ABSTRACT
Introduction: ROS1 as a driver mutation is observed in approximately 1%-2% of all non-small cell lung cancer (NSCLC). Given its rarity, we share our experience regarding ROS1-positive NSCLC including the access to ROS1 tyrosine kinase inhibitors (TKIs) in a low-middle income country like India. Methods: It is a retrospective analysis of ROS1-positive NSCLC patients registered between January 2015 to December 2021 for demographics, treatment patterns and outcomes i.e., overall survival (OS) and progression free survival (PFS). Results: Baseline characteristics were available for 70 patients of 78 patients positive for ROS1 by fluorescent in situ hybridisation. Median age at presentation was 52 years, 39 (55.7%) were males, most (51, 72.86%) were non-smokers and ten patients (14.3%) had poor Eastern Cooperative Oncology Group (ECOG) performance status (PS) i.e., PS >2 at presentation. A total of 67 patients receiving cancer directed therapy were analysed for survival. The first line (1L) therapies included - ROS1 TKIs in 38, chemotherapy in 20, epidermal growth factor receptor TKI in eight and chemotherapy-bevacizumab in one only. ROS1 TKI was provided to 20 patients as part of an assistance programme. The median OS for patients who received ROS1 TKI was not attained (95% CI 37.85-NA), while it was 8.11 (95% CI 6.31-NA) months for those who did not (HR-0.1673). The median PFS for the 1L ROS1 TKI compared to the no-TKI group was 27.07 (95% CI 24.28-NA) months versus 5.78 (95% CI 3.42-12) months (HR: 0.2047). Poor ECOG PS at presentation was the only independent prognosticator for survival. Conclusion: Using ROS1 TKI improves clinical outcomes in all-comers though statistically not significant. To further improve outcomes, future trials should pay special attention to patients with poor PS and find a way to increase the current limited access to TKI.
Subject(s)
Central Nervous System Neoplasms , Lymphoma, Non-Hodgkin , Humans , Lenalidomide/therapeutic use , Lymphoma, Non-Hodgkin/drug therapy , Lymphoma, Non-Hodgkin/radiotherapy , Rituximab/therapeutic use , Central Nervous System , Brain , Central Nervous System Neoplasms/drug therapy , Central Nervous System Neoplasms/radiotherapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic useABSTRACT
PURPOSE: There is a lack of published literature on systemic therapeutic options in cisplatin-ineligible patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC) undergoing chemoradiation. Docetaxel was assessed as a radiosensitizer in this situation. METHODS: This was a randomized phase II/III study. Adult patients (age ≥ 18 years) with LAHNSCC planned for chemoradiation and an Eastern Cooperative Oncology Group performance status of 0-2 and who were cisplatin-ineligible were randomly assigned in 1:1 to either radiation alone or radiation with concurrent docetaxel 15 mg/m2 once weekly for a maximum of seven cycles. The primary end point was 2-year disease-free survival (DFS). RESULTS: The study recruited 356 patients between July 2017 and May 2021. The 2-year DFS was 30.3% (95% CI, 23.6 to 37.4) versus 42% (95% CI, 34.6 to 49.2) in the RT and Docetaxel-RT arms, respectively (hazard ratio, 0.673; 95% CI, 0.521 to 0.868; P value = .002). The corresponding median overall survival (OS) was 15.3 months (95% CI, 13.1 to 22.0) and 25.5 months (95% CI, 17.6 to 32.5), respectively (log-rank P value = .035). The 2-year OS was 41.7% (95% CI, 34.1 to 49.1) versus 50.8% (95% CI, 43.1 to 58.1) in the RT and Docetaxel-RT arms, respectively (hazard ratio, 0.747; 95% CI, 0.569 to 0.980; P value = .035). There was a higher incidence of grade 3 or above mucositis (22.2% v 49.7%; P < .001), odynophagia (33.5% v 52.5%; P < .001), and dysphagia (33% v 49.7%; P = .002) with the addition of docetaxel. CONCLUSION: The addition of docetaxel to radiation improved DFS and OS in cisplatin-ineligible patients with LAHNSCC.[Media: see text].
Subject(s)
Carcinoma, Squamous Cell , Head and Neck Neoplasms , Adult , Humans , Adolescent , Docetaxel/therapeutic use , Cisplatin/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Taxoids/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Head and Neck Neoplasms/drug therapy , Squamous Cell Carcinoma of Head and Neck/drug therapyABSTRACT
Solitary bone plasmacytoma is an extremely rare entity and is characterized by localized proliferation of monoclonal plasma cells. Plasmacytomas are extremely rare in the pediatric population. The median age at diagnosis is usually the fifth or sixth decade, with axial skeleton being more commonly involved than appendicular. We hereby, report the case of a 13-year-old boy with solitary bone plasmacytoma of the right humerus. Though extremely rare in the pediatric age group, plasmacytomas may be considered as one of the remote differentials in children presenting with solitary bone tumors.
Subject(s)
Bone Neoplasms , Humeral Fractures , Plasmacytoma , Adolescent , Bone Neoplasms/metabolism , Bone Neoplasms/pathology , Bone Neoplasms/therapy , Humans , Humeral Fractures/metabolism , Humeral Fractures/pathology , Humeral Fractures/therapy , Male , Plasmacytoma/metabolism , Plasmacytoma/pathology , Plasmacytoma/therapyABSTRACT
PURPOSE: To estimate the dose response relationship for submandibular gland (SMG) recovery using salivary scintigraphy in patients diagnosed with head and neck cancer treated with curative image guided chemoradiation. MATERIAL AND METHODS: Ninety newly diagnosed head and neck cancer patients (T1-3, N0-2c, M0) treated with intensity modulated radiotherapy on a prospective clinical trial were assessed for salivary toxicity at predefined intervals using dynamic salivary scintigraphy. The SMG function was measured using salivary excretion fraction (SEF) ratios at baseline and 6 monthly. Tolerance dose (TD) 50 for submandibular gland was estimated from dose response curves. RESULTS: The mean SEF ratio of 180 SMGs decreased at 6â¯months with a nadir at 12â¯months after treatment (SEF ratio 15%) and progressively recovered over time reaching 38% over 24â¯months. There was significant inverse correlation between SEF ratio and mean SMG dose at 6â¯months (râ¯=â¯-0.18, pâ¯=â¯0.04); 12-months (râ¯=â¯-0.36, pâ¯<â¯0.001); 18-months (râ¯=â¯-0.48, pâ¯<â¯0.001); 24-months (râ¯=â¯-0.42, pâ¯<â¯0.001); and more than 24-months (râ¯=â¯-0.56, pâ¯<â¯0.001). The estimated TD 50 values at 1â¯year and 2â¯year post treatment were 36â¯Gy and 44â¯Gy respectively with SEF ratio of ≤45% used to define severe xerostomia. For every 1â¯Gy reduction in mean dose below 54â¯Gy, there is 2-2.5% reduction in the probability of severe xerostomia. CONCLUSION: The submandibular gland function declines after radiotherapy with a nadir at 12â¯months and there is incomplete recovery over time with continued improvement over 24â¯months. The TD 50 at 1â¯year and 2â¯year was 36â¯Gy and 44â¯Gy with a 2-2.5% reduction in the probability of severe xerostomia for every 1â¯Gy reduction in mean dose.