Maintenance therapy with a poly(ADP-ribose) polymerase inhibitor in patients with newly diagnosed advanced epithelial ovarian cancer: individual patient data and trial-level meta-analysis

Background

We synthesize the efficacy and toxicity of poly(ADP-ribose) polymerase inhibitors (PARPis) in patients with newly diagnosed advanced ovarian cancer.

Patients and methods

We manually extracted individual patient data (IPD) for progression-free survival (PFS) from published survival curves of randomized controlled trials (RCTs) that compared PARPi versus placebo as maintenance therapy in first-line treatment, for whole study populations and subgroups, based on BRCA1/BRCA2 mutation (germline and/or somatic) and homologous recombination deficiency (HRD) status, using WebPlotDigitizer software. The respective PFS curves for each study and combined population were reconstructed from extracted IPD. The primary outcome was PFS in combined whole population and subgroups.

Results

In IPD analysis of combined population from three RCTs, with 2296 patients and 1287 events, PFS was significantly longer in PARPi versus placebo [median 20.4 (95% confidence interval (CI) 18.6-21.9) versus 14.9 (95% CI 13.9-16.5) months, respectively; hazard ratio (HR) 0.67, 95% CI 0.60-0.75; P < 0.001]. In IPD subgroup analyses from four eligible RCTs (2687 patients and 1485 events), median PFS was significantly longer in PARPi versus placebo arm, in the BRCA-mutated (45.7 versus 17.7 months, respectively; HR 0.38, 95% CI 0.32-0.46; P < 0.001), HRD-positive including BRCA-mutated (34.7 versus 17.9 months, respectively; HR 0.45, 95% CI 0.38-0.54; P < 0.001), and HRD positive excluding BRCA-mutated (22.3 versus 13.1 months, respectively; HR 0.47, 95% CI 0.34-0.65; P < 0.001) subgroups, but not in the HRD-negative (15.0 versus 11.3 months, respectively; HR 0.90, 95% CI 0.76-1.05; P = 0.75) subgroup. Results of trial-level meta-analysis were concordant with IPD analysis in whole population and subgroups.

Conclusions

Among newly diagnosed ovarian cancer patients, PARPi maintenance therapy significantly improves PFS in those with germline and/or somatic BRCA mutation and/or HRD-positive tumor but not in those with HRD-negative tumor.

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Maintenance PARPi resulted in significant PFS improvement in total population, but benefit varied in subgroups.

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PARPi showed PFS gain in BRCA-mutated (45.7 versus 17.7 m) and HRD-positive subgroups.

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No significant PFS benefit was seen in the HRD-negative subgroup (15.0 versus 11.3 months; P = 0.75).

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PARPi should be a standard treatment in newly diagnosed ovarian cancer patients except those with HRD-negative tumors.

Performance evaluation of air pollution control device at traffic intersections in Delhi

Urban air pollution and exposure-related health impacts are being noticed and discussed very intensely in India. On the other hand, source-specific control is the primary focus for policymakers; however, diverse and complex sources make it difficult to immediately see the action and consequent impacts on better air quality. Many cities across the world have witnessed high air pollution levels at traffic junctions, more so in all Indian cities. Site-specific air pollution reduction can be a promising solution for managing the pollution level at highly polluted locations. CSIR-National Environmental Engineering Research Institute, India, has designed and developed Wind Augmentation and purifYing Unit (WAYU) to remove particulate and gaseous pollutants from urban hot spots such as traffic locations. In the present study, the authors attempted to evaluate the performance of two different designs of WAYU for the removal of particulate matters from polluted air at different traffic locations in Delhi City, the national capital territory of India. The performance analyses show that the current design of WAYU removes PM₁₀ and PM_2.5 concentrations in the range of 34-49% and 19-25%, respectively from the inlet air. The total PM collected from all WAYU devices was 34.19 kg from 120,557 operating hours' at all the sampling sites. The PM removal rate depends on the size-segregated particulate matter pollution load in the ambient air.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13762-021-03641-3.

Effect of Type II Diabetes Mellitus, Candida Albicans and Streptococcus Mutans on the Biofilm Formation on Prosthetic Materials

AIM

To investigate the biofilm formation on Prosthetic materials as affected by type II diabetes mellitus, Candida albicans and Streptococcus mutans.

MATERIALS AND METHODS

Two types of saliva, natural saliva, and artificial saliva were collected and prepared respectively. The natural saliva was divided into diabetic and non-diabetic saliva. The artificial saliva was further divided into two groups, one inoculated with Streptococcus mutans and the second with Candida albicans. The 150 samples of various prosthetic materials were prepared using nickel-chromium alloy, ceramic, soft liner, tooth molding powder; heat cured the acrylic resin. The samples were then immersed in natural saliva and artificial saliva and studied for biofilm formation.

