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Introduction: Ralstonia Mannitolilytica (RM) is a rare opportunistic pathogen capable of causing a serious infection in immunocompromised patients. It is ubiquitous in nature and a frequent contaminant of water supplies. RM infection in cancer patients may have serious implications as they are already susceptible due to underlying malignancy, treatment related immunosuppression, malnutrition and prolonged presence of indwelling central catheters. In this study, we report a case series of RM infection with focus on clinical characteristics, management and patterns of antibiotic sensitivity. Methods: This case series includes 17 cancer patients admitted at Healthcare Global oncology hospital, Bangalore, presenting with fever and/or chills between 22nd February 2020 to 5th May 2020, who had a positive blood culture and/or a chemoport/PICC/central venous catheter (CVC) tip culture positive for RM species.Results: Among all patients, RM was grown from the blood sample of 12 patients having an indwelling chemo-port, 4 patients with PICC line and 1 patient with a central venous line. All patients had a positive blood culture for RM, and two patients had a positive tip culture in their chemo-port and PICC line respectively. Antibiotic treatment includes cefoperazone-sulbactam for 10 patients, ceftazidime for 4 patients, meropenem for 2 patients and ceftriaxone for 1 patient. All 17 patients recovered from the infection without any complications. After 48 hours of incubation, no growth of Ralstonia was reported from any of the current environmental or pharmaceutical water samples. Conclusion: RM may be capable of causing serious infections in cancer patients as they are already immuno-compromised. Furthermore, RM may serve as an effective quality indicator of water and therapeutic supplies. Healthcare professionals should adhere to infection control policies, monitor outbreaks of unusual pathogens and study the emergence of pattern for antibiotic resistance.

Background and Objective: During the second COVID-19 wave in India (April to May 2021), mucormycosis has affected the ‘recovering’ and the ‘recovered but vulnerable’ COVID-19 patients across the country. This review synthesizes information on the risk factors and pathophysiology of mucor infection among COVID-19 patients, which in turn supplements existing information from public health and clinical sciences. The study objective includes analyzing the morbidity of mucor infection and its pathophysiological mechanism, during India’s second wave of the COVID-19 pandemic. Methods: We conducted a systematic literature search of PubMed and Google Scholar databases, using the following text terms: ‘COVID-19,’ ‘SARS-CoV-2,’ ‘mucormycosis,’ and ‘zygomycosis.’ We identified 24 citations and 16 other published literature which described mucormycosis in association with COVID-19. The relevant literature was analyzed for findings on the risk factors of mucor infection and its outcome among individuals with COVID-19. Results: The risk factors for mucor infection include diabetes mellitus, immunosuppression (for example, the administration of steroids/monoclonal antibodies/broad-spectrum antibiotics), prolonged stay in the intensive care unit, co-morbidities such as malignancy or post-transplantation, and prophylactic therapy with voriconazole (generic anti-fungal). The second wave of COVID-19 in India was more severe due to the increased occurrence of systemic inflammation and coagulopathy, which can cause direct damage to the blood vessels resulting in injuries to organs such as the liver, kidney, and heart. Conclusion and Implications for Translation: The increased incidence of mucormycosis during the second wave of the COVID-19 pandemic in India (April to May 2021) was due to a combination of immunocompromising effects of corticosteroids, microangiopathy of diabetes, and peripheral microthrombi among COVID-19 patients. The indiscriminate usage of steroids for treating COVID-19 disease seems to be the likely cause, including the use of immunomodulatory drugs such as interleukin 6 inhibitors like tocilizumab (TCZ) for patients with severe COVID-19. Clinical practices should adopt a judicious approach towards the prescription of steroids and monitoring blood sugar for all COVID-19 patients admitted to the hospital as well as those isolated at home (even during the post-recovery period). The high mortality rate of mucor infection demands appropriate primary prevention measures, as well as early diagnosis and treatment modalities for improving patient survival. Copyright © 2022 Ramani et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

With advances in targeted and personalized treatment for lung cancer, molecular analysis of tumors is routinely performed for sequencing of treatment options in patients with advanced non-small-cell lung cancer (NSCLC). Oncogene addiction due to driver mutations includes EGFR exon 20 insertion mutations, MET amplification, EML4-AL, KRAS G12C point mutations, RET rearrangements, HER2 amplification and mutations, and FGFR amplification and translocations. A re-biopsy at the time of tumor recurrence or progression after first-line treatment failure is important for further molecular assessment and personalized therapy. However, repeat tumor biopsies are fraught with challenges including access to the tumor, sample inadequacy, patient consent, patient performance status, safety, or physician’s choice or assessment. Cytological specimens are gaining importance but are limited due to validation difficulties. Liquid biopsies, which are minimally invasive have shown promise to assess dynamic biomarkers using ctDNA analysis and are thus frequently considered in routine clinical practice in advanced NSCLC patients to guide further targeted treatment. Here we present a comprehensive review that emphasizes the significance of performing tumor re-biopsy in advanced stage NSCLC patients following resistance to first-line treatment and simultaneously highlights the current challenges in performing the same and the current status and future perspectives of liquid biopsy in NSCLC.

