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Mahajan A, Buse J, Kline G. Parathyroid hormone-dependent familial hypercalcemia with low measured PTH levels and a presumptive novel pathogenic mutation in CaSR. Osteoporos Int 2020; 31:203-207. [PMID: 31641801 DOI: 10.1007/s00198-019-05170-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Abstract
Familial hypocalciuric hypercalcemia (FHH) is a benign autosomal dominant condition characterized by lifelong asymptomatic hypercalcemia. FHH is typically caused by a heterozygous inactivating mutation of the calcium-sensing receptor (CaSR) and characterized by moderate hypercalcemia, inappropriately normal or elevated serum parathyroid hormone (PTH), and relative hypocalciuria (FeCa < 2%) with histologically normal parathyroid glands. FHH should be distinguished from primary hyperparathyroidism so that unnecessary parathyroid surgery is avoided. We report a case that presented with asymptomatic, familial hypercalcemia but low PTH and normal (non-low) urinary calcium excretion found to be secondary to a novel pathogenic inactivating mutation of the CaSR gene. We present an asymptomatic 54-year-old Malaysian woman with incidentally discovered hypercalcemia, intermittent hypophosphatemia, and FeCa > 2%. PTH levels were repeatedly below the mean of the reference range (on two separate assays) and sometimes even below the lower reference limit. Two siblings, one niece, and her son had hypercalcemia without nephrolithiasis. Cinacalcet, used as a PTH-suppression test, normalized serum total and ionized calcium after 7 days of cinacalcet 30 mg BID, confirming her hypercalcemia was PTH-mediated. Given her family history, genetic testing was pursued and discovered a novel pathogenic mutation of the CaSR gene confirming the diagnosis of FHH type 1. Our case represents an atypical presentation of FHH1 with low PTH and FeCa > 2%. This contributes to the expanding clinical and biochemical spectrum of CaSR inactivating mutations and presents an innovative approach to evaluating biochemically uncertain familial hypercalcemia with cinacalcet before pursuing expensive genetic analysis.
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Sekhsaria S, Jourdan A, Kim E, Mahajan A, Verma K, Tiwari K, Vij R. P006 ANTIBIOTIC HYPERSENSITIVITY MANAGEMENT AND IMPLICATIONS IN CLINICAL PRACTICE. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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53
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Bhatia V, Mahajan A, Lokhandwala Y. Study of clinical presentation, management and outcomes of granulomatous cardiomyopathy presenting as cardiac arrhythmia. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Rajpurohit A, Patil V, Noronha V, Joshi A, Menon N, Puranik A, Purandare N, Mahajan A, Mummudi N, Krishnatry R, Kumar R, Yadav S, Prabhash K. Multidisciplinary brain metastasis clinic: Is it effective and worthwhile? Ann Oncol 2019. [DOI: 10.1093/annonc/mdz419.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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55
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Ludmir E, Buszek S, Grosshans D, Mcaleer M, Mcgovern S, Harrison D, Okcu M, Chintagumpala M, Mahajan A, Paulino A. Disease Control and Patterns of Failure following Proton Beam Therapy for Rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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56
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Das B, Goel G, Mahajan A, Vinit B, Arun G. Daft (dual aspiration and fluff technique) for stent retrievers in acute ischemic stroke with large vessel occlusion: A successful new technique for early recanalisation. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Prabhash K, Patil V, Noronha V, Joshi A, Bhattacharjee A, Mathrudev V, Bhelekar A, Nawale K, Agarwal J, Ghosh-Laskar S, Budrukkar A, Mahajan A, Agarwal A, Purandare N, Chaturvedi P, Pai P, Chaukar D. Nimotuzumab-cisplatin-radiation versus cisplatin-radiation in HPV-negative oropharyngeal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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58
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Das B, Goel G, Mahajan A, Banga V, Singh V. Surpass flow diverter in the treatment of acutely ruptured aneurysms: Indian multi-center experience. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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59
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Gan W, Bennett D, Mahajan A, Du H, Chen Z, McCarthy M, Clarke R. P6231Iron status and risk of cardio-metabolic diseases in European adults: a Mendelian randomization study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Observational studies have reported conflicting results about the associations of iron status with risk of cardio-metabolic diseases but such studies are constrained by confounding and reverse causality.
