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Growcott S, Renninson E, Rayner L, McKeon J, Ayre G, Comins C, Challapalli A, Owadally W, Beasley M, Hawley L, Hilman S, Strawson-Smith T, Bahl A. Commentary on the New National Institute for Health and Care Excellence Guideline for Metastatic Spinal Cord Compression. Clin Oncol (R Coll Radiol) 2024; 36:200-201. [PMID: 38216346 DOI: 10.1016/j.clon.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Affiliation(s)
- S Growcott
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - E Renninson
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - L Rayner
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - J McKeon
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - G Ayre
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - C Comins
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - A Challapalli
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - W Owadally
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - M Beasley
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - L Hawley
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - S Hilman
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - T Strawson-Smith
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - A Bahl
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
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Kumar A, Acharya SK, Singh SP, Duseja A, Madan K, Shukla A, Arora A, Anand AC, Bahl A, Soin AS, Sirohi B, Dutta D, Jothimani D, Panda D, Saini G, Varghese J, Kumar K, Premkumar M, Panigrahi MK, Wadhawan M, Sahu MK, Rela M, Kalra N, Rao PN, Puri P, Bhangui P, Kar P, Shah SR, Baijal SS, Shalimar, Paul SB, Gamanagatti S, Gupta S, Taneja S, Saraswat VA, Chawla YK. 2023 Update of Indian National Association for Study of the Liver Consensus on Management of Intermediate and Advanced Hepatocellular Carcinoma: The Puri III Recommendations. J Clin Exp Hepatol 2024; 14:101269. [PMID: 38107186 PMCID: PMC10724697 DOI: 10.1016/j.jceh.2023.08.005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/12/2023] [Indexed: 12/19/2023] Open
Abstract
Hepatocellular carcinoma (HCC) presents significant treatment challenges despite considerable advancements in its management. The Indian National Association for the Study of the Liver (INASL) first published its guidelines to aid healthcare professionals in the diagnosis and treatment of HCC in 2014. These guidelines were subsequently updated in 2019. However, INASL has recognized the need to revise its guidelines in 2023 due to recent rapid advancements in the diagnosis and management of HCC, particularly for intermediate and advanced stages. The aim is to provide healthcare professionals with evidence-based recommendations tailored to the Indian context. To accomplish this, a task force was formed, and a two-day round table discussion was held in Puri, Odisha. During this event, experts in their respective fields deliberated and finalized consensus statements to develop these updated guidelines. The 2023 INASL guidelines offer a comprehensive framework for the diagnosis, staging, and management of intermediate and advanced HCC in India. They represent a significant step forward in standardizing clinical practices nationwide, with the primary objective of ensuring that patients with HCC receive the best possible care based on the latest evidence. The guidelines cover various topics related to intermediate and advanced HCC, including biomarkers of aggressive behavior, staging, treatment options, and follow-up care.
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Affiliation(s)
- Ashish Kumar
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
| | - Subrat K. Acharya
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Kaushal Madan
- Clinical Hepatology, Max Hospitals, Saket, New Delhi, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GSMC & KEM Hospital, Mumbai, 400022, India
| | - Anil Arora
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
| | - Anil C. Anand
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
| | - Ankur Bahl
- Department of Medical Oncology, Fortis Memorial Research Institute, Sector - 44, Opp. HUDA City Center, Gurugram, 122002, India
| | - Arvinder S. Soin
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, CH Baktawar Singh Road, Sector 38, Gurugram, Haryana, 122 001, India
| | - Bhawna Sirohi
- Medical Oncology, BALCO Medical Centre, Raipur Chattisgarh, 493661, India
| | - Debnarayan Dutta
- Radiation Oncology, Amrita Institute of Medical Sciences, Ponekkara, AIMS (P.O.), Kochi, 682041, India
| | - Dinesh Jothimani
- Department of Hepatology, Dr. Rela Institute & Medical Centre, #7, CLC Works Road, Chromepet, Chennai, 600044, India
| | - Dipanjan Panda
- Department of Medical Oncology, Apollo Cancer Centre, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110076, India
| | - Gagan Saini
- Radiation Oncology, Max Institute of Cancer Care, Max Super-Speciality Hospital, W-3, Ashok Marg, near Radisson Blu Hotel, Sector-1, Vaishali, Ghaziabad, 201012, India
| | - Joy Varghese
- Department of Hepatology & Transplant Hepatology, Gleneagles Global Health City, 439, Cheran Nagar, Perumbakkam, Chennai, Tamil Nadu, 600100, India
| | - Karan Kumar
- Department of HPB Sciences and Liver Transplantation, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Tonk Road, Jaipur, 302022, Rajasthan, India
| | - Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Manas K. Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India
| | - Manav Wadhawan
- Liver & Digestive Diseases Institute, Institute of Liver & Digestive Diseases, BLK Max Hospital, Delhi, 110 005, India
| | - Manoj K. Sahu
- Department of Medical Gastroenterology, IMS & SUM Hospital, K8 Kalinga Nagar, Shampur, Bhubaneswar, Odisha 751 003, India
| | - Mohamed Rela
- The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, #7, CLC Works Road, Chromepet, Chennai, 600044, India
| | - Naveen Kalra
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Padaki N. Rao
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, No. 6-3-661, Punjagutta Road, Somajiguda, Hyderabad, Telangana, 500 082, India
| | - Pankaj Puri
- Fortis Escorts Liver & Digestive Diseases Institute (FELDI), Fortis Escorts Heart Institute & Research Centre, Okhla Road, New Delhi, 110025, India
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, CH Baktawar Singh Road, Sector 38, Gurugram, Haryana, 122 001, India
| | - Premashis Kar
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India
| | - Samir R. Shah
- Department of Hepatology and Liver Intensive Care, Institute of Liver Disease, HPB Surgery and Transplant Global Hospitals, Dr E Borges Road, Parel, Mumbai, 400012, India
| | - Sanjay S. Baijal
- Diagnostic and Interventional Radiology, Medanta The Medicity, CH Baktawar Singh Road, Sector 38, Gurugram, Haryana, 122 001, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Shashi B. Paul
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Shivanand Gamanagatti
- Fortis Escorts Liver & Digestive Diseases Institute (FELDI), Fortis Escorts Heart Institute & Research Centre, Okhla Road, New Delhi, 110025, India
| | - Subash Gupta
- Centre for Liver & Biliary Sciences, Liver Transplant and Biliary Sciences, Robotic Surgery, Max Super Speciality Hospital, No. 1, 2, Press Enclave Road, Mandir Marg, Saket Institutional Area, Saket, New Delhi, Delhi, 110017, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vivek A. Saraswat
- Department of Gastroenterology and Hepatology, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Tonk Road, Jaipur, 302022, Rajasthan, India
| | - Yogesh K. Chawla
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
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Gan R, Stokes S, Bahl A, Jose J. Modified transseptal approach in endoscopic transsphenoidal pituitary surgery. J Laryngol Otol 2023; 137:1409-1412. [PMID: 36799014 DOI: 10.1017/s0022215123000221] [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] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Transsphenoidal pituitary surgery is commonly performed via a direct transostial approach with a posterior septectomy. However, a technique via an endoscopic transseptal route has been described that avoids a posterior septectomy, but it comes with its own disadvantages. METHODS This paper describes a modification, and discusses its pros and cons. RESULTS The initial incision in the mucosa is placed level with the anterior middle turbinate. The mucoperichondrial flap is raised ipsilaterally until the sphenoid sinus ostium. An incision is made at the osseocartilaginous junction, and the contralateral mucoperichondrial flap is raised. The bony septum and posterior aspect of this flap is excised. The size and position of this window can be adapted. At the end of the operation, the lateralised intact mucoperichondrial flap is moved back to the midline. CONCLUSION Excision or deflection of the cartilaginous septum is not required. It maintains an intact septal mucosa on one side and avoids a septal perforation.
