Background: Peripheral T-cell lymphomas (PTCL) are a heterogeneous group of diseases with aggressive behavior and inferior outcomes as compared to B-cell lymphomas. We report the outcomes from a single center over a period of 18 years. Methods: The baseline clinical features, pathological subtypes, and prognostic factors of all patients with PTCL treated at our center between January 2000 and December 2017 were retrospectively analyzed. Event-free survival (EFS) and overall survival (OS) were calculated using the Kaplan–Meier method and prognostic factors were compared using the log-rank test. Results: During the study period, 144 patients (2–74 years) were diagnosed with PTCL. Male patients were 101 (70%) and females were 43 (30%). Mean age at diagnosis was 43.5 years (20–74 years) for adults (≥ ≥18 years). Of the 144 patients, 42 (29%) had limited stage (Stage I/II) and 102 (71%) had advanced-stage disease (III/IV). The most common histological diagnosis was PTCL-not otherwise specified observed in 61 patients (42.4%) followed by anaplastic large-cell lymphoma (ALCL) in 65 patients (45.2%). The median duration of follow-up was 70.5 months (range, 1–218 months). Five-year OS and EFS for the entire population were 55% and 33%, respectively. Patients with limited stage had better survival when compared to those with advanced disease. Five-year EFS was 52% versus 25% (P = 0.006) and 5-year OS was 70% versus 47% (P = 0.02) in limited and advanced stage, respectively. Patients with PTCL, anaplastic lymphoma kinase (ALK)-positive ALCL and ALK-negative ALCL had 5-year EFS and OS of 20% and 38%, 46% and 76%, 43% and 76%, respectively (P value for EFS = 0.009 and OS < 0.001). Conclusion: Majority of patients with PTCL at our center presented with advanced-stage disease. Outcomes of patients with ALCL are better than those diagnosed with other subtypes of PTCL.

Introduction: Salvage chemotherapy followed by autologous stem cell transplantation is the standard of care in relapsed lymphoma. The optimal regimen for salvage is not defined. The combination of gemcitabine, dexamethasone, and cisplatin (GDP) is an outpatient regimen which can lead to high response rates with minimal toxicity. Methods: This was a retrospective study of all patients with relapsed diffuse large B-cell lymphoma, Hodgkin's lymphoma (HL), or peripheral T-cell lymphoma who received GDP as salvage chemotherapy between January 2014 and December 2017. Baseline characteristics, treatment details, toxicity, and outcomes including survival were analyzed. Results: We included 39 patients in the study. The most common indication was relapsed high grade B-cell non-Hodgkin's lymphoma (NHL) (n = 20, 51%) followed by HL (n = 10, 25%) and T-cell NHL (n = 9, 24%). The median age was 46 years (range, 17–62 years); 27 patients (69%) were males. The most common Grade 3/4 toxicity was thrombocytopenia (n = 7, 18%) followed by neutropenia (n = 5, 12%) and anemia (n = 3, 8%). Overall response rate for GDP was 64% (complete response-10%, partial response-54%). Of the 30 patients who were eligible for transplant, 16 (57%) could undergo transplant. At a median follow-up of 12 months, the 2-year overall survival (OS) and progression-free survival (PFS) were 50% and 38% for the entire patient cohort. The 2-year OS was 68% in the patients who underwent transplant and 38% in the non-transplant group. The 2-year PFS was 58% in those who underwent transplant and 18% in those who did not undergo transplant. Conclusions: GDP is an effective and well-tolerated salvage regimen in relapsed lymphoma. The regimen is feasible in a resource-limited setting.

Introduction: Cytomegalovirus (CMV) infection is very common, although its manifestation as disease occurs usually in the setting of immunosuppression. It is usually seen in hematological malignancies and in post-transplant recipient patients. Data about CMV reactivation in solid malignancies are limited. Materials and Methods: This was a retrospective analysis of adult patients (from the past 10 years of clinical records) with various solid malignancies, who had CMV deoxyribonucleic acid (DNA) positivity and had varied clinical presentation. Results: Of total 73 adult patients of solid malignancies who had been tested for CMV DNA (by real-time polymerase chain reaction [RT-PCR]) with a detection limit of 150 copies/ml), 30 patients had at least one instance of CMV DNA positivity. Of them, we were able to obtain detailed records of 17 patients, who had CMV DNA positivity with clinical manifestations. Fever was the most common symptom in 88% of patients. CMV DNA copy numbers in these patients ranged from 250 to 1,490,000 copies/ml (by RT-PCR). Twelve of the 17 patients (71%) had positive tests for other microbes (based on culture testing) besides the positive CMV test. Ten of 17 (59%) patients were treated with ganciclovir and 7 patients responded to treatment. Seven patients (3 treated with ganciclovir and 4 remained untreated) died during the hospital course. Ten patients recovered (7 treated with ganciclovir and 3 remained untreated, with only monitoring of CMV DNA levels) of their acute illness. Conclusion: CMV infection and its manifestation in patients with solid malignancies is probably underdiagnosed. Given the high morbidity and mortality in these patients (with or without co-infections), it is very important to suspect and treat CMV reactivation.

