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Chavan P, Dey R, Castelino R, Kamble A, Poladia P, Bagal R, Jadhav M, Shirsat A, Chavan A, Dhumal S, Kumar S, Krishnamurty MN, Bhat V, Bhattacharjee A, Gota V. Safety, immunogenecity and effectiveness of ChAdOx1 nCoV-19 vaccine during the second wave of pandemic in India: a real-world study. Drug Metab Pers Ther 2023; 38:227-236. [PMID: 37098129 DOI: 10.1515/dmpt-2022-0150] [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] [Received: 06/30/2022] [Accepted: 01/23/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVES This real-world study was conducted to assess the adverse effects following immunization (AEFI) and immunogenicity of ChAdO×1 nCoV-19 vaccine in terms of neutralising antibody titers and to study the effects of covariates such as age, sex, comorbidities and prior COVID status on these outcomes. Also, the effectiveness of the vaccine based on interval between the two doses was also investigated. METHODS A total of 512 participants (M/F=274/238) aged 35(18-87) years comprising a mixed population of healthcare workers, other frontline workers and general public were enrolled between March and May 2021. Records for adverse events if any were collected telephonically by following up with participants up to 6 months post first dose and graded as per Common Terminology Criteria for Adverse Events (CTCAE) version 5. Blood samples for measuring antibody titers against the receptor binding domain (RBD) were collected serially using a convenient sampling strategy up to 6 months after the first dose. Data on breakthrough COVID infection was collected telephonically till December 2021. RESULTS Incidence of local reactions was higher after first dose at 33.4 % (171/512) compared to those after second dose at 12.9 % (66/512). Commonest side effect observed was injection site pain after the first (87.1 %; 149/171) and second (87.9 %; 56/66) dose respectively. Among systemic reactions, fever was the most common manifestation followed by myalgia and headache. Female sex (p<0⸱001) and age less than 60 years (p<0⸱001) had significantly higher predilection for systemic toxicities. Age ≤60 years (p=0.024) and prior-COVID (p<0.001) were found to be significantly associated with higher antibody titers, however, no association was found between these variables and breakthrough COVID infection. Longer spacing between the doses (≥6 weeks) was found to offer better protection against breakthrough infection compared to a spacing of 4 weeks. All breakthroughs were mild-moderate in severity, not requiring hospitalization. CONCLUSIONS The ChAdOx1 nCov-19 vaccine is apparently safe and effective against SARS-CoV-2 virus infection. Prior COVID infection and younger age group achieve higher antibody titers, but no additional protection. Delaying the second dose up to at least 6 weeks is more effective compared to shorter spacing between doses.
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Affiliation(s)
- Preeti Chavan
- Composite Lab, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - Rajashree Dey
- Division of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - Renita Castelino
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Akshay Kamble
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Pratik Poladia
- Composite Lab, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - Rajani Bagal
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
- Department of Microbiology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Monica Jadhav
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Aditi Shirsat
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Ashish Chavan
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Sachin Dhumal
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
- Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Sharath Kumar
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Manjunath Nookala Krishnamurty
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Vivek Bhat
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
- Department of Microbiology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Atanu Bhattacharjee
- Division of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - Vikram Gota
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
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Kamtalwar S, Mirgh S, More A, Gokarn A, Dhumal S, Sharma P, Lall S, Patkar N, Shetty N, Chatterjee G, Rajpal S, Bhat V, Khattry N, Gupta S. Triple Trouble: Disseminated Penicilliosis in a Cancer patient with COVID-19. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759505] [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: 03/31/2023] Open
Abstract
AbstractPenicilliosis is a fungal infection caused by the fungus Penicillium marneffei or Talaromyces marneffei. Penicillosis is commonly seen in immunocompromised patients such as in HIV(AIDS). Herein, we present a case of penicilliosis in an oral cavity cancer patient who was admitted for the management of SARS-CoV-2 infection at our hospital. A 50-year-old male patient operated on for squamous cell carcinoma of the oral cavity who completed his adjuvant chemoradiation 2 months ago, presented to our hospital with dry cough for more than 3 weeks. His nasopharyngeal swab was positive for the severe acute respiratory distress syndrome (SARS-CoV-2). During his hospital stay for SARS-CoV-2 infection, he was diagnosed with disseminated penicilliosis. The patient was treated with intravenous antifungals caspofungin and voriconazole. However, he succumbed to disseminated fungal sepsis. This case highlights the need to consider penicilliosis as a possible opportunistic pathogen, especially in immunocompromised patients such as cancer.
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Patil VM, Noronha V, Menon N, Rai R, Bhattacharjee A, Singh A, Nawale K, Jogdhankar S, Tambe R, Dhumal S, Sawant R, Alone M, Karla D, Peelay Z, Pathak S, Balaji A, Kumar S, Purandare N, Agarwal A, Puranik A, Mahajan A, Janu A, Kumar Singh G, Mittal N, Yadav S, Banavali S, Prabhash K. Low-Dose Immunotherapy in Head and Neck Cancer: A Randomized Study. J Clin Oncol 2023; 41:222-232. [PMID: 36265101 DOI: 10.1200/jco.22.01015] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The regimens approved for the treatment of advanced head and neck squamous cell carcinoma are accessible to only 1%-3% of patients in low- and middle-income countries because of their cost. In our previous study, metronomic chemotherapy improved survival in this setting. Retrospective data suggest that a low dose of nivolumab may be efficacious. Hence, we aimed to assess whether the addition of low-dose nivolumab to triple metronomic chemotherapy (TMC) improved overall survival (OS). METHODS This was a randomized phase III superiority study. Adult patients with recurrent or newly diagnosed advanced head and neck squamous cell carcinoma being treated with palliative intent with an Eastern Cooperative Oncology Group performance status of 0-1 were eligible. Patients were randomly assigned 1:1 to TMC consisting of oral methotrexate 9 mg/m2 once a week, celecoxib 200 mg twice daily, and erlotinib 150 mg once daily, or TMC with intravenous nivolumab (TMC-I) 20 mg flat dose once every 3 weeks. The primary end point was 1-year OS. RESULTS One hundred fifty-one patients were randomly assigned, 75 in TMC and 76 in the TMC-I arm. The addition of low-dose nivolumab led to an improvement in the 1-year OS from 16.3% (95% CI, 8.0 to 27.4) to 43.4% (95% CI, 30.8 to 55.3; hazard ratio, 0.545; 95% CI, 0.362 to 0.820; P = .0036). The median OS in TMC and TMC-I arms was 6.7 months (95% CI, 5.8 to 8.1) and 10.1 months (95% CI, 7.4 to 12.6), respectively (P = .0052). The rate of grade 3 and above adverse events was 50% and 46.1% in TMC and TMC-I arms, respectively (P = .744). CONCLUSION To our knowledge, this is the first-ever randomized study to demonstrate that the addition of low-dose nivolumab to metronomic chemotherapy improved OS and is an alternative standard of care for those who cannot access full-dose checkpoint inhibitors.
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Affiliation(s)
- Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rahul Rai
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Center for Cancer Epidemiology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ajay Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shweta Jogdhankar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rupali Tambe
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Riddhi Sawant
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Mitali Alone
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Devanshi Karla
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Zoya Peelay
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shruti Pathak
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Arun Balaji
- Department of Speech and Therapy, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Suman Kumar
- Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Archi Agarwal
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ameya Puranik
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Janu
- Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Gunjesh Kumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Subhash Yadav
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
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Parekh D, Patil VM, Nawale K, Noronha V, Menon N, More S, Goud S, Jain S, Mathrudev V, Peelay Z, Dhumal S, Jogdhankar S, Prabhash K, Prabhash K. Audit of screen failure in 15 randomised studies from a low and middle-income country. Ecancermedicalscience 2022; 16:1476. [PMID: 36819805 PMCID: PMC9934872 DOI: 10.3332/ecancer.2022.1476] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Growth and development in patient management occurs via randomised studies. Screen failure is a significant hurdle while conducting randomised studies. There is limited data available from low and middle-income countries about factors resulting in screen failure. Hence, this audit was performed to identify the proportion of patients who screen failed and to elucidate reasons for the same. Methods This was an audit of 15 randomised studies performed by medical oncology solid tumour unit II of Tata Memorial Centre. The screening logs of these studies were acquired. From the screening logs, data regarding the number of patients who had screen failed & reason for the same were obtained. Descriptive statistics were performed. Results A total of 7,481 patients were screened for 15 randomised clinical studies. Out of these, 3,666 (49.0%) patients were enrolled into trials and 3,815 (51.0%) screen failed. The most common reason for screen failure was 'not meeting inclusion criteria' (54.9%) followed by declining to take treatment (22.2%). Other factors that affect enrolment were 'not willing to stay in the locality of the trial site' (6.2%), being recruited in other studies (3.7%), poor performance status (PS) (3.4%), non-compliance (2.2%), meeting exclusion criteria (0.9%) and 'other' (6.5%). Conclusion The commonest causes of screen failure in lower and middle-income countries are non-meeting of inclusion criteria followed by declining to take treatment, not willing to stay in locality of trial site, recruited into other studies, poor PS, non-compliance, meeting exclusion criteria & 'other'. This information would help analysing and hence planning of newer strategies to decrease the rate of screen failure.