Ogilvie syndrome or intestinal pseudo-obstruction is a clinical syndrome characterized by autonomic imbalance affecting peristalsis of colon leading to obstructive signs and symptoms. The etiologies commonly implicated are drugs affecting the cholinergic system, narcotics, electrolyte imbalance, severe sepsis, cancer, major surgery, and renal and cardiac failure. Ogilvie syndrome secondary to chemotherapy is a very rare phenomenon with very few reports in the literature. Cisplatin-induced neuropathy has been reported to occur when the cumulative dose exceeds 360 mg/m2. It manifests predominantly as peripheral sensory neuropathy with autonomic neuropathy occurring very rarely in a subset of patients. All the reported cases to date who presented with autonomic dysfunction secondary to cisplatin also had peripheral sensory neuropathy. Herein, we report a case of metastatic nonseminomatous germ cell tumor treated with cisplatin based regimen, who presented with severe intestinal pseudo-obstruction when the cumulative dose exceeded 400 mg/m2 without any other manifestation of neuropathy. To our knowledge this is the first such case reported in the literature.

Aims: To study the clinico-pathological features of acute leukemia as second malignancy in primary solid cancer after conventional treatment. Objectives: To study and compare the demographics, treatment and prognosis of acute leukemia and solid cancer as second malignancy. Materials and Methods: It’s a retrospective study conducted over period of nine years in our centre using computer based data base and medical records as the data source from the department of medical oncology and hematology. Result: Total 17 patients were diagnosed with primary solid cancers who underwent conventional treatment including surgery, chemotherapy and/or radiation. Majority of cases were female patient (64.7%) with mean age of 58 years (range 39-96yrs) diagnosed as primary solid cancer with stage 3 (52.94%). With stage2 (41.17%). Out of 17 patients, only 4 patients (23.5%) developed acute leukemias which included 3 AML and 1ALL. Of these four patients, only one could be salvaged for about a year with allogenic transplantation while rest three died within a month in an average. Conclusion: Acute leukemias are one of the worst second malignancies that might occur after conventional treatment in solid cancers which should be regularly monitored during the follow up period. Keywords: Acute leukemia, Solid cancer, Treatment.

Introduction: Nasal NK/T-cell lymphoma is a rare extranodal large cell lymphoma that involves the nasal cavity. In majority of cases, Epstein Barr virus is present and Immunophenotype shows CD3 and CD56 positivity. Loco-regional relapse is very common with poor prognosis. Case Report: We report a case of Relapsed NK cell Lymphoma of the orbit and scalp region in a young boy with EBV negativity, CD3 negativity and clinically aggressive disease. Despite aggressive treatment, our case relapsed early and was complicated by prolonged pancytopenia, CNS involvement and patient died less than one year following diagnosis. Conclusion: NK cell lymphoma is an aggressive cancer with high mortality. Multidisciplinary modalities are essential to treat the NK cell lymphoma with radiotherapy, chemotherapy, newer agents, and hematopoietic stem cell transplantation. Keywords: NK/T cell Lymphoma, Immunopheno type, Scalp, Orbit.

Plerixafor is a CXCR4 antagonist which is administered along with granulocyte-colony-stimulating factor (G-CSF) to mobilize hematopoietic stem cells in patients with Non-Hodgkin lymphoma (NHL) or multiple myeloma (MM), who failed the mobilization with G-CSF alone.This was a single-center, retrospective study of the efficacy of the plerixafor and G-CSF in 32 patients with NHL (n = 11), MM (n = 11), and Hodgkin lymphoma (HL) (n = 10) who failed mobilization with G-CSF alone.A median number of 1.21 × 106, 1.32 × 106, and 6.73 × 106 CD34 + cells were mobilized in patients with MM, NHL, and HL, respectively. Overall, 31 (96.8%) patients mobilized more than 2 × 106 CD34 + stem cells and 21 (33.75%) patients mobilized more than 5 × 106 CD34 + stem cells. All 32 (100%) patients underwent hematopoietic stem cell transplantation. There were no adverse drug events reported.This retrospective study shows that plerixafor is an effective and safe mobilization agent in patients with NHL, MM, and HL who have failed mobilization with G-CSF alone.