Purpose
To assess the causal relevance of iron status biomarkers (transferrin, serum iron, and ferritin) for risk of coronary artery diseases (CAD), ischaemic stroke (IS), and type 2 diabetes (T2D), using Mendelian randomization (MR).
Methods
Effect size estimates for genetic variants associated with iron status biomarkers were obtained from the Genetics of Iron Status consortium (transferrin saturation, serum iron, and ferritin: n=48,972). The corresponding effects of these variants on the risk of CAD, IS and T2D were obtained from a meta-analysis of unrelated participants of European ancestry in the UK Biobank (UKB), together with previously recruited participants in CARDIOGRAMplusC4D (total n=90,377 CAD cases), MEGASTROKE (total n=43,381 IS cases) and DIAGRAM (total n=74,124 T2D cases), respectively. The main analysis used a two-sample inverse-variance weighted MR, while the sensitivity analyses used weighted-median, weighted-mode, MR-PRESSO, and MR-Egger approaches.
Results
MR analysis demonstrated significant inverse association of each of the three genetically-instrumented iron status biomarker with risk of CAD (transferrin saturation OR=0.96 [95% CI: 0.92–0.99], p=0.02; serum iron OR=0.93 [0.89–0.97], p=0.001; and ferritin OR=0.86 (0.79–0.94), p=0.001, per 1 SD higher level). In contrast, these iron status biomarkers showed positive associations with risk of T2D (transferrin saturation OR=1.06 [1.01–1.11], p=0.01; serum iron OR=1.06 [0.99–1.13], p=0.07; and ferritin OR=1.12 [0.99–1.26], p=0.06, per 1 SD higher level). There was positive, but non-significant, association of IS with each of the iron status biomarker analysed. Sensitivity analyses using several different MR approaches yielded concordant results.
Conclusions
Among European adults, iron status appeared to have causal associations, but in opposite directions, with the risk of CHD and T2D. Our findings highlight the need for caution about strategies for advocating iron supplementation in individuals with normal haemoglobin levels for prevention of CAD.
Acknowledgement/Funding
British Heart Found, Medical Research Council, Wellcome Trust, NIHR Biomedical Research Centre, Oxford
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Prabhash K, Noronha V, Patil V, Joshi A, Chougule A, Mahajan A, Janu A, Kumar R, More S, Goud S, Kumar N, Daware N, Bhattacherjee A, Shah S, Yadav A, Banavali S. P2.01-102 Outcome of Patients with EGFR Exon 19 Mutation in a Phase III Randomized Trial Comparing Gefitinib to Gefitinib with Chemotherapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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61
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Singh A, Pahwa R, Pruett N, Mahajan A, Madigan J, Schrump D, Hoang C. P2.06-13 Targeting RAS Signaling in Malignant Mesothelioma. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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62
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Al Feghali K, Randall J, Wefel J, Guha-Thakurta N, Grosshans D, Dibej S, McAvoy S, Li J, McGovern S, McAleer M, Ghia A, Paulino A, Sulman E, Penas-Prado M, Wang J, deGroot J, Heimberger A, Armstrong T, Gilbert M, Mahajan A, Brown P, Chung C. Prospective Phase II Randomized Trial Comparing Proton Therapy vs. IMRT for Newly Diagnosed GBM: Secondary Analysis Comparison of Progression Free Survival between Clinical Radiological Assessment vs. Response Assessment in Neuro-Oncology (RANO). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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63
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Sikkink S, Mahajan A, Thornton M, Westgate G, Tobin D. 634 Diabetes-associated High Glucose Levels Negatively Affects Cultured Human Fibroblast Subpopulations Isolated from Haired Skin. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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64
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Kann B, Hicks D, Payabvash S, Mahajan A, Gupta V, Burtness B, Husain Z, Aneja S. External Validation and Radiologist Comparison of a Deep Learning Model (DLM) to Identify Extranodal Extension (ENE) in Head and Neck Squamous Cell Carcinoma (HNSCC) with Pretreatment Computed Tomography (CT) Imaging. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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65
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Amsbaugh M, Chang E, Mahajan A, Zhu X, DeMonte F, Wefel J, Wu J, Liu D, Raza S, Grosshans D. Proton Beam Therapy for the Post-Operative Treatment of Skull Base Sarcoma: The Results of Two Phase II Single Arm Protocols. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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66