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Patil V, Kumar S, Noronha V, Menon N, Nawale KP, Alone M, Waratkar G, Dhumal S, Bhattacharjee A, Prabhash K. Long term outcomes of a randomized controlled clinical trial comparing the efficacy of Cabazitaxel versus docetaxel as second-line or above therapy in recurrent head and neck cancer. Oral Oncol 2022; 134:106085. [PMID: 36126602 DOI: 10.1016/j.oraloncology.2022.106085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 07/14/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Sravan Kumar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Mitali Alone
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.
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Patil VM, Kolkur M, Kumar Chinthala S, Waratkar G, Menon N, Noronha V, Ghosh Laskar S, Simha V, Talreja V, Dhumal S, Chandrasekharan A, Prabhash K. Long term toxicity and tolerance of concurrent docetaxel with radiotherapy in cisplatin-ineligible head and neck cancer patients. Oral Oncol 2022; 130:105908. [DOI: 10.1016/j.oraloncology.2022.105908] [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] [Received: 03/11/2022] [Revised: 05/07/2022] [Accepted: 05/08/2022] [Indexed: 12/01/2022]
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Kolkur M, Patil VM, Menon NS, Noronha V, Prabhash K, Simha V, Talreja V, Chandrasekharan A, Dhumal S. Long-term toxicity and tolerance of concurrent docetaxel with radiotherapy in cisplatin ineligible head and neck cancer patients. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18037] [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
e18037 Background: Docetaxel can be administered in several situations like low creatinine clearance or pre-existing grade 3-4 ototoxicity, where cisplatin is contraindicated. In this analysis, we present our data on toxicity and tolerance to docetaxel-based chemoradiation in cisplatin-ineligible patients. Methods: Patients who underwent docetaxel-based chemoradiation between January 2015 to December 2017 for locally advanced head and neck cancer, either in the radical or adjuvant setting were selected for this analysis. SPSS version 16 was used for analysis. Results: Nineteen patients were identified and the median age of the cohort was 58 years (range 41-71 years). The most common site of the primary was the oral cavity (n = 9, 47.4%). Sixteen patients (84.2%) had stage IV disease and 3 patients (15.8%) had stage 3 disease. The intent of chemoradiation was radical in 12 (63.9%) patients and adjuvant in 7 (36.1%) patients. Any grade 3 or above adverse events were seen in 12 patients (63.2%). The most common grade 3 or above adverse events observed were mucositis and hyponatremia in 9 patients (47.4%) each. At a median follow up of 5.3 years, the 2-year and 5-year PFS were 26.3% (Standard error-10.1) and 15.8% (Standard error- 8.4) while 2-year and 5-year OS were 36.8% (Standard error-11.1) and 15.8% (Standard error- 8.4). Conclusions: Docetaxel based chemoradiation is a feasible and tolerated option in cisplatin unfit patients and needs further testing in large randomized studies to prove its worth.
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Dhumal S, Patil A, More A, Kamtalwar S, Joshi A, Gokarn A, Mirgh S, Thatikonda P, Bhat P, Murthy V, Chavan P, Oak A, Gore S, Bhattacharjee A, Patkar N, Kannan S, Shetty N, Rawat A, Achrekar M, Trivedi B, Laskar S, Chaturvedi P, Badwe R, Khattry N, Gupta S. SARS-COV-2 reinfection after previous infection and vaccine breakthrough infection through the second wave of pandemic in India: An observational study. Int J Infect Dis 2022; 118:95-103. [PMID: 35192951 PMCID: PMC8857778 DOI: 10.1016/j.ijid.2022.02.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background There are sparse longitudinal data on SARS-CoV-2 infection after previous infection and after partial or full vaccination. Methods This study of a cohort of healthcare workers used Kaplan-Meier analysis with appropriate definition of events and censoring and used Cox models to assess outcomes, with data cut-off on June 18, 2021. Results A total of 1806 individuals with median age of 32 (18-64) years, 1483 (82.1%) with at least one vaccine dose, 1085 (60.1%) with 2 vaccine doses, 408 (22.6%) with at least one episode of SARS-CoV-2 infection, and 6 (1.47%) with 2 episodes of infection were included in the analysis. At median follow-up of 38.4 weeks after first SARS-CoV-2 infection (n=408), the 52-week probability of reinfection was 2.2% (95% CI, 1.0-4.91%); and at median follow-up of 13.3 weeks after second dose, the 16-week probability of breakthrough infection was 5.6% (95% CI, 4.33-7.23%), which was significantly higher among those without previous SARS-CoV-2 infection versus with previous infection (6.4% vs 1.8%, p=0.016, adjusted Cox HR=3.49, 95% CI, 1.09-11.20, p=0.036) and females versus males (7.9% vs 3.8%, p=0.007, adjusted Cox HR=2.06, 95% CI 1.19-3.56, p=0.01). Conclusions There was low probability of reinfection after previous SARS-CoV-2 infection and higher vaccine breakthrough infections among females and those without previous infection.
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Affiliation(s)
- Sachin Dhumal
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Amar Patil
- Department of Medical Administration, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Ashwini More
- Department of Medicine, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Sujeet Kamtalwar
- Department of Medicine, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Anant Gokarn
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Sumeet Mirgh
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Puneeth Thatikonda
- Department of Medical Administration, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Prasanth Bhat
- Department of Medical Administration, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Preeti Chavan
- Department of Composite Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Amey Oak
- Centre for Cancer Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Suvarna Gore
- Centre for Cancer Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Atanu Bhattacharjee
- Centre for Cancer Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Nikhil Patkar
- Department of Hematopathology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Sadhana Kannan
- Department of Biostatistics, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Nitin Shetty
- Department of Radiodiagnosis, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Anjali Rawat
- Department of Nursing, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Meera Achrekar
- Department of Nursing, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Bhakti Trivedi
- Department of Anaesthesiology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India
| | - Pankaj Chaturvedi
- Centre for Cancer Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Tata Memorial Centre, Navi Mumbai, India; Department of Surgical Oncology, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Rajendra Badwe
- Department of Surgical Oncology, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Navin Khattry
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, & Homi Bhabha National Institute, Mumbai, India.
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Joshi A, Patil VM, Noronha V, Bhattacharjee A, Menon N, Kumar A, Jain P, Mukadam S, Shrinivas A, Punia A, Abhyankar A, Agarwal A, Khaddar S, Rajpurohit A, Kumar KAP, Ravind R, Das K, Talreja V, Dhumal S, Prabhash K. Diclofenac versus tramadol for mucositis related pain in head and neck cancer patients undergoing concurrent chemoradiation-a phase 3 study. Ecancermedicalscience 2022; 15:1318. [PMID: 35047069 PMCID: PMC8723742 DOI: 10.3332/ecancer.2021.1318] [Citation(s) in RCA: 1] [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] [Received: 04/11/2021] [Indexed: 11/06/2022] Open
Abstract
Background Oral mucositis related pain during CTRT in head and neck cancers is a common problem. Unfortunately, in spite of it being common, there is limited evidence for selection of systemic analgesic in this situation. Hence, this study was designed to compare the analgesic effect of a non-steroidal anti-inflammatory drug (diclofenac) versus a weak opioid (tramadol). Patients and methods This was an open-label, parallel design, superiority randomised controlled study. In this study, head and neck cancer patients undergoing radical or adjuvant chemoradiation, who had grade 1 or above mucositis (in accordance with Common Terminology Criteria for Adverse Events version 4.03) and had pain related to it were randomly assigned to either diclofenac or tramadol for mucositis related pain control. The primary endpoint was analgesia after the first dose. The secondary endpoints were the rate of change in analgesic within 1 week, adverse events and quality of life. Results One hundred and twenty-eight patients were randomised, 66 in diclofenac and 62 in tramadol arm. The median area under the curve for graph of pain across time after first dose of pain medication for the diclofenac arm and the tramadol arm was 348.936 units (range: 113.64–1,969.23) and 420.87 (101.97–1,465.96), respectively, (p = 0.05619). Five patients (8.1%) in the tramadol arm and 11 patients (16.7%) in the diclofenac arm required a change in analgesic within 1 week of starting the analgesic (p = 0.184). There was no statistically significant difference in any adverse events between the two arms. However, the rate of any grade of renal dysfunction was numerically higher in the diclofenac arm (10.6% versus 4.8%, p = 0.326). Conclusion In this phase 3 study, evaluating diclofenac and tramadol for chemoradiation induced mucositis pain, there was no statistical difference in analgesic activity of these two drugs.