RESULTS

Diabetic saliva formed more biofilm than non-diabetic saliva. Streptococcus mutans were able to form more biofilm than Candida albicans in artificial saliva on constitutive androstane receptor (hCAR) and spinal length (SL). In Diabetic saliva, there was a significant difference in the biofilm formation seen between MC and NCA (p < 0.05). No biofilm was formed on hCAR in natural saliva (diabetic or non-diabetic). In artificial saliva inoculated with Candida albicans and streptococcus mutans there is a significant difference in the biofilm formation in all the materials except NCA.

CONCLUSION

Diabetic saliva has more potential to form biofilm than non-diabetic saliva. Also, Candida albicans and Streptococcus mutans both can form a biofilm on materials used with the maximum formation on hCAR. Smoother materials formed less biofilm than rougher surfaces like hCAR, PCM, SL.

CLINICAL SIGNIFICANCE

It is desirable for dental restorative materials to have a low susceptibility for accumulation and formation of biofilm as it may lead to pathologies such as dental caries, periodontal disease, peri-implantitis, etc. which are plaque-related. The most commonly used materials in prosthodontics have been used in the study to establish a direct relationship with the formation of biofilm, this, in turn, helps us to take the right call in choosing a material for a patient with an already compromised systemic condition.

A Comprehensive Review on Zygomatic Implants

Severely resorbed or atrophic maxilla has always posed a problem in terms of conventional implant therapy due to insufficient bone. A new approach to such situations is placing implants in the zygoma. Zygomatic implants are placed in patients with inadequate bone due to resection of the maxilla after surgery or in cases of resorbed maxilla. These are longer implants anchoraged in the zygoma, and present as an alternative to sinus augmentation or bone grafting. Being a technique sensitive procedure extreme care has to be taken during the placement of these implants to obtain promising results. This article reviews the zygomatic implants used in dentistry.

Eribulin in heavily pretreated metastatic breast cancer: A tertiary care center experience from India

INTRODUCTION

Heavily pretreated metastatic breast cancer (MBC) remains a major therapeutic challenge with limited treatment options this. Eribulin, an anti-microtubule agent, has been recently approved for this indication. There are sparse data from the Asian region for eribulin and merits exploration.

MATERIALS AND METHODS

This was a single institution retrospective analysis of MBC patients treated with eribulin from 2013 to 2014. These patients had received at least 2 lines of prior therapy for metastatic disease. Patients received standard doses of eribulin and were monitored for toxicity and responses.

RESULTS

Eighteen patients were included in this analysis. They had received a median of 6 lines of therapy previously (including adjuvant treatment) and had significant visceral involvement (median 3 organs). A median of 4 cycles of eribulin was delivered. There were no complete responses; partial responses were seen in 33% (6/18), stable disease status in 28% (5/18) patients, and progressive disease on eribulin in 39% (7/18) patients. The median progression-free survival was 15 weeks (3.5 months), and median overall survival was 27 weeks (6.2 months). Significant Grade 3/4 toxicities seen included peripheral neuropathy in 28% (5/18) and neutropenia in 28% (5/18) of patients while dose reductions were required in 22% (4/18) of patients.

CONCLUSION

Eribulin offers a viable, well-tolerated regimen that provides meaningful clinical benefit in Indian patients with MBC.

Everolimus in heavily pretreated metastatic breast cancer: Is real world experience different?

BACKGROUND

Drugs targeting mammalian target of rapamycin signaling pathway have been recently approved for treatment of hormone receptor (HR) positive metastatic breast cancer (MBC). However, there is lack of real world data from India on the use of this therapeutic strategy.

MATERIALS AND METHODS

A retrospective analysis of MBC patients who had recurrence or progression while receiving aromatase inhibitors (AI's) and further treated with everolimus and either tamoxifen/AI/fulvestrant between March 2012 and June 2014, was undertaken.

RESULTS

There were 41 patients with median age 55 years, 73% with visceral metastasis, and 73% with ≥2 sites of metastases. Thirty (73%) patients had received 3 prior lines of therapy including AI (100%), tamoxifen (94%), fulvestrant (39%), and chemotherapy (100%) while the remaining had received <3 lines of prior therapy. The commonest Grade 3/4 adverse events were stomatitis (19%), hyperglycemia (new/worsening, 17%), fatigue (14.5%), nonneutropenic infections (14%), anemia (12%) and pneumonitis (7%). Everolimus dose reductions were required in 31% patients. There were 30% partial responses, 38% prolonged disease stabilizations and 32% disease progression as best responses to everolimus. The median progression-free survival was 22 weeks (5 months).

