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Kumar S, Sharma A, Bakhshi S, Pushpam D, Gogia A, Sahoo RK, Pramanik R, Kumar A, Pathak N, Thulkar S, Sharma MC, Gupta R, Mallick S, Raina V. Autologous Stem Cell Transplantation in Adult Hodgkin Lymphoma at a Tertiary Care Center in India: Analysis of Outcomes and Prognostic Factors. Indian J Hematol Blood Transfus 2024; 40:181-189. [PMID: 38708163 PMCID: PMC11065798 DOI: 10.1007/s12288-023-01690-x] [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] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/10/2023] [Indexed: 05/07/2024] Open
Abstract
High-dose chemotherapy and autologous stem cell transplant (ASCT) is the standard of care treatment in relapsed/refractory Hodgkin lymphoma (rrHL). Published long-term follow-up data concerning this modality from the Indian subcontinent is lacking. In this retrospective study, the data on adults (> 16 years) with biopsy-confirmed rrHL who were autografted from 1 January 2000 to 31 December 2021 at our transplant unit were analyzed. Progression-free survival (PFS) was defined as time from transplant to disease progression or death due to any cause. Overall survival (OS) was determined from date of transplant to date of death due to any cause. Overall, 134 patients with Hodgkin lymphoma underwent ASCT. At a median follow-up of 38.2 (range, 0.1-240) months, 5 years PFS was 45.3% (95% CI 35.4-54.4). The probability of OS at 5 years was 60.5% (95% CI 49.6-69.6). Eleven (8.2%) patients suffered transplant-related mortality by 100 days. Post-transplant persistent disease, pre-transplant serum hypoalbuminemia (< 3.5 g/dl) and chemo-resistance (< PR after last salvage regimen) of tumour at transplant were independent prognostic factors associated with worse PFS in multivariable analysis. Likewise, age ≥ 30 years, ECOG performance status ≥ 1 and residual disease after transplantation correlated with inferior OS. Long-term outcomes of rrHL patients undergoing ASCT in India match those from the developed world in the era of peripheral blood stem cell transplantation. Pre-transplant performance status, chemo-sensitivity of disease, serum albumin and post-transplant remission status determined survival in our cohort. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-023-01690-x.
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Affiliation(s)
- Sudhir Kumar
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Atul Sharma
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Ajay Gogia
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Raja Pramanik
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Akash Kumar
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Neha Pathak
- Department of Medical Oncology, Institute of Liver and Biliary Sciences, New Delhi, 110070 India
| | - Sanjay Thulkar
- Department of Radio Diagnosis, Dr BRA IRCH All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Meher Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Ritu Gupta
- Department of Medical Oncology, Lab Oncology Unit, Dr BRA IRCH All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Soumya Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Vinod Raina
- Fortis Memorial Research Institute, Gurgaon, 122006 India
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Taylor C, Dodwell D, McGale P, Hills RK, Berry R, Bradley R, Braybrooke J, Clarke M, Gray R, Holt F, Liu Z, Pan H, Peto R, Straiton E, Coles C, Duane F, Hennequin C, Jones G, Kühn T, Oliveros S, Overgaard J, Pritchard KI, Suh CO, Beake G, Boddington C, Davies C, Davies L, Evans V, Gay J, Gettins L, Godwin J, James S, Kerr A, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Nakahara M, Read S, Taylor H, Ferguson J, Scheurlen H, Zurrida S, Galimberti V, Ingle J, Valagussa P, Veronesi U, Anderson S, Tang G, Fisher B, Fossa S, Valborg Reinertsen K, Host H, Muss H, Holli K, Albain K, Arriagada R, Bartlett J, Bergsten-Nordström E, Bliss J, Brain E, Carey L, Coleman R, Cuzick J, Davidson N, Del Mastro L, Di Leo A, Dignam J, Dowsett M, Ejlertsen B, Francis P, García-Sáenz JA, Gelber R, Gnant M, Goetz M, Goodwin P, Halpin-Murphy P, Hayes D, Hill C, Jagsi R, Janni W, Loibl S, Mamounas E, Martín M, McIntosh S, Mukai H, Nekljudova V, Norton L, Ohashi Y, Piccart M, Pierce L, Raina V, Rea D, Regan M, Robertson J, Rutgers E, Salgado R, Slamon D, Spanic T, Sparano J, Steger G, Toi M, Tutt A, Viale G, Wang X, Wilcken N, Wolmark N, Yu KD, Cameron D, Bergh J, Swain S, Whelan T, Poortmans P. Radiotherapy to regional nodes in early breast cancer: an individual patient data meta-analysis of 14 324 women in 16 trials. Lancet 2023; 402:1991-2003. [PMID: 37931633 DOI: 10.1016/s0140-6736(23)01082-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 03/22/2023] [Accepted: 05/24/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Radiotherapy has become much better targeted since the 1980s, improving both safety and efficacy. In breast cancer, radiotherapy to regional lymph nodes aims to reduce risks of recurrence and death. Its effects have been studied in randomised trials, some before the 1980s and some after. We aimed to assess the effects of regional node radiotherapy in these two eras. METHODS In this meta-analysis of individual patient data, we sought data from all randomised trials of regional lymph node radiotherapy versus no regional lymph node radiotherapy in women with early breast cancer (including one study that irradiated lymph nodes only if the cancer was right-sided). Trials were identified through the EBCTCG's regular systematic searches of databases including MEDLINE, Embase, the Cochrane Library, and meeting abstracts. Trials were eligible if they began before Jan 1, 2009. The only systematic difference between treatment groups was in regional node radiotherapy (to the internal mammary chain, supraclavicular fossa, or axilla, or any combinations of these). Primary outcomes were recurrence at any site, breast cancer mortality, non-breast-cancer mortality, and all-cause mortality. Data were supplied by trialists and standardised into a format suitable for analysis. A summary of the formatted data was returned to trialists for verification. Log-rank analyses yielded first-event rate ratios (RRs) and confidence intervals. FINDINGS We found 17 eligible trials, 16 of which had available data (for 14 324 participants), and one of which (henceforth excluded), had unavailable data (for 165 participants). In the eight newer trials (12 167 patients), which started during 1989-2008, regional node radiotherapy significantly reduced recurrence (rate ratio 0·88, 95% CI 0·81-0·95; p=0·0008). The main effect was on distant recurrence as few regional node recurrences were reported. Radiotherapy significantly reduced breast cancer mortality (RR 0·87, 95% CI 0·80-0·94; p=0·0010), with no significant effect on non-breast-cancer mortality (0·97, 0·84-1·11; p=0·63), leading to significantly reduced all-cause mortality (0·90, 0·84-0·96; p=0·0022). In an illustrative calculation, estimated absolute reductions in 15-year breast cancer mortality were 1·6% for women with no positive axillary nodes, 2·7% for those with one to three positive axillary nodes, and 4·5% for those with four or more positive axillary nodes. In the eight older trials (2157 patients), which started during 1961-78, regional node radiotherapy had little effect on breast cancer mortality (RR 1·04, 95% CI 0·91-1·20; p=0·55), but significantly increased non-breast-cancer mortality (1·42, 1·18-1·71; p=0·00023), with risk mainly after year 20, and all-cause mortality (1·17, 1·04-1·31; p=0·0067). INTERPRETATION Regional node radiotherapy significantly reduced breast cancer mortality and all-cause mortality in trials done after the 1980s, but not in older trials. These contrasting findings could reflect radiotherapy improvements since the 1980s. FUNDING Cancer Research UK, Medical Research Council.
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Radhakrishnan VS, Pincha R, Raina V, Garg JK, Nag A, Bhave SJ, Achari R, Dey D, Arun I, Lateef Z, Vinarkar SS, Parihar M, Sen S, Mishra DK, Chandy M, Nair R. Salvage Using Polatuzumab Vedotin Based Therapy in Relapsed Refractory Large B-Cell Lymphomas: Early Experience from a Real-World Middle-Income Setting Using Named-Patient Compassionate Access Program. Indian J Hematol Blood Transfus 2022; 39:1-5. [PMID: 36590655 PMCID: PMC9790077 DOI: 10.1007/s12288-022-01619-w] [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: 05/22/2022] [Accepted: 12/19/2022] [Indexed: 12/26/2022] Open
Abstract
Polatuzumab vedotin is a novel immunotherapy antibody-drug conjugate targeting CD79b. It has been used in relapsed/refractory (R/R) large B-cell lymphomas since its FDA approval in 2019. Presently, this drug is unaffordable or unavailable for patients in Lower-Middle Income Countries (LMIC) like India. This is a retrospective study of adult (> 18 years) patients with R/R large B-cell lymphoma failing two prior lines of therapy, who received Polatuzumab based salvage therapy on a compassionate or named-patient access program. Between May 2019 and April 2022, 10 patients received Polatuzumab vedotin, and 9 were evaluable. The most common regimen used was Polatuzumab-Bendamustine-Rituximab. Out of 43 infusions administered, the adverse event profile was manageable [One grade-2 infusion reaction, 4 patients developed grade 3-4 hematological toxicity and none had grade 3-4 non-hematological toxicities]. Ten infusions were administered in the day care service. After a median of 4.5 cycles (range 1-8), 4 patients achieved CR, 2 had partial response (PR), and 3 had progressive disease (PD). With a median follow up of 491 days (range 8-1048 days), four patients are alive (three in CR and one in PR), three patients have died and three patients were lost to follow up. Early real-world experience from a LMIC setting demonstrates feasibility and a favourable safety profile of Polatuzumab vedotin based approach, along with encouraging response rates in a subset of patients.
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Affiliation(s)
- V. S. Radhakrishnan
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - R. Pincha
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - V. Raina
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - J. K. Garg
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - A. Nag
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - S. J. Bhave
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - R. Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - D. Dey
- Department of Histopathology, Tata Medical Center, Kolkata, India
| | - I. Arun
- Department of Histopathology, Tata Medical Center, Kolkata, India
| | - Z. Lateef
- Department of Histopathology, Tata Medical Center, Kolkata, India
| | - S. S. Vinarkar
- Department of Laboratory Hematology, Cytogenetics and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - M. Parihar
- Department of Laboratory Hematology, Cytogenetics and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - S. Sen
- Department of Radiology, Tata Medical Center, Kolkata, India
| | - D. K. Mishra
- Department of Laboratory Hematology, Cytogenetics and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - M. Chandy
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - R. Nair
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
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Kumar S, Sharma A, Pramanik R, Pathak N, Gogia A, Kumar A, Kayal S, Sharma V, Sahoo RK, Thulkar S, Sharma MC, Gupta R, Mallick S, Thomas M, Raina V. Long-Term Outcomes and Safety Trends of Autologous Stem-Cell Transplantation in Non-Hodgkin Lymphoma: A Report From A Tertiary Care Center in India. JCO Glob Oncol 2022; 8:e2100383. [PMID: 35561291 PMCID: PMC9302266 DOI: 10.1200/go.21.00383] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Published experience with autologous stem-cell transplantation (ASCT) in non-Hodgkin lymphoma (NHL) from the Indian subcontinent is extremely limited. Here, we describe the activity and outcomes of this treatment modality at a large tertiary care center in India.
