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IntroductionIn locally advanced cervical cancer, nodal, local and distant relapse continue to be significant patterns of relapse. Therefore, strategies to improve the efficacy of chemoradiation are desirable such as biological pathway modifiers and immunomodulating agents. This trial will investigate the impact of nelfinavir, a protease inhibitor that targets the protein kinase B (AKT) pathway on disease-free survival (DFS).Methods and analysisRadiosensitising effect of nelfinavir in locally advanced carcinoma of cervix is a single-centre, open-label, parallel-group, 1:1 randomised phase-III study. Patients aged over 18 years with a diagnosis of carcinoma cervix stage III are eligible for the study. After consenting, patients will undergo randomisation to chemoradiation and brachytherapy arm or nelfinavir with chemoradiation and brachytherapy arm. The primary aim of the study is to compare the difference in 3-year DFS between the two arms. Secondary aims are locoregional control, overall survival, toxicity and quality of life between the two arms. Pharmacokinetics of nelfinavir and its impact on tumour AKT, programmed cell death ligand 1, cluster of differentiation 4, cluster of differentiation 8 and natural killer 1.1 expression will be investigated. The overall sample size of 348 with 1 planned interim analysis achieves 80% power at a 0.05 significance level to detect a HR of 0.66 when the proportion surviving in the control arm is 0.65. The planned study duration is 8 years.Ethics and disseminationThe trial is approved by the Institutional Ethics Committee-I of Tata Memorial Hospital, Mumbai (reference number: IEC/0317/1543/001) and will be monitored by the data safety monitoring committee. The study results will be disseminated via peer-reviewed scientific journals, and conference presentations. Study participants will be accrued after obtaining written informed consent from them. The confidentiality and privacy of study participants will be maintained.Trial registration numberThe trial is registered with Clinical Trials Registry-India (CTRI/2017/08/009265) and ClinicalTrials.gov (NCT03256916).

Introduction: The most common form of cardiotoxicity in cancer treatment is anthracycline-related cardiomyopathy. Objective: To study the factors affecting response to heart failure (HF) therapy in patients with anthracycline- related cardiomyopathy (ARC). Methods: Patients with ARC were included in the study. ARC was defined as left ventricular ejection fraction (LVEF) < 50% in patients who had received anthracycline based chemotherapy. 2Decho was done at baseline and every 3 months after starting anti-heart failure treatment. The primary endpoint of the study was response to anti-heart failure treatment. The patients were considered as responders when LVEF increased at least 10 absolute points. The secondary endpoint was overall survival. Results: 177 patients with ARC were included in the study. The median cumulative dose of doxorubicin was 275 mg/m2. Median clinical follow up duration was 19 months (range 3–73 months). 55% were responders. 25 cumulative doxorubicin dose of more than 200 mg/m2 increased the likelihood of non-response (p = 0.008), by a factor of 3.07 (95% CI: 1.34–7.05). 25 patients expired. There was a significant difference in overall survival among responders as compared to non-responders (p value: 0.002, log rank test). Conclusions: In patients with ARC cumulative doxorubicin dose of more than 200 mg/m2 increased the likelihood of non-response to anti-heart failure treatment. Responders have a better overall survival compared to non-responders in patients with ARC.

Cisplatin has been used for over 40 years in various cancer chemotherapies. Toxicity induced by cisplatin-based therapeutic regimens include gastrointestinal toxicity, myelotoxicity, neurotoxicity, ototoxicity and nephrotoxicity. Cisplatin-based regimens have been associated with a wide range of cardiovascular complications. In this paper, we report 2 cases of cisplatin-induced cardiotoxicity. We present cases of 2 young patients who developed acute myocardial infarction during combination chemotherapy with bleomycin, etoposide and cisplatin. The first patient had acute anterior wall ST elevation myocardial infarction and the second one had acute myocardial infarction with peripheral arterial thromboembolism. Cisplatin use can result in cardiovascular events. Clinicians should be very cautious while managing patients on cisplatin-based che

