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Mukherjee S, De MS, Goel G, Bhattacharyya A, Mallick I, Dabkara D, Bhaumik J, Roy MK, Majumdar PB, Chatterji S, Mukherjee S, Bhattacharya S, Chandy M. Multi-drug resistant (MDR) and extensively drug-resistant (XDR) bacteraemia rates among cancer patients in an oncology hospital in eastern India: an 11-year retrospective observational study. Infect Prev Pract 2023; 5:100275. [PMID: 36915471 PMCID: PMC10006829 DOI: 10.1016/j.infpip.2023.100275] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/03/2022] [Accepted: 02/12/2023] [Indexed: 02/22/2023] Open
Abstract
Background Trend analysis of bacteraemias caused by multi-drug resistant (MDR) and extensively drug resistant (XDR) bacteria helps to assess efficacy of infection prevention and control (IPC) practices. Data on the trends of MDR and XDR bacteraemias are lacking from cancer patients in India. Aims To report antibiotic resistance rates over time in bacteraemias and to assess the effect of IPC practices where patient isolation facilities were limited on the rates and trends of MDR and XDR bacteraemias from a cancer centre in eastern India. Methods A retrospective observational study was conducted in a specialist cancer hospital in India from 2011 to 2021. The study included both patients with haematological and solid organ malignancy. Data on blood cultures and surveillance culture samples were analysed. Blood cultures were processed using BACT/ALERT® (bioMérieux, Marcy-l'Étoile, France) and the identification and antibiotic susceptibilities of bacteria were performed using VITEK® 2 (bioMérieux, Marcy-l'Étoile, France). Surveillance cultures for MDR/XDR bacteria were performed on a subset of patients and processed based on a modified method described previously. Findings 3rd-generation cephalosporin-resistant Gram negative bacilli were the commonest cause of MDR bacteraemia (57.6%) followed by carbapenem resistant organisms (CRO) (35.7%). Bacteraemias caused by vancomycin-resistant enterococci (VRE), meticillin-resistant Staphylococcus aureus (MRSA) and colistin-resistant Gram negative bacilli were responsible for 1.3%, 2.3% and 3.0% of laboratory confirmed bloodstream infections (BSI) respectively. The ranges of the rates of MDR/XDR BSI per 1000 in-patients during the study period were: MRSA (1-1.18), VRE (0-0.88), 3rd generation cephalosporin-resistant Gram negative bacilli (10.10-20.32), CRO (5.05-13.07) and colistin-resistant Gram negative bacilli (E. coli, Klebsiella, Pseudomonas aeruginosa, Acinetobacter spp (0-1.3). Surveillance cultures collected from a subset of patients showed ranges of MRSA detection in 0-2.11%, VRE in 1.67%-7.49%, 3rd generation cephalosporin-resistant Gram negative bacilli in 55%-89.91% and carbapenem resistant Gram negative bacilli in 18.33%-31.11% of patients. Conclusion This is one of few studies providing trend data for MDR/XDR bacteraemia rates among cancer patients in India over a decade. In a high prevalence setting it was possible to keep the rates of MDR/XDR bacteraemia controlled with IPC strategies and without adequate isolation facilities. The results are of potential interest to policy makers, IPC specialists and clinicians.
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Affiliation(s)
| | | | - Gaurav Goel
- Department of Microbiology, Tata Medical Center, Kolkata, India
| | | | - Indranil Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Jaydip Bhaumik
- Department of Gyne-Onco-Surgery, Tata Medical Center, Kolkata, India
| | - Manas Kumar Roy
- Department of Gastrointesinal-Hepato-pancreato-biliary Surgery, Tata Medical Center, Kolkata, India
| | | | | | - Sudipta Mukherjee
- Department of Critical Care Medicine, Tata Medical Center, Kolkata, India
| | | | - Mammen Chandy
- Department of Clinical Hematology and Medical Administration, Tata Medical Center, Kolkata, India
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Chakrabarty N, Mahajan A, Prabhash K, Patil P, Chowhan M, Munmmudi N, Niyogi D, Dabkara D, Singh S, Singh A, Devarmani S, Dhull VS. Imaging Recommendations for Diagnosis, Staging, and Management of Esophageal Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1760324] [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: 02/12/2023] Open
Abstract
AbstractEarly staging and treatment initiation affect prognosis of patients with esophageal and esophagogastric junction cancer; hence, it is imperative to have knowledge of proper choice of imaging modality for staging of these patients, to effectively convey relevant imaging findings to the treating physician/surgeon. It is also essential to be aware of pertinent imaging findings that need to be conveyed to the treating physician/surgeon at staging, and after treatment, including post-therapy complications (if any), so as to provide timely management to such patients. In this article, we have provided imaging guidelines for diagnosis, staging, post-therapy response evaluation, follow-up, and assessment of post-therapy complications of esophageal and esophagogastric junction cancer in a systematic manner. Besides, risk factors and clinical workup have also been elucidated. We have also attached comprehensive staging and post-therapy contrast-enhanced computed tomography and fluorodeoxyglucose-positron emission tomography/computed tomography-based synoptic reporting formats “ECI-RADS” and “pECI-RADS,” respectively, for esophageal and esophagogastric junction cancer in the supplement, for effective communication of imaging findings between a radiologist and the treating physician/surgeon.
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Affiliation(s)
- Nivedita Chakrabarty
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prachi Patil
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Manoranjan Chowhan
- Department of Nuclear Medicine and PET/CT, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Naveen Munmmudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Devayani Niyogi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Deepak Dabkara
- Department of Oncology, CHL Hospitals, Indore, Madhya Pradesh, India
| | - Suryaveer Singh
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ajaykumar Singh
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sanjana Devarmani
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Varun Singh Dhull
- Department of Nuclear Medicine and PET/CT, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
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Pandey P, Dabkara D, Ganguly S, Ghosh J, Roy S, Mondal D, Gupta S, Nair R, Biswas B. Early metabolic syndrome in testicular germ cell tumors : A prospective study from India. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17010] [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: 11/20/2022] Open
Abstract
e17010 Background: Metabolic syndrome (MS) is a known complication in patients of testicular germ cell tumors . Early metabolic syndrome is not well-defined and literature on the same is scarce. Methods: This is a single institutional prospective cohort study of patients with testicular germ cell tumors from Jan’2020 to June 2021 with a minimum follow-up of 6 months after treatment completion. Patients were evaluated for MS as per NCEP ATP (National Cholesterol Education Program Adult Treatment Plan) III criteria and partial MS was defined if any one abnormal criteria was present. Clinicopathologic and treatment characteristics were correlated with development of MS. Results: Thirty-six (25 nonseminomatous tumor and 11 seminoma) were included with median age of 29 yrs (range: 18-44). Treatment protocol was - platinum based chemotherapy [BEP (n = 7), EP(n = 18),VIP(n = 4) ]in 81% (n = 29/36), single agent carboplatin in 8% (n = 3/36), and surveillance only in 11% (n = 4/36) patients. Incidence of complete metabolic syndrome noted in 42% (n = 15) and partial metabolic syndrome in 36% (n = 13) of patients after median follow-up of 13.2 months (range-6-22). Deranged parameters detected were - high serum triglyceride (≥150 mg/dl) in 64% (n = 23/36), low serum HDL cholesterol (< 40 mg/dl) in 53% (n = 19/36), high blood pressure (≥130/85 mm of Hg) in 47% (n = 17/36), high waist circumference (> 110 cm) in 6% (n = 2/36) and high fasting plasma glucose (≥5.6 mmol/L) in 22% (n = 8/36) of patients. Median weight gain was 5 Kg (range: 2-14). The median time to development of metabolic syndrome was 143 days (range: 90-461). Hypogonadism (testosterone < 433ng/dl.) showed positive correlation (degree of freedom = 0.3143) and C-reactive protein showed negative correlation (degree of freedom -0.3090) with MS, respectively. Conclusions: Majority of Testicular germ cell tumor patients (n = 28, 78%) had features of early MS, irrespective of treatment modalities. Patients with hypogonadism are more likely to develop early MS. Larger prospective studies are warranted to assess the incidence of early MS in patients with testicular germ cell tumors and to formulate appropriate health intervention to mitigate its significant long-term effects on mortality and morbidity.
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Mondal D, Ganguly S, Ghosh J, Roy S, Pandey P, Dabkara D, Nair R, Biswas B. High-sensitivity C-reactive protein as prognostic and predictive marker in metastatic non-small cell lung carcinoma : A prospective single center study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e21101] [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: 11/20/2022] Open
Abstract
e21101 Background: Systemic inflammation has been linked to incidence, progression, and poor outcomes in various cancers including non-small cell lung carcinoma (NSCLC). High-sensitivity CRP (hs-CRP) assays, generally used to assess cardiovascular risk, have rarely been evaluated in lung cancer studies. This study aimed to evaluate if baseline and on-treatment measurements of serum hs-CRP could provide prognostic and predictive information for patients with metastatic NSCLC treated with chemotherapy. Methods: In this single institutional prospective study 85 patients with metastatic NSCLC without targetable alterations who were treated with chemotherapy were included between 1st January 2020 and 31st December 2020, with a minimum follow-up duration of 6 months. Patients with coronary artery disease, active infections, autoimmune conditions, and chronic liver disease were excluded. Measurements of hs-CRP for all patients were done at baseline and every 12 weeks while on treatment. Patients were grouped by changes in hs-CRP levels compared to baseline levels as reduction (≥ 20% decline), and non-reduction (< 20% decline) to assess association with radiologic response and progression- free survival (PFS). Results: Pre-treatment hs-CRP values were elevated for the majority (92.9% patients with ≥ 1 mg/L, 70.6% with ≥ 3 mg/L, and 42.3% with ≥ 10 mg/dL). No significant association was detected between the pre-treatment hs-CRP value and the number of metastatic sites (P = 0.4), histology (P = 0.3), or smoking status (P = 0.7). At a median follow-up of 13.7 months, the median PFS was 7.8 months (95% confidence interval [CI] 5.3 - 10.3). Patients with hs-CRP ≥10 mg/L had shorter PFS than those with hs-CRP < 10 mg/L (Median PFS 7.5 months [95% CI 4.9 - 10] vs. 8.4 months [95% CI 0.1 - 17.4]; hazard ratio [HR] 1.8, 95% CI 1-3.4, P = 0.04). hs-CRP reduction (≥20% decline) after 12 weeks of treatment initiation predicted radiological response (P < 0.001). Median PFS was 14.7 months (95% CI 7.4 – 22.1) in patients who demonstrated hs-CRP reduction (≥20% decline) at 12 weeks compared to 3.1 months (95% CI 2.3 – 3.9) in patients who did not (HR 0.17, 95% CI 0.08 - 0.33, P < 0.001). Conclusions: Elevated hs-CRP at baseline was found to be a poor prognostic factor, while hs-CRP reduction by 20% or more on treatment predicted radiologic response and longer PFS in metastatic NSCLC patients treated with chemotherapy. Our findings of potential predictive and prognostic value of hs-CRP in metastatic NSCLC warrant validation in larger prospective studies.