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Paulino A, Grosshans D, Ludmir E, McGovern S, McAleer M, Su J, Okcu M, Khatua S, Zaky W, Mahajan A, Chintagumpala M. Preliminary Report of Secondary Malignant Neoplasm Incidence in Pediatric Patients Receiving Proton versus Photon Craniospinal Irradiation for Medulloblastoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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67
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Roberts K, Wilhite T, Breen W, Mullikin T, Ahmed S, Mahajan A, Arndt C, Rose P, Laack N. Effect of Peri-Operative Radiotherapy Boost on Local Control in Pediatric Nonrhabdomyosarcoma Soft Tissue Sarcoma (NSTS). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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68
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Prakash O, Saxena V, Choudhury S, Tanvi, Singh A, Debnath A, Mahajan A, Muthe K, Aswal D. Low temperature processable ultra-thin WO3 Langmuir-Blodgett film as excellent hole blocking layer for enhanced performance in dye sensitized solar cell. Electrochim Acta 2019. [DOI: 10.1016/j.electacta.2019.06.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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69
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Buszek S, Ludmir E, Grosshans D, McAleer M, McGovern S, Harrison D, Okcu M, Chintagumpala M, Mahajan A, Paulino A. Patterns of Failure and Toxicity Following Proton Beam Therapy for Pediatric Bladder and Prostate Rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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70
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Nelson RL, Go C, Darwish R, Gao J, Parikh R, Kang C, Mahajan A, Habeeb L, Zalavadiya P, Patnam M. Cesarean delivery to prevent anal incontinence: a systematic review and meta-analysis. Tech Coloproctol 2019; 23:809-820. [PMID: 31273486 DOI: 10.1007/s10151-019-02029-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cesarean delivery (CD), is increasingly recommended as a mode of delivery that prevents the anal incontinence (AI) that arises in some women after vaginal delivery (VD). The assessment of the efficacy of CD in this regard was the subject of this systematic review. METHODS Searches were conducted in Medline, EMBASE and the Cochrane Library. Both randomized (RCTs) and non-randomized trials (NRTs) comparing the risk of sustained fecal and/or flatus incontinence after VD or CD were sought from 1966 to 1 January, 2019. Studies were eligible if they assessed AI more than 6 months after birth, and had statistical adjustment for at least one of the three major confounders for AI: age, maternal weight or parity. In addition, each study was required to contain more than 250 participants, more than 50 CDs and more than 25 cases of AI. Data after screening and selection were abstracted and entered into Revman for meta-analysis. Analyses were done for combined fecal and flatus incontinence (comAI), fecal incontinence (FI), gas incontinence (GI), CD before or during labor, time trend of incontinence after delivery, assessment of both statistical and clinical heterogeneity, parity and late incident AI. RESULTS Out of the 2526 titles and abstracts found, 24 eligible studies were analyzed, 23 NRTs and one RCT. These included women with 29,597 VDs and women with 6821 CDs. Among the primary outcomes, VD was found not to be a significant predictor of postpartum comAI compared to CD in 6 studies, incorporating 18,951 deliveries (OR = 0.74; 0.54-1.02). VD was also not a significant predictor of FI in 14 studies, incorporating 29,367 deliveries, (OR = 0.89; 0.76-1.05). VD was not a significant predictor of GI in six studies, incorporating 6724 deliveries (OR = 0.96; 0.79-1.18). The strength of the grading of recommendations, assessment, development and evaluations (GRADE) evidence for each of these was low for comAI and moderate for FI and GI (upgrade for lack of expected effect). Time trend FI showed incontinence at 3 months often resolved at 1 year. Other secondary analyses assessing parity, delayed incidence of FI, clinical and statistical heterogeneity, spontaneous VD only, late risk of incidence of AI, and CD in or prior to labor all had similar results as in the primary outcomes. CONCLUSIONS There are three components of pelvic floor dysfunction that are thought to be caused by VD and hopefully prevented by CD: AI, urinary incontinence and pelvic floor prolapse. Of these, AI was not found to be reliably prevented by CD in this review.