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Affiliation(s)
- R Gan
- Ear, Nose & Throat Department, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - S Stokes
- Neurosurgery Department, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, UK
| | - A Bahl
- Neurosurgery Department, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, UK
| | - J Jose
- Ear, Nose & Throat Department, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
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Biernacka KM, Barker R, Sewell A, Bahl A, Perks CM. A role for androgen receptor variant 7 in sensitivity to therapy: Involvement of IGFBP-2 and FOXA1. Transl Oncol 2023; 34:101698. [PMID: 37307644 PMCID: PMC10276180 DOI: 10.1016/j.tranon.2023.101698] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/10/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023] Open
Abstract
Prostate cancer (PCa) is one of the leading causes of cancer-related deaths in men. Localised PCa can be treated effectively, but most patients relapse/progress to more aggressive disease. One possible mechanism underlying this progression is alternative splicing of the androgen receptor, with AR variant 7(ARV7) considered to play a major role. Using viability assays, we confirmed that ARV7-positive PCa cells were less sensitive to treatment with cabazitaxel and an anti-androgen-enzalutamide. Also, using live-holographic imaging, we showed that PCa cells with ARV7 exhibited an increased rate of cell division, proliferation, and motility, which could potentially contribute to a more aggressive phenotype. Furthermore, protein analysis demonstrated that ARV7 knock-down was associated with a decrease in insulin-like growth factor-2 (IGFBP-2) and forkhead box protein A1(FOXA1). This correlation was confirmed in-vivo using PCa tissue samples. Spearman rank correlation analysis showed significant positive associations between ARV7 and IGFBP-2 or FOXA1 in tissue from patients with PCa. This association was not present with the AR. These data suggest an interplay of FOXA1 and IGFBP-2 with ARV7-mediated acquisition of an aggressive prostate cancer phenotype.
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Affiliation(s)
- K M Biernacka
- Cancer Endocrinology Group, Translational Health Sciences, University of Bristol Southmead Hospital, BS10 5NB, Bristol, UK
| | - R Barker
- Cancer Endocrinology Group, Translational Health Sciences, University of Bristol Southmead Hospital, BS10 5NB, Bristol, UK
| | - A Sewell
- Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - A Bahl
- Bristol Haematology and Oncology Centre, Department of Clinical Oncology, University Hospitals Bristol, Bristol BS2 8ED, UK
| | - C M Perks
- Cancer Endocrinology Group, Translational Health Sciences, University of Bristol Southmead Hospital, BS10 5NB, Bristol, UK.
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Bahl A, Qureshi B, Bravo C, Mahr C, Li S. Race and Incidence of Right Heart Failure after Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.109] [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: 04/05/2023] Open
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Bahl A, Panda N, Bakshi J, Verma R, Oinam A, Mohindra S, Ghoshal S, Gupta R. 23P Treatment outcomes in nasal cavity and paranasal sinus tumors treated with postoperative volumetric modulated arc therapy. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101044] [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: 04/05/2023] Open
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Renninson E, Sonker P, Challapalli A, Hudson Z, Hilman S, Bahl A. Audit of Avelumab Maintenance Therapy for Advanced or Metastatic Urothelial Carcinoma Treated in the Early Access Scheme. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.041] [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: 01/13/2023]
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Renninson E, Channell K, Ball J, Masson S, Challapalli A, Bahl A. Patient Experience and Impact of Rectal Spacers on Dosimetry and Acute Toxicity in Patients Undergoing Radical Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.042] [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: 01/13/2023]
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Johnson S, Pai E, Voroba A, Chen NW, Bahl A. 222 ED-ACT, Examining D-dimer and Empiric Anti-coagulation in COVID-19 Related Thrombosis. Ann Emerg Med 2022. [PMCID: PMC9519214 DOI: 10.1016/j.annemergmed.2022.08.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Challapalli A, Ratnayake G, McGrane J, Frazer R, Gupta S, Parslow D, Kingdon S, Lydon A, Sharma A, Tuthill M, McCusker C, Ford V, Ferrera A, Malik J, Boh Z, Jones E, T.R. Geldart, Nelmes S, Brown J, Bahl A. 1463P Patterns of care and outcomes of metastatic renal cell carcinoma (mRCC) patients (pts) with bone metastases (BM): A UK multicenter review. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1566] [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: 11/01/2022] Open
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Ratnayake G, Challapalli A, McGrane J, Frazer R, Gupta S, Parslow D, Kingdon S, Lydon A, Sharma A, Tuthill M, McCartney T, Jabbar R, Charnley N, Malik J, Abhi D, Chau C, Geldart T, Halstead A, Anuforom U, Bahl A. 1457P A UK multicentre retrospective review of metastatic renal cell carcinoma (mRCC) patients (pts) outcomes with brain metastases (BM) in the modern era. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1560] [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: 11/24/2022] Open
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Bahl A, Rajappa S, Rawal S, Bakshi G, Murthy V, Patil K. A review of clinical evidence to assess differences in efficacy and safety of luteinizing hormone-releasing hormone (LHRH) agonist (goserelin) and LHRH antagonist (degarelix). Indian J Cancer 2022; 59:S160-S174. [PMID: 35343199 DOI: 10.4103/ijc.ijc_1415_20] [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] [Indexed: 06/14/2023]
Abstract
Luteinizing hormone-releasing hormone agonist (LHRH-A), goserelin, and antagonist, degarelix, are both indicated for the treatment of advanced prostate cancer (PCa); however, large comparative trials evaluating their efficacy and safety are lacking. In this review, we assessed the available evidence for both the drugs. Although degarelix achieves an early rapid decline in testosterone (T) and prostate-specific antigen (PSA) levels, median T and PSA levels, in addition to prostate volume and International Prostate Symptom Scores, become comparable with goserelin over the remaining treatment period. Degarelix causes no initial flare, therefore it is recommended in patients with spinal metastases or ureteric obstruction. Goserelin achieves lower PSA, improved time to progression, and better survival outcomes when administered adjunctively to radiotherapy compared with radiotherapy alone, with significant results even over long-term follow-up. The evidence supporting adjuvant degarelix use is limited. Goserelin has better injection site safety, single-step delivery, and an efficient administration schedule compared with degarelix, which has significantly higher injection site reactions and less efficient administration mechanism. There is conflicting evidence about the risk of cardiovascular disease (CVD), and caution is required when using LHRH-A in patients with preexisting CVD. There is considerable long-term evidence for goserelin in patients with advanced PCa, with degarelix being a more recent option. The available comparative evidence of goserelin versus degarelix has several inherent limitations related to study design, sample size, conduct, and statistical analyses, and hence warrants robust prospective trials and long-term follow-up.