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Malik PS, Noronha V, Dabkara D, Maddu VK, Rajappa S, Limaye S, Batra U. Safety of osimertinib in adult patients with metastatic epidermal growth factor receptor T790M mutation-positive non-small cell lung cancer: Results from a Phase IV study in India. Indian J Cancer 2022; 59:S1-S10. [PMID: 35343187 DOI: 10.4103/ijc.ijc_1374_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: 06/14/2023]
Abstract
BACKGROUND A Phase IV, single-arm study was conducted to assess the safety of osimertinib in Indian patients with epidermal growth factor receptor (EGFR) T790M mutation-positive stage IV non-small cell lung cancer (NSCLC). METHODS Enrolled patients received 80 mg osimertinib for six cycles or until disease progression or unacceptable toxicity or withdrawal. Primary safety variables included treatment-emergent adverse events (TEAEs), serious adverse events (SAEs), and adverse events (AEs) leading to discontinuation/interruption/change (D/I/C) of drug dose, and AEs of special interest (AESIs). AEs were summarized by the percentage of patients experiencing at least one occurrence of each event. RESULTS Of the 60 enrolled patients (median age 58 [range: 34-81] years; 51.7% women) at eight sites, nine patients were discontinued prematurely due to disease progression (n = 7) and death (n = 2); median (range) duration of treatment was 126 (1-134) days. Median age of patients was 58 (34-81) years; 51.7% (n = 31) were women; 86.7% (n = 52) were nonsmokers; and most of them (98.3%) had adenocarcinoma. About 75% (n = 45) of patients experienced any of the TEAEs, with the most frequent being fatigue and creatine phosphokinase (CPK) increase (n = 6, 10% each). TEAEs in 11 (18.3%) patients were judged as study treatment related, with CPK increase being the most common (n = 4, 6.7%). TEAEs led to D/I/C of drug dose in eight (13.3%) patients, with one being study treatment related. Nine (15%) patients had AESIs of dyspnea (n = 6), chest pain (n = 2), and cardiorespiratory arrest (n = 1); two of them had a fatal outcome. One AESI (mild dyspnea) was considered study drug related. TEAEs of grade ≥3 were reported in seven (11.7%) patients, including dyspnea in two (3.3%), followed by diarrhea, mucosal inflammation, cardiorespiratory arrest, and others (n = 1, 1.7% each). None of the SAEs and fatal events were considered as study treatment related. Seven (11.7%) patients had abnormal electrocardiogram (ECG; not clinically significant) at the end of the study. CONCLUSION Our study confirms the favorable safety profile of osimertinib without any new safety concerns in Indian patients with EGFR T790M mutation-positive stage IV NSCLC. CLINICALTRIALS.GOV IDENTIFIER NCT03853551.
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Affiliation(s)
- Prabhat S Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Dr. Ernest Borges road, Parel, Mumbai, Maharashtra, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, New town, Rajarhat, Kolkata, West Bengal, India
| | - Vamshi K Maddu
- Department of Medical Oncology, Apollo Cancer Institute, Jubilee Hills, Hyderabad, Telangana, India
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo-American Cancer Hospital, Banjara Hills, Hyderabad, Telangana, India
| | - Sewanti Limaye
- Department of Medical Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Andheri (W), Mumbai, Maharashtra, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute Research Centre, Rohini, New Delhi, India
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Bakshi G, Tongaonkar H, Addla S, Menon S, Pradhan A, Kumar A, Bapat A, Gore A, Joshi A, Raja A, Bradoo A, Ramesh A, Kumar A, Agrawal A, Ambekar A, Joshi A, Singh A, Singh BP, Dabkara D, Khadakban D, Gautam G, Prakash G, Pahwa HS, Goel HK, Kulkarni J, Mishra JJ, Patel K, Pal M, Chibber PJ, Tiwari P, Naik R, Raghunath SK, Krishnatry R, Shimpi R, Sharma R, Taran R, Trivedi S, Nabar S, Surekha S, Kumar S, Sawaimoon SK, Raina S, Narasimha S, Advani S, Ghouse SM, Muddu VK, Maniar V, Venkat V, Murthy V. Expert survey on management of prostate cancer in India: Real-world insights into practice patterns. Indian J Cancer 2022; 59:S19-S45. [PMID: 35343189 DOI: 10.4103/ijc.ijc_1145_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: 06/14/2023]
Abstract
To gain insights on the diverse practice patterns and treatment pathways for prostate cancer (PC) in India, the Urological Cancer Foundation convened the first Indian survey to discuss all aspects of PC, with the objective of guiding clinicians on optimizing management in PC. A modified Delphi method was used, wherein a multidisciplinary panel of oncologists treating PC across India developed a questionnaire related to screening, diagnosis and management of early, locally advanced and metastatic PC and participated in a web-based survey (WBS) (n = 62). An expert committee meeting (CM) (n = 48, subset from WBS) reviewed the ambiguous questions for better comprehension and reanalyzed the evidence to establish a revote for specific questions. The threshold for strong agreement and agreement was ≥90% and ≥75% agreement, respectively. Sixty-two questions were answered in the WBS; in the CM 31 questions were revoted and 4 questions were added. The panelists selected answers based on their best opinion and closest to their practice strategy, not considering financial constraints and access challenges. Of the 66 questions, strong agreement was reached for 17 questions and agreement was achieved for 22 questions. There were heterogeneous responses for 27 questions indicative of variegated management approaches. This is one of the first Indian survey, documenting the diverse clinical practice patterns in the management of PC in India. It aims to provide guidance in the face of technological advances, resource constraints and sparse high-level evidence.
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Affiliation(s)
- Ganesh Bakshi
- Department of Uro-Oncology, P D Hinduja National Hospital, Mumbai, India
| | - Hemant Tongaonkar
- Director of Surgical Oncology and Uro-Oncology, Max Nanavati Hospital, Mumbai, India
| | - Sanjai Addla
- Department of Uro-Oncology, Apollo Hospital, Hyderabad, India
| | - Santosh Menon
- Department of Uro-Onco Pathology, Tata Memorial Hospital & HBNI, Mumbai, India
| | - Aditya Pradhan
- Department of Uro-Oncology, BL Kapoor Hospital, Delhi, India
| | - Abhay Kumar
- Department of Uro-Oncology, Narayana Health, Kolkata, India
| | - Abhijit Bapat
- Department of Urology, Bapat Urology Hospital, Mumbai, India
| | - Adwaita Gore
- Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Anand Raja
- Department of Uro-Oncology, Cancer Institute (WIA), Adyar, Chennai, India
| | - Anil Bradoo
- Department of Urology, Excel Urology Centre, Mumbai, India
| | - Anita Ramesh
- Department of Medical Oncology, Apollo Hospital, Chennai, India
| | - Anup Kumar
- Department of Urology, Safdarjung Hospital, Delhi, India
| | - Archi Agrawal
- Department of Nuclear Medicine, Tata Memorial Hospital & HBNI, Mumbai, India
| | | | - Ashish Joshi
- Department of Medical Oncology, Mumbai Oncocare Centre, Mumbai, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | | | - Deepak Dabkara
- Department of Medical Oncology, Tata Memorial Centre, Kolkata, India
| | - Dhiraj Khadakban
- Department of Surgical Oncology, Oncolife Hospital, Satara, India
| | - Gagan Gautam
- Department of Uro-Oncology, Max Healthcare, Delhi, India
| | - Gagan Prakash
- Department of Uro-Oncology, Tata Memorial Hospital & HBNI, Mumbai, India
| | | | | | | | | | - Kaushal Patel
- Department of Medical Oncology, Tristar Hospital, Surat, India
| | - Mahendra Pal
- Department of Uro-Oncology, Tata Memorial Hospital & HBNI, Mumbai, India
| | | | - Priya Tiwari
- Department of Medical Oncology, Artemis Hospital, Delhi, India
| | - Radheshyam Naik
- Department of Medical Oncology, HCG Hospital, Bangalore, India
| | - S K Raghunath
- Department of Uro-Oncology, HCG Hospital, Bangalore, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Hospital & HBNI, Mumbai, India
| | | | - Rakesh Sharma
- Department of Uro-Oncology, Indo-American Hospital, Hyderabad, India
| | - Rakesh Taran
- Department of Medical Oncology, CHL Hospital, Indore, India
| | - Sameer Trivedi
- Department of Urology, Institute of Medical Science, Varanasi, India
| | - Sanjay Nabar
- Department of Urology, Nanavati Hospital, Mumbai, India
| | | | - Satish Kumar
- Department of Surgical Oncology, Mohan's Medicity Hospital, Madurai, India
| | | | | | | | - Suresh Advani
- Department of Medical Oncology, SL Raheja Hospital, Mumbai, India
| | | | | | - Vashishth Maniar
- Department of Medical Oncology, Mumbai Oncocare Centre, Mumbai, India
| | - Vivek Venkat
- Department of Urology, Nanavati Hospital, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital & HBNI, Mumbai, India
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Biswas B, Biswas G, Ganguly S, Ghosh J, Roy S, Roy MK, Pipara A, Karmakar J, Mukherjee N, Chakraborty S, Mishra DK, Midha D, Dabkara D. Not so 'rare'-an example of malignant melanoma in India: report from a tertiary cancer centre. Ecancermedicalscience 2022; 15:1335. [PMID: 35211204 PMCID: PMC8816508 DOI: 10.3332/ecancer.2021.1335] [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: 07/03/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose Malignant melanoma (MM) is rare in India. Indian data on demography and treatment outcome on advanced MM is very limited in the literature. Materials & methods This is a retrospective study of advanced MM treated between January 2013 and December 2020. We evaluated the clinicopathologic features, mutational profiles, survival outcome and prognostic factors in advanced MM patients. Results Out of a total 460 patients, 185 (42%) had metastatic disease at presentation and were enrolled in this study with a median age of 63 years (range: 28–93) and male:female ratio of 94:91. The mucosal primary was predominant (n = 110, 59%) than cutaneous primary (38%) and anorectum was the most common site (n = 84, 45%). Tumour mutational analysis was performed in 65 (35%) patients. BRAF mutations were detected in 12 patients and KIT mutations in 7 patients. Thirteen patients didn’t have any mutations and 22 patients had mutations other than KIT & BRAF. Only 59 (32%) patients took any systemic treatment – immune checkpoint inhibitors (ICIs) in 17, temozolomide in 18 and paclitaxel/carboplatin in 18, tyrosine kinase inhibitors in 6 patients. After a median follow-up of 26 months (95% confidence interval (CI): 11.6–not reached), median progression-free survival (PFS) was 7.1 months (95% CI: 4.4–9.1) and median overall survival was 14.8 months (95% CI: 7.7–18.2 months). The use of ICI emerged as an only significant good prognostic factor (p ≤ 0.001) for PFS, on multivariate analysis. Conclusion Mucosal origin was more common than cutaneous primary with anorectum being the most common site. BRAF mutation was less as compared to published literature. Very few patients received systemic therapy and the use of ICI showed superior PFS.
