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Background: Platinum-based combination chemotherapy is recommended as the standard treatment for patients with advanced non–small-cell lung cancer (NSCLC), but its benefit is limited to patients with performance status (PS) of 0 or 1. However, it is not clear whether these benefits apply to patients with poor performance status (PS 2 and above) and there are no predictors of outcome to suggest whom to treat. The patients with poor performance status (PS 2 and above) accounts for a significant portion (up to 30%) of patients of our practice. In this retrospective analysis, we have analyzed our experience of chemotherapy in patients with poor performance status. Method: A retrospective analysis of patients of advanced NSCLC with poor PS (ECOG PS 2 or more), treated with chemotherapy from October, 2016 to June, 2018 was done. Patients with driver mutations who were treated with first line tyrosine kinase inhibitors were excluded. Hospital case records were reviewed for baseline characteristics, treatment details, and outcome data. Kaplan-Meier curves were drawn to estimate progression free survival. Log-rank test was used to assess factors affecting survival. Data was analyzed using STATA ver 11 (StataCorp. 2009. College Station, TX: StataCorp LP). P value <0.05 was taken as significant. Result: A total of 96 patients were included in the analysis. The median age of the patients was 62 years (range 30-84 years). Majority (67.7%) was males and 65% patients were smokers (current or former). Patients with ECOG PS (Eastern Cooperative Oncology Group Performance Status) of 2 constituted 64.5% of this cohort and 34 patients (33.5%) had an ECOG PS of 3 or 4. The most common chemotherapy regimen used was combination of weekly paclitaxel (60 mg/m2) and carboplatin (AUC2) in 57.8%. Most patients (64%) could complete 4 or more cycles of chemotherapy, however, 15 patients (15.7%) could receive only 1 cycle. Grade 3⁄4 toxicities were observed in 22 (23%) % patients, which were hematological in most cases (anemia and thrombocytopenia). At least one point improvement in ECOG PS from baseline during chemotherapy was observed in 43 patients (45%) after 4 cycles of chemotherapy. Objective response and disease control rates were 20% and 48.42%, respectively. After a median follows-up of 11.2 months, median progression free survival was 6.3 months (95% confidence interval 5-10.63). On univariate analysis, we found that male sex and use of weekly paclitaxel-carboplatin were associated with better progression-free survival PFS. Conclusion: Systemic chemotherapy in modified doses and schedules in advanced NSCLC patients with PS 2 and above is feasible and may be associated with better symptom palliation with clinical benefit and improved survival. [ABSTRACT FROM AUTHOR]

Background: Sex disparity and its determinants in childhood cancer in India remain unexplored, with scarce information available through summary statistics of cancer registries. This study analysed the degree of sex bias in childhood cancer in India and its clinical and demographical associations.Methods: In this retrospective, multicentre cohort study, we collected individual data of children (aged 0-19 years) with cancer extracted from the hospital-based records of three cancer centres in India between Jan 1, 2005, and Dec 31, 2019, and two population-based cancer registries (PBCRs; Delhi [between Jan 1, 2005, and Dec 31, 2014] and Madras Metropolitan Tumour Registry [between Jan 1, 2005, and Dec 31, 2017]). We extracted data on age, sex, and confirmed diagnosis of malignancy (according to the International Classification of Diseases-10 coding),and excluded participants if they were without a recorded diagnosis, had a benign diagnosis, had missing sex information, resided outside of India, or were a donor for haematopoietic stem cell transplantation (HSCT). The primary outcome was the male-to-female incidence rate ratio (MF-IRR) in the two PBCRs and the male-to-female ratios (MFR) from the hospital-based and the HSCT data. For PBCR data, MF-IRR was estimated by dividing the MFR by the total population at risk. MFR was analysed for patients seeking treatment at the cancer centres and for those undergoing HSCT. Logistic regression analyses were done to explore the association of clinical and demographical variables with sex of the patients seeking treatment and those undergoing HSCT in hospital-based data and multivariable analyses were done to determine independent sociodemographic predictors of sex bias. Annual time trends of MFR and MF-IRR during the 15-year study period were ascertained by time series regression analyses.Findings: We included 11 375 children from PBCRs in the study. 