First-line management of metastatic non-small cell lung cancer: An Indian perspective

Lung cancer has been the most common cancer in the world for several decades. The non-small cell lung cancer (NSCLC) constitutes approximately about 80% of the total cases of lung cancer. Therapeutic interventions in NSCLC have shifted to the target-based approach from histology-based approach, and this has completely changed the face of the management of NSCLC. Developing countries, such as India, have very limited data compiled about the prevalence and treatment practices of lung cancer, despite a large burden of the disease. However, in recent times, there has been a lot of data generated in this regard. This article is an attempt to collate and shine light on the available data for the first-line treatment of NSCLC in India keeping in mind the current standards of care in this area.

Continuing cancer treatment in a “COVID HOTSPOT” in India: Are we overestimating the risks?

Context: We describe the treatment of cancer patients carried out in a Government of India-designated, dedicated coronavirus disease (COVID) hospital (DCH) in a COVID hotspot in India. Aims: The aim was to study the change and delay in the management of cancer patients during the pandemic and its complications. Settings and Design: This was an observational cohort study conducted at a tertiary care center, which was also a DCH. Subjects and Methods: Cancer patients receiving cancer surgery, chemotherapy, and radiotherapy in our DCH, during the lockdown, were studied. Results: A total of 864 patients received treatment for cancer in our hospital during the period of March 20, 2020 – May 31, 2020. There were no COVID-related complications. The treatment of 109/864 patients (12.61%) was delayed due to the pandemic and lockdown situation and the treatment plan was changed for 84/864 (9.72%) patients. There were 21 deaths in these 864 patients (2.43%), but only two deaths were COVID related. Symptomatic patients were tested for COVID, and 3/864 patients (0.34%) were detected to be COVID positive.Conclusions: We successfully delivered cancer treatment to patients in our DCH. The percentage of adverse effects, symptomatic COVID infection, and related mortality has been very low in our study. Cancer care can be continued with due diligence even during this pandemic.

First-line therapy outcomes in patients with advanced stage nonsmall cell lung cancer treated at nongovernment tertiary care centrer in India: Experience from a real world practice

INTRODUCTION

Reports on first line or subsequent treatment and their outcomes for patients with advanced nonsmall cell lung cancer (NSCLC) in India are scarce. The present study is an attempt to understand real world practice scenario of first-line therapy and outcome in advanced stage NSCLC patients.

METHODS

Observational study was conducted at a nongovernment tertiary cancer care center. Totally 83 patients with newly diagnosed advanced NSCLC who were evaluated for further treatment from 2008 onward were included in the study.

RESULTS

Best supportive care was the only treatment received in 11/83 patients. Sixty-three patients received platinum-based doublet chemotherapy and nine received epidermal growth factor receptor tyrosine kinase inhibitor (TKI) as first-line therapy. Pemetrexed and platinum was the most common first-line chemotherapy (56%) regimen used. First-line chemotherapy had to be discontinued in these eight patients due to Grade III/IV toxicity. Disease control rate with the first-line chemotherapy was 70% (partial response 38%, stable disease 32%). Median overall survival (OS) was 17 months with OS at 1 and 2 years was 52% and 29.5%, respectively.

CONCLUSION

First-line platinum-based chemotherapy is feasible and does achieve disease control in the majority of patients with advanced NSCLC. Strategies of selection of therapy based on histology and the presence of driver mutations, use of small molecule TKI, maintenance therapy and multiple lines of therapies are being increasingly implemented in clinical practice and thus improving survival of Indian patients of NSCLC.

Efficacy and safety of short course adjuvant trastuzumab combination chemotherapy in breast cancer

Background:

The adjuvant short course 9-week trastuzumab combination therapy for human epidermal receptor 2 positive breast cancer patients may often be considered as a cost-effective and safe option and has important implications for the Indian subcontinent as well as other developing countries. However, such regimens of shorter duration trastuzumab therapy like FinHer, offered in view of economic constraints, may not be able to achieve globally comparable cure rates in early breast cancer especially with high-risk women with more than 3 lymph node positive.

Methods and Material:

Outcome of 21 patients with HER2 positive breast cancer was treated with short course trastuzumab combination chemotherapy in the adjuvant setting was studied.

Results:

Out of 21 patients 15 are alive and disease free with a follow up of up to 73 months (median follow up 42 months).

Breast cancer: An overview of published Indian data

The Incidence of breast cancer has been steadily increasing in the last two decades, more so in urban areas of the sub-continent. Cancer ceters across the country have large numbers of patients being treated with multiple publications in this field. Inspite of paucity of prospective data and randomised clinical trials from India, there are large number of retrospective publications on various aspects of the disease including pathology, radiology, surgery, chemotherapy, radiation, palliative care and alternatitive treatment modalities. These published data provide an insight into the trends of breast cancer in the country and this comprehensive data review of Indian data will provide a basis for designing trials relevant to our population and planning health care.

Cytomegalovirus oesophagitis in a patient with Non-Hodgkin's lymphoma

Cytomegalovirus (CMV) infection is frequent in immunocompromised patients, especially in AIDS, organ transplantation and rarely in Hodgkin's disease and Non-Hodgkin's lymphoma (NHL). We present a case of NHL with CMV oesophagitis, which has rarely been documented in literature. Apart from fungal and herpes simplex infections, as the common differential diagnosis for oesophagitis in patients of lymphoma, CMV should be considered an important etiologic agent. Early diagnosis and prompt treatment of CMV oesophagitis with gancyclovir can avert significant morbidity and avoid unacceptable treatment delays.