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Affiliation(s)
- Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Gautam Biswas
- Department of Plastic & Reconstructive Surgery, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Somnath Roy
- Department of Medical Oncology, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Manas Kumar Roy
- Department of GI Surgery, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Amrit Pipara
- Department of GI Surgery, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Jagriti Karmakar
- Department of Medical Oncology, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Navonil Mukherjee
- Department of Medical Oncology, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Santam Chakraborty
- Department of Radiotherapy, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Deepak Kumar Mishra
- Department of Molecular Oncology, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Divya Midha
- Department of Pathology, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, 14 MAR [EW], New Town, Rajarhat, Kolkata 700160, West Bengal, India
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Dabkara D, Biswas B. Recent Advances in First-Line Management of Metastatic Renal Cell Carcinoma. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0041-1731968] [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] [Indexed: 10/19/2022] Open
Affiliation(s)
- Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
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Ganguly S, Ghosh J, Mishra D, Biswas G, Dabkara D, Roy S, Biswas B. Early Experience with Dabrafenib–Trametinib Combination in Patients with BRAF-Mutated Malignant Melanoma—A Single-Center Experience. South Asian J Cancer 2021; 10:187-189. [PMID: 34938683 PMCID: PMC8687866 DOI: 10.1055/s-0041-1736032] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Abstract
Background Combination of dabrafenib–trametinib is one of the standard treatments in patients with BRAF-mutated advanced malignant melanoma (MM). Real-world data on the usage of this combination is scarce, especially from India. Here, we are reporting our early experience with the usage of this combination therapy.
Materials and Methods This is a single institutional data assessment of patients with BRAF-mutated MM registered and treated with BRAF–MEK inhibitors in our hospital. Clinico-pathological features and treatment details were reviewed for all patients.
Results A total of seven patients with BRAF-mutated MM treated with this combination therapy with a median age of 66.5 years (range: 49–72 years) and a male:female ratio of 3:4. Six (85.7%) patients had metastatic disease at presentation. In total, 80% of our patient population had two or less than two sites of metastasis at presentation. The initial response rate of the study population was 71%. The drug was well tolerated with fever being the most common side effect which was seen in two (28.5%) of the patients.
Conclusion Combination of dabrafenib–trametinib is effective in patients with BRAF-mutated MM with good tolerability. Further studies are required to look for improvement in outcome in this group of patients.
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Affiliation(s)
- Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Mishra
- Department of Molecular Pathology, Tata Medical Center, Kolkata, West Bengal, India
| | - Gautam Biswas
- Department of Plastic Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Somanth Roy
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
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10
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Dabkara D, Ganguly S, Ghosh J, Mukherjee S, Gupta S, Mallick I, Mukherjee S, Midha D, Chatterjee M, Basu A, Hasan A, Biswas B. Clinicopathological characteristics, prognostic factors and treatment outcomes of seminomatous germ cell tumours from a tertiary cancer centre in eastern India. Natl Med J India 2021; 34:68-72. [PMID: 34599114 DOI: 10.4103/0970-258x.326752] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background . Seminomatous germ cell tumour (SGCT) is a rare but curable malignancy of young adults. The literature on management and outcome of SGCT is scarce from India. We report the demography and treatment outcome of SGCT at our centre. Methods . We did a retrospective analysis of patients with SGCT treated from March 2011 to December 2018. Patients were staged appropriately with imaging, and pre- and postoperative tumour markers. High inguinal orchiectomy was performed in all with a testicular primary and received subsequent stage-adjusted adjuvant treatment. Patients were monitored for metabolic syndrome during follow-up after completion of treatment. Results . We treated 85 patients with a median age of 37 (range 20-68) years. The primary site of the tumour was the testis in 80 (94%) and mediastinum in 5 (6%) patients. Cryptorchidism was present in 20 (25%) patients and testicular violation was present in 11 (14%) patients. Stage of the disease was I in 61, II in 13 and III in 6 patients. Adjuvant treatment in stage I disease was single-agent carbo-platin (area under the curve ×7) in 38 (62%), surveillance in 20 (33%) and radiotherapy in 3 (5%) patients. Five patients in the surveillance group relapsed. The 7-year mean (SD) relapse-free survival and overall survival were 83.1% (8%) and 98.7% (1.3%), respectively. Thirty-one patients (n = 52, 60%) had features of metabolic syndrome. Conclusions . SGCTs have a high cure rate. Long-term follow-up is essential for monitoring toxic effects. Early diagnosis, avoidance of testicular violation and multidisciplinary management are the key features for better long-term outcome in SGCT.
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Affiliation(s)
- Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Satyadip Mukherjee
- Department of Urosurgery, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Sujoy Gupta
- Department of Urosurgery, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Indranil Mallick
- Department of Radiotherapy, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Sumit Mukherjee
- Department of Radiology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Divya Midha
- Department of Pathology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Meheli Chatterjee
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Archisman Basu
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Ammara Hasan
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, West Bengal, India
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Abstract
AbstractBone loss is an important complication of prostate cancer and its associated treatments, especially androgen-deprivation therapy (ADT). There is a 5 to 10 times increased loss of bone mineral density (BMD) in men receiving ADT with yearly 4 to 13% BMD loss. The risk of fracture increases yearly by 5 to 8% with ADT. ADT associated bone loss of 10 to 15% of BMD doubles the risk of fractures. Hence, BMD evaluation through dual-energy X-ray absorptiometry and evaluation of individual fracture risk assessed before initiating ADT. The use of vitamin D, calcium, bisphosphonates, and denosumab has shown improved bone health in men with prostate cancer receiving ADT. Denosumab 60 mg is approved to increase bone mass in men at high risk for fractures receiving ADT for nonmetastatic prostate cancer. Denosumab has shown improvement of 5.6% BMD at 2 years in nonmetastatic prostate cancer patients, with significant improvements seen at the total hip, femoral neck, and distal third of the radius. Denosumab has shown a 62% decreased incidence of new vertebral fractures at 36 months. Furthermore, denosumab delays the onset of bone metastases in high-risk nonmetastatic prostate cancer patients. Denosumab can be preferred over other bone modifying agents owing to several advantages, such as subcutaneous administration and no requirement of hospitalization, no dose modifications in renal impairment and less incidence of acute phase anaphylactic reactions. We review the available evidence of denosumab for managing bone loss in nonmetastatic prostate cancer patients. The relevant articles used in this narrative review were obtained through general search on google and PubMed using the key terms “non-metastatic prostate cancer,” “denosumab,” “bone loss,” “bone mineral density,” “fracture,” “CTIBL,” and “chemotherapy induced bone loss.”
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Affiliation(s)
- Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
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12
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Ganguly S, Gargy S, Basu A, Chatterjee M, Ghosh A, Chakraborti B, Biswas B, Dabkara D, Rai S, Roy A, Mathai S, Bhaumik J, Ghosh J. Multidisciplinary management of ovarian germ cell tumours-a single institutional study from India. Ecancermedicalscience 2021; 15:1290. [PMID: 34824613 PMCID: PMC8580601 DOI: 10.3332/ecancer.2021.1290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/26/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ovarian germ cell tumours constitute a heterogeneous group of neoplasm with malignant potential being seen in 5% of cases. There is limited data on treatment outcomes of patients with malignant ovarian germ cell tumours (MOGCT). Here, we present our hospital audit of patients with MOGCT. MATERIAL AND METHODS This is a retrospective data review of patients with MOGCT treated between May 2011 and December 2019. Patients were treated with staging laparotomy and adjuvant chemotherapy, wherever applicable. Surveillance was allowed for those at low risk for recurrence. Clinicopathologic features and treatment details were recorded, and survival analysis was performed. RESULTS Sixty-five patients with a median age of 25 years (range: 11-52 years) were treated during the study period. The most common histology was immature teratoma in 35.3% of cases. International Federation of Gynecology and Obstetrics stage IC was the most common stage of presentation (47%). Surveillance was advised for 12.3% of cases. Systemic therapy was given in 51 (78%) patients. At a median follow-up of 46 months (range: 1-109 months), the median progression-free survival (PFS) was not reached. Five-year PFS was 79.3% (95% CI: 65.8-88). The most common toxicity was febrile neutropenia (22%) among those who received systemic therapy. CONCLUSION Immature teratoma was the most common histology in our series. The majority presented in the early stage. MOGCT is a highly curable disease with surgery and systemic therapy.
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Affiliation(s)
- Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Sumedha Gargy
- Department of Gynaecology, Rajendra Institute of Medical Sciences, Ranchi 834009, India
| | - Archisman Basu
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Meheli Chatterjee
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Anik Ghosh
- Department of Gynaecologic Oncosurgery, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Basumita Chakraborti
- Department of Gynaecologic Oncosurgery, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Shweta Rai
- Department of Gynaecologic Oncosurgery, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Arunava Roy
- Department of Gynaecologic Oncosurgery, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Sonia Mathai
- Department of Gynaecologic Oncosurgery, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Jaydip Bhaumik
- Department of Gynaecologic Oncosurgery, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
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13
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Roy S, Ghosh J, Ganguly S, Mondal D, Dabkara D, Chatterji S, Biswas B. Outcome of COVID-19 in Solid Organ Malignancies: Experience From a Tertiary Cancer Center in Eastern India. JCO Glob Oncol 2021; 7:1374-1379. [PMID: 34506223 PMCID: PMC8440012 DOI: 10.1200/go.21.00139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has imposed a unique challenge to oncology patients. Outcome data on COVID-19 in patients with cancer from the Indian subcontinent are scarce in the literature. We aimed to evaluate the outcome of patients with COVID-19 on active systemic anticancer therapy. MATERIALS AND METHODS This is a retrospective study of patients with solid organ malignancies undergoing systemic therapy with a diagnosis of COVID-19 between March 2020 and February 2021. COVID-19 was diagnosed if a reverse transcriptase polymerase chain reaction assay from oropharyngeal or nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2. The objectives were to evaluate the outcome of COVID-19 and factors predicting the outcome. RESULTS A total of 145 patients were included with a median age of 58 years (range, 20-81 years). Treatment was curative in 60 (42%) patients. Of all symptomatic cases (n = 88, 61%), 50 had mild, 27 had moderate and 19 had severe COVID-19–related symptoms as per WHO criteria. Fifty (34%) patients required hospitalization with a median duration of hospital stay of 12 days (range, 4-25 days); five patients required intensive care unit admission. The rest were treated with home isolation and did not require further hospitalization. Twenty-two (15%) patients died, and the risk of death was significantly associated with severity of symptoms (odds ratio, 91.3; 95% CI, 9.1 to 919.5, P = .0001) but not with any other clinical factors. Drug holiday was given to 63 (44%) patients with a median duration of 25 days (range, 7-88 days). The median duration to reverse transcriptase polymerase chain reaction–negative was 16 days (range, 7-62 days). CONCLUSION COVD-19–related death rate was 15% among patients with solid organ malignancies. The severity of the symptoms was related to mortality. The majority of patients with mild symptoms were treated at home isolation.