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Affiliation(s)
- Sudhir Kumar
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Pramanik
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Pathak
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Kumar
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vinod Sharma
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radio Diagnosis, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Medical Oncology, Lab Oncology Unit, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mercy Thomas
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Fortis Memorial Research Institute, Gurgaon, India
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5
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Affiliation(s)
- B.B Tyagi
- Delhi Cancer Registry, AIIMS, New Delhi-110029, India
| | - N Manoharan
- Delhi Cancer Registry, AIIMS, New Delhi-110029, India
| | - V Raina
- Department of Medicla Oncology, AIIMS, New Delhi-110029, India
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6
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Bradley R, Braybrooke J, Gray R, Hills RK, Liu Z, Pan H, Peto R, Dodwell D, McGale P, Taylor C, Francis PA, Gnant M, Perrone F, Regan MM, Berry R, Boddington C, Clarke M, Davies C, Davies L, Duane F, Evans V, Gay J, Gettins L, Godwin J, James S, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Read S, Straiton E, Jakesz R, Fesl C, Pagani O, Gelber R, De Laurentiis M, De Placido S, Gallo C, Albain K, Anderson S, Arriagada R, Bartlett J, Bergsten-Nordström E, Bliss J, Brain E, Carey L, Coleman R, Cuzick J, Davidson N, Del Mastro L, Di Leo A, Dignam J, Dowsett M, Ejlertsen B, Goetz M, Goodwin P, Halpin-Murphy P, Hayes D, Hill C, Jagsi R, Janni W, Loibl S, Mamounas EP, Martín M, Mukai H, Nekljudova V, Norton L, Ohashi Y, Pierce L, Poortmans P, Pritchard KI, Raina V, Rea D, Robertson J, Rutgers E, Spanic T, Sparano J, Steger G, Tang G, Toi M, Tutt A, Viale G, Wang X, Whelan T, Wilcken N, Wolmark N, Cameron D, Bergh J, Swain SM. Aromatase inhibitors versus tamoxifen in premenopausal women with oestrogen receptor-positive early-stage breast cancer treated with ovarian suppression: a patient-level meta-analysis of 7030 women from four randomised trials. Lancet Oncol 2022; 23:382-392. [PMID: 35123662 PMCID: PMC8885431 DOI: 10.1016/s1470-2045(21)00758-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND For women with early-stage oestrogen receptor (ER)-positive breast cancer, adjuvant tamoxifen reduces 15-year breast cancer mortality by a third. Aromatase inhibitors are more effective than tamoxifen in postmenopausal women but are ineffective in premenopausal women when used without ovarian suppression. We aimed to investigate whether premenopausal women treated with ovarian suppression benefit from aromatase inhibitors. METHODS We did a meta-analysis of individual patient data from randomised trials comparing aromatase inhibitors (anastrozole, exemestane, or letrozole) versus tamoxifen for 3 or 5 years in premenopausal women with ER-positive breast cancer receiving ovarian suppression (goserelin or triptorelin) or ablation. We collected data on baseline characteristics, dates and sites of any breast cancer recurrence or second primary cancer, and dates and causes of death. Primary outcomes were breast cancer recurrence (distant, locoregional, or contralateral), breast cancer mortality, death without recurrence, and all-cause mortality. As distant recurrence invariably results in death from breast cancer several years after the occurrence, whereas locoregional recurrence and new contralateral breast cancer are not usually fatal, the distant recurrence analysis is shown separately. Standard intention-to-treat log-rank analyses estimated first-event rate ratios (RR) and their confidence intervals (CIs). FINDINGS We obtained data from all four identified trials (ABCSG XII, SOFT, TEXT, and HOBOE trials), which included 7030 women with ER-positive tumours enrolled between June 17, 1999, and Aug 4, 2015. Median follow-up was 8·0 years (IQR 6·1-9·3). The rate of breast cancer recurrence was lower for women allocated to an aromatase inhibitor than for women assigned to tamoxifen (RR 0·79, 95% CI 0·69-0·90, p=0·0005). The main benefit was seen in years 0-4 (RR 0·68, 99% CI 0·55-0·85; p<0·0001), the period when treatments differed, with a 3·2% (95% CI 1·8-4·5) absolute reduction in 5-year recurrence risk (6·9% vs 10·1%). There was no further benefit, or loss of benefit, in years 5-9 (RR 0·98, 99% CI 0·73-1·33, p=0·89) or beyond year 10. Distant recurrence was reduced with aromatase inhibitor (RR 0·83, 95% CI 0·71-0·97; p=0·018). No significant differences were observed between treatments for breast cancer mortality (RR 1·01, 95% CI 0·82-1·24; p=0·94), death without recurrence (1·30, 0·75-2·25; p=0·34), or all-cause mortality (1·04, 0·86-1·27; p=0·68). There were more bone fractures with aromatase inhibitor than with tamoxifen (227 [6·4%] of 3528 women allocated to an aromatase inhibitor vs 180 [5·1%] of 3502 women allocated to tamoxifen; RR 1·27 [95% CI 1·04-1·54]; p=0·017). Non-breast cancer deaths (30 [0·9%] vs 24 [0·7%]; 1·30 [0·75-2·25]; p=0·36) and endometrial cancer (seven [0·2%] vs 15 [0·3%]; 0·52 [0·22-1·23]; p=0·14) were rare. INTERPRETATION Using an aromatase inhibitor rather than tamoxifen in premenopausal women receiving ovarian suppression reduces the risk of breast cancer recurrence. Longer follow-up is needed to assess any impact on breast cancer mortality. FUNDING Cancer Research UK, UK Medical Research Council.
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Karanth SS, Malik D, Khanna G, Sen IB, Manda D, Raina V. 18F-FDG PET/CT in Bilateral Breasts Metastasis From Ovarian Carcinoma. Clin Nucl Med 2022; 47:e194-e196. [PMID: 35006118 DOI: 10.1097/rlu.0000000000003986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Ovarian carcinomas generally metastasize within the peritoneal cavity due to exfoliation of malignant cells from primary tumor. Metastasis to the breasts is an unusual event and may mimic primary neoplastic disease. Usually, breast metastasis presents as a single isolated, well-circumscribed soft tissue lesion, and serous papillary carcinoma is the most common type of ovarian tumor that can metastasize to the breast. Concurrent bilateral breast metastasis is rare event. We present a follow-up case of metastatic carcinoma ovary, demonstrating FDG-avid soft tissue density masses in the bilateral breast parenchyma along with bilateral axillary lymphadenopathy, biopsy of which revealed metastatic deposits from carcinoma ovary.
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Affiliation(s)
| | | | - Gaurav Khanna
- Pathology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | | | | | - Vinod Raina
- From the Departments of Medical Oncology and Hematology
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Sharma A, Sharma A, Sharma V, Kumar S, Kumar A, Deo S, Pathy S, Shukla NK, Pramanik R, Raina V, Thulkar S, Kumar R, Mohanti BK. Long-Term Survivors of Metastatic Colorectal Cancer: A Tertiary Care Centre Experience. South Asian J Cancer 2021; 10:87-91. [PMID: 34568221 PMCID: PMC8460352 DOI: 10.1055/s-0041-1736343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background
Prognosis of metastatic colorectal cancer (mCRC) is poor and goal of treatment is mainly palliative unless there is limited metastatic disease which is surgically resectable. Here, we report a case series of long-term survivors treated predominantly with chemotherapy.
Methods
This is a single-center retrospective analysis of patients of mCRC. Records of metastatic colorectal cancer patients registered at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, between the year 2005 and 2015 were retrieved and reviewed. Inclusion criteria were patients who survived 5 years or more, treated mainly by chemotherapy, with either initial presentation as metastatic disease or those who progressed after initial surgery with or without adjuvant therapy. The details about the patient characteristics, treatment, and outcome were collected. The data were censored on September 30, 2020.
Results
Records of 370 mCRC patients were reviewed. Thirty-one patients with all the available details fulfilled the criteria for inclusion in the study. Median age was 53 years (range, 22–74 years). Sixteen were women (51.6%). Twenty-four (77%) were newly diagnosed cases with initial presentation as metastatic disease. Commonest site of primary was on the left (21, 67.6%) followed by right side and transverse colon in 5 patients each. Liver was the most common site of metastasis (
n
= 18, 58.06%). In metastatic setting, the most common chemotherapy regimen used in the first line was CAPOX (
n
= 11, 35.48%). Only three patients could undergo metastatectomy. Monoclonal antibodies could be used only in 14 patients. Median overall survival (OS) of this cohort is 81.6 months (95% confidence interval [CI], 69.73–117.9).
Conclusion
A small but significant proportion of mCRC patients may achieve and maintain durable responses and long term survival with use of combination of chemotherapy with or without biologics.