Background: There is a lack of information regarding Vitamin D deficiency in treatment-naive cancer patients. Aim: The aim of this was to study the prevalence of Vitamin D deficiency in cancer patients. Objectives: The objective was to measure the extent of Vitamin D insufficiency and deficiency in treatment-naive consecutive individual cancer patients from Eastern India. Materials and Methods: All consecutive new patients seen between April 2019 and September 2019 were offered a baseline test to measure serum 25-hydroxy Vitamin D [25 (OH) D] levels along with routine investigations. Vitamin D insufficiency was diagnosed when serum 25 (OH) D level was between 20 and 30 ng/mL, whereas patients with a level <20 ng/mL were designated as Vitamin D deficient. Patients with a Vitamin D level <10 ng/mL were termed as having severe Vitamin D deficiency. Descriptive statistics and frequency distribution were used in SPSS software, and Pearson's Chi-squared test was used to compare between the categorical variables. Results: Of 252 patients, 140 (56%) were female; median age was 51 years (range, 19–84 years) and 204 (81%) were diagnosed with solid organ malignancies. Mean (±standard deviation) Vitamin D level was 18.94 (±10.4). 169/252 (67%) had Vitamin D deficiency, whereas another 52/252 (21%) had Vitamin D insufficiency. Among these, 44/169 (26%) had severe Vitamin D deficiency. Females were more deficient compared to males, 76% versus 55% (P = 0.002). Vitamin D deficiency in younger (<50 years) and older (>50 years) population was 73% and 61% (P = 0.144); while that in solid versus hematolymphoid malignancies was 69% versus 58% (P = 0.173). In the three most common tumors, namely breast (21%), colorectal (8%), and ovary (8%), Vitamin D deficiency was noted in 75% of patients in each group. Vitamin D deficiency was the highest (84%) in esophageal and stomach cancer patients. Conclusion: More than two-thirds of Indian cancer patients are Vitamin D deficient. Patients with upper gastrointestinal, breast, colorectal, and ovarian cancers and female patients are the most vulnerable groups.

Introduction: There is a growing need for BRCA1/BRCA2 mutation frequencies among hereditary breast and ovarian carcinoma (HBOC) cases, specifically determined on the grounds of personal and family history profiles in the Indian population. The current study was intended to identify BRCA1/2 mutation frequency and spectrum in Indian women fulfilling the National Comprehensive Cancer Network criteria. Methods: One hundred and sixty unrelated women were screened for germline variations in BRCA1 and BRCA2 genes by sequencing. The variants were classified as pathogenic or benign on the basis of American College of Medical Genetics (ACMG) guidelines. Results: Of 160 women screened for BRCA mutations, 51 (31.9%) carried a pathogenic variant in BRCA1 (n = 36) or BRCA2 (n = 15) gene. An increased frequency of mutation was seen in women with a personal history of breast or ovarian cancer (34.5%) in comparison to unaffected family members (25%). A spectrum of 34 different pathogenic variants (20 in BRCA1 and 14 in BRCA2) was identified in 51 cases. This included a novel variant c.3683_3684dup in BRCA1 which was categorized as a pathogenic variant. The variant c.68_69delAG in BRCA1 was identified in 12/51 positive cases and appears to be the hotspot mutation in the Indian population. In addition, 11 different missense variants were identified in 10 of the study participants and were categorized as variants of unknown clinical significance (VUS) based on the ACMG guidelines. Of these, three of the variants (c.389A>C in BRCA1 and c.3179G>A and c.10124G>T in BRCA2) were unreported in the published literature. Conclusion: The prevalence of pathogenic variants in the Indian HBOC cohort is high and is similar to other Indian studies. The spectrum of BRCA variants is also diverse, and it is very important to correctly classify them as pathogenic, VUS, or benign. We reinforce the importance of complete BRCA gene screening in the index case, followed by genetic counseling and targeted mutation analysis in other at-risk family members.

Background: There is a scarcity of data to guide the management of older patients with cancer. We therefore conducted this study to compare the outcomes and toxicities in older versus younger patients with an epidermal growth factor receptor (EGFR)-positive non-small cell lung cancer (NSCLC). Patients and Methods: For this pooled analysis, we utilized the individual patient databases of two prospective, first-line Phase III randomized controlled trials in patients with EGFR-mutant advanced NSCLC. The therapies in the two trials included gefitinib alone, pemetrexed/carboplatin, followed by maintenance pemetrexed and the combination of gefitinib with pemetrexed/carboplatin chemotherapy. We evaluated the progression-free survival (PFS) and overall survival (OS) of older patients (=/> 60 years) as compared to younger patients. Grade 3 or worse adverse events were also compared. Results: A total of 640 patients were included in this analysis, of which 156 (24.3%) were 60 years or older. The median PFS with first-line therapy was 8.5 months (95% confidence interval [CI], 7.8–9.2) in younger versus 9 months (95% CI, 6.7–11.4) in older patients (hazard ratio [HR], 2.3; 95% CI, 0.8–6.7; P = 0.575). The median OS of younger patients was 23.2 months (95% CI, 20.6–25.6) compared to 19 months (95% CI, 14.2–23.7) in older patients (HR, 1.18; 95 CI, 0.89–1.54, P = 0.234). On comparing older with younger patients for various known prognostic factors, there was no difference in OS based on any of the factors. On comparing the toxicities between the younger and older patients in the combination group, there was no difference in Grade 3 or 4 toxicities between younger and older patients except higher incidence of diarrhea in older patients (24.4% versus 9.3%, P = 0.010). Conclusions: In patients with EGFR-mutated NSCLC, similar survival and toxicities were found in patients aged 60 years or older as compared to younger patients with Eastern Cooperative Oncology Group Performance Status of 0–2, except for a higher incidence of diarrhea in older patients.

