P2 Chairperson of the Organizing Committee Thea Maria Nader, P2 Secretary of the Organizing Committee Rita Aoun, P2 Chairperson of the Scheduling Committee Dana Rihawi, P2 Secretary of the Scheduling CommitteeMeet the
Media Committee
Pharmacy Education Committee Newsletter Committee
Adriana Sadek, P2 Chairperson of the Media Committee
Jessica Eid, P2 Secretary of the Media Committee
Cyrielle Saba, P3 Chairperson of the Education Committee
Abdo El Hayek, P1 Secretary of the Education Committee
Nour Chidiac, P3 Chairperson of the Newsletter Committee
Amanda Rose Khater, P4 Secretary of the Newsletter Committee
rd by Ghajar rsonofthe urricular sCommittee
Dear Readers,
For two consecutive years, I have had the honor of serving as chair of the Co-Curricular Activities Committee and witnessing the dependability and self-discipline of our members.
I would like to express my deepest appreciation to the committee members. I can proudly say that against all odds, we have been able to demonstrate that success is the result of hard work in adverse times.
I would also like to extend special thanks to the Newsletter Committee for its continued commitment to the values and mission of the CCA Committee. The latter played a decisive role in the publication of the prostate and breast cancer issue, along with the steadfast leadership and tireless support of the CCA Coordinator, Dr. Aline Bou Maroun.
On that note, I hope you have had an enjoyable read and that we have enriched your knowledge of prostate and breast cancer and met your expectations!
Did You Know? Did You Know?
BREAST CANCER CAN ALSO OCCUR IN PETS!
Animals can also develop breast cancer, not only humans. Despite being more common in dogs than cats, it is typically more aggressive in cats.
WASP DUNG: A TREATMENT FOR BREAST CANCER?
TOMATOES FOR PROSTATE CANCER!
A 20% decrease in the incidence of prostate cancer was observed in patients with a weekly increase in tomato sauce consumption. According to the Health Professionals Follow-up Study. Lycopene, the red pigment that gives tomatoes their color, may be to thank for this. However, more data from clinical trials are required to further demonstrate this.
Ancient treatments for breast cancer frequently used insect feces and were regarded as one of the most cutting-edge remedies until the Middle Ages. According to an Egyptian papyrus, a mixture of cow ' s brain and wasp dung should be given topically to breast tumors for four days. Fortunately, treatments have come a long way since then...
Many men who experience erection problems after having surgery for prostate cancer see significant recovery within a year, with up to 50% recovering their usual function.
ERECTILE DYSFUNCTION IS NOT PERMANENT
ToAngeloNassif
Grateful for being part of Rebangerissa :)
ToNourChidiac
Thank youfor alwaysbeingbymyside, for motivatingme andforbeingthe onei can share anythingwith.I’m sohappywe getto worktogether andbe creative together!Love you.
ToGraceJoyce
Dabaghian
You are a ball of sunshine and I hope that you’ll stay that way forever. I am so happy I got to meet you and I really wish you the best.
ToMabelleRechdan
the
to
ToAnnaMariaBouGharios Thank youforbeingalwayssokind andalwaysreadytohelp.Gratefulto bepartof“farhawtarhawmarha” Loveyounounou.
Iam sogratefulthatIhad
chance
meet someone likeyou in my life. You're the nicest, most caring andmosthardworkingperson Iknow, and people whogetto callyou their friendare simply the luckiestpeople on earth.
ToMariaHatemThankyou Mariaforbeinganamazing friend. You’realwaysready tohelpeach oneofus. Ihopeyou willalwaysbe blessedby warmthandlove!! Gratefultohavebecsias mybestie.Thankyoufor beingthebestlaband projectpartner.Most importantly,thankyou forbeinginmylifelove yousoooomuch ToRebeccaCharbel You YouThank Thank
You YouThank Thank
ToRitaElMurr
You are a literal beam of sunshine, always supportive, always caring, always hyping up everyone around you. Thank you for existing and for spreading smiles wherever you go.
ToAbdoElHayek
Thankyouforalwaysbeing hereMr.Right.
ToVanaMekhsiJerjian
ToNourChidiac
Thank you for beingthe most amazingfriend ever and for actuallybeing one of the highlights of my year. You are always so supportive and I’m so glad I have you in mylife. I wish you’ll achieve all of your dreams and to always believe in yourself because you ’re so smart and powerful and capable of doing anything you want!
ToMarcAnlian
Youarealwayssohelpfulandkindwitheveryone andI’msohappyImetsomeonelikeyou. I appreciateyoualotandthankyousomuchfor beinganamazingfriendandformaking pharmacyschoolbearable.
ToCelineBeydoun
I'm so happy we became friends this year and thank you for your incredible support! pharmacy school is more tolerable with you.
Thank you for being always positive and kind. Literally the kindest human being ever. Love you Vanaaaaa the best.
