113 results on '"Mittal, Abhenil"'
Search Results
2. Frequently asked questions on surrogate endpoints in oncology-opportunities, pitfalls, and the way forward
- Author
-
Mittal, Abhenil, Kim, Myung Sun, Dunn, Shenna, Wright, Kristin, and Gyawali, Bishal
- Published
- 2024
- Full Text
- View/download PDF
3. The role of cytoreductive nephrectomy and systemic therapy in the management of tumour thrombus in patients with metastatic renal cell carcinoma
- Author
-
Mittal, Abhenil, Al-Ezzi, Esmail, Li, Xuan, Moloney, Brian, Wilson, Brooke, Spiliopoulou, Pavlina, Sridhar, Srikala, Fallah-Rad, Nazanin, Chung, Peter, Hamilton, Robert James, O’malley, Martin, and Hansen, Aaron R.
- Published
- 2023
- Full Text
- View/download PDF
4. Benefit of adjuvant bisphosphonates in early breast cancer treated with contemporary systemic therapy: A meta-analysis of randomized control trials
- Author
-
Mittal, Abhenil, Tamimi, Faris, Molto, Consolacion, Di Iorio, Massimo, and Amir, Eitan
- Published
- 2024
- Full Text
- View/download PDF
5. Surrogate endpoints for HTA decisions of breast cancer drugs: utility and pitfalls
- Author
-
Wright, Kristin, Mittal, Abhenil, and Gyawali, Bishal
- Published
- 2023
- Full Text
- View/download PDF
6. Controversies and Challenges in the Management of Osteosarcoma—an Indian Perspective
- Author
-
Mittal, Abhenil, Pushpam, Deepam, Ganguly, Shuvadeep, Kumar, Venkatesan Sampath, Khan, Shah Alam, and Bakhshi, Sameer
- Published
- 2022
- Full Text
- View/download PDF
7. Three-year disease-free survival in randomized trials of neoadjuvant chemotherapy and HER2-targeted therapy in breast cancer: A meta-analysis
- Author
-
Mittal, Abhenil, Tamimi, Faris, Molto, Consolacion, Meti, Nicholas, Al-Showbaki, Laith, Wilson, Brooke E., and Amir, Eitan
- Published
- 2023
- Full Text
- View/download PDF
8. Profile of Pathogenic Mutations and Evaluation of Germline Genetic Testing Criteria in Consecutive Breast Cancer Patients Treated at a North Indian Tertiary Care Center
- Author
-
Mittal, Abhenil, Deo, S. V. S., Gogia, Ajay, Batra, Atul, Kumar, Akash, Bhoriwal, Sandeep, Deb, Koushik Sinha, Dhamija, Ekta, Thulkar, Sanjay, Ramprasad, V. L., Olopade, Olufunmilayo, and Pramanik, Raja
- Published
- 2022
- Full Text
- View/download PDF
9. Association between control group therapy and magnitude of clinical benefit of cancer drugs
- Author
-
Molto, Consolacion, Tibau, Ariadna, Bujosa, Aida, Tapia, Jose Carlos, Mittal, Abhenil, Tamimi, Faris, and Amir, Eitan
- Published
- 2022
- Full Text
- View/download PDF
10. What Is Ailing Oncology Clinical Trials? Can We Fix Them?
- Author
-
Mittal, Abhenil, Moore, Sara, Navani, Vishal, Jiang, Di Maria, Stewart, David J., Liu, Geoffrey, and Wheatley-Price, Paul
- Subjects
- *
CLINICAL trials , *DRUG dosage , *CANCER patients , *PATIENT safety , *ONCOLOGY - Abstract
Evidence from phase three clinical trials helps shape clinical practice. However, a very small minority of patients with cancer participate in clinical trials and many trials are not completed on time due to slow accrual. Issues with restrictive eligibility criteria can severely limit the patients who can access trials, without any convincing evidence that these restrictions impact patient safety. Similarly, regulatory, organizational, and institutional hurdles can delay trial activation, ultimately making some studies irrelevant. Additional issues during trial conduct (e.g., mandatory in-person visits, central confirmation of standard biomarkers, and inflexible drug dosage modification) contribute to making trials non-patient-centric. These real-life observations from experienced clinical trialists can seem nonsensical to investigators and patients alike, who are trying to bring effective drugs to patients with cancer. In this review, we delve into these issues in detail, and discuss potential solutions to make clinical trials more accessible to patients. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
11. Comparison of outcomes for Hispanic and non‐Hispanic patients with advanced renal cell carcinoma in the International Metastatic Renal Cell Carcinoma Database.
- Author
-
Guram, Kripa, Huang, Jiaming, Mouchati, Christian, Abdallah, Nour, Jani, Chinmay, Navani, Vishal, Xie, Wanling, El Zarif, Talal, Adib, Elio, Gebrael, Georges, Agarwal, Neeraj, Li, Haoran, Labaki, Chris, Labban, Muhieddine, Ruiz Morales, Jose Manuel, Choueiri, Toni K., Chin Heng, Daniel Yick, Mittal, Abhenil, Hansen, Aaron R., and Rose, Brent S.
- Subjects
RENAL cell carcinoma ,DATABASES ,PROTEIN-tyrosine kinase inhibitors ,BONE metastasis ,OVERALL survival - Abstract
Background: Existing data on the impact of Hispanic ethnicity on outcomes for patients with renal cell carcinoma (RCC) is mixed. The authors investigated outcomes of Hispanic and non‐Hispanic White (NHW) patients with advanced RCC receiving systemic therapy at large academic cancer centers using the International Metastatic Renal Cell Carcinoma Database (IMDC). Methods: Eligible patients included non‐Black Hispanic and NHW patients with locally advanced or metastatic RCC initiating systemic therapy. Overall survival (OS) and time to first‐line treatment failure (TTF) were calculated using the Kaplan–Meier method. The effect of ethnicity on OS and TTF were estimated by Cox regression hazard ratios (HRs). Results: A total of 1563 patients (181 Hispanic and 1382 NHW) (mostly males [73.8%] with clear cell RCC [81.5%] treated with tyrosine kinase inhibitor [TKI] monotherapy [69.9%]) were included. IMDC risk groups were similar between groups. Hispanic patients were younger at initial diagnosis (median 57 vs. 59 years, p =.015) and less likely to have greater than one metastatic site (60.8% vs. 76.8%, p <.001) or bone metastases (23.8% vs. 33.4%, p =.009). Median OS and TTF was 38.0 months (95% confidence interval [CI], 28.1–59.2) versus 35.7 months (95% CI, 31.9–39.2) and 7.8 months (95% CI, 6.2–9.0) versus 7.5 months (95% CI, 6.9–8.1), respectively, in Hispanic versus NHW patients. In multivariable Cox regression analysis, no statistically significant differences were observed in OS (adjusted hazard ratio [HR], 1.07; 95% CI, 0.86–1.31, p =.56) or TTF (adjusted HR, 1.06; 95% CI, 0.89–1.26, p =.50). Conclusions: The authors did not observe statistically significant differences in OS or TTF between Hispanic and NHW patients with advanced RCC. Receiving treatment at tertiary cancer centers may mitigate observed disparities in cancer outcomes. The authors demonstrate that there were no statistically significant differences in overall survival or time to first‐line treatment failure between non‐Black Hispanic and non‐Hispanic White patients with advanced renal cell carcinoma (RCC) treated at these large academic cancer centers. Our findings suggest that receiving treatment at a tertiary cancer center may mitigate previously observed disparities in cancer outcomes for non‐Black Hispanic patients with advanced RCC. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
12. ASO Visual Abstract: Profile of Pathogenic Mutations and Evaluation of Germline Genetic Testing Criteria in Consecutive Breast Cancer Patients Treated at a North Indian Tertiary Care Center
- Author
-
Mittal, Abhenil, Deo, SVS, Gogia, Ajay, Batra, Atul, Kumar, Akash, Bhoriwal, Sandeep, Deb, Koushik Sinha, Dhamija, Ekta, Thulkar, Sanjay, Ramprasad, VL, Olopade, Olufunmilayo, and Pramanik, Raja
