S Aggarwal

Clinical Experience with Gefitinib in Indian Patients

Introduction: Treatment options are limited in patients with advanced or refractory non-small cell lung cancer and lead to suboptimal outcome and/or benefit. The epidermal growth factor tyrosine kinase inhibitor gefitinib (IRESSA) has been approved in many countries. Increased responsiveness to gefitinib has been demonstrated in particular subsets of patients, for example never smokers and patients of Asian origin. However, to date, little is known of its use specifically in patients from India. Methods: Retrospective ad hoc analysis of clinical data from experience with gefitinib in patients with advanced NSCLC from India enrolled in the IRESSA Survival Evaluation in Lung (ISEL) study (n = 77) or included in the gefitinib expanded-access program in India (n = 133). Results: Among Indian patients enrolled in the ISEL study, median survival was 6.4 months with gefitinib and 5.1 month with placebo. The objective response rate in Indian patients was 14% with gefitinib versus 0% with placebo. In ISEL, tolerability data from Indian patients were consistent with the overall study population. In the Indian gefitinib expanded-access program, median survival was 6 months and gefitinib was well tolerated. Conclusions: Gefitinib seems well tolerated in Indian patients with advanced NSCLC, with some clinical benefit observed.

Assessment of the effect of slope on runoff potential of a watershed using NRCS-CN method

The rainfall-runoff is a very complex hydrological phenomenon, as this process is highly non-linear, time-varying and spatially distributed. The average slope within the watershed together with the overall length and retardance of overland flow are considered to be the main factors which govern the runoff process. The natural resources conservation service curve number (NRCS-CN), formerly known as soil conservation services curve number, is the most widely used method to estimate direct runoff from rainfall, due to its simplicity and the use of the single CN parameter. However, the NRCS-CN method has been developed for limited watershed area and slope. In the present study, the modified NRCS-CN method for slope and CN conversion have been investigated to determine runoff potential of a watershed in geo-spatial environment. Solani watershed, which is a sub-watershed of Ganga basin located partly in Uttarakhand and Uttar Pradesh states of India; has been considered for analysis. The daily rainfall-runoff study has been carried out for year 2006. It was found that slope factor effects runoff estimation significantly.

Histopathological pattern of lymphomas and clinical presentation and outcomes of diffuse large B cell lymphoma: A multicenter registry based study from India

Context: The distribution of various subtypes of lymphomas in India is different from other parts of the world. There is scarce multicentric data on the pattern and outcomes of lymphomas in India. Aims: The aim of this study is to evaluate the histopathological and the clinical pattern and treatment outcomes of lymphomas in India based on the retrospective data collected from a multicenter registry. Materials and Methods: Retrospective data was collected at 13 public and private hospitals in India for patients diagnosed with lymphoma between January 2005 and December 2009. The data collection was performed in the setting of a multicenter lymphoma registry Survival analyses were performed using the Kaplan-Meier method and compared using the log-rank test. Results: Non-Hodgkins lymphoma (NHL) constituted 83.17% and Hodgkins lymphoma (HL) for 16.83% of the 1733 registered and analyzed cases. Diffuse large B cell lymphoma (DLBCL) was the most common NHL (55%) followed by follicular lymphoma (11%). CHOP was the most common chemotherapy regimen administered (84%) while rituximab was used in 42.7% of those with DLBCL. Survival analysis of treatment naïve DLBCL patients (n = 791) was performed. Of these, 29% were lost to follow-up, 20% with active disease. The median follow-up in surviving patients is 31 (range: 1-88) months. Median progression-free survival (PFS) and overall survival (OS) in DLBCL patients has not reached. There was no significant difference in median PFS (69 months vs. 61 months, P = 0.1341), but OS was significant not reached (NR) vs. NR, P = 0.0012) within international prognostic index high or intermediate subgroups. Rituximab use was associated with significantly prolonged PFS (NR vs. 82 months, P = 0.0123), but not OS (NR vs. NR, P = 0.2214). Cox regression analysis in treatment naïve DLBCL patients showed a performatnce status, stage and receipt of six or more cycles of chemotherapy to be significantly associated with OS and all of the preceding plus rituximab use significantly associated with PFS. Conclusions: Our analysis confirms previous reports of distribution of lymphoma subtypes in India and suggests that patients who are able to receive the full course of chemotherapy achieve a better outcome. This indicates the importance of ensuring compliance to treatment utilizing various measures including patient and family counseling. Prospective studies are required to confirm these findings.

