Search

Background There is limited data on outcomes in cancer patients with coronavirus disease 2019 (COVID‐19) from lower middle‐income countries (LMICs). Patients and Methods This was an observational study, conducted between 12 April and 10 June 2020 at Tata Memorial centre, Mumbai, in cancer patients undergoing systemic therapy with laboratory confirmed COVID‐19. The objectives were to evaluate cumulative 30‐day all‐cause mortality, COVID‐19 attributable mortality, factors predicting mortality, and time to viral negativity after initial diagnosis. Results Of the 24 660 footfalls and 7043 patients evaluated, 230 patients on active systemic therapy with a median age of 42 (1‐75) years were included. COVID‐19 infection severity, as per WHO criteria, was mild, moderate, and severe in 195 (85%), 11 (5%), and 24 (11%) patients, respectively. Twenty‐three patients (10%) expired during follow‐up, with COVID‐19 attributable mortality seen in 15 patients (6.5%). There were no mortalities in the pediatric cohort of 31 (14%) patients. Advanced stage cancer being treated with palliative intent vs others [30‐day mortality 24%% vs 5%, odds ratio (OR) 5.6, 95% CI 2.28‐13.78, P, COVID‐19 attributable mortality in cancer patients on systemic therapy in LMICs appears lower than published data and slightly more than an unselected patient's cohort. Delayed recovery in terms of SARS COV‐2 negativity is seen in these patients. Treating Cancer remains the priority.

Introduction Diffuse large B-cell lymphoma (DLBCL) commonly affects the elderly population and the treatment is often challenging because of the close interplay between age, comorbidities, frailty as well as cognitive and psychosocial factors. Anthracycline constitutes the cornerstone of the treatment regimen of Non-Hodgkin lymphoma but is associated with several side-effects including cardiotoxicity. At our institute, we replace doxorubicin with etoposide in cases where compromised cardiac function, performance status (PS) and multiple comorbidities are major concerns. We aim to retrospectively analyze the treatment outcomes of patients with DLBCL aged ≥ 60 years and specifically compare R-CHOP and R-CEOP regimens. Methods In this retrospective study, we included patients aged ≥ 60 years, newly diagnosed with DLBCL according to WHO classification between January 2015 to December 2018 at our center. Chemotherapy regimens received included R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone), R-CE (Etoposide) OP for anthracycline-ineligible or elderly frail patients and R-EPOCH, followed by radiotherapy for residual disease or bulky sites (size > 7cm). The decision to use anthracycline or non-anthracycline based regimen was at the discretion of the physician depending on the performance status, frailty and serum albumin levels. Dose of etoposide used in the R-CEOP regimen was 65mg/m 2 orally on day 1-3. Primary G-CSF prophylaxis was used in all patients. After 4 cycles of chemotherapy, patients underwent an interim PET-CT for response evaluation. Patients who attained partial response underwent a repeat PET-CT evaluation at the end of 6 cycles. Post treatment completion, patients were followed up for clinical examination every three months for the first two years, six monthly for the next three years and annually thereafter. Results A total of 218 patients were included. The median age of patients was 65 years (range, 60-88 years). Patients were divided into two age-groups with 124 patients (56.9%) of the age group of 60-65 years and 94 patients (43.1%) were aged above 65 years. Of the 218 patients, 71 patients (32.6%) received R-CHOP regimen and 137 patients (62.4%) received R-CEOP regimen, while 10 patients (5.0%) received R-EPOCH. More patients aged >65 years received R-CEOP than in the 60-65 years age group (83% vs 47.6%) and the difference was statistically significant (p-value 2 (3.6%), and physician's discretion in 48.9% of cases. Baseline disease characteristics including NCCN-IPI of patients treated with both these regimens were comparable. Complete response rate and overall response rate were higher in the R-CHOP group compared to the R-CEOP group, but statistically significant difference was found only among 60-65 years of age group. Among patients aged 60-65 years, the incidence of febrile neutropenia and grade III/IV hematological toxicities were significantly higher in the R-CHOP group than in the R-CEOP group. The overall median follow-up was 22.71 months (Range 1-81 months). The 2-year progression-free survival (PFS) rate in the R-CHOP group was higher than that in the R-CEOP group (79.1% vs 49.6%, p-value Conclusion Age and comorbidities are not absolute contraindications to the use of anthracyclines. Fit patients without cardiac contraindications should receive R-CHOP regimen whenever possible. Geriatric assessment tools should be used for the frail or unfit patients to guide appropriate therapy and further prospective trials should be done in this direction. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Background: Older patients with cancer are underrepresented in most immunotherapy trials. Therefore, there is an urgent and unmet need for real-world data on the efficacy and safety of immune checkpoint inhibitors (ICIs) in older patients with cancer. Objectives: This study was aimed at analyzing the demographic pattern, treatment-related outcomes, and toxicities of ICIs in older patients with solid tumors. Materials and Methods: This retrospective study was conducted in the Department of Medical Oncology of the Tata Memorial Hospital, a tertiary cancer care center in Mumbai, India. Patients aged ≥ 60 years with histologically confirmed malignancies of the thoracic, head and neck and genitourinary systems who were treated with ICIs between August 2014 and February 2021, and had received at least 2 cycles of ICI were enrolled in the study. Data related to the demographic profile and pattern of care were obtained from the electronic medical records and physical patient files. Patient management was decided in a multidisciplinary tumor board meeting. The primary endpoint of the study was overall survival (OS). The secondary endpoints were objective response rate (ORR), progression-free survival (PFS), and rate of immune-related adverse events. Results: There were 150 patients included in the study. The most common indications for ICI use were non-small-cell lung cancer (52.7%) and head and neck squamous cell carcinoma (17.3%). Nivolumab was the most common ICI used in 119 (79.4%) patients. ICIs were used in the palliative setting in 144 (96%) patients. A total of 76 (50.6%) patients received ICIs as second-line therapy. The median number of cycles of ICI received was 5 (interquartile range, 3.0–9.5). The ORR to ICIs was 30%, and the clinical benefit rate was 52%. ICIs were discontinued due to toxicities in 4 (2.7%) patients. The median PFS and OS were 4.23 (95% confidence interval [CI], 1.38–7.08) months and 8.6 (95% CI, 4.9–12.2) months, respectively. Baseline performance status was the most significant prognostic factor for PFS and OS in the multivariate analysis. In addition, age, male sex, and comorbid conditions such as chronic kidney disease negatively impacted the OS. Conclusion: Our study shows that ICIs are efficacious and well tolerated in older Indian patients with solid tumors. There is an emerging need for larger prospective studies on ICIs with the incorporation of geriatric assessment scores in this vulnerable patient population.