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Affiliation(s)
- Ankur Bahl
- Senior Consultant, Medical Oncology and Hematology, Max Cancer Centre, New Delhi, India
| | - Senthil Rajappa
- Consultant Medical Oncologist, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
| | - Sudhir Rawal
- Medical Director, Chief Genito Uro-Oncology, RCGI, Delhi, India
| | - Ganesh Bakshi
- Department of Uro oncology, P D Hinduja National Hospital, Mahim, Mumbai, India
| | - Vedang Murthy
- Professor & Radiation Oncologist, Tata Memorial Center, Mumbai, India
| | - Ketaki Patil
- Medical Affairs, AstraZeneca Pharma India Ltd, Manyatha Tech Park, Rachenahalli, Bangalore, India
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Krebs M, Lord S, Kenny L, Baird R, MacPherson I, Bahl A, Clack G, Ainscow E, Barrett A, Dickinson P, Fuchter M, Lehnert M, Ali S, Mcintosh S, Coombes R. 230MO First in human, modular study of samuraciclib (CT7001), a first-in-class, oral, selective inhibitor of CDK7, in patients with advanced solid malignancies. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Howell S, Krebs M, Lord S, Kenny L, Bahl A, Clack G, Ainscow E, Arkenau HT, Mansi J, Palmieri C, Richards P, Jeselsohn R, Mitri Z, Gradishar W, Sardesai S, O'Shaughnessy J, Lehnert M, Ali S, McIntosh S, Coombes R. 265P Study of samuraciclib (CT7001), a first-in-class, oral, selective inhibitor of CDK7, in combination with fulvestrant in patients with advanced hormone receptor positive HER2 negative breast cancer (HR+BC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bahl A, Rajamanickam T, Isaacs R, Oberoi A. POS-560 HEMODIALYSIS CATHETER ASSOCIATED BLOODSTREAM INFECTIONS (CABSI) AT A TERTIARY CARE HOSPITAL IN NORTH INDIA: INCIDENCE,OUTCOME AND ANTIBIOGRAM OF THE ISOLATED ORGANISMS. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.589] [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: 11/30/2022] Open
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Biswas I, Bahl A, Kumar B, Singh H, Thingnam S, Puri G. COVID-19 Infection in a 13-year-old Heart Transplant Recipient in Immediate Post Transplant Period - A Case Report. J Heart Lung Transplant 2021. [PMCID: PMC7979411 DOI: 10.1016/j.healun.2021.01.1303] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Experience regarding course and outcome of Covid-19 infection in heart transplant recipients is limited. Case fatality rate of 25% of covid-19 infection in adult recipients of heart transplant and mild and self-limited disease in young heart transplant patients have been reported in small case series. We describe a case where a 13 year old patient contracted covid-19 infection on 7th post-operative day after undergoing heart transplant and was subsequently discharged from hospital uneventfully. Case Report A 13 year old boy, with dilated cardiomyopathy underwent orthotopic heart transplant surgery. In the immediate pre-operative period, the real-time polymerase chain reaction (RTPCR) of nasopharyngeal swabs of both the recipient and the brain-dead organ donor were negative for severe acute respiratory syndrome coronavirus type 2 (SARS CoV 2). The intraoperative and immediate postoperative periods were uneventful. The recipient got weaned off from mechanical ventilation on the 1st postoperative day and O2 support was weaned off on 4th postoperative day. He was put on immunosuppressive regimen consisting of mycophenolate mofetil, tacrolimus and prednisone. On 7th postoperative day, he complained of fever, sore throat and dry cough. Nasopharyngeal swab for RTPCR was sent. It reported positive for SARS CoV 2. He was shifted to isolation facility. He maintained more than 94% saturation on pulse oximetry in room air. Immunosuppressive regimen was continued. He was administered 5-day course of remdesivir. Inotropic support was weaned off on 10th postoperative day. On serial bedside echocardiography, the allograft function was found to be normal throughout. He was kept on prophylactic antimicrobial, antifungal and anti-cytomegaloviral therapy and on prophylactic dose of low molecular weight heparin. There was initial rise in neutrophil lymphocyte ratio (17), C reactive protein (58 mg/l), ferritin (871 ng/ml), D-dimer (1904 ng/ml), Troponin T (227 pg/ml) levels, which gradually came down to within normal limits. He was discharged on 38th postoperative day to a home isolation facility as his RTPCR for SARS CoV 2 was still positive, although he remained completely asymptomatic for the last 21 days. Summary The course of Covid-19 infection in the immediate post-transplant period of this young heart transplant recipient was largely uneventful.
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Ballari N, Rai B, Bahl A, Mittal BR, Ghoshal S. Prospective observational study evaluating acute and delayed treatment related toxicities of prophylactic extended field volumetric modulated arc therapy with concurrent cisplatin in cervical cancer patients with pelvic lymph node metastasis. Tech Innov Patient Support Radiat Oncol 2021; 17:48-56. [PMID: 33748442 PMCID: PMC7970137 DOI: 10.1016/j.tipsro.2021.02.009] [Citation(s) in RCA: 1] [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] [Received: 10/30/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the treatment related acute and delayed toxicities of extended field Volumetric modulated arc therapy (VMAT) with concurrent chemotherapy in patients of locally advanced cervical cancer with pelvic lymph nodes. MATERIAL AND METHODS From 2014 to 2016, 15 patients of locally advanced cervical cancer with Fluoro-deoxyglucose positron emission tomography (FDG-PET) positive pelvic lymph nodes were treated with extended field Simultaneous integrated boost (SIB)-VMAT 45 Gy/55 Gy/25#/5weeks and concurrent cisplatin. Acute toxicities were documented according to common terminology criteria for adverse events version 4 (CTCAE v.4). Dose volume parameters and patient characteristics were analyzed for association with toxicities. RESULTS Median age of patients at diagnosis was 48 years. 40% (6 patients) were stage IIB & 60% (9 patients) were stage IIIB. Median number of involved pelvic lymph nodes was 2 (range, 1-4), commonest location was external iliac lymph node region (86%). Median number of concurrent chemotherapy cycles received was five. Treatment was well tolerated and there were no grade ≥ 3 acute toxicities. Commonest acute toxicities observed were vomiting (≥grade2 -13.3%) followed by & nausea (grade ≥ 2 in 6%) and were associated with volume of bowel bag receiving 45 Gy. Constitutional symptoms (≥grade 2) were observed in 6% patients and had no dosimetric associations. At a median follow up of 43 months, delayed ≥ grade1, 2, 3 toxicity were observed in 80%, 0%, and 0% respectively with diarrhea being the commonest. CONCLUSION Prophylactic para aortic extended field VMAT with concurrent chemotherapy for locally advanced cervical cancer is well tolerated with acceptable acute toxicity profile. Significant grade 3 acute/delayed toxicities were not observed in this cohort of patients.
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Affiliation(s)
- N Ballari
- Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - B Rai
- Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - A Bahl
- Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - B R Mittal
- Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S Ghoshal
- Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Joshi S, Joshi U, Bahl A, Arya D, Anand AK, Arora RS. Exploring the Financial Toxicities of Patients with Locally Advanced Head and Neck Malignancies, Being Treated in a Private Sector Hospital in North India: A Thematic Analysis. Indian J Palliat Care 2021; 27:118-125. [PMID: 34035629 PMCID: PMC8121222 DOI: 10.4103/ijpc.ijpc_53_20] [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: 03/06/2020] [Revised: 03/24/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022] Open
Abstract
Background: The high cost of cancer diagnosis and treatment is a global concern. Evidence derived, mostly from high-income countries, shows how it gradually impacts the personal and household financial condition causing the increased psychosocial burden of the patient and their families (termed “financial toxicity”). Aim: To qualitatively explore the financial toxicities in patients with advanced head and neck malignancies in India, and to consider how it impacts the patient and his family. Methods: Interviewing a purposive sample of 8 patients using semi-structured interviews face to face. Interviews were transcribed verbatim, and a thematic content analysis was carried out. Results: Four major themes were identified: burden and amplifying factors, impact, rescue and relieving factors, and learning and innovation. The burden of cost relates to diagnosis, treatment and non-medical costs which gets amplified while navigating the healthcare labyrinth. Emerging themes describe financial journey of cancer patients, the issues faced by them and the ways they tackle these issues during their treatment. Healthcare system factors like limited availability of adequate/comprehensive/meaningful insurance and reimbursements potentiate the toxicity. The financial toxicity leads to a significant adverse financial, psychological and social impact on the patient and the family. While moving through the process of care, there were a few learnings and innovations which patients proposed. Conclusion: This study provides qualitative evidence of the considerable and pervasive nature of financial toxicity in head and neck cancer patients in India. The findings have implications for all cancer patients and highlight the unmet need of psychosocial support for these patients.
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Affiliation(s)
- Saurabh Joshi
- Consultant Palliative and Pain Medicine, Hospice India, New Delhi, India
| | - Upkar Joshi
- Senior Finance and Economics Expert, Founder Ascent Wealth Desk, Visiting Faculty- Delhi University, New Delhi, India
| | - Ankur Bahl
- Senior Consultant Medical Oncology, Max Super Specialty Hospital, New Delhi, India
| | - Devavrat Arya
- Principal Consultant Medical Oncology, Max Super Specialty Hospital, New Delhi, India
| | - A K Anand
- Chief Radiation Oncology and Senior Director, Max Super Specialty Hospital, New Delhi, India
| | - Ramandeep Singh Arora
- Senior Consultant, Paediatric Oncology, Max Super Speciality Hospital, New Delhi, India
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Babu G, Bahl A, Bhattacharya GS, Bhowmik KT, Dattatraya PS, Ghadyalpatil N, Karandikar SM, Kulkarni P, Sridharan N, Parikh P, Prabhash K, Raja T, Rajasundaram S, Subramanian S, Talapatra K, Vaid A. Oncology Gold Standard ® practical consensus recommendations for the use of monoclonal antibodies in the management of squamous cell carcinoma of head and neck. South Asian J Cancer 2020; 6:154-160. [PMID: 29404293 PMCID: PMC5763625 DOI: 10.4103/sajc.sajc_181_17] [Citation(s) in RCA: 2] [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] [Indexed: 12/20/2022] Open
Abstract
We present the 2017 Oncology Gold Standard Practical Consensus Recommendation for use of monoclonal antibodies in the management of advanced squamous cell carcinoma of head neck region.