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Affiliation(s)
- Aparna Sharma
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Sharma
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Kumar
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Svs Deo
- Department of Surgical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushmita Pathy
- Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - N K Shukla
- Department of Surgical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Pramanik
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - B K Mohanti
- Department of Radiation Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Arora S, Sharma A, Pramanik R, Raina V, Deo S, Kumar S, Shukla N, Pal S, Dash N, Pathy S, Mohanty B. 1395P Impact of delay in adjuvant chemotherapy on survival in resected gastric cancer: Real world data from India. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1504] [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: 10/20/2022] Open
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Bradley R, Braybrooke J, Gray R, Hills R, Liu Z, Peto R, Davies L, Dodwell D, McGale P, Pan H, Taylor C, Anderson S, Gelber R, Gianni L, Jacot W, Joensuu H, Moreno-Aspitia A, Piccart M, Press M, Romond E, Slamon D, Suman V, Berry R, Boddington C, Clarke M, Davies C, Duane F, Evans V, Gay J, Gettins L, Godwin J, James S, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Read S, Straiton E, Wang Y, Crown J, de Azambuja E, Delaloge S, Fung H, Geyer C, Spielmann M, Valagussa P, Albain K, Anderson S, Arriagada R, Bartlett J, Bergsten-Nordström E, Bliss J, Brain E, Carey L, Coleman R, Cuzick J, Davidson N, Del Mastro L, Di Leo A, Dignam J, Dowsett M, Ejlertsen B, Francis P, Gnant M, Goetz M, Goodwin P, Halpin-Murphy P, Hayes D, Hill C, Jagsi R, Janni W, Loibl S, Mamounas EP, Martín M, Mukai H, Nekljudova V, Norton L, Ohashi Y, Pierce L, Poortmans P, Raina V, Rea D, Regan M, Robertson J, Rutgers E, Spanic T, Sparano J, Steger G, Tang G, Toi M, Tutt A, Viale G, Wang X, Whelan T, Wilcken N, Wolmark N, Cameron D, Bergh J, Pritchard KI, Swain SM. Trastuzumab for early-stage, HER2-positive breast cancer: a meta-analysis of 13 864 women in seven randomised trials. Lancet Oncol 2021; 22:1139-1150. [PMID: 34339645 PMCID: PMC8324484 DOI: 10.1016/s1470-2045(21)00288-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Trastuzumab targets the extracellular domain of the HER2 protein. Adding trastuzumab to chemotherapy for patients with early-stage, HER2-positive breast cancer reduces the risk of recurrence and death, but is associated with cardiac toxicity. We investigated the long-term benefits and risks of adjuvant trastuzumab on breast cancer recurrence and cause-specific mortality. METHODS We did a collaborative meta-analysis of individual patient data from randomised trials assessing chemotherapy plus trastuzumab versus the same chemotherapy alone. Randomised trials that enrolled women with node-negative or node-positive, operable breast cancer were included. We collected individual patient-level data on baseline characteristics, dates and sites of first distant breast cancer recurrence and any previous local recurrence or second primary cancer, and the date and underlying cause of death. Primary outcomes were breast cancer recurrence, breast cancer mortality, death without recurrence, and all-cause mortality. Standard intention-to-treat log-rank analyses, stratified by age, nodal status, oestrogen receptor (ER) status, and trial yielded first-event rate ratios (RRs). FINDINGS Seven randomised trials met the inclusion criteria, and included 13 864 patients enrolled between February, 2000, and December, 2005. Mean scheduled treatment duration was 14·4 months and median follow-up was 10·7 years (IQR 9·5 to 11·9). The risks of breast cancer recurrence (RR 0·66, 95% CI 0·62 to 0·71; p<0·0001) and death from breast cancer (0·67, 0·61 to 0·73; p<0·0001) were lower with trastuzumab plus chemotherapy than with chemotherapy alone. Absolute 10-year recurrence risk was reduced by 9·0% (95% CI 7·4 to 10·7; p<0·0001) and 10-year breast cancer mortality was reduced by 6·4% (4·9 to 7·8; p<0·0001), with a 6·5% reduction (5·0 to 8·0; p<0·0001) in all-cause mortality, and no increase in death without recurrence (0·4%, -0·3 to 1·1; p=0·35). The proportional reduction in recurrence was largest in years 0-1 after randomisation (0·53, 99% CI 0·46 to 0·61), with benefits persisting through years 2-4 (0·73, 0·62 to 0·85) and 5-9 (0·80, 0·64 to 1·01), and little follow-up beyond year 10. Proportional recurrence reductions were similar irrespective of recorded patient and tumour characteristics, including ER status. The more high risk the tumour, the larger the absolute reductions in 5-year recurrence (eg, 5·7% [95% CI 3·1 to 8·3], 6·8% [4·7 to 9·0], and 10·7% [7·7 to 13·6] in N0, N1-3, and N4+ disease). INTERPRETATION Adding trastuzumab to chemotherapy for early-stage, HER2-positive breast cancer reduces recurrence of, and mortality from, breast cancer by a third, with worthwhile proportional reductions irrespective of recorded patient and tumour characteristics. FUNDING Cancer Research UK, UK Medical Research Council.
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Sharma V, Sharma A, Raina V, Dabkara D, Mohanti BK, Shukla NK, Pathy S, Thulkar S, Deo SVS, Kumar S, Sahoo RK. Metastatic colo-rectal cancer: real life experience from an Indian tertiary care center. BMC Cancer 2021; 21:630. [PMID: 34049505 PMCID: PMC8164292 DOI: 10.1186/s12885-021-08398-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background No data exist for the long-term outcome of metastatic colorectal cancer (mCRC) from the Southern part of Asia. The primary objective of the study is to evaluate the survival outcome of mCRC from an Indian tertiary care center. The study also aims to highlight the treatment pattern practiced and the unique clinico-pathologic characteristics. Methods This is a single-center retrospective observational study done at a large referral tertiary care center in North India. All patients with synchronous or metachronous mCRC who received at least one dose of chemotherapy for metastatic disease, registered between 2003 to 2017 were included. Primary outcome measures were overall survival and progression-free survival and prognostic factors of overall survival. Descriptive analysis was done for the clinicopathological characteristics and treatment patterns. Kaplan Meier method for overall survival and progression-free survival. Cox regression analysis was performed for the determination of the prognostic factors for overall survival. Result Out of 377 eligible patients, 256 patients (68%) had de novo metastatic disease and the remaining 121 (32%) progressed to metastatic disease after initial treatment. The cohort was young (median age, 46 years) with the most common primary site being the rectum. A higher proportion of signet (9%) and mucinous histology (24%). The three common sites of metastasis were the liver, peritoneum, and lung. In the first line, most patients received oxaliplatin-based chemotherapy (70%). Only 12.5% of patients received biologicals in the first-line setting. The median follow-up and median overall survival of study cohort were 17 months and 18.5 months. The factors associated with poor outcome for overall survival on multivariate analysis were ECOG performance status of > 1, high CEA, low albumin, and the number of lines of chemotherapy received (< 2). Conclusion The outcome of mCRC is inferior to the published literature. We found a relatively higher proportion of patients with the following characteristics; younger, rectum as primary tumor location, the signet, and mucinous histology, higher incidence of peritoneum involvement. The routine use of targeted therapies is limited. Government schemes (inclusion of targeted therapies in the Ayushman scheme), NGO assistance, and availability of generic low-cost targeted drugs may increase the availability.
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Affiliation(s)
- Vinod Sharma
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Vinod Raina
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Memorial Center, Kolkata, India
| | - Bidhu Kalyan Mohanti
- Department of Radiotherapy, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - N K Shukla
- Department of Surgical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sushmita Pathy
- Department of Radiotherapy, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S V S Deo
- Department of Surgical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Vanidassane I, Gogia A, Raina V, Tiwari P. Breast cancer associated with paraneoplastic cerebellar degeneration: A case series. Indian J Cancer 2021; 57:487-488. [PMID: 33078760 DOI: 10.4103/ijc.ijc_132_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ilavarasi Vanidassane
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Tiwari
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Sharma A, Kalyan Mohanti B, Pal Chaudhary S, Sreenivas V, Kumar Sahoo R, Kumar Shukla N, Thulkar S, Pal S, Deo SV, Pathy S, Ranjan Dash N, Kumar S, Bhatnagar S, Kumar R, Mishra S, Sahni P, Iyer VK, Raina V. Modified gemcitabine and oxaliplatin or gemcitabine + cisplatin in unresectable gallbladder cancer: Results of a phase III randomised controlled trial. Eur J Cancer 2019; 123:162-170. [PMID: 31707181 DOI: 10.1016/j.ejca.2019.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 12/24/2022]
Abstract
AIM To determine equivalence of modified gemcitabine and oxaliplatin compared with gemcitabine and cisplatin in unresectable gallbladder cancer (GBC). Primary end-point was overall survival (OS). METHODS Open label, prospective, randomised phase III equivalence study. Inclusion criteria included histologically proven unresectable GBC, 18 years or older, adequate organ functions and Eastern Cooperative Oncology Group ≤2. SAMPLE SIZE 108 patients were required in each arm to have an equivalence margin of ±2 months with power of 80%. TREATMENT Modified gemcitabine and oxaliplatin (mGemOx)-gemcitabine 900 mg/m2, oxaliplatin 80 mg/m2, maximum 6 cycles; gemcitabine + cisplatin (CisGem)-gemcitabine 1000 mg/m2, cisplatin 25 mg/m2, maximum 8 cycles, all day 1 and 8 every 3 weeks. RESULTS Two hundred sixty subjects were recruited between February 2011 and July 2015. Two hundred forty-three patients (119, mGemOx and 124, CisGem) received at least 1 dose and analysed for safety and efficacy (modified intention to treat). Median OS was 8·5 months for whole group (95% confidence interval [CI]: 7·9-9·1). Median OS in mGemOx was 9 months and 8·3 months in CisGem; p = 0·057 (hazard ratio = 0·78; 95% CI = 0·60-1·02). Restricted mean OS for follow-up limited to 30 months was 11·2 months (95% CI: 9·8-12·6) in mGemOx and 10·4 months (95% CI: 9·1-11·7) in CisGem. Difference of the mean was 0·8 months with 95% CI, exceeding 2 months (-1·1 to 2·7), hence rejecting equivalence. Peripheral neuropathy, thrombocytopaenia in mGemOx and nephrotoxicity was higher with CisGem. CONCLUSION This trial failed to show equivalence of eight cycles of CisGem to six cycles of mGemOx. Numerically OS was better with mGemOx. Toxicities were different. The trial was not powered to answer superiority. CLINICAL TRIAL REGISTRATION CTRI/2010/091/001406.
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Affiliation(s)
- Atul Sharma
- Department of Medical Oncology, Dr BRA IRCH, AIIMS, New Delhi 110029, India.
| | | | | | - V Sreenivas
- Department of Biostatistics, AIIMS, New Delhi 110029, India.
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Dr BRA IRCH, AIIMS, New Delhi 110029, India.
| | - Nootan Kumar Shukla
- Department of Surgical Oncology, Dr BRA IRCH, AIIMS, New Delhi 110029, India.
| | - Sanjay Thulkar
- Department of Radio Diagnosis, Dr BRA IRCH, AIIMS, New Delhi 110029, India.
| | - Sujoy Pal
- Department of Gastrointestinal Surgery and Liver Transplantation, AIIMS, New Delhi 110029, India.
| | - Surya V Deo
- Department of Surgical Oncology, Dr BRA IRCH, AIIMS, New Delhi 110029, India.
| | - Sushmita Pathy
- Department of Radiation Oncology, Dr BRA IRCH, AIIMS, New Delhi 110029, India.
| | - Nihar Ranjan Dash
- Department of Gastrointestinal Surgery and Liver Transplantation, AIIMS, New Delhi 110029, India.
| | - Sunil Kumar
- Department of Surgical Oncology, Dr BRA IRCH, AIIMS, New Delhi 110029, India.
| | - Sushma Bhatnagar
- Department of Onco-anaesthesia and Palliative Medicine, Dr BRA IRCH, AIIMS, New Delhi, 110029, India.
| | - Rakesh Kumar
- Professor Department of Nuclear Medicine, AIIMS, New Delhi, 110029, India.
| | - Seema Mishra
- Professor Department of Nuclear Medicine, AIIMS, New Delhi, 110029, India.
| | - Peush Sahni
- Department of Gastrointestinal Surgery and Liver Transplantation, AIIMS, New Delhi 110029, India.
| | | | - Vinod Raina
- Department of Medical Oncology, Dr BRA IRCH, AIIMS, New Delhi 110029, India.