CONCLUSIONS

Everolimus based treatment has meaningful activity in heavily pretreated patients with HR-positive MBC but is associated with considerable toxicity and requirement for dose adjustment.

Acute renal failure secondary to ingestion of alternative medication in a patient with breast cancer

Complementary and alternative medicine (CAM) use among cancer patients is widely prevalent and often underreported. Advanced stage of disease is significantly associated with CAM use. The concurrent use of alternative medicines and chemotherapy drugs has the potential to lead to toxicities as well as altered therapeutic activity due to unknown interactions. We report a case of early breast cancer who presented to us with non-oliguric acute renal failure related concurrent use of Ayurvedic medicines and adjuvant anthracycline based.

Sunitinib in patients with imatinib-resistant gastrointestinal stromal tumor: A single center experience study

AIM

The outcome of patients with advanced gastrointestinal stromal tumor (GIST) has improved with the use of imatinib. Despite high response rates with this drug resistance eventually develops in nearly all patients. We present an analysis of prospectively collected data on sunitinib efficacy and safety in patients with imatinib-resistant GIST.

SUBJECTS AND METHODS

Between November 2006 and October 2007, patients with GIST were accrued in an approved sunitinib patient access protocol. Key eligibility criteria included tumor resistance to imatinib and/or patient intolerance to this drug. Patients received sunitinib at a starting dose of 50 mg once daily for 4 weeks in a 6 week cycle, with standardized dose modification titrated to toxicity. Patients were continued on sunitinib until disease progression or unacceptable toxicity. The endpoints were safety, overall survival (OS) and objective response rate (ORR).

RESULTS

Fifteen patients, all of whom had imatinib resistance and none intolerance, with median age of 48 (26-69) years, were treated on the protocol. The most common sites of primary disease were small intestine (40%), stomach (26.7%) and retroperitoneal (26.7%). A median of 10 (1-47) cycles of sunitinib were delivered, 9 (60%) patients required dose reductions due to toxicity whereas dose delay of > 2 weeks was required in only one (6.7%) patient. There were no toxicity-related drug discontinuations. Hypothyroidism (n = 4; 26.7%) and hand-foot syndrome (n = 3; 20%) were the most common toxicities. There were no complete and 4 (26.7%) partial responses while prolonged disease stability was seen in 8 (53.3%) patients. At a median follow-up of 81 months in surviving patients, the median progression-free and overall survivals were 15.5 and 18.7 months, respectively.

CONCLUSIONS

Sunitinib appears to be an effective and well-tolerated treatment for Indian patients with imatinib-resistant GIST with outcomes similar to that reported previously. Adverse effects can be reasonably well managed using a dose modification strategy.

Abstract P4-14-07: Outcome with use of 12 weeks of adjuvant or neoadjuvant trastuzumab in a resource constrained setting

Background: Adjuvant trastuzumab has improved overall survival in women with HER2 receptor positive breast cancer. However, only a small fraction (4%) of eligible patients in resource constrained settings have access to this drug. A patient assistance program of 12 weeks of adjuvant or neoadjuvant trastuzumab was thus started for those who did not have any access to trastuzumab due to financial constraints. We undertook a retrospective analysis of outcomes in women who were enrolled between January 2011 to December 2012 in this patient assistance program.

Methods: Patients received four cycles of anthracycline based chemotherapy (AC/CAF/ EC/CEF) and 12 doses of weekly paclitaxel (80mg/m2) with trastuzumab (4mg/kg loading followed by 2mg/kg) in the neoadjuvant or adjuvant setting in either sequence (anthracycline followed by taxane trastuzumab or taxane trastuzumab followed by anthracycline). Patients received adjuvant hormonal therapy depending on the hormone receptor status. The primary endpoint of this analysis was disease free survival (DFS).

Results: A total of 103 patients with HER2 receptor positive breast cancer were analysed. The median age was 46 (24-65) years, 50% were premenopausal, 60.7% had stage III disease (86.8% had node positive disease) and 37% patients had ER and or PR positive disease. Forty patients (38.8%) had breast conserving surgery while the rest had modified radical mastectomy. At a median follow-up of 34 (7-46) months the 3-year DFS and overall survival was 77.2% and 82.7% respectively. Among patients who developed recurrence one had only local recurrence, 4 had both local and distant recurrence and 11 had distant metastasis alone. Of the 15 patients who developed distant metastasis 7 had brain involvement . Symptomatic cardiac dysfunction developed in four patients, two of whom died while in the other 2 ejection fraction recovered. The results are summarised in the table.

