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Background Carcinoma cervix is a leading cause of cancer in Indian females where 15%–60% of the cases eventually metastasize. This is a retrospective review of outcome of metastatic carcinoma cervix patients treated in Kidwai Memorial institute, Bangalore from 2016-2018. Methods We retrospectively analysed our data between October 2016 and September 2018 to identify the cases of metastatic carcinoma cervix and tried to analyse their outcomes with platinum-based chemotherapy. Results 138 cases of metastatic carcinoma cervix were identified during these 2 years. Median age was 49 years (29-73 years). 27(19.5%) patients were HIV+. 39(28.8%) were upfront metastatic & 99(71.8%) were recurrent metastatic. Most common histology was Squamous cell carcinoma, grade II (50%). Nodal recurrence was seen in 108 (78.2%) patients, with most common being pelvic lymph nodes (69.5%) followed by retroperitoneal lymphadenopathy (36.9%) & supraclavicular lymphadenopathy (19.5%). Distant recurrence seen in 93 patients (67.3%) & most common site was lung (54.3%) followed by liver(45.6%), adrenal(4.3%), bone(6.5%) & ascites(8.6%). Nodal-only recurrence was seen in 45 (32.6%) patients. 129(93.4%) patients received palliative chemotherapy as follows- Paclitaxel/Carboplatin (82.6%), Paclitaxel/Cisplatin (6.5%), Gemcitabine/Carboplatin (2.1%), Paclitaxel/Carboplatin/Bevacizumab (2.1%). Overall response rates were 32.6% (CR-4.3%). Median progression-free survival and overall survival (OS) were 6 months and 13 months, respectively. Conclusions Nodal-only metastasis did not show favourable outcome as compared to visceral metastasis. However, disease remains aggressive and poor survival demands further research into newer molecules & regimens. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Background Recurrence is a rule after 1st line therapy in small cell lung cancer (SCLC). Patients who would not tolerate platinum or who recur within 6 months of 1st line therapy; choice of 2nd line is not well defined in them. Methods SCLC patients, who progressed within 6 months after 1st line, or at anytime but who are not candidates for platinum, were non-randomly assigned to receive Paclitaxel 80mg/m2 weekly or Irinotecan 100mg/m2 weekly, till progression or for 12 cycles, or Temozolomide 75mg/m2 21days, every 4 weekly for 6 cycles in patients with brain metastasis. Response, toxicities, survival durations were noted. Results In Irinotecan arm 1(12.5%) had PR, 2(25%) had SD and 3(37.5%) had PD (Response rate[RR]=37.5%). In the Taxane arm, 2(9.5%) had CR, 8(38.0%) had PR, 5(23.8%) had SD, and 6(28.5%) had PD (RR = 71.4%). 2(33.3%) had PR, 1(16.6%) had SD (RR = 50%) in the Temozolomade arm. Mean and median PFS after 2nd line after a min follow up of 18 months was 2.27 and 1.5 months for the whole cohort. Same for Taxane, Irinotecan and Temozolomide were (3.04 and 3 months), (0.81 and 0 months) and (1.5 and 0 months) respectively (p = 0.035). HR for progression for Taxane and Irinotecan were (0.565 p = 0.24, 95% CI [0.218-1.464]) and (1.358 p = 0.575, 95% CI [0.466-3.957]) respectively. Avg grade ¾ haematologic toxicities, febrile neutropenia, GI and hepatotoxicities were lowest for Taxane (0.81/patient p = 0.001, 0.48/patient p = 0.047, 1.14/patient p = 0.137 and 0.19/patient p = 0.08 respectively). Hypersensitivity (all grades) were more common for Irinotecan than taxane (0.62 vs 0.33/patient, p = 0.196). 3 patients died of causes attributed to therapy (2 out of 8 [25%] of Irinotecan arm, 1 out of 21 [4.7%] of Taxane arm). Median OS for the whole cohort was 11.5 months; highest for Taxane 12.5 months> 11 months for Temozolomide>9.5 months for Irinotecan, p = 0.185. HR for death for Taxane and Irinotecan were (0.643 p = 0.376, 95% CI [0.242-1.710]) and (1.383 p = 0.550, 95% CI [0.477-4.009]) respectively. Conclusions Weekly Paclitaxel in 2nd line may have favourable toxicity profile and response rate comparable to Irinotecan or Temozolomide; may translate into better quality of life and OS. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Background Hormonal receptor-positive breast carcinoma constitutes the most common subtype of the disease. Neoadjuvant chemotherapy is the current standard of treatment for any locally advanced breast carcinoma. However, the hormone receptor-positive, Her-2 negative cancers are less likely to respond to neoadjuvant chemotherapy than other biologic subtypes. Studies have explored the efficacy of neoadjuvant hormone treatment in this cohort of patients and efforts are ongoing to identify the subgroup of patients who can be treated with hormonal therapy alone, hence avoiding the unnecessary toxicity of chemotherapy. Our study aims to assess the response to neoadjuvant hormonal therapy (NAHT) in the postmenopausal women who are considered to be low-risk subgroup and for whom chemotherapy can be safely avoided. Trial design Objectives Primary objective: To determine the clinical tumor response rate to