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Swain M, Budrukkar A, Murthy V, Pai P, Kanoja A, Ghosh-Laskar S, Deshmukh A, Pantvaidya G, Kannan S, Patil VM, Naronha V, Prabhash K, Sinha S, Kumar A, Gupta T, Agarwal J. Contralateral Nodal Relapse in Well-lateralised Oral Cavity Cancers Treated Uniformly with Ipsilateral Surgery and Adjuvant Radiotherapy With or Without Concurrent Chemotherapy: a Retrospective Study. Clin Oncol (R Coll Radiol) 2024; 36:278-286. [PMID: 38365518 DOI: 10.1016/j.clon.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
AIMS To evaluate the incidence and pattern of contralateral nodal relapse (CLNR), contralateral nodal relapse-free survival (CLNRFS) and risk factors predicting CLNR in well-lateralised oral cavity cancers (OCC) treated with unilateral surgery and adjuvant ipsilateral radiotherapy with or without concurrent chemotherapy. MATERIALS AND METHODS Consecutive patients of well-lateralised OCC treated between 2012 and 2017 were included. The primary endpoint was incidence of CLNR and CLNRFS. Univariable and multivariable analyses were carried out to identify potential factors predicting CLNR. RESULTS Of the 208 eligible patients, 21 (10%) developed isolated CLNR at a median follow-up of 45 months. The incidence of CLNR was 21.3% in node-positive patients. CLNR was most common at level IB (61.9%) followed by level II. The 5-year CLNRFS and overall survival were 82.5% and 57.7%, respectively. Any positive ipsilateral lymph node (P = 0.001), two or more positive lymph nodes (P < 0.001), involvement of ipsilateral level IB (P = 0.002) or level II lymph node (P < 0.001), presence of extranodal extension (P < 0.001), lymphatic invasion (P = 0.015) and perineural invasion (P = 0.021) were significant factors for CLNR on univariable analysis. The presence of two or more positive lymph nodes (P < 0.001) was an independent prognostic factor for CLNR on multivariable analysis. CLNR increased significantly with each increasing lymph node number beyond two compared with node-negative patients. CONCLUSION The overall incidence of isolated CLNR is low in well-lateralised OCC. Patients with two or more positive lymph nodes have a higher risk of CLNR and may be considered for elective treatment of contralateral neck.
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Affiliation(s)
- M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Kanoja
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Deshmukh
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Pantvaidya
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Kannan
- Clinical Research Secretariat Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi, Mumbai, India
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Naronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Sinha
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Kumar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Noronha V, Patil V, Menon N, Shah M, Chougule A, Peelay Z, Prabhash K. Gefitinib vs Gefitinib Plus Pemetrexed and Carboplatin Chemotherapy in EGFR-Variant Lung Cancer-Long-Term Results of a Randomized Clinical Trial. JAMA Oncol 2024:2817951. [PMID: 38662354 DOI: 10.1001/jamaoncol.2024.0584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
This randomized clinical trial examines whether adding chemotherapy with pemetrexed and carboplatin to gefitinib improves survival among patients with epidermal growth factor receptor (EGFR)–variant non–small cell lung cancer.
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Affiliation(s)
- Vanita Noronha
- Solid Tumor Unit, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Vijay Patil
- Solid Tumor Unit, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Nandini Menon
- Solid Tumor Unit, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Minit Shah
- Solid Tumor Unit, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Anuradha Chougule
- Solid Tumor Unit, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Zoya Peelay
- Solid Tumor Unit, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Solid Tumor Unit, Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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Rao AR, Noronha V, Ramaswamy A, Kumar A, Pillai A, Gattani S, Sehgal A, Kumar S, Castelino R, Pearce J, Dhekale R, Jagtap P, Tripathi V, Satamkar S, Krishnamurthy J, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nookala M, Chitre A, Kapoor A, Gota V, Banavali S, Badwe RA, Prabhash K. Assessing frailty in older Indian patients before cancer treatment: Comparative analysis of three scales and their implications for overall survival. J Geriatr Oncol 2024; 15:101736. [PMID: 38428186 DOI: 10.1016/j.jgo.2024.101736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Frailty, characterized by ageing-related vulnerability, influences outcomes in older adults. Our study aimed to investigate the relationship between frailty and clinical outcomes in older Indian patients with cancer. MATERIALS AND METHODS Our observational single-centre study, conducted at Tata Memorial Hospital from February 2020 to July 2022, enrolled participants aged 60 years and above with cancer. Frailty was assessed using the Clinical Frailty Scale (CFS), G8, and Vulnerable Elders Survey (VES)-13. The primary objective was to explore the correlation between baseline frailty and overall survival. Statistical analyses include Kaplan-Meier, Cox proportional hazards, and Harrell's C test. RESULTS A total of 1,177 patients (median age 68, 76.9% male) were evaluated in the geriatric oncology clinic. Common malignancies included lung (40.0%), gastrointestinal (35.8%), urological (11.9%), and head and neck (9.0%), with 56.5% having metastatic disease. Using CFS, G8, and VES-13 scales, 28.5%, 86.4%, and 38.0% were identified as frail, respectively. Median follow-up was 11.6 months, with 43.3% deaths. Patients fit on CFS (CFS 1-2) had a median survival of 28.02 months, pre-frail (CFS 3-4) 13.24 months, and frail (CFS ≥5) 7.79 months (p < 0.001). Abnormal G8 (≤14) and VES-13 (≥3) were associated with significantly lower median survival (p < 0.001). Multivariate analysis confirmed CFS's predictive power for mortality (p < 0.001), with hazard ratios [HRs] for pre-frail at 1.61(95% confidence interval [CI] 1.25 to 2.06) and frail at 2.31 (95%CI 1.74 to 3.05). G8 ≤ 14 had HR 2.00 (95%CI 1.42 to 2.83), and abnormal VES-13 had HR 1.36 (95%CI 1.11-1.67). In the likelihood ratio test, CFS significantly improved the model fit (p < 0.001). Harrell's C index for survival prediction was 0.62 for CFS, 0.54 for G8, and 0.58 for VES-13. DISCUSSION In conclusion, our study highlights varying frailty prevalence and prognostic implications in older Indian patients with cancer, emphasizing the need for personalized care in oncology for this aging population. We would recommend using CFS as a tool to screen for frailty for older Indian patients with cancer.
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Affiliation(s)
- Abhijith R Rao
- Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anita Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anupa Pillai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shreya Gattani
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Arshiya Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Sharath Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Renita Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Jessica Pearce
- NIHR Acaemic Clinical Fellow in Medical Oncology, Leeds Institute of Medical Research at St James', University of Leeds, United Kingdom
| | - Ratan Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Pravin Jagtap
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vinod Tripathi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sunita Satamkar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jyoti Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarika Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anuradha Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Lekhika Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jayita Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nabila Ansari
- Department of Occupational therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjusha Vagal
- Department of Occupational therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Purabi Mahajan
- Department of Digestive diseases and Clinical nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shivshankar Timmanpyati
- Department of Digestive diseases and Clinical nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjunath Nookala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Ankita Chitre
- Department of physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Akhil Kapoor
- Department of Medical oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rajendra A Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
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Peelay Z, Saha S, Patil V, Menon N, Singh A, Shah M, Sahu A, Ubharay A, Chowdhury OR, Prabhash K, Noronha V. Neoadjuvant Chemotherapy in Locally Advanced Sinonasal Teratocarcinosarcoma a Rare Malignancy: An Audit From an Academic Tertiary Care Centre in India. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00114-6. [PMID: 38565457 DOI: 10.1016/j.clon.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
AIMS Sinonasal teratocarcinosarcomas (SNTCS) are rare sinonasal malignancies, the incidence of which is less than 1% of all tumors. There is limited data available on SNTCS's, often as case reports and small case series. The management of SNTCS is complicated because of its location, locally aggressive biology, difficulty in achieving complete resection, and limited data on chemotherapy in these malignancies. This audit was performed to understand the role of neoadjuvant chemotherapy (NACT) in SNTCS's, its ability to downstage the disease, achieve complete resection, and impact on long-term survival outcomes. METHODS This was a retrospective analysis of a prospectively maintained database approved by the Institutional Ethics Committee (IEC). The baseline characteristics, the extent of tumor, Kadish stage, NACT regimen, and adverse events were extracted from the Electronic Medical Records and the patient's case file. Patients with baseline extensive/inoperable disease were referred for NACT from the multidisciplinary joint clinic followed by response assessment (RECIST v1.1). Patients underwent skull-base surgery if respectable post-completion of NACT, however, if deemed unresectable were treated with non-surgical modalities or palliative therapies. RESULTS The data of 27 patients were evaluated from the year 2015-2022. The median age was 42 years (IQR:30-56) and 85.2% (n = 23) were males. The ECOG-PS was 0-1 in 88.8% (n = 24) patients. All 27 patients received NACT in view of extensive disease at presentation. 74.1% (n = 20) patients received Cisplatin-Etoposide and 25.9% (n = 7) received other chemotherapy regimens. The median number of chemotherapy cycles was 2(IQR:2-3). 96.3% patients (n = 26) completed the planned NACT cycles. 70.4% (n = 19) patients achieved a partial response in post-NACT imaging. 77.8% (n = 18) underwent surgery, 18.5% (n = 5) received CTRT, and 7.4% (n = 2) received definitive-RT alone. The median PFS and OS of the cohort was 19months (95%CI:12.0-25.6) and 23months (95%CI:5.94-40.06) respectively. CONCLUSION NACT is safe, feasible, and effective with significant response rates, leading to effective downstaging, resectability and improved survival in patients with locally advanced SNTCS's.
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Affiliation(s)
- Z Peelay
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - S Saha
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - V Patil
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - N Menon
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - A Singh
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - M Shah
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - A Sahu
- Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - A Ubharay
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - O R Chowdhury
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - K Prabhash
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - V Noronha
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
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5
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Noronha V, Patil V, Chaturvedi P, Mathrudev V, Menon N, Bhattacharjee A, Singh A, Peelay Z, Chakraborty S, Jadhav M, Alone M, Bhagyavant P, Kolkur M, Srinivas S, Das S, Roy S, Mandal T, Dsouza H, Saha S, Rai R, Srikanth A, Shah D, Khan A, Muthuluri H, Kumar A, Agarwal A, Rajpurohit A, Goli VB, Sekar A, Mantri A, Kanteti APK, Majumdar S, Khaddar S, Shenoy R, Elamarthi P, Rathnasamy N, Kashyap L, Abraham G, Booma N, Simha V, Chaukar D, Pai P, Nair S, Laskar S, Nawale K, Naidu P, Salian S, Shelar P, Raulo R, Dhumal SB, Prabhash K. Phase 3 RCT comparing docetaxel-platinum with docetaxel-platinum-5FU as neoadjuvant chemotherapy in borderline resectable oral cancer. Eur J Cancer 2024; 200:113560. [PMID: 38306841 DOI: 10.1016/j.ejca.2024.113560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/27/2023] [Accepted: 01/13/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) with TPF (docetaxel, cisplatin, and 5FU) is one of the treatment options in very locally advanced oral cancer with a survival advantage over PF (cisplatin and 5FU). TP (docetaxel and cisplatin) has shown promising results with a lower rate of adverse events but has never been compared to TPF. METHODS In this phase 3 randomized superiority study, adult patients with borderline resectable locally advanced oral cancers were randomized in a 1:1 fashion to either TP or TPF. After the administration of 2 cycles, patients were evaluated in a multidisciplinary clinic and further treatment was planned. The primary endpoint was overall survival (OS) and secondary endpoints were progression-free survival (PFS) and adverse events. RESULTS 495 patients were randomized in this study, 248 patients in TP arm and 247 in TPF arm. The 5-year OS was 18.5% (95% CI 13.8-23.7) and 23.9% (95% CI 18.1-30.1) in TP and TPF arms, respectively (Hazard ratio 0.778; 95% CI 0.637-0.952; P = 0.015). Following NACT, 43.8% were deemed resectable, but 34.5% underwent surgery. The 5-year OS was 50.7% (95% CI 41.5-59.1) and 5% (95%CI 2.9-8.1), respectively, in the surgically resected versus unresected cohort post NACT (P < 0.0001). Grade 3 or above adverse events were seen in 97 (39.1%) and 179 (72.5%) patients in the TP and TPF arms, respectively (P < 0.0001). CONCLUSION NACT with TPF has a survival benefit over TP in borderline resectable oral cancers, with an increase in toxicity which is manageable. Patients who undergo surgery achieve a relatively good, sustained survival.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Ajay Singh
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Zoya Peelay
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Monica Jadhav
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Mitali Alone
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Manali Kolkur
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sujay Srinivas
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sudeep Das
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Somnath Roy
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Tanmoy Mandal
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Hollis Dsouza
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Saswata Saha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Rahul Rai
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Anne Srikanth
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Darshit Shah
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Arif Khan
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Hemanth Muthuluri
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Amit Kumar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Amit Agarwal
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Anu Rajpurohit
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vasu Babu Goli
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Anbarasan Sekar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Anoop Mantri
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Swaratika Majumdar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Satvik Khaddar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Ramnath Shenoy
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Prahlad Elamarthi
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Lakhan Kashyap
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - George Abraham
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Naveen Booma
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vijay Simha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Centre, HBNI, Mumbai, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sarbani Laskar
- Department of Radiation Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Priyanka Naidu
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sushmita Salian
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Priyanka Shelar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Ravinarayan Raulo
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India.
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Batra N, Mishra P, Pai T, Jiwnani S, Karimundackal G, Tiwari V, Purandare N, Janu A, Noronha V, Joshi A, Prabhash K, Tibdewal A, Agarwal JP, Pramesh CS, Kaushal RK. SALTT study: A retrospective analysis of 111 SAlivary gland tumors of Lung and Tracheobronchial Tree. Ann Diagn Pathol 2024; 70:152283. [PMID: 38447254 DOI: 10.1016/j.anndiagpath.2024.152283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Primary pulmonary salivary gland-type tumours (PPSGT) are rare lung neoplasms arising from submucosal seromucinous glands in the central airway. METHODS AND RESULTS We retrospectively analysed the clinicopathological features of 111 PPSGTs diagnosed at our institute between 2003 and 2021. The mean age at diagnosis was 43.8 years(range 6-78 years) and a male-to-female ratio of 2:1. On imaging, 92 % of cases had centrally located tumours and 37.3 % were early stage. The histopathological types included 70 cases (63 %) of mucoepidermoid carcinoma (MEC), 31 cases (27.7 %) of adenoid cystic carcinoma (ADCC), two cases of myoepithelial carcinoma, one case each of acinic cell carcinoma (ACC), clear cell carcinoma (CCC), epithelial myoepithelial carcinoma (EMC) and 5 others [including adenocarcinoma of minor salivary gland origin(n = 3), carcinoma with sebaceous differentiation(n = 1) and poorly differentiated carcinoma of salivary gland type(n = 1)]. The size of the tumours found in the resection specimens ranged from 1 cm to 13 cm, with an average size of 4.9 cm. High-risk attributes such as lymphovascular invasion (LVI), perineural invasion (PNI), pleural involvement, positive resection margins, and nodal metastasis were identified in 15.3 %, 15.3 %, 13.6 %,15.2 % and 6.7 % of cases, respectively. These attributes were found to be more frequent in ADCC than in MEC. Surgery was the main treatment modality [68/84 (80 %) cases]. ADCC cases had more recurrence and distant metastasis than MEC cases. The 3- year overall-survival (OS) and recurrence-free survival(RFS) were better in patients with age lesser than 60 years(p-value <0.0001), low pT stage (p-value 0.00038) and lower grade of MEC(p-value-0.0067). CONCLUSION It is crucial to have an acquaintance with the morphologic spectrum and immunophenotypic characteristics of PPSGT to recognize them in this unusual location. In tandem, it is crucial to differentiate them from conventional primary non-small cell lung carcinoma, as the management protocols and prognostic implications differ significantly.
