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Table of Contents
LETTER TO EDITOR
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 257-258

Author Reply to Kapoor et al.


1 Department of Medical Oncology, Tata Memorial Hospital; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
2 Department of Radiodiagnosis, Tata Memorial Hospital; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
3 Department of Pathology, Tata Memorial Hospital; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India

Date of Web Publication20-Dec-2019

Correspondence Address:
Vanita Noronha
Department of Medical Oncology, Tata Memorial Hospital, Room 304, Homi Bhabha Block, Parel, Mumbai - 400 012, Maharashtra; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_77_19

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How to cite this article:
Kashyap L, Noronha V, Patil V, Joshi A, Mahajan A, Mittal N, Prabhash K. Author Reply to Kapoor et al. Cancer Res Stat Treat 2019;2:257-8

How to cite this URL:
Kashyap L, Noronha V, Patil V, Joshi A, Mahajan A, Mittal N, Prabhash K. Author Reply to Kapoor et al. Cancer Res Stat Treat [serial online] 2019 [cited 2020 Feb 26];2:257-8. Available from: http://www.crstonline.com/text.asp?2019/2/2/257/273694



We thank Kapoor et al. for taking interest in our article[1],[2] and providing thoughtful comments.[3] As pointed out by the authors, there is lack of long-term follow-up data with neoadjuvant imatinib; hence, its impact on disease-free survival and overall survival is largely unknown.[4] Besides, recurrent dermatofibrosarcoma protuberans (DFSP) treated with surgery alone can be salvaged with imatinib, which may further undermine any impact of neoadjuvant imatinib on overall survival.[1]

However, the rationale of neoadjuvant imatinib is to shrink tumor size so that unresectable tumor can be taken up for surgery with acceptable cosmetic outcome. Neoadjuvant imatinib leads to reduced cellularity and hyalinized fibrosis in tumor resulting in shrinkage of tumor size.[5],[6] Ugurel et al. in DeCOG trial used neoadjuvant imatinib in advanced primary or locally recurrent DFSP. They reported hyalinized fibrosis in histopathology and could achieve negative margin in 14 evaluable patients. Only one patient had local recurrence.[5] Neoadjuvant imatinib may cause patchy areas of hyalinized fibrosis leading to skip lesions; however, this appears to be an uncommon occurrence in the reported literature.

We have reported all grade toxicities in 3 (33%) patients and Grade 3 toxicity in 1 (11%) patient. The patient who developed Grade 3 anemia was worked up for nutritional causes, and the levels were found to be normal. We agree with the authors that baseline nutritional anemia workup should be done in all patients planned for chemotherapy or targeted therapy. As part of our institutional protocol, we perform this workup in all our patients being planned for any form of chemotherapy or targeted therapy.

DFSP is an uncommon cutaneous sarcoma. There is a dearth of data regarding the use of imatinib with DFSP in general and with head and neck DFSP in particular. Collaborative multicenter studies may help in better deciphering the role of imatinib and its long-term impact on this rare tumor.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kashyap L, Noronha V, Patil V, Joshi A, Mahajan A, Mittal N, Prabhash K. Dermatofibrosarcoma protuberans of head and neck: Clinical outcome of nine cases treated with imatinib. Cancer Res Stat Treat 2019;2:112-8.  Back to cited text no. 1
  [Full text]  
2.
Pandey AV, Singh A. Head-and-neck dermatofibrosarcoma protuberans: Where does imatinib 'fit in'? Cancer Res Stat Treat 2019;2:74-5.  Back to cited text no. 2
  [Full text]  
3.
Kapoor A, Kumar A. Head-and-neck dermatofibrosarcoma protuberans: Scooping out data even in a dearth of evidence. Cancer Res Stat Treat 2019;2:256-7.  Back to cited text no. 3
  [Full text]  
4.
Rutkowski P, Van Glabbeke M, Rankin CJ, Ruka W, Rubin BP, Debiec-Rychter M, et al. Imatinib mesylate in advanced dermatofibrosarcoma protuberans: Pooled analysis of two phase II clinical trials. J Clin Oncol 2010;28:1772-9.  Back to cited text no. 4
    
5.
Ugurel S, Mentzel T, Utikal J, Helmbold P, Mohr P, Pföhler C, et al. Neoadjuvant imatinib in advanced primary or locally recurrent dermatofibrosarcoma protuberans: A multicenter phase II DeCOG trial with long-term follow-up. Clin Cancer Res 2014;20:499-510.  Back to cited text no. 5
    
6.
Han A, Chen EH, Niedt G, Sherman W, Ratner D. Neoadjuvant imatinib therapy for dermatofibrosarcoma protuberans. Arch Dermatol 2009;145:792-6.  Back to cited text no. 6
    




 

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