Cancer Research, Statistics, Treatment

Love in the time of cancer Vikas Talreja Cancer Research, Statistics, and Treatment 2018 1(2):75-77

Hypersensitivity reactions to paclitaxel with a modified dexamethasone intravenous premedication regimen Vanita Noronha, Deborah Enting, Ravi Thippeswamy, Amit Joshi, Vijay Maruti Patil, Kumar Prabhash Cancer Research, Statistics, and Treatment 2018 1(2):78-83 Background: The conventional paclitaxel premedication regimen consists of two oral dexamethasone doses of 20 mg each taken 12 h and 6 h before paclitaxel administration. For the sake of convenience, the premedication regimen has been modified with a single dose of dexamethasone administered intravenously 30–60 min before paclitaxel, omitting the oral doses. We assessed the rate of hypersensitivity reactions (HSRs) when a modified dexamethasone regimen was used. Materials and Methods: This was an observational prospective cohort study in patients receiving paclitaxel chemotherapy. We recorded demographics, prior history of allergy and comorbidities, diagnosis, chemotherapy regimen with schedule, details of HSRs, and details of rechallenge. Descriptive analysis and simple percentages were performed. Results: Between February 2011 and May 2011, 310 patients received 495 cycles of paclitaxel chemotherapy. The median age was 50 years, 77% of patients were female. Sixty-nine percent of patients had breast and gynecologic malignancies. Forty-four percent of patients were chemonaive. Sixty-eight percent of the paclitaxel cycles were once-in-3-week regimens; the remaining 32% were once a week. In all the paclitaxel cycles, a modified premedication regimen was administered. The dose of intravenous dexamethasone was 0 (n = 20), 8 mg (n = 210), 12 mg (n = 1), 16 mg (n = 56), and 20 mg (n = 163). The incidence of HSRs was 1.6%, with 1.2% incidence of severe hypersensitivity. No patient required hospitalization for the management of hypersensitivity. Three patients were rechallenged with paclitaxel after the development of hypersensitivity; all tolerated rechallenge without further infusion reactions. Conclusion: A modified dexamethasone premedication regimen is a safe and convenient option with a low risk of hypersensitivity.

Hypothyroidism post-chemoradiation on outcomes in head-and-neck cancer Vijay M Patil, Vanita Noronha, Amit Joshi, Tanmoy Kumar Mandal, Atanu Bhattacharjee, Alok Goel, Vikas Talreja, Arun Chandrasekharan, Nikhil Pande, Anant Ramaswamy, Kumar Prabhash Cancer Research, Statistics, and Treatment 2018 1(2):84-91 Background: Hypothyroidism is a known side effect of head-and-neck cancer treatment and might improve outcomes. However, whether the development of hypothyroidism or maintaining a hypothyroid state remains a factor is unclear. Methods: Once-a-week versus once-every-3-weeks cisplatin chemoradiation in locally advanced head and neck cancer was a Phase III open-label, noninferiority randomized study conducted by our group in the Medical Oncology Department of Tata Memorial Hospital, Mumbai, India. The database of this study was assessed for this analysis. Hypothyroidism was defined as a serum thyroid-stimulating hormone (TSH) level of above 5 uIU/ml. Duration of hypothyroidism was defined as cumulative duration in days postrandomization that the patient spent in hypothyroid state before progression. The relationship between duration of hypothyroidism (continuous variable) and peak TSH values and outcomes (locoregional failure [LRF] rate, progression-free survival [PFS], and overall survival [OS]) were analyzed. Results: Higher duration of time spent in a hypothyroid state had a favorable impact on PFS (HR: 0.996, 95% CI: 0.994–0.999, P = 0.007), and OS (HR: 0.995, 95% CI: 0.991–0.999, P = 0.016). This favorable impact on LRF (HR: 0.963, 95% CI: 0.929–0.997, P = 0.034), PFS (HR: 0.996, 95% CI: 0.993–0.999, P = 0.005), and OS (HR: 0.993, 95% CI: 0.987–0.999, P = 0.022) was confirmed on multivariate analysis too. Peak TSH value between 30 and 40 uIU/ml provided the maximum benefit for LRF with HR of 4.76 (standard error (SE) of HR as 0.627, P = 0.01). Conclusion: A longer duration and higher state of hypothyroidism (TSH – 30–40 Iu/ml) provided the maximum improvement in outcomes, this is an interesting hypothesis which needs to be confirmed with more studies.