NAHT. Secondary Objective: To assess the number of patients undergoing surgery and pCR rates. To assess biologic changes in the tumor, including hormonal receptor status and proliferation by Ki67 staining. Methods Type of study: Phase II Prospective single-center study. Patients: Postmenopausal women diagnosed with biopsy-proven, non-metastatic and potentially operable breast cancer. Inclusion Criteria: Clinical stage T3-T4c with node-negative or clinical stage T2-T4c with node-positive disease (N1, N2) ER-positive with Allred score 6-8, Her 2 negative and Ki67 Legal entity responsible for the study Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Background Bone marrow aspiration although being a common procedure is associated with significant pain and its reduction remains an unmet need. We evaluated the use of tramadol and eutectic mixture of local anaesthetics (prilocaine plus lignocaine) (EMLA) for reducing the severity of pain. Methods In this pilot study, we compared the addition of either Tramadol 50 mg per oral (Arm T) or EMLA local application (Arm E) or no added intervention (Arm L) in addition to local infiltration with lignocaine 2% before bone marrow aspiration in adults suspected / confirmed with malignancy. Both, tramadol and EMLA were administered one hour prior to the procedure. Primary end point was reduction in pain intensity with these interventions compared to local infiltration alone. Pain was assessed using numerical FACES pain scale ( 0-10), a visual analogue scale.Secondary end points were to see the effect on pre procedure apprehension and to find out other factors associated with increased pain associated with the procedure. Results A total of 225 patients were included in the study, 75 each in tramadol(T), EMLA(E) and only lignocaine local infiltration(L) arms respectively. The mean pain intensity on the visual scale was significantly lower in tramadol arm ( T,E,L - 3.3, 4.5, 4.7 respeactively)(p 10 minutes and age > 50 were positively correlated with more pain. Leukemia patients had significantly more pain compared to lymphoma and other solid malignancies. Only 4 patients had sedation/dizziness in tramadol arm compared to 2 each in the other two arms. No significant effect on pre procedure apprehension was noted in any of the arms. Conclusions Tramadol appears to have a preventive effect on bone marrow aspiration associated pain and appears to be well tolerated. Whereas EMLA was not associated with such effect. Larger studies may be done to ascertain the same. Legal entity responsible for the study Department of medical oncology, Kidwai cancer institute. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Background Follicular Lymphoma (FL) is known to be a disease of the elderly and younger patients are postulated to have distinct tumor biology and treatment outcomes. Various lymphoma groups across the world have studied this to understand if young adults (YA) need a different treatment approach. Our study fills the void in paucity of data from an Asian country on YA versus older population of Follicular Lymphoma. Methods The records of patients presented at our center between 2012 and 2018 were retrospectively reviewed. They were stratified by age into ≤40 (YA) and > 40 years and their demographics, clinicopathological features and outcomes were analyzed. Results A total of 167 patients of follicular lymphoma were identified with 24 (14.3%) patients belonging to YA group. A final analysis of 154 patients is presented after excluding patients with upfront Grade 3b disease. Median age in YA and older patients was 37 and 55 years respectively. YA group had a higher incidence of extranodal involvement, bone marrow involvement, and advanced disease at presentation, whereas high LDH and low hemoglobin levels were more common in older patients. As per FLIPI risk scoring, 43% of our patients in both groups had high-risk disease. All YA received treatment upfront, while 7.7% of older population underwent observation. Most commonly used chemotherapy regimen was CVP and 46% of our patients received Rituximab. The ORR was significantly more in YA population (91.3% vs 83.2%) At a median follow-up of 3.5 and 3.2 years (YA and >40 years respectively), YA had a better median PFS (3.5 yrs) and OS (5.9 yrs) compared to those older than 40 (PFS 3.1 yrs, OS 5.2 yrs). On multivariate analysis, normal LDH, lower FLIPI score and use of Rituximab were associated with a significantly longer PFS in older patients, however, it showed a trend towards improved PFS in young adult population that did not reach statistical significance. No parameter showed a significant association with OS. Conclusions YA more frequently present with advanced stage requiring upfront treatment, however they exhibit higher ORR and better PFS and OS compared to older counterparts. The survival rates seen are comparable to another Indian study but lower than the Western data. Legal entity responsible for the study Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.