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Affiliation(s)
- Nishtha Batra
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prabhashankar Mishra
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India; Department of Pathology, Army Hospital Research & Referral, New Delhi, India
| | - Trupti Pai
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sabita Jiwnani
- Department of Thoracic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - George Karimundackal
- Department of Thoracic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Virendra Tiwari
- Department of Thoracic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anil Tibdewal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Thoracic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Kumar Kaushal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
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7
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Noronha V, Sarkar L, Patil V, Menon N, Shah M, Pawar A, Chowdhury OR, Shetty O, Chougule A, Chandrani P, Kaushal R, Pai T, Janu A, Chakrabarty N, Prabhash K. Clinical characteristics, outcomes and prognostic factors in KRAS mutant lung cancers: experience from a tertiary care cancer center in India. Ecancermedicalscience 2024; 18:1674. [PMID: 38439805 PMCID: PMC10911678 DOI: 10.3332/ecancer.2024.1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Indexed: 03/06/2024] Open
Abstract
Objectives Kirsten rat sarcoma viral oncogene homologue (KRAS) mutations in lung cancers, long considered untargetable, have had a recent rise in interest due to promising data of agents targeting KRAS p.G12C. As Indian data are scarce, we sought to identify baseline clinical characteristics, prognostic factors and outcomes of lung cancer patients with KRAS mutations at our hospital. Methods Patients with KRAS mutant lung cancers treated at our institute from 2016 to 2022 were analysed. Results 133 patients with KRAS mutant lung cancers were identified. Median age was 57 (interquartile range 28-78) years, and 58 (43.6%) were smokers. 17 (12.7%) had brain metastases. The commonest variant was p.G12C, seen in 53 (39.8%) patients. Six (4.5%) had programmed death ligand 1 (PDL-1) expression >50% by Ventana SP263 PDL-1 assay, and 13 (9.7%) had epidermal growth factor mutation. Of 92 patients with available treatment details, the majority received intravenous chemotherapy, nine (9.8%) received tyrosine kinase inhibitors and four (4.4%) received immunotherapy (pembrolizumab). Median progression-free survival (PFS) with first-line therapy was 6 (95% confidence interval (CI) 2.8-9.2) months and median overall survival (OS) was 12 (CI 9.2-14.8) months. The incidence of brain metastases was higher in patients with G12C mutations (p = 0.025). Brain metastases (HR: 3.57, p < 0.001), Eastern Cooperative Oncology Group performance status (PS) ≥ 2 (HR: 2.13, p = 0.002) and G12C mutation (HR: 1.84, p = 0.011) were associated with inferior PFS, while brain metastases (HR: 4.6, p < 0.001), PS ≥ 2 (HR: 2.33, p = 0.001) and G12C mutation (HR: 1.93, p = 0.01) were associated with inferior OS. Conclusion This is the largest dataset of KRAS mutant lung cancers from India. Brain metastases were higher in patients with G12C mutations and associated with poorer PFS and OS. G12C mutation and PS ≥ 2 were also associated with inferior PFS and OS. Experience with targeted therapy for KRAS mutations remains an area of future exploration due to the unavailability of these agents in India.
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Affiliation(s)
| | | | - Vijay Patil
- Tata Memorial Hospital, Mumbai 400012, India
- The authors contributed equally to the work
| | - Nandini Menon
- Tata Memorial Hospital, Mumbai 400012, India
- The authors contributed equally to the work
| | - Minit Shah
- Tata Memorial Hospital, Mumbai 400012, India
- The authors contributed equally to the work
| | - Akash Pawar
- Tata Memorial Hospital, Mumbai 400012, India
- The authors contributed equally to the work
| | | | - Omshree Shetty
- Tata Memorial Hospital, Mumbai 400012, India
- The authors contributed equally to the work
| | - Anuradha Chougule
- Tata Memorial Hospital, Mumbai 400012, India
- The authors contributed equally to the work
| | - Pratik Chandrani
- Tata Memorial Hospital, Mumbai 400012, India
- The authors contributed equally to the work
| | - Rajiv Kaushal
- Tata Memorial Hospital, Mumbai 400012, India
- The authors contributed equally to the work
| | - Trupti Pai
- Tata Memorial Hospital, Mumbai 400012, India
- The authors contributed equally to the work
| | - Amit Janu
- Tata Memorial Hospital, Mumbai 400012, India
- The authors contributed equally to the work
| | - Nivedita Chakrabarty
- Tata Memorial Hospital, Mumbai 400012, India
- The authors contributed equally to the work
| | - Kumar Prabhash
- Tata Memorial Hospital, Mumbai 400012, India
- The authors contributed equally to the work
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8
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Noronha V, Kapu V, Joshi A, Menon N, Singh A, Prakash G, Menon S, Sable N, Murthy V, Pal M, Arora A, Kumar S, Banavali S, Prabhash K. Clinical Profile and Outcomes of Carcinoma Penis Patients Receiving Systemic Therapy at an Indian tertiary care Center: A Retrospective Observational Study. Clin Genitourin Cancer 2024; 22:102053. [PMID: 38442451 DOI: 10.1016/j.clgc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/03/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Penile cancer is a rare malignancy with scant data on the impact of systemic therapy on outcomes. METHODS Retrospective observational study of patients with a histological diagnosis of carcinoma penis treated with systemic therapy at the Tata Memorial Centre (Mumbai, India) between August 2010 and February 2018. Primary objective was overall survival (OS); secondary objectives included assessment of clinical characteristics, treatment approaches, and toxicity profiles. RESULTS We included 91 patients with penile carcinoma who received systemic therapy at our center. Intent of therapy was curative in 71 patients (78%), and palliative in 20 (22%). Median age was 57 years (interquartile range [IQR], 50-65.5) for curatively treated patients and 58.5 years (IQR, 44-65.2) for those with advanced disease. Common presenting symptoms were lumps (70%), and pain (57%). Neoadjuvant chemotherapy (NACT) with paclitaxel + platinum was administered to 19 patients (20.9%), of which 7 (37%) attained complete or partial response. Six patients (31.5%) underwent R0 surgery post-NACT. All 71 patients underwent primary surgery; 47 (66.2%) undergoing partial penectomy. Of the 20 patients treated with palliative first-line chemotherapy, 4(20%) attained a partial response. Median OS of patients treated in curative and palliative settings was 33.8 months (95% CI, 17.2-not recorded) and 11.4 months (95% CI, 9.53-23.3), respectively. CONCLUSIONS Patients with penile cancer treated with systemic therapy have poor outcomes. Little over a third of the patients respond to neoadjuvant chemotherapy and those with advanced disease have poor survival despite systemic therapy, emphasizing the need for early detection and optimum management of primary and nodal disease.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Venkatesh Kapu
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Ajaykumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Gagan Prakash
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Nilesh Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Mahendra Pal
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Amandeep Arora
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Sravan Kumar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India.
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9
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Bajpai J, Kapu V, Rath S, Kumar S, Sekar A, Patil P, Siddiqui A, Anne S, Pawar A, Srinivas S, Bhargava P, Gulia S, Noronha V, Joshi A, Prabhash K, Banavali S, Sarin R, Badwe R, Gupta S. Low-dose versus standard-dose olanzapine with triple antiemetic therapy for prevention of highly emetogenic chemotherapy-induced nausea and vomiting in patients with solid tumours: a single-centre, open-label, non-inferiority, randomised, controlled, phase 3 trial. Lancet Oncol 2024; 25:246-254. [PMID: 38224701 DOI: 10.1016/s1470-2045(23)00628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Olanzapine is an effective antiemetic agent but it results in substantial daytime somnolence when administered at the standard dose. Our aim was to compare the efficacy of low-dose versus standard-dose olanzapine after highly emetogenic chemotherapy in patients with solid tumours. METHODS This was a single-centre, open-label, non-inferiority, randomised, controlled, phase 3 trial done in a tertiary care referral centre in India (Tata Memorial Centre, Homi Bhabha National Institute, Mumbai). Patients aged 13-75 years with an Eastern Cooperative Oncology Group performance status of 0-2, who were receiving doxorubicin-cyclophosphamide or high-dose cisplatin for a solid tumour were eligible. Patients were randomly assigned (1:1), with block randomisation (block sizes of 2 or 4) and stratified by sex, age (≥55 or <55 years), and chemotherapy regimen, to receive low-dose (2·5 mg) oral olanzapine or standard-dose (10·0 mg) oral olanzapine daily for 4 days, in combination with a triple antiemetic regimen. Study staff were masked to treatment allocation but patients were aware of their group assignment. The primary endpoint was complete control, defined as no emetic episodes, no rescue medications, and no or mild nausea in the overall phase (0-120 hours), assessed in the modified intention-to-treat (mITT) population (ie, all eligible patients who received protocol-specified treatment, excluding those who had eligibility violations and who withdrew consent after randomisation). Daytime somnolence was the safety endpoint of interest. Non-inferiority was shown if the upper limit of the one-sided 95% CI for the difference in the complete control proportions between the treatment groups excluded the non-inferiority margin of 10%. This study is registered with the Clinical Trial Registry India, CTRI/2021/01/030233, is closed to accrual, and this is the final data analysis. RESULTS Between Feb 9, 2021, and May 30, 2023, 356 patients were pre-screened for eligibility, of whom 275 patients were enrolled and randomly assigned (134 to the 2·5 mg olanzapine group and 141 to the 10·0 mg olanzapine group). 267 patients (132 in the 2·5 mg group and 135 in the 10·0 mg group) were included in the mITT population, of whom 252 (94%) were female, 15 (6%) were male, and 242 (91%) had breast cancer. 59 (45%) of 132 patients in the 2·5 mg olanzapine group had complete control in the overall phase versus 59 (44%) of 135 in the 10·0 mg olanzapine group (difference -1·0% [one-sided 95% CI -100·0 to 9·0]; p=0·87). In the overall phase, there were significantly fewer patients in the 2·5 mg olanzapine group than in the 10·0 mg olanzapine group with daytime somnolence of any grade (86 [65%] of 132 vs 121 [90%] of 135; p<0·0001) and of severe grade on day 1 (six]5%] vs 54 [40%]; p<0·0001). INTERPRETATION Our findings suggest that olanzapine 2·5 mg is non-inferior to 10·0 mg in antiemetic efficacy and results in reduced occurrence of daytime somnolence among patients receiving highly emetic chemotherapy and should be considered as a new standard of care. FUNDING Progressive Ladies Welfare Association.
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Affiliation(s)
- Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Venkatesh Kapu
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sushmita Rath
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sravan Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anbarasan Sekar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Priyanka Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Altaf Siddiqui
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Srikanth Anne
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Akash Pawar
- Department of Biostatistics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sujay Srinivas
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Prabhat Bhargava
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rajiv Sarin
- Department of Radiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rajendra Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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10
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Shah M, Noronha V, Patil V, Menon N, Singh AK, Shah A, Kumar P, Roychoudhary O, Peelay Z, Janu A, Purandare N, Chakrabarty N, Patil V, Kaushal R, Shetty O, Pai T, Chandrani P, Chougule A, Prabhash K. The Role of Systemic Therapy in Patients with Advanced Non-small Cell Lung Cancer and a Poor Eastern Cooperative Oncology Group Performance Status. Clin Oncol (R Coll Radiol) 2024; 36:128-129. [PMID: 38097463 DOI: 10.1016/j.clon.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Affiliation(s)
- M Shah
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - V Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - N Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - A K Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - A Shah
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - P Kumar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - O Roychoudhary
- Biostatistics, Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Z Peelay
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - A Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - N Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - N Chakrabarty
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - V Patil
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - R Kaushal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - O Shetty
- Department of Molecular Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - T Pai
- Department of Molecular Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - P Chandrani
- Department of Medical Oncology Molecular Laboratory, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - A Chougule
- Department of Molecular Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
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11
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Sambath J, Noronha V, Manda SS, Mishra R, Chandrani P, Patil V, Menon N, Chougule A, Ramachandran V, Limaye S, Kuriakose MA, Banavali SD, Kumar P, Prabhash K. Whole exome sequencing uncovers HRAS mutations as potential mediators of resistance to metronomic chemotherapy. Gene 2024; 893:147952. [PMID: 37918550 DOI: 10.1016/j.gene.2023.147952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES The aim of this pilot study is to identify the genetic factors that contribute to the response of metronomic chemotherapy in head and neck squamous cell carcinoma (HNSCC) patients using whole-exome sequencing (WES). This study would facilitate the identification of predictive biomarkers, which would enable personalized treatment strategies and improve treatment outcomes for patients with HNSCC. MATERIALS AND METHODS We have selected patients with recurrent head and neck cancer who underwent metronomic chemotherapy. Sequential tumor biopsies were collected from the patients at different stages of treatment to capture the genomic alterations and tumor evolution during metronomic chemotherapy and sequenced using WES. RESULTS We identified several known HNSCC hallmark genes reported in COSMIC, including KMT2B, NOTCH1, FAT1, TP53, HRAS, CASP8, and CDKN2A. Copy number alteration analysis revealed amplifications and deletions in several oncogenic and tumor suppressor genes. COSMIC Mutational Signature 15 associated with defective DNA mismatch repair was enriched in 73% of HNSCC samples. Further, the comparison of genomic alterations between responders and non-responders identified HRAS gene uniquely mutated in non-responders that could potentially contribute to resistance against metronomic chemotherapy. DISCUSSION Our findings corroborate the molecular heterogeneity of recurrent HNSCC tumors and establish an association between HRAS mutations and resistance to metronomic chemotherapy, suggesting HRAS as a potential therapeutic target. Combining HRAS inhibitors with metronomic regimens could improve treatment sensitivity in HRAS-mutated HNSCC patients. Further studies are needed to fully elucidate the genomic mechanisms underlying the response to metronomic chemotherapy.
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Affiliation(s)
- Janani Sambath
- Institute of Bioinformatics, Bangalore, India; Manipal Academy of Higher Education (MAHE), Manipal, India
| | | | - Srikanth S Manda
- Karkinos Foundation, Mumbai, India; Karkinos Healthcare Pvt Ltd., Mumbai, India
| | | | | | | | | | | | | | - Sewanti Limaye
- Division of Medical and Precision Oncology, Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Moni A Kuriakose
- Karkinos Foundation, Mumbai, India; Karkinos Healthcare Pvt Ltd., Mumbai, India
| | | | - Prashant Kumar
- Karkinos Foundation, Mumbai, India; Karkinos Healthcare Pvt Ltd., Mumbai, India.
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12
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Mahajan A, Shaikh A, Shukla S, Vaish R, Agarwal U, Smriti V, Rastogi S, Deokar S, Suryavanshi S, Chaturvedi P, Laskar SG, Prabhash K, Patil V, Noronha V, Menon N, Pai P, Pantvaidya G, Rane SU, Bal M, Mittal N, Patil A, Dcruz AK. MR imaging-based risk stratification scoring system to predict clinical outcomes in carotid body tumors. Front Oncol 2024; 13:1200598. [PMID: 38348117 PMCID: PMC10860202 DOI: 10.3389/fonc.2023.1200598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/12/2023] [Indexed: 02/15/2024] Open
Abstract
Objectives This study aims to evaluate the role of pretherapy MRI in predicting outcomes in carotid body tumors and propose a grading system for high- and low-risk characteristics. Materials and methods A retrospective observational study of 44 patients with 51 lesions was carried out from year 2005 to 2020. MR images were reviewed for characteristics of carotid body tumor, and a score was given that was correlated with intra- and postoperative findings. The various other classifications and our proposed Mahajan classification were compared with Shamblin's classification. The area under the curve and ROC curves were used to present the accuracy of different predictive models. Results Our scoring system allotted a score of 0 to 15 on the basis of MRI characteristics, with scores calculated for patients in our study ranging from 0 to 13. Lesions with scores of 0-6 were considered low risk (45%), and scores of 7-15 were regarded as high risk for surgery (55%). The Mahajan classification stages tumors into four grades: I (10%), II (20%), IIIa (8%), and IIIb (62%). The frequency of vascular injury was 50% in category I and 64% in category IIIb. The frequency of cranial nerve injury was 50%, 66%, and 27% in categories I, II, and IIIb. Conclusion The Mahajan classification of CBTs evaluates high-risk factors like the distance of the tumor from the skull base and the angle of contact with ICA, which form the major predictors of neurovascular damage and morbidity associated with its surgery. Though the Shamblin classification of CBT is the most widely accepted classification, our proposed Mahajan classification system provides an imaging-based alternative to prognosticate surgical candidates preoperatively.