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Affiliation(s)
- Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India.,These authors contributed equally
| | - Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India.,These authors contributed equally
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India.,These authors contributed equally
| | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, Navi-Mumbai, 410210, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | - Amit Kumar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India.,These authors contributed equally
| | - Parmanand Jain
- Pain Clinic, Department of Anesthesia, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | - Sadaf Mukadam
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | - Avadhoot Shrinivas
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | - Anjali Punia
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | - Anuja Abhyankar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | - Amit Agarwal
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | - Satvik Khaddar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | - Anu Rajpurohit
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | | | - Rahul Ravind
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | - Kishore Das
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | - Vikas Talreja
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, 400012, India
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Shetty A, Chatterjee G, Rajpal S, Srivastava T, Gardi N, Mirgh S, Gokarn A, Punatar S, Shetty N, Joshi A, Nair S, Murthy V, Khattry N, Tembhare P, Dikshit R, Chaturvedi P, More A, Kamtalwar S, Chavan P, Bhat V, Patil A, Dhumal S, Bhat P, Subramanian P, Gujral S, Badwe R, Patkar N, Gupta S. Genomic Analysis of AZD1222 (ChAdOx1) Vaccine Breakthrough Infections in the City of Mumbai. Int J Clin Pract 2022; 2022:2449068. [PMID: 35685574 PMCID: PMC9159196 DOI: 10.1155/2022/2449068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This manuscript describes the genetic features of SARS-CoV-2 mutations, prevalent phylogenetic lineages, and the disease severity amongst COVID-19-vaccinated individuals in a tertiary cancer hospital during the second wave of the pandemic in Mumbai, India. METHODS This observational study included 159 COVID-19 patients during the second wave of the pandemic from 17th March to 1st June 2021 at a tertiary cancer care centre in Mumbai. The cohort comprised of healthcare workers, staff relatives, cancer patients, and patient relatives. For comparison, 700 SARS-CoV-2 genomes sequenced during the first wave (23rd April to 25th September 2020) at the same centre were also analysed. Patients were assigned to nonvaccinated (no vaccination or <14 days from the 1st dose, n = 92), dose 1(≥14 days from the 1st dose to <14 days from the 2nd dose, n = 29), and dose 2 (≥14 days from the 2nd dose, n = 38) groups. Primary measure was the prevalence of SARS-CoV-2 genomic lineages among different groups. In addition, severity of COVID-19 was assessed according to clinical and genomic variables. RESULTS Kappa B.1.1671.1 and delta B.1.617.2 variants contributed to an overwhelming majority of sequenced genomes (unvaccinated: 40/92, 43.5% kappa, 46/92, 50% delta; dose 1: 14/29, 48.3% kappa, 15/29, 51.7% delta; and dose 2: 23/38, 60.5% kappa, 14/38 36.8% delta). The proportion of the kappa and delta variants did not differ significantly across the unvaccinated, dose 1, and dose 2 groups (p = 0.27). There was no occurrence of severe COVID-19 in the dose 2 group (0/38, 0% vs. 14/121, 11.6%; p = 0.02). SARS-CoV-2 genomes from all three severe COVID-19 patients in the vaccinated group belonged to the delta lineage (3/28, 10.7% vs. 0/39, 0.0%, p = 0.04). CONCLUSIONS Sequencing analysis of SARS-COV-2 genomes from Mumbai during the second wave of COVID-19 suggests the prevalence of the kappa B.1.617.1 and the delta B.1.627.2 variants among both vaccinated and unvaccinated individuals. Continued evaluation of genomic sequencing data from breakthrough COVID-19 is necessary for monitoring the properties of evolving variants of concern and formulating appropriate immune response boosting and therapeutic strategies.
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Affiliation(s)
- Arusha Shetty
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Gaurav Chatterjee
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sweta Rajpal
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tuhina Srivastava
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Nilesh Gardi
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Sumeet Mirgh
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Anant Gokarn
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Sachin Punatar
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Nitin Shetty
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India
| | - Amit Joshi
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Sudhir Nair
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Vedang Murthy
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Navin Khattry
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Prashant Tembhare
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rajesh Dikshit
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Centre for Cancer Epidemiology, Tata Memorial Centre, Navi Mumbai, India
| | - Pankaj Chaturvedi
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Ashwini More
- Department of General Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Sujeet Kamtalwar
- Department of General Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Preeti Chavan
- Department of Laboratory Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Vivek Bhat
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Microbiology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Amar Patil
- Department of General Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Sachin Dhumal
- Department of General Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Prashant Bhat
- Department of General Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Papagudi Subramanian
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sumeet Gujral
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rajendra Badwe
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Nikhil Patkar
- Haematopathology Laboratory, ACTREC, Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudeep Gupta
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
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Kashyap L, Patil VM, Dhumal S, Noronha V, Joshi A, Menon N, Prabhash K. Outcome of neoadjuvant chemotherapy (NACT) with paclitaxel plus carboplatin and oral metronomic chemotherapy (OMCT) in patients with technically unresectable oral cavity squamous cell carcinoma (SCC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18034] [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
e18034 Background: NACT is often used in technically unresectable oral cavity SCC to improve resection rate. NACT regimen based on combination of maximum tolerated doses (MTD) and metronomic chemotherapy will debulk the tumor and subsequently inhibit angiogenesis which may overcome drug resistance of MTD schedule. We assessed outcome and tolerance of this combination as NACT in patients with technically unresectable oral cavity SCC. Methods: This is retrospective analysis of prospectively maintained data. Fourteen patients having technically unresectable oral cavity SCC received NACT with paclitaxel (175mg/m2) plus carboplatin (AUC5) every 3 weekly (MTD schedule) and OMCT (methotrexate 9mg/m2 once a week, celecoxib 200mg twice daily and erlotinib 150mg once daily). Patient were assessed clinically and radiologically after minimum of two cycles for surgery. Kaplan-Meier method was used for survival analysis. We report resectability, survival and tolerance of this regimen. Results: Median age of the patients was 38 years, and twelve patients (85%) were male. Twelve (85%) and two (15%) patients had buccal mucosa and oral tongue primary, respectively. AJCC 2017 stage IVA and IVB disease was present in twelve (85%) and two (15%) patients, respectively. Reason for technical unresectabilty was skin edema above zygoma in five (36%), high infratemporal fossa involvement in five (36%), nodal encasement of major vessels in two (14%) and posterior extent of oral tongue tumor into oropharynx in two (14%) patients. Median number of NACT administered were three. Tumor of nine patients (65%; 95% CI = 39%-89%) were deemed resectable after NACT. Eight patients underwent surgery and tumor of one patient showed pathologic complete response. Median follow up was 14.6 months (95% CI = 14.1 - 15 months). Median progression free survival was 11.4 months (95% CI = 7.9 – 15 months). Median overall survival (OS) was not reached while OS at 15 months was 63.5% (95% CI = 37.8% - 89.2%). Common grade 3/4 toxicities (CTCAE 5.0) were neutropenia in eight (57%), thrombocytopenia in three (21%), febrile neutropenia, hypokalemia and diarrhoea in two patients (14%) each. Two patients required in-patient supportive care for adverse events. Conclusions: Paclitaxel and carboplatin along with OMCT is well tolerated and less resource intensive regimen which leads to favorable resection rate and survival in patients with technically unresectable oral cavity SCC.