- Published
- 2022
- Full Text
- View/download PDF
13. ASO Author Reflections: Germline Testing for All Patients With Breast Cancer: Has the Time Finally Come?
- Author
-
Mittal, Abhenil and Pramanik, Raja
- Published
- 2022
- Full Text
- View/download PDF
14. An Updated Review of Management of Resectable Stage III NSCLC in the Era of Neoadjuvant Immunotherapy.
- Author
-
Verma, Saurav, Breadner, Daniel, Mittal, Abhenil, Palma, David A., Nayak, Rahul, Raphael, Jacques, and Vincent, Mark
- Subjects
PATIENT selection ,TERMS & phrases ,PREDICTION models ,SALVAGE therapy ,CLINICAL trials ,TREATMENT effectiveness ,OPERATIVE surgery ,IMMUNE checkpoint inhibitors ,CANCER chemotherapy ,COMBINED modality therapy ,TUMOR classification ,LUNG cancer ,HEALTH care teams ,BIOMARKERS - Abstract
Simple Summary: The recent evidence shows that patients with resectable non-small cell lung cancer (NSCLC) benefit from the addition of immunotherapy to chemotherapy before surgery. This approach improves pathological response rates and overall survival in these patients. However, there are many unanswered questions, especially in the context of heterogenous stage III NSCLC. In this review we discuss the new evidence, evolving definitions of resectability, controversies, possible salvage treatments and the ongoing research in this rapidly changing space. We highlight that multimodal treatment for stage III NSCLC should be individualized based on patient and tumor variables. Neoadjuvant immunotherapy and chemotherapy should be discussed with all patients with resectable (>4 cm and/or node positive, excluding N3) NSCLC. Immune-checkpoint inhibitors (ICIs) have an established role in the treatment of locally advanced and metastatic non-small cell lung cancer (NSCLC). ICIs have now entered the paradigm of early-stage NSCLC. The recent evidence shows that the addition of ICI to neoadjuvant chemotherapy improves the pathological complete response (pCR) rate and survival rate in early-stage resectable NSCLC and is now a standard of care option in this setting. In this regard, stage III NSCLC merits special consideration, as it is heterogenous and requires a multidisciplinary approach to management. As the neoadjuvant approach is being adopted widely, new challenges have emerged and the boundaries for resectability are being re-examined. Consequently, it is ever more important to carefully individualize the treatment strategy for each patient with resectable stage III NSCLC. In this review, we discuss the recent literature in this field with particular focus on evolving definitions of resectability, T4 disease, N2 disease (single and multi-station), and nodal downstaging. We also highlight the controversy around adjuvant treatment in this setting and discuss the selection of patients for adjuvant treatment, options of salvage, and next line treatment in cases of progression on/after neoadjuvant treatment or after R2 resection. We will conclude with a brief discussion of predictive biomarkers, predictive models, ongoing studies, and directions for future research in this space. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
15. The Survival Outcomes of the Metastatic Nonclear Cell Renal Cell Carcinoma in the Immunotherapy Era: Princess Margaret Cancer Centre Experience.
- Author
-
Al-Ezzi, Esmail, Mittal, Abhenil, Veitch, Zachary W., Zahralliyali, Amer, Diaz Mejia, Nely Mercy, Abdeljalil, Osama, Alqaisi, Husam, Kumar, Vikaash, Hansen, Aaron R., Fallah-Rad, Nazanin, and Sridhar, Srikala S.
- Subjects
- *
SURVIVAL rate , *RENAL cell carcinoma , *PROGRESSION-free survival , *IMMUNOTHERAPY , *METASTASIS , *PRINCESSES - Abstract
Immunotherapy (IO) with or without targeted therapy (TT) is the standard treatment for patients with metastatic clear cell renal cell carcinoma (RCC). The evidence supporting their use in metastatic nonclear cell renal cell carcinoma (nccRCC) subtypes is based on small prospective trials and retrospective analyses. Here, we report survival outcomes for patients with metastatic nccRCC treated with IO and/or TT at the Princess Margaret Cancer Centre, Toronto, ON, Canada. Demographics, disease characteristics, and survival outcomes were collected retrospectively. Overall (OS), progression-free survival (PFS), and objective response rates (ORR) were calculated. We identified 69 patients with metastatic nccRCC treated with IO and/or TT as the first-line treatment, and 36 (52.1%) patients as the second-line treatment. Median OS of the first line IO recipients (n = 12) and non-IO recipients (n = 57) was not reached (NR) and 17.2 months (95% confidence interval (95% CI): 7.3-27.0; P = 0.23), respectively. Median PFS of first-line IO recipients and non-IO recipients was NR and 4.7 months (95% CI: 3.7-5.6; P = 0.019), respectively. The ORR of IO recipients versus non-IO recipients was 50% versus 12.3% (P = 0.007). Median OS of the second-line IO recipients (n = 8) and non-IO recipients (n = 28) was NR and 6.3 months (95% CI: 3.2-9.3; P = 0.003), respectively. Median PFS of second-line IO recipients and non-IO recipients was 4.8 months (95% CI: 2.7-6.8) and 2.8 months (95% CI: 1.8-3.7; P = 0.014), respectively. ORR of IO recipients and non-IO recipients was 37.5% and 3.5%, respectively; P = 0.028. While the number of patients included in our retrospective review was small, our analysis suggested that patients with nccRCC have improved survival outcomes with IO treatment. Validation of prospective dataset is required before widespread clinical utilization. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
16. Isolated Lymph Node Amyloidosis: Response Assessment to Chemotherapy on Serial 18F-FDG PET/CT Scans
- Author
-
Tripathy, Sarthak, Bharadwaj, Mangu, Prakash, Sneha, Pramanik, Raja, Mittal, Abhenil, and Shamim, Shamim Ahmed