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Affiliation(s)
- Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Atif Shaikh
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Shreya Shukla
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Richa Vaish
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Ujjwal Agarwal
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | | | - Shivam Rastogi
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | - Shonal Deokar
- Department of Radiology, Tata Memorial Hospital, Mumbai, India
| | | | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Nandini Menon
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Prathamesh Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Anil Keith Dcruz
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India
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13
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Vaish R, Mahajan A, Ghosh Laskar S, Prabhash K, Noronha V, D’Cruz AK. Editorial: Site specific imaging guidelines in head & neck, and skull base cancers. Front Oncol 2024; 14:1357215. [PMID: 38304872 PMCID: PMC10830622 DOI: 10.3389/fonc.2024.1357215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
- Richa Vaish
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Radiology, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Kumar Prabhash
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anil K. D’Cruz
- Oncology-Apollo Group of Hospitals, Department of Oncology, Apollo Hospital, Navi Mumbai, India
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Panda GS, Noronha V, Patil V, Joshi A, Menon N, Kumar R, Pai T, Shetty O, Janu A, Chakrabarty N, Purandare N, Dey S, Prabhash K. Clinical outcomes of ROS1-positive non-small cell lung cancer with limited access to ROS1-tyrosine kinase inhibitors (TKIs): experience from an Indian tertiary referral centre. Ecancermedicalscience 2024; 18:1654. [PMID: 38425761 PMCID: PMC10901635 DOI: 10.3332/ecancer.2024.1654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction ROS1 as a driver mutation is observed in approximately 1%-2% of all non-small cell lung cancer (NSCLC). Given its rarity, we share our experience regarding ROS1-positive NSCLC including the access to ROS1 tyrosine kinase inhibitors (TKIs) in a low-middle income country like India. Methods It is a retrospective analysis of ROS1-positive NSCLC patients registered between January 2015 to December 2021 for demographics, treatment patterns and outcomes i.e., overall survival (OS) and progression free survival (PFS). Results Baseline characteristics were available for 70 patients of 78 patients positive for ROS1 by fluorescent in situ hybridisation. Median age at presentation was 52 years, 39 (55.7%) were males, most (51, 72.86%) were non-smokers and ten patients (14.3%) had poor Eastern Cooperative Oncology Group (ECOG) performance status (PS) i.e., PS >2 at presentation. A total of 67 patients receiving cancer directed therapy were analysed for survival. The first line (1L) therapies included - ROS1 TKIs in 38, chemotherapy in 20, epidermal growth factor receptor TKI in eight and chemotherapy-bevacizumab in one only. ROS1 TKI was provided to 20 patients as part of an assistance programme. The median OS for patients who received ROS1 TKI was not attained (95% CI 37.85-NA), while it was 8.11 (95% CI 6.31-NA) months for those who did not (HR-0.1673). The median PFS for the 1L ROS1 TKI compared to the no-TKI group was 27.07 (95% CI 24.28-NA) months versus 5.78 (95% CI 3.42-12) months (HR: 0.2047). Poor ECOG PS at presentation was the only independent prognosticator for survival. Conclusion Using ROS1 TKI improves clinical outcomes in all-comers though statistically not significant. To further improve outcomes, future trials should pay special attention to patients with poor PS and find a way to increase the current limited access to TKI.
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Affiliation(s)
- Goutam Santosh Panda
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
| | - Vanita Noronha
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
| | - Vijay Patil
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
| | - Amit Joshi
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
| | - Nandini Menon
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
| | - Rajiv Kumar
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
| | - Trupti Pai
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
| | - Omshree Shetty
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
| | - Amit Janu
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
| | - Nivedita Chakrabarty
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
| | - Nilendu Purandare
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
| | - Sayak Dey
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
| | - Kumar Prabhash
- Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr E Borges Road, Parel, Mumbai 400 012, India
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15
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Kumar S, Castelino R, Rao A, Gattani S, Kumar A, Pillai A, Sehgal A, Rane P, Ramaswamy A, Dhekale R, Krishnamurthy J, Banavali S, Badwe R, Prabhash K, Noronha V, Gota V. Performance of potentially inappropriate medications assessment tools in older Indian patients with cancer. Cancer Med 2024; 13:e6797. [PMID: 38183404 PMCID: PMC10807583 DOI: 10.1002/cam4.6797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medication (PIM) use are common problems in older adults. Safe prescription practices are a necessity. The tools employed for the identification of PIM sometimes do not concur with each other. METHODS A retrospective analysis of patients ≥60 years who visited the Geriatric Oncology Clinic of the Tata Memorial Hospital, Mumbai, India from 2018 to 2021 was performed. Beer's-2015, STOPP/START criteria v2, PRISCUS-2010, Fit fOR The Aged (FORTA)-2018, and the EU(7)-PIM list-2015 were the tools used to assess PIM. Every patient was assigned a standardized PIM value (SPV) for each scale, which represented the ratio of the number of PIMs identified by a given scale to the total number of medications taken. The median SPV of all five tools was considered the reference standard for each patient. Bland-Altman plots were utilized to determine agreement between each scale and the reference. Association between baseline variables and PIM use was determined using multiple logistic regression analysis. RESULTS Of the 467 patients included in this analysis, there were 372 (79.66%) males and 95 (20.34%) females with an average age of 70 ± 5.91 years. The EU(7)-PIM list was found to have the highest level of agreement given by a bias estimate of 0.010, the lowest compared to any other scale. The 95% CI of the bias was in the narrow range of -0.001 to 0.022, demonstrating the precision of the estimate. In comparison, the bias (95%) CI of Beer's criteria, STOPP/START criteria, PRISCUS list, and FORTA list were -0.039 (-0.053 to -0.025), 0.076 (0.060 to 0.092), 0.035 (0.021 to 0.049), and -0.148 (-0.165 to -0.130), respectively. Patients on polypharmacy had significantly higher PIM use compared to those without (OR = 1.47 (1.33-1.63), p = <0.001). CONCLUSIONS The EU(7)-PIM list was found to have the least bias and hence can be considered the most reliable among all other tools studied.
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Affiliation(s)
- Sharath Kumar
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Renita Castelino
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Abhijith Rao
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Shreya Gattani
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Anita Kumar
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Anupa Pillai
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Arshiya Sehgal
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Pallavi Rane
- Department of StatisticsAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Anant Ramaswamy
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Ratan Dhekale
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | | | - Shripad Banavali
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Rajendra Badwe
- Homi Bhabha National InstituteMumbaiIndia
- Department of Surgical OncologyTata Memorial HospitalMumbaiMaharashtraIndia
| | - Kumar Prabhash
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Vanita Noronha
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Vikram Gota
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
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16
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Noronha V, Dhanawat A, Patil VM, Menon N, Singh AK, Chaturvedi P, Pai P, Chaukar D, Laskar SG, Prabhash K. Long-term outcomes of neo-adjuvant chemotherapy on borderline resectable oral cavity cancers: Real-world data of 3266 patients and implications for clinical practice. Oral Oncol 2024; 148:106633. [PMID: 37988838 DOI: 10.1016/j.oraloncology.2023.106633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/08/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Neo-adjuvant chemotherapy (NACT) followed by response assessment is the standard treatment algorithm for locally advanced oral cavity squamous cell carcinomas (OCSCC) in the Indian subcontinent. The 3-drug NACT regimen (Docetaxel-Cisplatin-5-FU) has shown improvement in overall survival over 2-drug regimen (Docetaxel-Cisplatin) in a phase-3 randomised study. We have analysed the 10-year outcomes with this treatment algorithm. METHODS This was an institutional review board approved retrospective analysis of a prospectively collected dataset of borderline resectable OCSCC patients who underwent NACT. Patients who became resectable after NACT underwent surgery followed by appropriate adjuvant therapy. Patients who were unresectable received definitive chemoradiation (CTRT), palliative chemotherapy, radiotherapy or best supportive care based on general condition. RESULTS A total of 3266 patients were included. The most common subsite was buccal mucosa and the most frequent indication was peri-tumoral edema upto zygoma. More than 2-drugs NACT was offered to 32.9% patients. Overall, 32.5% patients had a response to NACT. A total of 1358 patients were offered curative treatment, of which 929 (32%) underwent surgery and the rest underwent definitive chemo-radiation (14.8%). Patients who received more than 2-drugs NACT versus those who received 2-drugs had a 10-years OS of 21% vs 5.1% (p < 0.001). Patients who underwent surgery versus those who did not had a 10-year OS of 21.8% vs 4.1% (p < 0.001). Patients who achieved pCR had a 5-year OS of 45.3% vs 13.3% for those who did not (p < 0.001). CONCLUSION NACT leads to long term survival benefit in patients of borderline resectable oral cavity cancer.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Aditya Dhanawat
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Ajay Kumar Singh
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Prathamesh Pai
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Devendra Chaukar
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India.
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17
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Noronha V, Menon NS, Patil VM, Chandrakanth M, More S, Dhanawat A, Chowdhary OR, Singh AC, Goud S, Shah S, Karuvandan N, Jobanputra KN, Shah DK, Shah MJ, Sarma R, Patel D, Joarder R, Kumar P, John A, Kaur J, Bagra S, Purandare N, Janu A, Mahajan A, Prabhash K. A Comparative Study Evaluating the Quality of Life and Survival Outcomes in Patients Receiving Chemotherapy Versus Oral Tyrosine Kinase Inhibitor in the Third Line and Beyond Setting for Advanced NSCLC. JTO Clin Res Rep 2024; 5:100622. [PMID: 38292414 PMCID: PMC10827558 DOI: 10.1016/j.jtocrr.2023.100622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 11/16/2023] [Accepted: 12/10/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction The outcomes in advanced NSCLC have improved owing to the availability of more effective systemic and improved supportive care. This has increased the number of patients who seek treatment in the third line and beyond setting. We conducted this study to compare the quality of life (QoL), toxicity, and outcomes in patients receiving chemotherapy and EGFR tyrosine kinase inhibitors (TKIs) in this setting. Methods In this phase 3, randomized, open-label study, patients with stage III or IV NSCLC with disease progression on at least two prior lines of chemotherapy, with a life expectancy of at least 3 months, without prior EGFR TKI exposure, and stable brain metastases (if any) were included. Patients were randomized to receive chemotherapy (gemcitabine or docetaxel or paclitaxel or vinorelbine) or an EGFR TKI (erlotinib or gefitinib). The primary end point was the change in QoL at 8 to 10 weeks; the secondary outcomes were safety and overall survival (OS). Patients underwent clinical evaluation at every visit, and toxicity was assessed as per Common Terminology Criteria for Adverse Events version 4.03. A radiological tumor response assessment was done every 8 to 12 weeks from the start of therapy. The QoL was assessed using the EORTC QLQ C30 and LC13 questionnaires. The change in QoL scores was calculated as the difference between scores at baseline and scores at 8 to 10 weeks (Δ) for each QoL domain. The Mann-Whitney U test was used to compare the mean difference (Δ) for each domain. OS and progression-free survival (PFS) were determined using the Kaplan-Meier method and Cox proportional regression analysis. Results A total of 246 patients were enrolled in the study, with 123 in each arm. There was a male predominance with 69.1% male patients in the chemotherapy arm and 70.7% in the EGFR TKI arm. The median age of patients in the chemotherapy arm was 54 years and 55 years in the chemotherapy and EGFR TKI arms, respectively. There was no significant difference in the change in QoL at baseline and the second visit (Δ) in both arms in all domains of EORTC QLQ C30 except cognitive function (p = 0.0045) and LC13 except alopecia (0.01249). The mean Δ Global Health Status was -28 in the chemotherapy arm and -26.8 in the EGFR TKI arm; this was not statistically significant (p = 0.973). The median follow-up was 88.1 months (95% confidence interval [CI]: 39.04-137.15). On the intention-to-treat analysis, the median PFS was 3.13 months (95% CI: 2.15-4.11) in the chemotherapy arm and 2.26 months (95% CI: 2.1-2.43) in the EGFR TKI arm, with hazard ratio at 1.074 (95% CI: 0.83-1.38) (p = 0.58). There were 120 deaths in each arm. The median OS was 7.63 months (95% CI: 5.96-9.30) in the chemotherapy arm and 7.5 months in the EGFR TKI arm (95% CI: 5.85-9.14); hazard ratio at 1.033 (95% CI: 0.80-1.33) (p = 0.805). The toxicity profile was similar in both arms except for a significantly higher incidence of fatigue (p = 0.043), peripheral neuropathy (0.000), alopecia, hypokalemia (0.037), and pedal edema (0.007) in the chemotherapy arm and dry skin (p = 0.000) and skin rash (p = 0.019) in the EGFR TKI arm. Conclusions There was no significant difference in most QoL scales (except cognitive function and alopecia), OS, and PFS of patients with advanced NSCLC receiving an EGFR TKI as compared with chemotherapy TKI in the third-line setting. The toxicity profile is consistent with the known toxicities of the agents.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nandini S. Menon
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M.V. Chandrakanth
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sucheta More
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Aditya Dhanawat
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Oindrila Roy Chowdhary
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Supriya Goud
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Srushti Shah
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Naveen Karuvandan
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Minit Jalan Shah
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rupjyoti Sarma
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Dhwaniben Patel
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ritam Joarder
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Prashant Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anupa John
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jaspreet Kaur
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Saurabh Bagra
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Janu
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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18
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Rao AR, Noronha V, Ramaswamy A, Kumar A, Pillai A, Gattani S, Sehgal A, Kumar S, Castelino R, Dhekale R, Krishnamurthy J, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nookala M, Chitre A, Kapoor A, Gota V, Banavali S, Badwe RA, Prabhash K. Correlation of the Geriatric Assessment with Overall Survival in Older Patients with Cancer. Clin Oncol (R Coll Radiol) 2024; 36:e61-e71. [PMID: 37953073 DOI: 10.1016/j.clon.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/09/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
AIMS Global guidelines recommend that all older patients with cancer receiving chemotherapy should undergo a geriatric assessment. However, utilisation of the geriatric assessment is often constrained by its time-intensive nature, which limits its adoption in settings with limited resources and high demand. There is a lack of evidence correlating the results of the geriatric assessment with survival from the Indian subcontinent. Therefore, the aims of the present study were to assess the impact of the geriatric assessment on survival in older Indian patients with cancer and to identify the factors associated with survival in these older patients. MATERIALS AND METHODS This was an observational study, conducted in the geriatric oncology clinic of the Tata Memorial Hospital (Mumbai, India). Patients aged 60 years and older with cancer who underwent a geriatric assessment were enrolled. We assessed the non-oncological geriatric domains of function and falls, nutrition, comorbidities, cognition, psychology, social support and medications. Patients exhibiting impairment in two or more domains were classified as frail. RESULTS Between June 2018 and January 2022, we enrolled 897 patients. The median age was 69 (interquartile range 65-73) years. The common malignancies were lung (40.5%), oesophagus (31.9%) and genitourinary (12.1%); 54.6% had metastatic disease. Based on the results of the geriatric assessment, 767 (85.4%) patients were frail. The estimated median overall survival in fit patients was 24.3 (95% confidence interval 18.2-not reached) months, compared with 11.2 (10.1-12.8) months in frail patients (hazard ratio 0.54; 95% confidence interval 0.41-0.72, P < 0.001). This difference in overall survival remained significant after adjusting for age, sex, primary tumour and metastatic status (hazard ratio 0.56; 95% confidence interval 0.41-0.74, P < 0.001). In the patients with a performance status of 0 or 1 (n = 454), 365 (80.4%) were frail; the median overall survival in the performance status 0-1 group was 33.0 months (95% confidence interval 24.31-not reached) in the fit group versus 14.4 months (95% confidence interval 12.25-18.73) in the frail patients (hazard ratio 0.50; 95% confidence interval 0.34-0.74, P = 0.001). In the multivariate analysis, the geriatric assessment domains that were predictive of survival were function (hazard ratio 0.68; 95% confidence interval 0.52-0.88; P = 0.003), nutrition (hazard ratio 0.64; 95% confidence interval 0.48-0.85, P = 0.002) and cognition (hazard ratio 0.67; 95% confidence interval 0.49-0.91, P = 0.011). DISCUSSION The geriatric assessment is a powerful prognostic tool for survival among older Indian patients with cancer. The geriatric assessment is prognostic even in the cohort of patients thought to be the fittest, i.e. performance status 0 and 1. Our study re-emphasises the critical importance of the geriatric assessment in all older patients planned for cancer-directed therapy.
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Affiliation(s)
- A R Rao
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Kumar
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Pillai
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S Gattani
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - S Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - R Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - R Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - J Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - L Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - N Ansari
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Vagal
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Mahajan
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Timmanpyati
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Nookala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - A Chitre
- Department of Physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - A Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - V Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - S Banavali
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - R A Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India.