45 year old male from Bihar, presented with carcinoma of left gingivobuccal sulcus (GBS). As part of his workup chest X-ray was done which showed multiple well defined slender shaped (“rice grain”) calcifications noted in subcutaneous tissue & along neck muscles, with their long axes oriented in the plane of the muscle fibers .This appearance is highly suggestive of cysticercosis. After asking the patient repeatedly later gives history of convulsions (since 15 years).He was non-vegetarian with frequent consumption of pork. CT scan done-showed multiple cystic lesions most of which were calcified inactive stage (Figure 1); few of the lesions show post contrast enhancement and active non calcified scolex in the vesicular stage. He was treated for neurocysticercosis after which he underwent treatment for malignancy with Surgery-mandible composite resection and neck dissection modified type II. Post-surgery received Radiotherapy. He is on regular follow up. Cysticercosis is a parasitic infection that results from ingestion of eggs from the adult tapeworm, Taenia solium (T. solium). These larval cysts infect brain, muscle, or other tissue, and are a major cause of adult onset seizures in most low-income countries. A person gets cysticercosis by swallowing eggs found in the feces of a person who has an intestinal tapeworm. Cysts, called cysticerci, can develop in the muscles, the eyes, the brain, and or the spinal cord. Symptoms caused by the cysts depend on the location, size, number, and stage of the cysts. Cysts in the muscles, Generally do not cause symptoms May cause lumps under the skin, which can sometimes become tender. Cysts in the brain or spinal cord Cause the most serious form of the disease, called neurocysticercosis, cause seizures and/or headaches (these are more common).

e22102Background: Metabolic syndrome (MS) is a group of disorders related to insulin resistance, characterized clinically by central obesity, hyperglycemia, dyslipidemia and hypertension. There is ...

e19012 Background: AIDS related non Hodgkin’s Lymphoma (ARL) remains a major cause of morbidity and mortality .There are limited prospective studies on ARLs in Indian population. We studied the clinical profile and outcome of patients with ARL . Methods: Consecutive patients diagnosed with ARL in the period February 2014-march 2016 who were treatment naïve were included in the study. Details of HIV and ARL, treatment details , complications and outcome were recorded. The primary objective was overall survival(OS), secondary objectives were response rates correlation of overall survival with CD4 count, IPI, duration of HIV, histopathology and stage of NHL. Survival was described with the Kaplan-Meier method, and effect of predictor variables was tested with the log-rank test. Results: 42 patients(28 males) with a median age 45.5 years were included in the study . The commonest types of NHL were DLBCL 22 (52.38 %) and plasmablastic lymphoma 14 (33.33%). HIV infection was detected at the time of lymphoma diagnosis in 21 (50%). The median CD4+ T cell count was 137 cells/mm3 . 32 (76.19%) had stage III/IV disease and and 35(83.3%) had extranodal involvement. IPI score was >2 in 20/40(50%). 30/42 patients received chemotherapy of these 21 received atleast 4 cycles. 19 patients received CVEP regimen , 8 REPOCH and 3 others . NNRTI plus 2 NRTI combination was the HAART regimen in 26/30(86.6%) patients. Grade 3-5 febrile neutropenia was seen in 17/30 (56.6%) . Response was assessed using PET-CT scan in 22 patients ,16 (72.7%) had complete response .16/30 patients expired , 8 of these were due to infections . Median survival was 10 months (0.0-20.4 months). The estimated 2 year overall survival is 43.6 % . Patients with early stage disease had better overall mean survival (p=0.01). Type of NHL, IPI, CD 4+ T cell count, HAART prior to NHL treatment did not affect overall survival . Conclusions: Patients of ARL present at a younger age ,with higher grade and advanced disease. Higher proportion of plasmablastic lymphomas were seen in our study as compared to western data. Though most patients achieve complete response the overall survival is low . Myelosuppression and associated infections continues to be a challenge in the management of ARL.