Introduction: Peripherally inserted central catheter (PICC) is a form of vascular access device (VAD) that can be used for a prolonged period of time in cancer patients for diverse indications. Despite the many advantages, catheter related complications are common. Objectives: The objective of this study was to evaluate infection and thrombotic complications of PICCs in cancer patients. Methodology: We conducted a prospective longitudinal study, over a duration of thirty months from June 2015 to December 2017 in the Department of Haematology and Medical Oncology at our tertiary care, cancer hospital to assess, analyze and compare the infection and thrombotic complications in cancer patients with a PICC line. All patients with cancer who met the inclusion criteria were enrolled and were followed up until catheter removal. The basic information regarding PICCs insertion, weekly care and removal was maintained. The data were analyzed and compared to identify catheter related complications Result: Four hundred and sixty-one PICCs were monitored for a total of 57,438 catheter-days (mean of 124 days i.e. 4.15 months, range : 1 to 434 days). Out of these 461 PICCs, 29 (6.29%) had both infection and thrombotic complications, as a result of which 22 were removed in 57,438 catheter days. (ie catheter removal rate was 0.38 per 1000 PICC days). Infection complications were found more with hematological malignancies while thrombotic complication were predominant in solid tumours. Conclusion: Infection complications were more common in hematological cancer patients than solid cancers where thrombotic complications were more common.

Apart from cervical cancer, Human papillomavirus (HPV) infection is associated with head and neck as well as other anogenital cancers such as vulva, vagina, anus, and penis. HPV vaccine provides specific protection against the disease and its subsequent manifestations.Vaccination programs for men tend to improve population-level control of HPV infection and directly prevent HPV related disease such as anogenital warts and oropharyngeal cancers in males. HPV vaccine does not treat existing infection or lesions/cancer and is intended for individuals before initiation fo sexual activity or any other form of exposure to HPV.Many programs across the globe do not include vaccination for boys because of the cost and little recognition of the emerging epidemic of HPV associated cancers in men. In the Indian context, as screening is not feasible for non-cervical HPV associated cancers, its incidence mostly among men will continue to rise until the present generation of vaccinated adolescents reaches their middle-age.Vaccination will reduce transmission rates and increase herd immunity. This in-turn, will prevent not just cervical cancers but also other HPV-associated malignancies among men and women.

The natural history of cancer in a patient can be simulated in a flexible broad-based disease model. Such models describe events and outcomes at the person level, the results of which can be aggregated to estimate the population morbidity. With minimal assumptions regarding the natural history of disease, models could project outcomes of interventions for cancer screening and treatment.The same could be used for testing conventional treatment protocols and assess the reasons for failure of a particular strategy. Leads from the analysis can be utilized for proposing improvisations for the treatment protocol such as combinatorial strategies, which enables better suppression of tumor despite the resistant cells.This commentary describes relevant concepts associated with simulation modeling of tumor growth and tumor-host interactions, and summarizes some of the prominent approaches.

Asymptomatic minimal pericardial effusion may be frequently found in patients with hypothyroidism. Cardiac tamponade secondary to hypothyroidism is rarely referenced in medical literature. Hypothyroidism as an adverse effect of pazopanib (tyrosine kinase inhibitor) treatment leading to cardiac tamponade is an even rarer occurrence. Here, we report an unusual case of a 71-year-old male, with a case of renal cell carcinoma on pazopanib treatment presenting with shortness of breath who was found to have hypothyroidism with a large pericardial effusion leading to cardiac tamponade. The patient did not have any prior reports of thyroid-stimulating hormone (TSH) or thyroid hormone levels at presentation. No such case of cardiac tamponade due to hypothyroidism as an adverse effect of pazopanib tablet treatment has been reported to our knowledge.

Plasmablastic lymphoma (PBL) is an aggressive lymphoma commonly associated with HIV infection. It most commonly presents in the oral cavity and rarely involves the kidney. Herein, we report a case of HIV positive male with renal involvement of PBL. The patient presented with unilateral severe hydronephrosis with unaltered renal functions. Despite aggressive management, there was an early relapse and the patient died within 2 years of the diagnosis. Despite the recent advances in the therapy of HIV-associated aggressive lymphomas, patients with PBL have a poor prognosis. Multimodal treatment with chemotherapy, newer targeted and biological agents, along with hematopoietic stem cell transplantation is essential for the treatment of PBL.

