Current Treatment Options for Human Epidermal Growth Factor Receptor 2-Directed Therapy in Metastatic Breast Cancer: An Indian Perspective

Human epidermal growth factor receptor 2 (HER2)-positive is an aggressive subtype of breast cancer and has historically been associated with poor outcomes. The availability of various anti-HER2 therapies, including trastuzumab, lapatinib, pertuzumab, and trastuzumab emtansine (TDM-1), has remarkably improved the clinical outcomes in patients with HER2-positive metastatic breast cancer (mBC). However, there is a need to optimize treatment within this population, given the wide variability in clinical presentation. Additionally, geographical and socio-economic considerations too need to be taken into account. To clarify and collate evidence pertaining to HER2-positive metastatic breast cancer, a panel of medical and clinical oncologists from across India developed representative clinical scenarios commonly encountered in clinical practice in the country. This was followed by two meetings wherein each clinical scenario was discussed in detail and relevant evidence appraised. The result of this process is presented in this manuscript as evidence followed by therapeutic recommendations of this panel for management of HER2-positive mBC in the Indian population.

Report of chronic myeloid leukemia in chronic phase from Cancer Institute (Women India Association), Chennai, 2002-2009

Cancer Institute Chennai is the first Institute of Oncological sciences to be established in the country. In ICON meeting, they presented the data of 516 patients, of which 91% patients achieved complete hematological response. The overall survival was 88% and event free survival was 65% at 5 years.

Primary renal lymphoma mimicking renal cell carcinoma

Primary renal lymphoma is very rare. Lymphomatous involvement of the kidney is often seen as a part of disseminated disease. The prognosis is usually poor with median survival less than a year. It is essential to differentiate between renal cell carcinoma and renal lymphoma in patients presenting with solitary renal masses. We present a 52-year-old lady who presented with a solitary renal mass and was diagnosed to have primary lymphoma of the kidney and discuss briefly about primary renal lymphoma.

Breast cancer in young women less than 30 years from southern India: Study on clinical profile and outcome

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Background: Breast cancer in young patients have an aggressive behaviour with poorer outcome. The patients are in their reproductive age group and are concerned with fertility issues,pregnancy and lactation. The literature pertaining to patients less than 30 years is limited. Methods: 213 Patients under the age of 30 years with breast cancer were studied for Demographics, clinical presentations, pathological profiles, treatment and survival. The case records were retrospectively analyzed between Jan 1993 - Dec 2003 at Cancer Institute (WIA) Chennai. Results: The mean age of the study population was 28 years and ranged between 17 to 30 years. Early menarche, defined as less than 12 years (17.5 %), Nulliparity (21.1%), first child birth less than 18 years (26.8%) were the major risk factors noted. Family history of breast and ovarian cases were seen in 6.6% of the patients. The Stage distribution included Stage I (1.4%), Stage II (31%), Stage III (49.6) and Stage IV (11%) and unclassifiable (7%). Node positive tumours constituted 158 patients (74.1%). Hormone receptor studies were negative in 62% of the patients. Modified radical mastectomy was performed in 164 (77%) of the patients. Non infiltratring ductal carcinoma histopathology was noted in 13.6%. Surgical and radiocastration was performed in 35.2% and 17% of the cases respectively. Of 201 (94.3%) patients who received chemotherapy anthracycline based chemotherapy was delivered in 30.3%. Recurrence pattern included local, local and distant and distant recuurences in 8.5%, 23.5% and 2.3% respectively. The 5 year over all survival for the evaluable patients was 53.2%. Conclusions: Very young Indian patients less than 30 years constitute a unique subset of breast cancer patients with majority being hormone receptor negative and locally advanced stage at presentation. The over all outcome is inferior compared to older patients with breast cancer. More aggressive adjuvant treatment may help in improving survival.

No significant financial relationships to disclose.

Imatinib mesylate experience of young patients with chronic myeloid leukemia in chronic phase—Care to cure

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Background: Chronic myeloid leukemia (CML) with introduction of imatinib has been transformed into a chronic illness. The options of treatment in a patient less than 35 years include imatinib or allogenic stem cell transplantation. Hence we studied this unique subset to look at the response rates, adverse effects, progression free survival, and overall survival with imatinib mesylate. Methods: 477 patients with Philadelphia positive CML in chronic phase were retrospectively analyzed from January 2002 to December 2007 at Cancer Institute (WIA), Chennai, India. Standard criteria were used for response evaluation and adverse effects. Results: A total of 248 young CML patients with age less than 35 years (51.9%) were diagnosed in chronic phase. The median age of study population was 27 years (4–35). The male to female ratio was 1.9: 1. Risk stratification was done using Sokal index and were classified into low (32.3%), intermediate (50.4%), and high (17.3%). All patients received imatinib 400 mg as the initial dose. Complete hematological remission (CHR) was seen in 96.7%.Cytogenetic (FISH) and molecular (RTPCR) monitoring was possible in 53.2% and 17.3%, respectively. 72% of the patients had major cytogenetic response. Major molecular response was seen in 34.8% while complete molecular response occurred in 23.2% of the patients. Primary and secondary imatinib failure was seen in 3.1% and 16.9%, respectively. 6.7% had grade 3 and grade 4 hematological toxicities. The other common non hematological toxicities included pedal edema (13.7%), hypo or hyper pigmentation (60.0%), hyalgia (14.5%), diarrhea (1.6%), and liver dysfunction (1.6%). None of the patients discontinued imatinib due to toxicities. The 3-year DFS and OS was 86.2% and 89.5%, respectively. Patients with male sex (p = 0.04), spleen > 8 cm (p = 0.02), high sokal index (p = 0.02), and loss of CHR (p < 0.001) were associated with poor outcome. Conclusions: Imatinib in young patients have an excellent tolerance and response. A small subset does not respond to therapy or develop resistance during treatment. Hence it is essential to identify these poor responders and to offer stem cell transplantation at the earliest.

No significant financial relationships to disclose.