Characteristics & outcomes of cancer patients with COVID-19: A multicentre retrospective study from India

Background & objectives

High mortality has been observed in the cancer population affected with COVID-19 during this pandemic. We undertook this study to determine the characteristics and outcomes of cancer patients with COVID-19 and assessed the factors predicting outcome.

Methods

Patients of all age groups with a proven history of malignancy and a recent diagnosis of SARS-CoV-2 infection based on nasal/nasopharyngeal reverse transcriptase (RT)-PCR tests were included. Demographic, clinical and laboratory variables were compared between survivors and non-survivors groups, with respect to observed mortality.

Results

Between May 11 and August 10, 2020, 134 patients were included from the three centres and observed mortality was 17.1 per cent. The median age was 53 yr (interquartile range 39-61 yr) and thirty four patients (25%) were asymptomatic. Solid tumours accounted for 69.1 per cent and breast cancer was the most common tumour type (20%). One hundred and five patients (70.5%) had received chemotherapy within the past four weeks and 25 patients (19.3%) had neutropenia at presentation. On multivariate analysis, age [odds ratio (OR) 7.99 (95% confidence interval [CI] 1.18-54.00); P=0.033], haemoglobin [OR 6.28 (95% CI 1.07-37.04); P=0.042] neutrophil-lymphocyte ratio [OR 12.02 (95% CI 2.08-69.51); P=0.005] and baseline serum albumin [OR 18.52 (95% CI 2.80-122.27); P=0.002], were associated with higher mortality. Recent chemotherapy, haematological tumours type and baseline neutropenia did not affect the outcome.

Interpretation & conclusions

Higher mortality in moderate and severe infections was associated with baseline organ dysfunction and elderly age. Significant proportion of patients were asymptomatic and might remain undetected.

PARP inhibitors in hereditary breast and ovarian cancer and other cancers: A review

There has been a paradigm shift in the management of cancer, with the immense progress in cancer genomics. More and more targeted therapies are becoming available by the day and personalized medicine is becoming popular with specific drugs being designed for selected subgroups of patients. One such new class of targeted drugs in the armamentarium is Poly ADP Ribose Polymerase (PARP) inhibitors (PARPi), which inhibit the enzyme PARP, thus interfering with DNA repair. This strategy utilizes a pre-existing genomic lesion in tumors with homologous recombination repair defects (including BRCA mutations), weakening tumor cells further by blocking the alternate pathway of DNA repair. In this review, we discuss in detail, the evolution, genetics, mechanism of action, mechanism of resistance, indications of use of PARP inhibitors, as well as combination with other agents and future directions.

Spontaneous pulmonary arterial embolization: A rare complication of the silicon-based peripherally inserted central venous catheter (PICC)

Peripherally inserted central catheters (PICC) are widely used in oncology for administration of chemotherapy. However, sometimes there may be complications associated with them such as infections, thrombosis and rarely fracture of catheter and embolization of the catheter fragments. Here we report a case of 59-year old gentleman with locally advanced carcinoma of head of pancreas, who had spontaneous fracture of a silicon based PICC and later migration of the catheter fragment through the heart and further into the right pulmonary arterial system. The embolized catheter fragment was retrieved through a vascular snare from the right femoral venous route. This case highlights the fact that silicon PICCs are fragile and have a high risk of spontaneous dislodgement and should be replaced by better alternative polyurethane PICCs.

Efficacy and tolerability of nimotuzumab in combination with chemotherapy in recurrent and metastatic squamous cell carcinoma of head and neck at a cancer center in Northern India

Introduction

Squamous cell carcinoma of head and neck (SCCHN) account for approximately 30-33% of all cancer and the median survival for recurrent and metastatic(R/M) SCCHN remains less than 1 year despite modern advances in therapy. Chemotherapy, usually single agent remains the backbone of therapy in these patients. EGFR antibodies are being used in (R/M) SCCHN. Nimotuzumab is one such agent that has anti-EGFR action similar to other agents without similar skin toxicity.

Methods

Prospective, interventional, non-randomized study done at Rajiv Gandhi Cancer Institute and Research Centre. A total 124 patients were enrolled and divided into Arm A (Chemotherapy + Nimotuzumab) and Arm B (Chemotherapy) in a ratio of 1:1 i.e., 62 in each arm. They were evaluated and treated as per protocol after a written informed consent. Statistical analysis was done using the SPSS software. Quantitative variables were compared using Unpaired t-test/Mann-Whitney Test. Qualitative variables were compared using Chi-Square test /Fisher's exact test. Kaplan-Meier analysis was used to assess the PFS, with log rank test for comparison between the groups. A p value of < 0.05 was considered statistically significant.