Introduction: Hodgkin lymphoma (HL) is one of the common lymphomas with high cure rate. Aims: The aim was to study the outcome of relapsed/refractory HL treated with autologous transplantation. Objectives: The objective was to study the overall survival, overall response, and disease-free survival of the relapsed/refractory HL after autologous transplantation. Methods: It was a retrospective study conducted over a period of 8 years in our center using computer-based database and medical records as the data source. Results: A total of 22 patients were diagnosed with relapsed/refractory HL of which majority of cases were male patients (59%) with a mean age of 29 years (range: 15–57 years) and were Stage 4A (40.9%), with nodular sclerosis (54.5%). The overall response rate was 81.8% with 9.1% complete response, 72.7% partial response, and 4.5% stable disease; the overall survival was 77.92 ± 6.65 months, and disease-free survival was 69.66 ± 8.13 months. Conclusion: Autologous stem cell transplant plays an integral role in the treatment of patients with relapsed/refractory Hodgkin lymphoma.

Plerixafor is a stem cell mobilising agent, and when administered along with G-CSF has been shown to improve CD34+ stem cell collections in lymphoma and multiple myeloma patients compared to G-CSF alone. Patients who failed to mobilize 6 cells/kg on Day 1 collection received Plerixafor and G CSF for further collections. Study population was divided into two groups as plerixafor yes (PY) who are poor mobilizers and Plerixafor No (PN) who are good mobilizers. Out of 49 patients, 28 patients were in PY group and 21 patients in PN group. Median value of apheresis CD34 of day 1 was 1.75 (range 0.258 to 8.52) in PY group and 2.63 (range 1.06 to 6.29) in PN group and that of day 2 was 3.845 (range 0.317 to 13.89) in PY group and 3.18 (range 0.88 to 6.348) in PN group. Median value of total apheresis CD34 was 8.10 (range 4.33 to 18.66) in PY group and 7.58 (range 4.06 to 9.8) in PN group. Median day of neutrophil engraftment was 11.5 (range 9 - 22) in PY group and 11 (range 9 - 36) in PN group whereas median day of platelet engraftment was 14 (range 9 - 98) in PY group and 13 (range 11 - 98) in PN group. It can be concluded that the use of plerixafor not only enabled poor mobilizers of Lymphoma and Multiple Myeloma to collect adequate stem cells to proceed to ASCT, but also had early neutrophil and platelet engraftment which was comparable with good mobilizers.

Importance: Corona virus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pandemic claiming millions of lives since the first outbreak was reported in Wuhan, China during December 2019. It is thus important to make cross-country comparison of the relevant rates and understand the socio-demographic risk factors. Methods: This is a record based retrospective cohort study. Table 1 was extracted from https://www.worldometers.info/coronavirus/ and from the Corona virus resource center (Table 2, Figures 1-3), Johns Hopkins University. Data for Table 1 includes all countries which reported >1000 cases and Table 2 includes 20 countries reporting the largest number of deaths. The estimation of CFR, RR and PR of the infection, and disease pattern across geographical clusters in the world is presented. Results: From Table 1, we could infer that as on 4th May 2020, COVID-19 has rapidly spread world-wide with total infections of 3,566,423 and mortality of 248,291. The maximum morbidity is in USA with 1,188,122 cases and 68,598 deaths (CFR 5.77%, RR 15% and PR 16.51%), while Spain is at the second position with 247,122 cases and 25,264 deaths (CFR 13.71%, RR 38.75%, PR 9.78%). Table 2 depicts the scenario as on 8th October 2020, where-in the highest number of confirmed cases occurred in US followed by India and Brazil (cases per million population: 23,080, 5007 & 23,872 respectively). For deaths per million population: US recorded 647, while India and Brazil recorded 77 and 708 respectively. Conclusion: Studying the distribution of relevant rates across different geographical clusters plays a major role for measuring the disease burden, which in-turn enables implementation of appropriate public healthcare measures.

