Variation of adverse drug reaction profile of platinum-based chemotherapy with body mass index in patients with solid tumors: an observational study.

OBJECTIVES: Toxicity of cancer chemotherapy may be affected by nutritional status of patients which is reflected in the body mass index (BMI). We sought to assess whether the adverse drug reaction (ADR) profile of platinum-based chemotherapy varies with BMI status. MATERIALS AND METHODS: Adult patients of either sex, suffering from a solid tumor (lung, head and neck, ovary, gall bladder, stomach, colon) and started on platinum-based chemotherapy as initial treatment were included. BMI at chemotherapy commencement was obtained from medical records. Events were recorded and graded as per Eastern Co-operative Oncology Group Common Toxicity Criteria-patients' complaints; clinically evident signs and laboratory reports were considered. Frequencies of individual adverse events were compared between low BMI (<18.5 kg/m(2)) and satisfactory BMI groups. Similar comparisons were done for events with grades 2 or 3 severities. RESULTS: A total of 50 patients were observed over a 3-month period of whom 17 (34%) belonged to the low BMI group. Nausea, vomiting, diarrhea, stomatitis, anemia, alopecia, tinnitus and paresthesia were the commonly observed ADRs. The frequencies of anemia (P = 0.152) and vomiting (P = 0.140) and severity of grades of nausea (P = 0.066), anemia (P = 0.120) and paresthesia (P = 0.128) showed a higher trend in the low BMI group though differences were not statistically significant. The frequencies of tinnitus (P = 0.021) and paresthesia overall (P = 0.036) were significantly higher in the low BMI group. CONCLUSION: ADR profile of primary platinum-based chemotherapy appears to be partly influenced by BMI. This suggests the importance of maintaining adequate nutrition in patients and the need for greater vigilance in those with low BMI.

Neoodjuvant imatinib mesylate for advanced primary and metastactic/recurrent gastro-intestinal stromal tumour (GIST).

Therapy of gastro-intestinal stromal tumour (GIST) has changed significantly with the use of imatinib mesylate. Disease progression remains a complicated clinical issue, suggesting the need for multimodality management. This is a prospective clinical study evaluating the neoadjuvant use of Imatinib mesylate in primary GIST. There is pre-operative use of imatinib in 10 patients with operable advanced and metastatic GIST. The follow-up continued postoperatively for maximum period of two years and postoperative imatinib was given for two years. Ten patients were accrued in the study. Following imatinib mesylate therapy, the median reduction of tumour volume was 45% (range 20-60%). Six of the ten patients underwent complete resection of the tumour following neoadjuvant imatinib for a median period of three months, and are disease-free for a median follow-up of eleven months (range 6-24 months). Three patients in whom the tumours were deemed to be operable after downsizing and who refused surgery are also continuing imatinib. Imatinib did not produce serious toxicity in any patient.

Renal cell carcinoma presenting with oral tongue metastasis: a rare case presentation.

Renal cell carcinoma is the most frequent kidney neoplasm, with a high tendency to metastasize. The occurrence of renal carcinoma metastasis to the head and neck region is extremely rare. Here we present one such case where the tongue metastasis was the initial presenting feature of disease.

Retrospective analysis of the clinical and demographic variables on the outcomes after second-line treatment in advanced non-small cell lung cancer.

BACKGROUND: Platinum based doublets chemotherapy are the standard of care for metastatic or advanced non-small cell lung carcinoma. This leads to modest survival advantage and improve quality-of-life. However, patients with advanced or metastatic disease eventually present disease progression and needs second-line systemic therapy in a selected group of patients or other supportive measures. There is very little knowledge available from the literature about the prognostic variables in patients, who receive second-line therapy. MATERIALS AND METHODS: We retrospectively reviewed 329 patients received second-line treatment from July 2007 to September 2011 in the Department of Radiation Oncology, Burdwan Medical College and Hospital. For statistical analysis, 12 potential prognostic variables included. Univariate and multivariate regression analysis carried out to identify the prognostic variables associated with survival. RESULTS: The results of univariate analysis for overall survival (OS) and survival after second-line therapy identified to have prognostic significance: Age, sex, performance status, smoking history, serum lactate dehydrogenase, histopathology, first-line chemotherapy and its response and second-line therapy except the stage at diagnosis and site of failure after first-line therapy. The multivariate Cox regression analysis has shown that only performance and second-line therapy were independent prognostic variables for survival after second-line treatment and above these prognostic factors; age, smoking status and progression free survival also for OS. CONCLUSION: The performance status has shown consistent result as a prognostic factor in univariate and multivariate analysis for OS and survival after second-line therapy. These findings may also facilitate pretreatment prediction of survival and be used for selecting patients for the correct choice of cytotoxic therapy.

