Open Access

Cancer research in Lebanon: Scope of the most recent publications of an academic institution (Review)

  • Authors:
    • Samah Tawil
    • Nada Khaddage-Soboh
  • View Affiliations

  • Published online on: June 3, 2024
  • Article Number: 350
  • Copyright: © Tawil et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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 Cancer may be considered one of the most interesting areas of study, and although oncology research has grown markedly over the last decade, there is as yet no known cure for cancer. The objective of the present review is to examine various approaches to cancer research from a single institution, summarize their key conclusions and offer recommendations for future evaluations. The review examined 72 cancer-associated studies that were published within six years from 2017 to 2022. Published works in the subject fields of ‘cancer’ or ‘oncology’ and ‘research’ that were indexed in Scopus and Web of Science were retrieved and sorted according to article title, author names, author count, citation count and key words. After screening, a total of 28 in vitro/animal studies and 46 patient-associated published studies were obtained. A large proportion of these studies comprised literature reviews (20/72), while 20 studies were observational in nature. The 72 publications included 23 in which various types of cancer were examined, while the remaining studies focused on specific types of cancer, including lung, breast, colon and brain cancer. These studies aimed to investigate the incidence, prevalence, treatment and prevention mechanisms associated with cancer. Despite the existence of extensive cancer research, scientists seldom contemplate an ultimate cure for cancer. However, it is crucial to continuously pursue research on cancer prevention and treatment in order to enhance the effectiveness and minimize potential side effects of cancer therapy.


Cancer poses an important global public health challenge and ranks as the second leading cause of death worldwide, following heart diseases. The American Association of Cancer Research states that the primary objective of the study of cancer is the development of safe and effective approaches for the prevention, detection, diagnosis, treatment and cure of this disease (1). Advancing the understanding of cancer, including its treatment options, preventive measures and psychological impact, is crucial for making substantial progress in the reduction of its profound human and economic toll on the well-being of patients. Enormous sums of money have been spent on cancer research worldwide (2). However, due to extensive exposure to numerous environmental chemicals in everyday life and the complex nature of chemical mixtures (3), it is challenging for long-term safety evaluations to provide perpetual true results concerning cancer diagnosis and treatment as well as accurate updates. An ultimate cure for cancer remains the top aim of numerous researchers (4). Despite the marked increase in cancer research and the substantial growth in the number of cancer survivors over the past three decades, it is undeniable that the global occurrence of this disease continues to rise (5). Regarding cancer survival, it has been reported that during the last decade half of the individuals diagnosed with cancer in England survived their disease for ≥10 years (6). While there have been numerous advancements in the pharmacological treatments of tumors, and new highly sensitive techniques for the early diagnosis of pathologies, including imaging, laboratory tests, tumor biopsy, endoscopic examination, surgery, genetic testing and microfluidic systems have been developed (7,8), a definite cure for cancer remains elusive. Nevertheless, researchers persist in their efforts to develop new and more effective treatments and preventive measures for cancer. For example, long-term epidemiological studies have identified specific risk factors, such as the maintenance of a healthy weight, avoidance of tobacco, limitation of alcohol intake and protection of the skin that, if reduced, can prevent the development of certain types of cancers (9,10). Moreover, cancer risk prediction models based on these epidemiologic data have identified the risk of an individual carrying a genetic mutation for a specific cancer, such as BRCA 1 and/or BRCA 2 (11). Additionally, several innovative treatments, including hormonal therapy, monoclonal antibodies and chimeric antigen receptor T-cell therapy (12), are already being used alongside more traditional cancer therapies. Research efforts are now particularly focused on the role of gene editing and nanoparticles in combating cancer cells (13). Furthermore, a recent breakthrough in our understanding of the regulatory functions of small RNAs, originally discovered in plants, is providing new insights into the biology of cancer (14). Despite the clear rational and contemporary interest in cancer research, its assessment comes with challenges. Firstly, despite the recent surge in interest, there remains a lack of knowledge regarding the most effective methods for conducting research assessments (15). Secondly, in 2020, updates on the diagnosis and treatment of cancer were negatively impacted by the coronavirus disease (COVID)-19 pandemic. Restrictive measures and the closure of healthcare settings during the pandemic led to limited access to care, resulting in delays to cancer diagnosis, treatment and research updates regarding cancer incidence and etiologies (16). In Lebanon, particularly at the Lebanese American University (LAU), several scientific studies were conducted to explore new cancer therapies and preventive measures (1720). However, according to a 2021 report from the Global Cancer Observatory of the National Cancer Registry, there were 11,589 new cancer cases and 6,438 cancer-related deaths in Lebanon in 2020 (21). One notable finding is the absence of data on the survival rate of cancer cases in the official Lebanese registry maintained by the Lebanese Ministry of Public Health (22).

Hence, the objectives of the present review are to examine cancer research methodologies documented in LAU libraries, with a particular focus on publications following the outbreak of COVID-19, assess these methodologies, consolidate their key findings and provide recommendations for future assessments. The present study encompasses various aspects of cancer research, including fundamental laboratory investigations and human studies, as well as basic scientific and applied research. It encompasses research pertaining to pediatric or adult cancer, as well as studies spanning the nursing, medical and public health aspects of cancer research. Consequently, the study seeks to achieve the following: i) Identify existing literature reviews that document approaches to the assessment of research impact and summarize these approaches; ii) summarize the findings of each study based on different cancer types; and iii) make recommendations to steer future cancer research towards addressing the specific requirements of the Lebanese population.