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Totadri S, Mahajan A, Gupta V, Das A, Meena J, Singh M, Mohammed S, Aggarwal P, Tuladhar S, Seth R, Naseem S, Varma N, Trehan A, Bansal D. PS1178 TREATMENT AND OUTCOME OF CHRONIC MYELOID LEUKEMIA IN CHILDREN AND ADOLESCENTS: THE INDIAN PEDIATRIC ONCOLOGY GROUP-CML-16–01 MULTICENTRIC STUDY. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000562996.37394.c4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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72
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Wadhwa S, Krishnab G, Malhotra M, Prabhash K, Noronha V, Joshi A, Patil V, Mahajan A. Radiogenomic signatures of NSCLC brain metastases: A potential non-invasive imaging marker for ALK mutation. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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73
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Seth R, Kapoor G, Arora R, Verma N, Kumar A, Mahajan A, Mandal P, Kumari P, Das A, Venkatraman R, Gupta V, Jain P, S S, Kakadia P. The indian childhood cancer survivorship study (c2s study): after treatment completion registry of childhood cancers: phase – i. An inpog-le-16-01 study. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2019. [DOI: 10.1016/j.phoj.2019.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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74
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Seth R, Kapoor G, Arora R, Verma N, Kumar A, Mahajan A, Mandal P, Kumari P, Das A, Venkatraman R, Gupta V, Jain P, S S, Kakadia P. The indian childhood cancer survivorship study (C2S study): after treatment completion registry of childhood cancers - phase – I. AN INPOG-LE-16-01 STUDY. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2019. [DOI: 10.1016/j.phoj.2019.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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75
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Mahajan A, Arora R, Dinand V, Kalra M, Jain S, Bakhshi S, Singh M, Seth R, Verma N, Kumar A, Radhakrishnan V, Mandal P, Kapoor G, Phulkar S, Arora A, Taluja A, Chandra J. Empirical Anti-tubercular Treatment given to children with Hodgkin Lymphoma: does it impact outcomes? PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2019. [DOI: 10.1016/j.phoj.2019.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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76
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Mahajan A, Gupta H, Jain S, Dang N, Sehgal K, Verma N, Mudaliar S, Singh M, Singh A, Kakkar S, Garg K, Jain P, Radhakrishnan N, Chandra J, Digra S, Rajendran A, Bagai P. Improving Access to Minimal Residual Disease Assessment: Lessons Learnt! PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2019. [DOI: 10.1016/j.phoj.2019.08.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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77
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Amsbaugh M, Mahajan A, Thall P, McAleer M, Grosshans D, Paulino A, Ketonen L, Khatua S, McGovern S. A Phase I/II Trial of Reirradiation for Diffuse Intrinsic Pontine Glioma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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78
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Chandrashekharan A, Patil V, Noronha V, Joshi A, Choughle A, Punatar S, Mahajan A, Janu A, Purandare N, Goud S, More S, Das S, Agrawal A, Rajpurohit A, Majumdar S, Khaddar S, Prabhash K. A randomized investigator initiated phase III study comparing low dose gemcitabine to standard dose gemcitabine with platinum in advanced squamous non driver mutated non-small cell lung cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy483.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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79
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Medek S, De B, Breneman J, Pater L, Laack N, Mahajan A, Wolden S, Vatner R. Physician Practice Patterns with Respect to Vertebral Body Target Delineation in the Treatment of Pediatric Patients with Craniospinal Irradiation. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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80
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Bagley A, Grosshans D, Philip N, McAleer M, McGovern S, Foster J, Mahajan A, Paulino A. Efficacy of Proton Therapy on Locoregional Control in Neuroblastoma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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81
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Avanzo M, Stavinoha P, Brodin P, Aridgides P, El Naqa I, McGovern S, Ronckers C, Constine L, Mahajan A. Modeling the Risk of Neurocognitive Effects from Radiation Therapy in Childhood Cancer Survivors: Initial Results From the Pediatric Normal Tissue Effects in the Clinic (PENTEC) CNS Task Force. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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82
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Ludmir E, Mahajan A, Paulino A, Jones J, Ketonen L, Ater J, Su J, Grosshans D, Adesina A, Dauser R, Weinberg J, Chintagumpala M. Increased Risk of Pseudoprogression Among Pediatric Low-Grade Glioma Patients Treated with Proton Versus Photon Radiation Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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83
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Bishop A, Tran K, Allen P, Mahajan A, McAleer M, Li J, Ghia A, Sulman E, Yeboa D, DeMonte F, Raza S, Grosshans D, McGovern S. Risk of Visual Toxicity Following Fractionated Proton vs Photon Radiation Therapy for Patients with Meningiomas. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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84