Patterns of cancer occurrence in different regions of West Bengal--a hospital based study.

The incidence of cancer has been rising steadily in the third world countries including India. The patterns of cancer incidence reflect the racial, cultural and pharmacogenomic diversity within populations and nowhere is this diversity more striking than in the Indian subcontinent. This article shows the diversity in patterns of incidence of major cancers across three medical college hospitals in the state of West Bengal in India. All the data were collected from the period between 2001 and 2005. The results show a striking variation of incidence of major cancers in the urban, semi-urban and rural parts of the same state. Indeed the differences of the patterns are explainable by the cultural and socioeconomic differences within the populations from which the study samples are drawn. This constitutes the largest single hospital based data collected from this part of the world till date and will help in re-evaluation of cancer control programmes promulgated by the health authorities of the region.

The effect of honey on mucositis induced by chemoradiation in head and neck cancer.

The aim of this study was to evaluate the effect of pure natural honey on radiation-induced mucositis. Fifty-five patients diagnosed with head and neck cancer requiring radiation to the oropharyngeal mucosal area were divided into two groups (study arm-28 and control arm-27) to receive either chemoradiation or chemoradiation plus topical application of honey. Patients were treated using a telecobalt machine at 2 Gy per day, five times a week up to a total dose of 66 Gy. in the study arm, patients were advised to take 20 ml of honey 15 minutes before, 15 minutes after and similar amount at bed time. Patients were evaluated every week for the development of radiation mucositis using the WHO grading system. There was significant reduction in the symptomatic grades 3 and 4 mucositis in honey-treated patients compared to controls ie, 18% versus 41% for grade 3 and 4% versus 22% for grade 4 mucositis. Seventy-one per cent of patients treated with topical honey showed no change or a positive gain in body weight. In the control group also 22% had no weight loss, though none showed weight gain. Furthermore, it didn't affect blood sugar level when initial fasting blood sugar level was < 150 mg%. Honey is a cheap, simple, easily available and effective agent in reducing radiation-induced mucositis. Within the limits of this study the results showed the application of natural honey is effective in managing radiation induced mucositis, which warrants further multicentric randomised trials to validate the findings.

Profile of childhood cancers: a multicentric study.

The incidence of cancer has been increasing steadily in the developing world including India. Childhood cancers are a special entity with different genetic, environmental factors playing a role in their aetiology. The profiles of cancer incidence reflect the racial, cultural and geographical diversity within populations. This article shows the profile of childhood cancer across three medical college hospitals in the state of West Bengal in India and the data were collected from the period between 2008 and 2011. The results showed leukaemia was the most common cancer affecting children followed by lymphoma and retinoblastoma.The profile of childhood cancers showed wide variation among the age groups. Frequency of retinoblastoma, renal tumours, neuroblastoma and hepatic tumours were higher in children less than five years whereas lymphoma, leukaemia, bone tumours and central nervous system tumours were found more in children above five years. As many of common childhood malignancies are curable there is need to have a dedicated paediatric cancer registry for assessing the magnitude of problem in our country as paediatric cancers show wide variation across centres.

Attitudes of patients to alternative medicine for cancer treatment.

Awareness of attitudes to different types of medicine is very important for estabishment of cancer prevention programs. Alternative medicine has become an important feature of oncology regardless of geographic region, and in India, the majority of cancer patients present at late advance stage of disease when curative treatment cannot be initiated. Given the lack of facilities it is no surprise that many Indian cancer patients try various complementary and alternative medicines, depsite the fact that little is known about their therapeutic efficacy and toxicity. A study was conducted in 300 biopsy proven cancer patients undergoing alternative cancer therapy with Psorinum in Kolkata. The main aim of the study was to analyze the patients'/caregivers narratives regarding the therapy they have been trying. One hundred and ninety five patients (65%) have consulted their oncologists before trying this therapy. About 18.5% of the patients expressed satisfaction with the therapy due to the holistic nature and team approach employed for patient management. The cost of the therapy was within the reach of many cancer patients belonging to the underprivileged segment of the society, contributing to its immense popularity in Kolkata. Whether this can be translated into a willingness to use similar natural compounds for cancer prevention and treatment purposes now needs to be analysed.