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Affiliation(s)
- Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Ankur Bahl
- Department of Medical Oncology, Max Hospital, New Delhi, India
| | - G S Bhattacharya
- Department of Medical Oncology, Fortis Hospital, Kolkata, West Bengal, India
| | - K T Bhowmik
- Department of Radiation Oncology, Safdarjung Hospital, New Delhi, India
| | - P S Dattatraya
- Department of Medical Oncology, Omega Hospital, Hyderabad, Telangana, India
| | - Nikhil Ghadyalpatil
- Department of Medical Oncology, Yashoda Hospitals, Hyderabad, Telangana, India
| | - S M Karandikar
- Department of Medical Oncology, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Padmaj Kulkarni
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Nithya Sridharan
- Department of Medical Oncology, VS Hospital, Chennai, Tamil Nadu, India
| | - Purvish Parikh
- Department of Precision Oncology, Asian Cancer Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - T Raja
- Department of Medical Oncology, Apollo Speciality Hospital, Chennai, Tamil Nadu, India
| | - S Rajasundaram
- Department of Surgical Oncology, Global Institute of Oncology, Chennai, Tamil Nadu, India
| | - S Subramanian
- Department of Medical Oncology, VS Hospital, Chennai, Tamil Nadu, India
| | - Kaustav Talapatra
- Department of Radiation Oncology, KDA Hospital, Mumbai, Maharashtra, India
| | - Ashok Vaid
- Department of Medical Oncology, Medanta Hospital, Gurugram, Haryana, India
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Gullick G, Mohan V, Gibbs L, Comins C, Braybrooke J, Jenkins J, Bahl A, Caws C. Leptomeningeal Disease in Breast Cancer, Bristol Experience. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.02.018] [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: 10/23/2022]
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21
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Bahl A, Talwar V, Sirohi B, Mehta P, Arya D, Shrivastava G, Dahiya A, Pavithran K. Primary Tumor Location as a Prognostic and Predictive Marker in Metastatic Colorectal Cancer (mCRC). Front Oncol 2020; 10:964. [PMID: 32612957 PMCID: PMC7309590 DOI: 10.3389/fonc.2020.00964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 05/15/2020] [Indexed: 12/27/2022] Open
Abstract
Clinico-pathological differences between adenocarcinoma in the right and left colo-rectum play a role in determining the prognosis and response to treatment. Studies suggest that primary tumor location is more relevant as the disease progresses and reflects a possible difference in biology and response to therapy. This review aims to explore the clinico-pathological features of right and left colo-rectum and the impact of primary tumor location on prognosis of CRC as well as discuss the available clinical data on tumor sidedness in metastatic colorectal cancer. In so far as the clinical data of tumor sidedness is concerned, very few reviews have discussed the clinical implications of sidedness in heavily pre-treated metastatic colorectal cancer (second and subsequent lines of therapy in metastatic disease). This review aims to fill the current gap in this setting.
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Affiliation(s)
- Ankur Bahl
- Department of Medical Oncology, Max Super Speciality Hospital, New Delhi, India
| | - Vineet Talwar
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Bhawna Sirohi
- Department of Medical Oncology, Max Super Speciality Hospital, New Delhi, India
| | - Prashant Mehta
- Department of Medical Oncology, Asian Institute of Medical Sciences, Faridabad, India
| | - Devavrat Arya
- Department of Medical Oncology, Max Super Speciality Hospital, New Delhi, India
| | - Gunjan Shrivastava
- Department of Medical Oncology, Max Super Speciality Hospital, New Delhi, India
| | - Akhil Dahiya
- Medical Affairs, Dr. Reddy's Laboratories Limited, Hyderabad, India
| | - K Pavithran
- Department of Medical Oncology, Amrita Institute of Medial Sciences and Research Centre, Kochi, India
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22
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Batra S, Jha SK, Bahl A, Chaturvedi H, Taneja S. Outcome of FOLFOX based chemotherapy in advanced pancreatobiliary cancers presenting with hyperbilirubinemia. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16605] [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
e16605 Background: Treatment of pancreatobiliary cancer patients with severe liver dysfunction including hyperbilirubinemia secondary to liver metastasis or biliary obstruction is challenging. A significant number of patients at presentation are in advanced/ locally advanced stage thus severely limiting chemotherapy options. FOLFOX (5 FU, Leucovorin, Oxaliplatin) represents a feasible option considering the pharmacokinetics. Clinical data on the dosage and tolerability of chemotherapy is limited and no recommendations are available to treat such patients in upfront setting with persistent hyperbilirubinemia. This observational study was done to find out safety and efficacy of FOLFOX based chemotherapy in these patients. Methods: Patients with advanced pancreatobiliary cancers with hyperbilirubinemia were treated with mFOLFOX6 based chemotherapy. Patients were treated till progression or 6 months or death (whichever occurred ealy) and assessed for toxicity and survival. Results: Only 13 out of 40 patients were able to complete all 12 cycle of chemotherapy. 12 patients were able to receive 2nd line chemotherapy of physician choice and 2 patients were able to received 3rd line chemotherapy. Total bilirubin of patients at start of chemotherapy ranged from 3 to 39.4 mg/dl with a mean value of 9.17±6.67 mg/dl and a median value of 7.5 mg/dl. Median progression free survival (PFS) of mFOLFOX6 was 5.97 months whereas median overall survival (OS) was 8.2 months. 6 patients were able to receive only one cycle of chemotherapy. 2 patients were able to receive only 2 cycles of chemotherapy. 26 patients completed 6 cycles of chemotherapy. Objective response rate was 45% after 6 cycles of chemotherapy. Of these 26 patients response assessment revealed progressive disease in 7 patients. 2 patient had complete metabolic response of which one of them had locally advanced disease. On laparotomy of this patient there were an extensive peritoneal disease curative surgery was not feasible. One patient successfully underwent Whipple’s procedure after 6 cycles of chemotherapy followed by adjuvant radiotherapy. Conclusions: FOLFOX based chemotherapy is a feasible option and a hope for patients of advanced pancreatobiliary cancers presenting with hyperbilirubinemia with a tolerable toxicity profile and providing comparable PFS and OS to other chemotherapy drugs/ regimens used in non hyperbilirubinemic patients.
