Background: Head and Neck Cancer is a major public health problem in India, majority of which are lifestyle related, male predominant requiring dedicated infrastructure and human resource. The 5-year survival is 59% for all stages combined and only 45% in patients with locally advanced inoperable head and neck cancer using current chemoradiation schedules. Chemotherapy agents administered in the induction or concurrent setting comprise of taxanes (Docetaxel, paclitaxel), platinum compounds (Cisplatin, carboplatin) and fluorouracil (TPF). For patients with advanced Head and neck squamous cell carcinoma (HNSCC), 3-weekly TPF regimen is the established standard induction chemotherapy (ICT) option based on overall survival benefit. However, TPF regimen is known to be associated with significant dose limiting toxicities which may impair tolerance and effectiveness of therapy. In this study we assessed the efficacy and toxicity of weekly vs. 3-weekly Docetaxel, Cisplatin, and Fluoro-uracil (TPF) induction chemotherapy in locally advanced Head and neck squamous cell carcinoma (LA-HNSCC). Methods: This was an open labeled randomized two arm study with 41 patients in the 3-weekly TPF arm and 41 patients in the weekly arm. Patients were randomized using numbers from a randomization software, data recorded, and results were analyzed. Results: The weekly group achieved far greater symptom relief than 3-weekly group (72 vs. 64%). The overall response rates were similar in both arms (ORR 75.6 and 73.1% in the weekly and 3-weekly groups, respectively). Renal toxicity was significantly lower in the weekly group as compared to 3 weekly arm post three cycles of chemotherapy (CrCl 91.49 ml/min vs. 76.67 ml/min, respectively). The weekly group had predominantly grade I and II neutropenia (19.5 and 17.1%, respectively) as compared to 3-weekly group where grade III and IV neutropenia (31 and 12%, respectively) was more prominent (p-0.003). Among non-hematological toxicities, mucositis, nausea/vomiting, and diarrhea in the weekly group were significantly lower when compared to 3-weekly group. Progression free survival was slightly higher in the weekly group (18 months) when compared to 3-weekly group (15 months) which was not statistically significant. Conclusion: Weekly induction with TPF had lower toxicity and similar efficacy as compared to 3-weekly regimen in locally advanced HNSCC patients. Myelosuppression, which was the most serious and common complication of 3-weekly TPF regimens was notably low using the weekly regimen. Our results suggest that weekly TPF regimen may be a safer and effective alternative to 3-weekly TPF for treatment of LA-HNSCC. To our knowledge this is the first study reporting the efficacy of weekly TPF regimen in LA-HNSCC till date.

Background:Eribulin mesylate is a non-taxane microtubule inhibitor which can be used after anthracycline and taxane treatment in patients with metastatic breast cancer (MBC). The purpose of this study was to investigate the efficacy and safety of eribulin monotherapy in heavily pretreated patients with MBC.Methods:In this study, a total of 45 eligible patients with MBC who received eribulin in HCG Cancer Speciality Center from November 2014 to March 2016 were prospectively analyzed. Breslow (generalized Wilcoxon) survival analysis was carried out for progression-free survival and for overall survival. Patients were excluded if they had not taken treatment for 3 cycles and defaulted/expired during the treatment.Results:In this study, median age of patients was 52 years. A total of 27 (60%) patients had estrogen receptor and progesterone receptor (PR) positive primary tumors, whereas HER2 was overexpressed or amplified in 7 (15.6%); a triple negative subtype was recorded in 13 patients (28.9%). Regarding toxicity, 30 patients (66.67%) tolerated treatment well and 3 patients (6.67%) got anemia, 6 patients (13.3%) experienced neutropenia, and 7 (15.62%) patients had neurological toxicity. About 14 (31.1%) patients showed PR, 12 (26.7%) patients had stable disease (SD), whereas 19 (42.25%) patients showed progression disease (PD). Response evaluation at 6 cycles was possible in 18 patients and revealed that 4 (22.5%) patients showed PR, 10 (55.5%) patients had SD, whereas 4 (22.2%) patients had PD. Progression-free survival of the overall study population was 3.95 months.Conclusions:Eribulin mesylate is efficacious and tolerable chemotherapy as second- and third-line treatment options for MBC.

Background: Lung cancer is the leading cause of cancer-related death worldwide with an estimated 1.6 million new cases diagnosed each year. According to standard guidelines in NSCLC, the effectiveness of combined chemotherapy regimen comprises of pemetrexed and platinum, and very few reports are available in Indian population. This study shows the experience with pemetrexed and platinum combination chemotherapy in metastatic NSCLC in first line setting. Methods: Total 61 patients with following inclusion criteria were recruited such as: 1) PS of 1 and 2; 2) NSCLC of non-squamous histology; 3) locally advanced or metastatic disease at diagnosis; 4) should have received minimum 3 cycles of pemetrexed and platinum as first line treatment and or continued for 6 cycles; 5) EGFR/ALK mutated or EGFR/ALK unknown patients but must have received upfront chemo. Primary endpoint of the present study is to assess Disease Control Rate (DCR) (CR + PR + SD). Progression Free Survival, OS and Toxicity assessment were secondary endpoints. Results: The mean number of average chemotherapy cycles was found to be 4.38. The range of chemotherapy was 2 -6 cycles. Disease control rate, defined as (CR + PR + SD), was seen in 44 (72.1%) patients. (PR in 26 (42.62%), SD 18 (29.5%)), Progressive disease (PD) was observed in 17 (27.9%) patients. Overall study showed that patients had PFS of 9.414 months (95% CI 6.709 -12.120) and OS of 13.437 months (95% CI 10.721 -16.153). Conclusion: Pemetrexed and platinum combination is effective and well-tolerated chemotherapy regimen in patients with metastatic adenocarcinoma lung cancer patients. Pemetrexed and cisplatin may be more effective in particular. Early switch over to TKIs is preferred immediately after obtaining molecular subtype result.How to cite this paper: Srinivasa, B