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19
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Noronha V, Patil V, Menon N, Kalra D, Singh A, Shah M, Goud S, Jobanputra K, Nawale K, Shah S, Chowdhury OR, Mathrudev V, Jogdhankar S, Singh MY, Singh A, Adak S, Sandesh M, Arunkumar R, Kumar S, Mahajan A, Prabhash K. Repurposing pantoprazole in combination with systemic therapy in advanced head and neck squamous cell carcinoma: a phase I/II randomized study. Med Oncol 2023; 41:26. [PMID: 38129716 DOI: 10.1007/s12032-023-02234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/28/2023] [Indexed: 12/23/2023]
Abstract
Pantoprazole decreases the acidity of the tumor microenvironment by inhibiting proton pumps on the cancer cell. This possibly leads to increased sensitivity to cytotoxic therapy. We conducted a phase I/II randomized controlled trial in adult patients with head and neck squamous cell carcinoma (HNSCC) planned for first-line palliative chemotherapy. Patients were randomized to chemotherapy + / - intravenous (IV) pantoprazole. The primary endpoint in phase I was to determine the maximum safe dose of intravenous pantoprazole, whereas it was progression-free survival (PFS) in phase II. The dose of IV pantoprazole established in phase I was 240 mg. Between Nov'18 and Oct'20, we recruited 120 patients in phase II, 59 on pantoprazole and 61 on the standard arm. Median age was 51 years (IQR 43-60), 80% were men. Systemic therapy was IV cisplatin in 22% and oral-metronomic-chemotherapy (OMC) in 78%. Addition of pantoprazole did not prolong PFS, which was 2.2 months (95% CI 2.07-3.19) in the pantoprazole arm and 2.5 months (95% CI 2.04-3.81, HR, 1.14; 95% CI 0.78-1.66; P = 0.48) in the standard arm. Response rates were similar; pantoprazole arm 8.5%, standard arm 6.6%; P = 0.175. Overall survival was also similar; 5.6 months (95% CI 4.47-8.51) in the pantoprazole arm and 5.4 months (95% CI 3.48-8.54, HR 1.06; 95% CI 0.72-1.57; P = 0.75) in the standard arm. Grade ≥ 3 toxicities were similar. Thus, pantoprazole 240 mg IV added to systemic therapy does not improve outcomes in patients with advanced HNSCC.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, P D Hinduja Hospital & Medical Research Centre, Khar & Mahim, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Devanshi Kalra
- Department of Clinical Operations, ImmunoAdoptive Cell Therapy Private Limited, R-977, Rabale Navi, Mumbai, 400701, India
| | - Ajaykumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Minit Shah
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Supriya Goud
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kunal Jobanputra
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Srushti Shah
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Oindrila Roy Chowdhury
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vijayalakshmi Mathrudev
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shweta Jogdhankar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Madhu Yadav Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Ashish Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Supriya Adak
- Department of Clinical Operations, Senior Clinical Study Monitor, DAVA Oncology LP, 2700 W Plano Pkwy, Plano, TX, 75075, USA
| | - Mayuri Sandesh
- Department of Clinical Medicine, Danish Center for Particle Therapy, Aarhus University Hospital, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8200, Aarhus, Denmark
| | - R Arunkumar
- Department of Cardiothoracic and Vascular Surgery, JIPMER, Puducherry, India
| | - Suman Kumar
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis, The Clatterbridge Cancer Centre NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | - Kumar Prabhash
- Department of Medical Oncology, Solid Unit, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, 400012, India.
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Mahajan A, Shukla S, Nandi D, Sable N, Ankathi SK, Vaish R, Patil V, Sahu A, Bhattacharya K, Agarwal U, Pai P, Laskar SG, Chaukar D, Prabhash K, Cruz AD, Patil A, Pantvaidya G, Noronha V, Patil V, Menon N, Thiagarajan S, Chaturvedi P. CT-Based Screening for Pulmonary Metastases in Head and Neck Squamous Cell Cancers: Diagnostic Accuracy and Cost Comparison with PET-CECT. Indian J Surg Oncol 2023; 14:881-889. [PMID: 38187855 PMCID: PMC10766925 DOI: 10.1007/s13193-023-01783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 06/10/2023] [Indexed: 01/09/2024] Open
Abstract
This study's objective was to compare detection rates of radiograph, computed tomography (CT), and positron emission tomography-contrast-enhanced computed tomography (PET-CECT) for pulmonary metastasis/synchronous primary lung tumors in head and neck squamous cell cancer (HNSCC) and its association with clinico-radio-pathological factors. Our retrospective study included 837 HNSCC patients from January 2012 to December 2017. Lung nodules were characterized on CT as benign, indeterminate, and metastatic. The true detection rate and statistical significance of associated risk factors were calculated. Risk factors for metastasis were determined using univariate and multivariate logistic regression models. Seventy-five (8.9%) patients had pulmonary metastasis and 3 (0.3%) had second lung primary. Detection rate of pulmonary metastasis by CT was higher (sensitivity-97.3%, specificity-97.2%) as compared to radiograph (sensitivity 49% and specificity 89%). Correlation was found between pulmonary and extra-pulmonary metastasis and N classification (P = 0.01, P = 0.02) and positive low jugular node (P = 0.001, P = 0.001). Using PET-CECT in place of CT costed an extra outlay of 7,033,805 INR (95,551.85 USD) while detecting distant metastasis in only 4 (0.47%) extra cases. Chest CT is a useful pulmonary metastases screening tool in advanced HNSCC patients with reasonable imaging cost as compared to PET-CT.
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Affiliation(s)
- Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Pembroke Place, Liverpool, L7 8YA UK
| | - Shreya Shukla
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Debanjan Nandi
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Nilesh Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Suman Kumar Ankathi
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Richa Vaish
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Vasundhara Patil
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Arpita Sahu
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Kajari Bhattacharya
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Ujjwal Agarwal
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Sarbani Ghosh Laskar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Anil D.’ Cruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
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Jha AK, Sherkhane UB, Mthun S, Jaiswar V, Purandare N, Prabhash K, Wee L, Rangarajan V, Dekker A. External Validation of Robust Radiomic Signature to Predict 2-Year Overall Survival in Non-Small-Cell Lung Cancer. J Digit Imaging 2023; 36:2519-2531. [PMID: 37735307 PMCID: PMC10584779 DOI: 10.1007/s10278-023-00835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/16/2023] [Accepted: 04/13/2023] [Indexed: 09/23/2023] Open
Abstract
Lung cancer is the second most fatal disease worldwide. In the last few years, radiomics is being explored to develop prediction models for various clinical endpoints in lung cancer. However, the robustness of radiomic features is under question and has been identified as one of the roadblocks in the implementation of a radiomic-based prediction model in the clinic. Many past studies have suggested identifying the robust radiomic feature to develop a prediction model. In our earlier study, we identified robust radiomic features for prediction model development. The objective of this study was to develop and validate the robust radiomic signatures for predicting 2-year overall survival in non-small cell lung cancer (NSCLC). This retrospective study included a cohort of 300 stage I-IV NSCLC patients. Institutional 200 patients' data were included for training and internal validation and 100 patients' data from The Cancer Image Archive (TCIA) open-source image repository for external validation. Radiomic features were extracted from the CT images of both cohorts. The feature selection was performed using hierarchical clustering, a Chi-squared test, and recursive feature elimination (RFE). In total, six prediction models were developed using random forest (RF-Model-O, RF-Model-B), gradient boosting (GB-Model-O, GB-Model-B), and support vector(SV-Model-O, SV-Model-B) classifiers to predict 2-year overall survival (OS) on original data as well as balanced data. Model validation was performed using 10-fold cross-validation, internal validation, and external validation. Using a multistep feature selection method, the overall top 10 features were chosen. On internal validation, the two random forest models (RF-Model-O, RF-Model-B) displayed the highest accuracy; their scores on the original and balanced datasets were 0.81 and 0.77 respectively. During external validation, both the random forest models' accuracy was 0.68. In our study, robust radiomic features showed promising predictive performance to predict 2-year overall survival in NSCLC.
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Affiliation(s)
- Ashish Kumar Jha
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India.
- Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Umeshkumar B Sherkhane
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Mthun
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vinay Jaiswar
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Leonard Wee
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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22
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Batra U, Prabhash K, Agarwal JP, Darlong L, Munshi A, Penumadu P, Thangakunam B, Bansal A. Clinical management of stage III non-small cell lung cancer in India: An expert consensus statement. Asia Pac J Clin Oncol 2023; 19:606-617. [PMID: 36815621 DOI: 10.1111/ajco.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/17/2022] [Accepted: 01/07/2023] [Indexed: 02/24/2023]
Abstract
Non-small cell lung cancer (NSCLC) is considered the most common type of lung cancer (>80% of all lung cancers); patients are often diagnosed at advanced stages of the disease. The management of NSCLC is considered challenging owing to variations in size, an extension of the tumors, involvement patterns, and classification. Although adequate literature and guidelines are available on the management of NSCLC in several countries, an Indian perspective on stage III NSCLC management is lacking. We used the modified Delphi approach to form consensus statements. A thorough literature search was done. The authors then convened and deliberated over published literature, available guidelines, and clinical judgment. Recommendation statements were formed for different clinical scenarios. These statements were sent as a form of survey to other oncologists, and their responses were recorded and mentioned. Evidence-based statements were formed for diagnosing and managing stage III NSCLC. These recommendation statements cover various aspects-surgical, radiation, and medical treatment in various clinical scenarios including adjuvant, neoadjuvant, and consolidation therapies.
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Affiliation(s)
- Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, Delhi, India
| | - Kumar Prabhash
- Department of Medical Oncology, TATA Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, TATA Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Laleng Darlong
- Department of Oncosurgery, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, Delhi, India
| | - Anusheel Munshi
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, Delhi, India
| | | | | | - Abhishek Bansal
- Department of Radiology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, Delhi, India
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23
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Ghosh S, Agrawal A, Rangarajan V, Choudhury S, Maitre P, Purandare N, Shah S, Puranik A, Bakshi G, Joshi A, Prakash G, Menon S, Prabhash K, Norohna V, Pal M, Murthy V. Evaluation of post-chemotherapy residual seminomatous masses by 18F-fluorodeoxyglucose PET/CT using tumor-to-liver ratio - conundrum or solution? Nucl Med Commun 2023; 44:1156-1162. [PMID: 37706256 DOI: 10.1097/mnm.0000000000001762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Assessment of diagnostic accuracy of FDG-PET/CT in the detection of viable disease in post-chemotherapy seminomatous residual masses using visual interpretation, SUVmax, and T/L ratio. METHODS This is a retrospective study assessing the post-chemotherapy seminomatous residual masses of size >3 cm. The PET/CT scan findings were interpreted visually for presence of residual disease which were validated from histopathology reports or imaging follow-up for a maximum of 3 years. SUVmax and T/L ratios were also determined for all the residual lesions. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value NPV were calculated and compared for all three parameters along with ROC analysis to obtain an optimal cutoff value for SUVmax and T/L ratio, respectively. RESULTS Sample size was 49. Out of these 49 patients, 8 had validation of PET results with histopathology. Rest was validated with imaging follow-up. FDG-PET was positive in 30 patients and negative in 19 patients by visual interpretation. The sensitivity, specificity, PPV, and NPV by this method were 100%, 62.5%, 73%, and 100%, respectively. The SUVmax and T/L ratios were also calculated for these lesions. The cutoff for these two variables was 4.56 and 1.21, respectively. The sensitivity, specificity, PPV, and NPV at these cutoffs were 76%, 87.5%, 86%, 77.7%, and 92%, 87.5%, 88%, 91%, respectively. CONCLUSION FDG-PET has a favorable diagnostic value in predicting viable disease in post-chemotherapy seminomatous residual masses and using T/L ratio cutoff of 1.21 will increase the specificity of the test.
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Affiliation(s)
- Suchismita Ghosh
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Sayak Choudhury
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Priyamvada Maitre
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Ameya Puranik
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Ganesh Bakshi
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute and
| | - Gagan Prakash
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute and
| | - Vanita Norohna
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute and
| | - Mahendra Pal
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute,
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24
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Sahu H, Patil VM, Menon N, Singh AK, Biswas S, Janu A, Chakraborty N, Prabhash K, Noronha V. Infections in Patients with Advanced-stage Epidermal Growth Factor Receptor-mutant Lung Cancer - a Post-hoc Analysis of a Randomised Trial. Clin Oncol (R Coll Radiol) 2023; 35:811-812. [PMID: 37838606 DOI: 10.1016/j.clon.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 10/16/2023]
Affiliation(s)
- H Sahu
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - V M Patil
- Department of Medical Oncology, Hinduja Hospital, Mumbai, Maharashtra, India
| | - N Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - A K Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - S Biswas
- Department of Microbiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - A Janu
- Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - N Chakraborty
- Department of Microbiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
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25
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Trivedi V, Noronha V, Sreekanthreddy P, Desai S, Poojary D, Varghese L, Gowda P, Butle A, Mishra R, Bal M, Mittal N, Rane S, Kane S, Basu S, Patil V, Menon N, Singh AK, Chaturvedi P, Chandrani P, Choughule A, Veldore V, Prabhash K, Dutt A. Association of Cutibacterium acnes with human thyroid cancer. Front Endocrinol (Lausanne) 2023; 14:1152514. [PMID: 38027096 PMCID: PMC10668118 DOI: 10.3389/fendo.2023.1152514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The diverse subtypes of thyroid carcinoma have distinct clinical outcomes despite a comparable spectrum of underlying genetic alterations. Beyond genetic alterations, sparse efforts have been made to characterize the microbes associated with thyroid cancer. In this study, we examine the microbial profile of thyroid cancer. Methods We sequenced the whole transcriptome of 70 thyroid cancers (40 papillary and 30 anaplastic). Using Infectious Pathogen Detector IPD 2.0, we analysed the relative abundance of 1060 microbes across 70 tumours from patients with thyroid cancer against 118 tumour samples from patients with breast, cervical, colorectal, and tongue cancer. Results Our analysis reveals a significant prevalence of Cutibacterium acnes in 58.6% thyroid cancer samples compared to other cancer types (p=0.00038). Immune cell fraction analysis between thyroid cancer samples with high and low Cutibacterium loads identify enrichment of immunosuppressive cells, including Tregs (p=0.015), and other anti-inflammatory cytokines in the tumour microenvironment, suggesting an immune evasion/immunosuppression milieu is associated with the infection. A higher burden of Cutibacterium acnes was also found to be associated with poor survival defining a distinct sub-group of thyroid cancer. Conclusion Cutibacterium acnes is associated with immune suppression and poor prognosis in a subpopulation of thyroid cancer. This study may help design novel therapeutic measures involving appropriate antibiotics to manage the disease better.
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Affiliation(s)
- Vaishakhi Trivedi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Sanket Desai
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - Disha Poojary
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Linu Varghese
- 4baseCare Oncosolutions Pvt ltd, Institute of Bioinformatics and Applied Biotechnology, Bengaluru, Karnataka, India
| | - Pooja Gowda
- 4baseCare Oncosolutions Pvt ltd, Institute of Bioinformatics and Applied Biotechnology, Bengaluru, Karnataka, India
| | - Ashwin Butle
- Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - Rohit Mishra
- Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - Munita Bal
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Neha Mittal
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Swapnil Rane
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shubhada Kane
- Consultant Onco-pathologist, Jaslok Hospital, Mumbai, Maharashtra, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ajay Kumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Department of Head and Neck Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Pratik Chandrani
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Medical oncology molecular laboratory, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Centre for Computational Biology, Bioinformatics and Crosstalk Lab, Advanced Centre for Treatment, Research, and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - Anuradha Choughule
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vidya Veldore
- 4baseCare Oncosolutions Pvt ltd, Institute of Bioinformatics and Applied Biotechnology, Bengaluru, Karnataka, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Dutt
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment, Research, and Education in Cancer, Navi Mumbai, Maharashtra, India
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Chougule A, Chandrani P, Noronha V, Pange P, Kale S, Nikam A, Nambiar K, Marchande D, Durve A, Gupta V, Jagtap V, Tiwrekar P, Menon N, Joshi A, Kaushal R, Pai T, Patil VM, Dutt A, Banavali SD, Prabhash K. Real-World Evidence of EGFR Targeted Therapy in NSCLC- A Brief Report of Decade Long Single Center Experience. JTO Clin Res Rep 2023; 4:100566. [PMID: 38033811 PMCID: PMC10682910 DOI: 10.1016/j.jtocrr.2023.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/10/2023] [Accepted: 08/20/2023] [Indexed: 12/02/2023] Open
Abstract
The significance of EGFR targeted therapy in the lung adenocarcinoma is paramount. Several controlled clinical trials have reported considerable survival of EGFR mutation positive patients on receiving the EGFR tyrosine kinase inhibitor (TKI). However, the real-world evidence of benefits of EGFR TKI would be further useful to understand how the designated therapeutic regimen benefits the patients. In this study, we report a decade long real-world evidence of EGFR molecular testing in lung cancer at Tata Memorial Hospital (Mumbai, India). Laboratory and hospital records containing basic demographic details, clinical characteristics, treatment regimen, survival outcome were collected retrospectively. Statistical association and survival analysis were performed using the R programming. The cohort includes 9,053 lung cancer patients tested for EGFR mutations during 2011 to 2019. Baseline T790M and compound mutations were the only mutations observed co-occurring while all other EGFR mutations were mutually exclusive. Furthermore, the baseline T790M were also observed to be associated with TTF1 positivity, smoking and local metastasis. Overall survival of the patients harboring co-occurring compound mutations was significantly lesser than the other EGFR positive patients. Overall, our study suggests that EGFR TKI may provide real-world benefit to the lung cancer patients harboring mutually exclusive EGFR mutations. On the other hand, further systematic study is essential to develop better therapeutic regimen for co-occurring baseline EGFR T790M and other compound mutations.
