The African Organisation for Research and Training in Cancer (AORTIC) held the 15th international conference on cancer from November 2-5, in Hammamet, Tunisia. UNC Project Malawi investigators participated, with groundbreaking presentations from Dr. Amon Chirwa, cancer medical officer; Tarsizious Chikaonda, data scientist and study coordinator for the TINY Ulysses Study; Dr. Shiraz Khan, pathologist and principle investigator for esophageal cancer studies; and Selena Kleber, a former intern. The research spanned treatment outcomes, epidemiology, patient experience, mental health, and end-of-life care, contributing essential evidence to improve cancer care in sub-Saharan Africa. AORTIC holds a continent-wide meeting every other year for sharing research and educational experiences, as well as capacity-building and networking.
“Rituximab for KSHV-associated Multicentric Castleman Disease: A Phase II Safety/Efficacy Trial”
Dr. Amon Chirwa presented results from the first-ever prospective trial in Africa (LCCC1950) examining how well rituximab-based treatment works for people with HIV-associated multicentric Castleman disease (MCD). Conducted at the National Cancer Centre in Lilongwe, Malawi from 2021–2024, the study showed promising early results:
- Many patients responded well to treatment, with 14/15 (93%) showing major improvement by week 12.
- Treatment was generally safe, with no severe side effects outside of expected blood-related issues like anemia and neutropenia.
- Patients also experienced better physical and mental health during the first months of therapy.
However, Dr. Chirwa noted that long-term outcomes at two years were not as strong as those reported in high-income countries:
“Rituximab is safe and effective in our setting. We need to expand access to rituximab for care in Africa. We need further studies to understand why there is a lower survival at two years compared to high income countries, whether immunobiological factors, or health system factors. We also need to look at other alternative therapies for participants who relapse despite treatment with rituximab.”
This work was also presented at the American Society of Hematology Annual Meeting in Orlando, FL, USA on 6 December and Dr. Chirwa was the recipient of an ASH Abstract Achievement Award
“Prognostic Factors for HIV-Associated MCD Treated with Cytotoxic Chemotherapy: a Prospective Cohort Study”
Tarsizious Chikaonda shared findings from a long-term study lymphoma study at Kamuzu Central Hospital (LCCC1229), covering patients diagnosed with HIV-associated MCD between 2013 and 2021—the largest dataset of its kind in Malawi.
“Patients that were treated with chemotherapy alone their survival was poor as most had relapsed within the first year as relapse rate was 84% at 12 months,” Chikaonda said.
Other key takeaways included:
- Long-term survival remains poor without access to rituximab.
- Baseline factors like hemoglobin levels did not predict which patients did better, highlighting the need for improved treatment options rather than relying on current chemotherapy-only approaches.
His findings reinforce a major gap in cancer care: limited availability of rituximab in sub-Saharan Africa. The team called for stronger health systems, better access to medicines, and targeted implementation strategies to improve outcomes.
Dr. Matthew Painschab, Adult Oncology, was also invited to talk about the LCCC1950 MCD study at the Heme-Onc Special Interest Group. The clinical research study, a collaboration between UNC Project-Malawi, the UNC Lineberger Comprehensive Cancer Center and the UNC Institute for Global Health and Infectious Diseases,
“The Association Between Stigma and Wellbeing Among Kaposi Sarcoma and Lymphoma Patients In Malawi”
Selena Kleber contributed with a poster presentation that examined how cancer-related stigma affects mental health and quality of life (QoL) among newly diagnosed patients with Kaposi Sarcoma (KS) and lymphoma.
Key Highlights:
- Patients with KS reported higher levels of internalized and anticipated stigma than those with lymphoma.
- The most challenging QoL domains were pain interference and participation in social activities.
- Over half of participants reported moderate to severe anxiety.
- Across all QoL domains, worse mental or physical health was associated with higher stigma scores.
- Internalized stigma was significantly linked to higher anxiety and depression, while anticipated stigma was associated with depression, pain interference, and anxiety.
The study highlighted the importance of addressing stigma and integrating mental health support within cancer care services in Malawi.
“Evaluating Malawian Caregiver Perception of the Chichewa-Version of the Quality of Dying and Death Questionnaire, Revised Global-Version”
In addition to a poster presentation, Selena Kleber had an oral presentation that focused on the Chichewa translation and cultural validation of a revised end-of-life care assessment tool (QODD-RGV). The tool was tested among 25 bereaved caregivers of patients who received care at Kamuzu Central Hospital.
Key Highlights:
- Participants understood the questions well, though many reported challenges linked to limited communication during end-of-life care.
- Themes that emerged were linked to quality of death and dying: Positive experiences were associated with family, religion, and reduced fear. Negative experiences were associated with stress, shame, and discrimination.
- The study supports the content validity of the Chichewa version and demonstrates its potential to guide policy development, quality improvement, and culturally appropriate end-of-life care strategies in Malawi and other low-resource settings.
“Endoscopic Screening For Esophageal Cancer Precursor Lesions in Malawi”
Dr. Shiraz Khan’s poster presentation shared early results from an ongoing community-based screening study aimed at improving early detection of esophageal squamous cell carcinoma (ESCC) in Malawi, a country with the highest global incidence of the disease.
The study is evaluating the prevalence of esophageal squamous dysplasia (ESD), using Lugol’s chromoendoscopy, and is testing a minimally invasive cytosponge device supported by AI-enabled cytology as a potential screening tool. To date, 394 volunteers aged 50–70 have been enrolled, with high completion rates for key procedures including dental exams, blood collection, cytosponge sampling (391 participants), and chromoendoscopy (350 participants with biopsies taken).
The study is also building a robust biobank of blood, oral samples, and tissue to support future molecular research. Preliminary findings demonstrate strong feasibility for community enrollment and screening, offering promising insights into scalable early-detection strategies for ESCC in resource-limited settings.
These investigators and their collective contributions underscore UNC Project Malawi’s leadership in cancer research, particularly in areas where evidence remains limited but urgently needed. Their presence at AORTIC 2025 reflects a deep commitment to advancing care and improving outcomes for patients facing complex and neglected cancers in Malawi and across the African continent.