Practical recommendation for rash and diarrhea management in Indian patients treated with tyrosine kinase inhibitors for the treatment of non‑small cell lung cancer.

Tyrosine kinase inhibitors (TKIs) are a pharmaceutical class of small molecules, orally available with manageable safety profile, approved worldwide for the treatment of several neoplasms, including lung, breast, kidney and pancreatic cancer as well as gastro‑intestinal stromal tumours and chronic myeloid leukaemia. In recent years, management of lung cancer has been moving towards molecular‑guided treatment, and the best example of this new approach is the use of the tyrosine kinase inhibitors (TKIs) in patients with mutations in the epidermal growth factor receptor (EGFR). The identification of molecular predictors of response can allow the selection of patients who will be the most likely to respond to these tyrosine kinase inhibitors (TKIs). Gastrointestinal (GI) adverse events (AEs) are frequently observed in patients receiving EGFR tyrosine kinase inhibitor therapy and are most impactful on the patient’s quality of life. Dermatologic side effects are also relatively common among patients treated with EGFR inhibitors. Evidence has emerged in recent years to suggest that the incidence and severity of rash, positively correlated with response to treatment. These skin disorders are generally mild or moderate in severity and can be managed by appropriate interventions or by reducing or interrupting the dose. Appropriate and timely management make it possible to continue a patient’s quality of life and maintain compliance; however if these adverse events (AEs) are not managed appropriately, and become more severe, treatment cessation may be warranted compromising clinical outcome. Strategies to improve the assessment and management of TKI related skin AEs are therefore essential to ensure compliance with TKI therapy, thereby enabling patients to achieve optimal benefits. This article provides a consensus on practical recommendation for the prevention and management of diarrhoea and rash in Non‑Small Cell Lung Cancer (NSCLC) patients receiving TKIs.

ICON 2013: Practical consensus recommendations for hormone receptor-positive Her2-negative advanced or metastatic breast cancer.

The management of hormone receptor‑positive Her2‑negative breast cancer patients with advanced or metastatic disease is a common problem in India and other countries in this region. This expert group used data from published literature, practical experience, and opinion of a large group of academic oncologists, to arrive at practical consensus recommendations for use by the community oncologists.

Management of primary and metastatic triple negative breast cancer: Perceptions of oncologists from India.

Background: In order to document the understanding of current evidence for the management of triple negative breast cancer and application of this knowledge in daily practice, we conducted an interactive survey of practicing Indian oncologists. Materials and Methods: A core group of academic oncologists devised two hypothetical triple negative cases (metastatic and early breast cancer, respectively) and multiple choice options under different clinical circumstances. The respondents were practicing oncologists in different Indian cities who participated in either an online survey or a meeting. The participants electronically chose their preferred option based on their everyday practice. Results: A total of 152 oncologists participated. Just over half (53.8%) preferred taxane based chemotherapy as first-line chemotherapy in the metastatic setting. In the adjuvant setting, a taxane regimen was chosen by 61%. Over half of respondents (52.6%) underestimated the baseline survival of a patient with node positive triple-negative tumor and 18.9% overestimated this survival compared to the estimate of the Adjuvant! program. Discussion: This data offers insight into the perceptions and practice of a diverse cross-section of practicing oncologists in India with respect to their therapeutic choices in metastatic and adjuvant settings in triple negative breast cancer.

Cetuximab plus radiotherapy in patients with unresectable locally advanced squamous cell carcinoma of head and neck region - A open labelled single arm phase II study.

Purpose : To evaluate feasibility, safety and outcome of cetuximab concurrent with radiotherapy in locally advanced head−neck cancer. Materials and Methods: Between March 2007 and January 2008 eligible cases of locally advanced unresectable (Stage IV) squamous cell carcinoma of head and neck were enrolled in this single arm, open labeled phase II Study. They were treated with cetuximab for a duration of 8 weeks and concomitant RT for 7 weeks (starting one week after initiating Cetuximab) Results: A total of 19 eligible patients were enrolled. The median age of patients was 53 years, all patients happening to be male. The performance status of the patients was 0/1. The location of the primary tumor was oropharynx in 12 cases, oral cavity in 4, larynx in 2, and hypopharynx in one case. The overall response rate (ORR) was 68.42% and the overall survival at 2 year was 84 %. All 13 patients who completed two years follow-up after completion of study treatment continued to be alive with no evidence of disease progression. One patient also remained alive with progressive disease. Conclusions: Cetuximab concurrent with radiotherapy is a safe and effective option in advanced head−neck cancer patients.

Molecular and functional characteristics, growth promoting effect and persistence of selected parent isolates and streptomycin resistant derivatives of rice rhizobacteria.

Molecular and functional characteristics of seven azospirilla and five phosphorus solubilizing bacteria (PSB) isolates of rice rhizosphere, growth promotion ability of two efficient strains, Azospirillum amazonense A10 (MTCC4716) and Bacillus megaterium P5 (MTCC4714) and their persistence based on streptomycin resistant derivatives (SRD), were determined. SDS-PAGE and isozyme banding patterns of the isolates were used to arbitrarily group the azospirilla into 4 and PSB into 3 clusters and as markers to ascertain their identity. The azospirilla produced 2.0 to 10.5 ppm of IAA like substances and showed nitrogenase activity of 0.02 to 3.55 nmole C2H4/hr/ml of pure culture. PSB isolates produced 7.8 to 15.0 ppm IAA like substances and 20 to 128 ppm soluble P. Induction of resistance to streptomycin resulted in changes of these properties. Co-inoculation of rice with SRD A10 and SRD P5 and their parental strains in separate treatments enhanced grain yield over control by 31 and 12.4%, respectively. Nitrogenase activity of rice roots under SRD co-inoculated treatment was higher (4.16 nmole C2H4/hr/hill) than that-under parental strains co-inoculated treatment (3.76 nmole C2H4/hr/hill). SDS-PAGE profile and population count of the strains confirmed their establishment in rice rhizosphere and persistence over a year after inoculation.

Hodgkin's disease relapse presenting as Pancoast's syndrome.

Among the various infrequent causes of Pancoast's syndrome, Hodgkin's disease is one. A 26 year old man was diagnosed as Hodgkin's disease. Five years later the disease relapsed producing Pancoast's syndrome. The importance of precise aetiological diagnosis before treatment of such cases with similar presentation is emphasized.