Ice sheet features identification, glacier velocity estimation and glacier zones classification using high resolution optical and SAR data

Ice sheet features, glacier velocity estimation and glacier zones or facies classification are important research activities highlighting the dynamics of ice sheets and glaciers in Polar Regions and in inland glaciers. The Cband inSAR data is of ERS 1/2 tandem pairs with one day interval for spring of 1996 and L-band PolinSAR data of ALOS-PALSAR-2 for spring of 2015 is used in glacier velocity estimation. Glacier classification is done using multi-temporal C-and L-band SAR data and also with single date full polarization and hybrid polarization data. In first part, a mean displacement of 9 cm day-1 was recorded using SAR interferometric technique using ERS 1/2 tandem data of 25-26 March 1996. Previous studies using optical data based methods has shown that Gangotri glacier moves with an average displacement of 4 cm and 6 cm day-1. As present results using ERS 1/2 data were obtained for one day interval, i.e., 25th March 05:00pm to 26th March 05:00 pm, 1996, variation in displacement may be due to presence of snow or wet snow melting over the glacier, since during this time snow melt season is in progress in Gangotri glacier area. Similarly the results of glacier velocity derived using ALOSPALSAR- 2 during 22 March – 19 April 2015 shows the mean velocity of 5.4 to 7.4 cm day-1 during 28 day time interval for full glacier and main trunk glacier respectively. This L-band data is already corrected for Faraday’s rotation effects by JAXA, and tropospheric correction are also being applied to refine the results. These results are significant as it is after gap of 20 years that DInSAR methods has given glacier velocity for fast moving Himalayan glacier. RISAT-1 FRS-1 hybrid data is used to create Raney’s decompositions parameters, which are further used for glacier zones classification using support vector machine based classification method. The Radarsat-2 and ALOS-PALSAR-2 fully polarized data of year 2010 and 2015 are also used for glacier classification. The identified and classified glaciers zones in Gangotri area are debris covered ice, clean ice, percolation zone, wet snow zone, ice wall, supra-glacier lakes and moraines, similarly ice sheet features and glacier landforms such as such as nunataks, wind scoop, glacier flow paths, moraine, horn, sastrugi, and crevasses were identified in Antarctic. RISAT-1 FRS-1 data was also successful in mapping the Crevasses hidden under wind-blown ice in Antarctic’s study area.

Practical consensus recommendations regarding role of mastectomy in metastatic breast cancer

Whether to recommend mastectomy in metastatic disease or not has been a matter of debate. Is local therapy, such as mastectomy, of any benefit in advanced breast cancer is the main question. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.

Practical consensus recommendations regarding role of postmastectomy radiation therapy

The use of radiation therapy after mastectomy (PMRT) has been limited to those patients who are at significant risk of cancer recurring in the chest wall or in the nodal basins. The use of PMRT has been widely accepted for patients with four or more positive lymph nodes, [1],[2] but there is still controversy regarding the value of PMRT for those with one to three positive nodes. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.

Practical consensus recommendations on ovarian suppression in early breast cancer (adjuvant)

Substantial survival benefits exist for patients with early-stage breast cancer who undergo treatment with single-modality ovarian suppression, but its value is uncertain. Expert oncologist discussed to determine whether additional benefits exist with ovarian suppression plus multiple adjuvant therapy which provides a new treatment option that reduces the risk of recurrence in early breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

Practical consensus recommendations on management of triple-negative metastatic breast cancer

Patients with breast cancer along with metastatic estrogen and progesterone receptor (ER/PR)- and human epidermal growth factor receptor 2 (HER2)-negative tumors are referred to as having metastatic triple-negative breast cancer (mTNBC) disease. Resistance to current standard therapies such as anthracyclines or taxanes limits the available options for previously treated patients with metastatic TNBC to a small number of non-cross-resistant regimens, and there is currently no preferred standard chemotherapy. Clinical experience suggests that many women with triple-negative metastatic breast cancer (MBC) relapse quickly. Expert oncologist discussed about new chemotherapeutic strategies and agents used in treatment of mTNBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

Practical consensus recommendatons for Paget's disease in breast cancer

Pagets disease of the breast is a rare type of cancer of the nipple–areola complex and that is often associated with an underlying in situ or invasive carcinoma. Diagnosis and treatment of Pagets disease is controversial. Expert oncologists discuss on the update on the approaches of Pagets disease diagnosis and its treatment options. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

Practical consensus recommendations regarding the management of HER2 neu positive metastatic breast cancer

Over-expression of HER2 is generally considered to be a negative prognostic feature because it accompanies an increase in breast cancer mortality. However, the development of agents that specifically target HER2 has improved the management of patients with these tumours. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations with regards to the use of these agents and the management of HER2 neu early breast cancer for the benefit of community oncologists.