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Affiliation(s)
- Somnath Roy
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Debapriya Mondal
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | | | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
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14
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Dabkara D, Mondal D, Ghosh J, Biswas B, Ganguly S. How I Treat Metastatic Hormone-Sensitive Prostate Cancer? Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1729725] [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: 10/21/2022] Open
Abstract
AbstractAndrogen deprivation therapy (ADT) combined with docetaxel or antiandrogens (abiraterone, enzalutamide, or apalutamide) improved the outcomes in men with metastatic hormone-sensitive prostate cancer (mHSPC). When multiple options are available, the dilemma remains how to choose among these options. Similarly, issues of bone health, long-term side effects of therapies, and hereditary risk need to be discussed for comprehensive care. In the present article, we reviewed the relevant evidence for the treatment of mHSPC. ADT alone is not the current standard of care for most patients. In these times of plenty and price crisis, it is imperative to find the best option for treating these patients.
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Affiliation(s)
- Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Debapriya Mondal
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
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15
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Sharma V, Sharma A, Raina V, Dabkara D, Mohanti BK, Shukla NK, Pathy S, Thulkar S, Deo SVS, Kumar S, Sahoo RK. Metastatic colo-rectal cancer: real life experience from an Indian tertiary care center. BMC Cancer 2021; 21:630. [PMID: 34049505 PMCID: PMC8164292 DOI: 10.1186/s12885-021-08398-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background No data exist for the long-term outcome of metastatic colorectal cancer (mCRC) from the Southern part of Asia. The primary objective of the study is to evaluate the survival outcome of mCRC from an Indian tertiary care center. The study also aims to highlight the treatment pattern practiced and the unique clinico-pathologic characteristics. Methods This is a single-center retrospective observational study done at a large referral tertiary care center in North India. All patients with synchronous or metachronous mCRC who received at least one dose of chemotherapy for metastatic disease, registered between 2003 to 2017 were included. Primary outcome measures were overall survival and progression-free survival and prognostic factors of overall survival. Descriptive analysis was done for the clinicopathological characteristics and treatment patterns. Kaplan Meier method for overall survival and progression-free survival. Cox regression analysis was performed for the determination of the prognostic factors for overall survival. Result Out of 377 eligible patients, 256 patients (68%) had de novo metastatic disease and the remaining 121 (32%) progressed to metastatic disease after initial treatment. The cohort was young (median age, 46 years) with the most common primary site being the rectum. A higher proportion of signet (9%) and mucinous histology (24%). The three common sites of metastasis were the liver, peritoneum, and lung. In the first line, most patients received oxaliplatin-based chemotherapy (70%). Only 12.5% of patients received biologicals in the first-line setting. The median follow-up and median overall survival of study cohort were 17 months and 18.5 months. The factors associated with poor outcome for overall survival on multivariate analysis were ECOG performance status of > 1, high CEA, low albumin, and the number of lines of chemotherapy received (< 2). Conclusion The outcome of mCRC is inferior to the published literature. We found a relatively higher proportion of patients with the following characteristics; younger, rectum as primary tumor location, the signet, and mucinous histology, higher incidence of peritoneum involvement. The routine use of targeted therapies is limited. Government schemes (inclusion of targeted therapies in the Ayushman scheme), NGO assistance, and availability of generic low-cost targeted drugs may increase the availability.
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Affiliation(s)
- Vinod Sharma
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Vinod Raina
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Memorial Center, Kolkata, India
| | - Bidhu Kalyan Mohanti
- Department of Radiotherapy, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - N K Shukla
- Department of Surgical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sushmita Pathy
- Department of Radiotherapy, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S V S Deo
- Department of Surgical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Sharma A, Biswas B, Reddy R, Thumbudorai R, Ganguly S, Dabkara D, Pramanik R, Kumar S, Sahoo RK, Sharma A, Kumar L, Batra A. Seminomatous and non-seminomatous mediastinal germ cell tumors (MGCT): A real-world analysis from two tertiary care centers in India. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18726] [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: 11/20/2022] Open
Abstract
e18726 Background: Mediastinal germ cell tumor (MGCT) is a rare entity and comprises 10-15% of all mediastinal tumors. We describe the real-world treatment patterns and outcomes of MGCT treated at two tertiary care centres in India. Methods: Patients diagnosed with GCT (any site) at two large tertiary care centres from January 2010 to December 2020 in India were identified using the ICD-09 code (C-62) from prospectively kept databases. From these databases, a manual search was performed to identify MGCT patients. A chart review was done to retrieve demographic, tumor-related (serum tumor marker levels as per International germ cell cancer consensus (IGCCC)) and treatment details. Relapse free survival (RFS) and overall survival (OS) were estimated and compared for seminomatous and non-seminomatous MGCT. Results: A total of 54 patients were identified and all were males with a median age of 25 years (interquartile range, 18-45). Common presenting symptoms included cough (81.4%) shortness of breath (64.8%), chest pain (25.9%), superior vena cava obstruction (20.3%), pleural effusion (18.5%) and pericardial effusion (5.6%). Approximately one-thirds (n = 17) were seminomatous, while two-thirds were non-seminomatous (n = 37). Serum tumors markers levels were S0 (7.4%),S1 (42.6%),S2 (29.6%) and S3 (20.4%). Treatment was primarily by multiagent chemotherapy [ Bleomycin/Etoposide/cisplatin(BEP) 63.0%, EP (Etoposide/Cisplatin) 18.5%, VIP (etoposide/ifosfamide/cisplatin) 13.0%). Median number of cycles administered was 3 (Range 1-6). Three patients did not receive chemotherapy (all seminoma) and were treated with upfront surgery. In total, 11 patients (20.4%) underwent surgery, and eight (14.8%) received radiation. Three patients were not evaluable for response, 33.3% achieved complete response (CR),44.4% achieved partial response (PR), 9.3% had SD (stable disease) and 7.4% progressed on first line chemotherapy. Median follow up was 14.4 months (95% confidence interval [CI] 9.03 -26.16). Three year relapse free survival was 64.0% in overall population, and 100% in seminoma vs 41.5% in non-seminoma (P < 0.001). Three year OS was 80.2% in all patients and 94.1% for seminoma versus 70.0% in non-seminoma (P = 0.178). Conclusions: In this largest real-world analysis of MGCT, we found excellent long-term survival rates for patients with seminomatous MGCT, while further optimization of treatment is needed for those with non-seminomatous MGCT.
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Affiliation(s)
- Aparna Sharma
- Dr. B.R. A. IRCH, All India Institute of Medical Sciences, Delhi, India
| | | | - Rohit Reddy
- All India Institute of Medical Science (AIIMS), New Delhi, India
| | | | | | | | - Raja Pramanik
- All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, Dr BRA.Institute Rotary Cancer Hospital, New Delhi, India
| | - Ranjit Kumar Sahoo
- Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Atul Sharma
- Dr Brairch, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- All India Institute of Medical Sciences, Delhi, India
| | - Atul Batra
- All India Institute of Medical Sciences, New Delhi, India
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Biswas B, Ganguly S, Ghosh J, Roy S, Bakshi R, Dabkara D. Real-world experience of dacomitinib in EGFR mutated advanced NSCLC: A single center experience from India. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21043 Background: Dacomitinib is an irreversible tyrosine kinase inhibitor of epidermal growth factor receptor (EGFR) approved in advanced non-small cell lung cancer (NSCLC) with mutated EGFR. Literature on real world experience of dacomitinib is lacking, especially in patients (pts) with brain metastasis and uncommon EGFR mutation. Methods: This is single center retrospective study of EGFR mutated advanced NSCLC patients treated with dacomitinib between July’19 and Dec’20. All patients received dacomitinib at 45 mg once oral dose except few with Eastern Cooperative Oncology Group performance status (ECOG PS) of 2-3 and elderly received 30 mg once daily. Clinicopathologic features, treatment details, toxicity and treatment outcome were recorded. Progression free survival was calculated from start date of dacomitinib till date of progression. All pts underwent re-biopsy with evaluation for EGFR T790M at progression. Results: Total 43 pts were treated with median age of 63 years (range:43-81) and M: F ratio of 22:21. 26 pts accessed the drug through early access program, 6 pts through clinical trial and rest through commercially available product. ECOG PS was 1 in 29 pts, 2 in 13 pts and 3 in 1 patient. Ten patients had brain metastasis (out of evaluated 38) and 9 received whole brain radiotherapy. Type of mutations was Del 19 in 27 pts, L858R in 12 pts, G719X in 2pts, and Del 19 + L858R, L861Q in one patient each. Histopathology types were – adenocarcinoma in 39 pts, adenosquamous in 2 pts, NSCLC-not otherwise specified and squamous histology in one patient each. Starting dose of dacomitinib was 45 mg in 34 pts and 30 mg in 9 pts. 39 pts had any grade of toxicity and 20 pts (47%) had any grade 2 & 3 toxicity- mostly diarrhea and acneiform skin rash. Total 18 pts (42%) required dose modification (all from 45 mg to 30 mg). 38 pts have evaluable response: complete response in 2, partial response in 34 and stable disease in 2 pts. 8 out of 10 pts with brain metastases had partial response. All three pts with uncommon EGFR mutation had partial response. Five pts underwent re-biopsy on subsequent progression (4 had Del 19 and one had L861Q) and two developed EGFR T790M mutation. Six patients died (5 died of infection and one died of acute myocardial infarction). After a median follow-up of 13.8 months (range: 1.2-20.1), the median PFS not reached (95% confidence interval [CI]: 17.9, not reached) and 2-yr PFS was 57.5%. Conclusions: This is the largest experience of dacomitinib in EGFR mutated advanced NSCLC from Indian subcontinent. This is first reported activity of dacomitinib in pts with brain metastasis and uncommon EGFR mutation. Response rate was high and durable. 42% pts on 45 mg oral daily dose required dose modification due to toxicity. 30 mg once daily may be an optimum dose of dacomitinib in Indian pts.