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Gogia A, Kumar L, Sharma A, Raina V, Gupta R, Rani L. Safety and efficacy of bendamustine and rituximab (BR) regimen in Indian chronic lymphocytic leukemia patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz251.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vanidassane I, Gogia A, Raina V, Gupta R. Treatment Related Acute Myeloid Leukemia in Breast Cancer Survivors: A Single Institutional Experience. Indian J Hematol Blood Transfus 2019; 35:561-562. [PMID: 31388274 DOI: 10.1007/s12288-019-01078-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
| | - Ajay Gogia
- 1Department of Medical Oncology, AIIMS, New Delhi, India
| | - Vinod Raina
- 2Department of Medical Oncology, Fortis Memorial Research Institute, Gurugram, India
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Gogia A, Raina V, Deo SVS, Shukla NK, Mathur S, Mohanti BK, Sharma DN. Clinico-pathological characteristics and treatment outcome in invasive lobular carcinoma of the breast: An Indian experience. Indian J Cancer 2019; 55:344-347. [PMID: 30829268 DOI: 10.4103/ijc.ijc_428_18] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) is the second most common histologic subtype of breast cancer and accounts for 10%-15% of all breast cancers in the west. There is a scarcity of data on ILC from the Indian subcontinent. This report intends to present the patterns of care, survival outcomes, and prognostic factors of ILC treated in a tertiary care institute. MATERIALS AND METHODS This retrospective analysis included consecutive patients diagnosed with ILC and registered at our Institute between 2009 and 2016. RESULTS We included 97 patients with a median age of 53 years (range 28-80). American Joint Committee on Cancer (7th edition) stage distribution was stage I-8.24%, stage II-45.36%, stage III- 34.10%, and stage IV-12.30%. Bilateral breast cancer was seen in 8 cases. Estrogen receptor, progesterone receptor, and HER 2/neu positivity was 90%, 85%, and 9%, respectively. Triple-negative breast cancer constituted 5% of cases. Twenty-nine events were recorded (systemic and locoregional relapse) with a median follow-up of 3.5 years. Three years relapse-free survival (RFS) and overall survival were 80% and 60%, respectively. Bones were the most common site of metastasis. Age <45 years [HR-1.4 (0.8-2.1), P < 0.001] and advanced clinical tumor stage [T4, HR-2.1 (1.1-3.8), P = 0.001] were associated with poor RFS. CONCLUSION ILC constituted 2.5% of breast cancer cases at our institute. Triple negativity and HER-2/neu positivity were seen in 9% and 5% of cases, respectively. Age <45 years and advanced clinical tumor stage were associated with poor RFS.
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Affiliation(s)
- Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Department of Medical Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | | | - Nootan Kumar Shukla
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Bidhu Kalyan Mohanti
- Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
e19007 Background: Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the West accounting for about 30% of leukemias, whereas in Indian subcontinent it accounts for 3-5% of all leukemias. We aimed to evaluate biological and molecular prognostic parameters as well as therapeutic considerations in CLL patients in India. Methods: We retrospectively analyzed 510 patients with CLL, who presented at our institute over a period of 18 years. Results: The median age of CLL patients at presentation was 60 years (range: 28 - 92 years) with male: female ratio = 3:1. The median total leukocyte count was 45X109/L . As per clinical Rai stage distribution 55 (10.08%) patients were in Stage 0, 92 (18%) in stage I, 174 (34%) in stage II, 92 (18%) in stage III and 97 (19%) were in stage IV. ZAP-70 was positive ( > 20%) in 206 (57% , n = 361) , CD 38( > 30%) in 107 (29% , n = 363), and CD49d was positive ( > 30%) in 63 (50.3%, n = 127) cases. Beta-2 microglobulin (B2M) was elevated (≥3.5 mg/L) in 243 patients (70%, n = 347). One hundred and fifty six cases (57%, n = 273) were IGHV mutated and Del (17p) by FISH was observed in 18 cases (12%, n = 150). A total of 331 (64.9 %) patients required treatment wherein 155 patients (46.8%) received Chlorambucil-based, 110 ( 33.2%) received BR, 42 (12.6%) received Fludarabine based ( FC-7,FCR-35) and 41 patients received others regimen. Overall response rate seen with Chlorambucil, BR and Fludarabine based regimen was 67% ( CR-3.2%), 90% ( CR-45%) & 88% ( CR-44%) respectively. Median event free survival (EFS) and overall survival (OS) and was 3.5 years and 5.5 years respectively, with median follow up period of 3.9 years. Clinical stage (Rai III/IV), elevated B2 M, IGHV-unmutated had statistically significant adverse impact on OS and EFS. Fludarabine based chemotherapy appeared toxic as half of patients developed febrile neutropenia and various infections whereas in BR , cutaneous side effects were more common(p = 0.001) . In early stage CLL, median time to first treatment was 22 months and; IGHV-unmutated, elevated B2M and CD38 positivity were significantly associated with shorter treatment free survival. Conclusions: This is the largest series of CLL reported from Asia. Clinical Rai Stage III/IV, unmutated IGHV and elevated B2M have statistically significant adverse impact on survival of patients with CLL. BR was better tolerated than fludarabine based regimen with similar responses and events.
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Affiliation(s)
- Ajay Gogia
- All India Institute of Medical Sciences, Delhi, India
| | - Ritu Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- All India Institute of Medical Sciences, Delhi, India
| | | | - Lata Rani
- Laboratory Oncology unit, Dr B.R.A. IRCH, AIIMS, New Delhi, India
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Gray R, Bradley R, Braybrooke J, Liu Z, Peto R, Davies L, Dodwell D, McGale P, Pan H, Taylor C, Barlow W, Bliss J, Bruzzi P, Cameron D, Fountzilas G, Loibl S, Mackey J, Martin M, Del Mastro L, Möbus V, Nekljudova V, De Placido S, Swain S, Untch M, Pritchard KI, Bergh J, Norton L, Boddington C, Burrett J, Clarke M, Davies C, Duane F, Evans V, Gettins L, Godwin J, Hills R, James S, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Read S, Wang Y, Wang Z, Fasching P, Harbeck N, Piedbois P, Gnant M, Steger G, Di Leo A, Dolci S, Francis P, Larsimont D, Nogaret JM, Philippson C, Piccart M, Linn S, Peer P, Tjan-Heijnen V, Vliek S, Mackey J, Slamon D, Bartlett J, Bramwell VH, Chen B, Chia S, Gelmon K, Goss P, Levine M, Parulekar W, Pater J, Rakovitch E, Shepherd L, Tu D, Whelan T, Berry D, Broadwater G, Cirrincione C, Muss H, Weiss R, Shan Y, Shao YF, Wang X, Xu B, Zhao DB, Bartelink H, Bijker N, Bogaerts J, Cardoso F, Cufer T, Julien JP, Poortmans P, Rutgers E, van de Velde C, Carrasco E, Segui MA, Blohmer JU, Costa S, Gerber B, Jackisch C, von Minckwitz G, Giuliano M, De Laurentiis M, Bamia C, Koliou GA, Mavroudis D, A'Hern R, Ellis P, Kilburn L, Morden J, Yarnold J, Sadoon M, Tulusan AH, Anderson S, Bass G, Costantino J, Dignam J, Fisher B, Geyer C, Mamounas EP, Paik S, Redmond C, Wickerham DL, Venturini M, Bighin C, Pastorino S, Pronzato P, Sertoli MR, Foukakis T, Albain K, Arriagada R, Bergsten Nordström E, Boccardo F, Brain E, Carey L, Coates A, Coleman R, Correa C, Cuzick J, Davidson N, Dowsett M, Ewertz M, Forbes J, Gelber R, Goldhirsch A, Goodwin P, Hayes D, Hill C, Ingle J, Jagsi R, Janni W, Mukai H, Ohashi Y, Pierce L, Raina V, Ravdin P, Rea D, Regan M, Robertson J, Sparano J, Tutt A, Viale G, Wilcken N, Wolmark N, Wood W, Zambetti M. Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials. Lancet 2019; 393:1440-1452. [PMID: 30739743 PMCID: PMC6451189 DOI: 10.1016/s0140-6736(18)33137-4] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/11/2018] [Accepted: 11/29/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increasing the dose intensity of cytotoxic therapy by shortening the intervals between cycles, or by giving individual drugs sequentially at full dose rather than in lower-dose concurrent treatment schedules, might enhance efficacy. METHODS To clarify the relative benefits and risks of dose-intense and standard-schedule chemotherapy in early breast cancer, we did an individual patient-level meta-analysis of trials comparing 2-weekly versus standard 3-weekly schedules, and of trials comparing sequential versus concurrent administration of anthracycline and taxane chemotherapy. The primary outcomes were recurrence and breast cancer mortality. Standard intention-to-treat log-rank analyses, stratified by age, nodal status, and trial, yielded dose-intense versus standard-schedule first-event rate ratios (RRs). FINDINGS Individual patient data were provided for 26 of 33 relevant trials identified, comprising 37 298 (93%) of 40 070 women randomised. Most women were aged younger than 70 years and had node-positive disease. Total cytotoxic drug usage was broadly comparable in the two treatment arms; colony-stimulating factor was generally used in the more dose-intense arm. Combining data from all 26 trials, fewer breast cancer recurrences were seen with dose-intense than with standard-schedule chemotherapy (10-year recurrence risk 28·0% vs 31·4%; RR 0·86, 95% CI 0·82-0·89; p<0·0001). 10-year breast cancer mortality was similarly reduced (18·9% vs 21·3%; RR 0·87, 95% CI 0·83-0·92; p<0·0001), as was all-cause mortality (22·1% vs 24·8%; RR 0·87, 95% CI 0·83-0·91; p<0·0001). Death without recurrence was, if anything, lower with dose-intense than with standard-schedule chemotherapy (10-year risk 4·1% vs 4·6%; RR 0·88, 95% CI 0·78-0·99; p=0·034). Recurrence reductions were similar in the seven trials (n=10 004) that compared 2-weekly chemotherapy with the same chemotherapy given 3-weekly (10-year risk 24·0% vs 28·3%; RR 0·83, 95% CI 0·76-0·91; p<0·0001), in the six trials (n=11 028) of sequential versus concurrent anthracycline plus taxane chemotherapy (28·1% vs 31·3%; RR 0·87, 95% CI 0·80-0·94; p=0·0006), and in the six trials (n=6532) testing both shorter intervals and sequential administration (30·4% vs 35·0%; RR 0·82, 95% CI 0·74-0·90; p<0·0001). The proportional reductions in recurrence with dose-intense chemotherapy were similar and highly significant (p<0·0001) in oestrogen receptor (ER)-positive and ER-negative disease and did not differ significantly by other patient or tumour characteristics. INTERPRETATION Increasing the dose intensity of adjuvant chemotherapy by shortening the interval between treatment cycles, or by giving individual drugs sequentially rather than giving the same drugs concurrently, moderately reduces the 10-year risk of recurrence and death from breast cancer without increasing mortality from other causes. FUNDING Cancer Research UK, Medical Research Council.