ToHibaAlqassab
Thank youfor caringabout our "ghada." Thank youforbeingso kind.Love youHiba.
ToCyrielleSaba
You are suchanamazingperson andI am sogratefulto have metyou in this life. Thankyou for always encouraging others to do more andgive more. Loveyou always.
ToKarineSawaya
Thank you for all that you have taught me!
Game Time! Game Time! WORD SEARCH FIND THE SECRET WORD Mammography Cancer PSA Prostate Breast Tumor The T in TCH+/-P Drug following Dose Dense AC Organoplatinum antineoplastic alkylating agent Brand name: Decapeptyl Drug used in HER2 positive and advanced prostate cancer 1. 2. 3. 4. 5. 6. Antiandrogen with the longest half-life 7. Alkylating agent used in HER2 negative treatment 8. Anthracyclin used to treat breast cancer 9. GnRH agonist: Brand name Zoladex Hints: Hints: Key Words: Key Words:
Meet our Meet our Committee Committee
Rita El Murr, P3 Writer & Editor
Nour Rehayem, P3 Designer
Elena Chalhoub, P2 Designer
Nour Chidiac, P3 Chairperson Designer & Editor
Amanda Rose Khater, P4 Secretary Designer & Editor
Mabelle Rechdan, P2 Writer, Editor Mahmoud Nasrallah, P2 Designer
Marc Anlian, P2 Writer
Nour Adra, P2 Editor
Sarah El Ali, P2 Writer
Thea Maria Nader, P2 Writer
Yara Azar, P2 Designer
Maria Fadel, P1 Writer & Designer
Credits Credits & Special & Special Thanks! Thanks! This concludes our SEVENTH issue of SixthFloorNews, Breast & Prostate Cancer Edition! We
Thank You
A Huge Thank You to our readers
Happy Break Everyone! May you all get the
you
One of the main goals of the newsletter is not only to share information that we need as pharmacists, but also share information that can be easily communicated to the community to serve our role as healthcare providers to patients in the community. This year, we are trying to include many students as possible in our newsletters, and hopefully, your help and engagement in the newsletter can make this come true!
would like to give a special thanks to everyone who contributed and left a mark on this newsletter!
to the School of Pharmacy for giving us this opportunity. Thank You to the students and faculty that participated. Thank You to the CCA Coordinator, Dr. Aline Bou Maroun and CCA Chairperson, Lea Ghajar. Thank You to the other task forces: Media, Organizing, Scheduling and Pharmacy Education. Thank You to the P1, P2, P3, and P4 Class Representatives.
for making it this far in the newsletter!
rest
deserve.
References References
Breast Cancer
Online Presentation by Dr. Jad Ghaddar, D.Pharm, MSc, PGDip, EUSOP Certified, ASHP Certified in Pediatric Oncology
Prostate Cancer
Online Presentation by Dr Carl Aoun, B S Pharm, Pharm D , BCPS
Novelties in the disease
Sideris, N. et al. (2022) LncRNAs in breast cancer: A link to future approaches, Nature News. Nature Publishing Group. Available at: https://www.nature.com/articles/s41417 022 00487 w (Accessed: November 28, 2022).
Mirzaei, S et al (2022) Molecular landscape of lncrnas in prostate cancer: A focus on pathways and therapeutic targets for Intervention Journal of Experimental & Clinical Cancer Research, SpringerLink BioMed Central Available at: https://link springer com/article/10 1186/s13046 022 02406 1 (Accessed: November 28, 2022).
Neal D. Shore, M.D. (2022) Enzalutamide monotherapy vs active surveillance in patients with low risk or intermediate risk localized prostate cancer, JAMA Oncology. JAMA Network. Available at: https://jamanetwork.com/journals/jamaoncology/article abstract/2793567 (Accessed: November 28, 2022).
Author links open overlay panelSaleh K IhmaidaAteyatallahAljuhanibMosaAlsehlibNadjetRezkibPersonEnvelopeAliAlawicAhme d J AldhafiricSamir A SalamadPersonEnvelopeHany E A AhmedaeMohamed R Aouadb et al (2021) Discovery of triaromatic flexible agents bearing 1,2,3 triazole with selective and potent anti breast cancer activity and CDK9 inhibition supported by molecular dynamics, Journal of Molecular Structure. Elsevier. Available at: https://www.sciencedirect.com/science/article/pii/S0022286021016963 (Accessed: November 28, 2022).
Cholera Section
Antibiotic treatment (2022) Centers for Disease Control and Prevention Centers for Disease Control and Prevention Available at: https://www cdc gov/cholera/treatment/antibiotic treatment html (Accessed: November 28, 2022)
Cholera (no date) World Health Organization. World Health Organization. Available at: https://www.who.int/news room/fact sheets/detail/cholera (Accessed: November 28, 2022).
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