Study retrieval

The present study focused on the analysis of publications from the LAU (Beirut, Lebanon) over the past 5 years, specifically from 2017 to 2022. These publications were selected as a representative sample of a Middle Eastern academic and medical research center. During this time period, the School of Pharmacy and the School of Medicine at LAU actively participated in cancer research, conducted studies and stayed up-to-date with the latest advancements. The dataset used for analysis was obtained from SciVal (, a research performance assessment tool that facilitates the analysis of data from Scopus and Web of Science (WOS). While there were variations in coverage between these two indices, the present study considered articles that appeared in both to provide a broader perspective on the correlation between citation count and author number. The study of published cancer research at LAU is based on the collaborative efforts between academic researchers and medical physicians. The search was initiated under ‘all subject areas’ and then proceeded using specific themes such as ‘medicine’ and ‘cancer research’. Published works were also extracted with specific keywords such as ‘neo*’, ‘tumor’, ‘cancer’, ‘oncol*’, ‘leukem*’, ‘lymph*’, ‘chemo*’ and ‘radio*’ as individual topics. The search in the category ‘institutions and groups’ was limited to ‘The Lebanese American University’; Lebanon was the country of choice in the category ‘countries/regions’ and the date limits were ‘2017–2022’. The data obtained from SciVal included i) article title, ii) author names, iii) author count, iv) citation count, v) field-weighted citation impact, and vi) CiteScore (CS). Bibliometric analysis was performed to compare the published works in the present study. In order to achieve this objective, the CS was used as the primary method for counting citations (23,24). The present review only included published articles and focused exclusively on peer-reviewed journals, even though the selection of journals may vary depending on the citation-based metric system being considered, resulting in different quartiles. No restrictions were made regarding author names and collaborations. Additionally, single- and hyper-authored publications, abstracts only, studies written in a language other than English, corrections to previous studies, errata, conference proceedings and book series were excluded.

Nearly all the published research from the specified years were included in the present study. To ensure accuracy and relevance, two independent reviewers conducted a thorough screening of all records based on the topic search. The screening process involved reviewing study titles for potential relevance to cancer research and examining the full-text articles for specific references to cancer.

Study design and setting

Between 2017 and 2022, a total of 2,137 research works by LAU were published in journals indexed in Scopus and WOS, covering various research fields. Out of these, 252 studies specifically focused on cancer research. Following the PRISMA guidelines, a thorough screening process was conducted based on the titles and abstracts of the publications as depicted in Fig. 1. After removing duplicates, corrections and errata, 124 papers remained for full-text review. Ultimately, 72 studies were deemed eligible and met the inclusion criteria. The number of publications gradually increased from 2017 until 2021, reaching its peak in 2020, when 26.3% of the studies were published and remained constant in 2021. However, the number of papers published dropped in 2022 (Fig. 2), comprising only 8.3% of the studies in this time period. Among the 72 publications, 25 focused on in vitro or animal studies, while 47 were patient-associated studies.

Considering the patient-associated studies, the highest proportion were literature reviews (18/72), followed by 5 systematic reviews, 1 meta-analysis and 22 observational studies of a cross-sectional, cohort or case-control nature. In addition, there was one interventional randomized controlled study. Fig. 3 provides an overview of the types of cancer studies reported by the LAU directory. Notably, two studies specifically targeted fetal cancer and metastasis, and involved pregnant women. Furthermore, five studies were conducted on the pediatric population.

Types of cancer and main endpoint

The faculty at LAU conducted research on various types of cancer. Some of these studies specifically investigated new herbal treatments and examined their anticancer properties (7/72 publications). In total, 28 of the 72 publications examined multiple cancer types or cancer in general. The primary objectives of these studies were twofold: Firstly, to explore pharmacological mechanisms and highlight pathways for cancer prevention (39.1%); and secondly, to evaluate the psychological challenges associated with cancer (30.4%). One study specifically focused on the identification of potential risk factors associated with cancer (5). The remaining studies each focused on specific types of cancer, such as lung, breast, colon or brain cancer. The main objectives of these studies were to investigate the incidence, prevalence, treatment options and prevention mechanisms for these specific types of cancer. Studies that focused on understanding the regulatory functions of small RNAs and human recombinant arginase I in the treatment of cancer constituted only 4.16% of all publications and were all published in 2020 (2527). Additionally, several in vitro studies were conducted, which examined either a variety of cancer types or specific types of cancer. More comprehensive information on the various types of cancer researched is presented in Fig. 4.

Detailed description of LAU cancer studies

In the LAU dataset of 72 cancer publications, 38.89% covered all types of cancer, as indicated in Table I (18,2853), while the remaining 61.11% focused on specific oncological types, as shown in Table II (10,17,19,20,2527,5490). These two tables provide additional information about each study, including its main focus, aim/purpose, study type, the type of cancer studied and key findings. Moreover, Figs. 5 and 6 depict the trends of cancer studies in terms of study types and types of cancer, respectively, across the years.

Table I.

Publications on miscellaneous types of cancer according to study type and date of publication.

Table I.

Publications on miscellaneous types of cancer according to study type and date of publication.

