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Abstract Background Precise prognostication is the key to optimum and effective treatment planning for early-stage hormone receptor (HR) positive, HER2/neu negative breast cancer patients. Differences in the breast cancer incidence and tumor anatomical features at diagnosis, pharmacogenomics data between Western and Indian women along with the vast diversity in the economic status and differences in insurance policies of these regions; suggest recommendations put forward for Western women might not be applicable to Indian/Asian women. Opinions from oncologists through a voting survey on various prognostic factors/tools to be considered for planning adjuvant therapy are consolidated in this report for the benefit of oncologists of the sub-continent, SAARC and Asia’s LMIC (low and middle-income countries). Methods A three-phase DELPHI survey was conducted to collect opinions on prognostic factors considered for planning adjuvant therapy in early-stage HR+/HER2/neu negative breast cancer patients. A panel of 25 oncologists with expertise in breast cancer participated in the survey conducted in 2021. The experts provided opinions as ‘agree’ or disagree’ or ‘not sure’ in phases-1 and 2 which were conducted virtually; in the final phase-3, all the panel experts met in person and concluded the survey. Results Opinions on 41 statements related to prognostic factors/tools and their implications in planning adjuvant endocrine/chemotherapy were collected. All the statements were supported by the latest data from the clinical trials (prospective/retrospective). The statements with opinions of consensus less than 66% were disseminated in phase-2, and later in phase-3 with supporting literature. In phase-3, all the opinions from panelists were consolidated and guidelines were framed. Conclusions This consensus guideline will assist oncologists of India, SAARC and LMIC countries in informed clinical decision-making on adjuvant treatment in early HR+/HER2/neu negative breast cancer patients.

Abstract Lung cancer is the primary cause of mortality in the United States and around the globe. Therapeutic options for lung cancer treatment include surgery, radiation therapy, chemotherapy, and targeted drug therapy. Medical management is often associated with the development of treatment resistance leading to relapse. Immunotherapy is profoundly altering the approach to cancer treatment owing to its tolerable safety profile, sustained therapeutic response due to immunological memory generation, and effectiveness across a broad patient population. Different tumor-specific vaccination strategies are gaining ground in the treatment of lung cancer. Recent advances in adoptive cell therapy (CAR T, TCR, TIL), the associated clinical trials on lung cancer, and associated hurdles are discussed in this review. Recent trials on lung cancer patients (without a targetable oncogenic driver alteration) reveal significant and sustained responses when treated with programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) checkpoint blockade immunotherapies. Accumulating evidence indicates that a loss of effective anti-tumor immunity is associated with lung tumor evolution. Therapeutic cancer vaccines combined with immune checkpoint inhibitors (ICI) can achieve better therapeutic effects. To this end, the present article encompasses a detailed overview of the recent developments in the immunotherapeutic landscape in targeting small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Additionally, the review also explores the implication of nanomedicine in lung cancer immunotherapy as well as the combinatorial application of traditional therapy along with immunotherapy regimens. Finally, ongoing clinical trials, significant obstacles, and the future outlook of this treatment strategy are also highlighted to boost further research in the field.

Conveyance of pathogens between organisms causes communicable diseases. On the other hand, a non-communicable disease (NCD) was always thought to have no causative transmissible infective agents. Today, this clear distinction is increasingly getting blurred and NCDs are found to be associated with some transmissible components. The human microbiota carries a congregation of microbes, the majority and the most widely studied being bacteria in the gut. The adult human gut harbors ginormous inhabitant microbes, and the microbiome accommodates 150-fold more genes than the host genome. Microbial communities share a mutually beneficial relationship with the host, especially with respect to host physiology including digestion, immune responses, and metabolism. This review delineates the connection between environmental factors such as infections leading to gut dysbiosis and NCDs and explores the evidence regarding possible causal link between them. We also discuss the evidence regarding the value of appropriate therapeutic immunomodulatory nutritional interventions to reduce the development of such diseases. We behold such immunomodulatory effects have the potential to influence in various NCDs and restore homeostasis. We believe that the beginning of the era of microbiota-oriented personalized treatment modalities is not far away.

Acts of violence against health care professionals (especially doctors) as well as facilities are a growing global problem. In our country, it has taken an unfortunate dramatic turn of the involvement of a mob—a ragtag group of persons who organize and perpetrate the crime based on community, caste, religion, or political affiliations. This crucial factor is the fundamental difference in what we face as compared with the so-called Yi Nao phenomenon of China. In India, the mob gathers and indulges in acts of violence, intimidation, and blackmail at the behest of its “leader,” often having no direct relationship with the deceased patient. It is premeditated and systematic vandalism. Often it is also associated with financial gain to the perpetrators through extortion and blackmail, adding to the woes of the health care professionals and hospital facility. We discuss what is the primary goal and what is a byproduct in this cycles of violence against the people who are doing their best to save the lives of patients. Unless the governments and the courts take this matter seriously as well as follow-up with corrective measures, the future looks bleak for all stakeholders.

Whether to recommend mastectomy in metastatic disease or not has been a matter of debate. Is local therapy, such as mastectomy, of any benefit in advanced breast cancer is the main question. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.