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Arora R, Rahman R, Joe W, Bakhshi S, Radhakrishnan V, Mahajan A, Chinnaswamy G, Bhattacharya A, Swami A, Manglani M, Seth R, Singh A, De S, MS L, Raj R, Borker A, Martiniuk A, Tsimicalis A. Families of Children Newly Diagnosed With Cancer Incur Significant Out-of-Pocket Expenditure for Treatment: Report of a Multi-Site Prospective Longitudinal Study From India (INPOG-ACC-16-01). J Glob Oncol 2018. [DOI: 10.1200/jgo.18.42400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Diagnosis of cancer in a child places considerable economic burden on families. The health expenditures are more catastrophic in resource limited countries like India where GDP spend on health is just over 1% and financing of treatment is usually out-of-pocket (OOP). Consequently parents may abandon their child's cancer treatment to ensure financial sustainability of the family. Research in this area is mostly from resource rich countries and OOP expenditure burden remains unknown in India. Aim: The objective of this study is to describe the OOP expenditure incurred by families of children (< 18 years age) with cancer being treated in India prior to and during cancer directed treatment. Methods: A prospective cost of illness study from a family household perspective was conducted in 14 centers (5 public, 5 private and 4 charitable trust sector) in 4 cities in India from 2016-2018. Baseline family demographic and socioeconomic data were collected followed by OOP expenditure incurred prior to start of treatment. For the duration of the child's treatment, a social worker contacted parents at regular intervals to record their expenditure on cancer directed treatment. Data collection was stopped when one of these happened - completion of treatment or death or progression/relapse or abandonment or transfer. Data were described descriptively and a univariate/multivariate analysis using logistic regression was done to detect factors associated with OOP expenditure. Results: 394 children (63% male, median age 5 years) with cancer (64% leukemia/lymphoma, 33% solid tumors, 3% CNS tumors) were enrolled from public (45%), charitable trust (28%) and private (27%) sector hospitals. They were symptomatic for a median duration of 6 weeks (range 0 to 104 weeks). 88% had no insurance and 73% were from families with monthly income of ≤ 10,000 rupees (≤ 159 US$). Mean OOP expenditure was Rs 209,500 (3325 US$) which is 195% of per capita income (1706 US$) of India. OOP expenditure from onset of symptoms to start of treatment was Rs 53,104 (843 US$) of which 77% was medical (15% laboratory tests, 11% medicines, 9% hospital bed costs) and 23% nonmedical (12% travel, 6% food, 3% lodging). OOP expenditure on cancer directed treatment was Rs 156,396 (2482 US$) of which 64% was medical (9% hospital bed costs, 9% supportive care drugs, 8% laboratory tests) and 36% nonmedical (19% food, 9% travel, 6% lodging). On univariate analysis age, gender, city, type of treatment facility, insurance, type of cancer, driving time and distance were significantly associated with OOP expenditure but only insurance and type of treatment facility were found significant on multivariate analysis. Conclusion: Families of children with cancer incur significant OOP expenditure prior to and during cancer directed treatment, which includes a significant portion on nonmedical expenses. Expenditure varied significantly by insurance and type of treatment facility.
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Mastall M, Majd N, Fuller G, Gule-Monroe M, Huse J, Khatua S, Rao G, Sandberg D, Wefel J, Yeboa D, Zaky W, Mahajan A, Puduvalli V, Suki D, Alfaro K, Weathers S, Harrison R, de Groot J, Penas-Prado M. P05.93 Adult medulloblastoma: analysis of use of chemotherapy in clinical practice. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Arevian AC, Springgate B, Jones F, Starks SL, Chung B, Wennerstrom A, Jones L, Kataoka SH, Griffith K, Sugarman OK, Williams P, Haywood C, Kirkland A, Meyers D, Pasternak R, Simmasalam R, Tang L, Castillo EG, Mahajan A, Stevens M, Wells KB. The Community and Patient Partnered Research Network (CPPRN): Application of Patient-Centered Outcomes Research to Promote Behavioral Health Equity. Ethn Dis 2018; 28:295-302. [PMID: 30202181 DOI: 10.18865/ed.28.s2.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective We describe the rationale, development, and progress on the Community and Patient Partnered Research Network (CPPRN). The CPPRN builds on more than a decade of partnered work and is designed to promote health equity by developing partnered research on behavioral health and social risk factors in Los Angeles and New Orleans. Setting A community-academic partnership across Los Angeles County and New Orleans. Methods Review of rationale, history, structure, activities and progress in applying community partnered participatory research (CPPR) to CPPRN. Findings Patient and community stakeholders participated in all phases of development, including local and national activities. Key developments include partnered planning efforts, progress on aggregating a large, de-identified dataset across county agencies, and development of an information technology-supported screening approach for behavioral and social determinants in health care, social, and community-based settings. Conclusion The CPPRN represents a promising approach for research data networks, balancing the potential benefit of information technology and data analytic approaches while addressing potential risks and priorities of relevant stakeholders.
