|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 1 | Page : 161-162
Authors' reply to Arun, Biswas et al., and Ganguly et al.
Sameer Rastogi1, Sorun Shishak2, Abhenil Mittal1
1 Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
2 Department of Radiation Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||23-Feb-2022|
|Date of Acceptance||10-Mar-2022|
|Date of Web Publication||31-Mar-2022|
MD, DM Medical Oncology, Additional Professor, Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rastogi S, Shishak S, Mittal A. Authors' reply to Arun, Biswas et al., and Ganguly et al. Cancer Res Stat Treat 2022;5:161-2
We were delighted at the interest in our study, “Clinical profile and outcomes of malignant melanoma in patients from an Indian institute: A retrospective analysis,” and the accompanying editorial evinced by Arun, Biswas et al., and Ganguly et al. We agree that the outcomes of the patients enrolled in our real-world study were dismal. Additionally, there was conspicuously lower mutation testing performed in our cohort. Regarding the comment by Arun, we compared the progression-free and overall survivals between the patients with mucosal and non-mucosal primaries and found no discernable differences between the two groups of patients. The lower uptake of mutation testing in our study may have been because of two main reasons: the absence of an in-house genetic testing facility and the lack of availability of BRAF inhibitors until 2019. Regarding testing for the c-kit mutation, we agree that imatinib is an inexpensive drug and patients should be given this option. The lack of information regarding the lactate dehydrogenase levels as pointed out by Biswas et al. was a limitation in our study.
There were 53 patients with mucosal melanoma in our series, including anorectal, ocular, head and neck mucosal, and urethral, which was around 56% of the total cohort and is comparable to that reported in other series by Bajpai et al. and Biswas et al..
We agree that low-dose immunotherapy can be a viable option in the future for our patients in view of the high cost of immunotherapy. However, prior to the routine use of low-dose immunotherapy, we need a well-conducted randomized trial to evaluate its efficacy and safety. Similarly, the role of metronomic chemotherapy in patients with melanoma needs to be explored in the setting of a clinical trial. We appreciate the suggestions by Ganguly et al. and Biswas et al. regarding incorporating telephonic follow-up, as well as the need for a country-wide melanoma registry to aid in providing a better picture of the patients' outcomes. Incorporating quality of life as an outcome measure in future studies on melanoma is also warranted.
Currently, rare diseases like melanoma and the costs associated with mutation testing and immunotherapy pose a formidable challenge. This certainly needs to be addressed with collaborations, prospective clinical trials evaluating low-cost therapies, and patient advocacy groups.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shishak S, Mittal A, Aswar H, Pandey R, Kalra K, Gupta A, et al
. Clinical profile and outcomes of malignant melanoma in patients from an Indian institute: A retrospective analysis. Cancer Res Stat Treat 2021;4:621-7. [Full text]
Raja A, Krishnan CK. Melanoma: Gaps in knowledge and treatment. Cancer Res Stat Treat 2021;4:728-30. [Full text]
Arun HN. Indian real-world data on melanoma. Cancer Res Stat Treat 2022;5:158-9. [Full text]
Biswas B, Roy S, Ganguly S. Malignant melanoma in India: Is it time to set the wheels in motion? Cancer Res Stat Treat 2022;5:159-60. [Full text]
Ganguly S, Bakhshi S. Profile and outcome of advanced malignant melanoma in India: Need for cost-effective innovations. Cancer Res Stat Treat 2022;5:157-8. [Full text]
Bajpai J, Abraham G, Saklani AP, Agarwal A, Das S, Chatterjee A, et al
. Demographics, pattern of care, and outcome analysis of malignant melanomas-experience from a tertiary cancer centre in India. Front Oncol 2021;11:710585.
Biswas B, Biswas G, Ganguly S, Ghosh J, Roy S, Roy MK, et al
. Not so 'rare' – an example of malignant melanoma in India: Report from a tertiary cancer centre. Ecancermedicalscience 2021;15:1335.
Patil VM, Noronha V, Joshi A, Abhyankar A, Menon N, Banavali S, Gupta S, Prabhash K. Low doses in immunotherapy: Are they effective? Cancer Res Stat Treat 2019;2:54-60. [Full text]
Banavali S, Patil V, Noronha V, Prabhash K. Metronomics: The next generation of multitargeted therapy. Cancer Res Stat Treat 2020;3:394-5. [Full text]
Salins N. Health-related quality of life: Is it a missing feature in the Indian cancer setting? Cancer Res Stat Treat 2019;2:213-4. [Full text]
Noronha V. Making a case for cancer research in India. Cancer Res Stat Treat 2018;1:71-4. [Full text]
Rangarajan B, Kannan RA, Kandakumar V. Reducing the dose: Balancing act between just right and too little? Cancer Res Stat Treat 2019;2:265. [Full text]