First author/s, yearStudy typeMain focus Observational/interventionalAim/purposeMain finding(Refs.)
Khazzaka et al, 2022SystematicIncidence/ Examination of the literatureFetal metastasis occurred(28)
reviewoccurrence/ concerning placental and fetalmainly in patients with
risk factorsmetastases among pregnantplacental metastases
women with cancer via thederived from melanoma
identification of clinical andand lung cancer primaries
pathological characteristics,and was associated with
treatment trends and prognosisa dismal prognosis
Atat et al, 2022LiteratureAnticancerNAExplain the importance of 3D3D systems are currently(29)
reviewupdates culture in representing theused for disease modeling
tumor microenvironment asand pre-clinical drug
well as the effects of 3Dtesting
cancer cells on the behavior,
resistance, proliferation and
metastasis of cancer
Sacca et al, 2022Cross-QualitativeObservationalEvaluation of patient trustThe role of confidence in(30)
sectional predictors when seekingseeking cancer-related
cancer-related informationinformation consistently
from doctors and the internetinfluences the levels of
trust attributed to each
source of information
Karam et al, 2021In vitroMOANAEvaluation of the targetedSupports the use of(31)
animal effect of parthenolide in vitroparthenolide and urges
and in animals, after extensivefurther clinical
experiments targeting its anti-development
inflammatory and anticancer
Hoteit et al, 2021LiteratureAnticancerNAExplain the immune-basedImmunotherapy used(32)
reviewupdates mechanisms used in tumoralone or in combination
cell proliferation andwith various types of
maintenance, as well as thetherapeutics has potential
rationale behind variousin cancer treatment
treatment methods
Jaafar et al, 2021In vitroSafetyNACollection of ambientThree major sources were(33)
particle-bound polycyclicfound to contribute to PAH
aromatic hydrocarbons (PAH)emissions at the urban
in three Lebanese coastalbackground site, namely,
cities and investigation oftraffic (48%), diesel
their cancer riskgenerators (23%), and
incineration (29%). The
cancer risk was found
higher than what was
measured at the same
site in previous years
with an increase of 35%
Chaftari et al, 2021Cross-MortalityObservationalUse of C-reactive protein,A simple new scoring(34)
sectional procalcitonin and lactatesystem for mortality
biomarkers of sepsis toprediction, based on
create a prediction modelreadily available clinical
for short-term mortalityand laboratory data,
in patients with cancer andincluding procalcitonin,
suspected infectionC-reactive protein and
lactate was developed
that can be used in
emergency departments
for patients with cancer
and suspected infection
Massoud et al, 2021Cross-Qualitative/ObservationalEvaluation of the healthyCommunication gaps(35)
sectionalopinion lifestyle practices recommendedbetween hematologists/
by hematologists/oncologistsoncologists and patients
for patients during treatment.with cancer should be
Correlational analysis betweenaddressed, and solutions
the hematologists/oncologists’to identified barriers
sociodemographics and theshould be implemented
lifestyle recommendationsto achieve higher quality
they provided to patientspatient-centered care
Alrubai et al, 2022Cross-Qualitative/ObservationalAssessment of theFindings including the(36)
sectionalopinion psychological health status,association between the
depression, anxiety and stressdevelopment of new pain
levels of patients with cancerand depression, raised
in Iraq during the COVID-19concerns regarding the
pandemic, and the relationshippsychological health of
between such factors andpatients diagnosed with
sociodemographic characteristicscancer during the
COVID-19 pandemic
Khaled et al, 2021Cross-ValidationObservationalValidation of the EPICEPIC FFQ can be(37)
sectional FFQ in Lebanonconsidered a valid tool
for the assessment of
diet in epidemiological
studies among Lebanese
Al-Koussa et al, 2020LiteratureMOANADiscussion of differentDe novo arginine(38)
review arginine deprivation agentssynthesis is not
and their mechanism ofsufficient to
action, stressing thecompensate for the
factors that affect cellhigh nutritional
migration and the effect ofrequirements of cancer
arginine on metastases viacells, forcing them to
polyaminesrely on an extracellular
supply of arginine
Diab et al, 2020LiteratureMOANAExplain the roles of CDK7CDK7 is uniquely(39)
review in cancer cells and provideinvolved in the
an overview of thetranscription regulation
pharmacophores of CDK7and cell cycle progression
inhibitors, their efficacy inin many types of cancer.
various cancer models andCDK7 inhibitors have
clinical developmentdemonstrated a
promising profile of
safety with lowgrade
side effects, and
regimens against
various advanced solid
tumors are in place
to assess their clinical
efficacy as a single agent
and in combination.
Bechnak et al, 2020In vitroMOANAStudy of the cytotoxicityA375 cells treated with(40)
of curcumin-based colloidalthe curcumin colloidal
nanocapsules and investigationnanocapsules showed a
of whether anticancer activitysignificant increase in
is enhanced by curcuminsingle- and/or double-
encapsulationstrand DNA breaks upon
exposure to light, indicating
promising biological effects
Hrusak et al, 2020Cross-Incidence/ObservationalInvestigation of COVID-19Children receiving anticancer(41)
sectionaloccurrence/ incidence and severity amongchemotherapy may have a
risk factors children on anticancermild or asymptomatic
treatment through a surveycourse of COVID-19.
distributed virtually over 25While the risk of
countriesdeveloping a more severe
course of COVID-19
should not be underestimated,
the intensity of preventive
measures should not cause
delays or obstructions to
oncological treatment
Nassour et al, 2020SystematicAnti-cancerNASystematic review ofSignificant heterogeneity(42)
reviewupdates/ anticancer drugs in thewithin methodologies
