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HIV and other Risk Factors for Esophageal Squamous Cell Carcinoma in Malawi

(PI, Dr.Bongani Kaimila)

Background: Esophageal cancer is the sixth leading cause of cancer worldwide, causing 400,000 deaths per year. Within Africa, there have been reports of high-incidence regions in southern Africa, central and eastern Africa. In Malawi, ESCC is the third commonest cancer nationwide behind Kaposi sarcoma and cervical carcinoma. Among cancers that are not classically HIV-related ESCC has the highest incidence in Malawi, yet very little is known about the epidemiology of this cancer in our setting. Due to continued uncertainty regarding causes of ESCC in Malawi, this case-control study examines the etiologies of ESCC at KCH and SGH. Based on prior work, we hypothesize the following etiologic contributors: HIV infection, polycyclic aromatic hydrocarbons (PAH) through exposure to indoor air pollution, biomass fuels, and dietary sources, fumonisin on maize and other dietary factors, such as dietary selenium deficiency, thermal injury from scalding hot beverages and tobacco and alcohol consumption.

Objectives: 1) To identify risk factors for ESCC through a case-control study implemented at a national teaching hospital, specifically focused on exposure to HIV infection, PAH exposure, dietary factors including fumonisin and selenium, scalding hot beverages and foods, and tobacco and alcohol consumption. 2) To identify and characterize common somatic genetic and epigenetic alterations in ESCC tumors from Malawi and characterize germline genetic and epigenetic alterations associated with susceptibility to ESCC

Funding source: National Cancer Institute– Funding Source; Lineberger Comprehensive Cancer Center – Sponsor

Targeted accrual: 600

Treatment Outcomes of Esophageal Cancer in Eastern Africa (TOEC-Eastern Africa)

(PI, Dr.Bongani Kaimila)

Background: This is a prospective observational cohort design in which patients with esophageal cancer at KCH in Lilongwe, Malawi are being followed to collect key clinical and treatment-related data including Quality of Life (QOL) metrics and survival until death or loss to follow up, with key data pertaining to treatment to include chemotherapy, radiation therapy, chemo-radiotherapy, oesophageal stenting (esophageal stenting is a tube placing a tube in a patients esophagus (throat) to keep open a blocked area. The tube helps the patient to swallow solids and liquids), esophagectomy (surgical procedure to remove some or all of the swallowing tube between your mouth and stomach (esophagus) and then reconstruct it using part of another organ, usually the stomach) palliative care alone, as well as any combined or sequential therapies (refers to treatment with drug regimens administered one after another. Combination therapy refers to treatment with drug regimens concurrently administered). The study has been established as a collaborative effort within the African Esophageal Cancer Consortium (AfrECC) and aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania. Enrolment in Malawi commenced in June 2021 at Kamuzu Central Hospital and includes two sub-studies looking at esophageal stenting and ESCC imaging.

Objectives: The purpose of the proposed research is to prospectively evaluate outcomes related to existing treatment strategies for EC at participating sites within the African Esophageal Cancer Consortium (AfrECC).  Aim 1) To describe the types of treatments administered for all patients diagnosed with EC at participating AfrECC sites, including chemotherapeutic regimens, radiation therapy, chemo-radiotherapy, esophageal stenting, esophagectomy, and palliative care. Aim 2) To evaluate the effect of different EC treatment modalities on patients’ QOL during and after completion of treatment. Aim 3) To measure the effect of different treatment modalities on overall survival.

Funding source: Celgene Cancer Care Links funding program and UJMT Fogarty Global Health Fellowship Program (NIH Fogarty International Center Grant #D43TW009340).

Targeted accrual: 300

Nkhoma Hospital feasibility of endoscopic screening for Esophageal Squamous Cell Carcinoma (ESCC)

(PI, Dr. Gita Mody, Dr.Bongani Kaimila)

Background: UNC Project Malawi Cancer Program esophageal cancer and cancer clinic division lead Bongani Kaimila, MBBS, MSc, launched a cross-sectional study to determine the feasibility of endoscopic screening for Esophageal Squamous Cell Carcinoma (ESCC) precursor lesions in Malawi and the relationship with poor oral health. In Malawi, ESCC is the third commonest cancer nationwide. Among cancers that are not classically HIV-related, ESCC has the highest incidence in Malawi. Few data are available on precursor lesions of ESCC in Malawi, and there relationship to poor oral health.

Objectives: Assess community prevalence of SCC or pre-SCC lesions and oral health in a population of asymptomatic individuals in a rural community in central Malawi.

Funding Source: Celgene Cancer Care Links

Targeted accrual: 100

Study status: Data analysis