A Study Comparing the Efficacy of Ondansetron, Palenosetron and Aprepitant in the Prevention of Chemotherapy induced Nausea and Vomiting in Breast Cancer patients receiving Moderately Emetogenic Chemotherapy.

Introduction: Nausea and vomiting are the most feared complications of chemotherapy experienced By the patients.1,2.Almost 70-80% of all cancer patients will be having chemotherapy induced Nausea and vomiting.3,4 The prevention of chemotherapy induced nausea and vomiting (CINV) is Very much important and necessary because it has huge implications on both patient’s and Clinician’s perspective. As it is the most common problem faced by patients and as it can be Prevented or controlled to a certain extent with the judicious and careful use of anti emetics sums Up the significance of the need to select an appropriate anti emetic regimen for a particular class Of chemotherapy. Prevention is always better than cure ,which is an old age saying holds very true in the Perspective of CINV also because it is always important to prevent CINV rather than treat CINV As damage would have already occurred in the form of poor oral intake, affection of quality of Life , anxiety in the minds of patients ,creating doubts about their ability to tolerate further Chemotherapy thus leading to anticipatory vomiting in the subsequent cycles or loss of Compliance leading to inadequate treatment of the disease and last but not the least the financial Burden on the individual and the family for supportive care, hospital admission and the rescue Medications .5 Treatment of breast cancer also has undergone considerable improvement in the recent Times leading to increased chance of cure .Hence it becomes extremely important to provide the Cure with least toxicities and side effects of treatment. The chemotherapy used in breast cancer Patients falls under moderately emetogenic chemotherapy type (MEC) 6 . The choice of anti Emetic regimen in patients treated for highly emetogenic chemotherapy is clear and non Controversial. The same cannot be told about the anti emetic regimen in patients receiving MEC.7The development of newer anti emetic agents like palonosetron, aprepitant, fosaprepitant And casopitant has led to tremendous opportunities and improved patient care. Conventionally Ondansetron was the anti emetic of choice for patients receiving MEC but now with the advent of Aprepitant it is becoming the new standard of care as an antiemetic regimen of choice in patients Receiving MEC especially those receiving a combination of anthracycline and an alkylating Agent.7 There are only a few trials and studies using aprepitant in patients receiving MEC and in Fact there are no studies till date comparing palonosetron with aprepitant in the prevention of CINV in MEC. Hence our study is a sincere effort in that regard trying to compare palonosetron And aprepitant to ondansetron. And we also have compared palonosetron with aprepitant with Respect to their efficacies in the prevention of CINV .This will be of great help to a limited Resource country like ours, where a cheaper alternative can be of great relief to the patient Herself/himself and also to the treating centres and also will have great financial implications If a Cheaper alternative is obtained. AIM: PRIMARY OUTCOME To compare the Complete response rates in the ondansetron, palonosetron and Aprepitant based antiemetic prophylaxis regimen in patients of breast cancer patients Receiving moderately emetogenic chemotherapy SECONDARY OUTCOMES To determine the complete response during the acute phase after initiation of Chemotherapy To determine the complete response during the delayed phase after initiation of Chemotherapy To determine the impact of CINV on quality of life using the Functional living Index- Emesis(FLIE) scores in each of the 3 arms To determine the effect of antiemetic agents on the reduction of usage of rescue Medication

Sarcomatoid carcinoma of the colon: a rare diagnosis

Report of a rare colon tumor treated successfully using conventional chemotherapy regimen.

Retinoblastoma – pattern, presentation and management: a quintessential experience of 5 years

Background: Retinoblastoma (RB) is the most common intraocular malignancy of childhood. It accounts for 10-15% of cancers that occur in infants. Objective of the study was to determine the pattern, presentation and management of Retinoblastoma (RB) patients at a tertiary cancer care center in South India, during a period of 5 years (1st November 2009 to 1st December 2014).Methods: This study was a retrospective analysis of the medical records of patients diagnosed as having retinoblastoma obtained from hospital information system and our cancer registry. Data sought was demographic characteristics, clinical presentation, investigations done, the methods of management and the treatment outcome of retinoblastoma patients.Results: Total number of cases studied was 31 and total number of eyes studied was 47. Out of 31 cases, 58% were female. 52% had bilateral involvement. The median age at presentation was 24 months. The commonest mode of presentation was leukocoria (55%) followed by proptosis (22%). Out of 47 eyes studied, 87% were advanced tumours belonging to Group D or Group E. Metastasis to the central nervous system was noted in 22.6% patients belonging to either Group D or Group E. Out of the 31 patients, 64.6% patients underwent enucleation. 6 out of 31 cases succumbed to death.Conclusions: Retinoblastoma continues to be a challenge in developing countries. Lack of awareness and inaccessibility to proper healthcare facilities are major stumbling blocks in achieving high cure rates. Educating the public and healthcare professionals, importance of early diagnosis and prompt referral are vital in reducing morbidity and mortality associated with the disease

