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No study has unequivocally proven that chemotherapy prolongs overall survival (OS) in advanced esophageal cancer. We conducted a Phase III randomized study in first‐line advanced unresectable/metastatic esophageal/GEJ cancer. Patients aged 18–70 years, with performance status 0–2, were randomized to best supportive care (BSC) alone, or BSC with weekly paclitaxel 80 mg/m2. BSC comprised, as indicated, education, counselling, radiation, stenting, feeding tube placement, nutritional supplementation, medications like analgesics, and referral to a support group and palliative care. The primary endpoint was OS; secondary endpoints included progression free survival (PFS), response, toxicity, and QoL. Between May 2016–December 2020, we recruited 281 patients: 143 to chemotherapy and 138 to BSC. Histopathology was squamous in 269 (95.7%) patients. Median number of paclitaxel doses was 12 (IQR, 7–23). Median OS was 4.2 months (95% CI, 3.42–5.32) in BSC, and 9.2 months (95% CI, 8.02–10.48) in chemotherapy; HR, 0.49 (95% CI, 0.39–0.64); p <.001. As compared to BSC, chemotherapy increased response (2.9% to 39%), median PFS (2.1 to 4.2 months), 1‐year OS (11% to 32%), 2‐year OS (0 to 9%), median dysphagia‐free survival (2.9 to 14.8 months), and global and esophagus‐specific QoL, without significantly increasing all‐grade or grade ≥3 toxicities. Using ESMO clinical benefit scale and ASCO Value Framework, palliative chemotherapy scored as having "substantial value." Our study provides the first level 1 evidence that chemotherapy prolongs survival in advanced esophageal/GEJ carcinoma. BSC alone is no longer appropriate. Weekly paclitaxel is an attractive option, especially in LMICs with limited access to immunotherapy. [ABSTRACT FROM AUTHOR]

Background Rapid on-site examination (ROSE) during endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) has been a subject of debate. We compared the yield of EUS-FNB with adequacy assessed using macroscopic on-site evaluation (MOSE), and smear cytology with adequacy confirmed by ROSE, acquired using the same needle. Methods Consecutive patients with solid pancreatic lesions (SPLs) who underwent EUS-FNB of pancreatic solid lesions between January 2021 and July 2022 were included. Demographic details, site and size of lesion, number of passes, and the diagnosis by cytology and histopathology of core tissue were noted. The first pass was used for ROSE adequacy assessment and was subsequently sent for cytological assessment. Additional passes were taken subsequently to acquire core tissue. Adequacy was confirmed by MOSE (whitish core of more than 4 mm). Final cytology and histopathology (HPE) were compared for diagnostic accuracy. Results One hundred fifty-five patients were included in the analysis during the study period (mean age 55.1+12.9 years; 60% male; 77% in pancreatic head; median size 3.7 cm). The final diagnosis was malignancy in 129, while 26 were negative for malignancy. Sensitivity and specificity for ROSE with cytology in detecting malignant SPLs were 96.9% and 100%, respectively. HPE with MOSE had sensitivity and specificity of 96.1% and 100%, respectively. A comparison of diagnostic accuracy showed no significant difference (P>0.99) between HPE with MOSE and ROSE with cytology, using an FNB needle. Conclusion MOSE is as good as ROSE in terms of diagnostic yield for solid pancreatic lesions sampled using newer-generation EUS biopsy needles. [ABSTRACT FROM AUTHOR]

Byline: Saurabh. Zanwar, Vanita. Noronha, Amit. Joshi, Vijay. Patil, Rajiv. Kaushal, Anuradha. Chougule, Amit. Janu, Abhishek. Mahajan, Akhil. Kapoor, Kumar. Prabhash BACKGROUND: A small proportion of Non-Small Cell Lung Cancers [...]

BACKGROUND: A small proportion of Non-Small Cell Lung Cancers (NSCLC) are detected with Anaplastic Lymphoma Kinase (ALK) mutation by immunohistochemistry (IHC) but are negative by Fluorescence in situ Hybridization (FISH). Data on responses and outcome of this subset of patients when treated with crizotinib is limited. We analyzed the outcomes of such patients who received crizotinib. PATIENTS AND METHODS: Demographics, treatment details, response to treatment, date of progression and date of death were collected for patients who were IHC positive and FISH negative for ALK mutation from a prospectively maintained database. Depending upon feasibility, patients received either platinum based doublet chemotherapy or the ALK inhibitor crizotinib as first line therapy. Outcomes were compared to our previously published historical cohort of FISH positive patients who were treated with crizotinib. RESULTS: Thirteen patients were detected to be IHC+/FISH- and out of these seven received crizotinib. Objective response rate for crizotinib was 57.15% with an estimated mean PFS of 9.6 months (95% CI 3.8 -15.5 months). The difference in ORR of ALK IHC+/FISH- when compared to our historical cohort of ALK FISH positive treated with crizotinib was not statistically significant (57.15% vs 69.8%; P = 0.265). Estimated mean and median PFS was similar between the two cohorts (median PFS 6.0 months vs 14 months; mean PFS 9.6 months versus 14.7 months; P = 0.467). CONCLUSION: NSCLCs positive for ALK mutation by IHC but not detected by FISH show good response to crizotinib and merit treatment with the same. [ABSTRACT FROM AUTHOR]