Background: The role of chemotherapy in Gastric Cancer is constantly evolving with various neoadjuvant and adjuvant strategies. Several chemotherapeutic agents are used in the treatment of locally advanced gastric cancer (LAGC) namely Platinum based compounds (Cisplatin, Oxaliplatin), Fluoropyrimidines like 5-Flurouracil [(5-FU), Capecitabine)], Taxanes (Docetaxel) and Anthracyclines (Epirubicin). Various doublet and triplet combination chemotherapy regimens have been used for neo-adjuvant chemotherapy (NACT) in LAGCs. In this study we evaluated the safety and efficacy of docetaxel based triplet regimen DOF [Docetaxel, Oxaliplatin, 5-Fluorouracil] in LAGC. Material and methods: 50 Newly diagnosed patients of Locally Advanced Gastric Cancer (stage II or III) deemed fit to receive chemotherapy were included in our study. After 3 cycles of neoadjuvant chemotherapy, patients were assessed based on radiological and pathological response. Results: 50 Patients were included in our study of which majority were male (32), median age at presentation was 55 years and 24 patients presented with a history of gastrointestinal reflux disease (GERD). The most common hematological toxicities observed in our study were anemia (61.2%), neutropenia (42.6%, febrile neutropenia constituted 6%) and thrombocytopenia (13.2%). The most common gastro-intestinal [GI] toxicities observed in our study included nausea (69.2%), vomiting (31.2%), diarrhea (34%), oral mucositis (14%) and constipation (6.6%). We found that safety profile of DOF regimen was favorable with majority of patients tolerating the regimen well. The Overall Response Rate (68%), Disease Control Rate (96%) and Resectability Rate (80%) were higher compared to western studies. Pathological CR (17.5%), ypN0 disease status (42.5%) and nodal down staging (52%), all showed positive correlations with survival outcomes. Conclusion: DOF regimen is an effective and feasible option for neoadjuvant treatment of LAGC in an Indian population.

Background: Peripherally inserted central catheters (PICCs) are commonly being used in haematological diseases for treatment and now are being used even in haemopoietic stem cells transplantation. The present study was planned with an objective to study the complications, safety and efficacy of PICCs in haemopoietic stem cell transplantation for haematological diseases. Methods: A prospective cohort study was conducted in stem cell transplantation department of our tertiary care cancer hospital for a period of two and half years as per the proforma. All patients with hematological cancer who were undergoing stem cell transplantation were enrolled and were followed up until catheter removal or patient death. The basic information was recorded at the time of PICC insertion, weekly care, and removal after the transplantation. The data were analyzed to study the aims and objectives of the study. Results: Seventy two PICCs were inserted over a period of two and half years for a total of 8048 catheter-days (mean of 111.77 +/_ 66.55 days i.e 3.7 months, range: 9 to 269 days). Out of these 72 PICCs, 11 (15.27%) PICCs had complications and all of them were removed at the rate of 1.35/1000 PICC-days. Catheter related blood stream infection (CRBSI) was higher in allogenic transplant group (16%) than in autologous group (2.5%) while thrombosis was present in allogenic group only. Mortality due to non-PICC complications was higher in allogenic transplant (40%) than in the autologous group (7.5%). Conclusion: PICCs plays an integral part to supportive care in hematopoietic stem cell transplantation for hematological cancers.

Background: Autologous HCT in multiple myeloma is done as upfront treatment in newly diagnosed transplant eligible patients after induction chemotherapy. In addition, it is standard for relapsed, aggressive non-Hodgkin lymphoma (NHL) and classical Hodgkin lymphoma (HL), and is curative in ~40% to 45% of patients. Over a decade, many efforts were made to find helpful parameters to predict an optimal time for initiating an efficient peripheral blood stem cell collection so that adequate stem cells are collected. It has been well accepted that CD34+ cell count in peripheral blood before leukapheresis is the best parameter to predict CD34 cell yield. However, white blood cell count, mononuclear cell count, and other easily obtained parameters are still used to guide the clinical practice of peripheral blood stem cell mobilization and collection. Materials and Methods: In the present study, we analyzed the correlation between peripheral blood MNC and Apheresis CD34 levels and also between peripheral blood CD34 by flow cytometry and apheresis CD34 levels. Results: We found that there was a statistically insignificant weak correlation between peripheral MNC and apheresis CD34. There was a statistically significant strong correlation between peripheral CD34 and apheresis CD34. Conclusion: The results show that peripheral blood MNC was analogous indicating that no reliable prediction can be done for CD34 cells collected in apheresis while peripheral CD34 by flow cytometry is the strongest predictor for initiating stem cell collection.