26 891 children from hospital-based records were screened, and data from 22 893 (85·1%) were included (including 514 who underwent HSCT). Residence details were missing for 257 (1·1%) of 22 893 patients from hospital-based records. The crude MFR of children at diagnosis was in favour of boys: 2·00 (95% CI 1·92-2·09) in the Delhi PBCR and 1·44 (1·32-1·57) in Madras Metropolitan Tumour Registry. The MF-IRRs for cancer diagnosis were also skewed in favour of boys in both PBCRs (Delhi 1·69 [95% CI 1·61-1·76]; Madras Metropolitan Tumour Registry 1·37 [1·26-1·49]). The MFR for children seeking treatment from hospital-based records was 2·06 (95% CI 2·00-2·12) in favour of boys. In subgroup analyses, the proportion of boys seeking treatment was higher in northern India than southern India (p<0·0001); in private centres than in centres providing subsidised treatment (p<0·0001); in patients with haematological malignancies than those with solid malignancies (p<0·0001); in those residing 100 km or further from the hospital than those within 100 km of a hospital (p<0·0001); and those living in rural areas than those living in urban areas (p=0·0006). The MFR of 514 children who underwent HSCT was 2·81 (95% CI 2·32-3·43) in favour of boys. Time trend analysis showed that MFR did not show any significant annual change in either the overall cohort or in any of the individual centres for hospital-based data; however, the analysis did show a declining MF-IRR in the Delhi PBCR from 2005 to 2014 (p=0·031).Interpretation: The sex ratio for childhood cancer in India has a bias towards boys at the level of diagnosis, which is more pronounced in northern India and in situations demanding greater financial commitment. Addressing societal sex bias and enhancing affordable health care for girls should be pursued simultaneously in India.Funding: None.Translation: For the Hindi translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

• 'MRplus' risk-score is being proposed for the risk-stratification in childhood B-ALL. • The integrated molecular genetic risk-score 'MRplus' can identify distinct subgroups in B-ALL. • 'MRplus' score can risk-stratify B-ALL patients at baseline into those with good, intermediate and poor outcomes. We propose "MRplus", a molecular genetic risk score and check its clinical application in the risk-stratification of pediatric B-ALL. The genomic DNA of untreated pediatric BCR-ABL1 negative B-ALL patients was analyzed for deletions of IKZF1, PAX5, CDKN2A/B, BTG1, RB1, ETV6, EBF1, ERG , pseudoautosomal region(PAR) genes using multiplex ligation-dependent probe amplification, along with the routine genetic work-up. The patients were assigned an 'M'score- 0 (M0) for low and 1 (M1) for high genetic-risk as per the criteria by Moorman et al., and another score "IKplus"-1 (IKplus1) for IKZF1plus as per the criteria by Stanulla et al., and 0 (IKplus0) for other patients. The final "MRplus" risk-score of 0 (MRplus0), 1 (MRplus1) or 2 (MRplus2) was obtained by adding both these scores. The association of risk scores with overall survival (OS) and event free survival(EFS) was seen using Cox proportion hazard model. The overall goodness of fit of the model was done using Cox-Snell residuals. The median age of 320 patients was 6 years (1−18 years). The patients with score M1 were 139 (43.4 %), M0−181 (56.6 %); IKplus1−32 (10 %) and IKplus0−288 (90 %). The final "MRplus" score of 0,1,or 2 was obtained in 181(56.6 %), 107(33.4 %) and 32(10 %) patients respectively. The post-induction remission rate was 90.7 %, 77.8 %, 73.9 % (p = 0.004); 4-year OS 67 %, 48 %, 27 % (p < 0.001); and 4-year EFS 56 %, 34 %, 19 %(p < 0.001) in patients with "MRplus" score 0,1,and 2 respectively. The proposed "MRplus" scoring at baseline could identify three distinct risk groups-good (MRplus0), intermediate (MRplus1) and poor (MRplus2), with different outcomes; in pediatric BCR-ABL1 negative B-ALL. This may help in better risk-stratification and selection of patients for alternative treatment approaches. [ABSTRACT FROM AUTHOR]