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Chauhan R, Jain D, Dorwal P, Roy G, Raina V, Nandi S. The incidence of immunofluorescence patterns and specific autoantibodies observed in autoimmune patients in a tertiary care centre. Eur Ann Allergy Clin Immunol 2019; 51:165-173. [DOI: 10.23822/eurannaci.1764-1489.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- R. Chauhan
- Molecular Genetics Laboratory, Medanta-The Medicity, Gurgaon, India
| | - D. Jain
- Molecular Genetics Laboratory, Medanta-The Medicity, Gurgaon, India
| | - P. Dorwal
- Molecular Genetics Laboratory, Medanta-The Medicity, Gurgaon, India
| | - G. Roy
- Molecular Genetics Laboratory, Medanta-The Medicity, Gurgaon, India
| | - V. Raina
- Molecular Genetics Laboratory, Medanta-The Medicity, Gurgaon, India
| | - S.P. Nandi
- Amity Institute of Biotechnology, Amity University, Noida, India
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Gogia A, Raina V, Deo S, Sharma D, Mathur S. Survival outcome of pregnancy associated breast cancer in resource limited country: an analysis. Breast 2019. [DOI: 10.1016/s0960-9776(19)30244-9] [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: 11/29/2022] Open
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Gogia A, Raina V, Deo S, Shukla N, Mohanti B, Sharma D, Mathur S. Neoadjuvant chemotherapy for young (</ = 35 years) locally advanced breast cancer patients: association of pathological complete response with survival. An Institutional analysis from developing country. Breast 2019. [DOI: 10.1016/s0960-9776(19)30426-6] [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: 11/16/2022] Open
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Patekar M, Adhikari N, Biswas A, Raina V, Kumar L, Mohanti BK, Gogia A, Sharma A, Batra A, Bakhshi S, Garg A, Thulkar S, Sharma MC, Vishnubhatla S, Baghmar S, Sahoo RK. Primary CNS Lymphoma in India: A 17-Year Experience From the All India Institute of Medical Sciences. J Glob Oncol 2019; 5:1-9. [PMID: 30811305 PMCID: PMC6426510 DOI: 10.1200/jgo.18.00124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The information about the outcome of primary CNS lymphoma (PCNSL) in India is scarce, because there is no population-based or large hospital-based data. MATERIALS AND METHODS This is a retrospective study that spanned 17 years (2001 to 2017) to study the outcome of PCNSL at the All India Institute of Medical Sciences (AIIMS), which is a tertiary care center in Northern India. RESULTS Only one of 99 patients was positive for HIV serology. Diffuse large B-cell lymphoma was the most common histology (97.7%). The median patient age was 50 years (range, 13 to 70 years), and the ratio of men to women was 1.9. The median duration of symptoms before diagnosis was 3.5 months (range, 0.5 to 48 months), and 58.5% had a performance status (PS) of 3 or more. Multiple intracranial lesions were present in 81.8% of patients. Surgical resection was performed in 45%, and approximately 22% of patients were ineligible for treatment. Most patients (n = 73) were treated with high-dose methotrexate (HDMTX)–based regimens (ie, methotrexate, vincristine, and procarbazine with or without rituximab). Pharmacokinetic monitoring of methotrexate was not available at our center. HDMTX-related mortality was 3.9%. The median follow-up duration, event-free survival (EFS), and overall survival (OS) were 34 months, 20.4 months, and 31.7 months, respectively. Addition of rituximab (n = 27) to MVP resulted in a higher objective response rate (88.9% v 73.9% without rituximab; P = .12), complete remission (81.5% v 56.5%; P = .03), 2-year EFS (57.3% v 40.4%; P = .02), and 2-year OS (61.6% v 53.4%; P = .056). CONCLUSION This is the largest study of PCNSL from India. The patients were immunocompetent and young but presented with a high-burden disease that precluded treatment in approximately 22%. The treatment with HDMTX appears safe without pharmacokinetic monitoring. The outcome is comparable to those observed in the West, and rituximab use showed additional benefit. There are notable barriers with respect to management of PCNSL in the real world, and efforts are required to improve the outcome more.
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Affiliation(s)
- Mukesh Patekar
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Narayan Adhikari
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Bidhu Kalyan Mohanti
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Atul Batra
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Meher Chand Sharma
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Sreenivas Vishnubhatla
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Saphalta Baghmar
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Kumar Sahoo
- 1 Dr B.R.A. Institute Rotary Cancer Hospital, New Delhi, India.,2 All India Institute of Medical Sciences, New Delhi, India
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Kumari K, Tripathy J, Mohapatra P, Verma S, Das B, Raina V, Ray L. Evaluation of toxicity of HCH isomers and its degradation metabolites on mammalian cell line and zebra fish embryos. N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.1142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Sharma A, Chaudhary S, Raina V, Shukla N, Sreenivas V, Prakash S, Priyatma P, Bharti S. Final results of a phase II/III, randomized, double blind, placebo-controlled study to investigate the efficacy of a high potency multistrain probiotic, on chemotherapy induced diarrhea in cancer patients receiving fluropyrimidines and/or irinotecan-based therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.085] [Citation(s) in RCA: 4] [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: 11/14/2022] Open
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Gogia A, Raina V, Sharma M. Primary gastric diffuse large B cell lymphoma: A single center experience from developing country. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Gupta S, Babu GK, Chacko RT, Doval D, Desai C, Kilara N, Nag SM, Shah CA, Deo SVS, Koppikar SB, Swarup B, Kukreja AA, Raina V. An open label, single arm, prospective phase II study to evaluate the efficacy and safety of bevacizumab with gemcitabine and carboplatin as first-line treatment for metastatic triple negative breast cancer patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sudeep Gupta
- Department of Medical Oncology, Breast Disease Management Group, Tata Memorial Centre (TMC), Mumbai, India
| | | | | | | | - Chirag Desai
- Vedanta Institute of Medical Science, Ahmedabad, India
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Gogia A, Raina V, Deo SVS, Shukla NK, Mathur S, Sharma DN. Neoadjuvant chemotherapy in locally advanced invasive lobular carcinoma: A limited institutional experience. South Asian J Cancer 2018; 7:64-65. [PMID: 29600240 PMCID: PMC5865103 DOI: 10.4103/sajc.sajc_17_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Department of Medical Oncology, FMRI, Gurgaon, Haryana, India
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - N K Shukla
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- Department of Radiation, All India Institute of Medical Sciences, New Delhi, India
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Asselain B, Barlow W, Bartlett J, Bergh J, Bergsten-Nordström E, Bliss J, Boccardo F, Boddington C, Bogaerts J, Bonadonna G, Bradley R, Brain E, Braybrooke J, Broet P, Bryant J, Burrett J, Cameron D, Clarke M, Coates A, Coleman R, Coombes RC, Correa C, Costantino J, Cuzick J, Danforth D, Davidson N, Davies C, Davies L, Di Leo A, Dodwell D, Dowsett M, Duane F, Evans V, Ewertz M, Fisher B, Forbes J, Ford L, Gazet JC, Gelber R, Gettins L, Gianni L, Gnant M, Godwin J, Goldhirsch A, Goodwin P, Gray R, Hayes D, Hill C, Ingle J, Jagsi R, Jakesz R, James S, Janni W, Liu H, Liu Z, Lohrisch C, Loibl S, MacKinnon L, Makris A, Mamounas E, Mannu G, Martín M, Mathoulin S, Mauriac L, McGale P, McHugh T, Morris P, Mukai H, Norton L, Ohashi Y, Olivotto I, Paik S, Pan H, Peto R, Piccart M, Pierce L, Poortmans P, Powles T, Pritchard K, Ragaz J, Raina V, Ravdin P, Read S, Regan M, Robertson J, Rutgers E, Scholl S, Slamon D, Sölkner L, Sparano J, Steinberg S, Sutcliffe R, Swain S, Taylor C, Tutt A, Valagussa P, van de Velde C, van der Hage J, Viale G, von Minckwitz G, Wang Y, Wang Z, Wang X, Whelan T, Wilcken N, Winer E, Wolmark N, Wood W, Zambetti M, Zujewski JA. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol 2018; 19:27-39. [PMID: 29242041 PMCID: PMC5757427 DOI: 10.1016/s1470-2045(17)30777-5] [Citation(s) in RCA: 605] [Impact Index Per Article: 100.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. METHODS We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality). FINDINGS Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5-14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81%] of 4756 women). More than two thirds (1349 [69%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65%] of 2320 treated with NACT vs 1135 [49%] of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21·4% for NACT versus 15·9% for adjuvant chemotherapy (5·5% increase [95% CI 2·4-8·6]; rate ratio 1·37 [95% CI 1·17-1·61]; p=0·0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38·2% for NACT vs 38·0% for adjuvant chemotherapy; rate ratio 1·02 [95% CI 0·92-1·14]; p=0·66), breast cancer mortality (34·4% vs 33·7%; 1·06 [0·95-1·18]; p=0·31), or death from any cause (40·9% vs 41·2%; 1·04 [0·94-1·15]; p=0·45). INTERPRETATION Tumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered-eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy. FUNDING Cancer Research UK, British Heart Foundation, UK Medical Research Council, and UK Department of Health.