waste aquatic environmentmade it challenging to
compare results and draw
conclusions. Nevertheless,
the study aids the
evaluation of proposed
recommendations to
guide future studies
and reviews
Mehanna et al, 2020In vitroMOANAOptimization and validationThe method was(43)
of a facile liquidadvantageous compared
chromatography-tandemwith prototypical
mass spectrometry methodinductively coupled
to detect and quantify threeplasma-mass
Ru(II) polypyridyl spectrometry-based
complexes in cells, plasmatechniques in vitro
and urineand in vivo, which
anticipates its utilization
in cellular uptake,
pharmacokinetics and
pharmacodynamics studies
Assi et al, 2020LiteratureMOANADiscussion of the majorCollaborative efforts at(44)
review resistance patterns andthe molecular level are
outcomes associated withadvancing the design
the use of prior targetedof improved drugs or
therapies in two oncologicalcombinatorial strategies
solid tumorsand the development
of more sensitive assays
to monitor responses
and resistance
El Baba et al, 2020LiteratureMOANAEvaluation of how RhoThe Rho GTPases are(45)
review GTPases regulate VEGFamong the most important
signaling and the outcomesmolecules for signal
of this interaction on thetransduction in cancer
progression of cancercells. They regulate
cytoskeleton remodeling,
proliferation, and migration
among others. VEGF
controls angiogenesis and
vascular permeability of
endothelial cells and acts
downstream of Rho
GTPase-related signaling.
The role of Rho GTPases,
in the regulation of
angiogenesis by modulating
the expression of VEGF or
regulating tube formation has
been well established
Elias et al, 2019In vitroMOANAIsolation of Cedrus libani7-HC possesses promising(18)
extract 7-HC and investigationanticancer and anti-
of its anticancer andinflammatory activities,
antiinflammatory activitiesand may serve as a lead
molecule in cancer therapy
Doumit et al, 2019CrossQualitative/ObservationalExploration of spiritualityAs the first study in the(46)
sectionalopinion and its positive effect onMiddle East to address
the family caregivers ofthe meaning of spirituality
children with cancer inin this population, may
Lebanonpave the way for a
customized palliative care
program and integrative
approach to patient care
Bar-Sela et al, 2019CrossQualitative/ObservationalStudy of the barriersDespite relatively high(47)
sectionalopinion to staff providing spirituallevels of spiritual care
care to patients, based on theprovision, there is a
observation that decreasedgap between desirability
usage of aggressive treatmentsand actual provision due
at the end of life occursto certain barriers, such
when patients feelas inadequate training
spiritually supported. Analyzedof healthcare professionals
a subgroup of physicians andand lack of space for
nurses whose inclination toappropriate discussions
provide improved spiritual
care provision was unrealized
Hageh et al, 2018In vitroMOANAInvestigation of a seriesThe photocytotoxicity of(48)
of sterically encumberedthese long-lived cuprous
Cu(I) bis-phenanthrolinephenanthroline complexes
complexes for use in PCTwas successfully
demonstrated, suggesting
that this class of
photosensitizers may be
exploited for PCT
Moghnieh et al, 2017LiteratureGuidelines/NAProvide guidelines on theVarious factors play a role(49)
reviewupdates management of infectionsin the management of
in patients with febrilefebrile neutropenia in
neutropenia in an era ofpatients with cancer,
rising antimicrobialincluding local
resistance, devised bymicrobiology epidemiology
panel members on behalfand the availability of
of the Lebanese Societydiagnostic tests and
of Infectious Diseasesantimicrobial agents
and Clinical Microbiology.
These are expected to
support care providers by
providing standardized
care processes
Doumit andCross-Qualitative/ObservationalInvestigation of theThe enabling factors were(50)
Khoury, 2017sectionalopinion factors facilitating andsocial/family support;
hindering the copingtalking about it; strong
methods of Lebanesereligious beliefs; and the
parents of a child withcommunication style
cancerof health workers. On
the other hand, the
deterring factors were
the waiting time and the
hospital stay; changes in
the couple's relationship;
and sibling rivalry. Nursing
and medical staff need
to be conscious of parents’
coping strategies and their
impact on family dynamics
and the relationship between
the family and the health
care team.
Razik et al, 2017In vitro/MOANASynthesis of two seriesCertain pyrazolopyrimidine(51)
animal of new purine bioisosteresderivatives possessed
comprising a pyrazolin vitro anti-inflammatory
(3,4-d)pyrimidine scaffoldand anticancer activities
linked to piperazine moiety
through different amide
linkages and evaluation
of their anticancer activity
Liu et al, 2021LiteratureMOANAReview of the roles ofDemonstrates the(52)
review divalent metal ions inimportanceof substrate-
the inhibition of IDH,metal ion complexes
their role in thein R132H IDH1
tricarboxylic acid cyclecatalysis and the basis
and the associatedfor selective
metabolismR132H IDH1 inhibition
Bar-Sela et al, 2019Cross-Qualitative/ObservationalSurvey of physicians andDevelopment level(53)
sectionalopinion surgeons from the Middleof a country is a key
East to investigate thefactor influencing attitudes
linkage between attitudestoward spiritual care and
to spiritual care and theits actual provision
spiritual care of patients
with cancer
Assi et al, 2020CrossQualitative/ObservationalAssessment of whetherNGS combined with(44)
sectionalopinion molecular profiling helpsIHC/other tests provides
physicians in therapeuticuseful information for
decision making via theaiding the treatment
analysis of moleculardecisions of oncologists
profiles of cancer afterin routine clinical practice
the failure of at least
one standard-of-care
treatment using NGS, IHC
and other tests