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Fatima U, Asadi MS, Mahajan A, Ortega G, Mota LG, Opoku-Asare I. P4662Impact of substance abuse and race on outcomes in patients with cardiac arrest - A retrospective analysis from NIS database. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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88
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Zanwar S, Noronha V, Joshi A, Patil VM, Chougule A, Kumar R, More S, Goud S, Janu A, Mahajan A, Prabhash K. Repeat biopsy in epidermal growth factor receptor mutation-positive nonsmall cell lung cancer: Feasibility, limitations, and clinical utility in Indian patients. Indian J Cancer 2018; 54:280-284. [PMID: 29199706 DOI: 10.4103/ijc.ijc_215_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The feasibility and success rate of repeat biopsy for epidermal growth factor receptor (EGFR) mutation-positive lung cancers that have progressed on tyrosine kinase inhibitors (TKIs) are varied and merits further assessment. MATERIALS AND METHODS EGFR mutation-positive lung cancers were offered repeat biopsy upon progression on TKIs. Two groups of patients, first one on a clinical trial and second one from a database, were included for analysis. The feasibility to perform a repeat biopsy was analyzed in the first group. Success rate of biopsy and tissue adequacy for molecular testing was analyzed in both groups. Descriptive statistics were used for analyzing the demography, EGFR mutation type, tissue adequacy, and molecular profile at repeat biopsy. Kolmogorov-Smirnov test was used to assess normality of data. Two sample t-tests were used for comparison of proportions. RESULTS The feasibility of undergoing repeat biopsy was 77% (95% confidence interval [CI] of 69.4%-83.5%) in the first group (114/148 patients). Feasibility was not analyzed in the second group of patients. Out of 196 patients who underwent a repeat biopsy, 154 patients (78.6%; 95% CI: 72.2%-84.1%) had tumor tissue adequate for performing molecular testing. 27/196 (13.8%) patients did not have any evidence of malignancy on repeat biopsy whereas 15/196 (7.6%) patients had scanty tissue on repeat biopsy prohibiting molecular testing. Six patients (3.06%; 95% CI: 1.1%-6.5%) had small cell transformation. T790M mutation was detected in 12 out of the 42 patients (28.6%; 95% CI: 15.7-44.6) in whom EGFR testing was performed on repeat biopsy specimen. CONCLUSION Repeat biopsy was able to provide adequate tissue acquisition in only two-thirds of the patients. Liquid biopsy represents an important tool to bridge this gap.
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Mahajan A, Prabhash K, Ghaytidak A, Noronah V, Joshi A, Patil V. 72PD MR imaging radiomics of NSCLC brain metastases: A potential targetable imaging biomarker for EGFR status. J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chung C, Brown P, Liu D, Grosshans D, Dibaj S, Guha-Thakurta N, Li J, McGovern S, McAleer M, Ghia A, Paulino A, Sulman E, Penas-Prado M, De Groot J, Heimberger A, Wang J, Armstrong T, Gilbert M, Mahajan A, Wefel J. EP-1239: Ph II randomized trial comparing cognitive outcomes of proton vs. photon radiation for glioblastoma. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Sinha S, Ghosh Laskar S, Agarwal J, Juvekar S, Mahajan A, Chakraborty S, Gupta T, Budrukkar A, Murthy V. EP-1153: Impact of pre-treatment imaging on outcomes of organ conservation in laryngopharyngeal cancers. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gallagher K, Youssef B, Georges R, Mahajan A, Feghali J, Tannous J, Nabha R, Ayoub Z, Jalbout W, Taddei P. EP-1861: Predicted reduction in fatal second cancers by proton therapy of childhood intracranial tumors. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Mahajan A. SP-0264: Not every single paediatric patient needs to receive proton beam therapy! Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fernandez AI, Graham G, Győrffy B, Cavalli L, Mahajan A, Riggins RB. Abstract P3-07-09: ERRβ copy number and expression in triple negative breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-07-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Triple negative breast cancer (TNBC) is a highly aggressive form of breast cancer prevalent in African-American (AA) women defined as estrogen receptor- (ER), progesterone receptor- (PR), and human epidermal growth factor receptor 2- (HER2) negative. Because ER- and HER2-targeted therapies are ineffective in TNBC, systemic chemotherapy is the standard of care and there is a tremendous need for new effective therapies with less toxicity. Steroid hormone receptors are highly druggable targets, and orphan nuclear receptors, members of the nuclear receptor superfamily, are emerging as targets for cancer therapy. In fact, we have previously shown that treatment of TNBC cells with a small molecule agonist ligand (DY131) for estrogen related receptor beta (ERRβ), has growth inhibitory and anti-mitotic activity. We have also shown that increased mRNA expression of ERRβ, correlates with better recurrence- and distant metastasis-free survival in TNBC/basal-like breast cancer. The goal of our current work is to comprehensively characterize ERRβ copy number and mRNA status in TNBC and determine its association with patients' prognosis.