Immune checkpoint inhibitor therapy has revolutionized the field of cancer immunotherapy. Even though it has shown a durable response in some solid tumors, several patients do not respond to these agents, irrespective of predictive biomarker (PD-L1, MSI, TMB) status. Multiple preclinical, as well as early-phase clinical studies are ongoing for combining immune checkpoint inhibitors with anti-cancer and/or non-anti-cancer drugs for beneficial therapeutic interactions. In this review, we discuss the mechanistic basis behind the combination of immune checkpoint inhibitors with other drugs currently being studied in early phase clinical studies including conventional chemotherapy drugs, metronomic chemotherapy, thalidomide and its derivatives, epigenetic therapy, targeted therapy, inhibitors of DNA damage repair, other small molecule inhibitors, anti-tumor antibodies hormonal therapy, multiple checkpoint Inhibitors, microbiome therapeutics, oncolytic viruses, radiotherapy, drugs targeting myeloid-derived suppressor cells, drugs targeting Tregs, drugs targeting renin-angiotensin system, drugs targeting the autonomic nervous system, metformin, etc. We also highlight how translational research strategies can help better understand the true therapeutic potential of such combinations.

Introduction Cancer patients commonly present with antecedent addiction to tobacco consumption. Our study describes the characteristics of this substance use. Following the diagnosis of cancer, continued consumption of tobacco results in reduced tolerance to treatment, failure of treatment, tumor progression, other primary tumors, secondary cancers, and poor quality of life. The aim of our study is to enumerate the clinico-social aspects of tobacco consumption among cancer patients. Methods This cross-sectional study includes 100 cancer patients admitted to Healthcare Global cancer hospital, Bangalore, India. The study subjects were assessed for tobacco consumption, as well as other substance use such as intake of alcohol. We assessed various dimensions of exposure to tobacco consumption such as duration, intensity, and cumulative dose as independent risk factors for cancer. Results Among the study subjects, 46.2% were found to smoke filter cigarettes. The mean duration of tobacco consumption among beedi users was found to be longer (25.9 years, SD: 14.4). When stratified for exclusive consumption, the mean durations were as follows: beedis (29 ± 14.4 years), cigarettes (23.8 ± 13.3 years), and chewing (15.9 ± 9.6 years). Along with tobacco, a large proportion (59.3%) of patients consumed alcohol as well. After attempts to quit, 89.01% patients had reversal of tobacco substance use. The data did not show significance for duration, intensity, and cumulative dose of tobacco consumption. Conclusion The diagnosis of cancer is a life-altering event, which results in higher motivation to quit the use of tobacco. Smoking cessation initiatives can reduce the risk of developing tobacco-related malignancies.

This study is an overall clinical analysis of anti-programmed cell death 1 (PD1) antibodies used in a single institution, emphasizing the role of baseline peripheral blood markers as a prognostic or predictor biomarker of immunotherapy.Sixty-one patients were retrospectively analyzed from hospital medical records. The endpoint of this study was death from any cause and the survival time was calculated from the date of start of immunotherapy to the date of death. Descriptive and survival statistics was performed using SPSS version 23. Cutoff values for baseline biomarkers (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], neutrophil-to-eosinophil ratio [NER], and lymphocyte-to-monocyte ratio [LMR]) were obtained using cutp function of Evaluate Cutpoints software (R survMisc package). Pearson and Pearman correlation coefficients were used to examine the relationship of peripheral blood biomarkers.Nighty-eight percent of the study population had Stage IV disease and total median overall survival postanti-PD1 therapy was 10.7 months. Patients receiving more than 5 doses of anti-PD1 therapy (12.6 m vs. 4.4 m, P0.001) and used in front lines (18.9 m vs. 10.7 m vs. 10.1 m vs. 2.8 m in first line, second line, third line, and3 lines, respectively, P = 0.049) were found to have an impact in overall survival. Pembrolizumab showed a better survival compared to nivolumab (17.4 m vs. 8.2 m, P = 0.049) in our study. Among baseline biomarkers assessed, NLR (cutoff - 2.81, P = 0.003) and LMR (cutoff - 5.76, P = 0.017) has shown a statistically significant relationship with immunotherapy response. NER (cutoff - 24.32, P = 0.051) and PLR (cutoff - 190.8, P = 0.072) were also found to exhibit a strong relationship with anti-PD1 therapy response. NLR exhibits a statistically significant positive correlation with PLR (r = 0.917 P0.001) and NER (r = 0.400 P = 0.014).Real-life data analysis of anti-PD1 use for solid cancers highlights that baseline NLR, PLR, NER, and LMR have a significant role as immunotherapy biomarkers. However, larger studies are required to further prove the specificity and sensitivity.

