Background: Although rare, taxane-induced interstitial pneumonitis is a well-recognized toxicity following chemotherapy. Data on taxane rechallenge in patients who developed taxane-induced interstitial pneumonitis following chemotherapy are limited. Here, we share our experience of acute interstitial pneumonitis following taxane chemotherapy for breast cancer and its clinical outcome following steroids and subsequent rechallenge with taxanes in selected patients without residual lung abnormalities on imaging following steroid treatment. Objectives: To study the taxane-induced acute interstitial pneumonitis in patients with breast cancer receiving chemotherapy and outcome of taxane rechallenge in these patients. Materials and Methods: Patients with breast cancer who developed taxane-induced acute interstitial pneumonitis following chemotherapy either with paclitaxel or docetaxel were included. Results: Among 1240 patients with breast cancer, who received chemotherapy with either docetaxel or paclitaxel, 41 patients developed taxane-induced acute interstitial lung disease (ILD) during the study period. The interstitial pneumonitis was more seen with docetaxel. Among paclitaxel regimens, weekly schedules showed more cases of ILD than 2 weekly paclitaxel. After steroid pulse/maintenance treatment, complete resolution of lung abnormalities was seen in 76%, but residual interstitial pattern on imaging was noted in 24% of patients. Taxane rechallenge was done in 20 (49%) patients. Agents used were paclitaxel, nab-paclitaxel, or docetaxel. All rechallenged patients received short-course oral steroids for one week following taxane rechallenge as a safety measure. Rechallenge was not done in 51% either due to patient unwillingness for rechallenge (27%) or patient with residual interstitial pattern on imaging (24%). None of the patients experienced any recurrence of pneumonitis or any mortality following taxane rechallenge. Conclusion: Acute interstitial pneumonitis is a well-known toxicity following taxanes in breast cancer and taxane rechallenge is an option in those patients without any residual pneumonitis following steroid pulse/maintenance. We also advise short-course oral steroids for 1 week following taxane rechallenge as a safety measure. We strongly do not recommend rechallenge in patients with residual lung abnormalities after steroids.

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Ectopic intrathoracic thyroid is very rare and represents only about 1% of mediastinal tumors. Mediastinal mass in a patient with an otherwise early-stage breast cancer needs evaluation. If the mass is a metastatic lymph node, it changes the entire treatment plan and prognosis. Here, we describe a case of a 57-year-old female presenting with a lump in the right breast of 6 months. Tru-cut biopsy of the lump showed infiltrating duct carcinoma, Grade III, triple-negative. Staging workup showed a mediastinal mass in addition to the right breast mass and ipsilateral axillary lymphadenopathy. Biopsy from the mediastinal mass was suggestive of an intrathoracic thyroid.

Introduction Multiple myeloma (MM) accounts for approximately 1% of all cancers and 10% of all hematologic malignancies. In our institution, we see around 200 patients with myeloma every year. We present our experience with multiple myeloma in the patients aged more than 60 years. Objectives This is a retrospective study of 300 newly diagnosed multiple myeloma patients above 60 years of age treated in the Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India, during the period between 2014 and 2017. The medical records of the patients were studied and following data were collected: demographic and clinical details, diagnostic and staging workup, primary treatment, response assessment, relapse, and survival. Survival was estimated using the Kaplan–Meier method. Results A total of 300 patients were included in the study. The median age was 66 years with a male-to-female ratio of 1.4:1. The common clinical presentations were backache (134), fatigue (49), lower respiratory infection (20), and paraparesis (14). Monoclonal protein was immunoglobulin (Ig)-G in 199 patients (66.6%), IgA in 52 patients (17.4%), IgM in 2 patients, and IgD in 1 patient. Light-chain disease was seen in 42 patients (14%). One hundred and sixty patients (53.5%) had ISS stage III. Only 285 patients received treatment, of which 203 (67.8%) received bortezomib-based regimen, - bortezomib and dexamethasone (BD; 33.4%); bortezomib, lenalidomide, and dexamethasone (BLD; 19.7%); bortezomib, cyclophosphamide, and dexamethasone (VCD; 8.7%); bortezomib, thalidomide, and dexamethasone (BTD; 2.3%); and bortezomib, melphalan, and prednisolone (3.7%). Nonbortezomib-based regimens used were melphalan and prednisolone (MP) alone or with thalidomide or lenalidomide (15%), lenalidomide and dexamethasone (LD; 10.4%), and thalidomide and dexamethasone (TD; 2%). Response assessment was done as per IMWG guidelines. Fifty-seven (26.3%) patients achieved complete response (CR), 94 (43.3%) achieved very good partial response (VGPR), 19 (8.8%) attained partial response (PR), 15 (5.6%) had stable disease, and 46 (15.4%) developed progressive disease. With bortezomib-based regimens, 119 patients (58.3%) achieved CR/VGPR, and with non-bortezomib based regimens, 42 patients (51.2%) achieved CR/VGPR. One hundred and forty-three patients (47.8%) received maintenance therapy of which 79 received maintenance with bortezomib, 49 with lenalidomide, and 15 with thalidomide. The average duration of maintenance was 24 months. Second-line chemotherapy regimens were used in 37 patients. Agents used were MP, LD, TD, and VCD. With second-line treatment, 15 patients achieved VGPR, 10 patients achieved partial response, and 25 patients developed progressive disease. Third-line chemotherapy regimens were used in 22 patients and the regimens used were pomalidomide and dexamethasone, MP, TD, LD, vincristine, doxorubicin, and dexamethasone and carfilzomib and dexamethasone. At a median follow-up of 34 months, the 2-year overall survival (OS) was 68%. The median progression-free survival was 21 months. The 2-year OS for patients receiving initial bortezomib-based regimen was 67.8% and non-bortezomib based regimen was 68% which was similar. Conclusion In this study, CR/VGPR rates and 2-year OS in patients treated with bortezomib and non-bortezomib based regimens were not statistically significant.