Background: Immune check point inhibitors (ICIs) have an established role in Microsatellite- Instability--High (MSI-H) and Combined Positive Score (CPS) high advanced gastric/ gastroesophageal (G/GE) adenocarcinomas, but there is limited real world data with regard to practice patterns, and efficacy of standard doses (SD-ICIs) and alternative lower doses (LD-ICIs). Methods: A retrospective study of patients with advanced G/GE adenocarcinomas receiving ICIs was conducted. The primary endpoint of the study was 12-month overall survival (OS), which was computed by Kaplan-Meier method. Results: A total of 91 patients were available for analysis during the study period. Seventy- four patients (81%) received nivolumab, while the remaining received pembrolizumab. Fifteen patients (16%) had MSI-H status and had a 12-month OS of 60% and median OS of 15 months (median follow-up -- 38.3 months). In the Microsatellite-Stable (MSS) cohort (84%; n = 76), ICIs (combined with chemotherapy) were used predominantly in pre-treated patients (54%; n = 41). Patients with CPS ≥5 (72%; n = 55) had improved survival compared to patients with CPS <5 (28%; n = 21) (12-month OS: 52% vs. 26%; Median OS: 12.8 months vs. 3.2 months; p = 0.005). There was no difference in survival between patients who received SD-ICIs (54%; n = 41) and LD-ICIs (46%; n = 35) (12-month OS: 42% vs. 48%; Median OS: 8.7 months vs. 11 months; p = 0.44). Conclusions: Patients with advanced G/GEJ adenocarcinomas in the real world predominantly received ICIs during later lines of therapy as opposed to first line therapy. Using a CPS cutoff of ≥5 as opposed to CPS <5 predicts for improved survivals in MSS patients and patients receiving low dose ICIs have similar survival outcomes to patients receiving standard dose ICIs within the confines of a heterogenous study cohort. [ABSTRACT FROM AUTHOR]

Introduction: Osimertinib is more efficacious and as safe as first-generation epidermal growth factor receptor (EGFR)-directed tyrosine kinase inhibitors. However, osimertinib is not affordable for most patients in developing nations. Moreover, the minimum biologically effective dose of osimertinib may be less than the approved dose. Materials and methods: This was a retrospective observational multicentric study aimed to describe the efficacy (objective response rate (ORR), disease control rate (DCR), progression free survival (PFS), overall survival (OS)) and toxicity of osimertinib 80 mg orally administered less frequently than daily (ranging from every other day to once-a-week) in patients with EGFR-mutated non-small cell lung cancer. Results: Between January 2021 and August 2023, we enrolled 22 patients. Six received osimertinib 80 mg once-a-week, nine received 80 mg once-in-3-days and seven received 80 mg on alternate days. Responses included 0 complete responses, 7 (31.8%) partial responses, 9 (40.9%) stable disease and 5 (22.7%) progressive disease. ORR was 31.8%, and DCR was 72.7%. Median PFS was 9.2 months (95% confidence interval (CI) 2.9-15.7), and median OS was 17.8 months (95% CI, 3.2-32.6). In patients who received reduced frequency osimertinib in the second line and beyond, the ORR was 29.4%, DCR was 70.5%, median PFS was 5.9 months (95% CI, 1.1-10.6) and median OS was 17.6 months (95% CI, 2.9-32.2). Grade 3 and higher toxicities were noted in 8 (36.3%) patients. Conclusion: Less frequent dosing of osimertinib may be a valid treatment option, especially in the second line and beyond setting in patients who cannot afford full dose daily osimertinib. This may provide an additional treatment option with a similar toxicity profile as that of standard dose osimertinib. [ABSTRACT FROM AUTHOR]