Introduction The mechanism by which a suppressed immune system of a cancer patient makes them susceptible to COVID‐19 is still unclear. Any delay or discontinuation of cancer care due to the pandemic is expected to have a detrimental impact on the outcome of cancer. A few studies have addressed the incidence of COVID‐19 among cancer patients, but the small sample size of such studies makes it difficult to draw inference to the general population. Methods For our review, ‘Pubmed’ database and Google search engines were used for searching the relevant articles. The criterion used for review includes their relevance to the defined review question, which is the pathophysiological mechanism of COVID‐19 among cancer patients and the relevant therapeutic interventions therewith. This review includes 20 studies and other relevant literature which address the determinants of COVID‐19 among Cancer patients. Results Delay in cancer diagnosis will increase the stage progression of cancer patients and increased mortality in the future. A short delay in administering cancer related treatment to aid the odds of patient surviving the acute SARS‐CoV‐2 infection, should be at the discretion of the treating Physician. Oncologists dilemma in the current situation includes titrating the density of drug doses and intensity of treatment regimen, for the optimal management of metastatic and adjuvant cancer patients. Patients are thus subjected to suboptimal treatment and undetected disease recurrence, To circumvent the immunosuppressive effects of chemotherapy, Providers need to consider staggered regimen or alternate therapies such as biological/immunotherapy, targeted therapy, anti‐angiogenic drugs, hormone therapy and/or antibody‐based therapeutics. Conclusion This review provides insights on the pathogenesis of SARS‐CoV‐2, which could enable Physicians in formulating therapeutic strategies for the management of severe patients, more so in Oncology settings, thus reducing the mortality. The key is to balance the continuation of urgent cancer care, but rationing the elective treatment according to the circumstances.

e13061 Background: In current clinical practice, the decision of using anti-HER2 targeted agents for breast cancer is based primarily on HER2 protein overexpression, assessed using immunohistochemistry and/or HER2 gene amplification on FISH assay(2018 ASCO/CAP guidelines). It is increasingly being recognized that HER2-negative breast cancer is characterized by a wide spectrum of HER2 expression, particularly important for the triple-negative breast cancer (TNBC) group, the treatment options for which are far less compared to hormone receptor-positive tumors. HER2-low breast cancer (HER1+ or 2+, without gene amplification) is an emerging subtype with differing clinicopathologic and prognostic implications. There is accumulating evidence that HER2-negative tumors may switch to HER2-low status and vice versa at tumor recurrence. The development of newer drug classes like antibody-drug conjugates and immunotherapy have created a window of opportunity for this sub-category of breast cancer. Methods: We aimed to evaluate HER2 0/normal and HER2-low expression in TNBCs, their clinicopathological characteristics, and prognostic significance. Clinical and laboratory data for 207 TNBC cases (184 non-metastatic and 23 metastatic) diagnosed between February 2010 and December 2019 was available for analysis and cases were followed up until December 2021. Androgen receptor (AR) immunohistochemistry was performed on available FFPE blocks. Results: Non-metastatic TNBCs: Median age was 50 (SD 11.77; range 23 to 82) years. 91.9% of HER2-low cases were more than 40years old compared to 70.1% of HER2 0 cases, p = 0.006. 79.9% were HER2 0, 14.1% were HER2 1+, and 6% were HER2 2+. 30.7% (39/127) of cases were AR+. Compared with HER2 0, HER2-low cases exhibited a lower histological grade (Her2 0 - Grade 3: 72.7%, Grade 2: 27.3%; Her2-low- Grade 3: 57.1%, Grade 2: 40%, Grade 1: 2.9% p=0.048). Compared with HER2 0, more of HER2-low cases were AR+ (For Her2 0 26.5% were AR+; For Her2-low 48% were AR+, p=0.036). There was no significant difference in disease-free survival between the two groups. There was no significant difference in overall survival (OS) between the two groups (Her2 0- Mean: 102.0 months, Median: Not achieved; Her2-low - Mean: 69.60 months, Median: 77.4 months p=0.73). Within the Her2-low group, patients ≤40 years had a median OS of 44.3 months. Metastatic TNBCs: Median age was 47 (SD 10.38; range 30 to 74) years. There was no significant correlation between the clinicopathological characteristics. No significant difference in OS was seen (Her2 0- Median: 44.9 months; Her2-low- Median: 24.3 months, p=0.20). Conclusions: The non-significant trend towards a lower survival for Her2-low TNBCs, coupled with a surprisingly lower histologic grade and a higher AR positivity needs to be further evaluated in larger studies. Further translational research to optimize treatment for this subgroup is needed.