- Published
- 2020
- Full Text
- View/download PDF
17. Utility of ctDNA in predicting relapse in solid tumors after curative therapy: a meta-analysis.
- Author
-
Mittal, Abhenil, Valiente, Consolacion Molto, Tamimi, Faris, Iorio, Massimo Di, Al-Showbaki, Laith, Cescon, David W, and Amir, Eitan
- Abstract
Background Presence of circulating tumor DNA (ctDNA) is prognostic in solid tumors treated with curative intent. Studies have evaluated ctDNA at specific "landmark" or multiple "surveillance" time points. However, variable results have led to uncertainty about its clinical validity. Methods A PubMed search identified relevant studies evaluating ctDNA monitoring in solid tumors after curative intent therapy. Odds ratios for recurrence at both landmark and surveillance time points for each study were calculated and pooled in a meta-analysis using the Peto method. Pooled sensitivity and specificity weighted by individual study inverse variance were estimated and meta-regression using linear regression weighted by inverse variance was performed to explore associations between patient and tumor characteristics and the odds ratio for disease recurrence. Results Of 39 studies identified, 30 (1924 patients) and 24 studies (1516 patients) reported on landmark and surveillance time points, respectively. The pooled odds ratio for recurrence at landmark was 15.47 (95% confidence interval = 11.84 to 20.22) and at surveillance was 31.0 (95% confidence interval = 23.9 to 40.2). The pooled sensitivity for ctDNA at landmark and surveillance analyses was 58.3% and 82.2%, respectively. The corresponding specificities were 92% and 94.1%, respectively. Prognostic accuracy was lower with tumor agnostic panels and higher with longer time to landmark analysis, number of surveillance draws, and smoking history. Adjuvant chemotherapy negatively affected landmark specificity. Conclusions Although prognostic accuracy of ctDNA is high, it has low sensitivity, borderline high specificity, and therefore modest discriminatory accuracy, especially for landmark analyses. Adequately designed clinical trials with appropriate testing strategies and assay parameters are required to demonstrate clinical utility. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
18. Diffuse Large B-Cell Lymphoma presenting as isolated pleural effusion with excellent response to R-PEPC regimen
- Author
-
Mittal, Abhenil, Gogia, Ajay, and Mallick, Saumyaranjan
- Subjects
Coronary heart disease -- Diagnosis ,Coronary artery bypass ,Non-Hodgkin's lymphomas -- Diagnosis ,Vincristine ,Pleural effusions -- Diagnosis ,Telmisartan ,Health - Abstract
Byline: Abhenil. Mittal, Ajay. Gogia, Saumyaranjan. Mallick Pleural involvement as part of systemic Non-Hodgkin's Lymphoma is seen in around 16% of cases,[1] however, isolated pleural effusion as a presentation of [...]
- Published
- 2020
19. Primary plasma cell leukaemia in a 20-year young adult male: a rare presentation
- Author
-
Kumar, Chandan, Jain, Garima, Mittal, Abhenil, Kumar, Lalit, and Chopra, Anita
- Published
- 2019
- Full Text
- View/download PDF
20. Leukemia Cutis: A Rare Initial Presentation of Chronic Lymphocytic Leukemia
- Author
-
Mittal, Abhenil, Gogia, Ajay, Mallick, Saumyaranjan, and Gupta, Ritu
- Published
- 2019
- Full Text
- View/download PDF
21. Triplet Therapy in Metastatic Castrate Sensitive Prostate Cancer (mCSPC)—A Potential New Standard of Care.
- Author
-
Mittal, Abhenil, Sridhar, Srikala S., Ong, Michael, and Jiang, Di Maria
- Subjects
- *
PROSTATE cancer , *CANCER chemotherapy , *DOCETAXEL , *ANDROGEN receptors , *STEROID receptors - Abstract
The treatment paradigm for metastatic castrate-sensitive prostate cancer (mCSPC) has evolved rapidly in the past decade with the approval of several life-prolonging therapies including docetaxel chemotherapy and multiple androgen receptor pathway inhibitors (ARPI) in combination with androgen deprivation therapy (ADT). Recently reported phase-three trials have demonstrated a survival benefit of upfront triplet therapy with ADT, docetaxel plus either abiraterone acetate or darolutamide when compared to ADT plus docetaxel alone. However, multiple questions including the incremental benefit of docetaxel to a combination of ADT and ARPI, the timing of ARPI, optimal patient selection for triplet therapy and clinical and genomic biomarkers still remain to be answered. Moreover, real-world data suggest suboptimal treatment intensification with many patients treated with ADT alone highlighting challenges in implementation. In this article, we review the phase-three data associated with triplet therapy in mCSPC. We also discuss the knowledge gaps that exist despite the completion of these studies and how ongoing studies are likely to change the paradigm in the near future. Finally, we provide a simple algorithm based on current data that clinicians can use in daily practice to select patients for appropriate treatment strategies. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
22. Filling the Gap after CDK4/6 Inhibitors: Novel Endocrine and Biologic Treatment Options for Metastatic Hormone Receptor Positive Breast Cancer.
- Author
-
Mittal, Abhenil, Molto Valiente, Consolacion, Tamimi, Faris, Schlam, Ilana, Sammons, Sarah, Tolaney, Sara M., and Tarantino, Paolo
- Subjects
- *
GENETIC mutation , *BRCA genes , *CANCER chemotherapy , *METASTASIS , *CYCLIN-dependent kinases , *BIOTHERAPY , *ENDOCRINE system , *HORMONE receptor positive breast cancer , *CHEMICAL inhibitors - Abstract
Simple Summary: There are limited treatment options beyond chemotherapy for patients with hormone receptor positive metastatic breast cancer after progression on first line therapy with CDK4/6 inhibitors and endocrine therapy. Recently, encouraging evidence has emerged from multiple drugs in this space with the potential to delay chemotherapy and improve outcomes. The most promising agents include the AKT inhibitor capivasertib, the oral selective estrogen receptor degrader (SERD) elacestrant, and PARP inhibitors for patients harboring pathogenic germline BRCA1/2 mutations. Additionally, a subset of patients may also potentially be candidates for continuation of CDK4/6 inhibitors beyond progression. In this review, we highlight clinical data supporting the use of these agents and critically analyze the available evidence for their use. We also provide an algorithm to guide clinicians in their daily practice for patients with progression following first line CDK4/6 inhibitors and endocrine therapy. The rise of cyclin-dependent kinase (CDK)4/6 inhibitors has rapidly reshaped treatment algorithms for hormone receptor (HR)-positive metastatic breast cancer, with endocrine treatment (ET) plus a CDK4/6-inhibitor currently representing the standard of care in the first line setting. However, treatment selection for those patients experiencing progression while on ET + CDK4/6-inhibitors remains challenging due to the suboptimal activity or significant toxicities of the currently available options. There is also a paucity of data regarding the efficacy of older regimens, such as everolimus + exemestane, post-CDK4/6 inhibition. In this setting of high unmet need, several clinical trials of novel drugs have recently reported encouraging results: the addition of the AKT-inhibitor capivasertib to fulvestrant demonstrated a significant improvement in progression-free survival (PFS); the oral selective estrogen receptor degrader (SERD) elacestrant prolonged PFS compared to traditional ET in a phase 3 trial, particularly among patients with detectable ESR1 mutations; finally, PARP inhibitors are available treatment options for patients with pathogenic BRCA1/2 germline mutations. Overall, a plethora of novel endocrine and biologic treatment options are finally filling the gap between first-line ET and later line chemotherapy. In this review article, we recapitulate the activity of these novel treatment options and their potential role in future treatment algorithms. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
23. Spectrum and management of breast cancer patients with variant of uncertain significance mutations at a tertiary care centre in North India.