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Affiliation(s)
- Anuradha Chougule
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Pratik Chandrani
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Centre for Computational Biology, Bioinformatics and Crosstalk Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Vanita Noronha
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Priyanka Pange
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Shrutikaa Kale
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Ankita Nikam
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Kavya Nambiar
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Dipika Marchande
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Arpana Durve
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Vinod Gupta
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Vinita Jagtap
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Priyanka Tiwrekar
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Nandini Menon
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Amit Joshi
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Rajeev Kaushal
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Trupti Pai
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Vijay Maruti Patil
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Amit Dutt
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Integrated Genomics Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, India
| | - Shripad Dinanath Banavali
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Kumar Prabhash
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
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Mahajan A, Goyal D, Agarwal U, Patil V, Shukla S, Noronha V, Joshi A, Menon N, Prabhash K. Exploring the implications of modified advanced lung cancer inflammation index on outcomes in patients with advanced non-small cell lung cancer. Explor Target Antitumor Ther 2023; 4:896-911. [PMID: 37970209 PMCID: PMC10645468 DOI: 10.37349/etat.2023.00172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/20/2023] [Indexed: 11/17/2023] Open
Abstract
Aim Sarcopenia and skeletal muscle density (SMD) have been shown to be both predictive and prognostic marker in oncology. Advanced lung cancer inflammation index (ALI) has been shown to predict overall survival (OS) in small cell lung cancer (SCLC). Computed tomography (CT) enables skeletal muscle to be quantified, whereas body mass index (BMI) cannot accurately reflect body composition. The purpose was to evaluate the prognostic value of modified ALI (mALI) using CT-determined third lumbar vertebra (L3) muscle index beyond original ALI and see the interaction between sarcopenia, SMD, neutrophil-lymphocyte ratio (NLR), ALI and mALI at baseline and post 4 cycles of chemotherapy and their effects on OS and progress free survival (PFS) in patients with advanced non-SCLC (NSCLC). Methods This retrospective study consisted of a total of 285 advanced NSCLC patients. The morphometric parameters such as SMD, skeletal muscle index (SMI) and fat-free mass (FFM) were measured by CT at the L3 vertebra. ALI was defined as BMI × serum albumin/NLR and mALI was defined as SMI × serum albumin/NLR. Results Sarcopenia was observed in over 70% of patients across all BMI categories. Patients having sarcopenia suffered from a higher incidence of chemotherapeutic drug toxicities but this was not found to be statistically significant. Concordance was seen between ALI and mALI in the pre-treatment setting and this was statistically significant. A significant proportion of patients with poor ALI (90.9%), poor pre-chemotherapy mALI (91.3%) and poor post-chemotherapy mALI (89%) had poor NLR and each of them was statistically significant. Conclusions In both univariate and multivariate analyses, this study demonstrated the statistical significance of sarcopenia, SMD, and mALI as predictive factors for OS. Additionally, sarcopenia and SMD were also found to be statistically significant factors in predicting PFS. These biomarkers could potentially help triage patients for active nutritional intervention for better outcomes.
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Affiliation(s)
- Abhishek Mahajan
- Clatterbridge Centre for Oncology NHS Foundation Trust, L7 8YA Liverpool, UK
| | - Devendra Goyal
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ujjwal Agarwal
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Shreya Shukla
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
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Saravanabavan S, Prakash GJ, Joshi A, Pal M, Gujela A, Arora A, Bakshi G, Prabhash K, Noronha V, Murthy V, Maitre P, Teja R. Patterns of Utilization and Outcomes of Perioperative Chemotherapy in Patients With Locally Advanced-urothelial Bladder Cancer (LABC)-Real World Data From an Indian Tertiary Care Cancer Center. Clin Genitourin Cancer 2023; 21:e326-e333. [PMID: 37211451 DOI: 10.1016/j.clgc.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 05/23/2023]
Abstract
AIM Optimal utilization of perioperative systemic therapy in locally advanced bladder cancer (LABC) holds the key in improving the survival outcomes. We aim to analyze the oncological outcomes of clinically locally advanced urothelial bladder cancer patients treated with neoadjuvant (NACT) or adjuvant chemotherapy or without any systemic therapy in the perioperative period of radical cystectomy. METHODS & MATERIAL We retrospectively analyzed the medical records of patients with cancer of the urinary bladder diagnosed between 2012 and 2020. The demographic profile, and the treatment received, was recorded for all patients. Oncological outcomes of the patients based on these variables were analyzed. RESULTS Two hundred and twenty nine (229) locally advanced bladder cancer patients were included in the study. Eighty eight (38%) of them underwent upfront radical cystectomy and 141 (62%) received neoadjuvant chemotherapy (NACT). With a median follow-up of 27 months, the 2-year DFS in either of the groups was 65.4% and 67.1% respectively (P - 0.373). In the multivariate analysis, the pathological lymph nodal status and lymph vascular invasion (LVI) status influenced the DFS. The initial modality of management chosen did not affect the outcome. (HR - 0.688; 95% CI: 0.38-1.21). The commonest reason for not receiving NACT was Cisplatin ineligibility due to malignant obstructive uropathy and a subgroup analysis of this set of patients also did not show any significant difference in 2 year DFS compared to those who received NACT. CONCLUSION A significant proportion of patients with LABC are unable to receive the recommended neoadjuvant chemotherapy and obstructive uropathy is the commonest reason for this in our centre. In our single centre series upfront radical cystectomy followed by adjuvant platinum based therapy had an outcome similar to neoadjuvant chemotherapy in LABC patients, in patients who were unable to receive the same due to various reasons.
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Affiliation(s)
- Srivishnu Saravanabavan
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Gagan J Prakash
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001.
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001. https://twitter.com/https://twitter.com/drgaganprakash
| | - Mahendra Pal
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Ajit Gujela
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Amandeep Arora
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Ganesh Bakshi
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Priyamvada Maitre
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Ravi Teja
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
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Paul S, Gupta T, Purandare N, Joshi K, Ghosh-Laskar S, Budrukkar A, Swain M, Sinha S, Kumar A, Joshi A, Prabhash K, Nair S, Rangarajan V, Agarwal JP. Diagnostic Performance of Response Assessment FDG-PET/CECT in HNSCC Treated With Definitive Radio(chemo)therapy Using NI-RADS. Otolaryngol Head Neck Surg 2023; 169:938-947. [PMID: 36856038 DOI: 10.1002/ohn.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/12/2023] [Accepted: 01/30/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To assess the diagnostic performance of response assessment 18F-fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (FDG-PET/CECT) following definitive radio(chemo)therapy in head and neck squamous cell carcinoma (HNSCC) using Neck Imaging Reporting and Data System (NI-RADS). STUDY DESIGN A retrospective analysis from a prospectively maintained dataset. SETTING Tertiary-care comprehensive cancer center in a low-middle-income country. METHODS Adults with newly diagnosed, biopsy-proven, nonmetastatic HNSCC treated with definitive radio(chemo)therapy were included. Posttreatment response assessment FDG-PET/CECT scans were retrospectively assigned NI-RADS categories (1-3) for the primary site, neck, and both sites combined. Locoregional recurrence occurring within 2-years was defined as the event of interest. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Locoregional control stratified by NI-RADS categories was computed with the Kaplan-Meier method and compared using the log-rank test. RESULTS Posttreatment FDG-PET/CECT scans were available in 190 patients constituting the present study cohort. Sensitivity, specificity, PPV, NPV, and overall accuracy of the NI-RADS template for the primary site was 73.5%, 81.4%, 46.3%, 93.4%, and 80.0%, respectively. Similar metrics for the neck were 72.7%, 87.5%, 43.2%, 96.1%, and 85.8%, respectively. Combining primary site and neck, the corresponding metrics of diagnostic accuracy were 84.4%, 69.7%, 46.3%, 93.5%, and 73.2%, respectively. At a median follow-up of 40 months, Kaplan-Meier estimates of 2-year locoregional control were significantly higher for NI-RADS category 1 (94.2%) compared to NI-RADS category 2 (69.4%) and category 3 (20.4%), respectively (stratified log-rank p < .0001). CONCLUSION FDG-PET/CECT using the NI-RADS template is associated with good diagnostic performance and prognostic utility in HNSCC treated with definitive radio(chemo)therapy.
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Affiliation(s)
- Sonz Paul
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kishore Joshi
- Department of Medical Physics, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
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Mahajan A, Unde H, Sable NP, Shukla S, Vaish R, Patil V, Agarwal U, Agrawal A, Noronha V, Joshi A, Kapoor A, Menon N, Agarwal JP, Laskar SG, Dcruz AK, Chaturvedi P, Pai P, Rane SU, Bal M, Patil A, Prabhash K. Response assessment of post-treatment head and neck cancers to determine further management using NI-RADS (Neck Imaging Reporting and Data System): a subgroup analysis of a randomized controlled trial. Front Oncol 2023; 13:1200366. [PMID: 37810970 PMCID: PMC10552531 DOI: 10.3389/fonc.2023.1200366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/03/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Interpreting complex post-treatment changes in head and neck cancer (HNC) is challenging with further added perplexity due to variable interobserver interpretation and hence evolved the NI-RADS lexicon. We evaluated the accuracy of NI-RADS in predicting disease status on 1st post-treatment follow-up CECT in a homogenous cohort of those who received only chemoradiation. Methods Retrospective analysis of imaging was done for LASHNC patients who received radical chemoradiation in an open-label, investigator-initiated, phase 3 randomized trial (2012-2018) randomly assigned to either radical radiotherapy with concurrent weekly cisplatin (CRT) or CRT with the same schedule plus weekly nimotuzumab (NCRT). 536 patients were accrued, and 74 patients who did not undergo PET/CECT after 8 weeks post-CRT were excluded. After assessing 462 patients for eligibility to allocate NI-RADS at primary and node sites, 435 cases fell in the Primary disease cohort and 412 cases in the Node disease cohort. We evaluated sensitivity, disease prevalence, the positive and negative predictive value of the NI-RADS lexicon, and accuracy, which were expressed as percentages. We also prepared flow charts to determine concordance with allocated NI-RADS category and established accuracy with which it can identify disease status. Results Out of 435 primary disease cohort, 92%, 55%, 48%,70% were concordant and had 100%, 72%, 70%, 82% accuracy in NI-RADS1 (n=12), NI-RADS2 (n=261), NIRADS3 (n=105), and NI-RADS 4 (n=60) respectively. Out of 412 nodes disease cohort, 95%, 90%, 48%, 70%were concordant and had 92%, 97%, 90%, 67% accuracy in NI-RADS1 (n=57), NI-RADS2 (n=255), NI-RADS3 (n=105) and NI-RADS4 (n=60) respectively. % concordance of PET/CT and CECT across all primary and node disease cohorts revealed that PET/CT was 91% concordant in primary NI-RADS2 as compared to 55% concordance of CECT whereas concordance of CECT was better with 57% in primary NI-RADS3 cohort as compared to PET/CT concordance of 41%. Conclusion The accuracy with which the NI-RADS lexicon performed in our study at node sites was better than that at the primary site. There is a great scope of research to understand if CECT performs better over clinical disease status in NI-RADS 3 and 4 categories. Further research should be carried out to understand if PET/CECT can be used for close interval follow-up in stage III/IV NI-RADS 2 cases.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, The Clatterbridge Cancer Centre, University of Liverpool, Liverpool, United Kingdom
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Himangi Unde
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Nilesh P. Sable
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shreya Shukla
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Richa Vaish
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Ujjwal Agarwal
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Archi Agrawal
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Akhil Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anil Keith Dcruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Swapnil Ulhas Rane
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Tanwar NA, Malhotra R, Satheesh AP, Khuntia SP, Sreekanthreddy P, Varghese L, Kolla S, Chandrani P, Choughule A, Pange P, Gupta V, Noronha V, Patil VM, Pramanik R, Kumar S, Nayak SP, Babu S, Shetty R, Kantharaju M, Chinder PS, Korlimarla A, Srinath BS, Prabhash K, Rishi KD, Goswami HM, Veldore VH. Understanding the Impact of Population and Cancer Type on Tumor Mutation Burden Scores: A Comprehensive Whole-Exome Study in Cancer Patients From India. JCO Glob Oncol 2023; 9:e2300047. [PMID: 38085046 PMCID: PMC10846780 DOI: 10.1200/go.23.00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/12/2023] [Accepted: 07/22/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE The purpose of this study was to understand the impact of population diversity and geographic variation on tumor mutation burden (TMB) scores across cancers and its implication on stratification of patients for immune checkpoint inhibitor (ICI) therapy. MATERIALS AND METHODS This retrospective study used whole-exome sequencing (WES) to profile 1,233 Indian patients with cancer across 30 different cancer types and to estimate their TMB scores. A WES-based pipeline was adopted, along with an indigenously developed strategy for arriving at true somatic mutations. A robust unsupervised machine learning approach was used to understand the distribution of TMB scores across different populations and within the population. RESULTS The results of the study showed a biphasic distribution of TMB scores in most cancers, with different threshold scores across cancer types. Patients with cancer in India had higher TMB scores compared with the Caucasian patients. We also observed that the TMB score value at 90th percentile (predicting high efficacy to ICI) was high in four different cancer types (sarcoma, ovary, head and neck, and breast) in the Indian cohort as compared with The Cancer Genome Atlas or public cohort. However, in lung and colorectal cancers, the TMB score distribution was similar between the two population cohorts. CONCLUSION The findings of this study indicate that it is crucial to benchmark both cancer-specific and population-specific TMB distributions to establish a TMB threshold for each cancer in various populations. Additional prospective studies on much larger population across different cancers are warranted to validate this observation to become the standard of care.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anuradha Choughule
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Priyanka Pange
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Vinod Gupta
- Medical Oncology Molecular Laboratory, Tata Memorial Centre, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | | | | | | | | | - Suresh Babu
- Fortis Cancer Research Centre, Bangalore, India
| | | | | | | | - Aruna Korlimarla
- Sri Shankara Cancer Hospital & Research Centre, Bangalore, India
| | - BS Srinath
- Sri Shankara Cancer Hospital & Research Centre, Bangalore, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
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Noronha V, Sekar A, Rajendra A, Mokal S, Patil V, Menon N, Chopade S, Singh AK, Kaushal RK, Mahajan A, Janu A, Purandare N, Dikshit R, Banavali S, Prabhash K, Badwe R. Epidemiological Trend of Esophageal Cancer at a Tertiary Cancer Center in Mumbai, India, Over the Past 15 Years. J Gastrointest Cancer 2023; 54:903-912. [PMID: 36418768 DOI: 10.1007/s12029-022-00887-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In developed countries, there has been a definite change in the histopathological spectrum of esophageal cancer towards adenocarcinoma. There are limited data from India regarding the histopathological profile of patients with esophageal cancer. MATERIALS AND METHODS We retrospectively evaluated patients with histologically proven esophageal cancer who were registered at the Tata Memorial Hospital (Mumbai, India) between 2003 and 2018. The primary aim of the study was to analyze the time-trend of the histological pattern of esophageal cancer. Our secondary objectives included evaluating whether there was any correlation between the histology of the esophageal cancer and the age, sex, socioeconomic status (the paying ability of the patient, which was reflected in the treatment category of the patient, i.e., private [full payment], general [subsidized payment], or no charge), comorbidities, and a history of substance abuse. RESULTS Among 7874 patients with esophageal cancer, 5092 (64.7%) were men, with a male-to-female ratio of 1.8:1. The median age was 57 years (IQR, 50-65). Of the 4912 patients in whom a history of tobacco or alcohol use had been elicited, 1360 (27.7%) had no history of substance abuse. A majority of the tumors (2942, 37.4%) originated in the middle-third of the esophagus. Squamous cell carcinoma was the predominant histological type, noted in 6413 (81.4%) patients and remained the most common histologic type consistently through the study with no evidence of a time-trend in the histological pattern. On the multivariate analysis, female sex and a history of substance abuse were associated with higher odds of squamous cell carcinoma, while the presence of comorbidities and lower esophageal/gastroesophageal junction primaries were associated with higher odds of adenocarcinoma. CONCLUSIONS There is no evidence of an epidemiological shift in the histopathologic spectrum of esophageal cancer in India over the last two decades. Four out of five Indian patients with esophageal cancer have squamous cell histology, with the commonest site of origin being the middle third. This is important to recognize, given the varying molecular spectrum and efficacy of therapeutic modalities based on histopathology.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Anbarasan Sekar
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Akhil Rajendra
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Smruti Mokal
- Department of Biostatistics, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Sunil Chopade
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Ajay Kumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Rajiv Kumar Kaushal
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Amit Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Rajesh Dikshit
- Department of Epidemiology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India.