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18
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Ghosh J, Ganguly S, Dabkara D, Biswas B, Chatterjee A, Mukhopadhyay S, Banerjee S, Sen S, Arun I. Pancreatic adenocarcinoma with primary tumor calcification and calcified liver metastasis: Report of a rare case and review of literature. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_102_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractCalcification is a feature of benign pancreatic diseases such as chronic calcific pancreatitis (CCP) or benign pancreatic tumors such as solid and papillary epithelial neoplasm of the pancreas and serous cystadenoma. The presence of calcification in a primary malignant pancreatic tumor is uncommon except for neuroendocrine tumors of the pancreas. Calcification in adenocarcinoma of the pancreas involving the primary tumor as well as the metastasis resulting thereof is extremely rare in the absence of CCP. To our knowledge, this is the first report of a case of primary adenocarcinoma of the pancreas that presented with calcification of the primary tumor as well as the metastatic liver nodules, accompanied by hypercalcemia.
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Affiliation(s)
- Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Arghya Chatterjee
- Department of Radiology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Sumit Mukhopadhyay
- Department of Radiology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Sudeep Banerjee
- Department of Surgical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Saugata Sen
- Department of Radiology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Indu Arun
- Department of Pathology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
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Ghosh J, Chatterjee M, Ganguly S, Datta A, Biswas B, Mukherjee G, Agarwal S, Ahmed R, Chatterjee S, Dabkara D. PDL1 expression and its correlation with outcomes in non-metastatic triple-negative breast cancer (TNBC). Ecancermedicalscience 2021; 15:1217. [PMID: 34158821 PMCID: PMC8183644 DOI: 10.3332/ecancer.2021.1217] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose Triple-negative breast cancer (TNBC) has a poor outcome compared to other subtypes, even in those with early disease. Immune checkpoint inhibitors (ICIs) have been approved in metastatic diseases and are being tested as a neoadjuvant strategy also. The response to ICIs is largely determined by the programmed death ligand 1 (PDL1) score, which also acts as a prognostic marker for outcomes. Here, we report the proportion of PDL1 expression in non-metastatic TNBC and its correlation with response to chemotherapy and outcomes. Methods We included all patients who had non-metastatic TNBC treated with neoadjuvant chemotherapy, followed by surgery with/without adjuvant radiotherapy between September 2011 and November 2017. PDL1 testing was carried out on pre-treatment tumour cells with immunohistochemistry (Ventana SP142) and was correlated with pathological response, relapse-free survival (RFS) and overall survival (OS). PDL1 staining was interpreted as negative or positive (more than 1% staining). Results A total of 107 patients were included for analysis with a median age of 47 years (28–65 yrs). The PDL1 expression of more than 1% was seen in 31 (28.97%) patients. After a median follow-up of 55 months (range: 4–93 months), median RFS and OS were not reached. PDL1 expression did not affect the achievement of pathological complete response (pCR). However, PDL1 expression improved OS (p = 0.016) and trend towards RFS (p = 0.05). Patients who achieved pCR had better RFS and OC compared to those who did not. Conclusion Our study shows PDL1 expression in 29% of the cases. PDL1 expression leads to better RFS and OS. Also, pCR improves survival.
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Affiliation(s)
- Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Meheli Chatterjee
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Anupurva Datta
- Department of Pathology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Geetashree Mukherjee
- Department of Pathology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Sanjit Agarwal
- Department of Breast Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Rosina Ahmed
- Department of Breast Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Sanjoy Chatterjee
- Department of Radiation Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, 14 MAR (E-W), New Town, Rajarhat, Kolkata, West Bengal 700156, India
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Biswas B, Dabkara D, Ganguly S, Ghosh J, Gupta S, Sen S, Chatterjee M, Basu A, Mukherjee S. Outcome of testicular non-seminomatous germ cell tumours: report from a tertiary cancer centre in eastern India. Ecancermedicalscience 2021; 15:1204. [PMID: 33889213 PMCID: PMC8043674 DOI: 10.3332/ecancer.2021.1204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/26/2020] [Indexed: 01/22/2023] Open
Abstract
Non-seminomatous germ cell tumour (NSGCT) is a rare but highly curable malignancy. The literature on the management and outcomes of NSGCT is scarce from India. Here, we report the demography and treatment outcomes of NSGCT treated at our centre. This is a retrospective analysis of testicular and retroperitoneal NSGCT patients treated from March 2011 to December 2019. Patients were staged appropriately with imaging, pre- and post-operative tumour marker. Patients received stage adjusted adjuvant treatment after high inguinal orchiectomy. Patients with advanced disease were risk stratified as per International Germ Cell Cancer Collaborative Group (IGCCCG) classification. A total of 100 patients were treated with a median age of 28 years (Range: 18–51). Primary site was testis in 92 and retroperitoneum in 8 patients. Testicular violation was present in 17 (18%) patients. The stage of the disease was I in 32, II in 19 and III in 49 patients, respectively. IGCCCG risk groups were good in 29 (46%), intermediate in 13 (21%) and poor in 21 (33%) patients. Eleven patients (24%) underwent retroperitoneal lymph node dissection amongst 45 with post-chemotherapy residual disease. After a median follow-up of 26.6 months (range: 2.2–100.7), 3-year event-free survival and overall survival (OS) were 70.7% ± 5.6% and 78.2% ± 5.4%, respectively. S3 tumour marker (p = 0.01) and non-pulmonary visceral metastasis (p < 0.001) emerged as independent poor prognostic factors for OS in multivariate analysis. To conclude, testicular NSGCT has very high cure rate. Two-third patients present with advanced disease and one-third of them had poor risk disease. S3 tumour marker and non-pulmonary visceral metastasis are poor risk factors for OS.
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Affiliation(s)
- Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, India
| | - Sujoy Gupta
- Department of Urosurgery, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, India
| | - Saugata Sen
- Department of Radiology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, India
| | - Meheli Chatterjee
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, India
| | - Archisman Basu
- Department of Medical Oncology, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, India
| | - Satyadip Mukherjee
- Department of Urosurgery, Tata Medical Center, 14 MAR (EW), New Town, Rajarhat, Kolkata 700160, India
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Abstract
Background Neuroendocrine carcinoma of the gallbladder (NECGB) is a rare pathological entity. They are found to be aggressive cancers. Treatment strategies are based largely on extrapolation from other small cell cancers. Survival is poor compared to adenocarcinoma. Data from low- and middle-income countries are sparse. Methods All patients with metastatic NECGB treated in our centre were identified. Their treatment details were captured from electronic medical records. Baseline characteristics were noted and survival was estimated using Kaplan-Meir method. Results A total of 15 patients were included. The median age was 55 years. Large cell comprises 2/15 and small cell was found in 13/15 patients. Chemotherapy was platinum-based in 12 patients. The response to first-line chemotherapy was partial in 3 (20%), stable disease in 2 (13.3%) and progressive disease in 10 (66.6%). After a median duration of follow-up of 12 months, the median progression free survival was 3 months and the median overall survival was 5 months. Conclusion The outcomes of small cell gallbladder cancer are dismal, despite good response rate. More prospective data are required.
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Affiliation(s)
- Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | | | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
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Biswas B, Dabkara D, Sengupta M, Ganguly S, Ghosh J, Arunsingh S M, Sen S. Multimodality treatment outcome in patients with primary malignant mediastinal germ cell tumor in adults. Cancer Rep (Hoboken) 2021; 4:e1306. [PMID: 33029924 PMCID: PMC7941572 DOI: 10.1002/cnr2.1306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/29/2020] [Accepted: 09/23/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Malignant mediastinal germ cell tumor (MGCT) is rare and has poor outcomes even after multimodality treatment. Data from resource-poor countries are scarce in the literature. AIMS To evaluate the clinicopathologic features and treatment outcome of primary malignant MGCT at our center. METHODS AND RESULTS Single institutional data review of patients aged ≥18 years, treated with a diagnosis of malignant MGCT between Nov'2013 and Nov'2019. Risk stratification was done as per International Germ Cell Cancer Collaborative Group (IGCCCG) classification. Patients were treated with platinum based chemotherapy and surgical resection for the residual disease was performed in non-seminomatous histology.28 patients had MGCT with a median age of 25 years (range:18-36) and all were male. Seven patients had superior vena cava obstruction (SVCO) at diagnosis and pre-treatment histological diagnosis was available in 23 (82%) patients. Seven (25%) patients had seminoma histology, all were of good risk as per IGCCCG risk criteria, whereas others had non-seminoma histology with poor-risk group. Seven patients with seminoma histology achieved a complete response after initial treatment. Six patients with non-seminoma histology underwent complete resection of residual disease post-chemotherapy and five revealed residual viable tumors. After a median follow-up of 10.8 months (range:2.9-75), 3-year progression-free survival (PFS) and overall survival (OS) estimate was 61.2% and 94.7% in the whole cohort, respectively and 3-year PFS and OS estimate was 100% in patients with seminoma histology. CONCLUSIONS This is the largest data set of MGCT patients' outcomes reported from India with multi-modality treatment. All patients were male and one-fourth had SVCO at presentation. Seminoma histology patients had a 100% outcome after initial platinum based chemotherapy. But, those with non-seminoma histology had a poor outcome even with chemotherapy and surgery.
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Affiliation(s)
- Bivas Biswas
- Department of Medical OncologyTata Medical CenterKolkataIndia
| | - Deepak Dabkara
- Department of Medical OncologyTata Medical CenterKolkataIndia
| | | | - Sandip Ganguly
- Department of Medical OncologyTata Medical CenterKolkataIndia
| | - Joydeep Ghosh
- Department of Medical OncologyTata Medical CenterKolkataIndia
| | | | - Saugata Sen
- Department of RadiodiagnosisTata Medical CenterKolkataIndia
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Ganguly S, Ghosh J, Gehani A, Basu A, Chatterjee M, Dabkara D, Biswas B. Non-small-cell lung cancer metastasis to unusual sites: A retrospective case series. Cancer Res Stat Treat 2021. [DOI: 10.4103/crst.crst_359_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Aim: Data on epidemiology and outcome in metastatic stomach carcinoma patients from India are scarce. We aimed to evaluate clinical features and treatment outcome in patients treated at our center. Materials and Methods: This is a single institutional review of metastatic gastric carcinoma patients treated between May 2011 and October 2016. Patients who received at least one cycle of chemotherapy were included for modified intent-to-treat survival analysis. Results: total of 143 patients were diagnosed with metastatic stomach carcinoma with a median age of 56 years (range: 29–86). The most common symptoms were abdominal pain in 112 (78%) patients. The most common site was body in 81 (57%) patients. Common site of metastasis was peritoneum in 86 (60%) and liver in (62%). Seventy-one (50%) patients were eligible for survival analysis. Common chemotherapy regimens were capecitabine-cisplatin in 27 (38%) and EOX in 22 (31%) patients. Survival status could not be assessed in 29 (41%) patients who lost to follow-up. After a median follow-up 9.7 months (range: 0.5–37.7), median progression-free survival (PFS) was 7.9 months (range: 0.5–23.9) and median overall survival (OS) was 12.2 months (range: 0.5–37.7). The Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2 and the presence of linitis plastica showed a trend toward inferior PFS (P = 0.052 and 0.053, respectively) only in univariate analysis. Female sex and ECOG PS ≥2 predicted inferior OS in both univariate and multivariate analysis (P = 0.012, 0.02 and 0.03 and 0.05, respectively). Conclusions: Platinum-based doublet chemotherapy was used in the majority of patients. The overall outcome was comparable to that of the available literature. Female sex and ECOG PS ≥2 predicted the inferior outcome.
