Bortezomib in newly diagnosed patients with multiple myeloma: A retrospective analysis from a tertiary care center in India.

INTRODUCTION: Bortezomib is a novel proteasome inhibitor in myeloma. There is a paucity of data from India regarding the efficacy and tolerance to bortezomib. MATERIALS AND METHODS: All patients with newly diagnosed multiple myeloma from January 2008 to December 2011 treated with bortezomib as the first-line therapy were studied in a retrospective analysis. The primary end point was the overall rate of response. Secondary end points were the progression free survival (PFS), reversibility of renal compromise and safety of bortezomib. RESULTS: Our study included 41 patients with newly diagnosed myeloma. The overall response to bortezomib was 88.5% (complete response [CR] 31.4%, very good partial response 34.2%, partial response [PR] 22.8%). A renal response (CR renal, PR renal or Minimal Response renal combined) was documented 96.2% patients with initial renal impairment. The median time to the first renal response was 21 days. 17 patients (41.4%) had severe toxicity (Grade 3 and 4). Bortezomib induced peripheral neuropathy (BIPN) was the most common toxicity seen (53.6%) and the most common cause for discontinuation of therapy. At a median follow-up of 9 months, median PFS was not reached. DISCUSSION: The results obtained in our study are comparable with those of established studies on bortezomib. Our patient population has similar responses and renal reversibility patterns. However, they are at an increased susceptibility to BIPN, leading to discontinuation of therapy. CONCLUSION: Bortezomib as first-line therapy has a good efficacy and safety.

Imatinib mesylate as first-line therapy in patients with chronic myeloid leukemia in accelerated phase and blast phase: a retrospective analysis.

INTRODUCTION: Imatinib is a bcr-abl tyrosine kinase inhibitor which has revolutionized the treatment for chronic myeloid leukemia (CML). Even though there is much data on CML chronic phase, there is limited data on imatinib-naοve advanced phase CML. MATERIALS AND METHODS: We retrospectively analysed 90 patients with advanced phase CML (accelerated phase [AP]: 51 and blast crisis [BC]: 39), patients who received imatinib as frontline therapy. RESULTS: The median age of presentation in CML-AP and CML-BC were 32 years (12-61) and 39 years (8-59), respectively. Imatinib at 600 mg/day was initiated within 2 weeks of diagnosis. Median time to complete hematological response in both CML-AP and CML-BC was 3 months (CML-AP: 1-9 months and CML-BC: 1-14 months). At 6 months 30 (59%) CML-AP and 15 (38%) CML-BC patients achieved major cytogenetic response (MCyR), of them 24 (47%) and 10 (25.6%) being the complete cytogenetic response, respectively. At a median follow-up of 41 months, the median overall survival in CML-AP was 61 months, but in CML-BC it was 14 months. The median progression-free survival and event-free survival were 30 months and 23 months in CML-AP and 14 and 12 months in CML-BC, respectively. On univariate analysis, performance status (PS), spleen size, and MCyR predicted survival in AP, whereas in BC, platelet count, PS, and early MCyR were predictive. Non-hematologic and hematologic adverse events were observed in 80% and 60% of patients, respectively. Dose was reduced in 10% of patients for grade IV toxicity and interrupted in 30% for grade III toxicity. CONCLUSION: Front-line imatinib is an option in advanced phases of CML especially in CML-AP in low-resource countries, where stem cell transplantation and alternate TKIs are not available.

Is there a positive effect of participation on a clinical trial for patients with advanced non-small cell lung cancer?

BACKGROUND: There is general belief that patients who enrolled on a clinical trial have better outcomes compared to those who are treated outside of a trial. We analyzed if there was a 'trial effect' for patients with advanced non-small cell lung cancer (NSCLC) treated with chemotherapy. MATERIALS AND METHODS: A retrospective analysis of cohorts of patients with advanced NSCLC who received chemotherapy inside and outside of a clinical trial were analyzed for response rates (RR), progression free survival (PFS), overall survival (OS), 1 and 2 year survival. RESULTS: There were 194 patients who received chemotherapy of which, 54 were on a clinical trial and 140 outside of it. For the whole group, the RR, median PFS, OS, one and two-year survivals were 35.4%, six months (range, 2-70), seven months (range, 2-72), 29.8% and 9.7% respectively. The differences in RR and PFS of patients who were treated inside and outside of a clinical trial were not significant (P=0.6164, 0.0881). The differences in median OS and one-year survivals between the groups were significant (P=0.0052, 0.022). For the whole group, patients who received II line chemotherapy had better OS (P< or = 0.0001). More patients in the trial group received II line chemotherapy (P=0.0004).The difference in the median OS between the groups continued to be significant even after patients who received II line chemotherapy were censored (P=0.0437). CONCLUSION: Patients with advanced NSCLC who were treated inside of a clinical trial had better OS compared to those who were treated outside of it.

Chemotherapy for advanced lung cancer: a 5-year experience.

BACKGROUND: Lung cancer is an important cause of cancer related deaths worldwide. There are few publications from India on treatment outcomes for non-small cell lung cancer (NSCLC). This study was done to analyze the response rates (RR), progression free survival (PFS), overall survival (OS), one and two-year survival of patients with advanced NSCLC treated with chemotherapy. MATERIALS AND METHODS: Data of all patients who received chemotherapy for stage IIIB and IV NSCLC between the years 2002-2006 was analyzed. Only patients who received at least two cycles of chemotherapy and had a radiological response evaluation were eligible for assessment of outcome parameters. RESULTS: There were 294 patients who received chemotherapy. Of these 194 (66%) were evaluable for outcome parameters. The RR, median PFS, OS, one and two-year survivals were 35.4%, six months (range, 2-70), seven months (range, 2-72), and 29.8% and 9.7% respectively. On univariate analysis, the strongest predictors for overall survival were female gender, absence of smoking and performance status (PS) (P= 0.0057, 0.0013, 0.0074). On multivariate analysis, only PS (P= 0.0387) was significant. The survival of patients treated with I generation platinum based doublet was not different from those treated with a II generation doublet (P= 0.45). The overall survival of patients who took II line chemotherapy was superior to those who did not receive it (P= < 0.0001). CONCLUSIONS: Treatment outcomes for patients with advanced NSCLC continue to be poor. The II generation platinum doublets were not superior to I generation doublets. Chemotherapy at disease progression significantly improves survival.