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Rai AK, Singh A, Saxena A, Seth T, Raina V, Mitra DK. Exonal switch down-regulates the expression of CD5 on blasts of acute T cell leukaemia. Clin Exp Immunol 2017; 190:340-350. [PMID: 28752543 DOI: 10.1111/cei.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2017] [Indexed: 11/27/2022] Open
Abstract
To date, CD5 expression and its role in acute T cell lymphoblastic leukaemia (T-ALL) have not been studied closely. We observed a significant reduction in surface expression of CD5 (sCD5) on leukaemic T cells compared to autologous non-leukaemic T cells. In this study, we have shown the molecular mechanism regulating the expression and function of CD5 on leukaemic T cells. A total of 250 patients suffering from leukaemia and lymphoma were immunophenotyped. Final diagnosis was based on their clinical presentation, morphological data and flow cytometry-based immunophenotyping. Thirty-nine patients were found to be of ALL-T origin. Amplification of early region of E1A and E1B transcripts of CD5 was correlated with the levels of surface and intracellular expression of CD5 protein. Functional studies were performed to show the effect of CD5 blocking on interleukin IL-2 production and survival of leukaemic and non-leukaemic cells. Lack of expression of sCD5 on T-ALL blasts was correlated closely with predominant transcription of exon E1B and significant loss of exon E1A of the CD5 gene, which is associated with surface expression of CD5 on lymphocytes. High expression of E1B also correlates with increased expression of cytoplasmic CD5 (cCD5) among leukaemic T cells. Interestingly, we observed a significant increase in the production of IL-2 by non-leukaemic T cells upon CD5 blocking, leading possibly to their increased survival at 48 h. Our study provides understanding of the regulation of CD5 expression on leukaemic T cells, and may help in understanding the molecular mechanism of CD5 down-regulation.
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Affiliation(s)
- A K Rai
- Cellular Immunology Division, Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.,Department of Biotechnology, Motilal Nehru National Institute of Technology Allahabad, Allahabad, India
| | - A Singh
- Cellular Immunology Division, Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - A Saxena
- Cellular Immunology Division, Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - T Seth
- Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - V Raina
- Department of Medical Oncology, BRAIRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - D K Mitra
- Cellular Immunology Division, Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Sharma MC, Gupta RK, Kaushal S, Suri V, Sarkar C, Singh M, Kale SS, Sahoo RK, Kumar L, Raina V. A clinicopathological study of primary central nervous system lymphomas & their association with Epstein-Barr virus. Indian J Med Res 2017; 143:605-15. [PMID: 27488004 PMCID: PMC4989834 DOI: 10.4103/0971-5916.187109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background & objectives: Primary central nervous system lymphomas (PCNSLs) are relatively uncommon, accounting for 2-3 per cent of primary brain tumours. Majority of these are diffuse large B cell lymphomas (DLBCL) occurring both in immunocompromised and immunocompetent patients. We undertook this study to classify PCNSL into germinal centre (GC) and non-germinal centre (NGC) type based on Hans classification and to find the role of Epstein-Barr virus (EBV) in pathogenesis both by conventional immunohistochemistry (IHC) and chromogenic in situ hybridization (CISH). Methods: The consecutive cases of PCNSL during a 10 years period were analysed by IHC for CD45, CD20, CD3, B-cell lymphoma 2 and 6 (Bcl-2 and Bcl-6), B-cell specific octamer binding protein-1 (BOB-1), multiple myeloma oncogene-1 (MUM-1), EBV latent-membrane protein 1 (LMP-1), cyclin-D1, CD10, CD5 and CD23, as well as by CISH for EBV. Results: During a period of 10 years, 65 PCNSL were diagnosed which comprised 0.69 per cent (65/9476) of all intracranial tumours. The mean age of presentation was 49 yr with sex ratio (M:F) of 1.4:1. Most common location was supratentorial region with predominant involvement of frontal lobe. Single lesions were seen in 38 (58.4%) and multifocal lesions in 27 (41.5%) patients. None of the patients were immunocompromised. All cases were B cell immunophenotype and were DLBCL except one case of follicular lymphoma. According to Hans classification, majority of them were NGC (n=51, 79.6%) and 13 (20.3%) were GC type. Bcl-2 expression was noted in 34 (52.3%) tumours. EBV was positive in three (4.6%) cases; two were detected both by IHC and CISH and one case by CISH only. Interpretation & conclusions: In Indian population, PCNSL occurs mainly in immunocompetent patients, and a decade earlier than in western population. Immunophenotyping revealed that all cases were DLBCL with predominance of NGC type. No prognostic difference was seen between GC and NGC DLBCL. Association of EBV was rare and this virus was possibly not involved in the pathogenesis of PCNSL in immunocompetent individuals. CISH was an easy, economical and less cumbersome method for detection of EBV in PCNSL.
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Affiliation(s)
- Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar Gupta
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kaushal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - S S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit K Sahoo
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Sharawat SK, Raina V, Kumar L, Sharma A, Bakhshi R, Vishnubhatla S, Gupta R, Bakhshi S. High fms-like tyrosine kinase-3 (FLT3) receptor surface expression predicts poor outcome in FLT3 internal tandem duplication (ITD) negative patients in adult acute myeloid leukaemia: A prospective pilot study from India. Indian J Med Res 2017; 143:S11-S16. [PMID: 27748272 PMCID: PMC5080919 DOI: 10.4103/0971-5916.191740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background & objectives: Mutations in fms-like tyrosine kinase 3 (FLT3) receptor have significant role in assessing outcome in patients with acute myeloid leukaemia (AML). Data for FLT3 surface expression in relation to FLT3 internal tandem duplication (ITD) status and outcome are not available from India. The objective of the current study was to investigate adult patients with AML for FLT3 expression and FLT3 ITD mutation, and their association with long-term outcome. Methods: Total 51 consecutive de novo AML patients aged 18-60 yr were enrolled in the study. FLT3 ITD was detected by polymerase chain reaction (PCR); flowcytometry and qPCR (Taqman probe chemistry) were used for assessment of FLT3 protein and transcript, respectively. Kaplan Meier curves were obtained for survival analysis followed by log rank test. Results: FLT3 ITD was present in eight (16%) patients. Complete remission was achieved in 33 (64.6%) patients. At 57.3 months, event free survival (EFS) was 26.9±6.3 per cent, disease free survival (DFS) 52.0±9.2 per cent, and overall survival event (OS) 34.5±7.4 per cent. FLT3 surface expression was positive (>20%) by flow-cytometry in 38 (88%) of the 51 patients. FLT3 surface expression and transcripts were not associated with FLT3 ITD status. FLT3 expression was significantly associated with inferior EFS (P=0.026) and OS (P=0.018) in those who were negative for FLT3 ITD. Interpretation & conclusions: This study evaluated FLT3 ITD mutation along with FLT3 expression in AML patients, and associated with survival. Negative impact of FLT3 surface expression on survival was observed in AML patients who were FLT3 ITD negative.
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Affiliation(s)
- Surender Kumar Sharawat
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vinod Raina
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Radhika Bakhshi
- Department of Biomedical Sciences, Shaheed Rajguru College of Applied Sciences, University of Delhi, Delhi, India
| | - Sreenivas Vishnubhatla
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ritu Gupta
- Laboratory Oncology Unit, Dr B.R.A. Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Abstract
Background: Follicular lymphoma (FL) is second most common lymphoma in adult, constituted 20% of all lymphoma cases in the west. There is limited information is available on FL from India. Methods: The clinico-pathological profile, treatment outcome and prognostic factors for survival were assessed retrospectively in 181 patients of FL seen at our center over a period of 17 years (1996-2012). Results: There were 120 males and 61 females. The median age was 51 years (24-80 years). The common presenting features were lymphadenopathy 71%, fatigue 23% and fever 20%. Ann Arbor stage distribution was: stage I - 9%, stage II - 11%, stage III -22 % and stage IV - 58%. Extra nodal involvement and bulky disease were present in 22% and 19% patients respectively. Follicular Lymphoma International Prognostic Index (FLIPI) 1 score : Low -25%, Intermediate-45% and high risk in 30% of cases. One forty five patients (80%) received treatment at presentation or during follow-up. Chemotherapeutic regimen used were: CHOP-45, CVP-51, chlorambucil and prednisolone -7, BR (bendamustine and rituximab)-12, RCHOP- 14 RCVP – 7 and other regimen were used in 5 cases. The overall response (ORR) and complete remission (CR) rates were 70% and 35% respectively. Median overall survival (OS) and event free survival (EFS) was 5.5 years and 2.5 years respectively, with median follow up period of 3.0 years. Grade 3 histology, failure to attain CR, low serum albumin, and high risk FLIPI were significantly associated with lower event free survival. High risk FLIPI (HR 1.46, 95% CI 1.03-2.10, p=0.003) and failure to attain CR (HR 2.64, CI 1.10-4.30, p=0.001) were predictors of poor OS. Conclusions: FL represents 9 % of all lymphoma in adult. This is the largest data from single institute from India. Eighty percentage of patients presented in stage III/IV disease. High risk FLIPI and failure to attain CR were important prognostic variables for OS.
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Affiliation(s)
- Ajay Gogia
- Department of Medical Oncology, IRCH, All India Institute of Medical Sciences, New Delhi, India.
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Sharma A, Tilak T, Bakhshi S, Raina V, Kumar L, Chaudhary S, Sahoo R, Gupta R, Thulkar S. Lactobacillus brevis CD2 lozenges prevent oral mucositis in patients undergoing high dose chemotherapy followed by haematopoietic stem cell transplantation. ESMO Open 2017; 1:e000138. [PMID: 28848667 PMCID: PMC5548970 DOI: 10.1136/esmoopen-2016-000138] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 12/05/2016] [Revised: 12/27/2016] [Accepted: 12/27/2016] [Indexed: 11/21/2022] Open
Abstract
Background Oral mucositis is a common inflammatory complication in patients undergoing high-dose chemotherapy and radiation followed by haematopoietic stem cell transplantation (HSCT). Lactobacillus brevis CD2 has been proven efficacious in preventing chemoradiotherapy-induced oral mucositis in squamous cell carcinoma of head and neck. Methods This phase II study aimed to evaluate the safety and efficacy of L. brevis CD2 lozenges in preventing oral mucositis in patients undergoing HSCT. Eligible patients received four to six lozenges of L. brevis CD2 per day, beginning from 4 to 7 days before initiation of chemotherapy and continuing until resolution of mucositis or till day +24. Results Of 31 patients enrolled, 7 (22.6%) patients did not develop any mucositis, 6 (19.4%) patients developed grade 1, 12 (38.7%) patients developed grade 2, 4 (12.9%) and 2 (6.5%) patients developed grade 3 and grade 4 mucositis, respectively. Median time to onset and for resolution of mucositis were 6 days and 8 days, respectively. No adverse events were reported with usage of study drug. However, one patient died of Klebsiella sepsis. Conclusion Promising results from the study encourage the use of L. brevis CD2 lozenges as a supportive care treatment option; however, a randomised, double-blind, multicentric trial in a larger population is warranted. Trials registration number NCT01480011 at https://www.clinicaltrials.gov/ (Registered on Nov 04, 2011).