- Author
-
Mittal, Abhenil, Deo, S. V. S., Gogia, Ajay, Batra, Atul, Kumar, Akash, Bhoriwal, Sandeep, Deb, Koushik Sinha, Ramprasad, Ekta Dhamija V. L., Olopade, Olufunmilayo, and Pramanik, Raja
- Subjects
- *
CANCER patients , *BREAST cancer , *BRCA genes , *GENETIC testing , *TERTIARY care , *GENETIC recombination , *GENE targeting - Abstract
Background: The spectrum and significance of Variants of Uncertain Significance (VUS) mutations in breast cancer predisposition genes is poorly defined in the Indian population. Methods: All new female breast cancer patients from 1 March 2019 to 28 February 2020 were screened. Those providing informed consent and without previous genetic testing were recruited. Multigene panel testing (107 genes) by next-generation sequencing was performed for all patients. Descriptive statistics was used to describe the spectrum of VUS mutations. Results: Out of 236 patients recruited in the study, a VUS was detected in 89 patients (37.71%). VUS pathogenic ratio was 2.02. A total of 121 different VUS mutations in 40 different genes were detected. Fourteen patients (15.7%) had a VUS in high penetrance genes and 36 VUS mutations (29.8%) were detected in one of the genes involved in homologous recombination repair pathway. No therapeutic interventions were done based on VUS. Conclusions: In this large prospective study of genetic determinants of breast cancer from India, a high prevalence of VUS (37.71%) was detected with 15.7% patients having a VUS in high penetrance genes. More evidence needs to be generated from larger multicentric studies to better understand the implications of these genetic variants and enable their reclassification. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
24. Current status of systemic therapy in head and neck cancer.
- Author
-
Mittal, Abhenil and Sharma, Atul
- Published
- 2022
- Full Text
- View/download PDF
25. Late effects in pediatric Hodgkin lymphoma survivors after uniform treatment with ABVD with or without radiotherapy.
- Author
-
Mittal, Abhenil, Bhethanabhotla, Sainath, Ganguly, Shuvadeep, Vishnubhatla, Sreenivas, Khadgawat, Rajesh, Patel, Chetan, Mohan, Anant, Biswas, Ahitagni, and Bakhshi, Sameer
- Published
- 2021
- Full Text
- View/download PDF
26. Imaging and Pathological Features of Alveolar Soft Part Sarcoma: Analysis of 16 Patients.
- Author
-
Gulati, Malvika, Mittal, Abhenil, Barwad, Adarsh, Pandey, Rambha, Rastogi, Sameer, and Dhamija, Ekta
- Subjects
- *
CANCER diagnosis , *MUSCLE cells , *CONFIDENCE intervals , *CANCER , *SOFT tissue tumors , *CANCER patients , *MEDICAL records , *DESCRIPTIVE statistics , *SARCOMA - Abstract
Context Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor most commonly occurring in deep intramuscular plane of lower extremities of adolescents and young adults. It is a highly vascular, slow growing tumor with malignant potential having lung as the most common site of metastases at the time of presentation. Aims The aim is to review the imaging findings of ASPS and determine characteristic imaging features of this rare tumor. Materials and Methods Sixteen patients having histopathological diagnosis and preoperative imaging of ASPS attending the dedicated sarcoma clinic at our institute were included in the study. The demographic, clinical, and imaging data were retrieved from the case records and then evaluated for characteristic imaging features which may raise suspicion of ASPS. Results The patients ranged from 3 to 72 years of age and with a slight male preponderance. Of the eight CECTs evaluated, 62.5% tumors showed well-defined lobulated margins, 87.5% cases showed intense enhancement with presence of feeder vessels. On CEMRI of 10 patients, 70% had well circumscribed lobulated margins with intense enhancement and tortuous flow voids in most of them. All cases showed T2 hyperintense signal. Fourteen of 16 (87.5%) patients had metastatic disease with lung as the most common site (92.8%). Conclusion ASPS is a rare soft tissue sarcoma seen in children and young adults. Imaging may mimic a vascular malformation due to the presence of tortuous feeders. Misdiagnosis at an early stage may lead to later metastatic presentation of the disease, thus emphasizing the need to suspect it on imaging. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
27. Sustained complete response on crizotinib in primary lung inflammatory myofibroblastic tumor - Case report and literature review.
- Author
-
Mittal, Abhenil, Gupta, Aarushi, Dhamija, Ekta, Barwad, Adarsh, and Rastogi, Sameer
- Subjects
LUNGS ,SOFT tissue tumors ,CRIZOTINIB ,LITERATURE reviews ,TEENAGERS ,COUGH - Abstract
Inflammatory myofibroblastic tumors (IMT) are rare soft tissue tumors of intermediate malignant potential occurring usually in children and adolescents. Treatment options for advanced disease are limited. A 35-year-old lady presented to us with fever, cough and decreased appetite. On evaluation, she was diagnosed with left lung IMT. She underwent surgery and developed recurrence with pleural nodules after two years. Immunohistochemistry showed positivity for ALK (diffuse). Since recent evidence suggested that crizotinib is effective in advanced IMT with 50% response rates, she was treated with crizotinib 250mg BD with which she had a complete radiological response at three months. She has completed one year of treatment thus far and continues to be in complete remission. Treatment with ALK inhibitors like crizotinib has brought about a paradigm shift in the management of advanced ALK-positive IMT's with excellent clinical responses which are durable in a majority of cases. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
28. Recurrent germ cell tumour presenting as fractured neck of the femur.
- Author
-
Sharma, Aparna, Mittal, Abhenil, Barwad, Adarsh, Mridha, Asit Ranjan, Venkatesan, S, Sahoo, Ranjit Kumar, and Batra, Atul
- Published
- 2022
- Full Text
- View/download PDF
29. Predictors of Dengue-Related Mortality and Disease Severity in a Tertiary Care Center in North India
- Author
-
Jain, Siddharth, Mittal, Abhenil, Sharma, Surendra Kumar, Upadhyay, Ashish Datt, Pandey, Ravindra Mohan, Sinha, Sanjeev, Soneja, Manish, Biswas, Ashutosh, Jadon, Ranveer Singh, Kakade, Mahadeo B., and Dayaraj, Cecilia
- Subjects
severity ,predictors ,outbreak ,Major Article ,dengue shock ,mortality - Abstract
Background. There is lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak in India. Methods. This prospective observational study included confirmed adult dengue patients hospitalized between August and November 2015 in a tertiary care centre in New Delhi, India. Appropriate statistical tests were used to compare clinicolaboratory characteristics, derive predictors of severe disease and mortality, and compute a predictive score for mortality. Serotyping was done. Results. Data of 369 patients were analyzed (mean age, 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (grade 1 or 2), and 46 (12%) developed dengue shock syndrome (DSS). Twenty-two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnea at rest were identified as independent predictors of severe disease. Age ≥24 years, dyspnea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnea), which, if ≥22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were dengue virus DENV2 and DENV4. Conclusion. Age ≥24 years, dyspnea at rest, and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine outcome in dengue patients. Timely referral/access to healthcare is important. The clinical risk score for mortality prediction that was developed in this study can be used in all healthcare settings, after validation in larger cohorts.