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23
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Bahl A, Bhatia K, Choudhary P, Singhla S, Shrivastava G, Bal J, Anand AK, Chaturvedi H, Dua B. Palliative chemotherapy with or without cetuximab in recurrent or metastatic squamous cell carcinoma of the head and neck: Indian tertiary care retrospective analysis. Head Neck 2020; 42:955-962. [DOI: 10.1002/hed.26070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 01/30/2023] Open
Affiliation(s)
- Ankur Bahl
- Department of Medical Oncology Max Superspeciality New Delhi India
| | - Komal Bhatia
- Department of Medical Oncology Max Superspeciality New Delhi India
| | | | - Suhas Singhla
- Department of Medical Oncology Max Superspeciality New Delhi India
| | | | - Jaspriya Bal
- Department of Nuclear Medicine Max Superspeciality Hospital New Delhi India
| | - Anil K. Anand
- Department of Radiation Oncology Max Superspeciality Hospital New Delhi India
| | - Harit Chaturvedi
- Department of Surgical Oncology Max Superspeciality Hospital New Delhi India
| | - Bharat Dua
- Department of Radiation Oncology Max Superspeciality Hospital New Delhi India
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24
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Immerzeel WW, Lutz AF, Andrade M, Bahl A, Biemans H, Bolch T, Hyde S, Brumby S, Davies BJ, Elmore AC, Emmer A, Feng M, Fernández A, Haritashya U, Kargel JS, Koppes M, Kraaijenbrink PDA, Kulkarni AV, Mayewski PA, Nepal S, Pacheco P, Painter TH, Pellicciotti F, Rajaram H, Rupper S, Sinisalo A, Shrestha AB, Viviroli D, Wada Y, Xiao C, Yao T, Baillie JEM. Importance and vulnerability of the world’s water towers. Nature 2019; 577:364-369. [DOI: 10.1038/s41586-019-1822-y] [Citation(s) in RCA: 477] [Impact Index Per Article: 95.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/11/2019] [Indexed: 11/09/2022]
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25
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Price J, Hijazi M, Clavette-Lachapelle L, Bahl A. 346 Ultra Long Versus Standard Long Peripheral Intravenous Catheters: A Randomized Controlled Trial of Ultrasound-Guided Catheter Survival. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.305] [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: 11/26/2022]
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26
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Bahl A, Elangovan A, Oinam A, Kumar R, Mittal B, Verma R, Panda N, Ghoshal S. PO-080 Radiotherapy versus concurrent chemo radiotherapy in cancers of unknown primary of Head and Neck. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30246-4] [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: 10/27/2022]
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27
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Randhawa M, Jones R, Stratton I, Bahl A, Bottomley D, Carruthers H. The National Radium-223 Dichloride Audit Group: Data from Patients in 17 UK Oncology Centres with Metastatic Castrate-resistant Prostate Cancer Treated with Radium-223 Dichloride. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2018.11.016] [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: 11/30/2022]
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Abstract
Purpose
The purpose of this paper is to prepare a methodology to evaluate availability analysis of distillery plant using Petri nets (PN). The effect of various failures, repair rate and availability of repair facilities on the system has been studied.
Design/methodology/approach
The PN model of a system is developed to study the dynamic behavior of the system under various working conditions. Availability analysis of the plant is presented taking into consideration of failure and repair rates of their subsystems and has been carried out using Monte Carlo simulation.
Findings
The bottle washing machine is the most critical machine from a maintenance point of view which has more compact on the system performance as compared to other machines. The availability analysis of distillery plant helps the management to adopt a suitable maintenance policy to improve upon plant production and plant availability.
Originality/value
The application of this proposed PN-based approach is very useful in finding the most critical subsystem and its effect on the performance of the system in terms of availability and plant production. Further, the advantage of the PN approach is that dynamic behavior of the system under consideration is modeled with graphic representation of the system and given distribution can be associated with the subsystems for analysis. The superiority of this approach over others, such as network, fault tree and Markov analysis, is outlined in the paper.
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Bahl A, Choudhary P, Bhatia K, Singhla S, Shrivastava G, Bal J, Anand A, Chaturvedi H. Palliative chemotherapy (CT) with or without cetuximab (CTX) in recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN): An Indian retrospective analysis. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy438.031] [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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30
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Elangovan A, Bahl A, Patel F, Dracham C, Rai B, Trivedi G. Is bone marrow sparing intensity modulated radiotherapy better than 3-dimensional conformal radiotherapy in reducing haematological toxicities during pelvic irradiation in locally advanced carcinoma cervix?: A prospective study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy436.010] [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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31
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Sharma A, Bahl A, Kirk H, White P, Law R, Challapalli A. Efficacy and Toxicity of Hypofractionated Palliative Radiation Therapy for Muscle Invasive Bladder Cancer in the Elderly: A Single Institution Experience. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.357] [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: 11/25/2022]
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32
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Kirk H, Challapalli A, Braybrooke J, Bahl A. Stage 1 Testicular Seminomas Treated with Single Cycle Carboplatin: Outcomes and Management of Relapse: A Single-Centre Experience. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.298] [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]
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33
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Velikova G, Williams LJ, Willis S, Dixon JM, Loncaster J, Hatton M, Clarke J, Kunkler IH, Russell NS, Alhasso A, Adamson D, Algurafi H, Allerton R, Anandadas C, Bahl A, Barraclough L, Barrett-Lee P, Barthakur U, Bedi C, Beresford M, Bishop J, Blackman G, Bliss P, Bloomfield D, Blunt M, Branson T, Brazil L, Brunt A, Chakrabarti A, Chittalie A, Churn M, Clarke J, Cleator S, Crellin P, Danwata F, De-Silva-Minor S, Dhadda A, Eicholz A, Fernando I, Forrest J, Fraser J, Geropantas K, Goodman A, Grieve R, Griffin M, Hadaki M, Hall A, Hatton M, Hicks J, Hignett S, Hogg M, Jyothirmayi R, Khan M, Kumar S, Lawton P, Lee D, Lewinski C, Lim C, Locke I, Loncaster J, Lumsden G, Lupton S, Magee B, Marshall J, Masinghe S, McGregor C, McLennan M, Memtsa P, Milanovic D, Misra V, Mithal N, Mukesh MB, Neal A, Needleman S, Persic M, Quigley M, Raj S, Riddle P, Ritchie D, Roberts F, Robson P, Roe H, Rolles M, Shah N, Sharma R, Sherwin E, Simmonds P, Skailles G, Skaria S, Soe W, Sripadam R, Stevens A, Stockdale A, Storey N, Storey N, Syndikus I, Thorp N, Thorp N, Upadhyay S, Varughese M, Walji N, Welch R, Wells T, Wolstenholme V, Wolstenholme V, Woodings P, Yuille F. Quality of life after postmastectomy radiotherapy in patients with intermediate-risk breast cancer (SUPREMO): 2-year follow-up results of a randomised controlled trial. Lancet Oncol 2018; 19:1516-1529. [DOI: 10.1016/s1470-2045(18)30515-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/12/2022]
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Shotkin P, Hang B, Brackney A, Joseph S, Karabon P, Nnanabu I, Mohammad A, Bahl A. 173 A Comparison of Ultrasound-Guided Vascular Access Catheter Survival between Standard Long Intravenous Lines and Extended Dwell Catheters. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.178] [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: 11/24/2022]
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35
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Wahlstrand JK, Zahedpour S, Bahl A, Kolesik M, Milchberg HM. Bound-Electron Nonlinearity Beyond the Ionization Threshold. Phys Rev Lett 2018; 120:183901. [PMID: 29775376 PMCID: PMC6074032 DOI: 10.1103/physrevlett.120.183901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Indexed: 05/25/2023]
Abstract
We present absolute space- and time-resolved measurements of the ultrafast laser-driven nonlinear polarizability in argon, krypton, xenon, nitrogen, and oxygen up to ionization fractions of a few percent. These measurements enable determination of the strongly nonperturbative bound-electron nonlinear polarizability well beyond the ionization threshold, where it is found to remain approximately quadratic in the laser field, a result normally expected at much lower intensities where perturbation theory applies.
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Affiliation(s)
- J. K. Wahlstrand
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, MD 20742
- Engineering Physics Division, National Institute of Standards and Technology, Gaithersburg, MD 20899
| | - S. Zahedpour
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, MD 20742
| | - A. Bahl
- College of Optical Sciences, University of Arizona, Tucson, AZ 85712
| | - M. Kolesik
- College of Optical Sciences, University of Arizona, Tucson, AZ 85712
| | - H. M. Milchberg
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, MD 20742
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36
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Zielinska HA, Holly JMP, Bahl A, Perks CM. Inhibition of FASN and ERα signalling during hyperglycaemia-induced matrix-specific EMT promotes breast cancer cell invasion via a caveolin-1-dependent mechanism. Cancer Lett 2018; 419:187-202. [PMID: 29331414 PMCID: PMC5832758 DOI: 10.1016/j.canlet.2018.01.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/25/2017] [Accepted: 01/08/2018] [Indexed: 12/11/2022]
Abstract
Since disturbed metabolic conditions such as obesity and diabetes can be critical determinants of breast cancer progression and therapeutic failure, we aimed to determine the mechanism responsible for their pro-oncogenic effects. Using non-invasive, epithelial-like ERα-positive MCF-7 and T47D human breast cancer cells we found that hyperglycaemia induced epithelial to mesenchymal transition (EMT), a key programme responsible for the development of metastatic disease. This was demonstrated by loss of the epithelial marker E-cadherin together with increases in mesenchymal markers such as vimentin, fibronectin and the transcription factor SLUG, together with an enhancement of cell growth and invasion. These phenotypic changes were only observed with cells grown on fibronectin and not with those plated on collagen. Analyzing metabolic parameters, we found that hyperglycaemia-induced, matrix-specific EMT promoted the Warburg effect by upregulating glucose uptake, lactate release and specific glycolytic enzymes and transporters. We showed that silencing of fatty acid synthase (FASN) and the downstream ERα, which we showed previously to mediate hyperglycaemia-induced chemoresistance in these cells, resulted in suppression of cell growth: however, this also resulted in a dramatic enhancement of cell invasion and SLUG mRNA levels via a novel caveolin-1-dependent mechanism.