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Affiliation(s)
- Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences,.
| | - Tvsvgk Tilak
- Department of Medical Oncology, All India Institute of Medical Sciences
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences
| | - Vinod Raina
- Department of Medical Oncology, All India Institute of Medical Sciences
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences
| | | | - RanjitKumar Sahoo
- Department of Medical Oncology, All India Institute of Medical Sciences
| | - Ritu Gupta
- Department of Laboratory Oncology, All India Institute of Medical Sciences
| | - Sanjay Thulkar
- Department of Radio-Diagnosis, All India Institute of Medical Sciences
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Abstract
BACKGROUND Male breast cancer (MBC) is a rare disease and accounts for 1% of all breast cancers. There is limited data on MBC from India. The aim of our study was to assess clinico-pathological parameters and outcome in MBC patients. MATERIALS AND METHODS This analysis was carried out in 76 patients of MBC who were registered at Institute Rotary Cancer Hospital of All India Institute Of Medical Sciences between 1996 and 2012. Patients' records were retrospective reviewed and data obtained from the computer database using International Classification of Diseases code (C-50). RESULTS The median age was 59 years (range: 28-80). The median duration of symptoms was 11 months (range: 0.5-40). Breast lump was the most common presenting symptom (left > right side). American Joint Committee on Cancer (7th edition) stage distribution was Stage I-2.6%, Stage II-13.1%, Stage III-59.3% and Stage IV-25%. Modified radical mastectomy was the commonest surgical procedure. Moreover, 30% of tumors were high-grade and 70% had pathological node positive disease. Estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER2)/neu positivity was 80% and 28%, respectively. Triple negative breast cancer constituted 19% of cases. With a median follow-up of 36 months, 3 years relapse free survival and overall survival was 60% and 80%. Advanced stage and visceral metastasis at baseline predicted poor outcome. CONCLUSION MBC constituted 0.8% at our institute. Our study population had a longer time to presentation, advanced disease at presentation, more HER2/neu positivity and triple negativity higher than the available literature.
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Affiliation(s)
| | - V Raina
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Abstract
BACKGROUND Breast cancer in women aged less than 35 years is uncommon and accounts for 1-2% of all breast cancer in the West. There is a paucity of data on young breast cancer from India. The aim of this study was to analyze the clinical, pathological, prognostic factors and outcome in young breast cancer patients. MATERIALS AND METHODS This analysis was performed in 251 patients aged <35 years or less (defined as breast cancer in the young), who were registered at our institute over an 11 year period between 2001 and 2011. RESULTS The median age was 31 years (range 18-35). Positive family history (siblings and parents) was elicited in only 10 patients. The TNM stage distribution was: Stage I was 2.5%, stage II - 20.5%, stage III - 55% and stage IV - 22%. The median clinical tumor size was 5.1 cm. Modified radical mastectomy was the most common surgical procedure and this was done in 79% of cases. 40% of tumors were high grade and 60% had pathological node positive disease. Estrogen and Progesterone and human epidermal growth factor receptor 2/neu positivity were 33% and 29% respectively. Triple negative breast cancer constituted 31% of patients. With a median follow-up of 30 months, 3 years relapse free survival and overall survival was 51% and 66%. CONCLUSION Young women constituted 8% of breast cancer cases. Advanced disease at presentation and triple negativity (nearly one third of patients) results poor outcome.
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Affiliation(s)
| | - V Raina
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Iqbal N, Sharma A, Shukla N, Mohanti BK, Deo SVS, Sahni P, Pal S, Pathy S, Raina V, Kumar L. Advanced gastrointestinal stromal tumors: 10-years experience from a tertiary care centre. ACTA ACUST UNITED AC 2016; 36:168-73. [PMID: 27522735 DOI: 10.7869/tg.278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. We aimed to study the pattern of presentation and treatment outcome of advanced GIST patients seen by us in a 10- year period. METHODS Medical records of GIST patients seen between years 2002-2012 were retrieved from institute as well as database maintained by authors. Patient included in this analysis had metastatic disease and unresectable and/or residual disease after surgery. RESULTS During the study period 62 patients fulfilled the inclusion criteria but 6 were lost to follow up before treatment and hence 56 patients were analysed. Median age was 45.5 years (range 17-70 years) with a male female ratio of 2:1. Thirty eight (67%) patients had metastatic disease whereas 32% patients had unresectable or incompletely resected disease. The most common primary site was small intestine in 24 (42.8%) which was followed by stomach in 11 (19.6%) patients. The most common site of metastases was liver in 27 (48%) patients. Median tumor size was 12 cm (range 4-50 cm). Thirty two (57%) patients had mitotic counts of > 5/50 HPF. All patients received imatinib. The most common response seen with imatinib was stable disease achieved in 29 (52%) patients. Imatinib was well tolerated by all patients without any drug discontinuation. The 5-year EFS and OS were 35% and 49%, respectively at a median follow up of 55 months. None of the patient or tumor factors were found to have prognostic significance in univariate survival analysis. CONCLUSIONS This is a single center experience of advanced GIST patients where small intestine was found to be the commonest disease site with imatinib producing disease stabilization in more than half of patients. Even though the survival was comparable to published reports, the major limitation was lack of mutation analysis.
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Sharma A, Shukla NK, Chaudhary SP, Sahoo R, Mohanti BK, Deo SVS, Pal S, Thulkar S, Kumar S, Pathy S, Sahni P, Vishnubhatla S, Bhatnagar S, Dash NR, Kumar R, Raina V, Iyer VK, Mishra S. Final results of a phase III randomized controlled trial comparing modified gemcitabine + oxaliplatin (mGEMOX) to gemcitabine+ cisplatin in management of unresectable gall bladder cancer (GBC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Atul Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - Nootan Kumar Shukla
- Department of Surgical Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - BK Mohanti
- Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - S. V. S. Deo
- Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
| | - Sujoy Pal
- All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Dept of Surgical Oncology,Dr BRA.Institute Rotary Cancer Hospital, New Delhi, India
| | - Sushmita Pathy
- All India Institute of Medical Sciences, New Delhi, India
| | - Peush Sahni
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Seema Mishra
- Dept of Anesthesia,Dr.BRA.Institute Rotary Cancer Hospital, New Delhi, India
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Roy S, Pathy S, Mohanti BK, Raina V, Jaiswal A, Kumar R, Kalaivani M. Accelerated hypofractionated radiotherapy with concomitant chemotherapy in locally advanced squamous cell carcinoma of lung: evaluation of response, survival, toxicity and quality of life from a Phase II randomized study. Br J Radiol 2016; 89:20150966. [PMID: 26986459 DOI: 10.1259/bjr.20150966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of accelerated hypofractionated radiation with concomitant chemotherapy (AHFx-RT-CT) in locally advanced squamous cell carcinoma (SCC) of the lung. METHODS 36 patients were enrolled in this study (CTRI/2013/11/004143). Patients in Arm A (n = 18) received neoadjuvant chemotherapy (NACT) (paclitaxel 200 mg m(-2) and carboplatin area under the curve 5) followed by external radiotherapy (60 Gy/30 fractions/6 weeks). Patients in Arm B (n = 18) received NACT as in Arm A followed by AHFx-RT (48 Gy/20 fractions/4 weeks) with concomitant chemotherapy (cisplatin 30 mg m(-2) weekly). Primary end points included comparative evaluation of overall locoregional response rates (ORRs) and progression-free survival (PFS). Secondary end points included toxicity, quality of life (QOL) and overall survival (OS). RESULTS The median follow-up duration was 15 months. The ORR at first follow-up (72.2% vs 44%, p = 0.06) and at 1 year after treatment completion (61% vs 5.5%, p = 0.04) were superior in Arm B. The median PFS (17 vs 5.36 months; p = 0.053) and OS (24.73 vs 12.33 months; p = 0.007) were also superior in Arm B. Grade ≥3 acute pharyngitis/oesophagitis was less in Arm B (p = 0.05). Improvement of emotional function, cognitive function and chest pain was observed in Arm B. CONCLUSION The study suggests that AHFx-RT-CT is feasible for locally advanced SCC of the lung with improved response rate, survival, QOL and favourable toxicity. ADVANCES IN KNOWLEDGE To the best of our knowledge, this is the first study comparing conventionally fractionated radiation with AHFx-RT-CT. Addition of low-dose weekly cisplatin as radiosensitizer may be the potential factor responsible for improved response rate, survival and favourable toxicity in the study arm despite lower biological effective dose.
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Affiliation(s)
- Soumyajit Roy
- 1 Department of Radiation Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushmita Pathy
- 1 Department of Radiation Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Bidhu K Mohanti
- 1 Department of Radiation Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- 2 Department of Medical Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Jaiswal
- 3 Department of Pulmonary Medicine, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Rakesh Kumar
- 4 Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- 5 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Dorwal P, Phanish M, Duggal R, Chauhan R, Raina V, Kher V. Chronic active antibody mediated rejection associated with human leukocyte antigen-C*07 antibodies. Indian J Nephrol 2016; 26:63-5. [PMID: 26937087 PMCID: PMC4753750 DOI: 10.4103/0971-4065.167282] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Dorwal
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon, Haryana, India
| | - M Phanish
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta-The Medicity, Gurgaon, Haryana, India
| | - R Duggal
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon, Haryana, India
| | - R Chauhan
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon, Haryana, India
| | - V Raina
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon, Haryana, India
| | - V Kher
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta-The Medicity, Gurgaon, Haryana, India
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Misra A, Mishra J, Chandramohan J, Sharma A, Raina V, Kumar R, Soni S, Chopra A. Old but Still Relevant: High Resolution Electrophoresis and Immunofixation in Multiple Myeloma. Indian J Hematol Blood Transfus 2016; 32:10-7. [PMID: 26855502 PMCID: PMC4733669 DOI: 10.1007/s12288-015-0605-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 10/05/2015] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION High resolution electrophoresis (HRE) and immunofixation (IFX) of serum and urine are integral to the diagnostic work-up of multiple myeloma. Unusual electrophoresis patterns are common and may be misinterpreted. Though primarily the responsibility of the hematopathologist, clinicians who are responsible for managing myelomas may benefit from knowledge of these. In this review article we intend to discuss the patterns and importance of electrophoresis in present day scenario. METHODS Patterns of HRE and IFX seen in our laboratory over the past 15 years were studied. RESULTS Monoclonal proteins are seen on HRE as sharply defined bands, sometimes two, lying from γ- to α-globulin regions on a background of normal, increased or decreased polyclonal γ-globulins, showing HRE to be a rapid and dependable method of detecting M-protein in serum or urine. Immunofixation complements HRE and due to its greater sensitivity, is able to pick up small or light chain bands, not apparent on electrophoresis, including biclonal disease even when electrophoresis shows only one M-band. Special features liable to misinterpretation are discussed. Familiarity with the interpretation of the varied patterns seen in health and disease is essential for providing dependable laboratory support in the management of multiple myeloma.