Posterior reversible encephalopathy syndrome in cancer patients: experience from a tertiary cancer center, South India

Posterior Reversible Encephalopathy Syndrome (PRES) is characterized by seizures, headaches, altered mental status, cortical blindness and typical transient lesions on MRI. PRES may be associated with chemotherapy, molecular targeted drugs and immunosuppressive agents used in patients with cancer. PRES is a very rare condition in cancer patients. PRES is usually reversible with appropriate supportive care and most patients can be restarted with treatment

Retrospective study of chemotherapy induced cardiotoxicity from a tertiary cancer centre in South India

Background: Ever increasing therapeutic modalities in treatment of various malignancies has resulted in an enormous number of cancer survivors. Cancer survivors face various issues in their long term health due to the cancer and/or its treatment. Late effects including organ damage, functional disability and risk of second malignancy continue to be elucidated. One of the most debilitating and serious toxicity is cardiotoxicity due to chemotherapy.Methods: This study was a retrospective analysis of all patients who developed chemotherapy induced cardiotoxicity between January 2013 to December 2015.Results: A total of 16 patients developed cardiotoxicity. 13 patients had doxorubicin induced toxicity. Cardiotoxicity was noted to occur at low cumulative doses. 2 patients had complete recovery of left ventricular ejection fraction (LVEF) on follow up. 1 patient had progressive worsening of LVEF. 1 patient died due to cardiotoxicity. On detection of cardiotoxicity, most of the patients received cardiac remodeling drugs - angiotensin converting enzyme inhibitors (mostly enalapril), other drugs used were carvedilol and diuretics.Conclusions: In Indian patients, cardiotoxicity can occur at very low cumulative doses of doxorubicin and in young patients too. Most of the patients did not have any underlying comorbid illnesses. We wish to highlight the need to diligently repeat cardiac screening investigations at frequent intervals to detect asymptomatic cardiotoxicity

Double malignancies: a clinicopathological and outcomes retrospective analysis from a tertiary cancer referral centre in South India

Background: The presence of second synchronous or metachronous primary malignancies in a cancer patient is not a rare phenomenon. Our study is an endeavour to present data on the frequency, types, and outcomes of double primary malignancies in Indian cancer patients.Methods: This was a retrospective study conducted in 28 cancer patients diagnosed with histologically confirmed double malignancy. Retrospective data of the cancer site, patient’s age at the presentation, gender, type of cancer (synchronous/metachronous), treatment, and outcome were recorded from patients presented with double malignancies from January 2012 to January 2019.Results: Among 28 patients (18 females; 10 males) with multiple primary malignancies, 10 (35.7%) and 18 patients (64.3%), respectively, had synchronous and metachronous primary malignancies. Overall, breast, gynecological, head, and neck cancer were the most common primary malignancies. Gastrointestinal tract, breast, and lung cancer emerged to be the most common second primary malignancy sites. Squamous cell carcinoma (SCC) and invasive ductal carcinoma (IDC) were the most common histopathological types of double malignancies. The majority of the patients received appropriate treatment for both the malignancies.Conclusions: Data from the present study clearly suggest that the occurrence of second primary malignancy is not rare in Indian cancer patients. The double malignancies can occur at any stage and for any type of cancer. Hence, we wish to highlight that the clinician should always be aware of the possibility of developing second malignancy either during evaluation or in follow up of a patient with malignancy

Retrospective analysis of clinical manifestations and treatment outcomes of patients diagnosed with langerhans cell histiocytosis from a tertiary cancer hospital in South India

Background: Langerhans cell histiocytosis (LCH) comprises a diverse group of disorders where pathologic Langerhans cells accumulate in a variety of organs. Aims and objectives of the study is to analyse the clinical manifestations and treatment outcomes of patients diagnosed with LCH in a tertiary cancer hospital in South India.Methods: Retrospective analysis of the case records of patients presenting with histological proven case of LCH over a period of 7 years from 2011 to 2018, being treated at Vydehi Institute of Medical Sciences and Research Centre.Results: 10 patients with biopsy proven LCH were included. The median age of diagnosis was 8 years (range 1 to 73 years) and 3 patients aged 18 years or older at the time of diagnosis. The male: female ratio was 3:2. Multisystem involvement was found in 4 patients (40%) and Single system Involvement in remaining 6 patients. Isolated bone lesions were found in 4 patients (40%), 1 patient had isolated Lymph node involvement; 1 patient had oral cavity lesion. None of the 4 patients with multisystem diseases had skin/mucosal involvement; 3 had bony involvement, 2 patients had lung involvement. One patients with multisystem disease expired while 5 patients were lost to follow-up. 4 out of the 10 patients are on regular follow-up and are in remission.Conclusions: Despite limitation by the retrospective nature, this descriptive study was done to provide further disease information regarding Indian population. Data from this study clearly confirms the known fact that most of the patients with Single System LCH have a very good response rate. Patients with multisystem disease have the highest risk of disease related mortality and morbidity as one among the 4 patients with multisystem disease died just after initiating treatment