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Affiliation(s)
- H A Zielinska
- IGFs & Metabolic Endocrinology Group, School of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 5NB, UK.
| | - J M P Holly
- IGFs & Metabolic Endocrinology Group, School of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - A Bahl
- Department of Clinical Oncology, Bristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - C M Perks
- IGFs & Metabolic Endocrinology Group, School of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 5NB, UK
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Bahl A, Singh R, Wadhwa J, Gupta S, Ahmed M, Uppal PN, Parikh PM, Aggarwal S. Practical consensus recommendations regarding the management of HER2 neu positive early breast cancer. South Asian J Cancer 2018; 7:102-105. [PMID: 29721473 PMCID: PMC5909284 DOI: 10.4103/sajc.sajc_111_18] [Citation(s) in RCA: 3] [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] [Indexed: 01/03/2023] Open
Abstract
Over-expression of HER2 is generally considered to be a negative prognostic feature because it accompanies an increase in breast cancer mortality. However, the development of agents that specifically target HER2 has improved the management of patients with these tumours. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations with regards to the use of these agents and the management of HER2 neu early breast cancer for the benefit of community oncologists.
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Affiliation(s)
- A. Bahl
- Deparment of Medical Oncology, Max Hospital, New Delhi, India
| | - R. Singh
- Department of Medical Oncology, Artemis Hospital, Gurugram, India
| | - J. Wadhwa
- Department of Medical Oncology, Medanta Hospital, Gurugram, India
| | - S. Gupta
- Department of Medical Oncology, Sarvodaya Hospital, New Delhi, India
| | - M. Ahmed
- Department of Radiation Oncology, Jolly Grant Himalayan Institute, Dehradoon, India
| | - P. N. Uppal
- Department of Surgical Oncology, Jaipur Golden Hospital, New Delhi, India
| | - Purvish M. Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S. Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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Jain A, Nayyar P, Chitkeshi V, Bahl A. An unusual complication after endobronchial ultrasound-guided transbronchial needle aspiration: Case report. Breathe (Sheff) 2018; 14:e6-e11. [PMID: 29928465 PMCID: PMC6003265 DOI: 10.1183/20734735.014717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/28/2022] Open
Abstract
Bronchoscopy with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is considered to be a safe procedure and is far less invasive than mediastinoscopy or percutaneous needle biopsy. It has been increasingly utilised for the diagnosis of sarcoidosis and unexplained mediastinal adenopathy, and for lung cancer staging. Complications from EBUS-TBNA are rare. Complications that have been reported are haemorrhages, pneumothorax, infectious complications like mediastinitis, pleuropericarditis, abscess, respiratory failure, airway injury and hypotension. Some of the patients also require intervention like tube drainage for pneumothorax [1]. Can you diagnose this unusual complication of EBUS-TBNA?http://ow.ly/y9bv30i73T4
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Affiliation(s)
- Ashish Jain
- Max Super Speciality Hospital, New Delhi, India
| | | | | | - Ankur Bahl
- Max Super Speciality Hospital, New Delhi, India
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Shams A, Hung J, Bahl A. Ability of computed tomography to predict right heart strain on an echocardiogram in patients with acute pulmonary embolus. J BIOL REG HOMEOS AG 2018; 32:365-370. [PMID: 29685020] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Patients with submassive pulmonary embolism (PE) resulting in right heart strain (RHS) have an increased risk of mortality compared to those with a preserved right ventricular function. This study aimed to investigate the predictive value of computed tomography pulmonary angiogram (CTPA) findings of right heart strain in patients with computed tomography (CT)-proven PE for the diagnosis of right heart strain by echocardiogram (ECHO). The institutional review board (IRB) approved retrospective chart review of the adult emergency department patients diagnosed with an acute PE between 2012 and 2016. A total of 128 patients diagnosed with RHS by CT who had received an ECHO during their hospitalization were included in the study. Descriptive statistics were run for the variables of interest. The majority of patients (101 patients) with reported findings of RHS on CT had similar findings on ECHO. In our cohort, a finding of enlarged right atrium (RA) on CT was 100% predictive of RHS diagnosis on ECHO, whereas having interventricular septal bowing alone on CT was the least predictive of RHS on subsequent ECHO (61%). The 2 remaining subgroups: right ventricle (RV) enlargement alone and RV enlargement with either interventricular septal bowing/hepatic vein blood reflux or both lies somewhere in between, with 80% of these patients showing strain on ECHO. We found that signs of RHS on CT are predictive of strain on an ECHO (78%) and RA enlargement in any combination was the most predictive finding of RHS on ECHO (100%). Future prospective randomized investigations are needed to confirm such findings.
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Affiliation(s)
- A Shams
- Department of Emergency Medicine, Beaumont Health System, Royal Oak, Michigan, United States of America
| | - J Hung
- Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine, Rochester, Michigan, United States of America
| | - A Bahl
- Department of Emergency Medicine, Beaumont Health System, Royal Oak, Michigan, United States of America
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Verma A, Rohatgi N, Julka PK, Walia M, Bahl A, Arora RS, Chaturvedi H, Anand AK, Rao R, Gay LM, Kaur J. FoundationOne as a relevant tool for comprehensive genomic profiling and assessment of tumor mutation burden in the era of precision oncology in India. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e23096] [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
e23096 Background: Comprehensive genomic profiling (CGP) is gaining acceptability globally, but clinical experience in developing countries like India is limited. CGP identifies genomic alterations (GA), with tumor mutation burden (TMB) and microsatellite status (MSI), revealing therapeutic options such as targeted inhibitors and immunotherapies. We sought to evaluate the mutation frequency and actionability across tumors. Methods: Metastatic and/or refractory patients (referred to Personalized Cancer Medicine Clinic) underwent CGP analysis, including calculation of TMB and MSI, using a targeted NGS panel (FoundationOne, 53 samples; FoundationOne Heme, 4 samples). This panel detects all relevant classes of GA: base substitutions, small indels, rearrangements and copy number changes. Mutation frequencies were compared with the larger Foundation database. TMB status was reported as low (≤5 mutations/Mb), intermediate (6-19 mut/Mb) or high (≥20 mut/Mb). Results: The most common tumor types were lung (23%), breast (14%) and sarcoma (12%); other tumor types, including unknown primary constituted the rest (51%). Most samples were from metastatic sites (60%). Oncogenic GA were found in 131 genes across all tumor subtypes and affected major pathways: apoptosis/cell cycle (31%), PI3K (14%), transcriptional regulation (13%), and receptor tyrosine kinases (10%). Among these GA, 38 were considered actionable and were distributed across 43 (75%) samples. Therapies with FDA approval for the tumor type analyzed were indicated for 18 samples; an additional 25 samples had GA associated with therapies FDA approved for another indication. More than 1 actionable GA was identified in 24/43 (56%). TMB status was low in 36 (63%), intermediate in 19 (33%) and high in 2 (3.5%). High TMB status correlated with high MSI status (p < 0.001). Trend observed in the mutation frequency was comparable with the larger Foundation database. Conclusions: This is the first study in India showing CGP identified actionable targets associated with FDA approved therapies in approx. 32% of cases. TMB status identified 2/57 samples with high mutation burden for whom immunotherapy might be relevant.