- Published
- 2017
30. Recurrent infantile inflammatory myofibroblastic tumor of mesentery––Case report and review of imaging findings
- Author
-
Gupta, Aarushi, Sharma, Swati, Mittal, Abhenil, Barwad, Adarsh, and Rastogi, Sameer
- Published
- 2021
- Full Text
- View/download PDF
31. Management of advanced melanoma in the current era: A medical oncology perspective for the Indian scenario.
- Author
-
MITTAL, ABHENIL, PUSHPAM, DEEPAM, and BAKHSHI, SAMEER
- Subjects
DRUG utilization ,MELANOMA ,ONCOLOGY ,BRAF genes ,IMMUNOTHERAPY - Abstract
Malignant melanoma is an aggressive malignancy with high recurrence rates after curative surgery and in advanced stages is characterized by resistance to conventional chemotherapy. With better understanding of the genomic landscape and mutational signature of these tumours over the past decade, there has been a paradigm shift in management of melanoma using immunotherapy (anti-PD-1 and anti-CTLA-4 antibodies) and targeted drugs against BRAF and MEK. These drugs have shown survival benefits in both adjuvant and metastatic setting with patients being eligible for immunotherapy irrespective of any biomarker. However, these drugs have varying toxicity profiles and there are no studies comparing these two classes of drugs in either the adjuvant or metastatic setting leaving the question of sequencing open to clinical judgement. Moreover, availability and cost are issues that need to be considered before use of these drugs in the Indian setting. [ABSTRACT FROM AUTHOR]
- Published
- 2020
32. Isolated central nervous system relapse of multiple myeloma post autologous stem cell transplant- A rare presentation
- Author
-
Mittal, Abhenil, Pushpam, Deepam, and Kumar, Lalit
- Published
- 2020
- Full Text
- View/download PDF
33. Role of Hypomethylating Agents in the Treatment of AML: Retrospective Study at a Tertiary Care Center
- Author
-
Naik, Ramavath Devendra, Kumar, Lalit, Baa, Annie K., Mittal, Abhenil, Sahitya, Dsk, Sahoo, Ranjit K., and Singh, Vishwajeet
- Published
- 2019
- Full Text
- View/download PDF
34. Prognostic value of human leukocyte antigen G (HLA-G) expression in solid tumors: A systematic review and meta-analysis.
- Author
-
Bartolome, Jorge, Molto, Consolacion, Benitez Fuentes, Javier David, Fernández-Hinojal, Gonzalo, Manzano, Aránzazu, Perez Segura, Pedro, Mittal, Abhenil, Tamimi, Faris, Amir, Eitan, and Ocana, Alberto
- Published
- 2023
- Full Text
- View/download PDF
35. Imbalance in treatment discontinuation without progression between experimental and control arms among randomized trials in advanced breast cancer.
- Author
-
Tamimi, Faris, Mittal, Abhenil, Molto, Consolacion, Malon Gimenez, Diego, Nadler, Michelle B., and Amir, Eitan
- Published
- 2023
- Full Text
- View/download PDF
36. The survival outcomes of metastatic non-clear cell renal cell carcinoma in the immunotherapy era: Princess Margaret Cancer Centre (PMCC) experience.
- Author
-
Al-Ezzi, Esmail Mutahar, Mittal, Abhenil, Veitch, Zachary William Neil, Zahralliyali, Amer, Diaz Mejia, Nely Mercy, Abdeljalil, Osama, Alqaisi, Husam, Kumar, Vikaash, Fallah-Rad, Nazanin, and Sridhar, Srikala S.
- Published
- 2023
- Full Text
- View/download PDF
37. Skin metastasis: a rare presentation in testicular germ cell tumour.
- Author
-
Vanidassane, Ilavarasi, Mittal, Abhenil, Kumar, Chandan, Tanwar, Pranay, Sahoo, Ranjit Kumar, and Batra, Atul
- Abstract
A 35-year-old man presented with a history of cough, haemoptysis, weight loss for 2 months along with ulceroproliferative lesions on the chin and the scalp. On evaluation he was found to have non-seminomatous germ cell tumour, stage 3 c, poor risk with Eastern Cooperative Oncology Group Performance Status of 4. The skin lesions were proven to be metastasis by fine-needle aspiration cytology. He showed significant improvement with a 3-day protocol of abbreviated etoposide and cisplatin chemotherapy and is planned for 4 cycles of VIP. This case describes an uncommon presentation of germ cell tumour in the form of skin metastasis with excellent response to chemotherapy. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
38. Letter to the Editor: Immune Checkpoint Inhibitors in Alveolar Soft Part Sarcoma: New Standard of Care?
- Author
-
Mittal, Abhenil, Arun Raj, ST, Gupta, Aarushi, Shamim, Shamim Ahmed, Barwad, Adarsh, and Rastogi, Sameer
- Subjects
- *
DISEASE progression , *BUTTOCKS , *BIOPSY , *LUNGS , *IMMUNOHISTOCHEMISTRY , *MAGNETIC resonance imaging , *PROTEIN-tyrosine kinase inhibitors , *TREATMENT effectiveness , *COMPUTED tomography , *SARCOMA , *EDEMA - Published
- 2021
- Full Text
- View/download PDF
39. Selected Summary.
- Author
-
GOGIA, AJAY, MITTAL, ABHENIL, SHARMA, ATUL, and SAGIRAJU, HARI KRISHNA RAJU
- Subjects
CANCER relapse ,HER2 positive breast cancer ,EPIDERMAL growth factor receptors - Abstract
The article summarizes the study "Evaluation of 1-Year Versus Shorter Durations of Adjuvant Trastuzumab Among Patients With Early Breast Cancer: An Individual Participant Data and Trial-Level Meta-Analysis" which appeared in the 2020 issue of "JAMA Network Open." Topics discussed include the use of six randomized clinical trials in the meta-analysis, approach to cardiotoxicity associated with trastuzumab, and the need to determine the optimum trastuzumab duration for patients.