Methods: ESRRB copy number was determined in 106 primary breast tumors (TNBC n=56, nonTNBC n=50) by array-CGH, using the Agilent SurePrint G3 Human CGH platform. ESRRB mRNA data and its association with overall survival was determined in systemically untreated patients from METABRIC using Illumina gene expression array data (probe ID ILMN_1707398).
Results: Copy number alterations (CNAs). Copy number losses at the ESRRB locus (14q24.3) were observed in 10/56 (17.8%) of TNBC vs. 10/50 (20%) of nonTNBC, while copy number gains were detected in 43/56 (76.8%) of TNBC vs. 29/50 (58%) of nonTNBC (c2 *p=0.036). Interestingly, in both TNBC and non-TNBC, ESRRB loss was seen with markedly higher frequency in AA patients when compared to Caucasian (CA) patients (c2 *p=0.012 for TNBC, p=0.052 for non-TNBC). mRNA expression. Among patients not treated with systemic chemotherapy in the METABRIC dataset, low ESRRB mRNA was significantly associated with shorter overall survival in TNBC, but not ER+ or HER2+ patients (TNBC hazard ratio 0.24, 95% confidence interval 0.07-0.85, *p=0.016). Low ESRRB also correlated with reduced overall survival in TP53 mutant (but not wild type) tumors (hazard ratio 0.28, 95% confidence interval 0.1-0.82, *p=0.013).
Conclusions: ESRRB presents significantly high levels of copy number losses in TNBC when compared to non-TNBC tumors. In breast tumors from AA women, both the TNBC and non-TNBC subtypes are significantly more likely to have reduced ESRRB copy number vs. CA women. Low ESRRB mRNA expression predicts for poor overall survival in TNBC and TP53 mutant tumors. These data advocate that ERRβ expression has prognostic value in breast cancer, particularly TNBC. Future goals include immunohistochemistry staining, and analysis, of a tissue microarray consisting of 150 primary breast tumors (50 TNBC, 50 ER+, 50 HER2+); as well as ERRβ overexpression and knock-down studies in TNBC cell lines to define the role it plays in TNBC.
Citation Format: Fernandez AI, Graham G, Győrffy B, Cavalli L, Mahajan A, Riggins RB. ERRβ copy number and expression in triple negative breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-07-09.