| | - Rajendra Badwe
- Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
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Murthy V, Maitre P, Singh M, Pal M, Arora A, Pujari L, Kapoor A, Pandey H, Sharma R, Gudipudi D, Joshi A, Prabhash K, Noronha V, Menon S, Mehta P, Bakshi G, Prakash G. Study Protocol of the Bladder Adjuvant RadioTherapy (BART) Trial: A Randomised Phase III Trial of Adjuvant Radiotherapy Following Cystectomy in Bladder Cancer. Clin Oncol (R Coll Radiol) 2023; 35:e506-e515. [PMID: 37208232 DOI: 10.1016/j.clon.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023]
Abstract
AIMS To assess the efficacy and safety of adjuvant radiotherapy in patients with high-risk muscle-invasive bladder cancer (MIBC) following radical cystectomy (RC) and chemotherapy. MATERIALS AND METHODS The BART (Bladder Adjuvant RadioTherapy) trial is an ongoing multicentric, randomised, phase III trial comparing the efficacy and safety of adjuvant radiotherapy versus observation in patients with high-risk MIBC. The key eligibility criteria include ≥pT3, node-positive (pN+), positive margins and/or nodal yield <10, or, neoadjuvant chemotherapy for cT3/T4/N+ disease. In total, 153 patients will be accrued and randomised, in a 1:1 ratio, to either observation (standard arm) or adjuvant radiotherapy (test arm) following surgery and chemotherapy. Stratification parameters include nodal status (N+ versus N0) and chemotherapy (neoadjuvant chemotherapy versus adjuvant chemotherapy versus no chemotherapy). For patients in the test arm, adjuvant radiotherapy to cystectomy bed and pelvic nodes is planned with intensity-modulated radiotherapy to a dose of 50.4 Gy in 28 fractions using daily image guidance. All patients will follow-up with 3-monthly clinical review and urine cytology for 2 years and subsequently 6 monthly until 5 years, with contrast-enhanced computed tomography abdomen pelvis 6 monthly for 2 years and annually until 5 years. Physician-scored toxicity using Common Terminology Criteria for Adverse Events version 5.0 and patient-reported quality of life using the Functional Assessment of Cancer Therapy - Colorectal questionnaire is recorded pre-treatment and at follow-up. ENDPOINTS AND STATISTICS The primary endpoint is 2-year locoregional recurrence-free survival. The sample size calculation was based on the estimated improvement in 2-year locoregional recurrence-free survival from 70% in the standard arm to 85% in the test arm (hazard ratio 0.45) using 80% statistical power and a two-sided alpha error of 0.05. Secondary endpoints include disease-free survival, overall survival, acute and late toxicity, patterns of failure and quality of life. CONCLUSION The BART trial aims to evaluate whether contemporary radiotherapy after standard-of-care surgery and chemotherapy reduces pelvic recurrences safely and also potentially affects survival in high-risk MIBC.
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Affiliation(s)
- V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - P Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Singh
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Pal
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Arora
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - L Pujari
- Department of Radiation Oncology, HBCH & MPMMMC, Varanasi, India
| | - A Kapoor
- Department of Medical Oncology, HBCH & MPMMMC, Varanasi, India
| | - H Pandey
- Department of Surgical Oncology, HBCH & MPMMMC, Varanasi, India
| | - R Sharma
- Department of Uro-Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - D Gudipudi
- Department of Uro-Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Mehta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Bakshi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Prakash
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Noronha V, Rao AR, Ramaswamy A, Kumar A, Pillai A, Dhekale R, Krishnamurthy J, Kapoor A, Gattani S, Sehgal A, Kumar S, Castelino R, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nookala M, Chitre A, Narasimhan PN, Banerjee J, Gota V, Banavali S, Badwe RA, Prabhash K. The current status of geriatric oncology in India. Ecancermedicalscience 2023; 17:1595. [PMID: 37799956 PMCID: PMC10550294 DOI: 10.3332/ecancer.2023.1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 10/07/2023] Open
Abstract
Geriatric oncology in India is relatively new. The number of older persons with cancer is increasing exponentially; at our institution, 34% of patients registered are 60 years and over. Apart from the Tata Memorial Hospital in Mumbai, there are currently no other Indian centers that have a dedicated geriatric oncology unit. Geriatric assessments (GAs) are done sporadically, and older patients with cancer are usually assessed and treated based on clinical judgement. Challenges to increasing the uptake of GA include a lack of training/time/interest or knowledge of the importance of the GA. Other challenges include a lack of trained personnel with expertise in geriatric oncology, and a paucity of research studies that seek to advance the outcomes in older Indian patients with cancer. We anticipate that over the next 10 years, along with the inevitable increase in the number of older persons with cancer in India, there will be a commensurate increase in the number of skilled personnel to care for them. Key goals for the future include increased research output, increased number of dedicated geriatric oncology units across the country, India-specific geriatric oncology guidelines, geriatric oncology training programs, and a focus on collaborative work across India and with global partners. In this narrative review, we provide a broad overview of the status of geriatric oncology in India, along with a description of the work done at our center. We hope to spark interest and provide inspiration to readers to consider developing geriatric oncology services in other settings.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Abhijith Rajaram Rao
- Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi 110023, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anita Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anupa Pillai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Ratan Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Jyoti Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Akhil Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi 221005, India
| | - Shreya Gattani
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Arshiya Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Sharath Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Renita Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Sarika Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anuradha Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Lekhika Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Jayita Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Nabila Ansari
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Manjusha Vagal
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Purabi Mahajan
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Shivshankar Timmanpyati
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Manjunath Nookala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Ankita Chitre
- Department of Physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi 400012, India
| | | | - Joyita Banerjee
- Venu Geriatric Care Centre, Venu Charitable Society, New Delhi 110017, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Navi Mumbai 410210, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Rajendra A Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
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Mahajan A, B G, Wadhwa S, Agarwal U, Baid U, Talbar S, Janu AK, Patil V, Noronha V, Mummudi N, Tibdewal A, Agarwal JP, Yadav S, Kumar Kaushal R, Puranik A, Purandare N, Prabhash K. Deep learning based automated epidermal growth factor receptor and anaplastic lymphoma kinase status prediction of brain metastasis in non-small cell lung cancer. Explor Target Antitumor Ther 2023; 4:657-668. [PMID: 37745691 PMCID: PMC10511818 DOI: 10.37349/etat.2023.00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/13/2023] [Indexed: 09/26/2023] Open
Abstract
Aim The aim of this study was to investigate the feasibility of developing a deep learning (DL) algorithm for classifying brain metastases from non-small cell lung cancer (NSCLC) into epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement groups and to compare the accuracy with classification based on semantic features on imaging. Methods Data set of 117 patients was analysed from 2014 to 2018 out of which 33 patients were EGFR positive, 43 patients were ALK positive and 41 patients were negative for either mutation. Convolutional neural network (CNN) architecture efficient net was used to study the accuracy of classification using T1 weighted (T1W) magnetic resonance imaging (MRI) sequence, T2 weighted (T2W) MRI sequence, T1W post contrast (T1post) MRI sequence, fluid attenuated inversion recovery (FLAIR) MRI sequences. The dataset was divided into 80% training and 20% testing. The associations between mutation status and semantic features, specifically sex, smoking history, EGFR mutation and ALK rearrangement status, extracranial metastasis, performance status and imaging variables of brain metastasis were analysed using descriptive analysis [chi-square test (χ2)], univariate and multivariate logistic regression analysis assuming 95% confidence interval (CI). Results In this study of 117 patients, the analysis by semantic method showed 79.2% of the patients belonged to ALK positive were non-smokers as compared to double negative groups (P = 0.03). There was a 10-fold increase in ALK positivity as compared to EGFR positivity in ring enhancing lesions patients (P = 0.015) and there was also a 6.4-fold increase in ALK positivity as compared to double negative groups in meningeal involvement patients (P = 0.004). Using CNN Efficient Net DL model, the study achieved 76% accuracy in classifying ALK rearrangement and EGFR mutations without manual segmentation of metastatic lesions. Analysis of the manually segmented dataset resulted in improved accuracy of 89% through this model. Conclusions Both semantic features and DL model showed comparable accuracy in classifying EGFR mutation and ALK rearrangement. Both methods can be clinically used to predict mutation status while biopsy or genetic testing is undertaken.
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Affiliation(s)
- Abhishek Mahajan
- Clatterbridge Centre for Oncology NHS Foundation Trust, L7 8YA Liverpool, UK
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Gurukrishna B
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Shweta Wadhwa
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ujjwal Agarwal
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ujjwal Baid
- Department of Electronics and Telecommunication Engineering, SGGS Institute of Engineering and Technology, Nanded 431606, Maharashtra, India
| | - Sanjay Talbar
- Department of Electronics and Telecommunication Engineering, SGGS Institute of Engineering and Technology, Nanded 431606, Maharashtra, India
| | - Amit Kumar Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Anil Tibdewal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - JP Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Subash Yadav
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Rajiv Kumar Kaushal
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ameya Puranik
- Department of Nuclear Medicine, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
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Lee SM, Schulz C, Prabhash K, Kowalski D, Szczesna A, Han B, Rittmeyer A, Talbot T, Vicente D, Califano R, Cortinovis D, Le AT, Huang D, Liu G, Cappuzzo F, Reyes Contreras J, Reck M, Palmero R, Mak MP, Hu Y, Morris S, Höglander E, Connors M, Biggane AM, Vollan HK, Peters S. First-line atezolizumab monotherapy versus single-agent chemotherapy in patients with non-small-cell lung cancer ineligible for treatment with a platinum-containing regimen (IPSOS): a phase 3, global, multicentre, open-label, randomised controlled study. Lancet 2023:S0140-6736(23)00774-2. [PMID: 37423228 DOI: 10.1016/s0140-6736(23)00774-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Despite immunotherapy advancements for patients with advanced or metastatic non-small-cell lung cancer (NSCLC), pivotal first-line trials were limited to patients with an Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 and a median age of 65 years or younger. We aimed to compare the efficacy and safety of first-line atezolizumab monotherapy with single-agent chemotherapy in patients ineligible for platinum-based chemotherapy. METHODS This trial was a phase 3, open-label, randomised controlled study conducted at 91 sites in 23 countries across Asia, Europe, North America, and South America. Eligible patients had stage IIIB or IV NSCLC in whom platinum-doublet chemotherapy was deemed unsuitable by the investigator due to an ECOG PS 2 or 3, or alternatively, being 70 years or older with an ECOG PS 0-1 with substantial comorbidities or contraindications for platinum-doublet chemotherapy. Patients were randomised 2:1 by permuted-block randomisation (block size of six) to receive 1200 mg of atezolizumab given intravenously every 3 weeks or single-agent chemotherapy (vinorelbine [oral or intravenous] or gemcitabine [intravenous]; dosing per local label) at 3-weekly or 4-weekly cycles. The primary endpoint was overall survival assessed in the intention-to-treat population. Safety analyses were conducted in the safety-evaluable population, which included all randomised patients who received any amount of atezolizumab or chemotherapy. This trial is registered with ClinicalTrials.gov, NCT03191786. FINDINGS Between Sept 11, 2017, and Sept 23, 2019, 453 patients were enrolled and randomised to receive atezolizumab (n=302) or chemotherapy (n=151). Atezolizumab improved overall survival compared with chemotherapy (median overall survival 10·3 months [95% CI 9·4-11·9] vs 9·2 months [5·9-11·2]; stratified hazard ratio 0·78 [0·63-0·97], p=0·028), with a 2-year survival rate of 24% (95% CI 19·3-29·4) with atezolizumab compared with 12% (6·7-18·0) with chemotherapy. Compared with chemotherapy, atezolizumab was associated with stabilisation or improvement of patient-reported health-related quality-of-life functioning scales and symptoms and fewer grade 3-4 treatment-related adverse events (49 [16%] of 300 vs 49 [33%] of 147) and treatment-related deaths (three [1%] vs four [3%]). INTERPRETATION First-line treatment with atezolizumab monotherapy was associated with improved overall survival, a doubling of the 2-year survival rate, maintenance of quality of life, and a favourable safety profile compared with single-agent chemotherapy. These data support atezolizumab monotherapy as a potential first-line treatment option for patients with advanced NSCLC who are ineligible for platinum-based chemotherapy. FUNDING F Hoffmann-La Roche and Genentech Inc, a member of the Roche group.
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Affiliation(s)
- Siow Ming Lee
- Department of Oncology, University College London Hospitals NHS Foundation Trust, CRUK Lung Cancer Centre of Excellence and UCL Cancer Institute, London, UK.
| | - Christian Schulz
- Bereich Pneumologie Klinik und Poliklinik für Innere Medizin II, University Hospital Regensburg, Regensburg, Germany
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Dariusz Kowalski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Aleksandra Szczesna
- Department of Lung Diseases, Mazowieckie Centrum Leczenia Chorób Płuc i Gruźlicy, Otwock, Poland
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Achim Rittmeyer
- Department of Thoracic Oncology, LKI Lungenfachklinik Immenhausen, Immenhausen, Germany
| | - Toby Talbot
- Department of Oncology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - David Vicente
- Medical Oncology Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Diego Cortinovis
- Department of Medical Oncology, AAST H S Gerardo Monza, Monza, Italy
| | - Anh Tuan Le
- Cho Ray Cancer Centre, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Dingzhi Huang
- Department of Thoracic Oncology, National Clinical Research Centre for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Geoffrey Liu
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Federico Cappuzzo
- Department of Oncology, National Cancer Institute IRCCS Regina Elena, Rome, Italy
| | | | - Martin Reck
- Department of Thoracic Oncology, Lungen Clinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany
| | - Ramon Palmero
- Department of Medical Oncology, Catalan Institute of Oncology, Hospital Duran i Reynals, L'Hospitalet, Barcelona, Spain
| | - Milena Perez Mak
- Department of Medical Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Youyou Hu
- F Hoffmann-La Roche, Basel, Switzerland
| | | | | | | | | | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
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Saha S, Patil VM, Noronha V, Menon N, Kumar Singh A, Patlekar G, Yadav N, Pai PS, Chaukar DA, Chaturvedi P, Ghosh Laskar S, Prabhash K. Real world data on long term outcome of neoadjuvant chemotherapy in locally advanced esthesioneuroblastoma and sinonasal tumor with neuroendocrine differentiation - Results from a single centre study. Oral Oncol 2023; 144:106486. [PMID: 37413771 DOI: 10.1016/j.oraloncology.2023.106486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/03/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Esthesioneuroblastoma and sinonasal neuroendocrine carcinoma (SNEC) are the most common histological subtypes of non-squamous Sinonasal Tumors. A multidisciplinary approach is preferred for locally advanced unresectable esthesioneuroblastoma and SNEC. METHODS From June 2010 to October 2021, 59 patients with esthesioneuroblastoma and SNEC received NACT. NACT consists of 2-3 cycles of Etoposide-Platinum based chemotherapy. Depending upon response and performance status, subsequent therapy was planned. SPSS descriptive statistics were performed for analysis. Kaplan Meir methods were used for the estimation of Progression Free Survival (PFS) and Overall Survival (OS). RESULTS 45 (76.3 %) Esthesioneuroblastoma and 14 (23.7 %) SNEC patients received NACT. The median age of the population was 45 years (range 20-81 years). The majority of patients received 2-3 cycles of Platinum (Cisplatin or Carboplatin) + Etoposide as NACT. 28 patients (47.5%) underwent surgery and 20 patients (33.9%) received definitive chemoradiotherapy after NACT. The most common grade 3 or above adverse events were anemia (13.6%), neutropenia (27.1), and hyponatremia (45.8%). At the time of analysis, the median PFS was 56 months (95% CI 31 months to 77 months), and the median OS was 70 months (95% CI 56 months to 86 months). The most common late toxicities noticed were metabolic syndrome (42.4%), hyperglycemia (39%), nasal bleeding (33.9%), hypertension (17%), dyslipidemia (8.5%), and hypothyroidism (5.1%). CONCLUSION The study shows that NACT is safe, and can be easily delivered without any life-threatening toxicities, with a favorable response and improved survival in this subset of patients.