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Patil VM, Abraham G, Noronha V, Joshi A, Menon N, Singh GK, Dhumal S, Prabhash K. The Pattern of Care of Use of Nivolumab in Head and Neck Cancers - Audit From a Tertiary Cancer Centre. Clin Oncol (R Coll Radiol) 2021; 33:342. [PMID: 33526335 DOI: 10.1016/j.clon.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Affiliation(s)
- V M Patil
- Department of Medical Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - G Abraham
- Department of Medical Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - N Menon
- Department of Medical Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - G K Singh
- Department of Medical Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - S Dhumal
- Department of Medical Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre and HBNI, Mumbai, India
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13
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Noronha V, Dhumal S, Patil V, Joshi A, Menon N, Nawale K, Tambe R, Prabhash K. Post hoc analysis of the screening log of phase III investigator-initiated randomized clinical trial comparing palliative oral metronomic versus intravenous chemotherapy in head-and-neck cancer. Cancer Res Stat Treat 2021. [DOI: 10.4103/crst.crst_157_21] [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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14
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Noronha V, Patil VM, Joshi A, Bhattacharjee A, Paul D, Dhumal S, Juvekar S, Arya S, Prabhash K. A tertiary care experience with paclitaxel and cetuximab as palliative chemotherapy in platinum sensitive and nonsensitive in head and neck cancers. South Asian J Cancer 2020; 6:11-14. [PMID: 28413788 PMCID: PMC5379885 DOI: 10.4103/2278-330x.202558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/25/2022] Open
Abstract
Background: The combination of paclitaxel and cetuximab (PaCe) has led to an encouraging response rate in Phase 2 setting with limited toxicity. The aim of our study was to assess the efficacy of this regimen in our setting in platinum sensitive and nonsensitive patients. Methods: This was a retrospective analysis of head and neck cancer patients treated with weekly PaCe as palliative chemotherapy between May 2010 and August 2014. The standard schedule of cetuximab along with 80 mg/m2 of weekly paclitaxel was administered till either disease progression or withdrawal of patient's consent. The toxicity and response were noted in accordance with CTCAE version 4.02 and RECIST version 1.1 criteria, respectively. The response rates between platinum sensitive and nonsensitive patients were compared by Chi-square test. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan–Meier survival method and log-rank test was used for comparison. Cox proportional hazard model was used for identification of factors affecting PFS and OS. Results: One Hundred patients with a median age of 52 years (interquartile range: 46–56 years) were included. Forty-five patients (45%) were platinum insensitive, whereas 55 patients (55%) were platinum sensitive. In platinum insensitive patients and sensitive patients, the response rates were 38.5% and 22.2%, respectively (P = 0.104), whereas the symptomatic benefit in pain was seen in 89.5% and 71.7%, respectively (P = 0.044). The median PFS in platinum insensitive and sensitive patients were 150 and 152 days, respectively (P = 0.932), whereas the median OS was 256 days (95% confidence interval [95% CI]: 168.2–343.8 days) and 314 days (95% CI: 227.6–400.4 days), respectively (P = 0.23). Nineteen patients (19%) had grades 3–4 adverse events during chemotherapy. Conclusion: Weekly paclitaxel combined with cetuximab has promising efficacy and good tolerability in the palliative setting in advanced head and neck cancer in both platinum sensitive and insensitive patients.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Atanu Bhattacharjee
- Division of Clinical Research and Biostatistics, Malabar Cancer Centre, Kannur, Kerala, India
| | - Davinder Paul
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shashikant Juvekar
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Supreeta Arya
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Patil V, Joshi A, Noronha V, Bhattacharjee A, Dhumal S, Chandrakanth MV, Karpe A, Talreja V, Chandrasekharan A, Turkar S, Pande N, Ramaswamy A, Prabhash K. Quality of life and quality-adjusted time without toxicity in palliatively treated head-and-neck cancer patients. South Asian J Cancer 2020; 7:249-253. [PMID: 30430094 PMCID: PMC6190391 DOI: 10.4103/sajc.sajc_233_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 01/02/2023] Open
Abstract
Background: Quality-adjusted time without toxicity (Q-TWiST) and quality of life (QOL) are indicators of benefit provided by different chemotherapy regimens. Methods: This was a prospective study, in which adult head-and-neck (H and N) cancer patients, treated with metronomic chemotherapy were enrolled. The Functional Assessment of Cancer Therapy-General H and N (FACT-G and H and N) version 4 pro formas were self-administered before the start of chemotherapy and then at 2, 4, and 6 months. FACT QOL and Q-TWiST analysis were then performed. Results: There was an improvement in the social well-being (P = 0.370), emotional well-being (P = 0.000), functional well-being (P = 0.000), H and N cancer subscale (P = 0.001), FACT H and N trial outcome index (P = 0.000), FACT G-total score (P = 0.000), and FACT H and N total score (P = 0.000) with palliative chemotherapy. The QTWiST value for a utility score of 0.25 for toxicity and relapse state was 145.93 days. Conclusion: Metronomic chemotherapy is associated with improvement in QOL and has a low duration of time spent in toxicity state.
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Affiliation(s)
- Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Atanu Bhattacharjee
- Department of Statistics and Epidemiology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - M V Chandrakanth
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Ashay Karpe
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Vikas Talreja
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Arun Chandrasekharan
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Siddharth Turkar
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Nikhil Pande
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Prabhash K, Patil V, Noronha V, Joshi A, Dhumal S, Menon N. Authors' reply to Kies and Katna et al. Cancer Res Stat Treat 2020. [DOI: 10.4103/crst.crst_235_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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Prabhash K, Patil V, Noronha V, Joshi A, Talreja V, Dhumal S, Menon N, Abhyankar A, Dsouza H, Singh G, Bhattacharjee A, Ghosh-Laskar S, Pai P, Chaturvedi P, Nair D, Chaukar D, DCruz A, Shetty P, Moiyadi A. Long-term outcomes of locally advanced and borderline resectable esthesioneuroblastoma and sinonasal tumor with neuroendocrine differentiation treated with neoadjuvant chemotherapy. Cancer Res Stat Treat 2020. [DOI: 10.4103/crst.crst_78_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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Prabhash K, Patil V, Srikanth A, Noronha V, Joshi A, Dhumal S, Menon N. The pattern of care in head-and-neck cancer: Comparison between before and during the COVID-19 pandemic. Cancer Res Stat Treat 2020. [DOI: 10.4103/crst.crst_161_20] [Citation(s) in RCA: 6] [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] Open
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Patil VM, Noronha V, Joshi A, Dhumal S, Mahimkar M, Bhattacharjee A, Gota V, Pandey M, Menon N, Mahajan A, Sable N, Kumar S, Nawale K, Mukadam S, Solanki B, Das S, Simha V, Abraham G, Chandrasekharan A, Talreja V, DSouza H, Srinivas S, Kashyap L, Banavali S, Prabhash K. Phase I/II Study of Palliative Triple Metronomic Chemotherapy in Platinum-Refractory/Early-Failure Oral Cancer. J Clin Oncol 2019; 37:3032-3041. [PMID: 31539316 DOI: 10.1200/jco.19.01076] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Platinum-resistant oral cancer has a dismal outcome with limited treatment options. We conducted a phase I/II study to identify the optimal biologic dose (OBD) of methotrexate when given along with erlotinib and celecoxib and to assess the efficacy of this three-drug regimen in advanced oral cancer. METHODS Patients with platinum-resistant or early-failure squamous cell carcinoma of the oral cavity were eligible for this study. They were orally administered erlotinib 150 mg once per day, celecoxib 200 mg twice per day, and methotrexate per week. The primary end point of phase I was to determine the OBD of methotrexate, and that of phase II was to determine the 3-month progression-free survival. The OBD of methotrexate was determined on the basis of the clinical benefit rate at 2 months and circulating endothelial cell level at day 8, using a de-escalation model. Pharmacokinetic evaluation was performed during phase I. Phase II consisted of an expansion cohort of 76 patients. RESULTS Fifteen patients were recruited in phase I, and 9 mg/m2 methotrexate was identified as the OBD. A total of 91 patients were recruited, and the median follow-up was 6.8 months (range, 0 to 16.8 months). The 3-month progression-free survival rate was 71.1% (95% CI, 60.5% to 79.3%), the 6-month overall survival rate was 61.2% (95% CI, 49.2% to 67.8%), and the response rate was 42.9% (95% CI, 33.2% to 53.1%; n = 39). The mean Functional Assessment of Cancer Therapy-Head and Neck Trial Outcome Index score at day 8 was improved by 6.1 units (standard deviation, 13.6 units) and was maintained around this magnitude ( P = .001). CONCLUSION Triple oral metronomic chemotherapy with erlotinib, methotrexate, and celecoxib is efficacious in platinum-refractory oral cavity cancers and represents a new therapeutic option in patients with poor prognosis.