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Mahajan A, Arora R, Dinand V, Kalra M, Jain S, Bakhshi S, Singh M, Seth R, Verma N, Kumar A, Radhakrishnan V, Mandal P, Kapoor G, Phulkar S, Arora A, Taluja A, Chandra J. Hodgkin lymphoma in the children under 5 years of age: do they behave diiferently? PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2018. [DOI: 10.1016/j.phoj.2018.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Noronha V, Zanwar S, Joshi A, Patil VM, Mahajan A, Janu A, Agarwal JP, Bhargava P, Kapoor A, Prabhash K. Practice Patterns and Outcomes for Pemetrexed Plus Platinum Doublet as Neoadjuvant Chemotherapy in Adenocarcinomas of Lung: Looking Beyond the Usual Paradigm. Clin Oncol (R Coll Radiol) 2018; 30:23-29. [PMID: 29239731 DOI: 10.1016/j.clon.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/08/2017] [Accepted: 10/16/2017] [Indexed: 02/05/2023]
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Mathew AS, Agarwal JP, Munshi A, Laskar SG, Pramesh CS, Karimundackal G, Jiwnani S, Prabhash K, Noronha V, Joshi A, Rangarajan V, Purandare NC, Jambhekar N, Tandon S, Mahajan A, Kumar R, Deodhar J. A prospective study of telephonic contact and subsequent physical follow-up of radically treated lung cancer patients. Indian J Cancer 2017; 54:241-252. [PMID: 29199699 DOI: 10.4103/0019-509x.219599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND We tested the hypothesis that telephonic follow-up (FU) may offer a convenient and equivalent alternative to physical FU of radically treated lung cancer patients. DESIGN Prospective study carried out at a tertiary referral cancer care institute, Mumbai. MATERIALS AND METHODS Two hundred consecutive lung cancer patients treated with curative intent were followed up regularly with telephonic interviews paired with their routine physical FU visits. Patient satisfaction with the telephonic call and the physical visit, the anxiety level of the patient after meeting the physician and the economic burden of the visit to the patient were noted in a descriptive manner. Kappa statistics was used to assess concurrence between the telephonic and physical impression of disease status. RESULTS With a median FU duration of 21.5 months, the median satisfaction scores for telephonic and physical FU were 8 and 9, respectively. The prevalence and bias adjusted kappa (PABAK) score of the entire cohort of patients was 0.64 (95% confidence interval [CI] =0.58-0.70). Data analyzed up to first disease progression/relapse on FU had a PABAK score of 0.71 (95% CI = 0.64-0.77) indicating substantial agreement. Patients with disease controlled at the FU had a significant PABAK score of 0.88 (95% CI = 0.80-0.94) indicating excellent concurrence. On average, each patient spent Rs. 5117.10 on travel and Rs. 3079.06 on lodging per FU visit. CONCLUSION Telephonic FU is substantially accurate in assessing disease status until the first relapse. In a resource-constrained country like India, it is worthwhile to further explore the benefits of such an alternative strategy.
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Joshi AP, Chandrakanth MV, Noronha V, Patil V, Chougule A, Mahajan A, Janu AK, Chanana R, Prabhash K. Ceritinib in anaplastic lymphoma kinase-positive nonsmall cell lung cancer among patients who were previously exposed to crizotinib: Experience from the Indian subcontinent. Indian J Cancer 2017; 54:144-147. [PMID: 29199678 DOI: 10.4103/ijc.ijc_186_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ceritinib is a novel ALK inhibitor approved for advanced stage NSCLC with ALK gene rearrangement, progressed and/or intolerant to crizotinib. 13 patients were included in our study who received ceritinib. Majority of them were women and never smokers with a median age of 47 yrs. Nearly half of them had a compromised performance status and received ceritinib in third line and beyond. Ceritinib showed nearly 50% response rates. With a median follow up of 9 months for the entire cohort, median PFS and OS were not reached. However, the mean values for PFS and OS were 10.9 and 14.8 months,with an estimated 1 year PFS and OS being 56% and 78% respectively.1/3 of the patients had gastrointestinal and liver toxicities. Metabolic abnormalities were seen in 1/4 th of them. ceritinib was permanently discontinued in one patient due to pneumonitis. In conclusion, ceritinib has a favorable efficacy and side effect profile in our patient population., similar to that reported in large clinical trials. It has shown promising efficacy even in patients with compromised performance status; presence of brain metastases and heavily pre-treated disease.
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Noronha VM, Jandyal S, Joshi A, Patil VM, Mahajan A, Prabhash K. Expanded panel test detecting mesenchymal-epithelial transition amplification leading to effective treatment in adenocarcinoma lung. Indian J Cancer 2017; 54:325-326. [PMID: 29199715 DOI: 10.4103/0019-509x.219596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Talreja V, Patil V, Joshi A, Noronha V, Chandrasekharan A, Dhumal S, Pande N, Turkar S, Shrirangwar S, Mahajan A, Juvrekar S, Bhattacharjee A, Prabhash K. Quality of life without toxicity or symptoms analysis of a randomized controlled clinical trial comparing efficacy of Cabazitaxel versus docetaxel in recurrent Head and Neck Cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx665.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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