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Zielinska HA, Bahl A, Holly JMP, Perks CM. Abstract P6-02-09: Hyperglycaemia and fibronectin: The criminal partnership during breast cancer progression. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-02-09] [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: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- HA Zielinska
- University of Bristol, Bristol, United Kingdom; Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - A Bahl
- University of Bristol, Bristol, United Kingdom; Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - JMP Holly
- University of Bristol, Bristol, United Kingdom; Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - CM Perks
- University of Bristol, Bristol, United Kingdom; Bristol Haematology and Oncology Centre, Bristol, United Kingdom
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Biernacka KM, Persad RA, Bahl A, Gillatt D, Holly JMP, Perks CM. Hyperglycaemia-induced resistance to Docetaxel is negated by metformin: a role for IGFBP-2. Endocr Relat Cancer 2017; 24:17-30. [PMID: 27754854 PMCID: PMC5118949 DOI: 10.1530/erc-16-0095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/17/2016] [Indexed: 12/13/2022]
Abstract
The incidence of many common cancers varies between different populations and appears to be affected by a Western lifestyle. Highly proliferative malignant cells require sufficient levels of nutrients for their anabolic activity. Therefore, targeting genes and pathways involved in metabolic pathways could yield future therapeutics. A common pathway implicated in energetic and nutritional requirements of a cell is the LKB1/AMPK pathway. Metformin is a widely studied anti-diabetic drug, which improves glycaemia in patients with type 2 diabetes by targeting this pathway. We investigated the effect of metformin on prostate cancer cell lines and evaluated its mechanism of action using DU145, LNCaP, PC3 and VCaP prostate cancer cell lines. Trypan blue dye-exclusion assay was used to assess levels of cell death. Western immunoblotting was used to determine the abundance of proteins. Insulin-like growth factor-binding protein-2 (IGFBP-2) and AMPK genes were silenced using siRNA. Effects on cell morphology were visualised using microscopy. IGFBP-2 gene expression was assessed using real-time RT-PCR. With DU145 and LNCaP cells metformin alone induced cell death, but this was reduced in hyperglycaemic conditions. Hyperglycaemia also reduced the sensitivity to Docetaxel, but this was countered by co-treatment with metformin. LKB1 was required for the activation of AMPK but was not essential to mediate the induction of cell death. An alternative pathway by which metformin exerted its action was through downregulation of IGFBP-2 in DU145 and LNCaP cells, independently of AMPK. This finding could have important implications in relation to therapeutic strategies in prostate cancer patients presenting with diabetes.
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Affiliation(s)
- K M Biernacka
- IGFs & Metabolic Endocrinology GroupSchool of Clinical Sciences, Learning & Research Building, Southmead Hospital, Bristol, UK
| | - R A Persad
- Department of UrologySouthmead Hospital, Bristol, UK
| | - A Bahl
- Department of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - D Gillatt
- Department of UrologySouthmead Hospital, Bristol, UK
| | - J M P Holly
- IGFs & Metabolic Endocrinology GroupSchool of Clinical Sciences, Learning & Research Building, Southmead Hospital, Bristol, UK
| | - C M Perks
- IGFs & Metabolic Endocrinology GroupSchool of Clinical Sciences, Learning & Research Building, Southmead Hospital, Bristol, UK
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Nair V, Madan H, Sofat S, Ganguli P, Jacob MJ, Datta R, Bharadwaj P, Sarkar RS, Pandit AJ, Nityanand S, Goel PK, Garg N, Gambhir S, George PV, Chandy S, Mathews V, George OK, Talwar KK, Bahl A, Marwah N, Bhatacharya A, Bhargava B, Airan B, Mohanty S, Patel CD, Sharma A, Bhatnagar S, Mondal A, Jose J, Srivastava A. Authors' response. Indian J Med Res 2016; 143:833. [PMID: 27748312 PMCID: PMC5094127 DOI: 10.4103/0971-5916.192081] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- V Nair
- Army Hospital (Research & Referral), New Delhi, India
| | - H Madan
- Army Hospital (Research & Referral), New Delhi, India
| | - S Sofat
- Army Hospital (Research & Referral), New Delhi, India
| | - P Ganguli
- Army Hospital (Research & Referral), New Delhi, India
| | - M J Jacob
- Army Hospital (Research & Referral), New Delhi, India
| | - R Datta
- Military Hospital, Cardio Thoracic Centre, Pune, India
| | - P Bharadwaj
- Military Hospital, Cardio Thoracic Centre, Pune, India
| | - R S Sarkar
- Military Hospital, Cardio Thoracic Centre, Pune, India
| | - A J Pandit
- Military Hospital, Cardio Thoracic Centre, Pune, India
| | - S Nityanand
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - P K Goel
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - N Garg
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S Gambhir
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - P V George
- Christian Medical College, Vellore, India
| | - S Chandy
- Christian Medical College, Vellore, India
| | - V Mathews
- Christian Medical College, Vellore, India
| | - O K George
- Christian Medical College, Vellore, India
| | - K K Talwar
- Postgraduate Institute of Medical Education & Research, Chandhigarh, India
| | - A Bahl
- Postgraduate Institute of Medical Education & Research, Chandhigarh, India
| | - N Marwah
- Postgraduate Institute of Medical Education & Research, Chandhigarh, India
| | - A Bhatacharya
- Postgraduate Institute of Medical Education & Research, Chandhigarh, India
| | - B Bhargava
- All India Institute of Medical Sciences, New Delhi, India
| | - B Airan
- All India Institute of Medical Sciences, New Delhi, India
| | - S Mohanty
- All India Institute of Medical Sciences, New Delhi, India
| | - C D Patel
- All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- Department of Biotechnology, Government of India, New Delhi, India
| | - S Bhatnagar
- All India Institute of Medical Sciences, New Delhi, India
| | - A Mondal
- Institute of Nuclear Medicine & Allied Sciences, Delhi, India
| | - J Jose
- Christian Medical College, Vellore, India
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Hilman S, Smith R, Masson S, Coomber H, Bahl A, Challapalli A, Jacobs P. Implementation of a Daily Transperineal Ultrasound System as Image-guided Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2016; 29:e49. [PMID: 27448432 DOI: 10.1016/j.clon.2016.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/10/2016] [Indexed: 11/17/2022]
Affiliation(s)
- S Hilman
- Bristol Cancer Institute, Bristol, UK
| | - R Smith
- Bristol Cancer Institute, Bristol, UK
| | - S Masson
- Bristol Cancer Institute, Bristol, UK
| | - H Coomber
- Bristol Cancer Institute, Bristol, UK
| | - A Bahl
- Bristol Cancer Institute, Bristol, UK
| | | | - P Jacobs
- Bristol Cancer Institute, Bristol, UK
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Thompson A, Adamson A, Bahl A, Borwell J, Dodds D, Heath C, Huddart R, Mcmenemin R, Patel P, Peters J, Payne H. Guidelines for the diagnosis, prevention and management of chemical- and radiation-induced cystitis. Journal of Clinical Urology 2016. [DOI: 10.1177/2051415813512647] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Haemorrhagic cystitis (HC) is a relatively common complication of chemotherapy and radiotherapy to the pelvic area, but can be a challenging condition to treat, particularly since there is currently a lack of UK-led guidelines available on how it should optimally be defined and managed. Materials and methods A comprehensive literature search was undertaken to evaluate the evidence for the diagnosis, prevention and management of cancer treatment-induced HC. Results Recommendations and a proposed management algorithm for the diagnosis, prevention and treatment of HC, as well as the management of intractable haematuria, have been developed based on the expert opinion of the multidisciplinary consensus panel following a comprehensive review of the available clinical data. Conclusion These guidelines are relevant and applicable to current clinical practice and will help clinicians optimally define and manage this potentially serious condition.