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Patil V, Noronha V, Joshi A, Deodhar J, Goswami S, Chakraborty S, Ramaswamy A, Dhumal S, M V C, Karpe A, Pande N, Talreja V, Chandrasekharan A, Turkar S, Prabhash K. Distress Management in Patients With Head and Neck Cancer Before Start of Palliative Chemotherapy: A Practical Approach. J Glob Oncol 2019; 4:1-10. [PMID: 30241232 PMCID: PMC6223409 DOI: 10.1200/jgo.17.00044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/20/2022] Open
Abstract
Purpose This study reports the incidence of distress, the factors associated with distress, and a practical strategy to resolve distress in patients with head and neck cancer who are starting palliative chemotherapy. Methods Adult patients with head and neck cancer planned for palliative chemotherapy underwent distress screening before the start of treatment as part of this single-arm prospective study. Patients who had a distress score > 3 on the National Comprehensive Cancer Network (NCCN) distress thermometer were counseled initially by the clinician. Those who continued to have high distress after the clinician-led counseling were referred to a clinical psychologist and were started on palliative chemotherapy. After counseling, distress was measured again. The relation between baseline distress and compliance was tested using Fisher's exact test. Results Two hundred patients were enrolled, and the number of patients with high distress was 89 (44.5% [95% CI, 37.8% to 51.4%]). The number of patients who had a decrease in distress after clinician-led counseling (n = 88) was 52 (59.1% [95% CI, 48.6% to 68.8%]) and after psychologist-led counseling (n = 32) was 24 (75.0% [95% CI, 57.6% to 72.2%]; P = .136). Compliance rates did not differ between the patients with or without a high level of distress at baseline (74.2% v 77.4%, P = .620). Conclusion The incidence of baseline distress is high in patients awaiting the start of palliative chemotherapy. It can be resolved in a substantial number of patients using the strategy of clinician-led counseling, with additional referral to a clinical psychologist as required. Patients with a greater number of emotional problems usually require psychologist-led counseling.
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Affiliation(s)
- Vijay Patil
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Vanita Noronha
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Amit Joshi
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Jayita Deodhar
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Savita Goswami
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Santam Chakraborty
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Anant Ramaswamy
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Sachin Dhumal
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Chandrakanth M V
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Ashay Karpe
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Nikhil Pande
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Vikas Talreja
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Arun Chandrasekharan
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Siddharth Turkar
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
| | - Kumar Prabhash
- Vijay Patil, Vanita Noronha, Amit Joshi, Jayita Deodhar, Savita Goswami, Santam Chakraborty, Anant Ramaswamy, Sachin Dhumal, M.V. Chandrakanth, Ashay Karpe, Nikhil Pande, Vikas Talreja, Arun Chandrasekharan, Siddharth Turkar, and Kumar Prabhash, Tata Memorial Centre, Mumbai, India
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Patil VM, Joshi A, Noronha V, Talreja V, Simha V, Dhumal S, Bandekar B, Chandrasekharan A, Prabhash K. Palliative chemotherapy in carcinoma nasopharynx. South Asian J Cancer 2019; 8:173-177. [PMID: 31489292 PMCID: PMC6699237 DOI: 10.4103/sajc.sajc_230_18] [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] [Indexed: 11/04/2022] Open
Abstract
Introduction Nasopharyngeal carcinoma is a rare malignancy. We conducted an audit of systemic therapies received in palliative setting in carcinoma nasopharynx and studied their outcomes. Methods Patients who underwent first-line palliative systemic chemotherapy between January 2014 and April 2017 for carcinoma nasopharynx at the department of medical oncology at authors' institute were selected for this analysis. Toxicities, responses, progression-free survival (PFS), and overall survival (OS) were analyzed. In addition, a Quality-Adjusted Time without Symptoms or Toxicity analysis with threshold utility analysis was performed. Results Fifty-one patients were included in this analysis. The indication of palliative chemotherapy was locoregionally recurrent disease in 25 (49.0%) patients and metastatic disease in 26 (51.0%) patients. The overall response rate was 62.0% (n = 33). The median PFS was 225 days (95% confidence interval [CI]: 164-274 days) and median OS was 513 days (95% CI: 286-931 days). The restricted mean TOX state duration was 2.6 days (95% CI: 0.3-4.9), restricted mean TWiST duration was 219.2 days (95% CI: 184.0-254.4), and restricted mean REL duration was 74.3 days (95% CI: 38.1-110.4). Conclusion Systemic cytotoxic therapy in nasopharyngeal cancers is associated with high response rates and clinically meaningful PFS; with low duration of time spent in adverse events.
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Affiliation(s)
- Vijay M Patil
- Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vikas Talreja
- Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vijai Simha
- Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sachin Dhumal
- Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Bhavesh Bandekar
- Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Arun Chandrasekharan
- Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Dhumal S, Chandrasekharan A, Patil V, Noronha V, Joshi A, Puranik A, Rangarajan V, Prabhash K. Neoadjuvant chemotherapy in technically unresectable adenocarcinoma of parotid. South Asian J Cancer 2019; 8:185. [PMID: 31489295 PMCID: PMC6699227 DOI: 10.4103/sajc.sajc_87_19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, Maharashtra
| | | | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, Maharashtra
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, Maharashtra
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, Maharashtra
| | - Ameya Puranik
- Department of Nuclear Medicine, Tata Memorial Centre, HBNI, Mumbai, Maharashtra
| | | | - Kumar Prabhash
- Department of Nuclear Medicine, Tata Memorial Centre, HBNI, Mumbai, Maharashtra
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Patil VM, Noronha V, Joshi A, Agarwal J, Ghosh-Laskar S, Budrukkar A, Murthy V, Gupta T, Mahimkar M, Juvekar S, Arya S, Mahajan A, Agarwal A, Purandare N, Rangarajan V, Balaji A, Chaudhari SV, Banavali S, Kannan S, Bhattacharjee A, D'Cruz AK, Chaturvedi P, Pai PS, Chaukar D, Pantvaidya G, Nair D, Nair S, Deshmukh A, Thiagarajan S, Mathrudev V, Manjrekar A, Dhumal S, Maske K, Bhelekar AS, Nawale K, Chandrasekharan A, Pande N, Goel A, Talreja V, Simha V, Srinivas S, Swami R, Vallathol DH, Dsouza H, Shrirangwar S, Turkar S, Abraham G, Thanky AH, Patel U, Pandey MK, Prabhash K. A randomized phase 3 trial comparing nimotuzumab plus cisplatin chemoradiotherapy versus cisplatin chemoradiotherapy alone in locally advanced head and neck cancer. Cancer 2019; 125:3184-3197. [PMID: 31150120 DOI: 10.1002/cncr.32179] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [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: 01/20/2019] [Revised: 03/02/2019] [Accepted: 03/22/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Because the addition of nimotuzumab to chemoradiation in patients with locally advanced head and neck cancer improved outcomes in a phase 2 study, the authors conducted a phase 3 study to confirm these findings. METHODS This open-label, investigator-initiated, phase 3, randomized trial was conducted from 2012 to 2018. Adult patients with locally advanced head and neck cancer who were fit for radical chemoradiation were randomized 1:1 to receive either radical radiotherapy (66-70 grays) with concurrent weekly cisplatin (30 mg/m2 ) (CRT) or the same schedule of CRT with weekly nimotuzumab (200 mg) (NCRT).The primary endpoint was progression-free survival (PFS); key secondary endpoints were disease-free survival (DFS), duration of locoregional control (LRC), and overall survival (OS). An intent-to-treat analysis also was performed. RESULTS In total, 536 patients were allocated equally to both treatment arms. The median follow-up was 39.13 months. The addition of nimotuzumab improved PFS (hazard ratio [HR], 0.69; 95% CI, 0.53-0.89; P = .004), LRC (HR, 0.67; 95% CI, 0.50-0.89; P = .006), and DFS (HR, 0.71; 95% CI, 0.55-0.92; P = .008) and had a trend toward improved OS (HR, 0.84; 95% CI, 0.65-1.08; P = .163). Grade 3 through 5 adverse events were similar between the 2 arms, except for a higher incidence of mucositis in the NCRT arm (66.7% vs 55.8%; P = .01). CONCLUSIONS The addition of nimotuzumab to concurrent weekly CRT improves PFS, LRC, and DFS. This combination provides a novel alternative therapeutic option to a 3-weekly schedule of 100 mg/m2 cisplatin in patients with locally advanced head and neck cancer who are treated with radical-intent CRT.