Eighty-five percent of oral cavity cancers present as locally advanced disease and are treated with multimodality approach. Patients who can undergo radical resection have the best outcomes, although the overall results are still unsatisfactory. Neoadjuvant chemotherapy (NACT) has been studied in oral cavity cancers with the aim of improving locoregional control and overall survival (OS) and as an organ preservation tool in resectable oral cavity cancers, It has also been studied in borderline resectable/technically unresectable tumors in order to reduce surgical margins, increase resectability, and achieve R0 resection and in unresectable tumors in order to improve disease-free survival and OS. In this review, we will critically analyze the current evidence for the use of NACT in oral squamous cell carcinoma (OSCC) and suggest an approach to select a patient who might benefit from NACT.

Introduction: Oral metronomic chemotherapy (OMC) is a less intensive and cost-effective palliative treatment modality in children with relapsed/refractory cancers in low-middle income countries. We aimed to study the safety and efficacy of OMC with oral etoposide and cyclophosphamide in relapsed/refractory pediatric malignancies treated at our center. Patients and Methods: This was a retrospective study from the case records of patients treated at our center from 2011 to 2018. Patients <18 years old and who received at least one cycle of OMC were included in the study. Cyclophosphamide and etoposide were given at a dose of 25 mg or 50 mg daily. Schedule of the drugs was variable; the most common schedule followed was 2 weeks on, followed by 2 weeks off. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Results: A total of 49 patients were included in the study. The median age was 8 years (range, 1–18 years) and 23/49 (46%) were males. The most common malignancies were Ewing's sarcoma (n = 13, 26%) and neuroblastoma (n = 11, 22%). The median duration of OMC intake was 50 days (range, 9–570 days). The clinical benefit rate was 22.4% with 10.2% patients having partial response and 12.2% having stable disease. Thirty-two (65.3%) patients had progressive disease on OMC and six (12.2%) were lost to follow-up. The median PFS was 63 days (95% confidence interval [CI], 18–107 days) and median OS was 155 days (95% CI, 19–219 days). Lower age and longer duration of treatment were independent predictors of higher OS. Conclusion: Oral cyclophosphamide and etoposide are a convenient and economical regimen with response rates and survival similar to those historically reported from other OMC regimes.

Introduction: Majority of the patients in low-to-middle income countries (LMICs) have no access to adjuvant trastuzumab due to financial constraints. Short-course (9 weeks) schedule of trastuzumab is a feasible alternative in this setting. The objective of this study was to assess the feasibility and outcomes of adjuvant short-course trastuzumab in patients with breast cancer treated at our center. Materials and Methods: This was a retrospective study conducted in a tertiary cancer center in South India. Case records of all patients who received short-course (9 weeks) adjuvant trastuzumab from June 2014 to December 2016 were reviewed. Baseline characteristics, treatment details, and outcomes were analyzed. Results: During the study, 129 patients received short-course trastuzumab. The median age was 50 years (range, 30–74 years). Majority of the patients were postmenopausal (64%). The most common histology was infiltrating ductal carcinoma; 57% had Grade 2 disease. The most common chemotherapy regimen used was doxorubicin + cyclophosphamide (AC), followed by weekly paclitaxel (n = 110, 86%) and docetaxel + cyclophosphamide (TC) (n = 17, 13%). Majority of the patients (n = 120, 93%) had T1 or T2 disease and were node-negative (n = 62, 57%). Sixty-two patients (48%) had hormone receptor-positive disease. One hundred and eight patients (84%) underwent modified radical mastectomy, and the rest had breast conservation surgery. At a median follow-up of 29 months, the 3-year overall survival (OS) was 98%; the median OS was not reached. The 3-year disease-free survival (DFS) was 97.4%; the median DFS was not reached. The regimen was well tolerated and none of the patients developed symptomatic cardiac failure. Conclusions: Our study shows that a 9-week short course of trastuzumab is a feasible strategy in a resource-limited setting and can lead to promising outcomes, especially in early breast cancer.

Introduction: Statistics is an unpleasant but essential part of an oncologist's academic life. This review is an attempt to simplify the concept of various types of clinical studies. Methods: Various books, articles, and online resources were used to gather information on types, definitions, clinical role, and brief methodology of various retrospective and prospective studies. Results: The collected information has been concisely put together along with relevant examples to make the manuscript reader-friendly. Discussion: This article is a brief account of various types of epidemiological and clinical studies used in medical research. Although some modifications are made time to time to suit the study requirements, basic framework remains the same.