Health-related quality of life in patients with multiple myeloma on novel agents: Report from a tertiary cancer center in rural India Vineetha Raghavan, Avaronnan Manuprasad, PB Sajeev Kumar, Zoheb Raj, Praveen Kumar Shenoy, Chandran K Nair Cancer Research, Statistics, and Treatment 2018 1(2):92-95 Background: Multiple myeloma is a disease where health-related quality of life (HRQoL) is an important treatment end point. There are limited quality of life data of patients on novel antimyeloma agents, especially from developing countries. Methods: All adult patients diagnosed with multiple myeloma who were on novel agents for a period of at least one year and attended our clinic between July 15, 2015 and July 30, 2015 were included in the study. They were asked to fill local language versions of European Organization for Research and Treatment of Cancer Questionnaire Core 30 (EORTC QLQ-C30), supplemented by the myeloma-specific module, and the outcomes were analyzed. Mean scores of the study population were compared with EORTC reference values. A higher score for a functional domain indicates a higher level of functioning, whereas a higher symptom score indicates a higher symptomatic burden. Results: Of the total 64 patients, median age was 60 years and 60% (n = 38) were females. Median duration from diagnosis was 23 months (12–92 months). Mean QoL score for global quality of life was 55.3 and was comparable to the reference score. Our patients had significantly lower physical function score and higher financial strain compared to the reference population. The most common symptom was pain (60%), and the most common adverse effect was peripheral neuropathy (60%). Sixty-five percent of the patients were worried about future health and 42% about dying. Conclusion: Our patients with multiple myeloma have lower HRQoL compared to the reference population in many domains, despite being on novel agents.

The enemy within J Barrett Cancer Research, Statistics, and Treatment 2018 1(2):96-97

Systemic treatment options in bladder cancer Rahul Ravind, Kumar Prabhash, Amit Joshi, Vijay Patil, Vanita Noronha Cancer Research, Statistics, and Treatment 2018 1(2):98-109 Since the 1980's, with the advent of MVAC (methotrexate, cisplatin, vinblastine, adriamycin) the role of chemotherapy for bladder cancer was defined. Since then, multiple chemotherapy regimens have been used and the field of chemotherapy has reached a therapeutic plateau. In the last decade, there have been recent updates in the systemic options used in bladder cancer. Early stage disease is managed with cystectomy. The role of neoadjuvant chemotherapy is well established and the trimodality approach for bladder preservation is widely being practiced worldwide. With the advent of immunotherapy, the survival pattern has changed in patients with metastatic disease, and still, more research work needs to be done. Here we aim to review all the latest trends in the systemic treatment options of bladder cancer.

Prevalence of tobacco use among school-going adolescents in India: A systematic review of the literature B Kumara Raja, V N Kavitha Devi Cancer Research, Statistics, and Treatment 2018 1(2):110-115 Individuals who initiate tobacco use during adolescence are likely to continue the use into adulthood, and this constitutes a major risk factor for premature death. The purpose of this study was to systematically review existing literature on the prevalence of tobacco use among school-going adolescents in India. Records were searched from the various databases such as PubMed, PubMed Central, Cochrane Library, Embase, and Google Scholar for studies published from 2000 to 2018. A total of 20 studies with a total population of 50, 390 were reviewed. The prevalence of tobacco smoking among school-going adolescents ranged from 5.9% to 49%. The common risk factor for tobacco usage among school-going adolescents was found to be peer pressure. Parents' smoking behavior, family conflict, stress, and curiosity were also found to be additional risk factors. The prevalence of tobacco usage among school-going adolescents was found to be high. These findings emphasize the need for formulating strict tobacco control policies at school premises.

Modified dose dexamethasone premedication for paclitaxel use Sharada Mailankody Cancer Research, Statistics, and Treatment 2018 1(2):116-117

Treatment-induced hypothyroidism in head-and-neck cancer – Is it a crystal ball? Tarun Puri Cancer Research, Statistics, and Treatment 2018 1(2):118-120

Current treatment landscape and emerging management options for extremity sarcoma Siddharth Turkar Cancer Research, Statistics, and Treatment 2018 1(2):121-138 Malignant tumors of extremity are mostly of mesenchymal origin and arise from bone or extraskeletal soft tissue. Combination chemotherapy has greatly increased the survival of non-metastatic localized osteosarcoma and Ewing's sarcoma; however, there is conflicting evidence regarding the role of neoadjuvant and adjuvant chemotherapy in soft tissue sarcoma due to the rarity and heterogeneous population. Despite intensive multimodal therapy and valiant efforts, most of the patients with relapsed and metastatic sarcoma will succumb to their disease. Molecular studies like next-generation sequencing have revealed various targetable biomarkers which can be further explored in the therapeutic landscape with specific targeted therapies. We reviewed all ongoing and completed clinical trials involving chemotherapy, targeted therapy, and immunotherapy valid for patients with extremity sarcoma. We present the current viable therapeutic options for such a cohort of patients in routine clinical practice.

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