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Affiliation(s)
- Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jaiprakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Manoj Mahimkar
- Mahimkar Laboratory, Advanced Center for Treatment, Research, and Education in Cancer, Navi Mumbai, India
| | | | - Supreeta Arya
- Department of Radiology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Archi Agarwal
- Department of Nuclear Medicine, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | - Arun Balaji
- Department of Speech and Therapy, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sadhana Kannan
- Department of Biostatistics, Advanced Center for Treatment, Research, and Education in Cancer, Navi Mumbai, India
| | - Atanu Bhattacharjee
- Department of Epidemiology, Advanced Center for Treatment, Research, and Education in Cancer, Navi Mumbai, India
| | - Anil K D'Cruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Prathamesh S Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgery, Tata Memorial Hospital, HBNI, Mumbai, India
| | | | - Vijayalakshmi Mathrudev
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Aparna Manjrekar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kamesh Maske
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Arti Sanjay Bhelekar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Arun Chandrasekharan
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nikhil Pande
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Alok Goel
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vikas Talreja
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vijai Simha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sujay Srinivas
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rohit Swami
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Dilip Harindran Vallathol
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Hollis Dsouza
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sameer Shrirangwar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Siddharth Turkar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - George Abraham
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Aditi Harsh Thanky
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Usha Patel
- Mahimkar Laboratory, Advanced Center for Treatment, Research, and Education in Cancer, Navi Mumbai, India
| | - Manish Kumar Pandey
- Mahimkar Laboratory, Advanced Center for Treatment, Research, and Education in Cancer, Navi Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
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Dhumal S, Patil VM, Noronha V, Joshi A, Bhattacharjee A, Roy S, Das S, Prabhash K. QOL assessment in head and neck cancer patients undergoing neoadjuvant chemotherapy and its impact on overall survival. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e17519] [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
e17519 Background: NACT (neoadjuvant chemotherapy) is one of the treatment options in advanced head and neck cancer (H&N cancer); however there is limited quality of life data available in these patients. Methods: Between August 2013- April 2014, 90 technically unresectable H&N cancer patients who were underwent NACT at our centre were selected for this analysis. EORTC QLQ-C30 and HN35 version 3.0 was used for quality of life assessment at baseline and after 02 cycles of NACT. PFS and OS was estimated by Kaplan Meier method. The mean change in QOL at various domains was calculated with 95% CI. The relationship between change in QOL domain and OS was analysed. Results: The median age of the cohort was 45 years (Range 21-65 years). The predominant subsite was oral cavity, in 62 patients (68.9%).The median PFS and OS was 10.53 months (95%CI 8.1-13.0) and 20.8 months (95%CI 15.1-26.5). The mean scores for all domains of QOL are shown in table 1. Conclusions: NACT leads to improvement in QOL in patients treated with head and neck cancers and its has impact on OS.[Table: see text]
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Affiliation(s)
| | | | | | - Amit Joshi
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Center, Mumbai, India
| | | | | | - Sudeep Das
- All India Institute of Medical Sciences, New Delhi, India
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Simha V, Patil VM, Joshi A, Noronha V, Talreja V, Dhumal S, Chandrasekharan A, Shrirangwar S, Prabhash K. Toxicity and tolerance of concurrent docetaxel with radiotherapy in cisplatin ineligible head and neck cancer patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18022] [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: 11/20/2022] Open
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Joshi A, Patil V, Noronha V, Dhumal S, Pande N, Chandrasekharan A, Turkar S, DSouza H, Shrirangwar S, Mahajan A, Arya S, Juvekar S, BhattaCharjee A, Prabhash K. Results of a phase II randomized controlled clinical trial comparing efficacy of Cabazitaxel versus Docetaxel as second line or above therapy in recurrent head and neck cancer. Oral Oncol 2017; 75:54-60. [PMID: 29224823 DOI: 10.1016/j.oraloncology.2017.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/02/2017] [Accepted: 10/23/2017] [Indexed: 02/08/2023]
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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] [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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Chanana R, Noronha V, Joshi A, Patil V, Dhumal S, Bhattacharya A, Chandrasekharan A, Pande N, Talreja V, Turkar S, Shrirangwar S, Prabhash K. QOL analysis of a phase II randomized controlled clinical trial comparing efficacy of cabazitaxel versus docetaxel as second line or above therapy in recurrent head and neck cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx665.006] [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: 11/14/2022] Open
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Parthiban S, Noronha V, Joshi A, Patil V, Dhumal S, Chandrashekar A, Pande N, Prabhash K. QTWiST analysis to compare the benefit of Metronomic chemotherapy versus intravenous cisplatin for patients with Head and neck cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx665.007] [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: 11/14/2022] Open
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Joshi A, Patil VM, Noronha V, Dhumal S, Chandrasekharan A, Pande N, MV C, Talreja V, Vallathol D, Srinivas S, Chanana R, Gupta K, Parthiban S, Prabhash K. Results of a phase II randomized controlled clinical trial comparing efficacy of cabazitaxel versus docetaxel as second-line or above therapy in recurrent head and neck cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6018] [Citation(s) in RCA: 2] [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
6018 Background: Cabazitaxel has shown activity in squamous cancer cell lines and in taxane resistant cell lines. Hence we planned a randomized phase 2 study to evaluate the efficacy and safety of cabazitaxel against docetaxel in recurrent head and neck cancer, post first line treatment. Methods: This was a phase 2 open label, investigator initiated, randomized controlled trial of Docetaxel (75 mg/m2) versus Cabazitaxel (20 mg/m2), in adult patients with head and neck cancer, ECOG performance status 0-2, with measurable disease, who have been exposed to at least one line of chemotherapy (CTRI/2015/06/005848). 1:1 central randomization was performed and chemotherapy was administered till progressive disease or until patient had intolerable side effects. The sample size of 92 (46 per group) was determined based on an assumption for a difference in disease control rate of 25%, an alpha of 0.05 and 80% power. The data was censored for analysis on 3rd March 2017. Primary analysis of disease control at 6 weeks (CR/PR/SD) was assessed and compared using the chi-square test. Progression free survival (PFS) and overall survival (OS) curves were estimated using the Kaplan-Meier method. Cox proportional hazard model was used for comparison of PFS and OS between the 2 arms. Results: 92 patients were accrued in the study with 46 in each arm. The disease control rate at 6 weeks was better in the docetaxel arm which was statistically significant over the cabazitaxel arm (13.6% versus 52.3%, p = 0.017). The median PFS was 21 days (95% CI 5.28-36.72 days) in the cabazitaxel arm versus 61 days (95% CI 16.21 to 105.79 days) in the docetaxel arm (HR = 1.466, 95% CI 0.923-2.328, p = 0.105). The median OS was 172 days (95% CI 111.78 to 232.22 days) in the cabazitaxel arm versus 188 days (95% CI 134.4 to 241.6 days) in the docetaxel arm (HR-1.408, 95% CI 0.738-2.688, p = 0.299). Conclusion: In this phase 2 study, docetaxel had a superior disease control rate at 6 weeks and PFS compared to cabazitaxel. Clinical trial information: CTRI/2015/06/005848.
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Affiliation(s)
- Amit Joshi
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Center, Mumbai, India
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Patil VM, Noronha V, Joshi A, Ramaswamy A, Dhumal S, Juvekar S, Arya S, Mahajan A, Chaturvedi P, D'Cruz A, Bhattacharjee A, Prabhash K. Neoadjuvant chemotherapy in geriatric head and neck cancers. Head Neck 2017; 39:886-892. [PMID: 28248432 DOI: 10.1002/hed.24694] [Citation(s) in RCA: 4] [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] [Received: 01/21/2016] [Revised: 11/07/2016] [Accepted: 11/30/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to present our findings on the treatment completion rates and outcomes in geriatric patients with head and neck cancer treated with neoadjuvant chemotherapy followed by definitive therapy. METHODS Geriatric patients with locally advanced head and neck cancer who received neoadjuvant chemotherapy were selected for this analysis. Overall survival (OS) and progression-free survival (PFS) were estimated. RESULTS Forty-six of 49 patients completed neoadjuvant chemotherapy (93.9%). The compliance to local treatment was 73.3% and the median OS was 49.9 months (95% confidence interval [CI] = 22.0-77.8 months) in patients who received neoadjuvant chemotherapy for organ preservation (n = 15). In patients receiving neoadjuvant chemotherapy for technically unresectable disease, the corresponding figures were 82.06% and 9.0 months (95% CI = 5.9-12.1 months), respectively. CONCLUSION Individualized neoadjuvant chemotherapy protocols in geriatric patients have high compliance rates to treatment and the median OS in geriatric patients treated for organ preservation is similar to that of young patients. © 2017 Wiley Periodicals, Inc. Head Neck 39: 886-892, 2017.