- Published
- 2021
40. Adding ovarian suppression to tamoxifen for pre-menopausal breast cancer.
- Author
-
MITTAL, ABHENIL and GOGIA, AJAY
- Subjects
BREAST cancer ,OVERALL survival ,TAMOXIFEN ,PROGRESSION-free survival ,ADJUVANT chemotherapy - Abstract
The ASTRAA trial by Kim et al. delves into a controversial area in breast oncology--role of ovarian function suppression (OFS) in premenopausal women with breast cancer. This question is more relevant in the Indian scenario where the median age of breast cancer is 47 years and a majority of women require chemotherapy as they have locally advanced disease at presentation.1,2 Even after the publication of the results of three large randomized trials and a meta-analysis,3-6 the value of adding OFS to standard therapy is not clear. If we look at the updated results of the SOFT and TEXT trials (reference updated analysis), the benefit of adding ovarian suppression was seen only in patients who required chemotherapy. The other group of patients who were sufficiently low risk not to warrant adjuvant chemotherapy did well irrespective of hormonal therapy regimen. Although distant recurrencefree survival and disease-free survival (DFS) were better with exemestane and OFS compared to OFS and tamoxifen, overall survival showed a reverse trend making interpretation of data difficult. Moreover, toxicity of 5 years of OFS was significant with 30% grade 3-4 toxicity in OFS arms in both SOFT and TEXT trials leading to 25%-30% early discontinuation rates. In this context, Kim et al. tried to answer the question whether benefits of OFS are maintained when duration is reduced to 2 years. They randomized only those patients who received chemotherapy, thus addressing the limitation of SOFT trial in which benefits in overall population might have been underestimated by the good-risk subset of patients not requiring chemotherapy. They also allowed for delayed recovery of ovarian function up to 2 years allowing more patients to be randomized and mimicking the real-world scenario more closely. The trial results showed a 4% DFS benefit in favour of OFS plus tamoxifen over tamoxifen alone. The events were too few to draw any firm conclusions about overall survival. [ABSTRACT FROM AUTHOR]
- Published
- 2020
41. Adjuvant chemotherapy in early breast cancer: Are we over-treating patients?
- Author
-
MITTAL, ABHENIL and BATRA, ATUL
- Subjects
CANCER chemotherapy ,ADJUVANT treatment of cancer ,MEDICAL sciences ,HORMONE receptor positive breast cancer ,TRIPLE-negative breast cancer ,METASTATIC breast cancer ,OBESITY ,ONCOLOGISTS ,MORTALITY - Abstract
The article focuses on adjuvant chemotherapy has been the standard of care for patients with early breast cancer (EBC) based on the studies of the National Surgical Adjuvant Breast and Bowel Project. Topics include the most EBC patients has especially those who being hormone-positive and lymph node-negative, the histological features may not be enough to make decisions regarding adjuvant therapy, and the recurrence score in 2004 in their landmark paper called Oncotype DX based on genes.
- Published
- 2019
42. High degree of fluoroquinolone resistance among pulmonary tuberculosis patients in New Delhi, India.
- Author
-
Sharma, Rohini, Sharma, Surendra, Singh, Binit, Mittal, Abhenil, and Kumar, Prahlad
- Subjects
- *
TUBERCULOSIS , *TUBERCULOSIS patients , *MYCOBACTERIUM tuberculosis , *DRUG resistance , *CLINICAL drug trials - Abstract
Background & objectives: The fluoroquinolones (FQs) group of antibiotics is the backbone drugs for the management of drug-resistant tuberculosis (TB). In routine clinical practice, drug susceptibility testing (DST) for FQs is not performed, and the patients are empirically treated. A limited information exists regarding FQs resistance among pulmonary TB cases. The present study was conducted to determine the FQs resistance among drug sensitive and drug-resistant pulmonary TB patients in a tertiary care centre in north India. Methods: A total of 1619 sputum/smear-positive specimens of pulmonary TB patients were subjected to DST for first-line drugs (FLDs) and second-line drugs. In addition, FQs DST was also performed using automated Mycobacterial Growth Indicator Tube-960 liquid culture technique. The immuno-chromatographic assay was performed to distinguish Mycobacterium tuberculosis complex (MTBC) from non-MTBC. Results: Mycobacterium tuberculosis (Mtb) was isolated in 1499 sputum specimens; 1099 culture specimens were sensitive to FLDs, 249 grew as multidrug-resistant (MDR) Mtb and the remaining 151 isolates revealed any drug resistance to FLDs. While FQs monoresistance among the FLD sensitive isolates was 3.1 per cent (35/1099), 27.3 per cent (68/249) among MDR Mtb isolates had additional FQs resistance. Interpretation & conclusions: FQs resistance among drug sensitive and MDR Mtb isolates was high in Delhi, India. Based on these findings, it is recommended that the DST for FQs should be routinely performed to avoid further amplification of drug resistance. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
43. Prognostic value of human leukocyte antigen G expression in solid tumors: a systematic review and meta-analysis.
- Author
-
Bartolome J, Molto C, Benitez-Fuentes JD, Fernandez-Hinojal G, Manzano A, Perez-Segura P, Mittal A, Tamimi F, Amir E, and Ocana A
- Subjects
- Humans, Disease-Free Survival, Prognosis, Progression-Free Survival, HLA-G Antigens genetics, Neoplasms metabolism
- Abstract
Introduction: Identification of modulators of the immune response with inhibitory properties that could be susceptible for therapeutic intervention is a key goal in cancer research. An example is the human leukocyte antigen G (HLA-G), a nonclassical major histocompatibility complex (MHC) class I molecule, involved in cancer progression., Methods: In this article we performed a systematic review and meta-analysis on the association between HLA-G expression and outcome in solid tumors. This study was performed in accordance with PRISMA guidelines and registered in PROSPERO., Results: A total of 25 studies met the inclusion criteria. These studies comprised data from 4871 patients reporting overall survival (OS), and 961 patients, reporting disease free survival (DFS). HLA-G expression was associated with worse OS (HR 2.09, 95% CI = 1.67 to 2.63; P < .001), that was higher in gastric (HR = 3.40; 95% CI = 1.64 to 7.03), pancreatic (HR = 1.72; 95% CI = 0.79 to 3.74) and colorectal (HR = 1.55; 95% CI = 1.16 to 2.07) cancer. No significant differences were observed between the most commonly utilized antibody (4H84) and other methods of detection. HLA-G expression was associated with DFS which approached but did not meet statistical significance., Discussion: In summary, we describe the first meta-analysis associating HLA-G expression and worse survival in a variety of solid tumors., Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022311973., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Bartolome, Molto, Benitez-Fuentes, Fernandez-Hinojal, Manzano, Perez-Segura, Mittal, Tamimi, Amir and Ocana.)
- Published
- 2023
- Full Text
- View/download PDF
44. Changes in circulating tumor DNA and outcomes in solid tumors treated with immune checkpoint inhibitors: a systematic review.