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Affiliation(s)
- A Thompson
- Urology Department, Wrightington, Wigan and Leigh NHS Foundation Trust, UK
| | - A Adamson
- Department of Urology, Royal Hampshire County Hospital, UK
| | - A Bahl
- Bristol Oncology and Haematology Centre, UK
| | - J Borwell
- Department of Urology, Frimley Park Hospital, UK
| | - D Dodds
- Beatson West of Scotland Cancer Care, UK
| | - C Heath
- Southampton Oncology Centre, Southampton General Hospital, UK
| | | | | | - P Patel
- Queen Elizabeth Hospital, UK
| | - J Peters
- Whipps Cross Hospital, Barts Health NHS Trust, UK
| | - H Payne
- University College Hospital, UK
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Eylert MF, Hounsome LS, Persad RA, Bahl A, Jefferies ER, Verne J, Mostafid H. Falling bladder cancer incidence from 1990 to 2009 is not producing universal mortality improvements. Journal of Clinical Urology 2016. [DOI: 10.1177/2051415813492724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The objective of this article is to obtain up-to-date epidemiological statistics of bladder cancer in England. Methods We collected incidence from the National Cancer Data Repository (NCDR), survival from the national Cancer Information System (CIS), ethnicity information from the Hospital Episode Statistics (HES), mortality and smoking rates from the Office for National Statistics (ONS). Results Incidence of bladder cancer has fallen continuously. Mortality has reduced less, leading to worsening survival. Bladder cancer mainly affects men, the most deprived, and the elderly. The gender gap is decreasing, and the deprivation gap is unchanged. Mortality is unchanged in the youngest, oldest and least deprived females. Mortality has recently increased in the oldest males. The highest incidence and mortality is found in industrial areas. This study is limited by i) its retrospective design using existing databases, allowing identification of associations and statistical differences, but not causation; and ii) very restricted ethnicity data. onclusion Reductions in bladder cancer incidence and mortality in England coincide with a decrease in high-risk occupations and public health measures to reduce smoking. Some risk factors in modern living may as yet be unidentified. It remains paramount to ensure equity of access and treatment regardless of gender, age, region and social deprivation to further improve mortality.
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Affiliation(s)
- MF Eylert
- Department of Urology, Morriston Hospital, UK
| | | | - RA Persad
- Department of Urology, Bristol Royal Infirmary, UK
| | - A Bahl
- Bristol Haematology and Oncology Centre, UK
| | - ER Jefferies
- Department of Urology, Royal United Hospital, UK
| | - J Verne
- South West Public Health Observatory, UK
| | - H Mostafid
- Department of Urology, The Royal Berkshire Hospital, UK
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Duran I, Fink M, Bahl A, Hoefeler H, Mahmood A, Lüftner D, Ghazal H, Wei R, Chung K, Hechmati G, Green J, Atchison C. Health resource utilisation associated with skeletal-related events in patients with bone metastases secondary to solid tumours: regional comparisons in an observational study. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12452] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 12/25/2022]
Affiliation(s)
- I. Duran
- Medical Oncology Department; Centro Integral Oncologico Clara Campal; Madrid Spain
| | - M.G. Fink
- Orange Coast Memorial Medical Center; Fountain Valley CA USA
| | - A. Bahl
- Bristol Haematology and Oncology Centre; University Hospitals Bristol; Bristol UK
| | - H. Hoefeler
- Forschungszentrum Ruhr; KliFoCenter GmbH; Witten Germany
| | - A. Mahmood
- Cancer Specialists of South Texas; Corpus Christi Cancer Center; Corpus Christi TX USA
| | - D. Lüftner
- Universitätsmedizin Berlin; Charité Campus Benjamin Franklin; Berlin Germany
| | | | - R. Wei
- Biostatistics; Amgen, Inc.; Thousand Oaks CA
| | - K.C. Chung
- Global Health Economics; Amgen Inc.; Thousand Oaks CA USA
| | - G. Hechmati
- Global Health Economics; Amgen Inc.; Zug Switzerland
| | - J. Green
- Global Study Management; Amgen Inc.; Thousand Oaks CA
| | - C. Atchison
- Global Health Economics; Amgen Inc.; Thousand Oaks CA USA
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Zeng L, Zielinska HA, Arshad A, Shield JP, Bahl A, Holly JMP, Perks CM. Hyperglycaemia-induced chemoresistance in breast cancer cells: role of the estrogen receptor. Endocr Relat Cancer 2016; 23:125-34. [PMID: 26647383 DOI: 10.1530/erc-15-0507] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/08/2022]
Abstract
Breast cancer patients with diabetes respond less well to chemotherapy; in keeping with this we determined previously that hyperglycaemia-induced chemoresistance in estrogen receptor (ERα) positive breast cancer cells and showed that this was mediated by fatty acid synthase (FASN). More recent evidence suggests that the effect of metabolic syndrome and diabetes is not the same for all subtypes of breast cancer with inferior disease-free survival and worse overall survival only found in women with ERα positive breast cancer and not for other subtypes. Here we examined the impact of hyperglycaemia on ERα negative breast cancer cells and further investigated the mechanism underlying chemoresistance in ERα with a view to identifying strategies to alleviate hyperglycaemia-induced chemoresistance. We found that hyperglycaemia-induced chemoresistance was only observed in ERα breast cancer cells and was dependent upon the expression of ERα as chemoresistance was negated when the ERα was silenced. Hyperglycaemia-induced an increase in activation and nuclear localisation of the ERα that was downstream of FASN and dependent on the activation of MAPK. We found that fulvestrant successfully negated the hyperglycaemia-induced chemoresistance, whereas tamoxifen had no effect. In summary our data suggests that the ERα may be a predictive marker of poor response to chemotherapy in breast cancer patients with diabetes. It further indicates that anti-estrogens could be an effective adjuvant to chemotherapy in such patients and indicates the importance for the personalised management of breast cancer patients with diabetes highlighting the need for clinical trials of tailored chemotherapy for diabetic patients diagnosed with ERα positive breast cancers.
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Affiliation(s)
- L Zeng
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - H A Zielinska
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - A Arshad
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - J P Shield
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - A Bahl
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - J M P Holly
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - C M Perks
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
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Kannan S, Bahl A, Khosla PP. Knowledge and perception of off-label drug use amongst prescribing physicians in a tertiary care hospital. Int J Risk Saf Med 2016; 27:219-23. [PMID: 26756895 DOI: 10.3233/jrs-150664] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Off-label drug use is commonly reported in various disciplines of medicine. Considering the lacunae of studies from prescribers in the Indian subcontinent, the present study was conducted to explore their awareness and views of off-label drug use. METHODS A validated questionnaire was administered to interns, junior residents and faculty members who were recruited in the present study of various medical and surgical departments of Subharti Medical College, Meerut, India, a tertiary care teaching hospital. Descriptive statistics was used for analyzing the data. RESULTS A total of 59/85 (69%) stated that they have used a drug in an off-label manner mainly [31/85 (36.5%)] related to indications. Nearly half of the study participants (41/85, 48.2%) considered prescribing an off-label drug illegal and only 25/85 (29.3%) participants felt that they had adequate knowledge regarding the use of drugs in off-label manner. Out of the total 70 participants who answered the question related to informing parents/relatives while prescribing an off label drug, only 39/70 (55.7%) answered affirmative. Out of the remaining 31/70 (44.3%) of participants who did not inform about prescribing an off label drug, 9/31 (29%) felt that it was illegal and more than two-third (24/31, 77%) felt their knowledge on off-label drug use was insufficient. Surprisingly, 74/82 (90.2%) participants felt that a drug approved to be used in adults cannot be used in children for the same indication despite not having any alternative in pediatric age group. CONCLUSION We found an inadequate knowledge regarding the off-label drug use amongst the prescribers in a tertiary care medical college hospital. Many of the physicians felt such use as illegal and do not inform the patient's relatives about such acts. Considering the legal issues, clearly there exists a need to patch up this lacuna in developing countries like India.
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Affiliation(s)
- S Kannan
- Department of Health Sciences, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - A Bahl
- Department of Phamacology, Subharti Medical College and Hospital, Meerut, Uttar Pradesh, India
| | - P P Khosla
- Department of Phamacology, Subharti Medical College and Hospital, Meerut, Uttar Pradesh, India
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Hallam S, Govindarajulu S, Huckett R, Bahl A. Breast-conserving Therapy and the Risk of Second Primaries in BRCA1/2 Mutation Carriers. Clin Oncol (R Coll Radiol) 2015; 28:225. [PMID: 26712587 DOI: 10.1016/j.clon.2015.11.012] [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: 10/15/2015] [Accepted: 11/19/2015] [Indexed: 11/17/2022]
Affiliation(s)
- S Hallam
- University Hospitals Bristol, Bristol, UK
| | | | - R Huckett
- University Hospitals Bristol, Bristol, UK
| | - A Bahl
- University Hospitals Bristol, Bristol, UK
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