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Affiliation(s)
- Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Supreeta Arya
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Anil D'Cruz
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Atanu Bhattacharjee
- Division of Clinical Research and Biostatistics, Tata Memorial Hospital, Mumbai, India.,Malabar Cancer Center, Kerala, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
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Prabhash K, Patil VM, Noronha V, Joshi A, Nayak L, Pande N, Chandrashekharan A, Dhumal S, Bhattacharjee A, Banavali S. Retrospective analysis of palliative metronomic chemotherapy in head and neck cancer. Indian J Cancer 2017; 54:25-29. [DOI: 10.4103/ijc.ijc_161_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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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Prabhash K, Patil VM, Noronha V, Joshi A, Agarwala V, Muddu V, Ramaswamy A, Chandrasekharan A, Dhumal S, Juvekar S, Arya A, Bhattacharjee A. Comparison of paclitaxel-cetuximab chemotherapy versus metronomic chemotherapy consisting of methotrexate and celecoxib as palliative chemotherapy in head and neck cancers. Indian J Cancer 2017; 54:20-24. [DOI: 10.4103/ijc.ijc_160_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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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Kane S, Patil VM, Noronha V, Joshi A, Dhumal S, D'Cruz A, Bhattacharjee A, Prabhash K. Predictivity of human papillomavirus positivity in advanced oral cancer. Indian J Cancer 2016; 52:403-5. [PMID: 26905153 DOI: 10.4103/0019-509x.176694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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]
Abstract
BACKGROUND AND OBJECTIVE Human papillomavirus (HPV) is a known prognostic factor world over in patients of carcinoma oropharynx. The role of HPV in oral cancers has not been investigated adequately. We tried to identify standard clinicopathological features in oral cancer, which would predict HPV-positivity. METHODS This was a retrospective analysis of 124 cases of T4 oral cancer patients at our center. HPV-positive was defined in accordance with positive p16 immunohistochemistry done on pretreatment local tumor site biopsy. Age, sex, habits (smoking history and oral tobacco), Eastern Cooperative Oncology Group performance status (ECOG PS), T stage, N stage, grade, and site were selected, for testing of prediction for HPV-positivity. The analysis was performed by R studio version 3.1.1. Two-sample test for equality of proportions with continuity correction was used to identify factors predicting for HPV-positivity. P = 0.05 was considered as significant. RESULTS Of 124 patients, 16 patients (12.9%) were HPV-positive. The median age of the whole cohort was 43 years (interquartile range 37-52 years) with 15 females (12.1%). All had squamous cell carcinoma (100%). The grade of the tumor was well differentiated in 9 patients (7.2%), moderately differentiated in 98 patients (79.1%), and poorly differentiated in 17 patients (13.7%). The ECOG PS 0 in 19 patients (15.3%), 1 in 104 patients (83.9%), and 2 in 1 patient (0.8%). The subsite of the tumor was buccal mucosa in 74 patients (59.7%), anterior two-third of tongue in 33 patients (26.6%), and others in 17 patients (13.7%). None of the tested factors except the use of oral tobacco were statistically significantly associated with HPV-positivity. History of tobacco usage had a statistical trend toward ability to predict HPV-positivity. The proportion of patients with HPV-positive oral cancer in patients without history usage of oral tobacco was 31.3% while it was 10.2% in patients with previous history of tobacco use (P = 0.03). CONCLUSION Standard clinicopathological variables could not predict for HPV-positivity. Negative history of tobacco (smokeless) usage showed statistical trends toward ability to predict HPV-positivity in oral cancer patients.
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Affiliation(s)
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Patil V, Joshi A, Noronha V, Deodhar J, Bhattacharjee A, Dhumal S, Chandrakanth M, Karpe A, Talreja V, Chandrasekharan A, Turkar S, Ramaswamy A, Prabhash K. Expectations and preferences for palliative chemotherapy in head and neck cancers patients. Oral Oncol 2016; 63:10-15. [DOI: 10.1016/j.oraloncology.2016.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/20/2016] [Accepted: 10/31/2016] [Indexed: 01/12/2023]
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Patil V, Joshi A, Noronha V, Deodhar J, Bhattacharjee A, Dhumal S, M V C, Karpe A, Talreja V, Chandrasekharan A, Turkar S, Prabhash K. 386P Expectations and preferences for palliative chemotherapy in head and neck cancers patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw587.028] [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: 11/14/2022] Open
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Patil V, Joshi A, Noronha V, Deodhar J, Bhattacharjee A, Dhumal S, Mv C, Karpe A, Talreja V, Chandrasekharan A, Turkar S, Prabhash K. 386P Expectations and preferences for palliative chemotherapy in head and neck cancers patients. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00544-5] [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: 11/17/2022] Open
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38
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Joshi A, Noronha V, Sharma M, Dhumal S, Juvekar S, Patil VM, Pai P, Prabhash K. Neoadjuvant chemotherapy in advanced sinonasal teratocarcinosarcoma with intracranial extension: Report of two cases with literature review. J Cancer Res Ther 2016; 11:1003-5. [PMID: 26881569 DOI: 10.4103/0973-1482.165878] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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]
Abstract
Sinonasal teratocarcinosarcoma (SNTCS) is a highly aggressive rare tumor of the nasal cavity. Surgery followed by concurrent chemoradiation is the mainstay of treatment in SNTCS. However, intracranial extension may complicate surgical resection, with difficulty in achieving R0 resection. Here we present two cases of SNTCS with intracranial extension; both patients were seen in skull base clinic of our hospital and deemed unsuitable for surgery. These patients then were offered neoadjuvant chemotherapy (NACT), both patients had a partial response with cisplatin and etoposide protocol; subsequently they underwent R0 resection (no macroscopic residual tumor at surgery with all margins were negative for tumor on microscopy). The present cases highlight the fact that NACT with cisplatin and etoposide protocol may be considered in technically unresectable SNTCS.
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Affiliation(s)
| | | | | | | | | | | | | | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Patil VM, Noronh V, Joshi A, Karpe A, Talreja V, Chandrasekharan A, Dhumal S, Prabhash K. Metronomic palliative chemotherapy in maxillary sinus tumor. South Asian J Cancer 2016; 5:56-8. [PMID: 27275447 PMCID: PMC4873696 DOI: 10.4103/2278-330x.181626] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Metronomic chemotherapy consisting of methotrexate and celecoxib recently has shown promising results in multiple studies in head and neck cancers. However, these studies have not included patients with maxillary sinus primaries. Hence, the role of palliative metronomic chemotherapy in patients with maxillary sinus carcinoma that is not amenable to radical therapy is unknown. Methods: This was a retrospective analysis of carcinoma maxillary sinus patients who received palliative metronomic chemotherapy between August 2011 and August 2014. The demographic details, symptomatology, previous treatment details, indication for palliative chemotherapy, response to therapy, and overall survival (OS) details were extracted. SPSS version 16 was used for analysis. Descriptive statistics have been performed. Survival analysis was done by Kaplan–Meier method. Results: Five patients had received metronomic chemotherapy. The median age was 60 years (range 37–64 years). The proportion of patients surviving at 6 months, 12 months, and 18 months were 40%, 40%, and 20%, respectively. The estimated median OS was 126 days (95% confidence interval 0–299.9 days). The estimated median survival in patients with an event-free period after the last therapy of <6 months was 45 days, whereas it was 409 days in patients with an event-free period postlast therapy above 6 months (P = 0.063). Conclusion: Metronomic chemotherapy in carcinoma maxillary sinus holds promise. It has activity similar to that seen in head and neck cancers and needs to be evaluated further in a larger cohort of patients.
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Affiliation(s)
- Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vanita Noronh
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ashay Karpe
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vikas Talreja
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Arun Chandrasekharan
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Sharma V, Patil VM, Noronha V, Joshi A, Dhumal S, Prabhash K. Toxicity, tolerance and outcomes of carboplatin based CTRT ( concurrent chemoradiation) in head and neck cancers in patients who were not fit for cisplatin based CTRT. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e17539] [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: 11/20/2022] Open
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41
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Noronha V, Joshi A, Patil V, Dhumal S, Agarwal JP, Ghosh-Lashkar S, Prabhash K. Cisplatin based adjuvant chemoradiation following neoadjuvant chemotherapy and surgery in advanced oral cavity cancers: A deliverable regimen? Indian J Cancer 2016; 53:141-2. [PMID: 27146765 DOI: 10.4103/0019-509x.180861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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]
Affiliation(s)
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Patil VM, Joshi A, Noronha V, Karpe A, Ramaswamy A, Dhumal S, Juvekar S, Arya S, Mahajan A, Chaturvedi P, Pai P, D'Cruz A, Prabhash K. Technically unresectable recurrent oral cancers: Is NACT the answer? Oral Oncol 2016; 56:e12-4. [PMID: 27050928 DOI: 10.1016/j.oraloncology.2016.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/15/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Ashay Karpe
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Supreeta Arya
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Surgical oncology, Tata Memorial Hospital, Mumbai, India
| | - Prathamesh Pai
- Department of Surgical oncology, Tata Memorial Hospital, Mumbai, India
| | - Anil D'Cruz
- Department of Surgical oncology, Tata Memorial Hospital, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India.