Purpose: High-dose (100 mg/m2) cisplatin with radiotherapy is the standard practice in locally advanced head-and-neck squamous cell carcinoma. Use of this regimen in resource- constrained and economically constrained countries like India is difficult. Methods: This study was a cross-sectional survey conducted among Indian oncologists treating head-and-neck cancer. The survey consisted of 25 questions relevant to general day-to-day practice in head-and-neck oncology. It included questions regarding the most common drug used in the concurrent chemoradiation (CRT) setting, the most common schedule of administration of cisplatin, the doses used in once-a-week or once-every-3-week cisplatin chemoradiotherapy, toxicities, and preventive strategies. Descriptive analysis was performed using SPSS software version 20. Results: Responses were obtained from 257 oncologists practicing in various oncology centers throughout the country. The agent most commonly used for radiosensitization was cisplatin (n = 243; 94.6%). The once-a-week regimen of cisplatin was the favored regimen (87.9%, n = 226). The reason for favoring the once-a-week regimen was better tolerance (n = 153, 59.5%). The once-every-3-weeks cisplatin schedule was prescribed for >50% of head-and-neck cancer patients by 23 participants only (8.9%). Conclusion: In this nationwide Indian survey, the majority of clinicians preferred the once-a-week cisplatin schedule for CRT in locally advanced head-and-neck cancer patients, due to better tolerance.

Purpose: Adherence to international antiemetic prophylaxis guidelines like those of ASCO can result in better control of chemotherapy-induced nausea and vomiting; however, the extent of implementation of such guidelines in India is unknown. Therefore, this survey was planned. Methods: This study was an anonymized cross-sectional survey approved by the ethics committee. Survey items were generated from the clinical questions given in the ASCO guidelines. The survey was disseminated through personal contacts at an oncology conference and via e-mail to various community oncology centers across India. The B1, B2, and B3 domains included questions regarding the optimal antiemetic prophylaxis for high, moderate, and low-minimal emetogenic regimens. Results: Sixty-six (62.9%) of 105 responded and 65 centers (98.5%) were aware of the published guidelines. The partial, full, and no implementation scores were 92.5%, 4.5%, and 3.0%, respectively. Full implementation was better for the low-minimal emetogenic regimens (34.8%) than the highly emetogenic regimens (6.1%). The three most frequent reasons for hampered implementation of ASCO guidelines in routine chemotherapy practice cited by centers were a lack of sensitization (26 centers; 39.4%), lack of national guidelines (12 centers; 18.2%), and lack of administrative support (10 centers; 15.2%). Conclusion: Awareness regarding ASCO antiemetic guidelines is satisfactory in Indian oncology practices; however, there is a need for sensitization of oncologists toward complete implementation of these guidelines in their clinical practice.

We present the 2017 Oncology Gold Standard Practical Consensus Recommendation for use of monoclonal antibodies in the management of advanced squamous cell carcinoma of head neck region.

Human papillomavirus (HPV) associated head and neck squamous cell cancers (HNSCC) have become increasingly common in the West, but the same cannot be said about India. These cancers have a different biology and confer a better prognosis, however, its current role in the management of patients in India is not clearly defined. At the 35th Indian Cooperative Oncology Network conference held in September 2016, a panel of radiation, surgical and medical oncologists, pathologists, and basic scientists from across the country having experience in clinical research with respect to HPV in HNSCC reviewed the available literature from India. All the ideas and facts were thereafter collated in this report. Various topics of controversy in dealing with the diagnosis and management of HPV-associated HNSCC have been highlighted in this report in context to the Indian scenario. Furthermore, the prevalence of the same and its association with tobacco and high-risk sexual behavior has been touched on. Conclusively, a set of recommendations has been proposed by the panel to guide the practicing oncologists of the country while dealing with HPV-associated HNSCC.

Maintaining appropriate dose intensity is important not only in the curative setting but also in treatment with palliative intent. We evaluated the outcome of advanced non small cell lung cancer treated with doublet platinum based chemotherapy. Outcome was compared between patients treated by medical oncologists at a tertiary cancer center and those treated by non medical oncologists in the community. The dose intensity, overall response rate and overall survival was significantly better when patients were treated by trained qualified and experienced medical oncologists. Hence, even in the palliative setting, cancer directed systemic therapy will yield maximum benefit for the patients when treated by medical oncologists.

Abstract Objective  To study the cancer pattern among HIV positive cancer cases. Method  The study group included patients registered in the HIV Cancer clinic at the Tata Memorial Hospital (TMH), Mumbai, which is the largest tertiary referral cancer center in India. We used the gender and age-specific proportions of each cancer site of the year 2002 that was recorded in the Hospital Cancer Registry to estimate an expected number of various cancer sites among HIV positive cancer patients during the period 2001–2005. The observed number of site-specific cancer cases was divided by the expected number to obtain proportional incidence ratio (PIR). Results  No case of Kaposi’s sarcoma was observed. Increased proportion of non- Hodgkin’s lymphoma (NHL) was observed (PIR in males = 17.1, 95%CI 13.33-21.84, females = 10.3, 95%CI 6.10-17.41).In males, PIR was increased for anal cancer (PIR = 10.3, 95%CI 4.30–24.83), Hodgkin’s disease, testicular cancer, colon cancer, and few head and neck cancer sites. Among females, the PIRs for cervical cancer (PIR = 4.1, 95%CI 2.90–5.75), vaginal cancer (PIR = 7.7, 95%CI 2.48–23.85), and anal cancer (PIR = 6.5, 95%CI 0.91–45.88) were increased. Conclusions  The absence of Kaposi’s sarcoma and increased PIRs for certain non –AIDS defining cancers among HIV infected cancer cases indicates a different spectrum of HIV associated malignancies in this region. The raised PIR for cervical cancer emphasizes the urgent need for screening programs for cervical cancer among HIV infected individuals in India. [ABSTRACT FROM AUTHOR]