Results

The most frequent primary location of tumor was oral cavity (n=38, 69%) and (n=33, 56.9%) in both arms. The overall response rate in Arm A was 38.2% and 19% in Arm B (p= 0.023). The disease control rate in Arm A was 74.5% and 43.1% Arm B (p= 0.0007). The median PFS in Arm A was 5.2 months whereas it was 3.2 months in Arm B (p= 0.009).

Conclusion

In this study, the combination of Nimotuzumab plus platinum/taxane based chemotherapy was active and well tolerated in Indian patients in R/M SCCHN. Addition of Nimotuzumab to chemotherapy had a response rate of 38.2% and median PFS of 5.2 months are strong arguments for clinically testing this combination.

Rectal cancer in young patients: Clinicoepidemiologic profile and treatment outcomes

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Background: Colorectal cancers are 3rd most common cause of cancer globally however studies of rectal cancers alone in younger patients are scarce. Rectal cancers in Asian patients present at a younger age and has an aggressive tumor biology. This study looks at rectal cancer in young patients, ≤30 years old, with the aim to report clinico-epidemiologic profile and treatment outcomes in this subgroup. Methods: Retrospective analysis was conducted at a tertiary care centre. Of total 845 rectal cancer patients between 2012-2017, 103 patients of young rectal cancers were enrolled. Kaplan Meier method was used for survival analysis and cox regression analysis was done to identify factors affecting survival. Results: Young rectal cancer patients constituted 12.2% of the total rectal cancer patients. Male: Female ratio was 2.3:1 and the mean age was 24.7 ± 3.9 years. Around 73.8 % patients had locoregional disease (stage I/II/III) at presentation.CEA levels were elevated in 36.9% of patients, while most common histology was signet ring cell histology which was present in 51.5% of patients. Of 76 patients with locoregional disease, 75% received neoadjuvant chemoradiotherapy, 7.9% received neoadjuvant chemotherapy alone while 3.9% received neoadjuvant radiotherapy alone. Of 76 patients with locoregional disease, 55 patients underwent surgery of which 53.9% underwent low anterior resection while 18.4% underwent abdomino-perineal resection. Pathologic CR rates were seen in 13.3%, while recurrences were seen in 55.4% of non-metastatic patients. Overall 5-year survival for the whole study group was 19.5%, while 1-year PFS and 3-year DFS for metastatic and non-metastatic disease were 5% and 43.8% respectively. On regression analysis elevated CEA levels and not achieving a pathologic CR (pCR) with neoadjuvant therapy had a trend towards worse overall survival (HR 2, 95% CI 1-4, p = 0.063), (HR 4.7, 95% CI 0.64-35.1, p = 0.125) respectively. Conclusions: Rectal cancers in Asia present at younger age and this younger population is associated with advanced stage, increased CEA at presentation, aggressive histology and poor survival. CEA raise and not achieving pCR were associated with trend towards worse survival.

Extranodal NK-T Cell Lymphoma, Nasal Type: Retrospective Analysis of Real-World Data

Peripheral T cell lymphomas constitute nearly 15% of all cases on non-Hodgkin lymphoma. Of these, NK-T cell lymphoma nasal type is a rare and aggressive form. We present our experience of 16 patients of NK/T cell lymphoma which constituted approximately 1% of all lymphoma (N = 1590) cases treated at our center. Male to female ratio was 4.3:1. Median age of presentation was 42 years. Early Stage patients (n = 11) were treated with DeVIC regimen (n = 10) and SMILE (n = 1) chemotherapy and RT to all the patients. Advanced stage patients were treated with SMILE regimen (n = 4) and ICE and local RT (n = 1) with one treatment related mortality. The presence of B-symptoms adversely affected survival. The estimated median PFS and OS were 39 and 49 months respectively. Overall survival was not reached in Limited Stage patients (stage 1 and 2) and 8 months in patients with advanced stage (stage IV) (p = 0.001). According to the new CSWOG staging (retrospectively applied), comparing the Limited versus Extensive Stage, the earlier group has a significantly better estimated PFS (p = 0.020) and OS (p = 0.007). ENKTL is a rare malignancy with aggressive course. B-symptoms portend a poor prognosis to patients with this aggressive lymphoma. The new staging system helps estimate survival better.