e15101 Background: There is no standard second-line chemotherapy after progression on 1st line therapy Gemcitabine and platinum combination chemotherapy, in locally advanced (unresectable) and metastatic Gall bladder cancer (LA/MGBC) patients. So this study was undertaken to assess the efficacy and safety of FOLFOX-4 regimen in this setting. Methods: In this prospective study, patients of LA/MGBC, with performance status ≤2, who progressed on first line therapy, were randomly enrolled from May 2012 to June 2013. FOLFOX-4 based treatment was administered until progression, unacceptable toxicity or up to 12 cycles. The response rates(RR), time to tumour progression(TTP) and overall survival (OS) were analyzed. Toxicity profile was recorded as per common toxicity criteria version 4. Results: Total 50 patients were enrolled. The median age of patients was 52 yrs (32yrs – 66yrs), out of which 16 (32%) were males and 34 (68%) were females. The median no. of cycles could be given were 11 (2-12). Only 50% patients in this study completed full twelve cycles of chemotherapy. 12 patients (24%) in this study required the dose reduction at least in one cycle of chemotherapy due to toxicities. Disease control rate was seen in 31(62%) patients, with CR in none, PR in 12 (24%), SD in 19 (38%) and PD in 19 (38%) patients. The median TTP was 3.8 months, median OS was 6 months. The main grade 3/4 side effects seen were hematological in 28% (n=14) and gastrointestinal in 26% (n=13) patients. Majority of patients (44%) had grade 1/2 peripheral neuropathy. Conclusions: FOLFOX-4 is an effective and well tolerated regimen as a second line treatment in LA/MGBC patients.
Abstract Background Next-generation sequencing (NGS) based assay for finding an actionable driver in non-small-cell lung cancer is a less used modality in clinical practice. With a long list of actionable targets, limited tissue, arduous single-gene assays, the alternative of NGS for broad testing in one experiment looks attractive. We report here our experience with NGS for biomarker testing in hundred advanced lung cancer patients. Methods Predictive biomarker testing was performed using the Ion AmpliSeq™ Cancer Hotspot Panel V2 (30 tumors) and Oncomine™ Solid Tumor DNA and Oncomine™ Solid Tumor Fusion Transcript kit (70 tumors) on Ion-Torrent sequencing platform. Results One-seventeen distinct aberrations were detected across 29 genes in eighty-six tumors. The most commonly mutated genes were TP53 (43% cases), EGFR (23% cases) and KRAS (17% cases). Thirty-four patients presented an actionable genetic variant for which targeted therapy is presently available, and fifty-two cases harbored non-actionable variants with the possibility of recruitment in clinical trials. NGS results were validated by individual tests for detecting EGFR mutation, ALK1 rearrangement, ROS1 fusion, and c-MET amplification. Compared to single test, NGS exhibited good agreement for detecting EGFR mutations and ALK1 fusion (sensitivity- 88.89%, specificity- 100%, Kappa-score 0.92 and sensitivity- 80%, specificity- 100%, Kappa-score 0.88; respectively). Further, the response of patients harboring tyrosine kinase inhibitor (TKI) sensitizing EGFR mutations was assessed. The progression-free-survival of EGFR positive patients on TKI therapy, harboring a concomitant mutation in PIK3CA-mTOR and/or RAS-RAF-MAPK pathway gene and/or TP53 gene was inferior to those with sole-sensitizing EGFR mutation (2 months vs. 9.5 months, P = 0.015). Conclusions This is the first study from South Asia looking into the analytical validity of NGS and describing the mutational landscape of lung cancer patients to study the impact of co-mutations on cancer biology and treatment outcome. Our study demonstrates the clinical utility of NGS testing for identifying actionable variants and making treatment decisions in advanced lung cancer.
Pulmonary sclerosing pneumocytoma (PSP) is a rare pulmonary tumor that behaves in a benign fashion and has excellent prognosis.[1] The tumor was historically termed as sclerosing hemangioma by Liebow and Hubbell in 1956.[2] The incidence peaks in sixth decade with a striking predilection for females (F:M = 5:1).[3] [4] Although it presents as a well-circumscribed solid nodular mass, the radiological features are nonspecific and can be misconstrued as malignant especially in large tumors.[5] Frozen sections and trucut biopsy interpretation of such tumors may also be misleading.
11514 Background: Hormone receptor positive patents historically had a better prognosis than their receptor negative counterparts when other parameters are balanced. However not all the patients expressing Estrogen and progesterone respond well to the hormonal manipulation. Therefore we thought of doing a retrospective analysis of our hospital data to find out the differences in the prognostic factors in therapy responders and non responders. Methods: The study was conducted at tertiary care cancer center from India. Between 2002–2003 a total of 120 breast cancer patients who expressed either Estrogen receptor (ER) or progesterone receptor (PR) were analyzed. Only patients with metastatic breast cancer were analyzed. The patients were treated with our standard institutional protocol at the beginning according to the stage of the disease. The details and baseline characters were shown in table . Results: The responders tend to be post menopausal, having low grade, node negative tumors, expressed both ER and PR, and had long interval from the date of initial diagnosis. However tumor size and the site of metastasis (visceral vs. non visceral) did not alter the outcome to hormone therapy. Conclusion: patients who are having higher age, lower tumor grade, lower number of nodes, longer disease free interval after adjuvant therapy and expressing both receptors tend to respond to hormone therapy better than those who had the opposite characters. However as thought earlier, presence of visceral metastasis or larger tumors at the time of initial diagnosis dose not preclude response to hormonal manipulation. [Table: see text] No significant financial relationships to disclose.
Lung cancer is reported as the leading cause of cancer-related mortality worldwide. Non-small cell lung cancer (NSCLC) constitutes 80%–85% of all lung cancers. Diagnosis of NSCLC is a complex multistep process. The prognosis of NSCLC is poor as most of the patients are presented at the metastatic stage. The management of these patients needs the expertise of different specialists. A multidisciplinary team (MDT) comprising specialists from different disciplines has a substantial role in improving outcomes in these patients. This is feasible through extensive discussions, accurate evaluation of patients, reviewing medical records, implementing ideal treatment strategies, and merging local treatments with systemic treatment concepts. Therefore, the MDT approach for stage III NSCLC management can enable early treatment initiation, optimal treatment modalities, and reduce healthcare expenditure. Studies have shown that MDT can provide multimodality care facilitating the diagnosis and treatment of stage III NSCLC, resulting in survival benefit of these patients. Thus, it is imperative to collate scientific evidence to get an insight into the MDT approach in advanced NSCLC treatment. This review aims to summarize the impact of MDT on treatment rates, survival outcome, treatment guideline adherence, and quality of life (QoL) of stage III NSCLC patients.
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