[i] 3D, 3-dimensional; NA, not applicable; MOA, mechanism of action; COVID, coronavirus disease; EPIC FFQ, European Prospective Investigation into Cancer Food Frequency Questionnaire; VEGF, vascular endothelial growth factor; 7-HC, 7-himachalen-7-ol; PCT, photochemotherapy; IDH, isocitrate dehydrogenase; NGS, next-generation sequencing; IHC, immunohistochemistry.

Table II.

Publications on specific cancer types according to study type and date of publication.

Table II.

Publications on specific cancer types according to study type and date of publication.

StudyCancer typeStudy typeMain focus Observational/interventionalAim/purposeMain finding(Refs.)
Jayaraj et al, 2020ProstateSystematicMOANASystematic review andThe expression of(25)
review/ meta-analysis of thespecific miRNAs
meta-analysis theragnostic effects ofas theragnostic
miRNA and the utilitybiomarkers in
of miRNAs as clinicalmedical oncology
theragnostic biomarkerswas suggested
Khalife et al, 2020BreastLiteratureMOANAReview of miRNAsSpecific miRNAs(26)
review involved in BC,were shown to be
highlighting their effectup- or downregulated
on drug and therapyin BC
Elias-Rizk et al, 2020BreastCross-MOAObservationalEvaluation of variousLncRNA H19 could(27)
sectional lncRNA H19 thresholdbe a potential
levels in normal vs.marker for BC
proliferative and malignantdiagnosis, prognosis
tissues, and investigationand risk management
of the link between such
levels and BC classification
Chemaly et al, 2022GastricSystematicIncidence/NAComparative analysis of Gastroesophageal(54)
reviewoccurrence/ data on gastroesophagealcancers after gastric
risk factor cancer occurrence afterbypass procedures
gastric bypass proceduresoccur commonly in
the excluded
stomach where
many are not
identified by
conventional means
Assouad et al, 2022KidneyCross-IncidenceObservationalAnalysis of kidney cancerLebanon presented(55)
sectional occurrence in Lebanon overan average-to-high
12 years and a comparativeASR for kidney
analysis with other countriescancer compared
with other countries
in its region, but a
below-average ASR
compared with
countries worldwide
Swayden et al, 2021ColorectalIn vitroMOANATesting the therapeuticColon cancer cells(56)
potential of targetingare partially
colon cancer cellsauxotrophic for
via arginine deprivationarginine and
induced by HuArgI(Co)-sensitive to
arginine deprivation
Activation of
autophagy is not
protective, but
induces cytotoxicity
and leads to cell
Nader et al, 2021BreastCase reportSafetyObservationalDescription of a case ofEarly recognition(57)
immune-mediatedof the side effects
encaphalitis and aand their treatment
literature review of theis crucial
neurological immune-
related adverse events
associated with various
checkpoint inhibitors
Chatila et al, 2021ColorectalCross-Incidence/ObservationalDemographical descriptionLebanese patients(10)
sectionaloccurrence/ of Lebanese patients withaffected by CRC
demographics CRC. The method oftend to present with
detection, age of onset,advanced disease
stage at presentation,stages, leading to
treatment modalities andpoor prognosis and
survival rate are detailedsurvival
El-Mais et al, 2021PancreaticIn vitroMOANAExamination of theHuArgI (Co)-PEG5000(58)
effects of arginine depletionshows promising
induced by HuArgI(Co)-results for arginine
PEG5000 on PANC-1 celldepletion in the
migration, adhesion andtreatment of pancreatic
invasioncancer cells
El-Saghir et al, 2021BreastLiteratureQualitative/NAExplorative commentaryGenetic counseling,(17)
reviewopinion presenting the challengescontinuing education,
of oncologists in theinfrastructure, testing,
diagnosis and managementexpertise and
of BC with BRCA genefinancial support
mutations in Lebanon andare required to
the Middle Eastfulfill unmet needs
in the management
of BRCA mutation
Khater and Abou-CNSLiteratureAnticancerNAElaboration of thePotential mechanisms(59)
Antoun, 2021 reviewupdates interventions that mayinclude the
contribute to the clinicaloverexpression and
therapeutic resistanceactivation of
observed in pediatriccompensatory
CNS tumors duringtumorigenic
medical trials of c-Metmechanisms within
targeting agentsthe tumors or
ineffective drug
delivery methods
Atallah et al, 2021OvarianCross-Incidence/ObservationalTesting the rate, repartitionSerous histology,(60)
sectionaloccurrence/ and risk factors of lymphgrade 3 tumors,
risk factors node metastasis in patientspositive peritoneal
with epithelial ovariancytology, advanced
cancerclinical stage,
interval surgery and
bilateral adnexal
involvement predict
lymph node
metastasis in
patients with
epithelial ovarian
El-Chami et al, 2021BreastIn vitroMOANAEvaluation of the effectLeTx treatment(61)
of LeTx on the migration,reduced the
adhesion and invasion ofmigration, adhesion
BC cells, and its potentialand invasion of BC
mechanism involving thecells, and this effect
dysregulation of the Rhowas associated with
GTPases RhoA and Cdc42the dysregulation of
RhoA and Cdc42
Hilal et al, 2021ColorectalCrossSurvivalObservationalComparative study ofIn younger patients(62)
sectional rectal cancer tumora worse disease-
characteristics and outcomesfree survival and
in patients older or youngerevidence of an
than 40 years in a Lebaneseassociation between
institutionyounger age at
diagnosis and poor
outcomes was
observed, suggesting
that the personalized
upfront intensification
of treatment should
be considered in the
Jaafar et al, 2021ProstateIn vitroMAONAEvaluation of the role ofStarD13 acts as a(63)
StarD13 and how it targetstumor suppressor
and interacts with cancerthat inhibits the
moleculesinvasion of PCa cells
Fayad et al, 2021Lung andIn vitroMAONAInvestigation of theComplex C3 was(64)
breast photochemistry andobserved to be a
effect of four strainedpromising selective
photoactivatable photoactivatable
polypyridyl ruthenium(II) chemotherapeutic
complexes on A549 NSCLCagent that induces
and MDA-MB-231 triplereactive oxygen
negative BC cellsspecies production
and apoptosis
Bahmad et al, 2021CNSIn vitroMOANATesting the potentialTideglusib targeted(19)
antitumor effect ofneuroblastoma CSCs,
tideglusib on threethereby overcoming
human neuroblastoma celltherapy resistance
lines, SK-N-SH, SH-SY5Y
and IMR-32
Khalil and Abi-PancreaticIn vitroMOANAEvaluation of thePancreatic cancer(65)
Habib, 2020 sensitivity of pancreaticcells are auxotrophic
cancer cells to HuArgI(Co)-for arginine and
PEG5000-induced argininesensitive to
deprivation and theHuArgI(Co)-
mechanisms underlying PEG5000-induced
deprivation-induced cellarginine deprivation
Idriss et al, 2020BreastIn vitroMOANAInvestigation of theVitamin E family(66)
antiproliferative effectsmember β-T3 is as
and pro-apoptotica promising
mechanisms of β-T3 onanticancer agent
the human breastthat is more
adenocarcinoma cell lineseffective than
MDA-MB-231 and MCF7γ-T3 for the
treatment of human
Nasreddine et al, 2020OvarianIn vitroMOANAAssessment of arginineActivation of(67)
auxotrophy in ovarianautophagy following
cancer cells through the arginine-deprivation,
induction of arginineis not protective
deprivation by HuArgI(Co)-and mediates cell
PEG5000cytotoxicity leading
to death by autophagy
Bahmad et al, 2020CNSLiteratureAnticancerNASummary of drugDrug repurposing(68)
reviewupdates repurposing methodologiesor repositioning is
adopted to cure pediatrica promising approach
brain tumors andfor the identification
discussion of compilationof novel therapeutic
approaches that may elevatestrategies to target
drug repurposing to anbrain tumors and