Aims and Objectives of the Study: Aim of this study is to study the clinic pathological feature, distribution and treatment outcomes of different types of extranodal non Hodgkin's lymphoma patients with special consideration to their diverse clinical presentations. Primary objective is to study the diverse clinical presentation and distribution of different types of extranodal non Hodgkin's lymphoma and secondary objectives are to determine response rates, pattern of relapses, progression free survival and overall survival. Material & Methods: Study Area: Department of Medical Oncology, Rajiv Gandhi Cancer Institute, New Delhi. Study population: A total of 61 biopsy and IHC proven patients with primary extranodal non Hodgkin's lymphoma were enrolled while patients with concomitant nodal involvement and those with plasmacytomas or any other malignancy were excluded. Data collection technique and tools: All enrolled patients were studied with respect to their clinical presentations, Ann Arbor staging, serum LDH levels, IPI at diagnosis and treatment outcomes. Clinical features, pathological features, response to treatment and their treatment outcome and follow up data were recorded. Data analysis: Results are expressed as mean standard deviation for continuous variables and in numbers and corresponding percentage for categorical variables. Categorical data is compared using Chi-square or Fisher's exact test for a two-sided p-value, whereas for ordinal data, the nonparametric tests are applied. The actuarial survival analysis is performed according to the method described by Kaplan and Meier. Cox regression analysis is used to correct for the confounding effect of differences in prognostic factors. The multivariate analysis of the variables predicting response is performed by using a logistic regression. The multivariate analysis for survival is performed by using the stepwise proportional hazards model after testing the proportionality assumptions for the co-variates. P value less than 0.05 is considered as statistical significance. All analyses performed with the statistical software SPSS version 22 (SPSS, Inc., Chicago, Ill., USA). Results: The median age of the patients is 54 years with 61 % patients being males. There were 8 deaths while 8 patients were lost to follow up at the time of evaluation. 21% patients had multifocal disease at presentation while systemic B symptoms were present only in 30 % cases. Most common site of involvement is GI tract (36%) followed by Bone (28%), Liver (13%), CNS (10%) and nose/nasopharynx (10%). Other uncommon sites of involvement included breast, kidney, testes, pancreas, skin, eyelids, uterus and submandibular gland. In GI Lymphoma, gastric lymphoma (26%) being most common followed by intestinal involvement (10%). Most common clinical presentation in case of GI lymphomas is abdominal pain and vomiting, in case of bony lymphomas with localized pain and swelling while focal neurological deficit is most common presentation in case of primary CNS lymphomas. DLBCL is the most common histological pattern (82%) observed in our study. 62% patients received R CHOP based chemotherapy while remaining patients received different regimens depending upon the site of involvement and histological type (DeAngelis protocol for primary CNS lymphoma (10%), R DA EPOCH (10%), Hyper CVAD (5%), CODOXM/IVAC for Burkitt's lymphoma). 57% patients achieved CR with first line induction chemotherapy, 33% patients achieved PR, and 3 % achieved stable disease while 2% progressed. Median follow up period of our study is 24.2 months (range, 1.03- 59.9). As estimated by Kaplan Meier curves, an overall 5 year disease free survival as estimated is 69.98% while 5 Year overall survival calculated is 80.05%. There were 14 relapses which were more common with multifocal disease, higher IPI, failure to achieve CR with first line chemotherapy and those with primary CNS lymphoma. 43% patients had early relapse while 57% patients had late relapse. Conclusions: 1) Primary extranodal lymphoma more commonly presents with site specific symptoms and with lesser B symptoms. 2) Gastrointestinal tract, mainly stomach and bone are the two most common extranodal sites. 3) DLBCL is the most common histology encountered in most of the studies in both nodal as well as extranodal location. 4) Multifocal disease at presentation imparts higher IPI and poor prognosis with higher chances of relapse despite achieving CR with first line treatment. 5) Response to chemotherapy is excellent with majority of patients achieving CR with first line chemotherapy however relapses are more frequent in those with higher IPI at presentation, CNS disease at presentation and in those who fail to achieve CR with first line chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Pulmonary sarcomatoid carcinoma (PSC) constitutes a heterogeneous group of poorly differentiated non-small cell lung cancers. Since these are rare tumours, we sought to determine the characteristics and clinical outcomes of these patients treated at our centre. Methods: We did a retrospective evaluation of all patients diagnosed with PSC between January 2013 and September 2020 at the Tata Memorial Hospital, Mumbai, India. Baseline demographic and treatment data and outcomes were obtained retrospectively from electronic medical records and survival was calculated by using the Kaplan--Meier method. Results: Out of 151 patients diagnosed with PSC during this period, 129 were included in the final analysis. The clinical stage was stage I in 3 (2.03%), stage II in 4 (3.1%), stage III in 35 (27.1%) and stage IV in 87 (67.4%). The median follow-up duration was 32 months (range, 15.0-48.9). The median overall survival (OS) of patients who received curative surgery was 18 months (95% confidence interval (95% CI), 2.59-33.4); concurrent chemoradiation was 11 months (95% CI, 2.99-19); palliative chemotherapy was 8 months (95% CI, 5.24-10.75) and best supportive care was 1 month (95% CI, 0.43-1.57, p = 0.001). On multivariate analysis, the presence of brain metastasis (p = 0.018; hazard ratio (HR), 2.47; 95% CI, 1.34-4.49) and the administration of chemotherapy (p = 0.037; HR, 2.2; 95% CI, 1.04-4.94) were the only factors impacting the OS. Conclusion: PSC usually presents in advanced stages and is associated with a poor prognosis. [ABSTRACT FROM AUTHOR]

Cholangiocarcinomas and gallbladder carcinomas are epithelial tumours with biliary differentiation. On histology and immunohistochemistry, they resemble adenocarcinomas and possess overlapping immunohistochemical profiles. Diagnosing these tumours is best done using appropriate imaging and clinical features with compatible immunohistochemistry. Immuno-staining for thyroid transcription factor-1 (TTF-1) and novel aspartic proteinase of pepsin A (Napsin-A) is believed to be specific for primary pulmonary adenocarcinomas. We herein report uncommon instances of strong and diffuse expression of these markers in two examples of adenocarcinomas arising from the bile duct and gallbladder. A review of the literature and a summary of similar studies relating to aberrant TTF-1 and Napsin-A expression in biliary tract adenocarcinomas are presented. [ABSTRACT FROM AUTHOR]