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Joshi A, Tandon N, Noronha V, Dhumal S, Patil V, Arya S, Juvekar S, Agarwal J, DCruz A, Pai P, Prabhash K. Neoadjuvant chemotherapy in technically unresectable carcinoma of external auditory canal. Indian J Med Paediatr Oncol 2016; 36:172-5. [PMID: 26855526 PMCID: PMC4743187 DOI: 10.4103/0971-5851.166734] [Citation(s) in RCA: 2] [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] [Indexed: 12/01/2022] Open
Abstract
Background: Carcinoma of external auditory canal (EAC) is a very rare malignancy with surgical resection as the main modality of treatment. The outcomes with nonsurgical modalities are very dismal. We present a retrospective analysis of 4 patients evaluating the role of neoadjuvant chemotherapy in technically unresectable cancers. Materials and Methods: This is a retrospective analysis of 4 patients from our institute from 2010 to 2014 with carcinoma EAC who were deemed unfit for surgery due to extensive disease involving occipital bone with soft tissue infiltration (n = 2), temporal dura (n = 1), left temporal lobe, and extensive soft tissue involvement (n = 1). All these patients received neoadjuvant chemotherapy with docetaxel, cisplatin and 5 fluorouracil (n = 3) and paclitaxel and cisplatin (n = 1). Results: Response evaluation showed a partial response (PR) in 3 and stable disease (SD) in 1 patient by Response Evaluation Criteria in Solid Tumors criteria. All 3 patients who received 3 drug chemotherapy had PR while 1 patient who received 2 drug chemotherapy had SD. Two of these patients underwent surgery, and other 2 underwent definitive chemoradiation. One of 3 patients who achieved PR underwent surgical resection; the other 2 remained unresectable in view of the persistent intradural extension and infratemporal fossa involvement. One patient who had SD could undergo surgery in view of clearance of infraatemporal fossa. Recent follow-up shows that 3 out of these 4 patients are alive. Conclusion: This indicates that there may be a role of induction chemotherapy in converting potentially unresectable tumors to resectable disease that could produce better outcomes in carcinoma EAC.
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Affiliation(s)
- Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Nidhi Tandon
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Supreeta Arya
- Department of Radiology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Shashikant Juvekar
- Department of Radiology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jaiprakash Agarwal
- Department of Radio-diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anil DCruz
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Prathmesh Pai
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Patil VM, Noronha V, Joshi A, Pinninti R, Dhumal S, Bhattacharjee A, Prabhash K. Metronomic chemotherapy in platinum-insensitive failures and/or early failures postmultimodality management in oral cancers. Indian J Med Paediatr Oncol 2016; 36:161-5. [PMID: 26855524 PMCID: PMC4743183 DOI: 10.4103/0971-5851.166725] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Oral cancer patients with platinum-resistant disease and or early failures have limited treatment options. This analysis was planned to study the efficacy of metronomic chemotherapy in this group of patients. MATERIALS AND METHODS This was a retrospective analysis of oral cancer patients who had squamous cell carcinoma and had an early failure and/or platinum-insensitive failure. Early failure was defined as a failure either within 1-month of adjuvant radiotherapy or within 6 months of chemoradiation (CTRT). A sample size of 100 patients was selected for this study. If ≥39 of 100 patients would have survived at 6 months with metronomic chemotherapy, then additional studies would be warranted. RESULTS The ECOG PS was 0-1 in 92 patients and 2 in 8 patients. The subsite of primary was buccal mucosa in 38 patients (38%), anterior two-third tongue (oral tongue) in 51 patients (51%), and alveolus in 11 patients (11%). The median estimated overall survival was 110 days (95% confidence interval [CI]: 85-134 days). The proportion of patients surviving at 6 months was 26.4% (95% CI: 17.9-35.6). CONCLUSION Metronomic combination of methotrexate and celecoxib failed to meet its prespecified efficacy limit and should not be used in these patients as routine.
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Affiliation(s)
- Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rakesh Pinninti
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Atanu Bhattacharjee
- Division of Clinical Research and Biostatistics, Malabar Cancer Centre, Kerala, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Shetty N, Joshi A, Noronha V, Dhumal S, Epari S, Prabhash K, Patil V. Extra-lymphatic filariasis at reconstructive surgery flap site recurrence of head and neck cancer. IDCases 2016; 3:8-9. [PMID: 26793481 PMCID: PMC4719799 DOI: 10.1016/j.idcr.2015.11.001] [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: 10/07/2015] [Revised: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 12/04/2022] Open
Abstract
Filarial infection is commonly encountered in the Indian subcontinent. Here we present a clinical image of filarial infestation at the site of recurrence of head and neck cancer.
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Affiliation(s)
- Nishitha Shetty
- Department of Medical Oncology, Father Muller Medical College, Mangalore, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
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Sahu P, Patil VM, Joshi A, Noronha V, Dhumal S, Kane S, D'Cruz A, Prabhash K. Neoadjuvant chemotherapy and surgical margin in technically unresectable buccal mucosa cancers. Oral Oncol 2015; 51:e91-2. [PMID: 26520048 DOI: 10.1016/j.oraloncology.2015.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 10/01/2015] [Accepted: 10/03/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Pankaj Sahu
- Department of Surgical oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - Shubhada Kane
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - Anil D'Cruz
- Department of Surgical oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, India.
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Patil VM, Noronha V, Joshi A, Muddu V, Dhumal S, Bhattacharjee A, Prabhash K. Compliance With Neoadjuvant Chemotherapy in T4 Oral Cancers: Place, Person, Socioeconomic Status, or Assistance. J Glob Oncol 2015; 1:65-72. [PMID: 28804775 PMCID: PMC5539870 DOI: 10.1200/jgo.2015.000265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/20/2022] Open
Abstract
PURPOSE Approximately 15% to 20% of our patients with head and neck cancer receiving neoadjuvant chemotherapy (NACT) discontinue therapy because of various nonmedical reasons. We sought to analyze the factors associated with treatment default and noncompliance among these patients. PATIENTS AND METHODS We performed a retrospective analysis of patients with T4 oral cancer treated with NACT between January 2011 and December 2012. We included patients who discontinued treatment for nonmedical reasons before the second cycle of NACT. The factors analyzed were income, education, socioeconomic status, age, sex, place of residence, habits, and payment pattern (government supported or personal capacity). Pearson χ2 test was used to identify significant factors associated with noncompliance. RESULTS Of 486 patients, 91 patients (18.7%) were noncompliant. Percentages of noncompliant patients in the age groups < 30, between 30 and 60, and > 60 years were 25.0%, 17.4%, and 25.5%, respectively (P = .27). Percentages of noncompliance in patients residing within the city, same state, or different state were 20.7%, 20.9%, and 17.1%, respectively (P = .44). Noncompliance rates were 20.3%, 15.7%, 18.1%, and 22.5% in upper middle, lower middle, upper lower, and lower economic strata, respectively (P = .60). Similarly, there was no significant difference in noncompliance according to occupation, education level, payment pattern, sex, or habits. CONCLUSION Our analysis failed to identify any specific significant factor associated with noncompliance with NACT among our patients with T4 oral cancers.
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Kane S, Patil VM, Joshi A, Noronha V, Muddu V, Dhumal S, Juvekar S, Arya S, D'Cruz A, Bhattacharjee A, Prabhash K. Neoadjuvant Chemotherapy in Technically Unresectable Oral Cancers: Does Human Papillomavirus Make a Difference? Clin Oncol (R Coll Radiol) 2015; 27:751-3. [PMID: 26412438 DOI: 10.1016/j.clon.2015.09.003] [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] [Received: 07/03/2015] [Revised: 08/14/2015] [Accepted: 09/08/2015] [Indexed: 11/24/2022]
Affiliation(s)
- S Kane
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - V Muddu
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - S Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - S Juvekar
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - S Arya
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - A D'Cruz
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Bhattacharjee
- Division of Clinical Research and Biostatistics, Tata Memorial Hospital, Mumbai, India; Malabar Cancer Centre, Kerala, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
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Patil VM, Kane S, Noronha V, Joshi A, Dhumal S, Juvekar S, Arya S, Kulkarni S, Bhattacharjee A, Prabhash K. NACT in locally advanced oral cancers : Does HPV make a difference? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e17068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Prabhash K, Patil VM, Noronha V, Dhumal S, Joshi A. Compliance to NACT in T4 oral cancers :The place, person, socioeconomic status or assistance. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e17534] [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: 11/20/2022] Open
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