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Affiliation(s)
- Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
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Ghosh J, Ganguly S, Dabkara D, Biswas B, Chatterjee A, Mukhopadhyay S, Chandra A, Sen S, Dey D. Metachronous muscle metastasis in a case of metastatic gallbladder cancer with TP35 gene mutation: A rare case report. South Asian J Cancer 2020; 8:240. [PMID: 31807487 PMCID: PMC6852630 DOI: 10.4103/sajc.sajc_139_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Arghya Chatterjee
- Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sumit Mukhopadhyay
- Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Aditi Chandra
- Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Saugata Sen
- Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Debdeep Dey
- Department of Pathology, Tata Medical Center, Kolkata, West Bengal, India
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Rout S, Rai S, Dabkara D, Ghosh J, Chakraborty B, Roy A, Ghosh A, Bhaumik J. Managing Brain Lesions in Gynecological Cancers: A Case Series. Indian J Gynecol Oncolog 2020. [DOI: 10.1007/s40944-020-00409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dabkara D, Ganguly S, Ghosh J, Patel A, Batra A, Krushna Das C, Tilak TVSVGK, Biswas B. How We Treat Genitourinary Cancers During COVID-19 Pandemic? Asian Pac J Cancer Care 2020. [DOI: 10.31557/apjcc.2020.5.s1.147-152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2) has become a pandemic and affected the entire globe. Daily routine life is affected due to global restriction of movement and infected more than 3.7 million peoples in more than 200 countries. It’s an invisible enemy which has imposed a clear threat to the humanity. Patients other than COVID-19 is also suffering a lot due to this unforeseen circumstances. This pandemic also shaken the powerful nations with best of healthcare settings. Oncology is a unique sector of healthcare as cancer patients are at more risk of SARS-CoV-2 infection and cancer treatments are also affected. Many regulatory bodies and professional organizations have come up with guidelines for healthcare personals and patients to guide anti-cancer treatment during COVID-19 pandemic. It’s time to formulate local treatment guidelines to guide cancer treatment with optimum use of healthcare resources at society and national level keeping in mind the load of COVID-19 at the concerned region. We have formulated guidelines to manage genitourinary cancer patients during this pandemic, especially in resource constraint setting with the aim of – optimum treatment of these patients with reduction of risk of contracting SARS-CoV-2 infection without affecting oncological outcome.
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Ghosh J, Ganguly S, Mondal D, Pandey P, Dabkara D, Biswas B. Perspective of Oncology Patients During COVID-19 Pandemic: A Prospective Observational Study From India. JCO Glob Oncol 2020; 6:844-851. [PMID: 32552110 PMCID: PMC7328097 DOI: 10.1200/go.20.00172] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has imposed a unique challenge to oncology patients and their treatment. There is no study related to the patients’ preference for systemic therapy during this pandemic. We have conducted a prospective study to analyze that aspect. METHODS All consecutive patients who visited during the lockdown period from April 1-10, 2020, for systemic chemotherapy were included in the study for a questionnaire-based survey to evaluate the willingness to continue chemotherapy during this pandemic and factors influencing the decisions. RESULTS A total of 302 patients were included (median age, 56 years; range, 21-77 years). Most common sites of cancer were breast (n = 114), lung (n = 44), ovary (n = 34), and colon (n = 20). Home address was within the city for 125 patients (42%), outside the city for 138 (46%), and outside the state for 37 (12%). Treatment was curative in 150 patients and palliative in 152. Educational status was primary and above for 231 patients and no formal schooling for 71. A total of 203 patients wanted to continue chemotherapy, 40 wanted to defer, and 56 wanted the physician to decide. Knowledge about COVID-19 strongly correlated with intent of treatment (P = .01), disease status (P = .02), knowledge about immunosuppression (P < .001), home location (P = .02), and education status (P = .003). The worry about catching SARS-CoV-2 was high in those with controlled disease (P = .06) and knowledge about immunosuppression (P = .02). Worry about disease progression was more with palliative intent (P < .001). CONCLUSION This study shows that oncology patients in our country are more worried about disease progression than the SARS-CoV-2 and wish to continue chemotherapy during this pandemic. The treatment guidelines in the COVID-19 scenario should incorporate patients’ perspectives.
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Affiliation(s)
- Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Debapriya Mondal
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Prashant Pandey
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
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Biswas B, Ganguly S, Dabkara D, Ghosh J, Srivastava P, Mehta P, Patel A, Bhethanabhotla S, Batra A, Pramanik R, Gupta VG, Das CK, Mahindru S. How We Treat lung Cancer during SARS-Cov-2 (COVID-19) Pandemic in India? Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_122_20] [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] [Indexed: 11/04/2022] Open
Affiliation(s)
- Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Priyanka Srivastava
- M.S. Patel Cancer Center, Shreekrishna Hospital and Research Center, Karamsad, Gujarat
| | - Prashant Mehta
- Department of Medical Oncology/Hematoncology and BMT, Asian Institute of Medical Sciences, Faridabad, Haryana
| | - Amol Patel
- Department of Medical Oncology, Army Hospital Research and Referral, New Delhi
| | | | - Atul Batra
- Department of Medical Oncology, Care Hospitals, All India Institute of Medical Sciences, New Delhi
| | - Raja Pramanik
- Department of Medical Oncology, Care Hospitals, All India Institute of Medical Sciences, New Delhi
| | | | - Chandan Krushna Das
- Regional Cancer Center, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Shubh Mahindru
- Department of Surgical Oncology, Ivy Hospital, SAS Nagar, Punjab
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Ghosh S, Ganguly S, Ghosh J, Biswas B, Dabkara D. A Novel Oxaliplatin Desensitization Protocol: Short, Safe, and Effective. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_99_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shouriyo Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
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Ganguly S, Ghosh J, Biswas B, Dabkara D. Ado-Trastuzumab Emtansine – The Monoclonal Drug Conjugate in Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_246_19] [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: 11/04/2022] Open
Abstract
AbstractHuman epidermal growth factor receptor 2 (HER2)-positive breast cancer comprises around 20%–25% of breast cancers. With the discovery of trastuzumab, there was a marked improvement in the survival of patients with HER2-positive breast cancer both in curative and metastatic settings. However, patients with trastuzumab will eventually progress or develop recurrences. Newer anti-HER2 therapies have evolved to improve the outcome of this group of patients. One of them is monoclonal antibody–drug conjugate which is ado-trastuzumab emtansine.
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Affiliation(s)
- Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
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Ghosh J, Ghosh A, Bhaumik J, Zameer L, Roy P, Chakraborty B, Roy A, Rai S, Mathai S, Ganguly S, Dabkara D, Ghosh P. A Rare Case of Hepatoid Carcinoma of the Ovary with Mini Review of Literature. Indian J Gynecol Oncolog 2020. [DOI: 10.1007/s40944-020-0371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ghosh J, Ganguly S, Biswas B, Dabkara D, Srivastava P, Patel A, Batra A, Mehta P. Systemic Treatment of Gastroesophageal Cancer during SARS-CoV2. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_118_20] [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] [Indexed: 11/04/2022] Open
Affiliation(s)
- Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Priyanka Srivastava
- Department of Medical Oncology, Shree Krishna Hospital and Medical Research Centre, Karamsad, Gujarat, India
| | - Amol Patel
- Department of Medical Oncology, Malignant Diseases Treatment Centre, Army Hospital Research and Referral, New Delhi, India
| | - Atul Batra
- Department of Medical Oncology, AIIMS, New Delhi, India
| | - Prashant Mehta
- Department of Medical Oncology, Asian Institute of Medical Sciences, Faridabad, Haryana, India
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Gupta P, Saha K, Vinarkar S, Banerjee S, Choudhury SS, Parihar M, Midha D, Mukherjee G, Lingegowda D, Chatterjee S, ArunsinghS M, Shrimali R, Ganguly S, Dabkara D, Biswas B, Mishra DK, Arora N. Next generation sequencing in lung cancer: An initial experience from India. Curr Probl Cancer 2020; 44:100562. [PMID: 32178863 DOI: 10.1016/j.currproblcancer.2020.100562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/08/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Approximately 35% of NSCLC patients in East Asia have EGFR mutations. Next-generation sequencing (NGS) provides a comprehensive mutational profile in lung cancer patients. MATERIAL AND METHOD Clinicopathologic characteristics and mutational profiling data was analyzed from nonsmall cell lung carcinoma /Adenocarcinoma over a duration of 42 months (October 2014 to March 2018) using next-generation sequencing Ion Ampliseq Cancer Hotspot panel v2 (Ampliseq, Life Technologies) on the Ion torrent PGM platform. RESULTS A total of 154 cases were processed during this period. The average number of mutations/case varied from one to four 72.07% (111/154), of these cases had minimum one genetic alteration. The most common mutated gene was TP53 gene (37.6%, n = 58) followed by EGFR (32.4%, n = 50), KRAS (18.18%, n = 28), ERBB2 (3.2%, n = 5), BRAF (1.94%, n = 3). EGFR positivity was more in females (43.3%) and non-smokers (52.08%) in comparison to males (26.7%) and smokers (16.1%). CONCLUSION In this paper, we have described the comprehensive mutational profiling of a large cohort of advanced lung adenocarcinoma patients from the eastern part of India. To the best of our knowledge, this is one of the largest studies from the country describing mutations in BRAF, ERBB2, TP53 genes and their clinicopathologic/histopathologic associations in lung cancers.