advanced levelovercome therapy
Tfayli et al, 2020LungRandomizedTreatmentInterventionalAssessment of the benefitsThe addition of(20)
controlled of immune checkpointimmunotherapy to
inhibitors in thechemotherapy did
neoadjuvant therapy ofnot appear to
patients with early-stageenhance the overall
NSCLCresponse rate in
patients with
resectable NSCLC
in the neoadjuvant
setting as the study
failed to meet its
primary endpoint
Joumaa et al, 2020ColorectalIn vitro/MOANATesting the effect ofChamomile acts as(69)
animal aqueous chamomilea potent dietary
extract against DMH- chemopreventive
induced CRC in miceagent against
DMH-induced CRC
Tannous et al, 2020LeukemiaIn vitroMOANAInvestigation of theENL exerts promising(70)
potential anticancer effectanticancer effects on
of the flaxseed lignansAML cell lines in vitro,
secoisolariciresinolby promoting DNA
diglucoside, enterodiol andfragmentation and the
ENL on AML cellsintrinsic apoptotic
in vitro and the underlyingpathway, highlighting
molecular mechanismthe protective health
benefits of flax
seeds in leukemia
Younes et al, 2020BreastIn vitroMOANAEvaluation of the potentialAELE exhibits a(71)
anticancer activity ofselective
AELE in vitro in MDA- antiproliferative
MB-231 and MCF-7 BCand pro-apoptotic
cell lines, andeffect on chemo-
determination of theresistant MDA-
toxicity level in normalMB-231 BC cells,
mesenchymal stem cellsproviding evidence
for the antitumor
effects of A. cherimola
Ghali et al, 2019BreastCase-Incidence/ObservationalExploration of theReveals the positive(72)
controloccurrence/ contribution of NF-κBassociation of
risk factors variants to the pathogenesisrs3774937 with BC
of BC in a Middle Eastern-
North African population
Bahmad et al, 2019CNSLiteratureMOANASummary of the keyExperimental(73)
review molecules in neuroblastomaevidence from
CSCsneuroblastoma cell
lines, patient-
derived xenografts
and primary tumors
is presented
Al-Koussa et al, 2019ColorectalIn vitroMOANATesting the cytotoxic effectArginine depletion(74)
of HuArgI(Co)-PEG5000is a potential selective
on the CRC cell lines HT-29,approach for inhibiting
Caco-2 and Sw837the motility and
invasion of CRC cells
Henaine et al, 2019ColorectalCohortAnticancerObservationalEvaluation of the clinicalTargeted therapy(75)
treatment effectiveness of targetedassociated with
therapy in patients withstandard therapy is
metastatic CRC inhighly prevalent in
Lebanese oncologic unitsLebanon in
and an estimation of themetastatic disease
costsand the associated
medical cost is
Cianci et al, 2019OvarianSystematicIncidence/NAReview of evidenceSarcopenia appears(76)
reviewoccurrence/ describing the associationto have an important
risk factors of sarcopenia withrole in the
surgical and oncologicaloncological outcomes
outcomes in patients withof patients with
ovarian cancerovarian cancer
Najem et al, 2019ColorectalIn vitroMOANAEvaluation of the effectProfound(77)
of SAHA, a pan-histoneantitumorigenic effects
deacetylase inhibitorof sequentially
and/or DAC, a DNAcombined SAHA and
methyltransferase inhibitor,DAC were found in
on the Caco-2 human colonthe CRC cell line
cancer cell line in vitroand new insights
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were obtained
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Aragon-Ching, 2019 reviewupdates clinical trials thatenzalutamide are
supported the approvalnew anti-androgen
of apalutamide andtreatment options
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non-nmCRPC settingsetting
as well as the main
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of these agents
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as a cancer
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rs3819025, rs10484879,AGGTG and GAGTG
rs7747909 and rs3748067)constitute independent
with CRC susceptibility infactors for CRC
a Tunisian populationsusceptibility. IL-17A
may be a target for
future CRC
Ghali et al, 2018BreastCase-Incidence/ObservationalEvaluation of theESR1 alleles and(82)
controloccurrence/ relationships amonggenotypes, and
risk factors estrogen receptorspecific 3-locus
ESR1 and ESR2 variants,ESR1 haplotypes
breast cancer andare associated with
associated features inincreased breast
Tunisian womencancer susceptibility
in Tunisian women
However, the ESR2
variant and specific
1-locus ESR1
haplotype have a
protective effect
Al Hassan et al, 2018CNSIn vitroMOANAInvestigation of theMetformin(83)
anti-invasivedemonstrates anti-
antimetastatic effectinvasive antimetastatic
of metformin onpotential. There was a
glioblastoma multiformesignificant decrease
and its mechanism ofin the survival of
actionSF268 cancer cells
in response to
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metformin. Furthermore,
metformin's efficiency
in inhibiting 2D cell
motility and cell invasion
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increasing cellular
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demonstrated in
SF268 and U87 cells
Nader et al, 2018ProstateLiteratureAnti-cancerNAProvision of aPromising results in(84)
reviewupdates historical summary andlocally advanced PCa
explanation of theand high-risk PCa
contemporary use ofhave been obtained
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in PCa in various statesand adjuvant settings
and phases of the disease
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animal anticancer activity oftreatment induced
Daucus carota oil extractcell cycle arrest and
HC against SW1116 colonpromoted apoptosis
cancer cell lines, andvia inhibition of the
evaluation its effect in aMAPK/ERK and
DMH-induced colonPI3K/AKT pathways.
carcinogenesis model inHC treatment
black 6 miceexerted an antitumor
effect in vivo with
no significant toxicity
to the mice
Abou-CNSLiteratureAnti-cancerNAReview of the progressCSC-targeting(86)
Antoun et al, 2017 reviewupdates in CSC biology and itsapproaches in
association with targetedcombination with
therapies that maycurrent clinical
clearly differ betweentherapies have the
pediatric and adultpotential to be
brain tumorsmore effective owing
to their ability to
compromise CSC
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of bone marrow-derivedcontribute to the
MSCs in the mediationadaptation and
of selective boneinvasiveness of
metastasis by BC cellsBC cells in skeletal
Salem et al, 2017BreastCross-DiagnosisObservationalAnalysis of the breastBreast density(88)
sectional mammogram densitydistribution in
distribution inLebanon is similar
Lebanese women andto that in western
its correlation with BCsociety. Also, similar
incidenceto other studies, it
showed that high
breast density is
statistically associated
with BC, particularly
in older and
menopausal women
El-Amm et al, 2017ProstateLiteratureAnticancerNAExamination of theAbiraterone has shown(89)
reviewupdates companion PROs inbenefits in the second-
conjunction withand first-line (post-
abiraterone acetateand pre-chemotherapy)
use, as PROs aresettings, with
increasingly consideredimprovements in
as a key metric for drugoverall survival
label claims whenand secondary end
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grant approvaland radiographic
response rates, time
to PSA progression
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animal cytotoxic effect ofexhibited marked
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activity of the pentanemediated through
diethyl ether fraction oninhibition of the
DMBA/TPA-inducedMAPK/ERK and
skin carcinogenesisPI3K/AKT pathways
in mice

