With the emergence of second wave of COVID-19 infection globally, particularly in India in March–April 2021, protection by massive vaccination drive has become the need of the hour. Vaccines have been proved to reduce the risk of developing severe illness and are emerging as vital tools in the battle against COVID-19. As per the GLOBOCAN database, nearly 19.3 million new cancer cases have been reported in 2020 globally, which posed a significant challenge to health care providers to protect such large number of ‘vulnerable’ patients from COVID-19. Nevertheless, a considerable degree of doubt, hesitancy and misconceptions are noted regarding the administration of vaccines particularly during active immuno-suppressant treatment. This review article highlights the added vulnerability of cancer patients to the COVID-19 infection and has explored the immunological challenges associated with malignancy, anticancer treatment and COVID-19 vaccination. Supplementary Information The online version contains supplementary material available at 10.1007/s12032-021-01540-8.

BackgroundTreatment for coronavirus disease 2019 (COVID-19) pneumonia remains largely supportive till date and multiple clinical trials took place within the short span of time to evaluate the role of investigational therapies. The anti-inflammatory effect of low dose whole lung radiation in treating pneumonia has been documented earlier. This clinical trial analyzed the effect of low dose radiation therapy (LDRT) in a moderately affected COVID-19 pneumonia patient cohort and has evaluated its effect in stopping the conversion of moderate disease into severe disease.MethodsPatients with moderate COVID-19 pneumonia as characterized by the Ministry of Health and Family Welfare (MOHFW), Government of India, were randomized (1:1) to low dose whole lung radiation versus no radiation. All treatment of patients was concurrently being given as per institutional protocol. Patients were followed up with clinical and laboratory parameters monitored on Days 1, 3, 7, and 14. Computed tomography scan (CT scan) of thorax was performed on Days 1 and 7. Patients were evaluated for conversion of moderate into severe disease as per National Early Warning Score-2 (NEWS-2 score) as the primary end point. The secondary endpoints included changes in ratio between peripheral capillary oxygen saturation and fraction of inspired oxygen (SpO2/FiO2), biochemical markers, 25-point CT severity score, and radiation induced acute pulmonary toxicities.FindingsAt the interim analysis, there were seven patients in the radiation arm and six in the control. A whole lung LDRT improved the outcome of SpO2/FiO2 at Day 3; however it did not convert into a statistically significant improvement for the NEWS-2 score. The serum levels of LDH, CRP, Ferritin and D-dimer were significantly reduced on 14 days in the LDRT arm in comparison to the baseline value but were not significant between the two groups.InterpretationLDRT seems to have the potential to prevent moderate COVID-19 pneumonia from a deteriorating to severe category. However, further randomized clinical trial with an adequate number of such patients is warranted to establish the definitive role of LDRT in the management of COVID-19 pneumonia.FundingAn intramural research project bearing code: I-27/621, was sanctioned from the All India Institute of Medical Sciences, Patna, India.Clinical Trial RegistrationClinical Trials Registry-India (CTRI/2021/06/033912, 25th May 2021) ctri.nic.in/Clinicaltrials/login.php

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Introduction: The novel coronavirus disease 2019 (COVID-19), is caused by the severe acute respiratory syndrome cronavirus 2 (SARS-CoV2). The management of cancer patients is very challenging during the COVID-19 pandemic. Cancer itself as well as anticancer treatment leads to compromised immunity of patients with increased risk of infection. This is turn leads to increased hospital visits. It forms a vicious cycle that increases the risk of COVID-19 susceptibility to cancer patients. Patients on anticancer treatment alongwith COVID-19 infection have higher risk of morbidity and mortality. Aim: To compare the epidemiological characteristics and management decisions in gallbladder cancer patients during COVID-19 pandemic. Methods: This retrospective study was conducted at All India Institute of Medical Sciences (AIIMS), Patna. Patients were divided into two group pre-COVID (patients attending radiotherapy department from December 2019 to February 2020) and established-COVID group patients (patients attending radiotherapy department from March 2020 to May 2020) with histopathological confirmed diagnosis of gallbladder cancer. Results: Histopathological confirmed cases of gallbladder cancer (n=85) were analyzed, 56 patients from pre-COVID timeline and 29 patients from established-COVID timeline were selected. During the pre-COVID timeline, 55.4% of the patients directly visited the radiotherapy department while, 24.1% patients directly attended the radiotherapy department during the established-COVID time. This reduction of number of patients at radiotherapy department was statistically significant (p = 0.006). There was statistically significant reduction (p = 0.014) in number of patients attending from rural areas during established-COVID time. Chemotherapy regimen used during pre-COVID and establishedCOVID timeline was significantly (p < 0.001) different. Conclusion: Cancer patient management during COVID-19 pandemic is an important issue. Chemotherapy increases the risk of COVID-19 infection by reducing the immunity. Single agent oral capecitabine is a good option for patients of gallbladder cancer in the adjuvant or palliative settings with less toxicity and requiring less hospital visits compared to intravenous chemotherapy.

Background: According to the GLOBOCAN 2020 report, the estimated incidence of lung cancer in India was 72,510 in all ages and both sexes. In incidence, lung cancer ranked fourth overall among the various types of cancer. To study epidemiological profile in terms of clinical presentation, stage, risk factors and factors associated with late stage presentations at a newly established tertiary cancer care hospital BiharMethods: This was a retrospective-prospective analysis of collected data of histopathologically proven lung cancer cases in the Outpatients department (OPD) of Department of Radiotherapy, All India Institute of Medical Sciences (AIIMS), Patna over a period of 2.5 years from March 2018 to October 2020.Results: There were 140 patients, with a median age of 56 years, 59.28% (n=83) were smokers, 37.14% (n=52) used chewing tobacco, 24.28% (n=34) worked on earthen stoves and 15% (n=21) had passive smoking exposure. The male-to-female ratio was 1.64:1. Non-small cell lung carcinoma comprised 87.85% (n=123), stage IV presentation in 76.42% (n=107) cases with the most common site of metastases being bone (35.51%, 38 patients). IHC was performed on 64 patients (45.71%) of total 140 patients of which 51 patients were of adenocarcinoma histology. 35.29% (n=18) were EGFR positive and 28.57% (n=4) tested ALK positive. 4 patients tested for ROS-1 were negative. 32.14% (n=45) cases were treated empirically for Tuberculosis on the finding of chest X-ray only.Conclusions: Majority of the patients were males in advanced stage. Bone is the most common site of metastases. Long empirical treatments lead to late presentations.