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Affiliation(s)
- Pragya Gupta
- Department of Molecular Genetics, Tata Medical Center, Kolkata, West Bengal, India
| | - Kallol Saha
- Department of Molecular Genetics, Tata Medical Center, Kolkata, West Bengal, India
| | - Sushant Vinarkar
- Department of Molecular Genetics, Tata Medical Center, Kolkata, West Bengal, India
| | - Saheli Banerjee
- Department of Molecular Genetics, Tata Medical Center, Kolkata, West Bengal, India
| | | | - Mayur Parihar
- Department of Cytogenetics, Tata Medical Center, Kolkata, West Bengal, India
| | - Divya Midha
- Department of Pathology, Tata Medical Center, Kolkata, West Bengal, India
| | | | | | - Sanjoy Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Moses ArunsinghS
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Raj Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak K Mishra
- Department of Molecular Genetics, Tata Medical Center, Kolkata, West Bengal, India
| | - Neeraj Arora
- Department of Molecular Genetics, Tata Medical Center, Kolkata, West Bengal, India.
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Kumar S, Joga S, Biswas B, Dabkara D, Prasad KT, Singh N, Malik PS, Khurana S, Ganguly S, Muthu V, Batra U. Immune checkpoint inhibitors in advanced non-small cell lung cancer: A metacentric experience from India. Curr Probl Cancer 2020; 44:100549. [PMID: 32035693 DOI: 10.1016/j.currproblcancer.2020.100549] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 01/09/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Immune check point inhibitors (ICIs) have changed the treatment paradigm of driver mutation negative non-small cell lung cancer (NSCLC) and they are increasingly incorporated in first-line treatment. Real-world experience of use of these drugs is limited. We aim to evaluate the real-world experience of use of ICIs in patients with advanced NSCLC. PATIENTS AND METHODS Medical records of patients with NSCLC treated with ICIs at 4 major academic cancer centers in India between January 2016 and December 2018 were analyzed. The type of ICI taken, response rates, survival, and toxicity profiles were analyzed. RESULTS The median age at presentation was 60 years (range: 27-79 years). Nivolumab was the most commonly used ICI drug [80%, n = 70] followed by pembrolizumab [10%, n = 9], and atezolizumab [10%, n = 9]. The median number of ICIs cycles received were 4 (range 2-65). Among the evaluable responses in 74 patients, the objective response rates was 25.6% and clinical benefit rate was 46%. Immune related toxicity occurred in 39.9% of patients but, severe toxicity of Grade III and Grade IV occurred in 5 (5.6%) patients. After a median follow-up time of 8.86 months (95%CI 5.2-11.1) the progression-free survival was 4.73 months (95%CI 3.7-8.9), and overall survival was 11.6 months (95%CI 7.33-NR). ECOG PS at the time of start of ICIs was found to be significant determinant of Progression-free survival and overall survival. CONCLUSION Our study demonstrates the feasibility of usage of ICIs in advanced NSCLC in Indian setting with acceptable safety profile and comparable responses with the published studies.
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Affiliation(s)
- Santosh Kumar
- Department of Medical Oncology, Dr B.R.A. Institute-Rotary Cancer Hospital., All India Institute of Medical Sciences, New Delhi, India
| | - Srujana Joga
- DNB General Medicine, DNB resident, Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, Dr B.R.A. Institute-Rotary Cancer Hospital., All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Khurana
- Department of Medical Oncology, Dr B.R.A. Institute-Rotary Cancer Hospital., All India Institute of Medical Sciences, New Delhi, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ullas Batra
- Senior Consultant, Department of Medical Oncology, Chief of Thoracic Medical Services, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
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Ganguly S, Biswas B, Bhattacharjee S, Ghosh J, Mukhopadhyay S, Midha D, Dabkara D. Clinicopathological characteristics and treatment outcome in small cell lung cancer: A single institutional experience from India. Lung India 2020; 37:134-139. [PMID: 32108598 PMCID: PMC7065549 DOI: 10.4103/lungindia.lungindia_370_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 12/24/2022] Open
Abstract
Background and Objectives Small cell lung cancer (SCLC) constitutes 14%-20% of all lung cancers. Clinical data on SCLC are scarce in literature. To report clinical features and treatment outcome of SCLC treated at our center. Materials and Methods This is a single institutional data review of SCLC patients treated between June 2011 and December 2018. Patients were staged as either localized or extensive disease after appropriate staging work-up. Patients with localized disease were treated with concurrent chemoradiation with platinum-based chemotherapy. Those with extensive disease were treated with platinum based palliative chemotherapy. Clinicopathological characteristics, treatment details, and outcome were recorded in this study. Patients who received at least one cycle of chemotherapy were included for survival analysis as intent-to-treat analysis. Results A total of 181 were patients registered with a median age of 62 years (range: 35-86 years) and male: female ratio of 166:15. Eighty-seven percent (n = 157) of patients had smoking history and 15% (n = 28) of patients had symptom of superior vena cava obstruction at baseline. Twenty-seven (15%) patients had localized disease at presentation. One hundred and twenty (66%) patients took systemic chemotherapy. Chemotherapy regimen was carboplatin only in 9 (7%), etoposide-carboplatin in 54 (45%), and cisplatin-etoposide in 57 (48%). Patients received median cycle number of 6 (range: 1-6). Of the evaluable 87 (73%) patients, initial response was complete response in 4, partial response in 57, stable disease in 20, and progressive disease in 6. Twenty patients received second-line chemotherapy at time of disease progression. After a median follow-up of 8.8 months (range: 0.3-46.1), median progression-free survival (PFS) of the whole population was 9.3 months. Conclusions Small cell carcinoma in our series had a high incidence of advanced stage (85%) and 13% of patients were nonsmoker. Only 66% of patients received palliative chemotherapy and achieved high disease control rate (>75%) in the evaluable patients with median PFS of 9.3 months.
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Affiliation(s)
- Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | | | - Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sumit Mukhopadhyay
- Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Divya Midha
- Department of Pathology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
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Ghosh J, Basu A, Chatterjee M, Ganguly S, Biswas B, Dabkara D. Leptomeningeal metastasis in lung cancer: Not always a gloomy picture. Cancer Res Stat Treat 2020. [DOI: 10.4103/crst.crst_151_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ghosh J, Das J, Ganguly S, Biswas B, Dabkara D. Cardiac metastasis from squamous cell carcinoma of the buccal mucosa: A case report and review of the literature. Cancer Res Stat Treat 2020. [DOI: 10.4103/crst.crst_62_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dabkara D, Basu A, Chatterjee M, Biswas B, Ganguly S, Ghosh J, Ghosh P. Adrenal metastasis in an older patient with seminoma. Cancer Res Stat Treat 2020. [DOI: 10.4103/crst.crst_250_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mallick I, Arunsingh M, Chakraborty S, Arun B, Prasath S, Roy P, Dabkara D, Achari R, Chatterjee S, Gupta S. A Phase I/II Study of Stereotactic Hypofractionated Once-weekly Radiation Therapy (SHORT) for Prostate Cancer. Clin Oncol (R Coll Radiol) 2019; 32:e39-e45. [PMID: 31551125 DOI: 10.1016/j.clon.2019.09.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/03/2019] [Revised: 07/30/2019] [Accepted: 08/09/2019] [Indexed: 12/25/2022]
Abstract
AIMS Stereotactic radiation therapy has been investigated predominantly in patients with low-intermediate-risk disease. We conducted a clinical trial of stereotactic hypofractionated radiation therapy delivered in once-weekly fractions on patients with all-risk non-metastatic disease to test feasibility, acute toxicities and patient-reported outcomes. MATERIALS AND METHODS In this phase I/II study, 30 patients with prostatic adenocarcinoma, any Gleason score, T1-4N0 and prostate-specific antigen ≤60 ng/ml were treated with volumetric intensity modulated arc radiation therapy to a dose of 35 Gy in five fractions delivered once weekly. Patients with high-risk disease also received elective nodal irradiation to a dose of 25 Gy in five fractions simultaneously. Androgen deprivation was offered to intermediate- and high-risk patients. The primary outcome was acute toxicity. Secondary outcome measures included biochemical control and late toxicity. Patient-reported outcomes were measured using the International Prostate Symptom Score and European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire (QLQ). RESULTS All 30 patients completed treatment per-protocol. Most patients had T3 (60%) and Gleason 7 (50%) tumours. The median prostate-specific antigen was 17 ng/ml. High-risk disease was present in 20 patients (66.7%). There was a low incidence of acute toxicities (grade 2 + urinary 3.3%, grade 2 rectal 0%). Within the EORTC QLQ framework, only the urinary symptom score showed a clinically meaningful worsening from a mean of 20/100 at baseline to 34/100 at the end of treatment (P < 0.001), but reduced to 24/100 at 6 months (P = 0.08). With a median follow-up of 41.5 months, two patients each reported grade 2 late urinary and rectal toxicity. The 3- and 4-year biochemical control rates were 96.7 and 87.9%, respectively. CONCLUSION In a cohort of mainly high-risk cancers, stereotactic once-weekly radiation therapy was easy to implement and well tolerated, with a low incidence of acute and late toxicity and excellent biochemical control.
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Affiliation(s)
- I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Chakraborty
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - B Arun
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Prasath
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - P Roy
- Department of Pathology, Tata Medical Center, Kolkata, India
| | - D Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - R Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Gupta
- Department of Urological Surgery, Tata Medical Center, Kolkata, India
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Shrimali RK, Nallathambi C, Saha A, Das A, Prasath S, Mahata A, Arun B, Mallick I, Achari R, Dabkara D, Thambudorai R, Chatterjee S. Radical radiotherapy or chemoradiotherapy for inoperable, locally advanced, non-small cell lung cancer: Analysis of patient profile, treatment approaches, and outcomes for 213 patients at a tertiary cancer center. Indian J Cancer 2019; 55:125-133. [PMID: 30604722 DOI: 10.4103/ijc.ijc_469_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/04/2022]
Abstract
INTRODUCTION Radical radiotherapy (RT) with curative intent, with or without chemotherapy, is the standard treatment for inoperable, locally advanced nonsmall cell lung cancer (NSCLC). MATERIALS AND METHODS We retrospectively reviewed the data for all 288 patients who presented with inoperable, locally advanced NSCLC at our institution, between May 2011 and December 2016. RESULTS RT alone or sequential chemoradiotherapy (SCRT) or concurrent chemoradiotherapy (CCRT) was used for 213 patients. Median age was 64 years (range: 27-88 years). Stage-III was the biggest stage group with 189 (88.7%) patients. Most patients with performance status (PS) 0 or 1 received CCRT, whereas most patients with PS 2 received RT alone (P < 0.001). CCRT, SCRT, and RT alone were used for 120 (56.3%), 24 (11.3%), and 69 (32.4%) patients, respectively. A third of all patients (32.4%) required either volumetric-modulated arc radiotherapy (VMAT) or tomotherapy. Median follow-up was 16 months. The median progression-free survival and median overall survival (OS) were 11 and 20 months, respectively. One-year OS and 2-year OS were 67.9% and 40.7%, respectively. Patients treated using CCRT lived significantly longer with a median survival of 28 months, compared with 13 months using SCRT and RT alone (P < 0.001). On multivariate analysis, OS was significantly affected by age, stage group, treatment approach, and response to treatment. CONCLUSION RT including CCRT is feasible, safe, and well tolerated in our patient population and results in survival benefits comparable with published literature. CCRT should be considered for all patients with inoperable, locally advanced NSCLC, who are fit and have good PS.