Patient Characteristic and outcome with 12 weks of adjuvant or neoadjuvant TrastuzumabNumber of PatientsNode Positive (%)Hormone Positive (%)DFS at 3 yearsOS at 3 yearsBrain Mets(%)Grade 3/4 Cardiac Toxicity(%)10386.83777.282.76.83.9

Conclusions: These results suggest that 12 weeks of neoadjuvant or adjuvant trastuzumab is an acceptable alternative in patients who lack access to full 1 year of trastuzumab.

Citation Format: Ghosh J, Joy Phillip DS, Ghosh J, Gupta S, Bajpai J, Gulia S, Parmar V, Nair N, Budrukkar AN, Jalali R, Desai SB, Sawant S, Dhir AA, Kembhavi S, Hawaldar R, Banavali SD, Badwe RA. Outcome with use of 12 weeks of adjuvant or neoadjuvant trastuzumab in a resource constrained setting. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-07.

Induction chemotherapy in technically unresectable locally advanced oral cavity cancers: does it make a difference?

BACKGROUND

Locally advanced and unresectable oral cavity cancers have a poor prognosis. Induction might be beneficial in this setting by reducing tumor bulk and allowing definitive surgery.

AIM

To analyze the impact of induction chemotherapy on locally advanced, technically unresectable oral cavity cancers.

MATERIALS AND METHODS

Retrospective analysis of patients with locally advanced oral cavity cancers, who were treated with neoadjuvant chemotherapy (NACT) during the period between June 2009 and December 2010. Data from a prospectively filled database were analyzed for information on patient characteristics, chemotherapy received, toxicity, response rates, local treatment offered, patterns of failure, and overall survival. The statistical analysis was performed with SPSS version 16.

RESULTS

123 patients, with a median age of 42 years were analyzed. Buccal mucosa was the most common subsite (68.30%). Three drug regimen was utilized in 26 patients (21.10%) and the rest received two drug regimen. Resectability was achieved in 17 patients treated with 3 drug regimen (68.00%) and 36 patients receiving 2 drug regimen. Febrile neutropenia was seen in 3 patients (3.09%) receiving 2 drug regimen and in 9 patients (34.62%) receiving 3 drug regimen. The estimated median OS was not reached in patients who had clinical response and underwent surgery as opposed to 8 months in patients treated with non-surgical modality post NACT (P = 0.0001).

CONCLUSION

Induction chemotherapy was effective in converting technically unresectable oral cavity cancers to operable disease in approximately 40% of patients and was associated with significantly improved overall survival in comparison to nonsurgical treatment.

High stability of yellow fever 17D-204 vaccine: A 12-year restrospective analysis of large-scale production

We have retrospectively analyzed 12 bulk lots of yellow fever vaccine Stamaril, produced between 1990 and 2002 and prepared from the same seed lot that has been in continuous use since 1990. All vaccine batches displayed identical genome sequence. Only four nucleotide substitutions were observed, compared to previously published sequence, with no incidence at amino-acid level. Fine analysis of viral plaque size distribution was used as an additional marker for genetic stability and demonstrated a remarkable homogeneity of the viral population. The total virus load, measured by qRT-PCR, was also homogeneous pointing out reproducibility of the vaccine production process. Mice inoculated intracerebrally with the different bulks exhibited a similar average survival time, and ratio between in vitro potency and mouse LD(50) titers remained constant from batch-to-batch. Taken together, these data demonstrate the genetic stability of the strain at mass production level over a period of 12 years and reinforce the generally admitted idea of the safety of YF17D-based vaccines.

Dendritic cells are essential for priming but inefficient for boosting antitumour immune response in an orthotopic murine glioma model

The prognosis of malignant gliomas remains dismal and alternative therapeutic strategies are required. Immunotherapy with dendritic cells (DCs) pulsed with tumour antigens emerges as a promising approach. Many parameters influence the efficacy of DC-based vaccines and need to be optimised in preclinical models. The present study compares different vaccine schedules using DCs loaded with tumour cell lysate (DC-Lysate) for increasing long-term survival in the GL26 orthotopic murine glioma model, focusing on the number of injections and an optimal way to recall antitumour immune response. Double vaccination with DC-Lysate strongly prolonged median survival compared to unvaccinated animals (mean survival 87.5 days vs. 25 days; p < 0.0001). In vitro data showed specific cytotoxic activity against GL26. However, late tumour relapses frequently occurred after 3 months and only 20% of mice were finally cured at 7 months. While one, two or three DC injections gave identical survival, a boost using only tumour lysate after initial DC-Lysate priming dramatically improved long-term survival in vaccinated mice, compared to the double DC-Lysate group, with 67.5% of animals cured at 7 months (p < 0.0001). In vitro data showed better specific CTL response and also the induction of specific anti-GL26 antibodies in the DC-Lysate/Lysate group, which mediated Complement Dependent Cytotoxicity. These experimental data may be of importance for the design of clinical trials that currently use multiple DC injections.