[i] NA, not applicable; ASR, age-standardized rate; MOA, mechanism of action; HuArgI (Co)-PEG5000, pegylated cobalt-substituted recombinant human arginase I; CRC, colorectal cancer; BC, breast cancer; CNS, central nervous system; LeTx, anthrax lethal toxin; PCa, prostate cancer; NSCLC, non-small cell lung cancer; CSCs, cancer stem cells; T3, tocotrioenol; miRNA, microRNA; DMH, 1,2-dimethyl hydrazine; ENL, enterolactone; AML, acute myeloid leukemia; lncRNA long non-coding RNA; AELE, Annona cherimola ethanolic leaf extract; SAHA, suberoylanilide hydroxamic acid; DAC, decitabine; nmCRPC, metastatic castration-resistant PCa; HSP, heat shock protein; IL, interleukin; HC, β-2-himachalen-6-ol; MSCs, mesenchymal stromal cells; PROs, patient-related outcomes; PSA, prostate-specific antigen; DMBA, dimethylbenzanthracene; TPA, tetradecanoylphorbol acetate.

Principal findings

The aim of the present investigation was to assess the quantity and quality of cancer studies reported by the LAU and explore their respective objectives and areas of focus. The review encompasses in vitro, in vivo and animal studies. A relatively high number of literature reviews and a prevalence of observational studies over experimental ones were conducted. This finding may be expected since observational studies are generally easier to perform, more convenient and less stringent compared with interventional studies, although they carry a lower level of evidence (91).

The aims of the included studies varied, and in some cases it appeared that the main objective was solely descriptive. Therefore, it is essential to conduct more interventional, experimental and well-controlled human studies that possess higher external validity and generalizability. Such studies would lead to more definitive conclusions and trustworthy recommendations (92).

The present analysis reveals that researchers at the LAU who are interested in cancer have focused on a variety of research areas. The most common type of study involved laboratory experiments, namely in vitro studies, which accounted for more than one-third of the LAU studies. Animal models are important tools in cancer research in vitro and in vivo, as they can be used in the identification of carcinogens, development of cancer therapies and drug screening, and for providing insights into the molecular mechanisms of tumor growth and metastasis (93). In addition, they are easy to manipulate, homogenous, accessible and do not require human participants (94). The latter point was highlighted in the present study, which showed that this type of study was most prevalent during 2020-2021, during the era of COVID-19.

Special updates and reviews on novel anticancer therapies were also shown to be prevalent in the present study. Notably, these findings, particularly those concerning the regulatory roles of small RNAs, have provided new insights to improve the global understanding of cancer biology. Although these types of studies were the most prevalent during the year 2020, prior to the spread of COVID-19 and the economic crisis that impacted research funding negatively in Lebanon, in coming years, broader revelations about fundamental aspects of cellular biology are likely to increase our understanding of the aberrant behavior of cancer cells and notably contribute to the advancement of biomedical research (14). In addition to anticancer treatment, other studies had additional objectives, such as determining the incidence and prevalence of specific types of cancer, identifying risk factors associated with certain cancers and exploring their socio-economic and psychological impacts. Indeed, the diverse range of findings from these studies on cancer underscores the broad spectrum of interest of researchers to this field and emphasizes the requirement for well-balanced, patient-centric research strategies that can yield improved outcomes and higher cure rates (95).

Just a few decades ago, clinical investigators and physicians were often advised to refrain from engaging in oncology due to its complexity and the discouraging clinical outcomes it yielded. Additionally, conducting cancer research required significant financial investment and relied on patients dedicating their time and effort (96). Currently, the primary challenge lies in the development of fundamental research on cancer prevention and treatment to impede the occurrence of new cases and reduce the global incidence of cancer.

Although the annual output of cancer research appears to be low when compared with that of other publications on different research subjects, a sharp increase in the number of cancer publications was noticed during the years of 2018 and 2019 in the present study. This underlines the increased involvement of LAU scholars in research as the aim of expanding the number of publications and citations, as well as the support offered by the academic institution as an incentive, seems to have had a positive impact on the publication rate of papers on cancer. In fact, Boutros and Fakih (97) argued in their recent publication that the number of academic publications was associated with academic promotion across all institutional settings. The authors also concluded that the positive consequences of the number of publications of each faculty member suggests that this factor should be a priority for administrators to consider when making decisions regarding promotion. LAU is a leading private and nonsectarian higher education institution that operates under a charter from the Board of Regents of the University of the State of New York, and has a large publication volume relative to its faculty size, which makes it an ideal source of relevant information (98). In terms of quality, LAU provides incentives for researchers to publish their studies in the top 10% of international journals; thus, LAU is a research-active institution of higher learning in Lebanon and the region, with no compromise in its commitment to quality teaching (99). Moreover, the urgency of conducting cancer research has escalated due to the high prevalence of cancer worldwide, with approximately one in two individuals receiving a cancer diagnosis in their lifetime (100). Despite current treatments, cancer-associated mortality and morbidity rates remain high (6). This global situation mirrors the situation in Lebanon, as indicated by the 2021 report from the Global Cancer Observatory of the National Cancer Registry, which revealed an increase in cancer cases despite ongoing research on cancer (22). As a result, oncological research has garnered public funding and global monetary investments to incentivize clinical investigators to pursue cancer research (101).