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Affiliation(s)
- Aroonima Misra
- />Room No. 423, 4th Floor, Laboratory Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, 110006 India
| | - Jyoti Mishra
- />Room No. 423, 4th Floor, Laboratory Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, 110006 India
| | - Jagan Chandramohan
- />Room No. 423, 4th Floor, Laboratory Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, 110006 India
| | - Atul Sharma
- />Medical Oncology, Dr.BRA-IRCH, AIIMS, New Delhi, India
| | - Vinod Raina
- />Medical Oncology, Dr.BRA-IRCH, AIIMS, New Delhi, India
| | - Rajive Kumar
- />Room No. 423, 4th Floor, Laboratory Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, 110006 India
| | - Sushant Soni
- />Room No. 423, 4th Floor, Laboratory Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, 110006 India
| | - Anita Chopra
- />Room No. 423, 4th Floor, Laboratory Oncology, Dr. BRA-IRCH, AIIMS, New Delhi, 110006 India
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Affiliation(s)
| | | | | | - V Raina
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Kakkar A, Baghmar S, Garg A, Suri V, Raina V, Sarkar C, Sharma MC. Recurrent rhabdoid meningioma with lymph node, pulmonary and bone metastases: a diagnostic and therapeutic challenge. Brain Tumor Pathol 2016; 33:228-33. [PMID: 26875176 DOI: 10.1007/s10014-016-0250-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
Rhabdoid meningioma is a rare meningioma variant, classified as WHO grade III. Although this tumor is known for its aggressive behavior and poor prognosis, extracranial metastasis is rare. We report the rare case of a 31-year-old patient with rhabdoid meningioma which recurred several times despite gross total resection, radiation therapy, and gamma knife radiosurgery, and the last recurrence was associated with metastases to lungs, lymph node and bone. The patient showed no response to paclitaxel-carboplatin, or vincristine-cyclophosphamide-adriamycin chemotherapy, and succumbed to the disease. Metastases from rhabdoid meningioma prove to be a diagnostic challenge, and treatment for metastatic meningiomas is not optimized, thus necessitating documentation and interdisciplinary consensus on management protocols.
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Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Saphalta Baghmar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vinod Raina
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Gogia A, Sharma A, Raina V, Chopra A. Superior vena cava syndrome: Initial presentation of acute myeloid leukemia in a child. Indian J Cancer 2016; 52:21. [PMID: 26837961 DOI: 10.4103/0019-509x.175592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - A Sharma
- Department of Medical Oncology, Dr. B. R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Mehta P, Kumar L, Raina V, Sharma A, Bakhshi S, Gogia A, Sahoo R, Pabbi S, Chopra A, Kumar R. 285O High dose (18 g/m2) versus low dose (12 g/m2) cytosine arabinoside as consolidation for acute myeloid leukemia: A phase 3 study: An interim analysis. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv526.01] [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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Abstract
AIM OF STUDY Chronic lymphocytic leukemia (CLL) is the most common chronic lympho-proliferative disorder. This study was undertaken to know the prevalence of ZAP-70 and CD 38 in the treatment naive patients of CLL seen at a tertiary care centre of north India. MATERIALS AND METHODS ZAP-70 and CD 38 were tested by flow cytometry on peripheral blood samples. ZAP-70 positive and CD 38 positivity was defined as positive expression on 20% and 30% of CLL cells, respectively. Clinico-hematological profile and its correlation with ZAP-70 and CD 38 were assessed in consecutive 80 CLL patients. RESULTS There were 64 males and median age of the group was 58 years. Sixteen patients (20%) were asymptomatic and diagnosed incidentally. Median total lymphocyte count (TLC) at presentation was 62 × 10 9 /L. Rai stage distribution was: Stage 0-6, stage I-20, stage II-36, stage III-5, and stage IV-13. ZAP-70 and CD 38 positivity were detected in 20 patients (25%) and 29 patients (36%), respectively. Eleven patients were positive and 34 were negative for both ZAP-70 and CD 38 yielding a concordance rate of 56%. There was no statistically significant difference between ZAP-70 and CD 38 positivity and negativity with regard to age, sex, Lymphocyte count, lymphadenopathy, organomegaly, and Rai staging. CONCLUSION ZAP-70 and CD 38 positivity were detected 25% and 36%, respectively, with concordance rate of 56%, which is higher than Western literature. There was no correlation of ZAP-70 and CD 38 positivity with age, sex, lymphadenopathy, organomegaly, and Rai staging.
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Affiliation(s)
| | - A Sharma
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Iqbal S, Vishnubhatla S, Raina V, Sharma S, Gogia A, Deo SSV, Mathur S, Shukla NK. Circulating cell-free DNA and its integrity as a prognostic marker for breast cancer. Springerplus 2015; 4:265. [PMID: 26090312 PMCID: PMC4469592 DOI: 10.1186/s40064-015-1071-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/28/2015] [Indexed: 12/14/2022]
Abstract
The aim of our study was to look for alternative predictive biomarkers for breast cancer management in limited resource setup. A comprehensive analysis of circulating cell-free DNA (CCFD) in serum at baseline was performed to assess its prognostic potential. Quantitative polymerase chain reaction (qPCR) of ALU sequences using ALU115 and ALU247 primers was carried out in patients (N: baseline 148, postoperative 47) and 51 healthy controls. Mean serum DNA integrity, levels of ALU 247 and levels of ALU 115 were significantly higher in patients than in healthy females. No significant differences were observed in the levels ALU 247 and ALU 115 between stage IV and earlier stages of the disease. The DNA integrity was significantly higher in stage IV than earlier stages. A significant decrease in DNA integrity was observed after surgery (pre: 0.55 ± 0.23 vs post: 0.43 ± 0.30; P = 0.002) while no such change could be observed for ALU 247 and ALU 115. Baseline DNA integrity was significantly higher in relapsed patients than in patients who were free of disease (P = 0.005). Higher baseline DNA integrity was also indicated, though statistically not significant, in patients who died (P = 0.14). In contrast, ALU 247 and ALU 115 levels were decreased in died patients as compared to survivors (24.8 ± 34.80 vs 73.5 ± 170.83, P = 0.02 for ALU 247 and 41.0 ± 47.99 vs 159.5 ± 299.54, P = 0.005 for ALU 115). Baseline levels of ALU 115 and ALU 247 were lower in relapsed patients, though statistically not significant. In univariate analysis, the only clinic-pathological parameter associated with disease prognosis was tumor size. The hazards of 5-year overall mortality was 3.60 (95 % CI: 1.03 12.53, P = 0.03) among patients with lower baseline serum levels of CCFD (ALU 247 < 21 and ALU 115 < 41). Similarly the 4 year hazards for recurrence was 2.30 (95 % CI: 0.96 5.52, P = 0.05) among patients with higher DNA integrity. Baseline serum levels of CCFD and its integrity were found to be potential prognostic biomarkers in patients of primary breast cancer at our centre.
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Affiliation(s)
- Sobuhi Iqbal
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vinod Raina
- Department of Medical Oncology, Hematology and Stem Cell Transplantation, Fortis Memorial Research Institute, Sector 44, Gurgoan, India
| | - Surabhi Sharma
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Suryanarayana S V Deo
- Department of Surgical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Nutan Kumar Shukla
- Department of Surgical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Gogia A, Raina V. P-076 Survival outcome of patient with primary gastric diffuse large B-cell lymphoma: An Institutional experience from developing country. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.76] [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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Abstract
BACKGROUND Pregnancy-associated breast cancer (PABC) has been defined as breast cancer diagnosed during pregnancy or within 1 year of delivery. There is a paucity of data on PABC from India. The aim of our study was to assess the clinical-pathological parameters and outcome of PABC at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences. MATERIALS AND METHODS We screened approximately 3,750 cases registered from January 2001 to December 2012 and found 26 cases of PABC. Patients' records were obtained from the computer database using International Classification of Diseases code (C-50). RESULTS The median age was 26 years (range 20-35). The median duration of symptoms was 11.5 months. The American Joint Committee on Cancer stage distribution was Stage I - 1, Stage II - 3, Stage III - 14 and in Stage IV - 8 patients. Median clinical tumor size is 5.5 cm. Four patients were presented with the inflammatory breast cancer. Positive family history was elicited in three patients. Twenty-one patients were diagnosed after delivery, two patients in the first trimester, two patients in the second trimester and three patients in the third trimester. Estrogen receptor (ER), progesterone receptor (PR) negativity and human epidermal growth factor receptor 2 (HER2/neu) positivity was 56% and 38%, respectively. Nearly, 40% of patients had a high-grade tumor and 70% had pathological node positivity. With a median follow-up of 33 months, 3 years relapse free survival and overall survival was 40% and 50% respectively. Bone was the most common site for systemic relapse. CONCLUSIONS PABC constituted 0.7% of all breast cancer patients. It is associated with advanced stage at presentation. Half of them were ER/PR negative and one-third was HER2/neu positive.
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Affiliation(s)
| | | | | | | | - V Raina
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Bahl A, Sharma A, Raina V, Kumar L, Bakhshi S, Gupta R, Kumar R. Long-term outcomes for patients with acute myeloid leukemia: a single-center experience from AIIMS, India. Asia Pac J Clin Oncol 2015; 11:242-52. [PMID: 25639656 DOI: 10.1111/ajco.12333] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/29/2022]
Abstract
AIM To analyze clinicopathological characteristics of acute myeloid leukemia (AML) patients and to evaluate long-term outcome of these patients presented to single tertiary care center in India. METHODS We evaluated outcomes of 480 patients (age 8-60 years), classified into good, intermediate and poor risk according to cytogenetic results. Standard "3 + 7" induction therapy with dose of daunorubicin ranging from 45 to 90 mg/m(2) followed by two to three courses of high-dose cytarabine (12-18 g/m(2) ) as consolidation therapy was given to majority. RESULTS The complete remission rate of the treated population (407 patients) was 70% with 84.8% in good risk, 67.9% in intermediate risk and 54.2% in poor risk (P = 0.0001). Induction mortality was 18.4%. One hundred twenty-nine patients relapsed with median treatment free interval of 10.4 months. At a median follow-up of 34.5 months, the median overall survival (OS) was 20.6 months with an estimated 5-year survival rate of 35.5%. No difference was found in OS between the three risk groups; however, patients with intermediate risk had a better leukemia-free survival (LFS) in comparison to good risk. Multivariate analysis showed age, performance status, treatment completion and hematopoietic stem cell transplant affecting OS, while only treatment completion affected LFS. CONCLUSION This is one of the largest single-center studies reflecting more accurately the outcome of AML in India. These results are likely due to uniform treatment protocols, intensification of induction and post-remission treatments with comprehensive supportive care.
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Affiliation(s)
- Ankur Bahl
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Laboratory Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Laboratory Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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