Primary non-Hodgkin's lymphoma (NHL) of the oral region is rare. Oral manifestations are present in 3-5% of cases of NHL and oral lesions are rarely the initial manifestation. We describe a 40 year old male who presented with a mass lesion primarily involving the tongue and was diagnosed as diffuse large B cell lymphoma. The patient was treated with CHOP chemotherapy with complete disappearance of lesion after first cycle. Pertinent literature is being reviewed.

Background Chemotherapy induced nausea- vomiting (CINV) is considered as the most common, feared and most troublesome side effect of chemotherapy. NEPA (NEtupitant 300 mg + PAlonosetron 0.50 mg) is the first commercially available oral fixed-dose combination (FDC) of two active antiemetic agents in India. The present study was planned to evaluate the effectiveness of NEPA in the real world setting of India. Methods This was a multicentric retrospective study conducted in two centers in India. The data of all chemonaive patients, who were prescribed NEPA was analyzed. Effectiveness i.e. complete response and complete protection in controlling overall, acute and delayed phase was analyzed. Results A total of 329 patients were enrolled in the study. 260 received highly emetogenic chemotherapy (HEC) regimen and 69 received moderately emetogenic chemotherapy (MEC) regimen. Among all the enrolled patients, complete response in acute, delayed and overall phase was 93, 85.71 and 85.41% respectively; and completed protection was 88.44, 81.76 and 80.54% respectively. Those who received HEC regimen, the completed response and complete protection in overall phase was 84.61 and 79.61% respectively and those who received MEC regimen the completed response and complete control in overall phase was 84.05 and 84.05% respectively. Conclusion A single oral dose of NEPA targeting dual pathways showed effective control of nausea-vomiting in patients on the HEC and MEC regimens and had good control over nausea-vomiting in acute, delayed and overall phase of nausea-vomiting.

The management of patients with advanced non-small-cell lung cancer (NSCLC) is becoming increasingly complex, with the identification of driver mutations/rearrangements and the development and availability of appropriate targeted therapies. In 2018, a group of medical oncologists with expertise in treating lung cancers used data from the published literature and experience to arrive at practical consensus recommendations for the treatment of advanced NSCLC for use by the community oncologists. These recommendations were subsequently published in 2019, with a plan to be updated annually. This article is an update to the 2019 consensus statement. For updating the consensus statement, a total of 25 clinically relevant questions on the management of patients with NSCLC on which consensus would be sought were drafted. The PubMed database was searched using the following terms combined with the Boolean operator “AND:” (lung cancer, phase 3, non-small cell lung cancer AND non-small-cell lung cancer [MeSH Terms]) AND (clinical trial, phase 3 [MeSH Terms]) AND (clinical trial, phase iii [MeSH Terms]). In addition, “carcinoma, non-smallcell lung/drug therapy” (MeSH Terms), “lung neoplasms/drug therapy” (MeSH), clinical trial, phase III (MeSH Terms) were used to refine the search. The survey results and literature were reviewed by the core members to draft the consensus statements. The expert consensus was that molecular testing is a crucial step to be considered for patients with NSCLC at baseline, and in those who progress on first-line chemotherapy and have not undergone any prior testing. For mutations/rearrangement-negative patients who progress on first-line immunotherapy, doublet or single-agent chemotherapy with docetaxel and/or gemcitabine and/or ramucirumab should be considered. Patients who progress on the newer anaplastic lymphoma kinase inhibitors should be considered for second-line therapy with lorlatinib or systemic chemotherapy. Maintenance therapy with pemetrexed is preferred for NSCLC with non-squamous histology and should be avoided in NSCLC with squamous histology.

A 57-year-old man on dialysis presented with fever due to Pseudomonas septicemia. Workup revealed very high triglycerides and serum ferritin levels. A bone marrow examination showed hemophagocytosis. A diagnosis of hemophagocytic lymphohistiocytosis (HLH) was made and steroids were started. He was put on automated peritoneal dialysis. Patients' condition continued to deteriorate and he succumbed to his illness. This case illustrates the development of HLH secondary to infections which are increasingly being recognized in the literature. Often this diagnosis is missed as it becomes difficult to differentiate between sepsis and HLH. The presence of high ferritin, hypertriglyceridemia, and hemophagocytosis in the bone marrow confirms the diagnosis.