- Author
-
Al-Showbaki L, Wilson B, Tamimi F, Molto C, Mittal A, Cescon DW, and Amir E
- Subjects
- Humans, Immune Checkpoint Inhibitors pharmacology, Immune Checkpoint Inhibitors therapeutic use, Prognosis, Biomarkers, Lung Neoplasms drug therapy, Circulating Tumor DNA genetics
- Abstract
Background: Quantification of circulating tumor DNA (ctDNA) levels is a reliable prognostic tool in several malignancies. Dynamic changes in ctDNA levels in response to treatment may also provide prognostic information. Here, we explore the value of changes in ctDNA levels in response to immune checkpoint inhibitors (ICIs)., Methods: We searched MEDLINE (host: PubMed) for trials of ICIs in advanced solid tumors in which outcomes were reported based on change in ctDNA levels. ctDNA reduction was defined as reported in individual trials. Typically, this was either >50% reduction or a reduction to undetectable levels. We extracted HRs and related 95% CIs and/or p values comparing ctDNA reduction versus no reduction for progression-free survival (PFS) and/or overall survival (OS). Data were then pooled in a meta-analysis. Variation in effect size was examined using subgroup analyses., Results: Eighteen trials were included in the meta-analysis. ctDNA levels were detectable in all participants in all studies prior to initiation of ICIs. A reduction in ctDNA measured 6-16 weeks after starting treatment was associated with significantly better PFS (HR 0.20; 95% CI, 0.14 to 0.28; p<0.001). Similarly, OS was superior in patients with reduced ctDNA levels (HR 0.18; 95% CI, 0.12 to 0.26; p<0.001). The results were consistent across all disease sites, lines of treatment, magnitude of change (to undetectable vs >50% reduction) and whether treatment exposure comprised single or combination ICIs., Conclusions: In advanced solid tumors, a reduction in ctDNA levels in response to ICIs is associated with substantial improvements in outcome. ctDNA change is an early response biomarker which may allow for de-escalation of cross-sectional imaging in patients receiving ICIs or support treatment de-escalation strategies., Competing Interests: Competing interests: DWC: Consulting or Advisory Role - AstraZeneca; Eisai; Exact Sciences; Gilead Sciences; GlaxoSmithKline; Merck; Novartis; Pfizer; Roche/GenentechResearch Funding - AstraZeneca (Inst); GlaxoSmithKline (Inst); Inivata (Inst); Merck (Inst); Pfizer (Inst); Roche/Genentech (Inst)Patents, Royalties, Other Intellectual Property - Patent (US62/675,228) for methods of treating cancers characterized by a high expression level of spindle and kinetochore-associated complex subunit 3 (ska3) gene. EA: Honoraria - Exact Sciences; Novartis; Sandoz. LA-S, BW, FT, CM and AM have nothing to disclose., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
- Full Text
- View/download PDF
45. Erratum: Near-complete response to low-dose ceritinib in recurrent infantile inflammatory myofibroblastic tumour.
- Author
-
Mittal A, Gupta A, Rastogi S, Barwad A, and Sharma S
- Abstract
[This corrects the article on p. 1 in vol. 15.]., (© the authors; licensee ecancermedicalscience.)
- Published
- 2021
- Full Text
- View/download PDF
46. Near-complete response to low-dose ceritinib in recurrent infantile inflammatory myofibroblastic tumour.
- Author
-
Mittal A, Gupta A, Rastogi S, Barwad A, and Sharma S
- Abstract
Background: Infantile inflammatory myofibroblastic tumour (IMT) is rare and the majority are driven by anaplastic lymphoma kinase (ALK) rearrangements. Previous literature on the use of ALK inhibitors in paediatric IMTs is extremely limited with no published literature on the use in infants. Crizotinib and ceritinib are two ALK inhibitors which are available and have been used in IMTs; however, ceritinib is much more affordable in the low- and middle-income country (LMIC) setting than crizotinib., Case: An 11-month-old child, who had undergone surgery for mesenteric IMT at the age of 3 months, had an unresectable recurrence with soft tissue deposits in the subdiaphragmatic location abutting the spleen and paravesical location. As surgery would have entailed splenectomy and partial cystectomy, she was treated with low-dose ceritinib (300 mg/m2/day) with which she had a near-complete response without any toxicity., Discussion and Conclusion: This is the first report of the use of ceritinib at a lower dose for infantile IMT having immense practical applications for the low- and middle-income setting., Competing Interests: None., (© the authors; licensee ecancermedicalscience.)
- Published
- 2021
- Full Text
- View/download PDF
47. Trabectedin in Advanced Sarcomas-Experience at a Tertiary Care Center and Review of Literature.
- Author
-
Verma S, Kalra K, Rastogi S, Dhamija E, Upadhyay A, Mittal A, Aggarwal A, and Shamim SA
- Abstract
Background There is sparse literature on trabectedin in advanced soft-tissue sarcomas from developing world. It would be interesting to know about use and outcomes of trabectedin in Indian patients. Method In a retrospective study, consecutive patients treated with trabectedin from 2016 to 2019 were analyzed. Patients with L-sarcomas were treated at a dose of 1.5 mg/m
2 , while those with translocation-related sarcomas were treated at a dose of 1.2 mg/m2 as a 24-hour infusion through peripherally inserted central catheter line. From July 2019, infusions were administered through an ambulatory elastomeric pump, while before that patients were admitted for 24 hours. We used SPSS version 23.0 for statistical calculation. Result A total of 20 patients received trabectedin with a total of 116 infusions. The median age was 46 years (range: 22-73 years). The male ( n = 11, 55%) and female patients were almost equal ( n = 9, 45%). Thirteen patients (65%) had Eastern Cooperative Oncology Group Performance Status 1. Majority of the patients had leiomyosarcoma ( n = 8, 40%); remaining comprised of liposarcoma (3, 15%), translocation-related sarcomas excluding myxoid liposarcoma ( n = 8, 40%) and others ( n = 1,5%). Most common site was extremity ( n = 11, 55%) followed by retroperitoneal ( n = 3, 15%), visceral ( n = 3, 15%), and others ( n = 3,15%). Median number of previous lines received was 2 (range: 0-4). Median number of trabectedin cycles received was 4 (range: 1-17). Best response assessed was stable disease ( n = 10, 50%), progressive disease ( n = 6, 30%), partial response ( n = 1, 5%), and not assessed in 3 patients. After a median follow-up of 19 months, median progression-free survival was 4 months. Conclusion In this heavily treated population (composed of L-sarcomas and translocation-related sarcomas) with many patients with poor performance status, the outcome with trabectedin is in synchrony with literature. However, the need of 24-hour admission might deter quality of life. Elastomeric pump seems to be a reasonable alternative to admission and can be a breakthrough in administering trabectedin, especially in developing countries., Competing Interests: Conflict of Interest None., (MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)- Published
- 2021
- Full Text
- View/download PDF
48. Short-duration adjuvant trastuzumab therapy in human epidermal growth factor receptor 2-positive breast cancers: Has its time come?
- Author
-
Gogia A, Mittal A, Sharma A, and Sagiraju HKR
- Subjects
- Combined Modality Therapy, Female, Humans, Receptor, ErbB-2, Trastuzumab adverse effects, Breast Neoplasms drug therapy
- Abstract
Competing Interests: None
- Published
- 2021
- Full Text
- View/download PDF
49. Recurrent infantile inflammatory myofibroblastic tumor of mesentery--Case report and review of imaging findings.
- Author
-
Gupta A, Sharma S, Mittal A, Barwad A, and Rastogi S
- Abstract
Inflammatory myofibroblastic tumors (IMT) are rare soft tissue tumors of intermediate malignant potential with tendency for local recurrence. Although they can occur at all age groups, occurrence in infants is extremely unusual and their imaging characteristics are not well described. A 3-month-old female infant presented with gradually progressive abdominal distention without any fever or weight loss. She had a large ill-defined homogenous hypodense lesion of size 8.4 × 11.4 × 11.3 cm (APxTraxSag) in the abdomen showing mild delayed post contrast enhancement. She underwent exploratory laparotomy with gross total excision of mesenteric mass, histopathology of which was suggestive of IMT. She had recurrence within 6 months of complete resection with a well-defined heterogeneously enhancing lesion of size 1.8 × 1.8 × 2.3cm (APxTraxSag) in right paravesical region abutting the bladder without invasion with a similar lesion of size 4.4 × 2.1 × 3 cm (APxTraxSag) in left subdiaphragmatic region abutting superior surface of spleen (no invasion). Since, surgery in our patient would have entailed splenectomy and partial cystectomy, systemic therapy with ceritinib (anaplastic lymphoma kinase [ALK] inhibitor) was planned for her with which she had a near complete response after 2 months. A high index of suspicion is required to differentiate IMT from other common causes of mesenteric masses in children and role of radiologist is quintessential in this regard. Local recurrence with abutment but without invasion of surrounding structures points to the intermediate malignant pathology of IMT and may provide a clue to diagnosis. Systemic therapy is effective in patients who are ALK positive and destructive surgery should be avoided., (© 2020 Published by Elsevier Inc. on behalf of University of Washington.)