Comparison of standard short infusion versus prolonged infusion of Doxorubicin in relation to its cardiotoxicity in South Indian population

Background: Anthracycline is one of the commonly used chemotherapeutic agents in the treatment of malignancies and their efficacy is undermined by potential life-threatening cardiotoxicity.  The aim of this study is to compare the cardiotoxicity in patients receiving standard short infusion (15-30 minutes) versus prolonged infusion (6 hours) of doxorubicin in the study group.Methods: In this study 80 patients who were planned for treatment with Doxorubicin >200 mg/m2 were included in this study and they were randomly allotted to either of the treatment group. Each patient was assessed clinically (History, Pulse rate, Blood pressure) along with ECG ,ECHO prior to initiation of chemotherapy, after completion of 200 mg/m2 of Doxorubicin, 3 months and 6 months after chemotherapy.Results: There were 40 patients in each group, and they received a total of 384 cycles of Doxorubicin containing regimens according to respective protocols. The median number of cycles was four (range four to six cycles). The mean cumulative dose of doxorubicin was 271.5 mg/m2 in the group which received standard short infusion and 264 mg/m2 in the group which received the drug by prolonged infusion. However, none of the patients developed any cardiac symptoms during or after the planned chemotherapy nor was there a drop in ejection fraction on serial ECHO.Conclusions: There was no benefit of prolonged infusion of doxorubicin as compared to the standard rapid infusion in terms of doxorubicin induced cardiotoxicity. At present, standard rapid infusion is the best option

Packed red cell blood transfusion practices review in medical oncology unit in a tertiary cancer center, South India

Background: Anaemia is a very common complication in cancer patients. Up to 60% of solid tumor patients and 70-90% of patients receiving myelosuppressive chemotherapy have anaemia. Pathophysiology of anaemia in cancer patients is multifactorial. The treatments for cancer related anaemia include Erythropoietin Stimulating Agents (ESAs), iron supplementing therapies (intravenous iron, oral iron) and blood transfusion. There are various safety concerns regarding usage of ESAs; also, their usage is less in India due to cost factor. There is scant literature regarding blood transfusion practices in patients undergoing chemotherapy.Methods: Patients diagnosed with cancer and patients receiving chemotherapy were included in the study. Retrospective case record review of cancer patients who received chemotherapy between January to March 2019 was done. Type of malignancy, presence of symptoms related to anemia and trigger for packed red cell transfusion were recorded.Results: Among 342 patients received total of 1365 cycles of chemotherapy in this time period. Mean age of patients was 46 years. 46 of the 342 patients received blood transfusion. Only 13% of the patients had symptoms of anemia like weakness and fatigue the average hemoglobin level at which transfusion was given was 6 gm/dL.Conclusions: Packed Red blood cell transfusion was usually administered at Hb <7 gm/dL. Very few patients reported anaemia related symptoms prior to transfusion. No patient received erythropoietin. Further data is needed from other tertiary cancer centres to understand the blood transfusion practices in Indian cancer patients undergoing chemotherapy

Prospective comparative study of dose dense neo-adjuvant chemotherapy followed by chemo-radiation and definitive chemo-radiation alone in stage IB2-IVA cervical cancer

Background: The standard of care for locally advanced cervical cancer is chemo-radiation. Role of neo-adjuvant chemotherapy not clear yet. Dose dense, short-term neo-adjuvant chemotherapy with early initiation of radiotherapy has shown survival benefit but randomised trials not available yet.  Hence this study was done for feasibility of neo-adjuvant chemotherapy and for its comparison with the standard chemo-radiation.                Methods: Cervical cancer patients not randomly assigned into two arms. Arm A received 3 cycles NACT of paclitaxel and carboplatin weekly. All patients of arm A after NACT and arm B received EBRT on linear accelerator for a dose of 4500-5000cGy in 23-25 fractions with concurrent cisplatin 40mg/m2 followed by 3 applications of HDR intracavitary brachytherapy of 700 or 800cGy respectively. All patients were assessed clinically and radiologically with MRI after completion of CTRT and at follow up of 6 weeks.Results: A total of 15 patients treated in each arm. Stage IIB and IIIB constituted 93% of the patients, well matched in both the arms. The CR rate at follow up of 6 weeks after NACT was 73% compared to only 46.7% in arm B. Neutropenia of grade 3 were seen equally in both the arms and grade 2 neutropenia was seen in about 60% patients in arm A compared to only 20% patients in arm B which was manageable without growth factors.Conclusions: Dose dense neo-adjuvant chemotherapy is a feasible and effective option in treating cancer cervix