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Affiliation(s)
- Saswata Saha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Ajay Kumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Gargi Patlekar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Nishant Yadav
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Prathamesh S Pai
- Department of Head & Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Devendra A Chaukar
- Department of Head & Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head & Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.
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Singh AG, Sharin F, Ramalingam N, Tuljapurkar V, Mummudi N, Prabhash K, Chaturvedi P. Determining the impact of COVID-19 pandemic on adjuvant therapy for oral cancer - A matched-pair analysis. Indian J Cancer 2023; 60:359-365. [PMID: 36861710 DOI: 10.4103/ijc.ijc_186_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background The ongoing coronavirus disease 2019 (COVID-19) pandemic has hard-pressed the health care systems beyond their capabilities, causing a lack of appropriate cancer treatment delivery. The aim of this study was to assess the impact of pandemic-related restrictions on adjuvant therapy delivery for oral cancer patients during these demanding times. Materials and Methods Oral cancer patients who were operated on between February and July 2020 and scheduled to receive prescribed adjuvant therapy during the COVID-19-related restrictions (Group I) were included in the study. The data were matched for the length of hospital stay and type of prescribed adjuvant therapy, with a set of patients who were similarly managed 6 months preceding the restrictions (Group II). Demographic and treatment-specific details, including inconveniences faced in procuring prescribed treatment, were obtained. Factors associated with delay in receiving adjuvant therapy were compared using regression models. Results A total of 116 oral cancer patients were considered for analysis, comprising 69% (n = 80) adjuvant radiotherapy alone and 31% (n = 36) concurrent chemoradiotherapy. The mean hospital stay was 13 days. In Group I, 29.3% (n = 17) of patients were not able to receive any form of their prescribed adjuvant therapy at all, which was 2.43 times higher than Group II (P = 0.038). None of the disease-related factors significantly predicted delay in receiving adjuvant therapy. Of the delay, 76.47% (n = 13) was present during the initial part of the restrictions, with the most common reason being unavailability of appointments (47.1%, n = 8), followed by inability to reach treatment centers (23.5%, n = 4) and redeem reimbursements (23.5%, n = 4). The number of patients who were delayed the start of radiotherapy beyond 8 weeks after surgery was double in Group I (n = 29) than in Group II (n = 15; P = 0.012). Conclusions This study highlights a small part of the rippling effect the COVID-19 restrictions have on oral cancer management and pragmatic actions may be needed by policymakers to deal with such challenges.
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Affiliation(s)
- Arjun G Singh
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, Maharashtra, India
| | - Florida Sharin
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, Maharashtra, India
| | - Natarajan Ramalingam
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, Maharashtra, India
| | - Vidisha Tuljapurkar
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, Maharashtra, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Centre and HBNI, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre and HBNI, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, Maharashtra, India
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Shenoy R, Rao AR, Rane PP, Noronha V, Kumar A, Pillai A, Pathak S, Gattani S, Sehgal A, Kumar S, Castelino R, Dhekale R, Krishnamurthy J, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nokala M, Chitre A, Kapoor A, Gota V, Banavali S, Prabhash K, Ramaswamy A. Validation of the Onco-MPI in predicting short-term mortality in older Indian patients with cancer. J Geriatr Oncol 2023; 14:101550. [PMID: 37327761 DOI: 10.1016/j.jgo.2023.101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The number of older patients with cancer is increasing exponentially worldwide, and a similar trend has also been noted in India. The Multidimensional Prognostic Index (MPI) strongly correlates the presence of individual comorbidities with mortality, and the Onco-MPI prognosticates patients accurately for overall mortality. However, limited studies have evaluated this index in patient populations beyond Italy. We evaluated the performance of the Onco-MPI index in predicting mortality in older Indian patients with cancer. MATERIALS AND METHODS This observational study was conducted between October 2019 and November 2021 in the Geriatric Oncology Clinic at Tata Memorial Hospital in Mumbai, India. The data of patients aged ≥60 years with solid tumors who underwent a comprehensive geriatric assessment was analysed. The study's primary aim was to calculate the Onco-MPI for patients in the study and correlate it with one-year mortality. RESULTS A total of 576 patients aged ≥60 years were included in the study. The median age (range) of the population was 68 (60-90) years, and 429 (74.5%) were male. After a median follow-up of 19.2 months, 366 (63.7%) patients had died. The proportion of patients classified as low risk (0-0.46), moderate risk (0.47-0.63) and high risk (0.64-1.0) were 38% (219 patients), 37% (211 patients) and 25% (145 patients), respectively. There was a significant difference in one-year mortality rates between the low-risk patients compared to medium and high-risk patients (40.6% vs 53.1% vs 71.7%; p < 0.001). DISCUSSION The current study validates the Onco-MPI as a predictive tool for estimating short-term mortality in older Indian patients with cancer. Further prospective studies need to build on this index to obtain a score with greater discrimination in the Indian population.
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Affiliation(s)
- Ramnath Shenoy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Abhijith Rajaram Rao
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anita Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anupa Pillai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shruti Pathak
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shreya Gattani
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Arshiya Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Sharath Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Renita Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Ratan Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jyoti Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarika Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anuradha Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Lekhika Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jayita Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nabila Ansari
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjusha Vagal
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Purbi Mahajan
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shivshankar Timmanpyati
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjunath Nokala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Ankita Chitre
- Department of Physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Akhil Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
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Chatterjee S, Kiyota N, Vaish R, Sharma A, Tahara M, Noronha V, Prabhash K, D'Cruz A. Weekly versus 3-weekly cisplatin along with radiotherapy for locoregionally advanced non-nasopharyngeal head and neck cancers: Is the equipoise in literature addressed yet? Head Neck 2023; 45:1594-1603. [PMID: 37019856 DOI: 10.1002/hed.27365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 04/07/2023] Open
Abstract
Concurrent chemoradiotherapy with 3-weekly cisplatin 100 mg/m2 has been the standard of care for locoregionally advanced head and neck cancer (LA-HNC) with level I evidence. While the outcomes in terms of efficacy have been well established, the toxicity profile, compliance, and real-world applicability has been an area of ongoing concern for this regimen, leading the oncologists to explore weekly cisplatin chemoradiotherapy regimen to potentially address the issue. A review of literature was conducted in Pubmed, Scopus, and Medline to compare and evaluate the present role of weekly cisplatin chemotherapy along with radiotherapy versus 3-weekly cisplatin chemotherapy along with radiotherapy in both adjuvant and definitive settings for locoregionally advanced head and neck cancers. Nasopharyngeal subsites were excluded from the literature review and 50 relevant articles were included in the analysis. Recently published evidences of noninferiority of weekly over 3-weekly cisplatin chemoradiotherapy regimen in definitive as well as adjuvant settings in locoregionally advanced head and neck cancers is highlighted and interpreted. Results supporting and against the above in different publications is elaborated in this article. Trials designed to demonstrate noninferiority of the weekly cisplatin chemoradiotherapy regimen over 3-weekly regimen, especially in definitive setting may conclude the debate in future. A lacunae in the existing literature is noted in the form of lack of superiority trials on the above topic, which may impact future conclusions.
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Affiliation(s)
- Sataksi Chatterjee
- Department of Oncology, Apollo Hospitals Navi Mumbai, Navi Mumbai, Maharashtra, India
| | - Naomi Kiyota
- Cancer Center, Kobe University Hospital, Kobe, Japan
| | - Richa Vaish
- Tata Memorial Hospital, Parel, Mumbai, 400012, India
| | - Atul Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anil D'Cruz
- Department of Oncology (Head and Neck Surgery), Apollo Hospitals Group, Chennai, India
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Batra U, Biswas B, Prabhash K, Krishna MV. Differential clinicopathological features, treatments and outcomes in patients with Exon 19 deletion and Exon 21 L858R EGFR mutation-positive adenocarcinoma non-small-cell lung cancer. BMJ Open Respir Res 2023; 10:e001492. [PMID: 37321664 PMCID: PMC10277533 DOI: 10.1136/bmjresp-2022-001492] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/28/2023] [Indexed: 06/17/2023] Open
Abstract
The most common oncogenic driver in non-small-cell lung cancer (NSCLC) is the epidermal growth factor receptor (EGFR) gene mutations that occur more frequently among Asians (30%-50%) as opposed to Caucasians (10%-15%). Lung cancer is one of the most prevalent cancers in India, with a reported adenocarcinoma positivity ranging between 26.1% and 86.9% in NSCLC patients. The prevalence of EGFR mutations in adenocarcinoma patients (36.9%) in India is higher than that of Caucasian patients and lower than that of East Asian patients. The exon 19 deletion (Ex19del) is more common than exon 21 L858R mutations in Indian patients with NSCLC. Studies have shown that the clinical behaviour of patients with advanced NSCLC differs between EGFR Ex19del and exon 21 L858R mutation status. In this study, we investigated the differences in clinicopathological features and survival outcomes after first line and second-line treatment with EGFR tyrosine kinase inhibitors (EGFR TKIs) in NSCLC patients with Ex19del and exon 21 L858R EGFR mutation status. This study also focuses on the role and potential benefits of dacomitinib, a second-generation irreversible EGFR TKI, in patients with Ex19del and exon 21 L858R EGFR mutation-positive advanced NSCLC in Indian settings.
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Affiliation(s)
- Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | | | - M Vamshi Krishna
- Department of Medical Oncology and Hematology, Institute of Oncology, AIG Hospital, Hyderabad, India
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Tannock IF, Bouche G, Goldstein DA, Goto Y, Lichter AS, Prabhash K, Ranganathan P, Saltz LB, Sonke GS, Strohbehn GW, von Moos R, Ratain MJ. Patient-centred, self-funding dose optimisation trials as a route to reduce toxicity, lower cost and improve access to cancer therapy. Ann Oncol 2023:S0923-7534(23)00687-7. [PMID: 37230253 DOI: 10.1016/j.annonc.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Ian F Tannock
- Division of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada; Optimal Cancer Care Alliance, Ann Arbor, MI, USA.
| | - Gauthier Bouche
- Anticancer Fund, Meise, Belgium; Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Daniel A Goldstein
- Optimal Cancer Care Alliance, Ann Arbor, MI, USA; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | | | - Kumar Prabhash
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Leonard B Saltz
- Optimal Cancer Care Alliance, Ann Arbor, MI, USA; Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gabe S Sonke
- Department of Medical Oncology, Antoni van Leeuwenhoek/Netherlands Cancer Institute, & University of Amsterdam, Amsterdam, The Netherlands
| | - Garth W Strohbehn
- Optimal Cancer Care Alliance, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan; Section of Hematology Oncology, Veterans Affairs Ann Arbor Healthcare System; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Roger von Moos
- Department of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland & SAKK Competence Center, Bern
| | - Mark J Ratain
- Optimal Cancer Care Alliance, Ann Arbor, MI, USA; Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
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Saha S, Patil VM, Noronha V, Menon N, Singh AK, Suman M, Agrawal A, Khaddar S, Chakraborty S, Pai PS, Chaukar DA, Chaturvedi P, Laskar SG, Prabhash K. Neoadjuvant chemotherapy in a rare type of very locally advanced sinonasal carcinomas - long-term results from a tertiary care centre. Ecancermedicalscience 2023; 17:1549. [PMID: 37377683 PMCID: PMC10292851 DOI: 10.3332/ecancer.2023.1549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Sinonasal carcinomas are a rare type of head and neck malignancy with various histologies. The outcomes of patients with unresectable locally advanced sinonasal carcinomas are poor. Hence, we performed this analysis to study the long-term outcomes of sinonasal adenocarcinoma (SNAC) and sinonasal undifferentiated carcinomas (SNUC) where neoadjuvant chemotherapy (NACT) has been given followed by local therapy. Methods 16 patients with SNUC and adenocarcinoma who received NACT were found eligible for the study. Descriptive statistical analysis was performed for baseline characteristics, adverse events and treatment compliance. Kaplan Meir methods were used for the estimation of progression-free survival (PFS) and overall survival (OS). Results Seven (43.75%) adenocarcinoma and nine (56.25%) SNUC patients were identified. The median age of the whole cohort was 48.5 years. The median number of cycles delivered was 3 (IQR 1-8). The incidence of grade 3-4 toxicity (CTCAE version 5.0) was 18.75%. The response was partial response or better in seven patients (43.75%). Post-NACT 11 patients (n = 15, 73%) were eligible for definitive therapy. The median PFS was 7.63 months (95% CI, 3.23 - NA months) and the median OS was 10.6 months (95% CI, 5.2-51.5 months). Median PFS and OS for those who underwent surgery post-NACT versus those who did not undergo surgery were 36.267 versus 3.7 months (p = 0.012) and 51.5 versus 10.633 months (p = 0.190), respectively. Conclusion The study shows a favourable role of NACT in improving resectability, significant improvement in PFS and non-significant improvement in OS after surgery.
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Affiliation(s)
- Saswata Saha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
- Both the authors contributed equally and to be considered as first author
| | - Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
- Both the authors contributed equally and to be considered as first author
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
| | - Ajay Kumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
| | - Mannavi Suman
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
| | - Amit Agrawal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
| | - Satvik Khaddar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
| | - Shatabdi Chakraborty
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
| | - Prathamesh S Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
| | - Devendra A Chaukar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai 400012, Maharashtra, India
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Mohamad I, Glaun MDE, Prabhash K, Busheri A, Lai SY, Noronha V, Hosni A. Current Treatment Strategies and Risk Stratification for Oral Carcinoma. Am Soc Clin Oncol Educ Book 2023; 43:e389810. [PMID: 37200591 DOI: 10.1200/edbk_389810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Management of oral cavity squamous cell carcinoma (OSCC) involves a multidisciplinary team approach. Surgery is ideally the primary treatment option for nonmetastatic OSCC, and less invasive curative surgical approaches are preferred in early-stage disease to minimize surgical-related morbidity. For patients at high risk of recurrence, adjuvant treatment using radiation therapy or chemoradiation is often used. Systemic therapy may also be used in the neoadjuvant setting (for advanced-stage disease with the intent of mandibular preservation) or in the palliative setting (for nonsalvageable locoregional recurrence and/or distant metastases). Patient involvement in treatment decision is the key for patient-driven management, particularly in clinical situation with poor prognosis, for example, early postoperative recurrence before planned adjuvant therapy.
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Affiliation(s)
- Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Mica D E Glaun
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Ahmed Busheri
- Department of Radiation Oncology, Kuwait Cancer Control Center, Kuwait
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Jha AK, Mithun S, Sherkhane UB, Jaiswar V, Osong B, Purandare N, Kannan S, Prabhash K, Gupta S, Vanneste B, Rangarajan V, Dekker A, Wee L. Systematic review and meta-analysis of prediction models used in cervical cancer. Artif Intell Med 2023; 139:102549. [PMID: 37100501 DOI: 10.1016/j.artmed.2023.102549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 11/18/2022] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Cervical cancer is one of the most common cancers in women with an incidence of around 6.5 % of all the cancer in women worldwide. Early detection and adequate treatment according to staging improve the patient's life expectancy. Outcome prediction models might aid treatment decisions, but a systematic review on prediction models for cervical cancer patients is not available. DESIGN We performed a systematic review for prediction models in cervical cancer following PRISMA guidelines. Key features that were used for model training and validation, the endpoints were extracted from the article and data were analyzed. Selected articles were grouped based on prediction endpoints i.e. Group1: Overall survival, Group2: progression-free survival; Group3: recurrence or distant metastasis; Group4: treatment response; Group5: toxicity or quality of life. We developed a scoring system to evaluate the manuscript. As per our criteria, studies were divided into four groups based on scores obtained in our scoring system, the Most significant study (Score > 60 %); Significant study (60 % > Score > 50 %); Moderately Significant study (50 % > Score > 40 %); least significant study (score < 40 %). A meta-analysis was performed for all the groups separately. RESULTS The first line of search selected 1358 articles and finally 39 articles were selected as eligible for inclusion in the review. As per our assessment criteria, 16, 13 and 10 studies were found to be the most significant, significant and moderately significant respectively. The intra-group pooled correlation coefficient for Group1, Group2, Group3, Group4, and Group5 were 0.76 [0.72, 0.79], 0.80 [0.73, 0.86], 0.87 [0.83, 0.90], 0.85 [0.77, 0.90], 0.88 [0.85, 0.90] respectively. All the models were found to be good (prediction accuracy [c-index/AUC/R2] >0.7) in endpoint prediction. CONCLUSIONS Prediction models of cervical cancer toxicity, local or distant recurrence and survival prediction show promising results with reasonable prediction accuracy [c-index/AUC/R2 > 0.7]. These models should also be validated on external data and evaluated in prospective clinical studies.