- Published
- 2020
- Full Text
- View/download PDF
50. Shortened treatment regimens versus the standard regimen for drug-sensitive pulmonary tuberculosis.
- Author
-
Grace AG, Mittal A, Jain S, Tripathy JP, Satyanarayana S, Tharyan P, and Kirubakaran R
- Subjects
- Clinical Protocols, Drug Administration Schedule, Drug Combinations, Drug Therapy, Combination methods, Humans, Randomized Controlled Trials as Topic, Antitubercular Agents therapeutic use, Tuberculosis, Pulmonary drug therapy
- Abstract
Background: Tuberculosis causes more deaths than any other infectious disease worldwide, with pulmonary tuberculosis being the most common form. Standard first-line treatment for drug-sensitive pulmonary tuberculosis for six months comprises isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE) for two months, followed by HRE (in areas of high TB drug resistance) or HR, given over a four-month continuation phase. Many people do not complete this full course. Shortened treatment regimens that are equally effective and safe could improve treatment success., Objectives: To evaluate the efficacy and safety of shortened treatment regimens versus the standard six-month treatment regimen for individuals with drug-sensitive pulmonary tuberculosis., Search Methods: We searched the following databases up to 10 July 2019: the Cochrane Infectious Diseases Group Specialized Register; the Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE (PubMed); Embase; the Latin American Caribbean Health Sciences Literature (LILACS); Science Citation Index-Expanded; Indian Medlars Center; and the South Asian Database of Controlled Clinical Trials. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform, ClinicalTrials.gov, the Clinical Trials Unit of the International Union Against Tuberculosis and Lung Disease, the UK Medical Research Council Clinical Trials Unit, and the Clinical Trials Registry India for ongoing trials. We checked the reference lists of identified articles to find additional relevant studies., Selection Criteria: We searched for randomized controlled trials (RCTs) or quasi-RCTs that compared shorter-duration regimens (less than six months) versus the standard six-month regimen for people of all ages, irrespective of HIV status, who were newly diagnosed with pulmonary tuberculosis by positive sputum culture or GeneXpert, and with presumed or proven drug-sensitive tuberculosis. The primary outcome of interest was relapse within two years of completion of anti-tuberculosis treatment (ATT)., Data Collection and Analysis: Two review authors independently selected trials, extracted data, and assessed risk of bias for the included trials. For dichotomous outcomes, we used risk ratios (RRs) with 95% confidence intervals (CIs). When appropriate, we pooled data from the included trials in meta-analyses. We assessed the certainty of evidence using the GRADE approach., Main Results: We included five randomized trials that compared fluoroquinolone-containing four-month ATT regimens versus standard six-month ATT regimens and recruited 5825 adults with newly diagnosed drug-sensitive pulmonary tuberculosis from 14 countries with high tuberculosis transmission in Asia, Africa, and Latin Ameria. Three were multi-country trials that included a total of 572 HIV-positive people. These trials excluded children, pregnant or lactating women, people with serious comorbid conditions, and those with diabetes mellitus. Four trials had multiple treatment arms. Moxifloxacin replaced ethambutol in standard four-month, daily or thrice-weekly ATT regimens in two trials; moxifloxacin replaced isoniazid in four-month ATT regimens in two trials, was given daily in one trial, and was given with rifapentine instead of rifampicin daily for two months and twice weekly for two months in one trial. Moxifloxacin was added to standard ATT drugs for three to four months in one ongoing trial that reported interim results. Gatifloxacin replaced ethambutol in standard ATT regimens given daily or thrice weekly for four months in two trials. Follow-up ranged from 12 months to 24 months after treatment completion for the majority of participants. Moxifloxacin-containing four-month ATT regimens Moxifloxacin-containing four-month ATT regimens that replaced ethambutol or isoniazid probably increased the proportions who experienced relapse after successful treatment compared to standard ATT regimens (RR 3.56, 95% CI 2.37 to 5.37; 2265 participants, 3 trials; moderate-certainty evidence). For death from any cause, there was probably little or no difference between the two regimens (2760 participants, 3 trials; moderate-certainty evidence). Treatment failure was rare, and there was probably little or no difference in proportions with treatment failure between ATT regimens (2282 participants, 3 trials; moderate-certainty evidence). None of the participants given moxifloxacin-containing regimens developed resistance to rifampicin, and these regimens may not increase the risk of acquired resistance (2282 participants, 3 trials; low-certainty evidence). Severe adverse events were probably little or no different with moxifloxacin-containing four-month regimens that replaced ethambutol or isoniazid, and with three- to four-month regimens that augmented standard ATT with moxifloxacin, when compared to standard six-month ATT regimens (3548 participants, 4 trials; moderate-certainty evidence). Gatifloxacin-containing four-month ATT regimens Gatifloxacin-containing four-month ATT regimens that replaced ethambutol probably increased relapse compared to standard six-month ATT regimens in adults with drug-sensitive pulmonary tuberculosis (RR 2.11, 95% CI 1.56 to 2.84; 1633 participants, 2 trials; moderate-certainty evidence). The four-month regimen probably made little or no difference in death compared to the six-month regimen (1886 participants, 2 trials; moderate-certainty evidence). Treatment failure was uncommon and was probably little or no different between the four-month and six-month regimens (1657 participants, 2 trials; moderate-certainty evidence). Acquired resistance to isoniazid or rifampicin was not detected in those given the gatifloxacin-containing shortened ATT regimen, but we are uncertain whether acquired drug resistance is any different in the four- and six-month regimens (429 participants, 1 trial; very low-certainty evidence). Serious adverse events were probably no different with either regimen (1993 participants, 2 trials; moderate-certainty evidence)., Authors' Conclusions: Evidence to date does not support the use of shortened ATT regimens in adults with newly diagnosed drug-sensitive pulmonary tuberculosis. Four-month ATT regimens that replace ethambutol with moxifloxacin or gatifloxacin, or isoniazid with moxifloxacin, increase relapse substantially compared to standard six-month ATT regimens, although treatment success and serious adverse events are little or no different. The results of six large ongoing trials will help inform decisions on whether shortened ATT regimens can replace standard six-month ATT regimens. 9 December 2019 Up to date All studies incorporated from most recent search All eligible published studies found in the last search (10 Jul, 2019) were included., (Copyright © 2019 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.)
- Published
- 2019
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.