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Affiliation(s)
- Raj Kumar Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Chandran Nallathambi
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Animesh Saha
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Avipsa Das
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sriram Prasath
- Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India
| | - Anurupa Mahata
- Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India
| | - B Arun
- Department of Radiotherapy Physics, Tata Medical Center, Kolkata, West Bengal, India
| | - Indranil Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Rimpa Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Robin Thambudorai
- Department of Thoracic Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Sanjoy Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
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Biswas B, Dabkara D, Ganguly S, Ghosh J. Lung cancer in adolescent & young adults: Single center experience from Eastern India. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy425.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Biswas B, Dabkara D, Ganguly S, Shrimali R, Ghosh J, E P, Midha D, Mukherjee G, Parihar M, Mishra D, Arora N. P3.01-07 Outcome and Prognostic Factors in ALK+ve Metastatic Adenocarcinoma of Lung: Single Center Experience From Eastern India. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ganguly S, Biswas B, Ghosh J, Shrimali R, Sen S, Mukhopadhyay S, Mukherjee G, Midha D, Dabkara D, Basu A, Chatterjee M, Hassan A, Das S. P1.12-19 Clinico-Pathological Characteristics and Treatment Outcome in Small Cell Lung Cancer: A Single Institutional Experience. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prabhash K, Parikh PM, Rajappa SJ, Noronha V, Joshi A, Aggarwal S, Bondarde S, Patil S, Desai C, Dattatreya PS, Naik R, Anand S, Chacko RT, Biswas G, Sahoo TP, Dabkara D, Patil V, Chandrakant MV, Das PK, Vaid AK, Doval DC. Patterns of epidermal growth factor receptor testing across 111 tertiary care centers in India: Result of a questionnaire-based survey. South Asian J Cancer 2018; 7:203-206. [PMID: 30112342 PMCID: PMC6069335 DOI: 10.4103/sajc.sajc_30_18] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: We conducted a survey of 111 medical oncologists across India to understand the current pattern of epidermal growth factor receptor (EGFR) mutation testing at their respective centers. Methods: Medical oncologists from 111 institutes across India were interviewed face to face using a structured questionnaire. They were divided into two groups – Group 1 with in-house EGFR testing and Group 2 who send samples to central/commercial laboratories outside their institutions. Answers of the two groups were analyzed to see the prevailing patterns of EGFR testing and differences between the two groups if any. Results: Ninety-five percent (105/111) of medical oncologists recommended testing for EGFR mutations in patients with adenocarcinoma histology and 40% (44/111) recommended EGFR testing in squamous cell histology. The average time duration to get EGFR test results was 10 days in Group 1 centers versus 18 days in Group 2 centers. Ninety-six percent (106/111) of the medical oncologists from Group 1 centers requested for factoring additional sample for biomarker testing compared to 69% (77/111) of the oncologists from Group 2 centers. Sixty-nine percent (77/111) of medical oncologists in Group 1 centers would prefer to wait for the test results before initiating treatment compared to 46% (51/111) in Group 2. EGFR tyrosine-kinase inhibitors were used in only approximately 60% of patients with diagnosed EGFR mutation in the first line. For patients in whom chemotherapy was initiated while waiting for test results, 50% (56/111) of medical oncologists would prefer to complete 4–6 cycles before switching to targeted therapy. At the time of progression, rebiopsy was possible in approximately 25% of the patients. Conclusions: Turnaround time for molecular testing should improve so that eligible patients can benefit from targeted therapies in the first line. There is a need to increase the awareness among pulmonologists, oncologists, and interventional radiologists regarding the importance of adequate samples required for molecular tests.
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Affiliation(s)
- Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hosptial, Mumbai, Maharashtra, India
| | - Purvish M Parikh
- Department of Medical Oncology, Asian Institute of Oncology, Mumbai, Maharashtra, India
| | - Senthil J Rajappa
- Department of Medical Oncology, Indo American Hospital, Hyderabad, Telangana, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hosptial, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hosptial, Mumbai, Maharashtra, India
| | - Shyam Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Shailesh Bondarde
- Department of Medical Oncology, Shatabdi Hospital, Nasik, Maharashtra, India
| | - Shekar Patil
- Department of Medical Oncology, HCG Hospital, Bengaluru, Karnataka, India
| | - Chirag Desai
- Department of Medical Oncology, Vendant Hospital, Ahmedabad, Gujarat, India
| | | | - Rajesh Naik
- Department of Oncology/Respiratory Medical Affairs Boehringer Ingelheim India Pvt. Ltd., Mumbai, Maharashtra, India
| | - Sohit Anand
- Department of Oncology/Respiratory Medical Affairs Boehringer Ingelheim India Pvt. Ltd., Mumbai, Maharashtra, India
| | - Raju Titus Chacko
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ghanshyam Biswas
- Department of Medical Oncology, Sparsh Hospital, Bhubaneswar, Odisha, India
| | - Tarini P Sahoo
- Department of Medical Oncology, Chirayu Hospital, Bhopal, Madhya Pradesh, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hosptial, Mumbai, Maharashtra, India
| | - M V Chandrakant
- Department of Medical Oncology, Narayana Superspeciality Hospital, Kolkata, West Bengal, India
| | - Pratap K Das
- Department of Medical Oncology, Apollo Hospitals, New Delhi, India
| | - Ashok K Vaid
- Department of Medical Oncology, Medanta - The Medicity, Gurugram, Haryana, India
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Ghosh J, Agarwal S, Ganguly S, Dabkara D, Biswas B, Nandi S, Chakraborty S, Datta S, Ahmed R, Chatterjee S. Patterns of recurrence in triple negative breast cancer patients (automated IHC) : An Indian Tertiary Care Center data. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ganguly S, Dabkara D, Biswas B, Ghosh J. Metronomic therapy in metastatic castrate-resistant prostate cancer: Experience from a tertiary cancer care center. Indian J Cancer 2018; 55:94-97. [DOI: 10.4103/ijc.ijc_346_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Biswas B, Dabkara D, Ganguly S. In-transit metastases from malignant melanoma. Natl Med J India 2017; 30:297. [PMID: 29916439 DOI: 10.4103/0970-258x.234405] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Bivas Biswas
- Department of Medical Oncology, Dr B.R. Ambedkar Institue-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center 14 Major Arterial Road (EW), New Town, Rajarhat, Kolkata, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center 14 Major Arterial Road (EW), New Town, Rajarhat, Kolkata, West Bengal, India
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Biswas B, Ganguly S, Ghosh J, E P, Dabkara D. Adjuvant Chemotherapy for Upper Tract Urothelial Carcinoma: Is There Sufficient Evidence? J Clin Oncol 2017; 35:2095-2096. [DOI: 10.1200/jco.2017.72.8600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bivas Biswas
- Bivas Biswas, Sandip Ganguly, Joydeep Ghosh, Prasad E, and Deepak Dabkara, Tata Medical Center, Kolkata, India
| | - Sandip Ganguly
- Bivas Biswas, Sandip Ganguly, Joydeep Ghosh, Prasad E, and Deepak Dabkara, Tata Medical Center, Kolkata, India
| | - Joydeep Ghosh
- Bivas Biswas, Sandip Ganguly, Joydeep Ghosh, Prasad E, and Deepak Dabkara, Tata Medical Center, Kolkata, India
| | - Prasad E
- Bivas Biswas, Sandip Ganguly, Joydeep Ghosh, Prasad E, and Deepak Dabkara, Tata Medical Center, Kolkata, India
| | - Deepak Dabkara
- Bivas Biswas, Sandip Ganguly, Joydeep Ghosh, Prasad E, and Deepak Dabkara, Tata Medical Center, Kolkata, India
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Prabhash K, Parikh PM, Rajappa SJ, Noronha V, Joshi A, Aggarwal S, Bondarde SA, Patil S, Desai CJ, Naik R, Anand S, Chacko RT, Biswas G, Sahoo TP, Dabkara D, Patil VM, MV C, Das PK, Vaid AK, Doval D. EGFR testing scenario across 111 centres in India: A questionnaire-based survey. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e13111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13111 Background: Lung cancer diagnosis now involves routine use of biomarker testing to identify the driver mutations. We conducted a survey of 111 medical oncologists across India to understand the current pattern of EGFR mutation testing at their respective centres. Methods: Medical oncologists from 111 institutes across India were interviewed face to face using a structured questionnaire. They were divided into two groups - Group 1 with in-house EGFR testing and Group 2 who send samples to central/commercial labs. Answers of the two groups were analysed to see the prevailing patterns of EGFR mutation testing and differences between the groups if any. Results: In India, 95% of medical oncologists recommend testing for EGFR mutations in patients with adenocarcinoma histology. 40% would also recommend testing in squamous histology. 80% of medical oncologists request for biomarker testing at the time of primary biopsy. From the time of biopsy, the average time duration to get EGFR test results is 18 days. In centres with in-house testing (Group 1), results are available in 10 days. 96% of the medical oncologists from Group 1 centres request for factoring additional sample for biomarker testing compared to only 69% from Group 2. 69% of medical oncologists in Group 1 centres would prefer to wait for the test results before initiating treatment compared to 46% in Group 2. EGFR TKIs are used in 60% of patients with diagnosed EGFR mutation in the first line. For patients in whom chemotherapy is initiated while waiting for test results, 50% of medical oncologists prefer completing 4-6 cycles before switching to targeted therapy. At the time of progression, rebiopsy is possible in 25% of the patients. Rapid disease progression and poor PS were the two most common reasons given for the low rebiopsy rates. Conclusions: Application of molecular testing is improving. Yield can be improved by training of multidisciplinary team involved in tumor biopsy. There is scope and need to reduce the turnaround time. This will reduce the current scenario of commencing chemotherapy while waiting for test results. Increasing application of liquid biopsy will help in initial diagnosis as well as at relapse, especially for patients with poor PS or difficult access to tumor site.
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Affiliation(s)
| | | | | | | | | | | | | | - Shekar Patil
- HCG Bangalore Institute of Oncology, Bangalore, India
| | | | - Rajesh Naik
- Boehringer Ingelheim India Pvt Ltd, Mumbai, India
| | - Sohit Anand
- Boehringer Ingelheim India Pvt Ltd, Mumbai, IA, India
| | | | | | | | | | | | | | | | - Ashok K. Vaid
- Medanta Cancer Institute Medanta The Medicity, Gurgaon Haryana, India
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