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Affiliation(s)
- Ashish Kumar Jha
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Sneha Mithun
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Umeshkumar B Sherkhane
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vinay Jaiswar
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Biche Osong
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sadhana Kannan
- Homi Bhabha National Institute, Mumbai, Maharashtra, India; Advance Centre for Treatment, Research, Education in Cancer, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India; Advance Centre for Treatment, Research, Education in Cancer, Mumbai, Maharashtra, India
| | - Ben Vanneste
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Andre Dekker
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Leonard Wee
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Babanrao Dhumal S, Patil V, Parekh D, Noronha V, Menon N, Peelay Z, Prakash Nawale K, Prabhash K. Long term outcomes of phase I/II study of palliative triple metronomic chemotherapy in platinum-refractory/early failure oral cancer. Lancet Reg Health Southeast Asia 2023; 12:100143. [PMID: 37384062 PMCID: PMC10306045 DOI: 10.1016/j.lansea.2023.100143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 06/30/2023]
Abstract
Background Triple metronomic chemotherapy is one of the options of treatment in platinum-refractory/early failure oral cancer. However, long term outcomes with this regimen are unknown. Methods Adult patients with platinum-refractory/early-failure oral cancer were enrolled in the study. Patients were administered triple metronomic chemotherapy ie erlotinib 150 mg once daily celecoxib 200 mg twice daily and methotrexate weekly (phase 1 in variable dose 15-6 mg/m2 & 9 mg/m2 in phase 2), all taken orally till progression of disease or development of intolerable adverse events. The primary objective was to estimate the long-term overall survival and factors impacting it. The Kaplan Meier method was used for time-to-event analysis. Cox proportional hazard model was used to identify factors impacting overall survival (OS) and progression-free survival (PFS). The factors included in the model were age, sex, Eastern Cooperative Oncology Group - performance status (ECOG PS), tobacco exposure and a subsite of primary and circulating endothelial cell levels at baseline. A p-value of 0.05 was considered significant. Clinical trials information: CTRI/2016/04/006834. Results A total of 91 patients were recruited (15 in phase 1 & 76 in phase 2), the median follow-up was 41 months and 84 events of death had occurred. The median OS was 6.7 months (95% CI 5.4-7.4). The 1-year, 2-years and 3-year OS' were 14.1% (95% CI 7.8-22.2), 5.9% (95% CI 2.2-12.2) and 5.9% (95% CI 2.2-12.2) respectively. The only factor favorably impacting OS was the detection of circulating endothelial cells at baseline (HR = 0.46; 95% CI 0.28-0.75, P = 0.0020). The median PFS was 4.3 months (95% CI 4.1-5.1) and the 1-year PFS was 13.0% (95% CI 6.8-21.2). The factors with statistically significant impact on PFS were detection of circulating endothelial cells at baseline (HR = 0.48; 95% CI 0.30-0.78, P = 0.0020) and no tobacco exposure at baseline (HR = 0.51; 95% CI 0.27-0.94, P = 0.030). Interpretation The long-term outcomes with triple oral metronomic chemotherapy ie erlotinib, methotrexate and celecoxib are unsatisfactory. Detection of circulating endothelial cells at baseline is a biomarker predicting efficacy of this therapy. Funding The study was funded by an intramural grant from Tata Memorial Center Research Administration Council (TRAC) and Terry Fox foundation.
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Affiliation(s)
- Sachin Babanrao Dhumal
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI) Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI) Mumbai, India
| | - Deevyashali Parekh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI) Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI) Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI) Mumbai, India
| | - Zoya Peelay
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI) Mumbai, India
| | - Kavita Prakash Nawale
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI) Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI) Mumbai, India
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Patil V, Noronha V, Menon N, Mathrudev V, Bhattacharjee A, Nawale K, Parekh D, Banavali S, Prabhash K. Metronomic adjuvant chemotherapy evaluation in locally advanced head and neck cancers post radical chemoradiation - a randomised trial. Lancet Reg Health Southeast Asia 2023; 12:100162. [PMID: 37384061 PMCID: PMC10305911 DOI: 10.1016/j.lansea.2023.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 06/30/2023]
Abstract
Background Locally advanced head and neck cancers treated with radical chemoradiation have unsatisfactory outcomes. Oral metronomic chemotherapy improves outcomes in comparison to maximum tolerated dose chemotherapy in the palliative setting. Limited evidence suggests that it may do so in an adjuvant setting. Hence this randomized study was conducted. Methods Patients of head and neck (HN) cancer with primary in oropharynx, larynx or hypopharynx, with PS 0-2 post radical chemoradiation with documented complete response were randomized 1:1 to either observation or oral metronomic adjuvant chemotherapy (MAC) for 18 months. MAC consisted of weekly oral methotrexate (15 mg/m2) and celecoxib (200 mg PO BD). The primary endpoint was OS and the overall sample size was 1038. The study had 3 planned interim analyses for efficacy and futility. Trial registration- Clinical Trials Registry- India (CTRI): CTRI/2016/09/007315 [Registered on: 28/09/2016] Trial Registered Prospectively. Findings 137 patients were recruited and an interim analysis was done. The 3 year PFS was 68.7% (95% CI 55.1-79.0) versus 60.8% (95% CI 47.9-71.4) in the observation and metronomic arm respectively (P value = 0.230). The hazard ratio was 1.42 (95% CI 0.80-2.51; P value = 0.231). The 3 year OS was 79.4% (95% CI 66.3-87.9) versus 62.4% (95% CI 49.5-72.8) in the observation and metronomic arm respectively (P value = 0.047). The hazard ratio was 1.83 (95% CI 1.0-3.36; P value = 0.051). Interpretation In this phase 3 randomized study, oral metronomic combinations of weekly methotrexate and daily celecoxib failed to improve the PFS or OS. Hence observation post-complete response post radical chemoradiation remains the standard of care. Funding ICON funded this study.
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Affiliation(s)
- Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Deevyashali Parekh
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
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Khandare J, Bharde A, Jayant S, Aland G, Garbhe M, Gosavi S, Janorkar A, Tikekar P, Patil M, Jadhav V, Khutale G, Ashturkar A, Vasudevan A, Prabhash K, Raut N, Chaturvedi P. Abstract 6684: Detection of PD-L1, HER2 and EGFR on circulating tumor cells in carcinoma patients. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-6684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Small molecular inhibitors and immunotherapy has emerged as a novel alternative treatment regime for a variety of epithelial cancers. Large number of clinical trials are in progress to gauge efficacy of tyrosine kinase inhibitors or immune checkpoint inhibitors against actionable targets such as receptor tyrosine kinases and program death ligand 1 (PD-L1). Although highly effective, the outcome of PD-L1 based ICI or TKI against RTKs is vitally contingent on the presence of PD-L1 or RTK expression on circulating tumor cells. We report validation of CTCs with PD-L1, HER2 and EGFR expression in different epithelial cancers.
Methods: We retrospectively evaluated 134 carcinoma patients blood for presence of CTCs expressing PD-L1, HER2 or EGFR markers respect. 45 % patients had lung cancer, while 25 % and 20 % were presented with breast and GI and CRC malignancies. Remaining were gallbladder, ovarian, prostate, and head and neck cancers. CTCs were isolated from DCGI approved OncoDiscover platform with immunomagnetic targeting of EpCAM. CTCs were confirmed with expression of CK18, absence of CD45 and presence of DAPI nucleus. Presence/absence of biomarkers was determined using fluorescence imaging. Expression of PD-L1, HER2 or EGFR was detected by fluorescence microscopy using fluorescently labelled anti PD-L1, HER2 or EGFR antibodies respect. Based on fluorescence intensity CTCs were binned as PD-L1, HER2 or EGFR negative for no detectable fluorescence signal or weakly or strongly positive based on low or high fluorescence signal.
Results: Among the evaluated cohort, 51% of CTCs showed presence of PD-L1 expression. While 63% showed HER2 positive CTCs (breast cancer). 20% from the PD-L1 positive population showed stronger PD-L1 expression. 78% of CTCs from lung cancer patients showed presence of detectable PD-L1 signal, while 66% breast, GI and CRC patients showed CTCs with PD-L1 expression. CTCs from HNC and gall bladder cancer patients showed low PD-L1 expression (25% and 50% respect.). Among CTCs originating from different cancer types, breast cancer CTCs showed higher mean expression of PD-L1 compared to CTCs from CRC patients. A clear subset of CTCs for PD-L1 and Her2 expression was observed in lung and breast cancer patients respect, suggesting the heterogeneity in expression or presence of different subclones within the same tumor type. CTCs evaluated for EGFR expression, 50% showed presence of detectable EGFR compared to the cut-off signal.
Conclusions: CTC can be used as a real-time surrogate for molecular profiling of PD-L1, HER2 and EGFR expression. These CTC cell surface markers offer alternative for immunotherapy or targeted therapies decisions in a adenocarcinomas.
Citation Format: Jayant Khandare, Atul Bharde, Sreeja Jayant, Gourishankar Aland, Meghana Garbhe, Sayali Gosavi, Apoorva Janorkar, Purva Tikekar, Mrunmayi Patil, Vikas Jadhav, Ganesh Khutale, Amrut Ashturkar, Aravindan Vasudevan, Kumar Prabhash, Nirmal Raut, Pankaj Chaturvedi. Detection of PD-L1, HER2 and EGFR on circulating tumor cells in carcinoma patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6684.
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Affiliation(s)
- Jayant Khandare
- 1Actorius Innovation and Research USA and India, Pune, India
| | - Atul Bharde
- 1Actorius Innovation and Research USA and India, Pune, India
| | - Sreeja Jayant
- 1Actorius Innovation and Research USA and India, Pune, India
| | | | - Meghana Garbhe
- 1Actorius Innovation and Research USA and India, Pune, India
| | - Sayali Gosavi
- 1Actorius Innovation and Research USA and India, Pune, India
| | | | - Purva Tikekar
- 1Actorius Innovation and Research USA and India, Pune, India
| | - Mrunmayi Patil
- 1Actorius Innovation and Research USA and India, Pune, India
| | - Vikas Jadhav
- 1Actorius Innovation and Research USA and India, Pune, India
| | - Ganesh Khutale
- 1Actorius Innovation and Research USA and India, Pune, India
| | - Amrut Ashturkar
- 1Actorius Innovation and Research USA and India, Pune, India
| | | | | | - Nirmal Raut
- 3Bhaktivedanta Hospital And Research Institute, Mumbai, India
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Kapoor A, Noronha V, Patil V, Menon N, Nandhana R, Kumar A, Mahajan A, Janu A, Kumar R, Prabhash K. Long-Term Outcomes of Crizotinib Treated ALK-Positive Lung Cancer Patients: A Retrospective Audit of Prospective Data from Resource-Constrained Settings. South Asian J Cancer 2023; 12:179-184. [PMID: 37969671 PMCID: PMC10635771 DOI: 10.1055/s-0042-1753478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Akhil KapoorPurpose Crizotinib has been one of the standard treatment options for the treatment of anaplastic lymphoma kinase (ALK) rearranged non-small cell lung cancer (NSCLC) based on higher progression-free survival (PFS) and objective response rates in phase III clinical trials. However, real-world data about the long-term efficacy and toxicity of crizotinib is limited. Methods A retrospective analysis of all patients with ALK-positive NSCLC, treated with crizotinib between March 2014 and December 2016, was performed. The main outcomes measured were PFS, overall survival (OS), and adverse effects. Results One hundred and eighty-eight patients treated with crizotinib during this period were included in this study. The median age was 50 years (range: 24-74) with a majority being males (73.2%) and 80.3% with a performance status of 0 to 1. The median duration of follow-up was 49.4 months (range: 3.4-86.3%). The median PFS of crizotinib was 17.3 months (95% confidence interval [CI], 13.0-21.6) and 12.8 months (95% CI, 8.1-17.6) when used in first line or subsequent lines, respectively. The median OS was 38.3 months (95% CI, 28.4-48.2). The patients who received crizotinib in the first line had a median OS of 45.5 months (95% CI, 29.6-61.4) as compared with 29.7 months (95% CI, 22.2-37.2) for those who received in subsequent line (hazard ratio, 0.6, 95% CI, 0.4-0.9, p =0.022). The most common all grade toxicities include transaminitis, anemia, fatigue, and corrected QT prolongation. Conclusion This real-world study confirms the long-term beneficial effects of crizotinib in ALK rearranged NSCLC with favorable toxicity profile like that of the registration studies, in resource constrained settings.
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Affiliation(s)
- Akhil Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center and Homi Bhabha Cancer Hospital (A Unit of Tata Memorial Center, Mumbai), Varanasi, Uttar Pradesh, India
| | - Vanita Noronha
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ravindra Nandhana
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Kumar
- Department of Medical Oncology, Homi Bhabha Cancer Hospital, Muzaffarpur, and Jay Prabha Medanta Hospital, Patna, Bihar, India
| | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Janu
- Department of Radiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Kumar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Prabhash K, Tan DSW, Soo RA, Sitthideatphaiboon P, Chen YM, Voon PJ, Syahruddin E, Chu S, Huggenberger R, Cho BC. Real-world clinical practice and outcomes in treating stage III non-small cell lung cancer: KINDLE-Asia subset. Front Oncol 2023; 13:1117348. [PMID: 37051534 PMCID: PMC10083698 DOI: 10.3389/fonc.2023.1117348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/24/2023] [Indexed: 03/29/2023] Open
Abstract
IntroductionStage III non-small cell lung cancer (NSCLC) is a heterogeneous disease requiring multimodal treatment approaches. KINDLE-Asia, as part of a real world global study, evaluated treatment patterns and associated survival outcomes in stage III NSCLC in Asia.MethodsRetrospective data from 57 centers in patients with stage III NSCLC diagnosed between January 2013 and December 2017 were analyzed. Median progression free survival (mPFS) and median overall survival (mOS) estimates with two sided 95% confidence interval (CI) were determined by applying the Kaplan-Meier survival analysis.ResultsOf the total 1874 patients (median age: 63.0 years [24 to 92]) enrolled in the Asia subset, 74.8% were men, 54.7% had stage IIIA disease, 55.7% had adenocarcinoma, 34.3% had epidermal growth factor receptor mutations (EGFRm) and 50.3% had programmed death-ligand 1 (PD-L1) expression (i.e. PD-L1 ≥1%). Of the 31 treatment approaches as initial therapy, concurrent chemoradiotherapy (CRT) was the most frequent (29.3%), followed by chemotherapy (14.8%), sequential CRT (9.5%), and radiotherapy (8.5%). Targeted therapy alone was used in 81 patients of the overall population. For the Asia cohort, the mPFS and mOS were 12.8 months (95% CI, 12.2–13.7) and 42.3 months (95% CI, 38.1–46.8), respectively. Stage IIIA disease, Eastern Cooperative Oncology Group ≤1, age ≤65 years, adenocarcinoma histology and surgery/concurrent CRT as initial therapy correlated with better mOS (p < 0.05).ConclusionsThe results demonstrate diverse treatment patterns and survival outcomes in the Asian region. The high prevalence of EGFRm and PD-L1 expression in stage III NSCLC in Asia suggests the need for expanding access to molecular testing for guiding treatment strategies with tyrosine kinase inhibitors and immunotherapies in this region.
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Affiliation(s)
- Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | - Ross A. Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Piyada Sitthideatphaiboon
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yuh Min Chen
- Taipei Veterans General Hospital, School of Medicine, National Yang-Ming Medical University, Taipei City, Taiwan
| | - Pei Jye Voon
- Department of Radiotherapy and Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Elisna Syahruddin
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia
| | - Sojung Chu
- Medical Affairs, AstraZeneca, Seoul, Republic of Korea
| | | | - Byoung-Chul Cho
- Division of Medical Oncology, Yonsei Cancer Centre, Yonsei University College of Medicine, Seoul, Republic of Korea
- *Correspondence: Byoung-Chul Cho,
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