Despite the aforementioned increase in cancer-associated publications, a reduction in the number of publications was observed in 2021. A possible explanation for this is the outbreak of the novel COVID-19 that has impacted all types of research in various forms (102,103). Another potential explanation is the lack of funds required for research in general imposed by the severe socio-economic Lebanese crisis and political instability manifested by unprecedented rates of unemployment, inflation and poverty, and a rapid devaluation of the Lebanese currency since the beginning of 2021 (104,105).

Research on breast and colorectal cancer was found to be the most prevalent among that on all types of cancer, accounting for >30% of all cancer studies. This finding is not unexpected since, according to previous studies, these types of cancer were the most prevalent in Lebanon during the last 5 years (22,106). Unfortunately, research on breast and colorectal cancers decreased in 2022 since Lebanon was continuing to face a serious economic crisis with an effect on fiscal and human resources.

Reflecting upon the approaches to cancer research outlined in the present study, it is necessary to highlight several further recommendations. First, it is essential to conduct more research using real-life data in order to accurately assess the actual impact of research on cancer incidence, treatment, outcomes and prevention techniques. Additionally, there is a requirement for more clinical studies involving the users and beneficiaries of cancer research, such as patients and their families. It would be beneficial for these studies to involve a greater representation of individuals from real-world populations, with the development of a prospective study plan to establish specific targets for trial enrolment based on disease epidemiology and incidence. Moreover, it is crucial to allocate more robust, sustained and predictable funding for additional clinical and translational longitudinal molecular profiling studies in large and diverse cohorts of patients with cancer. This will aid in understanding the natural progression of cancers and exploring the role of biology and genetics in cancer health disparities. Furthermore, the national public health workforce should prioritize cancer control initiatives that aim to reduce the incidence, morbidity and mortality of cancer. These initiatives may also focus on improving the quality of life for individuals with cancer by implementing evidence-based interventions for prevention, early detection, diagnosis and treatment. Additionally, it is important to develop well-planned strategies to guide future cancer research.

Significance of the study and future implications for policy and practice

The issue of cancer research studies being underrepresented or misrepresented is an important factor contributing to therapy delays and proactive measures are required to address this. The importance of the present review lies in its summary of the different cancer studies that were conducted in an academic university during a 5-year period. The review has shown that cancer research is an attractive topic for many academic researchers; however, the spread of COVID-19 and the economic crisis had a major impact on this type of research, which might have contributed to a shift in study types towards more observational or in vitro studies as well as a remarkable reduction in research output, particularly after the spread of COVID-19 in 2020. From this perspective, it is essential to emphasize that researchers must re-focus their efforts on conducting studies associated with cancer, since cancer research should be recognized as one of the most prevalent health concerns, as is COVID-19. To develop new therapies, gain a deeper understanding of cancer prognosis and survivorship and ensure the availability of new drugs in all healthcare settings, a collaborative effort involving the diverse cancer research community in each country is necessary. Translational cancer research, particularly interventional or experimental human studies, is recommended to be an integral part of the delivery of oncology care, ensuring that valuable knowledge is gained in academic institutions and nationally. For this reason, policy proposals should be made to enhance access to digital healthcare, expand healthcare programs, allocate funds for experimental cancer research and provide financial support to healthcare institutions. Moreover, interventional studies that focus on anticancer therapy should be the primary interest of pharmaceutical companies as well as research centers since, according to the present results, only a few of these were conducted.

It is important to emphasize that the impact of cancer research can be amplified when organizations use a multidisciplinary approach, as demonstrated by the diversity of studies in the present review, which can guide and enhance future evaluations.


At present, scientists seldom contemplate an ultimate cure for cancer. However, further research on the short-term and long-term effects of current cancer therapies is necessary. For instance, efforts can be made to address the psychological and socioeconomic challenges faced by cancer patients during their treatment, or to find methods of mitigating the potential side effects experienced during therapy. By combining technological advancements with ongoing operational research, the field of oncology will be able to move on from the era when surgery and chemotherapy were the sole treatment options available.


The authors would like to thank Professor Samer Saab (Dean of Graduate Studies, Lebanese American University Beirut, Lebanon) for their final revision of the manuscript and valuable comments.


Funding: No funding was received.

Availability of data and materials

Not applicable.

Authors' contributions

NKS wrote the literature review, was responsible for the methodology and organized the findings. ST collected and analyzed data, designed and guided the study, and drafted and critically revised the final version of the manuscript. Data authentication is not applicable. Both authors have read and confirmed the final version of the manuscript.

Ethics approval and consent to participate

Not applicable.

Patient consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.



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Tawil S and Tawil S: Cancer research in Lebanon: Scope of the most recent publications of an academic institution (Review). Oncol Lett 28: 350, 2024
Tawil, S., & Tawil, S. (2024). Cancer research in Lebanon: Scope of the most recent publications of an academic institution (Review). Oncology Letters, 28, 350.
Tawil, S., Khaddage-Soboh, N."Cancer research in Lebanon: Scope of the most recent publications of an academic institution (Review)". Oncology Letters 28.2 (2024): 350.
Tawil, S., Khaddage-Soboh, N."Cancer research in Lebanon: Scope of the most recent publications of an academic institution (Review)". Oncology Letters 28, no. 2 (2024): 350.