Background. Induction docetaxel, cisplatin, and 5-fluorouracil (TPF) chemotherapy followed by definitive concurrent chemoradiation remains the standard of care in locally advanced squamous cell carcinoma of head and neck cancers despite which the survival remains low. So, we analyzed the efficacy and adverse effect profile of the addition of nimotuzumab to standard TPF induction chemotherapy. Methods. We included 20 patients with locally advanced squamous cell carcinoma of the head and neck. Patients were administered with induction chemotherapy with nimotuzumab plus docetaxel, cisplatin, and 5-fluorouracil (TPF + N) followed by definitive concurrent chemoradiation with carboplatin. Treatment responses were assessed by PET-CT following induction chemotherapy and concurrent chemoradiation. Response rates, survival, and adverse effects data were tabulated and analyzed using the Kaplan Meier method. Results. At a minimum follow-up of two years, the median progression-free survival (PFS) and median overall survival (OS) were 16 months and 38 months, respectively. PFS and OS were not reached (NR) in patients who showed a complete radiological response (CR). Median PFS and OS in patients who had partial response were 17.6 and 34.5 months, respectively. All subsites of primary including oral cavity, hypopharynx, and oropharynx showed similar response rates and survival. Overall the treatment was well tolerated with predominantly grade 1/2 toxicities. Conclusions. Patients with locally advanced head and neck cancer could possibly have a better response and survival with nimotuzumab added to the standard TPF regimen. A complete response may serve as a good surrogate for survival irrespective of the primary site of head and neck cancer.

Hypermagnesemia is often an under reported finding in critically ill patients with cancer. Hypomagnesemia is a commonly encountered electrolyte abnormality in patients with cancer that is primarily caused by a reduced intake, secondary to chemotherapeutic drugs and malnutrition. Hypermagnesemia is rarely observed in patients with normal renal function, as excess intake can be compensated by renal excretion. However, in critically ill patients with reduced renal function, hypermagnesemia can add further to complications and increase mortality. Drugs such as lactulose, antacids, fentanyl and peptide hormones, including vasopressin, can further increase chances of hypermagnesemia, particularly when patients demonstrate decreased renal function and multiple organ failure. Prudence and caution must therefore be exercised while using these agents in critically ill patients with cancer to avoid increased complications and mortality. Herein, the current study reports three cases of critically ill patients with cancer admitted into intensive care who had refractory hypermagnesemia.

The declaration of COVID-19 as a global pandemic has warranted the urgent need for technologies and tools to be deployed for confirming diagnosis of suspected cases. Diagnostic testing for COVID-19 is critical for understanding epidemiology, contract-tracing, case management, and to repress the transmission of the SARS-CoV-2. Currently, the Nucleic Acid Amplification Test (NAAT)-based RT-PCR technique is a gold standard test used for routine diagnosis of COVID-19 infection. While there are many commercially available RT-PCR assay kits available in the market, selection of highly sensitive, specific, and validated assays is most crucial for the accurate diagnosis of COVID-19 infection. Laboratory diagnosis of SARS-CoV-2 is extremely important in the disease and outbreak management. Development of rapid point of care tests with better sensitivity and specificity is the critical need of the hour as this will help accurate diagnosis and aid in containing the spread of SARS-CoV-2 infection. Early detection of viral infection greatly enhances implementation of specific public health intervention, such as infection control, environmental decontamination, and the closure of specific high-risk zones. Large-scale sequencing of SARS-CoV-2 genome isolated from affected populations across the world needs to be carried to monitor mutations that might affect performance of molecular tests. Creation of genome repositories and open-source genetic databases for use by global researchers is clearly the way forward to manage COVID-19 outbreak and accelerate vaccine development. This review summarizes various molecular diagnostics methods, technical guidelines, and advanced testing strategies adopted in India for laboratory diagnosis of COVID-19.

Objectives: 1) To correlate the methylation status of the O-6-methylguanine-DNA-methyltransferase (MGMT promoter gene) and response to alkylating agent-based treatment in high-grade gliomas. Background: The MGMT gene is epigenetically silenced by promoter hypermethylation in gliomas and this modification has emerged as a relevant predictor of therapeutic response. Methods: 20 cases of high-grade glioma were analyzed for MGMT promoter methylation by methylation-specific PCR. Response to treatment and overall survival data were recorded and data analysed. Results: MGMT promoter methylation was found in 60% of gliomas by methylation-specific PCR. The mean survival time of glioblastoma patients submitted to adjuvant therapy was significantly higher among patients with MGMT promoter methylation (P = 0.035) and methylation status was an independent predictive factor that was associated with improved prognosis. Discussion and Conclusion: MGMT promoter methylation status was a more reliable predictor of response to adjuvant therapy and prognosis of high-grade gliomas. A subset of patients received irinotecan and bevacizumab in the second line setting and patients with unmethylated MGMT seemed to do better than the MGMT promoter methylated group.